PV 17 Flashcards
(21 cards)
A patient scheduled for an elective hysterectomy tells the nurse, “I am afraid that I will die in
surgery like my mother did!” Which initial response by the nurse is most appropriate?
a. “Tell me more about what happened to your mother.”
b. “Surgical techniques have improved in recent years.”
c. “You will receive medication to reduce your anxiety.”
d. “You should talk to the doctor again about the surgery.”
ANS: A
The patient’s statement may indicate an unusually high anxiety level or a family history of
problems such as malignant hyperthermia, which will require precautions during surgery. The
other statements may also address the patient’s concerns, but further assessment is needed
first.
A patient arrives at the outpatient surgical center for a scheduled laparoscopy under general
anesthesia. Which information requires the nurse’s preoperative intervention to maintain
patient safety?
a. The patient has never had general anesthesia.
b. The patient is planning to drive home after surgery.
c. The patient drank a sip of water 4 hours before arriving.
d. The patient’s insurance does not cover outpatient surgery.
ANS: B
After outpatient surgery, the patient should not drive that day and will need assistance with
transportation and home care. Clear liquids only require a minimum preoperative fasting
period of 2 hours. The patient’s experience with anesthesia and the patient’s insurance
coverage are important to establish, but these are not safety issues.
A 38-yr-old woman is admitted for an elective surgical procedure. Which information
obtained by the nurse during the preoperative assessment must be communicated to the
anesthesiologist and surgeon before surgery?
a. The patient’s lack of knowledge about postoperative pain control
b. The patient’s history of an infection following a cholecystectomy
c. The patient’s report that her last menstrual period was 8 weeks ago
d. The patient’s concern about being able to resume lifting heavy items
ANS: C
A last menstrual period 8 weeks ago in a woman of childbearing age suggests that the patient
could be pregnant and pregnancy testing is needed before administration of anesthetic agents.
Although the other data may also be communicated with the surgeon and anesthesiologist,
they will affect postoperative care and do not indicate a need for further assessment before
surgery.
A patient who has not had any prior surgeries tells the nurse doing the preoperative
assessment about allergies to avocados and bananas. Which action is most important for the
nurse to take?
a. Notify the dietitian about the specific food allergies.
b. Alert the surgery center about a possible latex allergy.
c. Reassure the patient that all allergies are noted on the health record.
d. Ask whether the patient uses antihistamines to reduce allergic reactions.
ANS: B
Certain food allergies (e.g., eggs, avocados, bananas, chestnuts, potatoes, peaches) are related
to latex allergies. When a patient is allergic to latex, special nonlatex materials are used during
surgical procedures. The staff will need to know about the allergy in advance to obtain
appropriate nonlatex materials and have them available during surgery. The other actions may
be appropriate, but prevention of allergic reaction during surgery is the most important action.
A patient who is scheduled for a therapeutic abortion tells the nurse, “Having an abortion is
wrong.” Which functional health pattern should the nurse further assess?
a. Value–belief
b. Cognitive–perceptual
c. Sexuality–reproductive
d. Coping–stress tolerance
ANS: A
The value–belief pattern includes information about conflicts between a patient’s values and
proposed medical care. In the cognitive–perceptual pattern, the nurse will ask questions about
pain and sensory intactness. The sexuality–reproductive pattern includes data about the impact
of the surgery on the patient’s sexuality. The coping–stress tolerance pattern assessment will
elicit information about how the patient feels about the surgery.
A patient undergoing an emergency appendectomy has been using St. John’s wort to prevent
depression. Which complication should the nurse expect in the postanesthesia care unit?
a. Increased blood pressure
b. Increased physical discomfort
c. Increased anesthesia recovery time
d. Increased postoperative wound bleeding
ANS: C
St. John’s wort may prolong the effects of anesthetic agents and increase the time to waken
completely after surgery. It is not associated with increased bleeding risk, hypertension, or
increased pain.
The surgical unit nurse has just received a patient with a history of smoking from the
postanesthesia care unit. Which action is most important at this time?
a. Auscultate for adventitious breath sounds.
b. Obtain the blood pressure and temperature.
c. Teach the patient about harmful effects of smoking.
d. Ask the health care provider to prescribe a nicotine patch.
ANS: A
The nurse should first ensure a patent airway and check for breathing and circulation (airway,
breathing, and circulation [ABCs]) in a responsive patient. Circulation and temperature can be
assessed after a patent airway and breathing have been established. The immediate
postoperative period is not the optimal time for patient teaching about the harmful effects of
smoking. Requesting a nicotine patch may be appropriate but is not a priority at this time.
The nurse obtains a health history from a patient who is scheduled for elective hip surgery in 1
week. The patient reports use of garlic and Ginkgo biloba. Which action by the nurse is
appropriate?
a. Teach the patient that these products may be continued preoperatively.
b. Advise the patient to stop the use of herbs and supplements at this time.
c. Discuss the herb and supplement use with the patient’s health care provider.
d. Reassure the patient that there will be no interactions with anesthetic agents.
ANS: C
Both garlic and G. biloba increase the risk for bleeding. The nurse should discuss the herb and
supplement use with the patient’s health care provider. The nurse should not advise the patient
to stop the supplements or to continue them without consulting with the health care provider
and the anesthesia care provider.
The nurse is preparing to witness the patient signing the operative consent form when the
patient says, “I don’t understand what the doctor said about the surgery.” Which action should
the nurse take next?
a. Provide a thorough explanation of the planned surgical procedure.
b. Notify the surgeon that the informed consent process is not complete.
c. Give the prescribed preoperative antibiotics and withhold sedative medications.
d. Notify the operating room nurse to give a complete explanation of the procedure.
ANS: B
The surgeon is responsible for explaining the surgery to the patient. The nurse should wait
until the surgeon has clarified the surgery before having the patient sign the consent form. The
nurse should communicate directly with the surgeon about the consent form rather than asking
other staff to pass on the message. It is not within the nurse’s legal scope of practice to explain
the surgical procedure. No preoperative medications should be given until the patient
understands the surgical procedure and signs the consent form.
Which topic should the nurse discuss preoperatively with a patient who is scheduled for an
open cholecystectomy?
a. Care for the surgical incision
b. Deep breathing and coughing
c. Oral antibiotic therapy after discharge
d. Medications to be used during surgery
ANS: B
Preoperative teaching, demonstration, and re-demonstration of deep breathing and coughing
are needed on patients having abdominal surgery to prevent postoperative atelectasis.
Incisional care and the importance of completing antibiotics are better discussed after surgery,
when the patient will be more likely to retain this information. The patient does not usually
need information about medications that are used intraoperatively, and that topic should be
discussed with the anesthesia provider.
Five minutes after receiving the ordered preoperative midazolam by IV injection, the patient
asks to get up to go to the bathroom to urinate. Which action by the nurse is most appropriate?
a. Perform a straight catheterization.
b. Assist the patient to the bathroom.
c. Offer the patient a urinal or bedpan.
d. Tell the patient that a catheter will be placed in the operating room.
ANS: C
The patient will be at risk for a fall after receiving the sedative, so the best nursing action is to
have the patient use a bedpan or urinal. Having the patient get up either with assistance or
independently increases the risk for a fall. The patient will be uncomfortable and risk
involuntary incontinence if the bladder is full during transport to the operating room. There is
no need to perform a straight catheterization.
The nurse plans to provide preoperative teaching to an alert older man who has hearing and
vision deficits. His wife answers most questions that are directed to the patient. Which action
should the nurse take when doing the teaching?
a. Use printed materials for instruction so that the patient will have more time to
review the material.
b. Direct all the teaching toward the wife because she is the obvious support and
caregiver for the patient.
c. Provide additional time for the patient to understand preoperative instructions and
carry out procedures.
d. Ask the patient’s wife to wait in the hall in order to focus preoperative teaching
with the patient himself.
ANS: C
The nurse should allow more time when doing preoperative teaching and preparation for older
patients with sensory deficits. Because the patient has visual deficits, he will not be able to use
written material for learning. The teaching should be directed toward both the patient and wife
because both will need to understand preoperative procedures and teaching.
A patient who has diabetes and uses insulin to control blood glucose has been NPO since
midnight before having a knee replacement surgery. Which action should the nurse take?
a. Withhold the usual scheduled insulin dose because the patient is NPO.
b. Obtain a blood glucose measurement before any insulin administration.
c. Give the patient the usual insulin dose because stress will increase the blood
glucose.
d. Give half the usual dose of insulin because there will be no oral intake before
surgery.
ANS: B
Preoperative insulin administration is individualized to the patient, and the current blood
glucose will provide the most reliable information about insulin needs. It is not possible to
predict whether the patient will require no insulin, a lower dose, or a higher dose without
blood glucose monitoring.
The outpatient surgery nurse reviews the complete blood cell (CBC) count results for a patient
who is scheduled for surgery. The results are white blood cell (WBC) count 10.2 103/μL;
hemoglobin 15 g/dL; hematocrit 45%; platelets 150 103/μL. Which action should the nurse
take?
a. Notify the surgeon and anesthesiologist immediately.
b. Ask the patient about any symptoms of a recent infection.
c. Continue to prepare the patient for the surgical procedure.
d. Discuss the possibility of blood transfusion with the patient.
ANS: C
The CBC count results are normal. With normal results, the patient can go to the holding area
when the operating room is ready for the patient. There is no need to notify the surgeon or
anesthesiologist, discuss blood transfusion, or ask about recent infection.
The nurse is preparing a patient on the morning of surgery. The patient prefers not to remove
a wedding ring, saying, “I’ve never taken it off since the day I was married.” How should the
nurse respond?
a. Have the patient sign a release form and leave the ring on.
b. Tell the patient that the hospital is not liable for loss of the ring.
c. Suggest that the patient give the ring to a family member to hold.
d. Inform the operating room personnel that the patient is wearing a ring.
ANS: C
Jewelry is not allowed to be worn by the patient, especially if electrocautery will be used.
Safety is the issue here. There is no need for a release form or to discuss liability with the
patient.
A patient has received atropine before surgery and reports a dry mouth. Which action by the
nurse is appropriate?
a. Check for skin tenting.
b. Notify the health care provider.
c. Ask the patient about any weakness or dizziness.
d. Explain that dry mouth is an expected side effect.
ANS: D
Anticholinergic medications decrease oral secretions, so the patient is taught that a dry mouth
is an expected side effect. The dry mouth is not a symptom of dehydration in this case.
Therefore, there is no immediate need to check for skin tenting. The health care provider does
not need to be notified about an expected side effect. Weakness, forgetfulness, and dizziness
are side effects associated with other preoperative medications such as opioids and
benzodiazepines.
Which statement by a patient scheduled for knee surgery is most important to report to the
health care provider before surgery?
a. “I have a strong family history of cancer.”
b. “I had a heart valve replacement last year.”
c. “I had bacterial pneumonia 3 months ago.”
d. “I have knee pain whenever I walk or jog.”
ANS: B
A patient with a history of valve replacement is at risk for endocarditis associated with
invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may
affect whether the patient should have surgery, but a history of pneumonia is not a reason to
postpone surgery. The patient’s knee pain is the likely reason for the surgery. A family history
of cancer does not have implications for the current surgery.
The nurse interviews a patient scheduled to undergo general anesthesia for a bilateral hernia
repair. Which information is most important to communicate to the surgeon and
anesthesiologist before surgery?
a. The patient drinks 3 cups of coffee every day.
b. The patient stopped taking aspirin 10 days ago.
c. The patient’s father died after general anesthesia for abdominal surgery.
d. The patient drank 4 ounces of apple juice 6 hours before coming to the hospital.
ANS: C
The information about the patient’s father suggests that there may be a family history of
malignant hyperthermia and that precautions may need to be taken to prevent this
complication. Current research indicates that having clear liquids 3 hours before surgery does
not increase the risk for aspiration in most patients. Patients are instructed to discontinue
aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages
postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative
implications.
Which information in the preoperative patient’s medication history is most important to
communicate to the health care provider before surgery?
a. The patient takes garlic capsules every day.
b. The patient quit using cocaine 10 years ago.
c. The patient uses acetaminophen for aches and pains.
d. The patient took a prescribed sedative the previous night.
ANS: A
Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of
a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine
use will not usually affect the surgical outcome.
A patient who takes a diuretic and a -blocker to control blood pressure is scheduled for
breast reconstruction surgery. Which patient information is most important to communicate to
the health care provider before surgery?
a. Hematocrit 36%
b. Blood pressure 144/82
c. Serum potassium 3.2 mEq/L
d. Pulse rate 54-58 beats/minute
ANS: C
The low potassium level may increase the risk for intraoperative complications such as
dysrhythmias. Slightly elevated blood pressure is common before surgery because of anxiety.
The lower heart rate would be expected in a patient taking a -blocker. The hematocrit is in
the low normal range but does not need any intervention before surgery.
When caring for a preoperative patient on the day of surgery, which actions can the nurse
delegate to unlicensed assistive personnel (UAP)? (Select all that apply.)
a. Teach incentive spirometer use.
b. Explain routine preoperative care.
c. Obtain and document baseline vital signs.
d. Remove nail polish and apply pulse oximeter.
e. Transport the patient by stretcher to the operating room.
ANS: C, D, E
Obtaining vital signs, removing nail polish, pulse oximeter placement, and transport of the
patient are routine skills that are appropriate to delegate. Teaching patients about the
preoperative routine and incentive spirometer use require critical thinking and should be done
by the registered nurse.
