Flashcards in Pre and Post Operative Care Deck (147)
During the preoperative interview, a patient scheduled for an elective hysterectomy to treat benign tumours of the uterus tells the nurse that she does not know whether she can go through with the surgery because she knows she will die in surgery, as her mother did. What is the most appropriate response?
a. “Tell me more about what happened to your mother.”
b. “Have you discussed these feelings with anyone else?”
c. “I am sure surgical techniques have improved since your mother had surgery.”
d. “Think positively! Positive thoughts have been shown to influence a positive surgical outcome.”
Anxiety can arise from lack of knowledge, which may range from not knowing what to expect during the surgical experience to uncertainty about the outcome of surgery and the potential findings; therefore, it is important that the nurse help explore the patient’s feelings. Also, further assessment may uncover a history of malignant hyperthermia, which will require precautions during the surgery.
A 74-year-old man is to have a left inguinal hernia repair at the outpatient surgical clinic. Preoperatively, what is it most important for the nurse to determine?
a. The patient has had outpatient surgery in the past.
b. The patient’s medical plan covers outpatient surgery.
c. The patient plans to stay overnight at the surgical centre.
d. A family member or friend is available for transportation and care at home.
Priority assessment is related to the need to have a responsible adult present for transportation home after surgery. Other preoperative information can include the day-of-surgery events such as patient registration, parking, what to wear, and what to bring, but these are not the priority.
A 36-year-old woman has been admitted to the hospital for knee surgery. Which of the following information that was obtained by the nurse during the preoperative assessment should be reported to the surgeon before surgery is performed?
a. Lack of knowledge about postoperative pain control
b. Knowledge of the possibility of an early, unplanned pregnancy
c. History of a postoperative infection following a prior cholecystectomy
d. Concern that she will be physically limited in caring for her children for a period postoperatively
If the patient states that she might be pregnant, information should be immediately given to the surgeon to avoid maternal and subsequent fetal exposure to anaesthetics during the first trimester.
Why is it especially important for the nurse to determine the patient’s current use of medications during the preoperative assessment?
a. These medications may alter the patient’s perceptions about surgery.
b. Anaesthetics alter renal and hepatic function, causing toxicity by other drugs.
c. Other medications may cause interactions with anaesthetics, altering the potency and effect of the drugs.
d. Routine medications are usually withheld the day of surgery, requiring dosage and schedule adjustments.
All findings of the medication history should be documented and communicated to the intraoperative and postoperative personnel. Although the anaesthesiologist will determine the appropriate schedule and dose of the patient’s routine medications before and after surgery based on the medication history, the nurse must ensure that all of the patient’s medications are identified, administer the medications as ordered, and monitor the patient for potential interactions and complications.
During a preoperative assessment, which of the following reported allergies does the nurse recognize as a risk for latex allergy in the patient?
c. Dairy products
An allergy to bananas puts the patient at risk for a latex allergy. Additional risk factors include food allergies to papain (meat tenderizer), avocados, kiwis, papayas, chestnuts, potatoes, tomatoes, celery, peaches, and other fruit with stones.
Sarah, 46 years old, is in the preoperative assessment area awaiting surgery. She is wringing her hands and perspiring, and she has a worried affect. The nurse’s communication with Sarah is based on the knowledge that the most prevalent fear of patients awaiting surgery is which of the following?
b. Altered body image
c. Potential for death
d. Results of the procedure
Patients fear surgery for many reasons, but the most prevalent are death and permanent disability
During the preoperative assessment of a patient scheduled for a cholecystectomy at an outpatient centre, the patient tells the nurse that she uses St. John’s wort to keep her spirits up. Why should the nurse notify the anaesthesiologist about this use of St. John’s wort?
a. It may increase the risk of bleeding.
b. It may prolong the effects of anaesthetics.
c. It may cause serious elevations in blood pressure.
d. It may depress the immune system response, delaying healing.
St. John’s wort may prolong the effects of anaesthetic agents.
Which of the following is the meaning of the suffix -ostomy?
a. Excision or removal
b. Creation of opening into
c. Incision or cutting into
d. Repair and reconstruction
The meaning of the suffix -ostomy is creation of an opening into; an example is a colostomy.
According to the Canadian Anesthesiologists’ Society, what is the minimum preoperative fasting time period for intake of clear fluids?
a. 30 minutes
b. 1 hour
c. 2 hours
d. 4 hours
According to the Canadian Anesthesiologists’ Society, the minimum preoperative fasting time period for intake of clear fluids is 2 hours.
The nurse visits the patient to have him sign the operative permit as directed in the physician’s preoperative orders. The patient tells the nurse that the physician has not really told him what is involved in the surgical procedure. What should the nurse do?
a. Ask family members whether they have discussed the surgical procedure with the physician.
b. Explain what the planned surgical procedure entails before having the patient sign the consent form.
c. Have the patient sign the form, and tell him the physician will visit him before surgery to explain the procedure.
d. Delay the patient’s signature on the consent form, and notify the physician that the informed-consent process is not complete.
The nurse can be a patient advocate, verifying that the patient (or a family member) understands the consent form and its implications and that consent for surgery is truly voluntary. The nurse will contact the surgeon and explain the need for additional information if the patient is unclear about operative plans.
What does appropriate preoperative teaching for a patient scheduled for abdominal surgery include?
a. How to care for the wound
b. How to breathe deeply and cough
c. What medications will be used during surgery
d. What drains and tubes will be present after surgery
All abdominal surgery patients are taught deep breathing and coughing exercises in the preoperative period.
Which following class of preoperative medications is administered to increase the patients’ gastric pH and decrease gastric volume?
d. Histamine H2-receptor antagonists
Histamine H2-receptor antagonists—for example, cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac)—are used preoperatively to increase gastric pH and decrease gastric volume.
An 82-year-old man is admitted to the hospital the evening before a prostatectomy for cancer of the prostate. He is alert and oriented but has difficulty seeing and hearing. His wife is at his bedside and answers most questions directed to the patient. What should the nurse do to accomplish preoperative teaching with the patient?
a. Use printed materials for instruction because the patient does not hear well.
b. Direct 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 on preoperative teaching with the patient himself.
Sensory deficits may necessitate that more time be allowed for the older adult to complete preoperative testing and understand preoperative instructions.
A patient with diabetes that is well controlled with insulin injections has been on nothing by mouth (NPO) status since midnight before having a mastectomy. The nurse notes that there are no preoperative orders regarding the patient’s daily insulin dose. What is the most appropriate nursing action?
a. Withhold any insulin dose because none is ordered and the patient is on NPO status.
b. Call the physician to clarify whether insulin should be given and at what dosage.
c. Give the patient half of her usual daily insulin dose because she will not be eating in the morning.
d. Give the patient her usual daily insulin dose because the stress of surgery will increase her blood glucose level.
In the case of insulin, it is important to clarify the time and amount of the last dose before surgery.
How would the nurse document the preoperative rating of physical status for a patient who has a history of controlled asthma?
a. Healthy patient with no systemic disease
b. Mild systemic disease without functional limitations
c. Severe systemic disease associated with functional limitations
d. Severe systemic disease that is an ongoing threat to life
A patient that has a history of controlled asthma would be rated as a II—a mild systemic disease without functional limitations.
As the nurse prepares a patient the morning of surgery, the patient refuses to remove her wedding ring. What should the nurse do?
a. Tape the ring securely to the finger.
b. Note the presence of the ring on the preoperative checklist form.
c. Insist that the patient remove the ring, and take it to the facility’s safe.
d. Tell the patient that the health facility cannot be responsible if something happens to her finger or the ring.
If the patient prefers not to remove a wedding ring, the ring can be taped securely to the finger to prevent loss.
Which of the following should be the nurse’s preoperative consideration when the patient states that she takes a garlic pill every day?
a. Garlic may cause inflammation of the liver.
b. Garlic may inhibit platelet activity.
c. Garlic may increase bleeding.
d. Garlic may increase pulse rate.
Garlic may increase bleeding, especially in patients taking anticoagulants.
What is the primary reason the perioperative nurse encourages a family member or a friend to remain with a patient in the preoperative holding area until the patient is taken into the operating room (OR)?
a. To ensure the proper identification of the patient before surgery
b. To protect the patient from cross-contamination with other patients
c. To assist the perioperative nurse to perform a complete patient history
d. To help minimize patient anxiety
Some institutions permit the family or a friend to wait with the patient until it is time to be transferred to the OR. It is believed that having a family member stay with the patient helps relieve anxiety.
What is the intraoperative activity that is performed by the perioperative nurse and is specific to the circulating function?
a. Identifying and assessing the patient
b. Counting sponges, needles, and instruments
c. Passing instruments to the surgeon and assistants
d. Preparing the instrument table and organizing sterile equipment
The circulating nurse is responsible for identifying and assessing the physiological and emotional status of the patient. Counting sponges, needles, and surgical instruments is included in both the circulating and scrub roles. Management of sterile instruments and handing instruments to the surgeon are included in the scrub role. Preparation of the instrument table and sterile equipment is included in both the circulating and scrub roles.
Which of the following is a principle of basic aseptic technique in the OR?
a. All supplies for the day are opened at the beginning of the shift in the sterile surgical room.
b. Torn items can be used as long as they are opened in the sterile room.
c. Sterile items can be opened and flipped onto the sterile table.
d. Each wrapper should be checked for wrapper integrity and changed chemical indicators.
Ensuring that each wrapper is checked for wrapper integrity and changed chemical indicators before use is a principle of basic aseptic technique in the OR.
What are the physical environment and traffic control measures of the OR primarily designed to do?
a. Protect the patient’s privacy.
b. Prevent transmission of infection.
c. Ensure the proper function of electrical equipment.
d. Promote the development of teamwork among the OR staff.
The surgical suite is a controlled environment designed to minimize the spread of infectious organisms and allow a smooth flow of patients, personnel, and the instruments and equipment needed to provide safe patient care.
Which one of the following intraoperative patient positions would the nurse anticipate for the patient who is being prepared for abdominal surgery?
d. Lateral decubitus
The nurse would anticipate a patient that was being prepared for abdominal surgery to be in a supine position for surgery.
The nurse would implement postoperative monitoring of a patient’s sedation score when the patient had received which one of the following anaesthetics?
a. Lidocaine (local spinal)
b. Fentanyl (analgesic spinal)
c. Lidocaine (local epidural)
d. Sufentanil (analgesic epidural)
The nurse would implement postoperative monitoring of the patient’s sedation score when the patient had received a local epidural anaesthetic, for example, lidocaine.
Which of the following data obtained during the perioperative nurse’s assessment of an older patient in the preoperative holding area would indicate a need for special protection techniques during surgery?
a. A history of spinal and hip arthritis
b. Verbalization of anxiety by the patient
c. The patient asking about the details of the surgical procedure
d. An 8-mm Hg increase in systolic blood pressure from the time of hospital admission
Older adults often have osteoporosis and osteoarthritis. These factors reinforce the need for careful transferring, lifting, and positioning techniques.
The nurse notes that a preoperative patient is drowsy, but oriented, in the receiving area. In addition to checking her hospital number and identification band, what should the nurse check?
a. Ask family members to verify the patient’s identity.
b. Check that the operative procedure is noted on the chart.
c. Ask the surgeon to identify the patient and the planned surgical procedure.
d. Ask the patient to state her name, her doctor’s name, and the operative procedure planned.
The identification process in the receiving area includes asking the patient to state her or his name, the surgeon’s name, and the operative procedure and location.
The nurse from the general surgical unit brings the patient’s hearing aid to the surgical suite because the patient left the unit without it and it is needed to communicate with the patient. At the surgical suite, what areas can the general surgical unit nurse enter?
a. Clean core
b. Scrub sink areas
c. Information or nursing station
d. Corridors of the ORs
In the OR area, the unrestricted area is where personnel in street clothes can interact with those in scrub clothing. These areas typically include the points of entry for patients (e.g., holding area), staff (e.g., locker rooms), and information (e.g., nursing station).
A preoperative patient in the holding area asks the nurse whether he will be “put to sleep” with a mask over his face. What is the most appropriate response?
a. “A drug will be injected through your intravenous line, which will cause you to go to sleep almost immediately.”
b. “Only your surgeon can tell you for sure what method of anaesthesia will be used. Should I ask your surgeon?”
c. “Masks are not used anymore for anaesthesia. A tube will be inserted into your throat to deliver a gas that will put you to sleep.”
d. “You will be so sleepy from the preoperative medication you have received that you will not be aware of the anaesthetic administration.”
Virtually all routine general anaesthetic protocols for use with adults begin with an intravenous (IV) induction agent, such as midazolam (Versed) or propofol (Diprivan).
A surgical patient received a volatile liquid as an inhalation anaesthetic during surgery. What would the nurse expect the patient to experience postoperatively?
a. Early onset of pain
b. Nausea and vomiting
c. Respiratory depression
d. Significant cardiac depression
With an inhalation anaesthetic, the nurse needs to assess and treat pain during early anaesthesia recovery.
Which assessment finding would the nurse expect to observe in a patient with malignant hyperthermia?
a. Decreased heart rate
b. Low, irregular respirations
c. Decreased temperature
d. Ventricular dysrhythmias
A patient with malignant hyperthermia will exhibit tachycardia, tachypnea, hypercarbia, and ventricular dysrhythmias.