Chapter 15. Priorities for the Preoperative Patient Flashcards
- A patient scheduled for an elective hysterectomy tells the nurse, I am afraid that I will die in surgery like my mother did! Which response by the nurse is most appropriate?
a. Tell me more about what happened to your mother.
b. You will receive medications to reduce your anxiety.
c. You should talk to the doctor again about the surgery.
d. Surgical techniques have improved a lot in recent years.
ANS: A
The patients 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 patients concerns, but further assessment is needed first.
- A patient arrives at the ambulatory surgery center for a scheduled laparoscopy procedure in outpatient surgery. Which information is of most concern to the nurse?
a. The patient is planning to drive home after surgery.
b. The patient had a sip of water 4 hours before arriving.
c. The patients insurance does not cover outpatient surgery.
d. The patient has not had surgery using general anesthesia before.
ANS: A
After outpatient surgery, the patient should not drive home and will need assistance with transportation and home care. The patients experience with surgery is assessed, but it does not have as much application to the patients physiologic safety. The patients insurance coverage is important to establish, but this is not usually the nurses role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually increase risk for aspiration.
- A 38-year-old female is admitted for an elective surgical procedure. Which information obtained by the nurse during the preoperative assessment is most important to report to the anesthesiologist before surgery?
a.
The patients lack of knowledge about postoperative pain control measures
b.
The patients statement that her last menstrual period was 8 weeks previously
c.
The patients history of a postoperative infection following a prior cholecystectomy
d.
The patients concern that she will be unable to care for her children postoperatively
ANS: B
This statement suggests that the patient may 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 never had any prior surgeries tells the nurse doing the preoperative assessment about an allergy to bananas and avocados. Which action is most important for the nurse to take?
a. Notify the dietitian about the food allergies.
b. Alert the surgery center about a possible latex allergy.
c. Reassure the patient that all allergies are noted on the medical 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, and 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 also 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 not right. 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 patients 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 patients 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. Johns wort to prevent depression. Which complication would the nurse expect in the postanesthesia care unit?
a. Increased pain
b. Hypertensive episodes
c. Longer time to recover from anesthesia
d. Increased risk for postoperative bleeding
ANS: C
St. Johns 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 patients blood pressure and temperature.
c. Remind the patient about harmful effects of smoking.
d. Ask the health care provider about prescribing a nicotine patch.
ANS: A
The nurse should first ensure a patent airway and check for breathing and circulation (airway, breathing, and circulation [ABCs]). 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 surgery. 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 most appropriate?
a. Ascertain that there will be no interactions with anesthetic agents.
b. Teach the patient that these products may be continued preoperatively.
c. Advise the patient to stop the use of all herbs and supplements at this time.
d. Discuss the herb and supplement use with the patients health care provider.
ANS: D
Both garlic and ginkgo biloba increase a patients risk for bleeding. The nurse should discuss the herb and supplement use with the patients 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. Determining the interactions between the supplements and anesthetics is not within the nurses scope of practice.
- The nurse is preparing to witness the patient signing the operative consent form when the patient says, I do not really understand what the doctor said. Which action is best for the nurse to take?
a. Provide an explanation of the planned surgical procedure.
b. Notify the surgeon that the informed consent process is not complete.
c. Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications.
d. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.
ANS: B
The surgeon is responsible for explaining the surgery to the patient, and 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 nurses legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient understands the surgical procedure and signs the consent form.
- Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for abdominal surgery for an open cholecystectomy?
a. Care for the surgical incision
b. Medications used during surgery
c. Deep breathing and coughing techniques
d. Oral antibiotic therapy after discharge home
ANS: C
Preoperative teaching, demonstration, and redemonstration 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.
- Five minutes after receiving the ordered preoperative midazolam (Versed) 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. Assist the patient to the bathroom and stay with the patient to prevent falls.
b. Offer a urinal or bedpan and position the patient in bed to promote voiding.
c. Allow the patient up to the bathroom because medication onset is 10 minutes.
d. Ask the patient to wait because catheterization is performed just before the surgery.
ANS: B
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.
- The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits. His wife usually 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 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 patients 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 the 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. Administer a lower 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 in a few days. The results are white blood cell (WBC) count 10.2 103/L; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 103/L. Which action should the nurse take?
a. Call the surgeon and anesthesiologist immediately.
b. Ask the patient about any symptoms of a recent infection.
c. Discuss the possibility of blood transfusion with the patient.
d. Send the patient to the holding area when the operating room calls.
ANS: D
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.
- As the nurse prepares a patient the morning of surgery, the patient refuses to remove a wedding ring, saying, I have never taken it off since the day I was married. Which response by the nurse is best?
a.
Have the patient sign a release and leave the ring on.
b.
Tape the wedding ring securely to the patients finger.
c.
Tell the patient that the hospital is not liable for loss of the ring.
d.
Suggest that the patient give the ring to a family member to keep.
ANS: D
Jewelry is not allowed to be worn by the patient, especially if electrocautery will be used. There is no need for a release form or to discuss liability with the patient.
