Chapter 16 - Preop

Question 1

Diagnostic surgery

Answer 1

Surgery performed to determine the origin and cause of a disorder or the cell type for cancer

Question 2

Curative Surgery

Answer 2

Performed to resolve a health problem by repairing or removing the cause

Question 3

Restorative Surgery

Answer 3

Performed to improve a patient’s functional ability

Question 4

Palliative Surgery

Answer 4

Performed to relieve symptoms of a disease process, but does not cure.

Question 5

Cosmetic Surgery

Answer 5

Performed primarily to alter or enhance personal appearance

Question 6

Elective Surgery

Answer 6

Planned for correction of a nonacute problem

Question 7

Urgent Surgery

Answer 7

Requires prompt intervention; may be life-threatening if treatment is delayed more than 24-48 hours.

Question 8

Emergent Surgery

Answer 8

Requires immediate intervention because of life-threatening consequences.

Question 9

Minor Surgery

Answer 9

Procedure without significant risk; often done with local anesthesia

Question 10

Major Surgery

Answer 10

Procedure of great risk; usually longer and more extensive than a minor procedure

Question 11

Simple Surgery

Answer 11

Only the most overtly affected areas involved in the surgery

Question 12

Radical Surgery

Answer 12

Extensive surgery beyond the area obviously involved. Directed at finding a root cause.

Question 13

MIS Minimally Invasive Surgery

Answer 13

Surgery performed in a body cavity or body area through one or more endoscopes; can correct problems, remove organs, take tissue for biopsy, re-route blood vessels and drainage systems; is a fast growing and ever changing type of surgery.

Question 14

Why do cardiac problems put patients at greater risk from having surgery?

Answer 14

Cardiac problems impair the patient’s ability to withstand hemodynamic changes and alter the response to anesthesia.

Question 15

Atelectasis

Answer 15

Collapse of alveoli. Reduces gas exchange and causes intolerance of anesthesia. Also a common problem After anesthesia.

Question 16

What meds put a patient at greater surgical risk or increase the risk for postoperative complications?

Answer 16

Antihypertensives
Tricyclic Antidepressants
Anticoagulants
NSAIDs

Question 17

What prior surgical experiences put patients at greater surgical risk or increase the risk for postop complications?

Answer 17

Less-than-optimal emotional reaction. Anesthesia reactions or complications. Postop complications.

Question 18

What health history puts patients at greater risk or increase the risk for postop complications?

Answer 18

Malnutrition or obesity.
Drug, tobacco, or alcohol or illicit substance use or abuse.
Altered coping ability.

Question 19

What family history puts patients at greater surgical risk or increase the risk for postop complications?

Answer 19

Malignant hyperthermia
Cancer
Bleeding disorder

Question 20

What type of surgical procedure planned puts patients at greater surgical risk or increases the risk for postop complications?

Answer 20

Neck, oral, or facial procedures (airway complications).
Chest or high abdominal procedures (pulmonary complications)
Abdominal surgery (paralytic ileus, VTE).

Question 21

What are some specific considerations when planning care of the older preoperative patient?

Answer 21

• Greater incidence of chronic illness.
• Greater incidence of malnutrition
• More allergies
• Increased incidence of impaired self-care abilities
• Inadequate support systems
• Decreased ability to withstand the stress of surgery and anesthesia
• increased risk for cardiopulmonary complications after surgery.
• risk for a change in mental status when admitted
• increased risk for fall and resultant injury from anesthesia

Question 22

Why is it important to assess MSKL status prior to surgery?

Answer 22

MSKL issues may interfere with positioning during and after surgery.

Question 23

Why should you ask about a history of joint replacement and document the placement of any prostheses?

Answer 23

If an electrocautery pad is placed on or near the prosthesis it can cause an electrical burn.

Question 24

What are indications for poor fluid or nutritional status?

Answer 24

• Brittle nails
• Muscle waste
• Dry or flaky skin
• Decreased skin turgor and hair changes (dull, sparse, dry).
• Orthostatic hypotension
• Decreased serum protein levels and abnormal serum electrolyte levels

Question 25

Why should hypokalemia be reported to the anesthesia team and the surgeon before surgery?

Answer 25

It increases the risk for toxicity if the patient is taking digoxin, slows recovery from anesthesia and increases cardiac irritability.

Question 26

Why should hyperkalemia be reported to the anesthesia team and the surgeon before surgery?

Answer 26

Increased risk for dysrhythmias, especially with the use of anesthesia.

Question 27

As part of the cardiopulmonary assessment, what should be reported to the anesthesia team and surgeon?

Answer 27

``` Hyper/hypotension Heart rate less than 60 or more than 120 bpm Irregular heart rate Chest pain SOB or dyspnea Tachypnea Pulse oximetry reading of less than 94% ```

Question 28

As part of the preop assessment report and signs or symptoms that could contraindicate surgery including:

Answer 28

Increased PTT, INR, or PT.

Question 29

Assess for and report other clinical conditions that may need to be assessed by a physician or advanced practice nurse before proceeding with surgery including:

Answer 29

- Change in mental status - Vomiting - Rash - Recent administration of an anticoagulant drug

Question 30

Patients at greater risk for VTE are:

Answer 30

- Obese - Older than 40 years - Have cancer - Have decreased mobility or are immobile - have a spinal cord injury - Have a history of VE, PE, varicose veins, or edema. - Taking oral contraceptives - Smokers - Have decreased cardiac output - Have hip fracture or total hip or total knee surgery.

Question 31

The nurse is educating a preop client about colostomy surgery. The colostomy surgery is categorized as what type of surgery?

Answer 31

Palliative

Question 32

``` In going through the preoperative checklist, the nurse notices that the client's armband does not match the handwritten name on the informed consent, but it matches the stamped name. What does the nurse do first? A. Calls admissions B. Cancels the surgery C. Contacts the surgeon D. Talks to the operating team ```

Answer 32

Talks to the operating team

Question 33

``` As the nurse obtains the informed consent, the client asks, "Now what exactly are they going to do to me?" What is the nurse's response? A. Contacts the anesthesiologist B. Contacts the surgeon C. Explains the procedure D. Has the client sign the form ```

Answer 33

Contacts the surgeon

Question 34

The nurse is educating the client who is about to undergo cardiac surgery with general anesthesia. Which statement by the client indicates the need for further instruction? A. "I will wake up with a tube in my throat." B. "I will have a bandage on my chest." C. "My family will not be able to see me right away." D. "Pain medication will take away my pain."

Answer 34

"Pain medication will take away my pain"

Question 35

The older client's adult child tells the nurse that the client does not want life support. What does the nurse do first? A. Calls the legal department to draft the paperwork B. Documents this in the chart C. Thanks the person and does nothing D. Talks to the client

Answer 35

Talks to the client

Question 36

The preoperative client smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best physical outcomes? A. Instructs the client to quit smoking B. Teaches about the dangers of tobacco C. Teaches the importance of incentive spirometry D. Tells the client where the smoking lounge is

Answer 36

Teaches the importance of incentive spirometry

Question 37

``` During a preoperative assessment, which statement by the client requires further investigation by the nurse to assess risk? A. "I am taking vitamins." B. "I drink a glass of wine a night." C. "I had a heart attack 4 months ago." D. "I don't like latex balloons." ```

Answer 37

I had a heart attack 4 months ago.

Question 38

The nurse completes the preoperative checklist on the client scheduled for general surgery. Which factor contributes the greatest risk for the planned procedure? A. Age of 59 years B. General anesthesia complications experienced by the client's brother C. Diet-controlled diabetes mellitus D. Ten pounds over the client's ideal body weight

Answer 38

Diet-controlled diabetes mellitus.

Question 39

``` Which electrolyte laboratory result does the nurse report immediately to the anesthesiologist? A. Creatinine, 1.9 mg/dL B. Fasting glucose, 80 mg/dL C. Potassium, 3.9 mEq/L D. Sodium, 140 mEq/L ```

Answer 39

Creatinine, 1.9 mg/dL

Question 40

The client is being prepared for gastrointestinal surgery and undergoes a bowel preparation. Why is this preoperative procedure done? A. Decreases expected blood loss during surgery B. Eliminates any risk of infection C. Ensures that the bowel is sterile D. Reduces the number of intestinal bacteria

Answer 40

Reduces the number of intestinal bacteria.

Question 41

``` What information about the postoperative client does the nurse include in the report to the postanesthesia care unit (PACU) nurse? A. Confirmation of informed consent B. Estimated blood loss C. Type of surgical instruments used D. Type of suture material used ```

Answer 41

Estimated blood loss

Question 42

The nurse is instructing the client about the use of antiembolism stockings. Which statement by the client indicates the need for further teaching? A. "I will take off my stockings one to three times a day for 30 minutes." B. "My stockings are too loose." C. "These stockings will prevent blood clots." D. "These stockings help promote blood flow."

Answer 42

These stockings will prevent blood clots.

Question 43

Which task would be best for the charge nurse to assign to the LPN/LVN working in the surgery admitting area? A. Provide preoperative teaching to a client who needs insertion of a tunneled central venous catheter. B. Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer. C. Obtain the medical history from a client who is scheduled for a total hip replacement. D. Assess the client who is being admitted for an elective laparoscopic cholecystectomy.

Answer 43

Insert a retention catheter in a client who requires a flap graft of a sacral pressure ulcer.

Question 44

At 8 AM, the registered nurse is admitting to the outpatient surgery department a client who is scheduled for sinus surgery. Which information given by the client would be of most immediate concern to the nurse? A. The client has an allergy to iodine and shellfish. B. The client was nauseated after a previous surgery. C. The client had a small glass of juice at 7 AM. D. The client expresses anxiety about the surgery.

Answer 44

The client had a small glass of juice at 7 am.

Question 45

A diabetic client who is scheduled for vascular surgery is admitted on the day of surgery with several orders. Which orders should the registered nurse accomplish first? A. Use electrical clippers to cut hair at the surgical site. B. Start an infusion of lactated Ringer's solution at 75 mL/hr. C. Administer one half of the client's usual lispro insulin dose. D. Draw blood for glucose, electrolyte, and complete blood count values.

Answer 45

Draw blood for glucose, electrolyte, and complete blood count values.