NUR243 - Medical-Surgical II > Chapter 18: Preoperative Care > Flashcards
Chapter 18: Preoperative Care Flashcards
the art and science of treating diseases, injuries, and deformities by operation and instrumentation
surgery
time before surgery
a. perioperative
b. intraoperative
c. postoperative
a. perioperative
Determining the presence and/or extent of pathology.
diagnosis
Eliminating or repairing pathology.
cure
Alleviating symptoms without cure.
palliation
Examples include removing a mole before it becomes malignant or removing the colon in a patient with familial polyposis to prevent cancer.
prevention
Examples include repairing a burn scar or breast reconstruction after a mastectomy.
cosmetic improvement
Conducting a surgical examination to determine the nature or extent of a disease.
exploration
excision or removal
a. - ectomy
b. - lysis
c. - orrhaphy
d. - oscopy
a. - ectomy
destruction of
a. - ectomy
b. - lysis
c. - orrhaphy
d. - oscopy
b. - lysis
repair or suture of
a. - ectomy
b. - lysis
c. - orrhaphy
d. - oscopy
c. - orrhaphy
looking into
a. - ectomy
b. - lysis
c. - orrhaphy
d. - oscopy
d. - oscopy
creation of opening into
a. - ostomy
b. - otomy
c. - plasty
d. - precual
a. - ostomy
cutting into or incision of
a. - ostomy
b. - otomy
c. - plasty
d. - precual
b. - otomy
repair or reconstruction of
a. - ostomy
b. - otomy
c. - plasty
d. - precual
c. - plasty
elective surgery
a carefully PLANNED surgery
emergency surgery
arise with unexpected urgency
same-day or outpatient
Ambulatory
For inpatient surgery, patients who are going to be admitted to the hospital are usually admitted on the day of surgery.
same-day admission
T/F
By being aware of the patient’s and caregiver’s needs, you can provide the information and support needed during the perioperative period.
true
What is the most common fear patients have when going into surgery?
the risk of death or permanent disability
T/F
The interaction of the patient’s current drugs and anesthetics will not alter the effects of the anesthetics.
false
one who is younger than the legal age of consent but is recognized as having the legal capacity to provide consent
emancipated minor
Who is responsible for obtaining consent from the patient?
surgeon
T/F
The patient can withdraw their permission for surgery to take place at any time.
true
T/F
A medical emergency may override the need for consent.
true
The nurse may __________ a signature from a patient giving their consent for a surgery.
witness
Why do you want your patient to void before surgery?
Reduces risk of urinary retention during early postoperative recovery.
A patient with obesity (BMI of 42.1) is scheduled for a laparoscopic cholecystectomy in an outpatient surgery setting. Which information would the nurse include in the plan of care?
A. The patient will be in the hospital for several days.
B. Surgery will involve removing a part of the liver.
C. The setting is not appropriate for the planned procedure.
D. Special equipment may be needed for the patient’s care.
D. Special equipment may be needed for the patient’s care.
A 17-year-old patient with a leg fracture who is scheduled for surgery is an emancipated minor. She has a statement from the court for verification. Which action would the nurse take?
A. Witness the patient signing the permit after the surgeon obtains consent
B. Call a parent or legal guardian to sign the permit since the patient is under 18
C. Notify the hospital attorney that an emancipated minor is consenting for surgery
D. Obtain verbal consent since written consent is not necessary for emancipated minors
A. Witness the patient signing the permit after the surgeon obtains consent
A 59-year-old man scheduled for a herniorrhaphy in 2 days reports that he takes an anticoagulant agent daily. Which action would the nurse take?
A. Inform the surgeon since the procedure may have to be rescheduled
B. Tell the patient to continue to take the drug up to the day before surgery
C. Ask the patient if he has any side effects from taking this drug supplement.
D. Notify the anesthesia care provider since this drug may interfere with anesthetics
A. Inform the surgeon since the procedure may have to be rescheduled
Which intervention would the nurse prioritize to aid a preoperative patient in coping with the fear of postoperative pain?
A. inform the patient that pain medication will be available
B. describe the type of pain expected after the patient’s surgery
C. teach the patient to use guide imagery to help manage pain
D. explain the pain management plan and the use of a pain rating scale
D. explain the pain management plan and the use of a pain rating scale
A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center. The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. Which action would the nurse take?
A. Tell the patient to come back tomorrow since he ate a meal.
B. Have the patient void before giving any preoperative medication.
C. Proceed with the preoperative checklist, including site identification.
D. Notify the anesthesia care provider of when and what the patient last ate.
D. Notify the anesthesia care provider of when and what the patient last ate.
A patient who takes metformin 500 mg every morning for control of type 2 diabetes asks if she should take her medication the day of surgery. Which recommendation would the nurse make?
A. Skip her medication the day of surgery.
B. Get instructions from the surgeon about medication adjustments
C. Take her usual morning doses at bedtime the night before surgery
D. Take her medication as usual with a sip of water in the morning
B. Get instructions from the surgeon about medication adjustments
Which preoperative considerations would the nurse plan for the care of an older adult? (SATA)
A. Using only large-print educational materials
B. Speaking louder for patients with hearing aids
C. Recognizing that sensory deficits may be present
D. Providing warm blankets to prevent hypothermia
E. Teaching important information early in the morning
C. Recognizing that sensory deficits may be present
D. Providing warm blankets to prevent hypothermia
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 would the nurse provide?
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.”
a. “Tell me more about what happened to your mother.”
A patient arrives at the outpatient surgical center for a scheduled laparoscopy under general anesthesia. Which information requires the nurse‘s 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.
b. The patient is planning to drive home after surgery.
The nurse is teaching the client who is preoperative for abdominal surgery. Which of the following statements should the nurse make? (SATA)
A. “Take your aspirin with a sip of water this morning before your surgery.”
B. “Splint the abdominal incision with a pillow when coughing and deep breathing after surgery.”
C. “You will be placed on bed rest for the first 48 hours after surgery.”
D. “You should perform calf pumping exercises after surgery.”
E. “Anti-embolism stockings are applied before surgery.”
B. “Splint the abdominal incision with a pillow when coughing and deep breathing after surgery.”
D. “You should perform calf pumping exercises after surgery.”
E. “Anti-embolism stockings are applied before surgery.”
The preoperative nurse is caring for the client who is having a colon resection. Which of the following actions should the nurse take? (SATA)
A. encourage the client to void prior to receiving preoperative medications
B. administer antibiotics 2 hours before the surgical incision
C. use a disposable razor to shave hair over the surgical site
D. remove nail polish on the client’s fingernails
E. instruct the client how to use an incentive spirometer
A. encourage the client to void prior to receiving preoperative medications
D. remove nail polish on the client’s fingernails
E. instruct the client how to use an incentive spirometer
A 38-year-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
c. The patient‘s report that her last menstrual period was 8 weeks ago
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.
b. Alert the surgery center about a possible latex allergy.
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 would the nurse take?
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.
c. Discuss the herb and supplement use with the patient‘s health 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 surgery.” Which action would the nurse take?
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.
b. Notify the surgeon that the informed consent process is not complete.
Which topic would 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
b. Deep breathing and coughing
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 would the nurse take?
a. Perform a straight catheterization.
b. Offer the patient a urinal or bedpan.
c. Assist the patient to ambulate to the bathroom.
d. Tell the patient that a catheter will be placed in the operating room.
b. Offer the patient a urinal or bedpan.
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 would 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 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.
c. Provide additional time for the patient to understand preoperative instructions and
carry out procedures.
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 would 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.
b. Obtain a blood glucose measurement before any insulin administration.
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 x 10 3 /L; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 x 10 3 /L. Which action would 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.
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 would 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.
c. Suggest that the patient give the ring to a family member to hold.
A patient has received atropine before surgery and reports a dry mouth. Which action would the nurse take?
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.
d. Explain that dry mouth is an expected side effect.
Which statement by a patient scheduled for knee surgery is 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.”
b. “I had a heart valve replacement last year.”
The nurse interviews a patient scheduled to undergo general anesthesia for a bilateral hernia repair. Which information is 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 surgery.
d. The patient drank apple juice 6 hours before coming to the hospital.
c. The patient‘s father died after general anesthesia for surgery.
Which information in the preoperative patient‘s medication history is 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.
a. The patient takes garlic capsules every day.
A patient who takes a diuretic and a -blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is 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
c. Serum potassium 3.2 mEq/L
When caring for a preoperative patient on the day of surgery, which actions can the nurse delegate to assistive personnel (AP)? (SATA)
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.
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.
Which results are expected patient outcomes of the nurse providing thorough preoperative teaching? (SATA)
a. Decreased anxiety
b. Reduced postoperative fear
c. Diminished patient satisfaction
d. Shorter length of hospitalization
e. Increased recovery time after discharge
f. Decreased development of complications
a. Decreased anxiety
b. Reduced postoperative fear
d. Shorter length of hospitalization
f. Decreased development of complications
