EAQ Chapter 17 preop care Flashcards
The nurse is preparing to give a dose of cefazolin 1.5 g intravenous piggyback (IVPB) to a patient before surgery. The vials available on the unit contain 500 mg in powder form. The instructions state to “dilute each 500 mg with 5 mL of sterile water.” After reconstituting the medication, the nurse should draw up total milliliters of solution for dosage preparation? Record your answer using a whole number.
Because the dose is 1.5 g and each vial contains 500 mg, the nurse needs to first convert grams to milligrams. 1.5 grams is equal to 1500 mg. Dividing 1500 by 500, the nurse needs to use a total of three vials. The nurse then adds 5 mL of sterile water to each vial of powder on the basis of the direction to “add 5 mL of sterile water per 500 mg of medication.” Once all vials are reconstituted, the concentration of each solution is 500 mg/5 mL. The nurse then needs to draw up the contents of all three vials, making the total volume 15 mL.
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A patient is scheduled for surgery to repair a deviated nasal septum and is to have nothing by mouth (NPO) orders since midnight and now surgery is delayed for several hours. The patient tells the nurse, “I am very hungry and thirsty, and I have a headache because I missed my morning coffee.” Which nursing actions are appropriate in this case? Select all that apply.
Give heavy food to the patient.
Give black coffee to the patient.
Give clear liquids to the patient.
Keep the patient apprised of the situation.
Tell the anesthesia care provider about the situation.
Keep the patient apprised of the situation.
Tell the anesthesia care provider about the situation
Nothing by mouth (NPO) restrictions are given to the patient to prevent aspiration and vomiting during surgery. Patients who are NPO from midnight frequently complain of hunger and thirst while waiting for surgery. Keep the patient updated on the situation and let them know they have not been forgotten. Patients who regularly drink caffeine in the morning often experience a “caffeine withdrawal” headache when fasting. The nurse should talk to the anesthesia care provider and ask if the patient can consume clear liquids; if he says yes, clear liquids and coffee should be offered, but not until after the anesthesia care provider has approved it. A heavy meal should be avoided before surgery because it can lead to the above-mentioned complications.
As the nurse is preparing a patient for outpatient surgery, the patient wants to give the patient’s hearing aid to the spouse so it will not be lost during surgery. Which action by the nurse should be taken in this situation?
Encourage the patient to wear it for the surgery.
Tape the hearing aid to the patient’s ear to prevent loss.
Give the hearing aid to the spouse as the patient wishes.
Tell the surgery nurse that the patient has the hearing aid out.
Encourage the patient to wear it for the surgery.
Although jewelry is removed before surgery, hearing aids should be left in place to allow the patient to better follow instructions given in the surgical suite and the postanesthesia care unit (PACU), as well as the dismissal instructions that will be given before the patient returns home for recovery. Removing the hearing aid could cause issues for the patient in following instructions in the surgical suite and PACU. Taping the hearing aid to the patient’s ear is not necessary to prevent loss.
The nurse is preparing a patient for surgery when they state, “I am terrified to be put to sleep. What if I don’t wake up?” What is the priority action by the nurse?
Administer an antianxiety medication to the patient.
Teach the patient to use guided imagery to help manage fear.
Describe the type of anesthesia expected with the patient’s particular surgery.
Inform the anesthesia care provider (ACP) so that he or she can talk further to the patient.
Inform the anesthesia care provider (ACP) so that he or she can talk further to the patient.
If the nurse identifies that the patient has fear of anesthesia, inform the ACP immediately so that he or she can talk further with the patient. Reassure the patient that a nurse and ACP will be present at all times during surgery. The nurse could use guided imagery to help manage fear or administer an antianxiety medication (if prescribed), but these interventions do not address directly the reason behind the patient’s fear, so they would not be the priority. It is not within the nurse’s scope of practice to describe the type of anesthesia that the patient will receive.
The nurse is to administer preoperative medications for a patient who is scheduled for surgery at 7:30: cefazolin intravenously (IV) to be infused 30 minutes before surgery, midazolam IV before surgery, and a scopolamine patch behind the ear. Which medication should the nurse administer first?
Cefazolin
Fentanyl
Midazolam
Scopolamine
Scopolamine
The scopolamine patch will be administered first to allow enough time for the serum level to become therapeutic. The cefazolin will be given at 7 to allow infusion 30 minutes before surgery. Fentanyl is a narcotic and was not prescribed preoperatively. The midazolam, a short-acting benzodiazepine, is used as a sedative.
When reviewing the preoperative forms, the nurse notices that the informed consent form is not signed. What is the best action for the nurse to take?
Have the patient sign a consent form.
Have the family sign the form for the patient.
Notify the health care provider to obtain consent for surgery.
Teach the patient about the surgery and get verbal permission.
Notify the health care provider to obtain consent for surgery.
The informed consent for the surgery must be obtained by the health care provider. The nurse can witness the signature on the consent form and verify that the patient (or caregiver if patient is a minor, unconscious, or mentally incompetent to sign) understands the informed consent. Verbal consents are not enough. The state’s nurse practice act and agency policies must be followed.
A patient with a body mass index (BMI) of 45 is admitted for abdominal surgery. The nurse explains to the patient the potential complications of abdominal surgery caused by obesity. Which statements should the nurse include in the explanation? Select all that apply.
Access to the surgical site is easy.
Recovery from anesthesia is faster.
The risk of wound infection is higher.
Anesthesia administration is more difficult.
The risk of a postoperative incisional hernia may be higher.
The risk of wound infection is higher.
Anesthesia administration is more difficult.
The risk of a postoperative incisional hernia may be higher.
It is difficult to administer anesthesia in obese patients due to the stress on the cardiopulmonary system caused by the increased body weight. Postoperatively, there is a high risk of incisional hernia due to increased stress on the sutures in obese patients. Because adipose tissue is less vascular than other tissue, the healing of the incisional site is slow, creating a high risk of wound infection. Due to fat deposits, access to the surgical site may be difficult in an obese patient. Some anesthetic agents are stored by adipose tissue and stay in the body for longer time, so the patient may recover slowly from anesthesia.
The nurse is preparing to administer a preoperative dose of cefazolin prior to an open cholecystectomy. What is the best explanation to the patient about why they are receiving this medication?
“It will prevent postoperative pneumonia.”
“It will treat your urinary tract infection (UTI).”
“It will prevent postoperative surgical-site infection.”
“It will remove harmful bacteria from your intestines before surgery.”
“It will prevent postoperative surgical-site infection.”
Cefazolin has enhanced activity against a wide variety of gram-negative organisms and is being used for perioperative prophylaxis against infection at the surgical site. The bowel has a wide variety of bacterial flora that could contaminate the abdominal cavity during surgery. This antibiotic is not used to prevent pneumonia. If the patient has a current infection (UTI), surgery may be postponed. The antibiotic will not remove all bacteria from the intestines but will reduce the risk of postoperative infection from intestinal bacteria.
An older adult patient is admitted to the surgical unit for a right hemicolectomy. The nurse is concerned regarding the hydration status of this patient. What reason does the nurse have for this concern?
It is difficult to find intravenous access in older patients.
Skin turgor assessment is not a reliable measure for dehydration in this patient.
There is an increased loss of water and electrolytes through sweating in old people.
There is a narrow margin of safety between overhydration and underhydration in elderly patients.
There is a narrow margin of safety between overhydration and underhydration in elderly patients.
The capacity to adapt to changes in fluid levels is low in elderly patients. The safety margin is very low between dehydration and over hydration, so the nurse should focus on the preoperative fluid balance history of this patient. Finding intravenous access in older patients may not be difficult. Old people do not sweat more than young people. Skin turgor assessment is a reliable measure for dehydration in this patient.
The nurse is administering a preoperative medication orally. What nursing action is appropriate when performing this intervention?
Give the medicine with a glass of milk.
Give the medicine with a small sip of water.
Give the medicine the night before surgery.
Give the medicine 5 minutes before going to the operating room.
Give the medicine with a small sip of water.
The preoperative medication should be given with a small sip of water 60 to 90 minutes before shifting the patient to the operating room. The medication should not be given only 5 minutes before going to the operating room, because effects of the medication will not begin to potentiate yet. The patient should not be given large amounts of fluid or milk orally, because it can increase the chances of regurgitation and asphyxia during surgery under the effects of anesthetics.
The nurse is to administer preoperative antibiotics to a group of patients. What patients are determined to require this medication? Select all that apply.
Patients undergoing cataract surgery
Patients with known coronary artery disease
Patients undergoing gastrointestinal surgery
Patients undergoing joint replacement surgery
Patients with a history of valvular heart diseases
Patients undergoing gastrointestinal surgery
Patients undergoing joint replacement surgery
Patients with a history of valvular heart diseases
In patients with a history of valvular heart disease, antibiotics may be administered to prevent infective endocarditis. Gastrointestinal surgery carries a risk of wound contamination and calls for antibiotic treatment. In joint replacement surgeries, wound infections can have serious consequences; therefore, it is prudent to give antibiotics. Patients undergoing cataract surgery may require eyedrops, and patients with a history of coronary artery disease may require beta blockers but not antibiotics.
The nurse is preparing to give a dose of cefazolin 1.5 g intravenous piggyback (IVPB) to a patient before surgery. The vials available on the unit contain 500 mg in powder form. The instructions state to “dilute each 500 mg with 5 mL of sterile water.” After reconstituting the medication, the nurse should draw up ____________ total milliliters of solution for dosage preparation? Record your answer using a whole number.
Because the dose is 1.5 g and each vial contains 500 mg, the nurse needs to first convert grams to milligrams. 1.5 grams is equal to 1500 mg. Dividing 1500 by 500, the nurse needs to use a total of three vials. The nurse then adds 5 mL of sterile water to each vial of powder on the basis of the direction to “add 5 mL of sterile water per 500 mg of medication.” Once all vials are reconstituted, the concentration of each solution is 500 mg/5 mL. The nurse then needs to draw up the contents of all three vials, making the total volume 15 mL.
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A patient who is scheduled for thyroid surgery reports amenorrhea that began two months ago. How should the nurse ensure the patient is not pregnant?
By taking an x-ray
By checking hematocrit level
By checking international normalized ratio level
By checking human chorionic gonadotropin level
By checking human chorionic gonadotropin level
Human chorionic gonadotropin (hCG) levels are measured to check for pregnancy status. X-rays of the abdomen are harmful to a fetus, so they should always be avoided in women of reproductive age if pregnancy is suspected. Hematocrit levels indicate the hemoglobin level in the blood. International normalized ratio (INR) is used to check for coagulation status.
A patient with obesity (BMI 26.1 kg/m 2) is scheduled for a laparoscopic hernia repair at an outpatient surgery setting. What should the nurse be prepared for prior to the surgery?
Explain to the patient that surgery will use minimally invasive techniques.
Explain to the patient that this setting is not appropriate for this procedure.
Explain to the patient that surgery will involve removing a portion of the colon.
Explain to the surgical services team that the patient will need special preparation.
Explain to the patient that surgery will use minimally invasive techniques.
Many operative procedures are performed as ambulatory surgery (i.e., same-day or outpatient surgery). The case implied that a laparoscopic technique will be used that involves several small incisions and meets the requirement of a minimally invasive technique. No portions of the colon will be removed during this type of surgery. Obesity is not a contraindication for surgery in the outpatient setting. This patient is not classified as obese based on the BMI.
An older adult patient has been admitted before having surgery for a bilateral mastectomy and breast reconstruction. What should the nurse include in the patient’s preoperative teaching? Select all that apply.
Information about various options for reconstructive surgery
Information about the risks and benefits of her particular surgery
Information about risk factors for breast cancer and the role of screening
Information about where in the hospital she will be taken postoperatively
Information about performing postoperative deep breathing and coughing exercises
Information about where in the hospital she will be taken postoperatively
Information about performing postoperative deep breathing and coughing exercises
During preoperative teaching, it is important to introduce the role of deep-breathing and coughing exercises and to inform the patient about the different locations involved in her hospital stay. The specific risks and benefits of her surgery and reconstruction options should be addressed by her health care provider. Teaching about breast cancer screening would be inappropriate, and likely insensitive, at this point in her disease trajectory.
The nurse is transporting a patient to the operating room. What concern should be the first priority for the nurse?
Premedication
Laboratory tests
Safety of the patient
Preoperative assessments
Safety of the patient
When transporting the patient to the operating room, the nurse’s primary concern should be the patient’s safety. The nurse should help the patient to move from the hospital bed to the stretcher. The side rails should be raised. The patient may be transported to the operating room by stretcher or wheelchair. If no sedatives have been given, the patient may even walk accompanied to the operating room. Premedication, assessments, and laboratory values are major concerns during the preoperative period but not when transporting the patient.
A patient is instructed not to have anything to eat or drink eight hours prior to surgery. When arriving to the preoperative holding area, the patient informs the nurse they ate eggs and toast about 2 hours ago. What is the best response by the nurse?
“We will do the surgery, but it will increase your risk of complications.”
“You were provided with strict instructions on what to do before surgery.”
“We will keep you in the hospital overnight to be sure you don’t do that again.”
“I will inform the anesthesia care provider and surgeon to see what the options are.”
“I will inform the anesthesia care provider and surgeon to see what the options are.”
The nurse should inform the anesthesia care provider and surgeon that the patient has ingested solid foods 2 hours prior to surgery so that the options for surgery can be discussed. The surgery will most likely be delayed since this increases the patient’s risk for complications such as aspiration. The patient should not be demeaned or chastised about eating and will not be kept the hospital overnight to ensure they do not eat again.
The nurse is admitting a patient to the same-day surgery unit and informs the nurse that they took kava last night to help them sleep. Which nursing action would be most appropriate?
Tell the patient that using kava to help sleep often is helpful.
Inform the anesthesiologist of the patient’s recent use of kava.
Tell the patient that the kava should continue to help with relaxation before surgery.
Inform the patient about the dangers of taking herbal medicines without consulting a health care provider.
Inform the anesthesiologist of the patient’s recent use of kava.
Kava may prolong the effects of certain anesthetics. Thus the anesthesiologist needs to be informed of recent ingestion of this herbal supplement. Patients should not take anything before surgery without the health care provider’s knowledge.
A nurse is preparing a patient for cataract surgery. The nurse needs to instill different eye drops into the patient’s eyes. How many minutes should the nurse wait between each set of eye drops?
5 minutes
10 minutes
30 minutes
There is no wait time between instillations.
5 minutes
It is important to administer the drugs as ordered and on time to adequately prepare the eye for surgery. If there are multiple sets of eyedrops, the nurse has to maintain at least 5 minutes of interval between each set of drops.
During the preoperative assessment of a patient, the patient informs the nurse they have been drinking whiskey in large quantities for 10 years. How should the nurse help prevent postoperative complications related to alcohol intake?
Instruct the patient to replace whiskey with a different beverage.
Permit the patient to consume alcohol until the day before surgery.
Recommend to the patient reducing the frequency of alcohol intake.
Instruct the patient to stop consuming alcohol under medical supervision.
Instruct the patient to stop consuming alcohol under medical supervision.
Chronic alcohol use can place the patient at risk because of lung, gastrointestinal, or liver damage. When liver function is decreased, metabolism of anesthetic agents is prolonged, nutritional status is altered, and the chances for postoperative complications are increased. Refraining from alcohol consumption may lead to alcohol withdrawal complications during lengthy surgery or in the postoperative period. Alcohol withdrawal can be dangerous, but the risk can be avoided with appropriate planning and management. Replacement of the beverage is not an option because doing so may have unintended negative consequences. Reducing the frequency of alcohol intake also increases the chances of complications. If the patient continues to consume alcohol before the day of surgery, he may experience complications during the perioperative period.
The nurse is performing a preoperative assessment for a patient scheduled for surgery. What does the nurse explain to the patient is the reason for obtaining accurate documentation of the current medications being taken?
“Some medications may alter the patient’s perceptions about surgery.”
“Some anesthetics alter renal and hepatic function, causing toxicity of other drugs.”
“Some medications may interact with anesthetics, altering the potency and effect of the drugs.”
“Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery.”
“Some medications may interact with anesthetics, altering the potency and effect of the drugs.”
Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that they have been communicated to the anesthesia care provider. Medications generally do not alter the patient’s perceptions about surgery. The anesthetics may interact with the other medications, but they are not likely to alter renal and hepatic function. Routine medications are not always held during surgery, and dosage and schedule adjustments are not always necessary. Routine medications may or may not be prescribed for use the day of surgery.
A patient is admitted to the hospital for elective surgery. The patient is taking nonsteroidal antiinflammatory drugs (NSAIDs) for knee pain. The nurse recognizes that NSAID use will have what effect on a postoperative patient?
It may increase the risk of infections.
It may cause atelectasis postoperatively.
It may increase risk of postoperative bleeding.
It may cause clotting of blood in the deep veins of legs.
It may increase risk of postoperative bleeding.
Although analgesics are required for surgical patients, the use of NSAIDS should be stopped before surgery because these drugs are associated with increased postoperative bleeding. NSAIDS do not increase the risk of infections. NSAIDS do not cause atelectasis postoperatively. NSAIDS do not increase blood clotting.
The nurse is caring for a patient with renal dysfunction who is scheduled for surgery. What are the priority nursing interventions in this situation? Select all that apply.
Order renal function test preoperatively.
Order coagulation studies preoperatively.
Check for the serum potassium levels preoperatively.
Report to perioperative team if the patient has a problem voiding.
Ready the sequential compression device in the preoperative holding area.
Order renal function test preoperatively.
Report to perioperative team if the patient has a problem voiding.
Many drugs are metabolized and excreted by the kidneys. A decrease in renal function can lead to altered drug response and unpredictable drug elimination. Hence, a renal function test is necessary before the surgery. If the patient has a problem voiding, the nurse should inform the perioperative team because the patient might exhibit improper voiding postoperatively. Coagulation studies of the patient should be on the chart before the patient is brought in for surgery in case of cardiovascular problems. Serum potassium levels of a patient are checked in case the patient is on diuretic medication to check the electrolyte imbalance. A sequential compression device is used preoperatively with patients who are predisposed to venous thromboembolism (VTE).
A patient is scheduled for a gastrectomy. During the preoperative evaluation, the patient reports taking ginseng regularly. What should the nurse do?
Inform the surgeon.
Advise the patient to decrease the dose of ginseng.
Advise the patient to take vitamin E in addition to the ginseng.
Advise the patient to replace the ginseng with another herbal drug.
Inform the surgeon.
The priority intervention is to inform the surgeon. The gastrectomy needs to be rescheduled. The next priority is to suggest that the patient discontinue the use of ginseng because ginseng increases blood pressure before and during surgery. Vitamin E should not be taken because it can increase bleeding. Decreasing the dose of ginseng will not remove the risk. Use of any herbal product should be discontinued 2 to 3 weeks before surgery because such medicines may increase the risk of postoperative bleeding.
A patient with an abdominal mass is scheduled for surgery today. Before the patient is admitted to the operating room, which preoperative documentation must be attached to the chart?
An electrocardiogram
A complete physical examination
Laboratory-test findings, including kidney- and liver-function parameters
All nursing subjective objective assessment plan (SOAP) notes for this admission
A complete physical examination
It is essential that a physical examination report be attached to the chart of a patient going into surgery. This document explains in detail the overall status of the patient for the surgeon and other members of the surgical team. Laboratory test findings, SOAP notes, and electrocardiograms also may be included in the chart; however, the physical examination must always be completed and in the chart before surgery.
During the preoperative assessment of a patient, the nurse finds that the patient is taking diuretics. What is the most important nursing intervention before surgery?
Administer antibiotic prophylaxis.
Have a serum potassium level drawn.
Apply a compression device to the legs.
Administer vasoactive drugs as advised.
Have a serum potassium level drawn.
People who take diuretics are at risk of developing low potassium levels due to fluid and sodium loss. Low potassium levels may be detrimental to cardiac health, and surgery may pose additional harm. Antibiotic prophylaxis is given if the patient has valvular heart disease. Compression devices can be applied to the legs if the patient has a risk of deep vein thrombosis. Vasoactive drugs are administered if the patient has hypertension.
A patient is a chronic smoker and is scheduled to have a benign tumor on the neck removed. To prevent perioperative complications, the nurse should instruct the patient to refrain from smoking for how many weeks before surgery?
The patient may smoke up until the day of surgery.
The patient should stop smoking 1 week before surgery.
The patient should stop smoking at least 6 weeks before surgery.
The patient should stop smoking at least 6 months before surgery.
The patient should stop smoking at least 6 weeks before surgery.
Smokers are at increased risk for respiratory complications during and after surgery. The health care professions should encourage smokers to quit smoking permanently or for at least 6 weeks before surgery to decrease the complications.
While performing preoperative teaching, the patient asks when to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, what is the best response by the nurse?
The patient needs to be NPO after midnight.
The patient must be nothing by mouth (NPO) after breakfast.
The patient can drink clear liquids up to 2 hours before surgery.
The patient can drink clear liquids up until the patient is moved to the operating room.
The patient can drink clear liquids up to 2 hours before surgery.
Practice guidelines for preoperative fasting state the minimum fasting period for clear liquids is 2 hours. Evidence-based practice no longer supports the long-standing practice of requiring patients to be NPO after midnight.
A patient due for surgery expresses concern about choosing between ambulatory surgery and inpatient regular surgery. Which information should the nurse include when comparing ambulatory to inpatient surgery for the patient? Select all that apply.
It involves minimal laboratory tests.
It requires fewer preoperative medications.
It reduces the risk of hospital-acquired infections.
It helps patients recover comfortably in the hospital.
It is more expensive for both patients and insurers.
It involves minimal laboratory tests.
It requires fewer preoperative medications.
It reduces the risk of hospital-acquired infections.
Ambulatory surgeries are often preferred over inpatient surgeries. These surgeries are usually minimally invasive, involve minimal laboratory tests, and require fewer preoperative medications. Because the patient recovers comfortably at home, there is no risk of hospital-acquired infections. These surgeries are less costly for both patients and insurers.
A woman is admitted to the hospital for an elective surgery. Her laboratory reports reveal that she is pregnant. An ultrasound of the abdomen shows that the fetus is 4 weeks old. What action should the nurse take immediately?
Inform the surgeon.
Inform the anesthetist.
Inform the patient’s husband.
Continue preparation for surgery.
Inform the surgeon.
Because anesthetics can put the mother and fetus at risk, exposure to anesthetics should be avoided. In this case, the priority is safety of the patient and fetus, so the nurse should immediately inform the surgeon. The surgeon will make the decision regarding the surgery. The husband and the anesthetist can be informed later. Congratulating the woman is important but is not the first priority.
