Test 1 Chapters 4, 5, 7

Question 1

Why would a patient take Epogen prior to surgery?

Answer 1

Epogen may be given before surg to stimulate red blood cell production; Pt will prob not need a blood transfusion

Question 2

What do you want to ensure happens prior to giving preoperative medications?

Answer 2

ensure the correct surgical procedure is identified on the consent form, the pt is mentally competent, the pt understands the procedure and risks and that it is signed before any pre-op meds are administered

Question 3

What are meridians when talking about acupressure or acupuncture

Answer 3

meridians are similar to that of nerve pathways; acupuncture originates from China and involves the use of tiny needles inserted into the skin at specific points called meridians

Question 4

Nursing interventions that help prevent atelectasis after surgery

Answer 4

Incentive spirometer, ‘huff’ cough, deep breathing, early ambulation, teach to cough properly

Question 5

Cultural considerations when patient have pain

Answer 5

-Stoic/denies pain: may not admit to having pain and may continue with regular activities
-May have many reasons for not admitting to pain: lack of understanding of pain control methods, fear of addiction, family expectations

Question 6

Adverse reaction that can occur when an Asian person is given Atropine

Answer 6

Asian + Atropine = tachycardia

Question 7

Frequency of nursing assessments while in the PACU

Answer 7

Assessments are performed at least every 15 mins or according to the pts status
temp initially then every 8 hours
Check every 15min x 1hr, every 30 mins x 4 hrs, every 1 hr x 4 hrs, every 4 hrs x 24-48hrs; or per agency protocol
continually assess pain

Question 8

Nursing interventions to do if a transdermal patch falls off too early

Answer 8

Thoroughly search pt and pts bed for patch (if found discard) and put another patch on and document the previous patch fell off

Question 9

Know what the Aldrete score is and what it tells us about the patient’s condition

Answer 9

is used to determine readiness for transfer; activity, respiration, circulation, consciousness, skin color, and oxygen saturation; the score needs to be 9 or 10 to transfer to nursing unit

Question 10

How do we advance a patient’s diet after surgery?

Answer 10

at least once per shift listen for bowel sounds in all four quadrants; once they are heard and pt is tolerating ice chips and clear liquids, a regular diet may be tolerated

Question 11

What do we teach family members about the use of massage in pain relief?

Answer 11

When a painful area has inflammation or consists of a wound or an incision, massaging another area of the body w/ gentle but firm pressure helps the pt direct attention away from the pain.

Question 12

How to know if your patient is emotionally prepared for surgery – what statement by the patient causes concern

Answer 12

Psychological assessment
Risk factors excessive fear
If a patient tells you the surgery is not wanted, delay preoperative preparations and explore the issue with the patient.

Question 13

Why is it important to obtain height and weight prior to surgery?

Answer 13

Height and weight measured and charted so anesthesiologist can accurately calculate anesthetic dosages

Question 14

Know the nociceptive pain sequence in order and what happens in each stage

Answer 14

Transduction
Transmission
Perception
Modulation

Question 15

Post-operative complications that can happen with a 90-year-old patient

Answer 15

The Risk of hypoventilation is greater in older adults because lung expansion may be hampered by cartilage and weakened respiratory muscles.

Question 16

Know the responsibilities of the circulating nurse prior to surgery and during surgery

Answer 16

-Prior to surgery: collects consent form, ensuring the surgical site has been marked

-During surgery: Opens sterile supplies for the scrub nurse, inserts foley catheter, updates families during long procedures

Question 17

How does the nurse use distraction in a patient with poor pain control?

Answer 17

Includes watching television, talking with friends, using an electronic device, or playing a game.

Question 18

Nursing actions when patient wake up from surgery confused

Answer 18

You need to reorient and reassure the patient that the surgery is over, that they are in the recovery room, and that their family member or contact person has been notified.

Question 19

Abnormal findings to report to the surgeon if they occur prior to surgery

Answer 19

Any deviations from normal range should be brought to the attention of the surgeon.

Question 20

Nursing interventions to offer a patient using the gate theory of pain management

Answer 20

Massage and vibration produce activity in the large-diameter nerve fibers

Distraction in the form of activity or social interaction produces these brainstem impulses.

Question 21

Discharge criteria for a patient being discharged home after same-day surgery

Answer 21

Normally takes 1 to 3 hours
Stable vitals
Able to sit up and ambulate unassisted
Take fluids without nausea
Empty the bladder

Question 22

If your patient refuses to take off her jewelry prior to surgery, what do you do to protect it

Answer 22

Tape it. If it is a stone, use a cotton ball with tape.

Question 23

What to teach your patient to do if they are having too much pain to cough after surgery

Answer 23

If the patient cannot cough effectively, instruct the patient to “huff” cough. If the patient is too weak to remove secretions, tracheal suctioning is indicated.

Question 24

What are the purposes of preoperative medications

Answer 24

Reduce anxiety and promote a restful state
Decrease secretion of mucus and other body fluids
Counteract nausea and reduce emesis
Enhance the effects of the anesthetic

Question 25

What do we teach patients about robotic surgery?

Answer 25

-Robot’s tiny camera has multiple lenses allowing magnification up to 12x that of normal vision
-Surgeon performs w/ assistance from second surgeon and assistants
-Remote-controlled instruments inserted through small incisions
-Advantage is ‘rock-steady’ than, with precision beyond human dexterity
-Pt has less postop pain and healing time with the smaller incisions

Question 26

How are pain threshold and pain tolerance different?

Answer 26

Pain threshold is the paint at which pain is perceived.

Pain tolerance is the length of time or the intensity of pain a person will endure before outwardly responding to it.

Question 27

Post-operative complications to report to the MD

Answer 27

-Atelectasis: Decreased breath sounds over area not aerating; dyspnea

-Wound dehiscence: Discharge of serosanguineous drainage from wound and sensation that “something gave”; Separation of wound edges

Question 28

Nursing interventions to perform if a patient is having increased pain after surgery and it is too early to give them additional pain meds

Answer 28

-Sleep, Heat, Cold, Distraction, Relaxation, Guided Imagery, Meditation, Hypnosis, Biofeedback, Music, Binders, Massage, Acupuncture and acupressure, Electrostimulation Devices, Spinal cord stimulator

Question 29

Know the postsurgical complications that can occur after a three-hour surgery and who is most likely to have complications

Answer 29

Pressure ulcer and joint pain

Question 30

What is the gate theory of pain control?

Answer 30

-The gate control theory recognizes that stimuli other than pain pass through the same gate. When a large volume of non-painful stimuli are competing for the gate, pain impulses may be blocked. A high volume of pain, however, may override other stimuli and pass through the gate, causing the individual to perceive the pain.

Question 31

Who is at risk for developing post-operative thrombophlebitis?

Answer 31

Pt who has had a past blood clot or CVA

Question 32

What is the temperature range in the operating room?

Answer 32

66 - 70 degrees to discourage microbial growth and keep the surgical team comfy under the bright lights and layers of surgical clothing

Question 33

What do we teach our patients after surgery regarding fear of addiction?

Answer 33

-False Perception: addiction to pain-relieving drugs is always a hazard, and for the sake of the pt, the nurse must withhold a drug even if pt is requesting it

-Fact: Approx 1% (no more than 3%) pt’s become addicted to drugs administered for the purpose of relieving acute pain. Addiction is an increasing problem in America, but acute pain managed properly is not the reason for the national opioid addiction increase. Pt’s need adequate pain relief

Question 34

Nursing interventions for patient who are experiencing increased gas after surgery

Answer 34

Taking only small amounts of liquid or food at a time, drinking only tepid liquids, refrain from drinking with a straw, and ambulating

Question 35

What position do we usually place patients in if possible in the PACU?

Answer 35

On their side

Question 36

What do you do when a patient taking pain medications breaks out in hives

Answer 36

-Report immediately
-Discontinue med’s and obtain alternative order
-May need an antihistamine

Question 37

Know the differences between the types of anesthesia that were discussed in Chapter 4

Answer 37

-4 types: General, Regional, Procedural/Conscious sedation (or Procedural Sedation and Analgesia PSA), and other
-Gen: Inhalation, IV
-Reg: Spinal, Epidural, Nerve block, Local
-Proc: USE- Surgery of short duration for which unconsciousness is undesirable; May be used in combination with local, spinal, or nerve blocks to enhance pt comfort. ADVANTAGE- Reversal is rapid; pt is unaware but can breathe without assistance; Little if any n/v; Amnesia of surgery

Question 38

Dangers of smoking postoperatively

Answer 38

Smoking decreases the amount of hemoglobin available to carry oxygen to the healing tissues and prolongs healing time

Question 39

Physiologic changes in the older adult that make them higher risk for surgery

Answer 39

-Pt’s older than 75 have 3x the surgical complication rate than those of younger adults
-Older adults are less able to adjust and compensate for the stress of surgery due to declining physiologic factors (cardiac, respiratory, renal)
-More likely to have impaired renal, hepatic, respiratory, and cardiac function that alter metabolism and excretion of drugs and anesthesia
-Presence of chronic diseases causes vulnerability to fluid and electrolyte imbalances during and after surgery

Question 40

What do you do if a patient tells you they don’t understand about their surgery after their consent is signed?

Answer 40

Notify the surgeon

Question 41

Teaching is completed on a patient having a needle biopsy – what should be included in this teaching?

Answer 41

-Diagnostic test
-Breast pain is still possible after surgery
-Usually not urgent
-Usually done with a local anest.
-May need further treatment

Question 42

Performed to determine the origin and cause of a disorder or the cell type for cancer; Breast biopsy, exploratory laparotomy, arthroscopy

Answer 42

diagnostic

Question 43

Why is it important to know if a pt is taking a corticosteroid

Answer 43

Can delay wound healing, alter fluid and electrolyte balance, and affect several metabolic functions (which would increase surgical risk)

Question 44

Which pain process begins when tissue damage causes the release of substances that stimulate the nociceptors and initiate the sensation of pain

Answer 44

transduction

Question 45

Which pain process involves the movement of the pain sensation to the spinal cord

Answer 45

transmission

Question 46

Which pain process occurs when impulses reach the brain and the pain is recognized

Answer 46

perception

Question 47

Which pain process occurs when neurons in the brain send signals back down the spinal cord by the release of neurotransmitter

Answer 47

modulation