Deck 13: Hernia Repair

Question 1

Contributing factors to hernia formation include age,gender,previous surgery,obesity,nutritional status,and pulmonary and cardiac disease.The formation of the hernia at a site of weakness is due to any number of conditions that cause:

A) impaired healing and defective collagen formation.
B) thinning and stretching of muscle fibers.
C) increased pressure within the abdomen.
D) loss of tissue elasticity.

Answer 1

C
Any number of conditions causing increased pressure within the abdomen can contribute to the formation of a hernia.Contributing factors to hernia formation include age,gender,previous surgery,obesity,nutritional status,occupation,and pulmonary and cardiac disease.

Question 2

Select the triad of the boundaries of the Hesselbach triangle.

A) Inguinal ligament, rectus abdominis muscle, deep epigastric vessels
B) Rectus abdominis muscle, Cooper ligament, aponeurosis
C) Scarpa's fascia, deep epigastric vessels, external oblique muscle
D) Inguinal ligament, inguinal canal, Cooper ligament

Answer 2

A
The deep epigastric vessels (inferior epigastric)arise from the external iliac vessels and enter the inguinal canal just proximal to the internal ring.The triangle formed by the deep epigastric vessels laterally,the inguinal ligament inferiorly,and the rectus abdominis muscles medially is referred to as the Hesselbach triangle.

Question 3

Hernia-entrapped viscera,typically loops of small intestine,will result in intestinal obstruction with resulting pain,vomiting,and distention.What is the appropriate descriptive diagnosis of this condition?

A) Nonreducible hernia
B) Incarcerated hernia
C) Torsion of the hernia sac
D) Gangrenous bowel

Answer 3

B
Patients with incarcerated hernias may have signs of intestinal obstruction,such as vomiting,abdominal pain,and distention.The greatest danger of an incarcerated hernia is that it may become strangulated.In a strangulated hernia,the blood supply of the trapped sac contents becomes compromised and eventually the sac contents necrose.

Question 4

Depending on their location,hernias are classified as direct inguinal,indirect inguinal,femoral,umbilical,incisional,or epigastric.Hernias in any of these groups are either reducible or nonreducible.The characteristic "reducible" hernia can best be described as a hernia:

A) that does not require surgical repair.
B) that is an urgent diagnosis.
C) with visceral contents that can be returned to the abdomen.
D) with a narrow sac neck that is closed with adhesions.

Question 5

Femoral hernias occur more frequently in which group of individuals?

A) Postoperative obese patients
B) Newborns
C) Weight lifters
D) Women

Question 6

Select the most common hernia that occurs in both men and women.

A) Direct femoral hernia
B) Indirect inguinal hernia
C) Indirect femoral hernia
D) Direct inguinal hernia

Question 7

A 37-year-old physically active male arrived at the preoperative receiving and waiting lounge of the ambulatory surgery center for an elective herniorrhaphy.His perioperative nurse introduced herself and began his preoperative nursing assessment.The patient wanted to know when he would be able to get back to work and resume his place as pitcher on his softball team.He also told the nurse that he planned to do some yard work today as soon as the anesthesia "wears off." Which one of the following nursing diagnoses is given priority in both preoperative and postoperative education?

A) Risk for urinary retention related to anesthesia
B) Activity intolerance related to pain and early postoperative ambulation
C) Risk for ineffective tissue perfusion related to scrotal swelling
D) Knowledge deficit related to disease process and convalescence

Question 8

The anterolateral abdominal wall consists of an arrangement of muscles,fascial layers,and muscular aponeuroses lined interiorly by peritoneum and exteriorly by skin.The key landmark of the _____________ designates the roof of the inguinal canal,and the key landmark of the __________ designates the floor of the inguinal canal.

A) external oblique aponeurosis; transversalis aponeurosis and fascia
B) lateral rectus abdominis; transversalis aponeurosis and fascia
C) external oblique aponeurosis; Cooper ligament aponeurosis
D) transversalis fascia; Poupart ligament

Question 9

Bupivacaine and ropivacaine are look-alike/sound-alike drugs.Adverse drug reactions (ADRs)can occur if a clinician confuses these two drugs.Both drugs promote nerve conduction blockage analgesia when given locally,but bupivacaine is cardiotoxic.When selecting a local anesthetic to fill an elastomeric pain pump,what is one contraindication that should be considered?

A) If the patient is hypersensitive to amide local anesthetics
B) If the patient has cardiovascular disease
C) If the patient is confused or unconscious
D) If the patient had a local injection of lidocaine during the procedure

Question 10

An 86-year-old retired plumber states that he has suffered from a groin hernia all of his adult life; he states,"as far back as I can remember." Sometimes he has to push the bulge back into his abdominal wall and then he is fine until he has a coughing spell.This morning the bulge was large and tender when he woke up,and he could not reduce it.As the pain increased,he felt weak and nauseated.His daughter took him to the emergency department (ED).The patient was diagnosed with a strangulated incarcerated hernia and scheduled for emergency surgery.If the contents of the patient's hernia sac become compromised,with strangulation of the bowel,the probable label on his surgical specimen will be:

A) compromised bowel.
B) strangulated bowel.
C) necrotic bowel.
D) intestinal obstruction.

Question 11

Ryan has an indirect hernia that is characterized by a small neck,thin walls,and close attachment to the cord structures.Marc has a hernia with a short,wide neck,and a thick-walled sac.Based on this description,Ryan has a(n)____________ hernia and Marc has a(n)__________ hernia.

A) acquired; congenital
B) reducible; nonreducible
C) congenital; acquired
D) pantaloon; sacular

Question 12

Which hernia type occurs within the Hesselbach triangle?

A) Direct inguinal hernia
B) Indirect inguinal hernia
C) Ventral hernia
D) Umbilical hernia

Question 13

What is the anatomical component of the lining of the herniated abdominal weakness and the hernia sac?

A) Fascia
B) Peritoneum
C) Muscularis
D) Rectus abdominis muscle

Question 14

Implantable mesh prosthetics can be made of synthetic,biosynthetic,or biological material.What is the primary advantage of biologic mesh?

A) Results in reduced absorption.
B) May be used in all wound classes.
C) Results in reduced cost.
D) Forms a dense fibrous capsule.

Question 15

A 49-year-old male had a laparoscopic hernia repair with good results and an uneventful recovery.Weeks later,as he reviewed his hospital bill,he noted that he had been charged for a preperitoneal distention balloon,polypropylene mesh,an endomechanical stapler,fibrin glue,and three endosurgical trocars.Which hernia repair technique was most likely performed on the patient?

A) TAPP repair
B) Shouldice repair
C) TEP repair
D) Mesh-plug insertion repair

Question 16

Identify the triad of anatomic sites of abdominal wall weakness with a potential for hernias.

A) Groin, ventral line, umbilicus
B) Inguinal rings, femoral canal, incision
C) Inguinal canal, femoral rings, umbilicus
D) Ventral line, aponeurosis, inguinal canal

Question 17

The mesh-plug open hernia repair technique is indicated for which type(s)of hernias?

A) Umbilical hernias
B) Indirect gastroesophageal hernias
C) Direct and indirect inguinal hernias
D) Strangulated scrotal hernias

Question 18

Laparoscopic inguinal hernia repair is another method of tension-free mesh repair,with several repair options.The most popular techniques include a totally extraperitoneal (TEP)and transabdominal preperitoneal (TAPP)approach.Which of the two techniques provides access to the preperitoneal space without entering the peritoneum?

A) The TEP technique
B) The TAPP technique
C) Both the TEP technique and the TAPP technique if the hernias are recurrent
D) Neither the TEP technique nor the TAPP technique; preperitoneal access is only possible with an open surgical approach

Question 19

A 37-year-old physically active male is getting dressed to return home from the emergency department (ED)after he experienced a large,tender bulge in his scrotum while straining at the toilet.The ED physician reduced the patient's indirect inguinal hernia and referred him to a general surgery practice for elective herniorrhaphy.The ED nurse prepared the patient for his discharge.An appropriate nursing intervention by the ED nurse would be to:

A) explain the signs and symptoms of an incarcerated hernia and appropriate action.
B) demonstrate how to reduce the hernia until he can see the surgeon.
C) provide contact information for the surgeon referral recommended by the ED physician.
D) measure him for a hernia belt to wear until his surgery is scheduled.

Question 20

A 4-year-old preschooler is scheduled for bilateral inguinal hernia repair.He is in the preoperative waiting lounge with his mother while his father looks for a parking space.The mother does not speak English,and she seems confused and intimidated as the perioperative nurse approaches.The surgeon has just marked both inguinal sites with his initials.The mother appears to indicate that the surgery will take place only on the right side; however,the consent states bilateral and is signed by the father.The perioperative nurse's first appropriate response should be to:

A) attempt to explain the notation on the consent with hand signals and her best Spanish until the father returns.
B) sit down next to the mother and convey calming behaviors until the father returns.
C) stay with the mother and patient while someone calls back the surgeon and a medical interpreter.
D) page the father to return and interpret for her.

Question 21

Which hernia repair approach(es)use(s)implantable mesh prosthetic?

A) The Shouldice repair
B) The Bassini repair
C) The Lichtenstein repair
D) The bilayer repair
E) The Descarda repair

Question 22

Regardless of the hernia type,the mesh-plug technique is performed on an ambulatory basis,through a small incision,often laparoscopically.Which advantage of the mesh-plug technique increases patient comfort,speeds rehabilitation,and contributes to a low recurrence rate?

A) Involves minimal blood loss.
B) Has a decreased chance of nerve injury.
C) Ensures a high-tension hernioplasty.
D) Is performed under local anesthesia.

Question 23

An example of a common postoperative complication related to inguinal hernia surgery is:

A) delayed return to activity.
B) inguinal nerve entrapment.
C) femoral canal adhesions.
D) hernia recurrence.

Question 24

A 37-year-old active male is in the postanesthesia care unit (PACU)recovering from a hernia repair and preparing for discharge.The perianesthesia nurse,after reading the nursing assessment from the preoperative documentation,prepares to complete the patient's discharge education.The best practice in ensuring that the patient understands the information would be to:

A) reinforce the discharge education by giving him written instructions.
B) place a copy of the instructions that he has signed into the patient chart.
C) include his wife in the teaching session.
D) provide an opportunity for him to "teach-back" his discharge instructions.