Deck 10: Gastrointestinal Surgery

Question 1

During a laparoscopic colectomy,the scrub person carefully placed the endoscopic electrosurgery instruments on the Mayo stand after inspecting the integrity of the insulation along the shaft.This practice is designed to meet the expectation for the following nursing outcome:The patient will be free from:

A) fluid and electrolyte imbalance.
B) thermal burns and adhesions.
C) impaired tissue integrity.
D) thermal burns and adhesions,and impaired tissue integrity.

Answer 1

C
The patient is at risk for impaired tissue integrity from thermal burns that may be caused by defects in the surface of the insulation coating on laparoscopic electrosurgery instruments."The patient will be free of evidence of impaired tissue integrity" is an approved nursing outcome.

Question 2

Single-incision laparoscopic surgery (SILS)and natural orifice endoscopic transluminal surgery (NOTES)are minimal access surgery (MIS)approaches and share many indications,implications,and instrument platforms.The benefits and drawbacks essentially parallel each other;however,there are several unique differences that set each apart and define their application.What is the one question that needs to be answered to determine if SILS should be considered in lieu of NOTES?

A) What is laparoscopic endoscopic single-port surgery (LESS)?
B) Will cost of instrumentation be the demise of MIS?
C) Is the umbilicus a natural orifice?
D) Is the risk of infection too great to use the rectum as a portal for surgery?

Answer 2

C
NOTES introduces flexible endoscopes and laparoscopic hybrid high-dexterity instruments through natural orifices (e.g.,mouth,anus,vagina)to access the intra-abdominal compartment,whereas SILS enters through a puncture within the folds of the umbilicus.Neither procedure creates or leaves noticeable scars.The umbilicus was an open portal before birth.

Question 3

Exposure of intra-abdominal anatomy is crucial to safe surgery and employs varied instruments,applications of highly technical energy sources,patient manipulations,light,and imaging.What is unique to the laparoscopic approach that promotes exposure?

A) Self-retaining retractors
B) Automatic rod-lens fiberscope
C) Carbon dioxide pneumoperitoneum
D) Endoscopic fan blades

Answer 3

C
Abdominal insufflation with carbon dioxide expands the abdominal compartment,permitting better visualization and room to manipulate instruments.

Question 4

Which statement about the McBurney incision is most correct?

A) It is an oblique inguinal incision in the left lower quadrant.
B) It is the incision of choice to repair a direct inguinal hernia.
C) It is an oblique inguinal incision in the right lower quadrant.
D) The direction is more transverse than oblique.

Question 5

Select the diagnosis/procedure option that pairs the correct surgical diagnosis with the surgical/endoscopic procedure for diseases of the esophagus:

A) Barrett's dysplasia of the distal esophagus/endoscopic mucosal resection (EMR)
B) Gastroesophageal reflux disease (GERD)/photodynamic therapy (PDT)
C) Zenker's diverticulum/Ivor Lewis esophagectomy
D) Esophageal varices/Heller myotomy

Question 6

Edward Lewis is scheduled for a transthoracic esophagectomy with lymph node dissection for cancer of the esophagus.Which incisional approach is indicated for this procedure?

A) Left thoracoabdominal incision
B) Right posterior lateral thoracotomy and midline abdominal incision
C) Three-incision (three-hole) approach with cervical,right thoracotomy,and midline laparotomy incisions
D) Any of the three above incisions may be used per surgeon preference or tumor location.

Question 7

As the surgeon prepared to clamp and transect the bowel during a small bowel resection for tumor,the scrub person transferred instruments from the Mayo stand to the back table and prepared the sterile field for bowel isolation technique.The rationale for this application involves which nursing diagnosis and matched stage of the nursing process?

A) Risk for Infection/implementation
B) Risk for Metastasis/implementation
C) Risk for Tissue injury/planning
D) Risk for Infection/planning

Question 8

Select the option that pairs the correct surgical diagnosis with the surgical/endoscopic procedure for diseases of the abdomen.

A) Peritoneal cancer/hyperthermic intraperitoneal chemotherapy
B) Ascites/hyperthermic intraperitoneal antibiotic therapy
C) Adhesions/lysis of adhesions
D) Peritoneal cancer/hyperthermic intraperitoneal chemotherapy and adhesions/lysis of adhesions

Question 9

Select the statement that best reflects the functional components of the gastrointestinal (GI)tract.

A) The GI tract is a continuous pathway from mouth to rectum.
B) Peristaltic waveforms produce agitation,which digests large food particles.
C) The alimentary canal extends from the mouth to the anus.
D) The microscopic ecosystem of the GI tract is an unbalanced colony of germs.

Question 10

Two patients are scheduled to have a gastrojejunostomy for obstruction.How will perioperative planning differ for a patient weighing 280 lb as compared to that for a 150-lb patient?

A) The ligament of Treitz will not need to be identified in a lighter person.
B) Forced air-warming devices are more important for a lighter patient.
C) The anastomosis will require sutures rather than staples for the heavier patient.
D) Deaver retractors will replace Richardson retractors with the heavier patient.

Question 11

Carly Shelmire is a 5-year-old girl with a history of weight loss and stomach upset and pain after eating;she is also small for her age.Her pediatrician suspects celiac disease.Carly has arrived at the pediatric endoscopy unit for a procedure that is less invasive and will also have the benefit of spending the next few hours in the mall across from the hospital with her mom until the procedure is over.What is Carly's scheduled procedure?

A) GI manometry
B) Small bowel enteroscopy
C) Capsule endoscopy
D) Stretta procedure

Question 12

Select the statement that most correctly matches a risk factor for adhesions with an appropriate preventive strategy.

A) Multiple surgeries may be managed with the use of sequential compression devices.
B) Glove powder adhesions can be prevented with cellulose mist.
C) Patients with endometriosis may be best served with a laparoscopic approach.
D) Fibrous bands within the peritoneum can be treated with sterile talcum powder.

Question 13

Goodloe Frazier is scheduled for a total colectomy with ileostomy in the morning.The wound ostomy care nurse (WOCN)has consulted Goodloe to initiate his ostomy teaching,answer his questions,and mark the site on his abdomen that would be ideal placement for the ileostomy.An appropriate nursing diagnosis for Goodloe at this time would be:

A) Risk for Impaired Tissue Integrity.
B) Deficient Knowledge related to impending surgery.
C) Disturbed Body Image related to intestinal diversion.
D) All of the options are correct.

Question 14

A patient whose neck has been slashed and has a severed lower trachea may also have injury to the:

A) aorta.
B) esophagus.
C) duodenum.
D) bronchial merge.

Question 15

Review the list below and select the answer that reflects the correct match between the procedure and the disease.

A) Duodenoscopy for gastric reflux disease and hiatal hernia
B) Bariatric surgery for Roux-en-Y for gastritis
C) Esophagogastroduodenoscopy (EGD) for gastric ulcer disease
D) Small bowel enteroscopy for ulcerative colitis

Question 16

Sharon Close has been diagnosed with severe gastroesophageal reflux disease (GERD)without the dysplastic changes of Barrett's esophagus.Her GERD is unresponsive to proton pump inhibitors and histamine blockers.She also has a history of endometriosis with multiple surgeries for ablation of endometrial implants on her small bowel and adhesiolysis.Her surgeon is hesitant to pursue an open or a laparoscopic Nissen surgical approach.What procedure might her surgeon consider in lieu of a Nissen?

A) Thoracoabdominal partial esophagectomy
B) Endoscopic mucosal resection
C) Endoluminal plication of the lower esophageal segment
D) Heller's myotomy

Question 17

An abdominal perineal resection,or APR,for a patient at high risk for colon cancer without anal/rectal involvement (e.g.,familial adenopolyposis [FAP])can be accomplished through an open laparotomy or laparoscopic-assisted ileoanal pull-through approach,per surgeon preference and appropriate patient selection.Which of these statements about approaches for APR is correct?

A) Both open and laparoscopic approaches require an abdominal skin incision(s) and perineal incision(s).
B) Neither approach requires two or more skin incisions.
C) Both procedures require only an abdominal skin incision(s) as the rectal segment is removed and anastomosed intraluminally.
D) The laparoscopic-assisted approach only has an abdominal skin incision(s).

Question 18

Triangulation is a term used to describe the method used to provide instrument access to the anatomy during abdominal surgery.It is uniquely associated with which surgical incision?

A) Mid-epigastric transverse incision
B) Left paramedian incision
C) Thoracoabdominal incision
D) Laparoscopic port incisions

Question 19

When setting up for a gastrectomy,the scrub person will ensure that appropriate instruments are available to clamp and ligate the:

A) branches of the peritoneal artery.
B) splenic vessels.
C) popliteal artery.
D) Treitz arterial stump.

Question 20

The general risks associated with gastrointestinal surgery parallel those risks associated with most abdominal procedures.Select a complication that is the most typical risk associated with surgery of the large bowel.

A) Colitis
B) Peritonitis
C) Paralytic ileostomy
D) Intestinal obstruction

Question 21

Ann Contreras has consulted a noted colorectal surgeon after experiencing episodes of rectal bleeding over the last 2 weeks.She had a screening colonoscopy 5 years ago with several adenomatous polyps and mild diverticular disease.She presents to the endoscopy suite after a successful bowel prep and NPO since midnight.The GI endoscopist is confident that she will find tumor growth in the rectum and decides to employ further diagnostic applications to determine potential for metastasis.Which of the following endoscopic procedures best describes Ann's procedure?

A) Endoscopic retrograde cholangiopancreatoscopy (ERCP)
B) Rectal manometry with dilatation
C) Flexible sigmoidoscopy
D) Colonoscopy with endoscopic ultrasound (EUS)

Question 22

Michael Mason has suffered from subsacral pain and swelling for 2 weeks and finally was referred to a colorectal surgeon for care.He is currently in the ambulatory surgical center OR bed positioned in the jackknife position.The perioperative nurse has gently but firmly taped his buttocks laterally to the rails of the OR bed to promote exposure to the surgical site.What procedure is Michael prepared to undergo,based on his symptoms and the surgical preparation?

A) Internal hemorrhoidectomy
B) External hemorrhoidectomy
C) Removal of rectal foreign body
D) Pilonidal cystectomy

Question 23

Jeannie Donahue is admitted for the fourth time for treatment and management of her pseudomyxoma peritonei,or peritoneal cancer.She is scheduled for open laparotomy for inspection with lymph node surveillance and frozen sections and peritoneal washings for cytologic examination.Her surgical oncologist has recommended a treatment that may slow the growth of the tumor seedings and prolong her life:intraoperative intraperitoneal hyperthermic chemotherapy.Jeannie's perioperative nurse prepares the OR and instructs the new scrub person on chemotherapy safety precautions.For this procedure,it is imperative that the staff:

A) know how to use the chemo spill kit and where it is stored.
B) have the chemotherapeutic solution in the room before the patient arrives.
C) be able to calculate the formula for body weight in kilograms per meters squared in order to comply with the 7 rights of medication administration.
D) wear full personal protective equipment beyond the sterile scrub attire.

Question 24

Sandra Roberts has arrived for her outpatient screening colonoscopy.She has all of her required paperwork and admits to a successful bowel prep.She is assessed by the perioperative nurse to be in good health and is listed as ASA class I.Sandra has no allergies and her vital signs are within normal range.She changes into the patient gown and awaits transfer to the procedure room when she is informed that she will not be transferred to the procedure room until __ and must wait for :

A) she is typed and screened;type and crossmatch
B) her ride home arrives;a responsible adult
C) she is NPO for 2 more hours;a bowel prep
D) her consent is signed;medical translation

Question 25

Specific positioning considerations for bariatric patients require particular attention to protecting these patients from inherent risks related to their size and weight.Of considerable concern is the risk of injury to staff.Protective measures to protect both patient and staff include those below.Which measure reflects the most safety protection for both patient and staff?

A) Review back safety precautions and awareness during preincision briefing.
B) Ensure that the OR bed can accommodate the patient's weight and girth.
C) Employ at least three safety straps over the patient's largest girth.
D) Overlap the viscoelastic gel mattress top with three lifting sheets.

Question 26

Ramona Guerne has been admitted through the emergency department for severe abdominal pain,distended abdomen,and fever.The surgery service has been consulted and has scheduled her for exploratory surgery.Ramona has undergone two abdominal surgeries in the past for "female problems" and states that she has a tendency to form keloids.A small bowel obstruction is suspected.Postoperative ileus is a common complication of open abdominal surgery.Select the procedure that is least likely to promote postoperative ileus formation in this patient.

A) Long (4-hour) laparoscopic procedure,with incidental peritonitis
B) Open small bowel resection with postoperative signs of pancreatitis
C) Laparoscopic lysis of adhesions with release of bowel torsion
D) Laparoscopic-assisted hemicolectomy with mild peritoneal inflammation