Deck 12: Repair of Hernias

Question 1

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 emergent diagnosis.
C) with visceral contents that can be returned to the abdomen.
D) with a narrow sac neck that is closed with adhesions.

Answer 1

C
A reducible hernia is an abdominal hernia whose contents of the hernia sac can be returned to the normal intra-abdominal position and are not trapped in the extra-abdominal sac (incarcerated).The conditions preventing the return of the hernia contents to the abdomen (nonreducible)can result from (1)adhesions between the contents of the sac and the inner lining of the sac(2)adhesions among the contents of the sac,or (3)narrowing of the neck of the sac.

Question 2

What composes the lining of a herniated abdominal sac?

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

Answer 2

B
A hernia is a sac lined by peritoneum that protrudes through a defect in the layers of the abdominal wall.Hernias can occur in several places in the abdominal wall,with protrusion of a portion of the parietal peritoneum and often a part of the intestine.Generally,the hernia mass is composed of covering tissues,a peritoneal sac,and any contained viscera.

Question 3

Femoral hernias occur more frequently in which group of individuals?

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

Answer 3

D
Femoral hernias occur much more frequently in females,and only 2% of females will develop inguinal hernias in their lifetime.

Question 4

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

Question 5

Charles Wilkins 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 very expensive preperitoneal distention balloon,polypropylene mesh,an endomechanical stapler,and three endosurgical trocars.What hernia repair technique was probably performed on Charles?

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

Question 6

Aubrey Scheel,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 emergency physician reduced Aubrey's indirect inguinal hernia and referred him to a general surgery practice for elective herniorrhaphy.The ED nurse prepared Aubrey 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) advise him on the best surgeon for this hernia and give contact information.
D) include all of the information listed above in his discharge instructions.

Question 7

While direct and indirect hernias both protrude into the inguinal canal and represent tears in the transversalis fascia,which one of the two occurs within the Hesselbach triangle?

A) Direct inguinal hernia
B) Indirect inguinal hernia
C) Both options occur within the triangle
D) Neither option occurs within Hesselbach's triangle

Question 8

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

Question 9

Aubrey Scheel arrived to the preoperative receiving and waiting lounge of the ambulatory surgery center for an elective hernia repair.His perioperative nurse introduced herself and began Aubrey's preoperative nursing assessment.It was a beautiful and warm spring day and Aubrey shared his concern about how he would feel after the procedure.He 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) Deficient Knowledge related to disease process and convalescence

Question 10

Aubrey Scheel,a 37-year-old active male,is in the 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 Aubrey's discharge education.Based on the perioperative nurse's nursing diagnosis of "Deficient Knowledge related to disease process and convalescence," an appropriate risk reduction strategy that is a best practice in ensuring that the patient understands the information would be to:

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

Question 11

Morris Bettelman,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 muscle 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 nauseous.His daughter took him to the emergency department.Morris was diagnosed with a strangulated incarcerated hernia and scheduled for emergency surgery.If the contents of Morris' 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 12

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

A) Femoral hernias
B) Indirect inguinal hernias
C) Direct inguinal hernias
D) All of the options are correct

Question 13

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;Poupart ligament
D) transversalis aponeurosis and fascia;Cooper ligament aponeurosis

Question 14

The transabdominal preperitoneal patch (TAPP)hernia repair and the totally extraperitoneal patch (TEP)repair differ in the manner in which access is gained to the preperitoneal space.Which of the two provides access to the preperitoneal space without entering the peritoneum?

A) The TEP technique
B) The TAPP technique
C) Both techniques require access into the peritoneal compartment
D) Neither technique enters the peritoneal compartment

Question 15

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 16

Select the most common hernia that occurs in both males and females and name the side on which it would most likely occur.

A) Direct femoral hernia on the left
B) Indirect inguinal hernia on the right
C) Indirect femoral hernia on the left
D) Direct inguinal hernia on the right

Question 17

Which two similar hernia repair approaches reestablish the integrity of the transversalis fascia and simultaneously reestablish and strengthen the posterior inguinal floor by sewing the transversalis fascia to the Poupart ligament?

A) The Shouldice and the McVay ligament repair
B) The Bassini and the Shouldice repair
C) The McVay and the Cooper ligament repair
D) The Shouldice and the Cooper ligament repair

Question 18

Of the open hernia procedures listed below,which classic hernia procedure is considered,by some surgeons,to not be anatomically correct because the superior transversalis fascia is sutured to the inguinal ligament instead of to the inferior portion of the transversalis fascia or the Cooper ligament?

A) Shouldice repair
B) Bassini repair
C) McVay repair
D) Cooper repair

Question 19

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.

Question 20

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 21

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

A) delayed return to activity.
B) delayed healing.
C) postoperative adhesions.
D) hernia recurrence.

Question 22

A study was conducted that compared laparoscopic and open-mesh methods of inguinal hernia repair and also compared TEP and TAPP techniques for cost and patient outcome effectiveness.Some of the factors measured included patient's return to prior activities,persisting pain and numbness,infection,length of operation time,and complications.The researchers discovered several compelling findings and many differences between the two approaches.Select two statements that reflect true findings from the study.

A) TEP and TAPP techniques were of similar cost to the patient.
B) Mesh infection rate was low with both techniques.
C) There was no significant difference in complication rates.
D) There was no apparent difference in the rate of hernia recurrence.
E) Return to work and activity was similar for the two techniques.
F)TEPP and open-mesh techniques shared equal costs to the patient.

Question 23

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 24

A group of United Kingdom (UK)researchers undertook an analysis of several research studies comparing the outcomes of laparoscopic versus open incisional hernia repair of patients who had prior laparotomies.They examined surgical time,duration of hospital stay,perioperative complications,postoperative surgical site pain,and recurrence rates in 183 patients whose incisional hernias were repaired by the open approach and 183 repaired by the laparoscopic approach.Based on the results of this study,an appropriate risk reduction strategy for patients with incisional hernias would be to repair incisional hernias:

A) laparoscopically.
B) through an open approach.
C) using either open or laparoscopic approaches for equally good patient outcomes.
D) with the open approach to decrease surgical time.

Question 25

Thomas Benito is a 4-year-old preschooler 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.