Deck 27: Geriatric Surgery

Question 1

Impaired nutritional status is highly prevalent among the elderly; as many as 12% of men and 8% of women in the healthy geriatric population are considered undernourished.During the preoperative assessment and interview,what information will the perioperative nurse review,in addition to a thorough assessment including body mass index and Mini Nutritional Assessment?

A) The nothing by mouth (NPO) status
B) The serum albumin level
C) The medication record for use of vitamins
D) The use of nutritional supplements

Answer 1

B
Higher rates of surgical complications and increased postoperative mortality have been observed in patients with poor nutritional status,as determined by a low body mass index,weight loss,a low preoperative serum albumin level,or a low Mini Nutritional Assessment score.

Question 2

An 87-year-old woman has been scheduled for a right cataract extraction with intraocular lens implant of her right eye.She also has a cataract in her left eye and is hearing-impaired in both ears.The perioperative nurse conducted a preliminary nursing assessment 1 day earlier by telephone and has documented her preliminary nursing interventions for the intraoperative nurse.Which nursing action by the perioperative nurse will assist the patient to maintain accurate perception and interpretation of environmental and sensory stimuli throughout the perioperative period?

A) Leave the operating room (OR) lights on high illumination during the procedure.
B) Leave hearing aids and eyeglasses in place for as long as possible.
C) Speak moderately louder than normal voice tone.
D) Conduct a cognitive assessment.

Answer 2

B
Changes in vision,hearing,taste,smell,and touch may influence the patient's response to care.If preadmission communication is done,the perioperative nurse may ask about vision and hearing and remind patients to bring their glasses and hearing aids to the facility.Of importance in the OR is an awareness of the older person's difficulty in adapting to changes in light.Moving patients from a dimly lit holding area to the bright lights of the OR can cause momentary "blindness."

Question 3

An 83-year-old woman,admitted for an abdominal perineal resection for early sigmoid cancer,has a recent history of a 4% weight loss.On admission to the OR,she is tachypneic,her tongue and mucous membranes of her mouth are dry,her speech is slurred,and she is confused.Her surgical unit nurse states that the patient's bowel prep the night before was successful.The patient states that she needs to vomit.The anesthesia provider tries to find a good vein for an intravenous (IV)access and asks the perioperative nurse to look for a possible vein on the patient's other arm as the left arm veins are flat.Based on these conditions,what nursing diagnosis is the patient presenting?

A) Risk for Deficient Fluid Volume related to intraoperative blood loss
B) Deficient Fluid Volume related to age-associated total body water and plasma volume loss
C) Risk for Deficient Fluid Volume related to NPO status and bowel prep
D) Deficient Fluid Volume related to NPO status and bowel prep

Answer 3

D
The patient's fluid volume deficit is due to her NPO status and bowel prep in addition to other age-related factors and possibly her primary surgical diagnosis.Since her surgery has not yet begun,her deficit is not related to intraoperative causes.

Question 4

An ethical consideration with older surgical patients centers on the dilemma of do not resuscitate (DNR)orders.When considering the decision to maintain or suspend DNR orders prior to surgery,the guiding principle should be to:

A) seek legal consultation through the facility ethics department.
B) facilitate the family to collaborate on consensus.
C) respect the patient's autonomy.
D) develop a facility-wide policy for either suspension or maintaining of DNR orders.

Question 5

Perioperative nurses caring for older adults must consider factors that affect the choice of medications and the effects of those medications on this population.Physiologic changes may affect the absorption,distribution,metabolism,and excretion of medications.Which statement about medication metabolism is true?

A) Older adults have faster excretion times because of increased renal blood flow.
B) Older adults have slower excretion times because of increased liver size and increased blood flow.
C) The increased liver size and increased blood flow in older adults decrease liver enzyme activity.
D) Older adults have slower excretion times attributable to a reduced glomerular filtration rate.

Question 6

Minimally invasive surgeries continue to increase in popularity.It seems logical that older patients would benefit from smaller incisions that produce less postoperative pain,atelectasis,and ileus.However,regardless of age,every surgical procedure possesses a certain amount of risk.Which minimally invasive surgical component can present hemodynamic and pulmonary consequences in patients with severe cardiac or pulmonary disease?

A) Robotic-assisted pelvic approach
B) CO₂ pneumoperitoneum
C) Ultrasonic dissection
D) Radiofrequency ablation

Question 7

A retired perioperative nurse celebrated her 100th birthday with family and friends.Which age group is she now a member of?

A) Elite-old
B) Centennial-old
C) Old-old
D) Frail-old

Question 8

There are many important considerations related to the extent of surgical treatment.Therefore,the decision for surgery relies heavily on the patient's physical status at the time of surgery and on the extent of disease progression.When treating patients who are nearing the end of life,attention should promote:

A) maximizing the quantity of life.
B) solely shifting to maximizing survival.
C) maximizing the quality of life and dignity.
D) minimizing suffering.
E) minimizing institutional cost and resources.

Question 9

Age-related skin changes include a thinning epidermis and decreased subcutaneous fat and elasticity.Which skin-related actions should the perioperative nurse take with regards to the older patient?

A) Smooth bed linens under the patient or positioning devices
B) Assess potential pressure areas before anesthesia induction and positioning
C) Wash skin often with soap and water
D) Gently lift, not slide, the patient to and from the OR bed

Question 10

When considering surgery for an elderly patient,the risk of surgery should be measured against the risk of not operating,and the expected postoperative quality of life.Which important factors should be evaluated in the decision making?

A) Personal motivation
B) Patient's state of independence
C) Disease course versus life expectancy
D) Patient's support system
E) Surgical risk versus nonoperative management

Question 11

Common abdominal procedures in people older than 65 years include cholecystectomy,lysis of adhesions,appendectomy,and partial excision of the small bowel.Many important clinical signs of abdominal disease may be less obvious in the elderly patient.Which of the following would be appropriate questions for the perioperative nurse to ask during the preoperative interview and assessment?

A) "Do you take nonsteroidal anti-inflammatory medications like ibuprofen?"
B) "Do you smoke cigarettes?"
C) "Have you ever had, or have, peptic ulcer disease?"
D) "Do you often stand for long periods of time?"

Question 12

Hyperthyroidism is the great masquerader in the elderly population and can easily be missed in patients older than 60 years.An important assessment point during the preoperative interview that could influence the positioning for the surgical procedure is based on which true statement?

A) The patient may have osteoporosis caused by hyperthyroidism.
B) Euthyroid syndrome is prevalent in hyperthyroidism and impairs neck flexion.
C) Positional injury can trigger thyroid storm.
D) Patients who have been exposed to radioactive iodine are at risk for pressure injuries.

Question 13

Changes to the elderly person's skeleton,such as the loss of bone mass,contribute to skeletal instability and make fractures of the hip,rib,distal radius,and vertebrae very common.Which interventions will the perioperative nurse provide in positioning older patients in the OR?

A) Assess the patient's pain rating before anesthesia induction and positioning.
B) Position the patient using appropriate padding and joint protection devices.
C) Apply pressure to the popliteal space and heels.
D) Abduct the arm boards to above a 90-degree angle through anatomic range of motion.

Question 14

As a person ages,digestive secretions decrease,mucus becomes thicker (causing dysphagia),and saliva becomes more alkaline.Decreased peristalsis and gastric motility,resulting in muscle tone loss,will cause delayed stomach emptying.What common digestive condition may result from delayed stomach emptying?

A) Odynophagia
B) Dysphagia
C) Esophageal reflux
D) Mucositis

Question 15

Factors in the evaluation of the older surgical patient are assessing cognitive ability and capacity,risk for postoperative delirium,screening for alcohol and substance abuse,documentation of functional status including falls,nutritional status,and understanding of treatment goals and expectations and their family/social support system.The Mini-Cog test can be used as a tool for:

A) assessing nutritional status.
B) assessing cognitive impairment.
C) determining fall risk.
D) screening for alcohol/substance abuse.

Question 16

The predominant reason for urologic surgery in elderly men is benign prostatic hypertrophy (BPH).Which appropriate assessment questions would the perioperative nurse ask the patient scheduled for a transurethral resection of the prostate (TURP)during the preoperative interview?

A) If he has symptoms that describe evidence of constipation
B) If he has symptoms that describe evidence of painful urination
C) If he has symptoms that describe evidence of blood in the urine
D) If he has symptoms that describe evidence of straining at urination

Question 17

Which action is considered a best practice when communicating with geriatric patients with cognitive impairments?

A) Treat the person as if he/she is special and address him/her in a soft, quiet manner.
B) Speak moderately loud, facing the patient and holding his/her hand.
C) Approach the patient from the front and identify yourself.
D) Take measures to minimize emotional inflections in your message.

Question 18

Age-related changes cause decreased blood flow to the kidneys with a resultant decrease in nephron function.Which condition is created from the cumulative effect of the multiple drugs that the elderly patient will receive during the perioperative phase?

A) Adverse drug reaction
B) Polypharmacy psychosis
C) Weakened bladder muscle tone with urinary incontinence
D) Liver toxicity

Question 19

The occurrence of perioperative mortality in geriatric surgical patients is influenced by several evidence-based factors.Select the patient most at risk for perioperative mortality.

A) A 70-year-old woman, scheduled for an emergency bowel resection with an American Society of Anesthesiologists (ASA) class IV
B) A 70-year-old man scheduled for a bunionectomy of the right foot, ASA class II
C) A 70-year-old man with type 2 diabetes, scheduled for a robotic-assisted prostatectomy, ASA class III
D) A 70-year-old woman with a hearing aid and bilateral cataracts, scheduled for a dilatation and curettage (D&C), ASA class IV

Question 20

The perioperative nurse assigns the patient scheduled for cataract surgery the following nursing diagnosis: Ineffective Breathing Pattern attributable to the patient's chronic lung disease.The nurse also documents a secondary nursing diagnosis: Risk for Injury related to increased intraocular pressure.Which potential event can result in this secondary nursing diagnosis?

A) The patient may cough while lying in the supine position.
B) The patient may be anxious and try to raise his or her head during the procedure.
C) Patients with cataracts often have glaucoma and may move their head to relieve the pressure.
D) Hypoxia from chronic lung disease can increase intraocular pressure.

Question 21

Perioperative nurses have a unique opportunity to assess and screen for signs of emotional and physical abuse in elderly patients during their preoperative assessment and while assisting with surgical positioning.Select the signs that may indicate abuse.

A) The older person has malnutrition or dehydration.
B) The older person is crying.
C) The older person has burns or pressure sores.
D) The older person verbalizes fear of the caregiver.
E) The older person complies with the treatment plan.
F) The older person shows signs of poor hygiene.

Question 22

A 92-year-old man is scheduled for emergency surgery for a strangulated scrotal hernia.He is thin and frail with a preoperative body temperature of 97.2° F.His skin is pink,and he is not shivering even though he states that he is cold.The perioperative nurse and the anesthesia provider have planned for the patient's hypothermia before he was transferred to the OR.What are the appropriate actions the nurse can take to raise the patient's core temperature?

A) Use active warming intraoperatively by applying a warming system.
B) Use warm blankets during transport to the OR.
C) Adjust ambient room temperature to a level of comfort.
D) Use warmed sterile irrigation, IV solutions, and skin preparation solutions.