Deck 26: Geriatric Surgery

Question 1

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.What special intervention will the perioperative nurse provide,in terms of additional attention and care,in one of the following nursing actions?

A) Document the patient's pain rating before anesthesia induction and positioning.
B) Position the patient using appropriate padding and joint protection devices.
C) Consider the patient's posture and flexibility during the preoperative interview.
D) All of the options are correct.

Answer 1

B
Extra care in positioning patients in the OR should be taken with the elderly patient,ensuring appropriate padding and joint protection.

Question 2

Martha Boyer,an 82-year-old woman with a displaced intertrochanteric fracture of the upper femur,is scheduled for an open reduction and internal fixation of her right hip.Martha had been scheduled for a total hip replacement for degenerative joint disease before this injury.The perioperative nurse assists with positioning Martha's affected hip and positions the other leg and her arms with equally as much care,using gentle handling,padding,and natural range of motion.In addition to Martha's osteoarthritis,what is the nurse's concern with positioning Martha's other limbs?

A) Martha may have fractured other parts of her body.
B) Martha also has osteoarthritis and rheumatoid arthritis.
C) Martha's upper femur fracture may cause a pulmonary embolus.
D) Martha may fall off of the fracture bed.

Answer 2

B
Osteoporosis is the most obvious skeletal change that occurs with advancing age.Degenerative joint disease (osteoarthritis)and inflammatory polyarticular disease (rheumatoid arthritis)are the primary indications for total joint replacement in the hip and knee.Age-related changes in bone increase the prevalence of displaced femoral and intertrochanteric fractures of the upper femur.Because the usual cause of death in patients with upper femur fracture is pulmonary embolus,surgery is designed to relieve the severe pain,allow movement in and out of bed,and return the patient to his or her former environment as quickly as possible with minimal debilitation.

Question 3

Age-related skin changes include a thinning epidermis and decreased subcutaneous fat and elasticity.What special consideration will the perioperative nurse provide,in terms of additional attention and care,in one of the following nursing actions?

A) Cover all appropriate,nonoperative,skin surfaces with soft bath blankets.
B) Document thorough,meticulous preoperative and postoperative skin assessment.
C) Perform meticulous sterile technique.
D) Gently lift,not slide,the patient to and from the OR bed.

Answer 3

D
The skin loses elasticity and subcutaneous fat and becomes more prone to shear force and pressure injury.Because of the thinness of the skin and small vessel fragility,bruising and hemorrhaging are quite common.

Question 4

Ruth Calaveras is an 87-year-old woman who 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 of Ruth 1 day earlier by telephone,and has documented her preliminary nursing interventions for the intraoperative nurse.What nursing action by the preoperative nurse will assist Ruth to maintain accurate perception and interpretation of environmental and sensory stimuli throughout the perioperative period?

A) Leave the OR lights on high illumination during the procedure.
B) Leave Ruth's hearing aids and eyeglasses in place as long as possible.
C) Speak moderately louder than normal voice tone.
D) Ask Ruth if she is able to read lips and request that the team not wear masks.

Question 5

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 NPO status
B) The serum albumin level
C) The medication record for use of vitamins
D) The use of nutritional supplements

Question 6

Hyperthyroidism is the great masquerader in the elderly population and can easily be missed in patients older than 60 years.It can be severe and even life-threatening.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 7

Elderly patients have an increased tendency for slower metabolism,multiple chronic diseases,and a decreased reserve capacity of their organs to respond to stress,when compared to younger patients.When considering the decision for surgery,the risk of surgery should be measured against the risk of not operating,and the expected postoperative quality of life.What important factors should be evaluated in the decision-making? Select all that apply.

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

Question 8

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) Janice,age 70,scheduled for an emergency bowel resection with an ASA class IV
B) Hans,a 70-year-old man scheduled for a bunionectomy of the right foot,ASA class IV
C) Seamus,age 70 with type 2 diabetes,scheduled for a robotic-assisted prostatectomy,ASA class III
D) Anna,a 70 year old with a hearing aid and bilateral cataracts,scheduled for a D&C,ASA class IV

Question 9

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

A) Increased chance for adverse reactions and consequential results
B) Polypharmacy psychosis
C) Weakened bladder muscle tone with urinary incontinence
D) Liver toxicity

Question 10

Wilbur Jenkins,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 Wilbur's hypothermia before he was transferred to the OR.What therapeutic measures will they implement to raise and maintain his core body temperature?

A) Use active warming intraoperatively by applying a forced air-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.

Question 11

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 perioperative concern may be influenced by this age-related digestive condition?

A) Traumatic injuries to the bowel
B) Decreased lean body mass
C) Esophageal reflux
D) Retention of lipophilic drugs

Question 12

During the preoperative assessment and interview with a patient scheduled for a transurethral resection of the prostate (TURP),the perioperative nurse notes that the patient has an inguinal hernia.What would be an appropriate statement that the nurse might make to the patient?

A) "I will tell the surgeon so that you can have the hernia repaired at the same time."
B) "Hernias rarely occur in men with prostate disease."
C) "You should consider having your hernia repaired in the near future at the ambulatory center."
D) "You should consider having a laparoscopic hernia repair in the near future."

Question 13

Anita Gergen,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 tachy-pneic,her tongue and mucous membranes of her mouth are dry,her speech is slurred,and she is confused.Her surgical unit nurse states that Anita's bowel prep the night before was successful.Anita states that she has to vomit.The anesthesia provider tries to find a good vein for an intravenous access and asks the perioperative nurse to look for a possible vein on Anita's other arm as the left arm veins are flat.Based on these conditions,what would be Anita's presenting nursing diagnosis?

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) High Risk for Deficient Fluid Volume related to NPO status and bowel prep
D) Deficient Fluid Volume related to NPO status and bowel prep

Question 14

The most common causes of acute abdominal complaints in older patients are biliary tract disease,intestinal obstruction,GI hemorrhage,hernia,diverticulitis,and appendicitis.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.What would be an appropriate question for the perioperative nurse to ask during the preoperative interview and assessment?

A) "Do you take nonsteroidal antiinflammatory medications like ibuprofen?"
B) "Do you smoke cigarettes?"
C) "Have you ever had,or have,peptic ulcer disease?"
D) All of the options are relevant for this population.

Question 15

What 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 16

A number of screening tools have been developed to accurately establish biologic age.One tool,the Comprehensive Geriatric Assessment (CGA),is a multidimensional evaluation that scrutinizes medications,functional ability,co-morbid conditions,cognitive ability,mental function,nutritional status,and socioenvironmental factors.In geriatric medical studies,the CGA has been valuable in providing a metric for describing healthy aging and:

A) predicting the incidence of hospitalization.
B) identifying at-risk individuals.
C) measuring performance of activities of daily living.
D) determining success of interventions.

Question 17

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

A) If he has symptoms that describe evidence of straining at urination (micturition)
B) If he has symptoms that describe evidence of painful urination (dysuria)
C) If he has symptoms that describe evidence of blood in the urine (hematuria)
D) All of the options are correct.

Question 18

The perioperative nurse,Lynne,assigns the patient scheduled for cataract surgery the following nursing diagnosis:Ineffective Breathing Patterns attributable to the patient's chronic lung disease.Lynne also documents a secondary nursing diagnosis:High Risk for Injury related to increased intraocular pressure.What 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 have glaucoma and may move their head to relieve the pressure.
D) Hypoxia from chronic lung disease can increase intraocular pressure.

Question 19

Gregorio Halverson is an 82-year-old diabetic patient with several other co-morbidities in addition to recent withdrawal from alcohol after he was admitted for emergency bowel obstruction surgery.He is both hearing-impaired and visually-impaired.His wife states that Gregorio has only an eighth-grade education and has occasional bouts of depression.The anesthesia provider classified Gregorio as an ASA IV for his surgery.He is now postoperative day 1,in the ICU,and exhibits confusion and delirium.His presentation suggests disorganized thinking,pain,and an acute onset of change in mental status.What risk reduction strategy before Gregorio's surgery might have provided substantial information for the care team to proceed with implementing corrective measures?

A) Conduct a meticulous assessment for underlying conditions.
B) Prepare Gregorio's wife to expect that he would be delirious postoperatively in the ICU.
C) Assess pain using the BODIES pain scale for demented and nonverbal elders.
D) Remember to "assume pain is present" in cognitively impaired perioperative patients.

Question 20

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.What statement about medication metabolism is true?

A) Older adults have a higher prevalence of nonprescription drug use.
B) Older adults have slower excretion times as a result 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.