Question 1

The nurse admits the patient to the postanesthesia care unit (PACU)after hand surgery.The patient is groggy but can respond after receiving conscious sedation and regional anesthesia.Which action by the nurse is priority?

Accepted Answer

Although the patient did not receive general anesthesia,the nurse's priority is maintaining the airway because short-acting benzodiazepines and opioids used during conscious sedation potentially depress respirations.If the patient is very lethargic,he or she may have trouble maintaining the airway and require temporary support.After establishing a stable airway,breathing,and circulation,the nurse elevates the hand according to the provider's preference while assessing it.Monitoring the circulatory status in the hand that was operated on is essential but not a priority.Checking the temperature is important but is not the priority.

Question 2

The patient asks why preoperative application of compression stockings has been ordered.Which response by the nurse is most appropriate?

Accepted Answer

The purpose of compression stockings is to promote circulation during periods of immobilization,reducing the risk of an embolism.They cannot prevent any chance of blood clots because blood clots can develop in other body areas for other reasons.The method of measurement doesn't answer the patient's question about why they are used.The devices connected to a pump to promote circulation in the lower extremities are called sequential compression devices.

Question 3

The nurse assesses a patient before knee surgery.Which assessment finding reported by the nurse will most likely require the surgery to be delayed?

Accepted Answer

Calf pain,tenderness,and swelling are consistent with clinical indicators of a deep vein thrombosis or an infection; thus the surgery most likely will be rescheduled after resolution of these findings.Impaired circulation of the lower extremities would require that the surgery be postponed.Many surgeons refuse to operate electively on patients with a significant smoking history unless they quit smoking for a long period because smoking impairs tissue healing.The patient should be fully recovered from an uncomplicated upper respiratory infection last month.Low-normal hemoglobin is sufficient to clear the patient for surgery.

Question 4

The nurse plans assignments for the staff in an ambulatory surgery center.Which assignment can the nurse delegate to nursing assistive personnel (NAP)?

Accepted Answer

The nurse delegates administering the preoperative enema to the NAP because this individual can be trained to perform this task.Handling medications is a nursing responsibility and cannot be delegated.Patient teaching remains a nursing responsibility because it involves assessment,planning,and evaluation components.

Question 5

The nurse assesses the patient and determines that he may be at risk for altered peripheral tissue perfusion.Which activity should the nurse include in patient teaching to prevent decreased perfusion to his extremities while he is on bed rest?

Accepted Answer

The nurse instructs the patient to perform ankle flexion and rotation to promote venous return from the lower extremities,which helps prevent thromboembolic complications and increases arterial perfusion to provide oxygen for the tissues while the patient is not ambulating.Passing gas has no correlation to decreased perfusion in the patient's lower extremities.Pain needs to be controlled,but this has little to do with potential impaired tissue perfusion in the lower extremities.Placing pillows between the legs when positioned on the side provides comfort and is a passive method of preventing compression of the lower leg by the upper one.This is not the most effective way of preventing perfusion to the lower extremities.

Question 6

While being prepared for surgery,the patient tells the nurse that he didn't take the ordered antibiotics in preparation for the surgery.What initial action should the nurse take?

Accepted Answer

The nurse must alert the surgeon of the patient's lack of compliance regarding taking the ordered antibiotics so the surgeon can make a decision.The nurse will document what the patient said,but it is more critical to alert the surgeon.The CDC has identified prophylactice antiobiotics,as recommended,to be crucial in preventing surgical site infections.The nurse cannot order a medication,even though the patient said that the surgeon has ordered it,because there is no order available; nor can the nurse change the medication route of administration.Asking a "why" question is nontherapeutic because it puts the patient in a defensive position.

Question 7

The nurse admits a male patient for ambulatory surgery.The patient tells the nurse that he skipped breakfast but drank a cup of coffee and some juice.Which does the nurse implement next?

Accepted Answer

The nurse obtains additional information from the patient before collaborating with the surgical team so he or she can present a complete picture of the patient's consumption.Drinking fluids before surgery increases this risk of aspiration of gastric contents.The nurse notifies the surgical team and collaborates with them to decide about rescheduling,delaying,or proceeding with the patient's procedure.The nurse does not change or delay the surgery independently.This is a collaborative effort within the patient's surgical team.

Question 8

The patient is prepared for shoulder surgery and tells the preoperative nurse that the scar will be invisible after the surgery.Which action should the nurse take at this time?

Accepted Answer

The patient's statement about an invisible scar is inconsistent with shoulder surgery because skin incisions always leave a scar.The inconsistent statement cues the nurse to verify the patient and the procedure on the surgical consent form and then,once patient identity is secure,address the patient's misunderstanding and ask the surgeon to speak with him or her.Many procedures leave a nonvisible scar,including vaginal,rectal,and cystoscopic procedures and procedures behind the hairline.The nurse avoids changing the consent form.The nurse does not know yet whether the patient is ready for surgery; he or she resolves the patient misunderstanding or misidentification first.

Question 9

The nurse instructs the patient about postoperative coughing and deep-breathing exercises following abdominal surgery.Which technique should the nurse use to engage the patient in prevention of pneumonia and atelectasis?

Accepted Answer

The nurse engages the patient in postoperative coughing and deep breathing by instructing him or her to splint the incision similar to when the patient is turning.By holding the incision,the patient stabilizes the edges of the wound and puts less stress on the incision.The nurse does not allow the patient to decide when and if coughing and deep breathing are done.He or she involves the patient actively.Simply taking a deep breath and holding it before exhaling does not clear secretions from the respiratory tract.As soon as the patient begins waking,he or she will be coached by the nurse to cough and deep breathe.Pain medication will help the exercises to be less painful.

Question 10

The nurse prepares the patient for surgery to begin in 1 hour,but the pregnancy test included in the preoperative orders written yesterday is not in the medical record.Which action should the nurse implement first?

Accepted Answer

The nurse should first find out if the test results are available before doing anything else.If the results cannot be found,the nurse obtains a blood specimen for a stat pregnancy test because the provider ordered one before surgery and the order is still valid.If the results have not been found after the specimen for the pregnancy test is drawn and sent to the lab,the nurse notifies the surgeon about the situation.The nurse avoids sending the patient to surgery on the basis of her verbal report because she may be unaware of a pregnancy or she may be concealing the truth.The aneshesia and other operative medications can do damage to an embryo or a fetus.

Question 11

The nurse interviews a preoperative patient who evades all questions about medications taken at home.Which is the best response for the nurse to use to facilitate safe,effective nursing care?

Accepted Answer

The best response is to validate the nurse's perception of the patient's behavior in a nonthreatening manner in order to elicit more information from the patient.The nurse avoids asking a "why" question because it may make a patient feel defensive.Stating that the patient is avoiding the question has the potential to be beneficial for interviewing,but concluding that the patient has a secret may be perceived as an accusation,sarcasm,or humor and lacks professionalism.It is unlikely to elicit more information.Asking a question that implies a position that the patient hasn't advocated (you don't think medications are important to discuss)is judgmental and unlikely to uncover the patient's true concerns.

Question 12

The nurse is explaining the purpose and procedure regarding informed consent to a nursing student.What information should be included in the explanation?

Accepted Answer

The nurse's role is to verify the patient's signature and verify that it is complete and consistent with the patient's understanding.The nurse must know the policies of the facility regarding what to do if the patient later states a lack of understanding.The informed consent states what is being done by whom and includes contingency plans,risks,and benefits.The nurse can help the patient understand the information,but the nurse does not provide it.The healthcare provider who performs the procedure provides informed consent and includes details about the procedure.The patient is potentially incompetent after receiving preoperative medication such as sedatives and opioids; thus the nurse verifies that the consent is in order before administering preoperative medication.

Question 13

The patient's family has had many surgical experiences with complications.What information is most important for the nurse to use to understand the patient's stress in the perioperative period?

Accepted Answer

The patient's perception of the perioperative experience creates a point of reference for evaluation of the situation.Asking about fears,cultural practices,and religious beliefs allows the nurse to anticipate the patient's and family caregiver's priorities and adapt the plan to give appropriate instruction and support.The nurse should get more information so potential concerns can be identified.Anxiolytics can relieve stress quickly by sedating the patient but do nothing to resolve the patient's stressor.Stressors can be difficult to identify and are usually more difficult to manage.Stress can develop from hereditary and environmental factors.

Question 14

The nurse is caring for a patient who had an ovarian cyst removed under general anesthesia 12 hours ago.Which is the most important goal for this patient?

Accepted Answer

The most important goal for this patient is ambulation because it promotes lung expansion,restoration of peristalsis,peripheral perfusion,venous return,and tissue integrity and thereby decreases atelectasis and prevents pneumonia,constipation,thromboembolic events,skin breakdown,and infection.The patient should not cough and deep breathe every hour.She must be allowed to sleep.Establishing bowel sounds within 24 hours after surgery is an unrealistic goal.If the intestines are emptied before surgery,restoring bowel sounds can take longer than 1 day,and producing a bowel movement often takes 4 to 5 days.Ankle and foot exercises promote perfusion and venous return,which help to prevent circulatory problems,but ambulation is best.

Question 15

A nurse admits a patient,who works in dental office,to ambulatory surgery.The patient's history includes multiple surgeries over the last 10 years.In addition,when the patient wears antiembolism stockings,a rash develops.Which action should the nurse take initially?

Accepted Answer

The nurse addresses the patient's potential hypersensitivity to latex directly to develop a comprehensive history of the problem before collaborating with the healthcare provider.If the patient has a hypersensitivity to latex,wearing powdered gloves potentially aggravates the problem because the powder can aerosolize and increase the risk of patient exposure by inhalation.Removing latex supplies is premature because the nurse needs to complete the patient assessment.The nurse must complete the assessment about the patient's potential allergies before notifying the surgeon.

Question 16

The nurse determines that the patient is at risk for atelectasis caused by pain from back surgery 3 hours ago.Which is the best goal for the nurse to help the patient achieve?

Accepted Answer

Because of the cut back muscles,the patient is at risk for respiratory problems after surgery due to pain.The outcome reflects the patient's status and is stated in a manner that can be evaluated.The patient would benefit from intravenous morphine to manage pain because it is easier to control.He or she can receive small,frequent doses for pain instead of a single,large dose that is more likely to result in hypotension.There is no indication for a cooling mattress.In addition,both of these are nursing interventions.For the patient at risk for alteration in cardiac output,maintaining a positive fluid balance increases the risk of fluid volume overload and can cause heart failure in the patient until the fluid is removed.The term adequate cannot be evaluated.

Question 17

The nurse assesses a patient before hip surgery.Which piece of information is most critical for the nurse to report to the surgeon before surgery?

Accepted Answer

The nurse reports the use of CPAP since this may indicate that the patient has obstructive sleep apnea,which poses a risk after surgery.The headache could potentially result from anxiety or hypoglycemia.A bruise on the patient's chest is not near the operative area.The elevated blood pressure could be a result of preoperative anxiety.

Question 18

The nurse provides instructions about postoperative exercises to the patient who is scheduled for a laparotomy.What does the nurse include in patient teaching?

Accepted Answer

The nurse instructs the patient to exercise each extremity several times to promote blood flow and venous return to prevent deep vein thrombosis formation.Once-daily coughing and deep breathing are inadequate.Performing each exercise twice is inadequate.The patient needs to reposition at least every 2 hours to prevent inadequate tissue perfusion caused by pressure.

Question 19

The nurse assesses a patient before surgery.Which piece of patient information is most likely to require follow-up nursing interventions?

Accepted Answer

A perioperative death of a first-degree relative warrants further investigation by the nurse to determine the details surrounding the death.If the father died from the surgery or anesthesia,the surgical team needs details to determine whether surgery is indicated for this patient.The patient's risk for developing chickenpox is past.The serum hemoglobin level is fine for surgery.The data indicate a normal weight for the patient's height.

Question 20

The nurse instructs the patient about scheduled surgery involving general anesthesia and about postoperative care.Which should the nurse include in patient teaching?

Accepted Answer

Patients must be asked about their cultural practices and religious beliefs that may alter their family caregiver's acceptance of necessary education and procedures.It is helpful to assess patient preference for pain medication,before and after surgery.The nurse instructs the patient to avoid food and fluid 6 to 8 hours before the procedure to prevent aspiration of gastric contents.The patient is advised that he will be unconscious in the operating room under general anesthesia.To avoid unnecessary patient upset and distress,the nurse also states that the patient will feel nothing,may remember nothing,and will wake up after the procedure.The surgeon will discuss resumption of exercise with the patient.

Quiz 28: Preoperative and Postoperative Care

The nurse admits the patient to the postanesthesia care unit (PACU) after hand surgery.The patient is groggy but can respond after receiving conscious sedation and regional anesthesia.Which action by the nurse is priority?