Chapter 17 My Nursing Test Banks

Osborn, Medical-Surgical Nursing, 2e
Chapter 17

Question 1

Type: MCSA

During preoperative assessment, the patient says, My surgery must be minor because its being done on an outpatient basis. How should the nurse respond?

1. Every surgical procedure is serious, and I will make sure you have the information you need for a successful recovery.

2. You are right.

3. If it were more serious, you would be admitted to the hospital.

4. Your insurance plan does not cover inpatient surgical procedures. Thats why your surgery is being done on an outpatient basis.

Correct Answer: 1

Rationale 1: The outpatient surgical patient must cope with the additional stress of needing to learn a great deal of information in a short span of time. The nurse should explain that every surgical procedure is serious and that the patient will be given information to have a successful recovery.

Rationale 2: The nurse should not agree with the patient that the surgery is minor just because it is scheduled as an outpatient procedure.

Rationale 3: Patients are admitted to the hospital for monitoring and nursing care. The seriousness of the surgery is not the determining factor.

Rationale 4: Outpatient surgery is less expensive and is preferred by insurance companies if patient safety can be assured. However, most plans allow for admission to the hospital after surgery if the patients condition warrants admission.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-1

Question 2

Type: MCSA

Prior to surgery, the nurse instructed the patient on exercises that should be done prior to and after surgery. The patient is currently recovering from surgery and is experiencing a deep vein thrombosis. Which preoperative exercise instruction was not adequate for this patient?

1. Leg exercises

2. Deep breathing and coughing

3. Use of incentive spirometry

4. Splinting when coughing

Correct Answer: 1

Rationale 1: Leg exercises reduce the risk of the complication deep vein thrombosis.

Rationale 2: Deep breathing and coughing are helpful to prevent complications of pneumonia and atelectasis.

Rationale 3: Incentive spirometry is helpful to prevent complications of pneumonia and atelectasis.

Rationale 4: Splinting when coughing is taught so that thoracic and abdominal incisions are protected from the increase in intra-abdominal pressure that occurs with coughing.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 17-5

Question 3

Type: MCSA

After administering a preoperative sedative, the nurse notes that the surgical consent form has not been signed by the patient. What is the nurses priority intervention?

1. Contact the surgeon.

2. Ask the patient to sign the consent form.

3. Send the patient for surgery with an unsigned consent form.

4. Phone the operating room suite to notify the nurse that the patient has not signed the consent form.

Correct Answer: 1

Rationale 1: The patient should be aware and alert before signing the consent form. The nurse should contact the surgeon in the event the patient receives preoperative sedative medication and has not yet signed the consent for surgery form.

Rationale 2: The nurse should not ask the patient to sign the consent form while under the influence of a sedative.

Rationale 3: The nurse should not send the patient for surgery with an unsigned consent form.

Rationale 4: While this intervention may be performed, it is not the priority.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-3

Question 4

Type: MCSA

A chart review reveals that a patient being prepared for surgery has been diagnosed with dehydration. Which laboratory results would the nurse review to evaluate the effect of treatment of this condition?

1. Hemoglobin and hematocrit

2. Glucose

3. White blood cell count

4. Platelet count

Correct Answer: 1

Rationale 1: An increase in hemoglobin and hematocrit levels would indicate dehydration. As treatment progresses, the H&H should normalize.

Rationale 2: Glucose does not reflect hydration status.

Rationale 3: An alteration in white blood cell count could indicate an infection or immune deficiencies.

Rationale 4: An alteration in platelet count could indicate a malignancy or clotting deficiency disorder.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 17-2

Question 5

Type: MCSA

An elderly patient is being prepared for orthopedic surgery. The nurse realizes this patient is at risk for which complication?

1. Decreased tolerance of general anesthesia

2. Prolonged effects of anesthesia because of herbal supplements

3. Wound dehiscence

4. Increased hypotensive effects of anesthesia

Correct Answer: 1

Rationale 1: Age-related changes affect physiologic, cognitive, and psychosocial responses to the stress of surgery. In addition, older adults experience decreased tolerance of general anesthesia and postoperative medications and delayed wound healing.

Rationale 2: The information provided does not indicate the use of herbal supplements.

Rationale 3: Despite the risk of delayed wound healing, there is no information to support an increased risk for wound dehiscence.

Rationale 4: There is no data to support concerns with hypotension related to anesthesia.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 17-2

Question 6

Type: MCSA

A patient who is being admitted for surgery asks the nurse why information is being collected about the patients use of herbal and natural supplements. Which statement is an appropriate nursing response?

1. Herbal supplements may interact with medications given during or after surgery.

2. We would like to continue these medications postoperatively.

3. The physician is in charge of medications.

4. There is no need to take these preparations.

Correct Answer: 1

Rationale 1: The use of herbal supplements must be documented prior to surgery. It is possible for these elements to interact with medications given during or after surgery.

Rationale 2: There is no evidence that herbal remedies are medications or that they will be continued postoperatively.

Rationale 3: Stating that the physician is in charge of medications does not adequately address the patients inquiry.

Rationale 4: Stating that there is no need to take these preparations does not adequately respond to the patients inquiry.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-3

Question 7

Type: MCSA

The patient who is preparing for surgery asks the nurse to keep his glasses in place until he is under anesthesia. Which statement by the nurse demonstrates accurate, therapeutic communication?

1. I will contact the surgery department to discuss your requests.

2. You cannot keep your glasses on.

3. The policies in the surgery unit will not allow it.

4. Certainly, you can keep them for that time.

Correct Answer: 1

Rationale 1: Communication will be enhanced if the patient can keep his glasses on for as long as possible. The nurse will need to check with the surgical department first before granting the patients wish.

Rationale 2: As a patient advocate, the nurse is responsible for making an inquiry.

Rationale 3: The nurse does not have the authority to make decisions on behalf of the surgical department.

Rationale 4: The nurse should not give information that may be inaccurate.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-4

Question 8

Type: MCSA

The nurse takes an informed consent document to the patients room in preparation for an emergency surgical procedure. The patient states, Doc said he would tell me all about the surgery when he gets here. Do you know what they are going to do? What is the nurses best response?

1. Lets wait on signing this until your physician has talked to you.

2. Let me go get a medical surgical textbook so I can use the pictures to explain the procedure.

3. I am not certain; let me call the nursing supervisor to explain it to you.

4. Go ahead and sign this so we will have that part done when the physician gets here.

Correct Answer: 1

Rationale 1: The informed consent document should not be signed until the procedure has been explained to the patient, and the explanation is the responsibility of the physician.

Rationale 2: This nurse should not explain the procedure.

Rationale 3: This nurse should not ask another nurse to explain the procedure.

Rationale 4: The signing of this document must wait until the patient is educated about the procedure so that true informed consent can be given.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-3

Question 9

Type: MCSA

While completing item 4 in the preoperative preparation section of the depicted checklist, the nurse notes that the patient depends on a hearing aid. What action should the nurse take?

1. Leave the device in the patients ear and notify the OR nurse of its presence.

2. Remove the device and place it in a denture cup in the patients room.

3. Remove the device and give it to the patients family member.

4. Place a piece of tape across the patients ear and the device.

Correct Answer: 1

Rationale 1: The patient must be able to hear and understand instruction that will be part of the universal protocol to reduce surgical errors, so the nurse should leave the device in the patients ear and notify the OR nurse of its presence.

Rationale 2: Removing the device and leaving it in the room will make it unavailable to the patient in the OR.

Rationale 3: Giving the device to the family will make it unavailable to the patient in the OR.

Rationale 4: Taping the device into the ear might damage it or injure the patients ear.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-3

Question 10

Type: SEQ

Place the steps of deep breathing in the order the nurse should teach the elderly preoperative patient.

Standard Text: Click and drag the options below to move them up or down.

Choice 1. Breathe out normally.

Choice 2. Breathe in deeply through your nose.

Choice 3. Hold your breath to a count of three.

Choice 4. Slowly exhale.

Choice 5. Take five to ten deep breaths every hour.

Correct Answer: 1,2,3,4,5

Rationale 1: The patient should first breathe out in a normal manner.

Rationale 2: The patient should be asked to take a deep breath in through the nose.

Rationale 3: The patient should be asked to hold the breath to the count of three.

Rationale 4: The patient should exhale slowly, keeping the lungs expanded as long as possible.

Rationale 5: Deep breathing should be repeated often for best results.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-5

Question 11

Type: MCMA

Which patient information is essential for the nurse to provide the physician who is preparing to administer conscious sedation to a patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient has a history of snoring.

2. The patient drank a cup of coffee 2 hours ago.

3. The patient wants to be asleep for the procedure.

4. The patients father was hypertensive.

5. The patient has a history of gout.

Correct Answer: 1,2

Rationale 1: The fact that the patient snores may give information about the physical configuration of the oral pharynx, the pharynx, and the neck. This patient may have difficulty maintaining an airway. This is essential information.

Rationale 2: The fact that the patient has not been NPO is essential.

Rationale 3: This is not relevant information as conscious sedation is planned. The patient will essentially be asleep.

Rationale 4: This information is not essential.

Rationale 5: This information is not essential.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-2

Question 12

Type: MCSA

The nurse is completing a preoperative assessment on a patient. Which reason would the nurse prioritize as the most important for this assessment?

1. The data provide information and guidance for preoperative and postoperative instruction.

2. The assessment data can be used to help plan for a future residential care institution.

3. The data provide information for the health care providers history and physical.

4. The potential risks are identified for the family to comfort them in case there is a bad outcome from surgery.

Correct Answer: 1

Rationale 1: The assessment data can be utilized to help guide the patients preoperative and postoperative teaching. The assessment also provides information regarding potential health risks perioperatively as well as baseline data for the patients physical and functional abilities during recovery

Rationale 2: The assessment data can be utilized at a residential care facility, but that is not the primary reason for completing assessment data.

Rationale 3: A health care providers history and physical may utilize some data from the nursing assessment, but the health care provider must also complete his or her own history/physical.

Rationale 4: Potential risks can be identified, but they are not done so for the comfort of the family.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 17-1

Question 13

Type: MCMA

Which information would the nurse manager tell a newly licensed nurse to collect as part of the preoperative assessment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Patient history

2. Current health problem

3. Discharge plans

4. Current medications

5. Past surgical history

Correct Answer: 1,2,4,5

Rationale 1: Patient history is part of the preoperative assessment.

Rationale 2: Information about the current health problem is included in the preoperative assessment.

Rationale 3: Discharge plans are not included in this assessment.

Rationale 4: Information on medications, including prescriptions, over-the-counter medications, and herbal remedies, is included in the preoperative assessment.

Rationale 5: Information about the past surgical history is included in the preoperative assessment.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-3

Question 14

Type: MCSA

A patient is receiving preoperative instructions from the nurse. The patient has chronic pain and has been taking aspirin on a routine basis. The nurse knows which potential postoperative complication could occur?

1. Blood clots

2. Pneumonia

3. Poor wound healing

4. Bleeding

Correct Answer: 4

Rationale 1: This patient would have the same risk for blood clots as other postoperative patients.

Rationale 2: The patient has no increased risk of pneumonia based on taking aspirin.

Rationale 3: Poor wound healing would occur with other drugs and certain disease conditions, but aspirin would not impact wound healing.

Rationale 4: The patient is at higher risk for postoperative bleeding due to the aspirin.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 17-2

Question 15

Type: MCSA

The nurse completes a preoperative assessment of a patient who uses a continuous positive airway pressure (CPAP) machine every night. What should be the nurses next action?

1. Contact the primary care health care provider to verify the patients use of CPAP.

2. Explain to the patient that CPAPs are not allowed in the hospital setting.

3. Discuss the patients surgery with the family.

4. Contact anesthesia to notify of the CPAP usage.

Correct Answer: 4

Rationale 1: There is no reason to verify what the patient has reported.

Rationale 2: The patient will be provided with any respiratory support needed while hospitalized.

Rationale 3: Information regarding the surgery should be shared at the patients direction, but this is not the next action.

Rationale 4: Continuous positive airway pressure (CPAP) machines are used in treatment of obstructive sleep apnea. Notifying anesthesia is critical because the patient could be at risk for hypoxemia during the surgical procedure and would need careful monitoring during and after the procedure.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 17-2

Question 16

Type: MCSA

Which preoperative finding should the nurse report immediately to the rest of the health care team?

1. No prior patient history or family history of malignant hyperthermia

2. Patients age greater than 70

3. Heart rate of 88 beats per minute

4. Latex allergy

Correct Answer: 4

Rationale 1: A patient history or family history of malignant hyperthermia would be critical information to relay to the health care team, but the fact that this patient does not have a history is not critical information.

Rationale 2: A patient who is older than 70 may have some increased surgical risks, but this would not require immediate communication with the health care team.

Rationale 3: A heart rate of 88 beats per minute is within normal limits.

Rationale 4: A patient who has a latex allergy will require special accommodations to ensure that there is no contact with products that contain latex.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-2

Question 17

Type: MCMA

A preoperative patient has a serum albumin level of 2.8 mg/dL. The nurse recognizes that this finding places the patient at higher risk for which postoperative complication?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Pneumonia

2. Bleeding

3. Increased pain

4. Blood clots

5. Infection

Correct Answer: 1,5

Rationale 1: A preoperative patient with a low serum albumin level of 2.8 mg/dL is at increased risk of postoperative pulmonary complications.

Rationale 2: This finding does not put the patient at greater risk of bleeding.

Rationale 3: This finding does not put the patient at greater risk for increased pain.

Rationale 4: This finding does not put the patient at greater risk for blood clots.

Rationale 5: A patient with poor nutritional status as evidenced by low albumin is at risk for infection.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 17-1

Question 18

Type: MCMA

A 28-year-old female patient has the following preoperative assessment: type 1 diabetes; no other significant health or family history; no recent surgeries; no use of alcohol, tobacco products, or illegal drugs; medications include insulin and aspirin. The nurse can anticipate which tests to be performed preoperatively?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Urine pregnancy test

2. Serum glucose

3. Chest X-ray

4. ECG

5. Hemoglobin and hematocrit

Correct Answer: 1,2,5

Rationale 1: A urine pregnancy test is performed on all menstruating females.

Rationale 2: Because this patient is diabetic, a serum glucose will likely be drawn.

Rationale 3: A chest X-ray is not essential for a young adult who does not smoke.

Rationale 4: This patient has no history of cardiac disease, so an ECG is not indicated.

Rationale 5: Hemoglobin and hematocrit are measured on all menstruating females.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 17-3

Question 19

Type: MCSA

A patient is receiving preoperative teaching. Which information should the nurse provide?

1. Teaching regarding the call lights and bed controls for the medical-surgical unit

2. Teaching regarding pain control in the postanesthesia recovery room (PACU)

3. Teaching regarding patient medications upon discharge

4. Teaching regarding the type of IV pump the patient will have after discharge to home health

Correct Answer: 2

Rationale 1: The call light and bed controls will be different for the beds in the surgical areas and thus are discussed when the patient reaches the medical-surgical unit.

Rationale 2: Preoperative teaching will include a discussion regarding potential pain control in the postanesthesia recovery room (PACU).

Rationale 3: The medical-surgical nurse will provide the final medication teaching upon discharge.

Rationale 4: Discussions regarding the IV pump for home use will be done by the home health nurse.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-5

Question 20

Type: MCSA

For which patient is the nurse most likely to request an order for a preoperative chest X-ray?

1. A 22-year-old with Down syndrome

2. A 50-year-old with a history of gallbladder disease

3. A 16-year-old with a history of abdominal pain

4. A 55-year-old current smoker with a recent productive cough

Correct Answer: 4

Rationale 1: Down syndrome by itself is not a reason to request a chest X-ray.

Rationale 2: The 50-year-old with a history of gallbladder disease has no past medical history of pulmonary or cardiac complications that would warrant a chest X-ray.

Rationale 3: The 16-year-old with a history of abdominal pain has no past medical history of pulmonary or cardiac complications that would warrant a chest X-ray.

Rationale 4: The 55-year-old smoker with a recent productive cough would have the greatest need for a preoperative chest X-ray due to the potential for preoperative pneumonia or infiltrates or postoperative pulmonary complications.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-4

Question 21

Type: MCSA

The nurse is providing preoperative teaching for a patient who will be having a coronary artery bypass graft (CABG). What is a priority nursing intervention for this patient?

1. Ensure the patient and family understand the various tubes that the patient will have in place.

2. Teach the patient about an incentive spirometer.

3. Discuss the location of the bed controls in the intensive care unit.

4. Teach the patient to request pain medication when the pain is unbearable.

Correct Answer: 1

Rationale 1: The patient and family need to understand the location of the incision and the various tubes that the patient will have in place when the family first sees the patient after the surgery.

Rationale 2: Teaching about the use of the incentive spirometer is important, but it is not the highest priority.

Rationale 3: The location of the bed controls in the ICU becomes an issue after the patient arrives there.

Rationale 4: The patient should be taught to request pain medications before pain is severe. Pain will initially be managed by the nurse.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-5

Question 22

Type: MCSA

The nurse is preparing a preoperative plan of care for an older Hispanic patient who is scheduled for a hysterectomy. What does the nurse recognize as the priority initial intervention?

1. Teach the patient about turning, coughing, and deep breathing.

2. Discuss the patients concerns about the surgery.

3. Explain that the patients pain will be controlled during the postoperative time frame.

4. Determine if the patient understands English or if an interpreter is needed.

Correct Answer: 4

Rationale 1: Teaching about postoperative breathing exercises is not the first priority.

Rationale 2: Discussing patient concerns is important but is not the first priority.

Rationale 3: Pain control is important but is not the first priority.

Rationale 4: The initial intervention should be determining whether the patient speaks and understands English. If not, an interpreter must be provided so that the patient understands all preoperative instructions and education.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-4

Question 23

Type: MCSA

A patient who is having outpatient gallbladder surgery states he will have a ride to the hospital for the surgery, but not a ride home, and he does not have anyone to be with him at home. Which nursing response is most appropriate at this time?

1. The health care provider will refuse to do the surgery on a patient who must go home alone.

2. Would it be better to reschedule your surgery until a day when you have someone who can take you home?

3. I am sorry; you will not be able to have your surgery then.

4. No problem, you can drive yourself home after the surgery.

Correct Answer: 2

Rationale 1: Telling the patient that the health care provider will refuse to do surgery is not helpful and may be interpreted as confrontational.

Rationale 2: The nurses priority is to assist the patient with alternatives for transportation.

Rationale 3: Telling the patient he cannot have surgery is not therapeutic and could be considered more punitive than helpful.

Rationale 4: The patient should not be told it is okay to drive himself home, as this could create liability for the institution.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-4

Question 24

Type: MCSA

Research allows nurses to validate and enhance nursing care. Which research question would be most relevant to promoting nursing care and outcomes for the preoperative patient?

1. How does the interaction of the patient with the health care provider impact the patients long-term recovery?

2. What is the optimal timing for preoperative teaching?

3. How much pain medicine does the patient prefer?

4. When should the patient be discharged?

Correct Answer: 2

Rationale 1: How well the patient interacts with the health care provider would be a research study for the medical community.

Rationale 2: The timing of preoperative teaching is nurse-focused and will improve patient care.

Rationale 3: The question of how much pain medicine patients prefer is too broad for a research study, although it could be narrowed and modified.

Rationale 4: The question of when patients should be discharged is too broad for a research study, although it could be narrowed and modified.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 17-5

Question 25

Type: MCSA

The nurse wonders if a patients outcome would be better if the patient stopped smoking 3 weeks or 2 months before surgery. This is an example of which concept?

1. A question to ask the patient

2. The nurses ability to think critically

3. A question to ask the health care provider

4. A potential nursing research question

Correct Answer: 4

Rationale 1: The patient would not know the answer to this question.

Rationale 2: Critical thinking does include questioning current practice. However, another option is more complete.

Rationale 3: The health care provider would likely have ideas on which time frame would be most beneficial, but research would help prove which time frame had a better outcome.

Rationale 4: This nurse asks the question, What is the optimal time frame for the patient to quit smoking to achieve the best outcome? This is a potential research question.

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 17-4

Question 26

Type: FIB

A patient has postponed an elective surgical procedure. The nurse would advise the patient that a new preoperative health assessment will be necessary if the original assessment document is over _____ days old.

Standard Text:

Correct Answer: 30

Rationale : A preoperative health evaluation is done within 30 days of a planned operation and must be documented in the patients medical record.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-1

Question 27

Type: MCSA

According to the medical record a patient is classified as an ASA I. The nurse assessing this patient would plan care for which situation?

1. A patient with severe chronic illness

2. A normally healthy patient

3. A patient with a mild underlying illness

4. A patient whose organs are being harvested for transplant

Correct Answer: 2

Rationale 1: A patient with severe chronic illness is classified as ASA III or ASA IV.

Rationale 2: A healthy, normal patient is classified as ASA I.

Rationale 3: A patient with mild systemic disease is classified as ASA II.

Rationale 4: A patient who is brain dead and whose organs are being removed for transplant is classified as ASA VI.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 17-1

Question 28

Type: MCMA

A patient asks the nurse about the possibility of donating blood for his upcoming surgery. Which information should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. You must have approval from your surgeon.

2. You must have a hemoglobin level of at least 14 g/dL to donate blood to yourself.

3. As long as you are still in good health, this plan can be considered.

4. Because you have an intermittent fever, this donation is not possible.

5. This is a type of directed donation that is not recommended.

Correct Answer: 1,3,4

Rationale 1: The surgeon or health care provider must approve this donation.

Rationale 2: The hemoglobin level required is 11 g/dL or higher, so the nurse is providing incorrect information.

Rationale 3: The patient must be in good health to make an autologous blood donation.

Rationale 4: The patient must be afebrile.

Rationale 5: As long as the patient meets all of the criteria, autologous blood donation is acceptable and may be a good idea for some patients.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-3

Question 29

Type: MCMA

A patient who has a permanent pacemaker must have surgery to repair a bowel obstruction. Which information should the nurse provide this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Because the surgical area is in your abdomen, the fact that you have a pacemaker is not important.

2. Some changes in medication given during the surgery will be necessary.

3. Your surgeon will need information about the type of pacemaker.

4. Your pacemaker will have to be turned off before surgery.

5. Cardiac monitoring during surgery will be different because you have a pacemaker.

Correct Answer: 2,3

Rationale 1: The presence of a pacemaker is a significant complication in all surgeries.

Rationale 2: Succinylcholine can cause muscle fasciculations that interfere with pacemaker function.

Rationale 3: The surgeon will need information about the type of device, lead system, and availability of technical support.

Rationale 4: There is no reason for the pacemaker to be turned off. Implantable cardioverter defibrillators are turned off prior to surgery.

Rationale 5: Cardiac monitoring during surgery is the same for all patients.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 17-2

Question 30

Type: MCMA

A 45-year-old woman is scheduled for an abdominal hysterectomy. She is a nonsmoker and has been taking opioid medications for pain control. She has a history of asthma and hypertension and is 20 pounds overweight. Which assessment data would the nurse evaluate as indicating increased risk for postoperative nausea and vomiting?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. She is middle-aged.

2. The scheduled surgery is gynecologic.

3. The patient has been taking opioid medications.

4. The patient is overweight.

5. The patient is female.

Correct Answer: 2,3,5

Rationale 1: Age is not a significant risk factor for postoperative nausea and vomiting.

Rationale 2: Gynecologic, abdominal, ear, and eye surgeries increase the risk for postoperative nausea and vomiting.

Rationale 3: Opioid use increases the risk for postoperative nausea and vomiting.

Rationale 4: Being overweight is not a risk for postoperative nausea and vomiting.

Rationale 5: Being female increases the risk for postoperative nausea and vomiting.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 17-4

 

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