Chapter 18: Nursing Management: Preoperative Care My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 18: Nursing Management: Preoperative Care

Test Bank

MULTIPLE CHOICE

1. During the preoperative interview, a patient scheduled for an elective hysterectomy tells the nurse, I am afraid that I will die in surgery like my mother did! Which response by the nurse is most appropriate?

a.

Tell me more about what happened to your mother.

b.

You will receive medications to reduce your anxiety.

c.

You should talk to the doctor again about the surgery.

d.

Surgical techniques have improved a lot in recent years.

ANS: A

The patients statement may indicate an unusually high anxiety level or a family history of problems such as malignant hyperthermia, which will require precautions during surgery. The other statements also may address the patients concerns, but further assessment is needed first.

DIF: Cognitive Level: Application REF: 335-337

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. A patient arrives at the ambulatory surgery center for a scheduled outpatient surgery. Which information is of most concern to the nurse?

a.

The patient has not had outpatient surgery before.

b.

The patient is planning to drive home after surgery.

c.

The patients insurance does not cover outpatient surgery.

d.

The patient had a glass of water a few hours before arriving.

ANS: B

After outpatient surgery, the patient should not drive home and will need assistance with transportation and home care. The patients experience with outpatient surgery is assessed, but it does not have as much application to the patients physiologic safety. The patients insurance coverage is important to establish, but this is not usually the nurses role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually increase risk for aspiration.

DIF: Cognitive Level: Application REF: 343

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

3. A 36-year-old woman is admitted for an outpatient surgery. Which information obtained by the nurse during the preoperative assessment is most important to report to the anesthesiologist before surgery?

a.

The patients lack of knowledge about postoperative pain control measures

b.

The patients statement that her last menstrual period was 8 weeks previously

c.

The patients history of a postoperative infection following a prior cholecystectomy

d.

The patients concern that she will be unable to care for her children postoperatively

ANS: B

This statement suggests that the patient may be pregnant, and pregnancy testing is needed before administration of anesthetic agents. Although the other data also may be communicated with the surgeon and anesthesiologist, they will affect postoperative care and do not indicate a need for further assessment before surgery.

DIF: Cognitive Level: Application REF: 339

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

4. A patient who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwifruit, and latex products. Which action is most important for the nurse to take?

a.

Notify the dietitian about the food allergies.

b.

Alert the surgery center about the latex allergy.

c.

Reassure the patient that all allergies are noted on the medical record.

d.

Ask whether the patient uses antihistamines to reduce allergic reactions.

ANS: B

When a patient is allergic to latex, special nonlatex materials are used during surgical procedures and the staff will need to know about the allergy in advance to obtain appropriate nonlatex materials and have them available on the surgical date. The other actions also may be appropriate, but prevention of allergic reaction (either contact dermatitis or anaphylaxis) during surgery is the most important action.

DIF: Cognitive Level: Application REF: 338

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

5. Any patient guilt about having a therapeutic abortion may be identified when the nurse assesses the functional health pattern of

a.

value-belief.

b.

cognitive-perceptual.

c.

sexuality-reproductive.

d.

coping-stress tolerance.

ANS: A

The value-belief pattern includes information about conflicts between a patients values and proposed medical care. In the cognitive-perceptual pattern, the nurse will ask questions about pain and sensory intactness. The sexuality-reproductive pattern includes data about the impact of the surgery on the patients sexuality. The coping-stress tolerance pattern assessment will elicit information about how the patient feels about the surgery.

DIF: Cognitive Level: Comprehension REF: 340 | 341

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

6. During the preoperative assessment of a patient scheduled for a colon resection, the patient tells the nurse about using St. Johns wort to prevent depression. The nurse should alert the staff in the postanesthesia recovery area that the patient may

a.

experience increased pain.

b.

have hypertensive episodes.

c.

take longer to recover from the anesthesia.

d.

have more postoperative bleeding than expected.

ANS: C

St. Johns wort may prolong the effects of anesthetic agents and increase the time to waken completely after surgery. It is not associated with increased bleeding risk, hypertension, or increased pain.

DIF: Cognitive Level: Application REF: 337-338

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

7. On the day of surgery, the nurse is admitting a patient with a history of cigarette smoking. Which action is most important at this time?

a.

Auscultate for adventitious breath sounds.

b.

Ask whether the patient has smoked recently.

c.

Remind the patient about harmful effects of smoking.

d.

Calculate the cigarette smoking history in pack-years.

ANS: A

Abnormal breath sounds may indicate the presence of an acute respiratory infection or chronic lung disease that will affect the choice of anesthesia and/or proceeding with the scheduled surgery. The other nursing actions also are appropriate but will not affect the immediate surgical procedure as much as the presence of abnormal breath sounds.

DIF: Cognitive Level: Application REF: 339

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

8. A patient is seen at the health care providers office several weeks before hip surgery for preoperative assessment. The patient reports use of echinacea, saw palmetto, and glucosamine/chondroitin. The nurse should

a.

ascertain that there will be no interactions with anesthetic agents.

b.

discuss the supplement use with the patients health care provider.

c.

teach the patient that these products may be continued preoperatively.

d.

advise the patient to stop the use of all herbs and supplements at this time.

ANS: B

The nurse should discuss the medication use with the patients health care provider because saw palmetto is used to decrease prostatic hyperplasia, and the patient may need to continue taking the medication or a prescription medication to prevent urinary retention. The nurse should not advise the patient to stop the supplements or to continue them without consulting with the health care provider. Determining the interactions between the supplements and anesthetics is not within the nurses scope of practice.

DIF: Cognitive Level: Comprehension REF: 337-338

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

9. Before the administration of preoperative medications, the nurse is preparing to witness the patient signing the operative consent form when the patient says, I do not really understand what the doctor said. Which action is best for the nurse to take?

a.

Provide an explanation of the planned surgical procedure.

b.

Notify the surgeon that the informed consent process is not complete.

c.

Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications.

d.

Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.

ANS: B

The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurses legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient signs the consent form.

DIF: Cognitive Level: Application REF: 344

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

10. Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for a colon resection?

a.

Care for the surgical incision

b.

Medications used during surgery

c.

Deep breathing and coughing techniques

d.

Oral antibiotic therapy after discharge home

ANS: C

Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this information. The patient does not usually need information about medications that are used intraoperatively.

DIF: Cognitive Level: Application REF: 341 | 343

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

11. Ten minutes after receiving the ordered preoperative opioid by intravenous (IV) injection, the patient asks to get up to go to the bathroom to urinate. The most appropriate action by the nurse is to

a.

assist the patient to the bathroom and stay with the patient to prevent falls.

b.

offer a urinal or bedpan and position the patient in bed to promote voiding.

c.

allow the patient up to the bathroom because the onset of the medication takes more than 10 minutes.

d.

ask the patient to wait because catheterization is performed at the beginning of the surgical procedure.

ANS: B

The patient will be at risk for a fall after receiving the opioid, so the best nursing action is to have the patient use a bedpan or urinal. Having the patient get up either with assistance or independently increases the risk for a fall. The patient will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room.

DIF: Cognitive Level: Application REF: 344-345

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

12. An alert 82-year-old who has poor hearing and vision is receiving preoperative teaching from the nurse. His wife answers most questions directed to the patient. Which action should the nurse take when doing the teaching?

a.

Use printed materials for instruction so that the patient will have more time to review the material.

b.

Direct the teaching toward the wife because she is the obvious support and caregiver for the patient.

c.

Provide additional time for the patient to understand preoperative instructions and carry out procedures.

d.

Ask the patients wife to wait in the hall in order to focus preoperative teaching with the patient himself.

ANS: C

The nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because the patient has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the patient and the wife because both will need to understand preoperative procedures and teaching.

DIF: Cognitive Level: Application REF: 347 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

13. A diabetic patient who uses insulin to control blood glucose has been NPO since midnight before having a mastectomy. The nurse will anticipate the need to

a.

withhold the usual scheduled insulin dose because the patient is NPO.

b.

obtain a blood glucose measurement before any insulin administration.

c.

give the patient the usual insulin dose because stress will increase the blood glucose.

d.

administer a lower dose of insulin because there will be no oral intake before surgery.

ANS: B

Preoperative insulin administration is individualized to the patient, and the current blood glucose will provide the most reliable information about insulin needs. It is not possible to predict whether the patient will require no insulin, a lower dose, or a higher dose without blood glucose monitoring.

DIF: Cognitive Level: Application REF: 339 TOP: Nursing Process: Planning

MSC: NCLEX: Physiological Integrity

14. The clinic nurse reviews the complete blood cell count (CBC) results for a patient who is scheduled for surgery in a few days. The results are white blood cell count (WBC) 10.2 103/L; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 103/L. Which action should the nurse take?

a.

Send the CBC results to the surgery facility.

b.

Call the surgeon and anesthesiologist immediately.

c.

Ask the patient about any symptoms of a recent infection.

d.

Discuss the possibility of blood transfusion with the patient.

ANS: A

The nurse should be sure that the CBC results, which are normal, are available at the surgical facility to avoid delay of the procedure. With normal results, there is no need to notify the surgeon or anesthesiologist, discuss blood transfusion, or ask about recent infection.

DIF: Cognitive Level: Application REF: 340

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

15. As the nurse prepares a patient the morning of surgery, the patient refuses to remove a wedding ring, saying, I have never taken it off since the day I was married. The nurse should

a.

have the patient sign a release and leave the ring on.

b.

tape the wedding ring securely to the patients finger.

c.

tell the patient that the hospital is not liable for loss of the ring.

d.

suggest that the patient give the ring to a family member to keep.

ANS: B

The ring can be taped to the patients finger and noted on the preoperative checklist. There is no need for a release form or to discuss liability with the patient. Wearing the ring is obviously important to the patient, so the nurse should tape the ring in place rather than have a family member keep the ring for the patient.

DIF: Cognitive Level: Application REF: 345

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

16. A patient is to receive atropine before surgery. The nurse teaches the patient to expect

a.

dizziness.

b.

weakness.

c.

dry mouth.

d.

forgetfulness.

ANS: C

Anticholinergic medications decrease oral secretions, so the patient is taught that a dry mouth is an expected side effect. Weakness, forgetfulness, and dizziness are side effects associated with other preoperative medications such as opioids and benzodiazepines.

DIF: Cognitive Level: Application REF: 347

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

17. The nurse is obtaining the health history for a patient who is scheduled for outpatient knee surgery. Which statement by the patient is most important to report to the health care provider?

a.

I had a heart valve replacement last year.

b.

I had bacterial pneumonia 6 months ago.

c.

I have knee pain whenever I walk or jog.

d.

I have a strong family history of breast cancer.

ANS: A

A patient with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may affect whether the patient should have surgery, but a history of pneumonia is not a reason to postpone surgery. The patients knee pain is the likely reason for the surgery. A family history of breast cancer does not have any implications for the current surgery.

DIF: Cognitive Level: Application REF: 339 | 345

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

18. When the nurse interviews a patient who is to have outpatient surgery using a general anesthetic, which information is most important to communicate to the surgeon and anesthesiologist before surgery?

a.

The patient drinks 3 or 4 cups of coffee every morning before going to work.

b.

The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago.

c.

The patient drank 4 ounces of apple juice 3 hours before coming to the hospital.

d.

The patients father died after receiving general anesthesia for abdominal surgery.

ANS: D

The information about the patients father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.

DIF: Cognitive Level: Application REF: 337 | 343-345

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

19. Which information about medication use in a preoperative patient is most important to communicate to the health care provider?

a.

The patient uses acetaminophen (Tylenol) occasionally for aches and pains.

b.

The patient takes garlic capsules daily but did not take any on the surgical day.

c.

The patient has a history of cocaine use but quit using the drug over 10 years ago.

d.

The patient took a sedative medication the previous night to assist in falling asleep.

ANS: B

Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome.

DIF: Cognitive Level: Application REF: 337-338

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

20. A 24-year-old who takes a diuretic and a -blocker to control blood pressure is scheduled for abdominal surgery. Which patient information is most important to communicate to the health care provider before surgery?

a.

Pulse rate 59

b.

Hematocrit 35%

c.

Blood pressure 142/78

d.

Serum potassium 3.3 mEq/L

ANS: D

The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of patient anxiety. The heart rate would be expectedin a patient taking a -blocker. The hematocrit is in the low normal range but does not require any intervention before surgery.

DIF: Cognitive Level: Application REF: 340

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity

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