Chapter 40. Perioperative Nursing My Nursing Test Banks

Chapter 40. Perioperative Nursing

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. The preoperative phase encompasses which period of time?

1)

Entry to the operating suite until admission to postanesthesia care

2)

Entry into the operating suite until discharge from the hospital

3)

The decision to have surgery until admission to postanesthesia care

4)

The decision to have surgery until entry to the operating suite

ANS: 4

The preoperative phase begins with the decision to have surgery and ends when the patient enters the operating room. The intraoperative phase begins when the patient enters the operating suite and ends when the patient is admitted to the postanesthesia care unit.

PTS:1DIF:EasyREF:p 1448

KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Comprehension

____ 2. A 2-year-old child is scheduled for a tonsillectomy. When determining the plan of care, the nurse should:

1)

Include the parents or caregivers in the plan of care.

2)

Explain to the child that she will have a sore throat after surgery.

3)

Tell the child that she can have her favorite foods for the first 24 hours after surgery.

4)

Prepare the child for discharge from the hospital as soon as she is alert.

ANS: 1

It is developmentally normal for toddlers to experience anxiety with separation from parents or caregivers. Be sure to include these people in the plan of care. Developmentally, a 2-year-old lives in the here and now and wouldnt grasp an intangible concept, such as pain in the future. The toddler would take liquids and soft foods within the first 24 hours when her throat is sore during swallowing. She should not eat foods that are rough and crunchy because they may scratch her throat and cause bleeding. After a tonsillectomy, the child will need to be monitored for bleeding and stable vital signs; therefore, she will not be discharged as soon as she is alert.

PTS: 1 DIF: Moderate REF: pp. 1449, 1455

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Synthesis

____ 3. Which of the following is the most appropriate nursing goal for a 2-year-old who is to have a tonsillectomy?

1)

Separation anxiety will be minimal.

2)

The child will verbalize understanding of expected pain.

3)

The child will tolerate a normal diet 24 hours after surgery.

4)

The parent will indicate readiness to assume the childs care.

ANS: 1

The only concrete information in this question is that the child is 2 years old. Therefore, the only problem the nurse can reasonably predict from this would be developmental in nature. It is developmentally normal for toddlers to experience anxiety with separation from parents or caregivers. Minimizing anxiety by involving the parents or caregivers would be the appropriate goal for separation anxiety. A 2-year-old child would not be expected to verbalize understanding of expected pain. The toddler would take liquids and soft foods within the first 24 hours when her throat is sore during swallowing. She should not eat foods that are rough and crunchy because they may scratch her throat and cause bleeding. Nurses should encourage parental involvement, but parents should not be expected to assume the childs care.

PTS:1DIFifficult

REF: p. 1449; critical-thinking question requiring synthesis of previously learned knowledge

KEY: Nursing process: Planning | Client need: PSI | Cognitive level: Application

____ 4. The focus of nursing activities in the preoperative phase is to:

1)

Admit the patient to the surgical suite.

2)

Prepare the patient mentally and physically for surgery.

3)

Set up the sterile field in the operating room.

4)

Perform the primary surgical scrub to the surgical site.

ANS: 2

The nursing focus in the preoperative phase is to prepare the patient mentally and physically for surgery. The patient is in the intraoperative phase when admitted to the surgical suite. The sterile field and the surgical scrub would be performed in the surgery suite during the intraoperative phase.

PTS:1DIF:EasyREF:p. 1451

KEY: Nursing process: Planning | Client need: PHSI | Cognitive level: Application

____ 5. A patient is scheduled for abdominal surgery tomorrow. While gathering preoperative data, the nurse learns that the patient takes the following medications daily: an anticoagulant, a multivitamin, and vitamin E 1,500 IU. The patient reports that he stopped taking the anticoagulant 4 days ago as instructed by the surgeon. He has continued to take the multivitamin and vitamin E. Based on the information given, the nurse notifies the surgeon because she:

1)

Needs an order to restart the anticoagulant.

2)

Is concerned about continued use of the multivitamin.

3)

Is concerned about the vitamin E dosage.

4)

Has canceled the surgery so more lab tests can be done.

ANS: 3

Both prescribed and over-the-counter medications may increase surgical risk. Many herbs can cause potassium loss and increase the risk for cardiac arrhythmias. High doses of vitamin E may increase the risk for bleeding. This patients use of 1,500 IU of vitamin E daily exceeds the recommended dosage, so the nurse should inform the surgeon of the vitamin E intake. Generally, the surgeon or anesthesiologist instructs patients to continue or discontinue taking their prescribed medicines. However, it is important to assess use of supplements and over-the-counter medicines. The nurse cannot cancel surgery without an order from the surgeon, who determines whether the surgery should be delayed or whether it is so urgent that it needs to continue as scheduled, even with the additional risk factor of the vitamin E dosage.

PTS:1DIFifficultREF:p. 1450

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Analysis

____ 6. A patient is admitted for hip surgery. The patient usually takes the following medications daily: an anticoagulant, a multivitamin, and vitamin E 1,500 IU. He stopped taking his anticoagulant 4 days ago as instructed by his surgeon, but has continued to take the multivitamin and vitamin E. An important problem for this patient is which of the following?

1)

Potential complication: anemia

2)

Risk for infection related to inadequate anticoagulant dosage

3)

Risk for noncompliance related to inability to follow instructions

4)

Risk for bleeding

ANS: 4

The patient is at an increased risk for bleeding due to his intake of vitamin E. He may be at risk for anemia if he experiences a large blood loss in surgery; however, this problem is not appropriate before he experiences the blood loss. This patient does not have a higher-than-average risk for infection because he is not having surgery involving a contaminated system (e.g., the gastrointestinal system). There is no evidence to suggest that this patient is noncompliant simply because he stopped taking his anticoagulant as ordered.

PTS:1DIFifficultREF:p. 1450

KEY: Nursing process: Diagnosis | Client need: PHSI | Cognitive level: Analysis

____ 7. A patient is admitted from a local skilled nursing facility to the outpatient surgery center for surgical dbridement of a stage IV sacral pressure ulcer. The perioperative nurse discovers that the patient does not have a signed consent form for the surgery on the chart or in the surgery center. The patient says that she has not talked to the surgeon and that she has many questions regarding her surgery. When informed of this, the surgeon tells the nurse to have the patient sign the informed consent form, and he will review it prior to the surgery. What should the nurse do?

1)

Follow the surgeons orders, and ask the patient to sign the surgical consent form.

2)

Inform the surgeon that she will have the patient sign after he discusses the surgery with the patient.

3)

Ensure that the signed surgical consent is witnessed by two nurses, because the surgeon is not available.

4)

Cancel the surgery and transfer the patient back to the long-term care facility.

ANS: 2

Informed surgical consent requires that the surgeon present information about the surgery to the patient, that the patient understands the information and agrees to the surgery, and that the patient has not been coerced to give consent. As a patient advocate, the nurse should verify with the patient that the surgeon has explained the procedure and answered all her questions. The surgeon is responsible for giving the patient the necessary information and determining the patients competence to make an informed decision about the surgery. If the patient has further questions, the nurse should notify the surgeon and delay sending the patient to surgery until an informed consent is obtained.

PTS:1DIFifficultREF:p. 1455, 1458

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

____ 8. Identify the type of surgery a terminally ill patient will undergo if the purpose is removal of tissue to relieve pain.

1)

Procurement

2)

Ablative

3)

Palliative

4)

Diagnostic

ANS: 3

Palliative surgery alleviates discomfort or other disease symptoms without producing a cure. Procurement surgery occurs when an organ or tissue is harvested for transplantation into another. Ablative surgery involves removal of a body part. Diagnostic surgery confirms or negates a diagnosis.

PTS:1DIF:EasyREF:p. 1449

KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall

____ 9. A patient had a hiatal hernia repair earlier today and is now in the postanesthesia care unit (PACU). The family asks the nurse why the patient is in the PACU rather than back in his room on the postsurgical unit. The nurse should inform the family that:

1)

Patients who have had surgical complications are observed in the PACU until they are stable enough to return to the floor.

2)

Patients recover from the effects of anesthesia in the PACU and then return to the postsurgical unit for further care.

3)

The PACU is a holding area for patients awaiting a surgical unit bed or awaiting adequate staff to provide care on the postsurgical unit.

4)

The nurse will ask the surgeon explain to them why the patient is not on the postsurgical unit, as is the usual procedure.

ANS: 2

A client remains in the PACU until he has recovered from the effects of anesthesia. In the PACU, the client is assessed every 5 to 15 minutes in order to quickly identify surgical or anesthesia-related problems. Most surgical units routinely admit patients to the PACU for a period of observation. Admission to the PACU does not indicate surgical complications or imply that a holding area is required. There is no reason the surgeon would need to explain this to the family, as the nurse could communicate the procedure. It is not usual procedure for a patient to be transferred directly from surgery to the postsurgical unit.

PTS:1DIF:ModerateREF:p. 1471

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

____ 10. The focus of nursing care in the intraoperative phase is to:

1)

Prepare the patient for surgery.

2)

Maintain the sterile field.

3)

Ensure patient safety during the surgery.

4)

Obtain a signed informed consent.

ANS: 3

The intraoperative phase begins when the patient enters the operating suite and ends when the patient is admitted to the postanesthesia care unit. The nursing focus is to ensure patient safety during the surgical procedure by functioning as an advocate when clients cannot advocate for themselves and by monitoring the client and surgical environment throughout the procedure. Although the sterile field must be maintained in this phase and sterility contributes to patient safety, the focus of care is broader than the maintenance of sterility. Obtaining informed consent and preparing the patient for surgery are activities associated with the preoperative phase.

PTS:1DIF:EasyREF:p. 1463

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Comprehension

____ 11. The nurse has a prescription to give a series of medications on an on call basis. The nurse realizes that these medications will be given:

1)

In the postanesthesia recovery unit.

2)

At the time specified in the order.

3)

On the patients arrival in the surgery suite.

4)

When the OR staff notify the nurse to do so.

ANS: 4

The anesthesia team may order medications to be given on call if the surgery time is likely to vary. The nurse will give on call medications when he is notified to do so by the OR staff.

PTS:1DIF:EasyREF:p. 1460

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension

____ 12. A patient has chronic confusion secondary to dementia. As a result, he is unable to sign an informed consent for surgery. In this situation:

1)

An informed consent is not needed.

2)

Two nurses may sign the informed consent for the patient.

3)

The surgeon must sign the informed consent.

4)

A family member will be asked to sign the informed consent.

ANS: 4

In most states, a family member, conservator, or legal guardian may give consent for a procedure if a patient is not capable of giving an informed consent or if the patient is a minor.

PTS:1DIF:ModerateREF:p. 1458

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

____ 13. The patient tells the nurse, Im so nervous. I want to be knocked out for the surgery so that I dont know what is going on. When the nurse communicates with the surgeon and anesthetist, she tells them that the patient desires which type of anesthesia?

1)

Conscious sedation

2)

General anesthesia

3)

Local anesthesia

4)

Regional anesthesia

ANS: 2

General anesthesia produces rapid unconsciousness and loss of sensation. During conscious sedation, the client feels sleepy but is easily aroused by touch or speech. Regional anesthesia interrupts nerve impulses to and from the affected area, but the patient remains alert. Local anesthesia produces loss of pain sensation at the desired site and is typically used for minor procedures. The client remains alert during local anesthesia.

PTS:1DIF:EasyREF:p. 1464

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension

____ 14. A patient is to have a sequential compression device (SCD) applied on the postoperative unit. The patient is wearing knee-high elastic (antiembolism) stockings. When applying the SCD, what should the nurse do?

1)

Remove the antiembolism stockings and not replace them.

2)

Replace the knee-high stockings with thigh-high stockings.

3)

Notify the surgeon that the patient is wearing antiembolism stockings.

4)

Apply the SCD over the knee-high antiembolism stockings.

ANS: 4

If elastic stockings have been ordered with the sequential compression device, leave them in place; if the patient is not yet wearing them, obtain them and put them on the patient. Knee-high stockings do not need to be replaced with thigh-high stockings. Some research has shown knee-high stockings to be equally effective. There is no need to notify the surgeon, as patients commonly return from surgery wearing antiembolism stockings, as prescribed.

PTS: 1 DIF: Moderate REF: p. 1490

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. Surgeries are commonly classified by which of the following? Choose all that apply.

1)

Acuity

2)

Level of urgency

3)

Length of surgery

4)

Organ involved

ANS: 1, 2

Surgeries can be classified by body systems, purpose, level of urgency, and degree of seriousness (acuity). The length of surgery and organ involved are not used for classifying surgeries.

PTS:1DIF:ModerateREF:p. 1449

KEY: Nursing process: N/A | Client need: SECE | Cognitive level: Analysis

____ 2. Which of the following describes the Perioperative Nursing Data Set? Choose all that apply.

1)

A standardized tool for assessing high-risk surgical patients

2)

A standardized vocabulary encompassing all surgical patient outcomes

3)

The first specialized nursing language recognized by the ANA

4)

A standardized language designed to describe the care of perioperative patients

ANS: 3, 4

The Perioperative Nursing Data Set (PNDS) is a standardized vocabulary specifically designed to describe the care of perioperative clients. It consists of 74 nursing diagnoses, 133 nursing interventions, and 28 nurse-sensitive patient outcomes appropriate for use in any surgical setting. It was the first specialty language recognized by the ANA.

PTS:1DIFifficultREF:p. 1451

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension

____ 3. The nurse is caring for a patient who had abdominal surgery 3 days ago and will be discharged home later today. The nurse will know that teaching is effective if the patient does which of the following? Choose all that apply.

1)

Describes clinical findings associated with infection

2)

Performs the dressing change as prescribed

3)

Demonstrates absence of surgical incision pain

4)

Completes the regimen of prescribed antibiotics

ANS: 1, 2, 4

The nurse would know that patient teaching was effective if the patient verbalizes signs and symptoms of infection, can perform the ordered dressing change, and completes the regimen of ordered antibiotics. Nurses cannot teach a patient to be free of pain. Pain is subjective. The nurse can teach the patient strategies to assist with pain, but they may not remove the pain completely.

PTS:1DIF:ModerateREF:p. 1481

KEY: Nursing process: Evaluation | Client need: PHSI | Cognitive level: Application

____ 4. Which of the following members of the operative team use sterile technique during the surgical procedure? Choose all that apply.

1)

Surgeon

2)

Anesthetist

3)

Scrub nurse

4)

Registered nurse first assistant

ANS: 1, 3, 4

The anesthetist is a member of the clean team and remains outside the sterile field. Members of the sterile team include the surgeon, the scrub nurse, and the registered first nurse assistant.

PTS:1DIF:ModerateREF:p. 1463

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Recall

____ 5. A young adult woman is scheduled for a bilateral breast reduction under general anesthesia. She is normally healthy and takes no daily medications. Identify the preoperative screening tests appropriate for this patient. Choose all that apply.

1)

Urinalysis

2)

EKG

3)

Creatinine clearance

4)

CBC

ANS:1, 4

Preoperative screening tests are ordered to determine if the client has undetected underlying health concerns. Most institutions require a complete blood count (CBC) and urinalysis prior to all surgical procedures. Generally, an electrocardiograph (ECG) is ordered for clients over the age of 50 years or with known cardiac disease. A creatinine clearance is not a routine presurgical screening test.

PTS: 1 DIF: Moderate REF: pp. 1451, 1454

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Application

____ 6. Identify the desired effects of general anesthesia. Choose all that apply.

1)

Reduction of risk

2)

Analgesia

3)

Amnesia

4)

Muscle relaxation

ANS: 2, 3, 4

General anesthesia is used to control pain (analgesia), relax muscles, and promote amnesia. Anesthesia is not used for the purpose of obtaining a reduction in risk potential; however, surgical risk is influenced by the type of anesthesia used.

PTS: 1 DIF: Moderate REF: p. 1464

KEY: Nursing process: N/A | Client need: PHSI | Cognitive level: Comprehension

____ 7. The preoperative nurse is preparing a patient for surgery. Identify the interventions the nurse will perform. Choose all that apply.

1)

Inform the family to wait in the surgical waiting room.

2)

Prepare the surgical suite for the operation.

3)

Remove the patients dentures and contact lenses.

4)

Assist the patient to complete a living will.

ANS: 1, 3

Before being transported to the operating suite, the patient must remove all artificial body parts, such as dentures, artificial limbs, or contact lenses. Wigs, eyeglasses, makeup, and jewelry must also be removed. The nurse will also inform the patients relatives where they may wait during the surgery. The surgical suite will be prepared by the surgical team. It is not necessary to have a living will prior to surgery. However, the nurse will ask the patient if there is one when obtaining the nursing history.

PTS:1DIF:ModerateREF:p. 1459

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

____ 8. A patient had a colon resection for removal of a cancerous tumor. Postoperatively, on the surgical floor which of the following activities would the nurse perform for the purpose of decreasing the risk of postoperative complications? Choose all that apply.

1)

Assist the patient to turn, breathe deeply, and cough every 2 hours.

2)

Teach the patient about the type of tumor removed.

3)

Assess the drainage from the surgical site.

4)

Monitor vital signs on a regular basis.

ANS: 1, 3, 4

The nurse assists the patient to turn, breathe deeply, and cough every 2 hours in order to decrease the risk of postoperative atelectasis or pneumonia. The nurse assesses the wound drainage to monitor for signs of bleeding, infection, or wound complications. Vital signs are monitored to detect the potential for infection or hemorrhage, not to prevent them. The nurse may teach the patient about cancerous tumors; however, this intervention will not decrease the risk of postoperative complications.

PTS:1DIF:ModerateREF:p. 1472

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Comprehension

____ 9. A patient returns from surgery with a nasogastric tube and intermittent gastric suction to provide abdominal decompression. Which of the following are correct nursing activities for managing the equipment and drainage? Choose all that apply.

1)

Wear nonsterile procedure gloves when emptying the drainage container.

2)

When irrigating the nasogastric tube, use sterile water.

3)

Wear sterile gloves when irrigating the nasogastric tube.

4)

Apply water-soluble lubricant if the patients lips are dry.

ANS: 1, 4

Nonsterile procedure gloves are to protect the nurse and other patients against microorganisms that might be present in body fluids; wearing them is in observance of standard precautions. For patients with an NG tube, frequent oral care, including water-soluble lubricant for dry lips, is important. Sterile gloves are not needed for irrigating the NG tube because the nasal passages, esophagus, and stomach are not sterile. Sterile normal saline and a sterile syringe are used for irrigation, however. Sterile water is not used; saline compensates for electrolytes lost through NG drainage.

PTS:1DIF:ModerateREF:pp. 1492-1493

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

Completion

Complete each statement.

1.____________________ surgery is the type of surgery that replaces a malfunctioning body part, tissue, or organ.

ANS: Transplant

Not applicable

PTS:1DIF:EasyREF:p. 1449

KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall

2.____________________ surgery is a surgery that is scheduled within 24 to 48 hours to alleviate symptoms, repair a body part, or restore function.

ANS: Urgent

Not applicable

PTS:1DIF:EasyREF:p. 1449

KEY:Nursing process: N/A | Client need: SECE | Cognitive level: Recall

3.The ____________________ registered nurse is responsible for preventing positioning injuries to the patient.

ANS: circulating

Not applicable

PTS:1DIF:ModerateREF:p. 1463

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Recall

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