NSG 3023 CHAPTER 39 QUIZ
Chapter 39: Surgical Patient
Potter: Essentials for Nursing Practice, 8th Edition
MULTIPLE CHOICE
1. A 57-year-old patient who is being admitted for an appendectomy. The patient is a
2-pack-a-day smoker, has a history of diabetes, and is 20 pounds overweight. Which of the
following potential postoperative complications should be the nurse’s highest concern for
prevention?
a. Atelectasis
b. Negative nitrogen balance
c. Delayed wound healing
d. Hyperthermia
ANS: A
There is a significant association between smoking and postoperative pulmonary
complications, specifically pneumonia and atelectasis. Chronic smoking increases the
amount and thickness of mucous secretions in the lungs. Patients who are obese are more
susceptible to developing atelectasis. Hyperthermia is incorrect because general anesthetics
inhibit shivering, a protective reflex to maintain body temperature, and anesthetics cause
vasodilation, which results in heat loss. Malnourished patients are more likely to have poor
tolerance of anesthesia, negative nitrogen balance, delayed postoperative recovery,
infection, and delayed wound healing.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 1131
OBJ: List factors to include in the preoperative assessment of a surgical patient.
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
2. The nurse working on a medical/surgical floor knows that pulmonary embolisms can be a
deadly complication after surgery. Which of the following patients is most likely to develop
a pulmonary embolism?
a. 45-year-old patient after bariatric surgery
b. 23-year-old patient with pneumonia
c. 13-year-old patient after appendectomy
d. 57-year-old patient after cholecystectomy
ANS: A
, A patient who is obese usually has reduced ventilatory capacity because of the upward
pressure against the diaphragm caused by an enlarged abdomen. There is also an increased
risk for aspiration during the administration of anesthesia. The recumbent and supine
positions required on the operating bed (table) for surgery further limit a patient’s
ventilation. The increased workload of the heart and atherosclerotic blood vessels often
results in compromised cardiovascular function. Because of these physiological changes,
patients who are obese often have difficulty resuming normal physical activity after surgery.
Hypertension, coronary artery disease, type 2 diabetes mellitus, and heart failure are
common in this population. They are also more susceptible to developing embolism,
atelectasis, and pneumonia after surgery than patients who are not obese.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 1131 OBJ: Identify factors to assess in a patient in postoperative
recovery.
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
3. A 45-year-old woman has been admitted for surgery to remove a cancerous abdominal
tumor. She has been on chemotherapy and recently radiotherapy to shrink the tumor without
success. To best facilitate wound healing, when is the best time for her to undergo surgery?
a. During the radiotherapy treatments
b. Immediately after the radiotherapy treatments
c. 2 to 3 weeks after radiotherapy treatments
d. 4 to 6 weeks after radiotherapy treatments
ANS: D
Ideally surgery takes place 4 to 6 weeks after the completion of radiation treatments to avoid
wound-healing problems. The patient with cancer may have radiotherapy before surgery to
reduce the size of a cancerous tumor to remove it surgically. Radiation causes fibrosis and
vascular scarring in the radiated area. This causes tissues to become fragile and poorly
oxygenated, increasing the risk for wound infection.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 1132 OBJ: Identify factors to assess in a patient in postoperative
recovery.
TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity
4. Which of the following patients is most at risk for hypovolemic shock after emergency
surgery?
a. 14-year-old adolescent with gastroenteritis
b. 59-year-old patient with pneumonia
c. 12-year-old patient with H1N1 flu
d. 28-year-old patient with a fractured ankle
ANS: A
Patients with gastroenteritis have gastrointestinal problems and are at greater risk of
complications. Patients with preexisting renal, fluid and electrolyte, gastrointestinal,
respiratory, or cardiovascular problems are at greatest risk for operative complications. For
example, a patient who is dehydrated from vomiting preoperatively is at greater risk for
hypovolemic shock.
Chapter 39: Surgical Patient
Potter: Essentials for Nursing Practice, 8th Edition
MULTIPLE CHOICE
1. A 57-year-old patient who is being admitted for an appendectomy. The patient is a
2-pack-a-day smoker, has a history of diabetes, and is 20 pounds overweight. Which of the
following potential postoperative complications should be the nurse’s highest concern for
prevention?
a. Atelectasis
b. Negative nitrogen balance
c. Delayed wound healing
d. Hyperthermia
ANS: A
There is a significant association between smoking and postoperative pulmonary
complications, specifically pneumonia and atelectasis. Chronic smoking increases the
amount and thickness of mucous secretions in the lungs. Patients who are obese are more
susceptible to developing atelectasis. Hyperthermia is incorrect because general anesthetics
inhibit shivering, a protective reflex to maintain body temperature, and anesthetics cause
vasodilation, which results in heat loss. Malnourished patients are more likely to have poor
tolerance of anesthesia, negative nitrogen balance, delayed postoperative recovery,
infection, and delayed wound healing.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 1131
OBJ: List factors to include in the preoperative assessment of a surgical patient.
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
2. The nurse working on a medical/surgical floor knows that pulmonary embolisms can be a
deadly complication after surgery. Which of the following patients is most likely to develop
a pulmonary embolism?
a. 45-year-old patient after bariatric surgery
b. 23-year-old patient with pneumonia
c. 13-year-old patient after appendectomy
d. 57-year-old patient after cholecystectomy
ANS: A
, A patient who is obese usually has reduced ventilatory capacity because of the upward
pressure against the diaphragm caused by an enlarged abdomen. There is also an increased
risk for aspiration during the administration of anesthesia. The recumbent and supine
positions required on the operating bed (table) for surgery further limit a patient’s
ventilation. The increased workload of the heart and atherosclerotic blood vessels often
results in compromised cardiovascular function. Because of these physiological changes,
patients who are obese often have difficulty resuming normal physical activity after surgery.
Hypertension, coronary artery disease, type 2 diabetes mellitus, and heart failure are
common in this population. They are also more susceptible to developing embolism,
atelectasis, and pneumonia after surgery than patients who are not obese.
PTS: 1 DIF: Cognitive Level: Analyzing (Analysis)
REF: 1131 OBJ: Identify factors to assess in a patient in postoperative
recovery.
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
3. A 45-year-old woman has been admitted for surgery to remove a cancerous abdominal
tumor. She has been on chemotherapy and recently radiotherapy to shrink the tumor without
success. To best facilitate wound healing, when is the best time for her to undergo surgery?
a. During the radiotherapy treatments
b. Immediately after the radiotherapy treatments
c. 2 to 3 weeks after radiotherapy treatments
d. 4 to 6 weeks after radiotherapy treatments
ANS: D
Ideally surgery takes place 4 to 6 weeks after the completion of radiation treatments to avoid
wound-healing problems. The patient with cancer may have radiotherapy before surgery to
reduce the size of a cancerous tumor to remove it surgically. Radiation causes fibrosis and
vascular scarring in the radiated area. This causes tissues to become fragile and poorly
oxygenated, increasing the risk for wound infection.
PTS: 1 DIF: Cognitive Level: Applying (Application)
REF: 1132 OBJ: Identify factors to assess in a patient in postoperative
recovery.
TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity
4. Which of the following patients is most at risk for hypovolemic shock after emergency
surgery?
a. 14-year-old adolescent with gastroenteritis
b. 59-year-old patient with pneumonia
c. 12-year-old patient with H1N1 flu
d. 28-year-old patient with a fractured ankle
ANS: A
Patients with gastroenteritis have gastrointestinal problems and are at greater risk of
complications. Patients with preexisting renal, fluid and electrolyte, gastrointestinal,
respiratory, or cardiovascular problems are at greatest risk for operative complications. For
example, a patient who is dehydrated from vomiting preoperatively is at greater risk for
hypovolemic shock.
