.Potter Perry Chapter 50 - Questions and Rationales

1. The nurse is precepting a new nurse in the perioperative area. The nurse explains that perioperative nursing is based on certain principles and includes (Select all that apply.) a. Purchasing the correct equipment. b. Providing high-quality and patient safety-focused care. c. Scheduling the right types of patients. d. Conducting multidisciplinary teamwork. e. Ensuring effective therapeutic communication. f. Providing advocacy for the patient. - ANS: B, D, E, F Perioperative nursing is a fast-paced, changing, and challenging field and is based on the nurse's understanding of several important principles, including high-quality, patient safety-focused care; multidisciplinary teamwork; effective therapeutic communication and collaboration with the patient, the patient's family, and the surgical team; effective and efficient assessment and intervention in all phases of surgery; advocacy for the patient and the patient's family; and understanding of cost containment. Purchasing the correct equipment is important in any specialty of nursing. Perioperative nursing cares not only for the "right" types of patients, but for all patients with surgical needs. 1. The nurse is precepting a student nurse and explains that perioperative nursing care occurs a. Before, during, and after surgery. b. In preadmission testing. c. During the surgical procedure. d. In the postanesthesia care unit. - ANS: A Perioperative nursing care occurs before, during, and after a surgery. Preadmission testing occurs before surgery and is considered preoperative. Nursing care provided during the surgical procedure is considered intraoperative, and in the postanesthesia care unit, it is considered postoperative. All of these are parts of the perioperative phase, but each individual phase does not explain the term completely. 2. The nurse is caring for a patient who is scheduled to undergo a surgical procedure. The nurse is completing an assessment and reviews the patient's laboratory tests and allergies. In which perioperative nursing phase would this work be completed? a. Perioperative b. Preoperative c. Intraoperative d. Postoperative - ANS: B Reviewing the patient's laboratory tests and allergies is done before surgery in the preoperative phase. Perioperative means before, during, and after surgery. Intraoperative means during the surgical procedure in the operating suite; postoperative means after the surgery and could occur in the postanesthesia care unit, in the ambulatory surgical area, or on the hospital unit. 2. The nurse is caring for an ambulatory surgery patient. To be discharged home, what criteria must the patient meet? (Select all that apply.) a. Able to drink fluids b. Able to eat crackers c. Manageable pain d. Able to void e. Dry and intact dressing f. Able to dress self - ANS: A, C, D, E To be discharged home, patients need to meet certain criteria. These criteria include meeting phase 1 criteria of activity, circulation, respiration, consciousness, and O2 saturation, as well as phase 2 criteria of dressing dry and intact, manageable pain, ambulation, able to drink fluids, and voiding. Eating and the ability to dress self are not included in these criteria. 3. The nurse is caring for a patient in the postanesthesia care unit. The patient has developed profuse bleeding from the surgical site, and the surgeon has determined the need to return to the operative area. This procedure would be classified as a. Elective. b. Urgent. c. Emergency. d. Major. - ANS: C An emergency procedure must be done immediately to save life or preserve function of a body part. An example would be repair of a perforated appendix, repair of a traumatic amputation, or control of internal hemorrhaging. An urgent procedure is necessary for a patient's health and often prevents additional problems form developing. An example would be excision of a cancerous tumor, removal of a gallbladder for stones, or vascular repair for obstructed artery. An elective procedure is performed on the basis of the patient's choice; it is not essential and is not always necessary for health. An example would be a bunionectomy, plastic surgery, or hernia reconstruction. A major procedure involves extensive reconstruction or alteration in body parts; it poses great risks to well-being. An example would be a coronary artery bypass or colon resection. 3. The nurse is caring for a postoperative patient with an incision. Which of the following nursing interventions have been found to decrease wound infections? (Select all that apply.) a. Perform hand hygiene before and after contact with the patient. b. Maintain normoglycemia. c. Use hair clippers to remove hair. d. Administer antibiotics within 30 to 60 minutes of incision time. e. Provide bath and linen change daily. f. Perform first dressing change 1 week postoperatively. - ANS: A, B, C, D Performing hand hygiene before and after contact with the patient helps to decrease the number of microorganisms and break the chain of infection. Maintaining blood glucose levels at less than 150 mg/dL has resulted in decreased wound infection. Removing unwanted hair by clipping instead of shaving decreases the numbers of nicks and cuts caused by a razor and the potential for the introduction of microbes. Administration of an antibiotic within 30 to 60 minutes of incision time supports the defense against infection. Providing a bath and linen change is positive but is not necessarily important daily for infection control unless copious body fluids are present. The physician usually is the person who changes a dressing the first time to inspect the condition of the site, but this is done well before 7 days postoperatively. 4. The nurse is caring for a patient in preadmission testing. The patient has been assigned a physical status classification by the American Society of Anesthesiologist of P3. Which of the following assessments would support this classification? a. Denial of any major illnesses or conditions b. Normal, healthy patient c. History of hypertension, 80 pounds overweight, history of asthma d. History of myocardial infarction that limits activity - ANS: C A P3 is a patient with a severe systemic disease. Patients with hypertension, obesity, diabetes mellitus, and asthma fit into this category. A P1 is a normal healthy patient. A P2 is a patient with mild systemic disease. A P4 is a patient with severe systemic disease that is a constant threat to life. 4. The nurse is preparing for a patient who will be going to surgery. The nurse screens for risk factors that can increase a person's risks in surgery. What risk factors are included in the nurse's screening? (Select all that apply.) a. Age b. Nutrition c. Race d. Obesity e. Pregnancy f. Ambulatory surgery - ANS: A, B, D, E Very young and old patients are at risk during surgery because of immature or declining physiological status. Normal tissue repair and resistance to infection depend on adequate nutrients. Obesity increases surgical risk by reducing respiratory and cardiac function. During pregnancy, the concern is for the mother and the developing fetus. Because all major systems of the mother are affected during pregnancy, risks for operative complications are increased. Race and ambulatory surgery are not risks associated with a surgical procedure. 5. The nurse is providing preoperative education and reviews with the patient what it will be like to be in the surgical environment. What points should the nurse include? (Select all that apply.) a. The surgical area is cold but warm blankets will be provided. b. The surgical staff will be dressed in special clothing with hats and masks. c. The operative suite will be very dark. d. Families are not allowed in the operating suite. e. The operating table or bed will be comfortable and soft. f. The nurses will be there to assist you through this process. - ANS: A, B, D, F The operating suite itself is kept cool to decrease microbial growth, so it can be very cold to patients as they enter the suite, particularly with limited clothing. The surgical staff is dressed in special clothing, hats, and masks—all for infection control. Families are not allowed in the operating suite for several reasons, which include infection control and the emotional effect of seeing a loved one in that condition. The nurse is there as the coordinator and patient advocate during a surgical procedure. The rooms are very bright so everyone can see, and the operating table is very uncomfortable for the patient.