Test bank for lewis medical surgical nursing 12th edition

Test Bank For Lewis's Medical-Surgical Nursing, 12th Edition by Mariann M. Harding, Jeffrey Kwong, Debra Hagler Chapter 18: Preoperative Care Harding: Lewis’s Medical-Surgical Nursing, 12th Edition MULTIPLE CHOICE 1. A patient scheduled for an elective hysterectomytells thenurse, “I am afraid that Iwill die in surgery like my mother did!” Which initial response would thenurse provide? A. “Tell me more about what happened to your mother.” B. “Surgical techniques have improved in recent years.” C. “You will receive medication to reduce your anxiety.” D. “You should talk to thedoctor again about thesurgery.” ANS: A The patient‘s statement may indicate an unusually high anxiety level or a family history of problems such as malignant hyperthermia, which will require precautions during surgery. theother statements may also address thepatient‘s concerns, but further assessment is needed first. 2. A patient arrives at theoutpatient surgical center for a scheduled laparoscopy under general anesthesia. Which information requires thenurse‘s intervention to maintain patient safety? A. The patient has never had general anesthesia. B. The patient is planning to drive home after surgery. C. The patient drank a sip of water 4 hours before arriving. D. The patient‘s insurance does not cover outpatient surgery. ANS: B The patient should not drive after general anesthesia. thenurse will need to help thepatient identify a means of safe transportation home. Clear liquids only require a minimum preoperative fasting period of 2 hours. thepatient‘s experience with anesthesia and thepatient‘s insurance coverage are important to establish, but these are not safety issues. 3. A 38-yr-old woman is admitted for an elective surgical procedure. Which information obtained by thenurse during thepreoperative assessment must be communicated to theanesthesiologist and surgeon before surgery? A. The patient‘s lack of knowledge about postoperative pain control B. The patient‘s history of an infection following a cholecystectomy C. The patient‘s report that her last menstrual period was 8 weeks ago D. The patient‘s concern about being able to resume lifting heavy items ANS: C A last menstrual period 8 weeks ago in a woman of childbearing age suggests that thepatient could be pregnant and pregnancy testing is needed before administration of anesthetic agents. Although theother data may also be communicated with thesurgeon and anesthesiologist, they will affect postoperative care and do not indicate a need for further assessment before surgery. 4. A patient who has not had any prior surgeries tells thenurse doing thepreoperative assessment about allergies to avocados and bananas. Which action is most important for thenurse to take? A. Notify thedietitian about thespecific food allergies. B. Alert thesurgery center about a possible latex allergy. C. Reassure thepatient that all allergies are noted on thehealth record. D. Ask whether thepatient uses antihistamines to reduce allergic reactions. ANS: B Certain food allergies (e.g., eggs, avocados, bananas, chestnuts, potatoes, peaches) are related to latex allergies. When a patient is allergic to latex, special nonlatex materials are used during surgical procedures. thestaff will need to know about theallergy in advance to obtain appropriate nonlatex materials and have them available during surgery. theother actions may be appropriate, but prevention of allergic reaction during surgery is themost important action. 5. The nurse obtains a health history from a patient who is scheduled for elective hip surgery in 1 week. thepatient reports use of garlic and Ginkgo biloba. Which action would thenurse take? A. Teach thepatient that these products may be continued preoperatively. B. Advise thepatient to stop theuse of herbs and supplements at this time. C. Discuss theherb and supplement use with thepatient‘s health care provider. D. Reassure thepatient that there will be no interactions with anesthetic agents. ANS: C Both garlic and G. biloba increase therisk for bleeding. thenurse should discuss theherb and supplement use with thepatient‘s health care provider. thenurse should not advise thepatient to stop thesupplements or to continue them without consulting with thehealth care provider and theanesthesia care provider. 6. The nurse is preparing to witness thepatient signing theoperative consent form when thepatient says, “I don‘t understand what thedoctor said about thesurgery.” Which action would thenurse take? A. Provide a thorough explanation of theplanned surgical procedure. B. Notifythesurgeon that theinformed consent process is not complete. C. Give theprescribed preoperative antibiotics and withhold sedative medications. D. Notify theoperating room nurse to give a complete explanation of theprocedure. ANS: B The surgeon is responsible for explaining thesurgery to thepatient. thenurse should wait until thesurgeon has clarified thesurgery before having thepatient sign theconsent form. thenurse should communicate directly with thesurgeon about theconsent form rather than asking other staff to pass on themessage. It is not within thenurse‘s legal scope of practice to explain thesurgical procedure. No preoperative medications should be given until thepatient understands thesurgical procedure and signs theconsent form. 7. Which topic would thenurse discuss preoperatively with a patient who is scheduled for an open cholecystectomy? A. Care for thesurgical incision B. Deep breathing and coughing C. Oral antibiotic therapy after discharge D. Medications to be used during surgery ANS: B Preoperative teaching, demonstration, and re-demonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and theimportance of completing antibiotics are better discussed after surgery, when thepatient will be more likely to retain this information. thepatient does not usually need information about medications that are used intraoperatively, and that topic should be discussed with theanesthesia provider. 8. Five minutes after receiving theordered preoperative midazolam by IV injection, thepatient asks to get up to go to thebathroom to urinate. Which action would thenurse take? A. Perform a straight catheterization. B. Offer thepatient a urinal or bedpan. C. Assist thepatient to ambulate to thebathroom. D. Tell thepatient that a catheter will be placed in theoperating room. ANS: B The patient will be at risk for a fall after receiving thesedative, so thebest nursing action is to have thepatient use a bedpan or urinal. Having thepatient get up either with assistance or independently increases therisk for a fall. thepatient will be uncomfortable and risk involuntary incontinence if thebladder is full during transport to theoperating room. There is no need to perform a straight catheterization. 9. The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits. His wife answers most questions that are directed to thepatient. Which action would thenurse take when doing theteaching? A. Use printed materials for instruction so that thepatient will have more time to review thematerial. B. Direct all theteaching toward thewife because she is theobvious support and caregiver for thepatient. C. Provide additional time for thepatient to understand preoperative instructions and carry out procedures. D. Ask thepatient‘s wife to wait in thehall in order to focus preoperative teaching with thepatient himself. ANS: C The nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because thepatient has visual deficits, he will not be able to use written material for learning. theteaching should be directed toward both thepatient and wife because both will need to understand preoperative procedures and teaching. 10. A patient who has diabetes and uses insulin to control blood glucose has been NPO since midnight before having a knee replacement surgery. Which action would thenurse take? A. Withhold theusual scheduled insulin dose because thepatient is NPO. B. Obtain a blood glucose measurement before any insulin administration. C. Give thepatient theusual insulin dose because stress will increase theblood glucose. D. Give half theusual dose of insulin because there will be no oral intake before surgery. ANS: B Preoperative insulin administration is individualized to thepatient, and thecurrent blood glucose will provide themost reliable information about insulin needs. It is not possible to predict whether thepatient will require no insulin, a lower dose, or a higher dose without blood glucose monitoring. 11. The outpatient surgery nurse reviews thecomplete blood cell (CBC) count results for a patient who is scheduled for surgery. theresults are white blood cell (WBC) count 10.2  103 /L; hemoglobin 15 g/dL; hematocrit 45%; platelets 150  103 /L. Which action would thenurse take? A. Notifythesurgeon and anesthesiologist immediately. B. Ask thepatient about any symptoms of a recent infection. C. Continue to prepare thepatient for thesurgical procedure. D. Discuss thepossibilityof blood transfusion with thepatient. ANS: C The CBC count results are normal. With normal results, thepatient can go to theholding area when theoperating room is ready for thepatient. There is no need to notify thesurgeon or anesthesiologist, discuss blood transfusion, or ask about recent infection. 12. The nurse is preparing a patient on themorning of surgery. thepatient prefers not to remove a wedding ring, saying, “I‘ve never taken it off since theday I was married.” How would thenurse respond? A. Have thepatient sign a release form and leave thering on. B. Tell thepatient that thehospital is not liable for loss of thering. C. Suggest that thepatient give thering to a family member to hold. D. Inform theoperating room personnel that thepatient is wearing a ring. ANS: C Jewelry is not allowed to be worn by thepatient, especially if electrocautery will be used. Safety is theissue here. There is no need for a release form or to discuss liability with thepatient. 13. A patient has received atropine before surgery and reports a dry mouth. Which action would thenurse take? A. Check forskin tenting. B. Notify thehealth care provider. C. Ask thepatient about any weakness or dizziness. D. Explain that drymouth is an expected side effect. ANS: D Anticholinergic medications decrease oral secretions, so thepatient is taught that a dry mouth is an expected side effect. thedry mouth is not a symptom of dehydration in this case. Therefore, there is no immediate need to check for skin tenting. thehealth care provider does not need to be notified about an expected side effect. Weakness, forgetfulness, and dizziness are side effects associated with other preoperative medications such as opioids and benzodiazepines. 14. Which statement by a patient scheduled for knee surgery is important to report to thehealth care provider before surgery? A. “I have a strong family history of cancer.” B. “I had a heart valve replacement last year.” C. “I had bacterial pneumonia 3 months ago.” D. “I have knee pain whenever Iwalk or jog.” ANS: B 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 thepatient should have surgery, but a history of pneumonia is not a reason to postpone surgery. thepatient‘s knee pain is thelikely reason for thesurgery. A family history of cancer does not have implications for thecurrent surgery. 15. The nurse interviews a patient scheduled to undergo general anesthesia for a bilateral hernia repair. Which information is important to communicate to thesurgeon and anesthesiologist before surgery? A. The patient drinks 3 cups of coffee every day. B. The patient stopped taking aspirin 10 days ago. C. The patient‘s father died after general anesthesia for surgery. D. The patient drank apple juice 6 hours before coming to thehospital. ANS: C The information about thepatient‘s 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 therisk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. thepatient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications. 16. Which information in thepreoperative patient‘s medication history is important to communicate to thehealth care provider before surgery? A. The patient takes garlic capsules every day. B. The patient quit using cocaine 10 years ago. C. The patient uses acetaminophen for aches and pains. D. The patient took a prescribed sedative theprevious night. ANS: A Chronic use of garlic may predispose to intraoperative and postoperative bleeding. theuse of a sedative theprevious night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect thesurgical outcome. 17. A patient who takes a diuretic and a -blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is important to communicate to thehealth care provider before surgery? A. Hematocrit 36% B. Blood pressure 144/82 C. Serum potassium 3.2 mEq/L D. Pulse rate 54-58 beats/minute ANS: C The low potassium level may increase therisk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of anxiety. thelower heart rate would be expected in a patient taking a -blocker. thehematocrit is in thelow normal range but does not need any intervention before surgery.