Chapter 18: Preoperative Nursing Management

Chapter 18: Preoperative Nursing Management

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Multiple Choice

 

 

 

 

1. A patient is admitted to the emergency department complaining of severe abdominal pain. The patient is vomiting “coffee-ground” like vomitus. The patient is diagnosed with a bowel obstruction and is informed that he needs surgery. When can the patient anticipate the surgery will be scheduled?
2. A) Within 24 hours
3. B) Within the next week
4. C) Without delay because the bowel obstruction is emergent
5. D) Difficult to predict because the surgeon may be unavailable

 

Ans:  C

Chapter:  18

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  6

Page and Header:  428, Special Considerations During the Perioperative Period

 

Feedback:  Emergency surgeries are unplanned and occur with little time for preparation for the patient or the perioperative team. A bowel obstruction is considered an emergency, and the patient requires immediate attention because the disorder may be life threatening. Therefore options A, B, and D are incorrect.

 

 

 

 

2. You are doing a preoperative assessment on a patient going to surgery. The patient informs you that he ingests 5 to 10 ounces of alcohol each day and has for the last 15 years. What postoperative difficulties can the nurse anticipate for this patient?
3. A) Delirium tremens immediately following surgery
4. B) Delirium tremens within 72 hours after his last alcohol drink
5. C) Delirium tremens upon administration of general anesthesia
6. D) Delirium tremens 1 week after his last alcohol drink

 

Ans:  B

Chapter:  18

Client Needs:  D-3

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  430, Preoperative Assessment

 

Feedback:  Alcohol withdrawal syndrome (ie, delirium tremens) may be anticipated between 48 and 72 hours after alcohol withdrawal and is associated with a significant mortality rate when it occurs postoperatively.

 

 

 

 

3. How should a nurse teach a patient to perform deep breathing and coughing to use postoperatively?
4. A) The patient should take three deep breaths and cough hard three times.
5. B) The patient should take three deep breaths and exhale forcefully and then take a quick short breath and cough from deep in the lungs.
6. C) The patient should take a deep breath in through the mouth and exhale all the air out through the mouth, take a short breath, and cough from deep in the lungs.
7. D) The patient should rapidly inhale, hold for 30 seconds, and exhale slowly.

 

Ans:  C

Chapter:  18

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  5

Page and Header:  434, General Preoperative Nursing Interventions

 

Feedback:  The patient assumes a sitting position to enhance lung expansion. The nurse then demonstrates how to take a deep, slow breath and how to exhale slowly. After practicing deep breathing several times, the patient is instructed to breathe deeply, exhale through the mouth, take a short breath, and cough from deep in the lungs.

 

 

 

 

4. The nurse is preparing a patient for surgery. The patient is to undergo a hysterectomy without oophorectomy and the nurse is witnessing the patient’s signature on a consent form. Which comment by the patient would best indicate informed consent?
5. A) “I know I’ll be fine because the physician said he has done this procedure hundreds of times.”
6. B) “I know I’ll have pain after the surgery.”
7. C) “The physician is going to remove my uterus and told me about the risk of hemorrhage.”
8. D) “Because the physician isn’t taking my ovaries, I’ll still be able to have children.”

 

Ans:  C

Chapter:  18

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  4

Page and Header:  428, Informed Consent

 

Feedback:  The surgeon must inform the patient of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods. The nurse clarifies the information provided, and, if the patient requests additional information, the nurse notifies the physician. In option C, the patient is able to tell the nurse what will occur during the procedure and the associated risks. This indicates the patient has a sufficient understanding of the procedure to provide informed consent. Clarification of information given may be necessary, but no additional information should be given. Options A, B, and D do not indicate patient understanding of the procedure.

 

 

 

 

5. You are doing patient teaching for a patient who is scheduled for an appendectomy. You must teach the patient about incision splinting and leg exercises. When is the best time for you to provide teaching?
6. A) Upon the patient’s admission to the postanesthesia care unit (PACU)
7. B) When the patient returns from the PACU
8. C) During the intraoperative period
9. D) Before the surgical procedure

 

Ans:  D

Chapter:  18

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  7

Page and Header:  434, General Preoperative Nursing Interventions

 

Feedback:  Teaching is most effective when provided before surgery. Preoperative teaching is initiated as soon as possible, beginning in the physician’s office, clinic, or at the time of PAT when diagnostic tests are performed. Upon admission to the PACU, the patient is usually drowsy, making this an inopportune time for teaching. Upon the patient’s return from the PACU, the patient may remain drowsy. During the intraoperative period, anesthesia alters the patient’s mental status, rendering teaching ineffective.