Chapter 28: Preoperative and Postoperative Care

Chapter 28: Preoperative and Postoperative Care

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The nurse instructs the patient about scheduled surgery involving general anesthesia and about postoperative care. Which should the nurse include in patient teaching?

a.	Determine patient preference about pain medication.
b.	Avoid eating or drinking anything 2 hours before surgery.
c.	Ask for antianxiety medication in the operating room.
d.	Follow the rules for beginning to exercise after the incision has healed.

 

 

ANS:  A

Patients must be asked about their cultural practices and religious beliefs that may alter their family caregiver’s acceptance of necessary education and procedures. It is helpful to assess patient preference for pain medication, before and after surgery. The nurse instructs the patient to avoid food and fluid 6 to 8 hours before the procedure to prevent aspiration of gastric contents. The patient is advised that he will be unconscious in the operating room under general anesthesia. To avoid unnecessary patient upset and distress, the nurse also states that the patient will feel nothing, may remember nothing, and will wake up after the procedure. The surgeon will discuss resumption of exercise with the patient.

 

DIF:    Cognitive Level: Apply                   REF:   Page 7556| Page 762

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation

 

2. The patient is prepared for shoulder surgery and tells the preoperative nurse that the scar will be invisible after the surgery. Which action should the nurse take at this time?

a.	Tell the patient that this surgery always leaves a scar.
b.	Change the operative consent form to reflect what the patient says.
c.	Inform the surgeon that the patient is not ready for surgery.
d.	Notify the surgeon of the patient’s statement before medication is given.

 

 

ANS:  D

The patient’s statement about an invisible scar is inconsistent with shoulder surgery because skin incisions always leave a scar. The inconsistent statement cues the nurse to verify the patient and the procedure on the surgical consent form and then, once patient identity is secure, address the patient’s misunderstanding and ask the surgeon to speak with him or her. Many procedures leave a nonvisible scar, including vaginal, rectal, and cystoscopic procedures and procedures behind the hairline. The nurse avoids changing the consent form. The nurse does not know yet whether the patient is ready for surgery; he or she resolves the patient misunderstanding or misidentification first.

 

DIF:    Cognitive Level: Analyze                REF:   Page 757| Page 759| Page 765

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Planning

 

3. The patient’s family has had many surgical experiences with complications. What information is most important for the nurse to use to understand the patient’s stress in the perioperative period?

a.	Ask the patient if medications will calm him or her before surgery.
b.	Identify specific concerns regarding the surgical experience.
c.	Explain to the patient that stress is easily identified and managed.
d.	Tell the patient that stress is unrelated to environmental factors.

 

 

ANS:  B

The patient’s perception of the perioperative experience creates a point of reference for evaluation of the situation. Asking about fears, cultural practices, and religious beliefs allows the nurse to anticipate the patient’s and family caregiver’s priorities and adapt the plan to give appropriate instruction and support. The nurse should get more information so potential concerns can be identified. Anxiolytics can relieve stress quickly by sedating the patient but do nothing to resolve the patient’s stressor. Stressors can be difficult to identify and are usually more difficult to manage. Stress can develop from hereditary and environmental factors.

 

DIF:    Cognitive Level: Analyze                REF:   Page 758| Page 760| Page 761

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Assessment

 

4. The nurse interviews a preoperative patient who evades all questions about medications taken at home. Which is the best response for the nurse to use to facilitate safe, effective nursing care?

a.	“I feel that you’re uneasy about discussing medications.”
b.	“Why don’t you want to talk about your medications?”
c.	“You’re avoiding me; so you must have a big secret.”
d.	“Don’t you think that it’s important to discuss medications?”

 

 

ANS:  A

The best response is to validate the nurse’s perception of the patient’s behavior in a nonthreatening manner in order to elicit more information from the patient. The nurse avoids asking a “why” question because it may make a patient feel defensive. Stating that the patient is avoiding the question has the potential to be beneficial for interviewing, but concluding that the patient has a secret may be perceived as an accusation, sarcasm, or humor and lacks professionalism. It is unlikely to elicit more information. Asking a question that implies a position that the patient hasn’t advocated (you don’t think medications are important to discuss) is judgmental and unlikely to uncover the patient’s true concerns.

 

DIF:    Cognitive Level: Analyze                REF:   Page 757

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Implementation

 

5. The nurse determines that the patient is at risk for atelectasis caused by pain from back surgery 3 hours ago. Which is the best goal for the nurse to help the patient achieve?

a.	The patient’s lungs will be clear when auscultated every 2 hours.
b.	The nurse will manage the patient’s pain with oral morphine.
c.	Cool the patient’s elevated temperature with a cooling mat.
d.	Maintain adequate cardiac output with a positive fluid balance.

 

 

ANS:  A

Because of the cut back muscles, the patient is at risk for respiratory problems after surgery due to pain. The outcome reflects the patient’s status and is stated in a manner that can be evaluated. The patient would benefit from intravenous morphine to manage pain because it is easier to control. He or she can receive small, frequent doses for pain instead of a single, large dose that is more likely to result in hypotension. There is no indication for a cooling mattress. In addition, both of these are nursing interventions. For the patient at risk for alteration in cardiac output, maintaining a positive fluid balance increases the risk of fluid volume overload and can cause heart failure in the patient until the fluid is removed. The term adequate cannot be evaluated.

 

DIF:    Cognitive Level: Analyze                REF:   Page 763

OBJ:   NCLEX: Physiological Integrity      TOP:   Nursing Process: Evaluation