Chapter 39: Surgical Patient

Chapter 39: Surgical Patient

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

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?

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?

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?

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?

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.

PTS:    1                      DIF:    Cognitive Level: Analyzing (Analysis)

REF:    1133                OBJ:    Identify factors to assess in a patient in postoperative recovery.

TOP:    Nursing Process: Assessment            MSC:   Client Needs: Physiological Integrity