Download Nurs 340 Review Questions with Complete Solutions Five minutes after receiving a preoperat and more Exams Nursing in PDF only on Docsity!
Nurs 340 Review Questions with Complete Solutions
Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. What is the most appropriate action for the nurse to take? A. Offer the patient to use the urinal/bedpan after explaining the need to maintain safety B. Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. C. Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes. D. Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room - Answer ✔️ ✔️ -A Rationale: The prime issue after administration of either sedative or opioid analgesic medications is safety. Because the medications affect the central nervous system, the patient is at risk for falls and should not be allowed out of bed, even with assistance. The other options would not be safe for the patient. What is the primary reason for accurately recording the patient's current medications during a preoperative assessment?
A. Some medications may alter the patient's perceptions about surgery. B. Many anesthetics alter renal and hepatic function, causing toxicity of other drugs. C. Some medications may interact with anesthetics, altering the potency and effect of the drugs. D. Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery. - Answer ✔️ ✔️ -C Rationale: Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that they have been communicated to the anesthesia care provider. Routine medications may or may not be prescribed for use the day of surgery. While performing preoperative teaching, the patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, the nurse tells the patient that? A. she must be NPO after breakfast. B. she needs to be NPO after midnight. C. she can drink clear liquids up to 2 hours before surgery. D. she can drink clear liquids up until she is moved to the OR. - Answer ✔️ ✔️ -C
B. A man whose type 1 diabetes is controlled with insulin injections four times daily C. A man who is taking clopidogrel (Plavix) after the placement of a coronary artery stent D. A man who recently started taking finasteride (Proscar) for the treatment of benign prostatic hyperplasia - Answer ✔️ ✔️ -C Rationale: Any drug that inhibits platelet aggregation, such as clopidogrel (Plavix), represents a bleeding risk. Insulin, metoprolol (Lopressor), and finasteride (Proscar) are less likely to contribute to a risk for bleeding. A 70-year-old woman has been admitted prior to having surgery for a bilateral mastectomy and breast reconstruction. What should the nurse include in the patient's preoperative teaching (select all that apply)? A. Information about various options for reconstructive surgery B. Information about the risks and benefits of her particular surgery C. Information about risk factors for breast cancer and the role of screening D. Information about where in the hospital she will be taken postoperatively E. Information about performing postoperative deep-breathing and coughing exercises - Answer ✔️ ✔️ -D, E
Rationale: During preoperative teaching, it is important to introduce the role of deep- breathing and coughing exercises and to inform the patient about the different locations involved in her hospital stay. The specific risks and benefits of her surgery and reconstruction options should be addressed by her surgeon. Teaching about breast cancer screening would be inappropriate, and likely insensitive, at this point in her disease trajectory. The patient is having a mole removed that has changed appearance. What does the nurse teach the patient about the rationale for this surgical procedure? A. It is to prevent malignancy. B. It is to alleviate symptoms. C. It is to cure the malignancy. D. It is to provide cosmetic improvement. - Answer ✔️ ✔️ -A Rationale: Removing a mole that is changing is to prevent as well as diagnose malignancy. There are no symptoms to alleviate mentioned or cosmetic problems for this patient. This will be the patient's first surgical experience and the patient states, "I am nervous about this." The vital signs show BP 158/88, HR 96, RR 24. In the assessment, the nurse finds that the lungs are clear, bowel tones are evident, peripheral pulses are strong, and the patient is fidgeting nervously. The patient
Past Health History, Smoker for past 25 years, last cigarette yesterday Has hypertension Tab 2 Laboratory and Diagnostic Results CBC within normal limits Chest X-ray clear UA within normal limits No other lab work drawn Tab 3 Medications Takes hydrochlorothiazide 50 mg every morning A. Blood glucose B. Pregnancy test C. Serum albumin D. Serum potassium - Answer ✔️ ✔️ -D Rationale:
The nurse should seek a serum potassium level as the patient takes a diuretic. An ECG would also be appropriate to seek with the history of hypertension and cigarette smoking. There are not indications for the need of a blood glucose, pregnancy, or serum albumin test. A 75-year-old patient is being prepared for surgery. What assessment data needs to be included for this patient (select all that apply)? A. Fluid balance history B. Attitude about surgery C. Foods the patient dislikes D. Current mobility problems E. Current cognitive function F. Patient's opinion about the surgeon - Answer ✔️ ✔️ -A, D, E Rationale: Preoperative fluid balance history is especially critical for older adults as they have reduced adaptive capacity that puts them at greater risk for over- and under- hydration. Mobility problems must be assessed to assist with intraoperative and postoperative positioning and ambulation. Preoperative assessment of the older person's baseline cognition function is especially crucial for intraoperative and postoperative evaluation as they are more prone to adverse outcomes during and after surgery from the stressors of the surgery, dehydration, hypothermia, and anesthesia. Attitude about surgery and opinion or faith in the surgeon is important
B. Tape the hearing aid to his ear to prevent loss. C. Encourage the patient to wear it for the surgery. D. Tell the surgery nurse that he has his hearing aid out. - Answer ✔️ ✔️ -C Rationale: Although jewelry is removed before surgery, hearing aids should be left in place to allow the patient to better follow instructions given in the surgical suite and the postanesthesia care unit (PACU), as well as the dismissal instructions that will be given before he returns home for recovery. It is 6:00 AM. The anesthesiologist prescribes preoperative medications for a patient who is scheduled for surgery at 7:30 AM: cefazolin (Ancef) IV to be infused 30 minutes before surgery; midazolam (Versed) before surgery and scopolamine patch (Transderm Scop) behind the ear. Which medication should the nurse administer first? A. Cefazolin (Ancef) B. Fentanyl (Sulimaze) C. Midazolam (Versed) D. Scopolamine (Transderm Scop) - Answer ✔️ ✔️ -D Rationale:
The scopolamine patch (Transderm Scop) will be administered first to allow enough time for the serum level to become therapeutic. The cefazolin (Ancef) will be given at 7:00 AM to allow infusion 30 minutes before surgery. Fentanyl (Sulimaze) is a narcotic and was not ordered preoperatively. The midazolam (Versed), a short-acting benzodiazepine, is used as a sedative. An alert male patient needs a tracheostomy because he has been intubated for 7 days with an endotracheal tube and cannot be weaned from the ventilator. The patient does not want the tracheostomy, but his family insists that the surgery be performed. What is the best action for the nurse to take? A. Advocate for the patient's rights. B. Try to change the patient's mind. C. Call surgery to cancel the procedure. D. Tell the family they cannot interfere. - Answer ✔️ ✔️ -A Rationale: The nurse must act as the patient's advocate and assist the patient with fulfilling his wishes. However, as the patient's advocate the nurse must be sure he knows the risks and benefits of refusing a tracheostomy. Trying to change the patient's mind is unethical because it is contrary to acting as an advocate. As long as the patient is lucid, he retains the right of self-determination. Canceling the procedure is not indicated until discussion with the patient and surgeon has occurred. Telling the family they cannot interfere can aggravate or escalate the situation.
Rationale: Malignant hyperthermia is a metabolic disease characterized by hyperthermia with rigidity of skeletal muscles from altered control of intracellular calcium occurring as a result of exposure to certain anesthetic agents in susceptible patients. Hypoxemia, hypercapnia, and ventricular dysrhythmias may also be seen with this disorder. Before admitting a patient to the operating room, which forms or results must the nurse make sure are in the chart of all patients (select all that apply)? A. Electrocardiogram B. Signed consent form C. Functional status evaluation D. Renal and liver function tests E. A history and physical report - Answer ✔️ ✔️ -B, E Rationale: The National Patient Safety Goals (NPSG) require documentation of a history and physical, signed consent form, and nursing and preanesthesia assessment in the chart of a patient going for surgery. The physical examination explains in detail the overall status of the patient before surgery for the surgeon and other members of the surgical team.
Which intraoperative nursing responsibilities should be performed by the scrub nurse (select all that apply)? A. Documenting intraoperative care B. Keeping track of irrigation solutions for monitoring of blood loss C. Passing instruments and supplies to the surgeon by anticipating his or her needs D. Coordinating the flow and activities of members of the surgical team in the surgical suite D. Performing the count of sponges, needles, and instruments used during the surgical procedure - Answer ✔️ ✔️ -B, C, D Rationale: Both the scrub nurse and circulating nurse will participate in the counting of surgical sponges, needles, and instruments, whereas passing instruments to the surgeon and other sterile activities are the exclusive responsibility of the scrub nurse. The circulating nurse takes primary responsibility for the coordination of the surgical suite and documentation. What event in the surgical suite represents a violation of aseptic technique? A. A glove contacts the leg of the table that supports the sterile field. B. The cuff of the scrub nurse's sterile gown contacts the sterile field. C. The sterile field was established at 0650, and the current time is 0900.
A 71-year-old male patient who is currently undergoing coronary artery bypass graft (CABG) surgery has just experienced intraoperative vomiting. The nurse should consequently anticipate the use of which drug? A. Midazolam (Versed) B. Fentanyl (Sublimaze) C. Meperidine (Demerol) D. Ondansetron (Zofran) - Answer ✔️ ✔️ -D Rationale: Ondansetron (Zofran) is an antiemetic, whereas midazolam (Versed) is a benzodiazepine, and fentanyl (Sublimaze) and meperidine (Demerol) are opioid analgesics. A surgical patient's premedication regimen includes midazolam (Versed). What are the most likely desired effects of this medication? A. Monitored anesthesia care and amnesia B. Potentiates volatile agents to speed induction C. Analgesia and prevention of intraoperative vomiting D. Relaxation of skeletal muscles and facilitation of endotracheal intubation - Answer ✔️ ✔️ -A
Rationale: Midazolam is a benzodiazepine that is widely used for its ability to induce amnesia and provide moderate sedation (conscious sedation). Nitrous oxide is a gaseous agent that potentiates volatile agents to speed induction and reduce total dosage and side effects. Antiemetics prevent intraoperative vomiting. Neuromuscular blocking agents facilitate endotracheal intubation. The new nursing student is confused about where the patient's family (who are wearing street clothes) can be with the patient in the surgical suite. Which explanation should the perioperative nurse give to the student nurse? A. The family is not allowed to talk to the nurse at the nursing station. B. The family can be with the patient in the preoperative holding area. C. The family cannot be with the patient until the postanesthesia care unit. D. The family is only allowed in the conference room for preoperative teaching. - Answer ✔️ ✔️ -B Rationale: The perioperative nurse should explain to the student nurse that the family can be in the preoperative holding area before the patient goes to surgery, but this includes talking to the nurse at the nursing station. They are also taken to the conference room for preoperative and postoperative meetings with staff, including teaching.
C. Identify patients at risk for suicide. D. Patient, surgical procedure, and site are checked. - Answer ✔️ ✔️ -D Rationale: During the surgical time-out the Universal Protocol is used to verify the patient's identity, surgical procedure, and site to prevent mistakes in surgery. Prevention of infection is to be done at all times. Improved staff communication relates to getting important test results to the right staff on time. Identifying patient's safety risks for suicide is not usually vital before surgery and does not occur during the time-out. A patient having an open reduction internal fixation (ORIF) of a left lower leg fracture will receive regional anesthesia during the procedure. As the patient is prepared in the operating room, what should the nurse implement to maintain patient safety during surgery that is directly related to the type of anesthesia being used? A. Apply grounding pad to unaffected leg. B. Assess peripheral pulses and skin color. C. Verify the last oral intake before surgery. D. Ensure a smooth surface under the patient. - Answer ✔️ ✔️ -D Rationale:
Regional anesthesia decreases sensation to the anesthetized area without impairing level of consciousness, which means the affected leg will be without sensation while the anesthetic is effective. A double tourniquet on the affected leg is used to restrict blood flow. This increases the patient's risk of impaired skin integrity because the patient does not have sensation and cannot identify discomfort or foreign objects and will not be moving during surgery. The nurse's role includes positioning the patient for correct alignment, exposure of the surgical site, and preventing injury. The other options will be occurring but are not directly related to the regional anesthesia. A 78-year-old patient is having surgery. What risk areas will the nurse need to be especially aware of for this patient during surgery? A. Sterility B. Paralysis C. Urine output D. Skin integrity - Answer ✔️ ✔️ -D Rationale: Skin of older adults has lost elasticity and is at increased risk for injury from tape, electrodes, warming or cooling blankets, and dressings. Pooling cleansing solution may create skin burns or abrasions. The nurse is responsible for monitoring patient safety and adjusting patient position as necessary to prevent pressure or misalignment. Sterility and urine output would be monitored for all patients.
