Nokea
A nursing instructor is teaching students about different surgical procedures and their classifications. Which procedures are correctly classified?
- A. Hemicolectomy: diagnostic
- B. Liver biopsy: diagnostic
- C. Spinal cord decompression: palliative
- D. Total shoulder replacement: restorative
- E. Mastectomy: restorative
Correct Answer: B,E
Rationale: A diagnostic procedure is used to determine cell type of cancer and to determine the cause of a problem, such as a liver biopsy. A restorative procedure aims to improve functional ability, such as a total shoulder replacement. A curative procedure either removes or repairs the causative problem, such as a mastectomy or hemicolectomy, which are not diagnostic or palliative.
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The perioperative nurse manager and the postoperative unit manager are concerned about the increasing number of surgical infections in their hospital. What action by the managers is best?
- A. Audit charts to see if the Surgical Care Improvement Project (SCIP) outcomes were met
- B. Encourage staff on both units to provide peer pressure to adhere to hand hygiene policy
- C. Hold educational meetings with the nursing and surgical staff on infection prevention
- D. Monitor staff on both units for consistent adherence to established hand hygiene practices
Correct Answer: A
Rationale: The SCIP project contains core measures that are mandatory for all surgical clients and focuses on preventing infection, serious cardiac events, and venous thromboembolism. The managers should start by reviewing charts to see if the guidelines of this project were implemented. The other actions may be necessary too, but first the managers need to assess the situation.
A student is caring for clients in the preoperative area. The nurse contacts the surgeon about a client whose heart rate is 120 beats per minute and now needs a beta blocker. The student asks why this was needed. What response by the nurse is best?
- A. Tachycardia increases the workload of the heart
- B. Tachycardia requires less oxygen delivery
- C. A high heart rate reduces cardiac effort
- D. A high heart rate prevents surgical stress
Correct Answer: A
Rationale: Tachycardia increases the workload of the heart and requires more oxygen delivery to the myocardial tissues. This added strain is not needed on top of the physical and emotional stress of surgery. The other statements are not accurate.
A nurse is giving a preoperative client a dose of ranitidine (Zantac). The client asks why the nurse is giving this drug when the client has no history of ulcers. What response by the nurse is best?
- A. It helps prevent ulcers from the stress of the surgery
- B. It reduces stomach acid to prevent aspiration
- C. Since you don't have ulcers, I will have to ask
- D. The physician prescribed this medication for you
Correct Answer: B
Rationale: Ranitidine (Zantac) is given preoperatively to reduce gastric acid production, which lowers the risk of aspiration during surgery. This is the most accurate explanation. Preventing ulcers is not the primary purpose in this context, and the other options do not provide a clear rationale.
A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best?
- A. Assess the client for anxiety
- B. Break the information into smaller bits
- C. Give the client written information
- D. Request the provider to repeat the information
Correct Answer: A
Rationale: Anxiety can interfere with learning and cooperation. The nurse should assess the client for anxiety. The other actions are appropriate too, and can be included in the teaching plan, but effective teaching cannot occur if the client is highly anxious.
A student nurse asks why older adults are at higher risk for complications after surgery. What reasons does the registered nurse give?
- A. Decreased cardiac output
- B. Decreased oxygenation
- C. Frequent nocturia
- D. Mobility issues
- E. Inability to adapt to new surroundings
Correct Answer: A,B,C,D
Rationale: Older adults have many age-related physiologic changes that put them at higher risk of complications after surgery, including decreased cardiac output, decreased oxygenation of tissues, nocturia, and mobility issues. They also have a decreased ability to adapt to new surroundings, but this is not the same as being unable to adapt.