Nokea
A patient is scheduled for a bowel resection in the morning and the patients orders include a cleansing enema tonight. The patient wants to know why this is necessary. The nurse should explain that the cleansing enema will have what therapeutic effect?
- A. Preventing aspiration of gastric contents
- B. Preventing the accumulation of abdominal gas postoperatively
- C. Preventing potential contamination of the peritoneum
- D. Facilitating better absorption of medications
Correct Answer: C
Rationale: The administration of a cleansing enema will allow for satisfactory visualization of the surgical site and to prevent trauma to the intestine or contamination of the peritoneum by feces. It will have no effect on aspiration of gastric contents or the absorption of medications. The patient should expect to develop gas in the postoperative period.
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A patient is on call to the OR for an aortobifemoral bypass and the nurse administers the ordered preoperative medication. After administering a preoperative medication to the patient, what should the nurse do?
- A. Encourage light ambulation
- B. Place the bed in a low position with the side rails up
- C. Tell the patient that he will be asleep before he leaves for surgery
- D. Take the patients vital signs every 15 minutes
Correct Answer: B
Rationale: When the preoperative medication is given, the bed should be placed in low position with the side rails raised. The patient should not get up without assistance. The patient may not be asleep, but he may be drowsy. Vital signs should be taken before the preoperative medication is given; vital signs are not normally required every 15 minutes after administration.
The clinic nurse is doing a preoperative assessment of a patient who will be undergoing outpatient cataract surgery with lens implantation in 1 week. While taking the patients medical history, the nurse notes that this patient had a kidney transplant 8 years ago and that the patient is taking immunosuppressive drugs. For what is this patient at increased risk when having surgery?
- A. Rejection of the kidney
- B. Rejection of the implanted lens
- C. Infection
- D. Adrenal storm
Correct Answer: C
Rationale: Because patients who are immunosuppressed are highly susceptible to infection, great care is taken to ensure strict asepsis. The patient is unlikely to experience rejection or adrenal storm.
The nurse is performing a preoperative assessment on a patient going to surgery. The patient informs the nurse that he drinks approximately two bottles of wine each day and has for the last several years. What postoperative difficulties can the nurse anticipate for this patient?
- A. Alcohol withdrawal syndrome immediately following surgery
- B. Alcohol withdrawal syndrome 2 to 4 days after his last alcohol drink
- C. Alcohol withdrawal syndrome upon administration of general anesthesia
- D. Alcohol withdrawal syndrome 1 week after his last alcohol drink
Correct Answer: B
Rationale: Alcohol withdrawal syndrome may be anticipated between 48 and 96 hours after alcohol withdrawal and is associated with a significant mortality rate when it occurs postoperatively.
The ED nurse is caring for an 11-year-old brought in by ambulance after having been hit by a car. The childs parents are thought to be en route to the hospital but have not yet arrived. No other family members are present and attempts to contact the parents have been unsuccessful. The child needs emergency surgery to save her life. How should the need for informed consent be addressed?
- A. A social worker should temporarily sign the informed consent
- B. Consent should be obtained from the hospitals ethics committee
- C. Surgery should be done without informed consent
- D. Surgery should be delayed until the parents arrive
Correct Answer: C
Rationale: In an emergency, it may be necessary for the surgeon to operate as a lifesaving measure without the patients informed consent. However, every effort must be made to contact the patients family. In this scenario, the surgery is considered lifesaving, and the parents are on their way to the hospital and not available. A delay would be unacceptable. Neither a social worker nor a member of the ethics committee may sign.
The nurse is caring for a hospice patient who is scheduled for a surgical procedure to reduce the size of his spinal tumor in an effort to relieve his pain. The nurse should plan this patient care with the knowledge that his surgical procedure is classified as which of the following?
- A. Diagnostic
- B. Laparoscopic
- C. Curative
- D. Palliative
Correct Answer: D
Rationale: A patient on hospice will undergo a surgical procedure only for palliative care to reduce pain, but it is not curative. The reduction of tumor size to relieve pain is considered a palliative procedure. A laparoscopic procedure is a type of surgery that is utilized for diagnostic purposes or for repair. The excision of a tumor is classified as curative. This patient is not having the tumor removed, only the size reduced.