Nokea
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.
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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.
Splinting an incision is an intervention to accomplish what goal?
- A. Provide extra support during coughing
- B. Reduce the need for analgesia
- C. Prevent shallow breathing
- D. Explain that some pain is normal
Correct Answer: A
Rationale: Splinting an incision provides extra support during coughing and activity and helps decrease pain. If the client is otherwise comfortable, no more analgesia is required. Shallow breathing can lead to atelectasis and pneumonia. The client should know some pain is normal and expected after surgery, but that answer alone does not provide any interventions to help the client.
A client who collapsed during dinner in a restaurant arrives in the emergency department. The client is going to surgery to repair an abdominal aortic aneurysm. What medication does the nurse prepare to administer as a priority with this client?
- A. Hydrocodone (Vicodin)
- B. Lorazepam (Ativan)
- C. Metoclopramide (Reglan)
- D. Morphine sulfate (Morphine)
Correct Answer: C
Rationale: Metoclopramide (Reglan) increases gastric emptying, an important issue for this client who was eating just prior to the operation to reduce the risk of aspiration. The other drugs are appropriate for pain or anxiety management but are not the priority in this scenario.
A client in the preoperative holding room has received sedation and now needs to urinate. What action by the nurse is best?
- A. Allow the client to walk to the bathroom
- B. Assist the client to the bathroom
- C. Give the client a bedpan or urinal to use
- D. Insert a urinary catheter now instead of waiting
Correct Answer: C
Rationale: Although possibly uncomfortable or embarrassing for the client, the client should not be allowed out of bed after sedation due to safety concerns. Providing a bedpan or urinal is the safest option. The client may or may not need a urinary catheter, depending on the surgical procedure.
A postoperative client has an abdominal drain. What assessment by the nurse indicates that goals for the client are being met?
- A. Drain output is clear and minimal
- B. Drain site is red and swollen
- C. Drain is clogged and not draining
- D. Client reports severe pain at drain site
Correct Answer: A
Rationale: A clear and minimal drain output indicates that the surgical site is healing appropriately and there is no significant infection or fluid accumulation. Redness and swelling, a clogged drain, or severe pain could indicate complications such as infection or obstruction, which would require further intervention.