Nokea
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.
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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.
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.
A preoperative nurse is reviewing morning laboratory values on four clients waiting for surgery. Which result warrants immediate communication with the surgical team?
- A. Creatinine 2 mg/dL
- B. Potassium 3.8 mEq/L
- C. Hemoglobin 12 g/dL
- D. Platelet count 150,000/mm³
Correct Answer: A
Rationale: A creatinine level of 2 mg/dL is elevated, indicating potential renal impairment, which can affect anesthesia and surgical outcomes. This warrants immediate communication with the surgical team. The other values are within normal ranges and do not require urgent reporting.
A nurse is giving a client instructions for showering with special antimicrobial soap the night before surgery. What instruction is most appropriate?
- A. After you wash the surgical site, shave the area with your own razor
- B. Be sure to wash the area where you will have surgery very thoroughly
- C. Use a washcloth to wash the surgical sites, do not take a full shower or bath
- D. Wash the surgical site first, then shampoo and wash the rest of your body
Correct Answer: B
Rationale: The proposed surgical site needs to be washed thoroughly and completely with the antimicrobial soap. Shaving, if absolutely necessary, should be done in the operative suite immediately before the operation begins, using sterile equipment. The client needs a full shower or bath (shower preferred). Washing the surgical site last ensures that soap does not run over the cleansed site if other areas are washed first.
A client is on the phone when the nurse brings a preoperative antibiotic before scheduled surgery. The circulating nurse has requested the antibiotic be started. The client wants the nurse to wait before starting it. What response by the nurse is most appropriate?
- A. Explain the rationale for giving the medicine now
- B. Leave the room and come back in 15 minutes
- C. Provide holistic client care and come back later
- D. Tell the client you must start the medication now
Correct Answer: A
Rationale: The preoperative antibiotic must be given within 60 minutes of the surgical start time to ensure the proper amount is in the tissues when the incision is made. The nurse should explain the rationale to the client for this timing. The other options do not take this timing into consideration and do not give the client the information needed to be cooperative.