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One of the things a nurse has taught to a patient during preoperative teaching is to have nothing by mouth for the specified time before surgery. The patient asks the nurse why this is important. What is the most appropriate response for the patient?
- A. You will need to have food and fluid restricted before surgery so you are not at risk for choking
- B. The restriction of food or fluid will prevent the development of pneumonia related to decreased lung capacity
- C. The presence of food in the stomach interferes with the absorption of anesthetic agents
- D. By withholding food for 8 hours before surgery, you will not develop constipation in the postoperative period
Correct Answer: A
Rationale: The major purpose of withholding food and fluid before surgery is to prevent aspiration. There is no scientific basis for withholding food and the development of pneumonia or interference with absorption of anesthetic agents. Constipation in patients in the postoperative period is related to the anesthesia, not from withholding food or fluid in the hours before surgery.
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The nurse is planning patient teaching for a patient who is scheduled for an open hemicolectomy. The nurse intends to address the topics of incision splinting and leg exercises during this teaching session. When is the best time for the nurse to provide teaching?
- A. Upon the patients admission to the postanesthesia care unit (PACU)
- B. When the patient returns from the PACU
- C. During the intraoperative period
- D. As soon as possible before the surgical procedure
Correct Answer: D
Rationale: Teaching is most effective when provided before surgery. Preoperative teaching is initiated as soon as possible, beginning in the physicians office, clinic, or at the time of preadmission testing when diagnostic tests are performed. Upon admission to the PACU, the patient is usually drowsy, making this an inopportune time for teaching. Upon the patients return from the PACU, the patient may remain drowsy. During the intraoperative period, anesthesia alters the patients mental status, rendering teaching ineffective.
The nurse is doing a preoperative assessment of an 87-year-old man who is slated to have a right lung lobe resection to treat lung cancer. What underlying principle should guide the nurses preoperative assessment of an elderly patient?
- A. Elderly patients have a smaller lung capacity than younger patients
- B. Elderly patients require higher medication doses than younger patients
- C. Elderly patients have less physiologic reserve than younger patients
- D. Elderly patients have more sophisticated coping skills than younger patients
Correct Answer: C
Rationale: The underlying principle that guides the preoperative assessment, surgical care, and postoperative care is that elderly patients have less physiologic reserve (the ability of an organ to return to normal after a disturbance in its equilibrium) than do younger patients. Elderly patients do not have larger lung capacities than younger patients. Elderly patients cannot necessarily cope better than younger patients and they often require lower doses of medications.
The nurse is caring for a 78-year-old female patient who is scheduled for surgery to remove her brain tumor. The patient is very apprehensive and keeps asking when she will get her preoperative medicine. The medicine is ordered to be given on call to OR. When would be the best time to give this medication?
- A. As soon as possible, in order to alleviate the patients anxiety
- B. As the patient is transferred to the OR bed
- C. When the porter arrives on the floor to take the patient to surgery
- D. After being notified by the OR and before other preoperative preparations
Correct Answer: D
Rationale: The nurse can have the medication ready to administer as soon as a call is received from the OR staff. It usually takes 15 to 20 minutes to prepare the patient for the OR. If the nurse gives the medication before attending to the other details of preoperative preparation, the patient will have at least partial benefit from the preoperative medication and will have a smoother anesthetic and operative course.
The nurse is caring for a patient in the postoperative period following an abdominal hysterectomy. The patient states, I dont want to use my pain meds because theyll make me dependent and I wont get better as fast. Which response is most important when explaining the use of pain medication?
- A. You will need the pain medication for at least 1 week to help in your recovery. What do you mean you feel you wont get better faster?
- B. Pain medication will help to decrease your pain and increase your ability to breath. Dependency is a risk with pain medication, but you are young and wont have any problems
- C. Pain medication can be given by mouth to prevent the risk of dependency that you are worried about. The pain medication has not been shown to affect your risk of a slowed recovery
- D. You will move more easily and heal more quickly with decreased pain. Dependence only occurs when it is administered for an extended period of time
Correct Answer: D
Rationale: Postoperatively, medications are administered to relieve pain and maintain comfort without increasing the risk of inadequate air exchange. In the responses by the nurse, (response D) addresses the patients concerns about drug dependency and the nurses need to increase the patients ability to move and recover from surgery. The other responses offer incorrect information, such as increasing the patients ability to breathe or specifying the time needed to take the medication. Opioids will cause respiratory depression.
An OR nurse will be participating in the intraoperative phase of a patients kidney transplant. What action will the nurse prioritize in this aspect of nursing care?
- A. Monitoring the patients physiologic status
- B. Providing emotional support to family
- C. Maintaining the patients cognitive status
- D. Maintaining a clean environment
Correct Answer: A
Rationale: During the intraoperative phase, the nurse is responsible for physiologic monitoring. The intraoperative nurse cannot support the family at this time and the nurse is not responsible for maintaining the patients cognitive status. The intraoperative nurse maintains an aseptic, not clean, environment.