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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.
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During the care of a preoperative patient, the nurse has given the patient a preoperative benzodiazepine. The patient is now requesting to void. What action should the nurse take?
- A. Assist the patient to the bathroom
- B. Offer the patient a bedpan or urinal
- C. Wait until the patient gets to the operating room and is catheterized
- D. Have the patient go to the bathroom
Correct Answer: B
Rationale: If a preanesthetic medication is administered, the patient is kept in bed with the side rails raised because the medication can cause lightheadedness or drowsiness. If a patient needs to void following administration of a sedative, the nurse should offer the patient a urinal. The patient should not get out of bed because of the potential for lightheadedness.
The nurse is doing preoperative patient education with a 61-year-old male patient who has a 40-pack per year history of cigarette smoking. The patient will undergo an elective bunionectomy at a time that fits his work schedule in a few months. What would be the best instruction to give to this patient?
- A. Reduce smoking by 50% to prevent the development of pneumonia
- B. Stop smoking at least 6 weeks before the scheduled surgery to enhance pulmonary function and decrease infection
- C. Aim to quit smoking in the postoperative period to reduce the chance of surgical complications
- D. Stop smoking 4 to 8 weeks before the scheduled surgery to enhance pulmonary function and decrease infection
Correct Answer: D
Rationale: The reduction of smoking will enhance pulmonary function; in the preoperative period, patients who smoke should be urged to stop 4 to 8 weeks before surgery.
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 providing preoperative teaching to a patient scheduled for surgery. The nurse is instructing the patient on the use of deep breathing, coughing, and the use of incentive spirometry when the patient states, I dont know why youre focusing on my breathing. My surgery is on my hip, not my chest. What rationale for these instructions should the nurse provide?
- A. To prevent chronic obstructive pulmonary disease (COPD)
- B. To promote optimal lung expansion
- C. To enhance peripheral circulation
- D. To prevent pneumothorax
Correct Answer: B
Rationale: One goal of preoperative nursing care is to teach the patient how to promote optimal lung expansion and consequent blood oxygenation after anesthesia. COPD is not a realistic risk and pneumothorax is also unlikely. Breathing exercises do not primarily affect peripheral circulation.
The nurse is preparing a patient for surgery. The patient states that she is very nervous and really does not understand what the surgical procedure is for or how it will be performed. What is the most appropriate nursing action for the nurse to take?
- A. Have the patient sign the informed consent and place it in the chart
- B. Call the physician to review the procedure with the patient
- C. Explain the procedure clearly to the patient and her family
- D. Provide the patient with a pamphlet explaining the procedure
Correct Answer: B
Rationale: While the nurse may ask the patient to sign the consent form and witness the signature, it is the surgeons responsibility to provide a clear and simple explanation of what the surgery will entail prior to the patient giving consent. The surgeon must also inform the patient of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods. The nurse clarifies the information provided, and, if the patient requests additional information, the nurse notifies the physician. The consent form should not be signed until the patient understands the procedure that has been explained by the surgeon. The provision of a pamphlet will benefit teaching the patient about the surgical procedure, but will not substitute for the information provided by the physician.