Nokea
The nurse admitting a patient who is insulin dependent to the same-day surgical suite for carpal tunnel surgery. How should this patients diagnosis of type 1 diabetes affect the care that the nurse plans?
- A. The nurse should administer a bolus of dextrose IV solution preoperatively
- B. The nurse should keep the patient NPO for at least 8 hours preoperatively
- C. The nurse should initiate a subcutaneous infusion of long-acting insulin
- D. The nurse should assess the patients blood glucose levels vigilantly
Correct Answer: D
Rationale: The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia. Close glycemic monitoring is necessary. Dextrose infusion and prolonged NPO status are contraindicated. There is no specific need for an insulin infusion preoperatively.
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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.
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.
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 teaching her to perform deep breathing and coughing to use postoperatively. What action should the nurse teach the patient?
- A. The patient should take three deep breaths and cough hard three times, at least every 15 minutes for the immediately postoperative period
- B. The patient should take three deep breaths and exhale forcefully and then take a quick short breath and cough from deep in the lungs
- C. The patient should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs
- D. The patient should rapidly inhale, hold for 30 seconds or as long as possible, and exhale slowly
Correct Answer: C
Rationale: The patient assumes a sitting position to enhance lung expansion. The nurse then demonstrates how to take a deep, slow breath and how to exhale slowly. After practicing deep breathing several times, the patient is instructed to breathe deeply, exhale through the mouth, take a short breath, and cough from deep in the lungs.
A clinic nurse is conducting a preoperative interview with an adult patient who will soon be scheduled to undergo cardiac surgery. What interview question most directly addresses the patients safety?
- A. What prescription and nonprescription medications do you currently take?
- B. Have you previously been admitted to the hospital, either for surgery or for medical treatment?
- C. How long do you expect to be at home recovering after your surgery?
- D. Would you say that you tend to eat a fairly healthy diet?
Correct Answer: A
Rationale: It is imperative to know a preoperative patients current medication regimen, including OTC medications and supplements. None of the other listed questions directly addresses an issue with major safety implications.