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The nurse is caring for a patient who is experiencing pain and anxiety following his prostatectomy. Which intervention will likely best assist in decreasing the patients pain and anxiety?
- A. Administration of NSAIDs rather than opioids
- B. Allowing the patient to increase activity
- C. Use of guided imagery along with pain medication
- D. Use of deep breathing and coughing exercises
Correct Answer: C
Rationale: The use of guided imagery will enhance pain relief and assist in reduction of anxiety. It may be combined with analgesics. Deep breathing and the increase in activity may produce increased pain. Replacing opioids with NSAIDs may cause an increase in pain.
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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 surgical nurse is preparing to send a patient from the presurgical area to the OR and is reviewing the patients informed consent form. What are the criteria for legally valid informed consent? Select all that apply.
- A. Consent must be freely given
- B. Consent must be notarized
- C. Consent must be signed on the day of surgery
- D. Consent must be obtained by a physician
- E. Signature must be witnessed by a professional staff member
Correct Answer: A,D,E
Rationale: Valid consent must be freely given, without coercion. Consent must be obtained by a physician and the patients signature must be witnessed by a professional staff member. It does not need to be signed on the same day as the surgery and it does not need to be notarized.
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 performing a preoperative assessment on a patient going to surgery. The patient informs the nurse that he drinks approximately two bottles of wine each day and has for the last several years. What postoperative difficulties can the nurse anticipate for this patient?
- A. Alcohol withdrawal syndrome immediately following surgery
- B. Alcohol withdrawal syndrome 2 to 4 days after his last alcohol drink
- C. Alcohol withdrawal syndrome upon administration of general anesthesia
- D. Alcohol withdrawal syndrome 1 week after his last alcohol drink
Correct Answer: B
Rationale: Alcohol withdrawal syndrome may be anticipated between 48 and 96 hours after alcohol withdrawal and is associated with a significant mortality rate when it occurs postoperatively.
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.