Nokea
The nurse is performing a preadmission assessment of a patient scheduled for a bilateral mastectomy. Of what purpose of the preadmission assessment should the nurse be aware?
- A. Verifies completion of preoperative diagnostic testing
- B. Discusses and reviews patients health insurance coverage
- C. Determines the patients suitability as a surgical candidate
- D. Informs the patient of need for postoperative transportation
Correct Answer: A
Rationale: Purposes of preadmission testing (PAT) include verifying completion of preoperative diagnostic testing. The nurses role in PAT does not normally involve financial considerations or addressing transportation. The physician determines the patients suitability for surgery.
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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 planning the care of a patient who has type 1 diabetes and who will be undergoing knee replacement surgery. This patients care plan should reflect an increased risk of what postsurgical complications? Select all that apply.
- A. Hypoglycemia
- B. Delirium
- C. Acidosis
- D. Glucosuria
- E. Fluid overload
Correct Answer: A,C,D
Rationale: Hypoglycemia may develop during anesthesia or postoperatively from inadequate carbohydrates or excessive administration of insulin. Hyperglycemia, which can increase the risk for surgical wound infection, may result from the stress of surgery, which can trigger increased levels of catecholamine. Other risks are acidosis and glucosuria. Risks of fluid overload and delirium are not normally increased.
You are caring for an 88-year-old woman who is scheduled for a right mastectomy. You know that elderly patients are frequently more anxious prior to surgery than younger patients. What would you increase with this patient to decrease her anxiety?
- A. Analgesia
- B. Therapeutic touch
- C. Preoperative medication
- D. Sleeping medication the night before surgery
Correct Answer: B
Rationale: Older patients report higher levels of preoperative anxiety; therefore, the nurse should be prepared to spend additional time, increase the amount of therapeutic touch utilized, and encourage family members to be present to decrease anxiety. For most patients, nonpharmacologic interventions should be attempted before administering medications.
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.
The nurse is preparing to send a patient to the OR for a scheduled surgery. What should the nurse ensure is on the chart when it accompanies the patient to surgery? Select all that apply.
- A. Laboratory reports
- B. Nurses notes
- C. Verification form
- D. Social work assessment
- E. Dieticians assessment
Correct Answer: A,B,C
Rationale: The completed chart (with the preoperative checklist and verification form) accompanies the patient to the OR with the surgical consent form attached, along with all laboratory reports and nurses records. Any unusual last-minute observations that may have a bearing on anesthesia or surgery are noted prominently at the front of the chart. The social work and dieticians assessments are not normally necessary when the patient goes to surgery.