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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.
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A 90-year-old female patient is scheduled to undergo a partial mastectomy for the treatment of breast cancer. What nursing diagnosis should the nurse prioritize when planning this patients postoperative care?
- A. Risk for Delayed Growth and Development related to prolonged hospitalization
- B. Risk for Decisional Conflict related to discharge planning
- C. Risk for Impaired Memory related to old age
- D. Risk for Infection related to reduced immune function
Correct Answer: D
Rationale: The lessened physiological reserve of older adults results in an increased risk for infection postoperatively. This physiological consideration is a priority over psychosocial considerations, which may or may not be applicable. Impaired memory is always attributed to a pathophysiological etiology, not advanced age.
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 creating the care plan for a 70-year-old obese patient who has been admitted to the postsurgical unit following a colon resection. This patients age and increased body mass index mean that she is at increased risk for what complication in the postoperative period?
- A. Hyperglycemia
- B. Azotemia
- C. Falls
- D. Infection
Correct Answer: D
Rationale: Like age, obesity increases the risk and severity of complications associated with surgery. During surgery, fatty tissues are especially susceptible to infection. In addition, obesity increases technical and mechanical problems related to surgery. Therefore, dehiscence (wound separation) and wound infections are more common. A postoperative patient who is obese will not likely be at greater risk for hyperglycemia, azotemia, or falls.
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 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.