Nokea
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.
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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.
An OR nurse will be participating in the intraoperative phase of a patients kidney transplant. What action will the nurse prioritize in this aspect of nursing care?
- A. Monitoring the patients physiologic status
- B. Providing emotional support to family
- C. Maintaining the patients cognitive status
- D. Maintaining a clean environment
Correct Answer: A
Rationale: During the intraoperative phase, the nurse is responsible for physiologic monitoring. The intraoperative nurse cannot support the family at this time and the nurse is not responsible for maintaining the patients cognitive status. The intraoperative nurse maintains an aseptic, not clean, environment.
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 policies and procedures on a preoperative unit are being amended to bring them closer into alignment with the focus of the Surgical Care Improvement Project (SCIP). What intervention most directly addresses the priorities of the SCIP?
- A. Actions aimed at increasing participation of families in planning care
- B. Actions aimed at preventing surgical site infections
- C. Actions aimed at increasing interdisciplinary collaboration
- D. Actions aimed at promoting the use of complementary and alternative medicine (CAM)
Correct Answer: B
Rationale: SCIP identifies performance measures aimed at preventing surgical complications, including venous thromboembolism (VTE) and surgical site infections (SSI). It does not explicitly address family participation, interdisciplinary collaboration, or CAM.
A patient is admitted to the ED complaining of severe abdominal pain, stating that he has been vomiting coffee-ground like emesis. The patient is diagnosed with a perforated gastric ulcer and is informed that he needs surgery. When can the patient most likely anticipate that the surgery will be scheduled?
- A. Within 24 hours
- B. Within the next week
- C. Without delay because the bleed is emergent
- D. As soon as all the days elective surgeries have been completed
Correct Answer: C
Rationale: Emergency surgeries are unplanned and occur with little time for preparation for the patient or the perioperative team. An active bleed is considered an emergency, and the patient requires immediate attention because the disorder may be life threatening. The surgery would not likely be deferred until after elective surgeries have been completed.