Nokea
The nurse is providing preoperative teaching to an older-adult patient who has poor hearing and vision. The partner answers most questions directed to the patient. Which of the following actions should the nurse take when implementing patient teaching?
- A. Use printed materials for instruction so that the patient will have more time to review the material.
- B. Direct the teaching toward the partner as the patient's support person and caregiver.
- C. Provide additional time for the patient to understand preoperative instructions and carry out procedures.
- D. Ask the partner to wait in the hall in order to focus preoperative teaching with the patient.
Correct Answer: C
Rationale: The nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because the patient has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the patient and the wife because both will need to understand preoperative procedures and teaching.
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The nurse is providing preoperative teaching to a patient who is scheduled for surgery in 3 days. Which of the following information should the nurse include when addressing preoperative sensory information?
- A. Warming blankets are available as the operating room is often cold
- B. Lighting in the operating room is low that may cause the patient to have blurred vision.
- C. The operating room bed is narrow and a safety strap is used to secure the patient to the bed.
- D. Not to be alarmed by the quiet environment as there is no conversation in the operating room.
- E. Machines may be making 'ticking and pinging noises' that can be heard.
Correct Answer: A,C,E
Rationale: When providing preoperative teaching related to sensory information the nurse should include that warming blankets will be available as the operating room is often cold, a safety strap will be applied over the patients knees as the operating room bed is narrow, and the operating room machines make noises that the patient may hear when they are awake. Lighting in the OR is very bright, not dull although the patient may have blurred vision related to the preoperative medication it would not be related to the OR. Talking may be heard in the OR but is often distorted because of the masks and patients should be directed to ask any questions that they may have.
Ten minutes after the nurse administered the ordered preoperative opioid by intravenous (IV) injection, the patient asks to get up to go to the bathroom to urinate. Which of the following actions is best for the nurse to implement?
- A. Assist the patient to the bathroom and ensure a call bell is within reach.
- B. Offer a urinal or bedpan and position the patient in bed to promote voiding.
- C. Allow the patient up to the bathroom because the onset of the medication takes more than 10 minutes.
- D. Ask the patient to wait because catheterization is performed at the beginning of the surgical procedure.
Correct Answer: B
Rationale: The patient will be at risk for a fall after receiving the opioid, so the best nursing action is to have the patient use a bedpan or urinal. Having the patient get up either with assistance or independently increases the risk for a fall. The patient will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room.
The nurse is preparing a patient for surgery. Which of the following information about medication use is most important for the nurse to communicate to the health care provider?
- A. The patient uses acetaminophen occasionally for aches and pains.
- B. The patient takes garlic capsules daily but did not take any on the surgical day.
- C. The patient has a history of cocaine use but quit using the drug over 10 years ago.
- D. The patient took a sedative medication the previous night to assist in falling asleep.
Correct Answer: B
Rationale: Persistent use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome.
The nurse is completing a preoperative assessment of a patient scheduled for a colon resection and the patient tells the nurse about using St. John's wort to prevent depression. Which of the following information should the nurse alert the staff in the postanaesthesia recovery area about?
- A. Increased pain
- B. Hypertensive episodes
- C. Increased postanaesthesia waking time
- D. Increased postoperative bleeding
Correct Answer: C
Rationale: St. John's wort may prolong the effects of anaesthetic agents and increase the time to waken completely after surgery. It is not associated with increased bleeding risk, hypertension, or increased pain.
Before the administration of preoperative medications, the nurse is preparing to witness the patient signing the operative consent form when the patient says, 'I do not really understand what the doctor said.' Which of the following actions is best for the nurse to take?
- A. Provide an explanation of the planned surgical procedure.
- B. Notify the surgeon that the informed-consent process is not complete.
- C. Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications.
- D. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.
Correct Answer: B
Rationale: The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurse's legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient signs the consent form.