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The PACU nurse is caring for a patient who has been deemed ready to go to the postsurgical floor after her surgery. What would the PACU nurse be responsible for reporting to the nurse on the floor? Select all that apply.
- A. The names of the anesthetics that were used
- B. The identities of the staff in the OR
- C. The patients preoperative level of consciousness
- D. The presence of family and/or significant others
- E. The patients full name
Correct Answer: C,D,E
Rationale: The PACU nurse is responsible for informing the floor nurse of the patients intraoperative factors (e.g., insertion of drains or catheters, administration of blood or medications during surgery, or occurrence of unexpected events), preoperative level of consciousness, presence of family and/or significant others, and identification of the patient by name. The PACU nurse does not tell which anesthetic was used, only the type and amount used. The PACU nurse does not identify the staff that was in the OR with the patient.
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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.
The nurse is providing preoperative teaching to a patient scheduled for surgery. The nurse is instructing the patient on the use of deep breathing, coughing, and the use of incentive spirometry when the patient states, I dont know why youre focusing on my breathing. My surgery is on my hip, not my chest. What rationale for these instructions should the nurse provide?
- A. To prevent chronic obstructive pulmonary disease (COPD)
- B. To promote optimal lung expansion
- C. To enhance peripheral circulation
- D. To prevent pneumothorax
Correct Answer: B
Rationale: One goal of preoperative nursing care is to teach the patient how to promote optimal lung expansion and consequent blood oxygenation after anesthesia. COPD is not a realistic risk and pneumothorax is also unlikely. Breathing exercises do not primarily affect peripheral circulation.
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.
A clinic nurse is conducting a preoperative interview with an adult patient who will soon be scheduled to undergo cardiac surgery. What interview question most directly addresses the patients safety?
- A. What prescription and nonprescription medications do you currently take?
- B. Have you previously been admitted to the hospital, either for surgery or for medical treatment?
- C. How long do you expect to be at home recovering after your surgery?
- D. Would you say that you tend to eat a fairly healthy diet?
Correct Answer: A
Rationale: It is imperative to know a preoperative patients current medication regimen, including OTC medications and supplements. None of the other listed questions directly addresses an issue with major safety implications.
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.