Nokea
Which of the following topics is most important for the nurse to discuss preoperatively with a patient who is scheduled for a colon resection?
- A. Care for the surgical incision
- B. Medications used during surgery
- C. Deep-breathing and coughing techniques
- D. Oral antibiotic therapy after discharge home
Correct Answer: C
Rationale: Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this information. The patient does not usually need information about medications that are used intraoperatively.
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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.
The nurse is preparing a patient for abdominal surgery who takes a diuretic and a β-blocker pill to control blood pressure. Which of the following patient information is most important for the nurse to communicate to the health care provider before surgery?
- A. Pulse rate 59 beats/minute
- B. Hematocrit 35%
- C. Blood pressure 142/78 mm/Hg
- D. Serum potassium 3.3 mmol/L
Correct Answer: D
Rationale: The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of patient anxiety. The heart rate would be expected in a patient taking a β-blocker. The hematocrit is in the low normal range but does not require any intervention before surgery.
The nurse is interviewing a patient who is to have outpatient surgery using a general anaesthetic. Which of the following information is most important to communicate to the surgeon and anaesthesiologist before surgery?
- A. The patient drinks three or four cups of coffee every morning before going to work.
- B. The patient takes a baby Aspirin daily but stopped taking Aspirin 2 weeks ago.
- C. The patient drank 120 mL of apple juice 3 hours before coming to the hospital.
- D. The patient's father died after receiving general anaesthesia for abdominal surgery.
Correct Answer: D
Rationale: The information about the patient's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue Aspirin 1-2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.
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 clinic nurse is reviewing the complete blood cell count (CBC) results for a patient who is scheduled for surgery in a few days. The results are white blood cell count (WBC) 10.2 ?? 10/1, hemoglobin 150 g/1, hematocrit 45%, platelets 150 ?? 10/1. Which of the following actions should the nurse take?
- A. Send the CBC results to the surgery facility.
- B. Call the surgeon and anaesthesiologist immediately.
- C. Ask the patient about any symptoms of a recent infection.
- D. Discuss the possibility of blood transfusion with the patient.
Correct Answer: A
Rationale: The nurse should be sure that the CBC results, which are normal, are available at the surgical facility to avoid delay of the procedure. With normal results, there is no need to notify the surgeon or anaesthesiologist, discuss blood transfusion, or ask about recent infection.