Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Postoperative Nursing Management

Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Postoperative Nursing Management Related

Review Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) - Postoperative Nursing Management related questions and content

You are caring for a 71-year-old patient who is 4 days postoperative for bilateral inguinal hernias. The patient has a history of congestive heart failure and peptic ulcer disease. The patient is highly reluctant to ambulate and will not drink fluids except for hot tea with her meals. The nurses aide reports to you that this patients vital signs are slightly elevated and that she has a nonproductive cough. When you assess the patient, you auscultate crackles at the base of the lungs. What would you suspect is wrong with your patient?

  • A. Pulmonary embolism
  • B. Hypervolemia
  • C. Hypostatic pulmonary congestion
  • D. Malignant hyperthermia
Correct Answer: C

Rationale: Hypostatic pulmonary congestion, caused by a weakened cardiovascular system that permits stagnation of secretions at lung bases, may develop; this condition occurs most frequently in elderly patients who are not mobilized effectively. The symptoms are often vague, with perhaps a slight elevation of temperature, pulse, and respiratory rate, as well as a cough. Physical examination reveals dullness and crackles at the base of the lungs. If the condition progresses, then the outcome may be fatal. A pulmonary embolism does not have this presentation and hypervolemia is unlikely due to the patients low fluid intake. Malignant hyperthermia occurs concurrent with the administration of anesthetic.

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The nurse admits a patient to the PACU with a blood pressure of 132/90 mm Hg and a pulse of 68 beats per minute. After 30 minutes, the patients blood pressure is 94/47 mm Hg, and the pulse is 110. The nurse documents that the patients skin is cold, moist, and pale. Of what is the patient showing signs?

  • A. Hypothermia
  • B. Hypovolemic shock
  • C. Neurogenic shock
  • D. Malignant hyperthermia
Correct Answer: B

Rationale: The patient is exhibiting symptoms of hypovolemic shock; therefore, the nurse should notify the patients physician and anticipate orders for fluid and/or blood product replacement. Neurogenic shock does not normally result in tachycardia and malignant hyperthermia would not present at this stage in the operative experience. Hypothermia does not cause hypotension and tachycardia.

The nursing instructor is discussing the difference between ambulatory surgical centers and hospital-based surgical units. A student asks why some patients have surgery in the hospital and others are sent to ambulatory surgery centers. What is the instructors best response?

  • A. Patients who go to ambulatory surgery centers are more independent than patients admitted to the hospital
  • B. Patients admitted to the hospital for surgery usually have multiple health needs
  • C. In most cases, only emergency and trauma patients are admitted to the hospital
  • D. Patients who have surgery in the hospital are those who need to have anesthesia administered
Correct Answer: B

Rationale: Patients admitted to the clinical unit for postoperative care have multiple needs and stay for a short period of time. Patients who have surgery in ambulatory centers do not necessarily have greater independence. It is not true that only trauma and emergency surgeries are done in the hospital. Ambulatory centers can administer anesthesia.

The intraoperative nurse is transferring a patient from the OR to the PACU after replacement of the right knee. The patient is a 73-year-old woman. The nurse should prioritize which of the following actions?

  • A. Keeping the patient sterile
  • B. Keeping the patient restrained
  • C. Keeping the patient warm
  • D. Keeping the patient hydrated
Correct Answer: C

Rationale: Special attention is given to keeping the patient warm because elderly patients are more susceptible to hypothermia. It is all important for the nurse to pay attention to hydration, but hypovolemia does not occur as quickly as hypothermia. The patient is never sterile and restraints are very rarely necessary.

An adult patient is in the recovery room following a nephrectomy performed for the treatment of renal cell carcinoma. The patients vital signs and level of consciousness stabilized, but the patient then complains of severe nausea and begins to retch. What should the nurse do next?

  • A. Administer a dose of IV analgesic
  • B. Apply a cool cloth to the patients forehead
  • C. Offer the patient a small amount of ice chips
  • D. Turn the patient completely to one side
Correct Answer: D

Rationale: Turning the patient completely to one side allows collected fluid to escape from the side of the mouth if the patient vomits. After turning the patient to the side, the nurse can offer a cool cloth to the patients forehead. Ice chips can increase feelings of nausea. An analgesic is not administered for nausea and vomiting.

An adult patient has just been admitted to the PACU following abdominal surgery. As the patient begins to awaken, he is uncharacteristically restless. The nurse checks his skin and it is cold, moist, and pale. The nurse concerned the patient may be at risk for what?

  • A. Hemorrhage and shock
  • B. Aspiration
  • C. Postoperative infection
  • D. Hypertension and dysrhythmias
Correct Answer: A

Rationale: The patient with a hemorrhage presents with hypotension; rapid, thready pulse; disorientation; restlessness; oliguria; and cold, pale skin. Aspiration would manifest in airway disturbance. Hypertension or dysrhythmias would be less likely to cause pallor and cool skin. An infection would not be present at this early postoperative stage.

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