Nokea
You are caring for an 88-year-old woman who is scheduled for a right mastectomy. You know that elderly patients are frequently more anxious prior to surgery than younger patients. What would you increase with this patient to decrease her anxiety?
- A. Analgesia
- B. Therapeutic touch
- C. Preoperative medication
- D. Sleeping medication the night before surgery
Correct Answer: B
Rationale: Older patients report higher levels of preoperative anxiety; therefore, the nurse should be prepared to spend additional time, increase the amount of therapeutic touch utilized, and encourage family members to be present to decrease anxiety. For most patients, nonpharmacologic interventions should be attempted before administering medications.
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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.
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.
The ED nurse is caring for an 11-year-old brought in by ambulance after having been hit by a car. The childs parents are thought to be en route to the hospital but have not yet arrived. No other family members are present and attempts to contact the parents have been unsuccessful. The child needs emergency surgery to save her life. How should the need for informed consent be addressed?
- A. A social worker should temporarily sign the informed consent
- B. Consent should be obtained from the hospitals ethics committee
- C. Surgery should be done without informed consent
- D. Surgery should be delayed until the parents arrive
Correct Answer: C
Rationale: In an emergency, it may be necessary for the surgeon to operate as a lifesaving measure without the patients informed consent. However, every effort must be made to contact the patients family. In this scenario, the surgery is considered lifesaving, and the parents are on their way to the hospital and not available. A delay would be unacceptable. Neither a social worker nor a member of the ethics committee may sign.
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.
A patient is on call to the OR for an aortobifemoral bypass and the nurse administers the ordered preoperative medication. After administering a preoperative medication to the patient, what should the nurse do?
- A. Encourage light ambulation
- B. Place the bed in a low position with the side rails up
- C. Tell the patient that he will be asleep before he leaves for surgery
- D. Take the patients vital signs every 15 minutes
Correct Answer: B
Rationale: When the preoperative medication is given, the bed should be placed in low position with the side rails raised. The patient should not get up without assistance. The patient may not be asleep, but he may be drowsy. Vital signs should be taken before the preoperative medication is given; vital signs are not normally required every 15 minutes after administration.