Nokea
You are the nurse caring for an unconscious trauma victim who needs emergency surgery. The patient is a 55 -year-old man with an adult son. He is legally divorced and is planning to be remarried in a few weeks. His parents are at the hospital with the other family members. The physician has explained the need for surgery, the procedure to be done, and the risks to the children, the parents, and the fianc. Who should be asked to sign the surgery consent form?
- A. The fianc
- B. The son
- C. The physician, acting as a surrogate
- D. The patients father
Correct Answer: B
Rationale: The patient personally signs the consent if of legal age and mentally capable. Permission is otherwise obtained from a surrogate, who most often is a responsible family member (preferably next of kin) or legal guardian. In this instance, the child would be the appropriate person to ask to sign the consent form as he is the closest relative at the hospital. The fianc is not legally related to him as the marriage has not yet taken place. The father would only be asked to sign the consent if no children were present to sign. The physician would not sign if family members were available.
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The nurse is teaching her to perform deep breathing and coughing to use postoperatively. What action should the nurse teach the patient?
- A. The patient should take three deep breaths and cough hard three times, at least every 15 minutes for the immediately postoperative period
- B. The patient should take three deep breaths and exhale forcefully and then take a quick short breath and cough from deep in the lungs
- C. The patient should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs
- D. The patient should rapidly inhale, hold for 30 seconds or as long as possible, and exhale slowly
Correct Answer: C
Rationale: The patient assumes a sitting position to enhance lung expansion. The nurse then demonstrates how to take a deep, slow breath and how to exhale slowly. After practicing deep breathing several times, the patient is instructed to breathe deeply, exhale through the mouth, take a short breath, and cough from deep in the lungs.
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.
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 surgical nurse is preparing to send a patient from the presurgical area to the OR and is reviewing the patients informed consent form. What are the criteria for legally valid informed consent? Select all that apply.
- A. Consent must be freely given
- B. Consent must be notarized
- C. Consent must be signed on the day of surgery
- D. Consent must be obtained by a physician
- E. Signature must be witnessed by a professional staff member
Correct Answer: A,D,E
Rationale: Valid consent must be freely given, without coercion. Consent must be obtained by a physician and the patients signature must be witnessed by a professional staff member. It does not need to be signed on the same day as the surgery and it does not need to be notarized.
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.