SESSION # 1
CHECK FOR UNDERSTANDING:
Discussion Questions:
1. What factors in C.J.’s background or personal situation might influence
his emotional response and physical reactions to this surgery?
Answer: family: children with cystic fibrosis who require extra care and expense
and concern that the wife will not be able to manage without him;
fear of cancer and the unknown; anemia;
contributes to fatigue and ability to cope.
2. What should C.J. know if his consent for surgery is to be truly informed?
Answer: three criteria for informed consent:
--adequate disclosure of the diagnosis; the nature and purpose of the proposed
treatment; risks and consequences of the proposed treatment; the availability,
benefits, and risks of alternative treatments; and the prognosis if treatment is not
instituted.
--sufficient comprehension of the information is provided.
--voluntary consent is given without persuasion or coercion.
3. Priority Decision: C.J. will be an outpatient for this procedure. What is
the priority preoperative teaching that should be done to prepare him for
surgery?
Answer: Outpatient Instructions;
when to arrive and the time of the surgery, how and where to register, what to
wear and bring, the need for a responsible adult for transportation home after the
procedure.
General preoperative instruction;
information related to preoperative routines and preparation, such as food and fluid
restrictions; approximate length of surgery; postoperative recovery.
4. What risk factors for surgical and anesthetic complications might you
anticipate for C.J.? What are the potential interventions that might
minimize the risks?
Answer: Smoking history increases the risk for posoperative respiratory
complications; the longer the patient can stop smoking before surgery,the less the
risk will be mild obesity and may contribute to problems with clearance of
respiratory secretions and complete expansion of the lungs. The patient should
have preoperative instruction about deep-breathing and coughing techniques. Fear
of a diagnosis of cancer can alter adaptation and recovery. The nurse can help to
minimize this risk by providing specific information about the experience and
through supportive listening.
5. Priority Decision: Based on the assessment data provided, what are the
priority nursing diagnoses? Are there any collaborative problems?
Answer: Nursing Diagnoses:
--fear related to possible diagnosis of cancer.
--interrupted family processes related to shift in family roles.
--ineffective health maintenance related to tobacco use.
Collaborative problems:
potential complications;
hemorrhage, laryngospasm/bronchospasm, pneumonia, pneumothorax
Multiple Choice
1. As a nurse, what is the importance of a thorough preoperative
assessment?
a. To identify and correct problems before surgery and establish a baseline for
postoperative comparison
b. To save time doing an assessment after the patient returns from surgery
c. To provide the doctor with information that may have been missed during the
preadmission assessment
d. To ensure that postoperative complications don’t occur
ANSWER: A
RATIO: It is used to compare all assessment data with expected normal values.
2. Before administering preoperative medication to a client, nurse Jonalyn
should plan to:
a. Verify the consent
b. Check the vital signs
c. Have the client void
d. Remove the client’s dentures
ANSWER: A
RATIO: It enables the patient to decide which treatments she/he do or do not want
to receive. Also, informed consent allows the patient to make decisions with
the healthcare provider.
3. A client with Cataract is about to undergo surgery. Nurse Princess is
preparing plan of care. Which of the following nursing diagnosis is most
appropriate to address the long term need of this type of patient?
a. Anxiety related to the operation and its outcome
b. Sensory perceptual alteration related to lens extraction and replacement
c. Knowledge deficit related to the pre-operative and post-operative self-care
d. Body Image disturbance related to the eye packing after surgery
ANSWER: B
RATIO: The most appropriate nursing diagnosis for the client scheduled for
cataract surgery is Disturbed sensory perception (visual) related to lens extraction
and replacement. Although the other options identify nursing diagnoses that may
be appropriate, they are not related specifically to cataract surgery.
4. On the morning of Mrs. Sy’s planned cholecystectomy, she awakens with
a pain in her right scapular area and thinks she slept in poor position.
While doing the pre-op check list you note that on her routine CB report
her WBC is 15,000. Your responsibility at this point is:
a. To notify the surgeon at once; this is an elevated WBC indicating an
inflammatory reaction
b. To record this finding in a prominent place on the pre-op checklist and in your
pre-op notes This document and the information thereon is the property of PHINMA
Education (Department of Nursing) 8 of 10
c. To call the laboratory for a STAT repeat WBC
d. None. This is not an unusual finding
ANSWER: A
RATIO: A WBC count of 15,000 probably indicates acute cholecystitis, especially
considering Mrs. Hogan’s new pain. The surgeon should be called as he/she may
treat the acute attack medically and delay the surgery for several days, weeks, or
months.
5. Mrs. Sy is scheduled for surgery 2 days later and is to be given atropine
0.3 mg IM and Demerol 50 mg IM one hour preoperatively. Which nursing
actions follow the giving of the pre-op medication?
a. Have her void soon after receiving the medication
b. Allow her family to be with her before the medication takes effect
c. Bring her valuables to the nursing station
d. Reinforce pre-op teaching
ANSWER: B
RATIO: Options A, C and D should all take place prior to administration of the
drugs. The family may also be involved earlier but certainly should have that time
immediately after the medication is given and before it takes full effect to be with
their loved ones. Good planning of nursing care can facilitate this.
6. A patient is admitted to the same day surgery unit for liver biopsy.
Which of the following laboratory tests assesses coagulation? SATA.
a. Partial thromboplastin time.
b. Prothrombin time.
c. Platelet count.
d. Hemoglobin
ANSWER: A, B, C
RATIO: Prothrombin time, partial thromboplastin time, and platelet count are all
included in coagulation studies. The hemoglobin level, though important information
prior to an invasive procedure like liver biopsy, does not assess coagulation.
7. A client with a perforated gastric ulcer is scheduled for emergency
surgery. The client cannot sign the operative consent form because he has
been sedated with opioid analgesics. The nurse should take which of the
following actions in the care of this client?
a. Obtain a telephone consent from the family member witnessed by two persons.
b. Obtain a court order for the surgery.
c. Send the client to surgery without the consent form being signed.
d. Have the hospital chaplain sign the informed consent immediately
ANSWER: A
RATIO: Every effort must be made to obtain permission from a responsible family
member to perform surgery if the client is unable to sign the consent form. A
telephone consent must be witnessed by two persons who hear the family
member’s oral consent. The two witnesses then sign the consent with the name of
the family member, noting that an oral consent was obtained.
8. A preoperative client expresses anxiety to the nurse about the upcoming
surgery. Which of the following responses by the nurse is most likely to
stimulate further discussion between the client and the nurse?
a. “I will be happy to explain the entire surgical procedure to you.”
b. “Let me tell you about the care you’ll receive after surgery and the amount of
pain you can anticipate.”
c. “If it’s any help, everyone is nervous before surgery.”
d. “Can you share with me what you’ve been told about your surgery?”
ANSWER: D
RATIO: Explanations should begin with the information that the client knows. By
providing the client with an individualized explanation of care and procedures, the
nurse can assist the client in handling fears and providing a smooth preoperative
experience. Clients who are calm and emotionally prepared for surgery withstand
anesthesia better and experience fewer postoperative complications. Options 1, 2,
and 3 are nontherapeutic responses.
9. A nurse is preparing the client for transfer to the operating room (OR).
The nurse should take which of the following actions in the care of this
client at this time?
a. Administer all the daily medications.
b. Ensure that the client has voided.
c. Verify that the client has not eaten for the last 24 hours.
d. Practice postoperative breathing exercises.
ANSWER: B
RATIO: The nurse should ensure that the client has voided if a Foley catheter is
not in place. The nurse does not administer all daily medications just prior to
sending a client to the OR. Rather, the physician writes a specific order outlining
which medications may be given with a sip of water. The client has nothing by
mouth for 8 hours prior to surgery, not 24. The time of transfer to the OR is not the
time to practice breathing exercises. This should have been accomplished earlier.
10. A nurse is reviewing the physician’s order sheet for the preoperative
client, which states that the client must be on nothing per mouth (NPO)
status after midnight. The nurse would clarify whether which of the
following medications should be given to the client and not withheld?
a. Conjugated estrogen (Premarin)
b. Atenolol (Tenormin)
c. Cyclobenzaprine (Flexeril)
d. Ferrous sulfate
ANSWER: B
RATIO: NPO is the short form of the Latin abbreviation for nothing by mouth.
According to the American Society of Anesthesiologists, one should not consume
easily digested solids or at least 6 hours before surgery. This is important to both
prevent nausea in the patient and to ensure that no food or liquid accidentally gets
into the lungs during surgery.
