1.

Which procedures are done for curative purposes (select all that
apply)?
a. Gastroscopy
b. Rhinoplasty
c. Tracheotomy
d. Hysterectomy
e. Herniorrhaphy
2. A patient is scheduled for a hemorrhoidectomy at an ambulatory
surgery center. An
advantage of performing surgery at an ambulatory center is a
decreased need for
a. diagnostic studies and perioperative medications.
b. preoperative and postoperative teaching by the nurse.
c. psychologic support to alleviate fears of pain and discomfort.
d. preoperative nursing assessment related to possible risks and
complications.
3. Patient-Centered Care: A patient who is being admitted to the
surgical unit for a
hysterectomy paces the floor, repeatedly saying, “I just want this
over.” What should
the nurse do to promote a positive surgical outcome for the patient?
a. Ask the patient what her specific concerns are about the surgery.
b. Redirect the patient’s attention to the necessary preoperative
preparations.
c. Reassure the patient that the surgery will be over soon and she will
be fine.
d. Tell the patient she should not be so anxious because she is having
a common, safe surgery.
4. Many common herbal products taken cause surgical problems.
Which herbs listed
subsequently should the nurse teach the patient to avoid before
surgery to prevent an
increase in bleeding for the surgical patient (select all that apply)?
a. Garlic
b. Fish oil
c. Valerian
d. Vitamin E
e. Astragalus
f. Ginkgo biloba
5. Priority Decision: When the nurse asks a preoperative patient
about allergies, the
patient reports a history of seasonal environmental allergies and
allergies to a variety
of fruits. What should the nurse do next?
b. Surgery will be rescheduled for the following day.
c. Surgery will be postponed for 8 hours after the fluid intake.
d. A nasogastric tube will be inserted to remove the fluids from the
stomach.
12. What is the reason for using preoperative checklists on the day of
surgery?
a. The patient is correctly identified and preoperative medications
administered.
b. All preoperative orders and procedures have been carried out
and
documented.
c. Voiding is the last procedure before the patient is transported to
the
operating room.
d. Patients’ families have been informed as to where they can
accompany and
wait for patients.
13. A common reason that a nurse may need extra time when
preparing older adults for
surgery is their
a. difficulty coping.
b. limited adaptation to stress.
c. diminished vision and hearing.
d. need to include caregivers in activities.
14. The nurse is reviewing the laboratory results for a preoperative
patient. Which study
result should be brought to the attention of the surgeon immediately?
a. Serum K+ of 3.8 mEq/L
b. Hemoglobin of 15 g/dL
c. Blood glucose of 100 mg/dL
d. White blood cell (WBC) count of 18,500/μL
15. The nurse is preparing a patient for transport to the operating
room. The patient is
scheduled for a right knee arthroscopy. What actions should the
nurse take at this
time (select all that apply)?
a. Ensure that the patient has voided.
b. Verify that the informed consent is signed.
c. Complete preoperative nursing documentation.
d. Verify that the right knee is marked with indelible marker.
e. Ensure that the history and physical examination (H&P),
diagnostic
reports, and vital signs are on the chart.

ANSWER KEY:
Chapter 17
1. d, e. Hysterectomy and herniorrhaphy are done to eliminate and
repair
pathologic conditions. Gastroscopy is for the purpose of diagnosis.
Rhinoplasty is done for a cosmetic improvement. A tracheotomy is
palliative.
2. a. Ambulatory surgery is usually less expensive and more
convenient,
generally involving fewer diagnostic studies, fewer preoperative and
postoperative medications, and less susceptibility to health care–
associated infections (HAIs). However, the nurse is still responsible
for
assessing, supporting, and teaching the patient who is undergoing
surgery,
regardless of where the surgery is performed.
3. a. Excessive anxiety and stress can affect surgical recovery and the
nurse’s role in psychologically preparing the patient for surgery is to
assess for potential stressors that could negatively affect surgery.
Specific
fears should be identified and addressed by the nurse by listening
and
explaining planned postoperative care. Ignoring her behavior, falsely
reassuring the patient, and telling her not to be anxious are not
therapeutic.
4. a, b, d, f. Garlic, fish oil, vitamin E, and ginkgo biloba may increase
bleeding for the surgical patient. Valerian may cause excess sedation.
Astragalus may increase BP before and during surgery.
5. c. Risk factors for latex allergies include a history of hay fever and
allergies to foods, such as avocados, kiwi, bananas, potatoes, peaches,
and
apricots. When a patient identifies such allergies, the patient should
be
further questioned about exposure to latex and specific reactions to
allergens. A history of any allergic responsiveness increases the risk
for
hypersensitivity reactions to drugs used during anesthesia, but the
hay
fever and fruit allergies are specifically related to latex allergy. After
the
nurse identifies the allergic reaction, the anesthesia care provider
(ACP)
should be notified, the allergy alert wristband should be applied, and
the
note in the record will include the allergies and reactions as well as
the
nursing actions related to the allergies.
6. d. Blood urea nitrogen (BUN), serum creatinine, and electrolytes
are used to assess renal function and should be evaluated before
surgery.
Other studies are often evaluated in the presence of heart or
respiratory
disease, or bleeding tendencies.
7. a. Obesity, as well as spinal, chest, and airway deformities, may
compromise respiratory function during and after surgery.
Dehydration
may require preoperative fluid therapy. An enlarged liver may
indicate
hepatic dysfunction that will increase perioperative risk related to
glucose
control, coagulation, and drug interactions. Weak peripheral pulses
may
reflect circulatory problems that could affect healing.
8. a, b, e. Procedural information includes what will be done for
surgical
preparation, including what to bring and what to wear to the surgery
center, length and type of food and fluid restrictions, physical
preparation
required, pain control, need for coughing and deep breathing (if
appropriate), and procedures done before and during surgery (such
as
vital signs, IV lines, and how anesthesia is administered).
Characteristics
of monitoring equipment is process information. Odors and
sensations
experienced are sensory information (see Table 17.6).
9. a. The HCP is ultimately responsible for obtaining informed
consent.
However, the nurse may be responsible for obtaining and witnessing
the
patient’s signature on the consent form. The nurse must be a patient
advocate during the signing of the consent form, verifying that
consent is
voluntary and that the patient understands the implications of
consent, but
the primary legal action by the nurse is witnessing the patient’s
signature.
10. a. The nurse should notify the surgeon because the patient needs
further explanation of the planned surgery.
b. Clear understanding of the information
11. a. The preoperative fasting recommendations of the American
Society
of Anesthesiology indicate that clear liquids may be taken up to 2
hours
before surgery for healthy patients undergoing elective procedures.
There
is evidence that longer fasting is not necessary (see Table 17.7).
12. b. The rationale for use of preoperative checklists is to ensure that
the
many preparations and precautions performed before surgery have
been
completed and documented. Patient identification, administration of
preoperative medications, voiding, and instructions to the family
may be
documented on the checklist, which ensures that no details are
omitted.
13. c. One of the major reasons that older adults need increased time
preoperatively is the presence of impaired vision and hearing that
slows understanding of preoperative instructions and preparation for
surgery.
Thought processes and cognitive abilities may also be impaired in
some
older adults. The older adult’s decreased adaptation to stress because
of
physiologic changes may increase surgical risks, and overwhelming
surgery-related losses may result in difficulty coping that is not
directly
related to time needed for preoperative preparation. The involvement
of
caregivers in preoperative activities may be appropriate for patients
of all
ages.
14. d. The elevated white blood count (WBC) count may indicate an
infection. The surgeon will probably postpone the surgery until the
cause
of the elevated WBC count has been found. The other values are
within
normal limits.
15. a, b, c, d, e. All of these are actions that are needed to ensure that
the
patient is ready for surgery. In addition, the nurse should verify that
the
identification band and allergy band (if applicable) are on; the patient
is
not wearing any cosmetics; nail polish has been removed; valuables
have
been removed and secured; and prosthetics, such as eyeglasses, have
been
removed and secured.