Chapter 26 Geriatric Surgery

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Chapter 26  Geriatric Surgery

 

 

Complete chapter Questions And Answers
 

Sample Questions

 

 

MULTIPLE CHOICE

1. A number of screening tools have been developed to accurately establish biologic age. One tool, the Comprehensive Geriatric Assessment (CGA), is a multidimensional evaluation that scrutinizes medications, functional ability, co-morbid conditions, cognitive ability, mental function, nutritional status, and socioenvironmental factors. In geriatric medical studies, the CGA has been valuable in providing a metric for describing healthy aging and:

  1. predicting the incidence of hospitalization.
  2. identifying at-risk individuals.
  3. measuring performance of activities of daily living.
  4. determining success of interventions.

ANS: B
The CGA may be used both to identify at-risk individuals and to guide interventions. In geriatric medical studies the CGA has been found to be potentially beneficial in reducing the incidence of hospitalization, falls, delirium, and readmission. It is predictive of both morbidity and mortality in older patients. When evaluated as a screening tool in the geriatric community, it has been shown to detect new and unsuspected problems in 76% of elderly persons living at home.

REF: Page 1162

2. As a person ages digestive secretions decrease, mucus becomes thicker (causing dysphagia), and saliva becomes more alkaline. Decreased peristalsis and gastric motility, resulting in muscle tone loss, will cause delayed stomach emptying. What perioperative concern may be influenced by this age-related digestive condition?

  1. Traumatic injuries to the bowel
  2. Decreased lean body mass
  3. Esophageal reflux
  4. Retention of lipophilic drugs

ANS: C
These factors are of particular importance for assessing the patient’s response to preoperative, anesthetic, and postoperative medications: relaxation of esophageal muscle tone, increasing the prevalence of esophageal reflux, decreased saliva production and gastric secretions, and bowel dysfunction from decreased peristalsis.

REF: Page 1164

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 26-2

3. Age-related changes cause decreased blood flow to the kidneys with a resultant decrease in nephron function. What condition is created from the cumulative effect of the multiple drugs that the elderly patient will receive during the perioperative phase?

  1. Increased chance for adverse reactions and consequential results
  2. Polypharmacy psychosis
  3. Weakened bladder muscle tone with urinary incontinence
  4. Liver toxicity

ANS: A
During the perioperative phase of the patient’s hospital stay, the greatest number and variety of drugs are given; the cumulative effect increases the chances for adverse and consequential results.

REF: Pages 1164-1165

4. Impaired nutritional status is highly prevalent among the elderly; as many as 12% of men and 8% of women in the healthy geriatric population are considered undernourished. During the preoperative assessment and interview, what information will the perioperative nurse review, in addition to a thorough assessment including body mass index and Mini Nutritional Assessment?

  1. The NPO status
  2. The serum albumin level
  3. The medication record for use of vitamins
  4. The use of nutritional supplements

ANS: B
Higher rates of surgical complications and increased postoperative mortality have been observed in patients with poor nutritional status, as determined by a low body mass index, weight loss, a low preoperative serum albumin level, or a low Mini Nutritional Assessment score.

REF: Page 1162

5. Age-related skin changes include a thinning epidermis and decreased subcutaneous fat and elasticity. What special consideration will the perioperative nurse provide, in terms of additional attention and care, in one of the following nursing actions?

  1. Cover all appropriate, nonoperative, skin surfaces with soft bath blankets.
  2. Document thorough, meticulous preoperative and postoperative skin assessment.
  3. Perform meticulous sterile technique.
  4. Gently lift, not slide, the patient to and from the OR bed.

ANS: D
The skin loses elasticity and subcutaneous fat and becomes more prone to shear force and pressure injury. Because of the thinness of the skin and small vessel fragility, bruising and hemorrhaging are quite common.

REF: Page 1163

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 26-3

6. Changes to the elderly person’s skeleton, such as the loss of bone mass, contribute to skeletal instability and make fractures of the hip, rib, distal radius, and vertebrae very common. What special intervention will the perioperative nurse provide, in terms of additional attention and care, in one of the following nursing actions?

  1. Document the patient’s pain rating before anesthesia induction and positioning.
  2. Position the patient using appropriate padding and joint protection devices.
  3. Consider the patient’s posture and flexibility during the preoperative interview.
  4. All of the options are correct.

ANS: B
Extra care in positioning patients in the OR should be taken with the elderly patient, ensuring appropriate padding and joint protection.

REF: Page 1165

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