Chapter 36 Preoperative and Postoperative Care

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Chapter 36  Preoperative and Postoperative Care

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

MULTIPLE CHOICE

1. When planning care for a surgical patient, the nurse recognizes that surgical site infections account for what percentage of hospital-acquired infection?
a.
22% to 40%
b.
5% to 10%
c.
45% to 70%
d.
75% to 100%

ANS: A
The National Nosocomial Infections Surveillance (NNIS) system of the Centers for Disease Control and Prevention (CDC) reports that surgical site infections (SSIs) account for up to 16% of hospital-acquired infections. Current research indicates that 38% of hospital-acquired infections are surgical site infections.

DIF: Cognitive Level: Application REF: Text reference: p. 881
OBJ: Explain the rationale for preoperative procedures. TOP: Hospital-Acquired Infections
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The goal of prophylactic antibiotic therapy is to protect the patient from infection with as little risk as possible. To achieve this goal, the nurse recognizes that antibiotics should be administered when they will be most beneficial. When would that be?
a.
Twenty-four hours before surgery
b.
For 2 weeks after surgery
c.
For no longer than 24 hours after surgery
d.
When signs of infection first appear

ANS: C
Overall, it is recommended that prophylactic antibiotics be given as close to the time of incision as possible (within 30 to 60 minutes) and not be given for longer than 24 hours postoperatively. However, vancomycin and fluoroquinolones may be given up to 2 hours before incision because of their longer infusion times. The goal of prophylactic antibiotic therapy is to protect the patient from infection with as little risk as possible. To achieve this goal, antibiotics must be administered when they will be most beneficial.

DIF: Cognitive Level: Application REF: Text reference: pp. 881-882
OBJ: Describe the activities needed to prepare a patient for surgery.
TOP: Hospital-Acquired Infections KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

3. While planning care for a surgical patient, the nurse recognizes that which of the following effects of hyperglycemia is seen in the immediate postoperative period?
a.
Increases risk for infection in the diabetic patient only
b.
Decreases risk for surgical site infection
c.
Increases risk for infection in diabetic and nondiabetic patients
d.
Has no effect on the body’s ability to fight infection

ANS: C
The presence of hyperglycemia in the immediate postoperative period increases the risk for infection in both diabetic and nondiabetic patients. The higher the serum glucose, the greater the potential for infection in both patient groups. Hyperglycemia has been shown to inhibit the body’s ability to fight infection. Immediate postoperative glucose control also has been correlated with a reduction in surgical infection.

DIF: Cognitive Level: Application REF: Text reference: p. 882
OBJ: Explain the rationale for preoperative procedures. TOP: Hyperglycemia
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

4. The nurse is to obtain an informed consent for a patient before surgery is performed. The nurse recognizes that which of the following statements is true?
a.
Informed consent is required by law to protect the surgeon in case of an adverse outcome.
b.
Only the patient can sign a surgical consent.
c.
The nurse’s legal responsibility is to ensure that the patient understands the information presented.
d.
The surgeon should give the patient information about the surgery.

ANS: D
The surgeon should give the patient information about the extent and type of surgery, alternative therapies, usual risks and benefits, and consequences of not having surgery in a nonthreatening manner, as outlined in The Patient Care Partnership developed by the American Hospital Association (AHA). Informed consent is required by law to help protect patients’ rights, their autonomy, and their privacy. The patient or the patient’s legal guardian must sign a surgical consent form that includes this information. If the patient’s cultural practices include male dominance, the husband, father, or oldest brother of a female patient also may need to sign the consent form. It is the nurse’s ethical (not legal) responsibility, acting as the patient’s advocate, to ensure that the patient understands the information. See institutional policy regarding consent.

DIF: Cognitive Level: Application REF: Text reference: p. 883
OBJ: Explain the rationale for preoperative procedures. TOP: Informed Consent
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

5. The nurse is planning care for a preoperative patient. Which intervention is implemented to ensure safe nursing care?
a.
Allowing the patient to have ice chips
b.
Always keeping the patient NPO for 12 to 14 hours before
c.
Allowing the patient to brush teeth and swallow water
d.
Allowing the patient to take specifically ordered oral medications with small amounts of water

ANS: D
Patients may take oral medications with sips of water (30 mL) if they are specially ordered to be taken preoperatively (e.g., antiarrhythmic or seizure medications). All other oral medications are withheld. The nurse must later check postoperative orders to ensure that scheduled medications unrelated to surgery are not forgotten. In general, food and fluids are withheld for 4 to 8 hours before surgery requiring general anesthesia, to minimize the risk for aspiration. Patients may brush their teeth but should not swallow water.

DIF: Cognitive Level: Application REF: Text reference: p. 886
OBJ: Adequately prepare a patient for surgery.
TOP: Preoperative Medication Administration
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

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