Chapter 38 Surgical Patient

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Chapter 38  Surgical Patient

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

MULTIPLE CHOICE

1. Richard is a 57-year-old patient who is being admitted for an appendectomy. He is a 2-pack-a-day smoker and has a history of diabetes. In addition to his other risk factors, he is 20 pounds overweight. Which of the following potential postoperative complications should the nurse be most concerned with?
A.
Atelectasis
B.
Negative nitrogen balance
C.
Dehydration
D.
Hypothermia

ANS: A
There is a significant association between smoking and postoperative pulmonary complications, specifically pneumonia and atelectasis. Chronic smoking increases the amount and thickness of mucous secretions in the lungs. Patients who are obese are more susceptible to developing atelectasis.

PTS: 1 DIF: Cognitive Level: Analysis REF: 1131
OBJ: List factors to include in the preoperative assessment of a surgical patient
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

2. Misty is a nurse who works in surgery. She knows that pulmonary embolisms can be a deadly complication of surgery. Which of the following patients is most likely to develop a pulmonary embolism?
A.
45-year-old patient after bariatric surgery
B.
23-year-old patient with head trauma
C.
13-year-old patient after appendectomy
D.
57-year-old patient after cholecystectomy

ANS: A
Patients who are obese are more susceptible to developing embolism postoperatively than patients who are not obese.

PTS: 1 DIF: Cognitive Level: Analysis REF: 1132
OBJ: Identify factors to assess in a patient in postoperative recovery
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

3. Shawna is a 45-year-old woman with cancerous abdominal tumor. She has been on chemotherapy and is having radiotherapy to shrink the tumor. She will be undergoing surgery to remove the tumor. To best facilitate wound healing, when is the best time for her to undergo surgery?
A.
During the radiotherapy treatments
B.
Immediately after the radiotherapy treatments
C.
2 to 3 weeks after radiotherapy treatments
D.
4 to 6 weeks after radiotherapy treatments

ANS: D
The patient with cancer may have radiotherapy before surgery to reduce the size of a cancerous tumor to remove it surgically. Radiation causes fibrosis and vascular scarring in the radiated area. This causes tissues to become fragile and poorly oxygenated, increasing the risk for wound infection. Ideally surgery takes place 4 to 6 weeks after the completion of radiation treatments to avoid wound-healing problems.

PTS: 1 DIF: Cognitive Level: Application REF: 1134
OBJ: Identify factors to assess in a patient in postoperative recovery
TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity

4. Which of the following patients is most at risk for hypovolemic shock after emergency surgery?
A.
14-year-old adolescent with gastroenteritis
B.
59-year-old patient with pneumonia
C.
12-year-old patient with H1N1 flu
D.
28-year-old patient with renal calculi

ANS: A
Patients with preexisting renal, fluid and electrolyte, gastrointestinal, respiratory, or cardiovascular problems are at greatest risk for operative complications. For example, a patient who is dehydrated from vomiting preoperatively is at greater risk for hypovolemic shock.

PTS: 1 DIF: Cognitive Level: Analysis REF: 1134
OBJ: Identify factors to assess in a patient in postoperative recovery
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

5. Clara is a perioperative nurse. She is monitoring the blood glucose level of Harold, a 56-year-old patient without diabetes who is undergoing orthopedic surgery. What is the main rationale for monitoring his blood glucose level during surgery?
A.
She does not want Harold to develop type 2 diabetes.
B.
Research shows a strong relationship between wound infections and hyperglycemia.
C.
She knows that normal glucose levels promote good tissue oxygenation.
D.
She is monitoring to prevent hypoglycemia.

ANS: B
Evidence has shown that there is a relationship between wound and tissue infection and blood glucose levels. Poor control of blood glucose levels (specifically hyperglycemia) during and after surgery increases the risk for wound infection and patient mortality in certain types of surgery.

PTS: 1 DIF: Cognitive Level: Analysis REF: 1134
OBJ: Describe intraoperative factors that affect a patient’s postoperative course
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

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