Chapter 39 Perioperative Care

Chapter 39  Perioperative Care

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The preoperative phase encompasses which period of time?
a)
Entry to the operating suite until admission to postanesthesia care
b)
Entry into the operating suite until discharge from the hospital
c)
The decision to have surgery until admission to postanesthesia care
d)
The decision to have surgery until entry to the operating suite

ANS: D
The preoperative phase begins with the decision to have surgery and ends when the patient enters the operating room. The intraoperative phase begins when the patient enters the operating suite and ends when the patient is admitted to the postanesthesia care unit.

Difficulty: Easy
Client Need: Safe and Effective Care
Cognitive Level: Comprehension

PTS: 1

2. A 2-year-old child is scheduled for a tonsillectomy. When determining the plan of care, the nurse should:
a)
Include the parents or caregivers in the plan of care
b)
Explain to the child that she will have a sore throat after surgery
c)
Tell the child that she can have her favorite foods for the first 24 hours after surgery
d)
Prepare the child for discharge from the hospital as soon as she is alert

ANS: A
It is developmentally normal for toddlers to experience anxiety with separation from parents or caregivers. Be sure to include these people in the plan of care. Developmentally, a 2-year-old lives in the “here and now” and wouldn’t grasp an intangible concept, such as pain in the future. The toddler would take liquids and soft foods within the first 24 hours when her throat is sore during swallowing. She should not eat foods that are rough and crunchy because they may scratch her throat and cause bleeding. After a tonsillectomy, the child will need to be monitored for bleeding and stable vital signs; therefore, she will not be discharged as soon as she is alert.

Difficulty: Moderate
Nursing Process: Interventions
Client Need: PSI
Cognitive Level: Synthesis

PTS: 1

3. Which of the following is the most appropriate nursing goal for a 2-year-old who is to have a tonsillectomy?
a)
Separation anxiety will be minimal.
b)
The child will verbalize understanding of expected pain.
c)
The child will tolerate a normal diet 24 hours after surgery.
d)
The parent will indicate readiness to assume the child’s care.

ANS: A
The only concrete information in this question is that the child is 2 years old. Therefore, the only problem the nurse can reasonably predict from this would be developmental in nature. It is developmentally normal for toddlers to experience anxiety with separation from parents or caregivers. Minimizing anxiety by involving the parents or caregivers would be the appropriate goal for separation anxiety. A 2-year-old child would not be expected to verbalize understanding of expected pain. The toddler would take liquids and soft foods within the first 24 hours when her throat is sore during swallowing. She should not eat foods that are rough and crunchy because they may scratch her throat and cause bleeding. Nurses should encourage parental involvement, but parents should not be expected to assume the child’s care.

Difficulty: Difficult
(Critical thinking question requiring synthesis of previously learned knowledge.)
Nursing Process: Planning
Client Need: PSI
Cognitive Level: Application

PTS: 1

4. The focus of nursing activities in the preoperative phase is to:
a)
Admit the patient to the surgical suite
b)
Prepare the patient mentally and physically for surgery
c)
Set up the sterile field in the operating room
d)
Perform the primary surgical scrub to the surgical site

ANS: B
The nursing focus in the preoperative phase is to prepare the patient mentally and physically for surgery. The patient is in the intraoperative phase when admitted to the surgical suite. The sterile field and the surgical scrub would be performed in the surgery suite during the intraoperative phase.

Difficulty: Easy
Nursing Process: Planning
Client Need: PHSI
Cognitive Level: Application

PTS: 1

5. A patient is scheduled for abdominal surgery tomorrow. While gathering preoperative data, the nurse learns that the patient takes the following medications daily: an anticoagulant, a multivitamin, and vitamin E. The patient reports that he stopped taking the anticoagulant 4 days ago as instructed by the surgeon. He has continued to take the multivitamin and vitamin E. Based on the information given, the nurse notifies the surgeon because she:
a)
Needs an order to restart the anticoagulant
b)
Is concerned about continued use of the multivitamin
c)
Is concerned about the vitamin E
d)
Has canceled the surgery so more lab tests can be done.

ANS: C
Both prescribed and over-the-counter medications may increase surgical risk. Many herbs can cause potassium loss and increase the risk for cardiac arrhythmias. Vitamin E may increase the risk for bleeding. This patient’s use of vitamin E daily should be discontinued 2 weeks prior to surgery, so the nurse should inform the surgeon of the vitamin E intake. Generally, the surgeon or anesthesiologist instructs patients to continue or discontinue taking their prescribed medicines. However, it is important to assess use of supplements and over-the-counter medicines. The nurse cannot cancel surgery without an order from the surgeon, who determines whether the surgery should be delayed or whether it is so urgent that it needs to continue as scheduled, even with the additional risk factor of the vitamin E intake.

Difficulty: Difficult
Nursing Process: Assessment
Client Need: PHSI
Cognitive Level: Analysis

PTS: 1