Sherpath: Advances in Surgery: Chapter 4, Care of Preoperative and Intraoperative Surgical Patients

Question 1 of 9

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Which assessment finding is related to an increased risk for a postoperative complication?

• • Has a prior removal of a breast tumorPrior removal of a breast tumor would not put the patient at risk for any specific postoperative complication.
• • Drinks one glass of wine per dayDrinking one glass of wine per day would not put the patient at risk for any specific postoperative complication.
• • Has a family history of cirrhosis of the liverA family history of cirrhosis of the liver would not put the patient at risk for any specific postoperative complication.
• Correct
  • Smokes 1 to 2 packs of cigarettes per dayIf the patient smokes 1 to 2 packs of cigarettes per day, then the patient could have a chronic respiratory disease and an increased risk for pulmonary complications related to anesthesia or hypoventilation. Many smokers have more copious and tenacious secretions with decreased ciliary activity as compared with nonsmokers.

Question 2 of 9

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In which way might inactive older adults respond to surgery differently from younger adults?

• • Pain tolerance is decreased.Pain tolerance is individualized, regardless of age.
• • Renal function increases with age.Renal function begins to decrease after 60 years of age.
• Correct
  • The risk for thrombus formation increases in inactive older adults.The incidence of thrombus formation is higher in inactive older adults.
• • Older adult patients experience more anxiety before surgery than younger patients.Anxiety may be high in a patient of any age.

Question 3 of 9

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Which medication often needs to be held or modified before surgery? Select all that apply. One, some, or all responses may be correct.

• Correct
  • AspirinDrugs that should be held or modified before surgery include aspirin, herbal products (including ginkgo and ginseng), NSAIDs, and anticoagulants. All of these drugs could cause a problem with bleeding and clotting during and after surgery.
• • Thyroid medicationsThyroid medications have no effect on the clotting or bleeding issues related to surgical procedures.
• • Calcium supplementsCalcium supplements have no effect on the clotting or bleeding issues related to surgical procedures.
• • Estrogen replacement medicationsEstrogen replacement medications have no effect on the clotting or bleeding issues related to surgical procedures.
• Correct
  • Ginkgo biloba supplementDrugs that should be held or modified before surgery include aspirin, herbal products (including ginkgo and ginseng), NSAIDs, and anticoagulants. All of these drugs could cause a problem with bleeding and clotting during and after surgery.
• Correct
  • Nonsteroidal antiinflammatory drugs (NSAIDs)Drugs that should be held or modified before surgery include aspirin, herbal products (including ginkgo and ginseng), NSAIDs, and anticoagulants. All of these drugs could cause a problem with bleeding and clotting during and after surgery.

Question 4 of 9

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In which way does the licensed practical nurse/licensed vocational nurse (LPN/LVN) contribute to the development of nursing problem statements in the preoperative period?

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  • Assists to gather data through assessmentsThe LPN/LVN role is to assist the registered nurse (RN) in making the preoperative assessments. Data gathered in the preoperative period are used by the RN to formulate the patient problem statement.
• • Makes a list of potential and actual patient problemsThe LPN/LVN does not make the list of potential or actual patient problems; this remains the RN role.
• • Analyzes data from the assessment informationThe LPN/LVN does not analyze data from the assessment information.
• • Consults the provider to develop problem statementsThe LPN/LVN does not consult the provider to develop problem statements. The RN retains control of nursing problem statements.

Question 5 of 9

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Which factor, if noted on the preoperative assessment, indicates increased risk for surgical complications in the adult? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Diabetes mellitusDiabetes mellitus increases the risk for wound infections and nonhealing.
• Correct
  • Inactive lifestyleThe older adult who is inactive is more likely to suffer from complications such as pneumonia and thrombus formation.
• • Independent at-home lifeThe patient who lives independently at home is not at increased risk for surgical complications.
• Correct
  • Demonstrates kidney impairmentKidney impairment can make it more difficult to metabolize medications and remove waste, contributing to increased risks for postsurgical complications.
• Correct
  • Body weight below normal rangeThe patient who has a lower than typical body weight may not have the nutritional reserves to support wound healing and cause an increase in infection risk.
• Correct
  • Excessive fearThe patient with excessive fear can have an increase in the sympathetic nervous system response leading to increased hormone release. This can result in difficulty with anesthesia, leading to complications.

Question 6 of 9

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Which explanation will the nurse provide to a patient who indicates concern about the surgeon using a robot to perform surgery?

• • The surgeon will use the robot so that you don’t need so much preoperative testing.The use of a robot does not eliminate the need for preoperative testing to determine risk factors. Preoperative testing is for the purposes of identifying risks and assessing the patient’s readiness for the procedure, whether it is being done using a robotic approach or not.
• • The surgeon uses a robot because the robot is programmed to do the procedure independently.The medical robot does not perform the procedure independently. The surgeon uses the robot to see the area more clearly, reduce healing time and pain, and provide precision in the procedure.
• Correct
  • The surgeon chooses a robot to be more precise and reduce your pain.The surgeon may use a medical robot to provide more precision and reduce pain and healing time for the patient.
• • The robot is the same as a laparoscopic procedure; it just has a different name.The medical robot is not the same as a laparoscopic procedure. A laparoscope is used to do surgery through a small opening. Although a robot may allow for a smaller incision, it is not the same as a laparoscope.

Question 7 of 9

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Which type of medication may be administered before a surgery that will use a bloodless surgical technique?

• • Garlic supplementThe use of herbal preparations such as garlic can interfere with clotting and should be avoided before surgery. The patient undergoing bloodless surgery would have medications to promote clotting and red blood cell (RBC) production.
• • Vitamin EVitamin E can affect clotting and so would be avoided before surgery. The patient undergoing bloodless surgery would receive medication to improve clotting and RBC production.
• • CorticosteroidsCorticosteroids can delay wound healing and alter fluid and electrolytes during the preoperative phase. These medications are typically avoided preoperatively. The patient undergoing bloodless surgery would have medications to promote clotting and RBC production.
• Correct
  • Epoetin alfa (Procrit)The epoetin alfa is administered as part of the bloodless surgery technique. Epoetin alfa simulates red blood cell production.

Question 8 of 9

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Which general nursing goal would the licensed practical nurse/licensed vocational nurse (LPN/LVN) recognize as appropriate for the patient who is preparing for a bilateral knee replacement?

• • The patient will describe strategies to overcome obstacles for self-care at home.The patient would describe strategies to overcome obstacles for self-care at home before discharge. Once the patient’s recovery is initiated, the patient and nurse can work to identify specific obstacles and strategies to deal with them.
• • The patient will demonstrate correct dressing change.The patient would not be expected to demonstrate dressing changes preoperatively. Rather, the patient would have the opportunity to practice and demonstrate dressing changes after the surgery.
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  • The patient demonstrates coughing and deep-breathing exercises.The patient would be expected to demonstrate coughing and deep breathing before surgery because it is important that the patient knows and can perform the exercises that are expected in the immediate postoperative period.
• • The patient will demonstrate the ability to walk with a walker.The patient will need to learn to walk with a walker before discharge but after surgery. This is not a general goal expected in the preoperative period.

Question 9 of 9

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Which assessment finding, if noted by the licensed practical nurse/licensed vocational nurse (LPN/LVN) during a preoperative assessment, would be reported directly to the surgical staff?

• Correct
  • The patient uses bilateral cochlear implants and cannot hear without the appliances.The finding that the patient uses cochlear implants and cannot hear without the appliances is essential information for the surgical staff who may need to communicate with the patient. Cochlear appliances may not be allowed in the surgical suite or need to be removed during the procedure.
• • The patient stopped taking corticosteroids 1 month before the surgery.The patient who stopped corticosteroids 1 month before surgery has stopped taking this medication appropriately and does not demonstrate additional risk at the time of surgery.
• • The patient lives alone and is fearful about being a burden on the family.Although it is important that the patient is concerned about being a burden on the family, this is not an assessment finding pertinent to the surgical staff. The postoperative nurse would need this information more than the surgical staff.
• • The patient is experiencing mild anxiety related to the procedure and potential outcome.Mild anxiety related to a procedure and its outcome is an expected and normal finding. If the patient were experiencing excessive anxiety, it would be pertinent to inform the surgical staff caused by potential physiologic consequences.