Med/surg Chapter 18

Front 1

Surgery is the

Back 1

art and science of treating diseases, inju­ • ries, and deformities by operation and instrumentation.

Front 2

Surgery may be performed for any of the following pur­ • poses:

Back 2

diagnosis
cure
palliation
prevention
cosmetic improvement
exploration

Front 3

Surgery definition of diagnosis?

Back 3

Determination of the presence and extent of a pathologic condition (e.g., lymph node biopsy, bronch­ oscopy).

Front 4

Surgery definition of cure?

Back 4

Elimination or repair of a pathologic condition (e.g., removal of ruptured appendix or benign ovarian cyst).

Front 5

Surgery definition of palliation?

Back 5

Alleviation of symptoms without cure (e.g., cutting a nerve root [rhizotomy] to remove symptoms of pain, creating a colostomy to bypass an inoperable bowel obstruction

Front 6

Surgery definition of prevention?

Back 6

(e.g., removal of a mole before it becomes malignant, removal of the colon in a patient with famil­ ial polyposis to prevent cancer).

Front 7

Surgery definition of cosmetic improvement?

Back 7

(e.g., repairing a burn scar, breast reconstruction after a mastectomy).

Front 8

Surgery definition of exploration?

Back 8

Surgical examination to determine the na­ ture or extent of a disease (e.g., laparotomy). With the advent of advanced diagnostic tests, exploration is less common because problems can be identified earlier and easier.

Front 9

-ectomy

Back 9

excision or removal of

Front 10

-lysis

Back 10

destruction of

Front 11

-orrhaphy

Back 11

repair or suture of

Front 12

-oscopy

Back 12

looking into

Front 13

-ostomy

Back 13

creation of an opening into

Front 14

-otomy

Back 14

cutting into or incision of

Front 15

-plasty

Back 15

repair or reconstruction of

Front 16

Surgery may be a carefully planned event which is termed a ?

Back 16

elective surgery

Front 17

may arise with unexpected urgency is an?

Back 17

emergency surgery

Front 18

The primary purposes of the patient interview are to? (3)

Back 18

(1) obtain the patient’s health information; (2) provide and clarify information about the planned surgery, including anesthesia; and (3) assess the patient’s emotional state and readiness for surgery, including his or her expectations about the surgical outcomes.

Front 19

Patients on long­term anticoagulation therapy (e.g., warfarin [Couma­ din]) present a unique challenge. The options for these patients include ? (3)

Back 19

(1) continuing therapy, (2) withholding therapy for a time before and after surgery, or (3) withholding the therapy and starting subcutaneous or IV heparin therapy during the perioperative period.

Front 20

Surgical patient who is on diuretic therapy will need to have a what done pre surgery?

Back 20

serum potassium level

Front 21

If the patient has a history of val­ vular heart disease pre surgery what may be done?

Back 21

antibiotic prophylaxis often is given before surgery to decrease the risk of bacterial endocarditis

Front 22

Postoperative venous thromboembolism (VTE), a condition that includes ?

Back 22

DVT
PE

Front 23

Generally, preoperative teaching includes three types of information:

Back 23

sensory, process, and procedural.

Front 24

patients find out what they will see, hear, smell, and feel during the surgery. For example, you may tell them that the OR will be cold, but they can ask for a warm blanket; the lights in the OR are bright; or many unfamiliar sounds and specific smells will be present…

Back 24

in the sensory preoperative teaching

Front 25

specific details but just the general flow of what is going to happen. This information would include the patient’s transfer to the holding area, visits by the nurse and the ACP before transfer to the OR, and waking up in the PACU will be present in the …..?

Back 25

process information teaching

Front 26

patients desire details that are more specific. For example, this information would include that an IV line will be started while the patient is in the holding area and the surgeon will mark the operative area with an indelible marker to verify site and side. These are taught in the?

Back 26

procedural information teaching

Front 27

an active, shared decision­making process between the health care provider and the recipient of care?

Back 27

informed consent

Front 28

Three conditions must be met for consent to be valid?

Back 28

First, there must be adequate disclosure of the diagnosis; the nature and purpose of the proposed treatment; the risks and consequences of the pro­ posed treatment; the probability of a successful outcome; the availability, benefits, and risks of alternative treatments; and the prognosis if treatment is not instituted. Second, the patient must demonstrate clear understanding of the information being provided before receiving sedating preoperative medications. Third, the recipient of care must give consent voluntarily. The patient must not be persuaded or coerced in any way by anyone to undergo the procedure.

Front 29

The physician is ultimately responsible for obtaining the patient’s?

Back 29

consent for surgical treatment.

Front 30

If the patient is unclear about the surgical plans, contact ?

Back 30

the surgeon about the patient’s need for additional information.

Front 31

The patient should also be aware that consent, even when signed, can be?

Back 31

withdrawn at anytime

Front 32

(SBAR) model for the hand­off process in the OR means what?

Back 32

Situation ­Background­ Assessment­ Recommendation

Front 33

An overweight patient (BMI 28.1 kg/m2) is scheduled for a laparo­
scopic cholecystectomy at an outpatient surgery setting. The nurse knows that
a. surgery will involve multiple small incisions.
b. this setting is not appropriate for this procedure.
c. surgery will involve removing a portion of the liver.
d. the patient will need special preparation because of obesity.

Back 33

a. surgery will involve multiple small incisions.

Front 34

The patient tells the nurse in the preoperative setting that she has noticed she has a reaction when wearing rubber gloves. What is the
most appropriate intervention?
a. Notify the surgeon so the case can be cancelled.
b. Ask additional questions to assess for a possible latex allergy.
c. Notify the OR staff immediately so that latex­free supplies can
be used.
d. No intervention is needed because the patient’s rubber sensiti­
vity has no bearing on surgery.

Back 34

b. Ask additional questions to assess for a possible latex allergy.

Front 35

A 59­year­old man is scheduled for a herniorrhaphy in 2 days. During the preoperative evaluation he reports that he takes ginkgo daily. What is the priority intervention?
a. Inform the surgeon, since the procedure may need to be
rescheduled.
b. Notify the anesthesia care provider, since this herb interferes
with anesthetics.
c. Ask the patient if he has noticed any side effects from taking this
herbal supplement.
d. Tell the patient to continue to take the herbal supplement up to
the day before surgery.

Back 35

a. Inform the surgeon, since the procedure may need to be
rescheduled.

Front 36

A 17­year­old patient with a leg fracture is scheduled for surgery. She reports that she is living with a friend and is an emancipated minor. She has a statement from the court for verification. Which intervention is most appropriate?
a. Witness the permit after consent is obtained by the surgeon.
b. Call a parent or legal guardian to sign the permit, since the
patient is under 18.
c. Obtain verbal consent, since written consent is not necessary for
emancipated minors.
d. Investigate your state’s nurse practice act related to emancipated
minors and informed consent.

Back 36

a. Witness the permit after consent is obtained by the surgeon.

Front 37

A priority nursing intervention to assist a preoperative patient in
coping with fear of postoperative pain would be to
a. inform the patient that pain medication will be available.
b. teach the patient to use guided imagery to help manage pain. c. describe the type of pain expected with the patient’s particular
surgery.
d. explain the pain management plan, including the use of a pain
rating scale.

Back 37

d. explain the pain management plan, including the use of a pain
rating scale.

Front 38

A patient is scheduled for surgery requiring general anesthesia at
an ambulatory surgical center. The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. What should the nurse do first?
a. Tell the patient to come back tomorrow, since he ate a meal.
b. Proceed with the preoperative checklist, including site identification.
c. Notifytheanesthesiacareproviderofwhenandwhatthepatient last ate.
d. Have the patient void before administering any preoperative medications.

Back 38

c. Notifytheanesthesiacareproviderofwhenandwhatthepatient last ate.

Front 39

A patient who normally takes 40 units of glargine insulin (long acting) at bedtime asks the nurse what to do about her dose the night before surgery. The best response would be to have her
a. skip her insulin altogether the night before surgery.
b. take her usual dose at bedtime and eat a light breakfast in the morning.
c. eat a moderate meal before bedtime and then take half her usual insulin dose.
d. get instructions from her surgeon or health care provider on any insulin adjustments.

Back 39

d. get instructions from her surgeon or health care provider on any insulin adjustments.

Front 40

Preoperative considerations for older adults include (select all that apply)
a. only using large­print educational materials.
b. speaking louder for patients with hearing aids.
c. recognizing that sensory deficits may be present.
d. providing warm blankets to prevent hypothermia.
e. teaching important information early in the morning.

Back 40

c. recognizing that sensory deficits may be present.
d. providing warm blankets to prevent hypothermia.

Front 41

Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. What is the most appropriate action for the nurse to take?
Offer the patient to use the urinal/bedpan after explaining the need to maintain safety.
Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done.
Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes.
Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room.

Back 41

Offer the patient to use the urinal/bedpan after explaining the need to maintain safety.

Front 42

What is the primary reason for accurately recording the patient's current medications during a preoperative assessment?
Some medications may alter the patient's perceptions about surgery.
Many anesthetics alter renal and hepatic function, causing toxicity of other drugs.
Some medications may interact with anesthetics, altering the potency and effect of the drugs.
Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery.

Back 42

Some medications may interact with anesthetics, altering the potency and effect of the drugs.

Front 43

While performing preoperative teaching, the patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, the nurse tells the patient that
she must be NPO after breakfast.
she needs to be NPO after midnight.
she can drink clear liquids up to 2 hours before surgery.
she can drink clear liquids up until she is moved to the OR.

Back 43

she can drink clear liquids up to 2 hours before surgery.

Front 44

The nurse is admitting a patient to the same-day surgery unit. The patient tells the nurse that he was so nervous he had to take kava last evening to help him sleep. Which nursing action would be most appropriate?
Tell the patient that using kava to help sleep is often helpful.
Inform the anesthesiologist of the patient's recent use of kava.
Tell the patient that the kava should continue to help him relax before surgery.
Inform the patient about the dangers of taking herbal medicines without consulting his health care provider.

Back 44

Inform the anesthesiologist of the patient's recent use of kava.

Front 45

Which preoperative patient has the greatest risk of bleeding as a result of his or her medication?
A woman who takes metoprolol (Lopressor) for the treatment of hypertension
A man whose type 1 diabetes is controlled with insulin injections four times daily
A man who is taking clopidogrel (Plavix) after the placement of a coronary artery stent
A man who recently started taking finasteride (Proscar) for the treatment of benign prostatic hyperplasia

Back 45

A man who is taking clopidogrel (Plavix) after the placement of a coronary artery stent

Front 46

A 70-year-old woman has been admitted prior to having surgery for a bilateral mastectomy and breast reconstruction. What should the nurse include in the patient's preoperative teaching (select all that apply)?
Information about various options for reconstructive surgery
Information about the risks and benefits of her particular surgery
Information about risk factors for breast cancer and the role of screening
Information about where in the hospital she will be taken postoperatively
Information about performing postoperative deep-breathing and coughing exercises

Back 46

Information about where in the hospital she will be taken postoperatively
Information about performing postoperative deep-breathing and coughing exercises

Front 47

The patient is having a mole removed that has changed appearance. What does the nurse teach the patient about the rationale for this surgical procedure?
It is to prevent malignancy.
It is to alleviate symptoms.
It is to cure the malignancy.
It is to provide cosmetic improvement.

Back 47

It is to prevent malignancy.

Front 48

This will be the patient's first surgical experience and the patient states, "I am nervous about this." The vital signs show BP 158/88, HR 96, RR 24. In the assessment, the nurse finds that the lungs are clear, bowel tones are evident, peripheral pulses are strong, and the patient is fidgeting nervously. The patient took alprazolam (Xanax) at bedtime last night and takes acetaminophen (Tylenol) for tension headaches. Related to this assessment information, what should the nurse do before the patient goes to surgery?
Review the surgery with the patient.
Notify the anesthesia care provider (ACP).
Administer another dose of alprazolam (Xanax).
Tell the patient that everything will be okay with the surgery.

Back 48

Notify the anesthesia care provider (ACP).

Front 49

A 52-year-old female patient has come to the ambulatory surgery center for surgery. When reviewing the assessment record, what test should the nurse seek an order for before this patient has surgery?
Tab 1 Tab 2 Tab 3
Past Health History Laboratory and Diagnostic Results Medications
Smoker for past 25 years, last cigarette yesterday
Has hypertension CBC within normal limits
Chest X-ray clear
UA within normal limits
No other lab work drawn Takes hydrochlorothiazide 50 mg every morning
Blood glucose
Pregnancy test
Serum albumin
Serum potassium

Back 49

Serum potassium

Front 50

A 75-year-old patient is being prepared for surgery. What assessment data needs to be included for this patient (select all that apply)?
Fluid balance history
Attitude about surgery
Foods the patient dislikes
Current mobility problems
Current cognitive function
Patient's opinion about the surgeon

Back 50

Fluid balance history
Current mobility problems
Current cognitive function

Front 51

When reviewing the preoperative forms, the nurse notices that the informed consent form is not present or signed. What is the best action for the nurse to take?
Have the patient sign the consent form.
Have the family sign the form for the patient.
Call the surgeon to obtain consent for surgery.
Teach the patient about the surgery and get verbal permission.

Back 51

Call the surgeon to obtain consent for surgery.

Front 52

As the nurse is preparing a patient for outpatient surgery, the patient wants to give his hearing aid to his wife so it will not be lost during surgery. Which action by the nurse should be taken in this situation?
Give the hearing aid to the wife as he wishes.
Tape the hearing aid to his ear to prevent loss.
Encourage the patient to wear it for the surgery.
Tell the surgery nurse that he has his hearing aid out.

Back 52

Encourage the patient to wear it for the surgery.

Front 53

It is 6:00 AM. The anesthesiologist prescribes preoperative medications for a patient who is scheduled for surgery at 7:30 AM: cefazolin (Ancef) IV to be infused 30 minutes before surgery; midazolam (Versed) before surgery and scopolamine patch (Transderm Scop) behind the ear. Which medication should the nurse administer first?
Cefazolin (Ancef)
Fentanyl (Sulimaze)
Midazolam (Versed)
Scopolamine (Transderm Scop)

Back 53

Scopolamine (Transderm Scop)

Front 54

An alert male patient needs a tracheostomy because he has been intubated for 7 days with an endotracheal tube and cannot be weaned from the ventilator. The patient does not want the tracheostomy, but his family insists that the surgery be performed. What is the best action for the nurse to take?
Advocate for the patient's rights.
Try to change the patient's mind.
Call surgery to cancel the procedure.
Tell the family they cannot interfere.

Back 54

Advocate for the patient's rights.

Front 55

The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes mellitus, weighs 146 kg, and is 5 feet 8 inches tall. Which patient assessment is a priority related to anesthesia?
Has hemoglobin A1C of 8.5%
Has several seasonal allergies
Has body mass index of 48.8 kg/m2
Has history of postoperative vomiting

Back 55

Has body mass index of 48.8 kg/m2