Nur 1410 Exam V Prep Points

Front 1

Which of the following statements accurately describe the surgical risk related to the developmental stage of the patient?

Back 1

a. Infants are at a greater risk from surgery than are middle-aged adults.
b. Infants experience a slower metabolism of drugs that require renal biotransformation.
d. Older adults have decreased renal blood flow and a reduced bladder capacity, necessitating careful monitoring a fluid or electrolyte status and input and output.
e. Older adults have an increased gastric pH and require monitoring of nutritional status during the perioperative period.

Front 2

Which of the following statements accurately describe how preexisting disease status affects surgical risk?

Back 2

b. Patients with respiratory disease may experience alterations in acid-base balance after surgery.
c. Kidney and liver diseases influence the patient’s response to anesthesia.
e. Endocrine diseases increase the risk for slow surgical wound healing.

Front 3

Which of the following statements accurately describe the effects the patient’s medications may have on surgical risk?

Back 3

c. Diuretics may cause respiratory depression from anesthesia.
d. Tranquilizers may increase the hypotensive effect of anesthetic agents.
f. Abrupt withdrawal from adrenal steroids may cause cardiovascular collapse in long-term users.

Front 4

Which of the following are significant abnormal findings related to presurgical screening tests?

Back 4

a. An elevated white blood cell count, indicating an infection.
b. Decreased hematocrit and hemoglobin level, indicating bleeding or anemia.
e. Abnormal urine constituents, indicating infection or fluid imbalances.

Front 5

Which of the following nursing interventions would be appropriate for a patient recovering from a surgical procedure?

Back 5

c. Place the patient in a semi-Fowler’s position to perform deep-breathing exercises every 1 to 2 hours for the first 24 to 48 hours after surgery and as necessary thereafter.
e. Teach the patient the appropriate leg exercises to increase venous blood return from the legs.
f. Encourage the patient to use incentive spirometry 10 times each waking hour for the first 5 days after surgery.

Front 6

Briefly describe the time period for the following stages of the perioperative period.

Back 6

a. Preoperative Phase: Begins with the decision that surgical intervention is necessary and lasts until the patient is transferred to the operating room table.
b. Intraoperative Phase: Extends from admission to the surgical department to transfer to the recovery area.
c. Postoperative Phase: Lasts from admission to the recovery area to the complete recovery from surgery.

Front 7

Indicate how each of the following diseases places the patient at greater risk for postoperative complications.

Back 7

a. Cardiovascular disease: Increased potential for hemorrhage and hypovolemic shock, hypotension, venous stasis, therombophlebitis, and over hydration with IV fluids.
b. Pulmonary disorders: Increased possibility of respiratory depression from anesthesia, postoperative pneumonia, atelectasis, and alterations in acid-base balance.
c. Kidney and liver function disorders: Influence the patient’s response to anesthesia, affect fluid and electrolyte as well as acid-base balance, alter metabolism and excretion of drugs, and impair wound healing.
d. Metabolic disorders: Increased potential for hypoglycemia or acidosis and slow wound healing.

Front 8

Describe how you would prepare a patient on the day of surgery in the following areas.

Back 8

a. Hygiene and skin preparation: Clean with skin with antibacterial soap to remove bacteria (the patient can do this in a bath or shower), shampoo the hair, and clean the fingernails. Remove hair from incisional area with depilatory cream or hair clipper if indicated.
b. Elimination: Emptying the bowel of feces is no longer a routine procedure, but the nurse should use preoperative assessments to determine the need for an order for bowel elimination. If indwelling catheter is not in place, the patient should void immediately before receiving preoperative medications

Front 9

Describe how you would prepare a patient on the day of surgery in the following areas. continued...

Back 9

c. Nutrition and fluids: Diet depends on the type of surgery; patients need to be well nourished and hydrated before surgery to counterbalance fluid, blood, and electrolyte loss during surgery.
d. Rest and Sleep: The nurse can facilitate rest and sleep in the immediate preoperative period by meeting psychological needs, carrying out teaching, providing a quiet environment, and administering prescribed bedtime sedative medication.

Front 10

Give an example of how the following factors may present a greater surgical risk for some patients.

Back 10

a. Developmental considerations: Infants and older adults are at greater risk from surgery than are children and young or middle-aged adults.
b. Medical history: Pathologic changes associated with past and current illnesses increase surgical risk
c. Medications: Use of anticoagulants before surgery may precipitate hemorrhage.
d. Previous surgery: Previous heart or lung surgery may necessitate adaptations in the anesthesia used in positioning during surgery.

Front 11

Give an example of how the following factors may present a greater surgical risk for some patients. continued...

Back 11

e. Perceptions and knowledge of surgery: The patient’s questions or statements are important for meeting his/her psychological needs and those of the family when preparing the patient for surgery.
f. Lifestyle: Cultural and ethnic background of the patient may affect surgical risk.
g. Nutrition: Malnutrition and obesity increase surgical risk.
h. Use of alcohol, illicit drugs, nicotine: Patients with a large habitual intake of alcohol require larger doses of anesthetic agents and postoperative analgesics, increasing the risk for drug-related complications

Front 12

Give an example of how the following factors may present a greater surgical risk for some patients. continued...

Back 12

i. Activities of daily living: Exercise, rest, and sleep habits are important for preventing postoperative complications and facilitating recovery.
j. Occupation: Surgical procedures may require a delay in returning to work.
k. Coping patterns: The patient needs information and emotional support to recover from surgery.
l. Support systems: Family members should be encouraged to provide support before and after surgery,
m. Sociocultural needs: The patient’s cultural background may require that nursing interventions be individualized to meet needs in such areas as language, food preferences, family interaction and participation, personal space, and health beliefs and practices.

Front 13

Explain what a nurse in the PACU would assess when checking a patient in the postoperative phase using the following guidelines.

Back 13

a. Vital Signs: Assess temperature, blood pressure, pulse and respiratory rates; note deviations from preoperative and PACU data as well as symptoms of complications
b. Color and temperature of skin: Assess for warmth, pallor, cyanosis, and diaphoresis.
c. Level of consciousness: Assess for orientation to time, place, and person as well as reaction to stimuli and ability to move extremities.
d. Intravenous fluids: Assess type and amount of solution, flow rate, securement and patency of tubing, and infusion site.

Front 14

Explain what a nurse in the PACU would assess when checking a patient in the postoperative phase using the following guidelines. continued...

Back 14

e. Surgical Site: Assess dressing and dependent areas for drainage. Assess drains and tubes and be sure they are intact, patent, and properly connected to drainage systems.
f. Other tubes: Assess indwelling urinary catheter, gastrointestinal suction, and so forth for drainage, patency, and amount of output.
g. Pain Management: Assess for pain and determine whether analgesics were given in the PACU. Assess for nausea and vomiting.

Front 15

Explain what a nurse in the PACU would assess when checking a patient in the postoperative phase using the following guidelines. continued...

Back 15

h. Position and safety: Place patient in the ordered position; if the patient is not fully conscious, place him/her in the side-lying position. Elevate side rails and place bed in low position.
i. Comfort: Cover the patient with a blanket, reorient him/her to the room as necessary, and allow family members to remain with the patient after the initial assessment is completed.
Applying Knowledge

Front 16

Cardiovascular:

Back 16

Hemmorhage: Monitor for a slipped suture, or a dislodged clot in the wound, or stress from a surgical site. Make sure the patient has the right surroundings for adequate rest, and keep them calm,, shock (hypovolemic shock), thrombophlebitis, pulmonary embolus,

Front 17

Cardiovascular:

Back 17

Shock: Monitor for indications such as restlessness, anxiety, frank bleeding, and hypotension; cold clammy skin; a weak thready and rapid pulse; cool, mottled extremities; deep, rapid respirations; decreased urine output; thirst; and apprehension. Improve and maintain tissue perfusion by eliminating the cause of shock. Maintain airway, placing the patient in trendelenburg, administer oxygen therapy; monitor vital signs, hematocrit, blood gas results, and general condition; maintain body warmth with covers and administer medications.

Front 18

Cardiovascular:

Back 18

Thrombophlebitis: Monitor for indications such as pain and cramping in the calf or thigh of the involved extremity, redness and swelling in the affected area, elevated temperature, and an increase in the diameter of the involved extremity. Work to prevent a clot from breaking loose and becoming an embolus that travels to the lungs, heart, or brain and prevent further clot formation. Possible interventions include administering medications (eg, anti-inflammatory agents, anticoagulants, analgesics), maintain the patient on bed rest, applying external heat, applying high antiembolic stockings or sequential pneumatic compression devices, and measuring bilateral calf or thigh circumference every shift. Also teach the patient not to message the legs.

Front 19

Respiratory

Back 19

Pneumonia: Monitor pt for early indications of pneumonia such as elevated temperature, chills, a cough that produces rusy or purulent sputum, crackles and wheezes, dyspnea, and chest pain. Monitor for respiratory complications and promote full aeration of the lungs by positioning the patient in semi-fowler’s or fowler’s position, administering oxygen therapy, administering medications (eg, antibiotics, expectorants, analgesics), providing frequent oral hygiene, and ensuring rest and comfort.

Front 20

Respiratory

Back 20

Atelectasis: Monitor for indications of atelectasis such as decreased lung sounds over the affected area, dyspnea, cyanosis, crackles, restlessness, and apprehension. Ensure oxygenation of tissues, prevent further atelectasis, and expand involved lung tissues. Monitor for respiratory complications, position the patient in semi-fowler’s position, administer oxygen therapy, and administer analgesics for pain.

Front 21

Preventing Surgical Site Complications:

Back 21

Monitor vital signs, especially temperature elevationl maintaining hydration; maintaining nutritional status; encouraging a diet high in proteins, carbohydrates, calories, and vitamins; using proper hand hygiene; and following aseptic technique when changing dressings at surgical site and exit sites for tubes and drains. Soiled gloves and dressings should be disposed of following standard precautions.

Front 22

1. Mr. Drennan will be ambulating for the first time since his cardiac surgery. Which of the following should the nurse consider when assisting Mr. Drenna?

Back 22

a. If an ambulating patient who a nurse is assisting begins to fall, the nurse should slide the patient down his/her own body to the floor, carefully protecting the patient’s head.

Front 23

2. Mr. Bellas is a 40-year-old man in a sedentary job who is beginning an exercise program. Which of the following effects will exercise have on his cardiovascular system?

Back 23

a. Decreased heart rate and blood pressure

Front 24

Atelectasis

Back 24

is an incomplete expansion or collapse of lung tissue.

Front 25

Footdrop

Back 25

is a complication of immobility in which the foot cannot maintain itself in the perpendicular position, heel-toe gait is impossible, and the patient experiences extreme difficulty in walking.

Front 26

A patient who has difficulty breathing, increased respiratory and pulse rates, and pale skin with regions of cyanosis may be suffering from which of the following?

Back 26

Hypoxia

Front 27

Which of the following cough suppressants is generally preferred, despite its addictive quality?

Back 27

Benylin

Front 28

A patient who complains of difficulty breathing should be placed in which of the following positions?

Back 28

Fowler’s Position

Front 29

4. Mr. Parks has chronic obstructive pulmonary disease. His nurse has taught him pursed-lip breathing, which helps him in which of the following ways?

Back 29

Decreases the amount of air trapping and resistance

Front 30

Place the following steps for teaching a patient to use an incentive spirometer in the order in which they should occur:

Back 30

Assist patient to upright position if possible and remove dentures if they fit poorly -> Medicated with ordered pain medication if needed. -> Demonstrate how to steady device with one hand and hold mouthpiece with other hand ->Instruct the patient to exhale normally and then place lips securely around mouthpiece and not to breathe through his or her nose -> Instruct the patient to inhale slowly and as deeply as possible through the mouthpiece -> Tell patient to hold breath and count to three. Check position of gauge to determine progress and level attained. -> Instruct the patient to remove lips from mouthpiece and exhale normally -> Tell patient to complete breathing exercises about 10 times every hour if possible and to rest between breaths as necessary.

Front 31

Describe the ABCs of basic life support

Back 31

a. Airway: Tip the head and check for breathing
b. Breathing: If the victim does not start to breathe spontaneously after the airway is opened, give two slow, full breaths.
c. Circulation: Check the pulse. If the victim has no pulse, artificial circulation must be started with breathing.

Front 32

Describe the seven comfort measures for patients with impaired respiratory functioning.

Back 32

a. Help the patient assume a position that allows for free movement of the diaphragm and expansion of the chest wall to promote ease of respiration
b. Keep the patient’s secretions thin by asking the patient to drink 2 to 3 quarts of clear fluids daily.
c. Provide humidified air.
d. Perform cupping on the patient’s lungs to loosen pulmonary secretions
e. Use vibration to help loosen respiratory secretions
f. Provide postural drainage
g. Help patient maintain good nutrition