Chapter 16

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking
for Collaborative Care, 6th Edition

Test Bank
Chapter 16: Care of Preoperative Patients
MULTIPLE CHOICE
1. How does palliative surgery differ from any other type of surgery?
A. The main purpose is cosmetic in nature rather than functional repair or comfort.
B. There are fewer risks associated with palliative surgery than with any other type of
surgery.
C. The outcomes of palliative surgery cannot be ensured to produce the desired effect or
restoration of functional ability.
D. Palliative surgery is performed to provide temporary relief of distressing symptoms
rather than to cure a problem or condition.
ANS: D
The purpose of palliative surgery is to improve the client's quality of life by reducing or
eliminating distressing symptoms. It does not cure a health problem and, often, does not
prolong life. Although the exact outcomes of palliative surgery cannot be ensured, neither
can the outcomes of any other type of surgery.
DIF: Cognitive Level: Comprehension
MSC: Client Needs Category: N/A
TOP: Nursing Process Step: N/A
2. In which situation is the nurse performing the role of client advocate during the
preoperative period?
A. Serving as a witness to the informed consent procedure
B. Teaching the client how to perform coughing and deep breathing exercises
C. Assuring the client whose religion does not permit blood transfusions that his or her
wishes will be followed
D. Ensuring that the client's impaired hearing problem is clearly communicated to the
entire surgical team
ANS: C
Many clients who do not want a blood transfusion, even when their lives are at stake, are
pressured to give consent for transfusions. The nurse can act as an advocate for the
client's wishes in this regard by not pressuring the client and communicating this
information.
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Psychosocial Integrity
3. The client undergoing preoperative assessment before an elective procedure tells the
nurse that she has been taking 10 mg of prednisone daily for rheumatoid arthritis.
What is the nurses best action?
A. Notify the surgeon and anesthesiologist.
B. Document the information as the only action.
C. Reschedule the surgery in 2 weeks when the client has cleared the drug from her
system.
D. Suggest that the client switch to a nonsteroidal anti-inflammatory agent for pain
relief.
ANS: A
The surgery does not need to be delayed; however, corticosteroids have many adverse
effects and will have an impact on the clients responses. In addition, clients who have
been taking corticosteroids on a daily basis need to continue this therapy through the
perioperative period to prevent adrenal insufficiency from abrupt withdrawal.
DIF: Cognitive Level: Application or higher
MSC: Client Needs Category: Physiological Integrity
4. The client tells the nurse during the preoperative history that he is a three-pack a day
cigarette smoker. This information alerts the nurse to which potential complication
during the intraoperative and postoperative periods?
A. A decreased tolerance to pain
B. A decreased clotting ability
C. An increased risk for atelectasis and hypoxia
D. An increased risk for excessive scar tissue formation
ANS: C
Smoking increases the level of circulating carboxyhemoglobin, which decreases oxygen
delivery to the tissues. In addition, cigarette smoking damages the cilia of mucous
membranes, decreasing transport of secretions and increasing the risk of pulmonary
infection and atelectasis.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
5. On admission to the preoperative area, the client who is scheduled for a hip
replacement tells the nurse that she has made three autologous blood donations for
this surgery in the past 5 weeks. What is the nurses best action?
A. Check the client's international normalized ratio (INR).
B. Call the laboratory to ensure that the blood is physically available at the operating
facility.
C. Ensure that the client has given consent to receive blood if a transfusion is necessary.
D. Inform the client that an autologous transfusion does not eliminate her risk for the
development of bloodborne diseases.
ANS: B
Many hospitals or surgical centers do not initially process autologous blood collections.
Any donated blood must be in the facility where the surgery will take place before the
client undergoes the planned surgical procedure.
6. The client receiving preoperative medication tells the nurse that all of the following
medications (drugs or herbs) were ingested yesterday. Which one should the nurse
report to the surgical team?
A. Acetaminophen (Tylenol)
B. Vitamin C
C. Motherwort
D. Diphenhydramine (Benadryl)
ANS: C
Motherwort interferes with coagulation, increasing the client's risk for bleeding during
and after the surgical procedure.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Analysis
7. What is the priority nursing diagnosis for an older adult client with sensory deficits
who is scheduled for surgery?
A.
B.
C.
D.
Deficient Knowledge related to difficulty with sensory processing

Risk for Impaired Skin Integrity related to incontinence and thin skin
Decreased Cardiac Output related to poor circulation and venous return
Risk for Activity Intolerance related to decreased respiratory reserve
ANS: A
Older adult clients with sensory deficits, especially those affecting vision and hearing,
may need more time for teaching and reinforcement of teaching.
TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Psychosocial Integrity/Physiological Integrity
8. When the nurse brings the preoperative medication to the client about to have
abdominal surgery, she tells the nurse that she does not need the injection because she
had a good night's sleep last night. What is the nurses best first action?
A. Tell the client that her surgeon has ordered the medication; therefore, she should go
ahead and take the medication because the surgeon knows what is best.
B. Tell the client that the preoperative medication is ordered to reduce the risk of some
problems during surgery rather than to ensure adequate rest.
C. Appropriately discard the preoperative medication and notify the surgeon.
D. Document the client's statement and notify the charge nurse.
ANS: B
The preoperative medication is prescribed to prevent a vagal response during intubation
and surgery, reduce the amount of anesthetic needed during induction, and reduce
anxiety.
MSC: Client Needs Category: Physiological Integrity/Psychosocial Integrity
9. While examining the 82-year-old client's preoperative laboratory blood tests, the
nurse finds the client's serum sodium level to be 139 mEq/mL. What is the nurses
best action?
A. Increase the IV flow rate.
B. Initiate oxygen therapy by mask.

C. Document the finding as the only action.
D. Notify the surgeon and anesthesiologist.
ANS: C
The normal range for serum sodium in clients of this age is 135 to 145 mEq/L.
10. The client who is scheduled to have surgery cannot read or write. The surgeon
obtaining the consent wants to have the client's spouse sign the consent instead. What
is the nurses best action?
A. Nothing; a signed informed consent statement does not need to be obtained from this
client.
B. Locate the spouse, because the informed consent statement must be signed by the
client's closest relative.
C. Inform the surgeon that the client may sign the informed consent statement with an
X in front of two witnesses.
D. Notify the administration because the court must appoint a legal guardian to
represent the client's best interests and give consent for all surgical procedures.
ANS: C
The lack of ability to read or write does not constitute incapacity to give legal consent. If
the client meets all other legal and clinical aspects of competence, he or she may use an X
to demonstrate consent if the act is witnessed by two persons.
11. When asked about allergies, the preoperative client tells the nurse she has allergies to
all of the following substances. Which allergy alerts the nurse to potential problems in
relation to the scheduled surgery?
A. Pollens
B. Bee stings
C. Shellfish
D. Peanuts
ANS: C
Many people who have hypersensitivities or allergies to shellfish will have allergies to
povidone-iodine, a substance commonly used to cleanse surgical sites.
12. The client is NPO for surgery scheduled to occur in 4 hours. It is now 9 AM and the
client's normal oral medications (consisting of digoxin, 0.125 mg, Colace, 300 mg,
and Feostat, 325 mg) are due to be administered. The physician will not be available
until the time of surgery. What is the nurses best action?
A. Hold all medications.
B. Administer all medications orally.
C. Administer all medications parenterally.
D. Administer digoxin with minimal water and hold the other drugs.
ANS: D
Regularly scheduled cardiac medications should be administered on schedule. If taken
with a few small sips of water at least 2 hours before surgery, this medication should not
increase the risk of intraoperative or postoperative aspiration.
TOP: Nursing Process Step: Evaluation
13. Extra precautions to promote venous return should be taken with which of the
following clients?
A. 58-year-old client whose international normalized ratio (INR) is 2.2
B. 48-year-old client having surgery for advanced ovarian cancer
C. 38-year-old client who is 15 pounds below ideal body weight
D. 28-year-old client who has a latex allergy
ANS: B
Clients with cancer often have hypercoagulopathy, although the cause of this
phenomenon is not known. This increases their risk for postoperative deep vein
thrombosis and pulmonary embolism.
14. Twenty minutes after the client has received a preoperative injection of atropine and
midazolam (Versed), the client tells the nurse that he must be allergic to the
medication because his mouth is dry and his heart seems to be beating faster than
normal. What is the nurses best first action?
A. Document the findings as the only action.
B. Check the client's pulse and blood pressure.
C. Prepare to administer epinephrine and diphenhydramine (Benadryl).
D. Explain to the client that these symptoms are normal responses to the medication.
ANS: B
Although these are the expected physiologic responses to the preoperative medication,
any time the client states that he or she can feel a change in normal cardiac function, the
system should be assessed. If the client's pulse and blood pressure are within normal
limits, the nurse should then explain the responses to the client and document the change.
TOP: Nursing Process Step: Assessment/Evaluation
15. The client scheduled to have surgery within the next 2 hours tells the nurse during the
admission interview the following information. Which piece of information should
the nurse be certain to communicate on the outside of the chart for the entire surgical
team to know?
A. The client is allergic to cats.
B. The client is hard of hearing.
C. The client had a glass of wine 12 hours ago.
D. The client takes 2000 mg of vitamin C each day.
ANS: B
The team will need to communicate with the client in the surgical holding area, the
operating room, and the postanesthesia recovery unit. Any problem with communication,
such as a hearing impairment, should be stressed so that team members can use
alternative means to assure accurate communication with the client.
16.
A.
B.
C.
D.
Which statement made by the client indicates a need for further teaching?
These exercises help prevent blood clots.
Once I am up and walking around, I won't need to do these as often.
Keeping my knees bent will prevent my arthritis from making me so stiff.
If I feel pain in my calf when I bend my ankles up and down, I should tell my
nurse.
ANS: C
The major purpose of the leg exercises is to promote venous return and prevent the
formation of blood clots. Keeping the knees bent inhibits venous return and may promote
blood clot formation.
TOP: Nursing Process Step: Evaluation
17. The clients surgery has been delayed because of hyperkalemia. The client doesnt
understand why. What is the nurses best response?
A. Potassium affects how the heart works and you could have a heart attack if this is
not corrected.
B. Your kidneys could quit working during surgery and the surgery would have to be
cancelled.
C. We want you to have the best recovery after surgery. Sometimes, if this problem is
not corrected before surgery, you may be too sleepy after surgery to talk to your
family.
D. By making sure your potassium is normal before surgery, it will keep your heart
functioning at its best during your surgery.
ANS: D
Hyperkalemia may cause cardiac dysrhythmias, especially during anesthesia. Explaining
to the client that correcting this problem helps his heart function at its best is consistent
with providing open, honest communication to the client. Telling the client that he may
have a heart attack would cause unnecessary anxiety, and may in fact create problems
during surgery.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step:
Implementation
COMPLETION
1. The older client is at increased risk for complications from surgery due to the normal
aging process, including a decreased ____________________ system function, which
delays wound healing.
ANS:
immune
Rationale: This is a normal process of aging. A history of decreased immunity may place
the client at risk. The preoperative nurse should ask the client about a history of frequent
cold, flu, and cuts and scrapes that a take long time to heal.

OTHER
1. The client is scheduled for ambulatory surgery. The preoperative period begins when
the client is scheduled for surgery and ends when the client is transferred to surgical
suite. Of the following, select the four most important nursing interventions:
A. Perform a nursing assessment.
B.
Obtain informed consent form.
C.
Identify abnormal laboratory results.
D.
Begin discharge planning.
E.
Ensure that electrocardiographic results are on the chart.
F.
Explain how the client will be positioned in the operating room.
G.
Teach postoperative breathing exercises.
ANS:
A, C, D, G
Rationale: These are the most critical factors for a successful client outcome. A thorough
nursing assessment is needed to establish baseline data. During the assessment, the nurse
can identify current health problems, potential complications related to anesthesia, and
possible client problems after surgery. Additionally, the nurse identifies psychosocial
issues such as anxiety and fear. Abnormal laboratory results must be reported to the
surgeon and/or anesthesia provider. Clients who are taught breathing exercises before
surgery can perform them better postoperatively. Discharge planning must begin before
surgery in the ambulatory setting to ensure that someone is available to take the client
home after surgery and assist as needed. If this help is not available, surgery may need to
be postponed.
TOP: Nursing Process Step: Assessment/Planning/Intervention
MSC: Client Needs Category: Physiological Integrity, Health Promotion and
Maintenance;

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Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking

for Collaborative Care, 6th Edition

TOP: Nursing Process Step: N/A

Deficient Knowledge related to difficulty with sensory processing

B. Initiate oxygen therapy by mask.

DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment

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