Chapter 14 Preoperative Nursing Management
1. A patient is admitted to the ED complaining of severe abdominal pain, stating that he has
been vomiting ìcoffee-groundî like emesis. The patient is diagnosed with a perforated gastric
ulcer and is informed that he needs surgery. When can the patient most likely anticipate that
the surgery will be scheduled?
A) Within 24 hours
B) Within the next week
C) Without delay because the bleed is emergent
D) As soon as all the day's elective surgeries have been completed
Ans: C
Feedback:
Emergency surgeries are unplanned and occur with little time for preparation for the patient
or the perioperative team. An active bleed is considered an emergency, and the patient
requires immediate attention because the disorder may be life threatening. The surgery
would not likely be deferred until after elective surgeries have been completed.
2. The nurse is performing a preoperative assessment on a patient going to surgery. The patient
informs the nurse that he drinks approximately two bottles of wine each day and has for the
last several years. What postoperative difficulties can the nurse anticipate
for this patient?
A) Alcohol withdrawal syndrome immediately following surgery
B) Alcohol withdrawal syndrome 2 to 4 days after his last alcohol drink
C) Alcohol withdrawal syndrome upon administration of general anesthesia
D) Alcohol withdrawal syndrome 1 week after his last alcohol drink
Ans: B
Feedback:
,Alcohol withdrawal syndrome may be anticipated between 48 and 96 hours after alcohol
withdrawal and is associated with a significant mortality rate when it occurs postoperatively.
, 3. In anticipation of a patient's scheduled surgery, the nurse is teaching her to perform
deep breathing and coughing to use postoperatively. What action should the nurse teach
the patient?
A) The patient should take three deep breaths and cough hard three times, at least
every 15 minutes for the immediately postoperative period.
B) The patient should take three deep breaths and exhale forcefully and then take a
quick short breath and cough from deep in the lungs.
C) The patient should take a deep breath in through the mouth and exhale through
the mouth, take a short breath, and cough from deep in the lungs.
D) The patient should rapidly inhale, hold for 30 seconds or as long as possible, and
exhale slowly. Ans: C
Feedback:
The patient assumes a sitting position to enhance lung expansion. The nurse then
demonstrates how to take a deep, slow breath and how to exhale slowly. After practicing
deep breathing several times, the patient is instructed to breathe deeply, exhale through the
mouth, take a short breath, and cough from deep in the lungs.
4. The nurse is preparing a patient for surgery prior to her hysterectomy without oophorectomy.
The nurse is witnessing the patient's signature on a consent form. Which comment by the
patient would best indicate informed consent?
A) ìI know I'll be fine because the physician said he has done this procedure hundreds of times.î
B) ìI know I'll have pain after the surgery but they'll do their best to keep it to a minimum.î
C) ìThe physician is going to remove my uterus and told me about the risk of bleeding.î
D) ìBecause the physician isn't taking my ovaries, I'll still be able to have children.î
Ans: C
Feedback:
The surgeon must inform the patient of the benefits, alternatives, possible risks,
, complications, disfigurement, disability, and removal of body parts as well as what to expect
in the early and late postoperative periods. The nurse clarifies the information provided, and,
if the patient requests additional information, the nurse notifies the physician. In the correct
response, the patient is able to tell the nurse what will occur during the procedure and the
associated risks. This indicates the patient has a sufficient understanding of the procedure to
provide informed consent. Clarification of information given may be necessary, but no
additional information should be given. The other listed statements do not reflect an
understanding of the surgery to be performed.
5. The nurse is planning patient teaching for a patient who is scheduled for an open
hemicolectomy. The nurse intends to address the topics of incision splinting and leg exercises
during this teaching session. When is the best time for the nurse to provide teaching?
A) Upon the patient's admission to the postanesthesia care unit (PACU) B) When the
patient returns from the PACU
C) During the intraoperative period
D) As soon as possible before the surgical procedure
Ans: D
Feedback:
Teaching is most effective when provided before surgery. Preoperative teaching is initiated as
soon as possible, beginning in the physician's office, clinic, or at the time of preadmission
testing when diagnostic tests are performed. Upon admission to the PACU, the patient is
usually drowsy, making this an inopportune time for teaching. Upon the patient's return from
the PACU, the patient may remain drowsy. During the intraoperative period, anesthesia alters
the patient's mental status, rendering teaching ineffective.
1. A patient is admitted to the ED complaining of severe abdominal pain, stating that he has
been vomiting ìcoffee-groundî like emesis. The patient is diagnosed with a perforated gastric
ulcer and is informed that he needs surgery. When can the patient most likely anticipate that
the surgery will be scheduled?
A) Within 24 hours
B) Within the next week
C) Without delay because the bleed is emergent
D) As soon as all the day's elective surgeries have been completed
Ans: C
Feedback:
Emergency surgeries are unplanned and occur with little time for preparation for the patient
or the perioperative team. An active bleed is considered an emergency, and the patient
requires immediate attention because the disorder may be life threatening. The surgery
would not likely be deferred until after elective surgeries have been completed.
2. The nurse is performing a preoperative assessment on a patient going to surgery. The patient
informs the nurse that he drinks approximately two bottles of wine each day and has for the
last several years. What postoperative difficulties can the nurse anticipate
for this patient?
A) Alcohol withdrawal syndrome immediately following surgery
B) Alcohol withdrawal syndrome 2 to 4 days after his last alcohol drink
C) Alcohol withdrawal syndrome upon administration of general anesthesia
D) Alcohol withdrawal syndrome 1 week after his last alcohol drink
Ans: B
Feedback:
,Alcohol withdrawal syndrome may be anticipated between 48 and 96 hours after alcohol
withdrawal and is associated with a significant mortality rate when it occurs postoperatively.
, 3. In anticipation of a patient's scheduled surgery, the nurse is teaching her to perform
deep breathing and coughing to use postoperatively. What action should the nurse teach
the patient?
A) The patient should take three deep breaths and cough hard three times, at least
every 15 minutes for the immediately postoperative period.
B) The patient should take three deep breaths and exhale forcefully and then take a
quick short breath and cough from deep in the lungs.
C) The patient should take a deep breath in through the mouth and exhale through
the mouth, take a short breath, and cough from deep in the lungs.
D) The patient should rapidly inhale, hold for 30 seconds or as long as possible, and
exhale slowly. Ans: C
Feedback:
The patient assumes a sitting position to enhance lung expansion. The nurse then
demonstrates how to take a deep, slow breath and how to exhale slowly. After practicing
deep breathing several times, the patient is instructed to breathe deeply, exhale through the
mouth, take a short breath, and cough from deep in the lungs.
4. The nurse is preparing a patient for surgery prior to her hysterectomy without oophorectomy.
The nurse is witnessing the patient's signature on a consent form. Which comment by the
patient would best indicate informed consent?
A) ìI know I'll be fine because the physician said he has done this procedure hundreds of times.î
B) ìI know I'll have pain after the surgery but they'll do their best to keep it to a minimum.î
C) ìThe physician is going to remove my uterus and told me about the risk of bleeding.î
D) ìBecause the physician isn't taking my ovaries, I'll still be able to have children.î
Ans: C
Feedback:
The surgeon must inform the patient of the benefits, alternatives, possible risks,
, complications, disfigurement, disability, and removal of body parts as well as what to expect
in the early and late postoperative periods. The nurse clarifies the information provided, and,
if the patient requests additional information, the nurse notifies the physician. In the correct
response, the patient is able to tell the nurse what will occur during the procedure and the
associated risks. This indicates the patient has a sufficient understanding of the procedure to
provide informed consent. Clarification of information given may be necessary, but no
additional information should be given. The other listed statements do not reflect an
understanding of the surgery to be performed.
5. The nurse is planning patient teaching for a patient who is scheduled for an open
hemicolectomy. The nurse intends to address the topics of incision splinting and leg exercises
during this teaching session. When is the best time for the nurse to provide teaching?
A) Upon the patient's admission to the postanesthesia care unit (PACU) B) When the
patient returns from the PACU
C) During the intraoperative period
D) As soon as possible before the surgical procedure
Ans: D
Feedback:
Teaching is most effective when provided before surgery. Preoperative teaching is initiated as
soon as possible, beginning in the physician's office, clinic, or at the time of preadmission
testing when diagnostic tests are performed. Upon admission to the PACU, the patient is
usually drowsy, making this an inopportune time for teaching. Upon the patient's return from
the PACU, the patient may remain drowsy. During the intraoperative period, anesthesia alters
the patient's mental status, rendering teaching ineffective.
