Chapter 19 Post-Operative Practice Questions and Answers 100% Correct

A patient is admitted to the postanesthesia care unit (PACU) after colon surgery. During the initial assessment, the patient tells the nurse they are going to "throw up." Which statement by the nurse reflects a priority nursing intervention? 1 "I need to check your vital signs." 2 "Let me help you turn to your side." 3 "Here is a sip of ginger-ale for you." 4 "I can give you some antinausea medicine." - ANSWER-Correct2 If the patient is nauseated and may vomit, place the patient in a lateral recovery position to keep the airway open and reduce the risk of aspiration if vomiting occurs. Checking vital signs does not address the nausea. It may not be appropriate to give the patient oral fluids immediately following bowel surgery. Administering an antiemetic may be appropriate after turning the patient to the side. Test-Taking Tip: As you answer each question, write a few words about why you think that answer is correct; in other words, justify why you selected that answer. If an answer you provide is a guess, mark the question to identify it. This will permit you to recognize areas that need further review. It will also help you to see how correct your "guessing" can be. Remember: on the licensure examination you must answer each question before moving on to the next question. Two days after colectomy for an abdominal mass, the patient reports gas pains and abdominal distension. The nurse plans care for the patient on the basis of the knowledge that these symptoms occur as a result of which condition? 1 Constipation 2 Nasogastric suctioning 3 Slowed gastric emptying 4 Inflammation of the bowel at the anastomosis site - ANSWER-Correct3 Until peristalsis returns to normal after anesthesia, the patient may experience slowed gastric motility, leading to gas pains and abdominal distension. Colectomy does not require a nasogastric tube; the bowel should not be inflamed following surgery unless infection is present. Constipation may occur following surgery; however, with bowel manipulation, slowed gastric emptying is the most common reason for gas pains and abdominal distention because of gas. A postoperative patient develops fever, abdominal pain, and diarrhea despite being on long-term antibiotics. What should the nurse evaluate for? 1 Wound infection 2 Urinary infection 3 Respiratory infection 4 Clostridium difficile infection - ANSWER-Correct4 Prolonged use of antibiotics increases the risk of Clostridium difficile infection by damaging the normal flora of the intestine. The infection is manifested as fever, diarrhea, and abdominal pain. Wound infection, urinary infection, and respiratory infection may present with fever, but these infections rarely present with diarrhea and abdominal pain. A patient that is an alcoholic had a hernia operation and is restless and irritable. On assessment, the nurse finds that the patient has auditory hallucinations. What is the most appropriate nursing action? 1 Conclude that these effects are due to alcohol withdrawal. 2 Consider the situation normal, due to the anesthetic drugs. 3 Conclude that the patient suffers from a psychotic disorder. 4 Infer that the patient is suffering from pain and suggest using pain killers. - ANSWER-Correct1 The patient is irritable and restless due to loss of the inhibitory effects of alcohol; this is also causing the hallucinations. The patient does not have a history of psychotic illness; therefore, the symptoms cannot be attributed to a psychotic disorder. Anesthetic drugs may cause delirium, but not hallucinations. Pain may cause restlessness and irritability, but not hallucinations. A nurse is providing postoperative care for a patient who has undergone exploratory abdominal surgery. To prevent the complication of atelectasis, what interventions should the nurse perform? 1 Medicating the patient with a narcotic analgesic as prescribed 2 Providing an abdominal binder to help the patient in ambulation 3 Encouraging the use of an incentive spirometer at least every hour 4 Turning the patient from one side to the other at least every 2 to 4 hours - ANSWER-Correct3 Use of an incentive spirometer after surgery encourages the patient to take deep, slow breaths, which facilitates the opening of terminal airways, mobilizes secretions, and prevents postoperative atelectasis. Narcotic analgesics, use of an abdominal binder for ambulation, and frequent turning in bed may indirectly support recovery and prevention of complications postoperatively. However, these interventions do not specifically address prevention of atelectasis and pneumonia in the way that the use of an incentive spirometer does. What is the priority nursing action when a patient is transferred from the postanesthesia care unit (PACU) to the surgical unit after a lobectomy? 1 Assess the patient's pain. 2 Take the patient's vital signs. 3 Check the rate of the intravenous (IV) infusion. 4 Check the health care provider's postoperative prescriptions. - ANSWER-Correct2 The highest priority action by the nurse is to assess the physiologic stability of the patient. This is in part accomplished by taking the patient's vital signs. Assessing the patient's pain, checking the prescriptions, and checking the rate of IV infusion can take place in a rapid sequence after taking the vital signs. A patient had an estimated blood loss of 400 mL during abdominal surgery. The patient received 300 mL of 0.9% saline during surgery and now is experiencing hypotension postoperatively. What should the nurse anticipate for this patient? 1 Restoring circulating volume 2 Monitor pulse and blood pressure 3 An ECG to check circulatory status 4 Return to surgery to check for internal bleeding - ANSWER-1 The nurse should anticipate restoring circulating volume with intravenous (IV) infusion. Although blood could be used to restore circulating volume, there are no manifestations in this patient indicating a need for blood administration. The nurse will need to do more than monitor pulse and blood pressure. An ECG may be done if there is no response to the fluid administration or there is a past history of cardiac disease or cardiac problems were noted during surgery. Returning to surgery to check for internal bleeding would only be done if the patient's level of consciousness changes or the abdomen becomes firm and distended. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. A patient with a history of psychosis has newly developed anxiety and is combative with the nurse. What does the nurse know may be causes of this change in behavior? 1 Delirium 2 Excessive sleep 3 Hyperoxygenation 4 Electrolyte imbalances - ANSWER-Correct4 The nurse knows electrolyte imbalances can cause an acute change in a patient's behavior. A new onset of anxiety and combativeness may cause delirium rather than the other way around. Sleep deprivation, not excessive sleep, would cause anxiety and aggression. Hyperoxygenation would not cause such behavior changes; hypoxemia does.