Chapter 2: Care of the Surgical Patient
MULTIPLE CHOICE
1. The patient who had a nephrectomy yesterday has not used the patient-controlled analgesia
(PCA) delivery system but admits to being in pain but fearful of addiction. What is the nurse’s
best response?
a. “Modern analgesic drugs do not cause addiction.”
b. “Pain relief is worth a short period of addiction.”
c. “Addiction rarely occurs in the brief time postsurgical analgesia is required.”
d. “Addiction could be a real concern.”
ANS: C
Addiction rarely occurs in the short time that it is required after surgery. Postsurgical
analgesia, because of its brief application, does not usually produce a physical or a
psychological dependence.
DIF: Cognitive Level: Application REF: Page 34 OBJ: 13
TOP: Fear of addiction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
2. A 73-year-old patient with diabetes was admitted for below-the-knee amputation of his right
leg. Removal of his right leg is an example of which type of surgery?
a. Palliative
b. Diagnostic
c. Reconstructive
d. Ablative
ANS: D
Ablative is a type of surgery where an amputation, excision of any part of the body, or
removal of a growth and harmful substance is performed.
DIF: Cognitive Level: Comprehension REF: Page 16, Table 2-1
OBJ: 2 TOP: Types of surgeries
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
3. In which situation might surgery be delayed?
a. The patient has taken Dilantin today.
b. An illegible signature is on the consent form..
c. The patient is still taking anticoagulants.
d. The admission office is unable to confirm insurance coverage.
ANS: C
All medications should be cancelled before surgery, except for drugs such as phenytoin
(Dilantin). Anticoagulant therapy increases the threat of hemorrhage and may be a cause for
delay.
DIF: Cognitive Level: Knowledge REF: Page 34, Page 36 Table 2-6
OBJ: 7 TOP: Anticoagulant therapy
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
, 4. Which circumstance could prevent the patient from signing his informed consent for a
cholecystectomy?
a. The patient complains of pain radiating to the scapula.
b. The patient received an injection of Demerol, 75 mg IM, 1 hour ago.
c. The patient is 85 years of age.
d. The patient is concerned over his lack of insurance coverage.
ANS: B
Informed consent should not be obtained if the patient is disoriented and under the influence
of sedatives. Age, illegibility, and lack of insurance coverage do not prevent signing the
consent. Pain into the scapula is a symptom of colitis.
DIF: Cognitive Level: Application REF: Page 23 OBJ: 7
TOP: Informed consent KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
5. The nurse anticipates that the patient will be given ______________anesthesia because of the
extensive tissue manipulation involved in a hysterectomy.
a. general
b. regional
c. specific
d. preoperative
ANS: A
An anesthesiologist gives general anesthetics by IV and inhalation routes through four stages
of anesthesia when the procedure requires extensive tissue manipulation.
DIF: Cognitive Level: Knowledge REF: Page 34 OBJ: 9
TOP: Anesthesia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
6. The nurse caring for a patient who had an epidural block for a vaginal repair should be alert
for:
a. a flushing of the face and torso.
b. numbness of the perineum.
c. complaint of thirst.
d. a sudden drop in blood pressure.
ANS: D
Epidural anesthesia may cause a sudden drop in blood pressure or respiratory difficulty as the
anesthetic agent moves up in the spinal cord. Elevating the patient’s torso may prevent
respiratory paralysis.
DIF: Cognitive Level: Comprehension REF: Page 37 OBJ: 9
TOP: Epidural block KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
7. Why might the older adult patient not respond to surgical treatment as well as a younger adult
patient?
a. Poor skin turgor
b. Fear of the unknown
c. Response to physiological changes
MULTIPLE CHOICE
1. The patient who had a nephrectomy yesterday has not used the patient-controlled analgesia
(PCA) delivery system but admits to being in pain but fearful of addiction. What is the nurse’s
best response?
a. “Modern analgesic drugs do not cause addiction.”
b. “Pain relief is worth a short period of addiction.”
c. “Addiction rarely occurs in the brief time postsurgical analgesia is required.”
d. “Addiction could be a real concern.”
ANS: C
Addiction rarely occurs in the short time that it is required after surgery. Postsurgical
analgesia, because of its brief application, does not usually produce a physical or a
psychological dependence.
DIF: Cognitive Level: Application REF: Page 34 OBJ: 13
TOP: Fear of addiction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
2. A 73-year-old patient with diabetes was admitted for below-the-knee amputation of his right
leg. Removal of his right leg is an example of which type of surgery?
a. Palliative
b. Diagnostic
c. Reconstructive
d. Ablative
ANS: D
Ablative is a type of surgery where an amputation, excision of any part of the body, or
removal of a growth and harmful substance is performed.
DIF: Cognitive Level: Comprehension REF: Page 16, Table 2-1
OBJ: 2 TOP: Types of surgeries
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
3. In which situation might surgery be delayed?
a. The patient has taken Dilantin today.
b. An illegible signature is on the consent form..
c. The patient is still taking anticoagulants.
d. The admission office is unable to confirm insurance coverage.
ANS: C
All medications should be cancelled before surgery, except for drugs such as phenytoin
(Dilantin). Anticoagulant therapy increases the threat of hemorrhage and may be a cause for
delay.
DIF: Cognitive Level: Knowledge REF: Page 34, Page 36 Table 2-6
OBJ: 7 TOP: Anticoagulant therapy
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
, 4. Which circumstance could prevent the patient from signing his informed consent for a
cholecystectomy?
a. The patient complains of pain radiating to the scapula.
b. The patient received an injection of Demerol, 75 mg IM, 1 hour ago.
c. The patient is 85 years of age.
d. The patient is concerned over his lack of insurance coverage.
ANS: B
Informed consent should not be obtained if the patient is disoriented and under the influence
of sedatives. Age, illegibility, and lack of insurance coverage do not prevent signing the
consent. Pain into the scapula is a symptom of colitis.
DIF: Cognitive Level: Application REF: Page 23 OBJ: 7
TOP: Informed consent KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
5. The nurse anticipates that the patient will be given ______________anesthesia because of the
extensive tissue manipulation involved in a hysterectomy.
a. general
b. regional
c. specific
d. preoperative
ANS: A
An anesthesiologist gives general anesthetics by IV and inhalation routes through four stages
of anesthesia when the procedure requires extensive tissue manipulation.
DIF: Cognitive Level: Knowledge REF: Page 34 OBJ: 9
TOP: Anesthesia KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
6. The nurse caring for a patient who had an epidural block for a vaginal repair should be alert
for:
a. a flushing of the face and torso.
b. numbness of the perineum.
c. complaint of thirst.
d. a sudden drop in blood pressure.
ANS: D
Epidural anesthesia may cause a sudden drop in blood pressure or respiratory difficulty as the
anesthetic agent moves up in the spinal cord. Elevating the patient’s torso may prevent
respiratory paralysis.
DIF: Cognitive Level: Comprehension REF: Page 37 OBJ: 9
TOP: Epidural block KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
7. Why might the older adult patient not respond to surgical treatment as well as a younger adult
patient?
a. Poor skin turgor
b. Fear of the unknown
c. Response to physiological changes
