Potter-Perry Chapter 50 Care of Surgical Patients Questions and Answers
1. The nurse is precepting a new nurse in the perioperative area. The nurse explains that perioperative nursing
is based on certain principles and includes (Select all that apply.)
a. Purchasing the correct equipment.
b. Providing high-quality and patient safety-focused care.
c. Scheduling the right types of patients.
d. Conducting multidisciplinary teamwork.
e. Ensuring effective therapeutic communication.
f. Providing advocacy for the patient. - ansANS: B, D, E, F
Perioperative nursing is a fast-paced, changing, and challenging field and is based on the nurse's understanding
of several important principles, including high-quality, patient safety-focused care; multidisciplinary teamwork;
effective therapeutic communication and collaboration with the patient, the patient's family, and the surgical
team; effective and efficient assessment and intervention in all phases of surgery; advocacy for the patient and
the patient's family; and understanding of cost containment. Purchasing the correct equipment is important in
any specialty of nursing. Perioperative nursing cares not only for the "right" types of patients, but for all
patients with surgical needs.
1. The nurse is precepting a student nurse and explains that perioperative nursing care occurs
a. Before, during, and after surgery.
b. In preadmission testing.
c. During the surgical procedure.
d. In the postanesthesia care unit. - ansANS: A
Perioperative nursing care occurs before, during, and after a surgery. Preadmission testing occurs before
surgery and is considered preoperative. Nursing care provided during the surgical procedure is considered
intraoperative, and in the postanesthesia care unit, it is considered postoperative. All of these are parts of the
perioperative phase, but each individual phase does not explain the term completely.
10. The nurse is encouraging the postoperative patient to utilize diaphragmatic breathing. Reasons for this
intervention include
a. Management of pain.
b. Decreased healing time.
,c. Prevention of atelectasis.
d. Decreased thrombus formation. - ansANS: C
During general anesthesia, the lungs are not fully inflated during surgery and the cough reflex is suppressed, so
mucus collects within airway passages. After surgery, patients may have reduced lung volume and may require
greater effort to cough and deep breathe; inadequate lung expansion can lead to atelectasis and pneumonia.
Purposely utilizing diaphragmatic breathing can decrease this risk. Diaphragmatic breathing, except for the
components of distraction, minimal increased level of oxygen, and minimal chest wall movement, does not
influence pain, healing time, or thrombus formation. Better, more effective interventions are available for
these situations.
11. The nurse is caring for a postoperative patient on the medical-surgical floor. To prevent venous stasis and
the formation of thrombus after general anesthesia, the nurse encourages
a. Coughing.
b. Diaphragmatic breathing.
c. Incentive spirometry.
d. Leg exercises. - ansANS: D
After general anesthesia, circulation slows, and when the rate of blood slows, a greater tendency for clot
formation is noted. Immobilization results in decreased muscular contractions in the lower extremities; these
promote venous stasis. Coughing, diaphragmatic breathing, and incentive spirometry are utilized to decrease
atelectasis.
12. The nurse is caring for a preoperative patient. The nurse teaches the principles and demonstrates leg
exercises for the patient. The patient is unable to perform leg exercises correctly. What is the nurse's best next
step?
a. Assess for the presence of anxiety, pain, or fatigue.
b. Ask the patient why he does not want to do the exercises.
c. Encourage the patient to practice at a later date.
d. Assess the educational methods used to educate the patient. - ansANS: A
If the patient is unable to perform leg exercises after sound educational principles and demonstration are
provided, the nurse should look for circumstances that may be impacting the patient's ability to learn. In this
case, the patient can be anticipating the upcoming surgery and may be experiencing anxiety. The patient may
also be in pain or may be fatigued; both of these can affect the ability to learn. Assessment of educational
methods may be needed, but in this case, sound principles and demonstration are being utilized. Asking
, anyone why can cause defensiveness and may not help in attaining the answer. In this case, the patient really
may want to participate and may not know why he is unable to learn. The nurse is aware that the patient is
unable to do the exercises. Moving forward without ascertaining that learning has occurred will not help the
patient in meeting goals.
13. Which nursing assessment would indicate that the patient is performing diaphragmatic breathing correctly?
a. Hands placed on border of rib cage with fingers extended will touch as chest wall contracts.
b. Hands placed on chest wall with fingers extended will separate as chest wall contracts.
c. The patient will feel upward movement of the diaphragm during inspiration.
d. The patient will feel downward movement of the diaphragm during expiration. - ansANS: A
Positioning the hands along the borders of the rib cage allows the patient to feel movement of the chest and
abdomen as the diaphragm descends and the lungs expand. As the patient takes a deep breath and slowly
exhales, the middle fingers will touch while the chest wall contracts. The fingers will separate as the chest wall
expands. The patient will feel normal downward movement of the diaphragm during inspiration and normal
upward movement during expiration.
14. The nurse is caring for a postoperative patient with an abdominal incision. A pillow is used during coughing
to provide
a. Pain relief.
b. Splinting.
c. Distraction.
d. Anxiety reduction. - ansANS: B
Surgical incisions cut through muscles, tissues, and nerve endings. Deep breathing and coughing exercises place
additional stress on the suture line and cause discomfort. Splinting incisions with hands and a pillow provides
firm support and reduces incisional pull. Providing a pillow during coughing does not provide distraction or
reduce anxiety. Providing a pillow does not provide pain relief. Coughing can increase anxiety because it can
cause pain.
15. The nurse is encouraging a reluctant postoperative patient to deep breathe and cough. What explanation
can the nurse provide that may encourage the patient to cough more effectively?
a. "If you don't deep breathe and cough, you will get pneumonia."
b. "Deep breathing and coughing will clear out the anesthesia."
1. The nurse is precepting a new nurse in the perioperative area. The nurse explains that perioperative nursing
is based on certain principles and includes (Select all that apply.)
a. Purchasing the correct equipment.
b. Providing high-quality and patient safety-focused care.
c. Scheduling the right types of patients.
d. Conducting multidisciplinary teamwork.
e. Ensuring effective therapeutic communication.
f. Providing advocacy for the patient. - ansANS: B, D, E, F
Perioperative nursing is a fast-paced, changing, and challenging field and is based on the nurse's understanding
of several important principles, including high-quality, patient safety-focused care; multidisciplinary teamwork;
effective therapeutic communication and collaboration with the patient, the patient's family, and the surgical
team; effective and efficient assessment and intervention in all phases of surgery; advocacy for the patient and
the patient's family; and understanding of cost containment. Purchasing the correct equipment is important in
any specialty of nursing. Perioperative nursing cares not only for the "right" types of patients, but for all
patients with surgical needs.
1. The nurse is precepting a student nurse and explains that perioperative nursing care occurs
a. Before, during, and after surgery.
b. In preadmission testing.
c. During the surgical procedure.
d. In the postanesthesia care unit. - ansANS: A
Perioperative nursing care occurs before, during, and after a surgery. Preadmission testing occurs before
surgery and is considered preoperative. Nursing care provided during the surgical procedure is considered
intraoperative, and in the postanesthesia care unit, it is considered postoperative. All of these are parts of the
perioperative phase, but each individual phase does not explain the term completely.
10. The nurse is encouraging the postoperative patient to utilize diaphragmatic breathing. Reasons for this
intervention include
a. Management of pain.
b. Decreased healing time.
,c. Prevention of atelectasis.
d. Decreased thrombus formation. - ansANS: C
During general anesthesia, the lungs are not fully inflated during surgery and the cough reflex is suppressed, so
mucus collects within airway passages. After surgery, patients may have reduced lung volume and may require
greater effort to cough and deep breathe; inadequate lung expansion can lead to atelectasis and pneumonia.
Purposely utilizing diaphragmatic breathing can decrease this risk. Diaphragmatic breathing, except for the
components of distraction, minimal increased level of oxygen, and minimal chest wall movement, does not
influence pain, healing time, or thrombus formation. Better, more effective interventions are available for
these situations.
11. The nurse is caring for a postoperative patient on the medical-surgical floor. To prevent venous stasis and
the formation of thrombus after general anesthesia, the nurse encourages
a. Coughing.
b. Diaphragmatic breathing.
c. Incentive spirometry.
d. Leg exercises. - ansANS: D
After general anesthesia, circulation slows, and when the rate of blood slows, a greater tendency for clot
formation is noted. Immobilization results in decreased muscular contractions in the lower extremities; these
promote venous stasis. Coughing, diaphragmatic breathing, and incentive spirometry are utilized to decrease
atelectasis.
12. The nurse is caring for a preoperative patient. The nurse teaches the principles and demonstrates leg
exercises for the patient. The patient is unable to perform leg exercises correctly. What is the nurse's best next
step?
a. Assess for the presence of anxiety, pain, or fatigue.
b. Ask the patient why he does not want to do the exercises.
c. Encourage the patient to practice at a later date.
d. Assess the educational methods used to educate the patient. - ansANS: A
If the patient is unable to perform leg exercises after sound educational principles and demonstration are
provided, the nurse should look for circumstances that may be impacting the patient's ability to learn. In this
case, the patient can be anticipating the upcoming surgery and may be experiencing anxiety. The patient may
also be in pain or may be fatigued; both of these can affect the ability to learn. Assessment of educational
methods may be needed, but in this case, sound principles and demonstration are being utilized. Asking
, anyone why can cause defensiveness and may not help in attaining the answer. In this case, the patient really
may want to participate and may not know why he is unable to learn. The nurse is aware that the patient is
unable to do the exercises. Moving forward without ascertaining that learning has occurred will not help the
patient in meeting goals.
13. Which nursing assessment would indicate that the patient is performing diaphragmatic breathing correctly?
a. Hands placed on border of rib cage with fingers extended will touch as chest wall contracts.
b. Hands placed on chest wall with fingers extended will separate as chest wall contracts.
c. The patient will feel upward movement of the diaphragm during inspiration.
d. The patient will feel downward movement of the diaphragm during expiration. - ansANS: A
Positioning the hands along the borders of the rib cage allows the patient to feel movement of the chest and
abdomen as the diaphragm descends and the lungs expand. As the patient takes a deep breath and slowly
exhales, the middle fingers will touch while the chest wall contracts. The fingers will separate as the chest wall
expands. The patient will feel normal downward movement of the diaphragm during inspiration and normal
upward movement during expiration.
14. The nurse is caring for a postoperative patient with an abdominal incision. A pillow is used during coughing
to provide
a. Pain relief.
b. Splinting.
c. Distraction.
d. Anxiety reduction. - ansANS: B
Surgical incisions cut through muscles, tissues, and nerve endings. Deep breathing and coughing exercises place
additional stress on the suture line and cause discomfort. Splinting incisions with hands and a pillow provides
firm support and reduces incisional pull. Providing a pillow during coughing does not provide distraction or
reduce anxiety. Providing a pillow does not provide pain relief. Coughing can increase anxiety because it can
cause pain.
15. The nurse is encouraging a reluctant postoperative patient to deep breathe and cough. What explanation
can the nurse provide that may encourage the patient to cough more effectively?
a. "If you don't deep breathe and cough, you will get pneumonia."
b. "Deep breathing and coughing will clear out the anesthesia."
