Med Surge Exam 2 PERIOPERATIVE CARE Questions and Answers
A 58-year-old man with a recent diagnosis of prostate cancer is scheduled for a radical prostatectomy (A radical
prostatectomy is an operation to remove the prostate gland and some of the tissue around it to remove
prostate cancer). Before signing the consent, the patient tells the nurse, "I am not sure if this surgery is safe."
Which response by the nurse is the most appropriate?
a. "Tell me what you know about your surgery and the risks involved."
b. "Any surgery has risks, but we will be here to take good care of you."
c. "You seem anxious. Once you sign the consent, I can give you a sedative."
d. "You do not need to be concerned. Your surgeon has not had any complaints." - ansA
The health care provider performing the surgery is responsible for obtaining the patient's consent. The nurse
may witness the patient's signature on the consent form. As a patient advocate, the nurse should verify that
the patient understands the surgery and the risks involved. If the nurse determines that the patient is unclear
about operative plans, the nurse should contact the health care provider about the patient's need for more
information. The other options provide false reassurance or do not respond to the patient's concern.
A 70-year-old woman has been admitted prior to having surgery for a bilateral mastectomy and breast
reconstruction. What should the nurse include in the patient's preoperative teaching (select all that apply)?
a. Information about various options for reconstructive surgery
b. Information about the risks and benefits of her particular surgery
c. Information about risk factors for breast cancer and the role of screening
d. Information about where in the hospital she will be taken postoperatively
e. Information about performing postoperative deep-breathing and coughing exercises - ansD,E
During preoperative teaching, it is important to introduce the role of deep-breathing and coughing exercises
and to inform the patient about the different locations involved in her hospital stay. The specific risks and
benefits of her surgery and reconstruction options should be addressed by her surgeon. Teaching about breast
cancer screening would be inappropriate, and likely insensitive, at this point in her disease trajectory.
A 71-year-old male patient who is currently undergoing coronary artery bypass graft (CABG) surgery has just
experienced intraoperative vomiting. The nurse should consequently anticipate the use of which drug?
a. Midazolam (Versed)
b. Fentanyl (Sublimaze)
,c. Meperidine (Demerol)
d. Ondansetron (Zofran) - ansD
Ondansetron (Zofran) is an antiemetic, whereas midazolam (Versed) is a benzodiazepine, and fentanyl
(Sublimaze) and meperidine (Demerol) are opioid analgesics.
A 75-year-old patient is being prepared for surgery. What assessment data needs to be included for this patient
(select all that apply)?
a. Fluid balance history
b. Attitude about surgery
c. Foods the patient dislikes
d. Current mobility problems
e. Current cognitive function
f. Patient's opinion about the surgeon - ansA,D,E
Preoperative fluid balance history is especially critical for older adults as they have reduced adaptive capacity
that puts them at greater risk for over- and under-hydration. Mobility problems must be assessed to assist with
intraoperative and postoperative positioning and ambulation. Preoperative assessment of the older person's
baseline cognition function is especially crucial for intraoperative and postoperative evaluation as they are
more prone to adverse outcomes during and after surgery from the stressors of the surgery, dehydration,
hypothermia, and anesthesia. Attitude about surgery and opinion or faith in the surgeon is important for all
patients. Foods the patient dislikes are not important unless the patient is allergic to them, but this is no more
important for older patients than it is for all patients.
A 78-year-old patient is having surgery. What risk areas will the nurse need to be especially aware of for this
patient during surgery?
a. Sterility
b. Paralysis
c. Urine output
d. Skin integrity - ansD
Skin of older adults has lost elasticity and is at increased risk for injury from tape, electrodes, warming or
cooling blankets, and dressings. Pooling cleansing solution may create skin burns or abrasions. The nurse is
responsible for monitoring patient safety and adjusting patient position as necessary to prevent pressure or
misalignment. Sterility and urine output would be monitored for all patients. Paralysis would not be unusual
, during some types of surgery but would have an impact on any patient's skin integrity.
A patient having an open reduction internal fixation (ORIF) of a left lower leg fracture will receive regional
anesthesia during the procedure. As the patient is prepared in the operating room, what should the nurse
implement to maintain patient safety during surgery that is directly related to the type of anesthesia being
used?
a. Apply grounding pad to unaffected leg.
b. Assess peripheral pulses and skin color.
c. Verify the last oral intake before surgery.
d. Ensure a smooth surface under the patient. - ansD
Regional anesthesia decreases sensation to the anesthetized area without impairing level of consciousness,
which means the affected leg will be without sensation while the anesthetic is effective. A double tourniquet
on the affected leg is used to restrict blood flow. This increases the patient's risk of impaired skin integrity
because the patient does not have sensation and cannot identify discomfort or foreign objects and will not be
moving during surgery. The nurse's role includes positioning the patient for correct alignment, exposure of the
surgical site, and preventing injury. The other options will be occurring but are not directly related to the
regional anesthesia.
A patient is having elective cosmetic surgery performed on her face. The surgeon will keep her at the surgery
center for 24 hours after surgery. What is the nurse's postoperative priority for this patient?
A. Manage patient pain.
B. Control the bleeding.
C. Maintain fluid balance.
D. Manage oxygenation status. - ansD
The nurse's priority is to manage the patient's oxygenation status by maintaining an airway and ventilation.
With surgery on the face, there may be swelling that could compromise her ability to breathe. Pain, bleeding,
and fluid imbalance from the surgery may increase her risk for upper airway edema causing airway obstruction
and respiratory suppression, which also indicate managing oxygenation status as the priority.
A surgical patient's premedication regimen includes midazolam (Versed). What are the most likely desired
effects of this medication?
a. Monitored anesthesia care and amnesia
A 58-year-old man with a recent diagnosis of prostate cancer is scheduled for a radical prostatectomy (A radical
prostatectomy is an operation to remove the prostate gland and some of the tissue around it to remove
prostate cancer). Before signing the consent, the patient tells the nurse, "I am not sure if this surgery is safe."
Which response by the nurse is the most appropriate?
a. "Tell me what you know about your surgery and the risks involved."
b. "Any surgery has risks, but we will be here to take good care of you."
c. "You seem anxious. Once you sign the consent, I can give you a sedative."
d. "You do not need to be concerned. Your surgeon has not had any complaints." - ansA
The health care provider performing the surgery is responsible for obtaining the patient's consent. The nurse
may witness the patient's signature on the consent form. As a patient advocate, the nurse should verify that
the patient understands the surgery and the risks involved. If the nurse determines that the patient is unclear
about operative plans, the nurse should contact the health care provider about the patient's need for more
information. The other options provide false reassurance or do not respond to the patient's concern.
A 70-year-old woman has been admitted prior to having surgery for a bilateral mastectomy and breast
reconstruction. What should the nurse include in the patient's preoperative teaching (select all that apply)?
a. Information about various options for reconstructive surgery
b. Information about the risks and benefits of her particular surgery
c. Information about risk factors for breast cancer and the role of screening
d. Information about where in the hospital she will be taken postoperatively
e. Information about performing postoperative deep-breathing and coughing exercises - ansD,E
During preoperative teaching, it is important to introduce the role of deep-breathing and coughing exercises
and to inform the patient about the different locations involved in her hospital stay. The specific risks and
benefits of her surgery and reconstruction options should be addressed by her surgeon. Teaching about breast
cancer screening would be inappropriate, and likely insensitive, at this point in her disease trajectory.
A 71-year-old male patient who is currently undergoing coronary artery bypass graft (CABG) surgery has just
experienced intraoperative vomiting. The nurse should consequently anticipate the use of which drug?
a. Midazolam (Versed)
b. Fentanyl (Sublimaze)
,c. Meperidine (Demerol)
d. Ondansetron (Zofran) - ansD
Ondansetron (Zofran) is an antiemetic, whereas midazolam (Versed) is a benzodiazepine, and fentanyl
(Sublimaze) and meperidine (Demerol) are opioid analgesics.
A 75-year-old patient is being prepared for surgery. What assessment data needs to be included for this patient
(select all that apply)?
a. Fluid balance history
b. Attitude about surgery
c. Foods the patient dislikes
d. Current mobility problems
e. Current cognitive function
f. Patient's opinion about the surgeon - ansA,D,E
Preoperative fluid balance history is especially critical for older adults as they have reduced adaptive capacity
that puts them at greater risk for over- and under-hydration. Mobility problems must be assessed to assist with
intraoperative and postoperative positioning and ambulation. Preoperative assessment of the older person's
baseline cognition function is especially crucial for intraoperative and postoperative evaluation as they are
more prone to adverse outcomes during and after surgery from the stressors of the surgery, dehydration,
hypothermia, and anesthesia. Attitude about surgery and opinion or faith in the surgeon is important for all
patients. Foods the patient dislikes are not important unless the patient is allergic to them, but this is no more
important for older patients than it is for all patients.
A 78-year-old patient is having surgery. What risk areas will the nurse need to be especially aware of for this
patient during surgery?
a. Sterility
b. Paralysis
c. Urine output
d. Skin integrity - ansD
Skin of older adults has lost elasticity and is at increased risk for injury from tape, electrodes, warming or
cooling blankets, and dressings. Pooling cleansing solution may create skin burns or abrasions. The nurse is
responsible for monitoring patient safety and adjusting patient position as necessary to prevent pressure or
misalignment. Sterility and urine output would be monitored for all patients. Paralysis would not be unusual
, during some types of surgery but would have an impact on any patient's skin integrity.
A patient having an open reduction internal fixation (ORIF) of a left lower leg fracture will receive regional
anesthesia during the procedure. As the patient is prepared in the operating room, what should the nurse
implement to maintain patient safety during surgery that is directly related to the type of anesthesia being
used?
a. Apply grounding pad to unaffected leg.
b. Assess peripheral pulses and skin color.
c. Verify the last oral intake before surgery.
d. Ensure a smooth surface under the patient. - ansD
Regional anesthesia decreases sensation to the anesthetized area without impairing level of consciousness,
which means the affected leg will be without sensation while the anesthetic is effective. A double tourniquet
on the affected leg is used to restrict blood flow. This increases the patient's risk of impaired skin integrity
because the patient does not have sensation and cannot identify discomfort or foreign objects and will not be
moving during surgery. The nurse's role includes positioning the patient for correct alignment, exposure of the
surgical site, and preventing injury. The other options will be occurring but are not directly related to the
regional anesthesia.
A patient is having elective cosmetic surgery performed on her face. The surgeon will keep her at the surgery
center for 24 hours after surgery. What is the nurse's postoperative priority for this patient?
A. Manage patient pain.
B. Control the bleeding.
C. Maintain fluid balance.
D. Manage oxygenation status. - ansD
The nurse's priority is to manage the patient's oxygenation status by maintaining an airway and ventilation.
With surgery on the face, there may be swelling that could compromise her ability to breathe. Pain, bleeding,
and fluid imbalance from the surgery may increase her risk for upper airway edema causing airway obstruction
and respiratory suppression, which also indicate managing oxygenation status as the priority.
A surgical patient's premedication regimen includes midazolam (Versed). What are the most likely desired
effects of this medication?
a. Monitored anesthesia care and amnesia
