NURS 3730 Exam 1 UPDATED
QUESTIONS AND CORRECT ANSWERS
What are the national patient safety goals? - correct answer 1. Correct procedure on correct
patient at correct body positions
2. Correct site parking
3. Pause before surgery for time out
What to obtain from patient during preoperative phase? - correct answer -history with ros
-medical and surgical hx (including anesthesia hx)
-drug and substance use
^ tobacco increases the risk of pulmonary complications
^ alcohol alters response to anesthesia and pain...withdrawal can cause delirium tremors
What to assess in the preoperative phase? - correct answer baseline vs
Cv - htn, hx of vte/dvt, etc
Respiratory - baseline
Kidney - affects effectiveness of drugs
Neurologic - orientation, gcs
Musculoskeletal - rom, etc
Nutrition - decr. Protein intake can slow recovery
Skin - temp, breakdown, etc
Psychosocial - anxiety/fear
Diagnostic assessments to get in the preoperative phase - correct answer urinalysis
Blood type and screen
Cbc or h&h
* incr. K+ = incr. Risk of dysrhythmias
* decr. K+ = slower recovery
Clotting studies (pt, inr, aptt)
,Metabolic panel
Preg test
Cxr
Cr/mri
Ekg
How to minimize anxiety during the preoperative phase - correct answer encourage
communication
Promote rest
Use distraction
Teach the caregiver
How can degenerative changes in myocardium and valves place an older adult at higher risk during
surgery and what can the nurse do about it? - correct answer decreased cardiac reserve puts
older adults at risk for decreased co, specially during times of stress
Assess baseline vs for tachycardia, fatigue, and arrhythmias
How can rigidity of arterial walls and reduction in sns and pns innervation to the heart place an older
adult at higher risk during surgery and what can the nurse do about it? - correct answer
alterations predispose patient to post op hemorrhage and rise in systolic and diastolic bp
Maintain adequate fluid balance to minimize stress to the heart. Ensure that bp is adequate to meet
circulatory demands
How can increased calcium and cholesterol deposits within small arteries as well as thickened arterial
walls place an older adult at higher risk during surgery and what can the nurse do about it? - correct
answer predispose patient to clot formation in lower extremities
Instruct patient in leg exercises and proper turning. Apply elastic stockings or intermittent pneumatic
compression devices. Give anticoagulants. Provide education about effects and dietary restrictions
How can decreased sq tissue and increased fragility of skin place an older adult at higher risk during
surgery and what can the nurse do about it? - correct answer prone to pressure injuries and skin
tears
Assess skin q4h; pad all bony prominences during surgery; turn or reposition at least q2-3h
How can decreased respiratory muscle strength and cough reflex place an older adult at higher risk
during surgery and what can the nurse do about it? - correct answer increased risk for
atelectasis
,Instruct patient to cough and deep breath and use incentive spirometer. Ensure adequate pain control
How can reduced rom in diaphragm place an older adult at higher risk during surgery and what can
the nurse do about it? - correct answer residual capacity increased, reducing amount of new air
brought into lungs with each inspiration
When possible, have patient ambulate and sit in chair frequently
How can stiffened lung tissue and enlarged air spaces place an older adult at higher risk during
surgery and what can the nurse do about it? - correct answer blood oxygenation reduced
Obtain baseline o2 sat; measure throughout periop period
How can delayed gastric emptying place an older adult at higher risk during surgery and what can the
nurse do about it? - correct answer increases risk for reflux and indigestion
Position patient with hob elevated at least 45 degrees. Reduce size of meals
How can decreased renal function with reduced blood flow to kidneys place an older adult at higher
risk during surgery and what can the nurse do about it? - correct answer increased risk of shock
when blood loss occurs; increased risk for fluid and electrolyte imbalance
For pts hospitalized before surgery, determine baseline uo for 24 hours
How can reduced glomerular filtration rate and excretory times place an older adult at higher risk
during surgery and what can the nurse do about it? - correct answer limited ability to eliminate
drugs or toxic substances
Assess for adverse responses to drugs
How can decreased bladder capacity place an older adult at higher risk during surgery and what can
the nurse do about it? - correct answer increased risk for urgency, incontinence, and uti
Tell pt to notify nurse when fullness of bladder develops. Toliet every 2 hours or more
How can sensory losses, including reduced tactile sense and increased pain tolerance place an older
adult at higher risk during surgery and what can the nurse do about it? - correct answer
decreased ability to respond to early warning signs of sx complications
Inspect bony prominences for signs of pressure that patient is unable to sense
How can febrile response during surgery place an older adult at higher risk during surgery and what
can the nurse do about it? - correct answer increased risk of undiagnosed infection
, Ensure careful, close monitoring of patient temperature; provide warm blankets; monitor heart
function; warm ivf
How can decreased reaction time place an older adult at higher risk during surgery and what can the
nurse do about it? - correct answer confusion and delirium after anesthesia; increased risk for
falls
Allow adequate time to respond, process info, and perform tasks. Perform fall risk screening and have
fall precautions. Orient to reality
How can lower bmr place an older adult at higher risk during surgery and what can the nurse do about
it? - correct answer reduced total oxygen consumption
Ensure adequate nutritional intake when diet is resumed but avoid intake of excess calories
How can reduced number of rbcs and hgb levels place an older adult at higher risk during surgery and
what can the nurse do about it? - correct answer reduced ability to carry adequate oxygen to
tissues
Administer necessary blood products as needed. Monitor blood test results and o2 sat
How can change in total amounts of body potassium and water volume place an older adult at higher
risk during surgery and what can the nurse do about it? - correct answer greater risk for fluid or
electrolyte imbalance
Monitor electrolyte levels and supplement as necessary. Provide cardiac monitoring as needed
How can bleeding disorders (thrombocytopenia and hemophilia) increase the risk of surgery? - correct
answer increases risk of hemorrhage during and after surgery
How can diabetes mellitus increase the risk of surgery? - correct answer increases susceptibility
to infection and impairs wound healing from altered glucose metabolism and associated circulatory
impairment. Stress of surgery often results in hyperglycemia
How can heart disease (recent mi, dysrhythmias, hf) and pvd increase the risk of surgery? - correct
answer stress of surgery causes increases demand on myocardium to maintain co. General
anesthetic agents depress cardiac function
How can hypertension increase the risk of surgery? - correct answer increases risk for cv
complications during anesthesia (e.g. Stroke, inadequate tissue of oxygenation)
How can obstructive sleep apnea increase the risk of surgery? - correct answer administration
of opioids increases risk of airway obstruction after surgery. Patient desat as revealed by drop in o2 sat
by pulse ox
QUESTIONS AND CORRECT ANSWERS
What are the national patient safety goals? - correct answer 1. Correct procedure on correct
patient at correct body positions
2. Correct site parking
3. Pause before surgery for time out
What to obtain from patient during preoperative phase? - correct answer -history with ros
-medical and surgical hx (including anesthesia hx)
-drug and substance use
^ tobacco increases the risk of pulmonary complications
^ alcohol alters response to anesthesia and pain...withdrawal can cause delirium tremors
What to assess in the preoperative phase? - correct answer baseline vs
Cv - htn, hx of vte/dvt, etc
Respiratory - baseline
Kidney - affects effectiveness of drugs
Neurologic - orientation, gcs
Musculoskeletal - rom, etc
Nutrition - decr. Protein intake can slow recovery
Skin - temp, breakdown, etc
Psychosocial - anxiety/fear
Diagnostic assessments to get in the preoperative phase - correct answer urinalysis
Blood type and screen
Cbc or h&h
* incr. K+ = incr. Risk of dysrhythmias
* decr. K+ = slower recovery
Clotting studies (pt, inr, aptt)
,Metabolic panel
Preg test
Cxr
Cr/mri
Ekg
How to minimize anxiety during the preoperative phase - correct answer encourage
communication
Promote rest
Use distraction
Teach the caregiver
How can degenerative changes in myocardium and valves place an older adult at higher risk during
surgery and what can the nurse do about it? - correct answer decreased cardiac reserve puts
older adults at risk for decreased co, specially during times of stress
Assess baseline vs for tachycardia, fatigue, and arrhythmias
How can rigidity of arterial walls and reduction in sns and pns innervation to the heart place an older
adult at higher risk during surgery and what can the nurse do about it? - correct answer
alterations predispose patient to post op hemorrhage and rise in systolic and diastolic bp
Maintain adequate fluid balance to minimize stress to the heart. Ensure that bp is adequate to meet
circulatory demands
How can increased calcium and cholesterol deposits within small arteries as well as thickened arterial
walls place an older adult at higher risk during surgery and what can the nurse do about it? - correct
answer predispose patient to clot formation in lower extremities
Instruct patient in leg exercises and proper turning. Apply elastic stockings or intermittent pneumatic
compression devices. Give anticoagulants. Provide education about effects and dietary restrictions
How can decreased sq tissue and increased fragility of skin place an older adult at higher risk during
surgery and what can the nurse do about it? - correct answer prone to pressure injuries and skin
tears
Assess skin q4h; pad all bony prominences during surgery; turn or reposition at least q2-3h
How can decreased respiratory muscle strength and cough reflex place an older adult at higher risk
during surgery and what can the nurse do about it? - correct answer increased risk for
atelectasis
,Instruct patient to cough and deep breath and use incentive spirometer. Ensure adequate pain control
How can reduced rom in diaphragm place an older adult at higher risk during surgery and what can
the nurse do about it? - correct answer residual capacity increased, reducing amount of new air
brought into lungs with each inspiration
When possible, have patient ambulate and sit in chair frequently
How can stiffened lung tissue and enlarged air spaces place an older adult at higher risk during
surgery and what can the nurse do about it? - correct answer blood oxygenation reduced
Obtain baseline o2 sat; measure throughout periop period
How can delayed gastric emptying place an older adult at higher risk during surgery and what can the
nurse do about it? - correct answer increases risk for reflux and indigestion
Position patient with hob elevated at least 45 degrees. Reduce size of meals
How can decreased renal function with reduced blood flow to kidneys place an older adult at higher
risk during surgery and what can the nurse do about it? - correct answer increased risk of shock
when blood loss occurs; increased risk for fluid and electrolyte imbalance
For pts hospitalized before surgery, determine baseline uo for 24 hours
How can reduced glomerular filtration rate and excretory times place an older adult at higher risk
during surgery and what can the nurse do about it? - correct answer limited ability to eliminate
drugs or toxic substances
Assess for adverse responses to drugs
How can decreased bladder capacity place an older adult at higher risk during surgery and what can
the nurse do about it? - correct answer increased risk for urgency, incontinence, and uti
Tell pt to notify nurse when fullness of bladder develops. Toliet every 2 hours or more
How can sensory losses, including reduced tactile sense and increased pain tolerance place an older
adult at higher risk during surgery and what can the nurse do about it? - correct answer
decreased ability to respond to early warning signs of sx complications
Inspect bony prominences for signs of pressure that patient is unable to sense
How can febrile response during surgery place an older adult at higher risk during surgery and what
can the nurse do about it? - correct answer increased risk of undiagnosed infection
, Ensure careful, close monitoring of patient temperature; provide warm blankets; monitor heart
function; warm ivf
How can decreased reaction time place an older adult at higher risk during surgery and what can the
nurse do about it? - correct answer confusion and delirium after anesthesia; increased risk for
falls
Allow adequate time to respond, process info, and perform tasks. Perform fall risk screening and have
fall precautions. Orient to reality
How can lower bmr place an older adult at higher risk during surgery and what can the nurse do about
it? - correct answer reduced total oxygen consumption
Ensure adequate nutritional intake when diet is resumed but avoid intake of excess calories
How can reduced number of rbcs and hgb levels place an older adult at higher risk during surgery and
what can the nurse do about it? - correct answer reduced ability to carry adequate oxygen to
tissues
Administer necessary blood products as needed. Monitor blood test results and o2 sat
How can change in total amounts of body potassium and water volume place an older adult at higher
risk during surgery and what can the nurse do about it? - correct answer greater risk for fluid or
electrolyte imbalance
Monitor electrolyte levels and supplement as necessary. Provide cardiac monitoring as needed
How can bleeding disorders (thrombocytopenia and hemophilia) increase the risk of surgery? - correct
answer increases risk of hemorrhage during and after surgery
How can diabetes mellitus increase the risk of surgery? - correct answer increases susceptibility
to infection and impairs wound healing from altered glucose metabolism and associated circulatory
impairment. Stress of surgery often results in hyperglycemia
How can heart disease (recent mi, dysrhythmias, hf) and pvd increase the risk of surgery? - correct
answer stress of surgery causes increases demand on myocardium to maintain co. General
anesthetic agents depress cardiac function
How can hypertension increase the risk of surgery? - correct answer increases risk for cv
complications during anesthesia (e.g. Stroke, inadequate tissue of oxygenation)
How can obstructive sleep apnea increase the risk of surgery? - correct answer administration
of opioids increases risk of airway obstruction after surgery. Patient desat as revealed by drop in o2 sat
by pulse ox
