NURS-3730 Exam 1 Questions and
Answers
Renal/urinary system assessment - ANSWER-kidney impairment inhibits
drugs/anesthetic agent excretion
Ask the patient about the appearance and odor of the urine. Assess the patient's
usual fluid intake and degree of continence. If the patient has kidney or urinary
problems, consult with the surgeon about further workup.
Neurologic System Assessment - ANSWER-Cerebral functioning and the level of
consciousness or awareness must be assessed in ALL patients who have received
general anesthesia or any type of sedation.
Determine baseline
Assess level of consciousness (LOC), ability to follow commands
includes the patient's overall mental status, level of consciousness, orientation, and
ability to follow commands. This information is needed before planning preoperative
teaching and care after surgery.
A problem in any of these areas affects the type of care needed during the surgical
experience. Determine the patient's baseline neurologic status to be able to identify
changes that may occur later.
Musculoskeletal system assessment - ANSWER-Assess instances of decreased
muscle tone and strength, loss of muscle mass, and contractures.
problems may interfere with positioning during and after surgery.
Nutritional system assessment - ANSWER-Malnutrition and obesity increase surgical
risk
Surgery increases metabolic rate and depletes potassium and vitamins C and B, all
of which are needed for wound healing and blood clotting. In poorly nourished
patients decreased serum protein levels may slow recovery.
Negative nitrogen balance may result from depleted protein stores. This problem
increases the risk for skin breakdown, delayed wound healing, possible dehiscence
or evisceration, dehydration, and sepsis.
Some older patients may have poor nutrition because of chronic illness, diuretic or
laxative use, poor dietary planning or habits, anorexia, lack of motivation, or financial
limitations.
Indications of poor fluid or nutrition status include: - ANSWER-• Brittle nails
• Muscle wasting
• Dry or flaky skin, decreased skin turgor, and hair changes (e.g., dull, sparse, dry)
• Orthostatic (postural) hypotension
• Decreased serum protein levels and abnormal serum electrolyte values
, Skin assessment - ANSWER-is an important component of the preoperative
assessment. Assess skin color, turgor, and temperature; signs of breakdown; open
sores; or areas that may be exposed to excessive pressure during the surgical
procedure.
Psychosocial Assessment - ANSWER-Most patients have some degree of anxiety or
fear before surgery.
Determine the patient's level of anxiety, coping ability, and support systems.
Provide information and support to the patient and family as needed. Identify coping
mechanisms used by the patient under similar situations or in the past when
confronted with a stressful situation. Ask open-ended questions about the patient's
feelings about the entire surgical experience.
Factors that influence coping include: - ANSWER-age, previous surgical or sick-role
experiences, and physical discomfort. Indications of anxiety include anger, crying,
restlessness, profuse sweating, increased pulse rate, palpitations, sleeplessness,
diarrhea, and urinary frequency.
Laboratory assessment - ANSWER-before surgery provide baseline data about the
patient's health and help predict potential complications.
The patient scheduled for surgery in an ambulatory surgical center or admitted to the
hospital on the morning of or day before surgery may have preadmission testing
(PAT) performed from 24 hours to 28 days before the scheduled surgery.
Analysis: Interpreting --> The priority collaborative problems for preoperative patients
are: - ANSWER-1. Need for health teaching due to unfamiliarity with surgical
procedures and preparation
---> Knowledge deficit related to unfamiliarity with surgical procedures and
preparation
2. Anxiety due to new or unknown experience, possibility of pain, and possible
surgical outcomes
---> Anxiety related to new or unknown experience, possibility of pain and possible
surgical outcomes
Planning and Implementation: Responding - ANSWER-- Providing information
- Ensuring informed consent --> Patient self-determination
- Implementing dietary restrictions
- Preventing respiratory complications
- Preventing cardiovascular complications
- Minimizing anxiety
Informed Consent - ANSWER-- Surgeon obtains signed consent before sedation
and/or surgery
- Nurse clarifies facts and dispels myths about surgery
- Nurse not responsible for providing detailed information about procedure!
Implementing Dietary Restrictions - ANSWER-NPO - Patient not to ingest anything
by mouth for 6 to 8 hours before surgery:
Answers
Renal/urinary system assessment - ANSWER-kidney impairment inhibits
drugs/anesthetic agent excretion
Ask the patient about the appearance and odor of the urine. Assess the patient's
usual fluid intake and degree of continence. If the patient has kidney or urinary
problems, consult with the surgeon about further workup.
Neurologic System Assessment - ANSWER-Cerebral functioning and the level of
consciousness or awareness must be assessed in ALL patients who have received
general anesthesia or any type of sedation.
Determine baseline
Assess level of consciousness (LOC), ability to follow commands
includes the patient's overall mental status, level of consciousness, orientation, and
ability to follow commands. This information is needed before planning preoperative
teaching and care after surgery.
A problem in any of these areas affects the type of care needed during the surgical
experience. Determine the patient's baseline neurologic status to be able to identify
changes that may occur later.
Musculoskeletal system assessment - ANSWER-Assess instances of decreased
muscle tone and strength, loss of muscle mass, and contractures.
problems may interfere with positioning during and after surgery.
Nutritional system assessment - ANSWER-Malnutrition and obesity increase surgical
risk
Surgery increases metabolic rate and depletes potassium and vitamins C and B, all
of which are needed for wound healing and blood clotting. In poorly nourished
patients decreased serum protein levels may slow recovery.
Negative nitrogen balance may result from depleted protein stores. This problem
increases the risk for skin breakdown, delayed wound healing, possible dehiscence
or evisceration, dehydration, and sepsis.
Some older patients may have poor nutrition because of chronic illness, diuretic or
laxative use, poor dietary planning or habits, anorexia, lack of motivation, or financial
limitations.
Indications of poor fluid or nutrition status include: - ANSWER-• Brittle nails
• Muscle wasting
• Dry or flaky skin, decreased skin turgor, and hair changes (e.g., dull, sparse, dry)
• Orthostatic (postural) hypotension
• Decreased serum protein levels and abnormal serum electrolyte values
, Skin assessment - ANSWER-is an important component of the preoperative
assessment. Assess skin color, turgor, and temperature; signs of breakdown; open
sores; or areas that may be exposed to excessive pressure during the surgical
procedure.
Psychosocial Assessment - ANSWER-Most patients have some degree of anxiety or
fear before surgery.
Determine the patient's level of anxiety, coping ability, and support systems.
Provide information and support to the patient and family as needed. Identify coping
mechanisms used by the patient under similar situations or in the past when
confronted with a stressful situation. Ask open-ended questions about the patient's
feelings about the entire surgical experience.
Factors that influence coping include: - ANSWER-age, previous surgical or sick-role
experiences, and physical discomfort. Indications of anxiety include anger, crying,
restlessness, profuse sweating, increased pulse rate, palpitations, sleeplessness,
diarrhea, and urinary frequency.
Laboratory assessment - ANSWER-before surgery provide baseline data about the
patient's health and help predict potential complications.
The patient scheduled for surgery in an ambulatory surgical center or admitted to the
hospital on the morning of or day before surgery may have preadmission testing
(PAT) performed from 24 hours to 28 days before the scheduled surgery.
Analysis: Interpreting --> The priority collaborative problems for preoperative patients
are: - ANSWER-1. Need for health teaching due to unfamiliarity with surgical
procedures and preparation
---> Knowledge deficit related to unfamiliarity with surgical procedures and
preparation
2. Anxiety due to new or unknown experience, possibility of pain, and possible
surgical outcomes
---> Anxiety related to new or unknown experience, possibility of pain and possible
surgical outcomes
Planning and Implementation: Responding - ANSWER-- Providing information
- Ensuring informed consent --> Patient self-determination
- Implementing dietary restrictions
- Preventing respiratory complications
- Preventing cardiovascular complications
- Minimizing anxiety
Informed Consent - ANSWER-- Surgeon obtains signed consent before sedation
and/or surgery
- Nurse clarifies facts and dispels myths about surgery
- Nurse not responsible for providing detailed information about procedure!
Implementing Dietary Restrictions - ANSWER-NPO - Patient not to ingest anything
by mouth for 6 to 8 hours before surgery:
