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A 50-year-old female has suffered with severe peripheral vascular disease in the lower
extremities as evidenced by multiple episodes of the appearance of venous stasis ulcers on her
legs. The patient arrives in the Phase I PACU after having a lumbar sympathectomy. On initial
assessment, vital signs are stable and the patient's surgical dressing is dry and intact. After the
first 15 minutes the nurse reassesses the patient and finds that the vital signs are stable and the
dressing now has some clear fluid on it that has a slight smell of urine. What would be the most
prudent action for the nurse to take?
A Place a Foley catheter to keep urine from soiling the dressing and causing an infection
B Check for bladder distention and perform straight catheterization
C Call the physician; this could be caused by lumbar vessel injury
D Notify the physician because the findings suggest ureteral injury Correct Ans-D Notify the
physician because the findings suggest ureteral injury correct anwser
Rationale:Sympathectomies are procedures that involve interrupting the sympathetic nerve chain
in order to improve peripheral blood flow and to provide relief from pain. Urine on a dressing
after a lumbar sympathectomy could be caused by damage to the ureter and may require surgical
intervention (Odom-Forren J, ed. Drain's PeriAnesthesia Nursing: A Critical Care Approach. 6th
ed. St. Louis, MO: Saunders; 2013:536.)
A patient with a family history of anesthesia problems is interested in genetic screening tests.
The patient and family should be counseled that current genetic testing for malignant
, hyperthermia (MH) is not as definitive as the muscle biopsy test because the genetic analysis
only detects_________ of patients at risk.
A 10% to 20%
B 20% to 40%
C 30% to 50%
D 40% to 60% Correct Ans-C 30% to 50% correct answer
Rationale:The current molecular genetic screening test can detect anywhere from 30% to 50% of
those patients at risk for malignant hyperthermia (MH). Since this method does not detect all
people susceptible for MH it cannot be used to replace the more definitive muscle biopsy testing.
(Odom-Forren J. Drain's Perianesthesia Nursing: A Critical Care Approach. St. Louis, MO:
Saunders; 2013:745.)
In addition to the comorbidities such as hypertension, ascites, or heart failure, requiring
emergency surgery increases a patient's risk of acute kidney failure by:
A25%
B 50%
C 75%
D 100% Correct Ans-D 100% correct answer