Question 1

A diabetic patient well controlled with insulin injections has been NPO since midnight before having a mastectomy. The nurse will anticipate the need to

Accepted Answer

A)   withhold any insulin dose because the patient is NPO.
B)   obtain a blood glucose measurement before any insulin administration.
C)   administer a lower dose of insulin because there will be no oral intake before surgery.
D)   give the patient the usual insulin dose because stress will increase the blood glucose. B

Question 2

When the nurse in the clinic is doing a preoperative assessment for a patient who is scheduled for outpatient surgery in 1 week, which information about the patient is most important to communicate to the staff at the outpatient surgery center before the patient arrives for surgery?

Accepted Answer

A)   The patient develops itching when iodine is used on the skin.
B)   The patient has a history of an anaphylactic reaction to penicillin.
C)   The patient has lactose intolerance.
D)   The patient is allergic to latex products. D

Question 3

During the preoperative interview with the nurse, a patient scheduled for an elective hysterectomy to treat benign tumors of the uterus tells the nurse that she just does not know whether she can go through with the surgery because she knows she will die in surgery as her mother did. The most appropriate response by the nurse is

Accepted Answer

A)   "Tell me more about what happened to your mother."
B)   "You will receive medications to reduce your anxiety."
C)   "Surgical techniques have improved a lot in recent years."
D)   "Many people have fears and anxieties about surgery." A

Question 4

The nurse is obtaining the health history for a patient who is scheduled for outpatient knee surgery. Which statement by the patient is most important to report to the health care provider?

Accepted Answer

A)   "I had rheumatic fever when I was 6 years old."
B)   "I had bacterial pneumonia 2 years ago."
C)   "I have knee pain whenever I walk or jog."
D)   "I have a strong family history of breast cancer."

Question 5

A patient is to have a left inguinal hernia repair at the outpatient surgical clinic. Preoperatively, it is most important for the nurse to determine whether the

Accepted Answer

A)   patient has had any experience with outpatient surgery in the past.
B)   patient's medical plan covers outpatient surgery.
C)   patient plans to stay overnight at the surgical center.
D)   patient has someone available for transportation and care at home.

Question 6

A patient is to receive atropine before surgery. The nurse teaches the patient to expect

Accepted Answer

A)   weakness.
B)   dry mouth.
C)   forgetfulness.
D)   dizziness.

Question 7

The nurse asks a hospitalized patient to sign the operative permit as directed in the health care provider's preoperative orders. The patient tells the nurse, "I do not really understand what is involved in the surgery." The nurse should

Accepted Answer

A)   postpone the consent form signing and notify the holding room staff that the health care provider needs to discuss the surgery with the patient.
B)   explain what the planned surgical procedure entails before having the patient sign the consent form.
C)   have the patient sign the form and ask the health care provider to visit the patient before surgery to further explain the procedure.
D)   delay the patient's signature on the consent form and notify the health care provider that the informed consent process is not complete.

Question 8

When the nurse is performing a physical examination of a patient who smokes and who is being admitted on the day of surgery, it is especially important to

Accepted Answer

A)   calculate the patient's smoking history in pack-years.
B)   auscultate for normal and adventitious breath sounds.
C)   encourage the patient to stop smoking during the postoperative period.
D)   determine whether the patient quit smoking for a few weeks preoperatively.

Question 9

Appropriate preoperative teaching for a patient scheduled for abdominal surgery includes

Accepted Answer

A)   care for the surgical incision.
B)   methods for effective deep breathing and coughing.
C)   medications used during surgery.
D)   the need to complete all ordered antibiotics after surgery.

Question 10

Ten minutes after receiving the ordered preoperative opioid by intravenous (IV) injection, the patient asks to get up to go to the bathroom to urinate. The most appropriate action by the nurse is to

Accepted Answer

A)   offer a urinal or bedpan and position the patient in bed to promote voiding.
B)   assist the patient to the bathroom and stay with the patient to prevent falls.
C)   ask the patient to wait because catheterization is performed at the beginning of the surgical procedure.
D)   allow the patient up to the bathroom because the onset of the medication takes more than 10 minutes.

Question 11

The nurse is assessing a 36-year-old woman who has been admitted for knee surgery. Which information obtained during the preoperative assessment should be reported to the surgeon before surgery?

Accepted Answer

A)   The patient's lack of knowledge about postoperative pain control measures
B)   The patient's statement that her last menstrual period was 8 weeks previously
C)   The patient's history of a postoperative infection following a prior cholecystectomy
D)   The patient's concern that she will be unable to care for her children postoperatively

Question 12

An 82-year-old man is admitted to the hospital the evening before a prostatectomy. He is alert and oriented but has difficulty seeing and hearing. His wife answers most questions directed to the patient. To accomplish preoperative teaching with the patient, the nurse plans to

Accepted Answer

A)   use printed materials for instruction so that the patient will have more time to review the material.
B)   direct the teaching toward the wife because she is the obvious support and caregiver for the patient.
C)   provide additional time for the patient to understand preoperative instructions and carry out procedures.
D)   ask the patient's wife to wait in the hall in order to focus preoperative teaching with the patient himself.

Question 13

The nurse is reviewing the complete blood cell count (CBC) results for a patient who is scheduled for surgery in a few days. The results include red blood cell count (RBC), 4.6 * 106/µl ; white blood cell count (WBC), 10.2 * 10³/µl; hemoglobin, 15 g/dl; hematocrit, 45%; platelets, 150 * 10³/µl. Which action should the nurse take?

Accepted Answer

A)   Call the surgeon and anesthesiologist immediately.
B)   Discuss the possibility of blood transfusion with the patient.
C)   Ask the patient about any symptoms of a recent infection.
D)   Send the CBC results to the surgery facility.

Question 14

Any patient guilt about having a therapeutic abortion may be identified when the nurse assesses the functional health pattern of

Accepted Answer

A)   value-belief.
B)   cognitive-perceptual.
C)   sexuality-reproductive.
D)   coping-stress tolerance.

Question 15

During the preoperative assessment of a patient scheduled for a colon resection, the patient tells the nurse about using St. John's wort to prevent depression. The nurse should alert the staff in the postanesthesia recovery area that the patient may

Accepted Answer

A)   have more postoperative bleeding than expected.
B)   take longer to recover from the anesthesia.
C)   have hypertensive episodes.
D)   experience increased pain.

Question 16

A 24-year-old patient who uses a diuretic for blood pressure control is scheduled for abdominal surgery. Which patient information should be communicated to the health care provider prior to surgery?

Accepted Answer

A)   Blood pressure 142/78
B)   Pulse rate 102
C)   Serum potassium 3.3 mEq/L
D)   Hematocrit 35%

Question 17

As the nurse prepares a patient the morning of surgery, the patient refuses to remove a wedding ring, saying, "I have never taken it off since the day I was married." The nurse should

Accepted Answer

A)   tape the wedding ring securely to the patient's finger.
B)   have the patient sign a release and leave the ring on.
C)   suggest that the patient give the ring to a family member to keep.
D)   tell the patient that the hospital is not liable for loss of the ring.

Question 18

A patient is seen at the health care provider's office several weeks before hip surgery for preoperative assessment. The patient reports use of echinacea, saw palmetto, and glucosamine/chondroitin. The nurse should

Accepted Answer

A)   advise the patient to stop the use of all herbs and supplements at this time.
B)   teach the patient that these products may be continued preoperatively.
C)   ascertain that there will be no interactions with anesthetic agents.
D)   discuss the supplement use with the patient's health care provider.

Question 19

Which information about medication use in a preoperative patient is most important to communicate to the health care provider?

Accepted Answer

A)   The patient takes garlic capsules daily but did not take any on the surgical day.
B)   The patient took a sedative medication the previous night to assist in falling asleep.
C)   The patient uses acetaminophen (Tylenol)  as needed for occasional aches and pains.
D)   The patient has a history of cocaine use but quit using the drug over 10 years ago.

Question 20

When the nurse interviews a 53-year-old patient who is to have abdominal surgery using a general anesthetic, which information is most important to communicate to the surgeon and anesthesiologist before surgery?

Accepted Answer

A)   The patient drank a glass of apple juice 3 hours before coming to the hospital.
B)   The patient usually takes a baby aspirin daily and stopped taking aspirin 10 days ago.
C)   The patient drinks 1 to 2 cups of coffee every morning before going to work.
D)   The patient's father died after receiving general anesthesia for abdominal surgery.

Exam 18: Nursing Management: Preoperative Care