Question 1

Aubrey Scheel,a 37-year-old active male,is in the PACU recovering from a hernia repair and preparing for discharge.The perianesthesia nurse,after reading the nursing assessment from the preoperative documentation,prepares to complete Aubrey's discharge education.Based on the perioperative nurse's nursing diagnosis of "Deficient Knowledge related to disease process and convalescence," an appropriate risk reduction strategy that is a best practice in ensuring that the patient understands the information would be to:

Accepted Answer

A)   reinforce the discharge education by giving Aubrey written instructions.
B)   place a copy of the instructions that Aubrey has signed into the patient chart.
C)   include Aubrey's wife in the teaching session.
D)   provide an opportunity for Aubrey to "teach back" his discharge instructions. D

Question 2

A group of United Kingdom (UK)researchers undertook an analysis of several research studies comparing the outcomes of laparoscopic versus open incisional hernia repair of patients who had prior laparotomies.They examined surgical time,duration of hospital stay,perioperative complications,postoperative surgical site pain,and recurrence rates in 183 patients whose incisional hernias were repaired by the open approach and 183 repaired by the laparoscopic approach.Based on the results of this study,an appropriate risk reduction strategy for patients with incisional hernias would be to repair incisional hernias:

Accepted Answer

A)   laparoscopically.
B)   through an open approach.
C)   using either open or laparoscopic approaches for equally good patient outcomes.
D)   with the open approach to decrease surgical time. A

Question 3

Morris Bettelman,an 86-year-old retired plumber,states that he has suffered from a groin hernia all of his adult life;he states,"as far back as I can remember." Sometimes he has to push the bulge back into his abdominal muscle and then he is fine until he has a coughing spell.This morning the bulge was large and tender when he woke up and he could not reduce it.As the pain increased,he felt weak and nauseous.His daughter took him to the emergency department.Morris was diagnosed with a strangulated incarcerated hernia and scheduled for emergency surgery.If the contents of Morris' hernia sac become compromised,with strangulation of the bowel,the probable label on his surgical specimen will be:

Accepted Answer

A)   compromised bowel.
B)   strangulated bowel.
C)   necrotic bowel.
D)   intestinal obstruction. C

Question 4

Thomas Benito is a 4-year-old preschooler scheduled for bilateral inguinal hernia repair.He is in the preoperative waiting lounge with his mother,while his father looks for a parking space.The mother does not speak English and she seems confused and intimidated as the perioperative nurse approaches.The surgeon has just marked both inguinal sites with his initials.The mother appears to indicate that the surgery will take place only on the right side;however,the consent states bilateral and is signed by the father.The perioperative nurse's first appropriate response should be to:

Accepted Answer

A)   attempt to explain the notation on the consent with hand signals and her best Spanish until the father returns.
B)   sit down next to the mother and convey calming behaviors until the father returns.
C)   stay with the mother and patient while someone calls back the surgeon and a medical interpreter.
D)   page the father.

Question 5

Of the open hernia procedures listed below,which classic hernia procedure is considered,by some surgeons,to not be anatomically correct because the superior transversalis fascia is sutured to the inguinal ligament instead of to the inferior portion of the transversalis fascia or the Cooper ligament?

Accepted Answer

A)   Shouldice repair
B)   Bassini repair
C)   McVay repair
D)   Cooper repair

Question 6

The transabdominal preperitoneal patch (TAPP)hernia repair and the totally extraperitoneal patch (TEP)repair differ in the manner in which access is gained to the preperitoneal space.Which of the two provides access to the preperitoneal space without entering the peritoneum?

Accepted Answer

A)   The TEP technique
B)   The TAPP technique
C)   Both techniques require access into the peritoneal compartment
D)   Neither technique enters the peritoneal compartment

Question 7

An example of a common postoperative complication related to inguinal hernia surgery is:

Accepted Answer

A)   delayed return to activity.
B)   delayed healing.
C)   postoperative adhesions.
D)   hernia recurrence.

Question 8

Contributing factors to hernia formation include age,gender,previous surgery,obesity,nutritional status,and pulmonary and cardiac disease.The formation of the hernia at a site of weakness is due to any number of conditions that cause:

Accepted Answer

A)   impaired healing and defective collagen formation.
B)   thinning and stretching of muscle fibers.
C)   increased pressure within the abdomen.
D)   loss of tissue elasticity.

Question 9

Aubrey Scheel,a 37-year-old physically active male,is getting dressed to return home from the emergency department (ED)after he experienced a large,tender bulge in his scrotum while straining at the toilet.The emergency physician reduced Aubrey's indirect inguinal hernia and referred him to a general surgery practice for elective herniorrhaphy.The ED nurse prepared Aubrey for his discharge.An appropriate nursing intervention by the ED nurse would be to:

Accepted Answer

A)   explain the signs and symptoms of an incarcerated hernia and appropriate action.
B)   demonstrate how to reduce the hernia until he can see the surgeon.
C)   advise him on the best surgeon for this hernia and give contact information.
D)   include all of the information listed above in his discharge instructions.

Question 10

Which two similar hernia repair approaches reestablish the integrity of the transversalis fascia and simultaneously reestablish and strengthen the posterior inguinal floor by sewing the transversalis fascia to the Poupart ligament?

Accepted Answer

A)   The Shouldice and the McVay ligament repair
B)   The Bassini and the Shouldice repair
C)   The McVay and the Cooper ligament repair
D)   The Shouldice and the Cooper ligament repair

Question 11

Charles Wilkins had a laparoscopic hernia repair with good results and an uneventful recovery.Weeks later,as he reviewed his hospital bill,he noted that he had been charged for a very expensive preperitoneal distention balloon,polypropylene mesh,an endomechanical stapler,and three endosurgical trocars.What hernia repair technique was probably performed on Charles?

Accepted Answer

A)   TAPP repair
B)   Laparoscopic Bassini repair
C)   TEP repair
D)   Mesh-plug insertion repair

Question 12

A study was conducted that compared laparoscopic and open-mesh methods of inguinal hernia repair and also compared TEP and TAPP techniques for cost and patient outcome effectiveness.Some of the factors measured included patient's return to prior activities,persisting pain and numbness,infection,length of operation time,and complications.The researchers discovered several compelling findings and many differences between the two approaches.Select two statements that reflect true findings from the study.

Accepted Answer

A)   TEP and TAPP techniques were of similar cost to the patient.
B)   Mesh infection rate was low with both techniques.
C)   There was no significant difference in complication rates.
D)   There was no apparent difference in the rate of hernia recurrence.
E)   Return to work and activity was similar for the two techniques.F) TEPP and open-mesh techniques shared equal costs to the patient.

Question 13

Select the triad of the boundaries of the Hesselbach triangle.

Accepted Answer

A)   Inguinal ligament,rectus abdominis muscle,deep epigastric vessels
B)   Rectus abdominis muscle,Cooper ligament,aponeurosis
C)   Scarpa's fascia,deep epigastric vessels,external oblique muscle
D)   Inguinal ligament,inguinal canal,Cooper ligament

Question 14

Hernia-entrapped viscera,typically loops of small intestine,will result in intestinal obstruction with resulting pain,vomiting,and distention.What is the appropriate descriptive diagnosis of this condition?

Accepted Answer

A)   Nonreducible hernia
B)   Incarcerated hernia
C)   Torsion of the hernia sac
D)   Gangrenous bowel

Question 15

What composes the lining of a herniated abdominal sac?

Accepted Answer

A)   Fascia
B)   Peritoneum
C)   Muscularis
D)   Rectus abdominis muscle

Question 16

The anterolateral abdominal wall consists of an arrangement of muscles,fascial layers,and muscular aponeuroses lined interiorly by peritoneum and exteriorly by skin.The key landmark of the _ designates the roof of the inguinal canal and the key landmark of the __ designates the floor of the inguinal canal.

Accepted Answer

A)   external oblique aponeurosis;transversalis aponeurosis and fascia
B)   lateral rectus abdominis;transversalis aponeurosis and fascia
C)   external oblique aponeurosis;Poupart ligament
D)   transversalis aponeurosis and fascia;Cooper ligament aponeurosis

Question 17

Select the most common hernia that occurs in both males and females and name the side on which it would most likely occur.

Accepted Answer

A)   Direct femoral hernia on the left
B)   Indirect inguinal hernia on the right
C)   Indirect femoral hernia on the left
D)   Direct inguinal hernia on the right

Question 18

Aubrey Scheel arrived to the preoperative receiving and waiting lounge of the ambulatory surgery center for an elective hernia repair.His perioperative nurse introduced herself and began Aubrey's preoperative nursing assessment.It was a beautiful and warm spring day and Aubrey shared his concern about how he would feel after the procedure.He wanted to know when he would be able to get back to work and resume his place as pitcher on his softball team.He also told the nurse that he planned to do some yard work today as soon as the anesthesia "wears off." Which one of the following nursing diagnoses is given priority in both preoperative and postoperative education?

Accepted Answer

A)   Risk for Urinary Retention related to anesthesia
B)   Activity Intolerance related to pain and early postoperative ambulation
C)   Risk for Ineffective Tissue Perfusion related to scrotal swelling
D)   Deficient Knowledge related to disease process and convalescence

Question 19

Bupivacaine and ropivacaine are look-alike/sound-alike drugs.Adverse drug reactions (ADRs)can occur if a clinician confuses these two drugs.Both drugs promote nerve conduction blockage analgesia when given locally,but bupivacaine is cardiotoxic.When selecting a local anesthetic to fill an elastomeric pain pump,what is one contraindication that should be considered?

Accepted Answer

A)   If the patient is hypersensitive to amide local anesthetics
B)   If the patient has cardiovascular disease
C)   If the patient is confused or unconscious
D)   If the patient had a local injection of lidocaine during the procedure

Question 20

Ryan has an indirect hernia that is characterized by a small neck,thin walls,and close attachment to the cord structures.Marc has a hernia with a short,wide neck,and a thick-walled sac.Based on this description,Ryan has a(n)hernia and Marc has a(n)__ hernia.

Accepted Answer

A)   acquired;congenital
B)   reducible;nonreducible
C)   congenital;acquired
D)   pantaloon;sacular

Exam 12: Repair of Hernias