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Chapter 04: Care of Preoperative and Intraoperative Surgical Patients
deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition
MULTIPLE CHOICE
1. The nurse is caring for a patient who has received epoetin alfa (Epogen) 2 to 3 weeks prior to a
scheduled surgery. Which statement best explains the goal for Epogen administration prior to
surgery?
a. The patient will only require a single antibiotic immediately prior to surgery.
b. The patient will have greater numbers of white blood cells (WBCs) following
surgery.
c. The patient will not require a blood transfusion during surgery.
d. The patient will maintain stable potassium levels during surgery.
ANS: C
Epoetin alfa (Epogen) is given to increase red blood cell production prior to surgery with the
goal of having a bloodless surgery. Epoetin alfa (Epogen) will not affect the need for an
antibiotic preoperatively, nor will it affect WBCs or serum potassium levels.
PTS: 1 DIF: Cognitive Level: Application REF: 62 OBJ: 1 (theory) TOP: Bloodless Surgery KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance
2. The nurse is performing a preoperative assessment on a patient scheduled for surgery today.
The patient reports drinking two glasses of wine daily, smoking one pack of cigarettes daily ´
20 years, completing a round of corticosteroids for asthma control 2 days ago, and taking a
dose of passion flower extract yesterday. Which action should the nurse take next?
a. Supply the patient with information on a smoking cessation class.
b. Educate the patient regarding the dangers of drinking alcohol on a daily basis.
c. Provide the patient with information regarding the dangers of using herbal
medications.
d. Notify the physician immediately regarding the patient’s recent use of
corticosteroids.
ANS: D
The use of corticosteroids reduces the body’s response to infection and delays healing. Surgery
may need to be delayed until the patient has been off the drug approximately 7 days. Providing
the patient with information regarding smoking cessation is advisable but is not a priority at
this time. Drinking two glasses of wine daily may not be a problem if not contraindicated by
the patient’s health status. Passion flower extract does not interfere with the surgery and poses
no apparent problems.
PTS: 1 DIF: Cognitive Level: Analysis REF: 65, Table 4- OBJ: 2 (theory) TOP: Perioperative Management KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
3. The nurse is caring for a presurgical patient. The patient asks the nurse why her height and
weight are recorded. How should the nurse respond?
a. “This information helps us to correctly calculate the anesthesia dose.”
b. “Height and weight are important predictors of blood loss.”
c. “This information is used to assess respiratory volume.”
d. “Height and weight help us anticipate your fluid needs.”
ANS: A
Height and weight are used to calculate anesthesia dosages.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 76 OBJ: 3 (theory) TOP: Presurgical Assessment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
4. The nurse is reviewing the presurgical patient’s laboratory reports and notes an elevated
aspartate aminotransferase (AST) and bilirubin. The nurse understands that this patient is most
at risk for which potential complication?
a. Excessive bleeding during or after surgery
b. An increased serum albumin level
c. Postsurgical respiratory infection
d. Delayed wound healing
ANS: A
The AST and bilirubin are liver studies. Elevated levels may indicate a dysfunctional liver. The
liver is directly involved with clotting factors; therefore, this patient would be at risk for
excessive bleeding. The serum albumin level would most likely be decreased if the liver is not
functioning properly. Postsurgical wound infection and delayed wound healing risks are not
directly related to liver function.
PTS: 1 DIF: Cognitive Level: Analysis REF: 64, Box 4-2, 65, Table 4- OBJ: 2 (theory) TOP: Preoperative Lab Studies KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
5. The patient received a preoperative dose of lorazepam (Ativan) 20 minutes ago. Which safety
precaution should the nurse take?
a. Monitor respiratory status.
b. Raise the bed rails.
c. Elevate the head of the bed 30 degrees.
d. Take seizure precautions.
ANS: B
Raising the bed rails is a safety precaution against the dizziness and hypotension caused by
this drug.
PTS: 1 DIF: Cognitive Level: Application REF: 71, Safety Alert OBJ: 12 (clinical) TOP: Preoperative Medication KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
PTS: 1 DIF: Cognitive Level: Application REF: 71, Cultural Considerations OBJ: 2 (theory) TOP: Immediate Preoperative Care KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
9. Which patient statement indicates a need for further instruction about the emotional
preparation for surgery?
a. “I’m going to hug my surgeon tomorrow.”
b. “My fate is in the hands of my surgeon. I’m frightened about the outcome.”
c. “I’ll be ready for a cheeseburger when I get back.”
d. “I know I may have some pain, but this gallbladder will be gone when I wake up.”
ANS: B
This response demonstrates the patient’s fear and insecurity, which warrant further discussion.
Providing additional information or answering patient questions may help alleviate the
patient’s emotional unpreparedness for surgery. The plan for a cheeseburger indicates a
potential need to further review nutrition in the postoperative period. The other responses
demonstrate positive statements regarding the upcoming postsurgical period.
PTS: 1 DIF: Cognitive Level: Analysis REF: 69 OBJ: 3 (theory) TOP: Planning KEY: Nursing Process Step: Evaluation MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
10. Which action should the nurse take prior to administering the preoperative doses of Demerol
and atropine?
a. Ensure that a family member is present.
b. Remove the patient’s underwear.
c. Verify that a consent form is signed.
d. Raise each of the bed rails.
ANS: C
Consent forms must be signed prior to giving any sedative or preoperative drug. Removal of
underwear and the raising of the side rails can be done after the administration of the drug.
The family member does not have to present.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 68 OBJ: 12 (clinical) TOP: Obtaining Consent KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
11. Which person is responsible for verifying that the consent form is signed and that the surgical
site?
a. The scrub nurse
b. The surgeon
c. The anesthesiologist
d. The circulating nurse
ANS: D
The circulating nurse is responsible for confirming a signature on the consent form and
marking the site for surgery.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 74, Box 4- OBJ: 7 (theory) TOP: Circulating Nurse Duties KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
12. The nurse warns the patient that, in order to retard the growth of microorganisms, the
operating room temperature must be maintained in which range?
a. 60 to 65° F
b. 66 to 70° F
c. 71 to 74° F
d. 75 to 77° F
ANS: B
The operating suite is kept at a temperature of 66 to 70° F to discourage microbial growth.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 73 OBJ: 3 (theory) TOP: The Surgical Suite KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
13. The nurse is caring for a patient in the immediate preoperative period. Which action best
demonstrates compliance with the National Patient Safety Goals protocol?
a. The nurse accompanies the patient to the operating room.
b. The nurse raises all side rails and elevates the head of the bed to 30 degrees.
c. The nurse verifies and marks the surgical site.
d. The nurse identifies all prosthetic devices before the time-out.
ANS: C
The National Patient Safety Goals require that the patient be identified, the surgical consent be
signed and correct, and the surgical site be marked.
PTS: 1 DIF: Cognitive Level: Application REF: 74, Box 4- OBJ: 3 (theory) TOP: Immediate Preoperative Care KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
14. The nurse clarifies the difference between regional anesthesia and procedural sedation
anesthesia. Which statement about procedural sedation anesthesia is true?
a. Procedural sedation anesthesia uses both intravenous (IV) sedation and regional
anesthesia.
b. Procedural sedation anesthesia uses both general anesthesia and IV sedation.
c. Procedural sedation anesthesia uses both alternative medicine herbs and regional
anesthesia.
d. Procedural sedation anesthesia uses both IV sedation and local anesthesia.
ANS: A
Procedural sedation anesthesia uses both IV sedation and regional anesthesia.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 75, Table 4-
PTS: 1 DIF: Cognitive Level: Comprehension REF: 76 OBJ: 8 (theory) TOP: Stages of General Anesthesia KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Physiological Adaptation
18. The nurse is planning care for four postoperative patients. Which patient is most likely to
develop postoperative complications?
a. 36-year-old with a history of controlled diabetes
b. 62-year-old with a history of hypothyroidism
c. 49-year-old with a history of a myocardial infarction (MI)
d. 76-year-old with mild osteoarthritis
ANS: D
Patients over the age of 75 are three times more likely to experience surgical complications.
An older adult is less able to adjust and compensate for the stress of surgery, as physiologic
reserves (cardiac, respiratory, and renal) have already declined with age.
PTS: 1 DIF: Cognitive Level: Analysis REF: 62, Older Adult Care Points OBJ: 4 (theory) TOP: Postoperative Complications KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
19. The LPN/LVN is in the patient’s room while the charge nurse is obtaining the patient’s
signature on the surgical consent form. The patient states, “I didn’t really understand what my
surgeon explained, but I trust him completely.” How should the nurse respond?
a. “I need to contact your surgeon so your questions can be answered.”
b. “I can answer any questions that you might have regarding your surgery.”
c. “As long as you are comfortable, then you may sign the consent form.”
d. “Maybe we should call your surgeon to be sure it is okay to sign the consent.”
ANS: A
An informed consent means that the surgeon has supplied information regarding the procedure
itself, as well as the risks and benefits, and that the patient understands this information. The
nurse’s responsibility is witnessing the signing of the form and ensuring the patient
understands what the surgeon has discussed, not providing information if the patient has no
understanding of the procedure.
PTS: 1 DIF: Cognitive Level: Application REF: 68 OBJ: 3 (theory) TOP: Informed Consent KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care MULTIPLE RESPONSE
20. The patient questions the nurse about robotics surgery. Which information should the nurse
include? ( Select all that apply. )
a. “Robotics gives the surgeon greater magnification than the human eye.”
b. “Robotics allows the surgeon to be more precise than normal.”
c. “Robotics allows for a smaller incision.”
d. “Robotics increases healing time.”
e. “Robotics procedures generally cause less postoperative pain.”
ANS: A, B, C, E
Robotics have 12 times magnification of the operative site, steady “hands,” and use a smaller
incision, which results in less postoperative pain. Healing time is decreased with robotics.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 60- OBJ: 1 (theory) TOP: Robotic Surgery KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
21. Which physiological change(s) explain why the older adult is at greater surgical risk? ( Select
all that apply. )
a. Fewer physiologic reserves
b. Greater probability of a chronic illness
c. Greater vulnerability to fluid loss
d. Less tolerance for pain
e. Less psychological stamina
ANS: A, B, C
The older adult does have less physiologic reserves, more probability for a chronic illness, and
more vulnerability to fluid loss. There is no indication that the older adult has less tolerance
for pain or less psychological stamina.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 62, Older Adult Care Points OBJ: 4 (theory) TOP: Older Adult Surgical Patient KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation
22. What are the purposes of preoperative medication? ( Select all that apply. )
a. To reduce anxiety
b. To decrease mucus secretion
c. To counteract nausea
d. To synergize anesthesia
e. To enhance ventilation
ANS: A, B, C, D
Preoperative medications are given to reduce anxiety, decrease mucus production, counteract
nausea, and enhance anesthesia. Many preoperative medications depress ventilation.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 71 OBJ: 3 (theory) TOP: Preoperative Medication KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
23. Which responses indicate to the nurse that the patient understands preoperative teaching?
( Select all that apply. )
a. “I will need to sign a consent form before I am given my medications prior to my
surgery.”
A needle breast biopsy is a diagnostic procedure that is used to determine if cancer cells are
present. This procedure typically requires only a local or regional anesthetic; procedures that
must be performed within 24 to 48 hours are considered urgent procedures for immediate life-
threatening conditions; indicating that less pain will be experienced describes a palliative
procedure; and indicating that less breast pain will occur describes a curative procedure.
PTS: 1 DIF: Cognitive Level: Application REF: 61, Table 4- OBJ: 5 (theory) TOP: Preoperative Teaching KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance COMPLETION
26. The nurse reminds the patient that in laparoscopic surgery, with the small incision and less
tissue trauma, there is less pain because of the diminished ______________.
ANS:
inflammatory response
There is less trauma, therefore less inflammatory response, which reduces pain.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 60 OBJ: 1 (theory) TOP: Laparoscopic Surgery KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
27. A(n) ________________ allows a patient to donate her own blood to be used during or after
surgery.
ANS:
autologous transfusion
An autologous transfusion is one in which the patient has donated her own blood to be used
during or after surgery.
PTS: 1 DIF: Cognitive Level: Comprehension REF: 62 OBJ: 1 (theory) TOP: Autologous Transfusion KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
28. The _____________functions within the sterile area of the operating room and maintains
sterile technique.
ANS:
scrub nurse
scrub person
The scrub nurse is a licensed nurse or surgery technician who functions in the sterile area of
the operating room and maintains sterility throughout the operative procedure.
PTS: 1 DIF: Cognitive Level: Knowledge REF: 74, Box 4- OBJ: 7 (theory) TOP: Scrub Nurse Duties KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
