Chapter 18

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Chapter: Chapter 18: Preoperative Nursing Management
Multiple Choice
1. A patient is admitted to the emergency department complaining of severe abdominal pain.

The patient is vomiting coffee-ground like vomitus. The patient is diagnosed with a bowel
obstruction and is informed that he needs surgery. When can the patient anticipate the surgery
will be scheduled?
A) Within 24 hours
B) Within the next week
C) Without delay because the bowel obstruction is emergent
D) Difficult to predict because the surgeon may be unavailable
Ans: C
Chapter: 18
Client Needs: D-3
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 6
Page and Header: 428, Special Considerations During the Perioperative Period
Feedback: Emergency surgeries are unplanned and occur with little time for preparation for the
patient or the perioperative team. A bowel obstruction is considered an emergency, and the
patient requires immediate attention because the disorder may be life threatening. Therefore
options A, B, and D are incorrect.
2. You are doing a preoperative assessment on a patient going to surgery. The patient informs
you that he ingests 5 to 10 ounces of alcohol each day and has for the last 15 years. What
postoperative difficulties can the nurse anticipate for this patient?
A) Delirium tremens immediately following surgery
B) Delirium tremens within 72 hours after his last alcohol drink
C) Delirium tremens upon administration of general anesthesia
D) Delirium tremens 1 week after his last alcohol drink
Ans: B
Chapter: 18
Client Needs: D-3
Cognitive Level: Analysis
Difficulty: Difficult
Objective: 3
Page and Header: 430, Preoperative Assessment
Feedback: Alcohol withdrawal syndrome (ie, delirium tremens) may be anticipated between 48
and 72 hours after alcohol withdrawal and is associated with a significant mortality rate when it
occurs postoperatively.
3. How should a nurse teach a patient to perform deep breathing and coughing to use
postoperatively?
A) The patient should take three deep breaths and cough hard three times.
B) The patient should take three deep breaths and exhale forcefully and then take a quick short
breath and cough from deep in the lungs.
C) The patient should take a deep breath in through the mouth and exhale all the air out through
the mouth, take a short breath, and cough from deep in the lungs.
D) The patient should rapidly inhale, hold for 30 seconds, and exhale slowly.
Ans: C
Chapter: 18
Client Needs: D-3
Integrated Process: Teaching/Learning
Objective: 5
Page and Header: 434, General Preoperative Nursing Interventions
Feedback: The patient assumes a sitting position to enhance lung expansion. The nurse then
demonstrates how to take a deep, slow breath and how to exhale slowly. After practicing deep
breathing several times, the patient is instructed to breathe deeply, exhale through the mouth,
take a short breath, and cough from deep in the lungs.
4. The nurse is preparing a patient for surgery. The patient is to undergo a hysterectomy without
oophorectomy and the nurse is witnessing the patient's signature on a consent form. Which
comment by the patient would best indicate informed consent?
A) I know I'll be fine because the physician said he has done this procedure hundreds of times.
B) I know I'll have pain after the surgery.
C) The physician is going to remove my uterus and told me about the risk of hemorrhage.
D) Because the physician isn't taking my ovaries, I'll still be able to have children.
Ans: C
Chapter: 18
Client Needs: A-1
Integrated Process: Communication and Documentation
Objective: 4
Page and Header: 428, Informed Consent
Feedback: The surgeon must inform the patient of the benefits, alternatives, possible risks,
complications, disfigurement, disability, and removal of body parts as well as what to expect in
the early and late postoperative periods. The nurse clarifies the information provided, and, if the
patient requests additional information, the nurse notifies the physician. In option C, the patient
is able to tell the nurse what will occur during the procedure and the associated risks. This
indicates the patient has a sufficient understanding of the procedure to provide informed consent.
Clarification of information given may be necessary, but no additional information should be
given. Options A, B, and D do not indicate patient understanding of the procedure.
5. You are doing patient teaching for a patient who is scheduled for an appendectomy. You must
teach the patient about incision splinting and leg exercises. When is the best time for you to
provide teaching?
A) Upon the patient's admission to the postanesthesia care unit (PACU)
B) When the patient returns from the PACU
C) During the intraoperative period
D) Before the surgical procedure
Ans: D
Chapter: 18
Client Needs: D-3
Objective: 7
Feedback: Teaching is most effective when provided before surgery. Preoperative teaching is
initiated as soon as possible, beginning in the physician's office, clinic, or at the time of PAT
when diagnostic tests are performed. Upon admission to the PACU, the patient is usually drowsy,
making this an inopportune time for teaching. Upon the patient's return from the PACU, the
patient may remain drowsy. During the intraoperative period, anesthesia alters the patient's
mental status, rendering teaching ineffective.
6. You are caring for a hospice patient who is scheduled for a surgical procedure to reduce the
size of the tumor in an effort to relieve pain. How would this hospice patient's surgical procedure
be classified?
A) Diagnostic
B) Laparoscopic
C) Curative
D) Palliative
Ans: D
Chapter: 18
Client Needs: D-1
Cognitive Level: Comprehension
Integrated Process: Caring
Objective: 2
Page and Header: 425, Surgical Classifications
Feedback: A patient on hospice will undergo a surgical procedure only for palliative care. The
reduction of tumor size to relieve pain is considered a palliative procedure. A laparoscopic
procedure is a type of surgery that is utilized for diagnostic purposes or for repair. The excision
of a tumor is classified as curative. This patient is not having the tumor removed, only the size
reduced.
7. During your preoperative teaching, you know to include exercise of the extremities. What is
the purpose of teaching a patient leg exercises prior to surgery?
A) Leg exercises increase the patient's appetite postoperatively.
B) Leg exercises improve circulation and prevent blood clots.
C) Leg exercises help to prevent pressure sores to the sacrum.
D) Leg exercise help increase the patient's level of consciousness after surgery.
Ans: B
Chapter: 18
Client Needs: D-3
Objective: 5
Feedback: Exercise of the extremities includes extension and flexion of the knee and hip joints
(similar to bicycle riding while lying on the side) unless contraindicated by type of surgical
procedure (eg, hip replacement). When the patient does leg exercises postoperatively, circulation
is increased, which helps to prevent blood clots from forming. Options A, C, and D are incorrect;
leg exercises do not increase the patient's appetite, prevent pressure sores to the sacrum, or
increase the patient's level of consciousness.
8. You are caring for a preoperative patient. You have given the patient a preoperative narcotic
and the patient is now requesting to void. What action should you take?
A) Assist the patient to the bathroom.
B) Offer the patient a bedpan.
C) Wait until the patient gets to the operating room and is catheterized.
D) Have the patient go to the bathroom.
Ans: B
Chapter: 18
Client Needs: A-2
Objective: 6
Page and Header: 438, Immediate Preoperative Nursing Interventions
Feedback: If a preanesthetic medication is administered, the patient is kept in bed with the side
rails raised because the medication can cause lightheadedness or drowsiness. If a patient needs to
void following administration of a sedative, the nurse should offer the patient a urinal. The
patient should not get out of bed because of the potential for lightheadedness.
9. You are preparing your patient for surgery. Prior to obtaining your patient's signature on the
operative permit, you ask the patient if she understands all aspects of the surgical procedure. The
patient replies that she is very nervous and really does not understand what the surgical
procedure is or how it will be performed. What is the most appropriate nursing action for you to
take?
A) Have the patient sign the operative permit and place it in the chart
B) Call the physician to review the procedure with the patient
C) Explain the procedure to the patient and her family
D) Provide the patient with a pamphlet explaining the procedure
Ans: B
Chapter: 18
Client Needs: A-1
Objective: 4
Feedback: While the nurse may ask the patient to sign the consent form and witness the
signature, it is the surgeon's responsibility to provide a clear and simple explanation of what the
surgery will entail prior to the patient giving consent. The surgeon must also inform the patient
of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal
of body parts as well as what to expect in the early and late postoperative periods. The nurse
clarifies the information provided, and, if the patient requests additional information, the nurse
notifies the physician. Option A is incorrect; before the patient signs the consent form, the
surgeon must provide a clear and simple explanation of what the surgery will entail. Option C is
incorrect; the consent formed should not be signed until the patient understands the procedure
that has been explained by the surgeon. Option D is incorrect; the provision of a pamphlet will
benefit teaching the patient about the surgical procedure but will not substitute for the
information provided by the physician.
10. You are the nurse caring for a patient who is admitted to the emergency room with the
diagnosis of acute appendicitis. You note during the assessment that the patient's ribs and xiphoid
process are prominent. The patient states she exercises daily. The patient's mother indicates she is
being treated for anorexia nervosa. What should you do?
A) Inform the postoperative nurse of the patient's risk for wound dehiscence.
B) Evaluate the patient's ability to manage her pain level.
C) Inform the surgical team and determine her electrolyte levels.
D) Instruct the patient on the need for proper nutrition to promote healing.
Ans: C
Chapter: 18
Client Needs: B
Objective: 2
Feedback: The surgical team should be informed about the patient's medical history regarding
anorexia nervosa. Any nutritional deficiency, such as malnutrition, should be corrected before
surgery to provide adequate protein for tissue repair. In the event of a surgical emergency, the
electrolyte levels should be evaluated and corrected to prevent metabolic abnormalities in the
operative and postoperative phase. The risk of wound dehiscence is more likely associated with
obesity. Instruction on proper nutrition should take place in the postoperative period, and a
consultation should be made with her psychiatric specialist. Evaluation of pain management is
always important but not significant in this scenario.
11. You are doing preoperative patient education with a patient who is a known smoker. What
would be the best instruction to give to this patient?
A) Reduce smoking to prevent the development of pneumonia.
B) Stop smoking at least 6 weeks before the scheduled surgery to enhance pulmonary function
and decrease infection.
C) Stop smoking at least 24 hours prior to surgery to promote pulmonary function.
D) Stop smoking 4 to 8 weeks before the scheduled surgery to enhance pulmonary function and
decrease infection.
Ans: C
Chapter: 18
Client Needs: B
Objective: 3
Feedback: The reduction of smoking will enhance pulmonary function, but in the preoperative
period, patients who smoke should be urged to stop 4 to 8 weeks before surgery. This makes
options A, B, and D incorrect.
12. You are doing preoperative teaching with a patient scheduled for surgery in 1 month. During
the preoperative teaching, the patient gives you a list of medications she takes, the dosage, and
frequency. Which of the following interventions provides the patient with the most accurate
information?
A) Instruct the patient to stop taking St. John's wort at least 2 weeks prior to surgery due to its
interaction with anesthetic agents.
B) Instruct the patient to continue taking ephedrine prior to surgery due to its effect on blood
pressure.
C) Instruct the patient to discontinue synthroid due to its effect on blood coagulation and
potential heart dysrrythmias.
D) Instruct the patient to continue any herbal supplements, and inform the patient that they have
no effect on the surgical procedure.
Ans: A
Chapter: 18
Client Needs: B
Objective: 7
Feedback: Because of the potential effects of herbal medications on coagulation and potential
lethal interactions with other medications, the nurse must ask surgical patients specifically about
the use of these agents, document their use, and inform the surgical team and anesthesiologist,
anesthetist, or nurse anesthetist. Currently, it is recommended that the use of herbal products be
discontinued 2 to 3 weeks before surgery. Patients with uncontrolled thyroid disorders are at risk
for thyrotoxicosis and respiratory failure. The administration of synthroid is imperative in the
preoperative period. The use of ephedrine in the preoperative phase can cause hypertension and
should be avoided.
13. You are caring for an elderly patient who is overweight. Your patient has been admitted to
the surgical unit following a colon resection. What complication is this patient at increased risk
for in the postoperative period?
A) Hyperglycemia
B) Azotemia
C) Falls
D) Infection
Ans: D
Chapter: 18
Client Needs: D-3
Objective: 5
Feedback: Like age, obesity increases the risk and severity of complications associated with
surgery. During surgery, fatty tissues are especially susceptible to infection. In addition, obesity
increases technical and mechanical problems related to surgery. Therefore, dehiscence (wound
separation) and wound infections are more common. A postoperative patient who is obese will be
at no greater risk for hyperglycemia, azotemia, or falls. However, the obese patient is at an
increased risk for infections, wound dehiscence, and pulmonary complications.
14. You are caring for a patient in the postoperative period following an abdominal
hysterectomy. Your patient states, I don't want to use my pain medication because it will make
me dependent, and I won't get better as fast. Which response is most important when explaining
the use of pain medication?
A) You will need the pain medication for at least 1 week to help in your recovery. What do you
mean you feel you won't get better faster?
B) Pain medication will help to decrease your pain and increase your ability to breath.
Dependency is a risk with pain medication, but you are young and won't have any problems.
C) Pain medication can be given by mouth to prevent the risk of dependency that you are
worried about. The pain medication has shown to increase your risk of a slowed recovery.
D) Pain medication decreases your pain so you can move more easily. You will heal more
quickly with decreased pain. Dependence only occurs when it is administered for an extended
period of time.
Ans: D
Chapter: 18
Client Needs: D-1
Objective: 7
Feedback: Postoperatively, medications are administered to relieve pain and maintain comfort
without increasing the risk of inadequate air exchange. In the responses by the nurse, the final
response addresses the patient's concerns about drug dependency and the nurse's need to increase
the patient's ability to move and recover from surgery. The remaining responses offer incorrect
information such as increasing the patient's ability to breath or specifying the time needed to take
the medication. Narcotic pain medication will cause respiratory depression.
15. You are the nurse working in the preoperative holding area. Your patient has just received a
preanesthetic medication. What should you instruct the patient to do?
A) Use the call light to summon the nurse for assistance.
B) Leave the bedpan at the bedside.
C) Have a bedside commode available for the patient.
D) Instruct the patient on catheterization.
Ans: A
Chapter: 18
Client Needs: A-1
Objective: 6
Page and Header: 438, Immediate Preoperative Nursing Interventions
Feedback: If preanesthetic medication is administered, the patient is kept in bed with the side
rails raised because the medication can cause lightheadedness or drowsiness. The patient should
be instructed to use the call light to summon the assistance of the nurse. The patient should not
get up, so the bedside commode should not be utilized. Also, the patient should void before
administering the preanesthetic medication. The patient should ask for assistance and only utilize
the bedpan with the nurse's assistance. If the patient requires catheterization, then the patient
should be catheterized in the operating room.
16. You are admitting a patient who is insulin dependent to the same-day surgical suite for
carpal tunnel surgery. You know that this patient may be at risk for which metabolic disorder?
A) Adrenal insufficiency
B) Thyrotoxicosis
C) Impaired acid-base balance
D) Hyperglycemia
Ans: D
Chapter: 18
Client Needs: B
Objective: 2
Feedback: The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and
hyperglycemia. Hyperglycemia during the surgical procedure is a risk based on the body's
defense mechanism to raise the blood sugar in the event of stress. Patients who have received
corticosteroids are at risk of adrenal insufficiency. Patients with uncontrolled thyroid disorders
are at risk for thyrotoxicosis. Because the kidneys are involved in excreting anesthetic
medications and their metabolites and because acid-base status and metabolism are also
important considerations in anesthesia administration, surgery is contraindicated when a patient
has acute nephritis, acute renal insufficiency with oliguria or anuria, or other renal problems.
17. You are obtaining informed consent for a 16-year-old woman who is married and expecting
her first child. She is scheduled for a cesarean section. She is still living with her parents and is
on her parents' health insurance. When obtaining informed consent for the cesarean section, who
is legally responsible for signing the operative permit?
A) Her parents
B) Her husband
C) The patient
D) The obstetrician
Ans: C
Chapter: 18
Client Needs: A-1
Objective: 4
Feedback: An emancipated minor (married or independently earning his or her own living) may
sign his or her own consent form. In this case, the patient is the only person who can provide
consent unless she would be neurologically incapacitated or incompetent, in which case her
husband would need to provide consent.
18. You are providing the preoperative teaching for a patient scheduled for surgery. You know to
instruct the patient on the use of deep breathing, coughing, and the use of incentive spirometry.
What is the rationale for these interventions?
A) To promote wound healing
B) To promote optimal lung expansion
C) To enhance peripheral circulation
D) To increase gas formation
Ans: B
Chapter: 18
Client Needs: D-3
Objective: 5
Feedback: One goal of preoperative nursing care is to teach the patient how to promote optimal
lung expansion and consequent blood oxygenation after anesthesia. In addition to enhancing
respiration, these exercises may help the patient relax. Ambulation will enhance the peripheral
circulation and promote optimal lung expansion.
19. One of the things taught to a patient during preoperative teaching is to have nothing by
mouth for 8 hours before surgery. The patient asks the nurse why this is important. What is the
most appropriate response for the patient?
A) You will need to have food and fluid restricted for 8 hours before surgery so you are not at
risk for aspiration.
B) The restriction of food or fluid will present the development of pneumonia related to
decreased lung capacity.
C) The presence of food in the stomach interferes with the absorption of anesthetic agents.
D) By withholding food for 8 hours before surgery, you will not develop constipation in the
postoperative period.
Ans: A
Chapter: 18
Client Needs: D-3
Objective: 7
Feedback: The major purpose of withholding food and fluid before surgery is to prevent
aspiration. There is no scientific basis for withholding food and the development of pneumonia
or interference with absorption of anesthetic agents. Constipation in patients in the postoperative
period is related to the anesthesia, not from withholding food or fluid in the 8 hours before
surgery.
20. Your patient is scheduled for a colon resection in the morning. The patient's orders include
receiving a cleansing enema. The patient wants to know why this is necessary. You explain that
the cleansing enema will
A) prevent aspiration of gastric contents.
B) prevent the development of gas postoperatively.
C) prevent contamination of the peritoneum.
D) allow for absorption of medications.
Ans: C
Chapter: 18
Client Needs: D-3
Objective: 5
Feedback: The administration of a cleansing enema will allow for satisfactory visualization of
the surgical site and to prevent trauma to the intestine or contamination of the peritoneum by
feces. It will have no effect on aspiration of gastric contents or the absorption of medications.
The patient should develop gas in the postoperative period.
21. You are caring for a postoperative patient who is experiencing pain and anxiety. Which
intervention will assist most in decreasing the patient's pain and anxiety?
A) The administration of a stronger pain medication
B) Allowing the patient to increase activity
C) The use of guided imagery with pain medication
D) The use of patient controlled analgesia
Ans: C
Chapter: 18
Client Needs: D-4
Objective: 5
Feedback: The use of guided imagery will enhance pain relief and assist in reduction of anxiety.
The administration of a stronger pain medication should be utilized only when the patient's pain
is unrelieved, not necessarily in combination with anxiety. The increase in activity may produce
increased pain. The use of patient controlled analgesia must be ordered by the physician and is
not an independent nursing intervention.
22. Your patient is going to the operating room for an aortobifemoral bypass. You administer the
preoperative medication that has been ordered. After administering a preoperative medication to
the patient, what should you do?
A) Allow him to walk to the bathroom unassisted.
B) Place the bed in low position with the side rails up.
C) Tell him that he'll be asleep before he leaves for surgery.
D) Take his vital signs.
Ans: B
Chapter: 18
Client Needs: A-2
Objective: 6
Feedback: When the preoperative medication is given, the bed should be placed in low position
with the side rails raised. The patient should void before the preoperative medication is given,
not after. The patient should not get up without assistance. The patient may not be asleep, but he
may be drowsy. Vital signs should be taken before the preoperative medication is given.
23. You are doing preadmission assessments on patients scheduled for surgery. What is one
purpose of a preadmission assessment?
A) Verifies completion of preoperative diagnostic testing
B) Discusses and reviews patient's spiritual beliefs
C) Initiates appropriate medications
D) Informs patient of need for postoperative transportation
Ans: A
Chapter: 18
Client Needs: B
Objective: 1
Page and Header: 425, Preadmission Testing
Feedback: Purposes of preadmission testing (PAT): verifying completion of preoperative
diagnostic testing, discussing and reviewing an advanced directive document, beginning
discharge planning by assessing the patients need for postoperative transportation and care, and
initiating teaching appropriate to the patients needs. PAT does not discuss and review the
patients spiritual beliefs, initiate medications, or tell the patient he needs any kind of
transportation.
Multiple Selection
24. You are the nurse in the preoperative holding area. What is included in the care you give to
each patient? (Mark all that apply.)
A) Establish an intravenous line
B) Verify surgical site and mark site per institutional policy
C) Take measures to ensure each patient's comfort
D) Review operative plans
E) Prepare medications administered in the OR
Ans: A, B, C
Chapter: 18
Client Needs: B
Objective: 1
Page and Header: 425, Perioperative Nursing
Feedback: In the holding area, the nurse reviews charts, identifies patients, verifies surgical site
and marks site per institutional policy, establishes intravenous lines, administers medications if
prescribed, and takes measures to ensure each patient's comfort. As a nurse in the preoperative
holding area, you do not review the operative plan nor do you prepare medications to be
administered by anyone else.
Multiple Choice
25. During the intraoperative phase of nursing care, what is one aspect of giving nursing care?
A) Physiologic monitoring
B) Providing emotional support to family
C) Maintaining patient's respiratory status
D) Maintaining a sterile, controlled environment
Ans: A
Chapter: 18
Client Needs: B
Objective: 1
Feedback: During the intraoperative phase, the nurse is responsible for physiologic monitoring.
Emotional support is provided to the patient, not the family; anesthesia maintains the patient's
respiratory status; the intraoperative nurse maintains an aseptic environment.
26. You are doing a preoperative assessment on an 87-year-old male who is going to have a lobe
resection of the right lung for a diagnosis of cancer. What do you know is the underlying
principle that guides the preoperative assessment of an elderly patient?
A) Elderly patients have a smaller lung capacity than do younger patients.
B) Elderly patients have more comorbidities than do younger patients.
C) Elderly patients have less physiologic reserve than do younger patients.
D) Elderly patients have more stamina than do younger patients.
Ans: C
Chapter: 18
Client Needs: D-4
Objective: 3
Feedback: The underlying principle that guides the preoperative assessment, surgical care, and
postoperative care is that elderly patients have less physiologic reserve (the ability of an organ to
return to normal after a disturbance in its equilibrium) than do younger patients. Option A is
incorrect; elderly patients do not necessarily have smaller lung capacities than younger patients.
Option B is incorrect; even though the statement is true, it is not the underlying principle that
guides the preoperative assessment of an elderly patient. Option D is incorrect; elderly patients
generally do not have more stamina than do younger patients.
Multiple Selection
27. You are the PACU nurse caring for a patient who is ready to go the floor after her surgery.
What would you be responsible for reporting to the nurse on the floor? (Mark all that apply.)
A) The kind of anesthetic gas that was used
B) The staff in the operating room
C) The patient's preoperative level of consciousness
D) The presence of family and/or significant others
E) Identification of the patient by name
Ans: C, D, E
Chapter: 18
Client Needs: D-4
Objective: 1
Feedback: The PACU nurse is responsible for informing the floor nurse of the patient's
intraoperative factors (eg, insertion of drains or catheters, administration of blood or medications
during surgery, or occurrence of unexpected events), preoperative level of consciousness,
presence of family and/or significant others, and identification of the patient by name. The PACU
nurse does not tell which anesthetic was used, only the type and amount used. The PACU nurse
does not identify the staff that was in the operating room with the patient.
Multiple Choice
28. When does the preoperative phase of perioperative nursing begin?

A) When the decision to do surgery is made
B) When the patient is admitted to preanesthesia holding
C) When the patient is admitted to the floor
D) When the patient signs an informed consent
Ans: A
Chapter: 18
Client Needs: D-4
Difficulty: Easy
Objective: 1
Feedback: The preoperative phase begins when the decision to proceed with surgical
intervention is made and ends with the transfer of the patient onto the OR table. This makes
options B, C, and D incorrect.
29. When does the postoperative phase of perioperative nursing end?

A) When the patient is returned to her room after surgery
B) When a follow-up evaluation in the clinical setting or home setting is done
C) When the patient is discharged home
D) When the family becomes responsible for the patient's care
Ans: B
Chapter: 18
Client Needs: D-4
Difficulty: Easy
Objective: 1
Feedback: The postoperative phase begins with the admission of the patient to the PACU and
ends with a follow-up evaluation in the clinical setting or home. This makes options A, C, and D
incorrect.
30. You are the nurse caring for a trauma victim in the emergency department (ED). Your patient
requires emergency surgery. Before the patient leaves the ED for the operating room, the patient
goes into cardiac arrest. You assist in the resuscitation and proceed to release your patient to the
operating room staff. When can you perform your preoperative assessment?
A) When the patient is being stabilized after admission to the ED
B) When you are taking your patient to the OR
C) When assisting with the resuscitation
D) When calling the code
Ans: C
Chapter: 18
Client Needs: D-4
Objective: 2
Feedback: The only opportunity for preoperative assessment may take place at the same time as
resuscitation in the emergency department. Option A is incorrect; the decision to do surgery has
not yet been made. Option B is incorrect; you cannot take the patient to the OR until the
assessment has been made. Option D is incorrect; calling the code takes precedence over making
a preoperative assessment.
31. You are doing preoperative assessments on patients in the clinic scheduled for ambulatory
surgery. Which assessment is important in preventing complications with anesthesia?
A) Physiologic normalities
B) Physical abnormalities
C) Genetic disabilities
D) Genetic considerations
Ans: D
Chapter: 18
Client Needs: D-4
Objective: 2
Feedback: Genetic considerations are taken into account during assessment to prevent
complications with anesthesia. Option A explains normal findings, not a concern for anesthesia.
Options B and C are considerations for the surgeon, not anesthesia.
32. You are the admitting nurse in a short-stay surgical unit. What do you need to verify before
the patient is taken to the preoperative holding area?
A) Preoperative teaching content
B) That the family is aware of the length of the surgery
C) That follow-up home care is not necessary
D) That the family understands the patient will be discharged right after surgery.
Ans: A
Chapter: 18
Client Needs: D-4
Objective: 2
Feedback: The nurse needs to be sure that the patient and family understand that the patient will
first go to the preoperative holding area before going to the OR for the surgical procedure and
then will spend some time in the PACU before being discharged home with the family later that
day. Other preoperative teaching content should also be verified and reinforced as needed. The
nurse should ensure that any plans for follow-up home care are in place. This makes options B,
C, and D incorrect.
33. You are performing a preoperative assessment on a 37-year-old male patient who is having
surgery in 1 week for a knee injury. You know that it is important to assess this patient's immune
function. What is one thing you would be assessing for?
A) Huntington disease
B) Allergies
C) Disabilities
D) Muscular dystrophy
Ans: B
Chapter: 18
Client Needs: A-2
Objective: 3
Feedback: The patient is asked to identify any substances that precipitated previous allergic
reactions, including medications, blood transfusions, contrast agents, latex, and food products,
and to describe the signs and symptoms produced by these substances. Options A, C, and D are
incorrect because they are not caused by the immune system.
34. You are the clinic nurse doing a preoperative assessment on a patient who will be
undergoing outpatient cataract surgery with lens implantation in 1 week. While taking the
patient's medical history, you note that this patient had a kidney transplant 8 years ago. The
patient is taking immunosuppressive drugs. What is this patient at increased risk for when having
surgery?
A) Rejection of the transplanted organ
B) Rejection of the implanted lens
C) Infection
D) Adrenal storm
Ans: C
Chapter: 18
Client Needs: D-4
Objective: 3
Feedback: The mildest symptoms or slightest temperature elevation must be investigated.

Because patients who are immunosuppressed are highly susceptible to infection, great care is
taken to ensure strict asepsis. Options A and B are incorrect; this patient is taking
immunosuppressive drugs so the transplanted organ and the implanted lens should not be at risk
because of the surgery. Option D is incorrect because immunosuppressive drugs will not cause an
adrenal storm.
Multiple Selection
35. The nursing instructor is talking with the junior nursing students about diabetes and surgery.
What complications that patients with diabetes could have because of undergoing routine surgery
would the nursing instructor be sure to talk with the nursing students about? (Mark all that
apply.)
A) Hypoglycemia
B) Nutritional deficiency
C) Acidosis
D) Glucosuria
E) Renal failure
Ans: A, C, D
Chapter: 18
Client Needs: D-4
Objective: 3
Feedback: Hypoglycemia may develop during anesthesia or postoperatively from inadequate
carbohydrates or excessive administration of insulin. Hyperglycemia, which can increase the risk
for surgical wound infection, may result from the stress of surgery, which can trigger increased
levels of catecholamine. Other risks are acidosis and glucosuria. Options B and E are incorrect.
Patients with diabetes generally are not at risk for nutritional deficiency or renal failure due to
having routine surgery.
36. You are obtaining the patient's signature on the surgical consent form. What are the criteria
for a valid informed consent? (Mark all that apply.)
A) Consent must be freely given
B) Signed by responsible party
C) Must be signed before the day of surgery
D) Consent must be obtained by a physician
E) Signature must be witnessed by a professional staff member
Ans: A, D, E
Chapter: 18
Client Needs: D-4
Objective: 4
Feedback: Valid consent must be freely given, without coercion. The patient must be at least 18
years of age (unless an emancipated minor). Consent must be obtained by a physician. The
patient's signature must be witnessed by a professional staff member. This makes options B and
C incorrect.
Multiple Choice
37. You are the nurse caring for an unconscious trauma victim who needs emergency surgery.
The patient is a 55-year-old male patient with two adult children. He is legally divorced and is
planning to be married in 3 days. His parents are at the hospital with the other family members.
The physician has explained the need for surgery, the procedure to be done, and the risks to the
children, the parents, and the fianc. Who would you ask to sign the surgery consent form?
A) The fianc
B) The oldest child
C) The youngest child
D) The patient's father
Ans: B
Chapter: 18
Client Needs: D-4
Objective: 4
Feedback: The patient personally signs the consent if of legal age and mentally capable.
Permission is otherwise obtained from a surrogate, who most often is a responsible family
member (preferably next of kin) or legal guardian. In this instance, the oldest child would be the
appropriate person to ask to sign the consent form as he is the closest relative at the hospital.
Option A is incorrect; the fianc is not legally related to him as the marriage has not yet taken
place. Option D is incorrect; the father would only be asked to sign the consent if no children
were present to sign. Option C is incorrect; the youngest child would only be considered next of
kin if the older sibling was not present and able to sign the consent.
38. You are the emergency-department nurse caring for an 11-year-old brought in by ambulance
after having been hit by a car. The child's parents are in route to the hospital but have not yet
arrived. No other family members are present. The child needs emergency surgery to save her
life. How would you obtain consent for the surgery?
A) By telephone
B) By fax
C) Surgery is done without informed consent
D) Surgery is delayed until the parent's arrival
Ans: C
Chapter: 18
Client Needs: D-3
Objective: 4
Feedback: In an emergency, it may be necessary for the surgeon to operate as a lifesaving

measure without the patient's informed consent. However, every effort must be made to contact
the patient's family. In such a situation, contact can be made by telephone, fax, or other electronic
means. In this scenario, the surgery is considered lifesaving, and the parents are on their way to
the hospital and not available by telephone or fax. This makes options A and B incorrect. Option
D is incorrect because it risks the child's life.
39. You are the nurse caring for a 78-year-old female patient who is scheduled for surgery for
the removal of a brain tumor. The patient is very apprehensive and keeps asking when she will
get her preoperative medicine. The medicine is ordered to be given on call to OR. When would
be the best time to give this medication?
A) After being notified by the OR and after making sure the consent and preoperative checklist
are complete
B) As the patient is transferred to the OR bed
C) When the preoperative staff arrives on the floor to take the patient to surgery
D) After being notified by the OR and before attending to other details of the preoperative
preparation
Ans: D
Chapter: 18
Client Needs: D-2
Objective: 6
Feedback: The nurse can have the medication ready to administer as soon as a call is received
from the OR staff. It usually takes 15 to 20 minutes to prepare the patient for the OR. If the nurse
gives the medication before attending to the other details of preoperative preparation, the patient
will have at least partial benefit from the preoperative medication and will have a smoother
anesthetic and operative course. This makes options A, B, and C incorrect.
Multiple Selection
40. You are the nurse sending a patient to the operating room for a scheduled surgery. What
would you make sure is on the chart when it accompanies the patient to surgery? (Mark all that
apply.)
A) Laboratory reports
B) Nurses' notes
C) Verification form
D) Physician's progress notes for the day
E) Dietician's assessment
Ans: A, B, C
Chapter: 18
Client Needs: D-4
Objective: 6
Feedback: The completed chart (with the preoperative checklist and verification form)
accompanies the patient to the OR with the surgical consent form attached, along with all
laboratory reports and nurses' records. Any unusual last-minute observations that may have a
bearing on anesthesia or surgery are noted prominently at the front of the chart. The physician's
progress notes for that day and the nutrition assessment are not necessary when the patient goes
to surgery.
Multiple Choice
41. You are caring for an 88-year-old female who is scheduled for a right mastectomy. You
know that elderly patients are more anxious prior to surgery than younger patients. What would
you increase with this patient to decrease her anxiety?
A) Teaching on guided imagery
B) Therapeutic touch
C) Preoperative medication
D) Sleeping medication the night before surgery
Ans: B
Chapter: 18
Client Needs: D-4
Objective: 7
Feedback: Older patients report higher levels of preoperative anxiety; therefore, the nurse should
be prepared to spend additional time, increase the amount of therapeutic touch utilized, and
encourage family members to be present to decrease anxiety. Option A is incorrect; an anxious
patient often does not retain increased instruction on alternative methods of pain or anxiety
control. Options C and D are incorrect; you need an order to increase the dosage of any
medication; it is not a nursing decision.
42. What does outpatient surgery teaching include?

A) What room the patient will be admitted to after the surgery
B) What activities the patient can do prior to the surgery
C) Bring a list of medications and allergies to the outpatient surgery department
D) Bring a diet journal for 24 hours prior to the scheduled surgery
Ans: C
Chapter: 18
Client Needs: B
Difficulty: Easy
Objective: 7
Feedback: In addition to answering questions and describing what to expect, the nurse tells the
patient when and where to report, what to bring (insurance card, list of medications and
allergies), what to leave at home (jewelry, watch, medications, contact lenses), and what to wear
(loose-fitting, comfortable clothes; flat shoes). Option A is incorrect; after outpatient surgery, the
patient is discharged home, not admitted to a room. Option B is incorrect; patients can participate
in their normal activities prior to outpatient surgery. Option D is incorrect; what is eaten the day
before outpatient surgery is not important, the time it was eaten is.

Chapter 18

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Chapter 18

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Import Settings:

Base Settings: Brownstone Default

Chapter: Chapter 18: Preoperative Nursing Management

1. A patient is admitted to the emergency department complaining of severe abdominal pain.

28. When does the preoperative phase of perioperative nursing begin?

29. When does the postoperative phase of perioperative nursing end?

Feedback: The mildest symptoms or slightest temperature elevation must be investigated.

Feedback: In an emergency, it may be necessary for the surgeon to operate as a lifesaving

42. What does outpatient surgery teaching include?

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