Chapter 18 Bridge to NCLEX Examination – Pre-OP
The number of the question corresponds to the same-numbered outcome at the beginning of the chapter.
1.
An overweight patient (BMI 28.1 kg/m2) is scheduled for a laparoscopic cholecystectomy at an
outpatient surgery setting. The nurse knows that
a.
surgery will involve multiple small incisions.
b.
this setting is not appropriate for this procedure.
c.
surgery will involve removing a portion of the liver.
d.
the patient will need special preparation because of obesity.
1. Correct answer: a
Rationale: Many operative procedures are performed as ambulatory surgery (i.e., same-day or outpatient
surgery). Obesity is not a contraindication to surgery in the outpatient setting. This patient is not classified as
obese on the basis of the BMI. The case implied that a laparoscopic technique will be used that involves several
small incisions and meets the requirement of a minimally invasive technique.
2.
The patient tells the nurse in the preoperative setting that she has noticed she has a reaction when
wearing rubber gloves. What is the most appropriate intervention?
a.
Notify the surgeon so the case can be cancelled.
b.
Ask additional questions to assess for a possible latex allergy.
c.
Notify the OR staff immediately so that latex-free supplies can be used.
d.
No intervention is needed because the patient's rubber sensiti-vity has no bearing on surgery.
2. Correct answer: b
Rationale: The nurse should ask additional screening questions to determine the patient’s risk for a latex
allergy. Latex precaution protocols should be used for patients identified as having a positive latex allergy test
result or a history of signs and symptoms related to latex exposure. Many health care facilities have created
latex-free product carts that can be used for patients with latex allergies.
3.
A 59-year-old man is scheduled for a herniorrhaphy in 2 days. During the preoperative
evaluation he reports that he takes ginkgo daily. What is the priority intervention?
a.
Inform the surgeon, since the procedure may need to be rescheduled.
b.
Notify the anesthesia care provider, since this herb interferes with anesthetics.
c.
Ask the patient if he has noticed any side effects from taking this herbal supplement.
d.
Tell the patient to continue to take the herbal supplement up to the day before surgery.
3. Correct answer: a
Rationale: Ginkgo can increase bleeding during and after surgery. The surgeon should determine how long it
should be discontinued before surgery.
4.
A 17-year-old patient with a leg fracture is scheduled for surgery. She reports that she is living
with a friend and is an emancipated minor. She has a statement from the court for verification. Which
intervention is most appropriate?
a.
Witness the permit after consent is obtained by the surgeon.
b.
Call a parent or legal guardian to sign the permit, since the patient is under 18.
c.
Obtain verbal consent, since written consent is not necessary for emancipated minors.
d.
Investigate your state's nurse practice act related to emancipated minors and informed consent.
4. Correct answer: a
Rationale: An emancipated minor may sign his or her own permit. The nurse should be available to witness the
signature, but no further action is required.
5.
A priority nursing intervention to assist a preoperative patient in coping with fear of
postoperative pain would be to
a.
inform the patient that pain medication will be available.
b.
teach the patient to use guided imagery to help manage pain.
c.
describe the type of pain expected with the patient's particular surgery.
d.
explain the pain management plan, including the use of a pain rating scale.
5. Correct answer: d
Rationale: If a patient has fear of pain and discomfort after surgery, the nurse should reassure the patient that a
pain management plan will be in place. The nurse should teach the patient to ask for medications after surgery
when pain is present and assure him or her that taking these medications will not contribute to an addiction. The
nurse should instruct the patient on the use of some form of pain rating scale (e.g., 0 to 10, FACES) and to
request pain medication before the pain becomes severe.
6.
A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center.
The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before
coming to the surgery center. What should the nurse do first?
a.
Tell the patient to come back tomorrow, since he ate a meal.
b.
Proceed with the preoperative checklist, including site identification.
c.
Notify the anesthesia care provider of when and what the patient last ate.
d.
Have the patient void before administering any preoperative medications.
6. Correct answer: c
Rationale: The nothing-by-mouth (NPO) protocol of each surgical facility should be followed. Restriction of
fluids and food is designed to minimize the potential risk of pulmonary aspiration and to decrease the risk of
postoperative nausea and vomiting. If a patient has not followed the NPO instructions, surgery may be delayed
or canceled. The nurse should notify the anesthesia care provider immediately.
7.
A patient who normally takes 40 units of glargine insulin (long acting) at bedtime asks the nurse
what to do about her dose the night before surgery. The best response would be to have her
a.
skip her insulin altogether the night before surgery.
b.
take her usual dose at bedtime and eat a light breakfast in the morning.
c.
eat a moderate meal before bedtime and then take half her usual insulin dose.
d.
get instructions from her surgeon or health care provider on any insulin adjustments.
7. Correct answer: d
Rationale: Insulin is not usually omitted completely. The patient should obtain instructions from her health care
provider or surgeon about any dosage adjustments that she should make the day before and the morning of
surgery (if applicable).
8.
Preoperative considerations for older adults include (select all that apply)
a.
only using large-print educational materials.
b.
speaking louder for patients with hearing aids.
c.
recognizing that sensory deficits may be present.
d.
providing warm blankets to prevent hypothermia.
e.
teaching important information early in the morning.
8. Correct answers: c, d
Rationale: Many older adults have sensory deficits. Preoperative and operating rooms are cool; warm blankets
should be provided as needed.