RNSG 1341 Module Answer Key
Nursing care of the individual with preoperative health care needs
Fill in the blanks – Classifications of Surgical Procedures
1. Emergency
2. Diagnostic
3. Ablative
4. Constructive
5. Reconstructive
6. Palliative
Matching of combining forms and suffixes with their meaning
1. o
2. p
3. v
4. a
5. t
6. s
7. w
8. x
9. r
10. q
11. f
12. k
13. e
14. h
15. b
16. g
17. c
18. l
19. m
20. n
21. a2
22. u
23. c2
24. d
25. z
26. y
27. j
28. i
29. d2
30. b2
Simple definitions:
1. Hysteropexy – suturing the uterus into place
2. Gastroscopy – visual examination of the inside of the stomach
3. Nephrostomy – creating an artificial opening into the kidney
4. Arthroplasty – restoration of tissue inside of a joint
5. Prostatectomy – surgical removal of the prostate gland
6. Tracheotomy – cutting into the trachea
7. Herniorrhaphy – surgical repair of a hernia
8. Cholecystectomy – surgical removal of the gallbladder
9. Lysis of adhesions – freeing an internal organ incased in excessive scar tissue
10. Thoracentesis – Puncture and aspiration of fluid from the chest cavity
Mark the items that correctly address the statement provided.
1. a, b, c
The most common complication for outpatient surgery is bleeding. There is
limited time for assessment and patient teaching because the patients move
through the facility so quickly.
2. a,b,d,e
Increased hospital stay increases risk for infection.
3. c,d
A family member or friend is not needed to witness the actual signing of a
consent form if the patient is a competent adult. Often the nurse signs this form
after witnessing the patient’s signature. In order for the consent to be valid, the
patient must not be under the influence of any medication that could impair
judgment or understanding so these medications must be administered after the
form has been signed. If a patient is incapacitated and there is no way to obtain
consent prior to emergency lifesaving surgery, the physician may perform the
surgery after documenting the details of the case in the legal record/chart.
4. b,c,d,e,f
It is the surgeon’s responsibility to explain the actual procedure, risks, etc.
5. b,c
Although aspiration is still considered a major risk, new data shows that it is safe
to allow moderate amounts of liquids and appropriate medications 2 hours prior to
surgery and meals as described in ‘c.’
6. a,b,c,d,e
7. a,b,c,d,e
Sputum studies are not routinely done. If needed, they should be done earlier so
that the patient could be treated adequately prior to surgery.
8. a,b,d,f,g
The patient may be directed to shower using a special antimicrobial cleanser prior
to admission however the final skin prep and ‘shave’ will be done in the OR
usually by the Circulating Nurse. The patient should be weighed and measured on
admission for accuracy.
9. a,b,c,d,e,f
The patient should have someone drive him home even if being discharged from
the inpatient setting. Most postoperative patients are still taking some form of
narcotic analgesic and may be more impaired than they realize.
10. a,b,c
Although an enema is sometimes ordered for some non-bowel surgeries; multiple
enemas, antibiotics to ‘sterilize’ the bowel and Go-lytely preps are reserved for
procedures in which the bowel is opened. Generally, Foley catheters are not used
for shorter procedures. They are inserted for long procedures, procedures near the
bladder, or procedures done on patients whose urinary output must be monitored
as an indicator of kidney perfusion or fluid balance.
11. c,e
Preoperative teaching about pain management helps to close gate #1 and thus can
reduce the pain anxiety cycle. The patient may experience pain greater than 3 at
some time during the post op period but pain management should be a major
focus of his nursing care. The patient’s rating of pain on the 0 to 10 scale is the
main indicator of need for analgesics. Respiratory rate helps to indicate that the
patient can safely receive a narcotic and pulse and blood pressure may indicate
the patient’s response to stress in general and are not the main way of determining
the amount of pain being experienced. They may not be significantly elevated in
patient’s with chronic pain.
12. a,b
Homan’s sign should be assessed prior to leg exercises and the exercises not done
if it is positive. This finding should be promptly reported to the physician.
Increasing strength, joint function, and weight reduction are not the goal of post
operative exercises rather they are performed to prevent complications such as
blood clots and pneumonia and to stimulate peristalsis.
Write the name of the appropriate diagnostic test(s) nest to its purpose.
1. WBC
2. RBC, H&H, ABG’s & Pulse ox, ECG & chest x-ray
3. Cholinesterase
4. BUN, creatinine, UA, & serum electrolytes
5. chest x-ray, ABG’s, & pulse ox
6. Blood sugar
7. ECG, chest x-ray, & serum electrolytes
8. AST/ALT
9. Platelets, PT/INR, & PTT
10. Pregnancy
11. Type & Crossmatch
Match the NANDA Stems with the following:
PERSON Data
1. A,B,D,E
2. B,D
3. B,C,D,E
4. B,C,D,E
5. A,B
Related to statements
1. A,B
2. B,C
3. E,B
4. D,E
Interventions
1. A,B,C,D,E
2. A,B,C
3. B,C,D,E
4. A
5. B,C,D,E
6. A
7. D
8. A,B
9. B.C
10. B,D
Contributing Factors for Surgical Complications and Preoperative Interventions
1. Delayed wound healing or dehiscence
Contributing Factors
Advanced Age, Obesity, Malnutrition, Diabetes mellitus, & Alcoholism
Preoperative Interventions
Careful, gentle preoperative skin preparation & positioning
Teach how to support wound when coughing
Administer Total Parenteral Nutrition IV or supplement dietary intake with protein,
adequate carbohydrates and vitamin C
Monitor blood sugar q 4 to 6 hours
Maintain blood sugar levels as with a Regular insulin sliding scale
2. Hemorrhage
Contributing Factors
Cardiovascular disorders, Liver dysfunction, Alcoholism, Malnutrieion,
Anticoagulant therapy, & Herbal supplements
Preoperative Interventions
Establish baseline range for patient’s vital signs
I&O
Promote hydration by po fluids or IV therapy while avoiding fluid overload
Assess lab findings for ability to clot
Assess for calcium and vitamin K deficiency
Assess for home medications and herbal supplements that delay clotting and report
these to the surgeon
3. Shock
Contributing Factors
Advanced Age, Malnutrition, Cardiovascular disorders
Preoperative Interventions
Assess for signs of decreased physiological reserves such as dehydration, anemia,
hypotension or treatment with antihypertensive medications
Administration of high protein supplements, vitamin C, Iron
I&O
Assess hydration and encourage po or IV fluids with fluid overloading the patient
Establish baseline range for patient’s vital signs
Assess pulse for rate, regularity, & strength
4. Atelectasis and Pneumonia
Contributing Factors
Advanced Age, Obesity, Nicotine use, Medications and Herbal supplements such as
Diuretics and Narcotic analgesics
Preoperative Interventions
Teach diaphragmatic breathing and use of Incentive Spirometer
Teach coughing if appropriate for the patient based on type of surgery or history
Assess for signs of respiratory infection and history of respiratory disorders
Determine baseline for breath sounds, respiratory rate and character
Assess smoking history including number of packs per day and number of years
smoked
Assess time of last smoke
Increase fluid intake to liquefy secretions and aid in expectoration
5. Infection
Contributing Factors
Advanced Age, Malnutrition, Diabetes mellitus, Herbal supplements, & Prednisone
Preoperative Interventions
Assess WBC count and report abnormal high or low values
Increase dietary intake of protein, vitamin C
Determine baseline temperature
Monitor breath sounds
Monitor blood sugar and cover elevations with sliding scale insulin
** Check with Surgeon prior to administering medications to lower blood sugar
** Do not abruptly D/C prednisone or similar drugs or resume them if patient is under
stress
6. Formation of clots and emboli
Contributing Factors
Dehydration, Cardiovascular disorders, Obesity, Immobility and Fracture of long
bones, Medications such as diuretics
Preoperative Interventions
I&O
IV or po fluids for hydration to decrease viscosity of blood
Assess for varicose veins, edema, and history of thrombophlebitis, pulmonary emboli,
CVA, etc.
Teach post operative exercises and importance of early ambulation
Assess for redness, edema, & tenderness along a vein and positive Homan’s sign
Identify the preoperative drug being described
1. Prevacid
2. Pepcid
3. Reglan
4. Atropine
5. Morphine
6. Reglan
7. Bicitra
8. Versed
True or False
1. T
2. T
3. F – It is estimated that about 1/3 of preoperative patients take some type of herbal
supplement and many are not part of a minority group
4. F – All teaching must precede the signing of an operative permit
5. T
6. F – Is more common now to not give an IM medication as a preoperative sedative
because of irregularities in rate of absorption. It is however common to administer
preoperative doses of a medication to control stomach acid and decrease the risk
of aspiration
7. F – Patients having eye, brain, large vessel surgery, and similar surgeries should
not cough
8. T
9. T
10. T