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Medical Surgical Nursing 6th Edition Ignatavicius Workman Test Bank

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Medical Surgical Nursing 6th Edition Ignatavicius Workman Test Bank

ISBN-13: 978-1416049036

ISBN-10: 1416049037

Description

Medical Surgical Nursing 6th Edition Ignatavicius Workman Test Bank

ISBN-13: 978-1416049036

ISBN-10: 1416049037

 

 

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Free Nursing Test Questions:

 

Ignatavicius: Medical-Surgical Nursing, 6th Edition

 

Chapter 16: Care of Preoperative Patients

 

Test Bank

 

  MULTIPLE CHOICE

 

  1. The client asks why the nurse signs the operative consent form under her signature as a witness. What is the nurse’s best response?
a. “It indicates that you understand teaching about the surgery.”
b. “It shows that you agreed that the surgery should be done.”
c. “It confirms that you voluntarily signed the form.”
d. “It confirms that you have authorized insurance payment for the surgery.”

 

 

ANS:   C

The nurse’s signature as a witness indicates that the consent form was signed by the client voluntarily.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 254

OBJ:    Learning Outcome 3

TOP:    Client Needs Category: Safe and Effective Care Environment (Management of Care)

MSC:   Integrated Process: Communication and Documentation

 

  1. The nurse is caring for an older adult client with a history of emphysema who will be undergoing surgery the following day. Which nursing diagnosis is the highest priority for this client?
a. Risk for caregiver role strain
b. Risk for activity intolerance
c. Risk for anxiety
d. Risk for impaired gas exchange

 

 

ANS:   D

Risk for caregiver role strain, anxiety, and activity intolerance are all lower priority than impaired gas exchange.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 8

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Nursing Process (Analysis)

 

  1. The nurse is completing preoperative teaching for a client, and it becomes apparent that the client does not understand the surgery that will be performed. What is the priority action for the nurse?
a. Obtain informed consent from the client.
b. Teach the client about the surgery to be performed.
c. Revise the teaching plan for the client.
d. Notify the surgeon and note the finding in the client’s chart.

 

 

ANS:   D

The surgeon should be notified right away so that the client can be instructed about the surgery to be performed.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcomes 5, 11

TOP:    Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC:   Integrated Process: Teaching/Learning

 

  1. During the preoperative assessment, the client tells the nurse that he smokes three packs of cigarettes daily. The information alerts the nurse to which potential complication that the client may experience during surgery and recovery?
a. Decreased pain tolerance
b. Decreased blood clotting ability
c. Increased risk for atelectasis and hypoxia
d. Increased risk for excessive scar formation

 

 

ANS:   C

Smoking increases the client’s risk for atelectasis and hypoxia.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 246

OBJ:    Learning Outcome 8

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Nursing Process (Planning)

 

  1. When the nurse brings the client’s preoperative medications, the client responds, “I don’t need that. I had a good night’s sleep last night.” What is the nurse’s best response?
a. “The doctor ordered this medication for youRemember, you should take it.”
b. “I will make a note that you refused to take the medication.”
c. “I will ask your surgeon if you should take the medication.”
d. “The medication will help prevent some complications during surgery.”

 

 

ANS:   D

Preoperative medications are often given to prevent laryngospasm and help reduce pharyngeal and gastric secretions.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcomes 4, 10

TOP:    Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies)            MSC:              Integrated Process: Communication and Documentation

 

  1. The client receiving preoperative medication tells the nurse that she took all the following vitamins and herbs last night before going to bed. Which one will the nurse report to the surgical team?
a. Valerian root
b. St. John’s wort
c. Garlic
d. Ginseng

 

 

ANS:   C

Garlic interferes with coagulation, increasing the client’s risk for bleeding during and after the surgical procedure.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 246, Table 16-3

OBJ:    Learning Outcome 8

TOP:    Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies)            MSC:              Integrated Process: Nursing Process (Assessment)

 

  1. The nurse reviews the client’s laboratory results prior to surgery. Which finding will the nurse report immediately?
a. Prothrombin time (PT): 15.2 seconds
b. Potassium: 4.1 mEq/L
c. Hematocrit: 42%
d. Random blood glucose: 122 mg/dL

 

 

ANS:   A

The prothrombin time is elevated, which could lead to bleeding during or after surgery. The surgeon and anesthesiologist should be notified of this laboratory test result right away.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 9

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Nursing Process (Assessment)

 

  1. A client is brought to the emergency department (ED) after a motorcycle accident. The client has suffered a ruptured spleen and requires surgery to stop the hemorrhaging. Which type of surgery will the client have?
a. Emergent surgery
b. Palliative surgery
c. Elective surgery
d. Radical surgery

 

 

ANS:   A

Emergent surgery is indicated when the client may die without immediate intervention.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 243, Table 16-1

OBJ:    Learning Outcome 1

TOP:    Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control)            MSC:              Integrated Process: Nursing Process (Implementation)

 

  1. The nurse has just completed preoperative teaching with a female client who will be having surgery the following day. Which statement by the client indicates that additional teaching is needed?
a. “When I brush my teeth tomorrow, I will be sure to spit out the water.”
b. “I will wear my lucky earrings tomorrow during the surgery.”
c. “I will remember to wear my glasses tomorrow instead of my contact lenses.”
d. “I won’t have to worry about putting my makeup on tomorrow morning.”

 

 

ANS:   B

Jewelry must be removed before surgery, except for rings, which may be taped in place.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 8

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Teaching/Learning

 

  1. The nurse is performing preoperative teaching with a client who will be having colon resection surgery the following day. The surgeon has ordered bowel preparation for the client to be taken that night. Which statement by the client indicates that additional teaching is needed?
a. “I will take my antibiotics with a glass of orange juice tonight.”
b. “I will expect loose stools and cramping tonight.”
c. “I will have a bowl of chicken broth for dinner tonight.”
d. “I should drink extra water tonight if I feel thirsty.”

 

 

ANS:   A

The client will be on a clear liquid diet that night, and orange juice is not a clear liquid.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 8

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Teaching/Learning

 

  1. When examining an adult client’s preoperative laboratory results, the nurse notes that the potassium level is 2.9 mEq/mL. What is the nurse’s best action?
a. Documents the finding
b. Initiates oxygen therapy by mask
c. Increases the IV flow rate
d. Notifies the surgeon and anesthesiologist

 

 

ANS:   A

The normal range for serum sodium in adult clients is 135 to 145 mEq/L.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 9

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Nursing Process (Implementation)

 

  1. The client scheduled to have surgery within the next 2 hours tells the nurse during the admission interview the following information. What information should the nurse be certain to communicate on the outside of the chart for the entire surgical team to know?
a. The client is allergic to cats.
b. The client is hard of hearing.
c. The client had a glass of wine 12 hours ago.
d. The client takes 2000 mg of vitamin C each day.

 

 

ANS:   B

The team will need to communicate with the client in the surgical holding area, the operating room, and the postanesthesia recovery unit. Any problem with communication, such as a hearing impairment, should be stressed so that team members can use alternative means to ensure accurate communication with the client.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 11

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Nursing Process (Implementation)

 

  1. The client will be undergoing palliative surgery to debulk an abdominal tumor. The client’s daughter asks why the surgery is considered to be palliative. What is the nurse’s best response?
a. “The surgery will relieve the symptoms of the bowel obstruction. It will not cure your father.”
b. “There are fewer risks with palliative surgery than with reconstructive or restorative surgery.”
c. “There is no guarantee of the outcome of the surgery.”
d. “The surgery must be performed immediately to save your father’s life.”

 

 

ANS:   A

The purpose of palliative surgery is to improve the client’s quality of life by reducing or eliminating distressing symptoms. It does not cure a health problem and often does not prolong life.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 243, Table 16-1

OBJ:    Learning Outcome 1

TOP:    Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control)            MSC:              Integrated Process: Communication and Documentation

 

  1. Twenty minutes after the client has received a preoperative injection of atropine and midazolam (Versed), the client tells the nurse that he must be allergic to the medication because his mouth is dry and his heart seems to be beating faster than normal. Which is the nurse’s priority action?
a. Documenting the findings
b. Assessing the client’s pulse and blood pressure
c. Preparing to administer diphenhydramine (Benadryl)
d. Explaining to the client that these symptoms are expected

 

 

ANS:   B

Although these are the expected physiologic responses to the preoperative medication, whenever the client states that he or she can feel a change in normal cardiac function, the system should be assessed.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 7

TOP:    Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies)            MSC:              Integrated Process: Nursing Process (Implementation)

 

  1. The client undergoing preoperative assessment before an elective procedure tells the nurse that she has been taking 10 mg of prednisone daily for rheumatoid arthritis. What is the nurse’s best action?
a. Tells the client not to take the medication on the day of surgery
b. Notifies the surgeon and the anesthesiologist
c. Documents the information in the client’s record
d. Suggests that the client take aspirin daily instead

 

 

ANS:   B

The surgery does not need to be delayed. However, corticosteroids have many adverse effects so both the surgeon and anesthesiologist should be aware of the medication use prior to surgery.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 8

TOP:    Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies)            MSC:              Integrated Process: Nursing Process (Implementation)

 

  1. The preoperative client tells the nurse that she has allergies to several substances. Which allergy presents the greatest potential problem considering the scheduled surgery?
a. Peanuts
b. Strawberries
c. Shrimp
d. Bee stings

 

 

ANS:   C

Many people who have hypersensitivities or allergies to shellfish will have allergies to povidone-iodine, a substance commonly used to cleanse the skin before surgery.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 246

OBJ:    Learning Outcome 8

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Nursing Process (Assessment)

 

  1. The client’s surgery has been delayed because of hyperkalemia. The client asks why. What is the nurse’s best response?
a. “Potassium affects how the heart works and you could have a heart attack if this is not corrected.”
b. “Your blood will not clot well when your potassium level is too high.”
c. “The anesthetist may have difficulty waking you up after your surgery if your potassium is too high.”
d. “By making sure your potassium level is normal before surgery, your heartbeat will be strong and regular during your surgery.”

 

 

ANS:   D

Hyperkalemia may cause cardiac dysrhythmias, especially during anesthesia. Explaining to the client that correcting this problem will help his heart offers reassurance.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 249

OBJ:    Learning Outcome 4

TOP:    Client Needs Category: Psychosocial Integrity (Therapeutic Communications)

MSC:   Integrated Process: Communication and Documentation

 

  1. The nurse is caring for a client who will be undergoing emergency surgery. Which information is most important for the nurse to teach the client at this time?
a. NPO status prior to surgery
b. Importance of early ambulation after surgery
c. What to expect in the operating and recovery room
d. Complications that may occur after surgery

 

 

ANS:   C

With only a few minutes before surgery, the nurse should tell the client what to expect in the operating room and recovery room to minimize his or her anxiety.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 6

TOP:    Client Needs Category: Psychosocial Integrity (Therapeutic Communications)

MSC:   Integrated Process: Teaching/Learning

 

  1. The preoperative client tells the nurse that he has an advance directive with durable power of attorney. The client asks how the advance directive will affect his surgery. What is the nurse’s best response?
a. “You will not be intubated during general anesthesia for the surgery.”
b. “Your wife will be responsible for signing all of the surgical consent forms.”
c. “The surgical staff will do CPR only if your heart stops during the operation.”
d. “If you are unable to make a decision, your designee will be asked.”

 

 

ANS:   D

The advance directive and durable power of attorney indicates who the client wishes to designate for medical decisions if he is unable to do so for himself.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 5

TOP:    Client Needs Category: Psychosocial Integrity (Therapeutic Communications)

MSC:   Integrated Process: Communication and Documentation

 

  1. A client is brought to the hospital unconscious and needs emergency surgery. The client’s only family member cannot come to the hospital before the surgery. Which is the best option for obtaining informed consent for the client’s emergent surgery?
a. Proceed with the surgery and have the family member sign the consent as soon as possible.
b. Contact the family member by phone and obtain verbal consent with two witnesses.
c. Obtain written consultation with two surgeons that the surgery is needed.
d. Have the hospital administrator appoint a temporary legal guardian.

 

 

ANS:   B

In the event that a family member cannot come to the hospital before the surgery needs to begin, verbal consent should be obtained over the phone with two witnesses.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 5

TOP:    Client Needs Category: Psychosocial Integrity (Therapeutic Communications)

MSC:   Integrated Process: Communication and Documentation

 

  1. The nurse is performing preoperative teaching with a client who will be having sinus surgery the following day. Which is an accurate statement for the nurse to include in preoperative teaching?
a. “You may take your digoxin (Lanoxin) in the morning with a small sip of water.”
b. “You should cough and deep-breathe every hour after surgery.”
c. “Please leave your hearing aids at home tomorrow morning.”
d. “You should take a deep breath and blow into your spirometer four times every hour after surgery.”

 

 

ANS:   A

Daily cardiac medications may be taken on the day of surgery with a small sip of water. Clients who are having sinus surgery should not be encouraged to cough after surgery.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcomes 4, 6

TOP:    Client Needs Category: Psychosocial Integrity (Therapeutic Communications)

MSC:   Integrated Process: Teaching/Learning

 

  1. The nurse is preparing to transfer a client to the operating room for surgery. The client has already received the preoperative medications and is becoming drowsy. What is the best method to verify the client’s identity?
a. Ask the nurse who administered the client’s preoperative medications.
b. Check the client’s room number and birth date with the name on the chart.
c. Ask the client to state his or her name and check the client’s ID band.
d. Check the client’s medical record number and name with the chart and ID band.

 

 

ANS:   D

At least two client identifiers should be used to ensure that the nurse has the correct client. The room number should never be used as a client identifier.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 254

OBJ:    Learning Outcome 2

TOP:    Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control)            MSC:              Integrated Process: Nursing Process (Implementation)

 

  1. The nurse is caring for a client who will be having surgery on his right knee. What is the best method to ensure that the surgery is performed on the correct knee?
a. Post the client’s knee x-rays in the operating room with the “left” and “right” views clearly labeled.
b. Ask the client which knee will be operated on just before anesthesia is administered.
c. Have the surgeon and the client mark a “yes” and their initials with marker on the knee to be operated on.
d. Verify the operative site with the client’s chart prior to the start of surgery.

 

 

ANS:   C

Having the surgeon and the client mark a “yes” and their initials is the most effective method listed to ensure that the correct knee is operated on.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 254

OBJ:    Learning Outcome 2

TOP:    Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control)            MSC:              Integrated Process: Nursing Process (Implementation)

 

  1. The nurse is conducting a preoperative assessment for a client who will be having surgery in a few days. Which client is at high risk for developing a deep vein thrombosis (DVT) postoperatively?
a. The client with a latex allergy
b. The client with body mass index (BMI) of 19
c. The client with an international normalized ratio (INR) of 2.2
d. The client undergoing hip replacement surgery

 

 

ANS:   D

The client will have limited mobility following hip replacement surgery, increasing the risk of postoperative deep vein thrombosis (DVT) development.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 8

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Nursing Process (Assessment)

 

  1. The nurse applies antiembolism stockings to a preoperative client, who complains that the hose are uncomfortable and that he wishes to have them removed. What is the nurse’s best response?
a. “No problem, I will remove them right now.”
b. “The stockings should be a little bit tight to help prevent blood clots.”
c. “I will roll the stockings down a little bit so that they will feel better.”
d. “They will only be on your legs during surgery and they will be removed in the recovery room.”

 

 

ANS:   D

Thromboembolic disease (TED) stockings should feel slightly tight on the legs to promote venous return and prevent DVT formation.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 12

TOP:    Client Needs Category: Physiological Integrity (Basic Care and Comfort)

MSC:   Integrated Process: Communication and Documentation

 

  MULTIPLE RESPONSE

 

  1. The nurse is completing a physical assessment for a client who will be undergoing surgery shortly. Which preoperative assessment findings will the nurse report immediately? (Select all that apply.)
a. Chest resonant to percussion over lung fields
b. Use of accessory muscles with respirations
c. Kussmaul respirations
d. Split S2 heart sound
e. Unequal chest expansion with respirations
f. Vesicular breath sounds heard over lung fields
g. Distended external jugular veins

 

 

ANS:   B, C, E, G

Abnormal physical assessment findings should be reported to the surgeon and anesthesiologist right away.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 7

TOP:    Client Needs Category: Physiological Integrity (Reduction of Risk Potential)

MSC:   Integrated Process: Nursing Process (Assessment)

 

  1. The nurse is conducting preoperative teaching with a client who will be undergoing pelvic surgery. The nurse explains the use of antiembolism stockings and pneumatic compression devices. Which statements by the client indicate that additional teaching is needed? (Select all that apply.)
a. “At least I will only have to wear the white stockings and SCD during surgery and not when I am recovering afterward.”
b. “Even though I will have the stockings on after surgery, I will still have to walk and do my leg exercises.”
c. “Since I am wearing antiembolism stockings, I won’t have to worry about putting my slippers on to go for a walk.”
d. “I’m amazed that TED stockings can come as ‘one size fits all’ since my legs are so short.”
e. “I can wear the TED stockings and SCD at the same time to help prevent clots.”
f. “I’m glad that the stockings and SCD will be off during the night so I can sleep.”

 

 

ANS:   A, C, D, F

A sequential compression device (SCD) and TED hose should be worn during surgery and recovery period during the day and night. The client should never walk in TED stockings without nonskid footwear. The nurse must measure the client’s legs to make sure that the TED stockings are the correct size.

 

DIF:    Cognitive Level: Application             REF:    N/A for Application and above

OBJ:    Learning Outcome 12

TOP:    Client Needs Category: Physiological Integrity (Basic Care and Comfort)

MSC:   Integrated Process: Teaching/Learning

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