Chapter 18: Nursing Management: Preoperative Care

Test Bank

MULTIPLE CHOICE

1. A patient scheduled for an elective hysterectomy tells the nurse, I am afraid that I will die in
surgery like my mother did! Which response by the nurse is most appropriate?
a. Tell me more about what happened to your mother.
b. You will receive medications to reduce your anxiety.
c. You should talk to the doctor again about the surgery.
d. Surgical techniques have improved a lot in recent years.
ANS: A
The patients statement may indicate an unusually high anxiety level or a family history of
problems such as malignant hyperthermia, which will require precautions during surgery. The
other statements may also address the patients concerns, but further assessment is needed
first.

DIF: Cognitive Level: Apply (application) REF: 318-319

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. A patient arrives at the ambulatory surgery center for a scheduled laparoscopy procedure in
outpatient surgery. Which information is of most concern to the nurse?
a. The patient is planning to drive home after surgery.
b. The patient had a sip of water 4 hours before arriving.
c. The patients insurance does not cover outpatient surgery.
d. The patient has not had surgery using general anesthesia before.
ANS: A
After outpatient surgery, the patient should not drive home and will need assistance with
transportation and home care. The patients experience with surgery is assessed, but it does
not have as much application to the patients physiologic safety. The patients insurance
coverage is important to establish, but this is not usually the nurses role or a priority in
nursing care. Having clear liquids a few hours before surgery does not usually increase risk
for aspiration.

DIF: Cognitive Level: Apply (application) REF: 325

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

3. A 38-year-old female is admitted for an elective surgical procedure. Which information

obtained by the nurse during the preoperative assessment is most important to report to the
anesthesiologist before surgery?
a. The patients lack of knowledge about postoperative pain control measures
b. The patients statement that her last menstrual period was 8 weeks previously
c. The patients history of a postoperative infection following a prior
cholecystectomy
d. The patients concern that she will be unable to care for her children
postoperatively
ANS: B
 This statement suggests that the patient may be pregnant, and pregnancy testing is needed
before administration of anesthetic agents. Although the other data may also be communicated
with the surgeon and anesthesiologist, they will affect postoperative care and do not indicate a
need for further assessment before surgery.

DIF: Cognitive Level: Apply (application) REF: 322

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

4. A patient who has never had any prior surgeries tells the nurse doing the preoperative
assessment about an allergy to bananas and avocados. Which action is most important for the
nurse to take?
a. Notify the dietitian about the food allergies.
b. Alert the surgery center about a possible latex allergy.
c. Reassure the patient that all allergies are noted on the medical record.
d. Ask whether the patient uses antihistamines to reduce allergic reactions.
ANS: B
Certain food allergies (e.g., eggs, avocados, bananas, chestnuts, potatoes, peaches) are related
to latex allergies. When a patient is allergic to latex, special nonlatex materials are used during
surgical procedures, and the staff will need to know about the allergy in advance to obtain
appropriate nonlatex materials and have them available during surgery. The other actions also
may be appropriate, but prevention of allergic reaction during surgery is the most important
action.

DIF: Cognitive Level: Apply (application) REF: 321

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Safe and Effective Care Environment

5. A patient who is scheduled for a therapeutic abortion tells the nurse, Having an abortion is
not right. Which functional health pattern should the nurse further assess?
a. Value-belief
b. Cognitive-perceptual
c. Sexuality-reproductive
d. Coping-stress tolerance
ANS: A
The value-belief pattern includes information about conflicts between a patients values and
proposed medical care. In the cognitive-perceptual pattern, the nurse will ask questions about
pain and sensory intactness. The sexuality-reproductive pattern includes data about the impact
of the surgery on the patients sexuality. The coping-stress tolerance pattern assessment will
elicit information about how the patient feels about the surgery.

DIF: Cognitive Level: Understand (comprehension) REF: 319

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

6. A patient undergoing an emergency appendectomy has been using St. Johns wort to prevent
depression. Which complication would the nurse expect in the postanesthesia care unit?
a. Increased pain
b. Hypertensive episodes
c. Longer time to recover from anesthesia
d. Increased risk for postoperative bleeding
 ANS: C
St. Johns wort may prolong the effects of anesthetic agents and increase the time to waken
completely after surgery. It is not associated with increased bleeding risk, hypertension, or
increased pain.

DIF: Cognitive Level: Apply (application) REF: 320

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

7. The surgical unit nurse has just received a patient with a history of smoking from the
postanesthesia care unit. Which action is most important at this time?
a. Auscultate for adventitious breath sounds.
b. Obtain the patients blood pressure and temperature.
c. Remind the patient about harmful effects of smoking.
d. Ask the health care provider about prescribing a nicotine patch.
ANS: A
The nurse should first ensure a patent airway and check for breathing and circulation (airway,
breathing, and circulation [ABCs]). Circulation and temperature can be assessed after a patent
airway and breathing have been established. The immediate postoperative period is not the
optimal time for patient teaching about the harmful effects of surgery. Requesting a nicotine
patch may be appropriate, but is not a priority at this time.

DIF: Cognitive Level: Apply (application) REF: 321

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

8. The nurse obtains a health history from a patient who is scheduled for elective hip surgery in 1
week. The patient reports use of garlic and ginkgo biloba. Which action by the nurse is most
appropriate?
a. Ascertain that there will be no interactions with anesthetic agents.
b. Teach the patient that these products may be continued preoperatively.
c. Advise the patient to stop the use of all herbs and supplements at this time.
d. Discuss the herb and supplement use with the patients health care provider.
ANS: D
Both garlic and ginkgo biloba increase a patient's risk for bleeding. The nurse should discuss
the herb and supplement use with the patients health care provider. The nurse should not
advise the patient to stop the supplements or to continue them without consulting with the
health care provider. Determining the interactions between the supplements and anesthetics is
not within the nurses scope of practice.

DIF: Cognitive Level: Apply (application) REF: 320 | 324

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

9. The nurse is preparing to witness the patient signing the operative consent form when the
patient says, I do not really understand what the doctor said. Which action is best for the
nurse to take?
a. Provide an explanation of the planned surgical procedure.
b. Notify the surgeon that the informed consent process is not complete.
c. Administer the prescribed preoperative antibiotics and withhold any ordered
sedative medications.
d. Notify the operating room staff that the surgeon needs to give a more complete
 explanation of the procedure.
ANS: B
The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait
until the surgeon has clarified the surgery before having the patient sign the consent form. The
nurse should communicate directly with the surgeon about the consent form rather than asking
other staff to pass on the message. It is not within the nurses legal scope of practice to explain
the surgical procedure. No preoperative medications should be administered until the patient
understands the surgical procedure and signs the consent form.

DIF: Cognitive Level: Apply (application) REF: 326

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

10. Which topic is most important for the nurse to discuss preoperatively with a patient who is
scheduled for abdominal surgery for an open cholecystectomy?
a. Care for the surgical incision
b. Medications used during surgery
c. Deep breathing and coughing techniques
d. Oral antibiotic therapy after discharge home
ANS: C
Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing
are needed on patients having abdominal surgery to prevent postoperative atelectasis.
Incisional care and the importance of completing antibiotics are better discussed after surgery,
when the patient will be more likely to retain this information. The patient does not usually
need information about medications that are used intraoperatively.

DIF: Cognitive Level: Apply (application) REF: 324-325

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

11. Five minutes after receiving the ordered preoperative midazolam (Versed) by IV injection, the
patient asks to get up to go to the bathroom to urinate. Which action by the nurse is most
appropriate?
a. Assist the patient to the bathroom and stay with the patient to prevent falls.
b. Offer a urinal or bedpan and position the patient in bed to promote voiding.
c. Allow the patient up to the bathroom because medication onset is 10 minutes.
d. Ask the patient to wait because catheterization is performed just before the
surgery.
ANS: B
The patient will be at risk for a fall after receiving the sedative, so the best nursing action is to
have the patient use a bedpan or urinal. Having the patient get up either with assistance or
independently increases the risk for a fall. The patient will be uncomfortable and risk
involuntary incontinence if the bladder is full during transport to the operating room.

DIF: Cognitive Level: Apply (application) REF: 327

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

12. The nurse plans to provide preoperative teaching to an alert older man who has hearing and
vision deficits. His wife usually answers most questions that are directed to the patient. Which
action should the nurse take when doing the teaching?
a. Use printed materials for instruction so that the patient will have more time to
 review the material.
b. Direct the teaching toward the wife because she is the obvious support and
caregiver for the patient.
c. Provide additional time for the patient to understand preoperative instructions and
carry out procedures.
d. Ask the patients wife to wait in the hall in order to focus preoperative teaching
with the patient himself.
ANS: C
The nurse should allow more time when doing preoperative teaching and preparation for older
patients with sensory deficits. Because the patient has visual deficits, he will not be able to use
written material for learning. The teaching should be directed toward both the patient and the
wife because both will need to understand preoperative procedures and teaching.

DIF: Cognitive Level: Apply (application) REF: 329

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

13. A patient who has diabetes and uses insulin to control blood glucose has been NPO since
midnight before having a knee replacement surgery. Which action should the nurse take?
a. Withhold the usual scheduled insulin dose because the patient is NPO.
b. Obtain a blood glucose measurement before any insulin administration.
c. Give the patient the usual insulin dose because stress will increase the blood
glucose.
d. Administer a lower dose of insulin because there will be no oral intake before
surgery.
ANS: B
Preoperative insulin administration is individualized to the patient, and the current blood
glucose will provide the most reliable information about insulin needs. It is not possible to
predict whether the patient will require no insulin, a lower dose, or a higher dose without
blood glucose monitoring.

DIF: Cognitive Level: Apply (application) REF: 323

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

14. The outpatient surgery nurse reviews the complete blood cell (CBC) count results for a patient
who is scheduled for surgery in a few days. The results are white blood cell (WBC) count 10.2
103/L; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 103/L. Which action should
the nurse take?
a. Call the surgeon and anesthesiologist immediately.
b. Ask the patient about any symptoms of a recent infection.
c. Discuss the possibility of blood transfusion with the patient.
d. Send the patient to the holding area when the operating room calls.
ANS: D
The CBC count results are normal. With normal results, the patient can go to the holding area
when the operating room is ready for the patient. There is no need to notify the surgeon or
anesthesiologist, discuss blood transfusion, or ask about recent infection.

DIF: Cognitive Level: Apply (application) REF: 323

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
15. As the nurse prepares a patient the morning of surgery, the patient refuses to remove a
wedding ring, saying, I have never taken it off since the day I was married. Which response
by the nurse is best?
a. Have the patient sign a release and leave the ring on.
b. Tape the wedding ring securely to the patients finger.
c. Tell the patient that the hospital is not liable for loss of the ring.
d. Suggest that the patient give the ring to a family member to keep.
ANS: D
Jewelry is not allowed to be worn by the patient, especially if electrocautery will be used.
There is no need for a release form or to discuss liability with the patient.

DIF: Cognitive Level: Apply (application) REF: 327

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

16. A patient has received atropine before surgery and complains of dry mouth. Which action by
the nurse is best?
a. Check for skin tenting.
b. Notify the health care provider.
c. Ask the patient about any dizziness.
d. Tell the patient dry mouth is an expected side effect.
ANS: D
Anticholinergic medications decrease oral secretions, so the patient is taught that a dry mouth
is an expected side effect. The dry mouth is not a symptom of dehydration in this case.
Therefore there is no immediate need to check for skin tenting. The health care provider does
not need to be notified about an expected side effect. Weakness, forgetfulness, and dizziness
are side effects associated with other preoperative medications such as opioids and
benzodiazepines.

DIF: Cognitive Level: Apply (application) REF: 329

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

17. Which statement by a patient scheduled for surgery is most important to report to the health
care provider?
a. I had a heart valve replacement last year.
b. I had bacterial pneumonia 3 months ago.
c. I have knee pain whenever I walk or jog.
d. I have a strong family history of breast cancer.
ANS: A
A patient with a history of valve replacement is at risk for endocarditis associated with
invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may
affect whether the patient should have surgery, but a history of pneumonia is not a reason to
postpone surgery. The patients knee pain is the likely reason for the surgery. A family history
of breast cancer does not have any implications for the current surgery.

DIF: Cognitive Level: Apply (application) REF: 321

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
18. The nurse interviews a patient scheduled to undergo general anesthesia for a hernia repair.
Which information is most important to communicate to the surgeon and anesthesiologist
before surgery?
a. The patient drinks 3 or 4 cups of coffee every morning before going to work.
b. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago.
c. The patient drank 4 ounces of apple juice 3 hours before coming to the hospital.
d. The patients father died after receiving general anesthesia for abdominal surgery.
ANS: D
The information about the patients father suggests that there may be a family history of
malignant hyperthermia and that precautions may need to be taken to prevent this
complication. Current research indicates that having clear liquids 3 hours before surgery does
not increase the risk for aspiration in most patients. Patients are instructed to discontinue
aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages
postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative
implications.

DIF: Cognitive Level: Apply (application) REF: 320

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

19. Which information in the preoperative patients medication history is most important to
communicate to the health care provider?
a.The patient uses acetaminophen (Tylenol) occasionally for aches and pains.
b.The patient takes garlic capsules daily but did not take any on the surgical day.
c.The patient has a history of cocaine use but quit using the drug over 10 years ago.
d.The patient took a sedative medication the previous night to assist in falling
asleep.
ANS: B
Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of
a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine
use will not usually affect the surgical outcome.

DIF: Cognitive Level: Apply (application) REF: 320

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

20. A patient who takes a diuretic and a b-blocker to control blood pressure is scheduled for breast
reconstruction surgery. Which patient information is most important to communicate to the
health care provider before surgery?
a. Hematocrit 36%
b. Blood pressure 144/82
c. Pulse rate 58 beats/minute
d. Serum potassium 3.2 mEq/L
ANS: D
The low potassium level may increase the risk for intraoperative complications such as
dysrhythmias. Slightly elevated blood pressure is common before surgery because of anxiety.
The lower heart rate would be expected in a patient taking a b-blocker. The hematocrit is in
the low normal range but does not require any intervention before surgery.
 DIF: Cognitive Level: Apply (application) REF: 323
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. When caring for a preoperative patient on the day of surgery, which actions included in the
plan of care can the nurse delegate to unlicensed assistive personnel (UAP)? (Select all that
apply.)
a. Teach incentive spirometer use. d. Remove nail polish and apply pulse
oximeter.
b. Explain preoperative routine care. e. Transport the patient by stretcher to
the operating room.
c. Obtain and document baseline vital signs.
ANS: C, D, E
Obtaining vital signs, removing nail polish, pulse oximeter placement, and transport of the
patient are routine skills that are appropriate to delegate. Teaching patients about the
preoperative routine and incentive spirometer use require critical thinking and should be done
by the registered nurse.

DIF: Cognitive Level: Apply (application) REF: 15-16

OBJ: Special Questions: Delegation; Alternate item format: Multiple response
TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment