SINGSON, KRISTINE DONDE C.

BSN 3-A6
Medical Surgical Nursing 1 – Lecture
Session #1: Preoperative Nursing Care
CHECK FOR UNDERSTANDING (60 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be
given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in
you answer/ratio is not allowed. You are given 60 minutes for this activity:

Case Study: Read and examine the case thoroughly.

Patient Profile: C.J., a 49-year-old construction worker, is scheduled for a bronchoscopy for biopsy of a
right lung lesion. He initially sought medical care for hemoptysis and increasing fatigue. When the nurse
asked him to sign the operative permit, he stated that he was not certain if he should go ahead with the
procedure because he fears a diagnosis of cancer.

Subjective Data
✔ Has never been hospitalized

✔ Has had no medical problems except mild obesity

✔ Has a cigarette smoking history of 40 pack-years

✔ Is married with two children, ages 6 and 8; both children have cystic fibrosis  Is fearful that his wife
will not be able to manage without him

Objective Data
 Diagnostic studies: chest x-ray revealed mass in upper
lobe of right lung  Hematocrit: 31%

Discussion Questions:
1. What factors in C.J.’s background or personal situation might influence his emotional response and
physical reactions to this surgery?
Answer: Family: both children with cystic fibrosis who needs care and expense and concern that
his wife will not be able to manage without him.

2. What should C.J. know if his consent for surgery is to be truly informed?
Answer: Sufficient comprehension of the information is being provided and voluntarily consent.
Also given without persuasion or coercion.

3. Priority Decision: C.J. will be an outpatient for this procedure. What is the priority preoperative
teaching that should be done to prepare him for surgery?
Answer: Outpatient instruction: When should we arrive, and what time is the surgery, how and
where to register, what should properly to bring and wear. General preoperative instruction:
Inform patient related to preoperative routines and preparations, such as fluid restrictions, food
restrictions, approximately time length of surgery: postoperative recovery.
4. What risk factors for surgical and anesthetic complications might you anticipate for C.J.? What are
the potential interventions that might minimize the risks?
Answer: Cigarette smoking history increases the risk for postoperative respiratory complication.
The longer the patients stop smoking before the surgery, the less of risk will be mild obesity may
contribute to problems with clearance of respiratory secretions and complete expansion of lungs.
The nurse can help minimize this risk by providing specific information about the experience and
through supportive listening.

5. Priority Decision: Based on the assessment data provided, what are the priority nursing diagnoses?
Are there any collaborative problems?
Answer: Based on the assessment data provided above, the priority nursing diagnoses are,
Ineffective health maintenance related to tobacco use, fear related to possible diagnosis of cancer
especially to lungs.
COLLABORATIVE PROBLEM: Potential complications, pneumonia, pneumothorax, hemorage, and
bronchospasm/ Laryngospasm.

Multiple Choice
1. As a nurse, what is the importance of a thorough preoperative assessment?

a. To identify and correct problems before surgery and establish a baseline for postoperative comparison
b. To save time doing an assessment after the patient returns from surgery
c. To provide the doctor with information that may have been missed during the preadmission
assessment
d. To ensure that postoperative complications don’t occur
ANSWER: A
RATIO: Preoperative goal is to assess and correcting physiologic and psychologic problems that may
increase surgical risk.

2. Before administering preoperative medication to a client, nurse Jonalyn should plan to:

a. Verify the consent

b. Check the vital signs
c. Have the client void
d. Remove the client’s dentures
ANSWER: B
RATIO: The first that nurse should do before administering preoperative medication to a patients is to
check first the vital signs, especially when administering IVF, so that it can be reconized early if the
patient is okay.

3. A client with Cataract is about to undergo surgery. Nurse Princess is preparing plan of care. Which of
the following nursing diagnosis is most appropriate to address the long term need of this type of
patient?

a. Anxiety related to the operation and its outcome

b. Sensory perceptual alteration related to lens extraction and replacement
c. Knowledge deficit related to the pre-operative and post-operative self-care
d. Body Image disturbance related to the eye packing after surgery
ANSWER: B
RATIO: The most specific associated problem for the client scheduled for cataract surgery is sensory
perceptual alteration related to lens extraction and replacement.

4. On the morning of Mrs. Sy’s planned cholecystectomy, she awakens with a pain in her right scapular
area and thinks she slept in poor position. While doing the pre-op check list you note that on her routine
CB report her WBC is 15,000. Your responsibility at this point is:

a. To notify the surgeon at once; this is an elevated WBC indicating an inflammatory reaction
b. To record this finding in a prominent place on the pre-op checklist and in your pre-op notes
c. To call the laboratory for a STAT repeat WBC
d. None. This is not an unusual finding
ANSWER: A
RATIO: A WBC count of 15,000 probably indicates acute cholecystitis, especially considering Mrs.
Hogan’s new pain, the surgeon should be called as he/she may treat the acute attack medically and
delay the surgery for several days, weeks, or months.

5. Mrs. Sy is scheduled for surgery 2 days later and is to be given atropine 0.3 mg IM and Demerol
50 mg IM one hour preoperatively. Which nursing actions follow the giving of the pre-op
medication?

a. Have her void soon after receiving the medication

b. Allow her family to be with her before the medication takes effect
c. Bring her valuables to the nursing station
d. Reinforce pre-op teaching
ANSWER: B
RATIO: The family may also be involved earlier but certainly should have that time immediately after
the medication is given and before it takes full effect to be with their love ones. Good planning of
nursing care can facilitate this.

6. A patient is admitted to the same day surgery unit for liver biopsy. Which of the following laboratory
tests assesses coagulation? SATA.

a. Partial thromboplastin time.

b. Prothrombin time.
c. Platelet count.
d. Hemoglobin
ANSWER: A,B,C
RATIO: Partial thromboplastin time, prothrombin time, and platelet count are all included in
coagulation studies, except the haemoglobin.

7. A client with a perforated gastric ulcer is scheduled for emergency surgery. The client cannot sign the
operative consent form because he has been sedated with opioid analgesics. The nurse should take
which of the following actions in the care of this client?
a. Obtain a telephone consent from the family member witnessed by two persons.
b. Obtain a court order for the surgery.
c. Send the client to surgery without the consent form being signed.
d. Have the hospital chaplain sign the informed consent immediately
ANSWER: A
RATIO: Every effort should made is to obtain permission from a responsible family members to
perform a surgery if the patients is unable to write or sign the consent form. Obtain a telephone
consent form from the family member witnessed by two persons.

8. A preoperative client expresses anxiety to the nurse about the upcoming surgery. Which of the
following responses by the nurse is most likely to stimulate further discussion between the client and
the nurse?

a. “I will be happy to explain the entire surgical procedure to you.”

b. “Let me tell you about the care you’ll receive after surgery and the amount of pain you can
anticipate.”
c. “If it’s any help, everyone is nervous before surgery.”
d. “Can you share with me what you’ve been told about your surgery?”
ANSWER: D
RATIO: Explanations should begin with the information that the client knows. By providing the client
with individualized explanations of care and procedures, the nurse can assist the client in handling
anxiety and fear for a smooth preoperative experience.

9. A nurse is preparing the client for transfer to the operating room (OR). The nurse should take
which of the following actions in the care of this client at this time?

a. Administer all the daily medications.

b. Ensure that the client has voided.
c. Verify that the client has not eaten for the last 24 hours.
d. Practice postoperative breathing exercises.
ANSWER: B
RATIO: The nurse’s first action is to ensure that the client has voided, if a Foley catheter is not in place.
The nurse does not administer all daily medications just prior to sending a client to the operating
room.

10. A nurse is reviewing the physician’s order sheet for the preoperative client, which states that the
client must be on nothing per mouth (NPO) status after midnight. The nurse would clarify whether
which of the following medications should be given to the client and not withheld?

a. Conjugated estrogen (Premarin)

b. Atenolol (Tenormin)
c. Cyclobenzaprine (Flexeril)
d. Ferrous sulfate
ANSWER: B
RATIO: Atenolol is a Beta blocker. Beta blockers should not be stopped abruptly, and the health care
provider should be contacted about the administration of this medication before surgery.