Author Question: The nurse is caring for a group of postoperative patients on the surgical unit. Which patient ... (Read 91 times)

fahad · **on:** Jul 22, 2018

The nurse is caring for a group of postoperative patients on the surgical unit. Which patient assessments indicate the nurse needs to follow up? (Select all that apply.)

a. Patient with abdominal surgery has patent airway.
b. Patient with knee surgery has approximated incision.
c. Patient with femoral artery surgery has strong pedal pulse.
d. Patient with lung surgery has 20 mL/hr of urine output via catheter.
e. Patient with bladder surgery has bloody urine within the first 12 hours.
f. Patient with appendix surgery has thready pulse and blood pressure is 90/60.

Question 2

The nurse is providing preoperative education and reviews with the patient what it will be like to be in the surgical environment. Which points should the nurse include in the teaching session? (Select all that apply.)

a. The operative suite will be very dark.
b. The family is not allowed in the operating suite.
c. The operating table or bed will be comfortable and soft.
d. The nurses will be there to assist you through this process.
e. The surgical staff will be dressed in special clothing with hats and masks.

polinasid · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

ANS: D, F
Thready pulse, low blood pressure, and urine output of 20 mL/hr need to have follow-up by the nurse. Hemorrhage results in a fall in blood pressure; elevated heart and respiratory rates; thready pulse; cool, clammy, pale skin; and restlessness. Notify the surgeon if these changes occur. If the patient has a urinary catheter, there should be a continuous flow of urine of approximately 30 to 50 mL/hr in adults; this patient requires follow-up since the output is 20 mL/hr. All the rest are normal findings. A patent airway, a strong distal pulse, and approximated incision are all normal findings. Surgery involving portions of the urinary tract normally causes bloody urine for at least 12 to 24 hours, depending on the type of surgery.

Answer to Question 2

ANS: B, D, E
The surgical staff is dressed in special clothing, hats, and masksall for infection control. Families are not allowed in the operating suite for several reasons, which include infection control and sterility. The nurse is there as the coordinator and patient advocate during a surgical procedure. The rooms are very bright so everyone can see, and the operating table is very uncomfortable for the patient.