During the informed consent process for surgery, which responsibility belongs to the surgeon rather than the preoperative nurse?
Explaining the risks and alternatives of the procedure
✓
Witnessing the patient's signature on the form
Confirming the patient can describe the surgery
Placing an allergy band on the patient's wrist
Correct Answer
Explaining the risks and alternatives of the procedure
Informed consent is a conversation in which the surgeon gives the details of the procedure, its risks, alternatives and expected recovery, and answers questions. Witnessing the patient's signature on the form is the preoperative nurse's role. Confirming the patient can describe the surgery is a nursing check that the explanation was understood. Placing an allergy band on the patient's wrist is a nursing safety task, not part of the surgeon's disclosure.
Category: Informed Consent
Question 2
Before signing the surgical consent, a patient asks the preoperative nurse whether a nonsurgical treatment might work instead. What should the nurse do?
Describe the nonsurgical options and then witness the signature
Notify the surgeon so the surgeon can discuss alternatives before consent is signed
✓
Have the patient sign now and pass the question to the surgeon afterward
Ask a family member to explain the surgeon's reasoning to the patient
Correct Answer
Notify the surgeon so the surgeon can discuss alternatives before consent is signed
Discussing alternatives is part of the surgeon's disclosure, and a patient who still has questions about the options has not yet given informed consent. Describing the nonsurgical options and then witnessing the signature puts the nurse in the surgeon's role. Having the patient sign now and passing the question to the surgeon afterward obtains a signature without informed agreement. Asking a family member to explain the surgeon's reasoning relies on someone who cannot provide the disclosure.
Category: Informed Consent
Question 3
An adult patient with advanced dementia has been judged unable to make medical decisions and needs surgery. Who signs the surgical consent?
The charge nurse on the surgical unit
The surgeon who will perform the procedure
The person who holds the patient's medical power of attorney
✓
Any adult friend who came to the hospital with the patient
Correct Answer
The person who holds the patient's medical power of attorney
When an adult lacks the capacity to consent, the person legally named as medical power of attorney signs on the patient's behalf. The charge nurse on the surgical unit has no legal authority to consent for a patient. The surgeon who will perform the procedure cannot consent for the patient, because the surgeon is the one seeking consent. Any adult friend who came to the hospital with the patient has no legal standing unless formally appointed.
Category: Informed Consent
Question 4
On the morning of surgery, a patient tells the preoperative nurse that the right knee is being replaced, but the orders and consent both say left knee. What should the nurse do first?
Prepare the left knee because the consent is the legal document
Mark the right knee and tell the operating room team
Have the patient sign the existing consent again
Stop and report the discrepancy to the surgeon
✓
Correct Answer
Stop and report the discrepancy to the surgeon
A mismatch between the patient's statement and the orders is a warning sign of wrong-site surgery, so preparation stops until the surgeon clarifies the site and corrects the orders and consent. Preparing the left knee because the consent is the legal document ignores the patient's report, which may reveal a paperwork error. Marking the right knee and telling the operating room team takes on the surgeon's job of marking the site. Having the patient sign the existing consent again would confirm a document that may name the wrong side.
Category: Preventing Wrong-Site Surgery
Question 5
Who places the mark on the operative site before surgery?
The surgeon performing the procedure
✓
The preoperative nurse
The circulating nurse
The patient
Correct Answer
The surgeon performing the procedure
The surgeon performing the procedure marks the correct limb or site after informed consent, and the preoperative and intraoperative nurses then verify the mark with the patient. The preoperative nurse verifies the mark but does not place it. The circulating nurse checks the mark again in the operating room but does not place it. The patient confirms the site verbally but does not mark it.
Category: Preventing Wrong-Site Surgery
Question 6
Which approach best confirms that a patient knows which procedure and site are planned?
Read the consent aloud and ask the patient to say yes
Ask the patient to state the procedure and site in their own words
✓
Compare the surgical schedule with the orders
Ask the family member who drove the patient to confirm
Correct Answer
Ask the patient to state the procedure and site in their own words
An open request, with no coaching, shows whether the patient's understanding matches the orders and consent and can catch a wrong-site error. Reading the consent aloud and asking the patient to say yes invites agreement without checking understanding. Comparing the surgical schedule with the orders checks paperwork against paperwork and leaves the patient out. Asking the family member who drove the patient to confirm does not show what the patient understands.
Category: Preventing Wrong-Site Surgery
Question 7
During preadmission assessment, a patient reports a past left mastectomy with lymph node removal. What should the nurse do?
Start the IV in the left arm to keep the right arm free
Apply a compression stocking to the left arm before surgery
Place a limb alert so the left arm is not used for blood pressure or IV access
✓
Record the history without any further action
Correct Answer
Place a limb alert so the left arm is not used for blood pressure or IV access
After a mastectomy with lymph node removal, blood pressure cuffs, blood draws and IVs on the affected arm are restricted, so the nurse places a limb alert, such as a colored band, as facility policy directs. Starting the IV in the left arm uses the very limb that should be protected. Applying a compression stocking to the left arm is not a measure ordered for this history. Recording the history without any further action leaves the team without a visible warning.
Category: Preadmission Assessment
Question 8
A patient scheduled for elective surgery under general anesthesia says she ate a full breakfast this morning. What should the nurse do?
Proceed as planned because breakfast is digested by the time of surgery
Give an antiemetic and continue the preparation
Insert a nasogastric tube and continue the preparation
Notify the surgeon and anesthesia provider before the patient goes to surgery
✓
Correct Answer
Notify the surgeon and anesthesia provider before the patient goes to surgery
Food in the stomach raises the risk of vomiting and aspiration under anesthesia, so the surgeon and anesthesia provider must decide whether to delay an elective case. Proceeding as planned assumes the stomach has emptied, which cannot be assumed. Giving an antiemetic and continuing the preparation does not remove the stomach contents. Inserting a nasogastric tube and continuing the preparation is not a nursing substitute for the providers' decision about delaying the case.
Category: Aspiration Risk
Question 9
Which statement shows that a patient understands the instruction to take nothing by mouth before surgery?
I can brush my teeth if I spit out the water and toothpaste
✓
I can chew gum on the way to the hospital
I can smoke one cigarette because it is not food
I can suck on a hard candy if my mouth feels dry
Correct Answer
I can brush my teeth if I spit out the water and toothpaste
Nothing by mouth means nothing swallowed, so brushing is allowed as long as the water and toothpaste are spit out. The statement about chewing gum on the way to the hospital is incorrect, because patients are told to avoid gum on the morning of surgery. The statement about smoking one cigarette is incorrect, because tobacco is also avoided. The statement about sucking on a hard candy is incorrect, because hard candy is on the list of items to avoid.
Category: Patient Teaching
Question 10
Why is a patient who smokes encouraged to quit well before planned surgery?
Smoking raises the risk of low blood glucose during surgery
Smoking raises the risk of surgical site infection and delayed healing
✓
Smoking triggers malignant hyperthermia under anesthesia
Smoking causes urinary retention after surgery
Correct Answer
Smoking raises the risk of surgical site infection and delayed healing
Smoking lowers tissue oxygen, so smokers face more delayed healing, surgical site infection, pneumonia and blood clots, and quitting before surgery lowers these risks. Smoking raises the risk of low blood glucose during surgery is not a recognized effect. Smoking triggers malignant hyperthermia under anesthesia is incorrect, because that reaction is an inherited response to certain anesthetic agents. Smoking causes urinary retention after surgery is not a recognized effect of smoking.
Category: Risk Factors
Question 11
Why does the nurse teach incentive spirometer use before surgery rather than waiting until afterward?
The device works only if it is used before the incision is made
Using it before surgery replaces the need to use it afterward
The patient can learn it and set a baseline goal before anesthesia and pain interfere
✓
Teaching after surgery is not permitted by most surgeons
Correct Answer
The patient can learn it and set a baseline goal before anesthesia and pain interfere
Learning the technique while alert and comfortable lets the patient set a baseline goal and use the device effectively after surgery to prevent atelectasis and pneumonia. The device works only if it is used before the incision is made is false; its main use is after surgery. Using it before surgery replaces the need to use it afterward is false, because postoperative use is what protects the lungs. Teaching after surgery is not permitted by most surgeons is not true; teaching is simply more effective beforehand.
Category: Patient Teaching
Question 12
Why is an older adult at greater risk of losing body heat during surgery?
A higher metabolic rate than younger adults
Thicker skin that releases heat quickly
More active sweat glands than younger adults
Less adipose tissue to insulate the body
✓
Correct Answer
Less adipose tissue to insulate the body
Older adults have less adipose tissue, so their temperature changes more easily, and hypothermia raises the risk of infection, bleeding and dysrhythmias. A higher metabolic rate than younger adults is incorrect, because metabolism slows with age. Thicker skin that releases heat quickly is incorrect, because skin thins and becomes fragile with age. More active sweat glands than younger adults is incorrect, because sweat gland activity declines with age.
Category: Older Adults
Question 13
A patient took a corticosteroid for several months earlier this year. Why does the nurse report this to the anesthesia provider before surgery?
The patient is at risk for adrenal crisis under surgical stress
✓
The patient is at risk for thyroid storm under anesthesia
The patient is at risk for diabetes insipidus after surgery
The patient is at risk for malignant hyperthermia
Correct Answer
The patient is at risk for adrenal crisis under surgical stress
Recent corticosteroid use can suppress the adrenal glands, so the body may not produce enough cortisol for the stress of surgery, and the team monitors for adrenal insufficiency. The patient is at risk for thyroid storm under anesthesia applies to poorly controlled hyperthyroidism, not steroid use. The patient is at risk for diabetes insipidus after surgery is a pituitary disorder unrelated to steroid use. The patient is at risk for malignant hyperthermia is an inherited reaction, not a steroid effect.
Category: Endocrine Risks
Question 14
Before surgery, a patient asks the nurse whether a spiritual leader can visit to pray with them. What should the nurse do?
Explain that visitors are not allowed in the preoperative area
Arrange the requested spiritual visit
✓
Suggest the patient wait until after surgery to pray
Record the request and take no further action
Correct Answer
Arrange the requested spiritual visit
Patient-centered preoperative care honors spiritual and cultural beliefs, and a request for prayer or a spiritual advisor is accommodated. Explaining that visitors are not allowed dismisses a reasonable request. Suggesting the patient wait until after surgery to pray ignores the need the patient has now. Recording the request and taking no further action documents the need without meeting it.
Category: Psychosocial and Cultural Care
Question 15
A patient with a stab wound is taken directly to emergency surgery. How does preoperative care change?
Preadmission testing is completed at a separate visit first
The patient receives written presurgical instructions to follow at home
Skin preparation is often done in the operating room to avoid delay
✓
The allergy history is skipped to save time
Correct Answer
Skin preparation is often done in the operating room to avoid delay
In an emergency there is little time, so the nurse gathers as much history as possible from the patient or family and skin preparation often happens in the operating room. Completing preadmission testing at a separate visit describes planned surgery. Sending written presurgical instructions home is not possible when surgery is immediate. Skipping the allergy history is incorrect; allergies and medications are still obtained to prevent complications.
Category: Emergency Surgery
Question 16
Why does the preoperative nurse report a patient's daily heavy alcohol use to the anesthesia provider?
Alcohol protects the patient from postoperative nausea
Alcohol use speeds wound healing after surgery
The patient will need no pain medication afterward
The patient may need larger amounts of anesthetic
✓
Correct Answer
The patient may need larger amounts of anesthetic
Heavy drinkers may need stronger or larger amounts of anesthesia, and alcohol use also raises the risk of bleeding, cardiac events, aspiration and withdrawal, so the care plan may change. Alcohol protects the patient from postoperative nausea is not a recognized effect. Alcohol use speeds wound healing after surgery is incorrect, because substance use impairs healing and immunity. The patient will need no pain medication afterward is incorrect and unsafe.
Category: Risk Factors
Question 17
Which instruction should the nurse give a patient who has antiembolism stockings applied before surgery?
Do not walk in the stockings without nonslip socks or shoes
✓
Roll the tops down if they feel tight
Leave any wrinkles, because they improve circulation
Remove them before walking to the restroom
Correct Answer
Do not walk in the stockings without nonslip socks or shoes
The stockings improve blood flow and lower clot risk, but the fabric is slippery, so the patient wears nonslip socks or shoes when walking. Rolling the tops down creates a band that restricts blood flow. Leaving wrinkles in place is incorrect, because wrinkles create pressure points and are smoothed out. Removing the stockings before walking to the restroom defeats their purpose of preventing clots.
Category: Preventing Complications
Question 18
The evening before planned abdominal surgery, a patient calls to say she feels sick and cannot finish the ordered bowel preparation. What should the nurse do?
Tell her she can stop because she has taken most of it
Notify the provider who ordered the preparation
✓
Advise her to skip the rest and fast instead
Tell her to double the remaining amount in the morning
Correct Answer
Notify the provider who ordered the preparation
Bowel preparation clears stool so the surgeon can see well and lowers infection risk if the bowel is accidentally entered, so a change to the ordered preparation is decided by the provider, not the nurse. Telling her she can stop because she has taken most of it alters the ordered preparation independently. Advising her to skip the rest and fast instead is also an independent change. Telling her to double the remaining amount in the morning is an unordered change that could worsen her symptoms.
Category: Bowel and Skin Preparation
Question 19
On the morning of surgery, a patient says they took their usual warfarin dose even though the surgeon's instructions said to stop it. What should the nurse do?
Proceed because a single dose has little effect
Give vitamin K and continue the preparation
Notify the surgeon before the procedure goes ahead
✓
Document the dose and continue the preparation
Correct Answer
Notify the surgeon before the procedure goes ahead
An anticoagulant taken against instructions raises bleeding risk, and the surgeon must decide whether to delay the procedure. Proceeding because a single dose has little effect assumes a safety that the nurse cannot judge alone. Giving vitamin K is a treatment that requires a prescriber's order. Documenting the dose and continuing the preparation records the problem without letting the surgeon act on it.
Category: Medication Safety
Question 20
During the preoperative interview, a patient says an uncle once developed a dangerously high fever and muscle rigidity during surgery. What should the nurse do?
Reassure the patient that the problem is not inherited
Apply a scopolamine patch to prevent the reaction
Record it as a drug allergy and take no other action
Report the family history to the anesthesia provider
✓
Correct Answer
Report the family history to the anesthesia provider
These details suggest malignant hyperthermia, an inherited reaction to certain anesthetic agents, so the anesthesia provider must know in order to plan precautions. Reassuring the patient that the problem is not inherited is incorrect, because susceptibility runs in families. Applying a scopolamine patch confuses a nausea measure with this reaction. Recording it as a drug allergy and taking no other action mislabels the problem and leaves the anesthesia provider unaware.
Category: Anesthesia Risks