Older adults often have reduced vital capacity as a result of normal physiologic changes. Which nursing intervention would be most important for the postoperative care of an older surgical patient specific to this change?

Take and record vital signs every shift.

Turn, cough, and deep breathe every 4 hours.

Encourage increased intake of oral fluids.

Assess bowel sounds daily.

Answer and Explanation

The Correct Answer is B

Normal aging decreases lung elasticity, chest wall compliance, and vital capacity. These changes make older adults more prone to hypoventilation, atelectasis, and respiratory infections after anesthesia. Nursing care must focus on pulmonary hygiene: turning, coughing, deep breathing, and using incentive spirometry.

Rationale for correct answer:

2. Turn, cough, and deep breathe every 4 hours: Reduced vital capacity in older adults increases the risk of atelectasis and pneumonia postoperatively. Encouraging frequent deep breathing and coughing expands alveoli, promotes secretion clearance, and improves oxygenation.

Rationale for incorrect answers:

1. Take and record vital signs every shift: Vital signs help monitor overall stability but do not directly address the physiologic change of reduced vital capacity.

3. Encourage increased intake of oral fluids: Fluids are important for hydration and mucous membrane health, but they don’t directly improve vital capacity.

4. Assess bowel sounds daily: Monitoring bowel function is important after surgery, but it does not address the pulmonary risks related to decreased lung function.

Take home points:

Older adults have decreased lung reserve, making pulmonary complications more likely after surgery.
Frequent pulmonary exercises (turn, cough, deep breathe, incentive spirometry) are the most effective interventions to prevent atelectasis and pneumonia.

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Correct Answer is B

Explanation

Preoperative anxiety is common; patients need empathy and a safe space to express fears. The nurse’s best immediate response acknowledges the feeling and opens a conversation so underlying concerns (fear of death, anesthesia, pain, loss of control) can be explored, corrected, and managed. Therapeutic communication (open-ended invitation, active listening) improves trust.

Rationale for correct answer:

2. “Let’s talk about how you are feeling.” Invites the patient to express concerns, shows empathy, and lets the nurse assess the intensity and content of the fear.

Rationale for incorrect answers:

1. “You have a wonderful doctor.” Diverts attention from the patient’s feelings and gives a vague reassurance rather than exploring fear.

3. “Everyone wakes up from surgery!” False reassurance; minimizes the patient’s worry and may undermine trust.

4. “Don’t worry, you will be just fine.” Dismissive; it shuts down emotional expression instead of addressing it.

Take home points:

Use open-ended, empathetic statements that invite expression rather than offering premature reassurance.
Exploring fears lets you assess need for teaching, more explanation from anesthesia, or anxiolytic interventions-don’t dismiss or minimize.

A. Stiffened lung tissue B. Reduced diaphragmatic excursion C. Increased laryngeal reflexes D. Reduced blood flow to kidneys E. Increased cholinergic transmission

Correct Answer is ["A","B","D"]

Explanation

Older adults have predictable physiologic changes (pulmonary stiffness, reduced diaphragmatic movement, diminished airway reflexes, decreased renal perfusion, altered pharmacodynamics) that lower physiologic reserve and increase vulnerability to anesthesia and surgical stress.

Rationale for correct answers:

1. Stiffened lung tissue: Aging causes decreased lung elasticity and increased chest-wall stiffness, reducing pulmonary compliance and reserve. This increases the risk of hypoventilation, atelectasis, and postoperative pulmonary complications.

2. Reduced diaphragmatic excursion: Older adults often have weaker respiratory muscles and reduced chest-wall mobility, which limits diaphragmatic movement. This promotes shallow breathing and inability to clear secretions effectively.

4. Reduced blood flow to kidneys: Renal blood flow and glomerular filtration decline with age. Reduced renal perfusion decreases drug clearance and increases susceptibility to renal injury and fluid/electrolyte imbalances during and after surgery.

Rationale for incorrect answers:

3. Increased laryngeal reflexes: Aging typically reduces protective airway reflexes (gag/cough), which increases risk of aspiration.

5. Increased cholinergic transmission: Normal aging is associated with a decline in cholinergic neurons/transmission; increased cholinergic activity is not typical and would not explain common geriatric perioperative risks.

Take home points:

Anticipate respiratory and renal vulnerabilities in elderly surgical patients.
Many protective reflexes and neurotransmitter activities decline with age.

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Older adults often have reduced vital capacity as a result of normal physiologic changes. Which nursing intervention would be most important for the postoperative care of an older surgical patient specific to this change?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Mr. Ying is scheduled for surgery. He says to the nurse, “I am so frightened-what if I don’t wake up?” What would be the best response?

Correct Answer is B

Explanation

An 85-year-old patient returns to the inpatient surgical unit after leaving the PACU. Which of the following place the patient at risk during surgery? Select all that apply

Correct Answer is ["A","B","D"]

Explanation

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