Perioperative Nursing

Why C is the answer

This order is reversed: the airway comes first. After a total laryngectomy, the removal of the voice box, the client breathes only through the stoma, the opening in the neck. Mucus and blood can block it, so clearing it comes before communication, nutrition and body image.

Why the other options are not the answer

• A — "Offering a writing board comes after suctioning the stoma": This order is correct. A writing board is important because the client can no longer speak, but an open airway comes before any way to communicate.
• B — "Humidifying inspired air comes before starting tube feedings": This order is correct. Moist air keeps secretions thin and the stoma open; feedings begin once breathing is stable.
• D — "Discussing voice restoration comes after checking oxygen saturation": This order is correct. Oxygen saturation shows whether the airway is working; voice restoration is planned later.

Why D is correct

A pneumonectomy removes the most lung tissue: it takes the whole lung on that side, so nothing of it is left behind.

These four names go in order from the least lung removed to the most. The ending -ectomy says tissue is removed; the front of the word says how much. A wedge resection removes a small piece of one lobe, one of the large sections of a lung. A segmentectomy removes one segment, a division inside a lobe. A lobectomy takes a whole lobe, and a pneumonectomy takes the whole lung.

Why the other options are wrong

• A — "A wedge resection": Only a small piece of a lobe is taken, with a margin of normal tissue around the lesion.
• B — "A segmentectomy": One bronchopulmonary segment, a division of a lobe, is removed with its own airway and vessels. It stays inside a single lobe.
• C — "A lobectomy": A lobe is only part of that side's lung. Taking a whole lobe is standard practice for a tumor confined to one lobe, but a pneumonectomy takes every lobe on that side.

Why D is correct

Steam suits heat- and moisture-stable items. No residue is left behind, so the tray returns to use at once. Ethylene oxide needs hours of aeration first.

Why the other options are wrong

• A — "Steam kills the spores that the low-temperature gas methods leave behind": Steam is sporicidal, but the low-temperature sterilants kill spores too.
• B — "Steam is gentler on the metal, so cutting edges stay sharp longer": Repeated cycles do not preserve an edge; wear does not pick the method.
• C — "Steam removes the protein soil that cleaning may have left behind": Steam is not a cleaning step; soil must be gone before packing.

Why D is correct

He understood that the papers for the land sale should wait until tomorrow. Legal papers and money decisions wait a full day after general anesthesia.

The anesthetic's effects can last about a day. His judgment and reaction time may stay dulled even after he feels clear. The whole of the first day at home is built around that.

Why the other options are wrong

• A — "'I will take my usual sleeping tablet tonight so I rest well.'": a sleeping tablet the same night adds to the anesthetic still in his system and deepens the drowsiness.
• B — "'I can have one bottle of beer with my supper later.'": alcohol is avoided for the first twenty-four hours for the same reason.
• C — "'I can look after my two-year-old by myself this afternoon.'": a small child needs an adult whose reaction time is normal, and his may not be until tomorrow. Wanting to take his turn at home is reasonable, but a two-year-old should not be left alone with him today.

Why D is correct

A ruptured appendix with an abscess is dirty or infected, not contaminated: the organisms were there before the incision.

Clean wounds enter no hollow tract (breathing, digestive, genital or urinary). Clean-contaminated wounds enter one under control. Contaminated wounds are a fresh open injury, a spill, or an incision through inflamed tissue without pus. Dirty wounds have infection already present or a perforated (burst) organ.

Why the other options are wrong

• A — "A stab wound to the abdomen explored within the hour": An open, fresh, accidental wound is contaminated.
• B — "A laparotomy in which bowel content spills into the abdomen": A large spill of bowel content (gross spillage) is contaminated, not yet infected.
• C — "An incision made through inflamed but uninfected tissue": An incision through inflamed tissue that is not infected is contaminated. Acute inflammation is an important finding, but the dirty class needs infection already present or a perforated organ.