# A 62-year-old postmenopausal woman is scheduled for a total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer. Which preoperative nursing intervention is most important for this patient? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540702 > language: ko > subject: Adult Health ## 문제 A 62-year-old postmenopausal woman is scheduled for a total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer. Which preoperative nursing intervention is most important for this patient? ## 보기 1. Administer prescribed anxiolytic medication to reduce preoperative anxiety 2. Provide detailed information about all possible surgical complications 3. Encourage the patient to discuss her concerns with family members 4. Assess the patient's understanding of the procedure and provide appropriate education **✔ 정답** **정답: 4** ## 해설 Assessing the patient's understanding and providing education is the priority preoperative intervention to ensure informed consent and reduce anxiety. Other options like administering anxiolytics or discussing complications are less comprehensive. ## 심화 해설 Understanding the Priority For a patient scheduled for major gynecologic cancer surgery, the most important preoperative nursing intervention is to first establish her baseline knowledge and emotional state. The nursing process dictates that assessment precedes intervention. Before you can administer medication, provide detailed complication lists, or facilitate family discussions, you must determine what the patient already understands and what specific fears or knowledge gaps she has. This is the foundation of patient-centered care and informed consent. Why Not the Other Options? - Administering an anxiolytic is a dependent nursing intervention that requires a prescription and is not the first-line nursing action. It addresses a symptom of anxiety without first assessing its root cause, which could be related to a knowledge deficit, fear of pain, or concerns about cancer. Nonpharmacological strategies should be considered first, and medication is only appropriate after a thorough assessment. - Providing detailed information about all possible surgical complications is not a nursing responsibility in isolation; this is a key component of the surgeon's informed consent process. Bombarding a patient with a list of all possible complications without context can dramatically increase anxiety and is not tailored to her individual learning needs or readiness. - Encouraging the patient to discuss concerns with family can be a supportive measure, but it is not the priority. The patient's own understanding and direct communication with the healthcare team are paramount. She may have concerns she is not ready to share with family, and her autonomy in decision-making must be respected first. The Pathophysiology of Preoperative Distress and the Nursing Role A total abdominal hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer carries a dual psychological burden: the loss of reproductive organs and a cancer diagnosis. This triggers a well-documented perioperative stress response. As highlighted in a meta-analysis by Wang et al., perioperative stress initiates a "vicious cycle of negative psychological emotions and adverse physiological stress responses" [1]. Unaddressed anxiety and depression can manifest physiologically, leading to elevated blood pressure and heart rate, which can complicate intraoperative and postoperative recovery [1]. By assessing the patient's understanding first, the nurse can identify specific misconceptions or fears that are driving this stress response. For instance, a patient might incorrectly believe the surgery will immediately cure her cancer or, conversely, that it has already metastasized widely. The nurse’s targeted education directly disrupts this cycle at its cognitive origin, which is a powerful nonpharmacological intervention. Connecting Assessment to Postoperative Risk Reduction A thorough preoperative assessment that reveals a patient's knowledge deficits and anxieties has direct implications for preventing postoperative complications. A systematic review and meta-analysis by Lee et al. identified that patient-related factors are critical in the development of new persistent opioid use (NPOU) after surgery . A patient who has unexpressed, catastrophic fears about postoperative pain may be at higher risk for developing NPOU. Through assessment and education, the nurse can correct these misconceptions, set realistic expectations for pain management, and discuss a multimodal analgesia plan, thereby addressing a modifiable risk factor before surgery even begins . Similarly, while the meta-analysis by Zhou et al. focused on prolapse surgery, it underscores that identifying risk factors for complications like postoperative urinary retention (POUR) is a key perioperative nursing responsibility . Assessing a patient's baseline understanding allows the nurse to provide anticipatory guidance about normal postoperative expectations, such as the possibility of a urinary catheter and the sensation of bladder fullness, which can reduce anxiety when these events occur. The Evidence for Nurse-Led Psychological Assessment and Support The critical role of nurse-led psychological intervention is supported by a randomized controlled trial by Xiang et al., which studied patients undergoing total hysterectomy . The study found that a structured psychological nursing intervention, based on assessing and leveraging patient expectations (the Rosenthal effect), significantly improved psychological state, self-efficacy, and quality of life . The intervention's success was predicated on the nurse's initial ability to assess the patient's self-perceived burden and psychological distress. This reinforces that the nursing action of "assessing understanding and providing appropriate education" is not merely an informational task but a therapeutic one that directly combats the psychological distress that impairs recovery. The nurse's assessment is the gateway to providing the tailored, supportive education that builds self-efficacy and forms the core of effective preoperative care .References (research sources) - [1]Effectiveness of Virtual Reality Interventions on Perioperative Anxiety, Depression, Blood Pressure, and Heart Rate: Systematic Review and Meta-Analysis of Randomized Controlled Trials.Meta-analysis/systematic reviewWang S, Yan H, Yang Z, Liu Y, Zhang T, Tang Y, Luo Y. (2026) · DOI: 10.2196/81799 ## 임상 시나리오 Preoperative Nursing Priorities for Major Gynecologic SurgeryAssessment and Education as the Foundation of Care The nursing process mandates that assessment precedes all interventions. For a patient undergoing a total abdominal hysterectomy, the priority is to first evaluate her baseline understanding of the procedure, its purpose, and the expected recovery. This identifies knowledge gaps and specific fears, which can then guide tailored education. The nurse's role in the informed consent process is to verify that the patient comprehends the information provided by the surgeon, not to independently explain all surgical risks. Effective preoperative education should be individualized, addressing the patient's immediate concerns and readiness to learn, rather than providing a generic list of complications. NoteAdministering an anxiolytic without a prior assessment is a task-focused, not patient-centered, approach. Non-pharmacological anxiety reduction, such as clarifying misconceptions, should be attempted first. Medication is a dependent intervention that requires a provider's order after a thorough nursing assessment. ## 핵심 개념 - **Nursing Process** — A systematic, patient-centered framework involving assessment, diagnosis, planning, implementation, and evaluation (ADPIE), where assessment is always the first step. - **Informed Consent** — A legal and ethical process where the provider explains the procedure, risks, benefits, and alternatives; the nurse's role is to witness the signature and verify patient comprehension. - **Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO)** — Surgical removal of the uterus, cervix, both fallopian tubes, and both ovaries through an abdominal incision, often performed for gynecologic cancers. - **Preoperative Anxiety** — A common emotional response before surgery that can stem from fear of pain, loss of control, or knowledge deficits, and is best managed initially through assessment and education. ## 같은 주제 문제 - [A 58-year-old postmenopausal woman presents to the clinic with a 3-month history of irregu…](https://mymerci.kr/pages/nclex_q.php?qn_id=540699) - [A 62-year-old postmenopausal woman presents to the clinic with a 2-month history of postco…](https://mymerci.kr/pages/nclex_q.php?qn_id=540700) - [A 58-year-old postmenopausal woman presents to the gynecology clinic with a 3-month histor…](https://mymerci.kr/pages/nclex_q.php?qn_id=540701) - [A 55-year-old postmenopausal woman diagnosed with stage II endometrial cancer is scheduled…](https://mymerci.kr/pages/nclex_q.php?qn_id=540703) - [A 58-year-old postmenopausal woman is scheduled for a total abdominal hysterectomy with bi…](https://mymerci.kr/pages/nclex_q.php?qn_id=540704) - [A 70-year-old postmenopausal woman with multiple comorbidities has been diagnosed with sta…](https://mymerci.kr/pages/nclex_q.php?qn_id=540705) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._