# A 70-year-old postmenopausal woman with multiple comorbidities has been diagnosed with stage I endometrial cancer and is scheduled for a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO). Which nursing intervention is most important during the preoperative period?

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> subject: Adult Health

## 문제

A 70-year-old postmenopausal woman with multiple comorbidities has been diagnosed with stage I endometrial cancer and is scheduled for a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO). Which nursing intervention is most important during the preoperative period?

The patient expresses anxiety about the surgery and asks about potential complications and recovery expectations.

## 보기

1. Administer prescribed anxiolytic medication to reduce preoperative anxiety
2. Provide comprehensive preoperative education about the procedure, expected outcomes, and postoperative care **✔ 정답**
3. Encourage the patient to discuss her concerns with family members for emotional support
4. Schedule a consultation with the hospital chaplain for spiritual counseling

**정답: 2**

## 해설

Comprehensive preoperative education is most important as it reduces anxiety through knowledge and improves surgical outcomes. Other interventions like anxiolytics or spiritual counseling are supportive but do not address the core need for patient understanding.

## 심화 해설

Understanding the Preoperative Priority for a Patient with Endometrial Cancer

This question focuses on identifying the most important nursing intervention for a patient scheduled for a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO). While the patient is expressing anxiety, the core of her statement reveals a knowledge deficit: she is asking for specific information about potential complications and recovery expectations. In the NCLEX-RN framework, addressing a knowledge deficit through education is a higher priority than simply treating the emotional response of anxiety, because the anxiety is often a direct result of the unknown.

The correct answer is to provide comprehensive preoperative education. This intervention directly targets the root cause of the patient's distress. A structured, comprehensive nursing care approach, which includes detailed preoperative education, has been shown to improve outcomes by setting realistic expectations and enhancing a patient's ability to participate in their own recovery. A study on comprehensive nursing care for gynecological surgery patients demonstrated that such holistic perioperative strategies are effective in reducing complications and improving recovery outcomes [2]. By explaining the surgical procedure, the expected postoperative course, pain management strategies, and signs of potential complications, you empower the patient, which in turn reduces anxiety and improves adherence to the postoperative plan.

The other options are less of a priority because they do not first address the patient's direct request for information. Administering an anxiolytic (Option 1) is a pharmacological intervention that may temporarily reduce anxiety but does not resolve the underlying knowledge gap; it should not be the primary intervention before education is provided. Encouraging discussion with family (Option 3) or scheduling a chaplain consultation (Option 4) are valuable supportive measures that address emotional and spiritual coping, but they are secondary to the nurse's independent and primary responsibility to provide the information the patient is explicitly seeking. The concept of preoperative visualization and dynamic risk management has also been linked to reduced anxiety and improved physiological stability in ambulatory gynecological procedures, highlighting the critical role of preoperative mental preparation and education in surgical nursing care .References (research sources)

- [2]Effects of comprehensive nursing care on infection prevention and recovery outcomes in women undergoing gynecological surgery.Research articleQiu J, Liu Y, Zeng R, Wang Y. (2025) · DOI: 10.1097/md.0000000000045363

## 임상 시나리오

Preoperative Teaching for TAH-BSOAddressing Knowledge Deficit to Reduce Anxiety
When a patient expresses anxiety and asks specific questions about complications and recovery, the priority is to assess for and address the underlying knowledge deficit. Comprehensive education directly reduces fear of the unknown.

Key teaching points include the surgical procedure, expected postoperative course (e.g., pain management, activity restrictions), and signs of complications like infection or hemorrhage. Use clear, simple language and provide written materials.

CautionDo not administer anxiolytics before completing a thorough assessment and providing necessary education. Pharmacological management of anxiety is a secondary intervention if education and emotional support are insufficient.

## 핵심 개념

- **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, commonly performed for gynecologic cancers.
- **Preoperative Education** — Structured teaching provided before surgery covering the procedure, expected sensations, pain management, activity restrictions, and signs of complications to reduce anxiety and improve outcomes.
- **Knowledge Deficit** — A nursing diagnosis indicating a lack of cognitive information or psychomotor skills needed for health restoration, preservation, or promotion, which is a primary cause of anxiety in surgical patients.

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