CH 14 - Preoperative Nursing Management

A nurse in the preoperative holding area is admitting a woman prior to reduction mammoplasty. What should the nurse include in the care given to this client? Select all that apply. A. Establishing an IV line B. Verifying the surgical site with the client C. Taking measures to ensure the client's comfort D. Applying a grounding device to the client E. Preparing the medications to be given in the OR

A, B, C In the holding area, the nurse reviews charts, identifies clients, verifies surgical site per institutional policy, establishes IV lines, administers any prescribed medications, and takes measures to ensure each client's comfort. A grounding device is applied in the OR. A nurse in the preoperative holding area does not prepare medications to be given by anyone else.

The nurse in preadmission testing learns that a client scheduled for a total hip replacement in three weeks smokes one pack of cigarettes per day. Which action(s) should the nurse take? Select all that apply. A. Notify the surgeon that the client is a cigarette smoker. B. Encourage smoking cessation before surgery. C. Explain the increased risk for venous thromboembolism after surgery. D. Tell the client to stop smoking the day before surgery. E. Provide resources for smoking cessation

A, B, C, E Because clients who smoke, especially clients having a total joint replacement, are more likely to experience complications, the surgeon needs to be informed about the client's smoking history. The client needs to be encouraged to stop smoking, especially before surgery, to reduce the risk of postoperative complications such as venous thromboembolism and pneumonia. Because stopping smoking the day before surgery will have minimal positive effects on the surgery, the client should be encouraged to stop smoking as soon as possible. The nurse should provide the client with resources, such as written information and support groups, to support the client in smoking cessation.

The nurse is planning teaching for a client who is scheduled for an open hemicolectomy. The nurse intends to address the topics of incision splinting and leg exercises during this teaching session. When is the best time for the nurse to provide teaching? A. Upon the client's admission to the postanesthesia care unit (PACU) B. When the client returns from the PACU C. During the intraoperative period D. As soon as possible, and before the surgical procedure

D. As soon as possible, and before the surgical procedure Teaching is most effective when provided before surgery. Preoperative teaching is initiated as soon as possible, beginning in the health care provider's office, clinic, or at the time of preadmission testing when diagnostic tests are performed.

The nurse is creating the care plan for a 70-year-old obese client who has been admitted to the postsurgical unit following a colon resection. This client's age and body mass index increase the risk for what complication in the postoperative period? A. Hyperglycemia B. Azotemia C. Falls D. Infection

D. Infection Like age, obesity increases the risk and severity of complications associated with surgery. During surgery, fatty tissues are especially susceptible to infection. In addition, obesity increases technical and mechanical problems related to surgery. Therefore, dehiscence (wound separation) and wound infections are more common.

The PACU nurse is caring for a client who had minimally invasive knee surgery. Which actions are the responsibility of the nurse in the PACU? Select all that apply. A. Monitoring the safe recovery from anesthesia B. Answering family questions about recovery C. Ensuring that informed consent has been signed D. Providing light nourishment E. Assessing the operative site for hemorrhage

A, B, D, E After surgery, the client is taken to the PACU, where the PACU nurse monitors the client for safe recovery from surgery and anesthesia. The PACU nurse also explains the equipment (such as an IV or sequential compression devices) to the client and family and answers their questions. The nurse brings the client, who has had nothing by mouth for 8 to 10 hours, light nourishment and assesses the client's response to eating. The PACU nurse also assesses the client's postoperative site for hemorrhage. Ensuring informed consent is the role of the nurse in the preoperative area.

The nurse is planning the care of a client who has type 1 diabetes and who will be undergoing knee replacement surgery. This client's care plan should reflect an increased risk of what postsurgical complication(s)? Select all that apply. A. Hypoglycemia B. Delirium C. Acidosis D. Glucosuria E. Fluid overload

A, C, D Hypoglycemia may develop during anesthesia or postoperatively from inadequate carbohydrates or excessive administration of insulin. Other risks are acidosis and glucosuria. The risks of fluid overload and delirium are not normally increased.

The surgical nurse is preparing to send a client from the presurgical area to the OR and is reviewing the client's informed consent form. What are the criteria for legally valid informed consent? Select all that apply. A. Consent must be freely given. B. Consent must be notarized. C. Consent must be signed on the day of surgery. D. Consent must be obtained by a health care provider .E. Signature must be witnessed by a professional staff member.

A, D, E Valid consent must be freely given, without coercion. Consent must be obtained by a health care provider, and the client's signature must be witnessed by a professional staff member. It does not need to be signed on the same day as the surgery and it does not need to be notarized.

A clinic nurse is conducting a preoperative interview with an adult client who will soon be scheduled to undergo cardiac surgery. What interview question most directly addresses the client's safety? A. "What prescription and nonprescription medications do you currently take?" B. "Have you previously been admitted to the hospital, either for surgery or for medical treatment?" C. "How long do you expect to be at home recovering after your surgery?" D. "Would you say that you tend to eat a fairly healthy diet?"

A. "What prescription and nonprescription medications do you currently take?" It is imperative to know a preoperative client's current medication regimen, including OTC medications and supplements.

One of the things a nurse has taught to a client during preoperative teaching is to have nothing by mouth for a specified time before surgery. The client asks the nurse why this is important. What is the most appropriate response for the client? A. "You will need to have food and fluid restricted before surgery so you are not at risk for aspiration." B. "The restriction of food or fluid will prevent the development of pneumonia related to decreased lung capacity." C. "The presence of food in the stomach interferes with the absorption of anesthetic agents." D. "By withholding food for 8 hours before surgery, you will not develop constipation in the postoperative period."

A. "You will need to have food and fluid restricted before surgery so you are not at risk for aspiration."

The nurse in preadmission testing is educating a client about a scheduled surgery. Which response should the nurse give when the client asks about pain management following surgery? A. "Your nurse will use a pain assessment scale to help rate and treat your pain." B. "Wait to ask for pain medication until the pain becomes intolerable." C. "Lying still in bed will help control your pain. "D. "Don't worry—most clients do not have much pain from this surgery."

A. "Your nurse will use a pain assessment scale to help rate and treat your pain." A pain assessment scale helps the nurse assess and effectively control the client's pain in the postoperative period. The nurse uses this scale to determine the effectiveness of pain control measures. The client should be instructed to take pain medication as prescribed rather than waiting until the pain reaches an intolerable level. Taking the medication on a regular schedule is more effective at controlling pain. The client should be taught to take pain medication so that the client is able to change position, cough and deep breathe, and ambulate to prevent postoperative complications.

The nurse is providing preoperative teaching to a client scheduled for hip replacement surgery in 1 month. During the preoperative teaching, the client gives the nurse a list of medications the client takes, along with their dosage and frequency. What intervention provides the client with the most accurate information? A. Instruct the client to stop taking St. John's wort at least 2 weeks prior to surgery due to its interaction with anesthetic agents. B. Instruct the client to continue taking ephedrine prior to surgery due to its beneficial effect on blood pressure. C. Instruct the client to discontinue levothyroxine sodium due to its effect on blood coagulation and the potential for heart dysrhythmias. D. Instruct the client to continue any herbal supplements unless otherwise instructed, and inform the client that these supplements have a minimal effect on the surgical procedure.

A. Instruct the client to stop taking St. John's wort at least 2 weeks prior to surgery due to its interaction with anesthetic agents. Because of the potential effects of herbal medications on coagulation and potential lethal interactions with other medications, the nurse must ask surgical clients specifically about the use of these agents, document their use, and inform the surgical team and anesthesiologist, anesthetist, or nurse anesthetist. Currently, it is recommended that the use of herbal products be discontinued at least 2 weeks before surgery.

An OR nurse will be participating in the intraoperative phase of a client's kidney transplant. What action will the nurse prioritize in this aspect of nursing care? A. Monitoring the client's physiologic status B. Providing emotional support to family C. Maintaining the client's cognitive status D. Maintaining a clean environment

A. Monitoring the client's physiologic status During the intraoperative phase, the nurse is responsible for physiologic monitoring. The intraoperative nurse cannot support the family at this time and the nurse is not responsible for maintaining the client's cognitive status. The intraoperative nurse maintains an aseptic, not clean, environment.

The admitting nurse in a short-stay surgical unit is responsible for numerous aspects of care. What must the nurse verify before the client is taken to the preoperative holding area? A. That preoperative teaching was performed B. That the family is aware of the length of the surgery C. That follow-up home care is not necessary D. That the family understands the client will be discharged immediately after surgery.

A. That preoperative teaching was performed The nurse needs to be sure that the client and family understand that the client will first go to the preoperative holding area before going to the OR for the surgical procedure and then will spend some time in the PACU before being discharged home with the family later that day. Other preoperative teaching content should also be verified and reinforced, as needed. The nurse should ensure that any plans for follow-up home care are in place.

The nurse is performing a preadmission assessment of a client scheduled for a bilateral mastectomy. The nurse should recognize which purpose as a valid reason for preadmission assessment? A. Verifies completion of preoperative diagnostic testing B. Discusses and reviews client's financial status C. Determines the client's suitability as a surgical candidate D. Informs the client of need for postoperative transportation

A. Verifies completion of preoperative diagnostic testing One purpose of preadmission testing (PAT) is to verify completion of preoperative diagnostic testing. The nurse's role in PAT does not normally involve financial considerations or addressing transportation. The health care provider determines the client's suitability for surgery.

The nurse is preparing a client for surgery. The client reports being nervous and not really understanding the surgical procedure or its purpose. What is the most appropriate action for the nurse to take? A. Have the client sign the informed consent and place it in the chart. B. Call the health care provider to review the procedure with the client. C. Explain the procedure clearly to the client and the family. D. Provide the client with a pamphlet explaining the procedure.

B. Call the health care provider to review the procedure with the client. While the nurse may ask the client to sign the consent form and witness the signature, it is the surgeon's responsibility to provide a clear and simple explanation of what the surgery will entail prior to the client giving consent. The surgeon must also inform the client of the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts as well as what to expect in the early and late postoperative periods. The nurse clarifies the information provided, and, if the client requests additional information, the nurse notifies the health care provider.

The nurse is performing a preoperative assessment on a client going to surgery. The client reports to the nurse drinking approximately two bottles of wine each day for the last several years. What postoperative difficulties should the nurse anticipate for this client? A. Nonadherence to prescribed treatment after surgery B. Increased risk for postoperative complications C. Alcohol withdrawal syndrome upon administration of general anesthesia D. Increased risk for allergic reactions

B. Increased risk for postoperative complications Alcohol use increases the risk of complications. Withdrawal does not occur immediately upon administration of anesthesia. Alcohol does not increase the risk of allergies and is not necessarily a risk factor for nonadherence.

A nurse is providing preoperative teaching to a client who will soon undergo a cardiac bypass. The nurse's teaching plan includes exercises of the extremities. What is the purpose of teaching a client leg exercises prior to surgery? A. Leg exercises increase the client's muscle mass postoperatively. B. Leg exercises improve circulation and prevent venous thrombosis. C. Leg exercises help to prevent pressure sores to the sacrum and heels. D. Leg exercise help increase the client's level of consciousness after surgery

B. Leg exercises improve circulation and prevent venous thrombosis. When the client does leg exercises postoperatively, circulation is increased, which helps to prevent blood clots from forming. Exercise of the extremities includes extension and flexion of the knee and hip joints (similar to bicycle riding while lying on the side) unless contraindicated by type of surgical procedure (e.g., hip replacement).

During the care of a preoperative client, the nurse has given the client a preoperative benzodiazepine. The client is now requesting to void. What action should the nurse take? A. Assist the client to the bathroom. B. Offer the client a bedpan or urinal. C. Wait until the client gets to the operating room and is catheterized. D. Have the client go to the bathroom.

B. Offer the client a bedpan or urinal. If a preanesthetic medication is given, the client is kept in bed with the side rails raised because the medication can cause lightheadedness or drowsiness. If a client needs to void following administration of a sedative, the nurse should offer the client a bedpan. The client should not get out of bed because of the potential for lightheadedness.

A client is on call to the OR for an aortobifemoral bypass and the nurse administers the prescribed preoperative medication. After administering a preoperative medication to the client, what should the nurse do? A. Encourage light ambulation. B. Place the bed in a low position with the side rails up. C. Tell the client that the client will be asleep before it is time to leave for surgery. D. Take the client's vital signs every 15 minutes.

B. Place the bed in a low position with the side rails up. When the preoperative medication is given, the bed should be placed in low position with the side rails raised. The client should not get up without assistance. The client may not be asleep, but may be drowsy. Vital signs should be taken before the preoperative medication is given; vital signs are not normally required every 15 minutes after administration.

The nurse is caring for an unconscious trauma client who needs emergency surgery. The client has an adult child, is legally divorced, and is planning to marry a partner in a few weeks. The client's parents are at the hospital with the other family members. The health care provider has explained the need for surgery, the procedure to be done, and the risks to the child, the parents, and the partner. Who should be asked to sign the surgery consent form? A. The partner B. The child C. The health care provider, acting as a surrogate D. The client's father

B. The child In this instance, the child would be the appropriate person to ask to sign the consent form as the child is the closest relative at the hospital. The partner is not legally related to the client as the marriage has not yet taken place. The father would only be asked to sign the consent if no children were present to sign. The health care provider would not sign if family members were available.

The nurse is providing preoperative teaching to a client scheduled for surgery. The nurse is instructing the client on the use of deep breathing, coughing, and the use of incentive spirometry when the client states, "I don't know why you're focusing on my breathing. My surgery is on my hip, not my chest." What rationale for these instructions should the nurse provide? A. To prevent chronic obstructive pulmonary disease (COPD) B. To promote optimal lung expansion C. To enhance peripheral circulation D. To prevent pneumothorax

B. To promote optimal lung expansion One goal of preoperative nursing care is to teach the client how to promote optimal lung expansion and consequent blood oxygenation after anesthesia. COPD is not a realistic risk and pneumothorax is also unlikely. Breathing exercises do not primarily affect peripheral circulation.

A client's coronary artery bypass graft has been successful, and discharge planning is underway. When planning the client's subsequent care, the nurse should know that the postoperative phase of perioperative nursing ends at what time? A. When the client is returned to the room after surgery B. When a follow-up evaluation in the clinical or home setting is done C. When the client is fully recovered from all effects of the surgery D. When the family becomes partly responsible for the client's care

B. When a follow-up evaluation in the clinical or home setting is done The postoperative phase begins with the admission of the client to the PACU and ends with a follow-up evaluation in the clinical setting or home.

The nurse is preparing a client for surgery prior to her hysterectomy without oophorectomy. The nurse is witnessing the client's signature on a consent form. Which comment by the client would best indicate informed consent? A. "I know I'll be fine because the health care provider has done this procedure hundreds of times." B. "I know I'll have pain after the surgery but they'll do their best to keep it to a minimum." C. "The health care provider is going to remove my uterus and told me about the risk of bleeding." D. "Because the health care provider isn't taking my ovaries, I'll still be able to have children."

C. "The health care provider is going to remove my uterus and told me about the risk of bleeding."

The nurse is caring for a client who is admitted to the ER with the diagnosis of acute appendicitis. The nurse notes during the assessment that the client's ribs and xiphoid process are prominent. The client reports exercising two to three times daily, and the client's parent indicates that the client is being treated for anorexia nervosa. How should the nurse best follow up on these assessment data? A. Inform the postoperative team about the client's risk for wound dehiscence. B. Evaluate the client's ability to manage pain level. C. Facilitate a detailed analysis of the client's electrolyte levels. D. Instruct the client on the need for a high-sodium diet to promote healing.

C. Facilitate a detailed analysis of the client's electrolyte levels. The surgical team should be informed of the client's medical history regarding anorexia nervosa. Any nutritional deficiency, such as malnutrition, should be corrected before surgery to provide adequate protein for tissue repair. The electrolyte levels should be evaluated and corrected to prevent metabolic abnormalities in the operative and postoperative phases. The risk of wound dehiscence is more likely associated with obesity. Instruction on proper nutrition should take place in the postoperative period, and a consultation should be made with a psychiatric specialist. Evaluation of pain management is always important, but not particularly significant in this scenario.

The clinic nurse is doing a preoperative assessment of a client who will be undergoing outpatient cataract surgery with lens implantation in 1 week. While taking the client's medical history, the nurse notes that this client had a kidney transplant 8 years ago and that the client is taking immunosuppressive drugs. For what is this client at increased risk when having surgery? A. Rejection of the kidney B. Rejection of the implanted lens C. Infection D. Adrenal storm

C. Infection Because clients who are immunosuppressed are highly susceptible to infection, great care is taken to ensure strict asepsis. The client is unlikely to experience rejection or adrenal storm.

A client is scheduled for a bowel resection in the morning and the client's orders are for a cleansing enema be administered tonight. The client wants to know why this is necessary. The nurse should explain that the cleansing enema will have what therapeutic effect? A. Preventing aspiration of gastric contents B. Preventing the accumulation of abdominal gas postoperatively C. Preventing potential contamination of the peritoneum D. Facilitating better absorption of medications

C. Preventing potential contamination of the peritoneum The administration of a cleansing enema will allow for satisfactory visualization of the surgical site and to prevent trauma to the intestine or contamination of the peritoneum by feces.

The ED nurse is caring for an 11-year-old brought in by ambulance after having been hit by a car. The child's parents are thought to be en route to the hospital but have not yet arrived. No other family members are present, and attempts to contact the parents have been unsuccessful. The child needs emergency surgery to survive. How should the need for informed consent be addressed? A. A social worker should temporarily sign the informed consent. B. Consent should be obtained from the hospital's ethics committee. C. Surgery should be done without informed consent. D. Surgery should be delayed until the parents arrive.

C. Surgery should be done without informed consent. In an emergency, it may be necessary for the surgeon to operate as a lifesaving measure without the client's informed consent. However, every effort must be made to contact the client's family. In such a situation, contact can be made by electronic means. In this scenario, the surgery is considered lifesaving, and the parents are on their way to the hospital and not available. A delay would be unacceptable. Neither a social worker nor a member of the ethics committee may sign.

The nurse is checking the informed consent for an older adult client who requires surgery and who has recently been diagnosed with Alzheimer disease. When obtaining informed consent, who is legally responsible for signing? A. The client's next of kin B. The client's spouse C. The client D. The surgeon

C. The client Just because a client has been diagnosed with Alzheimer disease does not mean that the client is not competent to provide informed consent, although many Alzheimer clients are ultimately declared to be legally incompetent. Because there is no evidence that this client is legally incompetent, the client would be required to personally provide informed consent.

In anticipation of a client's scheduled surgery, the nurse is teaching the client to perform deep breathing and coughing to use postoperatively. What action should the nurse teach the client? A. The client should take three deep breaths and cough hard three times, at least every 15 minutes for the immediate postoperative period. B. The client should take three deep breaths and exhale forcefully and then take a quick short breath and cough from deep in the lungs. C. The client should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs. D. The client should rapidly inhale, hold for 30 seconds or as long as possible, and exhale slowly.

C. The client should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs. The client assumes a sitting position to enhance lung expansion. The nurse then demonstrates how to take a deep, slow breath and exhale slowly. After the client practices deep breathing several times, the nurse instructs the client to breathe deeply, exhale through the mouth, take a short breath, and cough from deep in the lungs.

The nurse in the preoperative area places a warmed blanket on a client. Which reason does the nurse give the client for this action? A. Hypothermia assists in the induction of anesthesia. B. Warming reduces the risk of postoperative infection. C. The risk of bleeding is increased with hypothermia. D. The length of hospital stay is increased with warming.

C. The risk of bleeding is increased with hypothermia. The nurse places a warmed blanket on the client to reduce adverse effects of unintentional hypothermia, such as increased risk of bleeding.

The nurse is caring for a client who anticipates pain and anxiety following surgery. Which intervention should the nurse implement in the postoperative period to reduce the client's pain and anxiety? A. Administer NSAIDs for mild-to-moderate pain. B. Encourage the client to increase activity. C. Use guided imagery along with pain medication. D. Teach deep breathing and coughing exercises.

C. Use guided imagery along with pain medication. The use of guided imagery will enhance pain relief and assist in reduction of anxiety. The use of NSAIDs is appropriate for controlling mild-to-moderate pain, but will not reduce anxiety.

The nurse is caring for a trauma victim in the ED who will require emergency surgery due to injuries. Before the client leaves the ED for the OR, the client goes into cardiac arrest. The nurse assists in a successful resuscitation and proceeds to release the client to the OR staff. When can the ED nurse perform the preoperative assessment? A. When the nurse has the opportunity to review the client's electronic health record B. When the client arrives in the OR C. When assisting with the resuscitation D. Preoperative assessment is not necessary in this case

C. When assisting with the resuscitation The only opportunity for preoperative assessment may take place at the same time as resuscitation in the ED. Preoperative assessment is necessary, but the nurse could not normally enter the OR to perform this assessment. The health record is an inadequate data source.

A client is admitted to the ED reporting severe abdominal pain and vomiting "coffee-ground" like emesis. The client is diagnosed with a perforated gastric ulcer and is informed that they need surgery. When can the client most likely anticipate that the surgery will be scheduled? A. Within 24 hours B. Within the next week C. Without delay D. As soon as all the day's elective surgeries have been completed

C. Without delay Emergency surgeries are unplanned and occur with little time for preparation for the client or the perioperative team. An active bleed, which is indicated by the "coffee-ground" emesis, is considered an emergency, and the client requires immediate attention because the disorder may be life threatening. The surgery would not likely be deferred until after elective surgeries have been completed.

The nurse is caring for a hospice client who is scheduled for a surgical procedure to reduce the size of a spinal tumor in an effort to relieve pain. The nurse should plan this client care with the knowledge that this surgical procedure is classified as which of the following? A. Diagnostic B. Laparoscopic C. Curative D. Palliative

D. Palliative A client on hospice will undergo a surgical procedure only for palliative care, which means to reduce pain or provide comfort, not to cure disease (curative). The reduction of tumor size to relieve pain is considered a palliative procedure. A laparoscopic procedure is a type of surgery that is utilized for diagnostic purposes or for repair. Diagnostic procedures are performed to help diagnose a condition. The excision of a tumor is classified as curative. This client is not having the tumor removed, only the size reduced.

A 90-year-old client is scheduled to undergo surgery. Prevention of which potential complication should the nurse prioritize when planning this client's postoperative care? A. Reduced concentration related to stress B. Delayed growth and development due to a prolonged hospitalization C. Decision conflict related to discharge planning D. Pneumonia due to reduced respiratory reserve

D. Pneumonia due to reduced respiratory reserve The reduced physiologic reserve of older adults results in an increased risk for pneumonia postoperatively. This physiologic consideration is a priority over psychosocial considerations of impaired growth and development and decisional conflict, which may or may not be applicable. Reduced concentration should also be addressed, but the priority is first to assure adequate pulmonary function.

The nurse is doing preoperative client education with a client who has a 40 pack-year history of cigarette smoking. The client will undergo an elective bunionectomy at a time that fits his work schedule in a few months. What would be the best instruction to give to this client? A. Reduce smoking by 50% to prevent the development of pneumonia. B. Continue smoking so as to help manage stress levels before and after surgery. C. Aim to quit smoking in the postoperative period to reduce the chance of surgical complications. D. Stop smoking as soon as possible before the scheduled surgery to enhance pulmonary function and decrease infection.

D. Stop smoking as soon as possible before the scheduled surgery to enhance pulmonary function and decrease infection. Stopping smoking before the surgery will enhance pulmonary function and reduce the risk of infection in the postoperative period. Merely reducing smoking by 50% would not be as effective as stopping, nor would waiting until after the surgery to stop smoking. Although smoking may help the client manage stress, the pulmonary function and infection risks that it poses far outweigh any benefit it may offer related to stress reduction.

The nurse is admitting a client who is insulin dependent to the same-day surgical suite for carpal tunnel surgery. How should this client's diagnosis of type 1 diabetes affect the care that the nurse plans? A. The nurse should administer a bolus of dextrose IV solution preoperatively. B. The nurse should keep the client NPO for at least 8 hours preoperatively. C. The nurse should initiate a subcutaneous infusion of long-acting insulin. D. The nurse should assess the client's blood glucose levels frequently.

D. The nurse should assess the client's blood glucose levels frequently. The client with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia. Close glycemic monitoring is necessary. Dextrose infusion and prolonged NPO status are contraindicated. There is no specific need for an insulin infusion preoperatively.