Ch. 40 Preoperative nursing

Which of the following statements, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction?

"I can have a hamburger and French fries as soon as I wake up."

A physician has ordered a nurse to administer conscious sedation to a client. Which of the following is possible after administering conscious sedation to a client?

Client is relaxed, emotionally comfortable, and conscious.

A nurse is providing ongoing postoperative care to a client who has had knee surgery. The nurse assesses the dressing and finds it saturated with blood. The client is restless and has a rapid pulse. What should the nurse do next?

Apply a pressure dressing and report findings.

A nurse is educating a preoperative client on how to cough effectively. What can the nurse tell the client to do to facilitate coughing

"Hold a pillow or folded bath blanket over the incision."

In order to prevent the possibility of venous stasis, a nurse is teaching a surgical client how to perform leg exercises. Which of the client's following statements indicates a sound understanding of leg exercises?

"I'll practice these now and try to start them as soon as I can after my surgery."

Ask the client to hold his or her breath for three to five seconds and mentally count "one, one thousand, two, one thousand" and so forth.

"Let's talk about how you are feeling."

A client has arrived in the same‐day surgery suite. He states to the nurse, "I am so worried about being put to sleep and having the surgery." What would be the nurse's best response?

"Tell me what you are most worried about."

A nurse is educating a surgical client on postoperative p.r.n. pain control. Which of the following should be included?

"You need to ask for the medication before the pain becomes severe."

A nurse working in a PACU is responsible for conducting assessments on immediate postoperative clients. What is the purpose of these assessments?

. To prevent complications from anesthesia and surgery

A nurse is teaching a man scheduled to have same-day surgery. Which teaching method would be most effective in preoperative teaching for ambulatory surgery?

. Written instructions

A nurse has been asked to witness a patient signature on an informed consent form for surgery. For which of these patients would the document be valid? Select all that apply.

A 45-year-old patient who is oriented and alert A 22-year old patient having an abortion against her partner's wishes

The operating room nurse is aware that which of the following clients is at a greater risk related to a surgical procedure?

A woman 83 years of age Ans: D Infants and older adults are at a greater risk from surgery than are children and young or middle‐age adults. Physiologic changes associated with aging increase the surgical risk for older clients.

Which of the following clients most likely requires special pre‐operative assessment and treatment as a result of his or her existing medication regimen?

A woman who takes daily anticoagulants to treat atrial fibrillation

A client with abdominal incisions experiences excruciating pain when he tries to cough. What should the nurse do to reduce the client's discomfort when coughing?

Administer prescribed pain medication 30 minutes before deliberately attempting to cough.

Which of the following nursing interventions occurs in the postoperative phase of the surgical experience?

Airway/oxygen therapy/pulse oximetry

A nurse is preparing to receive a client in post‐anesthesia care unit (PACU). The client is diabetic and has undergone knee surgery. Which information would be most important for the receiving nurse to obtain to develop an appropriate plan of care for this client?

Amount of blood loss Feedback: To plan care effectively in the postoperative period, the nurse needs to know about the amount of blood lost during the surgery, the type of surgery that was performed on the client, and whether there were any surgical or anesthetic complications. Information on chronic disease history and allergy history are done in the pre‐operative period, not in the postoperative period. Information on the environment in the operation room is checked by the circulatory nurse during the intra‐ operative care plan; it is not associated with the postoperative care plan

Upon admission for an appendectomy, the client provides the nurse with a document that specifies instructions his health care team should follow in the event he is unable to communicate these wishes postoperatively. What is the document best known as?

An advance directive

A nurse is assisting a postoperative client with deep-breathing exercises. Which of the following is an accurate step for this procedure?

Ask the client to hold his or her breath for three to five seconds and mentally count "one, one thousand, two, one thousand" and so forth.

Which of the following interventions are recommended guidelines for meeting client postoperative elimination needs?

Assess for the return of peristalsis by auscultating bowel sounds every four hours when the client is awake.

A client returning to the floor after orthopedic surgery is complaining of nausea. The nurse is aware that an appropriate intervention is to do which of the following?

Avoid strong smelling foods.

The nurse is providing education to a client regarding pain control after surgery. What time does the nurse inform the client is the best time to request pain medication?

Before the pain becomes severe

A nurse is taking care of a client during the immediate post-operative period. Which of the following duties performed during the immediate post-operative period is most important?

Monitor the client for complications.

The telemetry unit nurse is reviewing laboratory results for a client who is scheduled for an operative procedure later in the day. The nurse notes on the laboratory report that the client has a serum potassium level of 6.5 mEq/L, indicative of hyperkalemia. The nurse informs the physician of this laboratory result because the nurse recognizes hyperkalemia increases the client's operative risk for which of the following?

Cardiac problems

A nurse is caring for a client who is scheduled to undergo a breast biopsy. Which of the following major tasks does the nurse perform immediately during the pre-operative period?

Conduct a nursing assessment.

The nurse is preparing a patient for a colonoscopy. The nurse is familiar with the colonoscopy procedures at the hospital and is aware that which type of anesthesia is commonly used for this procedure?

Conscious sedation

A pediatric nurse is preparing a child for cleft palate repair surgery. The nurse recognizes that this type of surgery is categorized as which of the following?

Constructive surgery

After conducting a preoperative health assessment, the nurse documents that the client has physical assessments supporting the medical diagnosis of emphysema. Based on this finding, what postoperative interventions would be included on the plan of care?

D. Monitor respirations and breath sounds.

A nurse is reinforcing wound edges and applying a blinder to the separated incisions of a client after a surgery. Which of the following postoperative complications has the client developed?

Dehiscence

A female client is scheduled for liposuction surgery to reduce her weight. Based on urgency, how is this surgery classified?

Elective

Which of the following interventions is of major importance during preoperative education?

Encouraging the client to identify and verbalize fears

A nurse is caring for an obese patient who has had surgery. The nurse monitors this patient for what postoperative complication?

Impaired wound healing

The nurse is preparing to send a client to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent for the procedure on the client's chart. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the client. What is the nurse's best action to the physician's request?

Inform the physician that it is his or her responsibility to obtain the signature.

A nurse is assisting a physician during a cesarean section for a client. The client is administered epidural anesthesia. Which of the following is an advantage of epidural anesthesia?

It decreases the risk of gastrointestinal complications.

A student is assessing a postoperative client who has developed pneumonia. The plan of care includes positioning the client in the Fowler's or semi-Fowler's position. What is the rationale for this position?

It promotes full aeration of the lungs.

A scrub nurse is assisting a surgeon with a kidney transplant. What are the patient responsibilities of this surgical team member? Select all that apply.

Maintaining sterile technique Draping and handling instruments and supplies

A perioperative nurse is preparing a patient for surgery for treatment of a ruptured spleen as the result of an automobile crash. The nurse knows that this type of surgery belongs in what category?

Major, emergency Feedback: This surgery would involve a major body organ, has the potential for postoperative complications, requires hospitalization, and must be done immediately to save the patient's life. Elective surgery is a procedure that is preplanned by essentially healthy people. Diagnostic surgery is performed to confirm a diagnosis. Palliative surgery is not curative, rather it is done to relieve or reduce the intensity of an illness.

In the postoperative phase of abdominal surgery, the client complains of severe abdominal pain. In the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect?

Paralytic ileus

A client states he has a latex allergy. What action should the nurse take?

Place an allergy identification band on the client.

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which of the following perioperative phases would this action occur?

Pre‐operative

The nurse recognizes the value of leg exercises in the prevention of postoperative thrombophlebitis. When should the nurse teach the correct technique for leg exercises to a client

Prior to surgery

A nurse is applying a pneumatic compression device to a client. What is the purpose of a pneumatic compression device?

Promotes circulation of venous blood

The nurse has entered the room of a client who is postoperative day one and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of PRN analgesia, and on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. How should the nurse respond to the client's concerns?

Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery."

A patient had a surgical procedure that necessitated a thoracic incision. The nurse anticipates that he will have a higher risk for postoperative complications involving which body system?

Respiratory system

A preoperative assessment finds a client to be 75 pounds overweight. The client is to have abdominal surgery. What nursing diagnosis would be appropriate based on the client's weight?

Risk for Infection

A nurse in an outpatient surgical center is teaching a client about what will be necessary for discharge to home. What information should the nurse include about transportation?

The client is not allowed to drive a car home.

A nurse is explaining pain control methods to a patient undergoing a bowel resection. The patient is interested in the PCA pump and asks the nurse to explain how it works. What would be the nurse's correct response?

The pump allows the patient to self-administer limited doses of pain medication."

What is the rationale for having the client void before surgery?

To prevent bladder distention

A nurse is caring for an older adult client who has been prescribed fluid restriction before surgery. Which of the following should the nurse check to assess the risks of fluid restriction in elderly clients?

Vital signs

A nurse from the ambulatory surgical center is preparing discharge instructions for a client who has had pelvic surgery. Which criterion would the client need to demonstrate to ensure that she is ready for discharge?

Void normally

A nurse is preparing a patient for a cesarean section and teaches her the effects of the regional anesthesia she will be receiving. Which effects would the nurse expect? Select all that apply.

c. Reduction or loss of reflex action d. Localized loss of sensation Feedback: A localized loss of sensation and possible loss of reflexes occurs with a regional anesthetic. Loss of consciousness and relaxation of skeletal muscles occurs with general anesthesia. Prolonged pain relief after other anesthesia wears off and infiltration of the underlying tissues in an operative area occur with topical anesthesia.