Chapter 17 - Preoperative Nursing Management

A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery? a. a history of chronic lower back pain b. a history of diabetes c. a history of sensitivity to aspirin d. a history of osteoarthritis

b. a history of diabetes rationale: As a chronic condition that affects many body systems, diabetes is a risk factor for surgical complications. The client's blood glucose level and insulin requirements need to be closely monitored before and after surgery. Being sensitive to aspirin does not pose a risk for the client in surgery. Osteoarthritis is not a systemic condition and does not place the client at risk during surgery. Chronic low back pain is not a systemic condition that places the client at risk during surgery; however, it can be exacerbated by positioning on the operating room table.

The on-call perioperative team is called for an urgent surgery to be performed as soon as they arrive. What surgical procedure is considered emergent?

A repair of multiple stab wounds rationale: Repair of multiple stab wounds is emergent. Removal of kidney stones is urgent. An exploratory laparotomy is required. A face lift is optional.

Informed consent from the surgical client is essential in all of the following categories of surgery except:

Emergent surgery rationale: In an emergency, a physician may perform surgery without a client's informed consent in order to save the client's life.

A client taking chlorpromazine is preparing to undergo surgery. Which of the following complications does the surgical team need to prepare to deal with before anesthetics are administered?

Hypotension rationale: Chlorpromazine (Thorazine) may increase the hypotensive action of anesthetics. Seizures are a potential interaction if diazepam (Valium) is withdrawn suddenly before surgery. The client who takes prednisone (Deltasone) is at risk for cardiovascular collapse if the medication is discontinued suddenly. The combination of erythromycin (Ery-Tab) and a curariform muscle relaxant can lead to apnea from muscle paralysis.

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications?

Splint the incision site using a pillow during deep breathing and coughing exercises. rationale: Splinting the incision site will help decrease pain and support the incision. This will increase compliance with the deep breathing and coughing exercises that assist in preventing respiratory complications. Pain medication should be taken regularly, not only before deep breathing and coughing exercises. Deep breathing and coughing exercises should be done at least every 2 hours, more frequently if possible. While some clients will find the exercises relaxing, most clients find it painful to complete them.

Which nutrient plays an important role in normal blood clotting?

Vitamin K rationale: Vitamin K is important for normal blood clotting. The other nutrients are not involved in clotting.

The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following? a. cheeseburger, french fries, coleslaw, and ice cream b. turkey breast, baked sweet potato, asparagus, and an orange c. baked chicken, mashed potatoes, broccoli, and strawberries d. grilled salmon, rice pilaf, green beans, and canteloupe

a. cheeseburger, french fries, coleslaw, and ice cream rationale: Important nutrients for wound healing include protein; vitamins A, B-complex, C, and K; arginine, magnesium, copper, and zinc; and water. The diet should be sufficient in carbohydrates and low to moderate in fats. The cheeseburger option is high in fat and low in vitamin C.

An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used? a. optimistic self-recitation b. distraction c. imagery d. progressive muscle relaxation

c. imagery rationale: Imagery has proven effective for anxiety in surgical clients. Optimistic self-recitation is practiced when the client recites optimistic thoughts such as, "I know all will go well." Distraction is used when the client is encouraged to think of an enjoyable story or recite a favorite poem. Progressive muscular relaxation requires contracting and relaxing muscle groups and is a physical coping strategy as opposed to a cognitive strategy.

The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which laboratory value would be of greatest concern to the nurse? a. Calcium 9.8 mg/dL b. white blood cell count 7.2 cells /mm c. potassium 6.2 mEq/L d. sodium 138 mEq/L

c. potassium 6.2 mEq/L rationale: Hyperkalemia places the client at risk for surgical complications. The sodium level, calcium level, and white blood cell count are within normal limits.

The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure? a. up to 6 hours before surgery b. up to 8 hours before surgery c. up to 2 hours before surgery d. up to 4 hours before surgery

c. up to 2 hours before surgery rationale: The major purpose of withholding food and fluid before surgery is to prevent aspiration. Until recently, fluid and food were restricted preoperatively overnight and often longer. The American Society of Anesthesiologists reviewed this practice and made new recommendations for people undergoing elective surgery who are otherwise healthy. Specific recommendations depend on the age of the patient and the type of food eaten. For example, adults may be advised to fast for 8 hours after eating fatty food and 4 hours after ingesting milk products. Healthy patients are allowed clear liquids up to 2 hours before an elective procedure (Crenshaw, 2011).