course point chapter 14 preoperative nursing management
Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern?
surgeon
When does the nurse understand the patient is knowledgeable about the impending surgical procedure?
the patient participates willingly in the preoperative preparation
An example of a curative surgical procedure is
tumor excision
A client is preparing to undergo a curative surgical procedure. Which of the following is the type of surgery the client could be having? Select all that apply.
removal of a tumor removal of a diseased appendix
The nurse recognizes that the client who takes hydrochlorothiazide to manage hypertension is predisposed for which interaction with anesthesia?
respiratory depression
A client scheduled for surgery asks why blood tests are being done to evaluate liver function. Which response will the nurse make?
"It is because the anesthesia you will receive is cleared through the liver."
The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed?
"The nurse will explain the details of the surgery before I sign a consent."
A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply.
- intravenous fluids and other lines and tubes- cough and deep-breathing exercises- postoperative pain control
The nurse is preparing the medical record for a client scheduled for surgery. Which item(s) will the nurse ensure are in the history and physical? Select all that apply.
Allergies Surgical history Medical history Current medications History of present illness
A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?
Allow the client to wear the ring and cover it with tape.
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?
Cheeseburger, french fries, coleslaw, and ice cream
What action by the nurse best encompasses the preoperative phase?
Educating clients on signs and symptoms of infection
A client asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate?
It prevents aspiration and respiratory complications.
The nurse is conducting a preoperative assessment on a client scheduled for gallbladder surgery. The client reports a frequent cough producing green sputum for 3 days and denies fever. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiratory wheeze. Respiratory rate is 20, temperature is 99.8 (taken orally), heart rate is 87, and blood pressure is 124/70. What is the best action by the nurse?
Notify the surgeon to possibly delay the surgery.
A client who is deaf without bilateral hearing aids has them removed in preparation for a surgical procedure. Which action(s) will the nurse take to communicate with this client? Select all that apply.
Provide written information. Use hand gestures to communicate. Speak slowly so the client can lip read. Plan for a sign language interpreter.
Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out?
Review the scheduled procedure, site, and client.
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.
Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period?
The 35-year-old client with non-insulin dependent diabetes.
The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician?
When the patient's blood ammonia concentration reaches 180 mg/dL
A client with osteoarthritis receives a recommendation to have joint replacement surgery. For which type of surgery will the nurse plan teaching for this client?
elective
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as
emergency
A fractured skull would be classified under which category of surgery based on urgency?
emergent
Informed consent from the surgical client is essential in all of the following categories of surgery except:
emergent surgery
The nurse expects informed consent to be obtained for insertion of:
gastrostomy tube
Which domain of perioperative nursing practice focuses on clinical processes and outcomes?
health care systems
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
A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective?
i will support my incision with my hands when I cough and do my deep breathing exercises
A client reports getting a rash when eating kiwi and bananas. For which potential allergy will the nurse plan care for this client?
latex
A client is undergoing preoperative assessment. During admission paperwork, the client reports having enjoyed a hearty breakfast this morning to be ready for the procedure. What is the nurse's next action?
notify the surgeon
The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply.
nutritional status age physical condition health status
A client is having surgery through an ambulatory surgical center. Which information will the nurse provide to the client's family?
"The client will go to the postanesthesia care unit after the surgery."
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery?
7
You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear?
Anxious clients have a poor response to surgery and are prone to complications.
The nurse is doing a preoperative assessment of an 87-year-old man who is slated to have a right lung lobe resection to treat lung cancer. What underlying principle should guide the nurse's preoperative assessment of an elderly client?
Elderly clients have less physiologic reserve than younger clients.
You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility?
Place gauze under and over the ring and apply adhesive tape over it.
The nurse is caring for the client in the preoperative period and documenting rationale for a palliative surgical procedure. Which rationale is appropriate?
The client and physician are focusing on symptom relief not a cure.
How does the nurse determine that the patient may have hidden fears about the impending surgical procedure? (Select all that apply.)
The patient avoids communication with the nurse.The patient repeatedly asks questions that have previously been answered.The patient talks incessantly.
An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults?
older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.
A patient is scheduled for a reduction mammoplasty. What classification of surgery does the nurse understand that this is?
optional
Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery?
physician
When is the ideal time to discuss preoperative teaching
preadmission visit
A client is scheduled for a spinal fusion to treat spinal stenosis. For which reason might the nurse anticipate surgery being delayed because of the risk for postoperative complications?
smoking
A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery?
7-10 days
The nurse recognizes that written informed consent is required for insertion of a(n):
Peripherally-inserted central catheter.
The nurse is caring for a client needing emergency surgery. Which preoperative teaching can be omitted when preparing the client for surgery?
Post-discharge diet
A client who is scheduled for knee surgery is anxious about the procedure, saying, "You hear stories on the news all the time about doctors working on the wrong body part. What if that happens to me?" What is the nurse's best response? Select all that apply.
The client can be involved in marking the knee, the site for the surgery. The surgical team performs a "time-out" prior to surgery to conduct a final verification. The client will be involved in the verification process prior to surgery.
A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed?
The client exhales forcefully with a short expiration.
The nurse is educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate?
Three phases of surgery and safety measures for each phase
The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. Which of the following is the most important function?
Verifies that operative consent is signed
A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?
a blood urea nitrogen level of 42 mg/dL
The nurse recognizes that which of the following clients is at the lowest risk for perioperative complications?
a client who has a history of arthritis
The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?
a safe environment
A client is scheduled for an invasive procedure. What should the nurse document in the chart regarding the procedure?
a signed consent form from the client
A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client?
adrenal insufficiency
When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period?
up to 72 hours after alcohol withdrawal
A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for kidney stones the next day. What category of surgery does this procedure fall into?
urgent
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?
use diaphragmatic breathing
A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which post-surgical risk factor would decrease if the surgical client maintained strict blood glycemic control?
wound healing