Perioperative Practice

D

Which nursing intervention is the MOST important in preventing postoperative complications? A) Progressing diet planning B) Pain management C) Bowel and elimination monitoring D) Early ambulation

Surgeon

Who must obtain consent for a surgery?

First Generation Cephalosporins

Widely used for prophylaxis against infection in surgical patients; rarely used for active infections

A

A 68-year-old male scheduled for a herniorrhaphy at an ambulatory surgical center expresses concern that he will not have enough care at home and asks if he can stay in the hospital after the surgery. The best response by the nurse is A) "Who is available to help you at home after the surgery?" B) "I'm sure you will be able to manage at home after surgery. It is a simple procedure." C) "We will teach you everything you need to know to be able to care for yourself after surgery." D) "Your health insurance will pay for inpatient care only if complications develop during

C

A circulating nurse is monitoring the temperature in a surgical suite. The nurse should identify that cool temperatures reduce a client's risk for which of the following potential complications of surgery? A) Malignant hyperthermia B) Blood clots C) Infection D) Hypoxia

A

A client has a left tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the fracture despite IV pain medication administered 30 minutes ago. Which should be the nurse's next assessment? A) Distal pulses B) Pain scale C) Vital signs D) Potential for drug tolerance

D

A client is transferred from the surgical suite to the PACU following oral surgery. While monitoring the client's vital signs, the nurse finds that the client's tongue has become swollen and is obstructing the airway. Which of the following actions should the nurse take first? A) Contact the anesthesiologist B) Assist with endotracheal intubation C) Increase the client's flow of oxygen D) Use the head-tilt, chin-lift method to open the airway

C

A nurse in a PACU is assessing who is postoperative. Which of the following findings should the nurse report to the provider? A) Blood pressure 10% lower than baseline B) Pain level of 4 on a 0 to 10 scale C) Presence of inspiratory stridor D) Small amount of sanguineous drainage on dressing

B

A nurse is assessing a client who is 2 days postoperative following a total prostatectomy. The nurse notes the client's right calf is red, edematous, and warm to the touch. Which of the following actions should the nurse take? A) Apply an ice pack to the client's right calf B) Elevate the client's right extremity C) Administer testosterone to the client D) Gently massage the client's right calf

A

A nurse is assessing a client who is 2 hr postoperative following an appendectomy. Which of the following findings should the nurse report to the provider? A) Urine output of 20 mL/hr B) Temperature of 36.5 C (97.7 F) C) A 2 cm x 2 cm area of bloody drainage on the dressing D) WBC count 9,000 mm3

B

A nurse is assessing a client who is preoperative. The nurse should identify that which of the following factors reported by the client increases the risk for a postoperative wound infection? A) Frequent use of echinacea B) Long term use of corticosteroids C) History of osteoporosis D) Diet high in vitamin C

C

A nurse is assessing a client who is recovering from spinal anesthesia. Which of the following sensations should the nurse expect to return to the client first? A) Pain B) Cold C) Touch D) Warmth

B

A nurse is assessing a client who received a preoperative IV dose of metoclopramide 1 hr ago. For which of the following findings should the nurse notify the provider? A) Dry mouth B) Muscle rigidity C) Tinnitus D) Diarrhea

D

A nurse is caring for a client who had an open transverse colectomy 5 days ago. The nurse enters the client's room and recognizes that the wound has eviscerated. After covering the wound with a sterile, saline soaked dressing, which of the following actions should the nurse take? A) Go to the nurses' station to seek assistance B) Reinsert the organs into the abdominal cavity C) Place the client in a reverse Trendelenburg positions D) Obtain vital sings to assess for shock

B

A nurse is caring for a client who has a surgical wound with a Penrose drain in place. Which of the following interventions should the nurse plan to perform? A) Cut a slit in a 4 inch square gauze pad to place around the drain B) Use the sterile technique when performing dressing changes C) Establish a clamping schedule prior to removal D) Apply negative pressure when emptying the drain

D

A nurse is caring for a client who has bradycardia following a surgical procedure using spinal anesthesia. The nurse should plan to administer which of the following medications to the client? A) Amiodarone B) Propanolol C) Methyldopa D) Epinephrine

A

A nurse is caring for a client who is 12 hrs postoperative form a gastrectomy and has an NG tube set to continuous low suction. Which of the following findings requires intervention by the nurse? A) Gastric distension B) Absent bowel sounds C) Urine output of 150 mL over the last 4 hrs D) Yellow drainage in the NG tube

B

A nurse is caring for a client who is 2 days postoperative following a cholecystectomy. The client has been vomiting for the past 24 hrs and reports a pain level of 8 on a 0 to 10 scale. The nurse notes a hard, distended abdomen and absent bowel sounds. After conferring with the provider, which of the following actions should the nurse take first? A) Draw the client's blood for electrolytes B) Insert an NG tube C) Administer pain medication D) Initiate intake and output

B

A nurse is caring for a client who is postoperative and is asking multiple questions about the risks of the procedure. Which of the following actions should the nurse take? A) Explain the risks and benefits of the surgery to the client B) Ask the surgeon to speak to the client for clarification C) Reassure the client that the procedure is necessary for recovery D) Notify the circulating nurse that the client has questions about the procedure

C

A nurse is caring for a client who is postoperative following abdominal surgery. Which of the following interventions should the nurse perform to prevent respiratory complications? A) Instruct the client to exhale into the incentive spirometer every 1 to 2 hr B) Minimize the amount of pain medication the client receives to prevent sedation C) Advise the client to splint the surgical incision when coughing and deep breathing D) Reposition the client every 8 hr for the first 48 hr

C

A nurse is caring for a client who is receiving moderate (conscious) sedation with midazolam. The client's respiratory rate decreases from 16/min to 6/min, and their oxygen saturation decreases from 92% to 85%. Which of the following medications should the nurse administer? A) Atropine B) Acetylcysteine C) Flumazenil D) Protamine Sulfate

B

A nurse is creating a plan of care for a client who is preoperative for a total hip arthroplasty. The client informs the nurse that they practice Judaism and adhere to a kosher diet. Which of the following interventions is the nurse's priority? A) Listen and allow the client to express feelings about the surgery B) Determine if the client's fait conflicts with the treatment plan C) Ensure the client's meal plan serves only kosher food following surgery D) Teach the client how to perform various relaxation exercises

A

A nurse is monitoring a client who received succinylcholine during a surgical procedure. Which of the following actions should the nurse take if the client develops manifestations of malignant hyperthermia? A) Administer dantrolene B) Institute seizure precautions C) Remove the endotracheal tube D) Administer IV atropine

C

A nurse is planning care for a client who is postoperative and has a closed wound drainage system in place. Which of the following interventions should the nurse plan to include? A) Check the patency of the drain every 12 hr B) Clamp the drain while the client is ambulating C) Cleanse the drain plug with alcohol after emptying D) Secure the drain to the client's bed sheet

B

A nurse is providing discharge instructions for a client who is postoperative following abdominal surgery. Which of the following client statements indicates an understanding of the teaching? A) I will have an increase in yellow colored drainage from my incision for 2 weeks B) I will eat foods that are high in protein and vitamin C during my recovery C) I should avoid taking over the counter pain medication if my pain is not severe D) I will remain on bed rest until my follow up appointment with my doctor

C

A nurse is providing discharge teaching for a client who is postoperative following a rhinoplasty using general anesthesia. Which of the following instructions should the nurse include? A) Lie on your side when resting for the first week after surgery B) Limit intake to clear liquids for the first 24 hours after surgery C) Use cool compresses on your eyes, nose, and face D) Close your mouth when you are about to sneeze

B

A nurse is providing preoperative teaching for a client who is scheduled to have a below the knee amputation. Which of the following instructions should the nurse include? A) You should avoid lying on your abdomen after surgery. B) Your surgeon might prescribe an antibiotic before surgery. C) It is important for you to sit in a chair at the bedside for several hours every day to reduce the risk of pneumonia. D) To promote wound healing, it is important to reduce your intake of carbohydrates once you return home

D

A nurse is providing preoperative teaching to a client who is scheduled for a gastrectomy in 1 week. The client expresses anxiety about the upcoming surgery. Which of the following actions should the nurse take? A) Sympathize with the client's feelings B) Reassure the client that the surgery will go fine C) Change the topic of discussion D) Provide concise, factual information

D

A nurse is providing preoperative teaching to a client who is scheduled to have a mastectomy with reconstructive surgery. Which of the following statements by the client indicates an understanding of the teaching? A) I should wait to take my pain medication until after I have complete my range of motion exercises B) I should wait until a week after surgery to start my hand strengthening exercises C) I will be able to lift an object that weighs 10 pounds 2 weeks after my surgery D) I will be able to shower after the doctor removes the drain

D

A nurse is providing teaching for a client who is scheduled to undergo moderate sedation for a bronchoscopy. Which of the following client statements indicates an understanding of the teaching? A) I will need to complete a bowel prep the day before the procedure B) I will drink plenty of fluids the morning of the procedure C) I can eat as soon as the procedure is over D) I can expect to feel sleepy for several hours after the procedure

A

A nurse is receiving evening shift report on four clients who returned from the PACU that morning. Which of the following clients should the nurse assess first? A) A client who is postoperative following a thoracotomy and has a chest tube with 150 mL of bright red blood in the collection chamber from the past 1 hr B) A client who is postoperative following a small bowel resection and has a temporary colostomy along with absent bowel sounds in all four quadrants C) A client who is postoperative following a tonsillectomy and has had one episode of coffee ground emesis D) A client who is postoperative following a total knee arthroplasty and is reporting a pain level of 7 on a scale from 0 to 10

A

A nurse is reviewing the medical record for a client who has a prescription for general anesthesia prior to surgery. Which of the following findings should the nurse report to the provider? A) Potassium 2.8 mEq/L B) Sodium 140 mEq/L C) INR 1.5 D) BUN 12 mg/dL

D

A nurse is reviewing the medical record of a client who is scheduled for an elective surgery. Which of the following medications should the nurse expect the provider to discontinue prior to surgery to minimize the risk for complications? A) Cefazolin B) Digoxin C) ONdansetron D) Warfarin

B

A nurse is teaching a client who is in the immediate postoperative period about the use of a PCA pump. Which of the following statements should the nurse include in the teaching? A) You will receive a dose of medication every time you push the button B) Do not allow visitors to push the PCA button if you are sleeping C) You cannot receive too much medication by pushing the button D) Do not push the PCA button until your pain reaches a severe level

D

A patient arrives to the PACU after surgery. Which respiratory assessment should the nurse complete FIRST? A) Oxygen saturation B) Respiratory rate C) Breath sounds D) Airway flow

D

A patient becomes restless and agitated in the postanesthesia care unit (PACU) as he begins to regain consciousness. The first action the nurse should take is to A) Turn the patient to a lateral position. B) Orient the patient and tell him that the surgery is over. C) Administer the ordered postoperative pain medication. D) Check the patient's oxygen saturation with pulse oximetry.

B

A patient is prescribed cefixime. The nurse should teach the patient to immediately report any signs of what? A) Milk intolerance B) Skin rash, hives, or itching C) Constipation, nausea, or vomiting D) Headache, contusions, or seizures

D

A patient tells the nurse on admission that she is uneasy about having to leave her children with a relative while being in the hospital for surgery. What should the nurse do? A) Reassure the patient that her children will be fine and she should stop worrying B) Contact the relative to determine his/her capacity to be an adequate care provider C) Encourage the patient to call the children to make sure they are doing well D) Gather more information about the client's feelings about the childcare arrangements

D

A patient undergoing an emergency appendectomy and tells the nurse he takes Vitamin E for his skin. Which complication might the nurse expect in during surgery? A) Higher pain threshold B) Increased blood pressure C) Increased anesthesia recovery time D) Increased postoperative wound bleeding

D

A patient who is to receive general anesthesia has a serum potassium level of 5.8 mEq/L. What should be the nurse's FIRST response? A) Call the operating room to cancel the surgery B) Send the patient to surgery C) Make a note in the patient's chart D) Notify the anesthesiologist

A

A surgical nurse enters a surgical suite to ensure surgical asepsis is maintained. For which of the following findings should the nurse intervene? A) The scrub technologist is wearing a watch under their scrubs B) The circulating nurse opens dressing packages before applying sterile gloves C) The surgeon has their hands folded 5 cm above their waist D) The holding area nurse is providing client education

A

After surgery, a patient has morphine prescribed for postoperative pain. It is most important for the nurse to make which assessment? A) Respiratory rate B) Heart rate C) Pain level D) Constipation

Oxycodone (Oxycontin, Roxycodone)

Analgesic, Opiod (Schedule II Controlled Substance); PO Immediate or Extended release options; Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perceptions; Side effects: Drowsiness, dizziness, confusion, euphoria, respiratory depression; Assess pain score, RR, Pulse Ox, LOC before and after administration

Metoprolol (Lopressor)

Antianginal, Antihypertensive Beta Blocker; Side effects include bradycardia, dizziness, bronchospasm; Assess apical pulse prior to administration (refer to admin parameters)

Surgery

Art and science of treating diseases, injuries, and deformities by operation and instrumentation

Incomplete Fracture

Bone is still in one piece

Transverse Fracture

Break extends across the bone shaft

Spiral Fracture

Break extends in a spiral directions along the bone shaft

Complete Fracture

Break is completely through bone

Metformin (Glucophage)

Inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin; Drug of choice for initial therapy in most patients with type II DM; Most common side effects are GI disturbances and hypo/hyperglycemia; Warning: Withhold before studies requiring iodinated contrast media and for 48 hours after

Dislocation

Complete displacement of joint

Sprain

Injury to ligaments surrounding a joint usually from wrenching or twisting; pain, swelling, tenderness

Avascular Necrosis

Death of bone tissue due to lack of blood supply

Fracture

Disruption or break in continuity of structure of bone; symptoms: localized pain, decreased function, inability to bear weight or use, may or may not have deformity, guard against movement

B

During admission of the patient to the holding area or operating room before surgery, the perioperative nurse must A) Verify the patient's understanding of the risks of surgery. B) Ensure the patient's identity with a formal identification process. C) Prepare the skin by scrubbing the surgical site with an antimicrobial agent. D) Perform a preoperative assessment with a patient history and physical examination.

B

During the administration of any regional anesthetic, it is most important that the nurse A) Monitor for ascending neurologic depression and unconsciousness B) Ensure that airway equipment, emergency drugs, and monitors are immediately available C) Monitor the patient's response to the anesthesia, assessing the extent of loss of sensation D) Have reversal drugs such as anticholinesterase agents (e.g., neostigmine [Prostigmin]) available in case of respiratory arrest

Strain

Excessive stretching of muscle or tendon; T for tendon or T also in stretching; pain, swelling, tenderness

Subluxation

Less severe dislocation; misalignment; clinical manifestations similar to dislocations but not as severe

Cephalosporins

Most widely used group of antibiotics; Binds to penicillin-binding proteins (PBPs), disrupt cell wall synthesis, and cause cell lysis; Nephrotoxic; Warnings/Precautions: PCN Allergy

Ibuprofen

NSAID; analgesic, anti-inflammatory, antipyretic; Side Effects: Headache, constipation, N/V; Onset 30 mins, Peak 1-2 Hours, Duration 6-8 hours; Administer with food; Steven Johnson Syndrome

Warfarin (Coumadin)

Needs to be discontinued 5-6 days pre-op; antidote is Vitamin K; Monitor INR

Aspirin

Needs to be discontinued 5-7 days pre-op

Aspirin and fish oil (Increased risk of bleeding)

Pam is currently taking HCTZ, glipizide (Glucotrol), multivitamin, fish oil, and a daily low-dose aspirin. Which medications need to be stopped before surgery?

Third Generation Cephalosporins

Preferred therapy for several infections; Highly active against gram-negative organisms; Able to penetrate to cerebrospinal fluid (CSF)

B

Prior to Kelly's scheduled surgery, she tells you she is very nervous and really does not understand what the surgical procedure is or how it will be performed. What is should you do next? A) Have Kelly sign the informed consent document and place it in the chart B) Call the HCP and ask them to come and explain the procedure to Kelly C) Explain the procedure to Kelly D) Provide Kelly written information regarding the procedure

Second Generation Cephalosporins

Rarely used for active infection

Ambulatory

Same day or outpatient surgery setting

Cyclobenzaprine (Amrix, Flexeril)

Skeletal Muscle Relaxant; PO Immediate or Extended release options; BEERS Criteria (Geriatric); Avoid use within 14 days of MAO inhibitors; Side Effects: Xerostomia (dry mouth), Dizziness, Drowsiness; Taper off gradually

A

Which goal is the priority for a client with a fractured femur who is in traction? A) Prevent effects of immobility while in traction B) Develop skills to cope with prolonged immobility C) Choose appropriate diversional activities during the prolonged recovery D) Adapt to inactivity from the impaired mobility

Cold

Temperature that vasoconstricts

Warm

Temperature that vasodilates

B

The nurse is assessing a client recovering from anesthesia. Which finding is an early indicator of hypoxemia? A) Decreased LOC B) Restlessness C) Chills D) Urgency

C

The nurse is caring for a client who is 30 years old with a fracture of the right femur and left tibia. Both legs are in a cast. The nurse assesses the following: respirations are 30 per minute and are rapid and shallow; there is a presence of a productive cough with thin pink sputum. The client is yelling at the nurse and wants to be released from the hospital; this behavior is unlike that previously reported. The last plan medication was administered 3 hours ago. What should the nurse do first? A) Cut slits in the top of casts B) Administer pain medication C) Notify the health care provider D) Obtain a chest x-ray

Adequate disclosure, understanding and comprehension, voluntarily give consent

What 3 things must be included in informed consent?

Rest, Ice, Compress, Elevate, Analgesia (NSAIDs)

What acute care should be done for sprains and strains within the first 24-48 hours?

Death, pain, disability, mutilation, anesthesia, disruption of life functioning

What are some of the main fears patients have prior to surgery?

30-40 seconds (1.5-2.5 times control value if on heparin)

What are the normal values for APTT?

37-47% women, 42-52% men

What are the normal values for Hematocrit?

12-16 g/dL women, 14-18 g/dL men (slightly decreased in elderly)

What are the normal values for Hemoglobin?

0.8-1.1 (2.5-3.5 on warfarin)

What are the normal values for INR?

11-12.5 seconds

What are the normal values for PT?

5,000-10,000 mm3

What are the normal values for WBC?

1.3-2.1 mg/dL

What are the normal values for magnesium?

150,000-400,000 mm3

What are the normal values for platelets?

3.5-5 mEq/L

What are the normal values for potassium?

135-145 mEq/L

What are the normal values for sodium?

Warm, moist heat

What care should be done for sprains and strains after 48 hours?

Distal to proximal

What direction should you go when wrapping a limb for compression?

Avascular necrosis and compartment syndrome

What do dislocation and subluxation increase risk of?

Removal

What does the suffix -ectomy mean?

Destruction of

What does the suffix -lysis mean?

Looking into

What does the suffix -oscopy mean?

Creation of opening into

What does the suffix -ostomy mean?

Cutting into or incision of

What does the suffix -otomy mean?

Repair or reconstruction of

What does the suffix -plasty mean?

B, C

What effect does cold have on an injured area? Select all that apply. A) Vasodilation B) Vasoconstriction C) Reduces transmission and perception of nerve impulses D) Induces hyperthermia

Information

What helps to lessen anxiety over surgery or treatment?

B

What is an injury to the ligaments surrounding a joint, usually caused by a wrenching or twisting motion? A) Strain B) Sprain C) Fracture D) Amputation

D

What is the first assessment you will make on a postoperative patient in the PACU? A) Heart rate B) Nail perfusion C) Core temperature D) Patency of the airway

DXA Scan

What test can be done to gauge bone density?