pre op post op

In which instance may a surgeon operate without informed consent? Invasive procedures Radiologic procedures Procedures requiring sedation Emergency situations

Emergency situations In an emergency, it may be necessary for the surgeon to operate as a lifesaving measure without the client's informed consent.

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

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

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 complications? Select all that apply. Fluid overload Acidosis Glucosuria Delirium Hypoglycemia

Hypoglycemia Acidosis Glucosuria Hypoglycemia may develop during anesthesia or postoperatively from inadequate carbohydrates or excessive administration of insulin. Hyperglycemia, which can increase the risk for surgical wound infection, may result from the stress of surgery, which can trigger increased levels of catecholamine. Other risks are acidosis and glucosuria. Risks of fluid overload and delirium are not normally increased.

Verification that all required documentation is completed is an important function of the intraoperative nurse. The intraoperative nurse should confirm that the client's accompanying documentation includes which of the following? Educational resources Analgesia prescription Informed consent Discharge planning

Informed consent It is important to review the client's record for the following: correct informed surgical consent, with client's signature; completed records for health history and physical examination; results of diagnostic studies; and allergies (including latex). Discharge planning records and prescriptions are not normally necessary. Educational resources would not be included at this stage of the surgical process.

After teaching a class about agents commonly associated with the development of malignant hyperthermia, the instructor determines that additional teaching is needed when the students identify which drug as a possible cause? Succinylcholine Halothane Morphine Epinephrine

Morphine Morphine is not associated with malignant hyperthermia. Agents such as halothane, succinylcholine, and epinephrine can induce malignant hyperthermia.

You are the circulating nurse in an outpatient surgery center. Your patient is scheduled to receive moderate sedation. You know that a patient receiving this form of anesthesia should: Receive an antiemetic Remember most of the procedure Never be left unattended by the nurse Be able to maintain his or her own airway

Never be left unattended by the nurse The patient receiving moderate sedation should never be left unattended. The patient's ability to maintain his or her airway depends on the level of sedation. The administration of moderate sedation is not necessarily an indication for giving an antiemetic. The patient receiving moderate sedation does not remember most of the procedure.

During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer: potassium chloride verapamil (Isoptin) an acetaminophen suppository dantrolene sodium (Dantrium)

dantrolene sodium (Dantrium) The client is exhibiting clinical manifestations of malignant hyperthermia. Dantrolene sodium, a skeletal muscle relaxant, is administered.

Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care: is a type of regional anesthesia. may result in the administration of general anesthesia. requires the introduction of an anesthetic agent into the epidural space. is used as an adjunct to spinal anesthesia.

may result in the administration of general anesthesia. Monitored anesthesia care may require the anesthesiologist to convert to general anesthesia.

A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply. postoperative pain control intravenous fluids and other lines and tubes the surgeon's fee and other hospital charges cough and deep-breathing exercises the client's spouse's thoughts about the upcoming surgery

postoperative pain control cough and deep-breathing exercises intravenous fluids and other lines and tubes Preoperative teaching involves teaching clients about their upcoming surgical procedure and expectations. Topics include preoperative medications (when they are given and their effects); postoperative pain control; explanation and description of the post anesthesia recovery room or postsurgical area; and deep-breathing and coughing exercises.

After teaching a patient scheduled for ambulatory surgery using moderate sedation, the nurse determines that the patient has understood the teaching based on which of the following statements? "I'll be sleepy but able to respond to your questions." "Only the surgical area will be numb." "I won't feel it, but I'll have a tube to help me breathe." "I'm so glad that I will be unconscious during the surgery."

"I'll be sleepy but able to respond to your questions." With moderate sedation, the patient can maintain a patent airway (i.e., doesn't need a tube to help breathing), retain protective airway reflexes, and respond to verbal and physical stimuli. The patient is not unconscious with moderate sedation. Local anesthesia involves anesthetizing or numbing the area of the surgery.

What medication should the nurse prepare to administer in the event the client has malignant hyperthermia? Dantrolene sodium Fentanyl citrate Thiopental sodium Naloxone

Dantrolene sodium Anesthesia and surgery should be postponed. However, if end-tidal carbon dioxide (CO2) monitoring and dantrolene sodium (Dantrium) are available and the anesthesiologist is experienced in managing malignant hyperthermia, the surgery may continue using a different anesthetic agent.

The nurse is aware that loss of consciousness occurs with which type of anesthesia? Moderate sedation Regional General Local

General A therapeutic effect of general anesthesia is loss of consciousness.

The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to: Be anxious throughout the procedure Need pain control throughout the procedure Need an endotracheal tube Respond verbally during the procedure

Respond verbally during the procedure Clients can respond to verbal and physical stimuli and maintain an oral airway and protective reflexes during moderate sedation.

A client at risk for malignant hyperthermia returns to the surgical unit. For what time period will the nurse monitor the client for development of malignant hyperthermia? The client will need to be discharged with special instructions. A client can develop malignant hyperthermia only with intravenous anesthesia after surgery. Malignant hyperthermia occurs in the operating room only. The client can develop malignant hyperthermia up to 24 hours after surgery.

The client can develop malignant hyperthermia up to 24 hours after surgery. Although malignant hyperthermia usually manifests about 10 to 20 minutes after induction of anesthesia, it can also occur during the first 24 hours after surgery. Malignant hyperthermia can be triggered by inhalant anesthesia with muscle relaxants.

A patient undergoes induction for general anesthesia at 8:30 a.m. and is being assessed continuously for the development of malignant hyperthermia. At which time would the patient be most likely to exhibit manifestations of this condition? 9:30 to 9:40 a.m. 8:40 to 8:50 a.m. 10:00 to 10:10 a.m. 9:00 to 9:10 a.m.

8:40 to 8:50 a.m. Malignant hyperthermia usually manifests about 10 to 20 minutes after the induction of anesthesia, which in this case would 8:40 to 8:50 a.m.

The nurse expects informed consent to be obtained for insertion of: An intravenous catheter A gastrostomy tube A nasogastric tube An indwelling urinary catheter

A gastrostomy tube Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.

A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign? An open reduction of a fracture Urethral catheterization An insertion of an intravenous catheter Irrigation of the external ear canal

An open reduction of a fracture Informed consent is necessary in the following circumstances: invasive procedures, such as a surgical incision (such as would be involved in an open reduction of a fracture), a biopsy, a cystoscopy, or paracentesis; procedures requiring sedation and/or anesthesia (see Chapter 18 for a discussion of anesthesia); a nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient; and procedures involving radiation. Non-invasive procedures such as insertion of an intravenous or urethral catheter or irrigation of the external ear canal would not require informed consent.

The client's surgery is nearly finished and the surgeon has opted to use tissue adhesives to close the surgical wound. This requires the nurse to prioritize assessments related to what complication? Hypothermia Infection Anaphylaxis Malignant hyperthermia

Anaphylaxis Fibrin sealants are used in a variety of surgical procedures, and cyanoacrylate tissue adhesives are used to close wounds without the use of sutures. These sealants have been implicated in allergic reactions and anaphylaxis. There is not an increased risk of malignant hyperthermia, hypothermia, or infection because of the use of tissue adhesives.

The intraoperative nurse advocates for each client who receives care in the surgical setting. How can the nurse best exemplify the principles of client advocacy? By eliciting informed consent from clients By maintaining the privacy of each client By limiting the client's contact with family members preoperatively By encouraging the client to perform deep breathing preoperatively

By maintaining the privacy of each client Patient advocacy in the OR entails maintaining the client's physical and emotional comfort, privacy, rights, and dignity. Deep breathing is not necessary before surgery and obtaining informed consent is the purview of the physician. Family contact should not be limited.

When practicing perioperative care, the nurse monitors clients for what symptoms that are indicative of malignant hyperthermia? Select all that apply. Diaphoresis Cyanosis Hypertension Muscle rigidity Increased urine output Irregular heart rate

Cyanosis Muscle rigidity Diaphoresis Irregular heart rate Symptoms of malignant hyperthermia include tachycardia, tachypnea, cyanosis, fever, muscle rigidity, diaphoresis, mottled skin, hypotension, irregular heart rate, decreased urine output, and cardiac arrest.

An instructor is developing for a class a teaching plan about agents used for intravenous (IV) anesthesia. Which of the following would the instructor include in this plan about these agents and this type of anesthesia? Select all that apply. Long duration of action Ease of administration Associated with more nausea Need for little equipment More pleasant onset of anesthesia

More pleasant onset of anesthesia Ease of administration Need for little equipment With IV anesthesia, the onset is pleasant. Agents have a brief duration of action, and the patient awakens with little nausea and vomiting. The agents also are nonexplosive, require little equipment, and are easy to administer.

A nurse suspects malignant hyperthermia in a patient who underwent surgery approximately 18 hours ago. Which of the following would the nurse identify as a late, ominous sign? Oliguria Muscle rigidity Rapid rise in body temperature Tachycardia

Rapid rise in body temperature A rise in body temperature is a late sign that develops rapidly, with the temperature possibly increasing 1 degree to 2 degrees C every 5 minutes and body core temperature exceeding 42 degrees C (107 degrees F). Tachycardia is often the earliest sign; muscle rigidity also is an early sign. Oliguria occurs with sympathetic nervous system stimulation.

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? Check that all surgical personnel are properly attired. Review the scheduled procedure, site, and client. Ensure that sufficient surgical supplies are available. Confirm that informed consent has been obtained.

Review the scheduled procedure, site, and client. According to the 2016 National Patient Safety Goals, accurate identification of the client, procedure, and operative site is essential.

A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first? Suction the mouth. Roll the client onto his or her side. Administer an antiemetic medication. Provide a basin.

Roll the client onto his or her side. The client must be rolled to the side to prevent aspiration. All the other interventions are correct for a sedated client who is vomiting, but the highest priority is preventing aspiration.

The perioperative nurse is constantly assessing the surgical client for signs and symptoms of complications of surgery. Which symptom should first signal to the nurse the possibility that the client is developing malignant hyperthermia? Oliguria Tachycardia Increased temperature Hypotension

Tachycardia The initial symptoms of malignant hyperthermia are related to cardiovascular and musculoskeletal activity. Tachycardia (heart rate greater than 150 beats per minute) is often the earliest sign. Oliguria, hypotension, and increased temperature are later signs of malignant hyperthermia.

Which clinical manifestation is often the earliest sign of malignant hyperthermia? Oliguria Hypotension Elevated temperature Tachycardia (heart rate >150 beats per minute)

Tachycardia (heart rate >150 beats per minute) Tachycardia is often the earliest sign of malignant hyperthermia. Hypotension is a later sign of malignant hyperthermia. The rise in temperature is actually a late sign that develops quickly. Scant urinary output is a later sign of malignant hyperthermia.

Which intervention should the nurse implement during the intraoperative period to protect the client from injury? Select all that apply. Verify scheduled procedure with client. Assess the client for allergies. Confirm the consent form is signed. Cover the client with warm blankets. Administer anti-anxiety medication.

Verify scheduled procedure with client. Assess the client for allergies. Confirm the consent form is signed. To protect the client from injury, the nurse needs to verify the procedure scheduled, assess for allergies, and confirm the consent form has been signed. Anti-anxiety medications reduce anxiety but do not protect the client from injury. Covering the client with warm blankets promotes comfort and prevents hypothermia, a potential complication of anesthesia.

A postoperative client returns to a surgical nursing unit. The nurse assesses the client and notes tachycardia and muscle rigidity. What is the most important nursing action? inserting a urinary catheter monitoring temperature notifying the health care provider administering supplemental oxygen

administering supplemental oxygen Recognizing symptoms early and discontinuing anesthesia promptly are imperative. The goals of treatment are to decrease metabolism, reverse metabolic and respiratory acidosis, correct dysrhythmias, decrease body temperature, provide oxygen and nutrition to tissues, and correct electrolyte imbalance. The initial symptoms of malignant hyperthermia are related to cardiovascular and musculoskeletal activity. Notifying the health care provider is important but not the first action of the nurse. The client with malignant hyperthermia needs to have temperature monitored, but this is not the first action. Inserting a urinary catheter will not provide oxygen to the client's tissues and reverse complications from the anesthesia.

A client develops malignant hyperthermia. What client symptom would the nurse most likely observe as the first indicator of the disorder? body temperature increase of 1 °C to 2 °C (2 °F to 4 °F) generalized muscle rigidity tetanus-like jaw movements heart rate over 150 beats per minute

heart rate over 150 beats per minute With malignant hyperthermia, tachycardia with a heart rate greater than 150 beats per minute is often the earliest sign because of an increase in end-tidal carbon dioxide. Generalized muscle rigidity and tetanus-like movement occurs often in the jaw are not the first signs for health care providers to note with malignant hyperthermia. The rise in body temperature is a late sign that develops rapidly.

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? Pulse rate of 110 beats/min Temperature of 102.5°F (39°C) Respiratory rate of 18 breaths/min Blood pressure of 104/62 mm Hg

Temperature of 102.5°F (39°C) Intra operative hyperthermia can indicate a life-threatening condition called malignant hyperthermia. The circulating nurse closely monitors the client for signs of hyperthermia. The pulse rate, respiratory rate, and blood pressure did not indicate a significant concern.

The dressing surrounding a mastectomy client's Jackson-Pratt drain has scant drainage on it. The nurse believes that the amount of drainage on the dressing may be increasing. How can the nurse best confirm this suspicion? Trace the outline of the drainage on the dressing for future comparison. Photograph the client's abdomen for later comparison using a smartphone. Describe the appearance of the dressing in the electronic health record. Remove and weigh the dressing, reapply it, and then repeat in 8 hours.

Trace the outline of the drainage on the dressing for future comparison. Spots of drainage on a dressing are outlined with a pen, and the date and time of the outline are recorded on the dressing so that increased drainage can be easily seen. A dressing is never removed and then reapplied. Photographs normally require informed consent, so they would not be used for this purpose. Documentation is necessary, but does not confirm or rule out an increase in drainage.

The nurse recognizes that written informed consent is required for insertion of a(n): Oral airway. Nasogastric tube. Peripherally-inserted central catheter. Urinary catheter.

Peripherally-inserted central catheter. Nonsurgical invasive procedures, such as insertion of a peripherally-inserted central catheter, that carry more than a slight risk to the client require written informed consent.

Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery? Case manager Physician Certified nurse's aide Nurse

Physician It is the physician's responsibility to provide appropriate information. It is not the responsibility of the nurse, case manager, or certified nurse's aide to gain informed consent.

A circulating nurse is preparing a client for a surgical procedure. What are the primary responsibilities of the circulating nurse in the perioperative experience? Select all that apply. coordinating the efforts of the surgical team marking the surgical site verifying informed consent passing the surgical instruments ensuring proper lighting

verifying informed consent ensuring proper lighting coordinating the efforts of the surgical team The responsibilities of the circulating nurse include verifying consent, ensuring proper lighting, and coordinating the surgical team. The marking the operative site is done by the surgeon. The passing of instruments is done by the scrub nurse.

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 surgeon on the team has never been involved in such a mix-up." "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." "Our surgical team would never make that mistake."

"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." There is an increased emphasis on making sure that the right client has the right procedure at the right site. To prevent "wrong site, wrong procedure, wrong person surgery," The Joint Commission (2019) established a universal protocol to achieve this goal. Included in this checklist are steps to verify the preoperative process, mark the operative site, and perform a "time-out." Telling the client that the surgeon has not been involved in such a mix-up or would never make that mistake is false reassurance.

The nurse is preparing a patient for surgery. The patient is to undergo a hysterectomy without oophorectomy, and the nurse is witnessing the patient's signature on a consent form. Which comment by the patient would best indicate informed consent? "Because the health care provider isn't taking my ovaries, I'll still be able to have children." "I know I'll have pain after the surgery." "The health care provider is going to remove my uterus and told me about the risk of hemorrhage." "I know I'll be fine because the health care provider said he has done this procedure hundreds of times."

"The health care provider is going to remove my uterus and told me about the risk of hemorrhage." The surgeon must also inform the patient 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 patient requests additional information, the nurse notifies the health care provider. Clarification of information given may be necessary, but no additional information should be given. The other options do not indicate patient understanding of the procedure.

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? "Because the physician isn't taking my ovaries, I'll still be able to have children." "The physician is going to remove my uterus and told me about the risk of bleeding." "I know I'll be fine because the physician said he has done this procedure hundreds of times." "I know I'll have pain after the surgery but they'll do their best to keep it to a minimum."

"The physician is going to remove my uterus and told me about the risk of bleeding." The surgeon must 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 physician. In the correct response, the client is able to tell the nurse what will occur during the procedure and the associated risks. This indicates the client has a sufficient understanding of the procedure to provide informed consent. Clarification of information given may be necessary, but no additional information should be given. The other listed statements do not reflect an understanding of the surgery to be performed.

A nurse is teaching a client who is at risk for malignant hyperthermia subsequent to general anesthesia. What should the nurse include in the teaching? "The surgical team is aware of the risk, so the team is prepared." "Your vital signs will indicate if you need more inhalant medication." "There are reversal agents that will lessen the occurrence of the malignant hyperthermia." "The surgery can continue as long as your temperature is controlled."

"The surgical team is aware of the risk, so the team is prepared." Recognizing symptoms early and discontinuing anesthesia promptly are imperative in countering malignant hyperthermia. The surgical team being aware of the possibility is crucial for safe management. The Malignant Hyperthermia Association of the United States (MHAUS) publishes a treatment protocol that should be posted in the OR and be readily available on a malignant hyperthermia cart. However, if end-tidal CO2 monitoring and dantrolene sodium (Dantrium) are available and the anesthesiologist is experienced in managing malignant hyperthermia, the surgery may continue using a different anesthetic agent. Although malignant hyperthermia usually manifests about 10 to 20 minutes after induction of anesthesia, it can also occur during the first 24 hours after surgery. That the surgery can continue is true but does not provide client reassurance. The reversal agents are not true, but a different anesthetic agent will be used. Vital signs will not determine more medication but a change in anesthesia.

The parent of a 16-year-old client asks the nurse, "How could the surgeon operate without my consent?" What is the best response by the nurse? "Your child had life-threatening injuries that required immediate surgery." "Two doctors decided your child needed the surgery, therefore we did not need to get consent." "We obtained consent from your child after your child requested the surgery." "The surgical procedure being performed does not require consent."

"Your child had life-threatening injuries that required immediate surgery." In an emergency, it may be necessary for the surgeon to operate as a lifesaving measure without the client's or parent's informed consent. Informed consent must be obtained before any invasive procedure. A minor cannot consent to a surgical procedure. The opinions of two doctors do not overrule the need to obtain informed consent.

A nurse knows that she must obtain a signed informed consent for which of the following procedures? Select all that apply. Arteriography Cystoscopy Insertion of a urethral catheter Insertion of a peripheral intravenous line Paracentesis Open reduction of a fracture

Arteriography Open reduction of a fracture Cystoscopy Paracentesis Informed consent is not currently required for insertion of an intravenous or urethral catheter.

The nurse is preparing a client for surgery. The client states that she is very nervous and really does not understand what the surgical procedure is for or how it will be performed. What is the most appropriate nursing action for the nurse to take? Call the physician to review the procedure with the client. Have the client sign the informed consent and place it in the chart. Provide the client with a pamphlet explaining the procedure. Explain the procedure clearly to the client and her family.

Call the physician 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 physician. The consent formed should not be signed until the client understands the procedure that has been explained by the surgeon. The provision of a pamphlet will benefit teaching the client about the surgical procedure, but will not substitute for the information provided by the physician.

Why should the nurse be vigilant with assessment of perioperative risks on the older adult client? Select all that apply. Liver size decreases, reducing the metabolism of anesthetics. Peristalsis increases. Fatty tissue increases, prolonging the effects of anesthesia. Ciliary action decreases, reducing the cough reflex. The elasticity of skin increases and decreases the risk of shearing.

Ciliary action decreases, reducing the cough reflex. Fatty tissue increases, prolonging the effects of anesthesia. Liver size decreases, reducing the metabolism of anesthetics. Lower doses of anesthetic agents are required in older adults due to decreased tissue elasticity (lung and cardiovascular systems) and reduced lean tissue mass. Older clients often experience an increase in the duration of clinical effects of medications. With decreased plasma proteins, more of the anesthetic agent remains free or unbound, and the result is more potent action. In addition, body tissues of the older adult are made up predominantly of water, and those tissues with a rich blood supply, such as skeletal muscle, liver, and kidneys, shrink as the body ages.

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. Consent must be notarized. Consent must be freely given. Consent must normally be obtained by a physician. Signature must be witnessed by a professional staff member. Consent must be signed on the day of surgery.

Consent must be freely given. Consent must normally be obtained by a physician. Signature must be witnessed by a professional staff member. Valid consent must be freely given, without coercion. Consent must be obtained by a physician 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.

When creating plans of nursing care for clients who are undergoing surgery using general anesthetic, what nursing diagnoses should the nurse identify? Select all that apply. Risk for impaired nutrition: less than body requirements related to anesthesia Disturbed body image related to anesthesia Anxiety related to surgical concerns Disturbed sensory perception related to anesthetic Risk of latex allergy response related to surgical exposure

Disturbed sensory perception related to anesthetic Risk of latex allergy response related to surgical exposure Anxiety related to surgical concerns Based on the assessment data, some major nursing diagnoses may include the following: anxiety related to surgical or environmental concerns, risk of latex allergy response due to possible exposure to latex in the OR environment, risk for perioperative positioning injury related to positioning in the OR, risk for injury related to anesthesia and surgical procedure, or disturbed sensory perception (global) related to general anesthesia or sedation. Malnutrition and disturbed body image are much less likely.

A postoperative client is being discharged home after minor surgery. The PACU nurse is reviewing discharge instructions with the client and the client's spouse. What actions by the nurse are appropriate? Select all that apply. Provide information on health promotion topics. Educate on activity limitations. Have the client sign his or her advance directive form. Have the spouse review when to notify the physician. Discuss wound care.

Educate on activity limitations. Discuss wound care. Have the spouse review when to notify the physician. Provide information on health promotion topics. The nurse should provide education on activity limitations and wound care, and should review complications that require notification to the physician. The nurse should also provide information regarding health promotion topics, such as weight management and smoking cessation. The client should not make any major decisions or sign any legal forms because of the effects of anesthesia.

The nurse is reviewing a preoperative informed consent when preparing the client for surgery. Which contents of the informed consent are required? Select all that apply. Estimated time of procedure Benefits of surgery Potential risks Personnel present Explanation of procedure Description of alternatives

Explanation of procedure Potential risks Benefits of surgery Description of alternatives Informed consents should be in writing and contain an explanation of procedure and risks, description of benefits and alternative, an offer to answer questions about procedure, ability to withdraw consent, and statement informing the client if the protocol differs from customary procedure. An estimated time of procedure and personnel present are not required in the informed consent.

A nurse is reviewing with a client the use of a patient-controlled anesthesia device and is explaining the benefits. Which of the following would the nurse correctly emphasize? Select all that apply. Facilitates reduction of postoperative pulmonary complications Fosters client participation in care Delays administration of analgesics Prevents drowsiness Allows drug levels to fluctuate with the client's vital signs

Fosters client participation in care Facilitates reduction of postoperative pulmonary complications PCA promotes client participation in care, eliminates delayed administration of analgesics, maintains a therapeutic drug level, and enables the client to move, turn, cough, and take deep breaths with less pain, thus reducing postoperative pulmonary complications.

A client has been administered ketamine for moderate sedation. What is the priority nursing intervention? Assessing for hallucinations Administering oxygen Frequently monitoring vital signs Providing a quiet dark room for recovery

Frequently monitoring vital signs Vital signs must be monitored frequently to assess for respiratory depression and to enable quick intervention. Oxygen may need to be administered if respiratory depression occurs; therefore, monitoring vital signs is a higher priority nursing intervention. Providing a dark quiet room is appropriate after the procedure is completed and the client is recovering. Hallucinations may occur as a side effect of the medication.

The nurse is caring for a postoperative client with a history of congestive heart failure and peptic ulcer disease. The client is highly reluctant to ambulate and will not drink fluids except for hot tea with her meals. The client's vital signs are slightly elevated and she has a nonproductive cough. The nurse auscultates crackles at the base of the lungs. What complication should the nurse first suspect? Pulmonary embolism Hypostatic pulmonary congestion Malignant hyperthermia Hypervolemia

Hypostatic pulmonary congestion Hypostatic pulmonary congestion, caused by a weakened cardiovascular system that permits stagnation of secretions at lung bases, may develop; this condition occurs most frequently in elderly clients who are not mobilized effectively. The symptoms are often vague, with perhaps a slight elevation of temperature, pulse, and respiratory rate, as well as a cough. Physical examination reveals dullness and crackles at the base of the lungs. If the condition progresses, then the outcome may be fatal. A pulmonary embolism does not have this presentation and hypervolemia is unlikely due to the client's low fluid intake. Malignant hyperthermia occurs concurrent with the administration of anesthetic.

The nurse admits a client to the PACU with a blood pressure of 132/90 mm Hg and a pulse of 68 beats per minute. After 30 minutes, the client's blood pressure is 94/47 mm Hg, and the pulse is 110. The nurse documents that the client's skin is cold, moist, and pale. Of what is the client showing signs? Neurogenic shock Hypovolemic shock Malignant hyperthermia Hypothermia

Hypovolemic shock The client is exhibiting symptoms of hypovolemic shock; therefore, the nurse should notify the client's physician and anticipate orders for fluid and/or blood product replacement. Neurogenic shock does not normally result in tachycardia and malignant hyperthermia would not present at this stage in the operative experience. Hypothermia does not cause hypotension and tachycardia.

The intraoperative nurse is implementing a care plan that addresses the surgical client's risk for vomiting. Interventions that address the potential for vomiting reduce the risk of what subsequent surgical complication? Hypoxia Impaired skin integrity Hypothermia Malignant hyperthermia

Hypoxia If the client aspirates vomitus, an asthma-like attack with severe bronchial spasms and wheezing is triggered. Pneumonitis and pulmonary edema can subsequently develop, leading to extreme hypoxia. Vomiting can cause choking, but the question asks about aspirated vomitus. Malignant hyperthermia is an adverse reaction to anesthesia. Aspirated vomitus does not cause hypothermia. Vomiting does not result in impaired skin integrity.

A nurse is planning preoperative teaching for an older client. Which structural or functional changes in the older adult impact the surgical experience? Select all that apply. Loss of collagen increases the risk of skin complications. Reduced tactile sensitivity can lead to assessment and communication problems. Increased fatty tissue prolongs elimination of anesthesia. Increased plasma proteins decrease the effects of anesthesia. Decreased ability to compensate for hypoxia increases the risk of an embolism. Enlarged liver, due to fatty deposits, alters the breakdown of anesthetic agents.

Increased fatty tissue prolongs elimination of anesthesia. Decreased ability to compensate for hypoxia increases the risk of an embolism. Loss of collagen increases the risk of skin complications. Reduced tactile sensitivity can lead to assessment and communication problems. The older adult has increased fatty tissue which prolongs elimination of anesthesia, decreased ability to compensate for hypoxia increases the risk of an embolism, loss of collagen increases the risk of skin complications, and reduced tactile sensitivity can lead to assessment and communication problems. The older adult has decreased plasma proteins, and no enlarged liver unless there is an underlying disease.

The nurse is preparing to send a client to the OR for a scheduled surgery. What should the nurse ensure is on the chart when it accompanies the client to surgery? Select all that apply. Social work assessment Laboratory reports Verification form Nurses' notes Dietitian's assessment

Laboratory reports Nurses' notes Verification form The completed chart (with the preoperative checklist and verification form) accompanies the client to the OR with the surgical consent form attached, along with all laboratory reports and nurses' records. Any unusual last-minute observations that may have a bearing on anesthesia or surgery are noted prominently at the front of the chart. The social work and dietitian's assessments are not normally necessary when the client goes to surgery.

A patient is complaining of a headache after receiving spinal anesthesia. What does the nurse understand may be the cause of the headache related to the spinal anesthesia? (Select all that apply.) An allergic reaction to the medication used Degree of patient hydration The patient lying in the supine position Leakage of spinal fluid from the subarachnoid space Size of the spinal needle used

Leakage of spinal fluid from the subarachnoid space Size of the spinal needle used Degree of patient hydration Headache may be an aftereffect of spinal anesthesia. Several factors are related to the incidence of headache: the size of the spinal needle used, the leakage of fluid from the subarachnoid space through the puncture site, and the patient's hydration status. Measures that increase cerebrospinal pressure are helpful in relieving headache. These include maintaining a quiet environment, keeping the patient lying flat, and keeping the patient well hydrated. A headache is not likely to occur as the result of the patient lying in the supine position or of an allergic reaction to the medication.

A postanesthesia care unit (PACU) nurse is caring for a client with the following assessment data: pale, cool, moist skin; thready pulse of 122; blood pressure 78/60; urine output of 25 mL/h; temperature 99.2°F. What interventions by the nurse are appropriate? Select all that apply. Administer blood products per orders. Apply a warming blanket. Raise the head of the bed 30 degrees. Frequently monitor neurological status. Apply oxygen per orders. Maintain a patent airway.

Maintain a patent airway. Frequently monitor neurological status. Administer blood products per orders. Apply oxygen per orders. The client is demonstrating signs and symptoms of shock. A client in shock may lose the ability to protect the airway. Frequent neurological assessment can provide information related to a decrease in oxygen to the brain. Administering blood products may reverse the signs and symptoms of shock. There is an increased need for oxygen when in shock, so it is appropriate to apply oxygen. The head of the bed should not be elevated. The client should be lying flat or in the Trendelenburg position.

Mr. McLeod has been admitted to the postsurgical unit from PACU after a transurethral prostatic resection (TUPR). Mr. McLeod has continuous bladder irrigation running to prevent clotting and his Foley catheter is draining appropriately. His vital signs on admission reveal a blood pressure of 171/ 98 despite the fact that he has no documented history of hypertension. What factor most likely accounts for Mr. McLeod's present increase in blood pressure? Mr. McLeod is showing signs and symptoms of malignant hyperthermia. Mr. McLeod's sympathetic nervous system is stimulated, possibly by pain. Mr. McLeod is experiencing a postoperative hemorrhage. Mr. McLeod is fluid overloaded from the intraoperative administration of IV fluids.

Mr. McLeod's sympathetic nervous system is stimulated, possibly by pain. Postoperative hypertension is often the result of sympathetic nervous system stimulation from pain, hypoxia, or bladder distention. This is more likely than fluid volume excess. This patient's presentation is not consistent with malignant hyperthermia or hemorrhage.

During the admission history the client reports to the nurse of taking the usual dose of warfarin the previous day. What is an appropriate nursing action? Notify the surgeon that the client took warfarin the day before surgery. Put a note on the preoperative checklist before sending the client into surgery. No action is needed, because the client takes warfarin on a continuing basis. Tell the client to inform the circulating nurse before the anesthesia is administered.

Notify the surgeon that the client took warfarin the day before surgery. Warfarin (Coumadin), an anticoagulant, places the client at risk for excessive bleeding during the intraoperative and postoperative periods.

A client is administered succinylcholine and propofol for induction of anesthesia. One hour after administration, the client demonstrates muscle rigidity with a heart rate of 180. What should the nurse do first? Document the assessment findings. Obtain cooling blankets. Notify the surgical team. Administer dantrolene sodium.

Notify the surgical team. Tachycardia and muscle rigidity are often the earliest signs of malignant hyperthermia. Early recognition of malignant hyperthermia increases survival. The nurse would document the findings, and administer dantrolene sodium, obtain cooling blankets as part of the treatment for malignant hyperthermia, but the nurse would need to ensure the surgical team is aware of the findings first.

A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention? Oxygen saturation (SaO2) of 85% Heart rate of 84 beats/minute Blood-tinged stools Decreased cough and gag reflexes

Oxygen saturation (SaO2) of 85% Normal SaO2 is 95% to 100%. Oxygen saturation of 85% indicates inadequate oxygenation, which may be a consequence of the moderate sedation. Appropriate nursing actions include rousing the client, if necessary, assisting the client with coughing and deep breathing, and evaluating the need for additional oxygen. A heart rate of 84 beats/minute is within normal limits. Colonoscopy doesn't affect cough and gag reflexes, although these reflexes may be slightly decreased from the administration of sedation. These findings don't require immediate intervention. Blood-tinged stools are a normal finding after colonoscopy, especially if the client had a biopsy.

Which of the following factors may contribute to rapid and shallow respirations in a postoperative client? Select all that apply. Pain Effects of analgesics and anesthesia Abdominal distention Constricting dressings Obesity

Pain Constricting dressings Abdominal distention Obesity Often, because of the effects of analgesic and anesthetic medications, respirations are slow. Shallow and rapid respirations may be caused by pain, constricting dressings, gastric dilation, abdominal distention, or obesity.

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? Circulating nurse Anesthesiologist Registered nurse first assistant Surgeon

Surgeon It is the surgeon's responsibility to explain the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts in obtaining informed consent from the client.

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 save her life. How should the need for informed consent be addressed? A social worker should temporarily sign the informed consent. Surgery should be delayed until the parents arrive. Surgery should be done without informed consent. Consent should be obtained from the hospital's ethics committee.

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 reviewing a list of surgical clients. Which clients would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period? Select all that apply. The 70-year-old client who takes no routine medications. The 25-year-old client who occasionally smoked marijuana in high school. The 27-year-old client with non-insulin dependent diabetes. The 47-year-old client who stopped smoking 4 years ago. The 43-year-old client with past surgeries.

The 27-year-old client with non-insulin dependent diabetes. The 70-year-old client who takes no routine medications. The client with diabetes is at risk for complications during the intraoperative or postoperative period. Hypoglycemia can develop during anesthesia or from inadequate carbohydrate intake or excess insulin administration postoperatively. Hyperglycemia can increase the risk for wound infection and delay wound healing. The older adult is at risk for complications because of his or her advanced age. The client with past surgeries is not at more risk for complications. Smokers are encouraged to stop 4 to 8 weeks before surgery. Recent illicit drug use can increase the risk for adverse reactions to anesthesia.

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? The surgeon The client The client's next of kin The client's spouse

The client A client with a new diagnosis of Alzheimer disease would be unlikely to have been declared incompetent; the client would consequently be required to personally provide informed consent.

A nurse is working in the postanesthesia unit (PACU). What evidence indicates that a client is ready for discharge from the PACU? Select all that apply. The client rates pain a 9 out of 10 on a 0-10 scale after receiving morphine sulfate. The client has been extubated, but still has an oropharyngeal airway in. The client is arousable, but falls back to sleep rapidly. The client has sonorous respirations and occasionally requires chin lift. The client has a blood pressure within 10 mm Hg of the baseline.

The client is arousable, but falls back to sleep rapidly. The client has a blood pressure within 10 mm Hg of the baseline. A client remains in the PACU until fully recovered from the anesthetic agent. Indicators of recovery include stable blood pressure, adequate respiratory function (no artificial airways or need of a chin tilt lift), and adequate oxygen saturation level compared with baseline. Pain levels are not considered when transferring clients out of PACU.

The OR nurse is taking the client into the OR when the client informs the operating nurse that his grandmother spiked a very high temperature in the OR and nearly died 15 years ago. What relevance does this information have regarding the client? The client may be at risk for a sudden onset of postsurgical infection. The client may be at risk for malignant hyperthermia. The client may be experiencing presurgical anxiety. The grandmother's surgery has minimal relevance to the client's surgery.

The client may be at risk for malignant hyperthermia. Malignant hyperthermia is an inherited muscle disorder chemically induced by anesthetic agents. Identifying clients at risk is imperative because the mortality rate is 50%. The client's anxiety is not relevant, the grandmother's surgery is very relevant, and all clients are at risk for hypothermia.

The circulating nurse in an outpatient surgery center is assessing a client who is scheduled to receive moderate sedation. What principle should guide the care of a client receiving this form of anesthesia? The client should begin a course of antiemetics the day before surgery. The client should be informed that he or she will remember most of the procedure. The client must be able to maintain his or her own airway. The client must never be left unattended by the nurse.

The client must never be left unattended by the nurse. The client receiving moderate sedation should never be left unattended. The client's ability to maintain his or her airway depends on the level of sedation. The administration of moderate sedation is not a counter indication for giving an antiemetic. The client receiving moderate sedation does not remember most of the procedure.

The physician requests lidocaine 2% with epinephrine for use in local infiltration anesthesia. What does the nurse understand is the purpose of adding epinephrine to the lidocaine? (Select all that apply.) The epinephrine prolongs the local action of the anesthetic agent. The lidocaine will not anesthetize the area locally without the epinephrine. The epinephrine prevents rapid absorption of the anesthetic drug. The epinephrine will prevent the patient from having an allergic reaction to the lidocaine. The epinephrine causes vasoconstriction.

The epinephrine causes vasoconstriction. The epinephrine prevents rapid absorption of the anesthetic drug. The epinephrine prolongs the local action of the anesthetic agent. Local anesthesia is often administered in combination with epinephrine. Epinephrine constricts blood vessels, which prevents rapid absorption of the anesthetic agent and thus prolongs its local action and prevents seizures.

A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse bases her next action on the principle that: it may be necessary to raise the head of this client's bed. inserting a Foley catheter can decrease fluid retention. this client may need intubation. administering I.V. antibiotics can prevent pneumonia.

it may be necessary to raise the head of this client's bed. The nurse should consider positioning when caring for a client who has COPD and difficulty breathing. Elevating the head of the bed assists these clients in breathing. There's no indication that it's necessary to intubate the client. A Foley catheter isn't indicated. Prophylactic I.V. antibiotics aren't administered with moderate sedation.

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication? malignant hyperthermia infection hypothermia fluid volume excess

malignant hyperthermia Malignant hyperthermia is an inherited disorder that occurs when body temperature, muscle metabolism, and heat production increase rapidly, progressively, and uncontrollably in response to stress and some anesthetic agents. If the client's temperature begins to rise rapidly, anesthesia is discontinued, and the OR team implements measures to correct physiologic problems, such as fever or dysrhythmias. Hypothermia is a lower than expected body temperature. Signs of infection would not present during the procedure. Increased body temperature would not indicate fluid volume excess.