PrepU Perioperative

The nurse expects informed consent to be obtained for insertion of

A gastrostomy tube

The nurse assesses an older adult patient who complains of dim division. What does this alert the nurse to plan for?

A safe environment

A client is postoperative day one after abdominal surgery. The client is receiving 0.9% normal saline at 75 ML/h, has a nasogastric tube to low wall suction with 200 mL every eight hours of light yellow fluid, and a wound drain with 50 mL of dark red drainage every eight hours. The 24 hour urine output total is 2430 mL. What action by the nurse is most appropriate?

Assess for signs and symptoms of fluid volume deficit

The post operative client is moving from the bed to a chair when blood drips from the dressing. The nurse assesses the incision and notes evisceration. What does the nurse do first?

Moisten sterile gauze with normal saline and place on the protruding organ.

A 33 year-old woman had a laparoscopic cholecystectomy performed this morning and was transferred at 15:00 To the post surgical unit from the PACU. It is now 16:30. At this point in the patient's recovery, what are the nursing priorities?

Monitoring and treating the patients pain, nausea, and vomiting

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.

A client is administered succinylcholine and propofol for induction of anesthesia. One hour after administration, the client demonstrates muscle rigidly with a heart rate of 180. What should the nurse do first?

Notify the surgical team

And OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position

On his back, with his head lower, so that the plane of his body meets the horizon of an angle

A circulating nurse is preparing a client for surgical procedure. What are the primary responsibilities of the circulating nurse in the perioperative experience? Select all that apply

1. Coordinating the efforts of the surgical team 2. Ensuring proper lighting 3. Verifying informed consent

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

1. Health status 2. Age 3. Physical condition 4. Nutritional status

Using the package room scoring guide, a nurse would give a patient an Admission cardiovascular score of two if the patient's blood pressure is what percentage of his or her pre-anesthetic level?

20%

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

Many meditations are available to control nausea and vomiting without over sedating the patient. At what point should a nurse normally administer anti-emetics to a surgical patient?

At the patient's first report of nausea

Nursing assessment findings revealed a temperature of 96.2°F, pulse oximetry 90%, shivering, and client complains of chilling. Which of the following actions by the nurse would be inappropriate

Restrict oral fluids

A 79-year-old man is scheduled for surgical repair of an inguinal hernia. In light of this patient's age, the nurse will prioritize nursing interventions aimed at preventing

Skin breakdown

Which findings would be indicated of a nursing diagnosis of decreased cardiac output?

Tachycardia: hemoglobin 10.9 g/dL: BP 88/56

Which client with 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

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.

A client develops a hemorrhage one hour post surgery. The nurse knows this is most likely an intermediary hemorrhage from a vein because it occurred

Within the first few hours, and has darkly colored blood that flows quickly.

Sudden withdrawal of which of the following may result in seizures?

tranquilizers

Nursing assessment findings revealed a temperature of 96.2°F, pulse oximetry of 90%, shivering, and client complains of chilling. The findings are indicated of which nursing diagnosis?

Ineffective thermoregulation

The nurse recognizes the client has reached stage III of general anesthesia when the client:

Has small pupils that react to light

A client develops malignant hyperthermia. What client symptoms with the nurse most likely observe as the first indicator of the disorder?

Heart rate over 150 bpm

You are admitting an insulin-dependent patient to the same day surgical suite for carpal tunnel surgery. You know that this patient may be at risk for which metabolic disorder?

Hyperglycemia

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

Which stage of surgical anesthesia is also known as excitement?

II

A novice nurse provides aftercare instructions to a client who has just had sutures removed. Which statement by the novice nurse requires the nurse preceptor to clarify? a patient to perform deep breathing and coughing to use postoperatively?

If the wound edges are red or raised, you should call your doctor

A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease. The nurse bases her next action on the principle that

It may be necessary to raise the head of this clients bed

Which nursing statement would best decrease a client anxiety before an emergency operative procedure?

Let me explain to you what will happen next

The nurse recognizes the client has reached stage three of general anesthesia when the client

Lies quietly on the table

Corticosteroids have which effect on wound healing?

Mask presence of infection

Which is the most common cause of anaphylaxis

Medications

The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery?

Post discharge diet

A nurse prepares to suction a clients tracheostomy tube. Place the procedure steps in correct order.

1. Position the client and Fowler's position. 2. Don sterile gloves. 3. Lubricate the sterile suction catheter 4. Insert suction catheter into the lumen of the tube. 5. Apply intermittent suction while withdrawing the catheter

A client who is receiving the maximum levels of pain medication for postoperative recovery asked the nurse if there are other measures that the nurse can employ to ease pain. Which of the following strategies might be a nurse employed? Select all that apply

1. Putting on soothing music 2. Changing the clients position 3. Performing guided imagery

A client is preparing to undergo a curative surgery procedure. Which of the following is the type of surgery the client could be having? Select all that apply

1. Removal of a disease appendix 2. Removal of a tumor

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 nurses best response? Select all that apply

1. The client can be involved in marking the knee, the site for the surgery. 2. The surgical team performs a time out prior to surgery to conduct a final verification. 3. The client will be involved in the verification process prior to surgery

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply

1. The patient will leave the hospital sooner than in the past. 2. Need for teaching is increased. 3. The client must be prepared to take on more self-care than here she may have done in the past.

The nurse is preparing to discharge a client from the PACU using a Packy room storing died. With what score candy client be transferred out of the recovery room?

7

Following a splenectomy, a client has a hemoglobin level of 7.5 g/dL, and a blood pressure lying in bed of 110/70 MMHG. The nurse suspects abnormal orthostatic changes when the client gets out of bed and reports vertigo. What vital sign value most supports the clients orthostatic changes

Blood pressure of 90/50 mm Hg

The client is experiencing intractable hiccups following surgery. What would the nurse expect the surgeon to order

Chlorpromazine

When the surgeon performs an appendectomy, the nurse recognizes that the surgical category will be defined as

Clean contaminated

The nurse is conducting a preoperative assessment on a client scheduled for gallbladder surgery. The client reports a frequent cough producing green sputum for three days and denies fever. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional Expiratory wheeze. Respiratory rate is 28, temperature is 99.8, heart rate is 87, and blood pressure is 124/70. What is the best action by the nurse?

Contact the surgeon to postpone the surgery

A PAC you nurse is caring for a postoperative client who received general anesthesia and has a hard, plastic oral airway in place. The patient has clear lung sounds, even and unlabored respirations of 16, and 98% oxygen saturation. The client is minimally responsive to pain stimuli. What action by the nurse is most appropriate

Continue with frequent client assessments.

What is the priority action by the scrub nurse when the surgery begins to close the surgical wound

Count the sponges

The nurse recognizes that a traumatic wound with fecal contamination would be Classified as

Dirty

A nurse evaluate the potential effects of a clients medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte in balance during anesthesia?

Diuretics

A nurse asks a client who had abdominal surgery one day ago if he has moved his bowels since surgery. The client states, "I haven't move my bowels, but I am passing gas." How should the nurse intervene?

Encourage the client to ambulate as soon as possible after surgery

A patient is scheduled for a reduction mammaplasty. What classification of surgery does the nurse understand that this is?

Optional

The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next?

Outline the drainage with a pen and record the date and time next to the drainage.

A nurse is reviewing the medication of a postoperative client. What medication related to the recent surgery may be of concern to the nurse?

Prednisone

To maintain their skill sets, the nurses here provide care in the OR of a large university hospital take turns acting in the circulating role and the scrub roll. Which of the following tasks is the sole domain of the scrub nurse?

Setting up a sterile field

A client asked the nurse about possible ill effects from general anesthesia. What is the best response by the nurse?

Some possible negative effects include difficulty waking up and slow heart rate

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

A client is receiving general anesthesia. The nurse and ethicist starts to administer the anesthesia. The client begins giggling and taking her legs. What stage of anesthesia would the nurse document related to the findings?

Stage II

The surgical client has been into baited and general anesthesia has been administered. The client exhibit cyanosis, shallow respirations, and a week, thready pulse. The nurse recognizes that the client is in which stage of general anesthesia?

Stage IV

A nurse is assessing the postoperative client on the second postoperative day. What assessment finding requires the nurse to immediately notify the healthcare provider?

The client has an absence of bowel sounds.

A nurse is caring for a client who is three hours postop from open abdominal surgery. During routine assessment, The nurse notes the previously stable client now appears anxious, apprehensive, and has a blood pressure of 90/56. What does the nurse consider is the most likely cause of the clients change in condition?

The client is displaying early signs of shock

The nurse is planning care for a client following abdominal surgery. Which outcome demonstrates a return of functioning to the gastrointestinal tract?

The client reports a small bowel movement.

A perioperative nurse is conducting an in-service education program about maintaining surgical asepsis during the intraoperative period. Which of the following with the nurse emphasize?

The edges of a sterile package, once opened, are considered unsterile.

A client asked the nurse how an inhalant general anesthetic is expelled by the body. What is the best response by the nurse?

The lungs primarily eliminate the anesthesia

How should a nurse teach a patient to perform deep breathing and coughing to use postoperatively?

The patient should take a deep breath in through the mouth and exhale all the air out through the mouth take a short breath, and cough from deep in the lungs.

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.

You are caring for a client who needs to ambulate. What considerations should be included when planning the postoperative ambulatory activities for the older adult?

Tolerance

A patient who is currently undergoing surgery has vomited a small amount of emesis. How should the OR nurse best respond to this intraoperative event?

Turn the patient on his or her side and perform oral suctioning

A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for a 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 instructions should the nurse include in the teaching?

Use diaphragmatic breathing

Which of the following clinical manifestations increase the rest of evisceration in the postoperative client?

Valsalva maneuver

The nurse is aware that which of the following nutrients promotes normal blood clotting?

Vitamin K

Which of the following is an inappropriate nursing action by the surgical nurse?

Wearing sterile gloves over artificial nails

The nurse is concerned that a postoperative patient may have a paralytic ileus. What assessment data may indicate that the patient does have a paralytic ileus?

absence of peristalsis

A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for

hypoglycemia