17 prepU Med Surg assessment of respiratory
The nurse is assisting the client with imagery as a relaxation strategy. Which statement by the client describes imagery?
"I am lying on the beach in Florida."
The nurse is preparing a client for surgery. The nurse would notify the surgeon if the client made which of the following statements? Select all that apply.
"I took my Coumadin as usual last evening." "I took two aspirins for joint pain this morning."
A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective?
"I will support my incision with my hands when I cough and do my deep breathing exercises."
A client with a history of alcoholism is scheduled for urgent surgery. The client asks the nurse, "Why is everyone so concerned about how much I drink?" What is the best response by the nurse?
"It is important for us to know how much and how often you drink to help prevent surgical complications."
Which nursing statement would best decrease a client's anxiety before an emergency operative procedure?
"Let me explain to you what will happen next."
You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply?
"Many people have diagnostic or short therapeutic surgical procedures."
The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed?
"The nurse will explain the details of the surgery before I sign a consent."
The nurse is completing a preoperative assessment. The nurse notices the client is tearful and constantly wringing their hands. The client states, "I'm really nervous about this surgery. Do you think it will be ok?" What is the nurse's best response?
"What are your concerns?"
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."
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery?
7
A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery?
7 to 10 days
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?
80 to 110 mg/dL
The nurse recognizes that which of the following clients is at least risk for perioperative complications?
A 65-year-old Caucasian man who has a history of arthritis
A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?
A blood urea nitrogen level of 42 mg/dL
The nurse expects informed consent to be obtained for insertion of:
A gastrostomy tube
A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery?
A history of diabetes
The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?
A safe environment
Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency?
Adrenal
A client refuses to remove her wedding band when preparing for surgery. What is the bestaction for the nurse to take?
Allow the client to wear the ring and cover it with tape.
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
You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear?
Anxious clients have a poor response to surgery and are prone to complications.
A nurse knows that she must obtain a signed informed consent for which of the following procedures? Select all that apply.
Arteriography Open reduction of a fracture Cystoscopy Paracentesis
The nurse recognizes that the client most at risk for mortality associated with surgery is the:
Client with chronic alcoholism
The nurse is assigned a client scheduled for an outpatient colonoscopy in an ambulatory care setting. During which phase of perioperative care would the nurse document the admission vital signs in the recovery room?
During the postoperative phase
At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period?
During the preoperative period
What action by the nurse best encompasses the preoperative phase?
Educating clients on signs and symptoms of infection
The nurse is conducting a preoperative assessment on a client scheduled for gallbladder surgery. The client reports a frequent cough producing green sputum for 3 days and denies fever. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiratory wheeze. Respiratory rate is 20, temperature is 99.8 (taken orally), heart rate is 87, and blood pressure is 124/70. What is the best action by the nurse?
Notify the surgeon to possibly delay the surgery.
During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse?
Notify the surgical team to remove all latex-based items.
An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults?
Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.
A patient is scheduled for a reduction mammoplasty. What classification of surgery does the nurse understand that this is?
Optional
A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications?
Osteoporosis
The nurse recognizes that written informed consent is required for insertion of a(n):
Peripherally-inserted central catheter.
Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery?
Physician
The nurse in the preoperative area has just medicated her client according to the anesthesiologist's orders. What is the nurse's priority action at this time?
Place the side rails in the up position and make sure the call button is in reach.
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
When is the ideal time to discuss preoperative teaching
Preadmission visit
A client is preparing to undergo a curative surgical procedure. Which of the following is the type of surgery the client could be having? Select all that apply.
Removal of a diseased appendix Removal of a tumor
A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?
Request that the surgeon come and answer the questions.
As a nurse working in an ambulatory surgery center, you are admitting a client who is going to have a biopsy of a skin lesion. What is an important part of the preoperative process?
Review preoperative instructions.
Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out?
Review the scheduled procedure, site, and client.
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications?
Splint the incision site using a pillow during deep breathing and coughing exercises.
The nurse is aware that the amino acid, arginine,
Stimulates T-cell response
Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period?
The 35-year-old client with non-insulin dependent diabetes.
The nurse is caring for the client in the preoperative period and documenting rationale for a palliative surgical procedure. Which rationale is most appropriate?
The client and physician are focusing on symptom relief not a cure.
A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed?
The client exhales forcefully with a short expiration.
The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities?
The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times.
How does the nurse determine that the patient may have hidden fears about the impending surgical procedure? (Select all that apply.)
The patient avoids communication with the nurse. The patient repeatedly asks questions that have previously been answered. The patient talks incessantly.
The nurse is educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate?
Three phases of surgery and safety measures for each phase
Sudden withdrawal of which of the following may result in seizures?
Tranquilizers
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?
Use diaphragmatic breathing.
The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. Which of the following is the most important function?
Verifies that operative consent is signed
The nurse would identify which vitamin deficiency to prevent hemorrhaging during surgery?
Vitamin k
The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician?
When the patient's blood ammonia concentration reaches 180 mg/dL
A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client?
adrenal insufficiency
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:
continuously monitors the sedated client.
A physically fit older adult is scheduled for right knee replacement. What factor for the client creates an increased risk for postoperative complications?
current smoking history
A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia?
diuretics
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as
emergency
A fractured skull would be classified under which category of surgery based on urgency?
emergent
Which domain of perioperative nursing practice focuses on clinical processes and outcomes?
health care systems
A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for?
hypoglycemia
In advance of a client's scheduled appendectomy, the nurse spends significant time explaining to the client what will happen, both before the procedure and after the procedure is complete. The primary reason the nurse puts so much effort into preoperative teaching is to:
increase the likelihood of a successful recovery
The nurse is physically preparing a client for surgery. What immediate pre-operative concerns would the nurse address before the client is taken to the operating room? Select all that apply.
medication elimination care of glasses
The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply.
nutritional status age physical condition health status
A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply.
postoperative pain control cough and deep-breathing exercises intravenous fluids and other lines and tubes
The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which laboratory value would be of greatest concern to the nurse?
potassium 6.2 mEq/L
The nurse is educating a community group about types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true?
tumor excision
A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for kidney stones the next day. What category of surgery does this procedure fall into?
urgent
Following diagnostic testing, a patient requires a cholecystectomy. This surgical procedure would be categorized as which of the following?
urgent
A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which client surgical risk factor would decrease if the surgical client maintained strict blood glycemic control?
wound healing
