Ch 14: Preoperative Nursing Management

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."

Which nursing statement would best ease 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 recognizes that which of the following clients is at the lowest risk for perioperative complications?

A client who has a history of arthritis

The nurse 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 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

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.

Age, Health status, Nutritional status, Physical condition

A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?

Allow the client to wear the ring and cover it with tape

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

A client schedules to have total hip replacement surgery in 2 weeks. Which activities will the nurse complete during preadmission testing within the preoperative phase? Select all that apply.

Begin client teaching, Complete initial assessment, Verify completion of diagnostic testing

During the preoperative assessment, the nurse learns that the client has been taking prednisone. The nurse realizes that the client is at risk for:

Cardiovascular collapse

The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following?

Cheeseburger, french fries, coleslaw, and ice cream

A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply.

Cough and deep-breathing exercises, Intravenous fluids and other lines and tubes, Postoperative pain control

The client is scheduled for a biopsy for suspected cancer of the prostate. The nurse recognizes the purpose of this surgical procedure is:

Diagnostic

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

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

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as

Emergency

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

Emergent surgery

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

Hypoglycemia

A client taking chlorpromazine is preparing to undergo surgery. Which of the following complications does the surgical team need to prepare to deal with before anesthetics are administered?

Hypotension

A client with a skull fracture after falling from a ladder requires surgery. The nurse should anticipate transporting the client to surgery during what time frame?

Immediately

A client asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate?

It prevents aspiration and respiratory complications.

The nurse is aware that a religious group that refuses blood transfusions for religious reasons is:

Jehovah's Witnesses

A client reports getting a rash when eating kiwi and bananas. For which potential allergy will the nurse plan care for this client?

Latex

A client is undergoing preoperative assessment. During admission paperwork, the client reports having enjoyed a hearty breakfast this morning to be ready for the procedure. What is the nurse's next action?

Notify the surgeon.

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.

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

Optional

Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery?

Physician

You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility?

Place gauze under and over the ring and apply adhesive tape over it.

The nurse has administered preanesthetic medication. What action should the nurse take next?

Place the client on bed rest with the side rails up

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.

A client who is deaf without bilateral hearing aids has them removed in preparation for a surgical procedure. Which action(s) will the nurse take to communicate with this client? Select all that apply.

Plan for a sign language interpreter, Provide written information, Speak slowly so the client can lip read, Use hand gestures to communicate

The nurse is caring for a client needing emergency surgery. Which preoperative teaching can be omitted when preparing the client for surgery?

Post-discharge diet

When is the ideal time to discuss preoperative teaching

Preadmission visit

In which phase of perioperative care will the nurse prepare the client's skin, encourage the client to void, and remove the client's dentures?

Preoperative

What is the major purpose of withholding food and fluid before surgery?

Prevent aspiration

A client is scheduled to have surgery to address a cleft palate. What type of surgery would the nurse be preparing this client for?

Reconstructive

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

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

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.

When does the nurse understand the patient is knowledgeable about the impending surgical procedure?

The patient participates willingly in the preoperative preparation.

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

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period?

Up to 72 hours after alcohol withdrawal

A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for kidney stones the next day. What category of surgery does this procedure fall into?

Urgent

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

Use diaphragmatic breathing

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

Vitamin K

Which nutrient plays an important role in normal blood clotting?

Vitamin K

The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed?

"The nurse will explain the details of the surgery before I sign a consent."

A client with type 2 diabetes is scheduled for surgery. For which potential complication(s) will the nurse plan care for this client? Select all that apply.

Acidosis, Glucosuria, Hypoglycemia, Hyperglycemia

A client has been transported to the operating room for emergent surgery. Which statement by the nurse best supports the need for emergent surgery?

"The client was unresponsive, had a distended abdomen, and had unstable vital signs after a motor vehicle accident."

A nurse knows that she must obtain a signed informed consent for which of the following procedures? Select all that apply.

Arteriography, Cystoscopy, Open reduction of a fracture, Paracentesis

A client scheduled for surgery follows a vegan eating plan. For which potential postoperative complication will the nurse plan care for this client?

Delayed wound healing

Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern?

Surgeon

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 bestresponse by the nurse?

"It is important for us to know how much and how often you drink to help prevent surgical complications."

The nurse is teaching leg exercises to the client preoperatively. The client asks why the exercises are important. The best response by the nurse is:

"Leg exercises help prevent blood clots in your legs."

The nurse is preparing the medical record for a client scheduled for surgery. Which item(s) will the nurse ensure are in the history and physical? Select all that apply.

Allergies, Current medications, History of present illness, Medical history, Surgical history

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.

Care of glasses, Elimination, Medication

A client scheduled for surgery asks why blood tests are being done to evaluate liver function. Which response will the nurse make?

"It is because the anesthesia you will receive is cleared through the liver."

You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear?

Anxious clients have a poor response to surgery and are prone to complications

The nurse is caring for a client who has just arrived for surgery. Which assessment finding indicates to the nurse that the client may be experiencing dehydration because of taking nothing by mouth after midnight for the surgery?

Blood pressure 80/50 mm Hg

Which is the least important issue concerning safety for the perioperative team before proceeding to the operating room?

Client's ambulatory aids

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 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 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."

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?

80 to 110 mg/dL

A client continuously repeats, "I know all will go well." What cognitive coping strategy should the nurse document?

Optimistic self-recitation

A client is having surgery through an ambulatory surgical center. Which information will the nurse provide to the client's family?

"The client will go to the postanesthesia care unit after the surgery."

At what point does the preoperative period end?

When the client is transferred onto the operating table

A client is scheduled for an invasive procedure. What should the nurse document in the chart regarding the procedure?

A signed consent form from the client

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

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.

Decreased ability to compensate for hypoxia increases the risk of an embolism, Increased fatty tissue prolongs elimination of anesthesia, Loss of collagen increases the risk of skin complications, Reduced tactile sensitivity can lead to assessment and communication problems

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."

The patient asks the nurse why food is withheld before surgery. What is the best response by the nurse?

"Aspiration is a concern and can be a complication if food or fluid is taken close to the surgery time."

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

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

A client will undergo abdominal surgery. The nurse provides preoperative education regarding the importance of diaphragmatic breathing exercises to prevent postoperative complications... The nurse will educate the client about the risk for developing __________, ______________, and _____________, if the client does not implement diaphragmatic breathing exercises in the postoperative period of care.

Atelectasis, Bronchospasm, Pneumonia

The nurse is providing preoperative teaching to a client scheduled for surgery. Place in order the instructions the nurse will provide the client to perform diaphragmatic breathing. Use all options.

Breathe out gently and fully to feel the ribs sink downward, Exhale and let all the air out through the nose and mouth, Hold the breath for a count of five, Place bed in at 30- to 45-degree angle, Place the hands on the front of the lower ribs, Practice this breathing twice a day before the surgery, Repeat the exercise 15 times with a rest after each group of five, Take a deep breath through the nose and mouth to make the abdomen rise

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.

Why is assessment of dentition important in the patient preparing to have a surgical procedure with general anesthesia?

Decayed teeth or dental prosthesis can become dislodged during intubation

The nurse recognizes that the client who takes hydrochlorothiazide to manage hypertension is predisposed for which interaction with anesthesia?

Depression

What action by the nurse best encompasses the preoperative phase?

Educating clients on signs and symptoms of infection

A client with osteoarthritis receives a recommendation to have joint replacement surgery. For which type of surgery will the nurse plan teaching for this client?

Elective

A fractured skull would be classified under which category of surgery based on urgency?

Emergent

A client scheduled for surgery has a blood pressure of 186/90 mm Hg. After documenting this in the medical record, which action will the nurse take?

Notify the health care provider of the blood pressure.

The nurse notes that the consent form for surgery needs to be signed; however, the client just received preoperative medication. Which action will the nurse take?

Notify the health care provider that the consent form has not been signed.

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 bestaction by the nurse?

Notify the surgeon to possibly delay the surgery

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.

The nurse recognizes that written informed consent is required for insertion of a(n):

Peripherally-inserted central catheter

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

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.

A client is scheduled for surgery that will require bed rest and arrives for preoperative teaching. Which exercise will the nurse instruct the client to perform to decrease likelihood of venous thrombosis?

Side-lying bicycle riding

A client is scheduled for a spinal fusion to treat spinal stenosis. For which reason might the nurse anticipate surgery being delayed because of the risk for postoperative complications?

Smoking

Which nursing assessment finding indicates the preoperative client has not met expected outcomes?

Sobs uncontrollably about pending amputation of foot.

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 appropriate?

The client and physician are focusing on symptom relief not a cure

An example of a curative surgical procedure is

Tumor excision

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 nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which post-surgical risk factor would decrease if the surgical client maintained strict blood glycemic control?

Wound healing