Ch14 prepu

The nurse expects informed consent to be obtained for insertion of:

A gastrostomy tube

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

Peripherally-inserted central catheter.

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

Use diaphragmatic breathing.

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency?

Adrenal

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

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. Provide written information. Use hand gestures to communicate. Speak slowly so the client can lip read. Talk loudly into one of the client's ears. Plan for a sign language interpreter.

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

What action by the nurse best encompasses the preoperative phase?

Educating clients on signs and symptoms of infection Educating clients on preventing or recognizing complications begins in the preoperative phase. Applying SCDs and frequently monitoring vital signs happen after the preoperative phase. Only electric clippers should be used to remove hair.

A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results? A serum creatinine level of 0.9 mg/dL A creatine kinase level of 120 U/L A urine creatinine level of 1.2 mg/dL A blood urea nitrogen level of 42 mg/dL

A blood urea nitrogen level of 42 mg/dL

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 A urine output of 60 mL/hr is within normal limits. A pulse of 88 beats per minute is within normal limits. A respiratory rate of 20 breaths per minute is within normal limits.

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? Aging processes reduce the chances that surgery will be successful for these clients. Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. All older people face similar risks when undergoing surgeries. Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.

Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.

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 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 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

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 is doing a preoperative assessment of an 87-year-old man who is slated to have a right lung lobe resection to treat lung cancer. What underlying principle should guide the nurse's preoperative assessment of an elderly client?

Elderly clients have less physiologic reserve than younger clients.

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

Emergent

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 Registered nurse first assistant Circulating nurse Anesthesiologist

Surgeon

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

For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery?

7

The policies and procedures on a preoperative unit are being amended to bring them closer into alignment with the focus of the Surgical Care Improvement Project (SCIP). What intervention most directly addresses the priorities of the SCIP?

Actions aimed at preventing surgical site infections

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 Surgical history Medical history Current medications History of present illness

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 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.

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

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. Check that all surgical personnel are properly attired. Ensure that sufficient surgical supplies are available. Confirm that informed consent has been obtained.

Review the scheduled procedure, site, and client.

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. rationale: 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. Smokers are encouraged to stop 4 to 8 weeks before surgery. Recent illicit drug use can increase the risk for adverse reactions to anesthesia. Healthy older adults are not at increased risk

The nurse is educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate? Intraoperative techniques used to perform the surgery Expected pain levels and narcotic medications used to treat the pain Risks and benefits of the surgical procedures Three phases of surgery and safety measures for each phase

Three phases of surgery and safety measures for each phase

When is the ideal time to discuss preoperative teaching

Preadmission visit

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? hypoglycemia obstruction adrenal insufficiency surgical site infection

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; nutritional status; use of alcohol, tobacco, and other substances; and physical condition.

A nurse is caring for a bariatric client prior to a surgical procedure. What surgical complications would the nurse monitor the bariatric client for postoperatively? Select all that apply.

cardiovascular complications pulmonary complications Rationale: The cardiovascular system is at risk for complications with obese surgical clients because of hypertension and diabetes complications. The client tends to have shallow respirations when supine, increasing the risk of hypoventilation and postoperative pulmonary complications

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. Intraoperative care includes the entire surgical procedure. During sedation, the nurse continuously evaluates the client. Assessment of heart rate, respiratory rate, BP, oxygen saturation, and level of consciousness occurs during all phases of perioperative care. Obtaining consent would occur during the preoperative phase of perioperative care. During the postoperative phase the nurse would assess how the client is recovering from anesthesia.

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

emergency.

An example of a curative surgical procedure is

tumor excision. A biopsy, a face-lift, and the placement of a gastrostomy tube are not examples of curative surgical procedures.

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

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 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 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. Ensure surgical site has been marked. Verify completion of diagnostic testing. Ask client to sign the consent for the surgery.

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

The nurse recognizes that the client most at risk for mortality associated with surgery is the:

Client with chronic alcoholism

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 Clients who smoke are more likely to experience poor wound healing, a higher incidence of surgical site infections, and complications that include venous thromboembolism and pneumonia

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 nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? Make inhalation longer than exhalation. Exhale through an open mouth. Use diaphragmatic breathing. Use chest breathing

Use diaphragmatic breathing. In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.