Ch17 Preoperative Nursing Management

Informed consent from the surgical client is not essential in what type of surgery

Emergent surgery

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

diagnostic

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

80 to 110 mg/dL

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

Several of the clients at the clinic are preparing to have surgery within the next 2 weeks. They are completing preoperative paperwork today with their visit. What are some of the reasons that people might need to have surgery? Select all that apply. a. Cosmetic b. Diagnostic c. Palliative d. Normative e. Causative

Cosmetic Diagnostic Palliative Reasons people have surgery include cosmetic reasons, diagnostic procedures, palliative surgeries, exploratory surgeries, and curative surgeries. Options D and E are distractors.

What action by the nurse best encompasses the preoperative phase? Educating clients on signs and symptoms of infection Documenting the application of sequential compression devices (SCDs) Monitoring vital signs every 15 minutes Shaving the client using a straight razor

Educating clients on signs and symptoms of infection

The nurse is aware that the amino acid, arginine,

Stimulates T-cell response

The physician schedules an elective surgical procedure for a patient who smokes cigarettes. When should the nurse recommend that the patient cease smoking before the surgical procedure to minimize risks associate with cigarette smoking?

1 to 2 months

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

7 days

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

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

optional

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

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 scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? UTI Osteoporosis Pregnancy Diabetes

Osteoporosis

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.

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

adrenal

The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery? Effective coughing and deep breathing Types of postoperative pain medication Post-discharge diet Knowledge of surgical procedure

Post-discharge diet

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 recognizes that the client most at risk for mortality associated with surgery is the: Client who is obese Client with chronic alcoholism Client with controlled diabetes Client with controlled hypertension

Client with chronic alcoholism

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 creatine kinase level of 120 U/L A serum creatinine level of 0.9 mg/dL A urine creatinine level of 1.2 mg/dL

A blood urea nitrogen level of 42 mg/dL

The nurse recognizes that which of the following clients is at the lowest risk for perioperative complications? A client who takes prednisone A client who takes clopidogrel A client who has a history of arthritis A client recently diagnosed with DM II

A client who has a history of arthritis

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. A)The client will leave the hospital sooner than in the past. B)Need for teaching is increased. C)The client must be prepared to take on more self-care than he or she may have done in the past. D)Discharge planning is minimal because the stay is so short. E)Home care and other referrals are unlikely because same-day surgeries are usually minor.

A) The client will leave the hospital sooner than in the past. B)Need for teaching is increased. C)The client must be prepared to take on more self-care than he or she may have done in the past The increasing use of ambulatory, same-day, or short-stay surgery, means that clients leave the hospital sooner, which increases the need for teaching, discharge planning, preparation for self-care, and referral for home care and rehabilitation services.

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 The best time to begin teaching about care needed in the postoperative period is during the preoperative time. At this time, the client is more alert and focused on the information provided by the nurse.

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? Documenting the application of sequential compression devices (SCDs) Shaving the client using a straight razor Monitoring vital signs every 15 minutes Educating clients on signs and symptoms of infection

Educating clients on signs and symptoms of infection

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.

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.

Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period? The 47-year-old client who stopped smoking 2 years ago. The 28-year-old client who occasionally smoked marijuana in high school. The 35-year-old client with non-insulin dependent diabetes. The 72-year-old client who takes no routine medications.

The 35-year-old client with non-insulin dependent diabetes.

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?

adrenal insufficiency

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?

diabetes

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

diaphragmatic breathing

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

hypoglycemia

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 activity support system

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 gender health status Ethnicity

nutritional status age physical condition health status

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." "I will ask for pain medication when the pain becomes unbearable." "I will need to learn how to give myself pain medication by injection for when I go home." "The pain from my incision will be very similar to my arthritis pain."

"I will support my incision with my hands when I cough and do my deep breathing exercises."

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? "If I do not follow the instructions, my surgery could be cancelled." "The nurse will explain the details of the surgery before I sign a consent." "My medical records will be sent to the ambulatory care center prior to my surgery." "The physician will update my family after the procedure and provide specific discharge instructions."

"The nurse will explain the details of the surgery before I sign a consent." Further instruction would be needed to clarify that the physician, not the nurse, explains the details of the surgery and obtains voluntary consent for the procedure. It is correct that preoperative instructions must be followed prior to surgery for the safety of the client, medical records are present for review prior to surgery, and the physician speaks with the family following the procedure and provides instructions for discharge.

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.

Which of the following medications may increases the hypotensive action of anesthesia? Chlorpromazine Prednisone Warfarin Hydrochlorothiazide

Chlorpromazine

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

Peripherally-inserted central catheter.

How does the nurse determine that the patient may have hidden fears about the impending surgical procedure? (Select all that apply.) The patient tells the nurse of concerns with the outcome of the procedure. The patient informs the nurse of problems with postoperative nausea in the past and that it was a bad experience. The patient avoids communication with the nurse. The patient repeatedly asks questions that have previously been answered. The patient talks incessantly.

The patient avoids communication with the nurse. The patient repeatedly asks questions that have previously been answered. The patient talks incessantly.

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

The patient participates willingly in the preoperative preparation.

obtaining consent occurs in

The preeoperative phase of periooperative care

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

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? Completes preoperative assessment Develops a plan of care Verifies that operative consent is signed Provides psychological support

Verifies that operative consent is signed

At what point does the preoperative period end?

When the client is transferred onto the operating table

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 When a lactate dehydrogenase concentration is 300 units When a serum albumin concentration is 5.0 g/dL When a serum globulin concentration reaches 2.8 g/dL

When the patient's blood ammonia concentration reaches 180 mg/dL

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.

what do you do if a person refuses to take off their wedding ring

cover it with tape

the entire surgical experience

perioperative Perioperative period includes the preoperative, intraoperative, and postoperative phases. The preoperative phase is the period of time from when the decision for surgical intervention is made to when the client is transferred to the operating room. The intraoperative phase is the period of time from when the client is transferred to the operating room to when he or she is admitted to the postanesthesia care unit. The postoperative phase is the period of time that begins with the admission of the client to the postanesthesia care unit and ends after a follow-up evaluation in the clinical setting or home.

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

physician

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