Chapter 16 - Preoperative Care
A client voluntarily signed the operative consent form. What is the nurse's next action? a. Teach the client about the surgery. b. Have family members witness the signature. c. Sign under the client's name as a witness. d. Call for the physician to sign the form.
c. Sign under the client's name as a witness. The nurse's signature as a witness indicates that the consent form was signed by the client voluntarily. None of the other steps are necessary.
A client will be undergoing palliative surgery. The client's daughter asks what this means. What is the nurse's best response? a. "The surgery will relieve the symptoms but will not cure your father." b. "There are fewer risks with this type of surgery." c. "There is no guarantee of the outcome of the surgery." d. "The surgery must be performed immediately to save your father's life."
a. "The surgery will relieve the symptoms but will not cure your father." The purpose of palliative surgery is to improve the client's quality of life by reducing or eliminating distressing symptoms. It does not cure a health problem and often does not prolong life.
The nurse is conducting preoperative teaching with a client who will be undergoing pelvic surgery. What teaching is essential for this client? (Select all that apply.) a. "Wearing elastic stockings and using pneumatic compression devices are essential after surgery." b. "Extended bedrest will help you heal after this type of surgery." c. "Coughing and deep breathing will help to decrease postoperative complications." d. "Turning and moving your legs after surgery will help prevent clots from forming." e. "You will need to have your abdomen shaved before surgery." f. "You cannot wear your hearing aid into the surgical suite."
a. "Wearing elastic stockings and using pneumatic compression devices are essential after surgery." c. "Coughing and deep breathing will help to decrease postoperative complications." d. "Turning and moving your legs after surgery will help prevent clots from forming." A pneumatic compression device and elastic stockings will help prevent clots after pelvic surgery. Coughing and deep breathing will help to decrease postoperative respiratory complications. Turning and moving legs after surgery will also help prevent clots. Hearing aids can be worn into the surgical suite because this will help communication before surgery. Extended bedrest is not helpful, and shaving would not be necessary.
Four clients are scheduled for surgery. Which client does the nurse determine is at highest risk for postsurgical complications? a. 89-year-old scheduled for a knee replacement b. 40-year-old requiring gallbladder surgery c. 19-year-old requiring a laparoscopy d. 10-year-old admitted for a tonsillectomy
a. 89-year-old scheduled for a knee replacement The older client is at highest risk for postoperative complications. Older adults often have multiple medical conditions, take several medications, are slightly dehydrated, and may have cognitive or physical impairments that potentially could hinder their recovery from an operation.
The nurse reviews a client's laboratory results before surgery and notes a fasting blood glucose of 120 mg/dL, a prothrombin time (PT) of 25 seconds, and potassium (K+) of 3.8 mEq/L. Which action by the nurse is best? a. Ask the surgeon for additional laboratory studies. b. Administer a potassium supplement of 20 mEq. c. Increase the IV infusion of D5W to 100 mL/hr. d. Record laboratory results on the preoperative assessment.
a. Ask the surgeon for additional laboratory studies. The prothrombin time is elevated, which could lead to bleeding during or after surgery. The surgeon and the anesthesiologist should be notified of this laboratory test result right away, and additional coagulation studies will be needed. The potassium is within normal limits. The blood glucose level is elevated but not critically so. The surgeon should be notified of all laboratory work, and the client may need an IV solution without glucose. The results should be recorded, but the surgery will likely be cancelled owing to the coagulation problem, which is the priority concern with this client.
A client is brought to the emergency department (ED) after a motorcycle accident. The client has suffered a ruptured spleen. What is the immediate priority? a. Emergent surgery to control bleeding b. Aggressive pain control c. Calling the family members d. Assessment of neurologic status
a. Emergent surgery to control bleeding Emergent surgery is indicated when the client may die without immediate intervention. Other interventions are appropriate but do not have the priority because controlling hemorrhage via surgery is the priority.
Which action is most appropriate during a preoperative chart review? a. Ensure that the consent form is signed, dated, and witnessed. b. Call the surgeon if the client has any food allergies. c. Make sure all marks are washed off the surgical site. d. Make sure the client understands the procedure.
a. Ensure that the consent form is signed, dated, and witnessed. During the preoperative chart review, the nurse should make sure that the consent form is signed, dated, and witnessed. The nurse does not have to call the surgeon for food allergies, nor should the marks be washed off the surgical site. The client should be taught about the procedure before the preoperative chart review.
Which medications does the nurse correctly administer preoperatively? (Select all that apply.) a. Hydroxyzine (Atarax, Vistaril) for sedation b. Lorazepam (Ativan) for anxiety c. Hydromorphone (Dilaudid) to decrease postoperative secretions d. Metoclopramide (Reglan) to increase stomach emptying e. Aspirin to decrease blood clotting postoperatively f. Cimetidine (Tagamet) to prevent infection
a. Hydroxyzine (Atarax, Vistaril) for sedation b. Lorazepam (Ativan) for anxiety d. Metoclopramide (Reglan) to increase stomach emptying The nurse will administer hydroxyzine (Atarax) for sedation, lorazepam (Ativan) for anxiety, and metoclopramide (Reglan) to increase stomach emptying. Hydromorphone is given for pain, and cimetidine (Tagamet) decreases histamine. Aspirin would not be administered preoperatively because it can increase bleeding.
The nurse is caring for an older adult client with a history of chronic lung disease who will be undergoing surgery the following day. When postoperative care is planned, which potential problem is the highest priority for this client? a. Maintaining oxygenation b. Tolerating activity c. Anxiety and fear d. Hypovolemia
a. Maintaining oxygenation Breathing problems take priority over the other problems listed. This would be compounded in a client with any chronic lung disorder.
The nurse is assessing a client before surgery. Which assessments contraindicate the client having surgery as scheduled? (Select all that apply.) a. Potassium level of 2.8 mEq/L b. International normalized ratio (INR) of 4 c. Prothrombin time (PTT) of 30 seconds d. Calcium level of 8.8 mEq/dL e. Positive pregnancy test f. Platelet count of 150,000
a. Potassium level of 2.8 mEq/L b. International normalized ratio (INR) of 4 e. Positive pregnancy test Hypokalemia, elevated bleeding times, and a positive pregnancy test could all contradict the client having surgery as scheduled and could lead to complications. Normal PTT, normal calcium, and normal platelet count would not contradict surgery.
The nurse has just completed preoperative teaching with a client who will be having surgery the following day. Which statement by the client indicates that additional teaching is needed? a. "When I brush my teeth before surgery, I will be sure to spit out the water." b. "I will go to the bathroom as soon as I receive all my preoperative medications." c. "I will remember to wear my glasses tomorrow instead of my contact lenses." d. "I won't have to worry about putting my makeup on tomorrow morning."
b. "I will go to the bathroom as soon as I receive all my preoperative medications." The client should void before receiving any preoperative medication. The medication could make the client sleepy and at risk for falling. The other statements are correct.
Twenty minutes after a client has received a preoperative injection of atropine and midazolam (Versed), the client tells the nurse that he must be allergic to the medication because his mouth is dry and his heart seems to be beating faster than normal. What is the nurse's priority action? a. Document the findings. b. Assess the client's pulse and blood pressure. c. Administer diphenhydramine (Benadryl). d. Explain to the client that these symptoms are expected.
b. Assess the client's pulse and blood pressure. Although these are expected physiologic responses to the preoperative medication, whenever the client states that he or she can feel a change in normal cardiac function, he should be assessed.
A client is brought to the hospital unconscious and needs emergency surgery. The client's only family member cannot come to the hospital before the surgery. Which is the best option for obtaining informed consent for the client's emergent surgery? a. Proceed with surgery and have the family member sign the consent as soon as possible. b. Contact the family member by phone and obtain verbal consent with two witnesses. c. Obtain written consultation with two surgeons that the surgery is needed. d. Have the hospital administrator appoint a temporary legal guardian.
b. Contact the family member by phone and obtain verbal consent with two witnesses. In the event that a family member cannot come to the hospital before the surgery needs to begin, verbal consent should be obtained over the phone with two witnesses.
What recently learned information about a client who is scheduled to have surgery within the next 2 hours is the nurse certain to communicate to the surgical team? a. An allergy to cats b. Hearing problem c. Consumption of a glass of wine 12 hours ago d. Taking 2000 mg of vitamin C each day
b. Hearing problem The team will need to communicate with the client in the surgical holding area, in the operating room, and in the postanesthesia recovery unit. Any problem with communication, such as a hearing impairment, should be stressed, so that team members can use alternative means to ensure accurate communication with the client.
A client undergoing preoperative assessment informs the nurse that he takes medication for high blood pressure and for asthma. What is the nurse's best action? a. Tell the client not to take the medication on the day of surgery. b. Notify the surgeon and the anesthesiologist. c. Document the information in the client's record. d. Tell the client to take medications preoperatively with a sip of water.
b. Notify the surgeon and the anesthesiologist. Medications for cardiac and respiratory problems usually are given with sips of water before surgery. However, the nurse should notify the surgeon and the anesthesiologist before giving the client any advice. While some medications can be given with a sip of water, other medications must be held for a specified time before surgery. Documentation should occur, but only after the nurse has consulted with the physician and anesthesiologist and has spoken to the client.
A client receiving preoperative medication tells the nurse that she took all the following vitamins and herbs last night before going to bed. Which one does the nurse report to the surgical team as a priority? a. Valerian root b. St. John's wort c. Garlic d. Chamomile
c. Garlic Garlic interferes with coagulation, increasing the client's risk for bleeding during and after the surgical procedure. This would be a critical piece of information for the surgical team to know.
During the preoperative assessment, the client tells the nurse that he smokes three packs of cigarettes daily. Which action by the nurse is best? a. Call the surgeon to cancel the surgery. b. Have baseline laboratory studies drawn. c. Perform a respiratory assessment. d. Give a nebulizer treatment.
c. Perform a respiratory assessment Smoking increases the client's risk for atelectasis and hypoxia. The nurse should assess the client for signs of respiratory disease. The physician will need to know this information but will not necessarily cancel the operation. Baseline laboratory studies need to be ordered by the physician. There is no indication for giving a nebulizer to this client
The nurse is caring for a client who will be undergoing emergency surgery as soon as possible. Which information is most important for the nurse to teach the client at this time? a. How the surgery will be performed b. Importance of early ambulation after surgery c. What to expect in the operating and recovery rooms d. Complications that may occur after surgery
c. What to expect in the operating and recovery rooms With only a few minutes before surgery, the nurse should tell the client what to expect in the operating room and in the recovery room to minimize his or her anxiety. Although the other information is important, the nurse needs to start with what is vital for the client to know right now
A client tells the nurse that he has an advance directive with durable power of attorney for health care. The client asks how the advance directive will affect the surgery. What is the nurse's best response? a. "You will not be intubated during general anesthesia for the surgery." b. "There will be no effect on your surgery." c. "The surgical staff will resuscitate only if your heart stops during the operation." d. "If you are unable to make a decision, your designee will be asked."
d. "If you are unable to make a decision, your designee will be asked." The advance directive with durable power of attorney indicates whom the client wishes to designate for medical decisions if he is unable to make decisions for himself. An advance directive with power of attorney does not eliminate the need for intubation during surgery. Although the document does not affect the procedure, simply acknowledging that fact does not help the client understand. If the client's heart stops during the operation and the client has not made his or her wishes known about that situation, the power of attorney would be consulted.
When the nurse brings a client's preoperative medications, the client responds, "I don't need that. I had a good night's sleep last night." What is the nurse's best response? a. "The doctor ordered this medication so you should take it." b. "I will make a note that you refused to take the medication." c. "I will ask your surgeon if you have to take the medication." d. "Let me teach you about your medications for surgery."
d. "Let me teach you about your medications for surgery." Preoperative medications can include sedatives but are often given to prevent laryngospasm and to help reduce pharyngeal and gastric secretions. The client must be fully aware of the rationale for all medications and the risks of not taking them.
The nurse is conducting preoperative assessments. Which client does the nurse teach about the possibility of developing a venous thromboembolism (VTE)? a. Client with a latex allergy b. Client with body mass index (BMI) of 19 c. Client with an international normalized ratio (INR) of 2.2 d. Client undergoing hip replacement surgery
d. Client undergoing hip replacement surgery The client will have limited mobility following hip replacement surgery, increasing the risk of postoperative venous thromboembolism (VTE). The other conditions will not increase the risk of VTE.
The nurse is completing preoperative teaching for a client, and it becomes apparent that the client does not understand the surgery that will be performed. What is the priority action for the nurse? a. Obtain informed consent from the client. b. Continue teaching the client about the surgery. c. Revise the teaching plan for the client. d. Notify the surgeon and document the finding.
d. Notify the surgeon and document the finding The surgeon should be notified right away so that the client can be instructed about the surgery to be performed. The client cannot give informed consent unless he or she understands the procedure.
When examining an adult client's preoperative laboratory results, the nurse notes that the potassium level is 2.9 mEq/mL. What is the nurse's priority action? a. Document the finding. b. Alter the client's diet to include fruit. c. Increase the IV flow rate. d. Notify the surgeon.
d. Notify the surgeon. The normal range for serum potassium is 3.5 to 5.0 mEq/L or mmol/L. A value of 2.9 represents hypokalemia, which must be corrected before surgery. The surgeon should be notified of this finding. The finding should be documented; however, notifying the surgeon is the priority.
The nurse applies antiembolism stockings to a client preoperatively. When the client says that they are uncomfortably tight, what is the nurse's best action? a. Remove the stockings for an hour to relieve the pressure. b. Pull the stockings down so that they are not constricting. c. Measure the client's calf to ensure that they are the correct size. d. Teach the client the purpose of wearing the stockings.
d. Teach the client the purpose of wearing the stockings. Thromboembolic disease (TED) stockings should feel slightly tight on the legs to promote venous return and prevent the client from developing venous thromboembolism (VTE). The nurse should not remove the stockings nor pull them down. The calf would have been measured before the stockings were obtained.
The nurse is performing preoperative teaching with an older adult client who will be having colon resection surgery the following day. The surgeon has ordered bowel preparation the night before. Which action is a priority? a. Administer antibiotics with a sip of water. b. Encourage the client to drink plenty of juice. c. Teach the client to eat only low-fat foods the night before surgery. d. Tell the client not to get up and go to the bathroom alone.
d. Tell the client not to get up and go to the bathroom alone. Safety is the priority, and the older adult client can become exhausted and may fall. Antibiotics, if ordered, would be administered with a sip of water, but this is not the priority. The client would not be encouraged to drink juice, because this is not a clear liquid.
