Chapter 17 PreupU

The nurse is preparing a client for surgery. The nurse would notify the surgeon if the client made which of the following statements?

- I took my Coumadin as usual last evening. -I took two aspirins for joint pain this morning.

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

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 >Preoperative care begins with the decision to perform surgery and continues until the client reaches the operating area. During this time, the nurse will physically prepare the client for surgery, and nursing actions may include skin preparation, hair removal, and food and fluids management.

A patient preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What should the patient be monitored for?

-Adrenal insufficiency

The nurse has just admitted a 12-year-old client who is going to have an above-the-knee amputation of their left leg due to osteosarcoma. The nurse knows that adequate preoperative teaching and learning is important for what reason?

-Client will have a shorter recovery period.

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

-Client with chronic alcoholism

The potential effects of prior medication therapy must be evaluated before surgery. Which of the following drug classifications may cause respiratory depression from an associated electrolyte imbalance during anesthesia?

-Diuretics

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 nurse concludes that further teaching about diaphragmatic breathing is needed when the client:

-Exhales forcefully with a short expiration

Which domain of perioperative nursing practice focuses on clinical processes and outcomes?

-Health care systems

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure?

-Let me explain to you what will happen next

An obese client is scheduled for open abdominal surgery. What priority education should the nurse provide to this client?

-Prevention of respiratory complications

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.

Sudden withdrawal of which of the following may result in seizures?

-Tranquilizers

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 >All choices listed are essential but, without a signed consent form, surgery cannot occur.

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

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. >A respiratory infection can delay a nonemergent surgical procedure because the infection can increase the risk for respiratory complications. Therefore, the nurse should notify the surgeon about delaying the surgery. The primary physician may be called to provide care based on the assessment findings, but that should be done only after the surgeon has been notified. Continuing through the preoperative phase without notifying the surgeon and waiting 1 hour then repeating the assessment are not appropriate.

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. >Allergies to avocados and bananas may indicate an allergy to latex. Although it is necessary to notify the dietary department and physician, it is not an immediate threat, as the patient is receiving nothing by mouth and pain medication will be ordered postoperatively. The nurse manager does not need to be notified of the client's allergies.

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 >Osteoporosis is likely not going to contribute to complications related to a cholecystectomy. Pregnancy decreases maternal reserves. Diabetes increases wound-healing problems and risks for infection. Urinary tract infection decreases the immune system's effectiveness, increasing the chance for infections.

Regarding the surgical client, which phase refers to the period of time that spans 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.

A client is scheduled for elective surgery. To prevent the complications of hypotension and cardiovascular collapse, the nurse should report the use of which medication?

-Prednisone >Clients who receive corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids such as prednisone can cause circulatory collapse and hypotension. Hydrochlorothiazide and erythromycin can cause respiratory complications. Warfarin increases the risk of bleeding.

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

-Respiratory depression >Common interaction effects of hydrochlorothiazide (HydroDIURIL) and anesthesia include respiration depression.

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. >Taking a deep abdominal breath and then "huff" coughing is the most effective manner of coughing. This technique helps facilitate removal of secretions and conserves energy for the client. The client should breathe slowly but not hold her breath. Short, panting breaths and then coughing from the throat do not promote expectoration of sputum from the lungs. Coughing forcefully can cause alveoli to collapse; "huff" coughing prevents this.

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 -physical condition -health status -age

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

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

-Adrenal

The nurse is aware that which of the following helps to stimulate T-cell response

-Arginine

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. >Prednisone, a corticosteroid, can result in cardiovascular collapse if suddenly discontinued. A bolus of corticosteroid may be given intravenously immediately before and after surgery. Hydrochlorothiazide and anesthetics may interact, resulting in respiratory depression. Phenothiazines may potentiate the hypotensive action of anesthetics. Anticoagulants can increase the risk of bleeding.

The nurse is physically preparing a client for surgery. What area does the nurse know needs to be addressed before the client is taken to the operating room?

-Elimination >When physically preparing a client for surgery these areas need to be addressed: skin preparation; elimination; attire/grooming; prosthesis; foods and fluids; and care of valuables. The physical preparation of a client for surgery does not include the areas of medication, activity, or the client's support system.