Chapter 23: perioperative nursing

The nurse is educating a client who is preparing for abdominal surgery tomorrow. A teaching demonstration has just been completed by the nurse related to splinting the incision site with a pillow. Which statement by the client best indicates the instructions provided by the nurse were effective?

"I will put the pillow on the incision then cough."

A nurse is preparing a client for discharge from the ambulatory surgical center. Which client statement would indicate a problem with the client's discharge?

"I'm going to take a taxi home."

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about deep breathing. The client asks, "Why am I practicing breathing when I'm having hernia surgery." What is the appropriate nursing response?

"It decreases the postoperative risk for respiratory complications."

The nurse has entered the room of a client who is postoperative day 1 and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of p.r.n. analgesia and, on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. How should the nurse respond to the client's concerns?

"Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery."

The nurse is providing education for a postoperative client regarding pain management. Which teaching point should the nurse include?

"You will receive pain medication by injection as long as you are n.p.o."

While reviewing the medical record of a client who has had abdominal surgery, the nurse notes that the client has developed a paralytic ileus. The nurse interprets this information as indicative of what?

Bowel functioning is significantly decreased.

A client is scheduled for liposuction surgery to reduce weight. Which action should the nurse take immediately after surgery?

Listen to bowel sounds

A nurse anesthetist administers regional anesthesia to a client being prepared for facial surgery. Which type of regional anesthesia would be the appropriate choice for this client?

Local infiltration with lidocaine

A client had an open cholecystectomy (gallbladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding?

Monitor the client closely and promote fluid intake.

A nurse is taking care of a client during the immediate postoperative period. Which duty performed during the immediate postoperative period is most important?

Monitor the client for complications.

A nurse is assessing a client who is experiencing pulmonary embolus. What would be the prioritynursing intervention for this client?

Place the client in semi-Fowler's position.

A nurse is caring for a female client who will undergo a curative surgery for cholecystectomy. Which precaution should the nurse take before surgery to prevent venous stasis?

Recommend that the client wear antiembolism stockings.

he nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?

Respiratory obstruction

A nurse is providing education to a client having same-day surgery. Which statement would be accurate regarding this type of surgery?

Some major surgeries can be done as same-day surgery.

Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply.

Spinal block Nerve block Epidural block

The nurse is caring for a client who had a procedure under moderate sedation at the ambulatory surgical center. Which assessment finding indicates to the nurse that the client may be ready for discharge to home?

The client is alert and oriented with a blood pressure 118/70 mm Hg and respirations 18 breaths/minute, is able to ambulate, is not nauseated or vomiting, pain is controlled with medication, and has no excessive bleeding and drainage is as expected.

The health care provider has prescribed the nurse to administer conscious sedation to a client that will have a closed reduction of the left shoulder. What outcome after administering conscious sedation to a client does the nurse hope to achieve?

The client is relaxed, emotionally comfortable, and conscious.

A female client age 54 years has been scheduled for a bunionectomy (removal of bone tissue from the base of the great toe) which will be conducted on an ambulatory basis. Which characteristic applies to this type of surgery?

The client will be admitted the day of surgery and return home the same day.

The nurse is taking a history on Kumar, who informs her that he has an allergy to adhesive tape. When the nurse asks Kumar to describe his reaction to the tape, he describes it as "blotchy and reddened." What type of allergic reaction is this?

Type IV

Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?

a 26-year-old client who is exhibiting a crowing sound

Which client would a nurse monitor most closely for postoperative respiratory complications?

a 55-year-old client with a history of asthma who had a colon resection

An operating room nurse is preparing for a surgical procedure on an infant. The nurse's perioperative care is based on what physiologic factor that puts infants at greater risk from surgery than adults?

lower total blood volume

the nurse has delegated to the unlicensed assistive personnel (UAP) the application of antiembolism stockings to a client who had an endarterectomy earlier in the day. Which UAP action requires the nurse to immediately intervene?

massages legs prior to application

A client is undergoing conscious sedation for an endoscopy. When the client becomes overly sedated, which medication does the nurse anticipate will be required?

naloxone

A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice? Select all that apply.

positioning the client on the operating table counting sponges before and after surgery monitoring the client's vital signs

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur?

preoperative

The nurse recognizes the value of leg exercises in the prevention of postoperative thrombophlebitis. When should the nurse teach the correct technique for leg exercises to a client?

prior to surgery

As a circulating nurse caring for a 45-year-old man undergoing left knee arthroscopic exploratory surgery, which task ensures that the team is on the same page and will perform the procedure on the right client and at the right site?

procedural pause (time-out)

The nurse enters a postoperative client's room and finds that the client is bleeding profusely from the surgical incision. What would be the nurse's most appropriate initial response?

Apply pressure to the surgical site to decrease bleeding.

A client postoperative from an appendectomy reports feeling cold and has a temperature of 96.2°F (35.7°C). Which action should the nurse perform first?

Apply warm blankets to the client.

A nurse from the ambulatory surgical center is preparing discharge instructions for a client who has had pelvic surgery. Which criterion would the client need to demonstrate to ensure that she is ready for discharge?

void normally

A nurse is discussing a surgical procedure with a client who needs to sign his informed consent. Which of these tasks is part of the nursing role?

witnessing the client signature with their consent for surgery

What is the nurse's role in the informed consent process for a surgical procedure?

witnessing the signed informed consent document

he circulating nurse calls for a time-out prior to the surgical procedure and the surgeon states, "I don't have time for this. I have another case to follow and need to get busy." What is the bestresponse by the circulator?

"We all have the same goal and that is the safety of the client, so let's do the time-out."

The nurse is caring for a client after breast augmentation. Before performing a bowel assessment, what education will the nurse provide the client?

"You can have decreased or absent bowel movement, called peristalsis because of administration of anesthetic agents or narcotics. By listening for bowel sounds, I can check for a return of peristalsis."

Which nursing interventions would be appropriate for a client recovering from a surgical procedure? Select all that apply.

-Place the client in a semi-Fowler's position to perform deep-breathing exercises every 1 to 2 hours for the first 24 to 48 hours after surgery, and as necessary thereafter. -Teach the client the appropriate leg exercises to increase venous blood return from the legs. -Encourage the client to use incentive spirometry 10 times each waking hour for the first 5 days after surgery.

A 2-year-old toddler just underwent a tonsillectomy and adenoidectomy surgery. The postanesthesia care unit (PACU) nurse is checking on him. What is the best course of action regarding the developmental care of this child?

Allow the parents into the PACU before the child wakes.

A postoperative home care client has developed thrombophlebitis in the right leg. What new plan of care will need to be added because of this complication?

Anticoagulant treatment and education about the increased risk of bleeding

A nurse is interacting with a client in the outpatient surgical unit intraoperatively. What is the nurse's priority responsibility?

Client safety

A nurse is working as part of an intraoperative team and is involved in the surgical verification process for a client. What would the nurse expect to be performed as the last step?

Complete the "time-out" procedure.

An elder adult client underwent a hip replacement and now states to the nurse, "My parents are coming to visit me today. I need to mow the lawn and run errands." The client is trying to get out of the bed. What does the nurse identify is occurring with this client?

Delirium

A nurse wraps a client with antiembolism stockings to help avoid thrombus formation. Which action can the client take directly to prevent formation of thrombi?

Drink plenty of fluids.

The nurse has admitted a client to the postoperative unit following a bowel resection and is providing postoperative health education on coughing and deep breathing. What does the nurse explain to the client about why these actions are important?

If you continue to breathe shallowly or cough ineffectively, this can lead to atelectasis and pneumonia.

After conducting a preoperative health assessment, the nurse documents that the client has physical assessments supporting the medical diagnosis of emphysema. Based on this finding, which is the priority risk of complications in the postoperative period?

Impaired gas exchange

A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client?

Implement leg exercises and turn the client in bed every 2 hours.

A nurse is caring for an older adult client who had surgery for the removal of a cataract in the left eye. Which issue would prevent the client from being discharged on the day of surgery?

Inability to ambulate

The nurse is preparing to send a client to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent for the procedure on the client's chart. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the client. What is the nurse's best action to the physician's request?

Inform the physician that it is their responsibility to obtain the signature.

The nurse is supervising a nursing student who is providing postoperative education to a client with an abdominal incision. The nurse sees the student coaching the client to perform coughing exercises, as pictured above. What is the nurse's best action?

Instruct the student to provide the client with a pillow or folded blanket to hug.

The nurse is teaching the client who recently experienced abdominal surgery to deep breathe and cough effectively. What observable action serves to best minimize pain that may result from the intervention?

Providing support to abdominal and accessory respiratory muscles

A nurse is caring for a postoperative client and preparing to apply a pneumatic compression device. How does the nurse explain the device to the client prior to application?

The device fills with air and squeezes the legs, which increases blood flow through the veins of the legs and helps to prevent blood clots.

Which client most likely requires special preoperative assessment and treatment as a result of the existing medication regimen?

a woman who takes daily anticoagulants to treat atrial fibrillation

Which nursing intervention occurs in the postoperative phase of the surgical experience?

airway/oxygen therapy/pulse oximetry

Nurses teach clients to restrict food and fluids before surgery. What condition does this measure attempt to avoid?

aspiration

The nurse is preparing a client for a colonoscopy. The nurse is familiar with the colonoscopy procedures at the hospital and is aware that which type of anesthesia is commonly used for this procedure?

conscious sedation

A client is undergoing surgery for an appendectomy. This would be considered what type of surgery?

emergency surgery

A nurse is reviewing postoperative protocols with the client, including an explanation and a demonstration of how to use an incentive spirometer. How does the nurse know that the teaching on the use of the incentive spirometer was effective?

he client completes a return demonstration and inhales with lips tightly sealed around the mouthpiece while sitting upright in bed.

A nurse is caring for an older adult following hip surgery. Which serious complication would the nurse attempt to avoid by encouraging use of the incentive spirometer?

pneumonia

Following a successful coronary artery bypass graft (CABG), a 71-year-old male client has been transferred to the postanesthesia care unit (PACU). What is the priority for the client's nursing care during this stage of his recovery?

protecting and maintaining the client's airway

A nurse has been asked to ensure informed consent for a surgical procedure. What might be a role of the nurse?

signing the consent form as a witness

The nurse recognizes that palliative surgery is performed for what purpose?

to lessen the intensity of an illness