Chp 30 PrepU Perioperative nursing
A nurse teaches deep breathing exercises to a preoperative client. Which action should the nurse perform?
Instruct the client to exhale gently and completely before inhaling.
Which surgical client does the nurse in the preoperative setting anticipate having the greatest potential for surgical complications?
76-year-old client with a history of renal failure and chronic bronchitis
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 is caring for an older adult following hip surgery. When teaching the client to use an incentive spirometer, the nurse should explain that this reduces the risk of what complication?
Pneumonia
A 9-month-old baby is scheduled for heart surgery. When preparing this client for surgery, the nurse should consider which surgical risk associated with infants?
Potential for hypothermia or hyperthermia
When an older adult client is brought to the recovery room and presents with irregular, loud respirations, the nurse determines that this is most likely a result of:
a partial airway obstruction.
The nurse is caring for a client who had an outpatient procedure. Which assessment finding indicates to the nurse that the client may be ready for discharge to home?
blood pressure 118/70 mmHg, respirations 18 breaths per minute
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
The preoperative nurse is teaching a client about deep-breathing exercises. The client asks, "Why do I need to learn about this?" Which response by the nurse is correct?
"After surgery, deep-breathing exercises help to remove anesthetic gases and mucus and improve oxygen supply to body tissues."
The nurse is preparing a client for surgery and asks if the client has an advance directive. The client asks "What is an advance directive?" What is the nurse's best response to this?
"An advance directive will communicate your wishes for health care postoperatively in case you are unable to do so."
Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction?
"I can have a hamburger and French fries as soon as I wake up."
A client who is scheduled to undergo coronary bypass surgery in a week asks the nurse whether he should discontinue taking his cholesterol medicine ahead of the surgery. Which should be the nurse's response?
"I will need to check with your health care provider about that."
The nurse assists a client to turn in the bed. The client has just returned from abdominal surgery. How does the nurse instruct the client?
"Use a pillow to splint the incision."
The nurse is caring for a postoperative client. During the past hour, there is 20 mL of dark, concentrated amber urine. Which actions should the nurse choose? Select all that apply
-Determine if the indwelling urinary catheter is kinked. -Assess skin turgor and mucous membranes. -Obtain vital signs and compare to baseline measurements. -Examine intake and output, including estimated blood loss from the operative report.
A client who has been experiencing a gradual decrease in mobility has been scheduled for elective knee replacement surgery in 3 weeks. Which teaching points should the nurse choose for the outpatient group education session? Select all that apply.
-How to cleanse skin with a special soap solution -Time for limitations with eating and drinking -When and where to arrive for surgery -What to expect before, during, and after surgery
The nurse is performing a preoperative screening of laboratory work prior to a client's surgery in the morning. What test results should be immediately discussed with the surgeon and anesthesia care provider? Select all that apply.
-a white blood cell count of 18,000 -a hemoglobin of 7.2 gm/dL -a sodium level of 128 mEq/L
A nurse preparing an older adult client for hip replacement surgery is aware of the surgical risks related to the client's age. Which of the following accurately describes these risks? Select all that apply.
-decreased peripheral circulation -increased vascular rigidity -decreased thermoregulation ability
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 caring for clients in a PACU assesses a client who is displaying signs and symptoms of shock. What is the priority nursing intervention for this client?
A nurse caring for clients in a PACU assesses a client who is displaying signs and symptoms of shock. What is the priority nursing intervention for this client?
A nurse is teaching a client about the rationale for fasting from food and fluids prior to surgery. What condition does this measure attempt to avoid?
Aspiration
A client has presented to the outpatient surgical center for a scheduled procedure. Which action should the nurse perform prior to the procedure?
Assess the client's allergy status
Which nursing action should the PACU nurse take to prevent postoperative complications in clients?
Assist the client to do leg exercises to increase venous return.
The acute care nurse is preparing a client for surgery. Which action is essential to complete before transferring the client to surgery?
Assure that diagnostic testing has been completed and results are available.
The nurse is performing a preoperative assessment of a client who has been scheduled for a reduction mammoplasty (breast reduction). The client states, "I'm starting to wonder if I made the right decision in going ahead with this." What should the nurse do next?
Explore the client's feelings and inform the surgeon
The nurse is caring for a 4-month-old client on the pediatric unit following repair of an umbilical hernia repair. The infant just woke up from anesthesia and is crying. What would be appropriate initial interventions? Select all that apply.
Have the parent hold the infant in a rocking chair. Offer a pacifier. Use distraction with a stuffed toy
The nurse monitors the urine output of a postoperative client. The results of this assessment allow the nurse to monitor for signs of what complication?
Impaired tissue perfusion
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 preparing a client for endotracheal intubation. The anesthesiologist has ordered an anticholinergic medication for this client. What is an action of this medication?
It decreases respiratory secretions.
The preoperative nurse is reviewing the chart of a client whose surgery is scheduled to begin in the next 15 minutes and notices that the consent form is not signed. The nurse contacts the surgeon who states, "We have already reviewed this procedure extensively, so ask the client to sign the consent form and I will verify it in the operating room." Which action by the nurse is appropriate?
Keep the client in the preoperative area and inform the surgeon that it is the health care provider's responsibility to obtain consent for surgery.
Which surgical clients will return to activities in their everyday lives more quickly?
Laparoscopic cholecystectomy
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.
The healthy adult client is given a narcotic prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first?
Notify the physician of the oversight.
A nurse is giving preoperative information to a client scheduled for outpatient surgery. What are recommended education guidelines? Select all that apply.
Notify the surgeon's office if a cold or infection develops before surgery. List allergies and be sure the operating staff is aware of these. Have someone available for transportation home after recovery from anesthesia.
Which nursing action will best promote pain management for a client in the postoperative phase?
Performing relaxation techniques
Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?
Place graduated compression stockings on the client.
A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client?
Place the client in semi-Fowler's position
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
Which nursing action will assist in pain management for a client in the postoperative phase?
Relaxation techniques
The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?
Respiratory obstruction
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 abdominal surgery yesterday and is reluctant to cough and perform deep breathing. Which strategy will most likely increase the client's willingness to cough and perform deep breathing?
Teach the client how to splint the abdomen while coughing.
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
A postoperative client states "I don't understand why you are checking my skin on my back. My surgery was on my stomach." What is the nurse's best response?
The operating table is a firm surface; we need to be sure your skin looks okay."
The procedural physician has initiated performance of a time-out in the operating room before surgery. The student nurse asks the operating room nurse why this is important. What is the operating room nurse's best response?
The time-out checks to be sure that we have the right client and procedure."
The nurse is providing education about deep-breathing exercises to a postoperative client whose surgery took place earlier today. Which instruction should the nurse provide?
Try to do your exercises every 1 to 2 hours."
Which factor is most important in the nurse's decision on assessment data, outcomes, and the monitoring needs of a client in preparing for surgery?
Type of surgery
The nurse needs to evaluate the effectiveness of a preoperative teaching session with a client scheduled for abdominal surgery. Which client statement indicates the need for further clarification?
While my pneumatic compression device is on, I don't need to do leg exercises."
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
The operating room nurse is aware that which client is at greatest risk related to a surgical procedure?
a woman 83 years of age
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
The nurse knows the term perioperative phase refers to care given to the client:
before, during, and after the operative phase.
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
The recovery nurse is caring for a surgical client in the PACU. The client's blood pressure is dropping and the heart rate is increasing. The nurse suspects the client is:
developing shock.
A client is undergoing surgery for an appendectomy. This would be considered what type of surgery?
emergency surgery
Which client will see the greatest permanent changes in lifestyle following surgery?
ileostomy
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
An operating room nurse is bringing a client to the nurse in the postanesthesia care unit (PACU). Which information would the operating room nurse provide during a hand-off report? Select all that apply.
medications given in operating room length of surgery drains inserted in surgery
A nurse is caring for an inpatient client scheduled to undergo a surgery for the removal of a malignant tumor. What risk factors does the nurse identify that increase the occurrence of perioperative complications? Select all that apply.
obesity bleeding tendencies low hemoglobin
In the postoperative phase of abdominal surgery, the client reports severe abdominal pain. In the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect?
paralytic ileus
The nurse is teaching a preoperative client about turning in bed after her surgery. Which picture demonstrates the proper technique?
patient grabbing rail, protecting incisional area with pillow or blanket, nurse with hand behind patient's lower thigh
A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur?
preoperative
The nurse has been waiting until after the administration of a toddler's anesthesia before removing the child's clothing and applying monitoring equipment. Doing these actions after the administration of anesthesia will:
prevent anxiety.
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)
A nurse is caring for an older adult client who had surgery for the removal of a cataract in the left eye. When can the client return home after outpatient surgery?
the same day
Who is legally responsible for obtaining the client's informed consent for a surgical procedure?
the surgeon
The nurse recognizes that palliative surgery is performed for what purpose?
to lessen the intensity of an illness