Med Surg 1 Test Review -

herbal supplements regarding pre-op assessment

-ginger: prevents nauseau aarnica: soft tissue healing multivitamins can be taken the day before avoid all other herbal supplements 2-3 weeks before surgery in general

A nurse is assessing a client for acute rejection of a kidney transplant. What assessment finding requires the most rapid communication with the provider?

Creatinine of 3.9 mg/dL

The nurse is admitting a patient to the same day surgery unit. The patient tells the nurse that he was so nervous he had to take kava last evening to help him sleep. Which of the following nursing actions would be most appropriate?

Inform the anesthesiologist of the patient's ingestion of kava.

Which intraoperative nursing responsibilities should be performed by the scrub nurse? Select all that apply.

Keeping track of irrigation solutions for monitoring of blood loss Passing instruments and supplies to the health care provider by anticipating his or her needs Performing the count of sponges, needles, and instruments used during the surgical procedure

A nursing instructor is teaching students about different surgical procedures and their classifications. Which examples does the instructor include? (Select all that apply.)

Liver biopsy: diagnostic total shoulder replacement: restorative

patient who received epidural anesthesia for surgery develops hypotension during the procedure. The nurse realizes that which of the following will be done to support this patient?

Provide normal saline intravenously with medications to stimulate venous return.

What best describes the role of the critical care nurse in the organ donation process?

Reinforce the explanation of brain death after the doctor has talked to the family.

A patient is being evaluated for rejection after a heart transplant. What will this assessment include?

Repeated heart biopsies to assess for myocyte damage or necrosis

While performing preoperative teaching, the patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, the nurse tells the patient that:

She can drink clear liquids up to 2 hours before surgery.

Select all that apply. Which of the following best describes a consent form?

Signifies that the patient understands all aspects of the procedure May be signed by an emancipated minor.

A client is receiving preoperative teaching. Which of the following can the client reasonably anticipate that the preoperative nurse will provide?

Teaching regarding pain control in the postanesthesia recovery room (PACU)

A nurse recognizes that advocating for organ donation is important because:

The organ recipient usually enjoys a better quality of life at less cost to the health care system

A patient recovering from a liver transplant is at risk for malnutrition. What would the nurse include when planning care for this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Consult with a dietician to plan for adequate energy from carbohydrates or fats. 2. Provide nutritional supplements enterally.

A patient with acute kidney injury is prescribed intermittent hemodialysis three times a week for 4 hours each session.

1. Fluid overload 2. Waste accumulation 3. Electrolyte imbalances

A client has developed malignant hyperthermia. The client weighs 136 pounds. What is the safe dose range for one dose of dantrolene sodium (Dantrium)?

124-186 mg The dose of dantrolene is 2 to 3 mg/kg. The client weighs 62 kg, so the safe dose range is 124 to 186 mg.

A patient undergoing a surgical procedure with general anesthesia exhibits muscle rigidity, body temperature (T) of 103° F (39.4° C), pulse (P) of 100 beats per minute (bpm), and a respiratory rate (RR) of 26 breaths per minute. The symptoms subside with the administration of dantrolene. What should the nurse include in the patient's postoperative instructions?

Consider getting genetic testing for malignant hyperthermia.

A student is caring for clients in the preoperative area. The nurse contacts the surgeon about a client whose heart rate is 120 beats/min. After consulting with the surgeon, the nurse administers a beta blocker to the client. The student asks why this was

"A rapid heart rate requires more effort by the heart.", adds on more stress for surgery

types of surgery:

-ectomy: removal of -lysis: destruction of -orrhaphy: repair or suture of -oscopy: looking into -otomy: cutting into; incision -plasty: repair or reconstruct

Select all that apply. A nurse is caring for a surgical patient in the preoperative area. The nurse obtains the patient's informed consent for the surgical procedure. Which statements are true regarding informed consent?

. Informed consent must be signed while the patient is free from mind-altering medications. B. Informed consent must be witnessed.

preoperative interview

1) pt health history 2)provide and clarify info of surgery 3)assess patients emotional state and readiness for surgery 4) assure consent form signed and witness and lab tests ordered

preoperative teaching- 3 types

sensory, process and procedural sensory: patients find out what they will hear smell, etc process: general flow of what will happen, preop holding area, etc. procedural: more specific details of surgery what to bring what to wear IV line insertion etc.

A 78-year-old patient is having a bilateral hip replacement. Of what risk areas will the nurse especially need to be aware for this patient during surgery?

skin integrity

NPO

starting at midnight the night before surgery to prevent aspiration and vomiting before surgery

graft vs host disease

the donated tissue rejects the host/recipient tissue -reaction begins 7-30 days -greatest challenge is infection -no treatment, prevention is best -corticosterioids used make pt more susceptible to infection

anaphylaxis

undesirable outcome in any case, a lot of times due to latex Risk factors for latex allergies include a history of hay fever and allergies to foods such as avocados, kiwi, bananas, potatoes, peaches, and apricots. When a patient identifies such allergies, the patient should be further questioned about exposure to latex and specific reactions to allergens.

A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team?

use of multiple herbs and supplements since they can interact with medications

Before applying alcohol-based surgical hand scrub, what action should the nurse take?

wash hands and forearms with soap

nueromuscular blocking agents

observe closely for airway patency and adequacy of respiratory muscular movement - a nerve block happens around a specific group of nerves

A client has arrived in the postoperative unit. What action by the circulating nurse takes priority?

participating in handoff report

regional anesthetic:

patients recieving this may need to be modified, keep back up equipment handy

A patient has become a candidate to donate organs in Town A. Based on the UNOS priority system, which potential recipient would be the best candidate to receive a kidney transplant?

A patient on dialysis with compatible blood type and six matching antigens who lives in Town B (60 miles away) -because they have the most matching antigens

A nurse working in the preoperative holding area performs which functions to ensure client safety? (Select all that apply.)

Allow small sips of plain water. Check that consent is on the chart. Ensure the client has an armband on. Have the client help mark the surgical site.

A client has a great deal of pain when coughing and deep breathing after abdominal surgery despite having pain medication. What action by the nurse is best?

Demonstrate how to splint the incision.

An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best?

Do not have the client sign the consent and call the surgeon.

Which intervention is most important to include in the multidisciplinary plan to prevent infection in a patient during the early post-transplant period?

Encouraging the patient to ambulate and use an incentive spirometer

`A client is scheduled for a below-the-knee amputation. The circulating nurse ensures the proper side is marked prior to the start of surgery. What action by the nurse is most appropriate?

Facilitate marking the site with the client and surgeon.

What should greatly reduce postoperative pain for a patient about to undergo a hip replacement?

Femoral nerve blocks`

A patient is demonstrating signs of organ rejection 3 months following a kidney transplant. The nurse recognizes this reaction as being what type of rejection?

acute rejection

common pyschological factors

anixety, fear and hope

The nursing student observing in the perioperative area notes the unique functions of the circulating nurse, which include which roles? (Select all that apply.)

ensure clients safety and monitor trafficking in the room The circulating nurse has several functions, including maintaining client safety and privacy, monitoring traffic in and out of the operating room, assessing fluid losses, reporting findings to the surgeon and anesthesia provider, anticipating needs of the team, and communicating to the family. they document care but not all of the documentation

Which of the following preoperative assessment findings should be reported to a surgeon for preoperative treatment?

excessive thirst

The circulating nurse is in the operating room and sees the surgeon don gown and gloves using appropriate sterile procedure. The surgeon then folds the hands together and places them down below the hips. What action by the nurse is most appropriate?

inform the surgeon that the sterile field has been broken.

general anesthesia

inhalants- can require respiratory care

A patient candidate for organ donation has developed diabetes insipidus. What will the nurse most likely assess in this patient?

large unit output and low urine specific gravity

Which of the following is most appropriate after administration of preoperative medications?

place pt in bed with the rails up! rails up always since patient is getting a med and can make them sleepy`

Which of the following nursing interventions should receive highest priority when a patient is admitted to the postanesthesia care unit?

positioning the patient

To prevent airway obstruction in the postoperative patient who is unconscious or semiconscious, the nurse

positions the patient in a side-lying position.

A circulating nurse wishes to provide emotional support to a client who was just transferred to the operating room. What action by the nurse would be best?

remain with the client!

ambulatory surgery

same day or outpatient surgery

scrub nurse vs. circulating nurse

scrub: everything sterile! circulating: unsterile, documentation

A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best? « on: July 17, 2015, 10:4

Assess the client for anxiety. it can interfere with learning and cooperation

A client is having surgery. The circulating nurse notes the client's oxygen saturation is 90% and the heart rate is 110 beats/min. What action by the nurse is best?

Assess the client's end-tidal carbon dioxide level.

a patient with end stage renal disease is being evaluated for kidney transplant, what is a contraindication

HLA identical match, positive antibody cross match. - a positive antibody cross match means there is an absolute contraindication for organ rejection! -negative cross match is good.

Which actions will the nurse include in the surgical time-out procedure before surgery (select all that apply)?

Have the patient state name and date of birth. Verify the patient identification band number. Ask the patient to state the surgical procedure. Confirm the hospital chart identification number.

A student nurse is caring for clients on the postoperative unit. The student asks the registered nurse why malnutrition can lead to poor surgical outcomes. What responses by the nurse are best? (Select all that apply.)

Many drugs are bound to protein in the body." "Protein stores are needed for wound healing." "Weakness and fatigue are common in malnutrition." "A malnourished client will have fragile skin."

A patient who developed signs of rejection to a liver transplant within the first week of receiving the organ is asking about the possibility of organ failure. What is the nurse's most appropriate response to this patient?

You are receiving medications to prevent the rejection. We will continue to do everything to treat the rejection and keep you informed of what is happening."

The patient is scheduled for an operative procedure that will require placement of an additional IV line, an indwelling urinary catheter, and a nasogastric tube. The nurse should advocate for these lines to be placed at what time?

after general anesthesia has been induced

Joint commision requires

all patients admitted to the OR have a documented history and physical exam in their chart. -day of or in advance -done by ACP, advanced prac nurses, Physician or PA -P1 healthy P6 brain dead

A patient wants to donate organs after cardiac death. One hour after the withdrawal of life support the patient continues to breathe shallowly and has a slow heartbeat. What is the nurse's most appropriate response?

allow death to occur naturally without organ donation, if after 60 mins and patient is still breathing organ donation is no longer an option

A nurse is caring for a postoperative client who reports discomfort, but denies serious pain and does not want medication. What action by the nurse is best to promote comfort?

assist the client to a position of comfort

Which intervention is important when the nurse is caring for a patient who is a potential lung donor in order to ensure that the lungs remain suitable for transplant? « on: October 2

avoid excess fluid replacement

A client is taking prednisone to prevent transplant rejection. What instruction by the nurse is most important?

avoid large crowds of people who are ill

The nurse would be alerted to the occurrence of malignant hyperthermia when the patient demonstrates:

muscle rigidity, may give problems with wound healing

for head and neck surgeries

need to be 2 surgeons present

A client is in stage 2 of general anesthesia. What action by the nurse is most important?

being prepared to suction the patient During stage 2 of general anesthesia (excitement, delirium), the client can vomit and aspirate.. positioning client is more stage 3 of general

MAC anesthesia- monitored anesthesia care

no inhalants MAC refers to sedation that is similar to general anesthesia using sedative, anxiolytic, and/or analgesic medications. It can be administered by an ACP.

A patient is in the operating room holding area and tells the nurse that he changed his mind and does not want the procedure. Which of the following should the nurse do?

cancel the procedure

An older client is hospitalized after an operation. When assessing the client for postoperative infection, the nurse places priority on which assessment?

change in behavior; older clients have change in behavior as an onset for sign of illness

what is the drug of choice for malignant hyperthermia - loosens up muscles

dantrium (dantrolene)

A patient was administered succinylcholine for thyroid surgery. A nurse finds that the patient has hyperthermia, tachycardia, tachypnea, and hypercarbia. Which drug will most likely help the patient?

dantrolene

The nurse is caring for a patient who is approaching death. When must the nurse notify the organ bank? When:

death is iminent in all cases, the death is for sure going to happen.

An elderly patient is being prepared for orthopedic surgery. The nurse realizes this patient is at risk for which complication?

decreased tolerance of general anesthesia

Which assessment findings would cause the nurse to suspect acute rejection of a transplanted kidney?

decreased urine output

medications in pre-op assessment

document all current routine meds including herbal and OTC also ask about possible recreational drug use because it can affect type of anesthisia