Med-Surg Chapter 31: Perioperative Nursing

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

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

A toddler will be undergoing hernia repair surgery. What nursing action will best reduce the client's anxiety?

Apply equipment and perform preparation after anesthetic has taken effect

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

Preoperative

Administering anesthesia via an epidural is considered which of the following?

Regional anesthesia

Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction?

"After this fasting, I'm looking forward to a hamburger and fries once I wake up."

The nurse is preparing a client for a total hip arthroplasty and is obtaining data preoperatively. Which statement made by the client is most important for the nurse to immediately report to the health care provider?

"I have been taking ibuprofen for my hip pain twice a day."

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."

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 nurse is teaching a client about postoperative pain management. The client states, "I would like to use as little medication as possible after surgery. Will anything else help to relieve my pain?" Which response is appropriate?

"There are several nonpharmacologic methods to reduce pain and anxiety. Let me teach you about some of them."

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."

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 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."

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 NPO."

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?

"an advanced directive will communicate your wishes for health care postoperatively in case you are unable to do so."

The nurse is caring for a client admitted for an outpatient surgical procedure. Which action will the nurse include in the care? Select all that apply. -Begin discharge education as soon as the procedure is completed. -Allow family members to be present during discharge education. -Begin discharge education in the preoperative period. -Following the procedure, investigate the client's home care and discharge transportation -Discuss discharge transportation during the preoperative period.

-Allow family members to be present during discharge education -Begin discharge education in the preoperative period -Discuss discharge transportation during the preoperative period

The nurse is developing a plan of care for a client who had a splenectomy. The outcome is prevention of surgical site infection. Which interventions should be included in the client's plan of care? Select all that apply. -Assess vital signs. -Monitor white blood cell count. -Use asepsis with dressing change. -Monitor bowel sounds. -Maintain hydration. -Reposition client frequently.

-Assess vital signs -Monitor white blood cell count -Use asepsis with dressing change -Maintain hydration

Which postoperative complications can be reduced by appropriate client teaching about deep-breathing exercises? Select all that apply. -Atelectasis -Wound infection -Pneumonia -Bronchitis -Severe hypoxemia -Deep vein thrombosis

-Atelectasis -Pneumonia -Bronchitis -Severe hypoxemia

A client will be having a surgical procedure requiring general anesthesia. Which desired outcomes of general anesthesia does the nurse expect to observe? Select all that apply. -Loss of consciousness -Analgesia -Relaxed skeletal muscles -Loos of sensation in specific area -Depressed reflexes

-Loss of consciousness -Analgesia -Relaxed skeletal muscles -Depressed reflexes

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 -Temperature of 99.2°F (37.3°C) -Bleeding tendencies -Low hemoglobin -Anxiety

-Obesity -Bleeding tendencies -Low hemoglobin

Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply. -Inhalation -Spinal block -Intravenous -Oral route -Nerve block -Epidural block

-Spinal block -Nerve block -Epidural block

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. -Where to park, so upon discharge can drive home -What to expect before, during and after surgery, -Time for limitations with eating and drinking -When and where to arrive for surgery -How to cleanse skin with a special soap solution

-What to expect before, during and after surgery, -Time for limitations with eating and drinking -When and where to arrive for surgery -How to cleanse skin with a special soap solution

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. -administering inhalation anesthetics -positioning the client on the operating table -administering regional nerve blocks -counting sponges before and after surgery -monitoring the client's vital signs

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

Which of the following medication categories may lead to cardiovascular collapse during surgery when taken long-term?

Adrenal steroids

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

The nurse is caring for a client in the postanesthesia care unit (PACU). The nurse uses specific interventions to avoid complications for each body system. Respiratory:

Assess skin color

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

A preoperative client reports having a latex allergy. Which action does the nurse take to communicate this allergy to hospital staff caring for the client?

Note the allergy on the client's record

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

A perioperative nurse is determining a plan of care for the client in the operating room. Which client outcome has priority?

Be free from injury and adverse effects

The nurse knows the term perioperative phase refers to care given to the client:

Before, during, and after the operative phase

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

Client safety

The nurse is caring for several postoperative clients and is planning their care. Which surgical client will likely resume activities of daily living most quickly?

Client who has had a laparoscopic cholecystectomy

A pediatric nurse is preparing a child for cleft palate repair surgery. The nurse identifies that this procedure will be documented as:

Constructive surgery

An older 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

Which of the following preoperative medications is a highly selective alpha 2-adrenergic receptor agonist that is helpful in reducing anesthesia requirements?

Dexmedetomidine

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

Emergency surgery

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

T/F: A tonsillectomy is an example of a surgical procedure classified as urgent

False

T/F: Nurses should provide preoperative teaching to patients as far in advance of the procedure as possible

False

T/F: The responsibility for securing informed consent from a patient who is going to have surgery lies with the registered nurse who completes and signs the preoperative checklist

False

The nurse educates a client about what to expect after abdominal surgery. How will the nurse explain the progression of a client's diet in the postoperative period?

Food and liquids will be withheld in the immediate postoperative period

The nurse is caring for a client in the postanesthesia care unit (PACU). The nurse uses specific interventions to avoid complications for each body system. Neurologic:

Gently touch the client

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

A nurse asks a preoperative client which medications he is currently taking. Which statement describes an accurate guideline for client teaching regarding these medications?

Many respiratory drugs may be taken the day of surgery per health care provider's order

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 preoperative nurse has prepared a client for surgery and has been notified that the operating room staff is ready for the client. The client states, "My bladder feels full. I need to go to the bathroom!" Which action by the nurse is appropriate?

Inform the operating room staff and assist the client to the bathroom

Which of the following postsurgical activities is encouraged to decrease the risk of thrombophlebitis or emboli?

Leg exercises

The nurse cares for an adult client following surgery to repair an abdominal aortic aneurysm. Which nursing intervention should the nurse perform to assist with healing and maintaining client comfort?

Maintain a calm environment

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 perioperative nurse is assessing a client scheduled for surgery. The client mentions taking aspirin on a daily basis since having a heart attack several years ago. In addition to ensuring the surgeon is aware of the medication use and prior myocardial infarction, what is the nurse's most appropriate action?

Monitor the client closely for signs of hemorrhage

Which of the following assessments are performed frequently during the first hour after surgery which specifically involves spinal anesthesia?

Neurologic checks

The healthy adult client is given an opioid 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 health care provider of the oversight

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?

Place the client in a flat position with legs elevated 45 degrees

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 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

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

Provide the client with a pillow or folded blanket to hug

The nurse is caring for a client in the postanesthesia care unit (PACU). The nurse uses specific interventions to avoid complications for each body system. Cardiac:

Provide verbal stimulation

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 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?

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

Which nursing action will assist in pain management for a client in the postoperative phase?

Relaxation techniques

Which nursing action will best promote pain management for a client in the postoperative phase?

Relaxation techniques

The nurse is caring for a confused older adult client who requires surgery for a broken hip. What steps does the nurse take to determine if the client has a durable power of attorney for health care and how to contact that person?

Review the medical chart for a copy of a durable power of attorney for health care or permission for disclosure contact

When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease?

Slow wound healing

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 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 and of the legs and helps to prevent blood clots

The nurse is helping to prepare a client for surgery. Who is legally responsible for obtaining the client's informed consent for the surgical procedure?

The surgeon

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

To lessen the intensity of an illness

In which position would the surgical nurse place a client undergoing minimally invasive surgery of the lower abdomen or pelvis?

Trendelenburg position

T/F: Evidence-based guidelines for the management of acute surgical pain are based on the principle that "the pain reported by the patient is the determining factor of pain control."

True

T/F: Final verification of the patient's identity, the procedure, and the correct surgical site is referred to as the time-out, and is completed by the RN, the surgeon, the OR technician, and the anesthesia provider

True

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