Perioperative Nursing and IV Therapy Lec Questions
How does obesity impact surgical considerations? (Select all that apply) A. Impaired medication clearance B. Positioning difficulties C. Respiratory difficulties D. Impaired pain responses E. Impaired blood coagulation
A, B, C
The client receiving continuous IV fluids notifies the nurse of pain at their IV site. After assessing the site, the nurse determines the client has developed phlebitis at the IV site. What nursing action(s) is/are appropriate? Select all that apply A. Remove the IV catheter at that site B. Apply warm moist heat to the site C. Start a new IV line in another vein D. Document the occurrence, actions taken, and the client's response E. Administer oral diphenhydramine F. Notify the health care provider
A, B, C, D, E Note: Not diphenhydramine since it's not an allergic reaction.
Recall the pre-op medications ordered for Mr. Cane: • Atropine 0.4 mg with Demerol 50 mg IM on call to OR • Nembutal 25 mg IM on call to OR What physiological effects can you anticipate secondary to the pre-op medications?
Atropine: it is anticholinergic that will help dry out secretions, so side affects such as a cough is to be expected. Demerol: is a narcotic to treat pain, can cause hypotension, altered mental status Nembutal: is a sedative, supported anesthesia
Preoperative orders have been written for a client scheduled for surgery in a few hours. What preoperative task is most important to do before surgery? A. Remove all jewelry or tape wedding ring B. Verify all consents have been signed C. Confirm all laboratory work is complete D. Inform family or next of kin
B
To prevent complications of immobility, which client activity is most beneficial for the nurse to plan during the first postoperative day after a colon resection? A. Turn, cough and deep breathe every 30 minutes B. Assist the client out of bed and ambulate to the bedside chair C. Provide passive range of motion three times daily D. Instruct the client on proper techniques for surgical wound care
B
What factor negates the validity of informed consent? A. The client is of legal age with a proper mental disposition B. When the client is unable to write, the nurse signs the consent for the client C. If the client is a child, secure consent from the parents or legal guardian D. The consent is secured before administration of preoperative medications
B
Which of the following items on a client's pre-surgery laboratory results would indicate a need to contact the surgeon immediately? A. Platele count of 250,000/cu/mm B. Hemoglobin 9.2 mg/dI C. Total cholesterol of 325 mg/dl D. Blood urea nitrogen (BUN)) 17 mg/dl
B Note: Low hemoglobin= oxygenation impact not enough oxvgen reaching organs
A client is three days postoperative and receives a lunch tray from the dietary department with lime gelatin, chocolate pudding, and vanilla soft serve ice cream. The nurse understands that, based on the foods found on the client's tray, the client has been ordered what type of diet? A. Bland diet B. Soft diet C. Regular diet D. Full liguid diet
D
Intravenous (IV) fluids have been infusing at 100 mL/hour via a central line catheter in the right internal jugular for approximately 24 hours to increase urine output and maintain the client's blood pressure. Upon entering the client's room, the nurse notes that the client is breathing rapidly and coughing. For which additional signs of a complication should the nurse assess based on the previously known data? A.Excessive bleeding B.Chest pain radiating to the left arm C.Crackles in the lungs D.Incompatibility of the infusion
C
The nurse has just reassessed the condition of a postoperative client who was admitted 2 hours ago to the surgical unit. Which assessment finding should the nurse prioritize and continue to closely monitor over the next hour? A. Temperature of 99.8 F B. Blood pressure of 112/70 C. Total urine output of 30 ml D. Serous fluid in the surgical drain
C
The nurse initiates IV therapy on a client admitted for persistent vomiting and diarrhea. 1000 mLs of 0.9% NSS is hung at 1420. While performing hourly rounds at 1545, the client complains of a pounding headache, chills, and appears apprehensive. The nurse notes the client is also dyspneic and tachycardic. The IV bag of 0.9%NSS has 450 mLs remaining. What is the priority nursing action? A.Remove the IV catheter B.Call the health care provider C.Slow or stop the infusion D.Administer 2 L/min oxygen via face mask
C
Based on knowledge of his underlying medical problems (Diabetes, COPD, PVD) and risks associated with age, how could these problems and risks affect the perioperative experience? How might Mr. Cane's routine meds place him at a higher surgical risk?
COPD for example can impair gas exchange, lung expansion, pneumonia, atelectasis. Diabetes can cause delayed wound healing, and increases risk for infections. Unstable blood glucose can occur as well. PVD can increase risk for clot
In the recovery room, the postoperative client suddenly becomes cyanotic. What is the priority nursing action? A. Administer oxygen at 4 L/min via nasal cannula B. Call the surgical technician for assistance C. Insert an oral airway and suction the nasopharynx D. Reposition the head and determine patency of airway
D
The nurse is assessing a client's peripheral IV site and notes that it is reddened, warm, slightly edematous proximal to the insertion site, and the client reports pain at the site. The nurse hypothesizes the client has experienced what IV-related complication? A. Infiltration of the IV line B. Hypersensitivity to the IV solution C. Allergic reaction to the IV catheter material D.Phlebitis of the vein
D
The nurse is caring for a client admitted for treatment of an infection. The client is receiving 1000 mLs of 5% dextrose in water with 20 mEg potassium chloride. The provider orders for IV infusion of ampicillin-sulbactam. The client only has one IV site available. What nursing action should the nurse plan to take first? A.Mix the pre-packaged ampicillin-sulbactam, per facility policy B.Prime the tubing with the IV solution, then back-prime with the medication C.Start a second IV site D.Check the compatibility of the medication and IV fluids
D
List three classifications of medications that, if found during the pre-operative assessment, would require the nurse to ask additional questions and/or alert the provider.
Corticosteroids, diuretics, anxiety meds, insulin, anti hypertensives, anti cougs, seizure meds, opioids, over the counter meds, herbal supplements.
A break in sterile technique during surgery would occur when the scrub nurse does which of the following? A. Touches the back of their hand to the instruments on the instrument tray B. Touches gloved hands to the gown at chest level C. Touches the drape at the incision site with gloved hands D. Touches their mask with gloved hands
D
Mr. Harold Cane is a 67-year-old male admitted to the surgical unit with a diagnosis of abdominal mass. He has been complaining of vague symptoms for the past 3 months. These symptoms include intermittent indigestion, abdominal pain, and constipation. His medical history includes COPD, PVD, and insulin-dependent diabetes mellitus. Mr. Cane is scheduled for an exploratory laparotomy at 0800 in the morning. His preoperative orders include: • CBC with differential and a comprehensive metabolic panel • NPO at 0600 and begin IV of 1000 NS at 50 mL/hr • Prep abdomen with Cloraprep scrub × 3. Cover abdomen with sterile towel after prep completed • Have Consent signed: I have discussed the surgical procedure/risks/expectations/ outcomes • Consult Pulmonary Services re: Respiratory status • Pre-op medications: • Atropine 0.4 mg with Demerol 50 mg IM on call to OR • Nembutal 25 mg IM on call to OR In reviewing Mr. Cane's orders, which order should be questioned by the nurse?
NPO at 0600 and Have consent
How would the nurse know if the postoperative client is experiencing hypovolemic shock and/or hemorrhaging? *List 3 indicators*
Pallor, cool skin, rapid respirations,rapid weak pulses that might be threats, low blood pressure, low urine outputs, cyanosis
