Prep U- Chap. 17: Preoperative Nursing Management

The patient asks the nurse why food is withheld before surgery. What is the best response by the nurse? -"Distention is a severe complication if food or fluid is taken close to the surgery time." -"Infection may occur if food or fluid is taken prior to surgery." -"Aspiration is a concern and can be a complication if food or fluid is taken close to the surgery time." -"Obstruction will occur if food or fluid is taken prior to surgery."

"Aspiration is a concern and can be a complication if food or fluid is taken close to the surgery time."

You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply? -"Many people have diagnostic or short therapeutic surgical procedures." -"Lots of people have cancer and need tumors removed." -"You know, we have a lot of sick people in the world." -"Not everyone has to go to the hospital to have surgery anymore."

"Many people have diagnostic or short therapeutic surgical procedures." -such as bone marrow biopsy, endoscopy, or cardiac catheterization—are now performed in outpatient settings and ambulatory surgical centers.

Which of the following activities are nursing activities in the preoperative phase of care? Select all that apply. -Establishing an intravenous line -Discussing and reviewing the advanced directive document -Ensuring that the sponge, needle, and instrument counts are correct -Administering medications, fluid, and blood component therapy, if prescribed -Beginning discharge planning

-Discussing and reviewing the advanced directive document -Establishing an intravenous line -Beginning discharge planning

For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? -1 -3 -7 -5

7 -7-10 day before surgery

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? -250 to 300 mg/dL -150 to 240 mg/dL -80 to 110 mg/dL -300 to 350 mg/dL

80 to 110 mg/dL

A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery? -A history of sensitivity to aspirin -A history of osteoarthritis -A history of chronic low back pain -A history of diabetes

A history of diabetes -The client's blood glucose level and insulin requirements need to be closely monitored before and after surgery.

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? -Thyroid -Parathyroid -Pituitary -Adrenal

Adrenal -Clients who have received corticosteroids are at risk of adrenal insufficiency

The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following? -Turkey breast, baked sweet potato, asparagus, and an orange -Baked chicken, mashed potatoes, broccoli, and strawberries -Grilled salmon, rice pilaf, green beans, and cantaloupe -Cheeseburger, french fries, coleslaw, and ice cream

Cheeseburger, french fries, coleslaw, and ice cream

At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period? -Following the surgical procedure -At the time of discharge instructions -During the preoperative period -Upon arrival to the surgical unit

During the preoperative period

A client is undergoing preoperative assessment. During admission paperwork, the client reports having enjoyed a hearty breakfast this morning to be ready for the procedure. What is the nurse's next action? -Notify the surgeon. -Cancel the surgery. -Give the client plenty of water to aid digestion. -Document what foods the client ate.

Notify the surgeon.

The nurse is aware that the amino acid, arginine, -Stimulates T-cell response -Is essential for antibody formation -Is important for normal blood clotting -Is involved in capillary formation

Stimulates T-cell response -Arginine is necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response

The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. -health status -nutritional status -Ethnicity -physical condition -age -gender

-nutritional status -age -physical condition -health status

You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility? -Explain that the client cannot go into the operating room with jewelry on. -Tell the physician and anesthesiologist. -Medicate the client and then remove the ring. -Place gauze under and over the ring and apply adhesive tape over it.

Place gauze under and over the ring and apply adhesive tape over it.

The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed? -"My medical records will be sent to the ambulatory care center prior to my surgery." -"If I do not follow the instructions, my surgery could be cancelled." -"The nurse will explain the details of the surgery before I sign a consent." -"The physician will update my family after the procedure and provide specific discharge instruction

"The nurse will explain the details of the surgery before I sign a consent."

The nurse expects informed consent to be obtained for insertion of: -An indwelling urinary catheter -An intravenous catheter -A gastrostomy tube -A nasogastric tube

A gastrostomy tube

gunshot wound would be classified under which category of surgery based on urgency? -Elective -Emergent -Urgent -Required

Emergent -Emergent surgery occurs when the patient requires immediate attention. -An elective surgery is classified as a surgery that the patient should have. -A required surgery means that the patient needs to have surgery. -An urgent surgery is one which the patient required prompt attention.

A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for? -Hypertension -Dehydration -Hypoglycemia -Glucosuria

Hypoglycemia -risk for both hypoglycemia and hyperglycemia. -Hypoglycemia may develop during anesthesia or postoperatively from inadequate carbohydrates or excessive administration of insulin. -Hyperglycemia, which can increase the risk of surgical wound infection, may result from the stress of surgery, which can trigger increased levels of catecholamine.

An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used? -Optimistic self-recitation -Distraction -Progressive muscular relaxation -Imagery

Imagery -Imagery has proven effective for anxiety in surgical clients. -Optimistic self-recitation is practiced when the client recites optimistic thoughts such as, "I know all will go well." -Distraction is used when the client is encouraged to think of an enjoyable story or recite a favorite poem. -Progressive muscular relaxation requires contracting and relaxing muscle groups and is a physical coping strategy as opposed to a cognitive strategy.

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? -Make inhalation longer than exhalation. -Exhale through an open mouth. -Use chest breathing. -Use diaphragmatic breathing.

Use diaphragmatic breathing. -chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out? -Check that all surgical personnel are properly attired. -Ensure that sufficient surgical supplies are available. -Confirm that informed consent has been obtained. -Review the scheduled procedure, site, and client.

Review the scheduled procedure, site, and client. -2016 National Patient Safety Goals, accurate identification of the client, procedure, and operative site is essential.

The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is: -To notify the surgeon -To have the client sign the consent immediately -For the nurse to sign the consent with verbal permission of the client -To have the client's next of kin sign the consent

To notify the surgeon

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period? -Upon awakening in the postanesthesia care unit -Up to 24 hours after alcohol withdrawal -Up to 72 hours after alcohol withdrawal -Immediately upon admission

Up to 72 hours after alcohol withdrawal -Alcohol withdrawal delirium is associated with a significant mortality rate when it occurs postoperatively

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as -elective. -urgent. -emergency. -required.

emergency. -client requires immediate attention and the disorder may be life threatening. -Urgent surgery means that the client requires prompt attention within 24 to 30 hours. -Required surgery means that the client needs to have surgery, and it should be planned within a few weeks or months. -Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic.

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? -"It is best to take deep breaths and relax before the procedure." -"We will keep your family informed of your progress." -"You will be just fine; the operating room nurses will take good care of you." -"Let me explain to you what will happen next."

"Let me explain to you what will happen next."

The nurse is completing a preoperative assessment. The nurse notices the client is tearful and constantly wringing their hands. The client states, "I'm really nervous about this surgery. Do you think it will be ok?" What is the nurse's best response? -"No one has ever died from the procedure you are having." -"What are your concerns?" -"What family support do you have after the surgery?" -"You have nothing to worry about; you have the best surgical team."

"What are your concerns?"

Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery? -Nurse -Certified nurse's aide -Physician -Case manager

Physician

A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate? -Place the consent form in the client's medical record. -Notify the nurse manager of the client's questions. -Answer the client's questions. -Request that the surgeon come and answer the questions.

Request that the surgeon come and answer the questions. -physician's responsibility to provide information pertaining to risks and benefits of surgery.

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? -Pain medication should be taken before completing deep breathing and coughing exercises. -Deep breathing and coughing exercises should be completed every 8 hours. -Splint the incision site using a pillow during deep breathing and coughing exercises. -Deep breathing and coughing exercises may be used as relaxation techniques.

Splint the incision site using a pillow during deep breathing and coughing exercises.

At what point does the preoperative period end? -When the client is transferred onto the operating table -When the client is admitted to the PACU -When the client signs the consent form -When the decision is made to proceed with surgery

When the client is transferred onto the operating table -preoperative phase begins when the decision to proceed with surgical intervention is made and ends with the transfer of the client onto the OR table. The intraoperative phase begins when the client is transferred onto the operating table and ends with admission to the PACU.

A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse: -continuously monitors the sedated client. -assesses how well the client is recovering from anesthesia. -obtains a surgical consent from the client's mother. -performs a complete assessment of the client.

continuously monitors the sedated client. -Intraoperative care includes the entire surgical procedure. During sedation, the nurse continuously evaluates the client. Assessment of heart rate, respiratory rate, BP, oxygen saturation, and level of consciousness occurs during all phases of perioperative care.