UWORLD: Perioperative Nursing Care

The nurse in the same-day surgery unit admits a client who will receive general anesthesia. The client has never had surgery before. Which question is most critical for the nurse to ask the client during the preoperative assessment and health history? 1. "Has any family member ever had a bad reaction to general anesthesia?" 2. "Have you ever experienced low back pain?" 3. "Have you ever had an anaphylactic reaction to a bee sting?" 4. "Have you ever received opioid pain medication?"

1. "Has any family member ever had a bad reaction to general anesthesia?"

The post-anesthesia care unit nurse receives report on a client after abdominal surgery. What sounds would the nurse expect to hear when auscultating the bowel? 1. Absent bowel sounds 2. Borborygmi sounds 3. High-pitched and gurgling sounds 4. Swishing or buzzing sounds

1. Absent bowel sounds

The nurse is caring for a 5-year-old client on the first postoperative day following a tonsillectomy. Which of the following interventions are appropriate to include in the plan of care? Select all that apply. 1. Administer prescribed liquid acetaminophen 2. Encourage drinking from a straw to increase fluid intake 3. Initiate strict intake and output monitoring 4. Monitor for and report increased swallowing 5. Teach the child to cough to clear the throat

1. Administer prescribed liquid acetaminophen 3. Initiate strict intake and output monitoring 4. Monitor for and report increased swallowing

The HCP explains the risks and benefits of a procedure to the client through an interpreter. The HCP leaves after asking the nurse to witness the client's signature in the consent. The interpreter and client now have a lengthy discussion in the foreign language. The nurse should take which action at this time? 1. Ask the interpreter to explain the discussion 2. Confirm the clients consent with the interpreter, using gestures 3. Have the interpreter witness the signature 4. Indicate that the interpreter was used when witnessing the client's signature

1. Ask the interpreter to explain the discussion

The evening shift nurse reviews the preoperative checklist and latest serum laboratory values for an elderly client with a ruptured diverticulum who is scheduled for surgery in the early morning. Which laboratory value is most important for the nurse to report to the health care provider? 1. Creatinine level 2.5 mg/dL 2. Potassium level 3.5 mEq/L 3. Sodium level 134 mEq/L 4. White blood cell count 16,000/ mm^3

1. Creatinine level 2.5 mg/dL

A nurse prepared a client for knee arthroscopy requiring general anesthesia. Which actions should the nurse complete?Select all 1. Encourage the client to void prior to surgery 2. Ensure that the client has been on NPO status 3. Place signed informed consents in the client's chart 4. Replace the current 20-gauge IV catheter with an 18-gauge 5. Witness that the correct surgery site is marked by the surgeon

1. Encourage the client to void prior to surgery 2. Ensure that the client has been on NPO status 3. Place signed informed consents in the client's chart 5. Witness that the correct surgery site is marked by the surgeon

The nurse is reviewing laboratory results and vital signs for a client with cholecystitis and cholelithiasis who will undergo open cholecystectomy later today. Which finding is most important for the nurse to report to the health care provider? 1. INR 2.0 2. Potassium level 3.5 mEq/L (3.5 mmol/L) 3. Temperature 100.6 F (38.1 C) 4. WBC count 12,500/mm^3 (12.5 x 10^9/L)

1. INR 2.0

The nurse has attended a staff education program about informed consent. Which of the following statements by the nurse would require follow-up? 1. "A client who is competent may withdraw initial consent at any time." 2. "Reviewing alternate therapies is not an element of informed consent." 3. "Informed consent includes understanding the right to refuse a procedure." 4. "A client who is currently receiving sedating medication cannot provide consent."

2. "Reviewing alternate therapies is not an element of informed consent."

A client is transferred from the post-anesthesia recovery unit to the surgical unit following an open cholecystectomy. Which interventions are most important for the nurse to perform to prevent postoperative pneumonia? Select all 1. Administer morphine only if the pain is >8 on a 1-10 pain scale 2. Ambulate within 8 hours after surgery if possible 3. Have client cough with splinting every hour 4. Have client deep breathe and the incentive spirometer every hour 5. Maintain pneumatic compression devices when client is in bed 6. Place client in Fowler's postion

2. Ambulate within 8 hours after surgery if possible 3. Have client cough with splinting every hour 4. Have client deep breathe and the incentive spirometer every hour 6. Place client in Fowler's postion

The male client had a hemicolectomy. The client is refusing to wear the prescribed SCDs. What is most important for the nurse to communicate to the client? 1. An appropriate form must be signed, verifying refusal 2. Complications, including death, could result 3. The client will be billed for the equipment regardless 4. The surgeon will be informed of the refusal

2. Complications, including death, could result

The nurse completes the preoperative assessment for a client scheduled for a total knee replacement today. Which information should the nurse report to the health care provider as soon as possible before the surgery? 1. Has allergy to strawberries 2. Is experiencing burning on urination starting yesterday 3. Rates knee pain as a 9 on a 0-10 scale 4. Stopped taking celecoxib 7 days ago

2. Is experiencing burning on urination starting yesterday

The HCP provides education to an adult client about an upcoming surgical procedure. The HCP asks the nurse to witness the client's signature and leaves the room. The client states, "i'm not clear on what is included in the low-fat diet that I'll be on after the cholecystectomy." What action should the nurse take? 1. Ask the client's family member to sign the consent form 2. Inform the client that HCP can discuss all questions after surgery 3. Provide the client with education material about low-fat diet options 4. Reinforce education about the procedure using a visual aid

3. Provide the client with education material about low-fat diet options

The nurse has attended a staff education program about malignant hyperthermia (MH). Which of the following statements by the nurse would require follow-up? 1. "Stress and heat may trigger MH." 2. "IV dantrolene is administered to treat MH." 3. "Rhabdomyolysis is a potential complication of MH." 4. "MH can be caused by the administration of local anesthetics."

4. "MH can be caused by the administration of local anesthetics."

The nurse is assessing a client in the postanesthesia recovery area immediately following a cesarean birth with spinal anesthesia. Which finding should the nurse report to the health care provider? 1. Client can move toes but is unable to lift buttocks or elevate legs 2. Client is shivering and has an oral temperature of 97 F (36.1 C) 3. Client's abdomen is mildly distended with hypoactive bowel sounds 4. Client's indwelling urinary catheter is draining bloody urine

4. Client's indwelling urinary catheter is draining bloody urine

The nurse in the operating room is caring for a client who is receiving general anesthesia. The nurse notes that the client has a heart rate of 160/min and increased end-tidal CO2 reading. Which of the following actions should the nurse take? 1. Place a warming blanket on the client. 2. Prepare to administer IM glucagon 3. Place the client in the side-lying position 4. Prepare to adminster IV dantrolene

4. Prepare to adminster IV dantrolene

The nurse is caring for a client who is scheduled for a surgical procedure in 1 hour. The client states, "I do not understand why I need surgery." Which of the following actions would be a priority for the nurse to take? 1. Inform the nurse manager that the client requires additional information 2. Notify the operating room that the procedure may need to be delayed 3. Provide the client with an education pamphlet about the procedure 4. Request that the health care provider address the client's concerns

4. Request that the health care provider address the client's concerns

The nurse is assisting with procedural moderate sedation at a clients bedside. The UAP comes to the door and indicates that the client in the next room needs the nurse right now. How should the nurse report? 1. Ask the UAP to go back and ask the client what the current needs are 2. Ask the UAP to stay and take over while the nurse goes to check on the client in the next room 3. Tell the UAP to inform the client in the next room that the nurse will be there shortly 4. Tell the UAP to tell the charge nurse about the needs of the client in the next room

4. Tell the UAP to tell the charge nurse about the needs of the client in the next room

An unconscious client is brought to the emergency department by the paramedics after being hit by a car. An emergency craniotomy is required. The client has no identification. What action should be taken next? 1. Contact the national database to see if the client has a healthcare proxy 2. Contact the police to help identify the client and locate family members 3. Obtain a court order for the client's surgical procedure 4. Transport the client to the operating room under implied consent

4. Transport the client to the operating room under implied consent

The nurse is caring for a women with obesity who is 3 days postoperative total hip joint replacement. Which laboratory value is of greatest concern and should be reported to the HCP Immediately? 1. Blood urea nitrogen (BUN) 22 mg/dL (7.9 mmol/L) 2. Glucose 158 mg/dL (8.7 mmol/L) 3. Hematocrit 33% (0.33) and hemoglobin 11 g/dL (110 g/L) 4. White blood cell count (WBC) 116,000mm^3 (16.0 x 10^9/ L)

4. White blood cell count (WBC) 116,000mm^3 (16.0 x 10^9/ L)

T or F: Preoperative nursing interventions may include obtaining a finger-stick blood glucose level, reviewing preoperative platelet count, placing an allergy wristband if indicated, verifying understaning of informed consent, reviewing home medication and notifying the health care provider of possible interactions, evaluating postoperative pain expectations, and identifying need for resources after discharge

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