Adult Health 2 Peri-operative Care

What ALDRETE score is required before a pt can discharge from the PACU?

7-8 points

A patient with fractured skull after falling from a ladder requires surgery. The nurse should anticipate transporting the pt to surgery during what time frame? A) Immediately B) In 1 week C)In 1 day D) In 48-72 hrs

A Immediately

This surgical team member is responsible for advocating for the pt while in surgery? A) Circulating nurse B) Scrub nurse/tech C) Surgeon D) Registered nurse first assistant E) Anesthesiologist

A) Circulating nurse

What action by the nurse best encompasses the preoperative phase? A) Monitoring VS Q15 minutes B) Shaving the pt using a straight razor C) Educating the pts on signs and symptoms of infection D) Documenting the application of sequential compression devices (SCD)

A) Educating the pts on signs and symptoms of infection.

A patient admitted to the ED with gun shot wounds to the abdomen would require what urgency of surgery? A) Emergency- without delay B) Urgent- within 24-30hr C) Required- weeks or months D) Elective- not catastrophic E) Optional-preference

A) Emergency- without delay

The pt is unarousable not even to painful stimuli and has lost the ability to maintain ventilatory function and requires the assistance in maintaining the patent airway? A)General anesthesia B) Regional anesthesia C) Moderate sedation D) Local anesthesia

A) General anesthesia

During the preoperative assessment, the patient states he is allergic to avocados, bananas, and hydrocodone (Vicodin). What is the priority action by the nurse? A) Notify the surgical team to remove all latex-based items. B) Notify the dietary department C) Notify the physician regarding postoperative pain medications D) Notify the nurse manager to follow up on the procedure

A) Notify the surgical team to remove all latex based items. Allergies to avocados and bananas may indicate an allergy to latex.

A pt continuously states,"I know all will go well." What cognitive coping strategy should the nurse document? A) Optimistic self recitation B) Distraction C) Music therapy D) Imagery

A) Optimistic self recitation

An obese pt is scheduled for open abdominal surgery. What priority education should the nurse provide this pt? A) Prevention of respiratory complications B) Prevention of wound dehiscence C) Venous thromboembolism prevention D) Wound care and infection prevention

A) Prevention of respiratory complications

What is the priority for PACU? A) Respiratory B) Cardiovascular C) Neurology D) Fluid and Electrolyte E) Gastrointestinal F) Integumentary G) Pyschosocial

A) Respiratory

The nurse is educating patients requiring surgery for various ailments n the perioperative experience. What education provided by the nurse is most appropriate? A) Three phases of surgery and safety measures for each phase B) Intraoperative techniques used to perform the surgery C) Expected pain levels and narcotic pain medication used to treat the pain D) Risks and benefits of the surgical procedures

A) Three phases of surgery and safety measures for each phase The perioperative period includes the preoperative, intraoperative, and postoperative phases. Specific safety guidelines are followed for all surgical patients. The information provided should be general enough to be informative about surgery and should not focus on individual surgeries, as all patients are having different surgeries.

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

A) What are your concerns?

A parent of a 16 year old pt asks the nurse, "How could the surgeon operate without my consent?" What is the best response given by the nurse? A) Your child had life-threatening injuries that required immediate surgery. B) We obtained consent from your child after your child requested the surgery. C) Two doctors decided your child needed the surgery, therefore we did not need to get consent. D) The surgical procedure being performed does not require consent.

A) Your child had life threatening injuries that required immediate surgery.

Which of the following are the nurses responsibility regarding consent? A) Ensure pt signs prior to giving preop medications B) Provide additional information if pt has questions C) Clarify any points given by physician D) Documenting the pt signing the consent form in chart E) Delegate witnessing the pts signature on the consent form to the pt care assistant.

A, B, C, D

Using the ALDRETE score how many points does a pt get for the following? Ability to breathe deeply and cough Limited respiratory effort (dyspnea or splinting) No spontaneous effort

Ability to breathe deeply and cough =2 Limited respiratory effort (dyspnea or splinting) =1 No spontaneous effort =0

Using the ALDRETE score how many points does a pt get for the following? Ability to move all extremities Ability to move 2 extremities Unable to control any extremity

Ability to move all extremities =2 Ability to move 2 extremities =1 Unable to control any extremity =0

Using the ALDRETE score how many points does a pt get for the following? Able to maintain O2 sat > 92% on room air Needs O2 inhalation to maintain O2 sat >90% O2 sat < 90% even with O2 supplement

Able to maintain O2 sat > 92% on room air =2 Needs O2 inhalation to maintain O2 sat >90% =1 O2 sat < 90% even with O2 supplement =0

What interventions are used to reduce the pt and family anxiety prior to surgery?

Anticipatory guidance= what to expect after surgery Rest Communication Acknowledging fear

What is ALDRETE?

Assessment to transfer from PACU to the clinical setting. Activity Respirations Circulation Consciousness O2 saturation

The nurse has administered the preanesthetic medication. What action should the nurse take next? A) Obtain the pt's signature on the consent form. B) Place the pt on bed rest with the side rails up. C) Review the pt's list of home medications D) Educate the pt on discharge instructions.

B) Place the pt on bed rest with the side rails up.

The pt is injected around nerves so that the region supplied by the nerves is anesthetized, pt is awake and aware of his or her surroundings unless medications are given to produce mild sedation or to relieve anxiety? A)General anesthesia B) Regional anesthesia C) Moderate sedation D) Local anesthesia

B) Regional anesthesia

The nurse is educating a pt scheduled for elective surgery. The pt currently takes aspirin daily. What education should the nurse provide in regard to the medication? A) Increase three days before surgery, and then it should be discontinued until 3 days after surgery. B) Stop taking 7 days before the surgery, unless otherwise directed by your physician C) Continue to take as ordered D) Take half doses until one week after surgery

B) Stop taking 7 days before the surgery, unless otherwise directed by your physician.

The nurse is education a community group regarding types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true? A) A biopsy B) The excision of a tumor C) The placement of gastrostomy tube D) A face lift

B) The excision of a tumor.

A patient has been transported to the OR for emergent surgery. Which statement by the nurse best supports the need for emergent surgery? A) The pt had epigastric abdominal pain, an elevated white blood count, and vomiting for 1 day. B) The pt was unresponsive, had a distended abdomen, and unstable VS following a motor vehicle accident C) The pt had severe pain and laceration to the face with minimal bleeding after being attacked by a dog 1hr ago. D) The pt was tachycardic, had progressive weight loss, and bouts of insomnia as a result of hyperthyroidism.

B) The pt was unresponsive, had a distended abdomen, and unstable VS following a motor vehicle accident.

A patient diagnosed with kidney stones would be a candidate for which urgency of surgery? A) Emergency- without delay B) Urgent- within 24-30hr C) Required- weeks or months D) Elective- not catastrophic E) Optional-preference

B) Urgent- within 24-30hr

Using the ALDRETE score how many points does a pt get for the following? BP 20% of preanesthetic level BP 20% - 49% of preanesthetic level BP 50% of preanesthetic level

BP 20% of preanesthetic level =2 BP 20% - 49% of preanesthetic level =1 BP 50% of preanesthetic level =0

A pt refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? A) Remove the ring once the pt is sedated. B) Notify the surgeon to cancel the surgery C) Allow the ring to stay on the pt and cover it with tape D) Discuss the risk for infection caused by wearing the ring.

C) Allow the ring to stay on the pt and cover it with tape.

Anesthesia that involves the IV administration of sedatives or analgesic medications to reduce pt anxiety and control pain during dx or therapeutic procedures. Pt is able to maintain patent airway, retain protective airway reflexes and respond to verbal and physical stimuli. A)General anesthesia B) Regional anesthesia C) Moderate sedation D) Local anesthesia

C) Moderate sedation

A pt is scheduled to have a cholecystectomy. Which of the nurse's findings is least likely to contribute to surgical complications? A) Diabetes B) Urinary tract infection C) Osteoporosis D) Pregnancy

C) Osteoporosis

A patient is diagnosed with thyroid cancer would be a candidate for which urgency of surgery? A) Emergency- without delay B) Urgent- within 24-30hr C) Required- weeks or months D) Elective- not catastrophic E) Optional-preference

C) Required- weeks or months

A surgical pt has been transferred to the holding area. What nursing intervention(s) promote safe and effective nursing care? Select all that apply. A) Maintain an aseptic environment B) Provide oral fluids to the pt C) Review the medical records D) Verify the surgical site and mark it appropriately. E) Identify the pt using two identifiers F) Apply grounding and devices to the pt.

C), D), E)

What is the nurses role in operative permit/ informed consent?

Clarify and pt advocate

The nurse is triaging the surgical patients. Which patient would the nurse document as urgent for surgical care? A) A pt w/ severe bleeding B) A pt needing cataract surgery C) A pt scheduled for cosmetic surgery D) A pt with an acute gallbladder infection

D) A pt with an acute gallbladder infection

A pt is scheduled for an invasive procedure. What is the priority documentation needed regarding the procedure? A) A health hx obtained by the primary physician B) The medication reconciliation form C) Prescriptions for postoperative medications D) A signed consent form from the pt.

D) A signed consent form from the pt.

A client is diagnosed with vaginal prolapse which type of surgery would the client be a candidate for? A) Emergency- without delay B) Urgent- within 24-30hr C) Required- weeks or months D) Elective- not catastrophic E) Optional-preference

D) Elective- not catastrophic

A pt with a hx of alcoholism and schedule for an urgent surgery asks the nurse, "Why is everyone so concerned about how much I drink?" What is the best response by the nurse? A) It is a required screening question for all pt having surgery. B) The amount of alcohol you drink will determine the amount of pain medication you will need postoperatively. C) We can have counselors available after surgery; if it is determined you need help for you drinking. D) It is important for us to know how much and how often you drink to help prevent surgical complications.

D) It is important to know how much and how often you drink to help prevent surgical complications. Alcohol use and alcoholism can contribute to serious postoperative complications

A pt asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate? A) It prevents overhydration and hypertension B) It decreases urine output so that a catheter would not be needed. C) It decreases the risk of elevated blood sugars and slow wound healing. D) It prevents aspiration and respiratory complications.

D) It prevents aspiration and respiratory complications.

The injection of a solution containing the anesthetic agent into the tissues at the planned incision site. Usually administered with epinephrine. A)General anesthesia B) Regional anesthesia C) Moderate sedation D) Local anesthesia

D) Local anesthesia

The nurse is conducting a preoperative assessment on a pt scheduled for gallbladder surgery. The pt reports having a frequent cough producing green sputum for 3 days and denies fever. Upon auscultation, the nurse note rhonchi throughout the right lung with an occasional expiratory wheeze. Respiratory rate is 20, temp is 99.8 taken orally, heart rate is 87, and BP is 124/70. What is the nurse's best action? A) Wait 1hr and complete the assessment again. B) Document the findings and continue the patient through the preoperative phase. C) Notify the primary physician about the findings. D) Notify the surgeon to possibly delay the surgery.

D) Notify the surgeon to possibly delay the surgery. A respiratory infection can delay the nonemergent surgical procedure because the infection can increase the risk for respiratory complications.

A pt is scheduled for elective surgery. To prevent the complication of hypotension and cardiovascular collapse, the nurse should report the use of what medication? A) hydrochlorothiazide B) Warfarin C)Erythromycin D) Prednisone

D) Prednisone Pts who have recieved corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids can cause circulatory collapse and hypotension.

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

D) Request that the surgeon come and answer the questions.

The nurse would identify which of the following vitamin deficiencies to prevent the complication of hemorrhaging during surgery? A) Zinc B) Vit A C)Magnesium D)Vit K

D) Vit K

An anxious preoperative surgical pt is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used? A) Distraction B)Imagery C) Optimistic self recitation D) Progressive muscular relaxation

D. Imagery

What does the ALDRETE II include in addition to ALDRETE?

Dressing Pain Ambulation Fasting/Feeding Urine Output

A client has undergone a mastectomy and is considering breast reconstruction. What type of surgery would the breast reconstruction be considered as? A) Emergency- without delay B) Urgent- within 24-30hr C) Required- weeks or months D) Elective- not catastrophic E) Optional-preference

E) Optional-preference

Using the ALDRETE score how many points does a pt get for the following? Fully awake Arousable on calling Not responding

Fully awake =2 Arousable on calling =1 Not responding =0

When is ALDRETE II used?

In ambulatory care units

What is important to remember about emergency consent?

May be obtained over the phone and requires two witnesses

Who's responsibility is it to get operative permit/ informed consent from the pt prior to surgery?

Physician

Which surgical environment requires the use of shoe covers, surgical scrubs, face mask, cap and gloves?

Restricted Zone

Which surgical environment is where the front desk is located?

Semi restricted Zone

What does minor surgery refer to?

Surgery that does not require anesthesia that compromises airway, smaller incisions such as laparotomy procedures, and shorter procedure time and or recovery times.

What does major surgery refer to?

Surgery that requires general anesthesia, large incisions, and long procedures and or recovery time.

Which surgical environment is where family members and pts wait prior to going to the OR and where medications maybe given?

Unrestricted Zone

What teaching is important to discuss in pre-op?

What they should expect after the procedure: Drains/tubes IV's Breathing exercises Antiembolism hoses Pneumatic compression devices ROM pain

When does the preoperative stage end?

When the pt is placed on the OR table

What medications can the nurse anticipate for patients going to the PACU

analgesics, antiemetics, anticoagulants, antibiotics, fluids,and demoral (for shivering)

What medication is given 1 hr prior to cut time?

antibiotics

What medication is given to dry up secretions?

atropine

What is the first line medication used for hypovolemia?

fluids

What are the common complications of general anesthesia that usually occurs during induction or emergency?

hypothermia hypotension hypoxia

What prophylactic postoperative care is used to prevent DVT?

low dose heparin, low molecular wt, warfarin external pneumatic compression devices early ambulation avoid dangling on edge of bed too long, pillows/blanketsunder knees Reposition q2h monitor for calf pain, warmth, leg swelling, fever, chills, sweating

Who should be included in the pre-op instructions?

patient and family/significant others

What medication is commonly used for preop?

versed and zofran