chapter 17- Preoperative nursing management

Informed consent from the surgical client is essential in all of the following categories of surgery except: Elective surgery Emergent surgery Required surgery Urgent surgery

emergency surgery

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

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

A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery? 2 weeks 4 weeks 7 to 10 days 2 to 3 days

7 to 10 days

A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed? The client places the hands on the lower chest to feel the rise and fall with breathing. The client performs diaphragmatic breathing in a semi-Fowler's position. The client exhales forcefully with a short expiration. The client breathes in deeply through the nose and mouth.

The client exhales forcefully with a short expiration.

Which question is most important for the nurse to ask the client when obtaining the preoperative admission history? "Who is here with you?" "Did you bring a copy of your health care power of attorney?" "When is the last time you ate or drank?" "Did you bring any valuables with you?"

"When is the last time you ate or drank?"

What action by the nurse best encompasses the preoperative phase? Educating clients on signs and symptoms of infection Documenting the application of sequential compression devices (SCDs) Monitoring vital signs every 15 minutes Shaving the client using a straight razor

Educating clients on signs and symptoms of infection

The nurse is aware that which of the following helps to stimulate T-cell response: Arginine Biotin Vitamin D Zinc

arginine- necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response.

Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern? Anesthesiologist Circulating nurse Registered nurse first assistant Surgeon

surgeon

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? "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." "My medical records will be sent to the ambulatory care center prior to my surgery." "The physician will update my family after the procedure and provide specific discharge instructions."

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

When does the nurse understand the patient is knowledgeable about the impending surgical procedure? The patient participates willingly in the preoperative preparation. The patient discusses stress factors causing the patient to feel depressed. The patient expresses concern about postoperative pain. The patient verbalizes fears to family.

The patient participates willingly in the preoperative preparation.

A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client? obstruction surgical site infection hypoglycemia adrenal insufficiency

adrenal insufficiency-Clients who have received corticosteroids are at risk for adrenal insufficiency

A physically fit older adult is scheduled for right knee replacement. What factor for the client would create an increased risk for postoperative complications? current smoking history type of surgery ability to metabolize medication surgical site

current smoking history

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

emergency

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

gastronomy tube-

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. nutritional status age physical condition gender health status Ethnicity

nutritional status age physical condition health status

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

80 to 110 mg/dL

A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective? "I will support my incision with my hands when I cough and do my deep breathing exercises." "I will ask for pain medication when the pain becomes unbearable." "I will need to learn how to give myself pain medication by injection for when I go home." "The pain from my incision will be very similar to my arthritis pain."

"I will support my incision with my hands when I cough and do my deep breathing exercises."

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."

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for? A safe environment Restrictions of the patient's unassisted mobility activities Probable cataract extractions Referral to an ophthalmologist

A safe environment

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

Allow the client to wear the ring and cover it with tape.

You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear? Anxiety and fear increases the need for anesthesia and postoperative medications. Anxious clients have a poor response to surgery and are prone to complications. Anxious clients need psychological counseling after surgery. Anxiety and fear can affect a client positively during and after surgery.

Anxious clients have a poor response to surgery and are prone to complications.

During the preoperative assessment, the nurse learns that the client has been taking prednisone. The nurse realizes that the client is at risk for: Cardiovascular collapse. Respiratory depression. Decreased blood pressure. Increased blood loss.

Cardiovascular collapse.

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

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. Document what foods the client ate. Give the client plenty of water to aid digestion. Cancel the surgery.

Notify the surgeon.

An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults? Aging processes reduce the chances that surgery will be successful for these clients. Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. All older people face similar risks when undergoing surgeries.

Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.

The nurse recognizes that written informed consent is required for insertion of a(n): Nasogastric tube. Urinary catheter. Peripherally-inserted central catheter. Oral airway.

Peripherally-inserted central catheter.

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. Medicate the client and then remove the ring. Place gauze under and over the ring and apply adhesive tape over it. Tell the physician and anesthesiologist.

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

The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery? Effective coughing and deep breathing Types of postoperative pain medication Post-discharge diet Knowledge of surgical procedure

Post-discharge diet

When is the ideal time to discuss preoperative teaching Preadmission visit Day of surgery Prior to entering the pre-op area When the patient is comfortable and sedated

Preadmission visit

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? Answer the client's questions. Request that the surgeon come and answer the questions. Place the consent form in the client's medical record. Notify the nurse manager of the client's questions.

Request that the surgeon come and answer the questions.

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? Ensure that sufficient surgical supplies are available. Check that all surgical personnel are properly attired. Review the scheduled procedure, site, and client. Confirm that informed consent has been obtained.

Review the scheduled procedure, site, and client

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

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

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

Stimulates T-cell response

The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities? The client breathes through her nose, holds her breath, and then exhales slowly before coughing. The client takes short, panting breaths and coughs from the throat to expectorate sputum. The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times. The client takes three deep breaths and then coughs forcefully.

The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times.

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 diaphragmatic breathing. Use chest breathing.

Use diaphragmatic breathing

At what point does the preoperative period end? When the decision is made to proceed with surgery 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 client is transferred onto the operating table

The nurse recognizes that the client most at risk for mortality associated with surgery is the: Client who is obese Client with chronic alcoholism Client with controlled diabetes Client with controlled hypertension

client with chronic alcoholism

A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia? corticosteroids diuretics insulin anticoagulants

diuretics

A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? Pregnancy Diabetes Urinary tract infection Osteoporosis

osteoporosis

The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which laboratory value would be of greatest concern to the nurse? sodium 138 mEq/L calcium 9.8 mg/dL white blood cell count 7.2 cells/mm potassium 6.2 mEq/L

potassium 6.2 mEq/L- patient is hyperkalemic