Chapter 17 - Preoperative Nursing Management

A client scheduled for surgery asks why blood tests are being done to evaluate liver function. Which response will the nurse make?

"It is because the anesthesia you will receive is cleared through the liver."

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

7

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?

7 to 10 days

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?

80 to 110 mg/dL

A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?

A blood urea nitrogen level of 42 mg/dL

The nurse expects informed consent to be obtained for insertion of:

A gastrostomy tube

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency?

Adrenal

The nurse is preparing the medical record for a client scheduled for surgery. Which item(s) will the nurse ensure are in the history and physical? Select all that apply.

Allergies, surgical history, medical history, current medications & history of present illness

A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?

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

What action by the nurse best encompasses the preoperative phase?

Educating clients on signs and symptoms of infection

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

Hypoglycemia

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?

Imagery

A client scheduled for surgery has a blood pressure of 186/90 mm Hg. After documenting this in the medical record, which action will the nurse take?

Notify the health care provider of the blood pressure.

The nurse notes that the consent form for surgery needs to be signed; however, the client just received preoperative medication. Which action will the nurse take?

Notify the health care provider that the consent form has not been signed.

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 & health status

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?

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

A client continuously repeats, "I know all will go well." What cognitive coping strategy should the nurse document?

Optimistic self-recitation

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

Use diaphragmatic breathing

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?

a safe environment

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?

adrenal insufficiency

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.

A client scheduled for surgery follows a vegan eating plan. For which potential postoperative complication will the nurse plan care for this client?

delayed wound healing

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?

diuretics

A client with osteoarthritis receives a recommendation to have joint replacement surgery. For which type of surgery will the nurse plan teaching for this client?

elective

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as

emergency

A fractured skull would be classified under which category of surgery based on urgency?

emergent

A client reports getting a rash when eating kiwi and bananas. For which potential allergy will the nurse plan care for this client?

latex

The nurse is physically preparing a client for surgery. What immediate pre-operative concerns would the nurse address before the client is taken to the operating room? Select all that apply.

medication, elimination & care of glasses

An inappropriate nursing action implemented to keep the client safe includes:

moving the client swiftly

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

An example of a curative surgical procedure is

tumor excision

A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for kidney stones the next day. What category of surgery does this procedure fall into?

urgent

A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which post-surgical risk factor would decrease if the surgical client maintained strict blood glycemic control?

wound healing

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?

Up to 72 hours after alcohol withdrawal

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?

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

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."

Which nursing statement would best ease a client's anxiety before an emergency operative procedure?

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

A client is having surgery through an ambulatory surgical center. Which information will the nurse provide to the client's family?

"The client will go to the postanesthesia care unit after the surgery."

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?

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

A client with a body mass index of 48 is scheduled for knee replacement surgery. For which potential complications will the nurse plan care for this client? Select all that apply.

Bleeding, stasis pneumonia, surgical site infection & joint replacement failure

The nurse is caring for a client who has just arrived for surgery. Which assessment finding indicates to the nurse that the client may be experiencing dehydration because of taking nothing by mouth after midnight for the surgery?

Blood pressure 80/50 mm Hg

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.

Which of the following medications may increases the hypotensive action of anesthesia?

Chlorpromazine

The nurse recognizes that written informed consent is required for insertion of a(n):

Perpherally-inserted central catheter

A client is scheduled for surgery that will require bed rest and arrives for preoperative teaching. Which exercise will the nurse instruct the client to perform to decrease likelihood of venous thrombosis?

Side-lying bicycle riding

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.

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?

Surgeon

A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed?

The client exhales forcefully with a short expiration.

When does the nurse understand the patient is knowledgeable about the impending surgical procedure?

The patient participates willingly in the preoperative preparation.

At what point does the preoperative period end?

When the client is transferred onto the operating table

Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery?

physician

The nurse will educate the client about the risk for developing _____________, ___________________ and ______________ if the client does not implement diaphragmatic breathing exercises in the postoperative period of care.

pneumonia, atelectasis, and bronchospasm

The nurse is caring for a client needing emergency surgery. Which preoperative teaching can be omitted when preparing the client for surgery?

post-discharge diet

A client who is deaf without bilateral hearing aids has them removed in preparation for a surgical procedure. Which action(s) will the nurse take to communicate with this client? Select all that apply.

provide written information, use hand gestures to communicate, speak slowly so the client can lip read, plan for a sign language interpreter