Chapter 30 PrepU

A postoperative client states "I don't understand why you are checking my skin on my back. My surgery was on my stomach." What is the nurse's best response?

"The operating table is a firm surface; we need to be sure your skin looks okay."

Which surgical client does the nurse in the preoperative setting anticipate having the greatest potential for surgical complications?

76-year-old client with a history of renal failure and chronic bronchitis

The nurse enters a postoperative client's room and finds that the client is bleeding profusely from the surgical incision. What would be the nurse's most appropriate initial response?

Apply pressure to the surgical site to decrease bleeding.

A client postoperative from an appendectomy reports feeling cold and has a temperature of 96.2°F (35.7°C). Which action should the nurse perform first?

Apply warm blankets to the client.

Which nursing action will best promote pain management for a client in the postoperative phase?

Performing relaxation techniques

The preoperative nurse is teaching a client about deep-breathing exercises. The client asks, "Why do I need to learn about this?" Which response by the nurse is correct?

"After surgery, deep-breathing exercises help to remove anesthetic gases and mucus and improve oxygen supply to body tissues."

A client who is scheduled to undergo coronary bypass surgery in a week asks the nurse whether he should discontinue taking his cholesterol medicine ahead of the surgery. Which should be the nurse's response?

"I will need to check with your health care provider about that."

A nurse is caring for a client in the same-day surgery unit. The client asks the nurse, "Do I really need to be put to sleep for this surgery?" Which would be the nurse's best response?

"Tell me what you are most worried about."

The nurse assists a client to turn in the bed. The client has just returned from abdominal surgery. How does the nurse instruct the client?

"Use a pillow to splint the incision."

The nurse working in the holding area is performing an assessment on a client scheduled for surgery. Which question will the nurse ask prior to the client receiving general anesthesia?

"When was the last time you had anything to eat or drink?"

The licensed practical nurse (LPN) is observed by the registered nurse (RN) engaging in the reinforcement of teaching related to therapeutic deep breathing and coughing with a client who is recovering from abdominal surgery. Which statement by the RN best supports the LPN's role in the implementation of this intervention?

"You served as a good role model while showing the client the proper technique for this intervention."

A client has been admitted to the surgical recovery unit following abdominal surgery. Which nursing intervention occurs during this phase of the surgical experience?

Administering supplementary oxygen, as needed

A nurse is teaching a client about the rationale for fasting from food and fluids prior to surgery. What condition does this measure attempt to avoid?

Aspiration

A client has presented to the outpatient surgical center for a scheduled procedure. Which action should the nurse perform prior to the procedure?

Assess the client's allergy status.

The nurse is caring for a client who has had abdominal surgery. Which intervention(s) will the nurse include to prevent complications for this client? Select all that apply.

Assist the client with the use of incentive spirometry. Turn the client and change position frequently. Administer analgesic medication as required.

A nurse is interacting with a client in the outpatient surgical unit intraoperatively. What is the nurse's priority responsibility?

Client safety

An older adult client underwent a hip replacement and now states to the nurse, "My parents are coming to visit me today. I need to mow the lawn and run errands." The client is trying to get out of the bed. What does the nurse identify is occurring with this client?

Delirium

A client is being prepared for discharge home from the postanesthesia care unit (PACU). What action is essential for the nurse to take?

Ensure a client who is dizzy has help at home to prevent falls.

The nurse is assessing a postoperative client who is recovering from anesthesia. Which signs should the nurse interpret as indicating that peristalsis is returning in the client? Select all that apply.

Flatus Presence of bowel sounds

The nurse has admitted a client to the postoperative unit following a bowel resection and is providing postoperative health education on coughing and deep breathing. What does the nurse explain to the client about why these actions are important?

If you continue to breathe shallowly or cough ineffectively, this can lead to atelectasis and pneumonia.

A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client?

Implement leg exercises and turn the client in bed every 2 hours.

The nurse cares for a client following surgery to repair an abdominal aortic aneurysm. Which nursing intervention assists with healing and maintaining client comfort?

Maintaining a calm environment

After a client receives morphine sulfate for pain in the postanesthesia care unit (PACU), which assessment finding would the nurse obtain as a priority?

Measure respiratory rate.

A client had an open cholecystectomy (gallbladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding?

Monitor the client closely and promote fluid intake.

A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client?

Place the client in semi-Fowler's position.

The nurse is teaching the client who recently experienced abdominal surgery to deep breathe and cough effectively. What observable action serves to best minimize pain that may result from the intervention?

Providing support to abdominal and accessory respiratory muscles

The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?

Respiratory obstruction

The nurse is caring for a confused older adult client who requires surgery for a broken hip. What steps does the nurse take to determine if the client has a durable power of attorney for health care and how to contact that person?

Review the medical chart for a copy of a durable power of attorney for health care or permission for disclosure contact.

The nurse is caring for a client who had abdominal surgery yesterday and is reluctant to cough and perform deep breathing. Which strategy will most likely increase the client's willingness to cough and perform deep breathing?

Teach the client how to splint the abdomen while coughing.

The nurse is caring for a client who had a procedure under moderate sedation at the ambulatory surgical center. Which assessment finding indicates to the nurse that the client may be ready for discharge to home?

The client is alert and oriented with a blood pressure 118/70 mm Hg and respirations 18 breaths/minute, is able to ambulate, is not nauseated or vomiting, pain is controlled with medication, and has no excessive bleeding and drainage is as expected.

The nurse is teaching a client about postoperative pain management. The client states, "I would like to use as little medication as possible after surgery. Will anything else help to relieve my pain?" Which response is appropriate?

There are several nonpharmacologic methods to reduce pain and anxiety. Let me teach you about some of them."

The nurse is taking a history on Kumar, who informs her that he has an allergy to adhesive tape. When the nurse asks Kumar to describe his reaction to the tape, he describes it as "blotchy and reddened." What type of allergic reaction is this?

Type IV

Which client most likely requires special preoperative assessment and treatment as a result of the existing medication regimen?

a woman who takes daily anticoagulants to treat atrial fibrillation

A nurse is reinforcing wound edges and applying a blinder to the separated incisions of a client after a surgery. Which postoperative complication has the client developed?

dehiscence

A client scheduled for surgery has been taking aspirin since his heart attack in 1997. The client is at risk for:

hemorrhage.

A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice? Select all that apply.

positioning the client on the operating table counting sponges before and after surgery monitoring the client's vital signs

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur?

preoperative

The PACU nurse has received a semiconscious client from the operating room and reviews the chart for orders related to positioning of the client. There are no specific orders on the chart related to the client's position. In this situation, in what position will the nurse place the client?

side-lying position

Who is legally responsible for obtaining the client's informed consent for a surgical procedure?

the surgeon

The nurse recognizes that palliative surgery is performed for what purpose?

to lessen the intensity of an illness