Incorrect PrepU- Exam 3 - Ch29: Perioperative Nursing

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur? a) Preoperative b) Intraoperative c) Postoperative d) Postanesthesia care unit (PACU)

Preoperative Explanation: Exercises and physical activities occurring in the preoperative phase include deep-breathing exercises, coughing, incentive spirometry, turning, leg exercises, and pneumatic compression stockings

As a circulating nurse caring for a 45-year-old man undergoing left knee arthroscopic exploratory surgery, which task ensures that the team is on the same page and will perform the procedure on the right client and at the right site? a) Procedural pause (time-out) b) Preoperative checklist c) Informed consent d) Operative site marking

Procedural pause (time-out) Explanation: The procedural pause (time-out) must be done prior to any procedure to ensure client safety and to verify the client identity, staff roles, and procedure being performed.

A client who came in through the emergency department with a severely fractured leg will be transported to surgery within the hour. When the client asks how long hospitalization will occur after surgery, what is the appropriate nursing response? a) "Because you are having inpatient surgery, you will be at least 1 day after surgery." b) "The anesthesiologist will be able to give you a better idea of how long you will be hospitalized." c) "With the type of injury you have sustained, you will be in the hospital about 4 days." d) "Outpatient surgery patients usually get to go home the same day.

"Because you are having inpatient surgery, you will be at least 1 day after surgery." Explanation: With a severe fracture, the client will be considered as having inpatient surgery, and will be hospitalized at least a day. The nurse should not give a definitive period of time for hospitalization, and the surgeon (not the anesthesiologist) will give the best predictor of length of stay.

The nurse has entered the room of a client who is postoperative day 1 and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of p.r.n. analgesia and, on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. How should the nurse respond to the client's concerns? a) "The hospital has excellent resources for dealing with any addiction that might result from the medications you take to control your pain." b) "You should remind yourself that treating your pain is important now, and that dealing with any resulting dependency can come later." c) "Actually, people who are not addicted to drugs before their surgery never develop a tolerance or addiction during their recovery." d) "Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery."

"Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery." Explanation: There is little danger of addiction to pain medications used in the postoperative management of pain.

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? a) "The operating table is a firm surface; we need to be sure your skin looks okay." b) "We wanted to be sure we didn't leave any sponges or syringes underneath you." c) "The covers underneath you need to be straightened out. They look messy." d) "We needed to be sure you didn't have any skin breakdown before surgery."

"The operating table is a firm surface; we need to be sure your skin looks okay." Explanation: The client who has been on the operating table should be examined to ensure skin breakdown hasn't occurred. The client would not be told that his covers looked messy, or that the nurse was concerned about sponges or syringes underneath. The client's skin should be assessed on admission; after surgery would not be the time to do this initial assessment to document skin breakdown.

A client who is in the holding area awaiting knee replacement surgery tells the nurse, "I am afraid of getting HIV if I have to have a blood transfusion during this surgery." What is the appropriate nursing response? a) "The risk of acquiring a blood-borne disease from a blood transfusion is very small." b) "You should have given your own blood preoperatively." c) "Perhaps we can have one of your siblings donate blood in case you need it." d) "Knee replacement surgeries usually do not require blood transfusions."

"The risk of acquiring a blood-borne disease from a blood transfusion is very small." Explanation: The nurse will teach that the chance of acquiring a blood-borne disease from a blood transfusion is very small. Giving blood preoperatively may have been ideal, but that does not address the client's immediate concern. Although transfusions are not commonly associated with knee replacement surgery, this does not address the client's concern. Siblings should not donate blood for a client because antigens in the transfused blood sensitizes the client recipient, which would rule them out as a future organ or tissue donator for the client.

A client is undergoing a knee replacement tomorrow morning. She is ordered nothing by mouth (n.p.o.) prior to surgery. She asks the nurse how long she can drink water prior to the procedure. Based on the nurse's knowledge of standard protocols, what is the nurse's best response? a) 6 hours b) 12 hours c) 4 hours d) 2 hours

2 hours Explanation: Two hours is a standard n.p.o. time for clear liquids, though the nurse should always check with the institution's policy.

Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse? a) a 26-year-old client who is exhibiting a crowing sound b) an 80-year-old client who is disoriented to place and time c) a 30-year-old client who is drowsy with and reporting pain d) a 6-year-old client who is crying for a parent to visit

A 26-year-old client who is exhibiting a crowing sound Explanation: A client with a crowing sound is exhibiting stridor, which is an indication of an airway obstruction and can be a respiratory emergency. This client needs immediate attention. The client with disorientation needs to be frequently reoriented and observed for safety reasons but is not a priority over respiratory distress. The client who needs pain medication, or the pediatric client requesting a parent, are also not priority over a client in respiratory distress

A nurse is preparing to receive a client in post-anesthesia care unit (PACU). The client is diabetic and has undergone knee surgery. Which information would be most important for the receiving nurse to obtain to develop an appropriate plan of care for this client? a) Chronic disease history b) Amount of blood loss c) Environment of the operating room d) Information about allergic agents

Amount of blood loss Explanation: To plan care effectively in the postoperative period, the nurse needs to know about the amount of blood lost during the surgery, the type of surgery that was performed on the client, and whether there were any surgical or anesthetic complications. Information on chronic disease history and allergy history are done in the preoperative period, not in the postoperative period. Information on the environment in the operation room is checked by the circulatory nurse during the intraoperative care plan; it is not associated with the postoperative care plan.

The nurse is preparing a client for a colonoscopy. The nurse is familiar with the colonoscopy procedures at the hospital and is aware that which type of anesthesia is commonly used for this procedure? a) Conscious sedation b) Nerve block c) Spinal anesthesia d) Epidural anesthesia

Conscious sedation Explanation: Moderate sedation/analgesia is also known as conscious sedation or procedural sedation. It is used for short-term and minimally invasive procedures such as endoscopy procedures (e.g., colonoscopy)

The preoperative nurse is reviewing the chart of a client whose surgery is scheduled to begin in the next 15 minutes and notices that the consent form is not signed. The nurse contacts the surgeon who states, "We have already reviewed this procedure extensively, so ask the client to sign the consent form and I will verify it in the operating room." Which action by the nurse is most appropriate? a) Keep the client in the preoperative area and inform the surgeon that it is the physician's responsibility to obtain consent for surgery. b) Ask the operating room staff to delay the procedure until the consent is signed. c) Send the client to the operating room and inform the staff that the consent form needs to be signed. d) Ask the client to sign the consent; witness the signature and inform the operating room staff of the modification in the procedure.

Keep the client in the preoperative area and inform the surgeon that it is the physician's responsibility to obtain consent for surgery. Explanation: The responsibility for securing informed consent from the client lies with the person who will perform the procedure. This is usually the physician. The nurse may sign as a witness, signifying that the client signed the consent form without coercion and was alert and aware of the act.

Which nursing action will best promote pain management for a client in the postoperative phase? a) Breathing into a paper bag b) Performing relaxation techniques c) Providing food and medication d) Dimming the lights

Performing relaxation techniques Explanation: Performing relaxation techniques is the best nursing action to promote pain management for a client in the postoperative phase.

Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client? a) Educate the client about the use of incentive spirometer. b) Elevate bilateral legs when client is lying in bed. c) Place graduated compression stockings on the client. d) Encourage the client to elevate the head of bed.

Place graduated compression stockings on the client. Explanation: Use of graduated compression stockings and/or pneumatic compression devices on the client will help with prevention of DVT, which is a risk for clients after surgery. Elevating the client's legs will passively improve venous return but not prevent DVT if a client is not up and walking (to more actively promote the venous return). Elevating the head of the bed and using the incentive spirometer help prevent postoperative complications of atelectasis or pneumonia.

The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency? a) Wound infection b) Cardiac distress c) Dehydration d) Respiratory obstruction

Respiratory obstruction Explanation: Respiratory obstruction may occur as a result of secretion accumulation, obstruction by the tongue, laryngospasm (a sudden, violent contraction of the vocal cords), or laryngeal edema. Cardiac distress, wound infection, and dehydration are all possible postoperative complications, but respiratory obstruction is most common.

The procedural physician has initiated performance of a time-out in the operating room before surgery. The student nurse asks the operating room nurse why this is important. What is the operating room nurse's best response? a) "The time-out allows us to make sure that the client has had adequate anesthesia." b) "The time-out checks to be sure that we have the right client and procedure." c) "We need to be sure the client has had the preoperative antibiotic." d) "We are checking the client's baseline vital signs during time-out."

The time-out checks to be sure that we have the right client and procedure." Explanation: The time-out is a safety measure performed before any surgical procedure and allows the operating room staff to determine they have the right client, procedure, and side (if appropriate). The client's baseline vital signs should have already been performed. The anesthesia is managed by the anesthetist or anesthesiologist when the procedural physician is prepared for the beginning of the operation; however, this is not part of the time-out. The preoperative antibiotic should be administered within 60 minutes of the surgery but is also not part of the time-out.

A nurse is discussing a surgical procedure with a client who needs to sign his informed consent. Which of these tasks is part of the nursing role? a) witnessing the client signature with their consent for surgery b) explaining to the client about potential risks of having the surgery c) determining for the client what other treatment options exist d) describing how the client will benefit from the surgical procedure

Witnessing the client signature with their consent for surgery Explanation: The nursing role with informed consent is to witness the client signature on the form. The procedural physician is responsible for explaining the procedure, any alternative treatment, and the risks and benefits of having the surgery. The nurse may clarify information, but if in-depth explanation is needed, the procedural physician should be notified.

Which of these clients in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse? a) a client reporting incisional pain rated 8/10 and no medication orders b) a client with snoring respirations who arouses readily c) a client who is pale and diaphoretic with a heart rate of 115 beats/minute d) a client reporting nausea who requests an antiemetic

a client who is pale and diaphoretic with a heart rate of 115 beats/minute Explanation: All of these clients need attention but the one who is pale and diaphoretic with an elevated heart rate is the most unstable; this client needs further assessment to determine if there is a fluid volume deficit, which could be due to active bleeding or inadequate fluid replacement during surgery.

The nurse knows the term perioperative phase refers to care given to the client: a) from the start of surgery until its conclusion. b) immediately before an operative procedure. c) before, during, and after the operative phase. d) immediately after the operative phase.

before, during, and after the operative phase. Explanation: Perioperative nursing includes three distinct phases: preoperative, intraoperative, and postoperative.

A nurse is discussing a surgical procedure with a client who needs to sign his informed consent. Which of these tasks is part of the nursing role? a) witnessing the client signature with their consent for surgery b) determining for the client what other treatment options exist c) describing how the client will benefit from the surgical procedure d) explaining to the client about potential risks of having the surgery

witnessing the client signature with their consent for surgery Explanation: The nursing role with informed consent is to witness the client signature on the form. The procedural physician is responsible for explaining the procedure, any alternative treatment, and the risks and benefits of having the surgery. The nurse may clarify information, but if in-depth explanation is needed, the procedural physician should be notified.

A 51-year-old woman with a diagnosis of breast cancer has been scheduled for a unilateral mastectomy during which biopsies of her axillary lymph nodes will be taken. Which categorizations of surgical procedures are represented in this client's case? Select all that apply. a) Curative b) Reconstructive c) Diagnostic d) Constructive e) Palliative

• Diagnostic • Curative Explanation: Curative surgery involves the removal of a diseased body part (e.g., breast tissue). Diagnostic surgery, such as biopsy of a lymph node, involves the removal of tissue for determining a diagnosis or the extent of disease involvement. This client is not receiving constructive, reconstructive, or palliative surgery at this time

Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply. a) Oral route b) Inhalation c) Epidural block d) Intravenous e) Nerve block f) Spinal block

• Spinal block • Nerve block • Epidural block Explanation: Regional anesthesia occurs when an anesthetic agent is injected near a nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors. Regional anesthesia includes spinal blocks, nerve blocks, and epidural blocks. Inhalation and intravenous administration of anesthesia are associated with general anesthesia. Anesthesia is not administered via the oral route

The postanesthesia care unit (PACU) nurse has just received a client who underwent coronary artery bypass grafting (CABG). Which will the nurse assess while the client is in the PACU? (Select all that apply.) a) pain level b) urine output c) family perception of the surgery d) condition of incision e) drains and drainage characteristics f) ease of breathing

• condition of incision • drains and drainage characteristics • ease of breathing • pain level • urine output Explanation: The nurse will assess all of these components with the exception of family perception of the surgery. Family will be allowed to visit after the client is stabilized and transitioned out of the PACU to a floor.