Med Surge- Peri Op PrepU

A patient with an upper respiratory infection (common cold) tells the nurse, "I am so angry with the nurse practitioner because he would not give me any antibiotics." What would be the most accurate response by the nurse?

"Antibiotics have no effect on viruses."

Which statement by the client indicates further teaching about epidural anesthesia is necessary?

"I will become unconscious."

The nurse is providing teaching about tissue repair and wound healing to a client who has a leg ulcer. Which of the following statements by the client indicates that teaching has been effective?

"I'll eat plenty of fruits and vegetables."

A physician orders morphine sulfate 1 mg IV stat for chest pain. The drug is available in 2 mg per 1 mL syringe. How many mL does the nurse administer? Enter the correct number ONLY.

0.5

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 abnormal postoperative urinary output should the nurse report to the physician for a 2-hour period?

<30 mL

What measurement should the nurse report to the physician in the immediate postoperative period?

A systolic blood pressure lower than 90 mm Hg

How should the administration of analgesics be scheduled to provide a uniform level of pain relief to a client?

Administering the analgesics on a regular basis

The recovery room nurse is admitting a client from the OR following the client's successful splenectomy. What is the first assessment that the nurse should perform on this newly admitted client?

Airway patency

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.

The nurse is preparing an older adult for a surgical procedure. Which action will the nurse take to protect the client from injury during the operative period?

Apply a warm blanket after the procedure.

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

A client is transferred from the postanesthesia care unit (PACU) to an inpatient care unit. What will the nurse assess first?

Breathing

The nurse is completing a postoperative assessment for a patient who has received a depolarizing neuromuscular blocking agent. The nursing assessment includes careful monitoring of which body system?

Cardiovascular system

The nurse is responsible for monitoring cardiovascular function in a postoperative patient. What method can the nurse use to measure cardiovascular function?

Central venous pressure

A nurse is preparing a client for surgery. The assessment is complete, all consents have been signed, and the client's family is present. Before administering preoperative medications, what is the nurse's first step?

Check the client's ID bracelet.

The infectious control nurse is presenting a program on West Nile virus for a local community group. To reduce the incidence of this disease, the nurse should recommend what action?

Consistent use of mosquito repellents

The nurse is assessing a patient complaining of severe pain. What physiologic indicator does the nurse recognize as significant of acute pain?

Diaphoresis

The nurse is doing a preoperative assessment of an 87-year-old man who is slated to have a right lung lobe resection to treat lung cancer. What underlying principle should guide the nurse's preoperative assessment of an elderly client?

Elderly clients have less physiologic reserve than younger clients.

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

The surgeon's preoperative assessment of a client finds that the client is at a high risk for venous thromboembolism. Once the client is admitted to the postsurgical unit, what intervention should the nurse prioritize to reduce the client's risk of this complication?

Encourage early ambulation.

A client will be undergoing a total hip arthroplasty later in the day and it is anticipated that the client may require blood transfusion during surgery. How can the nurse best ensure the client's safety if a blood transfusion is required?

Ensure that the client has had a current cross-match.

Prior to a client's scheduled surgery, the nurse has described the way that members of diverse health disciplines will collaborate in the client's care. What is the main rationale for organizing perioperative care in this collaborative manner?

Evidence-based practice

A 20-year-old man has presented to the emergency department with a 24-hour history of abdominal pain. The nurse who is admitting the patient notes that he is diaphoretic, wincing, and guarding the lower right quadrant of his abdomen. The nurse asks the patient to rate his pain on a scale of 1 to 10, to which the patient responds, "One or two." How should the nurse best respond to this patient's statement?

Explain the 0-to-10 pain scale in greater detail.

Which stage of surgical anesthesia is also known as excitement?

II

A nurse is caring for a client following knee surgery that was performed under a spinal anesthetic. What intervention should the nurse implement to prevent a spinal headache?

Keep the client positioned supine.

The anesthetist is coming to the surgical admissions unit to see a client prior to surgery scheduled for tomorrow morning. What is the priority information that the nurse should provide to the anesthetist during the visit?

Latex allergy

A client is 2 hours' postoperative with an indwelling urinary catheter. The last hourly urine output recorded for this client was 10 mL. The tubing of the catheter is confirmed to be patent. What should the nurse do?

Notify the health care provider and continue to monitor the hourly urine output closely.

During the care of a preoperative client, the nurse has given the client a preoperative benzodiazepine. The client is now requesting to void. What action should the nurse take?

Offer the client a bedpan or urinal.

Unless contraindicated, how should the nurse position an unconscious client?

On the side with a pillow at the patient's back and the chin extended, to minimize the dangers of aspiration

Which is a classic sign of hypovolemic shock?

Pallor

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

Physician

The scrub nurse is responsible for:

Preparing the sterile instruments for the surgical procedure

An elderly client has a fractured hip and is in Buck's traction. The client is disoriented and cannot express herself. At 0730 the client was calm. Now, at 0930, the client is restless and agitated. The nurse reviews the medication administration record. The last dose of opioid was at 0330. The nurse assesses the client's agitation may be from

Recurring pain

The nurse observes that a postsurgical client has hemorrhaged and is in hypovolemic shock. Which nursing intervention will manage and minimize hemorrhage and shock?

Reinforcing the dressing or applying pressure if bleeding is frank

The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to:

Respond verbally during the procedure

A 2-year-old is brought to the clinic by her mother who tells the nurse her daughter has diarrhea and the child is complaining of pain in her stomach. The mother says that the little girl had not eaten anything unusual, consuming homemade chicken strips and carrot sticks the evening prior. Which bacterial infection would the nurse suspect this little girl of contracting?

Salmonella

Which method of wound healing is one in which wound edges are not surgically approximated and integumentary continuity is restored by granulation?

Second-intention healing

A 79-year-old man is scheduled for surgical repair of an inguinal hernia. In light of this patient's age, the nurse will prioritize nursing interventions aimed at preventing

Skin breakdown

The ED nurse is caring for an 11-year-old brought in by ambulance after having been hit by a car. The child's parents are thought to be en route to the hospital but have not yet arrived. No other family members are present, and attempts to contact the parents have been unsuccessful. The child needs emergency surgery to survive. How should the need for informed consent be addressed?

Surgery should be done without informed consent.

A nurse is caring for a client who is three hours post op from open abdominal surgery. During routine assessment, the nurse notes the previously stable client now appears anxious, apprehensive, and has a blood pressure of 90/56. What does the nurse consider is the most likely cause of the client's change in condition?

The client is displaying early signs of shock.

An adult client in the ICU has a central venous catheter in place. Over the past 24 hours, the client has developed signs and symptoms that are suggestive of a central line associated bloodstream infection (CLABSI). What aspect of the client's care may have increased susceptibility to CLABSI?

The client's central line was placed in the femoral vein.

The post anesthesia care unit nurse is caring for a client who has arrived from the operating room. During the initial assessment, the nurse observes that the client's skin has become blue and dusky. The nurse looks, listens, and feels for breathing, and determines the client is not breathing. Which intervention is the priority?

Tilt the head back and push forward on the angle of the lower jaw.

The dressing surrounding a client's Jackson-Pratt drain has scant drainage on it. The nurse believes that the amount of drainage on the dressing may be increasing. How can the nurse best confirm this suspicion?

Trace the outline of the drainage on the dressing for future comparison.

Following diagnostic testing, a patient requires a cholecystectomy. This surgical procedure would be categorized as which of the following?

Urgent

Family members are caring for a client with HIV in the client's home. What should the nurse encourage family members to do to reduce the risk of infection transmission?

Use caution when shaving the client.

A client is admitted to the ED reporting severe abdominal pain and vomiting "coffee-ground" like emesis. The client is diagnosed with a perforated gastric ulcer and is informed that they need surgery. When can the client most likely anticipate that the surgery will be scheduled?

Without delay

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

The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors?

age, nutritional status, health status, physical condition

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?

allergies, surgical history, medical history

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

emergency.

A written informed consent is necessary for which of the following?

invasive procedures, procedures requiring sedation, procedures requiring radiation

The primary objective in the immediate postoperative period is

maintaining pulmonary ventilation.

A client in the postanesthesia care unit (PACU) develops a blood pressure of 180/90 mm Hg. Which assessment will the nurse complete to determine the cause of the blood pressure findings? Select all that apply.

pain, hypoxia, bladder distention

A client is in the post anesthesia care unit following abdominal surgery. The client is showing frank, increased bleeding, and the client's blood pressure is plummeting. Which intervention will the nurse perform to manage and minimize hemorrhage and shock?

reinforce dressing and apply pressure

An client in the ambulatory surgery clinic is having difficulty undressing and putting clothing away. The client arrived via taxi, lives alone, and has few friends. The client will be unaccompanied before surgery and the client's children all live in different parts of the country. This client may not be a suitable candidate for ambulatory surgery because

the client's postoperative care is questionable.

A nurse is caring for a client who underwent a skin biopsy and has three stitches in place. This wound is healing by:

third intention.

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

A client is being prepared for a surgical procedure. Which medication will the nurse anticipate being administered during surgery to decrease gastric acid production?

Famotidine

Which type of healing occurs when granulation tissue is not visible and scar formation is minimal?

First intention

Which stage of anesthesia is referred to as surgical anesthesia?

III

The nurse places a client in isolation. Isolation techniques have the potential to break the chain of infection by interfering with what component of the chain of infection?

Mode of transmission

A laser is being used to excise tissue during a client's surgical procedure. Which item will the nurse apply to minimize personal risk due to the smoke from the device?

N95 respiratory mask

A client is scheduled for a bowel resection in the morning and the client's orders are for a cleansing enema be administered tonight. The client wants to know why this is necessary. The nurse should explain that the cleansing enema will have what therapeutic effect?

Preventing potential contamination of the peritoneum

What complication is the nurse aware of that is associated with deep venous thrombosis?

Pulmonary embolism

The perioperative nurse is constantly assessing the surgical client for signs and symptoms of complications of surgery. Which symptom should first signal to the nurse the possibility that the client is developing malignant hyperthermia?

Tachycardia

The nurse is planning care for a client following abdominal surgery. Which outcome demonstrates a return of functioning to the gastrointestinal tract?

The client reports a small bowel movement and flatus.

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

The patient participates willingly in the preoperative preparation.

The nurse is educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate?

Three phases of surgery and safety measures for each phase

The nurse just received a postoperative client from the postanesthesia care unit to the medical

surgical unit. The client had surgery for a left hip replacement. Which concern should the nurse prioritize for this client in the first few hours on the unit? - Closely monitoring neurologic status

The nurse is planning teaching for a client who is scheduled for an open hemicolectomy. The nurse intends to address the topics of incision splinting and leg exercises during this teaching session. When is the best time for the nurse to provide teaching?

As soon as possible, and before the surgical procedure

What medication should the nurse prepare to administer in the event the client has malignant hyperthermia?

Dantrolene sodium

A client reports abdominal pain as "8" on a pain intensity scale of 0

10 thirty minutes after receiving an opioid intravenously. Her past medical history includes partial-thickness burns to approximately 60% of her body several years ago. The nurse assesses: - That the client's past experiences with pain may influence her perception of current pain

A circulating nurse provides care in a surgical department that has multiple surgeries scheduled for the day. The nurse should know to monitor which client most closely during the intraoperative period because of the increased risk for hypothermia?

A 74-year-old client with a low body mass index

The nurse is performing wound care on a postsurgical client. Which practice violates the principles of surgical asepsis?

A circulating nurse touching a sterile drape

A surgical client has just been admitted to an inpatient nursing unit from the postanesthesia care unit with client-controlled analgesia (PCA). What must the client require for safe and effective use of PCA?

A clear understanding of the need to self-dose

A client is at postoperative day 1 after abdominal surgery. The client is receiving 0.9% normal saline at 75 mL/h, has a nasogastric tube to low wall suction with 200 mL every 8 hours of light yellow fluid, and a wound drain with 50 mL of dark red drainage every 8 hours. The 24-hour urine output total is 2430 mL. What action by the nurse is most appropriate?

Assess for signs and symptoms of fluid volume deficit.

Why is assessment of dentition important in the patient preparing to have a surgical procedure with general anesthesia?

Decayed teeth or dental prosthesis can become dislodged during intubation.

A nurse is caring for a client with a chest tube connected to a dry suction water seal drainage system. The nurse notes 2 cm of water and intermittent bubbling in the water seal chamber. Which action will the nurse take?

Document the findings.

You are admitting an insulin-dependent patient to the same-day surgical suite for carpal tunnel surgery. You know that this patient may be at risk for which metabolic disorder?

Hyperglycemia

The nurse admits a client to the postanesthesia care unit with a blood pressure of 132/90 mm Hg and a pulse of 68 beats per minute. After 30 minutes, the client's blood pressure is 94/47 mm Hg, and the pulse is 110. The nurse documents that the client's skin is cold, moist, and pale. This client is showing signs of what potential issue?

Hypovolemic shock

A client is receiving general anesthesia. The nurse anesthetist starts to administer the anesthesia. The client begins giggling and kicking her legs. What stage of anesthesia would the nurse document related to the findings?

II

The clinic nurse is doing a preoperative assessment of a client who will be undergoing outpatient cataract surgery with lens implantation in 1 week. While taking the client's medical history, the nurse notes that this client had a kidney transplant 8 years ago and that the client is taking immunosuppressive drugs. For what is this client at increased risk when having surgery?

Infection

An operating room (OR) nurse is teaching a nursing student about the principles of surgical asepsis as a requirement in the restricted zone of the operating suite. What personal protective equipment should the nurse wear at all times in the restricted zone of the OR?

Mask covering the nose and mouth

A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention?

Mask is placed over nose and extends to bottom lip.

What is an example of an intravenous anesthetic that is a hypnotic and produces excellent amnesia?

Midazolam

One of the things a nurse has taught to a client during preoperative teaching is to have nothing by mouth for a specified time before surgery. The client asks the nurse why this is important. What is the most appropriate response for the client?

"You will need to have food and fluid restricted before surgery so you are not at risk for aspiration."

A nurse documents the presence of granulation tissue in a healing wound. Which of the following is the best description for the tissue?

Pink to red and soft, noting that it bleeds easily

What does the nurse recognize as one of the most common postoperative respiratory complications in elderly clients?

Pneumonia

A nurse is caring for a client in the PACU after surgery requiring general anesthesia. The client tells the nurse, "I think I'm going to be sick." What is the primary action taken by the nurse?

Position the client in the side-lying position.

The circulating nurse will be participating in a 78-year-old client's total hip replacement. Which consideration should the nurse prioritize during the preparation of the client in the operating room?

Pressure points should be assessed and well padded.

The nurse is taking the client into the operating room (OR) when the client informs the nurse that the client's grandparent spiked a very high temperature in the OR and nearly died 15 years ago. What relevance does this information have regarding the client?

The client may be at risk for malignant hyperthermia.

The nurse is admitting a client who is insulin dependent to the same-day surgical suite for carpal tunnel surgery. How should this client's diagnosis of type 1 diabetes affect the care that the nurse plans?

The nurse should assess the client's blood glucose levels frequently.

A physician orders a stool culture for client who complains of frequent, persistent diarrhea and cramping. The most likely purpose of this diagnostic test is to check for:

intestinal ova or parasites.

A patient is complaining of a headache after receiving spinal anesthesia. What does the nurse understand may be the cause of the headache related to the spinal anesthesia?

leakage of spinal fluid, size of spinal needle used, degree of patient hydration

The nurse understands that the purpose of the "time out" is to:

maintain the safety of the client.