PERIOP

A patient is to have elective surgery. The RN should plan with the patient to schedule the surgery: 1. If the patient wished to have the procedure done. 2. At the patient's convenience 3. Within the next 2 wteeks. 4. Within the next 2 days.

2 its elective

During the preoperative interview the nurse obtains information about the client's medication history. Which of the following is not necessary to record about the client? 1) Current use of medications, herbs, and vitamins. 2) Over the counter medication use in the last 6 weeks. 3) Steroid use in the last year. 4) Use of all drugs taken in the last 18 months.

1. only needs to know current meds

What is included in the pre-op assessment?

-Nutrition & fluid status -Drug/alcohol use -Respiratory status -Cardiovascular status -Hepatic & renal function -Endocrine function -Immune function -Functional ability -Blood tests -X-rays -Diagnostic tests

Treatment of Malignant Hyperthermia

-terminate surgery -administer datrolene IV--muscle relaxant -administer 100%O2 -ABGs -infuse iced IV NS -cooling blanket -apply ice to axillae, groin, neck, & head -insert foley

A client is admitted to the hospital for surgical repair of a detached retina in the right eye. In planning care for this patient postoperatively, the nurse should encourage the patient to do which of the following? 1. Perform self-care activities. 2. Maintain patches over both eyes. 3. Limit movement of both eyes. 4. Refrain from excessive talking.

3

The nurse requests a client to sign the surgical consent form for an emergency appen-dectomy. Which statement by the client indicates that further teaching is needed? 1. "I will be glad when this is over so that I can go home." 2."I will not be able to eat or drink anything prior to my surgery." 3."I need to practice relaxing by listening to my favorite music." 4."I will need to get up and walk as soon as possible."

Answer 1. "I will be glad when this is over so that I can go home" . When recuperating from emergency sur-gery, the client will be in the hospital for afew days. This is not a day-surgery proce-dure. The client needs more teaching.

An order is written to start an IV on a 74-year-old client who is getting ready to go to the operating room for a total hip replacement. What gauge of catheter would best meet the needs of this client? A) 18 B) 20 C) 21 butterfly D) 25

A

When completing the assessment for the client in the day surgery unit, the client states,"I am really afraid of having this surgery. I'm afraid of what they will find." Which state-ment would be the best therapeutic response by the nurse? 1."Don't worry about your surgery. It is safe." 2."Tell me why you're worried about your surgery." 3."Tell me about your fears of having this surgery." 4."I understand how you feel. Surgery is frightening.

Answer 3

While completing the preoperative assessment, the male client tells the nurse that heis allergic to codeine. Which intervention should the nurse implement first? 1.Apply an allergy bracelet on the client's wrist. 2.Label the client's allergies on the front of the chart. 3.Ask the client what happens when he takes the drug. 4.Document the allergy on the medication administration record

Answer 3

When preparing a client for surgery, which intervention should the nurse implement first? 1.Check the permit for the spouse's signature. 2.Take and document intake and output. 3.Administer the "on call" sedative. 4.Complete the preoperative checklist."

Answer 4 Rationale: 1. The client's signature, not the spouse's, shouldbe on the surgical permit. 2.This would be information that would be im-portant if abnormal, but it is not the first inter- vention. 3."On call" sedations should be administeredafter the surgical checklist is completed. 4.Completing the preoperative checklist hasthe highest priority to ensure that all detailsare completed without omissions

Which of the laboratory result would require immediate intervention by the nurse for the client scheduled for surgery? 1. Calcium 9.2 mg/dL 2. Bleeding time 2min 3. Hemoglobin 15 g/dL 4. Potassium 2.4 mEq/L

Answer 4: Potassium 2.4 mEq/L 1. This laboratory value is within normal limits 2. This laboratory value is within normal limits 3. This laboratory value is within normal limits 4. This potassium levels is low and should be reported to the health care provider because potassium is important for muscle function, including the cardiac muscle

The physician has ordered preoperative atropine for a client undergoing surgery. Which of the following provides the best rationale for the use of this medication? A. It induces general calmness and sleepiness B. It reduces oral and pulmonary secretions and prevents laryngeospasms C. It is used to reduce anxiety and ease anesthetic induction. D. It reduces gastric fluid volume and gastric acidity.

Answer B. Anticholinergics, such as atropine, scopolamine, and glycopyrrolate (Robinul), reduce oral and pulmonary secretions and prevent laryngospasm.

A client is diagnosed with a spontaneous pneumothorax necessitating the insertion of a chest tube. What is the best explanation for the nurse to provide this client? A. "The tube will drain fluid from your chest." B. "The tube will remove excess air from your chest." C. "The tube controls the amount of air that enters your chest." D. The tube will seal the hole in your lung.""

Answer B. The purpose of the chest tube is to create negative pressure and remove the air that has accumulated in the pleural space.

A client with a perforated gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form because of sedation from opiod analgesics that have been administered. The nurse should take which appropriate action in the care of this client? 1.Obtain a court order for the surgery 2.Send the client to surgery without the consent form being signed. 3.Have the hospital chaplain sign the consent form. 4.Obtain a telephone consent from a family member, following agency policy

Answer: 4 Rationale: Every effort should be made to obtain consent from a responsible family member to perform the surgery if a client is unable to sign the consent form

Lydia is scheduled for elective splenectomy. Before the clients goes to surgery, the nurse in charge final assessment would be: a. signed consent b. vital signs c. name band d. empty bladder"

B

The nurse provides a referral to Alcoholics Anonymous to a client who describes a 20-year history of alcohol abuse. The primary function of this group is to: a. Encourage the use of a 12-step program. b. Help members maintain sobriety. c. Provide fellowship among members. d. Teach positive coping mechanisms.

B

indicates the need for insulin & predicts wound healing problems

Blood Sugar

indicates the level of kidney function

Blood Urea Nitrogen (BUN) & Creatinine

While performing preoperative teaching, the patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, the nurse tells the patient that: A. She must be NPO after breakfast. B. She needs to be NPO after midnight. C. She can drink clear liquids up to 2 hours before surgery. D. She can drink clear liquids up until she is taken to the OR.

C

Which of the following nursing actions should be given highest priority when admitting the patient into the operating room? A.) Level of consciousness B.) Vital signs C.) Patient identification and correct operative consent D.) Positioning and skin preparation

C.) Patient identification and correctoperative consent

To prevent airway obstruction in the postoperative patient who is unconscious or semiconscious, the nurse: A. encourages deep breathing. B. elevates the head of the bed. C. administers oxygen per mask. D. positions the patient in a side-lying position.

D

What is Ablative Surgery? Give an example.

Excision or removal of diseased body part. Example: Amputation, removal of appendix, cholecystectomy

What is the most common post-op complication?

Resp. Depression

What is Reconstructive/Restorative surgery? Give an example

Restores function or appearance to traumatized or malfunctioning tissues. Example: Internal fixation of fractures, scar revision

occurring in the period immediately before, during, and/or after surgery

PERIOPERATIVE

Care preceding an operation, including the medical evaluation of the risks of surgery, and the psychological adjustment of the patient

PREOP

What is Elective surgery? Give and example.

Performed on basis of client's choice; is not essential and is not always necessary for health. Example: Bunionectomy, facial plastic surgery, hernia repair, breast reconstruction

What is Cosmetic surgery? Give an example

Performed to improve personal appearance. Example: Blepharoplasty to correct eyelid deformities; rhinoplasty to reshape nose

What is a Palliative surgery? Give an example.

Relieves or reduces intensity of disease symptoms; will not produce cure. Example: Colostomy, debridement of necrotic tissue, resection of nerve roots

What is informed consent?

Surgery cannot be legally or ethically performed until a client understands the need for a procedure, the steps involved, risks, expected results, and alternative treatments.

What is a Diagnostic surgery? Give an example.

Surgical exploration that allows health care providers to confirm diagnosis; often involves removal of tissue for further diagnostic testing Example: Exploratory laparotomy or breast mass biopsy

What effect does age have on surgery?

Very young and old clients are at risk during surgery because of immature or declining physiological status.

When does pre-op begin?

decision for surgical internet

A nurse is developing a plan of care for a client scheduled for surgery The nurse should include which activity in the nursing care plan for the client on the day of surgery? 1. Have the client void immediately before going into surgery 2. Avoid oral hygiene and rinsing with mouthwash 3. Verify that the client has not eaten for the last 24 hours 4. Report immediately any slight increase in blood pressure or pulse.

answer #1 The nurse would assist the client to void immediately before surgery so that the bladder will be empty. A slight increase in blood pressure and pulse is common during the preoperative period and is usually the result of anxiety. The client usually has a restriction of food and fluids for 6 to 8 hours before surgery instead of 24 hours. Oral hygeine is allowed, but the client should not swallow any water.

The nurse assesses a preoperative client. Which question should the nurse ask the client, to help determine the client's risk for developing malignant hyperthermia in the periperative period? A. Have you ever had heat exhaustion or heat stroke? B. What is the normal range for you body temperature? C. Do you or any of your family members have frequent infections? D. Do you or any of your family members have problems with anesthesia

answer D Do you or any of your family members have problems with anesthesia? Malignat hyperthermia is a genetic disorder in which a combination of anesthetic agents triggers uncontrolled skeletal muscle contractions that lead to a potentially fatal hyperthermia. Questioning the client about family history of general anesthesia problems reveal this as a risk for the client. Options A, B, and C are unrelated to this surgical complication.

First signs of malignant hyperthermia

increased CO2 decreased O2 tachycardia

helps to identify if certain procedures can be performed or if certain meds can be safely administered in order to protect an unborn child

pregnancy (HcG)

Triggering agents of malignant hyperthermia

succinylcholine & inhalation agents

prepares blood or blood products that may be needed to replace loss prior to, during, or after surgery

type & crossmatch

When does pre-op end?

when patient is transported to the OR or care transferred to the OR nurse

During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? a. vitamin A b. vitamin D c. vitamin E d. vitamin K

Answer D. Intestinal bacteria synthesize such nutritional substances as vitamin K, thiamine, riboflavin, vitamin B12, folic acid, biotin, and nicotinic acid. Therefore, antibiotic therapy may interfere with synthesis of these substances, including vitamin K. Intestinal bacteria don't synthesize vitamins A, D, or E.

Preoperatively, the nurse develops a plan to prepare a 7-month-old infant psychologically for a scheduled herniorrhaphy the next day. Which of the following should the nurse expect to implement to accomplish this goal? 1. Explaining the preoperative and postoperative procedures to the mother. 2. Having the mother stay with the infant. 3. Making sure the infant's favorite toy is available. 4. Allowing the infant to play with surgical equipment.

Answer 2 2. The best way to prepare a 7-month-old infant psychologically for surgery is to have the primary caretaker stay with the child. Infants in the second 6 months of life commonly develop separation anxiety. Therefore, the priority in this case is to support the child by having the parent present. Teaching the mother what to expect may decrease her anxiety; this is important because infants sense anxiety and distress in parents, but the priority in this case is to have the parent present. Actual play and acting out life experiences are appropriate for preschool-age children. Allowing an infant to play with surgical equipment would be inappropriate and dangerous.

A nurse is conducting preoperative teaching with a client about the use of incentive spirometer. The nurse should include which piece of information in discussions with the client? A. Inhale as rapidly as possible. B. Keep a loose seal between the lips and mouth piece. C. After maximum inspiration, hold teh breath for 15 seconds and exhale. D. The best results are achieved when sitting up or with the head of the bed elevated 45-90 degrees.

Answer D must be in high fowler's position for optimal lung expansion. The mouthpiece should be covered tightly and breath holds for 5 seconds.

A patient who is dependent on barbiturates is scheduled for surgery following an automobile accident. The nurse recognizes that this patient a. may need less pain medication during the postoperative period. b. should be provided with taper doses of barbiturates following surgery. c. may have an immediate onset of withdrawal symptoms when given anesthetic and analgesic agents. d. has a low risk for physical withdrawal symptoms but is likely to experience craving and drug-seeking behavior during the post-operative period.

Answer: B Rationale: withdrawal from sedative hypnotics can be very serious.After 24 hours, the patient may experience delirium, seizures, and respiratory and cardiac arrest, and withdrawal from high doses requires close monitoring in an inpatient setting. Long-acting agents such as diazepam (Valium), chlordiazepoxide (Librium), clonazepam (Klonopin), or phenobarbital may be substituted for the abused drug and gradually tapered after stabilization. Mild to moderate symptoms can persist for 2 to 3 weeks after a 3- to 5-day period of acute symptoms.

Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR is higher, than before the medication was administered. A. The patient is having an allergic reaction to the drug. B. The patient needs a higher dose of this drug C. This is normal side-effect of AtSO4 D. The patient is anxious about upcoming surgery"

Answer C Atropine lowers body fluid in throat and mouth pre-surgery

A nurse is reviewing a physician's order sheet for a preoperative client that states that the client must be NPO after midnight. The nurse would telephone the physician to clarify whether which of the following medications should be given to the client and not withheld? 1) Ferrous sulfate. 2) Prednisone (Deltasone) . 3) Cyclobenzaprine (Flexeril). 4) Conjugated estrogen (Premarin).

Answer 2 2: Prednisone (Deltasone) is a corticosteroid. With prolonged use, corticosteroids cause adrenal atrophy, which reduces the ability of the body to withtand stress. When stress is severe, corticosteroids are essential to life. Before and during surgery, dosages may be increased temporarily. Ferrous sulfate is an oral iron preparation used to treat iron deficiency anemia. Cyclobenzaprine is a skeletal muscle relaxant. Conjugated strogen is used for hormone replacement therapy in postmenopausal women. These three meds can be withheld before surgery without consequences.

the client just had surgery to create an ileostomy. the nurse assesses the client in the immediate postoperative period for which most frequent complication of this type of surgery? 1. folate deficiency 2. malabsorption of fat 3. intestinal obstruction 4. fluid and electrolyte imbalance

Answer 4

Which task would be most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1. Complete the preoperative checklist. 2. Assess the client's preoperative vital signs. 3. Teach the client about coughing and deep breathing. 4. Assist the client to remove clothing and jewelry.

Answer 4 1. The nurse should complete this form because it requires analysis, which cannot be delegated to the UAP. 2. Nurses cannot delegate assessment. 3. The nurse cannot delegate teaching to a UAP. 4. The UAP can remove clothing and jewelry.

An 85-year-old woman with a hip fracture is scheduled for surgery. She has Alzheimer's disease and is only oriented to her name. Which of the following should the nurse look for on the informed consent? a. The patient's mark witnessed by the surgeon. b. The patient's explanation of the operative procedure. c. A signature of a person who has legal guardianship of the patient. d. The surgeon's note stating that the surgery was explained to the patient.

Answer C Rationale: If the patient is mentally incompetent to sign the permit for surgery, then written permission may be given by a legally appointed representative or responsible family member.

Which of the following preoperative patients likely faces the greatest risk of bleeding as a result of their medication? a. A woman who takes metoprolol (Lopressor) for the treatment of hypertension b. a man whose type 1 diabetes is controlled with insulin injections four times daily c. a man who is taking copidogrel (Plavix) after the placement of a coronary artery stent d. a man who recently started taking finasteride (Proscar) for the treatment of benign prostatic hyperplasia

Answer C: Any drug that inhibits platelet aggregation, such as clopidogrel (Plavix), represents a bleeding risk. Insulin, metoprolol (Lopressor), and finasteride (Proscar) are less likely to contribute to a risk for bleeding.

A patient is scheduled for a laparoscopic cholecystectomy at an ambulatory surgery center. What do you expect? A. Curative surgery for cancer of the pancreas. B. Palliative surgery for a resection of a tumor. C. Surgery with small incisions for removal of the liver. D. Removal of the gallbladder using a minimally invasive technique.

Answer D Most surgical procedures are being performed as ambulatory surgery (also called same-day or outpatient surgery). Many of these operations use minimally invasive techniques (e.g., laparoscopic techniques). Cholecystectomy is removal of the gallbladder.