Preoperative Nursing Management

You are working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks you why these medications are needed. What would be your best answer?

"These medications decrease gastric acidity and volume."

Which question is most important for the nurse to ask the client when obtaining the preoperative admission history?

"When is the last time you ate or drank?"

The surgical unit nurse is developing a postoperative plan of care. In which client's plan of care would the nurse document interventions of coughing and deep breathing, gastrointestinal assessment, and effective regulation of temperature?

A client with gastrointestinal surgery and general anesthesia

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

Adrenal

A physically fit 86-year-old is scheduled for right knee replacement. What factor in this client makes them at increased risk for surgery?

Age

Informed consent from the surgical client is essential in all of the following categories of surgery except:

Emergent surgery

A client will be undergoing an appendectomy tomorrow morning. The nurse spends significant time explaining to the client what will happen, including before and after the procedure is complete. What is the primary reason the nurse puts so much effort into preoperative teaching?

It increases the likelihood of a successful recovery.

A 57-year-old client is undergoing preoperative assessment before surgical repair of a fractured ulna. During admission paperwork, the client reveals that she enjoyed a hearty breakfast this morning to be ready for her procedure. What is the nurse's next action?

Notify the surgeon.

During the preoperative assessment, the patient states he is allergic to avocados, bananas, and hydrocodone (Vicodin). What is the priority action by the nurse?

Notify the surgical team to remove all latex-based items.

You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility?

Place gauze under and over the ring and apply adhesive tape over it.

An obese patient is scheduled for open abdominal surgery. What priority education should the nurse provide this patient?

Prevention of respiratory complications

As a nurse working in an ambulatory surgery center, you are admitting a client who is going to have a biopsy of a skin lesion. What is an important part of the preoperative process?

Review preoperative instructions.

A client is placed on the operating room table for the surgical procedure. Which surgical team member is responsible for handing sterile instruments to the surgeon and assistants?

Scrub nurse

A patient 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.

A 17-year-old male client is having same-day surgery to remove a neuroma from his foot. Which of the following nursing interventions would occur during the intra operative phase of peri operative care?

The nurse continuously monitors the sedated client.

Sudden withdrawal of which of the following may result in seizures?

Tranquilizers

When a person with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the patient may show signs of alcohol withdrawal delirium during which time period?

Up to 72 hours after alcohol withdrawal

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

Use diaphragmatic breathing.

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

emergency.

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

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

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."

The nurse recognizes that the client most at risk for mortality associated with surgery is the:

Client with chronic alcoholism

What action by the nurse best encompasses the preoperative phase?

Educating the patients on signs and symptoms of infection

You are caring for a client postoperatively. What nursing interventions help prevent venous stasis and other circulatory complications in a client who has undergone surgery?

Encourage the client to move legs frequently and do leg exercises.

The nurse concludes that further teaching about diaphragmatic breathing is needed when the client:

Exhales forcefully with a short expiration

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately?

Temperature of 102.5° F

The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is:

To notify the surgeon

You are caring for a client 6 hours post surgery. You observe that the client voids urine frequently and in small amounts. You know that this most probably indicates what?

Urine retention

The nurse is physically preparing a client for surgery. What area does the nurse know needs to be addressed before the client is taken to the operating room?

Elimination

Which of the following would be the least important issue concerning safety for the perioperative team prior to proceeding to the operating room?

Patient ambulatory aids

Which nursing assessment finding indicates the preoperative client has not met expected outcomes?

Sobs uncontrollably about pending amputation of foot.

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

7

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

A gastrostomy tube

A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery?

A history of diabetes

The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following?

Cheeseburger, french fries, coleslaw, and ice cream

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

Chlorpromazine (Thorazine)

The nurse is assigned a client scheduled for an outpatient colonoscopy in an ambulatory care setting. During which phase of perioperative care would the nurse document the admission vital signs in the recovery room?

During the postoperative phase

At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period?

During the preoperative period

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

Emergent

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which of the following complications?

Malignant hyperthermia

A patient is scheduled to have a cholecystectomy. Which of the nurse's finding is least likely to contribute to surgical complications?

Osteoporosis

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

Peripherally-inserted central catheter.

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

Physician

A nurse is witnessing a patient sign the consent form for surgery. After the patient signs the consent form, the patient starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?

Request that the surgeon come and answer the questions.

You are caring for a client during the immediate postoperative period. What signs and symptoms indicate that the client may be in shock?

Weak and rapid pulse rate

An example of a curative surgical procedure is

the excision of a tumor.

Completing your preoperative assessment, you mentally rehearse your client's needs to determine if there is increased risk for complications intra operatively or postoperatively. Which of the following are general risk factors? Select all that apply.

• Nutritional status • Age • Physical condition • Health status