Preoperative Nursing PrepU questions

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

Respiratory obstruction

The nurse is preparing a client for a surgical procedure that is scheduled for the next morning. What nursing action(s) is important to limit the risk of intraoperative and postoperative complications? Select all that apply.

- checking that all diagnostic tests are completed - having the client void immediately before surgery - educating client about postoperative care - measuring baseline vital signs

The nurse is caring for a client who just returned from the PACU following surgery to repair a fractured arm. Place the following interventions in order from highest priority to lowest priority. A. Measure pulse, BP, respiration and temperature B. Place the client in a position that facilitates breathing C. Assess neurovascular status to the affected arm D. Measure O2 saturation E. Assess dressing for bleeding and other drainage F. Assess for pain and administer prescribed analgesics, if indicated

1. Place the client in a position that facilitates breathing 2. Measure pulse, BP Respiration and temp 3. Measure O2 saturation 4. Assess neurovascular status to the affected arm 5. Assess the dressing for bleeding or drainage 6. Assess for pain and administer prescribed analgesics, if indicated Reason: "priority of assessment is airway, breathing and circulation"

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 nurses response? A. "I will need to check with your health care provider about that" B. "No--you should stay on your normal medication before the surgery" C. "You should stay on your cholesterol medicine but stop taking all other medications 12 hours before surgery" D. "Yes--you should be off of all of your medications for 24 hours before surgery"

A. "I will need to check with your health care provider about that" Reason: "The client may be permitted to take certain medications before surgery. The health care provider, not the nurse, should provide guidance about which medications should be taken and which ones should be held" Remember that: - anticoagulants can cause hemorrhage - Diuretics can cause electrolyte imbalance and respiratory depression - Tranquilizers can increase hypotension - Abrupt withdrawal of adrenal steroids will may CV collapse - antibiotics in the mycin group may cause respiratory paralysis

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? A. "There are several non-pharmacologic methods to reduce pain and anxiety. Let me teach you about some of them" B. "Are you afraid of becoming addicted to pain medications?" C. "There are non-pharmacologic methods, but they only work when clients have practiced them extensively beforehand" D. "your pain needs to be managed with medication for the first 24 hours, then you can try non-pharmacologic methods"

A. "There are several non-pharmacologic methods to reduce pain and anxiety. Let me teach you about some of them" Reason: "Non-pharmacological measures may reduce anxiety and reduce the need for pain mediation at any time during the postoperative period. Asking about fear of addiction does not address the client's question. Non-pharm methods can be implemented postoperatively regardless of prior client experience"

A nurse is creating a leg exercise regimen for a client who is recovering from surgery. Which factors should the nurse consider when recommending leg exercises to this client? Select all that apply A. Client's individual needs B. Current popularity of the exercise C. Client's physical condition D. Health care provider preference E. Facility protocol F. Cardiovascular intensity of the exercise

A. Client's individual needs C. Client's physical condition D. Health care provider preference E. Facility protocol Reasoning: "leg exercises increase venous return through flexion and contraction of the quadriceps and gastrocnemius muscle. It is important to individualize leg exercise to client needs, physical condition, health care provider preference, and facility protocol. Current popularity of the exercise and the cardiovascular intensity are not factors to consider"

The preoperative nurse is admitting a client who is scheduled for surgery later in the day. The client is wearing contact lenses, has several body piercings, has fingernails covered with nail polish, and is wearing cosmetics, false eyelashes and a wedding band. Which should the nurse instruct the client to remove before surgery? Select all that apply: A. Cosmetics B. Wedding band C. Contact lenses D. Body piercings E. False eyelashes F. Fingernail polish

A. Cosmetics C. Contact lenses D. Body piercings E. False Eyelashes F. Fingernail polish Reason: "the nurse should request that the client remove all but the wedding band. Cosmetics, jewelry, nail polish and prosthesis (=contact lenses and false eye lashes) can interfere with assessment during surgery, so clients should be asked to remove them. Some facilities allow a wedding band to be taped to the finger"

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 A. Flatus B. Frequency C. Presence of bowel sounds D. Burning E. Chills F. Urgency

A. Flatus C. Presence of bowel sounds Reason: "anesthetic agents and narcotics depress peristalsis and normal functioning of the GI. Flatus and presence of bowel sounds indicate return of peristalsis. Frequency, burning and urgency may indicate possible urinary tract abnormalities. Clients may experience chills in the postoperative period but this is not an indication of returning peristalsis."

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 contracts the surgeon who states, "we have already reviewed this procedure extensively, so ask the client to sign the form and I will verify it in the OR" Which action by the nurse is appropriate? A. Keep the client in the preoperative area and inform the surgeon that it is the health care provider's responsibility to obtain consent for surgery B. Send the client to the operating room and inform the staff that the consent form needs to be signed C. Ask the operating room staff to delay the procedure until the consent is signed D. Ask the client to sign the consent; witness the signature and inform the OR staff of the modification in the procedure

A. Keep the client in the preoperative area and inform the surgeon that it is the health care provider's responsibility to obtain consent for surgery Reason: "If a consent form is not signed, the nurse should notify the surgeon. It is the health care provider's responsibility to obtain consent for surgery and anesthesia. Preoperative medications cannot be given until the consent form is signed. The client should not proceed to surgery without a signed consent form (unless it is an emergency)"

Which postoperative complications can be reduced by appropriate client teaching about deep-breathing exercises? Select all that apply: A. Pneumonia B. Wound Infection C. Bronchitis D. Atelectasis E. Severe Hypoxemia F. Deep vein thrombophlebitis

A. pneumonia C. Bronchitis D. Atelectasis E. Severe hypoxemia Reasoning: "deep-breathing exercises can decrease respiratory complications. Deep vein thrombophlebitis and wound infection are unrelated to respiration" Notes: Deep breathing helps hyperventilate the alveoli of the lungs to prevent their collapse, it improves lung expansion and volume, rids anesthetic gases and mucus from airways and oxygenates body tissues"

A 2-year-old toddler just underwent a tonsillectomy and adenoidectomy surgery. The postanesthesia care unit (PACU) nurse is checking on him. What is the best course of action regarding the developmental care of this child?

Allow the parents into the PACU before the child wakes Reason: "toddlers are prone to separation anxiety"

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 expected outcome of the forced-warm air device has been met when the client's temperature reaches what range? A. 95.9 F-97.9 F B. 99.5 F- 100.4 F C. 97.9 F- 99.5 F D. 10.4 F to 103.1 F

B. 99.5 F to 100.4 F Reason: "the expected outcome of a forced-warm air device is a client body temperature of 97.9 F- 99.5 "

The acute care nurse is preparing a client for surgery. Which action is essential to complete before transferring the client to surgery? A. Place the client in a side-lying position B. Assure that the diagnostic testing has been completed and results are available C. Remove graduated compression stockings D. Mark the client's skin to indicate the location of the surgery

B. Assure that diagnostic testing has been completed and results are available Reason: "all prescribed diagnostic tests should be performed, and results made available before going into surgery. Unless otherwise indicated, no special positioning is required preoperatively. Graduated compression stockings, if prescribed, should remain in place. The surgeon, not the nurse, is responsible for marking the skin"

How often is body temperature monitored for a client who has a forced-warm air device applied? A. Every 15 minutes B. Every 30 minutes C. Every 4 hours D. Every 60 minutes

B. Every 30 minutes Reason: "this is done to see if any changes need to be made"

The nurse is assessing a postoperative client and notes that the client has pale nail beds and mucous membranes. What action should the nurse take? A. Reposition the client in bed B. Notify the health care provider C. Encourage client to use incentive spirometer D. Administer a PRN dose of pain medication

B. Notify the health care provider Reason: "pale nail beds and mucous membranes can indicate hypothermia. The client may benefit from a prescription for a forced-warm air devise. repositioning would not increase body temp, there is no indication for pain medication and the use of incentive spirometer does not increase body temperature"

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? A. assist the client in a side-lying position to cough B. Teach the client how to splint the abdomen while coughing C. Administer respiratory treatments to encourage coughing D. Remind the client of the serious complications that can result from ineffective coughing and deep breathing

B. Teach the client how to splint the abdomen while coughing Reasoning: "splinting the abdomen decreases discomfort while coughing. Telling the client about complications will be less effective than teaching splinting techniques. Respiratory treatments are not indicated for cough production. Side-lying position is less effective than upright positioning to clear secretions and expand the lungs"

The nurse assits a client to turn in the bed. The client has just returned from abdominal surgery.How does the nurse instruct the client? A. Raise the head of the bed before turning" B. "wait for assistance before moving in bed"" C. "use a pillow to splint the incision" D. "Change your position frequently"

C. "use a pillow to splint the incision" Reason: "the client needs to use a pillow to splint the incision during movement to reduce pain. the client needs to change position every 2 hours or less; "frequently" could be misinterpreted by the client. It is easier to turn laterally when the head of the bed is flat. Independence is encouraged, so if the client feels capable, he or she may move in the bed on their own"

A nurse is instructing a client on how to perform leg exercises following surgery. The client asks the nurse, "why do I have to do these exercises?" Which is the health reason the nurse should tell them? A. To improve the efficiency of the heart B. To increase flexibility in the joints C. To increase venous return of blood to the heart D. To strengthen leg muscles

C. To increase venous return of blood to the heart Reason: "during surgery, venous blood return from the legs slows. In addition, some client positions used during surgery decrease venous return. Thrombophlebitis, DVT, and the risk for emboli are potential complications from circulatory status in the legs. Leg exercises increase venous return through flexion and contraction of the quadriceps and gastrocnemius muscles. Although leg exercises may also strengthen the leg muscles, improve the efficiency of the heart and increase flexibility, the health reason to perform them following surgery is to increase venous return of blood to the heart"

The nurse is caring for a client who has a forced-warm air device applied. The nurse notes that the client's temperature has risen 3.5 F (2 C) in the past hour. What action should the nurse take? A.Turn up the setting of the forced-warm air device B. obtain a repeat temperature in 15 minutes C. Turn down the forced-warm air decive D. Report the temperature to the healthcare provider

C. Turn down the forced-warm air device Reason: "The temperature on the forced-warm air device should be turned down to prevent rapid vasodilation effect. The temperature should not be turned up as this could harm the client. The nurse should not wait 15 minutes before reassessing temperature. The device temperature should be turned down and temperature reassessed prior to notifying the healthcare provider. If the client continues to have elevated temperatrues, the provider may need to be notified at a later point"

The outpatient surgery nurse is preparing to discharge a client who has recovered from surgery. What action should the nurse plan to carry out before the client is discharged? A. provide a sterile specimen cup and instructions about collecting a routine postoperative urine sample B. Ask the client to list home medications and allergies C. Provide written postoperative instructions D. Provide contact information to schedule a postoperative appointment with the surgeon E. Provide instructions about caring for the IV catheter that will remain in place until the postoperative appointment F. Provide verbal postoperative instructions

C. provide written postoperative instructions D. Provide contact information to schedule a postoperative appointment with the surgeon F. Provide verbal postoperative instructions Reasoning : "patients must go home accompanied with written and verbal instructions for home as well as information about a follow up about post-op appointment" Choice A is incorrect because urine sample is not a routine post-op procedure. Choice B is incorrect because asking about allergies and meds is a pre-op task Choice E is incorrect because IV catheters are removed before discharge

The nurse is caring for a client who returned from the PACU 3 hours ago. The surgical dressing was dry and intact upon arrival to the Post-OP unit, but now it is saturated with fresh blood. What actions should the nurse take first? A. Reinforce the dressing with more bandages until bleeding stops B. Remove the dressing and inspect the wound C. Measure vital signs D. Draw a circle around the drainage and note the time

C. reinforce the dressing with more bandages until the bleeding stops Reason: "in this situation, the nurse should not remove the dressing but rather reinforce it. removing bandage could dislodge and clot that is forming and lead to further blood loss. Measuring vital signs would be lower of a priority than reinforcing. Drawing a circle is not the proper first action"

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? A. "these types of exercise help distract you from the postoperative pain" B. "These techniques will prevent trapped air from accumulating in your lungs" C. "If you learn how to perform these exercises correctly, you will not need supplemental oxygen during surgery" D. "after surgery, deep-breathing exercises help to remove anesthetic gasses and mucus and improve oxygen supply to the body tissues"

D. "after surgery, deep-breathing exercises help to remove anesthetic gasses and mucus and improve oxygen supply to the body tissues" Reasoning "deep-breathing exercises are intended to help prevent postoperative complications, such as low oxygen levels, accumulation of secretions and atelectasis" Method: The patient should be sitting up in the Fowler's positions with their hands on their rib cage; they should exhale and breath in through their nose, hold the breath for five seconds and breath out through their mouth. They will repeat this three times and perform deep breathing every 1 to 2 hours while awake for the first 24 hours after surgery

The preoperative nurse has prepared a client for surgery and has been notified that the operating room staff is ready for the client. The client states, "my bladder feels full. I need to go to the bathroom!" Which action by the nurse is appropriate? A. Inform the client that anesthesia will prevent the bladder from emptying during surgery B. Remind the client that bladder fullness is common preoperative sensation C. Insert a catheter into the bladder D. Inform the operating room staff and assist the client to the bathroo

D. Inform the operating room staff and assist the client to the bathroom Reason: "Clients should empty their bowel and bladder before surgery. A urinary catheter is not indicated. Statements A and B are untrue"

The nurse is educating a client who is preparing for abdominal surgery tomorrow. A teaching demonstration has just been completed by the nurse related to splinting the incision site with a pillow. Which statement by the client best indicates the instructions provided by the nurse were effective?

I will put the pillow on the incision then cough

The nurse is supervising a nursing student who is providing postoperative education to a client with an abdominal incision. The nurse sees the student coaching the client to perform coughing exercises, as pictured above. What is the nurse's best action?

Instruct the student to provide the client with a pillow or folded blanket to hug.

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.

The healthy adult client is given a narcotic prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first?

Notify the physician of the oversight

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

Perform relaxation techniques

A female client age 54 years has been scheduled for a bunionectomy (removal of bone tissue from the base of the great toe) which will be conducted on an ambulatory basis. Which characteristic applies to this type of surgery?

The client will be admitted the day of surgery and return home the same day.

The nurse is providing education about deep-breathing exercises to a postoperative client whose surgery took place earlier today. Which instruction should the nurse provide?

Try to do your exercises every 1 to 2 hours.

When an older adult client is brought to the recovery room and presents with irregular, loud respirations, the nurse determines that this is most likely a result of:

a partial airway obstruction Reason: loud, irregular respirations may indicate obstructions from emesis secretions, or client positioning (allowing the tongue to fall back into the throat)

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

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

The recovery nurse is caring for a surgical client in the PACU. The client's blood pressure is dropping and the heart rate is increasing. The nurse suspects the client is:

developing shock

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

preoperative

When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease?

slow wound healing Reason: "due to impaired circulation and high glucose levels, the client with diabetes is at an increased risk for slow wound healing. The surgical risk of fluid and electrolyte imbalance is often associated with kidney or liver disease. The risk for respiratory depression results from respiratory disorders. Altered metabolism may occur as a result of liver disease"

What is the nurse's role in the informed consent process for a surgical procedure?

witnessing the signed informed consent documen