PrepU ch. 29: Preoperative Nursing

A nurse teaches deep-breathing exercises to a preoperative client. What accurately describes a step in this exercise?

Instruct the client to exhale gently and completely before breathing in.

A nurse caring for patients in a PACU assesses a patient who is displaying signs and symptoms of shock. What is the priority nursing intervention for this patient?

Place the patient in a flat position with legs elevated 45 degrees.

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?

Procedural pause (time-out)

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

Relaxation techniques

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

Respiratory obstruction

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about deep breathing. When the client asks, "Why am I practicing breathing when I'm having hernia surgery," what is the appropriate nursing response?

"It decreases the postoperative risk for respiratory complications."

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?

"Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery."

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?

"The operating table is a firm surface; we need to be sure your skin looks okay."

The nurse is talking with a client who wishes to have a tattoo removed. Which client statement indicates that the client understands how the procedure will be accomplished?

"The provider will perform this laser surgery in an ambulatory care setting."

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?

"The risk of acquiring a blood-borne disease from a blood transfusion is very small."

The nurse is providing education for a postoperative client regarding pain management. Which teaching point should the nurse include?

"You will receive pain medication by injection as long as you are n.p.o."

The nurse enters a postoperative client's room and finds that the client is bleeding profusely from the surgical incision. What would be the nurse's most appropriate initial response?

Apply pressure to the surgical site to decrease bleeding.

A client postoperative from an appendectomy reports feeling cold and has a temperature of 96.2°F (35.7°C). Which action should the nurse perform first?

Apply warm blankets to the client.

A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client?

Implement leg exercises and turn the client in bed every 2 hours.

A nurse asks a preoperative patient what medications he is currently taking. Which of the following is an accurate guideline for patient teaching regarding these medications?

Certain respiratory drugs may be taken the day of surgery per physician's order.

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?

Conscious sedation

The nurse is obtaining a history from a client before surgery. Which areas would be important for the nurse to ask about to determine potential risk factors?

Current medications Previous surgeries Alcohol use Support systems

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

Ames is an 87-year-old man who underwent a hip replacement today. He is telling the nurse that his parents, who are deceased, are coming to visit him today. He continues to tell the nurse that he needs to cut the lawn and run errands. The last time the nurse entered the room, Ames was trying to climb over the bed rail. Which term best describes Ames' condition?

Delirium

Which client will see the greatest permanent changes in lifestyle following surgery?

Ileostomy

A nurse is dressing the wound of a client who is admitted to the outpatient surgical unit. What is a major advantage of outpatient surgery?

It interferes less with the client's daily routine.

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?

Keep the client in the preoperative area and inform the surgeon that it is the physician's responsibility to obtain consent for surgery.

A nurse anesthetist administers regional anesthesia to a client being prepared for facial surgery. Which type of regional anesthesia would be the appropriate choice for this client?

Local infiltration with lidocaine

After a client receives morphine sulfate for pain in the postanesthesia care unit (PACU), which assessment finding would the nurse obtain as a priority?

Measure respiratory rate.

A client had an open cholecystectomy (gall bladder 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.

In the postoperative phase of abdominal surgery, the client reports severe abdominal pain. In the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect?

Paralytic ileus

A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client?

Place the client in semi-Fowler's position.

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.

Which personnel are legally responsible for obtaining the client's informed consent for a surgical procedure?

The surgeon

A client has arrived to the postanesthesia care unit (PACU) and is drowsy with a respiratory rate of 12 breaths per minute. What would be an accurate interpretation by the nurse?

This is an expected finding in the immediate postoperative period.

Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?

a 26-year-old client who is exhibiting a crowing sound

Which client would a nurse monitor most closely for postoperative respiratory complications?

a 55-year-old client with a history of asthma who had a colon resection

Which of these clients in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?

a client who is pale and diaphoretic with a heart rate of 115 beats/minute

Which nursing action provides the greatest assistance in healing?

maintaining a restful environment

Surgery can lead to hypothermia. Which client is at greatest risk for hypothermia?

an older adult man with a fractured hip

The nurse knows the term perioperative phase refers to care given to the client:

before, during, and after the operative phase.

The nurse is caring for a client who had an outpatient procedure. Which assessment finding indicates to the nurse that the client may be ready for discharge to home?

blood pressure 118/70 mm Hg, respirations 18 breaths per minute

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.

An operating room nurse is bringing a client to the nurse in the postanesthesia care unit (PACU). Which information would the operating room nurse provide during a hand-off report? Select all that apply.

medications given in operating room length of surgery drains inserted in surgery

A client is undergoing conscious sedation for an endoscopy. When the client becomes overly sedated, which medication does the nurse anticipate will be required?

naloxone

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

partial airway obstruction.

A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice?

positioning the client on the operating table counting sponges before and after surgery monitoring the client's vital signs

The nurse has been waiting until after the administration of a toddler's anesthesia before removing the child's clothing and applying monitoring equipment. Doing these actions after the administration of anesthesia will:

prevent anxiety.

A nurse is caring for an infant who is postoperative following cardiac surgery. What is the most common postoperative complication found in this age group?

respiratory complications

The PACU nurse has received a semiconscious client from the operating room and reviews the chart for orders related to positioning of the client. There are no specific orders on the chart related to the client's position. In this situation, in what position will the nurse place the client?

side-lying position

The nurse recognizes that palliative surgery is performed for what purpose?

to lessen the intensity of an illness

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?

witnessing the client signature with their consent for surgery

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

witnessing the signed informed consent document