Therapeutics Chapter 39

A nurse from the ambulatory surgical center is preparing discharge instructions for a client who has had pelvic surgery. Which criterion would the client need to demonstrate to ensure that she is ready for discharge? A. Void normally B. Eat without nausea C. Verbalize absence of pain D. Exhibit no bleeding

Void normally Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 882.

Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse? A. a 30-year-old client who is drowsy with and reporting pain B. a 6-year-old client who is crying for a parent to visit C. a 26-year-old client who is exhibiting a crowing sound D. an 80-year-old client who is disoriented to place and time

a 26-year-old client who is exhibiting a crowing sound Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 875.

Which surgical client does the nurse in the preoperative setting anticipate having the greatest potential for surgical complications? A. 50-year-old overweight client with controlled hypertension B. 76-year-old client with a history of renal failure and chronic bronchitis C. 6-month-old client who has just been introduced to solid food D. 40-year-old client with type 2 diabetes mellitus and a history of anxiety

76-year-old client with a history of renal failure and chronic bronchitis Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, pp. 860-861.

The operating room nurse is aware that which client is at greatest risk related to a surgical procedure? A. A woman 83 years of age B. A man 48 years of age C. A woman 34 years of age D. A boy 8 years of age

A woman 83 years of age Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 860.

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? A. Assess the client's vital signs. B. Apply pressure to the surgical site to decrease bleeding. C. Determine the possible cause of the client's bleeding. D. Notify the health care provider.

Apply pressure to the surgical site to decrease bleeding. Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 12: Diagnosing, p. 254.

Which nursing action should the PACU nurse take to prevent postoperative complications in clients? A. Avoid turning the client in bed until the incision is no longer painful. B. Instruct the client to avoid coughing to prevent injury to the incision. C. Assist the client to do leg exercises to increase venous return. D. Encourage the client to breathe shallowly to prevent collapse of the alveoli.

Assist the client to do leg exercises to increase venous return. Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed., Philadelphia: Wolters Kluwer Health, 2015, Chapter 29, Perioperative Nursing, pp. 874-875.

What is the best action for the nurse in determining return of peristalsis in the postoperative client? A. Auscultate the bowel sounds. B. Lightly palpate the abdomen. C. Give the client sips of water. D. Check the symphysis pubis.

Auscultate the bowel sounds. Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 892.

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about leg exercises. When the client asks, "Why am I practicing leg exercises when I'm having hernia surgery", what is the appropriate nursing response? A. "It prevents the postoperative risk for respiratory complications." B. "Doing this reduces your risk of developing blood clots." C. "This technique will help with pain control." D. "Leg exercises facilitate quicker healing of the incision."

"Doing this reduces your risk of developing blood clots." Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 29: Perioperative Nursing, p. 869.

Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction? A. "The better I eat before surgery, the more likely I will heal." B. "I might be sick to my stomach and throw up after surgery." C. "I can have a hamburger and French fries as soon as I wake up." D. "When I can eat again, the best meal would be steak and orange juice."

"I can have a hamburger and French fries as soon as I wake up." Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, pp. 892-893.

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? A. "Doing this reduces your risk of developing blood clots." B. "It decreases the postoperative risk for respiratory complications." C. "Deep breathing facilitates quicker healing of the incision." D. "This technique will help with pain control."

"It decreases the postoperative risk for respiratory complications." Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 29: Perioperative Nursing, p. 868.

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? A. "We wanted to be sure we didn't leave any sponges or syringes underneath you." B. "The operating table is a firm surface; we need to be sure your skin looks okay." C. "The covers underneath you need to be straightened out. They look messy." D. "We needed to be sure you didn't have any skin breakdown before surgery."

"The operating table is a firm surface; we need to be sure your skin looks okay." Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 867.

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? A. "The risk of acquiring a blood-borne disease from a blood transfusion is very small." B. "Perhaps we can have one of your siblings donate blood in case you need it." C. "Knee replacement surgeries usually do not require blood transfusions." D. "You should have given your own blood preoperatively."

"The risk of acquiring a blood-borne disease from a blood transfusion is very small." Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 39: Fluid, Electrolyte, and Acid-Base Balance, p. 1514.

The procedural physician has initiated performance of a time-out in the operating room before surgery. The student nurse asks the operating room nurse why this is important. What is the operating room nurse's best response? A. "We need to be sure the client has had the preoperative antibiotic." B. "The time-out allows us to make sure that the client has had adequate anesthesia." C. "The time-out checks to be sure that we have the right client and procedure." D. "We are checking the client's baseline vital signs during time-out."

"The time-out checks to be sure that we have the right client and procedure." Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 872.

A 17-year-old client who lives with her parents wishes to have a breast reduction. Which information will the nurse provide to the client? A. "Your parent or legal guardian must sign the consent form." B. "You can sign the consent form on this line." C. "I am able to give informed consent for you to have this procedure." D. "Because you are a minor, no consent form is needed."

"Your parent or legal guardian must sign the consent form." Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 29: Perioperative Nursing, p. 858.

A nurse is assessing clients in the Post Anesthesia Care Unit (PACU). Which nursing actions would the nurse perform in this phase of the perioperative period? Select all that apply. A. Inform the client that surgical intervention is necessary. B. Transfer the client to the recovery room. C. Assess for complications as the client emerges from anesthesia. D. Assess the client's ability to return to the inpatient room when arousable E. Prepare the client for home care. F. Arrange for a rehabilitative program for the client.

- Prepare the client for home care. - Assess the client's ability to return to the inpatient room when arousable - Assess for complications as the client emerges from anesthesia. Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed., Philadelphia: Wolters Kluwer Health, 2015, Chapter 29, Perioperative Nursing, p. 874.

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? A. Conscious sedation B. Nerve block C. Epidural anesthesia D. Spinal anesthesia

Conscious sedation Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 857.

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? A. Dehiscence B. Hypoxemia C. Evisceration D. Shock

Dehiscence Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 880.

A client is undergoing surgery for an appendectomy. This would be considered what type of surgery? A. Palliative surgery B. Emergency surgery C. Diagnostic surgery D. Elective surgery

Emergency surgery Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 856.

Which surgical clients will return to activities in their everyday lives more quickly? A. Open-heart surgery B. Right nephrectomy C. Laparoscopic cholecystectomy D. Vaginal hysterectomy

Laparoscopic cholecystectomy Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015,

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? A. Increase the rate of the client's intravenous infusion. B. Monitor the client closely and promote fluid intake. C. Immediately administer a cleansing enema. D. Contact the physician to come assess the client.

Monitor the client closely and promote fluid intake. Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 880.

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? A. Ask the client if he still wants to proceed with the procedure. B. Immediately have the client sign the consent form. C. Notify the physician of the oversight. D. Have the client's family member sign the consent form.

Notify the physician of the oversight. Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015,

Which nursing action will best promote pain management for a client in the postoperative phase? A. Performing relaxation techniques B. Dimming the lights C. Breathing into a paper bag D. Providing food and medication

Performing relaxation techniques Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 867.

Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client? A. Educate the client about the use of incentive spirometer. B. Encourage the client to elevate the head of bed. C. Place graduated compression stockings on the client. D. Elevate bilateral legs when client is lying in bed.

Place graduated compression stockings on the client. Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 872.

A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client? A. Instruct the client to perform Valsalva maneuver. B. Place the client in semi-Fowler's position. C. Assist the client to ambulate every 2 to 3 hours. D. Attempt to overhydrate the client with fluids.

Place the client in semi-Fowler's position. Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed., Philadelphia: Wolters Kluwer Health, 2015, Chapter 29, Perioperative Nursing, pp. 879-880.

A 9-month-old baby is scheduled for heart surgery. When preparing this client for surgery, the nurse should consider which surgical risk associated with infants? A. Potential for hypothermia or hyperthermia B. Gastrointestinal upset C. Congestive heart failure D. Prolonged wound healing

Potential for hypothermia or hyperthermia Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed., Philadelphia: Wolters Kluwer Health, 2015, Chapter 29, Perioperative Nursing, p. 860.

The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency? A. Cardiac distress B. Respiratory obstruction C. Dehydration D. Wound infection

Respiratory obstruction Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed., Philadelphia: Wolters Kluwer Health, 2015, Chapter 29, Perioperative Nursing, p. 875.

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? A. The client will be admitted the day of surgery and return home the same day. B. The surgery is classified as urgent rather than elective. C. The client must be previously healthy with low surgical risks. D. The surgery will be conducted using moderate sedation rather than general anesthesia.

The client will be admitted the day of surgery and return home the same day. Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 856.

Which personnel are legally responsible for obtaining the client's informed consent for a surgical procedure? A. Any licensed person B. The admissions clerk C. The licensed practical nurse D. The surgeon E. The registered nurse

The surgeon Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015,

Which of these clients in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse? A. a client who is pale and diaphoretic with a heart rate of 115 beats/minute B. a client reporting incisional pain rated 8/10 and no medication orders C. a client with snoring respirations who arouses readily D. a client reporting nausea who requests an antiemetic

a client who is pale and diaphoretic with a heart rate of 115 beats/minute Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 878.

Surgery can lead to hypothermia. Which client is at greatest risk for hypothermia? A. an adolescent for arthroscopic surgery B. a woman giving birth by C-section C. a young adult with a fractured leg D. an older adult man with a fractured hip

an older adult man with a fractured hip Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015,

A client scheduled for surgery has been taking aspirin since his heart attack in 1997. The client is at risk for: A. hemorrhage. B. blood clots. C. infection. D. thrombophlebitis.

hemorrhage. Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 888.

Which nursing action provides the greatest assistance in healing? A. keeping the client recumbent B. providing solid food in the first day C. allowing family members to visit often D. maintaining a restful environment

maintaining a restful environment Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 871.

A client is undergoing conscious sedation for an endoscopy. When the client becomes overly sedated, which medication does the nurse anticipate will be required? A. morphine B. naloxone C. midazolam D. lorazepam

naloxone Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 34: Comfort and Pain Management, p. 1174.

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: A. effects of anesthesia. B. partial airway obstruction. C. type of surgery. D. normal return of reflexes.

partial airway obstruction. Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015,

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? A. circulatory complications B. infection C. renal complications D. respiratory complications

respiratory complications Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 894.

When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease? A. altered metabolism and excretion of drugs B. slow wound healing C. fluid and electrolyte imbalance D. respiratory depression from anesthesia

slow wound healing Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed., Philadelphia: Wolters Kluwer Health, 2015, Chapter 29, Perioperative Nursing, p. 861.

A nurse is caring for an older adult client who had surgery for the removal of a cataract in the left eye. When can the client return home after outpatient surgery? A. after 1 week B. the same day C. after 2 days D. after 10 days

the same day Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, p. 858.

The nurse recognizes that palliative surgery is performed for what purpose? A. to remove a part of the body that is diseased B. to restore function to tissue that is traumatized C. to lessen the intensity of an illness D. to make or confirm a diagnosis

to lessen the intensity of an illness Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 855.

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? A. determining for the client what other treatment options exist B. describing how the client will benefit from the surgical procedure C. witnessing the client signature with their consent for surgery D. explaining to the client about potential risks of having the surgery

witnessing the client signature with their consent for surgery Explanation: Reference: Taylor, C.R. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015, Chapter 29: Perioperative Nursing, p. 858.

What is the nurse's role in the informed consent process for a surgical procedure? A. witnessing the signed informed consent document B. providing benefits and risks of procedure C. granting permission for surgery to be done D. explaining what takes place during the procedure

witnessing the signed informed consent document Explanation: Reference: Taylor, C., et al. Fundamentals of Nursing, 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015, Chapter 29: Perioperative Nursing, p. 858.