CH 14
A client has been given hydroxyzine (Atarax) in the preoperative holding area. What action by the nurse is most important for this client A. Document giving the drug. B. Raise the siderails on the bed. C. Record the client's vital signs. D. Teach relaxation techniques
B
A client in the preoperative holding room has received sedation and now needs to urinate. What action by the nurse is best A. Allow the client to walk to the bathroom. B. Delegate assisting the client to the nurse's aide. C. Give the client a bedpan or urinal to use. D. Insert a urinary catheter now instead of waiting.
C
A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best A. Assess the client for anxiety. B. Break the information into smaller bits. C. Give the client written information. D. Review the information again
A
A student is caring for clients in the preoperative area. The nurse contacts the surgeon about a client whose heart rate is 120 beats/min. After consulting with the surgeon, the nurse administers a beta blocker to the client. The student asks why this was needed. What response by the nurse is best A. "A rapid heart rate requires more effort by the heart." B. "Anesthesia has bad effects if the client is tachycardic." C. "The client may have an undiagnosed heart condition." D. "When the heart rate goes up, the blood pressure does too."
A
An older client is hospitalized after an operation. When assessing the client for postoperative infection, the nurse places priority on which assessment A. Change in behavior B. Daily white blood cell count C. Presence of fever and chills D. Tolerance of increasing activity
A
The perioperative nurse manager and the postoperative unit manager are concerned about the increasing number of surgical infections in their hospital. What action by the managers is best A. Audit charts to see if the Surgical Care Improvement Project (SCIP) outcomes were met. B. Encourage staff on both units to provide peer pressure to adhere to hand hygiene policy. C. Hold educational meetings with the nursing and surgical staff on infection prevention. D. Monitor staff on both units for consistent adherence to established hand hygiene practices.
A
A student nurse asks why older adults are at higher risk for complications after surgery. What reasons does the registered nurse give (Select all that apply.) A. Decreased cardiac output B. Decreased oxygenation C. Frequent nocturia D. Mobility alterations E. Inability to adapt to changes
A B C D
A client is clearly uncomfortable and anxious in the preoperative holding room waiting for emergent abdominal surgery. What actions can the nurse perform to increase comfort (Select all that apply.) A. Allow the client to assume a position of comfort. B. Allow the client's family to remain at the bedside. C. Give the client a warm, non-caffeinated drink. D. Provide warm blankets or cool washcloths as desired. E. Pull the curtains around the bed to provide privacy
A B D E
A student nurse is caring for clients on the postoperative unit. The student asks the registered nurse why malnutrition can lead to poor surgical outcomes. What responses by the nurse are best (Select all that apply.) A. "A malnourished client will have fragile skin." B. "Malnourished clients always have other problems." C. "Many drugs are bound to protein in the body." D. "Protein stores are needed for wound healing." E. "Weakness and fatigue are common in malnutrition."
A C D E
A nurse recently hired to the preoperative area learns that certain clients are at higher risk for venous thromboembolism (VTE). Which clients are considered at high risk (Select all that apply.) A. Client with a humerus fracture B. Morbidly obese client C. Client who underwent a prolonged surgical procedure D. Client with severe heart failure E. Wheelchair-bound client
B C D E
A nurse working in the preoperative holding area performs which functions to ensure client safety (Select all that apply.) A. Allow small sips of plain water. B. Check that consent is on the chart. C. Ensure the client has an armband on. D. Have the client help mark the surgical site. E. Allow the client to use the toilet before giving sedation
B C D E
A new perioperative nurse is receiving orientation to the surgical area and learns about the Surgical Care Improvement Project (SCIP) goals. What major areas do these measures focus on preventing (Select all that apply.) A. Hemorrhage B. Infection C. Serious cardiac events D. Stroke E. Thromboembolism
B C E
A nursing instructor is teaching students about different surgical procedures and their classifications. Which examples does the instructor include (Select all that apply.) A. Hemicolectomy: diagnostic B. Liver biopsy: diagnostic C. Mastectomy: restorative D. Spinal cord decompression: palliative E. Total shoulder replacement: restorative
B E
A nurse is caring for several clients prior to surgery. Which medications taken by the clients require the nurse to consult with the physician about their administration (Select all that apply.) A. Metformin (Glucophage) B. Omega-3 fatty acids (Sea Omega 30) C. Phenytoin (Dilantin) D. Pilocarpine hydrochloride (Isopto Carpine) E. Warfarin (Coumadin)
A C D E
A client who collapsed during dinner in a restaurant arrives in the emergency department. The client is going to surgery to repair an abdominal aortic aneurysm. What medication does the nurse prepare to administer as a priority for this client A. Hydroxyzine (Atarax) B. Lorazepam (Ativan) C. Metoclopramide (Reglan) D. Morphine sulfate
C
