CH 14: Preoperative Nursing Management
An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used? A) Imagery B) Distraction C) Progressive muscular relaxation D) Optimistic self-recitation
A
Which nutrient plays an important role in normal blood clotting? A) Vitamin K B) Vitamin C C) Protein D) Zinc
A
A client is scheduled to have surgery to address a cleft palate. What type of surgery would the nurse be preparing this client for? A) corrective B) reconstructive C) diagnostic D) prophylactic
B
A gunshot wound would be classified under which category of surgery based on urgency? A) Elective B) Emergent C) Urgent D) Required
B
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? A) 1 B) 7 C) 3 D) 5
B
When is the ideal time to discuss preoperative teaching A) Prior to entering the pre-op area B) When the patient is comfortable and sedated C) Preadmission visit D) Day of surgery
C
You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear? A) Anxious clients need psychological counseling after surgery. B) Anxiety and fear increases the need for anesthesia and postoperative medications. C) Anxiety and fear can affect a client positively during and after surgery. D) Anxious clients have a poor response to surgery and are prone to complications.
D
A fractured skull would be classified under which category of surgery based on urgency? A) Emergent B) Required C) Urgent D) Elective
A
A client scheduled for surgery follows a vegan eating plan. For which potential postoperative complication will the nurse plan care for this client? A) Hypoactive bowel sounds B) Delayed wound healing C) Blood clots D) Stasis pneumonia
B
A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which post-surgical risk factor would decrease if the surgical client maintained strict blood glycemic control? A) respiratory complications B) wound healing C) liver dysfunction D) nutrient deficiencies
B
The nurse recognizes that written informed consent is required for insertion of a(n): A) Oral airway. B) Peripherally-inserted central catheter. C) Urinary catheter. D) Nasogastric tube.
B
What action by the nurse best encompasses the preoperative phase? A) Monitoring vital signs every 15 minutes B) Educating clients on signs and symptoms of infection C) Shaving the client using a straight razor D) Documenting the application of sequential compression devices (SCDs)
B
The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. Which of the following is the most important function? A) Verifies that operative consent is signed B) Provides psychological support C) Develops a plan of care D) Completes preoperative assessment
A
A client who is scheduled for knee surgery is anxious about the procedure, saying, "You hear stories on the news all the time about doctors working on the wrong body part. What if that happens to me?" What is the nurse's best response? Select all that apply. A) "The surgical team performs a 'time-out' prior to surgery to conduct a final verification." B) "Our surgical team would never make that mistake." C) "The client can be involved in marking the knee, the site for the surgery." D) "The client will be involved in the verification process prior to surgery." E) "The surgeon on the team has never been involved in such a mix-up."
A, C, and D
Which question is most important for the nurse to ask the client when obtaining the preoperative admission history? A) "Did you bring a copy of your health care power of attorney?" B) "When is the last time you ate or drank?" C) "Who is here with you?" D) "Did you bring any valuables with you?"
B
A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery? A) 7 to 10 days B) 2 to 3 days C) 2 weeks D) 4 weeks
A
A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client? A) adrenal insufficiency B) hypoglycemia C) obstruction D) surgical site infection
A
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? A) Splint the incision site using a pillow during deep breathing and coughing exercises. B) Pain medication should be taken before completing deep breathing and coughing exercises. C) Deep breathing and coughing exercises may be used as relaxation techniques. Deep breathing and coughing exercises should be completed every 8 hours.
A
A client with osteoarthritis receives a recommendation to have joint replacement surgery. For which type of surgery will the nurse plan teaching for this client? A) Elective B) Emergent C) Urgent D) Required
A
A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia? A) diuretics B) insulin C) anticoagulants D) corticosteroids
A
An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults? A) Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. B) Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. C) All older people face similar risks when undergoing surgeries. D) Aging processes reduce the chances that surgery will be successful for these clients.
A
An inappropriate nursing action implemented to keep the client safe includes: A) Moving the client swiftly B) Accurately identifying the client C) Screening for latex allergy D) Protecting bony prominences
A
The nurse expects informed consent to be obtained for insertion of: A) A gastrostomy tube B) A nasogastric tube C) An indwelling urinary catheter D) An intravenous catheter
A
The nurse is doing a preoperative assessment of an 87-year-old man who is slated to have a right lung lobe resection to treat lung cancer. What underlying principle should guide the nurse's preoperative assessment of an elderly client? A) Elderly clients have less physiologic reserve than younger clients. B) Elderly clients have a smaller lung capacity than younger clients. C) Elderly clients require higher medication doses than younger clients. D) Elderly clients have more sophisticated coping skills than younger clients.
A
The nurse notes that the consent form for surgery needs to be signed; however, the client just received preoperative medication. Which action will the nurse take? A) Notify the health care provider that the consent form has not been signed. B) Ask the client to sign the consent form now. C) Document that the client provided verbal consent to the surgery. D) Ask a family member to sign the consent form.
A
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? A) 80 to 110 mg/dL B) 150 to 240 mg/dL C) 250 to 300 mg/dL D) 300 to 350 mg/dL
A
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as A) emergency. B)required. C) urgent. D) elective.
A
A client is preparing to undergo a curative surgical procedure. Which of the following is the type of surgery the client could be having? Select all that apply. A) Removal of a tumor B) Insertion of a gastrostomy tube C) Skin biopsy D) Removal of a diseased appendix E) Mammoplasty
A and D
The nurse is preparing the medical record for a client scheduled for surgery. Which item(s) will the nurse ensure are in the history and physical? Select all that apply. A) Medical history B) Allergies C) History of present illness D) Current medications E) Home care needs F) Surgical history
A, B, C, D, and F
A surgical client has been transferred to the holding area. What nursing intervention(s) promote safe and effective nursing care? Select all that apply. A) Identify the client using two identifiers. B) Verify the surgical site has been marked per institutional policy C) Maintain an aseptic environment. D) Review the medical records. E) Apply grounding devices to the client. F) Provide oral fluids to the patient.
A, B, and D
The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. A) nutritional status B) ethnicity C) age D) physical condition E) gender F) health status
A, C, D, and F
A client scheduled for surgery asks why blood tests are being done to evaluate liver function. Which response will the nurse make? A) "It is just a routine test done before every surgery." B) "It is because the anesthesia you will receive is cleared through the liver." C) "It is done to determine if you need antibiotics prior to surgery." D) "It is to make sure that you haven't had any alcohol before the surgery."
B
A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed? A) The client performs diaphragmatic breathing in a semi-Fowler's position. B) The client exhales forcefully with a short expiration. C) The client places the hands on the lower chest to feel the rise and fall with breathing. D) The client breathes in deeply through the nose and mouth.
B
A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for kidney stones the next day. What category of surgery does this procedure fall into? A) elective B) urgent C) emergent D) required
B
The nurse is caring for a client who has just arrived for surgery. Which assessment finding indicates to the nurse that the client may be experiencing dehydration because of taking nothing by mouth after midnight for the surgery? A) Pulse 88 beats per minute B) Blood pressure 80/50 mm Hg C) Respiratory rate 20 breaths per minute D) Urine output 60 mL/hr
B
When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period? A) Immediately upon admission B) Up to 72 hours after alcohol withdrawal C) Upon awakening in the postanesthesia care unit D) Up to 24 hours after alcohol withdrawal
B
Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period? A) The 28-year-old client who occasionally smoked marijuana in high school. B) The 35-year-old client with non-insulin dependent diabetes. C) The 72-year-old client who takes no routine medications. D) The 47-year-old client who stopped smoking 2 years ago.
B
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? A) Make inhalation longer than exhalation. B) Exhale through an open mouth. C) Use diaphragmatic breathing. D) Use chest breathing.
C
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? A) "The physician will update my family after the procedure and provide specific discharge instructions." B) "If I do not follow the instructions, my surgery could be cancelled." C) "The nurse will explain the details of the surgery before I sign a consent." D) "My medical records will be sent to the ambulatory care center prior to my surgery."
C
The policies and procedures on a preoperative unit are being amended to bring them closer into alignment with the focus of the Surgical Care Improvement Project (SCIP). What intervention most directly addresses the priorities of the SCIP? A) Actions aimed at increasing interdisciplinary collaboration B) Actions aimed at increasing participation of families in planning care C) Actions aimed at preventing surgical site infections D) Actions aimed at promoting the use of complementary and alternative medicine (CAM)
C
Which nursing statement would best ease a client's anxiety before an emergency operative procedure? A) "We will keep your family informed of your progress." B) "You will be just fine; the operating room nurses will take good care of you." C) "Let me explain to you what will happen next." D) "It is best to take deep breaths and relax before the procedure."
C
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? A) Medicate the client and then remove the ring. B) Tell the physician and anesthesiologist. C) Place gauze under and over the ring and apply adhesive tape over it. D) Explain that the client cannot go into the operating room with jewelry on.
C
A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate? A) Answer the client's questions. B) Place the consent form in the client's medical record. C) Notify the nurse manager of the client's questions. D) Request that the surgeon come and answer the questions.
D
The nurse is educating a community group about types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true? A) A face-lift B) Placement of gastrostomy tube C) A biopsy D) Tumor excision
D
The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure? A) Up to 6 hours before surgery B) Up to 8 hours before surgery C) Up to 4 hours before surgery D) Up to 2 hours before surgery
D
Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery? A) Nurse B) Certified nurse's aide C) Case manager D) Physician
D