Ch 50 Care of Surgical Patients NCLEX Q'S

A preoperative client expresses anxiety to the nurse about the upcoming surgery. Which of the following responses by the nurse is most likely to stimulate further discussion between the client and the nurse?

"Can you share with me what you've been told about your surgery?"

A client with arthritis is scheduled for a surgical knee joint replacement. The client will be admitted to the hospital on the day of the surgical procedure, and the nurse is providing instructions to the client regarding preparation for the surgical procedure. Which statement by the client indicates an understanding of the preoperative instructions?

"I cannot drink or eat anything after midnight on the night before surgery."

A nurse is providing instructions to a client following mastectomy who will be discharged with an axillary drain in place. The client will be receiving home care visits from a registered nurse to monitor drainage and perform dressing changes. Which statement by the client indicates a need for further instructions?

"I need to begin full range-of-motion (ROM) exercises to my upper arm as soon as I get home."

A client who currently underwent abdominal surgery experiences an evisceration. Which statement made by the client supports this diagnosis?

"It felt like something just slit me wide open.

A client who had knee surgery 4 days ago reports to the home health nurse that he has not had a bowel movement since before the surgery. Which question would assist the nurse in the collection of data regarding the client's problem?

"What have you been eating and drinking since the surgery?

The nurse is assessing a client's postoperative pain using the PQRSTU method. Using this method, which of the following questions would the nurse ask the client? Select all that apply

"What makes your pain better or worse? "What does the pain feel like?" Where is the pain locatedHow does the pain affect you?"

informed consent of surgery involves

(surgeons responsibility) involves pts. understanding of need for procedure, steps involved, risks, expected results, alternative treatments

An 82-year-old man tells the nurse that he is having difficulty hearing and that he has "too much earwax." Considering the patient's age, what question should the nurse ask?

*1* *"Have you ever experienced impacted earwax?"* 2 "Do you have an upper respiratory infection?" 3 "Do you swim in a pool with chlorinated water?" 4 "Have you noted a change in the color of the earwax?" Obstruction of the ear is most often caused by impacted cerumen. Older adults are more susceptible to cerumen impaction because hair in the ear becomes coarser with age and traps the wax. Upper respiratory problems, swimming in pools, and changes in the color of the earwax are not relevant questions.

What are the symptoms of carpal tunnel syndrome? Select all that apply.

*1* *Tingling* *2* *Weakness* *3* *Numbness* 4 Blurred vision 5 Reduced taste sensation Carpal tunnel syndrome is a common use-related injury. Repetitive wrist or finger movements cause pressure on the median nerve, resulting in carpal tunnel syndrome. In this syndrome, alteration of tactile sensation occurs. A tingling sensation, weakness, and numbness are symptoms of carpal tunnel syndrome. Blurred vision and reduced taste sensation are not symptoms of carpal tunnel syndrome.

The nurse finds that a patient is very sensitive to visual glare. Which appropriate nursing interventions are helpful for the patient? Select all that apply.

*1* *Use blinds on the windows.* 2 Use a telescopic lens. 3 Use a pocket magnifier. *4* *Wear sunglasses outside.* *5* *Use yellow or amber lenses.* Sensitivity to glare may occur due to aging. The pupil's ability to adjust to light diminishes and results in sensitivity to glare. Blinds should be put on windows to minimize glare. Wearing sunglasses outside reduces the glare of direct sunlight. Using yellow or amber lenses minimizes glare. Telescopic lens eyeglasses and pocket magnifiers are helpful for reading in case of reduced visual acuity but not for minimizing glare. Telescopic lens eyeglasses are smaller, easier to focus, and have a greater range. A pocket magnifier helps the patient to read most printed material.

Nursing Interventions to Facilitate Postoperative Coping and Adaptation

*Accept each patient as a unique individual. *Identify through verbal and nonverbal cues patients who are at risk for alteration in self-concept. The risk is increased if the patient has little support from others, a visible alteration, or an alteration that will seriously affect functional ability. * Allow time for patients and families to verbalize their feelings about the alteration, and do not assume that all patients will have problems. Identify and support strengths and effective coping mechanisms. *Encourage the patient and family to be part of goal setting and decision-making throughout the surgical experience. *Provide teaching and honest information to the patient and family about all aspects of care. *Work collaboratively with other members of the health care team to provide referrals and resources as necessary to meet physical, psychological, and spiritual needs.

The usual interval at which nursing assessments, including vital signs, are monitored in the postoperative phase is every:

-15 minutes times 4; every 30 minutes times 4; every hour times 4; then every 4 hours

The stage of general anesthesia that includes the administration of anesthetic agents and endotracheal intubation is:

-Induction

A client who had abdominal surgery complains of feeling as though "something gave way" in the incisional site. The nurse removes the dressing and notes the presence of a loop of bowel protruding through the incision. Which nursing intervention(s) would the nurse take? Select all that apply.

-Notify the registered nurse. -Document the client's complaint. -Instruct the client to remain quiet. -Prepare the client for wound closure.

Select all the true statements regarding medications and surgery:

-Review of the patient's current medication regimen is essential to promote a safe surgical outcome. -A seriously ill patient may receive as many as 20 medications in a perioperative setting at one time. -patient's chart should be "flagged" to alert all healthcare providers to the patient's allergy status;

Which of the following is true regarding preoperative medication?

-The preoperative phase is the optimal time to introduce the concept of PCA to the patient.

how diabetes increase risks of surgery

-^ susceptibility to infection & impairs wound healing from altered glucose metabolism & associated circulatory impairment -stress of surgery often results in hyperglycemia

A routine type of sedation that might be used for a surgical procedure that does not require complete anesthesia but rather a depressed level of consciousness is called:

-conscious sedation

factors that place older adults at risk during surgery renal system

-decreased renal function w/ reduced blood flow to kidneys -reduced glomerular filtration rate & excretory times -decreased bladder capacity

factors that place older adults at risk during surgery pulmonary system

-decreased respiratory muscle strength & cough reflex -reduced range of movement in diaphragm -stiffened lung tissue & enlarged air spaces

factors that place older adults at risk during surgery cardiovascular system

-degenerative change in myocardium & valves -rigidity of arterial walls & reduction in sympathetic & parasympathetic innervation to heart -increased calcium & cholesterol deposits within small arteries; thickened arterial walls

physical examination of pt. before surgery includes

-general survey -head & neck -integumentary -thorax & lungs -heart & vesicular system -abdomen -neurological status

how structured teaching throughout perioperative influences sense of well-being

-have less anxiety

factors that contribute to airway obstruction in postoperative pt.

-history of obstructive sleep apnea -weak pharyngeal or laryngeal muscle tone from anesthetics -secretions in pharynx, bronchial tree, or trachea -laryngeal or subglottic edema

responsibilities of nurse caring for patient on day of surgery

-hygiene -hair & cosmetics -removal of prostheses -safeguarding valuables -preparing bowl & bladder -vital signs -prevention of deep vein thrombosis -administering preoperative meds -documentation & handoff -eliminating wrong site & wrong procedure surgery

2 phases of postoperative course

-immediate postoperative recovery -recovery in ambulatory surgery

how structured teaching throughout perioperative influences ventilatory function

-improves ability & willingness to deep breath & cough effectively

how structured teaching throughout perioperative influences physical functional capacity

-improves understanding & willingness to ambulate & resume activities of ADL

27. potential or actual nursing diagnoses appropriate for preoperative patient

-ineffective airway clearance -anxiety -ineffective coping -impaired skin integrity -risk for aspiration -risk for perioperative positioning injury -risk for infection -deficient knowledge -impaired physical mobility -ineffective thermoregulation -nausea -acute pain -delayed surgical pain

nursing diagnosis for patient during intraoperative period

-ineffective airway clearance -risk for deficient fluid volume -risk for perioperative positioning injury -risk for impaired skin integrity -risk for thermal injury -risk for injury

how structured teaching throughout perioperative influences anxiety about pain

-less anxious bout pain; ask what they need & require less after

factors that place older adults at risk during surgery metabolic system

-lower basal metabolic rate -reduced # RBCs & hemoglobin levels -change in total amounts of body potassium & water volume

expected outcomes for patient to verbalize the significance of postoperative exercises

-performs deep breathing & coughing exercises upon awakening from anesthesia -performs postoperative leg exercises & ambulation -performs incentive spirometry upon return to pt. care -pt. verbalizes rationale for early ambulation 24 hrs. postoperatively

types of care that perioperative nursing includes

-preoperative (before) -intraoperative (during) -postoperative (after)

comprehensive pain assessment includes

-pt. & family expectations for pain management after surgery -pts. perceived tolerance to pain -exploring past experiences & prior successful interventions used

topics developed by Association of Perioperative Registered Nurse 2015 that should be covered to ensure comprehensive preoperative instruction

-pt. understands reasons for preoperative instructions & exercises -preoperative routines -surgical procedure -time of surgery -postoperative unit & location of family during surgery & recovery -anticipated postoperative monitoring & therapies -sensory preparation -postoperative activity resumption -pain-relief measures

how structured teaching throughout perioperative influences length of hospital stay

-reduces stay by preventing or minimizing complications

interventions to physically prepare patient for surgery

-reduction of risk of surgical wound infection skin asepsis -maintain normal fluid & electrolyte balance -prevention of bowl & bladder incontinence

factors that place older adults at risk during surgery neurological system

-sensory losses, reduces tactile sense & increased pain tolerance -blunted febrile response during infection -decrease reaction time

surgical risk factors that can affect pt. at any point in perioperative experience

-smoking -age: very young & older adult -nutrition: poor tolerance to anesthesia, (-) nitrogen balance -obesity: atelectasis & pneumonia -obstructive sleep apnea: oxygen desaturation -immunosuppressant: infection -fluid & electrolyte imbalance -post op nausea & vomiting -venous thromboembolism

how heart disease increase risk of surgery

-stress of surgery causes increased demands on myocardium to maintain cardiac output -general anesthetic agents depress cardiac function

The registered nurse is discussing the care of a postsurgical older adult with a group of nursing students. Which of a nursing student's statements indicates a need for further discussion?

1 "Older adults are at risk for postoperative delirium." 2 "Medical complications are more common in older adults." 3 "Unexpected drug responses are often observed in older adults." 4 "Older adults can tolerate long surgeries due to their increased physiological reserves."

On a home visit, the nurse finds that a patient has sensory impairment. Which environmental factors can increase the risk of falls for the patient? Select all that apply.

1 A bathroom with a shower 2 Water faucets with red and blue rings indicating hot and cold water *3* *Stairways without lamps* *4* *Lack of handrails* *5* *Phone cords in the main route of walking* The patient with proprioceptive problems or visual impairment will need well-lit stairways to prevent falls. Handrails on the sides of stairways are important for providing support. Phone cords should be placed to the side and not in the main route of walking. A bathroom with a shower and water faucets with red and blue rings indicating hot and cold water are not hazards but are necessary in the home of patients with sensory alterations.

While working with a patient on positive expiratory pressure (PEP) therapy, the nurse instructs the patient to place his or her lips around the mouthpiece of the PEP device. What is the rationale behind this instruction?

1 Facilitates diaphragm excursion 2 Ensures the patient breathes through the mouth 3 Enhances the expansion of the thorax 4 Reduces the transmission of microorganisms

The nurse is reviewing the complete blood count of a postsurgical patient. What is the significance of a high hematocrit value?

1 Infection 2 Increased risk of a blood clot 3 Dehydration 4 Polycythemia

Which drug can be administered to induce conscious sedation during surgery?

1 Lidocaine 2 Clonidine 3 Midazolam 4 Dantrolene sodium

Which nursing action may help decrease postoperative nausea?

1 Promoting ambulation 2 Maintaining adequate fluid intake 3 Providing desired servings of food 4 *Moving the patient slowly when changing positions*

A patient with a history of a hearing deficit comes to the medical clinic for a routine checkup. His wife died 2 years ago, and he admits to feeling lonely much of the time. What are some interventions the nurse uses to reduce loneliness? Select all that apply.

1 Reassuring the patient that loneliness is a normal part of aging *2* *Providing information about local social groups in the patient's neighborhood* 3 Maintaining distance while talking to avoid overstimulating the patient *4* *Recommending that the patient consider making living arrangements that will put him closer to family or friends* *5* *Introducing the idea of bringing a pet into the home* Loneliness is not a normal part of aging. Principles for reducing loneliness include providing information about local social groups and recommending alterations in living arrangements if physical isolation occurs. When appropriate, bringing a companion such as a pet into the home can help to reduce loneliness.

Which strategies does the nurse keep in mind when communicating with a hearing-impaired patient? Select all that apply.

1 Speak loudly towards the patient's ear. 2 Avoid sitting at the same level as the patient. *3* *Avoid eating or chewing while speaking.* *4* *Use a normal tone of voice and normal inflections of speech.* *5* *Use written information to enhance the spoken word.* The patient has a hearing impairment, so precaution should be taken while communicating with the patient. Eating or chewing while speaking may lead to misinterpretation of the message by the patient, because the patient tends to read facial expressions and interpret messages. Using a normal tone of voice and inflections of speech help the patient to hear and understand properly. Written information can be used to enhance the spoken word so that the patient can completely understand the message. The nurse should avoid speaking loudly towards the patient's ear, because higher pitched sound often impedes hearing by accentuating vowel sounds and concealing consonants. Sitting at the same level as the patient helps the patient to easily see the communicator, read lip movements, and read facial expressions.

List the areas the nurse assesses to determine fluid and electrolyte alterations:

1) Assess the hydration status and monitor cardiac and neurological function 2) Monitor and compare laboratory values 3) Maintain patency of IV lines 4) Record accurately the I& O, daily weights 5) Assess daily weight for the first several days after surgery and compare with preoperative weight

Identify the measures the nurse would provide to promote normal urinary elimination:

1) Assume normal position 2) Check frequently for the need to void 3) Assess for bladder distention 4) Monitor I & O

A nurse is preparing to provide a patient with instructions for how to perform incentive spirometry. The patient will likely have incisional pain after returning form an elective colon resection. Which of the following steps for incentive spirometry is the patient likely to have the most difficulty performing? (select all that apply) 1) Assuming semi-Fowler's or high-Fowler's position 2) Setting the incentive spirometer device scale at the volume level to be attained 3) Placing the mouthpiece of the incentive spirometer so lips completely cover 4) Inhaling slowly while maintaining constant flow through unit until it reaches goal volume 5) Breathing normally for a short period between each of the 10 breaths on the incentive spirometer 6) Ending with two coughs after the end of 10 incentive spirometry breaths hourly

1) Assuming semi-Fowler's or high-Fowler's positions 4) Inhaling slowly while maintaining constant flow through unit until it reaches goal volume 6) Ending with two coughs after the end of 10 incentive spirometry breaths hourly

The primary reason that family members should be included when the nurse teaches the patient preoperative exercises is so they can: 1) Coach and encourage the patient after surgery. 2) Demonstrate to the patient at home. 3) Relieve the nurse by getting the patient to do the exercises every 2 hours. 4) Practice with the patient while he or she is waiting to be taken to the operating room.

1) Coach and encourage the patient after surgery.

List the measures that the nurse would use to promote expansion of the lungs:

1) Encourage diaphragmatic breathing exercises every hour. 2) Administer CPAP or NIPPV to patients who use this modality at home. 3) Use incentive spirometer for maximum inspiration 4) Early ambulation 5) Turn the patient on his or her sides every 1 to 2 hours and maintain pain control 6) Provide oral hygiene 7) Initiate orotracheal or nasotracheal suction for inability to cough 8) Administer oxygen and monitor saturation

List the measures the nurse would use to prevent circulatory complications:

1) Encourage the patient to perform leg exercises at least every 4 hours while awake. 2) Apply graded compression stockings or pneumatic compression stockings 3) encourage early ambulation 4) Avoid positioning the patient in a manner that interrupts blood flow to the extremities 5) Administer anticoagulant drugs as ordered

List the typical postoperative orders prescribed by surgeons:

1) Frequency of VS assessments 2) Types of IV fluids and rates 3) Postoperative medications 4) Resumption of preoperative medications 5) Fluid and food allowed 6) Level of activity 7) Positions 8) Intake and output 9) Laboratory tests and radiography studies 10) Special directions related to drains, irrigations, and dressings

List the factors that contribute to airway obstruction in the postoperative period:

1) History of obstructive sleep apnea (OSA) 2) Weak pharyngeal or laryngeal muscle tone from anesthetics 3) Secretions in the pharynx, bronchial tree, or trachea 4) Laryngeal or subglottic edema

List the potential nursing diagnoses that are common in a postoperative patient:

1) Ineffective Airway Clearance 2) Anxiety 3) Fear 4) Risk for Infection 5) Deficient Knowledge 6) Impaired Physical Mobility 7) Nausea 8) Delayed Surgical Recovery 9) Impaired Skin Integrity

List the potential or actual nursing diagnoses appropriate for the preoperative patient

1) Ineffective Airway Clearance 2) Anxiety 3) Ineffective Coping 4) Impaired Skin Integrity 5) Risk for Aspiration 6) Risk for Perioperative Positioning Injury 7) Risk for Infection 8) Deficient Knowledge 9) Impaired Physical Mobility 10) Ineffective Thermoregulation 11) Nausea 12) Acute Pain 13) Delayed Surgical Recovery

A patient is admitted through the emergency department for multisystem trauma following a motorcycle crash with multiple orthopedic injuries. He goes to surgery for repair of fractures. He is postoperative day 3 from an open reduction internal fixation of bilateral femur fractures and external fixator to his unstable pelvic fracture. Interventions that are necessary for prevention of venous thromboembolism in this high-risk postsurgical patient include: (Select all that apply.) 1) Intermittent pneumatic compression stockings. 2) Vitamin K therapy. 3) Passive range-of-motion exercises every 4 hours 4) Subcutaneous heparin or enoxaparin (Lovenox). 5) Continuous heparin drip with a goal of an international normalized ratio (INR) 5 times higher than baseline.

1) Intermittent pneumatic compression stockings. 4) Subcutaneous heparin or enoxaparin (Lovenox).

List the measures the nurse would provide to promote the return of normal elimination:

1) Maintain a gradual progression in dietary intake (clear liquids, full liquids, light diet,usual diet) 2) Promote ambulation and exercise 3) Maintain an adequate fluid intake 4) Stimulate the patient's appetite (remove noxious odors, positioning, desired food, and oral hygiene) 5) Fiber supplements, stool softeners 6) Provide meals when patient is rested and free from pain

You are caring for a patient after surgery who underwent a liver resection. His prothrombin time (PT) or an activated partial thromboplastin time (APTT) is greater than normal. He has low blood pressure; tachycardia; thready pulse; and cool, clammy, pale skin, and he is restless. You assess his surgical wound, and the dressing is saturated with blood. Which immediate interventions should you perform? (Select all that apply.) 1) Notify the surgeon. 2) Maintain intravenous (IV) fluid infusion and prepare to give volume replacement. 3) Monitor the patient's vital signs every 15 minutes or more frequently until his condition stabilizes. 4) Wean oxygen therapy. 5) Provide comfort through bathing.

1) Notify the surgeon. 2) Maintain intravenous (IV) fluid infusion and prepare to give volume replacement. 3) Monitor the patient's vital signs every 15 minutes or more frequently until his condition stabilizes.

List the areas of assessment that help to determine a postoperative patient's neurologic status:

1) Orientation to self and the hospital 2) Pupil and gag reflexes, hand grips, and movement of all extremities 3) neurologic assessment 4) extremity strength

List the topics developed by the Association of peri-Operative Registered Nurses 2015 (AORN) that should be covered to ensure comprehensive preoperative instruction.

1) Patient understands reasons for preoperative instructions and exercises 2) Preoperative routines 3) Surgical procedure 4) Time of surgery 5) Postoperative unit and location of family during surgery and recovery 6) Anticipated postoperative monitoring and therapies 7) Sensory preparation 8) Postoperative activity resumption 9) Pain-relief measures

Identify the expected outcomes for the postoperative patient:

1) Patients incision remains close and intact. 2) Patients incision remains free of infectious drainage 3) Patient remains afebrile

Identify the expected outcomes for a patient to verbalize the significance of postoperative exercises:

1) Performs deep breathing and coughing exercises upon awakening from anesthesia 2) Performs postoperative leg exercises and ambulation 3) Performs incentive spirometry upon return to patient care 4) Patient verbalizes rationale for early ambulation 24 hours postoperatively

Identify the two phases of the postoperative course:

1) Phase one is the immediate postoperative recovery 2) Phase two is the recovery in ambulatory surgery.

Identify the measures the nurse would use to promote the patients self-concept:

1) Provide privacy with dressing changes or inspection of wound 2) Maintain patient's hygiene 3) Prevent drainage devices from overflowing 4) Provide a pleasant environment 5) Offer opportunities for the patient to discuss fears or concerns 6) Provide the families with opportunities to discuss ways to promote self concept

Identify the interventions to physically prepare the patient for surgery

1) Reduction of risk of surgical wound infection-skin asepsis 2) Maintain normal fluid and electrolyte balance 3) Prevention of bowel and bladder incontinence

After a surgical patient has been given preoperative sedatives, which safety precaution should a nurse take? 1) Reinforce to the patient to remain in bed or on the stretcher 2) Raise the side rails and keep the bed or stretcher in the high position 3) Determine if the patient has any allergies to latex 4) Obtain informed consent immediately after sedative administration

1) Reinforce to the patient to remain in bed or on the stretcher

Identify the nursing diagnosis for the patient during the intraoperative period:

1) Risk for Deficient Fluid Volume 2) Risk for Perioperative Positioning Injury 3) Risk for Impaired Skin Integrity 4) Risk for Thermal Injury 5) Risk for Injury

The operating room (OR) and postanesthesia care unit (PACU) are high-risk environments for patients with a latex allergy. Which safety measures to prevent a latex reaction should the nurse implement? (Select all that apply.) 1) Screening patients about food allergies known to have a cross-reactivity to latex such as kiwis and bananas 2) Having a latex allergy cart available at all times 3) Communicating with the operating room (OR) team as soon as 24 to 48 hours in advance of the surgery when a latex-sensitive patient is identified 4) Scheduling the latex-sensitive patient for the last operative case of the day

1) Screening patients about food allergies known to have a cross-reactivity to latex such as kiwis and bananas 2) Having a latex allergy cart available at all times 3) Communicating with the operating room (OR) team as soon as 24 to 48 hours in advance of the surgery when a latex-sensitive patient is identified

Structured teaching throughout the perioperative period influences the following. Briefly explain why.

1) Ventilatory function-improves the ability and willingness to deep breathe and cough effectively 2) Physical functional capacity-improves understanding and willingness to ambulate and resume activities of ADL 3) Sense of well-being- have less anxiety 4)Length of hospital stay-reduces stay by preventing or minimizing complications 5) Anxiety about pain- less anxious about pain; ask what they need and require less after surgery

Hand-off communications that occur between the postanesthesia care unit (PACU) nurse and the nurse on the postoperative nursing unit should be done when a patient returns to the nursing unit. Select appropriate components of a safe and effective hand-off. (Select all that apply.) 1) Vital signs, the type of anesthesia provided, blood loss, and level of consciousness 2) Uninterrupted time to review the recent pertinent events and ask questions 3) Verification of the patient using one identifier and the type of surgery performed 4) Review of pertinent events occurring in the operating room (OR) while at the nurses' station 5) Location of patient's family members

1) Vital signs, the type of anesthesia provided, blood loss, and level of consciousness 2) Uninterrupted time to review the recent pertinent events and ask questions 5) Location of patient's family members

Explain the reasons why distention of the abdomen may occur:

1) accumulation of gas 2) Development of paralytic ileus

Explain the responsibilities for the following operating room nurse: 1) circulating nurse 2) scrub nurse

1) circulating nurse-reviews the preoperative assessment, establishes and implements the intraoperative plan of care, evaluates the care, and provides the continuity of care postoperatively. 2) Scrub nurse-mainatins a sterile field during the surgical procedure and assists with supplies.

The physical examination of a patient before surgery includes:

1) general survey 2) head and neck 3) integument 4) thorax and lungs 5) heart and vascular system 6) abdomen 7) neurologic status

List the responsibilities of a nurse caring for a patient on the day of surgery

1) hygiene 2) hair and cosmetics 3) removal of prostheses 4) safeguarding valuables 5) preparing the bowel and bladder 6) vital signs 7) prevention of deep vein thrombosis (DVT) 8) Administering preoperative medications 9) Documentation and handoff 10) Eliminating the wrong site and wrong procedure surgery

List the types of care that perioperative nursing includes:

1) postoperative (before) 2) Intraoperative (during) 3) Postoperative (after surgery)

Explain the following complications related to the skin postoperatively: rash, abrasions or petechiae, and burns

1) rash-a rash can indicate a drug sensitivity or allergy 2)Abrasion or petechiae-result from inappropriate positioning or restraining that injures skin layers or clotting from a clotting disorder 3) Burns-indicate that an electrical cautery grounding pad was incorrectly placed

List the surgical risk factors that can affect a patient at any point in the postoperative experience

1) smoking 2) age: very young and older adult 3) nutrition: poor tolerance to anesthesia, negative nitrogen balance 4) obesity: atelectasis and pneumonia 5) obstructive sleep apnea: oxygen desaturation 6) immunosuppression: infection 7) fluid and electrolyte imbalance 8) post op nausea and vomiting

A comprehensive pain assessment includes

1) the patient and family's expectation for pain management after surgery 2) The patient's perceived tolerance to pain 3) Exploring past experiences and prior successful interventions used

Explain how the following habits affect the patients: smoking, alcohol and substance abuse

1)smoking places the patient at a greater risk for pulmonary complication because of an increased amount and thickness of mucous secretions in the lungs 2) alcohol and substance use predisposes the patient to adverse reactions to anesthetic agents and cross-tolerance to anesthetic agents; malnourishment also leads to delayed wound healing

You have been given the following postoperative patients to care for on your shift. Based on the information provided, which patient should you see first? 1) A 75-year-old following hip replacement surgery who is complaining of moderate pain in the surgical site, with a heart rate of 92 2) A 57-year-old following hip replacement 6 hours earlier who is receiving intravenous patient-controlled analgesia (PCA) with a history of OSA. The pulse oximeter has been alarming and reading 85% 3) A 36-year-old following bladder neck suspension who is 30 minutes late to receive her postoperative dose of antibiotic 4) A 48-year-old following total knee replacement who needs help repositioning in bed

2) A 57-year-old following hip replacement 6 hours earlier who is receiving intravenous patient-controlled analgesia (PCA) with a history of OSA. The pulse oximeter has been alarming and reading 85%

You are caring for a 65-year-old patient 2 days after surgery and helping him walk down the hallway. The surgeon has ordered exercise as tolerated. Your assessment indicates that the patient's heart rate at baseline is 88. After walking approximately 30 yards down the hallway, the heart rate is 110. What should be your next action? 1) Stop exercise immediately and have him sit in a nearby chair. 2) Ask him how he feels; determine if there is any discomfort or shortness of breath; and, if not, continue exercise. 3) Tell him that he needs to walk further to reach a heart rate of 120. 4) Have him walk slower; he has reached his maximum.

2) Ask him how he feels; determine if there is any discomfort or shortness of breath; and, if not, continue exercise.

A nurse is recovering a patient who received conscious sedation for cosmetic surgery. Which of the following is an advantage that conscious sedation has over general anesthesia? (Select all that apply) 1) Loss of sensation at the surgical site 2) Reduction of fear and anxiety 3) Amnesia about procedure 4) Monitoring in phase I recovery 5) Close monitoring for airway patency

2) Reduction of fear and anxiety 3) Amnesia about procedure

A nurse is working in the preoperative holding area and is assigned to care for a patient who is having a prosthetic aortic valve placed. The nurse inserts an intravenous (IV) line and obtains vital signs. The patient has a temperature of 39° C (102° F), heart rate of 120, blood pressure (BP) of 84/50, and an elevated white blood cell (WBC) count. The nurse immediately notifies the surgeon of the patient's vital signs because: 1) They need to get the patient into the operating room (OR) quickly to start the surgery because of the low blood pressure. 2) The surgery may need to be delayed to check the patient's WBC count and investigate the source of fever before surgery. 3) The nurse anticipates the need for a fluid bolus to increase the patient's BP. 4) The nurse anticipates an order for a sedative to help calm the patient and decrease the heart rate.

2) The surgery may need to be delayed to check the patient's WBC count and investigate the source of fever before surgery.

Obesity places patients at an increased surgical risk because of which of the following factors? (Select all that apply.) 1) Risk for bleeding is increased. 2) Ventilatory capacity is reduced. 3) Fatty tissue has a poor blood supply. 4) Metabolic demands are increased. 5) Physical Mobility is often impaired.

2) Ventilatory capacity is reduced. 3) Fatty tissue has a poor blood supply. 5) Physical mobility is often impaired.

Because an older adult is at increased risk for respiratory complications after surgery, the nurse should: 1) Withhold pain medications and ambulate the patient every 2 hours. 2) Monitor fluid and electrolyte status every shift and vital signs with temperature every 4 hours. 3) Orient the patient to the surrounding environment frequently and ambulate the patient every 2 hours. 4) Encourage the patient to turn, deep breathe, and cough frequently and ensure adequate pain control.

4) Encourage the patient to turn, deep breathe, and cough frequently and ensure adequate pain control.

You are a nurse in the postanesthesia care unit (PACU), and you note that your patient has a heart rate of 130 beats/min and a respiratory rate of 32 breaths/min; you also assess jaw muscle rigidity and rigidity of limbs, abdomen, and chest. What do you suspect, and which intervention is indicated? 1) Infection: Notify surgeon and anticipate administration of antibiotics. 2) Pneumonia: Listen to breath sounds, notify surgeon, and anticipate order for chest radiography. 3) Hypertension: Check blood pressure, notify surgeon, and anticipate administration of antihypertensives. 4) Malignant hyperthermia: Notify surgeon/anesthesia provider immediately, prepare to administer dantrolene sodium (Dantrium), and monitor vital signs frequently.

4) Malignant hyperthermia: Notify surgeon/anesthesia provider immediately, prepare to administer dantrolene sodium (Dantrium), and monitor vital signs frequently.

In the postanesthesia care unit (PACU) the nurse notes that the patient is having difficulty breathing and suspects an upper airway obstruction. The nurse would first: 1) Suction the pharynx and bronchial tree. 2) Give oxygen through a mask at 4 L/min. 3) Ask the patient to use an incentive spirometer. 4) Position the patient on one side with the face down and the neck slightly extended so the tongue falls forward.

4) Position the patient on one side with the face down and the neck slightly extended so the tongue falls forward.

Which of the following statements made by a nurse reflects the greatest insight into the responsibility an ambulatory care nurse has to the client's family? a. "A client's family deserves the attention of the nursing staff." b. "Family is important to my client, and so family is important to me." c. "I consider myself as having several clients: the surgical client and all the family that's present." d. "I am responsible for keeping the family informed of the status of their loved one both during and after the procedure."

ANS: "I consider myself as having several clients: the surgical client and all the family that's present." Family members attempt to provide support through their presence but face many of the same stressors as the client. You need to effectively communicate with the client and family; they are clients as well.

Which of the following statements made by a nurse reflects the greatest insight into the planning needs of a same-day surgical experience? a. "Time is a precious resource in same-day surgery units; being organized allows for the best utilization of time." b. "Everything must be checked and verified as being ready before the client is admitted into the surgical area." c. "With only a few hours from time of admission to the beginning of the procedure, things have to be effectively organized." d. "I take the time to review the client's pre-admission and preoperative data in order to formulate the most individualized plan of care possible."

ANS: "I take the time to review the client's pre-admission and preoperative data in order to formulate the most individualized plan of care possible." Ambulatory and same-day surgical programs offer challenges in gathering a complete assessment in a limited time. Clients are admitted only hours before the surgical event, so it is important for you to organize and verify data obtained preoperatively and implement a perioperative plan of care. Although the remaining options are not incorrect, they do not stress the importance of effective organization of the client's plan of care.

A 24-year-old male client has been scheduled to undergo surgery for an ACL repair of his right knee. The client states that he is confused about what the surgeon will be doing. The best response from the nurse is: a. "The surgeon went over this procedure with you in his office" b. "Let me get the surgeon to talk with you before we proceed so that you fully understand what will be happening" c. To share with the client what he can expect in regard to the procedure d. "This is just a simple procedure—you should feel much better afterwards"

ANS: "Let me get the surgeon to talk with you before we proceed so that you fully understand what will be happening" The surgeon is responsible for making sure that the client completely understands the procedure before the client gives informed consent. The client may not remember the conversation that the surgeon had with him regarding the procedure due to anxiety. The nurse should not discount the client's concerns.

Which of the following statements made by the nurse shows the most informed understanding of the role of family in the client's postoperative recovery? a. "The family will be the ones you will be dealing with regarding postoperative needs." b. "When the family is more relaxed about caring for the client, the client is more relaxed." c. "The more the family understands what to expect during recovery, the more comfortable they are in caring for the client." d. "Teaching the family what they need to know before the surgery will maximize their effectiveness regarding the client's postoperative care."

ANS: "Teaching the family what they need to know before the surgery will maximize their effectiveness regarding the client's postoperative care." Often a family member is the caregiver when the client recovers from surgery. Perioperative preparation of family members before surgery helps to maximize effective caregiving while minimizing anxiety and misunderstanding.

Which of the following statements most accurately reflects nursing accountability in the intraoperative phase? a. "I would like to see the client have a regional anesthetic rather than a general anesthetic." b. "There seems to be a missing sponge, so a recount should be done of all the sponges that have been removed." c. "Did the client receive the medications and sign the consent?" d. "The client looks to be reactive and stable."

ANS: "There seems to be a missing sponge, so a recount should be done of all the sponges that have been removed." The scrub nurse counts the sponges and instruments, and the circulating nurse verifies the counts. This statement by the nurse reflects accountability in the intraoperative phase.

The nurse is working in a postoperative care unit in an ambulatory surgery center. Of the following clients that have come to have surgery, the client at the greatest risk during surgery is a: a. 78-year-old taking an analgesic agent b. 43-year-old taking an antihypertensive agent c. 27-year-old taking an anticoagulant agent d. 10-year-old taking an antibiotic agent

ANS: 27-year-old taking an anticoagulant agent Anticoagulants alter normal clotting factors and thus increase the risk for hemorrhaging during surgery. Aminoglycosides (a type of antibiotic) may cause mild respiratory depression from depressed neuromuscular transmission; however, the client who has been taking anticoagulants is at greater risk during surgery.

Which of the following preoperative assessment findings would most likely delay a planned procedure requiring general anesthetic? a. A cough and low-grade fever b. The pulse oximetry reading of 97% on room air c. A blood pressure that is 10 systolic points higher than baseline d. The client's report of "being so nervous about this procedure"

ANS: A cough and low-grade fever Preoperative assessment occasionally reveals an abnormality that delays or cancels surgery. A client who presents with a cough and low-grade fever on admission would require the nurse to notify the surgeon immediately. The other options do not necessarily warrant delay or cancellation of a procedure.

A client is in the postanesthesia care unit (PACU) recovering from a vagotomy and pyloroplasty. Which of the following is a normal expectation of the client in this stage of recovery? a. Returned normal bowel sounds on auscultation b. Pain that is relieved with noninvasive comfort measures c. Voluntary bladder control and function d. A subdued level of consciousness and neurological function

ANS: A subdued level of consciousness and neurological function In the PACU the client is often drowsy. The effects of anesthetic agents subdue the client's level of consciousness and neurological function. Normally during the immediate recovery phase in the PACU, faint or absent bowel sounds are auscultated in all four quadrants. Clients who have had abdominal surgery may develop paralytic ileus, with a return of bowel sounds 24 to 48 hours later. The acute incisional pain experienced in this stage of recovery is usually not relieved with noninvasive comfort measures but will require pharmacological measures of pain relief. Depending on the surgery, a client may not regain voluntary control over urinary function for 6 to 8 hours after anesthesia.

Following abdominal surgery, the nurse suspects that the client may be having internal bleeding. Which of the following findings is indicative of this complication? a. Increased blood pressure b. Incisional pain c. Abdominal distention d. Increased urinary output

ANS: Abdominal distention Signs of internal bleeding following abdominal surgery may include abdominal distention; swelling or bruising around the incision; increased pain; a drop in blood pressure; elevated heart and respiratory rates; thready pulse; cool, clammy, pale skin; and restlessness. The client who is hemorrhaging will have a decreased blood pressure. Incisional pain may occur as a result of surgery. A continuous increase in pain in conjunction with other symptoms of bleeding may indicate internal hemorrhaging. A client who is bleeding will have a decreased urinary output.

An appendectomy is appropriately documented by the nurse as: a. Diagnostic surgery b. Palliative surgery c. Ablative surgery d. Reconstructive surgery

ANS: Ablative surgery Ablative surgery is the excision or removal of a diseased body part, such as an appendectomy. Diagnostic surgery is surgical exploration that allows the health care provider to confirm a diagnosis. This type of surgery may involve removal of tissue for further diagnostic testing. An example would be a breast mass biopsy. Palliative surgery relieves or reduces the intensity of disease symptoms. It will not produce a cure. An example is resection of nerve roots. Reconstructive surgery restores function or appearance to traumatized or malfunctioning tissues. An example is internal fixation of a hip fracture.

The client will have an incision in the lower left abdomen. Which of the following measures by the nurse will help decrease discomfort in the incisional area when the client coughs postoperatively? a. Applying a splint directly over the lower abdomen b. Keeping the client flat with her feet flexed c. Turning the client onto the right side d. Applying pressure above and below the incision

ANS: Applying a splint directly over the lower abdomen Deep-breathing and coughing exercises place additional stress on the suture line and cause discomfort. Splinting the incision with hands or a pillow provides firm support and reduces incisional pulling. Keeping the client flat will not decrease discomfort in the incisional area when the client coughs. Having the knees bent slightly will aid in relaxing the abdominal muscles, causing less discomfort. Turning the client onto the right side will not decrease discomfort in the incisional area when the client coughs. The client should turn from side to side at least every 2 hours and may splint the incision to decrease discomfort when doing so. Splinting should be done directly over the incision to provide firm support and reduce incisional pulling as the client coughs postoperatively.

The nurse is evaluating the client in the hospital's postanesthesia care unit (PACU) and determines that the Aldrete score is 8. Based on this assessment, the nurse anticipates that the client will: a. Be sent to the intensive care unit b. Be discharged back to his or her room on the nursing unit c. Remain in the PACU until the score improves d. Return to the operating room for surgical evaluation

ANS: Be discharged back to his or her room on the nursing unit The client must receive a composite Aldrete score of 8 to 10 before being discharged from the PACU. The nurse may anticipate that the client with an Aldrete score of 8 will be discharged back to his or her room on the nursing unit. If the client's condition is still poor 2 to 3 hours after surgery (an Aldrete score below 8), the health care provider may transfer the client to an intensive care unit. If the client's condition is still poor 2 to 3 hours after surgery (an Aldrete score below 8), the health care provider may lengthen the client's stay in the PACU until the score improves. A client with an Aldrete score of 8 is unlikely to return to the operating room for surgical evaluation.

A 36-year-old female diabetic client is having an elective breast augmentation procedure done. Which of the following tests must be done on the day of surgery? a. Complete blood count (CBC) b. Blood glucose c. Serum electrolytes d. Coagulation studies

ANS: Blood glucose Blood glucose level can be obtained by either a finger stick or peripheral blood sample. Clients often require treatment of low or high levels preoperatively and postoperatively.

The initial client education-related nursing action by the preadmission nurse is to: a. Respond to questions presented by the family regarding the client's surgery b. Call the client before the surgery to restate presurgery routine c. Provide the client with a list of preoperative requirements d. Arrange a time for presurgical blood work to be drawn

ANS: Call the client before the surgery to restate presurgery routine Preadmission nurses call clients up to 1 week before surgery to clarify questions and reinforce explanations. The remaining options are directed toward either facilitating compliance with preoperative requirements or addressing the needs of the client's family.

Which of the following client outcomes is most therapeutic for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information? a. Client will share the preoperative routines of surgical care with family to facilitate compliance. b. Client will understand the preoperative routines of surgical care before leaving provider's office. c. Client will call laboratory to schedule appointment for preoperative blood draw for required testing. d. Client will present for drawing of preoperative laboratory blood at least 48 hours before scheduled surgery.

ANS: Client will present for drawing of preoperative laboratory blood at least 48 hours before scheduled surgery. The answer provides for behavior that is measurable and pertinent to the preoperative goals. Sharing the information and calling for the appointment are appropriate outcomes, but they are not the most therapeutic because they not related to actual compliance with the preoperative routine. The remaining option is a client goal.

Which of the following goals is most appropriate for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information? a. Client will understand the need for scheduled surgery before leaving the provider's office. b. Client will understand the preoperative routines of surgical care before leaving provider's office. c. Client will present for drawing of preoperative laboratory blood at least 48 hours before scheduled surgery. d. Client will be able to successfully accomplish the preoperative bowel preparation by morning of scheduled surgery.

ANS: Client will understand the preoperative routines of surgical care before leaving provider's office. Understanding the need for the surgery is not as directly related to preoperative requirements as is the understanding of preoperative routines. The remaining options are client outcomes.

Which of the following client evaluations is most reflective of compliance for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information? a. Client will present for scheduled blood laboratory work 48 hours before surgery. b. Client's preoperative blood laboratory work results are present on preoperative chart. c. Client will share the preoperative routines of surgical care with family to facilitate compliance. d. Client will understand the preoperative routines of surgical care before leaving provider's office.

ANS: Client's preoperative blood laboratory work results are present on preoperative chart. The answer shows proof of the client's compliance, whereas the remaining options are either goals or outcomes.

An obese client is admitted for abdominal surgery. The nurse recognizes that this client is more susceptible to the postoperative complication of: a. Anemia b. Seizures c. Protein loss d. Dehiscence

ANS: Dehiscence An obese client is susceptible to poor wound healing and wound infection because of the structure of fatty tissue, which contains a poor blood supply. This increases the risk for dehiscence. A client who is malnourished is more susceptible to being anemic. A client with liver disease may have altered protein metabolism.

The perioperative nurse realizes that the most effective means of evaluating the client's understanding of previous teaching is to: a. Provide written material on the subject to be reviewed after discharge b. Reinforce the material with family as the procedure is being performed c. Discuss it with the client and family in the immediate preoperative period d. Offer to answer any questions that the client or family have just before discharge

ANS: Discuss it with the client and family in the immediate preoperative period In the immediate preoperative period, assess the client's understanding of previous teaching. The other options are not truly evaluations of the client's knowledge.

The client had surgery in the morning that involved the right femoral artery. To assess the client's circulation status to the right leg, the nurse will make sure to check the pulse at the: a. Radial artery b. Ulnar artery c. Brachial artery d. Dorsalis pedis artery

ANS: Dorsalis pedis artery The nurse should assess peripheral pulses and capillary refill distal to the site of surgery. After surgery to the femoral artery, the nurse assesses posterior tibial and dorsalis pedis pulses. The nurse also compares pulses in the affected extremity with those in the non affected extremity.

The client asks the nurse the purpose of having medications (Demerol and Vistaril) given before surgery. The nurse should inform the client that these particular medications: a. Reduce preoperative fear b. Promote emptying of the stomach c. Reduce body secretions d. Ease the induction of the anesthesia

ANS: Ease the induction of the anesthesia Preoperative medications such as Demerol and Vistaril help reduce the client's anxiety, the amount of general anesthesia required, the risk for nausea and vomiting and resulting aspiration, and the amount of respiratory secretions. They may also help the client feel drowsy and lessen his or her anxiety associated with fear. Vistaril (hydroxyzine pamoate) is often given to control nausea and vomiting by suppressing the central nervous system (CNS). Vistaril will have an anticholinergic effect, reducing body secretions. These medications given together will ease the induction of anesthesia.

After discharge from the postanesthesia care unit (PACU), the client returned to the surgical nursing unit at 10:00 AM. It is now 11:30 AM, and the client is not experiencing any complications or difficulties. The nurse will plan to measure the client's vital signs: a. Every 15 minutes b. Every 30 minutes c. Every 1 hour d. Every 4 hours

ANS: Every 1 hour Vital sign monitoring on the postoperative nursing unit should initially be hourly for 4 hours and then every 4 hours. As the client's condition stabilizes, the frequency of assessment will usually decrease to once a shift until discharge. Upon the client's arrival to recovery, the nurse repeats measurement of vital signs every 15 minutes, not for the client who is stable on the surgical nursing unit. The client who is not experiencing any complications or difficulties does not require vital sign measurement every 30 minutes. After the client's vital signs are obtained hourly for 4 hours and remain stable, then the client may have his or her vital signs measured every 4 hours.

When discussing the details of having a procedure done in a facility's ambulatory surgery department, the nurse includes which of the following as advantages? (Select all that apply.) a. Facilitates faster postsurgical recovery b. Reduces hospital-oriented expenses c. Allows for more one-on-one attention by staff d. Cuts preparation time for surgical procedures e. Minimizes risk for acquiring a nosocomial infection f. The anesthetic drugs used result in faster "wake-up" time

ANS: Facilitates faster postsurgical recovery; Reduces hospital-oriented expenses; Minimizes risk for acquiring a nosocomial infection; The anesthetic drugs used result in faster "wake-up" time There are distinct benefits for the client who has ambulatory surgery. Anesthetic drugs that metabolize rapidly with few after-effects allow shorter operative times and faster recovery time. Ambulatory surgery also offers cost savings by eliminating the need for hospital stays. This reduces the possibility of acquiring health care-associated infections, which occur when normal skin flora changes from hospitalization and clients become colonized with bacteria found in the hospital setting. Preparation time and staff attention are not necessarily affected.

The nurse recognizes which of the following as the greatest barrier to meeting a preoperative client's nursing diagnosis of deficient knowledge regarding surgical procedure? a. Effects of preoperative medication b. Complicated nature of the information c. Fear or anxiety regarding the procedure d. Emotional denial regarding surgical outcomes

ANS: Fear or anxiety regarding the procedure Anxiety and fear are barriers to learning, and both emotions heighten as surgery approaches. Education should be provided before any preoperative sedation is administered; the information should be introduced in terms that the client can understand. The presence of denial is an assumption that is not necessarily correct.

A client who receives general or regional anesthesia in an ambulatory surgery center: a. Has to meet identified criteria in order to be discharged home b. Will remain in the phase I recovery area longer than a hospitalized client c. Is allowed to ambulate as soon as being admitted to the recovery area d. Is immediately given liberal amounts of fluid to promote the excretion of the anesthesia

ANS: Has to meet identified criteria in order to be discharged home Ambulatory surgical clients are discharged to home when they meet certain criteria. With new anesthetic agents and techniques, many ambulatory surgery clients are able to bypass phase I. However, if the client is in need of close monitoring, the client is assessed and cared for in the same fashion as inpatient clients in phase I. Whether the client will be able to ambulate as soon as being admitted to the recovery area depends upon the ambulatory client's condition, type of surgery, and anesthesia. This is not a true statement for all ambulatory surgery clients. The administration of fluids is dependent upon the client's condition and type of surgery. The excretion of anesthetic depends on many factors, including the route of administration (e.g., fluids will not promote the excretion of anesthetic gases). Oral fluids cannot be given until it is determined the client has a gag reflex and bowel sounds. Fluids are often given to prevent circulatory complications.

Upon admission to the postanesthesia care unit (PACU), the client who has no orthopedic or neurological restrictions is positioned with the: a. Bed flat and the client's arms to the sides b. Client's neck flexed and body positioned laterally c. Head of the bed slightly elevated with the client's head to the side d. Client's arms crossed over the chest and the bed in high-Fowler's position

ANS: Head of the bed slightly elevated with the client's head to the side To promote a patent airway, the head of the bed may be slightly elevated and the client's neck slightly extended, with the client's head turned to the side. The client's head should not be flexed as this may occlude the airway. The client's arms should never be positioned over or across the chest, because this reduces maximal chest expansion.

A client who is scheduled for surgery is found to have thrombocytopenia. A specific postoperative concern for the nurse for this client is: a. Hemorrhage b. Wound infection c. Fluid imbalance d. Respiratory depression

ANS: Hemorrhage A client with thrombocytopenia is at risk for hemorrhaging during and after surgery. Clients with immunological disorders or diabetes mellitus have an increased risk for wound infection after surgery. A client who has a fever is at risk for fluid imbalance. A client who has chronic respiratory disease may be at increased risk for respiratory depression, not the client with thrombocytopenia.

A client who has type 2 diabetes is scheduled for the removal of a skin lesion on his right shoulder at an ambulatory surgery unit. The nursing diagnosis the client is at greatest risk for postoperatively is: a. Risk for injury b. Risk for infection c. Impaired wound healing d. Imbalanced nutrition: less than body requirements

ANS: Impaired wound healing Diabetes increases susceptibility to infection and impairs wound healing from altered glucose metabolism and associated circulatory impairment. The stress of surgery often causes increases in blood glucose levels. Although all the options present with possible nursing diagnoses, the remaining options are not of primary concern because steps can be taken (e.g., antibiotic, intravenous fluids) to minimize the risk. Impaired wound healing is not as easily managed.

Given a rationale for preoperative and postoperative procedures, the client is better prepared to participate in care. For which of the following should the nurse provide instruction and rationale? a. Incentive spirometry b. Specific details regarding the progression of diet c. Working the call button for the nurse d. Using the patient-controlled analgesia (PCA) pump

ANS: Incentive spirometry Given a rationale for preoperative and postoperative procedures, the client is better prepared to participate in care. The diet progression should be discussed with the client by the unit nurse as the postsurgical diet progresses. The call light may be specific to the unit the client is on and is best taught to the client once he or she is on the unit so that the client can demonstrate to the nurse that he or she understands how to use it. The PCA pump is best taught to the client once he or she is on the unit so that the client can demonstrate to the nurse that he or she understands how to use it.

The nurse is evaluating the outcome "Client describes surgical procedures and postoperative treatment" and determines that the client has not achieved this outcome. The nurse should: a. Obtain the consent, because this is expected with preoperative anxiety b. Teach the client all about the procedure c. Ask the unit manager to assist with a teaching plan d. Inform the surgeon so that information can be provided

ANS: Inform the surgeon so that information can be provided When the client has little or no understanding about the surgery, the health care provider will need to be notified to reinform the client. If the client does not understand the surgical procedure, the client would not be giving informed consent. It is the surgeon's responsibility to explain the procedure and obtain the informed consent. The nurse can augment the health care provider's explanations, but it is the health care provider's responsibility to teach the client about the procedure. This teaching includes the need for the procedure, steps involved, risks, expected results, and alternative treatments.

A client with a history of sleep apnea has had a same-day surgery procedure that will require the administration of morphine postoperatively to manage pain. This client will be assessed most appropriately by the perioperative nurse for the risk for respiratory complications by frequently: a. Listening to breath sounds b. Monitoring pulse oximetry c. Evaluating spirometer use d. Counting respirations per minute

ANS: Listening to breath sounds Administration of opioids increases risk for airway obstruction postoperatively. Clients will desaturate as revealed by a drop in oxygen saturation by pulse oximetry. The remaining options are not as specific for this particular client's risk.

Which surgical classification would be the most appropriate for a cardiac catheterization scheduled on a 44-year-old male client who is in the hospital with chest pain? a. Major b. Minor c. Ablative d. Elective

ANS: Major Major surgery involves extensive reconstruction or alteration in body parts and poses great risks to well-being. Minor surgery involves minimal alteration in body parts, is often designed to correct deformities, and involves minimal risks compared with major procedures. Ablative surgery is the excision or removal of a diseased body part. Elective surgery is performed on the basis of client's choice, is not essential, and is not always necessary for health.

A prostate biopsy is an acceptable procedure to be performed as an ambulatory surgery on an otherwise healthy adult male because the American Society of Anesthesiologists (ASA) considers that a: a. Physical status class 1 b. Physical status class 2 c. Physical status class 4 d. Physical status class 5

ANS: Physical status class 1 ASA physical status classes 1 and 2 and also stable class 3 are now acceptable for ambulatory surgery. Classes 4 and 5 require inpatient surgery.

The client is scheduled for abdominal surgery and has just received the preoperative medications. The nurse should: a. Keep the client quiet b. Obtain the consent c. Prepare the skin at the surgical site d. Place the side rails up on the bed or stretcher

ANS: Place the side rails up on the bed or stretcher After administering preoperative medications, the nurse should raise the side rails on the bed or stretcher and keep the bed or stretcher in low position. Preanesthetic medications will help reduce the client's anxiety. Consent must be obtained before preoperative medications are administered or the consent is invalid. Preparing the skin at the surgical site is often done in the operating room.

A client scheduled for an ambulatory surgery procedure requiring anesthetics arrives with a low-grade fever and a productive sough. The postponement of the procedure is most likely a result of the: a. Client's increased risk for a respiratory tract infection b. Possibility of a respiratory complication during anesthesia c. Increased risk for the client's infecting staff and other clients d. Client's impaired resistance as a result of a respiratory tract infection

ANS: Possibility of a respiratory complication during anesthesia Cough and low-grade fever increases the risk for respiratory complications during anesthesia (e.g., pneumonia and spasm of laryngeal muscles). Although the other options are not incorrect, they do not represent the most likely risk factor that would result in the cancellation of the procedure.

The client tells the nurse that "blowing into this tube thing (incentive spirometer) is a ridiculous waste of time." The nurse explains that the specific purpose of the therapy is to: a. Directly remove excess secretions from the lungs b. Increase pulmonary circulation c. Promote lung expansion d. Stimulate the cough reflex

ANS: Promote lung expansion The primary purpose of using an incentive spirometer is to promote lung expansion. Coughing exercises are used to remove excess secretions from the lungs. Ambulation helps increase pulmonary circulation as the respiratory rate increases. The primary purpose of incentive spirometry is not to stimulate the cough reflex, but to promote lung expansion.

A 48-year-old male client with a history of chronic obstructive pulmonary disease (COPD) is scheduled for an inguinal hernia repair. The nurse instructs that client that he can expect the health care provider to order which of the following tests before surgery? a. Human immunodeficiency virus (HIV) antibody b. Prolactin level c. Pulmonary function test d. Glucose tolerance test

ANS: Pulmonary function test Pulmonary function testing and occasionally arterial blood gas analysis are often performed before surgery on clients with preexisting lung disease. An HIV-antibody test diagnoses HIV. It is not a test that is normally ordered before surgery. Prolactin levels are used to diagnose and monitor prolactin-secreting pituitary adenomas. A glucose tolerance test is used to assist in the diagnosis of diabetes mellitus and is also used in the evaluation of hypoglycemia. It is not a test that is normally ordered before surgery.

A 74-year-old is accompanied by his daughter to the ambulatory surgery department for the surgical removal of a suspicious skin lesion. The client has experienced dysphasia since a cerebral vascular accident 3 years ago. The most effective way for the nurse to secure the necessary preoperative interview information is to: a. Question the client's daughter b. Review the client's past medical records c. Present the questions in a simple format d. Rely on the client's preadmission survey

ANS: Question the client's daughter If a client is unable to relate all of the necessary information, rely on family members as resources. The remaining options are not reliable, effective methods of securing information regarding this client.

A 92-year-old client is scheduled for a colectomy. Which normal physiological change that accompanies the aging process increases this client's risk for surgery? a. An increased tactile sensation b. An increased metabolic rate c. A relaxation of arterial walls d. Reduced glomerular filtration rate

ANS: Reduced glomerular filtration rate An older adult is likely to have a reduced glomerular filtration rate. This limits the body's ability to eliminate drugs or toxic substances. An older adult has reduced tactile sense, which decreases the client's ability to respond to early warning signs of surgical complications, including sensing pressure over bony prominences. An older adult has a lower basal metabolic rate, reducing total oxygen consumption. The nurse should ensure the client obtains adequate nutritional intake when diet is resumed, but the client should avoid intake of excess calories.

The female client on the surgical unit is being prepared for abdominal surgery with general anesthesia. In preparing this client for surgery, the nurse should: a. Leave all of her jewelry intact b. Provide her with sips of water for a dry mouth c. Remove her makeup and nail polish d. Remove her hearing aid before transport to the operating room

ANS: Remove her makeup and nail polish All makeup, including nail polish, should be removed to expose normal skin and nail color to determine the client's level of oxygenation and circulation during and after surgery. Jewelry and other valuables should be given to family members or secured for safekeeping. A wedding band can be taped in place unless there is a risk that the client will experience swelling of the hand or fingers. For safety, metal items, such as for pierced areas, should be removed. The client should be allowed nothing by mouth (NPO) before surgery to prevent vomiting and aspiration with general anesthesia. Clients may be allowed to keep personal items such as a hearing aid until they reach the preoperative area.

Which of the following best describes the primary nursing role regarding a client's consent to surgery immediately before surgery? a. Explaining the procedure to the client in a fashion that is easily understood b. Placing the signed consent in the client's medical record c. Ensuring that the client understands the possible risks of the procedure before signing the consent d. Reviewing the client's surgical consent as a part of the routine preoperative checklist

ANS: Reviewing the client's surgical consent as a part of the routine preoperative checklist It is the surgeon's responsibility to explain the procedure and obtain the informed consent. After the client completes the consent form, place it in the medical record. The record goes to the operating room with the client after the nurse confirms all required information has been included.

The nurse is completing the preoperative checklist for an adult female client who is scheduled for an operative procedure later in the morning. Which of the following preoperative assessment findings for this client indicates a need to contact the surgeon? a. Hemoglobin (Hgb) 14 g/100 mL b. Blood urea nitrogen (BUN) 15 mg/100 mL c. Platelets 300,000/mm3 d. Serum creatinine 3.2 mg/100 mL

ANS: Serum creatinine 3.2 mg/100 mL The normal serum creatinine in women is 0.5 to 1.1 mg/100 mL. A serum creatinine of 3.2 mg/100 mL should be reported to the health care provider, because it can be an indication of renal failure. A Hgb of 14 g/100 mL is within the normal limits of 12 to 16 g/100 mL for women. A BUN of 15 mg/100 mL is within the normal limits of 10 to 20 mg/100 mL. A platelet count of 300,000/mm3 is within the normal limits of 150,000 to 400,000/mm3.

In the postoperative period, the nurse recognizes that an early sign of malignant hyperthermia is: a. Fever b. Tachycardia c. Muscle relaxation d. Skin pallor

ANS: Tachycardia Malignant hyperthermia should be suspected when there is unexpected tachycardia and tachypnea; jaw muscle rigidity; body rigidity of limbs, abdomen, and chest; or hyperkalemia. Temperature elevation is a late sign of malignant hyperthermia. Muscle rigidity, not relaxation, is an early sign of malignant hyperthermia. Skin pallor is not an early sign of malignant hyperthermia. Skin pallor may be seen in the immediate postoperative period, because the body is cool.

The nurse is completing the preoperative checklist for an adult client who is scheduled for an operative procedure later in the morning. Which of the following preoperative assessment findings for this client indicates a need to contact the anesthesiologist? a. Temperature is 100° F. b. Pulse is 90 beats per minute. c. Respiratory rate is 20 breaths per minute. d. Blood pressure is 130/74 mm Hg.

ANS: Temperature is 100° F. An elevated temperature before surgery is a cause for concern. If the client has an underlying infection, the surgeon may choose to postpone surgery until the infection has been treated. An elevated body temperature increases the risk for fluid and electrolyte imbalance after surgery. Anxiety and fear commonly cause elevations in heart rate and blood pressure. A pulse rate of 90 beats per minute is not a concern. A respiratory rate of 20 breaths per minute is normal for an adult. A blood pressure of 130/74 mm Hg is not excessively elevated.

A 47-year-old female client has been scheduled to undergo surgery for removal of her gallbladder. Preoperatively the nurse is teaching the client what to expect when she wakes up in the postanesthesia care center. The nurse tells the client that her vision may be blurry due to which of the following reasons? a. The client's blood pressure may be high from the postoperative pain. b. The client may be slow to arouse from the anesthesia, causing her vision to be blurred upon waking. c. The anesthesia provider applies ointment to clients' eyes to prevent corneal damage. d. The lighting in the postanesthesia area will be subdued, causing the client to have blurred vision upon waking.

ANS: The anesthesia provider applies ointment to clients' eyes to prevent corneal damage. The anesthesia provider applies ointment to clients' eyes to prevent corneal damage. Warning clients about sensations of blurred vision will reduce their anxiety on awakening from surgery. The client's pain should be under control and therefore will not cause her blood pressure to be raised. The more subdued lighting in the postanesthesia care area should help the client's vision to focus upon coming out from under the anesthesia.

A 64-year-old male client has been scheduled to undergo surgery for a total knee replacement. The client would like to be able to use his own blood for the surgery, if needed. The nurse explains that there are several advantages to the client's having an autologous infusion, but there are some drawbacks as well. Which of the following would be considered a drawback to an autologous infusion? a. The client has a decreased risk for contracting HIV. b. There is an decreased risk for infection. c. The client has less risk for a transfusion reaction. d. The client may have a decreased hemoglobin and hematocrit level on the day of surgery.

ANS: The client may have a decreased hemoglobin and hematocrit level on the day of surgery. The client must plan ahead in plenty of time in order to be able to donate his own blood. In addition, the client who does self-donation sometimes exhibits a lower hemoglobin and hematocrit level on the day of surgery. Autologous infusions are an option for some clients who choose to donate their own blood before surgery to reduce the risk for transfusion-related infections. The client is at less risk for a transfusion reaction because it is his own blood. There is a lowered risk for infection because the blood is from the client.

A 43-year-old client is scheduled to have a gastrectomy. Which of the following is a major preoperative concern? a. The client's brother had a tonsillectomy at age 11. b. The client smokes a pack of cigarettes a day. c. The client has an intravenous (IV) infusion. d. The client has a history of employment as a computer programmer.

ANS: The client smokes a pack of cigarettes a day. The client who smokes is at greater risk for postoperative pulmonary complications than a client who does not. An IV should be in place for surgery so access is available to administer medications, fluids, or blood products if necessary. Keeping the client well hydrated will help prevent postoperative thrombophlebitis.

The nurse knows that the client is most likely going to arrive for the surgical procedure having adhered to the required bowel preparation if: a. The client understands the need for the laxative b. The laxative ordered is pleasant tasting c. The bowel preparation is an uncomplicated process d. The client has the appropriate support at home

ANS: The client understands the need for the laxative Given a rationale for preoperative and postoperative procedures, the client is better prepared to participate in care. The remaining options may have an effect on compliance but not to the degree that understanding the need and purpose of the bowel preparation.

The nurse is very busy and needs to delegate some tasks to the nursing assistive personnel (NAP). Which of the following would be the most appropriate task to delegate? a. Postoperative client teaching b. Demonstrating postoperative exercises c. Transporting the preoperative client from the unit to the holding area d. Reviewing the preoperative assessment to make sure that the client's vital signs have been documented

ANS: Transporting the preoperative client from the unit to the holding area In many hospitals a nursing orderly or transporter brings a stretcher for transporting the client. The transporter checks the client's identification bracelet for two identifiers against the client's chart to be sure that the right person is going to surgery.

Which of the following statements regarding culture and ethnic considerations is considered to be a true statement?

African Americans may avoid pain medication because of fear of addiction.

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

Answer: " The operating table is a firm surface; we need to be sure your skin looks okay." Rationale: The client who has been on the operating table should be examined to ensure skin breakdown hasn't occurred. The client would not be told that his covers looked messy, or that the nurse was concerned about sponges or syringes underneath. The client's skin should be assessed on admission; after surgery would not be the time to do this initial assessment to document skin breakdown.

The nurse is preparing a client for surgery and asks if the client has an advance directive. The client asks "What is an advance directive?" What is the nurse's best response to this? a) "When you are going to have surgery, the hospital likes to have you fill out all paperwork needed beforehand." b) "An advance directive will communicate your wishes for health care postoperatively in case you are unable to do so." c) "An advance directive is a living will. Some people already have one when they come to the hospital." d) "We are not sure if you will wake up after surgery so the advance directive will let us know your wishes just in case."

Answer: "An advance directive will communicate your wishes for health care postoperatively in case you are unable to do so." Rationale: An advance directive allows the client to communicate instructions for health care postoperatively in case of an inability to do so. Although an advance directive is either a living will or a durable power of attorney for health care, and the hospital does like to determine if the client has these, these are not the best answers to the client's question. The nurse would not want to explain to the client that he or she may not wake up after surgery.

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

Answer: "I can have a hamburger and French fries as soon as I wake up." Rationale: Oral fluid and food may be withheld until intestinal motility resumes.

A 70-year-old male is scheduled for surgery. He says to the nurse, "I am so frightened—what if I don't wake up?" What would be the nurse's best response? a) "You have a wonderful doctor." b) "Let's talk about how you are feeling." c) "Everyone wakes up from surgery!" d) "Don't worry, you will be just fine."

Answer: "Let's talk about how you are feeling." Rationale: This answer allows the patient to talk about his feelings and fears, and is therapeutic.

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? a) "Actually, people who are not addicted to drugs before their surgery never develop a tolerance or addiction during their recovery." b) "You should remind yourself that treating your pain is important now, and that dealing with any resulting dependency can come later." c) "Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery." d) "The hospital has excellent resources for dealing with any addiction that might result from the medications you take to control your pain."

Answer: "Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery." Rationale: There is little danger of addiction to pain medications used in the postoperative management of pain.

A nurse is explaining pain control methods to a patient undergoing a bowel resection. The patient is interested in the PCA pump and asks the nurse to explain how it works. What would be the nurse's correct response? a) "The pump allows the patient to be completely free of pain during the postoperative period." b) "The pump allows the patient to take unlimited amounts of medication as needed." c) "The pump allows the patient to choose the type of medication given postoperatively." d) "The pump allows the patient to self-administer limited doses of pain medication."uu

Answer: "The pumps allows the patient to self-administer limited doses of pain medication." Rationale: PCA infusion pumps allow patients to self-administer doses of pain-relieving medication within physician-prescribed time and dose limits. Patients activate the delivery of the medication by pressing a button on a cord connected to the pump or a button directly on the pump.

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) "The time-out checks to be sure that we have the right client and procedure." b) "We need to be sure the client has had the preoperative antibiotic." c) "We are checking the client's baseline vital signs during time-out." d) "The time-out allows us to make sure that the client has had adequate anesthesia."

Answer: "The time-out checks to be sure that we have the right client and procedure." Rationale: The time-out is a safety measure performed before any surgical procedure and allows the operating room staff to determine they have the right client, procedure, and side (if appropriate). The client's baseline vital signs should have already been performed. The anesthesia is managed by the anesthetist or anesthesiologist when the procedural physician is prepared for the beginning of the operation; however, this is not part of the time-out. The preoperative antibiotic should be administered within 60 minutes of the surgery but is also not part of the time-out.

The nurse is providing education for a postoperative client regarding pain management. Which teaching point should the nurse include? a) "Be sure to ask for your p.r.n. medication when the pain becomes severe." b) "If your pain is not relieved, ask your nurse to order a different medication." c) "You will receive pain medication by injection as long as you are n.p.o." d) "All postoperative pain control methods will be given by injection."

Answer: "You will receive pain medication by injection as long as you are n.p.o." Rationale: As long as the client is n.p.o. pain medication will be administered in some form of injection, such as intramuscular and intravenous route. Clients should ask for their medication at the onset of pain for better pain control. While the nurse can ask for a different pain medication, alternative pain therapy methods (such as changing the client's position) may relieve pain. There are a variety of pain control methods, not just injectables.

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

Answer: A 76-year-old client with history of renal failure and chronic bronchitis Rationale: The client who is elderly with renal and lung disease has the most risk factors preoperatively for surgery. This client will have concerns over administration of anesthesia and medication with the kidneys being able to clear these from the body, as well as with the lungs and potential postoperative complications of atelectasis and pneumonia. Clients who are young, have chronic disease, or obese have risk factors as well, but not as many as the elderly client with both renal and pulmonary disease.

A scrub nurse is assisting a surgeon with a kidney transplant. What are the patient responsibilities of this surgical team member? Select all that apply. a) Maintaining sterile technique b) Draping and handling instruments and supplies c) Identifying and assessing the patient on admission d) Integrating case management e) Preparing the skin at the surgical site f) Providing exposure of the operative area

Answer: A, B Rationale: The scrub nurse is a member of the sterile team who maintains sterile technique while draping and handling instruments and supplies. Two duties of the circulating nurse are to identify and assess the patient on admission to the operating room and prepare the skin at the surgical site. The RNFA actively assists the surgeon by providing exposure of the operative area. The APRN coordinates care activities, collaborates with physicians and nurses in all phases of perioperative and postanesthesia care, and integrates case management, critical paths, and research into care of the surgical patient.

A nurse is caring for an inpatient client scheduled to undergo a surgery for the removal of a malignant tumor. What are the risk factors that increase the likelihood of perioperative complications? Select all that apply. a) Bleeding tendencies b) Anxiety c) Obesity d) Low hemoglobin e) Raised temperature

Answer: A, C, D Rationale: Certain surgical risk factors, such as obesity, bleeding tendencies, low hemoglobin, smoking, diabetes, cardiopulmonary disease, drug and alcohol abuse, and diabetes, increase the likelihood of perioperative complications. Raised temperature and anxiety are causes for postponing or cancelling the surgery.

A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice? a) positioning the client on the operating table b) administering inhalation anesthetics c) counting sponges before and after surgery d) administering regional nerve blocks e) monitoring the client's vital signs

Answer: A, C, E Rationale: The RN's role is a supportive one for the client, monitoring vital signs and positioning the client on the operating room table. The RN also helps maintain safety by counting sponges and instruments that may have been used during the surgery. The RN is unable to administer anesthetics, such as inhalation agents or regional nerve blocks, without an advanced practice degree.

Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply. a) Nerve block b) Intravenous c) Spinal block d) Inhalation e) Oral route f) Epidural block

Answer: A, C, F Rationale: Regional anesthesia occurs when an anesthetic agent is injected near a nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors. Regional anesthesia includes spinal blocks, nerve blocks, and epidural blocks. Inhalation and intravenous administration of anesthesia are associated with general anesthesia. Anesthesia is not administered via the oral route.

A nurse is assessing clients in a PACU. Which nursing actions would the nurse perform in this phase of the perioperative period? Select all that apply. a) Prepare the client for home care. b) Arrange for a rehabilitative program for the client. c) Transfer the client to the recovery room. d) Admit the client to the postoperative care unit. e) Inform the client that surgical intervention is necessary. f) Assess for complications as the client emerges from anesthesia.

Answer: A, D, F Rationale: Outpatient/same-day surgery clients return home after full recovery in the PACU or phase 2 recovery. The critical role functions of the PACU nurse include vigilant monitoring during emergence from anesthesia and the first hours after surgery, pain management, fluid and electrolyte balance, stabilization of physiologic parameters (such as heart and respiratory rate), and preparation for the next level of care in the postoperative care unit. The client has already had the surgery when the PACU nurse receives the client. Informing a client that he needs surgery is not a nursing responsibility. Rehabilitative care is arranged by the postoperative care unit nurse.

A responsibility of the nurse is the administration of preoperative medications to patients. Which statements describe the action of these medications? Select all that apply. a) Diazepam is given to alleviate anxiety. b) Ranitidine is given to facilitate patient sedation. c) Atropine is given to decrease oral secretions. d) Morphine is given to depress respiratory function. e) Cimetidine is given to prevent laryngospasm. f) Fentanyl citrate-droperidol is given to facilitate a sense of calm.

Answer: A,C,F Rationale: Sedatives, such as diazepam (Valium), midazolam (Versed), or lorazepam (Ativan) are given to alleviate anxiety and decrease recall of events related to surgery. Anticholinergics, such as atropine and glycopyrrolate (Robinul) are given to decrease pulmonary and oral secretions and to prevent laryngospasm. Neuroleptanalgesic agents, such as fentanyl citrate-droperidol (Innovar) are given to cause a general state of calm and sleepiness. Histamine-2 receptor blockers, such as cimetidine (Tagamet) and ranitidine (Zantac) are given to decrease gastric acidity and volume. Narcotic analgesics, such as morphine, are given to facilitate patient sedation and relaxation and to decrease the amount of anesthetic agent needed.

Clients with a latex allergy may have intolerance to which items? Select all that apply a) Gloves b) Underwear c) Balloons d) Condoms

Answer: ALL Rationale: All of these substances may contain latex. Latex is found in the elastic of underwear.

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? a) Administer acetaminophen before the child wakes. b) Extubate the child as soon as possible. c) Give the child a new teddy bear. d) Allow the parents into the PACU before the child wakes.

Answer: Allow the parents into the PACU before the child wakes. Rationale: Toddlers are prone to separation anxiety. Allowing the child to be with the parents will lower anxiety levels for all members of the family. This will subsequently ease the care for the bedside nurse

A client has presented to a clinic for a preoperative consult, during which the client has expressed concern about having to fast before surgery. Current recommendations for preoperative fasting include: a) Although fasting is still often recommended, it is medically unnecessary. b) no eating or drinking anything after midnight the night before surgery. c) allowing clear liquids up to 2 hours before surgery. d) allowing eating and drinking until just prior to anesthetic being administered.

Answer: Allowing clear liquids up to 2 hours before surgery. Rationale:Current practice is to allow clients to drink liquids or eat food up to 2 hours before surgery, depending on the type of surgery and with permission of the physician.

A 72-year-old woman who is scheduled for a hip replacement is taking several medications on a regular basis. Which drug category might create a surgical risk for this patient? a) Anticoagulants b) Antacids c) Laxatives d) Sedatives

Answer: Anticoagulants Rationale: Anticoagulant drug therapy would increase the risk for hemorrhage during surgery

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? a) Check the client's blood pressure. b) Apply warm blankets to the client. c) Notify the health care provider. d) Apply an oxygen saturation monitor.

Answer: Apply warm blankets to the client

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) Assist the client to do leg exercises to increase venous return. c) Instruct the client to avoid coughing to prevent injury to the incision. d) Encourage the client to breathe shallowly to prevent collapse of the alveoli.

Answer: Assist the client to do leg exercise to increase venous return.

A nurse is preparing a patient for a cesarean section and teaches her the effects of the regional anesthesia she will be receiving. Which effects would the nurse expect? Select all that apply. a) Loss of consciousness b) Relaxation of skeletal muscles c) Reduction or loss of reflex action d) Localized loss of sensation e) Prolonged pain relief after other anesthesia wears off f) Infiltrates the underlying tissues in an operative area

Answer: B, C Rationale: A localized loss of sensation and possible loss of reflexes occurs with a regional anesthetic. Loss of consciousness and relaxation of skeletal muscles occurs with general anesthesia. Prolonged pain relief after other anesthesia wears off and infiltration of the underlying tissues in an operative area occur with topical anesthesia.

A nurse is preparing a patient for a cesarean section and teaches her the effects of the regional anesthesia she will be receiving. Which effects would the nurse expect? Select all that apply. a) A 92-year-old patient who is severely confused b) A 45-year-old patient who is oriented and alert c) A 10-year-old patient who is oriented and alert d) A 36-year-old patient who has had a narcotic premedication e) A 45-year-old mentally ill patient who has been ruled incompetent f) A 22-year old patient having an abortion against her partner's wishes

Answer: B, F Rationale: A consent form is not legal if the patient signing the form is confused, sedated, unconscious, or a minor.

A patient tells the nurse she is having pain in her right lower leg. How does the nurse assess for the presence of thrombophlebitis? a) By palpating the skin over the tibia and fibula b) By documenting daily calf circumference measurements c) By recording vital signs obtained four times a day d) By noting difficulty with ambulation

Answer: By documenting daily calf circumference measurements Rationale: Inflammation from thrombophlebitis increases the size of the affected extremity and can be assessed by measuring circumference on a regular basis.

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? Select all that apply. a) Previous antibiotic use b) Family history of illness c) Previous surgeries d) Support systems e) Current medications f) Alcohol use

Answer: C, D, E, F Rationale: The client needs to be interviewed regarding his or her medication history, any prior surgeries, use of illegal substances, such as alcohol, and support systems to help determine any risk factors during and after surgery that need to be addressed. The client's family history of illness or previous antibiotic use is not a key area to address as a risk factor.

A client is in the preoperative area and states "I am not sure about having surgery." What is the nurse's best response? a) "Can you tell me what your feelings are about the surgery?" b) "Why wouldn't you want the surgery so you can feel better?" c) "You really need to have this surgery done." d) "I will tell the surgeon you changed your mind."

Answer: Can you tell me what your feelings are about the surgery? Rationale: The client who is unsure about surgery needs his or her feelings explored to determine why the client doubts the decision. After exploring these feelings, the nurse can then contact the procedural physician and make him or her aware of the client's concerns. Asking the client why he or she wouldn't want the surgery is phrased negatively and implies a judgment by the nurse on the client's feelings; likewise, the client wouldn't be told to have the surgery done without allowing him or her to express feelings

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) Nerve block b) Epidural anesthesia c) Conscious sedation d) Spinal anesthesia commonly used for this procedure?

Answer: Conscious sedation Rationale: Moderate sedation/analgesia is also known as conscious sedation or procedural sedation. It is used for short-term and minimally invasive procedures such as endoscopy procedures (e.g., colonoscopy).

A client is undergoing surgery for an appendectomy. This would be considered what type of surgery? a) Emergency surgery b) Diagnostic surgery c) Palliative surgery d) Elective surgery

Answer: Emergency surgery Rationale: An appendectomy is considered emergency or urgent surgery. Elective surgery can be scheduled in advance, and delay has no ill effects. Palliative surgery is done to relieve or reduce the intensity of an illness. Diagnostic surgery is done to make or confirm a diagnosis.

While assessing a patient in the PACU, a nurse notes increased wound drainage, restlessness, a decreasing blood pressure, and an increase in the pulse rate. The nurse interprets these findings as most likely indicating: a) Thrombophlebitis b) Atelectasis c) Infection d) Hemorrhage

Answer: Hemorrhage Rationale: Increased wound drainage, restlessness, decreasing blood pressure, and increasing pulse rate are assessment findings that indicate hemorrhage. Manifestations of thrombophlebitis are pain and cramping in the calf or thigh of the involved extremity, redness and swelling in the affected area, elevated temperature, and an increase in the diameter of the involved extremity. Manifestations of atelectasis include decreased lung sounds over the affected area, dyspnea, cyanosis, crackles, restlessness, and apprehension. Signs of infection include elevated white blood count and fever.

A nurse is caring for an obese patient who has had surgery. The nurse monitors this patient for what postoperative complication? a) Hunger b) Impaired wound healing c) Hemorrhage d) Gas pains

Answer: Impaired wound healing Rationale: Fatty tissue is less vascular and, therefore, less resistant to infection and more prone to delayed wound healing

A nurse is explaining the rationale for performing leg exercises after surgery. Which reason would the nurse include in the explanation? a) Promote respiratory function b) Maintain functional abilities c) Provide diversional activities d) Increase venous return

Answer: Increase venous return Rationale: Leg exercises in the postoperative period increase venous return. As a result, the patient has a decreased risk for thrombophlebitis and emboli.

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? a) It requires intensive preoperative education in a short time. b) It reduces the time for establishing a nurse-client rapport. c) It allows less opportunity for family contact and support. d) It interferes less with the client's daily routine.

Answer: It interferes less with the client's daily routine. Rationale: A major advantage of outpatient surgery is that it interferes less with the client's daily routine. It also allows more opportunity for family contact and support. Some disadvantages are that it reduces the time for establishing a nurse-client relationship and requires intensive preoperative education in a short time.

A perioperative nurse is preparing a patient for surgery for treatment of a ruptured spleen as the result of an automobile crash. The nurse knows that this type of surgery belongs in what category? a) Minor, diagnostic b) Minor, elective c) Major, emergency d) Major, palliative

Answer: Major, emergency Rationale: This surgery would involve a major body organ, has the potential for postoperative complications, requires hospitalization, and must be done immediately to save the patient's life. Elective surgery is a procedure that is preplanned by essentially healthy people. Diagnostic surgery is performed to confirm a diagnosis. Palliative surgery is not curative, rather it is done to relieve or reduce the intensity of an illness.

After a client receives morphine sulfate for pain in the postanesthesia care unit (PACU), which assessment finding would the nurse obtain as a priority? a) Auscultate bowel sounds. b) Check the neurological status. c) Obtain temperature. d) Measure respiratory rate.

Answer: Measure respiratory rate Rationale: The client who is receiving morphine sulfate for pain has a potential for decreased respiratory effort because of the side effect of respiratory depression; the client may also have constipation as a side effect but this would not be a priority over respiratory depression. The postoperative client needs to be monitored for changes in their neurological status and temperature but this would not be a priority over the respiratory status.

Which nursing action will best promote pain management for a client in the postoperative phase? a) Providing food and medication b) Breathing into a paper bag c) Performing relaxation techniques d) Dimming the lights

Answer: Performing relaxation techniques Rationale: Performing relaxation techniques is the best nursing action to promote pain management for a client in the postoperative phase.

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

Answer: Place the client in semi-fowler's position Rationale: Nursing interventions include notifying the physician immediately, calling the medical intervention team, maintaining the client on bed rest in the semi-Fowler's position, assessing vital signs frequently, administering oxygen, administering medications (e.g., anticoagulants, analgesics), and instructing the client to avoid Valsalva maneuver (this prevents increased intrathoracic pressure and, possibly, increased emboli).

A patient had a surgical procedure that necessitated a thoracic incision. The nurse anticipates that he will have a higher risk for postoperative complications involving which body system? a) Respiratory system b) Circulatory system c) Digestive system d) Nervous system

Answer: Respiratory system Rationale: A thoracic incision is an incision into the pleural space of the chest. It makes it more painful for the patient to take deep breaths or cough. Shallow respirations and ineffective coughing increase the risk for respiratory complications.

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 client must be previously healthy with low surgical risks. c) The surgery is classified as urgent rather than elective. d) The surgery will be conducted using moderate sedation rather than general anesthesia.

Answer: The client will be admitted the day of surgery and return home the same day. Rationale: Outpatient surgeries, also known as ambulatory surgeries, are conducted with admission and discharge on the same day. Such surgeries have become increasingly common in recent years, and some surgeries of increasing complexity and risk are conducted on an outpatient basis. General anesthesia is possible, and common. This approach is more common for elective surgeries than urgent surgeries.

A client has arrived to the postanesthesia care unit (PACU) and is drowsy with a respiratory rate of 12 breaths per minute. Which of the following would be an accurate interpretation by the nurse? a) The client should be returned to the operating room for further evaluation. b) The client needs to have his or her neurological status fully evaluated. c) The procedural physician should be notified immediately of patient findings. d) This is an expected finding in the immediate postoperative period.

Answer: This is an expected finding in the immediate postoperative period Rationale: Having drowsiness and a respiratory rate of 12 breaths/minute are normal findings in the immediate postoperative period. The client needs to be monitored to ensure that there is no deterioration in respiratory status, and the client awakens readily. As the anesthetics wear off, the client should return to a normal level of consciousness. The nurse would not need to notify the procedural physician or return the client to the operating room because this is not an emergent situation.

Older adults often have reduced vital capacity as a result of normal physiologic changes. Which nursing intervention would be most important for the postoperative care of an older surgical patient specific to this change? a) Take and record vital signs every shift. b) Turn, cough, and deep breathe every 4 hours. c) Encourage increased intake of oral fluids. d) Assess bowel sounds daily.

Answer: Turn, cough, and deep breathe every 4 hours Rationale: Reduced vital capacity in older adults increases the risk for respiratory complications, including pneumonia and atelectasis. Having the patient turn, cough, and deep breathe every 4 hours maintains respiratory function and helps to prevent complications.

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) Exhibit no bleeding b) Void normally c) Eat without nausea d) Verbalize absence of pain

Answer: Void normally Rationale: Before discharge from an ambulatory surgical unit, the client should be able to void normally after a pelvic surgery. It is natural for the client to experience pain after surgery; however, the client should also have the comfort level to control it. The client may not be in a position to eliminate nausea and vomiting completely before discharge, but should suffer minimally from them. The client may have some bleeding or drainage, which should not be excessive at the time of discharge from an ambulatory surgical unit.

A nurse is teaching a man scheduled to have same-day surgery. Which teaching method would be most effective in preoperative teaching for ambulatory surgery? a) Lecture b) Discussion c) Audiovisuals d) Written instructions

Answer: Written instructions Rationale: Written instructions are most effective in providing information for same-day surgery.

Which client would a nurse monitor most closely for postoperative respiratory complications? a) a 55-year-old client with a history of asthma who had a colon resection b) a 31-year-old client with no medical problems who had an appendectomy c) a 75-year-old client with a history of hypertension who had a colonoscopy d) an 8-year-old client with no medical problems who had a tonsillectomy

Answer: a 55-year-old client with a history of asthma who had a colon resection Rationale: All of these clients have a potential for respiratory complications, which can occur with chest or abdominal surgery, preexisting cardiovascular or respiratory disease, and in older adults or obese clients. The client who has had abdominal surgery and has preexisting respiratory disease would be at the greatest risk for observation of any respiratory complications (due to having two factors instead of only one). The pediatric client having a tonsillectomy would need to be observed for any airway problems but would not be a greater risk than the client with two risk factors.

A client is going to surgery, and the nurse is having the client sign his informed consent. Which client would be appropriate to sign the informed consent for surgery? a) a 68-year-old client with dementia having a cholecystectomy b) a 16-year-old diabetic client having a tonsillectomy c) a 70-year-old hypertensive client having a colonoscopy d) a 45-year-old disoriented client having an appendectomy

Answer: a 70-year-old hypertensive client having a colonoscopy Rationale: The 70-year-old client having the colonoscopy has no indications that he is not competent for having the procedure. Clients who are minors or those who are confused or have dementia are unable to sign their informed consent; they must have their next of kin, as determined by state law, make this decision.

Which client most likely requires special preoperative assessment and treatment as a result of the existing medication regimen? a) a man who regularly treats his rheumatoid arthritis with over-the-counter nonsteriodal anti-inflammatory drugs (NSAIDs) b) a man who takes an angiotensin-converting enzyme (ACE) inhibitor because he has hypertension c) a woman who takes daily anticoagulants to treat atrial fibrillation d) a woman who takes daily thyroid supplements to treat her longstanding hypothyroidism

Answer: a woman who rakes daily anticoagulants to treat atrial fibrillation Rationale: Anticoagulants present a risk of hemorrhage. This risk supersedes that posed by thyroid supplements, ACE inhibitors, or most NSAIDs.

A nurse is preparing to receive a client in post-anesthesia care unit (PACU). The client is diabetic and has undergone knee surgery. Which information would be most important for the receiving nurse to obtain to develop an appropriate plan of care for this client? a) Chronic disease history b) Information about allergic agents c) Environment of the operating room d) Amount of blood loss

Answer: amount of blood loss Rationale: To plan care effectively in the postoperative period, the nurse needs to know about the amount of blood lost during the surgery, the type of surgery that was performed on the client, and whether there were any surgical or anesthetic complications. Information on chronic disease history and allergy history are done in the preoperative period, not in the postoperative period. Information on the environment in the operation room is checked by the circulatory nurse during the intraoperative care plan; it is not associated with the postoperative care plan.

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) Determine the possible cause of the client's bleeding. b) Assess the client's vital signs. c) Apply pressure to the surgical site to decrease bleeding. d) Notify the health care provider.

Answer: apply pressure to the surgical site to decrease bleeding. Rationale: It is essential that the nurse be prepared to address life-threatening needs of the client. Excessive bleeding is a life-threatening issue. Determining the cause of the client's bleeding, assessing the vital signs, and notifying the health care provider are important, but the life-threatening issue must be addressed first.

The nurse knows the term perioperative phase refers to care given to the client: a) immediately before an operative procedure. b) from the start of surgery until its conclusion. c) immediately after the operative phase. d) before, during, and after the operative phase.

Answer: before, during, and after the operative phase Rationale: Perioperative nursing includes three distinct phases: preoperative, intraoperative, and postoperative.

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) Shock b) Dehiscence c) Hypoxemia d) Evisceration

Answer: dehiscence Rationale: The nurse is taking care of a client with dehiscence. Hypoxemia develops when there is inadequate oxygenation of blood. Evisceration occurs when there is protrusion of abdominal organs through a separated wound. A client has shock when there is inadequate blood flow.

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? a) Delirium b) Dementia c) Boredom d) Narcotic overuse

Answer: delirium Rationale: Delirium refers to acute confusion that is reversible. It is common in the acute postoperative period

A client comes to the postoperative area and complains of chest pain and palpitations. Which assessment information does the nurse need to obtain? a) heart rate and blood pressure b) current medications c) temperature and urine output d) prior medical history

Answer: heart rate and blood pressure Rationale: A client having chest pain and palpitations needs to have his vital signs (particularly blood pressure and heart rate) checked to ensure that he is hemodynamically stable. These symptoms may indicate cardiac problems so the client must be examined closely for any complications such as a myocardial infarction. Urine output and temperature would not indicate the client's stability related to the symptoms being experienced. Although prior medical history and medications may give indications on why the client is experiencing chest pain, the client needs an accurate assessment of the hemodynamic status first

A client has been taking aspirin since his heart attack in 1997. The client is at risk for: a) blood clots. b) hemorrhage. c) thrombophlebitis. d) infection.

Answer: hemorrhage Rationale: Current medication use, especially use of medications that can affect coagulation status (warfarin, nonsteroidal anti-inflammatory drugs, aspirin) is important and should be reported to the surgeon.

A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client? a) Keep the client from ambulating until the day after surgery. b) Implement leg exercises and turn the client in bed every 2 hours. c) Position the client in bed with pillows placed under his knees to hasten venous return. d) Keep the client cool and uncovered to prevent elevated temperature.

Answer: implement leg exercise and turn the client in bed every 2 hours Rationale: Ambulation and leg exercises increase circulation, which prevents cardiovascular complications. The nurse should provide covers, forced warm air, or other warming devices/techniques as necessary to prevent shivering and hypothermia caused by the surgical procedure, the procedure's length, anesthetic agents, a cool environment, the client's age, or the use of cool irrigating/infusion fluids. Pillows placed under the knees can cause venous pooling, leading to thrombophlebitis.

A nurse administers anticholinergics to a patient as a postoperative medication. What condition does this medication help to prevent? a) Laryngospasm b) Shock c) Nausea d) Cardiovascular complications

Answer: larygospasm Rationale: Anticholinergics, such as atropine and glycopyrrolate (Robinul), to decrease pulmonary and oral secretions and to prevent laryngospasm. Cardiovascular complications, nausea, and shock are not affected by anticholinergic medications.

Which postoperative exercise promotes venous return and decreases complications related to venous stasis? a) Incentive spirometry b) Coughing c) Deep breathing d) Leg exercises

Answer: leg exercise Rationale: Leg exercises assist in preventing muscle weakness, promote venous return, and decrease complications related to venous stasis. Coughing helps remove retained mucus from the respiratory tract. Incentive spirometry and deep-breathing exercises improve lung expansion and volume.

Which nursing action provides the greatest assistance in healing? a) maintaining a restful environment b) providing solid food in the first day c) keeping the client recumbent d) allowing family members to visit often

Answer: maintaining a restful environment Rationale: The nurse should plan for adequate periods of rest and sleep, maintaining a quiet, restful environment.

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? a) Normal response b) Paralytic ileus c) Hernia development d) Abdominal infection

Answer: paralytic ileus Rationale: A potential complication after surgery is paralytic ileus, a condition in which there is decreased bowel functioning.

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

Answer: place graduated compression stockings on the client. Rationale: Use of graduated compression stockings and/or pneumatic compression devices on the client will help with prevention of DVT, which is a risk for clients after surgery. Elevating the client's legs will passively improve venous return but not prevent DVT if a client is not up and walking (to more actively promote the venous return). Elevating the head of the bed and using the incentive spirometer help prevent postoperative complications of atelectasis or pneumonia.

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? a) Place the patient in the prone position. b) Place the patient in a flat position with legs elevated 45 degrees. c) Do not administer any further medication. d) Remove extra coverings on the patient to keep temperature down.

Answer: place the patine in a flat position with legs elevated 45 degrees Rationale: Placing the patient in a flat position with the legs elevated 45 degrees uses gravity to help direct blood to the vital organs. Removing extra coverings would cause the patients temperature to drop further during the blood loss occurring during shock. Medications will likely be ordered to help treat the shock. Prone position would be contraindicated.Placing the patient in a flat position with the legs elevated 45 degrees uses gravity to help direct blood to the vital organs. Removing extra coverings would cause the patients temperature to drop further during the blood loss occurring during shock. Medications will likely be ordered to help treat the shock. Prone position would be contraindicated.

A 9-month-old baby is scheduled for heart surgery. When preparing this patient for surgery, the nurse should consider which surgical risk associated with infants? a) Congestive heart failure b) Prolonged wound healing c) Gastrointestinal upset d) Potential for hypothermia or hyperthermia

Answer: potential for hypothermia or hyperthermia Rationale: Infants have difficulty maintaining stable body temperature during surgery because the shivering reflex is not well developed, making hypothermia or hyperthermia more likely. They are not at an increased risk for prolonged wound healing, congestive heart failure, or gastrointestinal upset.

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur? a) Preoperative b) Intraoperative c) Postoperative d) Postanesthesia care unit (PACU)

Answer: preoperative rationale: Exercises and physical activities occurring in the preoperative phase include deep-breathing exercises, coughing, incentive spirometry, turning, leg exercises, and pneumatic compression stockings.

The nurse recognizes the value of leg exercises in the prevention of postoperative thrombophlebitis. When should the nurse teach the correct technique for leg exercises to a client? a) in postanesthesia recovery b) upon transfer from postanesthesia care unit (PACU) to the postoperative unit c) prior to surgery d) when early signs of venous stasis are evident

Answer: prior to surgery Rationale: Though leg exercises are begun after surgery, such preventative measures should ideally be taught to the client during the preoperative period.

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? a) Informed consent b) Operative site marking c) Procedural pause (time-out) d) Preoperative checklist

Answer: procedural pause (time-out) Rationale: The procedural pause (time-out) must be done prior to any procedure to ensure client safety and to verify the client identity, staff roles, and procedure being performed.

A nurse is applying a pneumatic compression device to a client. What is the purpose of a pneumatic compression device? a) reduces swelling and pain b) promotes circulation of venous blood c) enables the client to void d) pumps liquid diet to the client

Answer: promotes circulation of venous blood Rationale: A pneumatic compression device promotes the circulation of venous blood and relocation of excess fluid into the lymphatic vessels. The device does not pump a liquid diet to the client, help the client to void, or reduce swelling and pain.

When educating a client in the postoperative period, it is important to educate the client to consume a diet high in: a) bicarbonate. b) potassium. c) calcium. d) protein.

Answer: protein Rationale: After surgery, a diet with sufficient amounts of protein and vitamins A and C helps rebuild tissues and promotes wound healing.

A nurse is working with a group of clients in the preoperative area. Which client task would be the highest priority? a) Inserting a Foley catheter in a client before major surgery b) Measuring a diabetic client's blood glucose c) Obtaining a list of home medications from a client d) Raising the stretcher side rails when administering a sedative

Answer: raising the stretcher side rails when administering a sedative Rationale: Although all of these are important to do, making sure of client safety with raising the side rails of the client's bed when administering a sedative is most important. Inserting the Foley catheter before surgery, obtaining a list of home medications, and measuring a blood glucose on a client could potentially prevent safety issues as well but are not as direct an intervention as raising the side rails of the bed to prevent a patient fall.

Avery is a 15-year-old client with acute lymphocytic leukemia (ALL). Avery is a practicing Jehovah's Witness and has asked not to receive blood products. You know that the prognosis for ALL is very good but clients often require blood products during treatment. What is the most appropriate action? a) Tell Avery that her request will be upheld. b) Document Avery's request in her medical record. c) Request an ethics consultation. d) Tell Avery that her request is not appropriate.

Answer: request an ethics consultation Rationale: This request is beyond your scope of practice as a nurse. There are many ethical considerations in this case, including the fact that Avery is considered a minor and that her request will likely place her life in danger. An ethics team may help the client and family arrive at a plan of care that upholds Avery's religious beliefs, except in an extreme life-threatening emergency.

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) Renal complications b) Respiratory complications c) Infection d) Circulatory complications

Answer: respiratory complications Rationale: According to Dunn (2005), most postoperative complications are related to the respiratory system in infants. After receiving general anesthesia, premature infants are at greater risk for apnea.

The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency? a) Respiratory obstruction b) Wound infection c) Dehydration d) Cardiac distress

Answer: respiratory obstruction Rationale: Respiratory obstruction may occur as a result of secretion accumulation, obstruction by the tongue, laryngospasm (a sudden, violent contraction of the vocal cords), or laryngeal edema. Cardiac distress, wound infection, and dehydration are all possible postoperative complications, but respiratory obstruction is most common.

A patient is scheduled for cardiac surgery in an acute-care facility. What intervention would occur in the intraoperative phase of this patient's perioperative care? a) Visit by the anesthesiologist b) Frequent vital signs/assessments c) Airway/oxygen therapy/pulse oximetry d) Skin preparation

Answer: skin preparation Rationale: The intraoperative phase begins when the patient is transferred to the OR bed until transfer to the postsurgical recovery area. One of the interventions performed in this phase is skin preparation. The preoperative phase provides patient teaching regarding the surgical experience, including a visit by the anesthesiologist. The postoperative phase begins immediately after the surgical procedure is completed. Assessments and therapies (listed in answers A and C) are performed in this phase.

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

Answer: slow wound healing Rationale: 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 imbalances is often associated with clients who have kidney and liver disease. The risk of respiratory depression from surgery increases for clients with existing respiratory disorders. Altered metabolism may occur as a result of surgery for clients with kidney and liver diseases.

A client in the immediate postoperative period begins to report nausea and ultimately begins vomiting. The nausea and vomiting are most likely related to: a) movement of bowels during surgery. b) inactivity and emotional upset. c) severe pain at the operative site. d) the effects of anesthetic agents.

Answer: the effects of anesthetic agents Rationale: Nausea and vomiting can occur postoperatively from the effects of anesthetic agents.

The nurse recognizes that palliative surgery is performed for what purpose? a) to remove a part of the body that is diseased b) to lessen the intensity of an illness c) to make or confirm a diagnosis d) to restore function to tissue that is traumatized

Answer: the lessen the intensity of an illness Rationale: Palliative surgery is performed to help lessen the intensity of an illness; it is not meant to be curative but will help improve the client's quality of life. A diagnostic surgery makes or confirms a diagnosis such as with a biopsy to check for cancer. A removal of a body part that is diseased is ablative surgery, such as an appendectomy. Restoring function to traumatized tissue is reconstructive surgery, such as with plastic surgery.

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 10 days b) after 1 week c) after 2 days d) the same day

Answer: the same day Rationale: Outpatient surgery, also called ambulatory surgery and same-day surgery, is the term used for operative procedures performed on clients who return home the same day. It generally is reserved for clients in an optimal state of health whose recovery is expected to be uneventful.

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) explaining to the client about potential risks of having the surgery d) witnessing the client signature with their consent for surgery

Answer: witnessing the client signature with their consent for surgery Rationale: The nursing role with informed consent is to witness the client signature on the form. The procedural physician is responsible for explaining the procedure, any alternative treatment, and the risks and benefits of having the surgery. The nurse may clarify information, but if in-depth explanation is needed, the procedural physician should be notified.

Which factors should the nurse consider when assessing patients for postsurgical risks? (Select all that apply.) a) Endocrine diseases increase the risk for hyperglycemia after surgery. b) Cardiovascular diseases increase the risk for dehydration after surgery. c) Kidney and liver diseases influence the patient's response to anesthesia. d) Patients with respiratory disease may experience alterations in acid-base balance after surgery. e) Endocrine diseases increase the risk for slow surgical wound healing. f) Pulmonary disorders increase the risk for hemorrhage and hypovolemic shock after surgery.

Answer: • Patients with respiratory disease may experience alterations in acid-base balance after surgery. • Kidney and liver diseases influence the patient's response to anesthesia. • Endocrine diseases increase the risk for slow surgical wound healing.

A client has an intravenous infusion (IV) started before surgery for a right below-the-knee amputation. In addition to the intravenous infusion, blood is drawn and a surgical skin preparation is done. The nurse anticipates that the client is likely to experience which psychosocial problem in the preoperative period?

Anxiety

The skin surrounding a postoperative client's abdominal wound is becoming irritated in the area where the dressing tape is being reapplied with each dressing change. Which of the following is the appropriate nursing action?

Apply Montgomery ties.

When performing a surgical dressing change of a client's abdominal dressing, a nurse notes an increase in the amount of drainage and separation of the incision line. The underlying tissue is visible to the nurse. The nurse should plan to do which of the following in the initial care of this wound?

Apply a sterile dressing soaked with normal saline

A nurse is checking a client's surgical incision and notes an increase in the amount of drainage, a separation of the incision line, and the appearance of underlying tissue. Which of the following is the initial action?

Apply a sterile dressing soaked with normal saline to the wound.

A nurse is changing the abdominal dressing on a client following abdominal surgery. The nurse notes that the incision line is separated and the appearance of underlying tissue is noted. Wound dehiscence is suspected. Which of the following is the appropriate initial nursing action?

Apply a sterile dressing soaked with sterile normal saline to the wound.

A nurse is caring for a client who is scheduled for surgery. The client is concerned about the surgical procedure. To alleviate the client's fears and misconceptions about surgery, the nurse should:

Ask the client to discuss information known about the planned surgery.

How does body image need to be assessed in order to understand the impact of surgery on a patient's and family's emotional health?

Assess for body image alterations that patients perceive will result, taking into consideration culture, age, self concept, and self-esteem; removal of parts often leaves permanent disfiguration, alterations in body function, or concern over mutilation, loss of body function

To help prevent respiratory complications postoperatively, the nurse should:

Assist the patient to ambulate within a few hours of surgery, unless contraindicated.

Nursing Assessments and Interventions to meet Postoperative Elimination Needs

Bowel Elimination *Assess for the return of peristalsis by auscultating bowel sounds every 4 hours when the patient is awake. Assess abdominal distention, especially if bowel sounds are not audible or are high pitched (indicative of possible paralytic ileus, which is an absence of intestinal peristalsis). *Assess ability to pass flatus and stool. *Assist with movement in bed and ambulation to relieve gas pains, a common postoperative discomfort. Encourage food and fluid intake when ordered, especially fruit juices and high-fiber foods. *Maintain privacy when patient is using the bedpan, urinal, commode, or bathroom. *Administer suppositories, enemas, or medications, such as stool softeners, as prescribed. Urinary Elimination *Monitor patterns of intake and output. *Assist in assuming normal position to void by using an upright position when on a bedpan and using a bedside commode or bathroom when able, or by assisting the male patient to stand upright to void with a urinal. *Assess for bladder distention by palpating above the symphysis pubis if the patient has not voided within 8 hours after surgery or if the patient has been voiding frequently in amounts of less than 50 mL; notify the physician of abnormal assessment results. *Maintain prescribed intravenous fluid infusion rates. *Encourage oral fluid intake when prescribed. *Provide privacy when the patient is using bedpan, bedside commode, urinal, or bathroom. Initiate urinary catheterization, if prescribed.

List the areas the nurse would assess to determine the postoperative patient's circulatory status:

Careful assessment of heart rate and rhythm, along with blood pressure, reveals the patient's cardiovascular status; capillary perfusion-note refill, pulses and the color and temperature of the nail beds.

A nurse is monitoring a postoperative client on an hourly basis. The nurse notes that the client's hourly urine output is 25 mL. Based on this finding, the first action of the nurse would be to

Check the client's overall intake and output record.

A client's preoperative vital signs are temperature 98.6° F orally, apical pulse 80 beats per minute with a regular rhythm, respiration rate 22 breaths per minute, and blood pressure 168/94 mm Hg in the right arm. Based on the interpretation of these findings, which action should the nurse take first?

Compare these values to those recorded previously.

Explain conscious sedation:

Conscious sedation is routinely used for procedures that do not require complete anesthesia but rather a depressed level of consciousness.

A client is admitted to the surgical unit postoperatively with a wound drain (Hemovac) in place. Which of the following nursing actions would the nurse avoid in the care of the drain?

Curl the drain tightly and tape it firmly to the body.

Which of the following is an accurate statement regarding the older adult facing surgery?

Disorientation or toxic reactions can occur in the older adult after the administration of anesthetics, sedatives, or analgesics.

A nurse is caring for a client following an abdominal hysterectomy performed 1 day ago. An intravenous (IV) line is infusing and a nasogastric (NG) tube is in place and attached to low intermittent suction. The nurse monitors the client and notes that the bowel sounds are absent. The nurse should appropriately:

Document the finding and continue to check for bowel sounds

A nurse is preparing the client for transfer to the operating room (OR). The nurse should take which of the following actions in the care of this client at this time?

Ensure that the client has voided.

Describe the frequency of vital sign assessment in the immediate postoperative period:

Every 15 minutes twice, every 30 minutes twice, and then hourly every 2 hours and then every 4 hours per orders.

Explain general anesthesia:

General anesthesia is given by IV and inhalation routes through three phases (induction, maintenance, and emergence), resulting in an immobile, quiet patient who does not recall the surgical procedure

A nurse is developing a plan of care for a client who is scheduled for surgery. The nurse would include which of the following activities in the nursing care plan for the client on the day of surgery?

Have the client void immediately before surgery.

How does self concept need to be assessed in order to understand the impact of surgery on a patient's and family's emotional health?

Have the patient identify personal strengths and weaknesses; poor self-concept hinders the ability to adapt to stress of surgery and aggravated feelings of guilt or inadequacy

List the complications of malignant hyperthermia:

Hypercarbia, tachypnea, tachycardia, remature ventricular contractions (PVC), unstable blood pressure, cyanosis, skin mottling, and muscular rigidity

The goal of the postoperative assessment is to:

Identify a patient's normal postoperative function and the presence of any risks to recognize, prevent and minimize possible postoperative complication

A client has been taking prednisone for 3 years to treat symptoms of lupus erythematosa. She is scheduled for abdominal hysterectomy because of menorrhagia. The nurse plans care realizing that postoperatively the client is at risk for which condition?

Increased likelihood of surgical site infection

A nurse is monitoring the status of the postoperative client. The nurse would become most concerned with which of the following signs, which could indicate an evolving complication?

Increasing restlessness

Identify what the informed consent for surgery involves

Informed consent for surgery (surgeons responsibility) involves the patient's understanding of the need for a procedure, steps involved, risks, expected results, and alternative treatments

A surgeon is performing an abdominal hysterectomy. Before the surgery is completed, the operating room nurse counts the sponges and notes that the sponge count is not correlating with the preoperative count. Which action by the nurse is important?

Informing the surgeon of the situation

A nurse checks the sternotomy incision of a client on the second postoperative day after cardiac surgery. The incision shows some slight "puffiness" along the edges and is non-reddened with no apparent drainage. The client's temperature is 99° F (37.2° C) orally. The white blood cell (WBC) count is 7500 cells/mm3. The nurse interprets that the incision line:

Is slightly edematous but shows no active signs of infection

When positioning for a surgical procedure, the nurse understands that the client's respiratory system is most at risk for dysfunction when in which position?

Lithotomy

Explain local anesthesia:

Local anesthesia involves the loss of sensation at the desired site; common for minor procedures.

A nurse is getting a postoperative client out of bed for the first time since surgery. The nurse raises the head of the bed, and the client complains of dizziness. Which of the following actions should the nurse take first?

Lower the head of the bed slowly until the dizziness is relieved.

how nonsteroidal anti-inflammatory drugs affect pt. during surgery

NSAIDs (ibuprofen) inhibit platelet aggregation & prolong bleeding time, ^ susceptibility to postoperative bleeding

How to promote postoperative rest and comfort.

Nausea and Vomiting Avoid giving large amounts of fluids or food at one time, especially after being NPO. Administer prescribed medications. Provide oral hygiene, as needed. Maintain clean environment. Avoid use of a straw. Avoid strong-smelling food. Assess for possible allergy to medications, such as antibiotics or analgesics. Maintain bowel elimination. Thirst Offer sips of water or ice chips when NPO (if permitted). Maintain oral hygiene. Hiccups Have the patient do the following: Take several swallows of water while holding the breath (if not NPO). Rebreathe into a paper bag. Eat a teaspoon of granulated sugar. Surgical Pain Assess pain frequently; administer prescribed analgesics every 2 to 4 hours on a regular schedule during the first 24 to 36 hours after surgery. Reinforce preoperative teaching for pain management. Offer nonpharmacologic measures to supplement medications: massage, position changes, relaxation, guided imagery, meditation, music.

A nurse is changing an abdominal dressing on a client with an open incision and notes the presence of sanguineous drainage. Which nursing action would be appropriate?

Notify the registered nurse

Which of the following is true regarding preoperative teaching?

Preoperative information helps lessen anxiety, reduce the amount of anesthesia required, decrease postoperative pain, and reduce corticosteroid production.

A nurse is assigned to assist in caring for a client who recently returned from the operating room. On data collection, the nurse notes that the client's vital signs are as follows: blood pressure (BP) 102/62 mm Hg, pulse 91 beats per minute, respirations 16 breaths per minute. Preoperative vital signs were BP 124/78 mm Hg, pulse 74 beats per minute, respirations 20 breaths per minute. Which of the following actions should the nurse plan to take first?

Recheck the vital signs in 15 minutes.

Explain regional anesthesia:

Regional anesthesia results in loss of sensation in an area of the body via spinal, epidural, or a peripheral nerve block with no loss in consciousness

Identify the responsibilities of the nurse in the post anesthesia care unit (PACU):

Responsibilities include maintaining the patient's airway, respiratory, circulatory, and neurologic status and managing pain

A nurse is preparing a client for surgery. Which of the following would be a component of the plan of care?

Review the results of the preoperative laboratory studies.

A client has returned to the nursing unit following abdominal hysterectomy. To most effectively gather data on the client's postoperative bleeding, the nurse will implement which intervention?

Rolling the client to one side to view bedding

A nurse is caring for a postoperative client who has a drain inserted into the surgical wound. Which of the following actions would the nurse avoid in the care of the drain?

Secure the drain by curling or folding it and taping it firmly to the body

A nurse provides preoperative teaching to a client who will wear an abdominal binder postoperatively following abdominal surgery. Which should the nurse include in the preoperative teaching plan?

Sit up for coughing while splinting the incision.

A nurse is teaching a client about the use of an incentive spirometer in the postoperative period. The nurse should include which of the following pieces of information in discussions with the client?

The best results are achieved when sitting at least halfway or fully upright.

Identify the outcomes for discharge from the PACU

The patient will show vital sign stability, temperature control, good ventilatory function and oxygenation status, orientation to surroundings, absence of complications, minimal pain and nausea, controlled wounds drainage, adequate output, and fluid and electrolyte balance.

A nurse is explaining the universal protocol for preventing wrong site, wrong procedure, and wrong person surgery to a group of nursing students. The nurse explains that site marking involves:

The surgeon marking the area of the operative procedure

Select the true statement regarding informed consent:

The witness of a consent form is only verifying that this is the person who signed the consent and that it was a voluntary consent.

A nurse in the health care provider's office is measuring vital signs on a postoperative client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. The nurse should tell the client that:

These sensations dissipate over several months and usually resolve after 1 year.

A nurse is explaining the concept of a time-out in the perioperative area. The purpose of a time-out is:

To allow the surgical team a chance to verbally verify its agreement about the client's name, the surgical procedure, and the site

A nurse is explaining the concept of time-out in the perioperative area to a group of nursing students, knowing that the purpose of time-out is:

To allow the surgical team a chance to verbally verify their agreement on the client's name, surgical procedure, and site

A nurse is reviewing the preoperative orders of a client with a colon tumor who is scheduled for abdominal perineal resection. The nurse notes that the health care provider has prescribed neomycin sulfate (Mycifradin) for the client. The nurse determines that this medication has been prescribed:

To decrease the bacteria in the bowel

A nurse just reassessed the condition of a postoperative client who was admitted 1 hour ago to the surgical unit. The nurse plans to most carefully monitor which of the following parameters during the next hour?

Urinary output of 20 mL/hr

how upper respiratory infection increases risk of surgery

^ risk of respiratory complications during anesthesia (pneumonia & spasm of laryngeal muscles)

constructive

a

ASA 1 definition

a normal healthy patient

A nurse receives a client in the surgical unit who was transferred from the postanesthesia care unit. The nurse checks the client for which of the following first?

a patent airway

19. The nurse is providing preoperative teaching for the ambulatory surgery patient who will be having a cyst removed from the right arm. Which would be the best explanation for diet progression after surgery? a) "Start with clear liquids, soup, and crackers. Advance to a normal diet as you tolerate." b) "There is no limitation on your diet. You can have whatever you want." c) "Stay on clear liquids for 24 hours. Then you can progress to a normal diet." d) "Start with clear liquids for 2 hours, then full liquids for 2 hours. Then progress to a normal diet."

a) "Start with clear liquids, soup, and crackers. Advance to a normal diet as you tolerate." Correct

23. During preoperative assessment for a 7:30 case, the patient indicates to the nurse that he had a cup of coffee this morning. The nurse reports this information to the anesthesia provider anticipating: a) A delay in or cancellation of surgery. b) Questions regarding components of the coffee. c) Additional questions about why the patient had coffee. d) Instructions to determine what education was provided in the preoperative visit.

a) A delay in or cancellation of surgery. Correct

40. The nurse is caring for an ambulatory surgery patient. To be discharged home, what criteria must the patient meet? (Select all that apply.) a) Able to drink fluids b) Able to eat crackers c) Manageable pain d) Able to void e) Dry and intact dressing f) Able to dress self

a) Able to drink fluids Correct c) Manageable pain Correct d) Able to void Correct e) Dry and intact dressing Correct

42. The nurse is preparing for a patient who will be going to surgery. The nurse screens for risk factors that can increase a person's risks in surgery. What risk factors are included in the nurse's screening? (Select all that apply.) a) Age b) Nutrition c) Race d) Obesity e) Pregnancy f) Ambulatory surgery

a) Age Correct b) Nutrition Correct d) Obesity Correct e) Pregnancy Correct

26. The nurse is preparing a patient for a surgical procedure on the right great toe. Which of the following actions would be most important to include in this patient's preparation? a) Ascertain that the surgical site has been correctly marked. b) Ascertain where the family will be located during the procedure. c) Place the patient in a clean surgical gown. d) Ask the patient to remove all hairpins and cosmetics.

a) Ascertain that the surgical site has been correctly marked. Correct

12. The nurse is caring for a preoperative patient. The nurse teaches the principles and demonstrates leg exercises for the patient. The patient is unable to perform leg exercises correctly. What is the nurse's best next step? a) Assess for the presence of anxiety, pain, or fatigue. b) Ask the patient why he does not want to do the exercises. c) Encourage the patient to practice at a later date. d) Assess the educational methods used to educate the patient.

a) Assess for the presence of anxiety, pain, or fatigue. Correct

29. The nurse is caring for a patient in the operating suite. Which of the following outcomes would be most appropriate for this patient? a) At the end of the intraoperative phase, the patient will be free of burns at the grounding pad. b) At the end of the intraoperative phase, the patient will be free of infection. c) At the end of the intraoperative phase, the patient will be free of nausea and vomiting. d) At the end of the intraoperative phase, the patient will be free of pain.

a) At the end of the intraoperative phase, the patient will be free of burns at the grounding pad. Correct

1. The nurse is precepting a student nurse and explains that perioperative nursing care occurs: a) Before, during, and after surgery. b) In preadmission testing. c) During the surgical procedure. d) In the post anesthesia care unit.

a) Before, during, and after surgery.

31. The nurse is caring for a postoperative patient with a history of obstructive sleep apnea. The nurse monitors for which of the following? a) Choking and noisy, irregular respirations b) Shallow respirations c) Moaning and reports of pain d) Disorientation

a) Choking and noisy, irregular respirations Correct

7. The nurse is preparing a patient for surgery. Aims of assessment before surgery include: a) Establishing a patient's baseline of normal function. b) Planning for care after the procedure. c) Educating the patient and family about the procedure. d) Gathering appropriate equipment for the patient's needs.

a) Establishing a patient's baseline of normal function. Correct

27. The nurse is caring for a patient intraoperatively. Primary roles of the circulating nurse include: a) Establishing and implementing the plan of care. b) Maintaining a sterile field. c) Assisting with applying sterile drapes. d) Handing sterile instruments and supplies to the surgeon.

a) Establishing and implementing the plan of care. Correct

45. The nurse is caring for a patient in the operating suite. The nurse assists in positioning the patient to: (Select all that apply.) a) Gain access to the operative site. b) Sustain adequate circulatory and respiratory function. c) Ensure patient safety and skin integrity. d) Support the use of equipment. e) Maintain neuromuscular structures. f) Provide warmth and comfort.

a) Gain access to the operative site. Correct b) Sustain adequate circulatory and respiratory function. Correct c) Ensure patient safety and skin integrity. Correct d) Support the use of equipment. e) Maintain neuromuscular structures. Correct f) Provide warmth and comfort.

13. Which nursing assessment would indicate that the patient is performing diaphragmatic breathing correctly? a) Hands placed on border of rib cage with fingers extended will touch as chest wall contracts. b) Hands placed on chest wall with fingers extended will separate as chest wall contracts. c) The patient will feel upward movement of the diaphragm during inspiration. d) The patient will feel downward movement of the diaphragm during expiration.

a) Hands placed on border of rib cage with fingers extended will touch as chest wall contracts. Correct

8. The nurse is completing a medication history for the surgical patient in preadmission testing. Which of the following medications should the nurse instruct the patient to hold in preparation for surgery? a) Ibuprofen b) Acetaminophen c) Vitamin C d) Miconazole

a) Ibuprofen Correct

25. The nurse has completed a preoperative assessment for a patient going to surgery and gathers assessment data. Of the following, which would be the most important next step? a) Notify the operating suite that the patient has a latex allergy. b) Document that the patient had a bath at home this morning. c) Ask the nursing assistant to obtain vital signs. d) Administer the ordered preoperative intravenous antibiotic.

a) Notify the operating suite that the patient has a latex allergy. Correct

22. The nurse is reviewing the surgical consent with the patient during preoperative education. The patient indicates that he does not understand what procedure will be completed. What is the nurse's best next step? a) Notify the physician about the patient's question. b) Explain the procedure that will be completed. c) Ask the patient to sign the form. d) Continue with preoperative education.

a) Notify the physician about the patient's question. Correct

41. The nurse is caring for a postoperative patient with an incision. Which of the following nursing interventions have been found to decrease wound infections? (Select all that apply.) a) Perform hand hygiene before and after contact with the patient. b) Maintain normoglycemia. c) Use hair clippers to remove hair. d) Administer antibiotics within 30 to 60 minutes of incision time. e) Provide bath and linen change daily. f) Perform first dressing change 1 week postoperatively.

a) Perform hand hygiene before and after contact with the patient. Correct b) Maintain normoglycemia. Correct c) Use hair clippers to remove hair. Correct d) Administer antibiotics within 30 to 60 minutes of incision time. Correct

17. The nurse is preparing to assist the patient in using the incentive spirometer. Which nursing intervention should the nurse provide first? a) Perform hand hygiene. b) Place in reverse Trendelenburg position. c) Explain use of the mouthpiece. d) Instruct the patient to inhale slowly.

a) Perform hand hygiene. Correct

43. The nurse is providing preoperative education and reviews with the patient what it will be like to be in the surgical environment. What points should the nurse include? (Select all that apply.) a) The surgical area is cold but warm blankets will be provided. b) The surgical staff will be dressed in special clothing with hats and masks. c) The operative suite will be very dark. d) Families are not allowed in the operating suite. e) The operating table or bed will be comfortable and soft. f) The nurses will be there to assist you through this process.

a) The surgical area is cold but warm blankets will be provided. Correct b) The surgical staff will be dressed in special clothing with hats and masks. Correct d) Families are not allowed in the operating suite. Correct f) The nurses will be there to assist you through this process. Correct

44. The nurse is using a preoperative checklist to assist in preparing a patient on the day of surgery. What will the checklist include? (Select all that apply.) a) Vital signs b) Laboratory data c) Living will d) NPO e) Identification (ID) band on f) Family location

a) Vital signs Correct b) Laboratory data Correct d) NPO Correct e) Identification (ID) band on Correct

role body image plays in impact of surgery on pts. & family's emotional health

access for body-image alterations that pts. perceive will result, taking into consideration culture, age, self-concept, self-esteem; removal of body parts often leaves permeant disfigurement, alteration in body function, or concern over mutilation, loss of body function

how obstructive sleep apnea increases risk of surgery

admin. of opioids ^ risk of airway obstruction after surgery. Pts. desaturate as reveled by drop in oxygen saturation by pulse oximetry

how renal disease increases risk of surgery

alters excretion of anesthetic drugs & their metabolites, ^ risk for acid-base imbalance & other complications

how liver disease increases risk of surgery

alters metabolism & elimination of drugs admin. during surgery & impairs wound healing & clotting time cuz of alterations in protein metabolism

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? a) Cardiac drugs must be stopped for 1 week before surgery. b) If the patient is diabetic and takes insulin, the dose may be increased before surgery. c) Certain respiratory drugs may be taken the day of surgery per physician's order. d) Aspirin is generally stopped 1 month before surgery.

answer: Certain respiratory drugs may be taken the day of surgery per physician's order. Rationale: Adjustments in taking medications may be needed before surgery. Anticoagulants are stopped days before surgery. Certain cardiac and respiratory drugs may be taken the day of surgery per physician's order. If the patient is diabetic and takes insulin, the insulin dosage may be reduced.

Which nursing action would avoid pressure on the popliteal nerve when applying the safety strap across the client's legs on the operating table?

apply the safety strap 2 inches above the knees

ablative

b

5. The patient has presented to the ambulatory surgery center to have a colonoscopy. The patient is scheduled to receive moderate sedation (conscious sedation) during the procedure. Moderate sedation is used routinely for procedures that require: a) Performance on an outpatient basis. b) A depressed level of consciousness. c) Loss of sensation in an area of the body. d) The patient to be immobile.

b) A depressed level of consciousness. Correct

37. The nurse is caring for a patient who will undergo a coronary artery bypass graft procedure. What level of care will the patient require immediately post procedure? a) Acute care—medical-surgical unit b) Acute care—intensive care unit c) Ambulatory surgery d) Ambulatory surgery—extended stay

b) Acute care—intensive care unit Correct

33. The nurse is caring for a postoperative patient who has had a carpel tunnel repair. The patient has a temperature of 97° F and is shivering. Which of the following is the best reason for this condition? a) The patient is dressed only in a gown. b) Anesthesia lowers metabolism. c) The surgical suite has laminar flow. d) The open body cavity contributed to heat loss.

b) Anesthesia lowers metabolism. Correct

9. The nurse is caring for a potential surgical patient in the preadmission testing unit. The medication history indicates that the patient is currently taking warfarin (Coumadin). Which of the following actions should the nurse take? a) Consult with the physician regarding a radiological examination of the chest. b) Consult with the physician regarding an international normalized ratio (INR). c) Consult with the physician regarding blood urea nitrogen (BUN). d) Consult with the physician regarding a complete blood count (CBC).

b) Consult with the physician regarding an international normalized ratio (INR). Correct

18. The nurse and the nursing assistant are caring for a group of postoperative patients who need turning, coughing, deep breathing, incentive spirometer, and leg exercises. The nurse directs the nursing assistant to: a) Teach and demonstrate postoperative exercises. b) Inform the nurse if the patient is unwilling to perform exercises. c) Document in the medical record when exercises are completed. d) Do nothing associated with postoperative exercises.

b) Inform the nurse if the patient is unwilling to perform exercises. Correct

32. The nurse is caring for a patient in the operating suite who is experiencing hypercarbia, tachypnea, tachycardia, premature ventricular contractions, and muscle rigidity. The nurse suspects that this patient may be experiencing: a) Hypoxia. b) Malignant hyperthermia. c) Fluid imbalance. d) Hemorrhage.

b) Malignant hyperthermia. Correct

2. The nurse is caring for a patient who is scheduled to undergo a surgical procedure. The nurse is completing an assessment and reviews the patient's laboratory tests and allergies. In which perioperative nursing phase would this work be completed? a) Perioperative b) Preoperative c) Intraoperative d) Postoperative

b) Preoperative Correct

39. The nurse is precepting a new nurse in the perioperative area. The nurse explains that perioperative nursing is based on certain principles and includes (Select all that apply.) a) Purchasing the correct equipment. b) Providing high-quality and patient safety-focused care. c) Scheduling the right types of patients. d) Conducting multidisciplinary teamwork. e) Ensuring effective therapeutic communication. f) Providing advocacy for the patient.

b) Providing high-quality and patient safety-focused care. Correct d) Conducting multidisciplinary teamwork. Correct e) Ensuring effective therapeutic communication. Correct f) Providing advocacy for the patient. Correct

30. The nurse is concerned about the skin integrity of the patient in the intraoperative phase of surgery. Which of the following actions helps to minimize skin breakdown? a) Encouraging the patient to bathe before surgery b) Securing attachments to the operating table with foam padding c) Periodically adjusting the patient during the surgical procedure d) Measuring the time a patient is in one position during surgery

b) Securing attachments to the operating table with foam padding Correct

14. The nurse is caring for a postoperative patient with an abdominal incision. A pillow is used during coughing to provide: a) Pain relief. b) Splinting. c) Distraction. d) Anxiety reduction.

b) Splinting. Correct

36. The post anesthesia care unit (PACU) nurse transports the inpatient surgical patient to the medical-surgical floor. Before leaving the floor, the medical-surgical nurse obtains a complete set of vital signs. What is the rationale for this nursing action? a) The first action in a head-to-toe assessment is vital signs. b) This is done to compare and monitor for vital sign variation during transport. c) This is done to ensure that the medical-surgical nurse checks on the postoperative patient. d) This is done to follow hospital policy and procedure for care of the surgical patient.

b) This is done to compare and monitor for vital sign variation during transport. Correct

A nurse is caring for a postoperative client who had a pelvic exenteration. The health care provider has changed the client's diet from nothing by mouth (NPO) to clear liquids. The nurse checks which of the following before administering the clear liquids?

bowel sounds

urgent

c

15. The nurse is encouraging a reluctant postoperative patient to deep breathe and cough. What explanation can the nurse provide that may encourage the patient to cough more effectively? a) "If you don't deep breathe and cough, you will get pneumonia." b) "Deep breathing and coughing will clear out the anesthesia." c) "Coughing will not harm the incision if done correctly." d) "You will need to cough only a few times during this shift."

c) "Coughing will not harm the incision if done correctly." Correct

20. The nurse explains the pain relief measures available after surgery during preoperative teaching for a surgical patient. Which of the following comments from the patient indicates the need for additional education on this topic? a) "I will take the pain medication as the physician prescribes it." b) "I will be asked to rate my pain on a pain scale." c) "I will have minimal pain because of the anesthesia." d) "I will take my pain medications before doing postoperative exercises."

c) "I will have minimal pain because of the anesthesia." Correct

21. The nurse is making a preoperative education appointment with a patient. The patient asks if he should bring family with him to the appointment. What is the best response by the nurse? a) "There is no need for an additional person at the appointment." b) "Your family can come and wait with you in the waiting room." c) "We recommend including family in this appoint to ease everyone's anxiety." d) "It is required that you have a family member at this appointment."

c) "We recommend including family in this appoint to ease everyone's anxiety." Correct

28. The nurse is caring for a patient in the preoperative holding area of an ambulatory surgery center. Which nursing action would be most appropriate for this area? a) Monitor vital signs every 15 minutes. b) Empty the urinary drainage bag. c) Apply a warm blanket. d) Check the surgical dressing.

c) Apply a warm blanket. Correct

35. The nurse is caring for a patient in the post anesthesia care unit. The patient asks for a bedpan and states to the nurse, "I feel like I need to go to the bathroom, but I can't." Which of the following nursing interventions would be most appropriate? a) Encourage the patient to wait a minute and try again. b) Call the physician and obtain an order for catheterization. c) Assess the patient's intake and the patient for bladder distention. d) Inform the patient that everyone feels this way after surgery.

c) Assess the patient's intake and the patient for bladder distention. Correct

3. The nurse is caring for a patient in the post anesthesia care unit. The patient has developed profuse bleeding from the surgical site, and the surgeon has determined the need to return to the operative area. This procedure would be classified as: a) Elective. b) Urgent. c) Emergency. d) Major.

c) Emergency. Correct

4. The nurse is caring for a patient in preadmission testing. The patient has been assigned a physical status classification by the American Society of Anesthesiologist of P3. Which of the following assessments would support this classification? a) Denial of any major illnesses or conditions b) Normal, healthy patient c) History of hypertension, 80 pounds overweight, history of asthma d) History of myocardial infarction that limits activity

c) History of hypertension, 80 pounds overweight, history of asthma Correct

38. The ambulatory surgical nurse calls to check on the patient at home the morning after surgery. The patient is reporting continued nausea and vomiting. Which of the following discharge education points should be reviewed with the patient? a) Instruct the patient to take deep breaths. b) Instruct the patient to drink ginger ale and eat crackers. c) Instruct and attempt to connect the patient with the physician. d) Instruct the patient to go to the emergency department.

c) Instruct and attempt to connect the patient with the physician. Correct

24. The nurse has administered an anxiolytic as a preoperative medication to the patient going to surgery. Which of the following is the best next step? a) Waste any unused medication according to policy. b) Notify the operating suite that the medication has been given. c) Instruct the patient to call for help to go to the restroom. d) Ask the patient to sign the consent for surgery.

c) Instruct the patient to call for help to go to the restroom. Correct

34. The nurse is monitoring a patient in the post anesthesia care unit (PACU) for postoperative fluid and electrolyte imbalance. Which of the following actions would be most appropriate for this patient? a) Encourage copious amounts of water. b) Weigh the patient and compare with preoperative weight. c) Measure and record all intake and output. d) Start an additional intravenous (IV) line.

c) Measure and record all intake and output. Correct

10. The nurse is encouraging the postoperative patient to utilize diaphragmatic breathing. Reasons for this intervention include: a) Management of pain. b) Decreased healing time. c) Prevention of atelectasis. d) Decreased thrombus formation.

c) Prevention of atelectasis. Correct

6. The nurse is caring for a patient in the post anesthesia care unit who has undergone a left total knee arthroplasty. The anesthesia provider has indicated that the patient received a left femoral peripheral nerve block. Which assessment would be an expected finding for a patient with this type of regional block? a) Decreased pulse at the left posterior tibia b) Left toes cool to touch and slightly cyanotic c) Sensation decreased in the left leg d) Patient report of pain in the left foot

c) Sensation decreased in the left leg Correct

areas nurse would assess to determine postoperative pts. circulatory status

carful assessment of heart rate & rhythm, blood pressure, reveals pts. cardiovascular status; capillary perfusion- note refill, pulses, color & temp. of nail beds

A nurse obtains the vital signs on a postoperative client who just returned to the nursing unit. The client's blood pressure (BP) is 100/60 mm Hg, the pulse is 90 beats per minute, and the respiration rate is 20 breaths per minute. On the basis of these findings, which of the following nursing actions should be performed?

continue to monitor vital signs

A nurse is assisting in providing surgical instructions to a preoperative client. Which instruction would be most appropriate to include in the preoperative plan of care?

coughing and deep breathing exercise

major

d

16. The nurse and the nursing assistant are assisting a postoperative patient to turn in the bed. To assist in minimizing discomfort, which instruction should the nurse provide to the patient? a) "Close your eyes and think about something pleasant." b) "Hold your breath and count to three." c) "Hold my shoulders with your hands." d) "Place your hand over your incision." Correct

d) "Place your hand over your incision." Correct

11. The nurse is caring for a postoperative patient on the medical-surgical floor. To prevent venous stasis and the formation of thrombus after general anesthesia, the nurse encourages: a) Coughing. b) Diaphragmatic breathing. c) Incentive spirometry. d) Leg exercises. Correct

d) Leg exercises. Correct

factors that place older adults at risk during surgery integumentary system

decreased subcutaneous tissue & increased fragility of skin

A nurse is collecting data from a client who is scheduled for surgery in 1 week in the ambulatory care surgical center. The nurse notes that the client has a history of arthritis and has been taking acetylsalicylic acid (aspirin). The nurse reports the information to the surgeon and anticipates that the surgeon will prescribe which of the following?

discontinue the aspirin 48 hours before the scheduled surgery

How does coping resources need to be assessed in order to understand the impact of surgery on a patient's and family's emotional health?

discussion of feeling and self concept reveals whether the patient is able to cope with stress of surgery, past stress management and behaviors used, and coping resources.

role coping resources play in impact of surgery on pts. & family's emotional health

discussion of feelings & self-concept reveals whether pt. is able to cope w/ stress of surgery, past stress management & behaviors used, coping resources

how diuretics affect pt. during surgery

diuretics such as furosemide (Lasix) potentiate electrolyte imbalances (particularly potassium) after surgery

A nurse is providing instructions to a client and family regarding home care following cataract removal from the left eye. The nurse would provide the client with which of the following pieces of information about positioning in the postoperative period?

do not sleep on left side

cosmetic

e

A nurse has admitted a client to the clinical nursing unit following a right mastectomy. The nurse plans to place the right arm in which of the following positions?

elevated on one or two pillows

frequency of vital sign assessment in immediate postoperative period

every 15 minutes twice, every 30 minutes twice, & then hourly for every 2 hours & then every 4 hours or per orders

Define the surgical procedure classification: Ablative

excision or removal of diseased body part

Define the surgical procedure classification: Diagnostic

exploration that allows diagnosis to be confirmed

Define the surgical procedure classification: Major

extensive reconstruction, poses great threat to well being

restorative

f

emergency

g

factors that place older adults at risk during surgery GI system

gastric emptying delayed- reflux, indigestion

general anesthesia

given by IV & inhalation routes through 3 phases (induction, maintenance, emergence), resulting in immobile, quiet pt. who does not recall surgical procedure

minor

h

role self-concept plays in impact of surgery on pts. & family's emotional health

have pt. identify personal strengths & weakness; poor self-concept hinders ability to adapt to stress of surgery & aggravates feelings of guilt or inadequacy

diagnostic

i

goal of preoperative assessment

identify pts. normal preoperative function & presence of any risks to recognize, prevent, minimize possible postoperative complications

Identify possible sources of a surgical patient's pain:

incision area, drainage tubes, tight dressing or casts, muscular strains caused by positioning

how immunologic disorders increase risk of surgery

increase risk for infection & delayed wound healing after surgery

how hypertension increase risk of surgery

increase risk of cardiovascular complications during anesthesia (stroke, inadequate tissue oxygenation)

how thrombocytopenia increase risks of surgery

increase risk of hemorrhage during & after surgery

A nurse is assisting in caring for a client immediately following an abdominal surgical procedure who lost a significant amount of blood during surgery. Which finding would indicate a sign of a potential complication?

increasing restlessness

A nurse monitors a postoperative client for signs of complications. Which of the following signs would the nurse determine to be indicative of a potential complication?

increasing restlessness

Define the surgical procedure classification: Minor

involves minimal risks compared with major procedures

Define the surgical procedure classification: Elective

is not essential and is not always necessary for health

elective

j

procurement

k

palliative

l

how anticonvulsants affect pt. during surgery

long term use of certain anticonvulsants (phenytoin & phenobarbital) alters metabolism of anesthetic agents

regional anesthesia

loss in sensation in an area of body via spinal, epidural, or peripheral nerve block w/ no loss of consciousness

local anesthesia

loss of sensation at desired site; common for minor procedures

responsibilities of nurse in postanesthesia care unit (PACU)

maintain pts. airway, respiratory, circulatory, neurologic status, managing pain

scrub nurse

maintains sterile field during surgical procedure & assists w/ supplies

how antidysrhythmic affect pt. during surgery

meds (beta blockers) can reduce cardiac contractibility & impair cardiac conduction during anesthesia

how anticoagulants affect pt. during surgery

meds such as warfarin (coumadin) or aspirin after normal clotting factors & thus increase risk of hemorrhaging. Discontinue at least 48 hrs. before surgery

how antihypertensive affect pt. during surgery

meds. such as betablockers & calcium channel blockers interact w/ anesthetic agents to cause bradycardia, hypotension, impaired circulation. Inhibit synthesis & storage of norepinephrine in sympathetic nerve endings

ASA 11 characteristics

mild diseases only without substantive functional changes (current smoker, social alcohol drinker, pregnancy, obesity BMI 30-39, well controlled DM/HTN, mild lung disease)

ASA V definition

moribund pt. who is not expected to survive without operation

Define the surgical procedure classification: Emergency

must be done immediately to save life or preserve function of body part

During a surgical procedure a nurse prevents a client's extremities from dangling over the sides of the table, knowing that this action may cause:

nerve and muscle damage

ASA 1 characteristics

no physiological, biological, organic disturbance, healthy, nonsmoking; no or minimal alcohol use

Define the surgical procedure classification: Urgent

not necessarily emergent

A nurse is caring for a postoperative client who is being monitored by pulse oximetry. Which of the following is an expected measurement determined by the pulse oximeter?

oxygen saturation 95% to 100%

A nurse is caring for a client immediately following a total abdominal hysterectomy. The nurse anticipates that which of the following will be the priority in the first 24 hours following surgery?

pain

A client arrives to the surgical nursing unit after surgery. The initial nursing action is to check the:

patency of the airway

ASA 11 definition

patient w/ mild systemic disease

ASA 111 definition

patient w/ severe systemic disease

ASA IV definition

patient w/ severe systemic disease that is a constant threat to life

Define the surgical procedure classification: Cosmetic

performed to improve personal appearance

how smoking affects pt.

places pt. at greater risk for pulmonary complication cuz of ^ amount & thickness of mucus secretions in lungs

A nurse monitors the postoperative client frequently for the presence of secretions in the lungs, knowing that accumulated secretions can lead to:

pneumonia

how antibiotics affect pt. during surgery

potentiate (enhance action of) anesthetic agents. if taken within 2 weeks before surgery, aminoglycosides (gentamicin, neomycin, tobramycin) may cause mild respiratory depression from depressed neuromuscular transmission

how alcohol and street drugs increase risk of surgery

ppl. abusing drugs sometimes have underlying disease (HIV, hepatitis) that affects healing. Alcohol addiction causes unpredictable reactions to anesthesia. Ppl go through withdraw during & after surgery

how alcohol & substance use affects pt.

predisposes pt. to adverse reactions to anesthetic agents & cross-tolerance to agents; malnourishment also leads to delayed wound healing

how fever increase the risk of surgery

predisposes pt. to fluid & electrolyte imbalances & sometimes indicate underlying infection

ASA VI definition

pt. declared brain dead whose organs are being removed for donor purpose

outcomes for discharge from PACU

pt. show vital sign stability, temp. control, good ventilatory function & O2 status, orientation to surroundings, absence of complications, minimal pain & nausea, controlled wound drainage, adequate output, fluid & electrolyte balance

how insulin affect pt. during surgery

pts. insulin requirements fluctuate after surgery. Some pts. need ^ doses due to stress response from surgery. Other pts. need less due to decreased nutritional intake following surgery

ASA IV characteristics

recent (less then 3 months) MI, CVA, TIA, ongoing cardiac ischemia or severe valve dysfunction, sepsis, disseminated intravascular coagulation, end stage renal disease not undergoing regularly scheduled dialysis

how chronic respiratory disease increase the risk of surgery

reduces pts. means to compensate for acid-base alterations. Anesthetic agents reduce respiratory function, increasing risk for severe hypoventilation

how chronic pain increases ricks of surgery

regular use of pain meds. often result in higher tolerance. ^ doses of analgesics sometimes necessary to achieve postoperative pain control

Define the surgical procedure classification: Palliative

relieves or reduces the intensity of disease symptoms; will not produce cure

Define the surgical procedure classification: Procurement

removal of organs or tissues from a dead person for transplantation into another

Define the surgical procedure classification: Constructive

restores function lost or reduced as a result of congenital anomalies

Define the surgical procedure classification: Restorative

restores function or appearance to traumatized tissues

circulating nurse

reviews preop assessment, establishes & implements intraoperative plan of care, evaluates the care, provides for continuity of care postop

conscious sedation anesthesia

routinely used for procedure that do not require complete anesthesia but rather depressed level of consciousness

ASA V characteristics

ruptured abdominal/ thoracic aneurysm, massive trauma, intracranial bleed w/ mass effect, ischemic bowl w/ significant cardiac pathology

A nurse is assisting in caring for a client in transfer from the post-anesthesia care unit following nasal surgery. Nasal packing and a mustache dressing are in place. The nurse places the client in which position to best reduce swelling?

semi fowler's

ASA 111 characteristics

substantive functional changes w/ 1 or more moderate to severe diseases (poorly controlled DM or HTN, COPD, morbid obesity BMI 40 or greater, active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of cardiac ejection fraction)

A nurse is caring for a postoperative client who has been NPO, and the health care provider has prescribed a clear liquid diet. In planning to initiate this diet, which priority item should the nurse place at the client's bedside?

suction equipment

What equipment should the nurse plan to have at the bedside when initiating a clear liquid diet for a postoperative client who has had general anesthesia?

suction equipment

What equipment should the nurse plan to have at the bedside when initiating a clear liquid diet in a postoperative client who has had general anesthesia?

suction equipment

A nurse checks the client's surgical incision for signs of infection. Which of the following would be indicative of a potential infection?

the presence of purulent drainage

A nurse is explaining The Joint Commission's (TJC's) universal protocol for preventing wrong-site, wrong-procedure, and wrong-person surgery to a group of nursing students. The nurse explains that site marking involves:

the surgeon marking the area of the operative procedure

how herbal therapies affect pt. during surgery

these herbal therapies have ability to affect platelet activity & ^ susceptibility to postoperative bleeding. Ginseng ^ hypoglycemia w/ insulin therapy

A nurse is monitoring an adult client for postoperative complications. Which of the following would be the most indicative of a potential postoperative complication that requires further observation?

urinary output of 20 mL per hour

A client returns from the recovery room following an abdominal surgical procedure. Following the arrival of the client to the nursing unit, the initial nursing action is to check the

vital signs

how corticosteroids affect pt. during surgery

w/ prolonged use, corticosteroids such as prednisone cause adrenal atrophy, reducing ability of body to withstand stress. Before & during surgery, dosages are often increased temporarily

ASA VI characteristics

wide variety of dysfunctions that are being managed to optimize blood flow to heart & organs (aggressive fluid replacement & blood pressure meds.