Ch.30 preoperative care

A client has presented to a clinic for a preoperative consult, during which the client has expressed concern about having to fast before surgery. What should the nurse discuss with the client reflecting current standards by the American Society of Anesthesiologists related to fasting prior to surgery?

allowing clear liquids up to 2 hours before surgery with an order by the health care provider

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

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

A nurse explains the effects of conscious sedation to a client undergoing a colonoscopy. Which of the following occurs with conscious sedation?

altered mood

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

blood pressure 118/70 mmHg, respirations 18 breaths per minute

A client with a diagnosis of breast cancer has been scheduled for a unilateral mastectomy during an axillary lymph node dissection. Which categorizations of surgical procedures are represented in this client's case? Select all that apply.

diagnostic curative

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur?

preoperative

A nurse is caring for a client who is admitted to the health care facility for surgery. Which activities take place before inpatient surgery? Select all that apply.

prior laboratory tests diagnostic tests meet anesthesiologist

An elder adult client underwent a hip replacement and now states to the nurse, "My parents are coming to visit me today. I need to mow the lawn and run errands." The client is trying to get out of the bed. What does the nurse identify is occurring with this client?

Delirium

The nurse is preparing a postoperative assessment of a client who has been admitted to the postsurgical unit from the recovery room. Which action should the nurse perform first?

Establish therapeutic rapport with the client and family.

The nurse is caring for a 4-month-old client on the pediatric unit following repair of an umbilical hernia repair. The infant just woke up from anesthesia and is crying. What would be appropriate initial interventions? Select all that apply.

Have the parent hold the infant in a rocking chair. Offer a pacifier. Use distraction with a stuffed toy

Which fact should the nurse keep in mind when obtaining consent forms from clients scheduled to undergo surgery?

In emergency situations, the doctor may obtain consent over the telephone.

A nurse teaches deep breathing exercises to a preoperative client. Which action should the nurse perform?

Instruct the client to exhale gently and completely before inhaling.

The healthy adult client is given a narcotic prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first?

Notify the physician of the oversight.

A nurse is assessing clients in the Post Anesthesia Care Unit (PACU). Which nursing actions would the nurse perform in this phase of the perioperative period? Select all that apply.

Prepare the client for home care. Assess the client's ability to return to the inpatient room when arousable Assess for complications as the client emerges from anesthesia.

The client has been transported to the operating suite and positioned on the operating table. Suddenly, the client states, "I don't want to do this. Get me out of here now!" Which action should occur?

The procedure should be stopped.

When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease?

slow wound healing

Which nursing intervention is most likely to prevent respiratory complications such as pneumonia and atelectasis in a postoperative client?

use of incentive spirometry

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?

void normally

A pediatric nurse is preparing a child for cleft palate repair surgery. The nurse identifies that this procedure will be documented as:

constructive surgery.

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

ileostomy

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

Relaxation techniques

The preoperative nurse is teaching a client about deep-breathing exercises. The client asks, "Why do I need to learn about this?" Which response by the nurse is correct?

"After surgery, deep-breathing exercises help to remove anesthetic gases and mucus and improve oxygen supply to body tissues."

A perioperative nurse is determining a plan of care for the client in the operating room. Which client outcome has priority?

Be free from injury and adverse effects.

A client is undergoing surgery for an appendectomy. This would be considered what type of surgery?

emergency surgery

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

Apply pressure to the surgical site to decrease bleeding.

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

Apply warm blankets to the client.

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

witnessing the signed informed consent document

A client will be having a surgical procedure requiring general anesthesia. Which desired outcomes of general anesthesia does the nurse expect to observe? Select all that apply.

loss of consciousness analgesia relaxed skeletal muscles depressed reflexes

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

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

Which preoperative task can the nurse delegate to the UAP (unlicensed assistive personnel)?

Assisting the client to the bathroom before surgery

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

Respiratory obstruction

Which factor is most important in the nurse's decision on assessment data, outcomes, and the monitoring needs of a client in preparing for surgery?

Type of surgery

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

before, during, and after the operative phase.

Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction?

"I can have a hamburger and French fries as soon as I wake up."

A client who is scheduled to undergo coronary bypass surgery in a week asks the nurse whether he should discontinue taking his cholesterol medicine ahead of the surgery. Which should be the nurse's response?

"I will need to check with your health care provider about that."

The nurse is educating a client who is preparing for abdominal surgery tomorrow. A teaching demonstration has just been completed by the nurse related to splinting the incision site with a pillow. Which statement by the client best indicates the instructions provided by the nurse were effective?

"I will put the pillow on the incision then cough."

Which surgical client does the nurse in the preoperative setting anticipate having the greatest potential for surgical complications?

76-year-old client with a history of renal failure and chronic bronchitis

Which postoperative complications can be reduced by appropriate client teaching about deep-breathing exercises? Select all that apply.

Atelectasis Pneumonia Bronchitis Severe hypoxemia

A client is being prepared for discharge home from the postanesthesia care unit (PACU). What action is essential for the nurse to take?

Check that the client is able to drink liquids without nausea.

The preoperative nurse has prepared a client for surgery and has been notified that the operating room staff is ready for the client. The client states, "My bladder feels full. I need to go to the bathroom!" Which action by the nurse is appropriate?

Inform the operating room staff and assist the client to the bathroom

The nurse is supervising a nursing student who is providing postoperative education to a client with an abdominal incision. The nurse sees the student coaching the client to perform coughing exercises, as pictured above. What is the nurse's best action?

Instruct the student to provide the client with a pillow or folded blanket to hug.

The nurse is performing a preoperative assessment of a client who has been scheduled for a reduction mammoplasty (breast reduction). The client states, "I'm starting to wonder if I made the right decision in going ahead with this." What should the nurse do next?

Explore the client's feelings and inform the surgeon.

A nurse is preparing a client for endotracheal intubation. The anesthesiologist has ordered an anticholinergic medication for this client. What is an action of this medication?

It decreases respiratory secretions.

A client who has been experiencing a gradual decrease in mobility has been scheduled for elective knee replacement surgery in 3 weeks. Which teaching points should the nurse choose for the outpatient group education session? Select all that apply.

How to cleanse skin with a special soap solution Time for limitations with eating and drinking When and where to arrive for surgery What to expect before, during, and after surgery

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

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

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

It interferes less with the client's daily routine.

The preoperative nurse is reviewing the chart of a client whose surgery is scheduled to begin in the next 15 minutes and notices that the consent form is not signed. The nurse contacts the surgeon who states, "We have already reviewed this procedure extensively, so ask the client to sign the consent form and I will verify it in the operating room." Which action by the nurse is appropriate?

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

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

Local infiltration with lidocaine

The nurse-anesthetist is monitoring the client during surgery. He notices a ventricular dysrhythmia and unstable blood pressure. He notifies the surgeon. The operative team suspects:

Malignant hyperthermia

A nurse asks a preoperative client which medications he is currently taking. Which statement describes an accurate guideline for client teaching regarding these medications?

Many respiratory drugs may be taken the day of surgery per health care provider's order.

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

Measure respiratory rate.

A client had an open cholecystectomy (gallbladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding?

Monitor the client closely and promote fluid intake.

The nurse is caring for a client who just returned from the postanesthesia care unit following surgery to repair a fractured arm. Place the following interventions in order of highest priority to lowest priority.

Place the client in a position that facilitates breathing. Measure pulse, blood pressure, respirations, and temperature. Measure oxygen saturation. Assess neurovascular status to the affected arm. Assess dressing for bleeding or other drainage. Assess for pain and administer prescribed analgesics, if indicated.

A nurse is caring for an older adult following hip surgery. When teaching the client to use an incentive spirometer, the nurse should explain that this reduces the risk of what complication?

Pneumonia

The outpatient surgery nurse is preparing to discharge a client who has recovered from surgery. Which actions should the nurse plan to carry out before the client is discharged? Select all that apply.

Provide verbal postoperative instructions. Provide written postoperative instructions. Provide contact information to schedule a postoperative appointment with the surgeon.

The nurse is teaching the client who recently experienced abdominal surgery to deep breathe and cough effectively. What observable action serves to best minimize pain that may result from the intervention?

Providing support to abdominal and accessory respiratory muscles

The nurse is caring for a client who returned from the postanesthesia care unit 3 hours ago. The surgical dressing was dry and intact upon arrival to the postoperative unit, but now it is saturated with fresh blood. Which actions should the nurse take first?

Reinforce the dressing with more bandages until the bleeding stops.

A nurse caring for a client postoperatively notes that the dressing on the client's incision was recently clean and dry but is now saturated with a large amount of fresh blood. What intervention should be taken by the nurse in this situation, along with notifying the primary care provider?

Reinforce the dressing.

A client is scheduled for elective hernia surgery. While taking a medical history, the nurse learns that the client is taking antibiotics for an infection. Which surgical risk should the nurse monitor based on this antibiotic use?

Respiratory paralysis

A nurse is providing education to a client having same-day surgery. Which statement would be accurate regarding this type of surgery?

Some major surgeries can be done as same-day surgery.

Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply.

Spinal block Nerve block Epidural block

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

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

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

a partial airway obstruction.

Following a surgical procedure, who is generally responsible for moving the client to the recovery area?

The anesthesiologist, circulating nurse, and surgeon

A postoperative client states "I don't understand why you are checking my skin on my back. My surgery was on my stomach." What is the nurse's best response?

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

The nurse is providing education about deep-breathing exercises to a postoperative client whose surgery took place earlier today. Which instruction should the nurse provide?

"Try to do your exercises every 1 to 2 hours."

The nurse assists a client to turn in the bed. The client has just returned from abdominal surgery. How does the nurse instruct the client?

"Use a pillow to splint the incision."

The circulating nurse calls for a time-out prior to the surgical procedure and the surgeon states, "I don't have time for this. I have another case to follow and need to get busy." What is the best response by the circulator?

"We all have the same goal and that is the safety of the client, so let's do the time-out."

The licensed practical nurse (LPN) is observed by the registered nurse (RN) engaging in the re-inforcement of teaching related to therapeutic deep breathing and coughing with a client who is recovering from abdominal surgery. Which statement by the RN best supports the LPN's role in the implementation of this intervention?

"You served as a good role model while showing the client the proper technigue for this intervention."

The nurse needs to evaluate the effectiveness of a preoperative teaching session with a client scheduled for abdominal surgery. Which client statement indicates the need for further clarification?

"While my pneumatic compression device is on, I don't need to do leg exercises."

The nurse is caring for a client admitted for an outpatient surgical procedure. Which action will the nurse include in the care? Select all that apply.

Allow family members to be present during discharge education. Begin discharge education in the preoperative period. Discuss discharge transportation during the preoperative period.

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?

Allow the parents into the PACU before the child wakes.

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?

Amount of blood loss

A nurse is assigned to be the circulating nurse during a surgical procedure. The nurse would be responsible for which activity?

Anticipating the needs of other members of the surgical team

A nurse is teaching a client about the rationale for fasting from food and fluids prior to surgery. What condition does this measure attempt to avoid?

Aspiration

A client has presented to the outpatient surgical center for a scheduled procedure. Which action should the nurse perform prior to the procedure?

Assess the client's allergy status.

The nurse is developing a plan of care for a client who had a splenectomy. The outcome is prevention of surgical site infection. Which interventions should be included in the client's plan of care? Select all that apply.

Assess vital signs. Monitor white blood cell count. Use asepsis with dressing change. Maintain hydration.

Which nursing action should the PACU nurse take to prevent postoperative complications in clients?

Assist the client to do leg exercises to increase venous return.

The acute care nurse is preparing a client for surgery. Which action is essential to complete before transferring the client to surgery?

Assure that diagnostic testing has been completed and results are available.

A postoperative client is experiencing decreased lung sounds, dyspnea, cyanosis, crackles, restlessness, and apprehension. Which condition would the nurse suspect?

Atelectasis

A nurse administers anticholinergics to a client as a postoperative medication. What condition does this medication help to prevent?

Laryngospasm

A nurse is giving preoperative information to a client scheduled for outpatient surgery. What are recommended education guidelines? Select all that apply.

Notify the surgeon's office if a cold or infection develops before surgery. List allergies and be sure the operating staff is aware of these. Have someone available for transportation home after recovery from anesthesia.

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

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

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

Place the client in semi-Fowler's position.

The nurse is caring for a client who had abdominal surgery yesterday and is reluctant to cough and perform deep breathing. Which strategy will most likely increase the client's willingness to cough and perform deep breathing?

Teach the client how to splint the abdomen while coughing.

The nurse is teaching a client about postoperative pain management. The client states, "I would like to use as little medication as possible after surgery. Will anything else help to relieve my pain?" Which response is appropriate?

There are several nonpharmacologic methods to reduce pain and anxiety. Let me teach you about some of them."

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

This is an expected finding in the immediate postoperative period.

In which position would the surgical nurse place a client undergoing minimally invasive surgery of the lower abdomen or pelvis?

Trendelenburg position

The nurse is taking a history on Kumar, who informs her that he has an allergy to adhesive tape. When the nurse asks Kumar to describe his reaction to the tape, he describes it as "blotchy and reddened." What type of allergic reaction is this?

Type IV

A nurse preparing an older adult client for hip replacement surgery is aware of the surgical risks related to the client's age. Which of the following accurately describes these risks? Select all that apply.

decreased peripheral circulation increased vascular rigidity decreased thermoregulation ability

The nurse is assessing an obese client scheduled for heart surgery. Which priority surgical risk related to obesity should the nurse monitor?

delayed wound healing and wound infection

The nurse has delegated to the unlicensed assistive personnel (UAP) the application of antiembolism stockings to a client who had an endarterectomy earlier in the day. Which UAP action requires the nurse to immediately intervene?

massages legs prior to application

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

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

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

paralytic ileus

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

prevent anxiety.

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?

prior to surgery

As a circulating nurse caring for a 45-year-old man undergoing left knee arthroscopic exploratory surgery, which task ensures that the team is on the same page and will perform the procedure on the right client and at the right site?

procedural pause (time-out)

When educating a client in the postoperative period, it is important to educate the client to consume a diet high in:

protein

A nurse is working with a group of clients in the preoperative area. Which client task would be the highest priority?

raising the stretcher side rails when administering a sedative

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

side-lying position

Who is legally responsible for obtaining the client's informed consent for a surgical procedure?

the surgeon

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

to lessen the intensity of an illness