Chapter 14 Preoperative Nursing Management

A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective? "The pain from my incision will be very similar to my arthritis pain." "I will ask for pain medication when the pain becomes unbearable." "I will support my incision with my hands when I cough and do my deep breathing exercises." "I will need to learn how to give myself pain medication by injection for when I go home."

"I will support my incision with my hands when I cough and do my deep breathing exercises."

A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery? 4 weeks 2 weeks 2 to 3 days 7 to 10 days

7 to 10 days

The nurse is caring for a client who has just arrived for surgery. Which assessment finding indicates to the nurse that the client may be experiencing dehydration because of taking nothing by mouth after midnight for the surgery? Pulse 88 beats per minute Blood pressure 80/50 mm Hg Urine output 60 mL/hr Respiratory rate 20 breaths per minute

Blood pressure 80/50 mm Hg

The nurse is completing a preoperative assessment with an older adult. Which preoperative testing will the nurse anticipate being used to determine the client's risk of developing cardiovascular complications from anesthesia? Select all that apply. Basic metabolic panel Electrocardiogram Blood pressure screening Cardiac catheterization Echocardiogram

Blood pressure screening Electrocardiogram Basic metabolic panel

Which is the least important issue concerning safety for the perioperative team before proceeding to the operating room? Surgical site Client identification Surgical procedure Client's ambulatory aids

Client's ambulatory aids

A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia? anticoagulants corticosteroids insulin diuretics

Diuretics

Which of the following nursing activities would not be part of the preoperative phase of care? Select all that apply. Beginning discharge planning Discussing and reviewing the advanced directive document Ensuring that the sponge, needle, and instrument counts are correct Administering medications, fluid, and blood component therapy, if prescribed Establishing an intravenous line

Ensuring that the sponge, needle, and instrument counts are correct Administering medications, fluid, and blood component therapy, if prescribed

An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used? Imagery Optimistic self-recitation Progressive muscular relaxation Distraction

Imagery

When is the ideal time to discuss preoperative teaching When the patient is comfortable and sedated Preadmission visit Prior to entering the pre-op area Day of surgery

Preadmission visit

A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate? Notify the nurse manager of the client's questions. Place the consent form in the client's medical record. Answer the client's questions. Request that the surgeon come and answer the questions.

Request that the surgeon come and answer the questions

Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out? Check that all surgical personnel are properly attired. Ensure that sufficient surgical supplies are available. Confirm that informed consent has been obtained. Review the scheduled procedure, site, and client.

Review the scheduled procedure, site, and client

A client is scheduled for a spinal fusion to treat spinal stenosis. For which reason might the nurse anticipate surgery being delayed because of the risk for postoperative complications? Hematocrit level 43% BMI 23 Blood pressure 116/80 mm Hg Smoking

Smoking

The nurse is caring for the client in the preoperative period and documenting rationale for a palliative surgical procedure. Which rationale is appropriate? The physician is repairing a deformity from birth or disease process. The client wishes to improve body structures and elects a procedure. The client and physician are focusing on symptom relief not a cure. The physician needs additional information to plan medical treatment.

The client and physician are focusing on symptom relief not a cure

A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed? The client exhales forcefully with a short expiration. The client breathes in deeply through the nose and mouth. The client places the hands on the lower chest to feel the rise and fall with breathing. The client performs diaphragmatic breathing in a semi-Fowler's position.

The client exhales forcefully with a short expiration

When does the nurse understand the patient is knowledgeable about the impending surgical procedure? The patient verbalizes fears to family. The patient discusses stress factors causing the patient to feel depressed. The patient participates willingly in the preoperative preparation. The patient expresses concern about postoperative pain.

The patient participates willingly in the preoperative preparation

The nurse is educating a community group about types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true? Placement of gastrostomy tube Tumor excision A biopsy A face-lift

Tumor excision

The nurse would identify which vitamin deficiency to prevent hemorrhaging during surgery? Zinc Vitamin A Magnesium Vitamin K

Vitamin K

A nurse is caring for a bariatric client prior to a surgical procedure. What surgical complications would the nurse monitor the bariatric client for postoperatively? Select all that apply. gastrointestinal complications nervous system complications renal complications pulmonary complications cardiovascular complications

cardiovascular complications, pulmonary complications

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as required. elective. urgent. emergency.

emergency

The nurse expects informed consent to be obtained for insertion of: A gastrostomy tube An indwelling urinary catheter A nasogastric tube An intravenous catheter

A gastrostomy tube

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? Adrenal Pituitary Thyroid Parathyroid

Adrenal

A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? Remove the ring once the client is sedated. Discuss the risk for infection caused by wearing the ring. Allow the client to wear the ring and cover it with tape. Notify the surgeon to cancel surgery.

Allow the client to wear the ring and cover it with tape

A gunshot wound would be classified under which category of surgery based on urgency? Emergent Urgent Elective Required

Emergent

Informed consent from the surgical client is essential in all of the following categories of surgery except: Emergent surgery Required surgery Elective surgery Urgent surgery

Emergent surgery

Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery? Case manager Physician Certified nurse's aide Nurse

Physician

You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility? Place gauze under and over the ring and apply adhesive tape over it. Tell the physician and anesthesiologist. Explain that the client cannot go into the operating room with jewelry on. Medicate the client and then remove the ring.

Place gauze under and over the ring and apply adhesive tape over it

A client scheduled for surgery asks why blood tests are being done to evaluate liver function. Which response will the nurse make? "It is just a routine test done before every surgery." "It is done to determine if you need antibiotics prior to surgery." "It is because the anesthesia you will receive is cleared through the liver." "It is to make sure that you haven't had any alcohol before the surgery."

"It is because the anesthesia you will receive is cleared through the liver."

You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply? "Many people have diagnostic or short therapeutic surgical procedures." "Lots of people have cancer and need tumors removed." "You know, we have a lot of sick people in the world." "Not everyone has to go to the hospital to have surgery anymore."

"Many people have diagnostic or short therapeutic surgical procedures."

A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery? A history of osteoarthritis A history of diabetes A history of sensitivity to aspirin A history of chronic low back pain

A history of diabetes

The policies and procedures on a preoperative unit are being amended to bring them closer into alignment with the focus of the Surgical Care Improvement Project (SCIP). What intervention most directly addresses the priorities of the SCIP? Actions aimed at increasing participation of families in planning care Actions aimed at preventing surgical site infections Actions aimed at promoting the use of complementary and alternative medicine (CAM) Actions aimed at increasing interdisciplinary collaboration

Actions aimed at preventing surgical site infections

A client with osteoarthritis receives a recommendation to have joint replacement surgery. For which type of surgery will the nurse plan teaching for this client? Urgent Required Elective Emergent

Elective

A client scheduled for surgery has a blood pressure of 186/90 mm Hg. After documenting this in the medical record, which action will the nurse take? Inform the operating room of the blood pressure when the client arrives. Notify the health care provider of the blood pressure. Provide preoperative medications early. Document the blood pressure in the medical record.

Notify the health care provider of the blood pressure

A client is undergoing preoperative assessment. During admission paperwork, the client reports having enjoyed a hearty breakfast this morning to be ready for the procedure. What is the nurse's next action? Give the client plenty of water to aid digestion. Cancel the surgery. Document what foods the client ate. Notify the surgeon.

Notify the surgeon

The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which laboratory value would be of greatest concern to the nurse? sodium 138 mEq/L potassium 6.2 mEq/L calcium 9.8 mg/dL white blood cell count 7.2 cells/mm

potassium 6.2 mEq/L

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? Splint the incision site using a pillow during deep breathing and coughing exercises. Deep breathing and coughing exercises should be completed every 8 hours. Pain medication should be taken before completing deep breathing and coughing exercises. Deep breathing and coughing exercises may be used as relaxation techniques.

Splint the incision site using a pillow during deep breathing and coughing exercises

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply. The client will leave the hospital sooner than in the past. Discharge planning is minimal because the stay is so short. Need for teaching is increased. The client must be prepared to take on more self-care than he or she may have done in the past. Home care and other referrals are unlikely because same-day surgeries are usually minor.

The client will leave the hospital sooner than in the past. Need for teaching is increased. The client must be prepared to take on more self-care than he or she may have done in the past.

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period? Up to 72 hours after alcohol withdrawal Upon awakening in the postanesthesia care unit Up to 24 hours after alcohol withdrawal Immediately upon admission

Up to 72 hours after alcohol withdrawal

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? Use diaphragmatic breathing. Make inhalation longer than exhalation. Use chest breathing. Exhale through an open mouth.

Use diaphragmatic breathing

A client will undergo abdominal surgery. The nurse provides preoperative education regarding the importance of diaphragmatic breathing exercises to prevent postoperative complications. Drag words from the choices below to fill in each blank in the following sentence. The nurse will educate the client about the risk for developing ________,_________,__________ if the client does not implement diaphragmatic breathing exercises in the postoperative period of care.

atelectasis, pneumonia, bronchospasm