Chapter 17: Preoperative Nursing Management

For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? 1 3 5 7

7

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? 2 weeks 4 weeks 7 to 10 days 2 to 3 days

7 to 10 days

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? 80 to 110 mg/dL 150 to 240 mg/dL 250 to 300 mg/dL 300 to 350 mg/dL

80 to 110 mg/dL

Which domain of perioperative nursing practice focuses on clinical processes and outcomes? Health care systems Safety Behavioral responses Physiological responses

Health care systems

A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for? Dehydration Hypertension Hypoglycemia Glucosuria

Hypoglycemia

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 Distraction Progressive muscular relaxation

Imagery

A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? Pregnancy Diabetes Urinary tract infection Osteoporosis

Osteoporosis

In which phase of perioperative care will the nurse prepare the client's skin, encourage the client to void, and remove the client's dentures? preoperative postoperative intraoperative transoperative

Preoperative

Following diagnostic testing, a patient requires a cholecystectomy. This surgical procedure would be categorized as which of the following? Urgent Emergent Required Elective

Urgent

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

Use diaphragmatic breathing

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

emergency

A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which post-surgical risk factor would decrease if the surgical client maintained strict blood glycemic control? nutrient deficiencies respiratory complications wound healing liver dysfunction

wound healing

The nurse is aware that which of the following nutrients promotes normal blood clotting? Magnesium Vitamin C Zinc Vitamin K

Vitamin K

A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client? obstruction surgical site infection hypoglycemia adrenal insufficiency

adrenal insufficiency

The nurse recognizes that which of the following clients is at the lowest risk for perioperative complications? A client who takes prednisone A client who takes clopidogrel A client who has a history of arthritis A client recently diagnosed with type 2 diabetes

A client who has a history of arthritis

You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear? Anxiety and fear increases the need for anesthesia and postoperative medications. Anxious clients have a poor response to surgery and are prone to complications. Anxious clients need psychological counseling after surgery. Anxiety and fear can affect a client positively during and after surgery.

Anxious clients have a poor response to surgery and are prone to complications.

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

Emergent

A client with a skull fracture after falling from a ladder requires surgery. The nurse should anticipate transporting the client to surgery during what time frame? In 1 week In 48-72 hours In 1 day Immediately

Immediately

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 diabetes A history of sensitivity to aspirin A history of osteoarthritis A history of chronic low back pain

A history of diabetes

The nurse recognizes that the client most at risk for mortality associated with surgery is the: Client who is obese Client with chronic alcoholism Client with controlled diabetes Client with controlled hypertension

Client with chronic alcoholism

Which of the following activities are nursing activities in the preoperative phase of care? Select all that apply. Discussing and reviewing the advanced directive document Establishing an intravenous line Ensuring that the sponge, needle, and instrument counts are correct Administering medications, fluid, and blood component therapy, if prescribed Beginning discharge planning

Discussing and reviewing the advanced directive document Establishing an intravenous line Beginning discharge planning

The nurse is assigned a client scheduled for an outpatient colonoscopy in an ambulatory care setting. During which phase of perioperative care would the nurse document the admission vital signs in the recovery room? During the preoperative phase During the intraoperative phase During the transfer phase During the postoperative phase

During the postoperative phase

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

Emergent surgery

The nurse recognizes that written informed consent is required for insertion of a(n): Nasogastric tube. Urinary catheter. Peripherally-inserted central catheter. Oral airway.

Peripherally-inserted central catheter.

The nurse is educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate? Three phases of surgery and safety measures for each phase Intraoperative techniques used to perform the surgery Expected pain levels and narcotic medications used to treat the pain Risks and benefits of the surgical procedures

Three phases of surgery and safety measures for each phase

The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. Which of the following is the most important function? Completes preoperative assessment Develops a plan of care Verifies that operative consent is signed Provides psychological support

Verifies that operative consent is signed

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

A gastronomy tube

Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern? Anesthesiologist Circulating nurse Registered nurse first assistant Surgeon

Surgeon

The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed? "If I do not follow the instructions, my surgery could be cancelled." "The nurse will explain the details of the surgery before I sign a consent." "My medical records will be sent to the ambulatory care center prior to my surgery." "The physician will update my family after the procedure and provide specific discharge instructions."

"The nurse will explain the details of the surgery before I sign a consent."

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? 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. Tell the physician and anesthesiologist.

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

The nurse in the preoperative area has just medicated her client according to the anesthesiologist's orders. What is the nurse's priority action at this time? Place the side rails in the up position and make sure the call button is in reach. Take the client to the bathroom. Have the family go to the waiting room. Take the client's vital signs.

Place the side rails in the up position and make sure the call button is in reach.

The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery? Effective coughing and deep breathing Types of postoperative pain medication Post-discharge diet Knowledge of surgical procedure

Post-discharge diet

A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results? A blood urea nitrogen level of 42 mg/dL A creatine kinase level of 120 U/L A serum creatinine level of 0.9 mg/dL A urine creatinine level of 1.2 mmol/L

A blood urea nitrogen level of 42 mg/dL Normal BUN: 6-24 mg/dL Normal CK: 22-198 U/L Normal serum creatinine: 0.74-1.35 (men), 0.59-1.04 (women) Normal urine creatinine: 2.5-8.2 mmol/L

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for? A safe environment Restrictions of the patient's unassisted mobility activities Probable cataract extractions Referral to an ophthalmologist

A safe environment

Which would be considered to require an urgent surgical procedure? Loose facial skin Cataract Acute gallbladder infection Severe bleeding

Acute gallbladder infection

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? Pituitary Adrenal 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? 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. Remove the ring once the client is sedated.

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

At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period? During the preoperative period Upon arrival to the surgical unit Following the surgical procedure At the time of discharge instructions

During the preoperative period

What action by the nurse best encompasses the preoperative phase? Educating clients on signs and symptoms of infection Documenting the application of sequential compression devices (SCDs) Monitoring vital signs every 15 minutes Shaving the client using a straight razor

Educating clients on signs and symptoms of infection

A client asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate? It prevents overhydration and hypertension. It decreases urine output so that a catheter will not be needed. It prevents aspiration and respiratory complications. It decreases the risk of elevated blood sugar and slow wound healing.

It prevents aspiration and respiratory complications.

The nurse is conducting a preoperative assessment on a client scheduled for gallbladder surgery. The client reports a frequent cough producing green sputum for 3 days and denies fever. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiratory wheeze. Respiratory rate is 20, temperature is 99.8 (taken orally), heart rate is 87, and blood pressure is 124/70. What is the best action by the nurse? Notify the surgeon to possibly delay the surgery. Notify the primary physician about the assessment findings. Document the findings and continue moving the client through the preoperative phase. Wait 1 hour and complete the assessment again.

Notify the surgeon to possibly delay the surgery.

An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults? Aging processes reduce the chances that surgery will be successful for these clients. Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. All older people face similar risks when undergoing surgeries.

Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.

A client continuously repeats, "I know all will go well." What cognitive coping strategy should the nurse document? Imagery Optimistic self-recitation Distraction Music therapy

Optimistic self-recitation

A patient is scheduled for a reduction mammoplasty. What classification of surgery does the nurse understand that this is? Urgent Optional Required Necessary

Optional

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? Immediately upon admission Upon awakening in the postanesthesia care unit Up to 72 hours after alcohol withdrawal Up to 24 hours after alcohol withdrawal

Up to 72 hours after hours

A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for kidney stones the next day. What category of surgery does this procedure fall into? emergent urgent required elective

Urgent

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? Ensure that sufficient surgical supplies are available. Check that all surgical personnel are properly attired. Review the scheduled procedure, site, and client. Confirm that informed consent has been obtained.

Review the scheduled procedure, site, and client.

Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period? The 47-year-old client who stopped smoking 2 years ago. The 28-year-old client who occasionally smoked marijuana in high school. The 35-year-old client with non-insulin dependent diabetes. The 72-year-old client who takes no routine medications.

The 35-year-old client with non-insulin dependent diabetes.

A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse: continuously monitors the sedated client. performs a complete assessment of the client. obtains a surgical consent from the client's mother. assesses how well the client is recovering from anesthesia.

continuously monitors the sedated client.

The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. nutritional status age physical condition gender health status Ethnicity

nutritional status age physical condition health status

The nurse is teaching leg exercises to the client preoperatively. The client asks why the exercises are important. The best response by the nurse is: "Leg exercises help prevent blood clots in your legs." "Leg exercises help prevent pneumonia while you are on bed rest." "Your intestinal tract slows down following surgery, and the exercises will help restore normal intestinal activity." "Clients are often on bed rest following surgery, and the exercises can help prevent pressure ulcers."

"Leg exercises help prevent blood clots in your legs."

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? "You will be just fine; the operating room nurses will take good care of you." "It is best to take deep breaths and relax before the procedure." "Let me explain to you what will happen next." "We will keep your family informed of your progress."

"Let me explain to you what will happen next."

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? corticosteroids diuretics insulin anticoagulants

Diuretics

A client is preparing to undergo a curative surgical procedure. Which of the following is the type of surgery the client could be having? Select all that apply. Removal of a tumor Skin biopsy Mammoplasty Removal of a diseased appendix Insertion of a gastrostomy tube

Removal of a tumor Removal of a diseased appendix

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. Pain medication should be taken before completing deep breathing and coughing exercises. Deep breathing and coughing exercises should be completed every 8 hours. Deep breathing and coughing exercises may be used as relaxation techniques.

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

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

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 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. The client breathes in deeply through the nose and mouth.

The client exhales forcefully with a short expiration.

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

The patient participates willingly in the preoperative preparation.

At what point does the preoperative period end? When the decision is made to proceed with surgery When the client is transferred onto the operating table When the client is admitted to the PACU When the client signs the consent form

When the client is transferred onto the operating table

A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply. postoperative pain control cough and deep-breathing exercises the client's spouse's thoughts about the upcoming surgery the surgeon's fee and other hospital charges intravenous fluids and other lines and tubes

postoperative pain control cough and deep-breathing exercises intravenous fluids and other lines and tubes

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

preadmission visit

A client is scheduled to have surgery to address a cleft palate. What type of surgery would the nurse be preparing this client for? reconstructive corrective diagnostic prophylactic

reconstructive