Fundamentals Nursing Chapter 29 Perioperative Nursing

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

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.

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?

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

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?

Potential for hypothermia or hyperthermia

Which client would a nurse monitor most closely for postoperative respiratory complications?

a 55-year-old client with a history of asthma who had a colon resection

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

a client who is pale and diaphoretic with a heart rate of 115 beats/minute

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?

witnessing the client signature with their consent for surgery

The nurse is performing a preoperative assessment for a client prior to surgery in the morning. What statement made by the client alerts the nurse that there is a potential for latex allergy? Select all that apply.

• "I am allergic to bananas" • "I had a rash after using a condom." • "I broke out in hives after eating sliced avocado"

What information must be provided to a patient to obtain informed consent? (Select all that apply.)

• A description of the procedure or treatment, along with potential alternative therapies • The underlying disease process and its natural course • Explanation of the risks involved and how often they occur

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

• Diagnostic • Curative

The circulating nurse is caring for an older adult client undergoing removal of a liver tumor. The spouse is waiting in the family waiting area. Which actions by the nurse would be appropriate during the intraoperative phase? Select all that apply.

• Provide emotional support to the client and spouse immediately before the surgery. • Notify the client's spouse when the procedure is over. • Bring the client's spouse to be with the client as soon as possible.

Which personnel are legally responsible for obtaining the client's informed consent for a surgical procedure?

The surgeon

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?

"An advance directive will communicate your wishes for health care postoperatively in case you are unable to do so."

A client is in the preoperative area and states, "I am not sure about having surgery." What is the nurse's best response?

"Can you tell me what your feelings are about the surgery?"

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about leg exercises. When the client asks, "Why am I practicing leg exercises when I'm having hernia surgery", what is the appropriate nursing response?

"Doing this reduces your risk of developing blood clots."

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."

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about deep breathing. When the client asks, "Why am I practicing breathing when I'm having hernia surgery," what is the appropriate nursing response?

"It decreases the postoperative risk for respiratory complications."

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?

"Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery."

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 talking with a client who wishes to have a tattoo removed. Which client statement indicates that the client understands how the procedure will be accomplished?

"The provider will perform this laser surgery in an ambulatory care setting."

A client is undergoing a knee replacement tomorrow morning and is ordered nothing by mouth (n.p.o.) prior to surgery. The client asks the nurse how long before the procedure can water be taken in. Based on the nurse's knowledge of standard protocols, what is the nurse's best response?

2 hours

The operating room nurse is aware that which client is at greatest risk related to a surgical procedure?

A woman 83 years of age

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 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

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.

What is the best action for the nurse in determining return of peristalsis in the postoperative client?

Auscultate the bowel sounds.

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?

Conscious sedation

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?

Dehiscence

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

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

Emergency surgery

The nurse monitors the urine output of a postoperative client. The results of this assessment allow the nurse to monitor for signs of what complication?

Impaired tissue perfusion

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.

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.

Which surgical clients will return to activities in their everyday lives more quickly?

Laparoscopic cholecystectomy

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

Laryngospasm

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

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 (gall bladder 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 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.

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

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

Performing relaxation techniques

Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?

Place graduated compression stockings on the client.

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

Preoperative

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)

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

Relaxation techniques

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?

The client will be admitted the day of surgery and return home the same day.

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 patient undergoing minimally invasive surgery of the lower abdomen or pelvis?

Trendelenburg position

Which of the following factors 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

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

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

Which client most likely requires special preoperative assessment and treatment as a result of the existing medication regimen?

a woman who takes daily anticoagulants to treat atrial fibrillation

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

Surgery can lead to hypothermia. Which client is at greatest risk for hypothermia?

an older adult man with a fractured hip

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

before, during, and after the operative phase.

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 mm Hg, respirations 18 breaths per minute

A client is scheduled for surgery within the hour. Which assessment data requires immediate nursing intervention?

consumed a diet soda thirty minutes ago

The recovery nurse is caring for a surgical client in the PACU. The client's blood pressure is dropping and the heart rate is increasing. The nurse suspects the client is:

developing shock

A client scheduled for surgery has been taking aspirin since his heart attack in 1997. The client is at risk for:

hemorrhage

Which nursing action provides the greatest assistance in healing?

maintaining a restful environment

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

A client is undergoing conscious sedation for an endoscopy. When the client becomes overly sedated, which medication does the nurse anticipate will be required?

naloxone

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

partial airway obstruction

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

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 caring for an infant who is postoperative following cardiac surgery. What is the most common postoperative complication found in this age group?

respiratory complications

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

respiratory obstruction

A client is being discharged following surgery for cancer. The client will require extensive dressing changes 2 times per day but is on a fixed income and cannot afford to purchase dressing supplies. The nurse contacts a local non-profit agency to assist in the provision of dressings. What will this contribution of supplies assist the client with?

self-concept

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

A nurse is assisting a physician in an emergency surgery for a client with intestinal perforation. Which description is most suitable to the type of surgery performed?

surgery required immediately for survival

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

to lessen the intensity of an illness

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?

• What medications the patient is currently taking including over-the-counter supplements • If the client has had previous surgeries and any complications from surgery • Does the client abuse alcohol or any illicit drugs • Who will be accompanying the client and assisting postoperatively at home

Which clients would the nurse schedule for surgery based on purpose? Select all that apply.

• a client undergoing a breast biopsy • a client needing a cleft palate repair • a client needing a bowel resection • A client post mastectomy who decides to have breast reconstruction

The postanesthesia care unit (PACU) nurse has just received a client who underwent coronary artery bypass grafting (CABG). Which will the nurse assess while the client is in the PACU? Select all that apply.

• condition of incision • drains and drainage characteristics • ease of breathing • pain level • urine output

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

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

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