Med Surg: Chapter 17

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." "Let me explain to you what will happen next." "It is best to take deep breaths and relax before the procedure." "We will keep your family informed of your progress."

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

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. - Document what foods the client ate. - Cancel the surgery. - Notify the surgeon.

- Notify the surgeon.

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 to 3 days 4 weeks 2 weeks 7 to 10 days

7 to 10 days

The nurse expects informed consent to be obtained for insertion of: An indwelling urinary catheterAn intravenous catheterA nasogastric tubeA gastrostomy tube

A gastrostomy tube

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 chronic low back pain A history of osteoarthritis

A history of diabetes

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

Adrenal

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? Anxious clients need psychological counseling after surgery. Anxiety and fear increases the need for anesthesia and postoperative medications. Anxious clients have a poor response to surgery and are prone to complications. 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.Anxiety and fear, if extreme, can affect a client's condition during and after surgery. Anxious clients have a poor response to surgery and are prone to complications. The scenario does not indicate an increased need for anesthesia or postoperative medications in the anxious and fearful client. Anxious clients do not generally need psychological counseling after surgery. Anxiety and fear do not affect a client positively during and after surgery.

The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following? Grilled salmon, rice pilaf, green beans, and cantaloupe Baked chicken, mashed potatoes, broccoli, and strawberries Cheeseburger, french fries, coleslaw, and ice cream Turkey breast, baked sweet potato, asparagus, and an orange

Cheeseburger, french fries, coleslaw, and ice cream

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

During the preoperative period

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

Educating clients on signs and symptoms of infection

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

Emergent

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

Emergent surgery

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

Hypoglycemia

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? All older people face similar risks when undergoing surgeries. Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. Aging processes reduce the chances that surgery will be successful for these clients. Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. SUBMIT ANSWER

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

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

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? Medicate the client and then remove the ring. Explain that the client cannot go into the operating room with jewelry on. Tell the physician and anesthesiologist. Place gauze under and over the ring and apply adhesive tape over it.

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

Which nursing assessment finding indicates the preoperative client has not met expected outcomes? Demonstrates how to use incentive spirometry. Discusses financial concerns with the social worker. Sobs uncontrollably about pending amputation of foot. Remains in bed after receiving preanesthetic medication.

Sobs uncontrollably about pending amputation of foot. Why? Expected outcomes for the preoperative client include demonstrating how to use incentive spirometry, remaining in bed after receiving preanesthetic medication, and discussing financial concerns with the social worker. The client who sobs uncontrollably about pending amputation of foot is coping ineffectively.

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 Registered nurse first assistant Circulating nurse Surgeon

Surgeon Why? It is the surgeon's responsibility to explain the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts in obtaining informed consent from the client.

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 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 physician is repairing a deformity from birth or disease process.

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

At what point does the preoperative period end?

When the client is transferred onto the operating table

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

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as

emergency

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. health status gender Ethnicity physical condition nutritional status age

nutritional status age physical condition health status

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

osteoporosis -pregnancy decreases reserves-diabetes impairs wound healing-UTI decreases immu

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 white blood cell count 7.2 cells/mm calcium 9.8 mg/dL potassium 6.2 mEq/L

potassium 6.2 mEq/L

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

wound healing

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."

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? "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." "If I do not follow the instructions, my surgery could be cancelled." "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."

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

7

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

80 to 110 mg/dL

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

A blood urea nitrogen level of 42 mg/ dl

In preparing the client for transfer to the operating room, which of the following actions by the nurse is inappropriate? Allow the client to wear dentures. Remove all jewelry. Have the client void. Have client wear hospital gown.

Allow the client to wear dentures.

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? Take the client's vital signs. Have the family go to the waiting room. Take the client to the bathroom. Place the side rails in the up position and make sure the call button is in reach.

Answer: Place the side rails in the up position and make sure the call button is in reach.Why? Immediately after giving the medications, the nurse instructs the client to remain in bed; he or she places side rails in the up position and ensures that the call button is within easy reach. Once the client has been preoperatively medicated you do not get them up to the bathroom. The nurses' immediate responsibility after preoperatively medicating the client is not to take the clients' vital signs or to send the family to the waiting room.

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

Preadmission visit

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? Deep breathing and coughing exercises should be completed every 8 hours. Pain medication should be taken before completing deep breathing and coughing exercises. Splint the incision site using a pillow during 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 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 breathes in deeply through the nose and mouth. The client exhales forcefully with a short expiration.

The client exhales forcefully with a short expiration.

When does the nurse understand the patient is knowledgeable about the impending surgical procedure? 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.

The patient participates willingly in the preoperative preparation.

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.

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. Intraoperative care includes the entire surgical procedure. During sedation, the nurse continuously evaluates the client. Assessment of heart rate, respiratory rate, BP, oxygen saturation, and level of consciousness occurs during all phases of perioperative care. Obtaining consent would occur during the preoperative phase of perioperative care. During the postoperative phase the nurse would assess how the client is recovering from anesthesia.