Prep U ch. 17
A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply. - intravenous fluids and other lines and tubes - cough and deep-breathing exercises - postoperative pain control - 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 - cough and deep-breathing exercises - postoperative pain control
An example of a curative surgical procedure is - tumor excision. - placement of gastrostomy tube. - a biopsy. - a face-lift.
- tumor excision.
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? - nutrient deficiencies - liver dysfunction - respiratory complications - wound healing
- wound healing
manifestations of latex allergy
-allergic to kiwi, avocado, banana -cannot blow up balloons
Perioperative nursing
-crucial: communication, teamwork, patient assessment -consists of 2 phases that being & end at particular points: a. Preoperative phase b. Intraoperative phase c. Postoperative phase -4 domains of nursing practice by the Perioperative Nursing Data Set: 1) safety 2) physiologic response 3) behavioral response 4) health care systems
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 -age -nutritional status -physical condition
Genetic conditions that may cause complications with anesthesia
-malignant hyperthermia -central core disease -Duchenne muscular dystrophy -Hyperkalemic periodic paralysis -King-Denoborough syndrome
Minimally invasive surgery
-surgical procedures that use specialized instruments inserted into the body -enables many surgeries to be performed on an outpatient basis
To prepare for surgery, all patients require a comprehensive
1) preoperative nursing assessment 2) Patient education 3) Nursing interventions to prepare for surgery
Valid informed consent
1. voluntary consent: must be without coercion, must be at least 18 years old -incompetent patient= not autonomous to withhold consent 2. informed subject: should be in writing a. explanation of procedure & risks b. benefits & alternatives c. offer to answer questions about procedure d. instructions that the patient may withdraw consent e. informing patient that protocol differs 3. patient able to comprehend
For the patient who is taking aspirin, it is important to stop taking this medication at least how many day(s) prior to surgery?
7
A patient having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the patient stop taking the aspirin before the surgery?
7 to 10 days
The on-call perioperative team is called for an urgent surgery to be performed as soon as they arrive. What surgical procedure is considered emergent?
A repair of multiple stab wounds
The nurse expects informed consent to be obtained for insertion of: a) An intravenous catheter b) An indwelling urinary catheter c) A nasogastric tube d) A gastrostomy tube
A gastrostomy tube Explanation: Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.
Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? - "Let me explain to you what will happen next." - "We will keep your family informed of your progress." - "It is best to take deep breaths and relax before the 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."
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."
Which question is most important for the nurse to ask the client when obtaining the preoperative admission history? - "Who is here with you?" - "Did you bring any valuables with you?" - "Did you bring a copy of your health care power of attorney?" - "When is the last time you ate or drank?"
- "When is the last time you ate or drank?"
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? - 7 to 10 days - 2 to 3 days - 4 weeks - 2 weeks
- 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 - 300 to 350 mg/dL - 150 to 240 mg/dL - 250 to 300 mg/dL
- 80 to 110 mg/dL
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
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 sensitivity to aspirin - A history of osteoarthritis - A history of diabetes - A history of chronic low back pain
- A history of diabetes
A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign? - Urethral catheterization - An open reduction of a fracture - An insertion of an intravenous catheter - Irrigation of the external ear canal
- An open reduction of a fracture
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 - Turkey breast, baked sweet potato, asparagus, and an orange - Baked chicken, mashed potatoes, broccoli, and strawberries - Cheeseburger, french fries, coleslaw, and ice cream
- Cheeseburger, french fries, coleslaw, and ice cream
The client is scheduled for a biopsy for suspected cancer of the prostate. The nurse recognizes the purpose of this surgical procedure is: - Reparative - Diagnostic - Curative - Palliative
- Diagnostic
At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period? - Following the surgical procedure - During the preoperative period - At the time of discharge instructions - Upon arrival to the surgical unit
- During the preoperative period
What action by the nurse best encompasses the preoperative phase? - Shaving the client using a straight razor - Educating clients on signs and symptoms of infection - Documenting the application of sequential compression devices (SCDs) - Monitoring vital signs every 15 minutes
- Educating clients on signs and symptoms of infection
In which instance may a surgeon operate without informed consent? - Radiologic procedures - Emergency situations - Invasive procedures - Procedures requiring sedation
- Emergency situations
A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for? - Dehydration - Glucosuria - Hypertension - Hypoglycemia
- Hypoglycemia
A nurse knows that she must obtain a signed informed consent for which of the following procedures? Select all that apply. - Open reduction of a fracture - Arteriography - Cystoscopy - Insertion of a peripheral intravenous line - Insertion of a urethral catheter - Paracentesis
- Open reduction of a fracture - Arteriography - Cystoscopy - Paracentesis
A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? - Diabetes - Osteoporosis - Urinary tract infection - Pregnancy
- Osteoporosis
When is the ideal time to discuss preoperative teaching - Pre-admission visit - Day of surgery - When the patient is comfortable and sedated - Prior to entering the pre-op area
- Pre-admission visit
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. - Skin biopsy - Insertion of a gastrostomy tube - Removal of a diseased appendix - Removal of a tumor - Mammoplasty
- Removal of a diseased appendix - Removal of a tumor
When does the nurse understand the patient is knowledgeable about the impending surgical procedure? - The patient participates willingly in the preoperative preparation. - The patient expresses concern about postoperative pain. - 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 nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is: - To notify the surgeon - To have the client sign the consent immediately - For the nurse to sign the consent with verbal permission of the client - To have the client's next of kin sign the consent
- To notify the surgeon
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? - Tumor excision - A face-lift - Placement of gastrostomy tube - A biopsy
- Tumor excision
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 - Up to 24 hours after alcohol withdrawal - Immediately upon admission - Upon awakening in the post-anesthesia care unit
- Up to 72 hours after alcohol withdrawal
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as - required. - elective. - emergency. - urgent.
- emergency.
The nurse assesses a client to determine if there is increased risk for complications intra-operatively or postoperatively. Which are general risk factors? Select all that apply. - health status - physical condition - gender - Ethnicity - nutritional status - age
- health status - physical condition - nutritional status - age
In advance of a client's scheduled appendectomy, the nurse spends significant time explaining to the client what will happen, both before the procedure and after the procedure is complete. The primary reason the nurse puts so much effort into preoperative teaching is to: - absolve the hospital of legal responsibility should complications arise. - increase the likelihood of a successful recovery. - minimize the time that will need to be spent on postoperative questions. - decrease the client's participation and allow the family to take on the caregiver role.
- increase the likelihood of a successful recovery.
Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? - Pituitary - Thyroid - Parathyroid - Adrenal
- Adrenal
before any surgical treatment, obtain
-health history, physical examination (vital signs), database for future comparisons -joint mobility= affect patient in surgery -genetic considerations = to prevent complications with anesthesia -ask patient about use of prescription & OTC & herbal supplements -activity level -known allergies -sign of abuse -blood test, x-rays, diagnostic tests
A patient having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the patient stop taking the aspirin before the surgery?
7 to 10 days -Aspirin, a common OTC medication that inhibits platelet aggregation, should be prudently discontinued 7 to 10 days before surgery; otherwise, the patient may be at increased risk for bleeding
The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician? - When the patient's blood ammonia concentration reaches 180 mg/dL - When a lactate dehydrogenase concentration is 300 units - When a serum albumin concentration is 5.0 g/dL - When a serum globulin concentration reaches 2.8 g/dL
Correct response: When the patient's blood ammonia concentration reaches 180 mg/dL Explanation: The liver is important in the biotransformation of anesthetic compounds. Disorders of the liver may substantially affect how anesthetic agents are metabolized. Acute liver disease is associated with high surgical mortality; preoperative improvement in liver function is a goal. Careful assessment may include various liver function tests (see Chapter 49).
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? a) Place gauze under and over the ring and apply adhesive tape over it. b) Tell the physician and anesthesiologist. c) Medicate the client and then remove the ring. d) Explain that the client cannot go into the operating room with jewelry on.
Place gauze under and over the ring and apply adhesive tape over it. Correct Explanation: If the client is reluctant to remove a wedding band, the nurse may slip gauze under the ring, then loop the gauze around the finger and wrist or apply adhesive tape over a plain wedding band. You would not tell the client that he or she cannot go to the operating room wearing the ring. You would never medicate the client and then remove the ring against his or her will. It is not necessary to tell the physician and the anesthesiologist that the client does not want to remove the wedding band.
When a person with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the patient may show signs of alcohol withdrawal delirium during which time period?
Up to 72 hours after alcohol withdrawal
Postoperative phase
begins with the admission of the patient to the PACU & ends with a follow-up evaluation in the clinical setting/ home 1) transfer of patient to post-anesthesia care unit 2) postoperative assessment recovery area 3) surgical nursing unit 4) home/clinic
When the patient is encouraged to concentrate on a pleasant experience or restful scene, the cognitive coping strategy being employed by the nurse is a) distraction. b) progressive muscular relaxation. c) imagery. d) optimistic self-recitation.
imagery Correct Explanation: Imagery has proven effective for oncology patients. Optimistic self-recitation is practiced when the patient is encouraged to recite optimistic thoughts such as, "I know all will go well." Distraction is employed when the patient is encouraged to think of an enjoyable story or recite a favorite poem. Progressive muscular relaxation requires contracting and relaxing muscle groups and is a physical coping strategy as opposed to a cognitive strategy
Informed consent
patient's autonomous decision about whether to undergo a surgical procedure -voluntary & written informed consent from patient is necessary before non-emergent surgery -to protect patient from unsanctioned surgery & protect surgeon -legal mandate -helps the patient prepare psychologically (ensure & understand surgery) -surgeon's responsibility to provide a clear & simple explanation of what the surgery will entail prior to patient giving consent (must inform benefits, alternatives, possible risks, complications, disfigurement, disability, removal of body parts, what to expect postoperatively) --> nurse: clarifies information & notifies physician
An example of a curative surgical procedure is a) a face-lift. b) a biopsy. c) the excision of a tumor. d) the placement of gastrostomy tube.
the excision of a tumor. Explanation: An example of a curative surgical procedure is the excision of a tumor. A biopsy, face-lift, and the placement of a gastrostomy tube are not examples of curative surgical procedures.
A patient refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?
Allow the ring to stay on the patient and cover it with tape.
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?
Cheeseburger, french fries, coleslaw, and ice cream
A fractured skull would be classified under which category of surgery based on urgency? - Elective - Required - Urgent - Emergent
Correct response: Emergent Explanation: Emergent surgery occurs when the client requires immediate attention. An elective surgery is classified as a surgery that the client should have. A required surgery means that the client needs to have surgery. An urgent surgery occurs when the client requires prompt attention.
A gunshot wound would be classified under which category of surgery based on urgency? a) Urgent b) Required c) Elective d) Emergent
Emergent Explanation: Emergent surgery occurs when the patient requires immediate attention. An elective surgery is classified as a surgery that the patient should have. A required surgery means that the patient needs to have surgery. An urgent surgery is one which the patient required prompt attention.
You are caring for a client postoperatively. What nursing interventions help prevent venous stasis and other circulatory complications in a client who has undergone surgery?
Encourage the client to move legs frequently and do leg exercises. -The nurse should encourage the client to move legs frequently and do leg exercises to prevent venous stasis and other circulatory complications. The nurse should not place pillows under the client's knees or calves unless ordered and should avoid placing pressure on the client's lower extremities. Placing the client in a side-lying position will not help prevent venous stasis and other circulatory complications in a client who has undergone surgery.
The nurse concludes that further teaching about diaphragmatic breathing is needed when the client:
Exhales forcefully with a short expiration
The nurse concludes that further teaching about diaphragmatic breathing is needed when the client:
Exhales forcefully with a short expiration - Diaphragmatic breathing should be performed gently and fully.
The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of: Laryngospasm Hyperventilation Hypoxemia and hypercapnia. Pulmonary edema and embolism.
Hypoxemia and hypercapnia. Explanation: The primary objective in the immediate postoperative period is to maintain pulmonary ventilation and thus prevent hypoxemia and hypercapnia. Both can occur if the airway is obstructed and ventilation is reduced. Besides checking the health care provider's orders for and administering supplemental oxygen, the nurse assesses respiratory rate and depth, ease of respirations, oxygen saturation, and breath sounds.
A 57-year-old client is undergoing preoperative assessment before surgical repair of a fractured ulna. During admission paperwork, the client reveals that she enjoyed a hearty breakfast this morning to be ready for her procedure. What is the nurse's next action?
Notify the surgeon. -If the client has not carried out a specific portion of preoperative instructions, such as withholding foods and fluids, the nurse immediately notifies the surgeon. Do the preoperative instructions allow food intake before this procedure? This scenario does not include information to support this nursing action. It is not the nurse's responsibility to cancel the surgery
An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position?
On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle - The Trendelenburg position usually is used for surgery on the lower abdomen and pelvis to obtain good exposure by displacing the intestines into the upper abdomen. In this position, the head and body are lowered. The patient is held in position by padded shoulder braces.
A patient is scheduled to have a cholecystectomy. Which of the nurse's finding is least likely to contribute to surgical complications?
Osteoporosis -Osteoporosis is most likely not going to contribute to complications related to a cholecystectomy. Pregnancy decreases maternal reserves. Diabetes increases wound-healing problems and risks for infection. Urinary tract infection decreases the immune system, increasing the chance for infections
The nurse recognizes that written informed consent is required for insertion of a(n):
Peripherally-inserted central catheter.
The nurse recognizes that written informed consent is required for insertion of a(n): a) Peripherally-inserted central catheter. b) Nasogastric tube. c) Oral airway. d) Urinary catheter.
Peripherally-inserted central catheter. Explanation: Nonsurgical invasive procedures, such as insertion of a peripherally-inserted central catheter, that carry more than a slight risk to the client require written informed consent.
Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery?
Physician -It is the physician's responsibility to provide appropriate information. It is not the responsibility of the nurse, case manager, or certified nurse's aide to gain informed 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?
Place gauze under and over the ring and apply adhesive tape over it.
The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which of the following values would be of greatest concern to the nurse?
Potassium 6.2 mEq/L
The nurse recognizes that the client who takes hydrochlorothiazide (HydroDIURIL) to manage hypertension is predisposed for which interaction with anesthesia?
Respiratory depression
As a nurse working in an ambulatory surgery center, you are admitting a client who is going to have a biopsy of a skin lesion. What is an important part of the preoperative process? a) Review preoperative instructions. b) Give caregiver instructions. c) Teach dressing changes. d) Give postoperative instructions.
Review preoperative instructions. Explanation: On admission, the nurse reviews preoperative instructions, such as diet restrictions and skin preparations, to ensure the client has followed them. The preoperative nurse does not give postoperative instructions; teach dressing changes or give instructions to caregivers
Which of the following consequences may result if tranquilizers are withdrawn suddenly? a) Respiratory depression b) Cardiovascular collapse c) Hypotension d) Seizures
Seizures Explanation: Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly. Abrupt withdrawal of steroids may precipitate cardiovascular collapse. Monoamine oxidase inhibitors increase the hypotensive effects of anesthetics. Thiazide diuretics may cause excessive respiratory depression during anesthesia due to an associated electrolyte imbalance.
A patient 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.
The nurse is aware that the amino acid, arginine, a) Is essential for antibody formation b) Is involved in capillary formation c) Stimulates T-cell response d) Is important for normal blood clotting
Stimulates T-cell response Explanation: Arginine is necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response.
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? a) Registered nurse first assistant b) Circulating nurse c) Surgeon d) Anesthesiologist
Surgeon Explanation: 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 planning care for a client following abdominal surgery. Which outcome demonstrates a return of functioning to the gastrointestinal tract? a) The client states being hungry. b) The client is tolerating sips of water. c) The client is passing flatus. d) The client reports a small bowel movement.
The client reports a small bowel movement. Explanation: A bowel movement demonstrates that the nursing outcome of the return to function of the gastrointestinal track has been met. All of the other options are components of meeting the outcome of functioning.
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
The client with chronic alcoholism who experiences alcohol withdrawal symptoms is at significant risk for mortality, which can be attributed to cardiac dysrthymias, cardiomyopathy, and bleeding tendencies.
The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is:
To notify the surgeon
The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is: a) To notify the surgeon b) For the nurse to sign the consent with verbal permission of the client c) To have the client sign the consent immediately d) To have the client's next of kin sign the consent
To notify the surgeon Explanation: Preoperative medication can impair the thinking ability of the client. FFor informed consent to be valid, the client must be competent to give consent. The surgery will be canceled.
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?
Use diaphragmatic breathing.
At what point does the preoperative period end?
When the client is transferred onto the operating table
Preoperative phase
begins when the decision to proceed with surgical intervention is made & ends with transfer of the patient onto the OR (operating room) bed 1) PAT - readmission testing 2) Admission to surgical center 3) In the holding area
Intraoperative phase
begins when the patient is transferred onto the OR bed & ends with admission to the PACU -nursing responsibilities: a. acting as scrub nurse b. circulating nurse c. registered nurse first assistant 1) maintenance of safety 2) physiologic monitoring 3) psychologic support
if the surgical patient is currently using beta-blockers.
particular attention is given to ensure timely administration of the beta-blocker & appropriate monitoring of vital signs
Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery?
physician
An example of a curative surgical procedure is
the excision of a tumor. -An example of a curative surgical procedure is the excision of a tumor. A biopsy, face-lift, and the placement of a gastrostomy tube are not examples of curative surgical procedure
Emergency surgeries
unplanned & occur with little time for preparation of patient/ perioperative team
Which question is most important for the nurse to ask the client when obtaining the preoperative admission history?
when is the last time you ate or drank
Choice Multiple question - Select all answer choices that apply. Which of the following nursing activities would not be part of the preoperative phase of care? Select all that apply. a) Beginning discharge planning b) Establishing an intravenous line c) Ensuring that the sponge, needle, and instrument counts are correct d) Administering medications, fluid, and blood component therapy, if prescribed e) 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 Explanation: Of the activities listed, discussing and reviewing the advanced directive document, establishing an intravenous line, and beginning discharge planning are preoperative nursing activities.
Several of the clients at the clinic are preparing to have surgery within the next 2 weeks. They are completing preoperative paperwork today with their visit. What are some of the reasons that people might need to have surgery? Select all that apply. a) Palliative b) Normative c) Cosmetic d) Diagnostic e) Causative
• Palliative • Cosmetic • Diagnostic Correct Explanation: Reasons people have surgery include cosmetic reasons, diagnostic procedures, palliative surgeries, exploratory surgeries, and curative surgeries. Options D and E are distractors.
A patient with a history of alcoholism and scheduled for an urgent surgery asks the nurse, "Why is everyone so concerned about how much I drink?" What is the best response by the nurse?
"It is important for us to know how much and how often you drink to help prevent surgical complications." Correct - Alcohol use and alcoholism can contribute to serious postoperative complications. If the medical and nursing staff is aware of the use or abuse, measures can be implemented proactively to prevent complications. Although alcohol may interfere with a medication's effectiveness, it does not determine the amount of pain medications that are prescribed following surgery. Even though this is a required screening question and counselors can be made available for those who want help, those are not the best responses to answer the patient's question.
Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? a) "Let me explain to you w8hat will happen next." b) "You will be just fine; the operating room nurses will take good care of you." c) "It is best to take deep breaths and relax before the procedure." d) "We will keep your family informed of your progress."
"Let me explain to you w8hat will happen next." Correct Explanation: Many clients feel fearful of knowing little about the operative procedure and what to expect. This fear causes anxiety and can lead to a poorer response to surgery and surgical complications. Explanations of what the client is to expect can help to decrease anxiety. False reassurance of being fine does not diminish anxiety. Deep breathing and relaxation techniques can be helpful to the client, but addressing the source of the anxiety is more beneficial. Keeping the family informed helps the family and is not client focused.
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."
A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective? - "I will support my incision with my hands when I cough and do my deep breathing exercises." - "The pain from my incision will be very similar to my arthritis pain." - "I will need to learn how to give myself pain medication by injection for when I go home." - "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."
The parent of a 16-year-old client asks the nurse, "How could the surgeon operate without my consent?" What is the best response by the nurse? - "We obtained consent from your child after your child requested the surgery." - "Your child had life-threatening injuries that required immediate surgery." - "The surgical procedure being performed does not require consent." - "Two doctors decided your child needed the surgery, therefore we did not need to get consent."
- "Your child had life-threatening injuries that required immediate surgery."
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 blood urea nitrogen level of 42 mg/dL - A urine creatinine level of 1.2 mg/dL
- A blood urea nitrogen level of 42 mg/dL
The on-call peri-operative team is called for an urgent surgery to be performed as soon as they arrive. What surgical procedure is considered emergent? - A repair of multiple stab wounds - A face lift - An exploratory laparotomy - Removal of kidney stones
- A repair of multiple stab wounds
A physically fit 86-year-old is scheduled for right knee replacement. Which factor the client at increased risk for complications during or after surgery? - Ability to metabolize medication - Nutritional status - Type of surgery - Age
- Age
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 client wear hospital gown. - Have the client void.
- Allow the client to wear dentures.
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. - Anxiety and fear can affect a client positively during and after surgery. - Anxious clients need psychological counseling after surgery.
- Anxious clients have a poor response to surgery and are prone to complications.
A client asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate? - It prevents over-hydration 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.
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.
An obese client is scheduled for open abdominal surgery. What priority education should the nurse provide to this client? - Prevention of respiratory complications - Prevention of wound dehiscence - Prevention of venous thromboembolism - Wound care and infection prevention
- Prevention of respiratory complications
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? - Request that the surgeon come and answer the questions. - Answer the client's questions. - Notify the nurse manager of the client's questions. - Place the consent form in the client's medical record.
- Request that the surgeon come and answer the questions.
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? - Pain medication should be taken before completing deep breathing and coughing exercises. - Deep breathing and coughing exercises should be completed every 8 hours. - 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.
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? - Circulating nurse - Anesthesiologist - Registered nurse first assistant - Surgeon
- Surgeon
The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure? - Up to 6 hours before surgery - Up to 8 hours before surgery - Up to 4 hours before surgery - Up to 2 hours before surgery
- Up to 2 hours before surgery
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? - Use diaphragmatic breathing. - Use chest breathing. - Make inhalation longer than exhalation. - Exhale through an open mouth.
- Use diaphragmatic breathing.
Surgical complications risk factors
- hypovolemia -dehydration/ electrolyte imbalance -nutritional deficit -extremes of age -extremes of weight -infection & sepsis -toxic conditions -immunologic abnormalities -pulmonary disease (obstructive/restrictive disorder/ respiratory infection) -pregnancy -cardiovascular disease: a. coronary artery disease/ myocardial infection b. cardiac failure c. dysrhythmias d. hypertension e. prosthetic heart valve f. thromboembolism g. hemorrhagic disorder h. cerebrovascular diseases -endocrine dysfunction (diabetes, adrenal disorder, thyroid malfunction) -hepatic disease (cirrhosis, hepatitis) -pre-existing mental/physical disability
The nurse is caring for a patient who is obese prior to a surgical procedure. What surgical complications positively correlated with obesity should the nurse monitor for? (Select all that apply.)
-Cardiovascular system -GI system -Pulmonary system
Circumstances that informed consent is necessary
1) Invasive procedures e.g. surgical incision, biopsy, cystoscope, paracentesis 2) procedures requiring sedation/ anesthesia 3) nonsurgical procedure e.g. arteriography that carriers more than a slight risk to the patient 4) Procedures involving radiation
For the patient who is taking aspirin, it is important to stop taking this medication at least how many day(s) prior to surgery? a) 1 b) 5 c) 7 d) 3
7 Explanation: Aspirin should be stopped at least 7 to 10 days before surgery. The other timeframes are incorrect. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 17: Preoperative Nursing Management, p. 411. Chapter 17: Preoperative Nursing Management - Page 411
The nurse recognizes that which of the following clients is at least risk for perioperative complications? a) A 32-year-old African-American woman who takes prednisone b) A 76-year-old Asian man who takes clopidogrel (Plavix) c) A 45-year-old African-American man recently diagnosed with type 2 diabetes d) A 65-year-old Caucasian man who has a history of arthritis
A 65-year-old Caucasian man who has a history of arthritis Explanation: A history of arthritis does not increase the risk for complications during the perioperative period.
The nurse expects informed consent to be obtained for insertion of:
A gastrostomy tube -Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.
The nurse is triaging the surgical patients. Which patient would the nurse document as urgent for surgical care? a) A patient needing cataract surgery b) A patient scheduled for cosmetic surgery c) A patient with severe bleeding d) A patient with an acute gallbladder infection
A patient with an acute gallbladder infection Explanation: An acute gallbladder infection is considered an urgent surgical procedure. Cosmetic surgery and cataract surgery are not considered urgent surgical procedures. Severe bleeding could be considered an emergent surgical procedure.
Patients who have received corticosteroids preoperatively are at risk for which type of insufficiency?
Adrenal
Patients who have received corticosteroids preoperatively are at risk for which type of insufficiency?
Adrenal -Patients who have received corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids does not occur to the pituitary, thyroid, or parathyroid glands.
Patients who have received corticosteroids preoperatively are at risk for which type of insufficiency? a) Parathyroid b) Thyroid c) Pituitary d) Adrenal
Adrenal Correct Explanation: Patients who have received corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids does not occur to the pituitary, thyroid, or parathyroid glands.
A patient was admitted 2 hours ago to the postsurgical unit from PACU following a Hartmann's resection (bowel surgery). During the nurse's most recent assessment of the patient, significant bleeding was noted on the patient's abdominal dressing, which was previously dry and intact. What action should the nurse perform first? -Apply a transparent dressing over the existing bandage and position the patient side-lying. -Remove the patient's dressing and insert gauze packing if dehiscence is apparent. -Check the results of the patient's preoperative blood group and screen -Apply a sterile gauze and hold it in place while applying moderate pressure.
Apply a sterile gauze and hold it in place while applying moderate pressure. If bleeding is evident at a surgical site, a sterile gauze pad and a pressure dressing are applied, and the site of the bleeding is elevated to heart level if possible. The patient is placed in the shock position (flat on back, legs elevated at a 20-degree angle, knees kept straight). It would be inappropriate to remove the dressing or insert packing.
The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next? Make the client NPO and order a stat hemoglobin and hematocrit. Remove the dressing, assess the wound, and apply a new sterile dressing. Outline the drainage with a pen and record the date and time next to the drainage. Take the client's vital signs and call the surgeon.
Areas of drainage on the dressing should be outlined with a pen, and the date and time should be recorded next to the drainage. Blood drainage from the incision is a normal expected finding in the immediate postoperative period; however, excessive amounts should be reported to the surgeon.
The nurse is caring for a female postoperative client who is having difficulty voiding. Which nursing action is most helpful to promote normal voiding? a) Run water to assist in the let-down reflex. b) Offer to catheterize. c) Assist to the bathroom. d) Encourage 8 oz of water.
Assist to the bathroom. Explanation: The nurse encourages the client to void within 4 hours of surgery to minimize the risk of a urinary tract infection. Ambulating the client to the bathroom promotes normal body positioning for urination. Running water is a common psychological strategy to cause urination, but positioning is a better option. Encouraging water will help fill the bladder but not urination. Offering to catheterize is a last option.
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
Correct response: Verifies that operative consent is signed Explanation: All choices listed are essential but, without a signed consent form, surgery cannot occur.
The potential effects of prior medication therapy must be evaluated before surgery. Which of the following drug classifications may cause respiratory depression from an associated electrolyte imbalance during anesthesia? Corticosteroids Diuretics Insulin Anticoagulants
Diuretics
What action by the nurse best encompasses the preoperative phase?
Educating the patients on signs and symptoms of infection -Educating the patient on prevention or recognition of complications begins in the preoperative phase. Applying SCD and frequent vital sign monitoring happens after the preoperative phase. Only electric clippers should be used to remove hair.
A fractured skull would be classified under which category of surgery based on urgency?
Emergent
A fractured skull would be classified under which category of surgery based on urgency?
Emergent -Emergent surgery occurs when the patient requires immediate attention. An elective surgery is classified as a surgery that the patient should have. A required surgery means that the patient needs to have surgery. An urgent surgery occurs when the patient requires prompt attention.
Informed consent from the surgical client is essential in all of the following categories of surgery except:
Emergent surgery -In an emergency, a physician may perform surgery without a client's informed consent in order to save the client's life.
During the admission history the client reports to the nurse of taking the usual dose of warfarin (Coumadin) the previous day. The appropriate nursing action is:
Notify the surgeon that the client took warfarin the day before surgery. -Warfarin, an anticoagulant, places the client at risk for excessive bleeding during the intraoperative and postoperative periods.
A patient is scheduled to have a cholecystectomy. Which of the nurse's finding is least likely to contribute to surgical complications? a) Pregnancy b) Urinary tract infection c) Diabetes d) Osteoporosis
Osteoporosis Explanation: Osteoporosis is most likely not going to contribute to complications related to a cholecystectomy. Pregnancy decreases maternal reserves. Diabetes increases wound-healing problems and risks for infection. Urinary tract infection decreases the immune system, increasing the chance for infections.
When is the ideal time to discuss preoperative teaching
Pre-admission visit
Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period? a) The 35-year-old client with non-insulin dependent diabetes. b) The 72-year-old client who takes no routine medications. c) The 47-year-old client who stopped smoking 2 years ago. d) The 28-year-old client who occasionally smoked marijuana in high school.
The 35-year-old client with non-insulin dependent diabetes. Explanation: The client with diabetes is at risk for complications during the intraoperative or postoperative period. Hypoglycemia can develop during anesthesia or from inadequate carbohydrate intake or excess insulin administration postoperatively. Hyperglycemia can increase the risk for wound infection and delay wound healing. Smokers are encouraged to stop 4 to 8 weeks before surgery. Recent ilicit drug use can increase the risk for adverse reactions to anesthesia. Healthy older adults are not at increased risk.
You are caring for a client 6 hours post surgery. You observe that the client voids urine frequently and in small amounts. You know that this most probably indicates what?
Urine retention -Voiding frequent, small amounts of urine indicates retention of urine with elimination of overflow. The nurse should assess the volume of first voided urine to determine adequacy of output. If the client fails to void within 8 hours of surgery, the nurse should consult with the physician regarding instituting intermittent catheterization until voluntary voiding returns and is not required in this case. Frequent and small amounts of urine voiding does not indicate urinary infection nor does it indicate the formation of a calculus.
Ambulatory surgeries
surgery that does not require an overnight hospital stay -PAT: readmission testing & preoperative preparation prior to admission (patient demographics, health history, consent forms, diagnostic & lab results) -increase the need for patient education, discharge planning, rehabilitation services -includes: a. outpatient b. same-day c. short stay surgery -does not require overnight hospital stay but observation in hospital setting for 23 hour/less
Completing your preoperative assessment, you mentally rehearse your client's needs to determine if there is increased risk for complications intra operatively or postoperatively. Which of the following are general risk factors? Select all that apply. a) Physical condition b) Gender c) Age d) Nutritional status e) Health status f) Ethnicity
• Physical condition • Age • Nutritional status • Health status Correct Explanation: General surgical risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition.
A client is scheduled for elective surgery. To prevent the complications of hypotension and cardiovascular collapse, the nurse should report the use of which medication? - Hydrochlorothiazide - Prednisone - Warfarin - Erythromycin
Correct response: Prednisone Explanation: Clients who receive corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids such as prednisone can cause circulatory collapse and hypotension. Hydrochlorothiazide and erythromycin can cause respiratory complications. Warfarin increases the risk of bleeding.
The nurse is aware that the amino acid, arginine, - Stimulates T-cell response - Is essential for antibody formation - Is involved in capillary formation - Is important for normal blood clotting
Correct response: Stimulates T-cell response Explanation: Arginine is necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response.
The nurse is caring for a client in heart failure with signs of hypervolemia. Which vital sign is indicative of the disease process? Low heart rate Elevated blood pressure Rapid respiration Subnormal temperature
Elevated BP Indicative of hypervolemia is a bounding pulse and elevated blood pressure due to the excess volume in the system. Respirations are not typically affected unless there is fluid accumulation in the lungs. Temperature is not generally affected.
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? a) Take the client's vital signs. b) Place the side rails in the up position and make sure the call button is in reach. c) Take the client to the bathroom. d) Have the family go to the waiting room.
Place the side rails in the up position and make sure the call button is in reach. Explanation: 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. (less)
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? a) Confirm that informed consent has been obtained. b) Ensure that sufficient surgical supplies are available. c) Review the scheduled procedure, site, and client. d) Check that all surgical personnel are properly attired.
Review the scheduled procedure, site, and client. Explanation: According to the 2009 National Patient Safety Goals, accurate identification of the client, procedure, and operative site is essential.
Sudden withdrawal of which of the following may result in seizures? - Tranquilizers - Steroids - Monoamine-oxidase inhibitors - Thiazide diuretics
Correct response: Tranquilizers Explanation: Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly. Abrupt withdrawal of steroids may precipitate cardiovascular collapse. Monoamine oxidase inhibitors increase the hypotensive effects of anesthetics. Thiazide diuretics may cause excessive respiratory depression during anesthesia due to an associated electrolyte imbalance.
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.
Correct response: - 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. Explanation: The increasing use of ambulatory, same-day, or short-stay surgery, means that clients leave the hospital sooner, which increases the need for teaching, discharge planning, preparation for self-care, and referral for home care and rehabilitation services.
A client taking chlorpromazine is preparing to undergo surgery. Which of the following complications does the surgical team need to prepare to deal with before anesthetics are administered? - Cardiovascular collapse - Seizures - Hypotension - Apnea from respiratory paralysis
Correct response: Hypotension Explanation: Chlorpromazine (Thorazine) may increase the hypotensive action of anesthetics. Seizures are a potential interaction if diazepam (Valium) is withdrawn suddenly before surgery. The client who takes prednisone (Deltasone) is at risk for cardiovascular collapse if the medication is discontinued suddenly. The combination of erythromycin (Ery-Tab) and a curariform muscle relaxant can lead to apnea from muscle paralysis.
At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period? a) During the preoperative period b) At the time of discharge instructions c) Upon arrival to the surgical unit d) Following the surgical procedure
During the preoperative period Correct Explanation: The best time to begin teaching about care needed in the postoperative period is during the preoperative time. At this time, the client is more alert and focused on the information provided by the nurse. Clients and family members can better be prepared and participate in the recovery period if they know what to expect. Anxiety is a factor on arrival to the surgical unit that could interfere with learning. Pain could interfere with the learning process, following a surgical procedure. At the time of discharge, both pain and timeliness may be an issue in understanding and obtaining care needed during the postoperative time.
What action by the nurse best encompasses the preoperative phase? a) Documenting the application of sequential compression devices (SCD) b) Monitoring vital signs every 15 minutes c) Educating the patients on signs and symptoms of infection d) Shaving the patient using a straight razor
Educating the patients on signs and symptoms of infection Correct Explanation: Educating the patient on prevention or recognition of complications begins in the preoperative phase. Applying SCD and frequent vital sign monitoring happens after the preoperative phase. Only electric clippers should be used to remove hair
You are caring for a client postoperatively. What nursing interventions help prevent venous stasis and other circulatory complications in a client who has undergone surgery? a) Place pillows under the client's knees or calves. b) Encourage the client to move legs frequently and do leg exercises. c) Maintain the client in a side-lying position. d) Apply pressure on the client's lower extremities.
Encourage the client to move legs frequently and do leg exercises. Explanation: The nurse should encourage the client to move legs frequently and do leg exercises to prevent venous stasis and other circulatory complications. The nurse should not place pillows under the client's knees or calves unless ordered and should avoid placing pressure on the client's lower extremities. Placing the client in a side-lying position will not help prevent venous stasis and other circulatory complications in a client who has undergone surgery.
A client is placed on the operating room table for the surgical procedure. Which surgical team member is responsible for handing sterile instruments to the surgeon and assistants? a) Circulating nurse b) First assistant c) Certified registered nurse anesthetist d) Scrub nurse
Scrub nurse Explanation: The scrub nurse is sterile and assists the surgical team by handing instruments to the surgeon, preparing sutures, receiving specimens to be sent to the lab, and counting sponges and needles. The circulating nurse is not sterile and obtains and opens sterile equipment, adjusts lights, and keeps records. The first assistant is involved with the client's preoperative care. The certified registered nurse anesthetist assists in the client's anesthesia.
When a person with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the patient may show signs of alcohol withdrawal delirium during which time period? a) Up to 24 hours after alcohol withdrawal b) Up to 72 hours after alcohol withdrawal c) Immediately upon admission d) Upon awakening in the postanesthesia care unit
Up to 72 hours after alcohol withdrawal Explanation: Alcohol withdrawal delirium is associated with a significant mortality rate when it occurs postoperatively. Onset of symptoms depends upon time of last consumption of alcohol. Twenty-four hours is too short a time frame to consider alcohol withdrawal delirium as no longer a threat to a chronic alcoholic
The surgical unit nurse is developing a postoperative plan of care. In which client's plan of care would the nurse document interventions of coughing and deep breathing, gastrointestinal assessment, and effective regulation of temperature? a) A client having a knee replacement and regional anesthesia b) A client with gastrointestinal surgery and general anesthesia c) A client having lower extremity muscle repair and spinal anesthesia d) A client with spinal stenosis and a regional nerve blockade
A client with gastrointestinal surgery and general anesthesia Correct Explanation: General anesthesia acts on the central nervous system to produce a loss of sensation, reflexes, and consciousness. The anesthesiologist monitors the vital functions of breathing, circulation, and temperature. Following general anesthesia, nurses must closely monitor for effective breathing and oxygenation, temperature regulation, and adequate fluid balance. Nursing interventions for those clients with regional anesthesia, spinal anesthesia, and regional nerve blockades focus on assessing for allergic reactions, neurovascular assessments to specific body regions, and side effects of the medication
A physically fit 86-year-old is scheduled for right knee replacement. What factor in this client makes them at increased risk for surgery? a) Age b) Ability to metabolize medication c) Nutritional status d) Type of surgery
Age Explanation: On admission, the nurse reviews preoperative instructions, such as diet restrictions and skin preparations, to ensure the client has followed them. If the client has not carried out a specific portion of the instructions, such as withholding foods and fluids, the nurse immediately notifies the surgeon. He or she identifies the client's needs to determine if the client is at risk for complications during or after the surgery. General risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition. In this scenario the risk to the client is age, the other options are incorrect according to the scenario described.
Which of the following medications may increases the hypotensive action of anesthesia? - Chlorpromazine - Prednisone - Warfarin - Hydrochlorothiazide
Correct response: Chlorpromazine Explanation: Chlorpromazine (Thorazine) may increase the hypotensive action of anesthetics. Prednisone (Deltasone) may cause cardiovascular collapse and should be discontinued immediately. Warfarin (Coumadin) can increase the risk of bleeding during the intraoperative and postoperative periods. Hydrochlorothiazide (HydroDIURIL) may cause respiratory depression resulting from an associated electrolyte imbalance during anesthesia.
Categories of Surgery based on urgency:
1) Emergent: patient requires immediate attention; disorder may be life threatening -surgery without delay e.g. severe bleeding, bladder/intestinal obstruction, fractured skull, gunshot/ stab wounds, extensive burns 2) Urgent: requires prompt attention -surgery within 24-30 hours e.g. acute gallbladder infection, kidney/ureteral stones 3) Required: needs to have surgery -plan within a few weeks/months e.g. prostatic hyperplasia without bladder obstruction, thyroid disorders, cataracts 4) Elective: should have surgery -failure to have surgery not catastrophic e.g. repair of scars, simple hernia, vaginal repair 5) Optional: decision rests with patient -personal preference e.g. cosmetic surgery
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) A history of chronic low back pain b) A history of sensitivity to aspirin c) A history of osteoarthritis d) A history of diabetes
A history of diabetes Explanation: As a chronic condition that affects many body systems, diabetes is a risk factor for surgical complications. The client's blood glucose level and insulin requirements need to be closely monitored before and after surgery. Being sensitive to aspirin does not pose a risk for the client in surgery. Osteoarthritis is not a systemic condition and does not place the client at risk during surgery. Chronic low back pain is not a systemic condition that places the client at risk during surgery; however, it can be exacerbated by positioning on the operating room table.
A patient refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?
Allow the ring to stay on the patient and cover it with tape. -Most facilities will allow a wedding band to remain on the patient during the surgical procedure. The nurse must secure the ring with tape. Although it is appropriate to discuss the risk for infection, the patient has already refused removal of the ring. The surgery should not be canceled and the ring should not be removed without permission.
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? a) Anxious clients need psychological counseling after surgery. b) Anxiety and fear increases the need for anesthesia and postoperative medications. c) Anxious clients have a poor response to surgery and are prone to complications. d) 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. Correct Explanation: 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 reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which laboratory value would be of greatest concern to the nurse? - potassium 6.2 mEq/L - calcium 9.8 mg/dL - white blood cell count 7.2 cells/mm - sodium 138 mEq/L
- potassium 6.2 mEq/L
Bariatrics
-patients who are obese -increases the risk & severity of complications associated with surgery -during surgery --> fatty tissues susceptible to infection -increases technical & mechanical problems (dehiscence; wound separation) -tend to have shallow respirations with supine= increasing the risk of hypoventilation & postoperative pulmonary complications -increased oxygen demand & decreased pulmonary reserves -frequently assess for obstructive sleep apnea & Tx: CPAP (continuous positive airway pressure)
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 & deep-breathing exercises -Intravenous fluids & other lines & tubes
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? a) Grilled salmon, rice pilaf, green beans, and cantaloupe b) Turkey breast, baked sweet potato, asparagus, and an orange c) Baked chicken, mashed potatoes, broccoli, and strawberries d) Cheeseburger, french fries, coleslaw, and ice cream
Cheeseburger, french fries, coleslaw, and ice cream Explanation: Important nutrients for wound healing include protein; vitamins A, B-complex, C, and K; arginine, magnesium, copper, and zinc; and water. The diet should be sufficient in carbohydrates and low to moderate in fats. The cheeseburger option is high in fat and low in vitamin C. (less)
The nurse has just admitted a 12-year-old client who is going to have an above-the-knee amputation of their left leg due to osteosarcoma. The nurse knows that adequate preoperative teaching and learning is important for what reason? a) Client will have a shorter recovery period. b) Client will understand after surgery they will not have a left leg. c) Client will understand they have cancer. d) Client's family will understand their child will lose their leg in the surgery.
Client will have a shorter recovery period. Explanation: The purpose of adequate preoperative teaching/learning is for the client to have an uncomplicated and shorter recovery period. He or she will be more likely to deep breathe and cough, move as directed, and require less pain medication. Options B, C, and D are incorrect because preoperative teaching does not ensure that a 12-year-old client understands they are losing their leg or understand that they will have cancer. Preoperative teaching also does not ensure the client's family understands the child will lose their leg. This is the responsibility of the physicians who are treating the child and their family
What is the blood glucose level goal for a diabetic patient who will be having a surgical procedure? - 3.5 and 5.5 mmol/L - 8 to 13 mmol/L - 13 to 16 mmol/L - 16 to 19 mmol/L
Correct response: 3.5 and 5.5 mmol/L Explanation: Although the surgical risk in the patient with controlled diabetes is no greater than in the patient without diabetes, strict glycemic control (3.5 to 5.5 mmol/L) leads to better outcomes (Alvarex et al., 2010). Frequent monitoring of blood glucose levels is important before, during, and after surgery.
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
Correct response: diuretics Explanation: Diuretics during anesthesia may cause excessive respiratory depression resulting from an associated electrolyte imbalance. Corticosteroids, insulin, and anticoagulants are not known to cause respiratory depression during anesthesia.
A nurse who works in the operating room is required to assess the client continuously and protect the client from potential complications. Which symptoms would the nurse watch for as indicative of malignant hyperthermia? Select all that apply. Cyanosis Cardiac arrest Increased urine output Mottled skin
Cyanosis Cardiac arrest Mottled skin Symptoms of malignant hyperthermia include tachycardia, tachypnea, cyanosis, fever, muscle rigidity, diaphoresis, mottled skin, hypotension, irregular heart rate, decreased urine output, and cardiac arrest.
The nurse is physically preparing a client for surgery. What area does the nurse know needs to be addressed before the client is taken to the operating room? a) Support system b) Activity c) Medication d) Elimination
Elimination Explanation: When physically preparing a client for surgery these areas need to be addressed: skin preparation; elimination; attire/grooming; prosthesis; foods and fluids; and care of valuables. The physical preparation of a client for surgery does not include the areas of medication, activity, or the client's support system
A fractured skull would be classified under which category of surgery based on urgency? a) Urgent b) Elective c) Required d) Emergent
Emergent Explanation: Emergent surgery occurs when the patient requires immediate attention. An elective surgery is classified as a surgery that the patient should have. A required surgery means that the patient needs to have surgery. An urgent surgery occurs when the patient requires prompt attention.
The nurse concludes that further teaching about diaphragmatic breathing is needed when the client: a) Performs diaphragmatic breathing in a semi-Fowler's position b) Breathes in deeply through the nose and mouth c) Places the hands on the lower chest to feel the rise and fall with breathing d) Exhales forcefully with a short expiration
Exhales forcefully with a short expiration Explanation: Diaphragmatic breathing should be performed gently and fully. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 17: Preoperative Nursing Management, p. 414. Chapter 17: Preoperative Nursing Management - Page 414
During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which of the following complications? a) Infection b) Malignant hyperthermia c) Fluid volume excess d) Hypothermia
Malignant hyperthermia Explanation: This inherited disorder occurs when body temperature, muscle metabolism, and heat production increase rapidly, progressively, and uncontrollably in response to stress and some anesthetic agents. If the client's temperature begins to rise rapidly, anesthesia is discontinued, and the OR team implements measures to correct physiologic problems, such as fever or dysrhythmias. Hypothermia is a lower than expected body temperature. Signs of infection would not present during the procedure. Increased body temperature would not indicate fluid volume excess.
A patient is scheduled for elective surgery. To prevent the complication of hypotension and cardiovascular collapse, the nurse should report the use of what medication? a) Erythromycin (Ery-Tab) b) Warfarin (Coumadin) c) Prednisone (Deltasone) d) Hydrochlorothiazide (HydroDIURIL)
Prednisone (Deltasone) Explanation: Patients who have received corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids can cause circulatory collapse and hypotension. Hydrochlorothiazide and erythromycin can cause respiratory complications. Warfarin will increase the risk of bleeding.
Your 72-year-old client is scheduled to have a mastectomy. You will prepare the client's skin, encourage the client to void, and remove the client's dentures during which phase of peri operative care? a) Transoperative b) Preoperative c) Postoperative d) Intraoperative
Preoperative Correct Explanation: Preoperative care begins with the decision to perform surgery and continues until the client reaches the operating area. During this time, the nurse will physically prepare the client for surgery, and nursing actions may include skin preparation, hair removal, and food and fluids management.
What is the major purpose of withholding food and fluid before surgery? a) Decrease urine output b) Prevent aspiration c) Decrease risk of constipation d) Prevent overhydration
Prevent aspiration Explanation: The major purpose of withholding food and fluid before surgery is to prevent aspiration. Decreasing overhydration, decreasing urine output, and decreasing constipation are not major purposes of withholding food and fluid before surgery. Until recently, fluid and food were restricted preoperatively overnight and often longer. Currently, specific recommendations depend on the age of the patient and the type of food eaten.
A patient 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. -Splinting the incision site will help decrease pain and support the incision. This will increase compliance with the deep breathing and coughing exercises that assist with the prevention of respiratory complications. Pain medication should be taken regularly and not only before deep breathing and coughing exercises. Deep breathing and coughing exercises should be done at least every 2 hours, more frequently if possible. While some patients will find the exercises relaxing, most patients find it painful to complete the exercises.
When planning care for a client in the postoperative period, prioritize nursing diagnoses in the sequence from highest to lowest priority? a) Altered Comfort b) Impaired Gas Exchange c) Risk for Infection d) Anxiety e) Fluid Volume Deficit
just click them all because you can't put them in order... :/
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. a) Skin biopsy b) Removal of a tumor c) Removal of a diseased appendix d) Mammoplasty e) Insertion of a gastrostomy tube
• Removal of a tumor • Removal of a diseased appendix Correct Explanation: A surgical procedure may be diagnostic (e.g., biopsy, exploratory laparotomy), curative (e.g., excision of a tumor or an inflamed appendix), or reparative (eg, multiple wound repair). It may be reconstructive or cosmetic (e.g., mammoplasty or a facelift) or palliative (e.g., to relieve pain or correct a problem—for instance, a gastrostomy tube may be inserted to compensate for the inability to swallow food).
Choice Multiple question - Select all answer choices that apply. 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. a) Need for teaching is increased. b) The client must be prepared to take on more self-care than he or she may have done in the past. c) The client will leave the hospital sooner than in the past. d) Discharge planning is minimal because the stay is so short. e) 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. Explanation: The increasing use of ambulatory, same-day, or short-stay surgery, means that clients leave the hospital sooner, which increases the need for teaching, discharge planning, preparation for self-care, and referral for home care and rehabilitation services.
Choice Multiple question - Select all answer choices that apply. A client who is scheduled for knee surgery is anxious about the procedure, saying, "You hear stories on the news all the time about doctors working on the wrong body part. What if that happens to me?" What can you tell this client to help alleviate his concerns? a) The surgical team performs a "time-out" prior to surgery to conduct a final verification. b) The surgeon on his team has never been involved in such a mix-up. c) He can be involved in marking his knee, the site for the surgery. d) The client will be involved in the verification process prior to surgery.
• The surgical team performs a "time-out" prior to surgery to conduct a final verification. • He can be involved in marking his knee, the site for the surgery. • The client will be involved in the verification process prior to surgery. Correct Explanation: There is an increased emphasis on making sure that the right client has the right procedure at the right site. To prevent "wrong site, wrong procedure, wrong person surgery," The Joint Commission (2012) established a universal protocol to achieve this goal. Included in this checklist are steps to verify the preoperative process, mark the operative site, and perform a "time-out."
The nurse is assisting the client with imagery as a relaxation strategy. Which statement by the client describes imagery?
"I am lying on the beach in Florida." - Imagery requires the client to think of a pleasant or restful experience.
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: a) "Clients are often on bed rest following surgery, and the exercises can help prevent pressure ulcers." b) "Leg exercises help prevent blood clots in your legs." c) "Your intestinal tract slows down following surgery, and the exercises will help restore normal intestinal activity." d) "Leg exercises help prevent pneumonia while you are on bed rest."
"Leg exercises help prevent blood clots in your legs." Explanation: Leg exercises improve circulation of the lower extremities by preventing venous stasis, which can lead to deep vein thrombosis in the postoperative client.
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? a) "The physician will update my family after the procedure and provide specific discharge instructions." b) "If I do not follow the instructions, my surgery could be cancelled." c) "The nurse will explain the details of the surgery before I sign a consent." d) "My medical records will be sent to the ambulatory care center prior to my surgery."
"The nurse will explain the details of the surgery before I sign a consent." Explanation: Further instruction would be needed to clarify that the physician, not the nurse, explains the details of the surgery and obtains voluntary consent for the procedure. It is correct that preoperative instructions must be followed prior to surgery for the safety of the client, medical records are present for review prior to surgery, and the physician speaks with the family following the procedure and provides instructions for discharge. (less)
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? a) "The nurse will explain the details of the surgery before I sign a consent." b) "If I do not follow the instructions, my surgery could be cancelled." c) "My medical records will be sent to the ambulatory care center prior to my surgery." d) "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." Explanation: Further instruction would be needed to clarify that the physician, not the nurse, explains the details of the surgery and obtains voluntary consent for the procedure. It is correct that preoperative instructions must be followed prior to surgery for the safety of the client, medical records are present for review prior to surgery, and the physician speaks with the family following the procedure and provides instructions for discharge. (less)
ou are working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks you why these medications are needed. What would be your best answer?
"These medications decrease gastric acidity and volume." -The anesthesiologist frequently orders preoperative medications. Common preoperative medications include the following: anticholinergics, which decrease respiratory tract secretions, dry mucous membranes, and interrupt vagal stimulation; anti anxiety drugs, which reduce preoperative anxiety, slow motor activity, and promote induction of anesthesia; histamine2-receptor antagonists, which decrease gastric acidity and volume; narcotics, which decrease the amount of anesthesia needed, help reduce anxiety and pain, and promote sleep; sedatives, which promote sleep, decrease anxiety, and reduce the amount of anesthesia needed; and tranquilizers, which reduce nausea, prevent emesis, and enhance preoperative sedation.
You are working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks you why these medications are needed. What would be your best answer? a) "These medications slow motor activity." b) "These medications decrease anxiety before surgery." c) "These medications decrease the amount of anesthesia you will need." d) "These medications decrease gastric acidity and volume."
"These medications decrease gastric acidity and volume." Explanation: The anesthesiologist frequently orders preoperative medications. Common preoperative medications include the following: anticholinergics, which decrease respiratory tract secretions, dry mucous membranes, and interrupt vagal stimulation; anti anxiety drugs, which reduce preoperative anxiety, slow motor activity, and promote induction of anesthesia; histamine2-receptor antagonists, which decrease gastric acidity and volume; narcotics, which decrease the amount of anesthesia needed, help reduce anxiety and pain, and promote sleep; sedatives, which promote sleep, decrease anxiety, and reduce the amount of anesthesia needed; and tranquilizers, which reduce nausea, prevent emesis, and enhance preoperative sedation.
Which question is most important for the nurse to ask the client when obtaining the preoperative admission history? a) "Did you bring a copy of your health care power of attorney?" b) "Did you bring any valuables with you?" c) "Who is here with you?" d) "When is the last time you ate or drank?"
"When is the last time you ate or drank?" Explanation: Consumption of food and fluids near to the time of surgery places the client at increased risk for aspiration.
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." - "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." - "My medical records will be sent to the ambulatory care center prior to my surgery."
- "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? - 5 - 7 - 1 - 3
- 7
A client is scheduled for an invasive procedure. What priority documentation is needed regarding the procedure? - A health history obtained by the primary physician - A signed consent form from the client - Prescriptions for postoperative medications - The medication reconciliation form
- A signed consent form from the client
A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? - 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. - Discuss the risk for infection caused by wearing the ring.
- Allow the client to wear the ring and cover it with tape.
A fractured skull would be classified under which category of surgery based on urgency? - Emergent - Elective - Required - Urgent
- Emergent
A gunshot wound would be classified under which category of surgery based on urgency? - Urgent - Elective - Required - Emergent
- Emergent
Informed consent from the surgical client is essential in all of the following categories of surgery except: - Urgent surgery - Emergent surgery - Elective surgery - Required surgery
- Emergent surgery
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 - Progressive muscular relaxation - Optimistic self-recitation - Distraction
- Imagery
Which health care profession has the ultimate responsibility to provide appropriate information regarding a non-emergent surgery? - Certified nurse's aide - Case manager - Nurse - Physician
- 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.
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? - Review the scheduled procedure, site, and client. - 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.
At what point does the preoperative period end? - When the decision is made to proceed with surgery - When the client is admitted to the PACU - When the client is transferred onto the operating table - When the client signs the consent form
- When the client is transferred onto the operating table
A 17-year-old client is having same-day surgery. Solely during the intra-operative phase of peri-operative care, the nurse: - assesses how well the client is recovering from anesthesia. - continuously monitors the sedated client. - obtains a surgical consent from the client's mother. - performs a complete assessment of the client.
- continuously monitors the sedated client.
A physically fit older adult is scheduled for right knee replacement. What factor for the client creates an increased risk for postoperative complications? - ability to metabolize medication - current smoking history - surgical site - type of surgery
- current smoking history
Sudden withdrawal of which of the following may result in seizures? Tranquilizers Steroids Monoamine-oxidase inhibitors Thiazide diuretics
Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly. Abrupt withdrawal of steroids may precipitate cardiovascular collapse. Monoamine oxidase inhibitors increase the hypotensive effects of anesthetics. Thiazide diuretics may cause excessive respiratory depression during anesthesia due to an associated electrolyte imbalance.
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
Correct response: - Discussing and reviewing the advanced directive document - Establishing an intravenous line - Beginning discharge planning Explanation: Of the activities listed, discussing and reviewing the advanced directive document, establishing an intravenous line, and beginning discharge planning are preoperative nursing activities.
The nurse is witnessing a surgical consent for an adolescent client who is deemed an emancipated minor. What are the nursing considerations with client's rights as an emancipated minor? Select all that apply. - Each state has laws defining an emancipated minor. - The adolescent can be legally married and be considered an emancipated minor. - The adolescent must be self-supporting as an emancipated minor. - The hospital defines the emancipated minor abilities. - The emancipated minor is often incapable to make health care decisions .
Correct response: - Each state has laws defining an emancipated minor. - The adolescent can be legally married and be considered an emancipated minor. - The adolescent must be self-supporting as an emancipated minor. Explanation: Each state has laws defining an emancipated minor. An emancipated minor as an adolescent can be legally married and must be self-supporting. Each state has laws that defines an emancipated minor not the hospital. The emancipated minor is often capable to make health care decisions.
The nurse is reviewing a preoperative informed consent when preparing the client for surgery. Which contents of the informed consent are required? Select all that apply. - Explanation of procedure - Estimated time of procedure - Potential risks - Benefits of surgery - Personnel present - Description of alternatives
Correct response: - Explanation of procedure - Potential risks - Benefits of surgery - Description of alternatives Explanation: Informed consents should be in writing and contain an explanation of procedure and risks, description of benefits and alternative, an offer to answer questions about procedure, ability to withdraw consent, and statement informing the client if the protocol differs from customary procedure. An estimated time of procedure and personnel present are not required in the informed consent.
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. - cardiovascular complications - gastrointestinal complications - pulmonary complications - renal complications - nervous system complications
Correct response: - cardiovascular complications - pulmonary complications Explanation: Like age, obesity increases the risk and severity of complications associated with surgery. The cardiovascular system is at risk for complications with obese surgical clients because of hypertension and diabetes complications. The client tends to have shallow respirations when supine, increasing the risk of hypoventilation and postoperative pulmonary complications. The acquired physical characteristics-a short, thick neck; large tongue; recessed chin; and redundant pharyngeal tissue, associated with increased oxygen demand and decreased pulmonary reserves-impede intubation. Obesity should not cause postoperative complications with the gastrointestinal system, renal system, or nervous system.
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 mg/dL
Correct response: A blood urea nitrogen level of 42 mg/dL Explanation: The kidneys are involved in excreting anesthetic medications and their metabolites; therefore, surgery is contraindicated if a patient has acute nephritis, acute renal insufficiency with oliguria or anuria, or other acute renal problems (see Chapter 54). A blood urea nitrogen level of 42 mg/dL (significantly elevated) is an indicator of renal failure. The other levels are normal.
Which would be considered to require an urgent surgical procedure? - Loose facial skin - Cataract - Acute gallbladder infection - Severe bleeding
Correct response: Acute gallbladder infection Explanation: An acute gallbladder infection is considered to require an urgent surgical procedure. Cosmetic surgery and cataract surgery are not considered urgent surgical procedures. Severe bleeding could be considered an emergent surgical procedure.
During the preoperative assessment, the nurse learns that the client has been taking prednisone. The nurse realizes that the client is at risk for: - Cardiovascular collapse. - Respiratory depression. - Decreased blood pressure. - Increased blood loss.
Correct response: Cardiovascular collapse. Explanation: Prednisone, a corticosteroid, can result in cardiovascular collapse if suddenly discontinued. A bolus of corticosteroid may be given intravenously immediately before and after surgery. Hydrochlorothiazide and anesthetics may interact, resulting in respiratory depression. Phenothiazines may potentiate the hypotensive action of anesthetics. Anticoagulants can increase the risk of bleeding.
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
Correct response: During the preoperative period Explanation: The best time to begin teaching about care needed in the postoperative period is during the preoperative time. At this time, the client is more alert and focused on the information provided by the nurse. Clients and family members can better be prepared and participate in the recovery period if they know what to expect. Anxiety is a factor on arrival to the surgical unit that could interfere with learning. Pain could interfere with the learning process, following a surgical procedure. At the time of discharge, both pain and timeliness may be an issue in understanding and obtaining care needed during the postoperative time.
You are admitting an insulin-dependent patient to the same-day surgical suite for carpal tunnel surgery. You know that this patient may be at risk for which metabolic disorder? - Adrenal insufficiency - Thyrotoxicosis - Impaired acid base balance - Hyperglycemia
Correct response: Hyperglycemia Explanation: The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia. Hyperglycemia during the surgical procedure is a risk based on the body's defense mechanism to raise the blood sugar in the event of stress. Patients who have received corticosteroids are at risk of adrenal insufficiency. Patients with uncontrolled thyroid disorders are at risk for thyrotoxicosis. Because the kidneys are involved in excreting anesthetic medications and their metabolites and because acid-base status and metabolism are also important considerations in anesthesia administration, surgery is contraindicated when a patient has acute nephritis, acute renal insufficiency with oliguria or anuria, or other renal problems.
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.
Correct response: Use diaphragmatic breathing. Explanation: In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.
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.
Correct response: Notify the surgeon to possibly delay the surgery. Explanation: A respiratory infection can delay a nonemergent surgical procedure because the infection can increase the risk for respiratory complications. Therefore, the nurse should notify the surgeon about delaying the surgery. The primary physician may be called to provide care based on the assessment findings, but that should be done only after the surgeon has been notified. Continuing through the preoperative phase without notifying the surgeon and waiting 1 hour then repeating the assessment are not appropriate.
The nurse recognizes that written informed consent is required for insertion of a(n): - Nasogastric tube. - Urinary catheter. - Peripherally-inserted central catheter. - Oral airway.
Correct response: Peripherally-inserted central catheter. Explanation: Nonsurgical invasive procedures, such as insertion of a peripherally-inserted central catheter, that carry more than a slight risk to the client require written informed consent.
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
Correct response: Post-discharge diet Explanation: The least helpful postoperative teaching that could be omitted due to the need to obtain emergency surgery is explaining the post-discharge diet. This is not essential information to improve client participation in their postoperative recovery. Coughing and deep breathing is essential in the immediate postoperative period. Clients are often concerned about postoperative pain so instruction on pain medication can decrease anxiety. Knowledge of the surgical procedure must be explained by a physician when signing a surgical consent.
As a nurse working in an ambulatory surgery center, you are admitting a client who is going to have a biopsy of a skin lesion. What is an important part of the preoperative process? - Review preoperative instructions. - Give postoperative instructions. - Teach dressing changes. - Give caregiver instructions.
Correct response: Review preoperative instructions. Explanation: On admission, the nurse reviews preoperative instructions, such as diet restrictions and skin preparations, to ensure the client has followed them. The preoperative nurse does not give postoperative instructions; teach dressing changes or give instructions to caregivers.
The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities? - The client breathes through her nose, holds her breath, and then exhales slowly before coughing. - The client takes short, panting breaths and coughs from the throat to expectorate sputum. - The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times. - The client takes three deep breaths and then coughs forcefully.
Correct response: The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times. Explanation: Taking a deep abdominal breath and then "huff" coughing is the most effective manner of coughing. This technique helps facilitate removal of secretions and conserves energy for the client. The client should breathe slowly but not hold her breath. Short, panting breaths and then coughing from the throat do not promote expectoration of sputum from the lungs. Coughing forcefully can cause alveoli to collapse; "huff" coughing prevents this.
How does the nurse determine that the patient may have hidden fears about the impending surgical procedure? (Select all that apply.) - The patient tells the nurse of concerns with the outcome of the procedure. - The patient informs the nurse of problems with postoperative nausea in the past and that it was a bad experience. - The patient avoids communication with the nurse. - The patient repeatedly asks questions that have previously been answered. - The patient talks incessantly.
Correct response: The patient avoids communication with the nurse. The patient repeatedly asks questions that have previously been answered. The patient talks incessantly. Explanation: People express fear in different ways. Some patients may ask repeated questions, regardless of information already shared with them. Others may withdraw, deliberately avoiding communication by reading, watching television, or talking about trivialities. Consequently, the nurse must be empathetic, listen well, and provide information that helps alleviate concerns. If the patient talks about his or her fears, then they are no longer hidden.
The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure? - Up to 8 hours before surgery - Up to 6 hours before surgery - Up to 4 hours before surgery - Up to 2 hours before surgery
Correct response: Up to 2 hours before surgery Explanation: The major purpose of withholding food and fluid before surgery is to prevent aspiration. Until recently, fluid and food were restricted preoperatively overnight and often longer. The American Society of Anesthesiologists reviewed this practice and made new recommendations for people undergoing elective surgery who are otherwise healthy. Specific recommendations depend on the age of the patient and the type of food eaten. For example, adults may be advised to fast for 8 hours after eating fatty food and 4 hours after ingesting milk products. Healthy patients are allowed clear liquids up to 2 hours before an elective procedure (Crenshaw, 2011).
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? a) During the postoperative phase b) During the transfer phase c) During the intraoperative phase d) During the preoperative phase
During the postoperative phase Explanation: The nurse realizes that documentation of vital signs in the recovery room begins the postoperative phase of perioperative care. The preoperative phase occurs until the client reaches the operating area. The intra operative phase includes the entire surgical procedure until the transfer to the recovery area. There is no transfer phase of perioperative care
What action by the nurse best encompasses the preoperative phase?
Educating the patients on signs and symptoms of infection
Which domain of perioperative nursing practice focuses on clinical processes and outcomes? a) Health care systems b) Safety c) Physiological responses d) Behavioral responses
Health care systems Explanation: The health care system consists of structural data elements and focuses on clinical processes and outcomes. Safety, behavioral responses, and physiological responses reflect phenomena of concern to perioperative nurses and are composed of nursing diagnoses, interventions, and outcomes.
A client taking chlorpromazine (Thorazine) is preparing to undergo surgery. Which of the following complications does the surgical team need to prepare to deal with before anesthetics are administered? a) Hypotension b) Apnea from respiratory paralysis c) Seizures d) Cardiovascular collapse
Hypotension Explanation: Chlorpromazine (Thorazine) may increase the hypotensive action of anesthetics. Seizures are a potential interaction if diazepam (Valium) is withdrawn suddenly before surgery. The client who takes prednisone (Deltasone) is at risk for cardiovascular collapse if the medication is discontinued suddenly. The combination of erythromycin (Ery-Tab) and a curariform muscle relaxant can lead to apnea from muscle paralysis.
A client will be undergoing an appendectomy tomorrow morning. The nurse spends significant time explaining to the client what will happen, including before and after the procedure is complete. What is the primary reason the nurse puts so much effort into preoperative teaching?
It increases the likelihood of a successful recovery. -Teaching clients about their surgical procedure and expectations before and after surgery is best done during the preoperative period. Clients and family members can better participate in recovery if they know what to expect. Although preoperative teaching may minimize the time spent postoperatively on questions and help nurses improve their teaching skills, these are not the primary reasons for spending significant preoperative time on teaching. Clients must participate in their recovery process. Education encourages clients to participate in their own care in addition to giving important information to family. This would not be a primary nursing goal.
A client will be undergoing an appendectomy tomorrow morning. The nurse spends significant time explaining to the client what will happen, including before and after the procedure is complete. What is the primary reason the nurse puts so much effort into preoperative teaching? a) It absolves the hospital of legal responsibility should complications arise. b) It decreases the client's participation and allows the family to take on the caregiver role. c) It increases the likelihood of a successful recovery. d) It minimizes the time needed to be spent on postoperative questions.
It increases the likelihood of a successful recovery. Explanation: Teaching clients about their surgical procedure and expectations before and after surgery is best done during the preoperative period. Clients and family members can better participate in recovery if they know what to expect. Although preoperative teaching may minimize the time spent postoperatively on questions and help nurses improve their teaching skills, these are not the primary reasons for spending significant preoperative time on teaching. Clients must participate in their recovery process. Education encourages clients to participate in their own care in addition to giving important information to family. This would not be a primary nursing goal.
A postoperative client is moving from the bed to a chair when blood drips from the dressing. The nurse assesses the incision and notes evisceration. What does the nurse do first? a) Place a dry, sterile dressing over the protruding organs. b) Moisten sterile gauze with normal saline and place on any organ. c) Place a pressure dressing over the opening and secure. d) Have the client lay quietly on back and call the physician.
Moisten sterile gauze with normal saline and place on any organ. Explanation: A wound evisceration occurs when the wound completely separates, and the internal organs protrude. The first action by the nurse would be to cover the protruding organs with sterile dressings moistened with normal saline. Once the client is safe, the nurse can notify the physician. The client is positioned in a manner that places the least stress on the organs. Dry or pressure dressings are placed over the protruding organ.
The nurse is conducting a preoperative assessment on a patient scheduled for gallbladder surgery. The patient reports having 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 nurse's best action? a) Notify the primary physician about the assessment findings. b) Notify the surgeon to possibly delay the surgery. c) Document the findings and continue the patient through the preoperative phase. d) 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? a) Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. b) Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. c) All older people face similar risks when undergoing surgeries. d) 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. Explanation: The underlying principle that guides preoperative assessment, surgical care, and postoperative care is that elderly clients have less physiologic reserve (the ability of an organ to return to normal after a disturbance in its equilibrium) than younger clients. The hazards of surgery for the elderly are proportional to the number and severity of coexisting health problems and the nature and duration of the operative procedure. Respiratory and cardiac complications are the leading causes of postoperative morbidity and mortality in older adults.
When a patient recites, "I know all will go well," what is the cognitive coping strategy he or she is using? a) Music therapy b) Distraction c) Imagery d) Optimistic self-recitation
Optimistic self-recitation Correct Explanation: When that patient verbalizes this statement, is an optimistic response. Imagery occurs when the patient concentrates on a pleasant experience or restful scene. Distraction occurs when the patient thinks of an enjoyable story or recites a favorite poem or song. Music therapy would be an incorrect answer.
Regarding the surgical patient, which one of the following phases refers to the period of time that constitutes the surgical experience? a) Postoperative b) Intraoperative c) Perioperative d) Preoperative
Perioperative Explanation: Perioperative period includes the preoperative, intraoperative, and postoperative phases. Preoperative phase is the period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table. Intraoperative phase is the period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit. Postoperative phase is the period of time that begins with the admission of the patient to the postanesthesia care unit and ends after a follow-up evaluation in the clinical setting or home.
Regarding the surgical client, which phase refers to the period of time that spans the entire surgical experience? - Preoperative - Intraoperative - Postoperative - Perioperative
Perioperative period includes the preoperative, intraoperative, and postoperative phases. The preoperative phase is the period of time from when the decision for surgical intervention is made to when the client is transferred to the operating room. The intraoperative phase is the period of time from when the client is transferred to the operating room to when he or she is admitted to the postanesthesia care unit. The postoperative phase is the period of time that begins with the admission of the client to the postanesthesia care unit and ends after a follow-up evaluation in the clinical setting or home.
The nurse recognizes that written informed consent is required for insertion of a(n):
Peripherally-inserted central catheter. -Nonsurgical invasive procedures, such as insertion of a peripherally-inserted central catheter, that carry more than a slight risk to the client require written informed 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?
Place gauze under and over the ring and apply adhesive tape over it. -If the client is reluctant to remove a wedding band, the nurse may slip gauze under the ring, then loop the gauze around the finger and wrist or apply adhesive tape over a plain wedding band. You would not tell the client that he or she cannot go to the operating room wearing the ring. You would never medicate the client and then remove the ring against his or her will. It is not necessary to tell the physician and the anesthesiologist that the client does not want to remove the wedding band.
The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which of the following values would be of greatest concern to the nurse? a) Calcium 9.8 mg/dL b) Potassium 6.2 mEq/L c) Sodium 138 mEq/L d) White blood cell count 7.2 cells/mm
Potassium 6.2 mEq/L Explanation: Hyperkalemia places the client at risk for surgical complications. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 17: Preoperative Nursing Management, p. 408. Chapter 17: Preoperative Nursing Management - Page 408
When is the ideal time to discuss preoperative teaching a) Day of surgery b) Prior to entering the pre-op area c) When the patient is comfortable and sedated d) Preadmission visit
Preadmission visit Explanation: The ideal timing for preoperative teaching is not on the day of surgery but during the preadmission visit, when diagnostic tests are performed. Teaching should be done long before the patient enters the preop area. Preoperative teaching should not be done when the patient is sedated
A nurse is witnessing a patient sign the consent form for surgery. After the patient signs the consent form, the patient starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate? a) Place the consent form in the patient's medical record. b) Answer the patient's questions. c) Notify the nurse manager of the patient's questions. d) Request that the surgeon come and answer the questions.
Request that the surgeon come and answer the questions. Explanation: It is the physician's responsibility to provide information pertaining to risks and benefits of surgery. It is not the responsibility of the nurse or nurse manager to discuss risks and benefits. The consent form should not be placed in the medical record until all questions are answered fully for the patient.
A client is placed on the operating room table for the surgical procedure. Which surgical team member is responsible for handing sterile instruments to the surgeon and assistants?
Scrub nurse -The scrub nurse is sterile and assists the surgical team by handing instruments to the surgeon, preparing sutures, receiving specimens to be sent to the lab, and counting sponges and needles. The circulating nurse is not sterile and obtains and opens sterile equipment, adjusts lights, and keeps records. The first assistant is involved with the client's preoperative care. The certified registered nurse anesthetist assists in the client's anesthesia.
A patient is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? a) Pain medication should be taken before completing deep breathing and coughing exercises. b) Deep breathing and coughing exercises should be completed every 8 hours. c) Splint the incision site using a pillow during deep breathing and coughing exercises. d) Deep breathing and coughing exercises may be used as relaxation techniques.
Splint the incision site using a pillow during deep breathing and coughing exercises. Correct Explanation: Splinting the incision site will help decrease pain and support the incision. This will increase compliance with the deep breathing and coughing exercises that assist with the prevention of respiratory complications. Pain medication should be taken regularly and not only before deep breathing and coughing exercises. Deep breathing and coughing exercises should be done at least every 2 hours, more frequently if possible. While some patients will find the exercises relaxing, most patients find it painful to complete the exercises.
The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? a) Pulse rate of 110 beats/min b) Blood pressure of 104/62 mm Hg c) Respiratory rate of 18 breaths/min d) Temperature of 102.5° F
Temperature of 102.5° F Explanation: Intra operative hyperthermia can indicate a life-threatening condition called malignant hyperthermia. The circulating nurse closely monitors the client for signs of hyperthermia. The pulse rate, respiratory rate, and blood pressure did not indicate a significant concern.
The nurse is caring for the client in the preoperative period and documenting rationale for a palliative surgical procedure. Which rationale is most appropriate? a) The physician is repairing a deformity from birth or disease process. b) The client wishes to improve body structures and elects a procedure. c) The physician needs additional information to plan medical treatment. d) The client and physician are focusing on symptom relief not a cure.
The client and physician are focusing on symptom relief not a cure. Explanation: The nurse realizes a palliative surgical procedure is focused on the relief of symptoms or enhancement of function without a cure. Diagnostic surgical procedures provide additional information for medical diagnosis and treatment. Cosmetic surgery procedures are elective, with the purpose of improving body appearance. Reconstructive surgery corrects a deformity
The nurse is assessing the postoperative client on the second postoperative day. Which assessment finding requires immediate physician notification? a) The client states a moderate amount of pain at the incisional site. b) A moderate amount of serous drainage is noted on the operative dressing. c) The client's lungs reveal rales in the bases. d) The client has an absence of bowel sounds.
The client has an absence of bowel sounds. Explanation: A nursing assessment finding of concern on the second postoperative day is the absence of bowel sounds, which may indicate a paralytic ileus. Other assessment findings may include abdominal pain and distention as fluids, solids, and gas do not move through the intestinal tract. Rales in the bases are a frequent finding postoperatively, especially if general anesthesia was administered. Encourage the client to cough and deep breathe. Pain is a common symptom following a surgical procedure. Serous drainage on the postoperative dressing needs to monitored and brought to the physician's attention when he or she assesses the client.
A 17-year-old male client is having same-day surgery to remove a neuroma from his foot. Which of the following nursing interventions would occur during the intra operative phase of peri operative care? a) The nurse continuously monitors the sedated client. b) The nurse obtains a surgical consent from the client's mother. c) The nurse assesses how well the client is recovering from anesthesia. d) The nurse performs a complete assessment of the client.
The nurse continuously monitors the sedated client. Explanation: Intraoperative care includes the entire surgical procedure. During sedation, the nurse continuously evaluates the client. Monitoring during all phases includes assessment of heart rate, respiratory rate, BP, oxygen saturation, and level of consciousness. This would occur during the preoperative phase of perioperative care. During the postoperative phase of perioperative care, an important assessment is determining how the client is recovering from anesthesia.
When does the nurse understand the patient is knowledgeable about the impending surgical procedure?
The patient participates willingly in the preoperative preparation.
When does the nurse understand the patient is knowledgeable about the impending surgical procedure?
The patient participates willingly in the preoperative preparation. -The nurse knows that the patient understands the surgical intervention when the patient participates in preoperative preparation. The other answers pertain to the patient experiencing decreased fear or anxiety, not knowledge about the procedure.
A patient has been transported to the operating room for emergent surgery. Which statement by the nurse best supports the need for emergent surgery?
The patient was unresponsive, had a distended abdomen, and unstable vital signs following a motor vehicle accident." -Emergency surgery means that the patient requires immediate attention and the disorder may be life threatening. The patient with unstable vital signs and a distended abdomen following a motor vehicle accident requires immediate attention. The patient with left sided abdominal pain may not need surgery. Epigastric pain with vomiting for 1 day is usually not an indication for emergent surgery. Lacerations to the face require sutures, not emergent surgery. A thyroidectomy to treat hyperthyroidism is a required surgery, not an emergent one
The nurse is educating patients requiring surgery for various ailments on the perioperative experience. What education provided by the nurse is most appropriate? a) Risks and benefits of the surgical procedures b) Intraoperative techniques used to perform the surgery c) Three phases of surgery and safety measures for each phase d) Expected pain levels and narcotic pain medication used to treat the pain
Three phases of surgery and safety measures for each phase Correct Explanation: The perioperative period includes the preoperative, intraoperative, and postoperative phases. Specific safety guidelines are followed for all surgical patients. The information provided should be general enough to be informative about surgery and should not focus on individual surgeries, as all the patients are having different surgeries. Intraoperative techniques, expected pain levels, and pain medication are specific to the patient and type of surgery. The risks and benefits of the surgical procedure should be discussed by the physician.
When assessing a postoperative client, the nurse is correct to relate which surgical risk factor that would decrease if the surgical client maintained a blood glucose level under 150 mg/dL? a) Respiratory complications b) Wound healing c) Nutrient deficiencies d) Liver dysfunction
Wound healing Explanation: In caring for a postoperative client, the nurse is correct to correlate hyperglycemia with an increased risk of surgical incision infections and delayed wound healing. There is no direct correlation between blood glucose levels and nutrient deficiencies, respiratory complications, and liver dysfunction
Sudden withdrawal of which of the following may result in seizures? a) Monoamine-oxidase inhibitors b) Tranquilizers c) Thiazide diuretics d) Steroids
Tranquilizers Explanation: Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly. Abrupt withdrawal of steroids may precipitate cardiovascular collapse. Monoamine oxidase inhibitors increase the hypotensive effects of anesthetics. Thiazide diuretics may cause excessive respiratory depression during anesthesia due to an associated electrolyte imbalance
Following diagnostic testing, a patient requires a cholecystectomy. This surgical procedure would be categorized as which of the following? a) Required b) Urgent c) Elective d) Emergent
Urgent Explanation: Acute gallbladder infection would be categorized as an urgent surgery. Emergent surgeries include severe bleeding, bladder or intestinal obstruction, and a fractured skull. Required surgeries include thyroid disorders and cataracts. Elective surgeries include repair of scars, simple hernia, and vaginal repair.
You are caring for a client 6 hours post surgery. You observe that the client voids urine frequently and in small amounts. You know that this most probably indicates what? a) Requirement of intermittent catheterization b) Calculus formation c) Urinary infection d) Urine retention
Urine retention Explanation: Voiding frequent, small amounts of urine indicates retention of urine with elimination of overflow. The nurse should assess the volume of first voided urine to determine adequacy of output. If the client fails to void within 8 hours of surgery, the nurse should consult with the physician regarding instituting intermittent catheterization until voluntary voiding returns and is not required in this case. Frequent and small amounts of urine voiding does not indicate urinary infection nor does it indicate the formation of a calculus.
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?
Use diaphragmatic breathing. -In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? a) Make inhalation longer than exhalation. b) Use diaphragmatic breathing. c) Exhale through an open mouth. d) Use chest breathing.
Use diaphragmatic breathing. Explanation: In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.
At what point does the preoperative period end? a) When the client is transferred onto the operating table b) When the decision is made to proceed with surgery c) When the client signs the consent form d) When the client is admitted to the PACU
When the client is transferred onto the operating table Explanation: The preoperative phase begins when the decision to proceed with surgical intervention is made and ends with the transfer of the client onto the OR table. The intraoperative phase begins when the client is transferred onto the operating table and ends with admission to the PACU.
When assessing a postoperative client, the nurse is correct to relate which surgical risk factor that would decrease if the surgical client maintained a blood glucose level under 150 mg/dL?
Wound healing
A 17-year-old client is having same-day surgery. During the intraoperative phase of perioperative care, the nurse:
continuously monitor sedated client
At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period?
during preoperative period
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as
emergency. -Emergency surgery means that the patient requires immediate attention and the disorder may be life threatening. Urgent surgery means that the patient requires prompt attention within 24 to 30 hours. Required surgery means that the patient needs to have surgery, and it should be planned within a few weeks or months. Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as a) required. b) emergency. c) urgent. d) elective.
emergency. Explanation: Emergency surgery means that the patient requires immediate attention and the disorder may be life threatening. Urgent surgery means that the patient requires prompt attention within 24 to 30 hours. Required surgery means that the patient needs to have surgery, and it should be planned within a few weeks or months. Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic.
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?
notify the surgeon
Choice Multiple question - Select all answer choices that apply. Which of the following activities are nursing activities in the preoperative phase of care? Select all that apply. a) Beginning discharge planning b) Discussing and reviewing the advanced directive document c) Establishing an intravenous line d) Administering medications, fluid, and blood component therapy, if prescribed e) Ensuring that the sponge, needle, and instrument counts are correct
• Beginning discharge planning • Discussing and reviewing the advanced directive document • Establishing an intravenous line Correct Explanation: Of the activities listed, discussing and reviewing the advanced directive document, establishing an intravenous line, and beginning discharge planning are preoperative nursing activities
The nursing instructor is talking with her class about spinal anesthesia. What would be the nursing care intervention required when caring for a client recovering from spinal anesthesia? a) Assist the client to a sitting position at the side of the bed. b) Turn the client from side to side at least every 2 hours. c) Instruct the client to stay in bed until sensation and movement returns. d) Monitor respiratory rate and sensation every 2 hours or as per ordered.
• Instruct the client to stay in bed until sensation and movement returns. • Monitor respiratory rate and sensation every 2 hours or as per ordered. Explanation: The client who has received spinal anesthesia should remain in bed until sensation and movement returns. Also, the respiratory rate and sensation must be monitored every 2 hours. If permitted, the nurse should turn the client from side to side at least every 2 hours. The client who has received spinal anesthesia should be permitted to sit.
Choice Multiple question - Select all answer choices that apply. A client is undergoing a surgical procedure to repair his ulcerated colon. During your care, you discuss at length pertinent information for his condition peri operatively. Which of the following client education topics will be discussed preoperatively? Select all that apply. a) The surgeon's fee and other hospital charges b) Intravenous fluids and other lines and tubes c) Postoperative pain control d) His wife's thoughts about the upcoming surgery e) Cough and deep-breathing exercises
• Intravenous fluids and other lines and tubes • Postoperative pain control • Cough and deep-breathing exercises Correct Explanation: Preoperative teaching involves teaching clients about their upcoming surgical procedure and expectations. Topics include preoperative medications (when they are given and their effects); postoperative pain control; explanation and description of the post anesthesia recovery room or postsurgical area; and deep-breathing and coughing exercises.
Choice Multiple question - Select all answer choices that apply. You are providing preoperative care to a 51-year-old male client who is anxious about his total hip replacement surgery. "What if I can never walk again? I don't want to end up like my father!" What are some ways you might help alleviate his anxiety? Select all that apply. a) Make sure the client understands what will happen during surgery. b) Review the client's postoperative goals following the procedure. c) Listen empathetically to the client's concerns about the procedure. d) Ask the client if he would like to speak with a clergyperson. e) Offer the client a sedative to help him relax and feel more comfortable. f) Remind the client that the chances of something going wrong are statistically low.
• Make sure the client understands what will happen during surgery. • Listen empathetically to the client's concerns about the procedure. • Review the client's postoperative goals following the procedure. • Ask the client if he would like to speak with a clergyperson. Explanation: Preparing the client emotionally and spiritually is as important as doing so physically. Anxiety and fear, if extreme, can affect a client's condition during and after surgery. Careful preoperative teaching and listening by the nurse about what will happen and what to expect can help allay some of these fears and anxieties.