302 Hinkle ch. 17 Preoperative Nursing Management

A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective?

"I will support the incision with my hands when I cough and do my deep breathing exercises" Splinting of the incision provides support to the incision and helps to control pain, so this client statement is correct. Clients should take pain medication routinely and frequently after surgery. Pain medications for postoperative clients are given orally at home. Pain is a subjective feeling, so comparison is difficult.

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure?

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

Which question is most important for the nurse to ask the client when obtaining the preoperative admission history?

"When was the last time you ate or drank?" Consumption of food and fluids near to the time of surgery places the client at increased risk for aspiration.

The physician schedules an elective surgical procedure for a patient who smokes cigarettes. When should the nurse recommend that the patient cease smoking before the surgical procedure to minimize risks associate with cigarette smoking?

1-2 months Patients who smoke are urged to stop 4 to 8 weeks before surgery to significantly reduce pulmonary and wound healing complications.

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

7 Aspirin should be stopped at least 7 to 10 days before surgery. The other time frames are incorrect.

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?

7-10 days Aspirin, a common OTC medication that inhibits platelet aggregation, should be prudently discontinued 7 to 10 days before surgery; otherwise, the client may be at increased risk for bleeding.

The nurse is aware that which of the following helps to stimulate T-cell response:

Arginine Arginine is necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response.

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 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.

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 Beginning discharge planning Of the activities listed, discussing and reviewing the advanced directive document, establishing an intravenous line, and beginning discharge planning are preoperative nursing activities.

A fractured skull would be classified under which category of surgery based on urgency?

Emergent 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 client is preparing to undergo a curative surgical procedure. Which of the following is the type of surgery the client could be having? Select all that apply.

Removal of a tumor removal of a diseased appendix A surgical procedure may be diagnostic (e.g., biopsy, exploratory laparotomy), curative (e.g., excision of a tumor or an inflamed appendix), or reparative (e.g., 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).

Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period?

The 35-year old client with non-insulin dependent diabetes 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 illicit drug use can increase the risk for adverse reactions to anesthesia. Healthy older adults are not at increased risk.

The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities?

The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times. 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.

The nurse recognizes that which of the following clients is at least risk for perioperative complications?

a 65-year old Caucasian male who has a history of Arthritis A history of arthritis does not increase the risk for complications during the perioperative period.

The nurse is triaging surgical clients. Which client would the nurse document as in need of urgent surgical care?

a client with an acute gallbladder infection 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.

The nurse expects informed consent to be obtained for insertion of:

a gastronomy tube Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?

a safe environment Sensory limitations, such as impaired vision or hearing and reduced tactile sensitivity, frequently interact with the postoperative environment, so falls are more likely to occur (Meiner, 2011). Maintaining a safe environment for older adults requires alertness and planning.

Which would be considered to require an urgent surgical procedure?

acute gallbladder infection 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.

You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear?

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

Which is the least important issue concerning safety for the perioperative team before proceeding to the operating room?

client's ambulatory aids It is imperative that the entire perioperative team participates in verifying the client's identity, the correct surgical procedure, and the appropriate surgical site before preceding to the OR. The client's ambulatory aids are not an important safety concern before proceeding to the OR.

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?

diuretics 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.

In which instance may a surgeon operate without informed consent?

emergency situations In an emergency, it may be necessary for the surgeon to operate as a lifesaving measure without the client's informed consent.

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 Imagery has proven effective for anxiety in surgical clients. Optimistic self-recitation is practiced when the client recites optimistic thoughts such as, "I know all will go well." Distraction is used when the client 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.

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:

increase the likelihood of 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. Absolving the hospital of legal responsibility would not be a primary nursing goal.

During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse?

notify the surgical team to remove all latex-based items Allergies to avocados and bananas may indicate an allergy to latex. Although it is necessary to notify the dietary department and physician, it is not an immediate threat, as the patient is receiving nothing by mouth and pain medication will be ordered postoperatively. The nurse manager does not need to be notified of the client's allergies.

When caring for a patient with alcoholism, when should the nurse assess for symptoms of alcoholic withdrawal?

on the second or third day The person with a history of chronic alcoholism often suffers from malnutrition and other systemic problems or metabolic imbalances that increase surgical risk. In patients who are alcohol dependent, alcohol withdrawal syndrome may be anticipated 2 to 4 days after the last drink and is associated with a significant mortality rate when it occurs postoperatively.

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 Hyperkalemia places the client at risk for surgical complications. The sodium level, calcium level, and white blood cell count are within normal limits.

A gunshot wound would be classified under which category of surgery based on urgency?

emergent

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.

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

adrenal insufficiency Clients who have received corticosteroids are at risk for adrenal insufficiency. They are not at greater risk for obstruction, infection, or hypoglycemia during the operative experience.

A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?

blood urea nitrogen level of 42 mg/dl 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.

The nurse in the preoperative area has just medicated her client according to the anesthesiologist's orders. What is the nurse's priority action at this time?

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

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency?

adrenal Clients who have received corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids does not occur in the pituitary, thyroid, or parathyroid glands.

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 Most facilities will allow a client to wear a wedding band during a surgical procedure. The nurse must secure the ring with tape. Although it is appropriate to discuss the risk for infection, the client has already refused to remove the ring. The surgery should not be canceled and the ring should not be removed without permission.

A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:

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

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

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.

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?

verifies that operative consent is signed All choices listed are essential but, without a signed consent form, surgery cannot occur.

The nurse is preparing a client for surgery. The nurse would notify the surgeon if the client made which of the following statements? Select all that apply.

"I took my Coumadin as usual last evening." "I took two aspirins for joint pain in the morning" The nurse needs to alert the surgeon to any medications the client has taken that increase the client's risk for bleeding. *Aspirin inhibits platelet aggregation and should be stopped at least 7 to 10 days prior to surgery. Coumadin (warfarin) interferes with the synthesis of vitamin K-dependent clotting factors.* The type of surgical procedure and the medical condition of the client determine when the Coumadin should be stopped prior to surgery.

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.

cosmetic diagnostic palliative Reasons people have surgery include cosmetic reasons, diagnostic procedures, palliative surgeries, exploratory surgeries, and curative surgeries. Options D and E are distractors.

A physically fit older adult is scheduled for right knee replacement. What factor for the client creates an increased risk for postoperative complications?

current smoking history The nurse identifies the client's current smoking status as a risk factor for surgical complications. General risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition. The type of surgery, the ability to metabolize medication, and surgical site are not a risk factors.

What action by the nurse best encompasses the preoperative phase?

educating client's on signs and symptoms of infection Educating clients on preventing or recognizing complications begins in the preoperative phase. *Applying SCDs and frequently monitoring vital signs happen after the preoperative phase*. Only electric clippers should be used to remove hair.

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

emergency Emergency surgery means that the client requires immediate attention and the disorder may be life threatening. Urgent surgery means that the client requires prompt attention within 24 to 30 hours. Required surgery means that the client 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.

An inappropriate nursing action implemented to keep the client safe includes:

moving the client swiftly National Patient Safety goals for the surgical client include verification of the client and protecting the client from physical harm.

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 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. This scenario does not include information to support documentation of the client's food intake or giving the client water at this point. It is not the nurse's responsibility to cancel the surgery.

The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply.

nutritional status age physical condition health status 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 a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications?

osteoporosis Osteoporosis is 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's effectiveness, increasing the chance for infections.

The nurse is aware that the amino acid, arginine,

stimulates t-cell response Arginine is necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response.

The nurse is educating a client scheduled for elective surgery. The client currently takes aspirin daily. What education should the nurse provide with regard to this medication?

stop taking aspirin 7 days before the surgery, unless otherwise directed by your physician Aspirin should be stopped at least 7 to 10 days before surgery. The other directions provided are incorrect.

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

urgent Surgery for kidney or urethral stones is considered urgent; it is usually performed the next day. Emergent surgery is performed without delay. Required surgery is performed within a few weeks or months. Elective surgery refers to procedures that the client plans in advance.

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.

The nurse is aware that which of the following nutrients promotes normal blood clotting?

vitamin K Vitamin K is important for normal blood clotting.

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 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).

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?

80-110 mg/dl Although the surgical risk in the client with controlled diabetes is no greater than in the client without diabetes, strict glycemic control (80 to 110 mg/dL) leads to better outcomes. Frequent monitoring of blood glucose levels is important before, during, and after surgery.

The nurse is monitoring a presurgical patient for electrolyte imbalance. Which classification of medication may cause electrolyte imbalance?

diuretics During anesthesia, diuretics may cause excessive respiratory depression resulting from an associated electrolyte imbalance. The other drugs listed do not cause an electrolyte imbalance.

Which domain of perioperative nursing practice focuses on clinical processes and outcomes?

health care systems 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 comprise nursing diagnoses, interventions, and outcomes.

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

reconstructive Clients have surgery for many different reasons. Reconstructive surgery is intended to repair or reconstruct physical deformities and abnormalities caused by traumatic injuries, birth defects, developmental abnormalities, or disease. Corrective surgery usually involves fixing a problem. Diagnostic surgery is the removal and study of tissue to make a diagnosis. Prophylactic surgery is the removal of tissue that does not yet contain cancer cells but has a high probability of becoming cancerous in the future.

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 According to the 2016 National Patient Safety Goals, accurate identification of the client, procedure, and operative site is essential.

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications?

splint the incision site with 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 in preventing respiratory complications. Pain medication should be taken regularly, 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 clients will find the exercises relaxing, most clients find it painful to complete them.

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?

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

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?

surgeon 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 educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate?

the three phases of surgery and safety measures for each phase The perioperative period includes the preoperative, intraoperative, and postoperative phases. Specific safety guidelines are followed for all surgical clients. The information provided should be general enough to be informative about surgery and should not focus on individual surgeries, as all the clients 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.

At what point does the preoperative period end?

when the client is transferred into the operating table 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.

A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which client surgical risk factor would decrease if the surgical client maintained strict blood glycemic control?

wound healing 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. Strict control of glycemic blood levels at the therapeutic range of 80-110 mg/dL would reduce this risk factor. There is no direct correlation between blood glucose levels and nutrient deficiencies, respiratory complications, or liver dysfunction.

The nurse recognizes that the client most at risk for mortality associated with surgery is the:

a client with chronic alcoholism The client with chronic alcoholism who experiences alcohol withdrawal symptoms is at significant risk for mortality, which can be attributed to cardiac dysrhythmias, cardiomyopathy, and bleeding tendencies.

A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery?

a history of diabetes 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 with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for?

hypoglycemia The patient with diabetes who is undergoing surgery is at risk for both hypoglycemia and hyperglycemia. Hypoglycemia may develop during anesthesia or postoperatively from inadequate carbohydrates or excessive administration of insulin. Hyperglycemia, which can increase the risk of surgical wound infection, may result from the stress of surgery, which can trigger increased levels of catecholamine. Other risks are acidosis and glucosuria, but hypoglycemia is a bigger risk. Dehydration is a lesser risk for a patient with diabetes than is hypoglycemia.

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 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.

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?

an open reduction of a fracture Informed consent is necessary in the following circumstances: invasive procedures, such as a surgical incision (such as would be involved in an open reduction of a fracture), a biopsy, a cystoscopy, or paracentesis; procedures requiring sedation and/or anesthesia (see Chapter 18 for a discussion of anesthesia); a nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient; and procedures involving radiation. Non-invasive procedures such as insertion of an intravenous or urethral catheter or irrigation of the external ear canal would not require informed consent.

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 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 of the client's questions are answered fully.

A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed?

the client exhales forcefully with a short expiration Diaphragmatic breathing should be performed gently and fully. Placing the hands on the lower chest to feel the rise and fall with breathing, performing diaphragmatic breathing in a semi-Fowler's position, and breathing deeply through the nose and mouth are all aspects of diaphragmatic breathing.

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 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.

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 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 is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery?

post discharge diet 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.

Sudden withdrawal of which of the following may result in seizures?

tranquilizers 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 undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply.

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