Chapter 17-19: Pre-op, Intra-op, Post-op

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) 7 b) 1 c) 5 d) 3

a) 7 Aspirin should be stopped at least 7 to 10 days before surgery. The other timeframes are incorrect.

Patients who have received corticosteroids preoperatively are at risk for which type of insufficiency? a) Adrenal b) Parathyroid c) Thyroid d) Pituitary

a) 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.

The nurse should know that, postoperatively, a general anesthetic is primarily eliminated via what organ(s)? a) The lungs b) The liver c) The skin d) The kidneys

a) The lungs When anesthetic administration is discontinued, the vapor or gas is eliminated through the lungs.

The nurse is preparing a client for surgery. The nurse would notify the surgeon if the client made which of the following statements? a) "I have not had any metformin for the past week." b) "I took two aspirins for joint pain this morning." c) "I took two Tylenol last evening for a headache." d) "I took my Coumadin as usual last evening." e) "I took my lisinopril this morning."

b) "I took two aspirins for joint pain this morning." d) "I took my Coumadin as usual last evening." 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.

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

c) 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 nursing diagnosis should the nurse plan to address first in the client upon arrival in the intraoperative setting? a) Risk for perioperative positioning injury related to positioning in the OR b) Disturbed sensory perception related to the effects of general anesthesia c) Anxiety related to ineffective coping with surgical concerns d) Risk of latex allergy response related to possible exposure in the OR environment

c) Anxiety related to ineffective coping with surgical concerns Putting the client at ease helps the client prepare for the surgical experience by promoting psychological comfort of the client and giving the client a sense of control.

The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response? a) "The anesthetic may last for 1 hour." b) "The anesthetic may last for 7 hours." c) "The anesthetic may last for 5 hours." d) "The anesthetic may last for 3 hours."

d) "The anesthetic may last for 3 hours." Local anesthesia is the injection of a solution containing the anesthetic agent into the tissues at the planned incision site. Often it is combined with a local regional block by injecting around the nerves immediately supplying the area. It is ideal for short (3 hours) and minor surgical procedures.

The nurse is aware that the amino acid, arginine, a) Is important for normal blood clotting b) Is involved in capillary formation c) Is essential for antibody formation d) Stimulates T-cell response

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

Which of the following factors may contribute to rapid and shallow respirations in a postoperative client? Select all that apply. a) Constricting dressings b) Abdominal distention c) Effects of analgesics and anesthesia d) Pain e) Obesity

a) Constricting dressings b) Abdominal distention d) Pain e) Obesity Often, because of the effects of analgesic and anesthetic medications, respirations are slow. Shallow and rapid respirations may be caused by pain, constricting dressings, gastric dilation, abdominal distention, or obesity.

Which intervention should the nurse plan to implement to decrease the client's risk for injury during the intraoperative period? a) Verify the client's preoperative vital signs. b) Assess the client for allergies. c) Keep the family informed of the client's status. d) Allow the client to verbalize fears.

b) Assess the client for allergies. The nurse must be aware of the client's allergies to prevent exposure to the client.

A patient is scheduled for a reduction mammoplasty. What classification of surgery does the nurse understand that this is? a) Urgent b) Optional c) Reconstructive d) Required

b) Optional Cosmetic surgery, including reduction mammoplasties, is optional, as the decision to have the surgery rests with the patient.

During surgery a patient develops hypothermia. The circulating nurse would monitor the patient closely for which of the following? a) Rebound hyperthermia b) Hypoxia c) Metabolic acidosis d) Anaphylaxis

c) Metabolic acidosis When a patient's temperature falls, glucose metabolism is reduced. As a result, metabolic acidosis may develop. Rebound hyperthermia, anaphylaxis, and hypoxia are not associated with hypothermia during surgery.

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

a) 80 to 110 mg/dL Although the surgical risk in the patient with controlled diabetes is no greater than in the patient without diabetes, strict glycemic control (80 to 110 mg/dL) leads to better outcomes (Alvarex et al., 2010). Frequent monitoring of blood glucose levels is important before, during, and after surgery.

To prevent thromboembolism in the postoperative client, the nurse should include which of the following in the plan of care? a) Assist with oral fluid intake. b) Splint the incision when ambulating. c) Assist the client with deep breathing. d) Place a pillow under the knees.

a) Assist with oral fluid intake. Dehydration, immobility, and pressure on leg veins promote venous stasis, which can lead to thromboembolism.

The nurse is completing a postoperative assessment for a patient who has received a depolarizing neuromuscular blocking agent. The nursing assessment includes careful monitoring of which body system? a) Cardiovascular system b) Endocrine system c) Genitourinary system d) Gastrointestinal system

a) Cardiovascular system Depolarizing muscle relaxants can cause cardiac dysrhythmias.

Which of the following nursing activities would not be part of the preoperative phase of care? Select all that apply. a) Ensuring that the sponge, needle, and instrument counts are correct b) Discussing and reviewing the advanced directive document c) Beginning discharge planning d) Administering medications, fluid, and blood component therapy, if prescribed e) Establishing an intravenous line

a) Ensuring that the sponge, needle, and instrument counts are correct d) Administering medications, fluid, and blood component therapy, if prescribed Of the activities listed, discussing and reviewing the advanced directive document, establishing an intravenous line, and beginning discharge planning are preoperative nursing activities.

A patient is administered succinylcholine and propofol (Diprivan) for induction of anesthesia. One hour after administration, the patient is demonstrating muscle rigidity with a heart rate of 180. What should the nurse do first? a) Notify the surgical team. b) Document the assessment findings. c) Administer dantrolene sodium (Dantrium). d) Obtain cooling blankets.

a) Notify the surgical team. Tachycardia and muscle rigidity is often the earliest sign of malignant hyperthermia. Early recognition of malignant hyperthermia increases survival. The nurse would document the findings, administer dantrolene sodium (Dantrium), obtain cooling blankets as part of the treatment for malignant hyperthermia, but the nurse would need to ensure the surgical team is aware of the findings first.

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 postoperative instructions. c) Give caregiver instructions. d) Teach dressing changes.

a) Review preoperative instructions. 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.

What evidence does the nurse understand indicates that a patient is ready for discharge from the recovery room or PACU? (Select all that apply.) a) The patient has a blood pressure within 10 mm Hg of the baseline. b) The patient is arousable but falls back to sleep rapidly. c) The patient rates pain a 9 out of 10 on a 0-10 scale after receiving morphine sulfate. d) The patient has sonorous respirations and occasionally requires chin lift. e) The patient has been extubated but still has an oropharyngeal airway in.

a) The patient has a blood pressure within 10 mm Hg of the baseline. b) The patient is arousable but falls back to sleep rapidly. d) The patient has sonorous respirations and occasionally requires chin lift. A patient remains in the PACU until fully recovered from the anesthetic agent. Indicators of recovery include stable blood pressure, adequate respiratory function, and adequate oxygen saturation level compared with baseline.

A client is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid) block during surgery. In the operating room, the nurse positions the client according to the anesthesiologist's instructions. Why does the client require special positioning for this type of anesthesia? a) To prevent cerebrospinal fluid (CSF) leakage b) To prevent seizures c) To prevent cardiac arrhythmias d) To prevent confusion

a) To prevent cerebrospinal fluid (CSF) leakage The client receiving a subarachnoid block requires special positioning to prevent CSF leakage and headache and to ensure proper anesthetic distribution. Proper positioning doesn't help prevent confusion, seizures, or cardiac arrhythmias.

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) Wound healing b) Respiratory complications c) Liver dysfunction d) Nutrient deficiencies

a) 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. There is no direct correlation between blood glucose levels and nutrient deficiencies, respiratory complications, and liver dysfunction.

A patient is complaining of a headache after receiving spinal anesthesia. What does the nurse understand may be the cause of the headache related to the spinal anesthesia? (Select all that apply.) a) An allergic reaction to the medication used b) Degree of patient hydration c) Size of the spinal needle used d) The patient lying in the supine position e) Leakage of spinal fluid from the subarachnoid space

b) Degree of patient hydration c) Size of the spinal needle used e) Leakage of spinal fluid from the subarachnoid space Headache may be an aftereffect of spinal anesthesia. Several factors are related to the incidence of headache: the size of the spinal needle used, the leakage of fluid from the subarachnoid space through the puncture site, and the patient's hydration status. Measures that increase cerebrospinal pressure are helpful in relieving headache. These include maintaining a quiet environment, keeping the patient lying flat, and keeping the patient well hydrated. A headache is not likely to occur as the result of the patient lying in the supine position or of an allergic reaction to the medication.

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) Monitor vital signs every 2 hours. b) Instruct the client to remain flat for 6 to 12 hours. c) Assist the client to a sitting position at the side of the bed. d) Turn the client from side to side at least every 2 hours.

b) Instruct the client to remain flat for 6 to 12 hours. The client who has received spinal anesthesia should remain flat for 6 to 12 hours unless ordered otherwise. 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. It is not required to monitor the vital signs every 2 hours.

An obese patient is scheduled for open abdominal surgery. What priority education should the nurse provide this patient? a) Wound care and infection prevention b) Prevention of respiratory complications c) Prevention of wound dehiscence d) Venous thromboembolism prevention

b) Prevention of respiratory complications All answers are correct but the obese patient has an increased susceptibility to respiratory complications, and maintaining a patent airway would be the priority.

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.) a) Renal system b) Pulmonary system c) Nervous system d) Gastrointestinal system e) Cardiovascular system

b) Pulmonary system d) Gastrointestinal system e) Cardiovascular system Like age, obesity increases the risk and severity of complications associated with surgery. The estimation of about 25 additional miles of blood vessels needed for every 30 pounds of excess weight results in increased cardiac demand (Alvarex, Brodsky, Lemmens, et al., 2010). The patient tends to have shallow respirations when supine, increasing the risk of hypoventilation and postoperative pulmonary complications. The acquired physical characteristics of short thick necks, large tongues, recessed chins, and redundant pharyngeal tissue, associated with increased oxygen demand and decreased pulmonary reserves, impedes intubation (Haupt & Reed, 2010). Obesity also affects the gastrointestinal system.

A 55-year-old patient arrives at the operating room. The nurse is reviewing the medical record and notes that the patient has a history of osteoporosis in her lower back and hips. The patient is scheduled to receive epidural anesthesia. Which of the following nursing diagnoses would be a priority for this patient? a) Anxiety related to the surgical experience b) Risk for perioperative positioning injury related to operative position c) Disturbed sensory perception related to sedation d) Risk for injury related to effects of anesthetic agents

b) Risk for perioperative positioning injury related to operative position Although any of the nursing diagnoses might apply for this patient, the priority would be risk for perioperative positioning injury related to the patient's history of osteoporosis. The bone loss associated with this condition necessitates careful manipulation and positioning during surgery.

Which nursing diagnosis is most important for the client who is undergoing a surgical procedure expected to last several hours? a) Disturbed sensory perception related to the effects of general anesthesia b) Risk for perioperative positioning injury related to positioning in the OR c) Risk of latex allergy response related to possible exposure in the OR environment d) Anxiety related to ineffective coping with surgical concerns

b) Risk for perioperative positioning injury related to positioning in the OR Pressure ulcers, nerve and blood vessel damage, and discomfort are risks associated with prolonged, awkward positioning required for surgical procedures.

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) The client has an absence of bowel sounds. c) The client's lungs reveal rales in the bases. d) A moderate amount of serous drainage is noted on the operative dressing.

b) The client has an absence of bowel sounds. 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.

The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities? a) The client takes three deep breaths and then coughs forcefully. b) The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times. c) The client breathes through her nose, holds her breath, and then exhales slowly before coughing. d) The client takes short, panting breaths and coughs from the throat to expectorate sputum.

b) 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.

Which findings would be indicative of a nursing diagnosis of decreased cardiac output? a) confusion; tachypnea; hemoglobin 14.2 gm/dL b) tachycardia; hemoglobin 10.9 gm/dL; BP 88/56 c) bradycardia; urinary output < 30 ml; confusion d) urinary output > 60 ml; BP 90/60; tachypnea

b) tachycardia; hemoglobin 10.9 gm/dL; BP 88/56 Clinical manifestations of decreased cardiac output include tachycardia, tachypnea, urinary output < 30 ml/hr, decreased hemoglobin and hematocrit, and acute confusion.

The hazards of surgery for the aged increase as the number and severity of coexisting health problems increase. Which of the following are structural or functional changes in the elderly that impact the surgical experience? Select all that apply. a) c. Decreased ability to compensate for hypoxia increases the risk of an embolism. b) b. Increased fatty tissue prolongs elimination of anesthesia. c) d. Enlarged liver, due to fatty deposits, alters the breakdown of anesthetic agents. d) f. Reduced tactile sensitivity can lead to assessment and communication problems. e) e. Loss of collagen increases the risk of skin complications. f) a. Increased plasma proteins decrease the effects of anesthesia.

b. Increased fatty tissue prolongs elimination of anesthesia. c. Decreased ability to compensate for hypoxia increases the risk of an embolism. e. Loss of collagen increases the risk of skin complications. f. Reduced tactile sensitivity can lead to assessment and communication problems. The elderly usually have low plasma proteins, which results in free or unbound anesthetic agents. The liver is usually reduced in size, which inactivates many anesthetic agents. Refer to Table 5-2 in the text.

What is the most important postoperative instruction a nurse must give to a client who has just returned from the operating room after receiving a subarachnoid block? a) "Notify a nurse if you experience blood in your urine." b) "Avoid drinking liquids until the gag reflex returns." c) "Remain supine for the time specified by the physician." d) "Avoid eating milk products for 24 hours."

c) "Remain supine for the time specified by the physician." The nurse should instruct the client to remain supine for the time specified by the physician. Local anesthetics used in a subarachnoid block don't alter the gag reflex. No interactions between local anesthetics and food occur. Local anesthetics don't cause hematuria.

The nurse is assisting with positioning the patient on the operating table. The nurse understands that the most commonly used position is which of the following? a) Lithotomy b) Sims c) Dorsal recumbent d) Trendelenburg

c) Dorsal recumbent The usual position for surgery is the dorsal recumbent position. The Trendelenburg position is used for surgery on the lower abdomen and pelvis. The lithotomy position is used for nearly all perineal, rectal, and vaginal surgical procedures. The Sims or lateral position is used for renal surgery.

A medical student, scheduled to observe surgery, enters the unrestricted surgical zone wearing jeans, a t-shirt, and tennis shoes. What is the best action by the nurse? a) Provide the medical student a cap and mask. b) Immediately escort the medical student out of the area. c) Educate the medical student on required attire for each surgical zone. d) No action is needed.

c) Educate the medical student on required attire for each surgical zone. It would be best to educate the medical student on the required attire for each surgical zone. Since the student will be observing a surgery, the student will need to dress appropriately in each zone to decrease the risk of introducing pathogens. The unrestricted zone allows for street clothes; therefore, the student does not need to be removed. If no action is taken by the nurse, the student could enter the semirestricted or restricted zone without appropriate attire. Providing a cap and mask does not address the need to change out of the street clothes to observe the surgery.

A nurse is reviewing the medical record of a patient who is to receive general anesthesia and notes a nursing diagnosis of anxiety related to surgical concerns. The nurse implements measures to reduce the patient's anxiety based on the understanding of which of the following? a) The patient is at risk for additional complications. b) Anxiety interferes with progression through the stages of general anesthesia. c) Increased anxiety can increase the patient's postoperative pain level. d) The anesthetic will result in a more potent effect on the patient.

c) Increased anxiety can increase the patient's postoperative pain level. Anxiety increases the amount of anesthetic medication needed, the level of postoperative pain, and overall recovery time. Anxiety may place the patient at risk for complications, but other factors are usually also involved. When a patient is anxious, induction is slower and greater quantities of anesthetic agents are required because the brain receives a smaller quantity of anesthetic agent. Anxiety is unrelated to the patient's progression through the stages of general anesthesia. Additionally, when opioid agents and neuromuscular blockers are administered as part of general anesthesia, several of the stages are absent.

A patient is scheduled to have a cholecystectomy. Which of the nurse's finding is least likely to contribute to surgical complications? a) Urinary tract infection b) Diabetes c) Osteoporosis d) Pregnancy

c) 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 the older adult is at risk for surgical complications due to: a) decreased adipose tissue b) increased cardiac output c) decreased renal function d) increased skeletal mass

c) decreased renal function Renal function declines with age, resulting in slowed excretion of waste products and anesthetic agents.

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 decrease the amount of anesthesia you will need." b) "These medications slow motor activity." c) "These medications decrease anxiety before surgery." d) "These medications decrease gastric acidity and volume."

d) "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.

When developing a teaching plan for a patient scheduled for ambulatory surgery with epidural anesthesia, which of the following would the nurse include? a) "The anesthetic is introduced directly into the spinal cord." b) "You won't be able to move, but you'll be able to feel sensations." c) "Normally, the blood pressure drops fairly low initially." d) "You shouldn't experience a headache after this type of anesthesia."

d) "You shouldn't experience a headache after this type of anesthesia." With epidural anesthesia, a headache usually does not occur. If the dura mater is punctured during epidural anesthesia and the anesthetic travels toward the head, high spinal anesthesia can occur, producing severe hypotension and respiratory depression and arrest. This is a complication and not a typical reaction. The anesthetic is introduced into the epidural space surrounding the dura mater of the spinal cord. It blocks sensory, motor, and autonomic functions.

Which of the following interventions would be most appropriate for a client who has undergone surgery for a liver disorder and has started shivering? a) Place the client on a hypothermia blanket. b) Ensure that the room temperature is below 70°F. c) Provide the client with warm fluids. d) Cover the client with a light blanket.

d) Cover the client with a light blanket. When the client is shivering, the nurse should cover the client with a light blanket. This will prevent the client from shivering. This is because the client who has undergone surgery for liver disorder also faces the risk of hyperthermia related to infection, rejection, or both. Providing the client with warm fluids will not control shivering. The client is covered with a hypothermia blanket if the temperature rises to 105ºF. The room temperature need not be below 70°F.

The circulating nurse is preparing a patient for a surgical procedure. What primary responsibility does the circulating nurse have in the perioperative experience? a) Passing instruments during the intraoperative phase b) Marking the operative site c) Coordinating the efforts of the surgical team d) Discussing the complications of the surgical procedure with the patient

d) Discussing the complications of the surgical procedure with the patient A foremost responsibility of the circulating nurse includes verifying consent; if not obtained, surgery may not commence. Verifying consent would include discussing the complications of the surgical procedure with the patient.

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

d) 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.

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) Apnea from respiratory paralysis b) Cardiovascular collapse c) Seizures d) Hypotension

d) Hypotension 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.

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

d) 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.

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) Warfarin (Coumadin) b) Hydrochlorothiazide (HydroDIURIL) c) Erythromycin (Ery-Tab) d) Prednisone (Deltasone)

d) Prednisone (Deltasone) 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.

The nurse is caring for a client during an intraoperative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? a) Blood pressure of 104/62 mm Hg b) Pulse rate of 110 beats/min c) Respiratory rate of 18 breaths/min d) Temperature of 102.5° F

d) Temperature of 102.5° F 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

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) Urinary infection b) Calculus formation c) Requirement of intermittent catheterization d) Urine retention

d) 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.