Chapter 17 prepu

he nurse concludes that teaching about pain management was effective when the client states: "I will need to learn how to give myself pain medication by injection for when I go home." "I will support my incision with my hands when I do my coughing and deep breathing exercises." "The pain from my incision will be very similar to my arthritis pain." "I will ask for pain medication when the pain becomes unbearable."

"I will support my incision with my hands when I do my coughing and deep breathing exercises."

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? "We will keep your family informed of your progress." "Let me explain to you w8hat will happen next." "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 w8hat will happen next."

What is the blood glucose level goal for a diabetic patient 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 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 surger

The nurse expects informed consent to be obtained for insertion of: An indwelling urinary catheter An intravenous catheter A nasogastric tube A gastrostomy tube

A gastrostomy tube

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? An exploratory laparotomy A repair of multiple stab wounds A face lift Removal of kidney stones

A repair of multiple stab wounds

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

Adrenal

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? Irrigation of the external ear canal An insertion of an intravenous catheter Urethral catheterization An open reduction of a fracture

An open reduction of a fracture

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. Estimated time of procedure Benefits of surgery Explanation of procedure Potential risks Description of alternatives Personnel present

Benefits of surgery Explanation of procedure Potential risks Description of alternatives

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

Educating the patients on signs and symptoms of infection

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

Emergent

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

Emergent

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. Intravenous fluids and other lines and tubes P ostoperative pain control His wife's thoughts about the upcoming surgery The surgeon's fee and other hospital charges Cough and deep-breathing exercises

Intravenous fluids and other lines and tubes P ostoperative pain control Cough and deep-breathing exercises

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? Document the findings and continue the patient through the preoperative phase. Wait 1 hour and complete the assessment again. Notify the surgeon to possibly delay the surgery. Notify the primary physician about the assessment findings.

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 care for 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 is not appropriate.

A patient 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 may be used as relaxation techniques. Splint the incision site using a pillow during 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.

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's next of kin sign the consent For the nurse to sign the consent with verbal permission of the client To have the client sign the consent immediately

To notify the surgeon

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 Up to 24 hours after alcohol withdrawal Upon awakening in the postanesthesia care unit Immediately upon admission

Up to 72 hours after alcohol withdrawal

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. 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.

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as urgent. required. emergency. elective.

emergency.

When the patient is encouraged to concentrate on a pleasant experience or restful scene, the cognitive coping strategy being employed by the nurse is progressive muscular relaxation. optimistic self-recitation. imagery. distraction.

imagery.

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 5 3 1

7

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."

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

During the preoperative period

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. Nutritional status Gender Physical condition Age Health status Ethnicity

Nutritional status Physical condition Age Health status

The nurse in the preoperative area has just medicated her client according to the anesthesiologist's orders. What is the nurse's priority action at this time? Take the client to the bathroom. Place the side rails in the up position and make sure the call button is in reach. Have the family go to the waiting room. Take the client's vital signs.

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

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 White blood cell count 7.2 cells/mm Sodium 138 mEq/L Calcium 9.8 mg/dL

Potassium 6.2 mEq/L

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? The nurse performs a complete assessment of the client. The nurse obtains a surgical consent from the client's mother. The nurse assesses how well the client is recovering from anesthesia. The nurse continuously monitors the sedated client.

The nurse continuously monitors the sedated client.

When does the nurse understand the patient is knowledgeable about the impending surgical procedure? The patient discusses stress factors causing the patient to feel depressed. The patient participates willingly in the preoperative preparation. The patient verbalizes fears to family. The patient expresses concern about postoperative pain.

The patient participates willingly in the preoperative preparation.