Chapter 30 Perioperative Nursing

The healthy adult client is given a narcotic prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first? a) Immediately have the client sign the consent form. b) Have the client's family member sign the consent form. c) Ask the client if he still wants to proceed with the procedure. d) Notify the physician of the oversight.

Do not administer any medications that might alter judgment or perception before the client signs the consent form because many drugs commonly administered as preoperative medications, such as narcotics or barbiturates, can alter cognitive abilities and invalidate informed consent.

The nurse is performing a preoperative assessment of a client who has been scheduled for a reduction mammoplasty (breast reduction). The client states, "I'm starting to wonder if I made the right decision in going ahead with this." What should the nurse do next? a) Explore the client's feelings and inform the surgeon. b) Assess the client's rationale and affirm that she has made a good decision. c) Remind the client that she has signed the informed consent documents. d) Ask the client about her understanding of the potential benefits of the surgery.

a) Explore the client's feelings and inform the surgeon. The nurse should discuss this and notify the care provider. Clients should not undergo surgery until they are sure that surgery is what they want. Informed consent documents do not bind the client to an earlier decision. It would be inappropriate to try to convince the client to go through with the surgery if she is questioning her decision.

The preoperative nurse is teaching a client about deep-breathing exercises. The client asks, "Why do I need to learn about this?" Which response by the nurse is correct? a) "After surgery, deep-breathing exercises help to remove anesthetic gases and mucus and improve oxygen supply to body tissues." b) "These types of exercises help distract you from the postoperative pain." c) "If you learn how to perform these exercises correctly, you will not need supplemental oxygen during surgery." d) "These techniques will prevent trapped air from accumulating in your lungs."

a) "After surgery, deep-breathing exercises help to remove anesthetic gases and mucus and improve oxygen supply to body tissues." Deep-breathing exercises are intended to help prevent postoperative complications, such as low oxygen levels, accumulation of secretions, and atelectasis.

Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction? a) "I can have a hamburger and French fries as soon as I wake up." b) "The better I eat before surgery, the more likely I will heal." c) "I might be sick to my stomach and throw up after surgery." d) "When I can eat again, the best meal would be steak and orange juice."

a) "I can have a hamburger and French fries as soon as I wake up." Oral fluid and food may be withheld until intestinal motility resumes.

A client who is scheduled to undergo coronary bypass surgery in a week asks the nurse whether he should discontinue taking his cholesterol medicine ahead of the surgery. Which should be the nurse's response? a) "I will need to check with your health care provider about that." b) "Yes—you should be off all of your medications for 24 hours before surgery." c) "No—you should stay on your normal medication schedule before the surgery." d) "You should stay on your cholesterol medicine but stop taking all other medications 12 hours before surgery."

a) "I will need to check with your health care provider about that." The client may be permitted to take certain medications before surgery. The health care provider, not the nurse, should provide guidance about which medications should be taken and which ones should be held.

The nurse assists a client to turn in the bed. The client has just returned from abdominal surgery. How does the nurse instruct the client? a) "Use a pillow to splint the incision." b) "Change your position frequently." c) "Raise the head of the bed before turning." d) "Wait for assistance before moving in bed."

a) "Use a pillow to splint the incision." The client needs to use a pillow to splint the incision during movement to reduce pain. The client needs to change position every 2 hours or less; "frequently" could be misinterpreted by the client. It is easier to turn laterally when the head of the bed is flat. Independence is encouraged, so if the client feels capable, he or she may move in the bed on his or her own.

A client has presented to the outpatient surgical center for a scheduled procedure. Which action should the nurse perform prior to the procedure? a) Assess the client's allergy status. b) Encourage the client to create an advance directive. c) Have the client perform leg exercises every 30 minutes. d) Administer analgesia (pain medications).

a) Assess the client's allergy status. The nurse should assess or confirm the client's allergy status prior to surgery. An advance directive may be in place, but one would not be created on the day of surgery if it were not already established. Analgesia is not normally given preoperatively. Leg exercises should be taught and modeled preoperatively, but they do not need to be performed during this phase.

The acute care nurse is preparing a client for surgery. Which action is essential to complete before transferring the client to surgery? a) Assure that diagnostic testing has been completed and results are available. b) Place the client in a side-lying position. c) Remove graduated compression stockings. d) Mark the client's skin to indicate the location of the surgery.

a) Assure that diagnostic testing has been completed and results are available. All prescribed diagnostic tests should be performed, and results made available before the client goes to surgery. Unless otherwise indicated, no special positioning is required preoperatively. Graduated compression stockings, if prescribed, should remain in place. The surgeon, not the nurse, is responsible for marking the skin.

The preoperative nurse has prepared a client for surgery and has been notified that the operating room staff is ready for the client. The client states, "My bladder feels full. I need to go to the bathroom!" Which action by the nurse is appropriate? a) Inform the operating room staff and assist the client to the bathroom. b) Inform the client that anesthesia will prevent the bladder from emptying during surgery. c) Insert a catheter into the bladder. d) Remind the client that bladder fullness is a common preoperative sensation.

a) Inform the operating room staff and assist the client to the bathroom. Clients should empty the bowel and bladder before surgery. A urinary catheter is not indicated. The remaining statements are untrue.

The nurse is supervising a nursing student who is providing postoperative education to a client with an abdominal incision. The nurse sees the student coaching the client to perform coughing exercises while the client has her arms folded over her abdomen. What is the nurse's best action? a) Instruct the student to provide the client with a pillow or folded blanket to hug. b) Help the student assist the client into a high Fowler's position. c) Help the client determine whether she is able to dangle at the side of the bed. d) Remind the student to support the client while she performs the exercises.

a) Instruct the student to provide the client with a pillow or folded blanket to hug. Because coughing is often painful, the student should teach the client how to splint the incision (i.e., support the incision with a pillow or folded bath blanket). It is not normally necessary to physically support the client, and it may be unsafe for the client to dangle. The client should not be in a supine or in a low Fowler's position, but the client does not necessarily need to be fully upright.

The preoperative nurse is reviewing the chart of a client whose surgery is scheduled to begin in the next 15 minutes and notices that the consent form is not signed. The nurse contacts the surgeon who states, "We have already reviewed this procedure extensively, so ask the client to sign the consent form and I will verify it in the operating room." Which action by the nurse is appropriate? a) Keep the client in the preoperative area and inform the surgeon that it is the health care provider's responsibility to obtain consent for surgery. b) Ask the client to sign the consent; witness the signature and inform the operating room staff of the modification in the procedure. c) Send the client to the operating room and inform the staff that the consent form needs to be signed. d) Ask the operating room staff to delay the procedure until the consent is signed.

a) Keep the client in the preoperative area and inform the surgeon that it is the health care provider's responsibility to obtain consent for surgery. If a consent form is not signed, the nurse should notify the surgeon. It is the health care provider's responsibility to obtain consent for surgery and anesthesia. Preoperative medications cannot be given until the consent form is signed. The client should not proceed to surgery without a signed consent form (unless it is an emergency).

A client had an open cholecystectomy (gallbladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding? a) Monitor the client closely and promote fluid intake. b) Contact the physician to come assess the client. c) Immediately administer a cleansing enema. d) Increase the rate of the client's intravenous infusion.

a) Monitor the client closely and promote fluid intake. Bowel function does not typically return immediately after surgery, but it can be promoted by encouraging fluid and fiber intake as appropriate to the client and his or her surgery. A medical assessment is likely unnecessary at this early postoperative stage, and an enema would likely be premature. The nurse may not independently increase the client's IV infusion, and doing so would not necessarily promote a bowel movement.

The nurse is teaching a preoperative client about turning in bed after her surgery. Which demonstrates the appropriate action? a) Nurse encourages client to raise one knee and grasp the side rail b) Nurse pulling client arm towards side rail c) Nurse pushes client from behind with hands on her thigh and back d) Nurses pushes client from behind with hands on her back

a) Nurse encourages client to raise one knee and grasp the side rail The nurse should teach the client to turn in bed by raising one knee, reaching across to grasp the side rail on the side toward which she is turning, and rolling over while pushing with the bent leg and pulling on the side rail. The nurse will not be pulling on the client's arm or pushing her.

The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency? a) Respiratory obstruction b) Cardiac distress c) Wound infection d) Dehydration

a) Respiratory obstruction Respiratory obstruction may occur as a result of secretion accumulation, obstruction by the tongue, laryngospasm (a sudden, violent contraction of the vocal cords), or laryngeal edema. Cardiac distress, wound infection, and dehydration are all possible postoperative complications, but respiratory obstruction is most common.

The nurse is caring for a client who had abdominal surgery yesterday and is reluctant to cough and perform deep breathing. Which strategy will most likely increase the client's willingness to cough and perform deep breathing? a) Teach the client how to splint the abdomen while coughing. b) Remind the client of the serious complications that can result from ineffective coughing and deep breathing. c) Administer respiratory treatments to encourage coughing. d) Assist the client to a side-lying position to cough.

a) Teach the client how to splint the abdomen while coughing. Splinting the abdomen decreases discomfort while coughing. Telling the client about complications will be less effective than teaching splinting techniques. Respiratory treatments are not indicated for cough production. Side-lying position is less effective than upright positioning to clear secretions and expand the lungs.

A female client age 54 years has been scheduled for a bunionectomy (removal of bone tissue from the base of the great toe) which will be conducted on an ambulatory basis. Which characteristic applies to this type of surgery? a) The client will be admitted the day of surgery and return home the same day. b) The surgery will be conducted using moderate sedation rather than general anesthesia. c) The surgery is classified as urgent rather than elective. d) The client must be previously healthy with low surgical risks.

a) The client will be admitted the day of surgery and return home the same day. Outpatient surgeries, also known as ambulatory surgeries, are conducted with admission and discharge on the same day. Such surgeries have become increasingly common in recent years, and some surgeries of increasing complexity and risk are conducted on an outpatient basis. General anesthesia is possible and common. This approach is more common for elective surgeries than urgent surgeries.

The nurse is teaching a client about postoperative pain management. The client states, "I would like to use as little medication as possible after surgery. Will anything else help to relieve my pain?" Which response is appropriate? a) There are several nonpharmacologic methods to reduce pain and anxiety. Let me teach you about some of them." b) Are you afraid of becoming addicted to pain medications?" c) "Your pain needs to be managed with medication for the first 24 hours, then you can try nonpharmacologic methods." d) "There are nonpharmacologic methods, but they only work when clients have practiced them extensively beforehand."

a) There are several nonpharmacologic methods to reduce pain and anxiety. Let me teach you about some of them." Nonpharmacologic measures may reduce anxiety and reduce the need for pain medication at any time during the postoperative period. Asking about fear of addiction does not address the client's question. Nonpharmacologic methods can be implemented postoperatively regardless of prior client experience.

Which factor is most important in the nurse's decision on assessment data, outcomes, and the monitoring needs of a client in preparing for surgery? a) Type of surgery b) Age of client c) Client's support system d) Type of anesthesia

a) Type of surgery Although all of these factors would need to be taken into account in planning care for a client going to surgery, the type of surgery is the most important influence on what type of care the client will require after surgery. Anesthesia and age play a role in monitoring needs postoperatively. The client needs an adequate support system when leaving the hospital, but the type of surgery influences the client's needs overall.

Which client most likely requires special preoperative assessment and treatment as a result of the existing medication regimen? a) a woman who takes daily anticoagulants to treat atrial fibrillation b) a woman who takes daily thyroid supplements to treat her longstanding hypothyroidism c) a man who takes an angiotensin-converting enzyme (ACE) inhibitor because he has hypertension d) a man who regularly treats his rheumatoid arthritis with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs)

a) a woman who takes daily anticoagulants to treat atrial fibrillation Anticoagulants present a risk of hemorrhage. This risk supersedes that posed by thyroid supplements, ACE inhibitors, or most NSAIDs. Thyroid supplements assist with thyroid function. Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels and lower blood pressure. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a drug class that reduce pain, decrease fever, prevent blood clots, and, in higher doses, decrease inflammation.

Upon admission for an appendectomy, the client provides the nurse with a document that specifies instructions for his health care team to follow in the event he is unable to communicate these wishes postoperatively. This document is best known as: a) an advance directive. b) an informed consent. c) a Patient's Bill of Rights. d) an insurance card.

a) an advance directive. An advance directive, a legal document, allows the client to specify instructions for his or her health care treatment should he or she be unable to communicate these wishes postoperatively. The advance directive allows the client to discuss his or her wishes with the family members in advance of the surgery. Two common forms of advance directives include living wills and durable powers of attorney for health care. An informed consent is a document that the client and surgeon signs prior to surgery identifying and describing risks and benefits of surgery. A client's bill of rights is a list of guarantees for those receiving medical care. It may take the form of a law or a nonbinding declaration. An insurance card is an identifying card that specifies the type of insurance coverage guaranteed by the company.

An operating room nurse is bringing a client to the nurse in the postanesthesia care unit (PACU). Which information would the operating room nurse provide during a hand-off report? Select all that apply. a) medications given in operating room b) length of surgery c) drains inserted in surgery d) all personnel present in operating room e) performance of time-out before surgery

a) b) c) The operating room nurse should give a hand-off report when bringing the client from the operating room and must include several critical pieces of information: medications given, the length of surgery, and any drains inserted. Other data that would be important include presenting condition of the client and any events that occurred during surgery. All personnel present in the operating room would not be an important detail to share; however, this is documented on the operating room record, as well as the time-out that was performed.

The nurse knows the term perioperative phase refers to care given to the client: a) before, during, and after the operative phase. b) from the start of surgery until its conclusion. c) immediately before an operative procedure. d) immediately after the operative phase.

a) before, during, and after the operative phase. Perioperative nursing includes three distinct phases: preoperative, intraoperative, and postoperative.

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur? a) preoperative b) intraoperative c) postoperative d) postanesthesia care unit (PACU)

a) preoperative Exercises and physical activities occurring in the preoperative phase include deep breathing exercises, coughing, incentive spirometry, turning, leg exercises, and pneumatic compression stockings. The intraoperative phase is when the client is in the operating room. In the postoperative area and postanesthesia care unit areas, clients are monitored and deep breathing exercises begin.

A nurse is caring for an older adult client who had surgery for the removal of a cataract in the left eye. When can the client return home after outpatient surgery? a) the same day b) after 1 week c) after 2 days d) after 10 days

a) the same day Outpatient surgery, also called ambulatory surgery and same-day surgery, is the term used for operative procedures performed on clients who return home the same day. It generally is reserved for clients in an optimal state of health whose recovery is expected to be uneventful.

The nurse is providing education about deep-breathing exercises to a postoperative client whose surgery took place earlier today. Which instruction should the nurse provide? a) "Take off your oxygen nasal prongs during your exercises and replace them as soon as you're done." b) "Try to do your exercises every 1 to 2 hours." c) "It's best to do your exercises before a meal rather than after eating and drinking." d) "If possible, lie flat on your back while you're doing your breathing exercises."

b) "Try to do your exercises every 1 to 2 hours." Instruct the client that deep-breathing exercises should be performed every 1 to 2 hours for the first 24 hours after surgery.

A nurse has been asked to witness a patient signature on an informed consent form for surgery. What information should be included on the form? Select all that apply. a) The option of nontreatment b) The underlying disease process and its natural course c) Notice that once the form is signed, the patient cannot withdraw the consent d) Explanation of the guaranteed outcome of the procedure or treatment e) Name and qualifications of the provider of the procedure or treatment f) Explanation of the risks and benefits of the procedure or treatment

a, b, e, f. The information contained in informed consent includes the description of the procedure or treatment, potential alternative therapies, and the option of nontreatment, the underlying disease process and its natural course, the name and qualifications of the health care provider performing the procedure or treatment, explanation of the risks and benefits, explanation that the patient has the right to refuse treatment and consent can be withdrawn, and explanation of expected (not guaranteed) outcome, recovery, and rehabilitation plan and course.

A scrub nurse is assisting a surgeon with a kidney transplant. What are the patient responsibilities of the scrub nurse? Select all that apply. a) Maintaining sterile technique b) Draping and handling instruments and supplies c) Identifying and assessing the patient on admission d) Integrating case management e) Preparing the skin at the surgical site f) Providing exposure of the operative area

a, b. The scrub nurse is a member of the sterile team who maintains sterile technique while draping and handling instruments and supplies. Two duties of the circulating nurse are to identify and assess the patient on admission to the OR and prepare the skin at the surgical site. The RNFA actively assists the surgeon by providing exposure of the operative area. The APRN coordinates care activities, collaborates with physicians and nurses in all phases of perioperative and postanesthesia care, and integrates case management, critical paths, and research into care of the surgical patient.

A responsibility of the nurse is the administration of preoperative medications to patients. Which statements describe the action of these medications? Select all that apply. a) Diazepam is given to alleviate anxiety. b) Ranitidine is given to facilitate patient sedation. c) Atropine is given to decrease oral secretions. d) Morphine is given to depress respiratory function. e) Cimetidine is given to prevent laryngospasm. f) Fentanyl citrate-droperidol is given to facilitate a sense of calm.

a, c, f. Sedatives, such as diazepam, midazolam, or lorazepam, are given to alleviate anxiety and decrease recall of events related to surgery. Anticholinergics, such as atropine and glycopyrrolate are given to decrease pulmonary and oral secretions and to prevent laryngospasm. Neuroleptanalgesic agents, such as fentanyl citrate-droperidol are given to cause a general state of calm and sleepiness. Histamine-2 receptor blockers, such as cimetidine and ranitidine, are given to decrease gastric acidity and volume. Narcotic analgesics, such as morphine, are given to facilitate patient sedation and relaxation and to decrease the amount of anesthetic agent needed.

A patient had a surgical procedure that necessitated a thoracic incision. The nurse anticipates that the patient will have a higher risk for postoperative complications involving which body system? a) Respiratory system b) Circulatory system c) Digestive system d) Nervous system

a. A thoracic incision makes it more painful for the patient to take deep breaths or cough. Shallow respirations and ineffective coughing increase the risk for respiratory complications.

A 72-year-old woman who is scheduled for a hip replacement is taking several medications on a regular basis. Which drug category might create a surgical risk for this patient? a)Anticoagulants b) Antacids c) Laxatives d) Sedatives

a. Anticoagulant drug therapy would increase the risk for hemorrhage during surgery.

A client has arrived in the same-day surgery suite. The client states to the nurse, "I am so worried about being put to sleep and having the surgery." What would be the nurse's best response? a) "You don't have to worry. It will be fine." b) "Tell me what you are most worried about." c) "I will have the anesthesiologist talk to you." d) "Have you ever had surgery before?"

b) "Tell me what you are most worried about." The nurse should first assess what the client is most worried about, and then provide emotional support.

A postoperative client states "I don't understand why you are checking my skin on my back. My surgery was on my stomach." What is the nurse's best response? a) "We wanted to be sure we didn't leave any sponges or syringes underneath you." b) "The operating table is a firm surface; we need to be sure your skin looks okay." c) "The covers underneath you need to be straightened out. They look messy." d) "We needed to be sure you didn't have any skin breakdown before surgery."

b) "The operating table is a firm surface; we need to be sure your skin looks okay." The client who has been on the operating table should be examined to ensure skin breakdown hasn't occurred. The client would not be told that his covers looked messy, or that the nurse was concerned about sponges or syringes underneath. The client's skin should be assessed on admission; after surgery would not be the time to do this initial assessment to document skin breakdown.

The nurse needs to evaluate the effectiveness of a preoperative teaching session with a client scheduled for abdominal surgery. Which client statement indicates the need for further clarification? a) "I will splint my incision while I cough." b) "While my pneumatic compression device is on, I don't need to do leg exercises." c) "Every 2 hours while I am awake, I will take deep breaths and cough." d) "I will sit up in bed before using my incentive spirometer."

b) "While my pneumatic compression device is on, I don't need to do leg exercises." Compression stockings and pneumatic compression devices help to decrease the formation of thrombus by helping to promote venous return to the heart. The nurse needs to clarify that the pneumatic compression device does not replace leg exercises because the exercises help keep the joints flexible and help strengthen muscles while the client is in bed. The client is correct that splinting the incision when coughing is important. The client should sit up in bed when using the incentive spirometer, taking deep breaths and coughing. The client should take deep breaths and cough at least every 2 hours while awake to help expand lungs, loosen secretions, and help prevent atelectasis and pneumonia.

Which surgical client does the nurse in the preoperative setting anticipate having the greatest potential for surgical complications? a) 50-year-old overweight client with controlled hypertension b) 76-year-old client with a history of renal failure and chronic bronchitis c) 6-month-old client who has just been introduced to solid food d) 40-year-old client with type 2 diabetes mellitus and a history of anxiety

b) 76-year-old client with a history of renal failure and chronic bronchitis The client who is elderly with renal and lung disease has the most risk factors preoperatively for surgery. This client will have concerns over administration of anesthesia and medication, with the kidneys being able to clear these from the body, as well as with the lungs and potential postoperative complications of atelectasis and pneumonia. Clients who are young, have chronic disease, or are obese have risk factors as well, but not as many as the elderly client with both renal and pulmonary disease.

The nurse enters a postoperative client's room and finds that the client is bleeding profusely from the surgical incision. What would be the nurse's most appropriate initial response? a) Determine the possible cause of the client's bleeding. b) Apply pressure to the surgical site to decrease bleeding. c) Assess the client's vital signs. d) Notify the health care provider.

b) Apply pressure to the surgical site to decrease bleeding. It is essential that the nurse be prepared to address life-threatening needs of the client. Excessive bleeding is a life-threatening issue. Determining the cause of the client's bleeding, assessing the vital signs, and notifying the health care provider are important, but the life-threatening issue must be addressed first.

An elder adult client underwent a hip replacement and now states to the nurse, "My parents are coming to visit me today. I need to mow the lawn and run errands." The client is trying to get out of the bed. What does the nurse identify is occurring with this client? a) Dementia b) Delirium c) Narcotic overuse d) Boredom

b) Delirium Delirium refers to acute confusion that is reversible. It is common in the acute postoperative period.

Which surgical clients will return to activities in their everyday lives more quickly? a) Vaginal hysterectomy b) Laparoscopic cholecystectomy c) Right nephrectomy d) Open-heart surgery

b) Laparoscopic cholecystectomy Clients who have surgery using a laparoscope are able to return to previous activity levels much sooner.

Which nursing action will best promote pain management for a client in the postoperative phase? a) Breathing into a paper bag b) Performing relaxation techniques c) Dimming the lights d) Providing food and medication

b) Performing relaxation techniques Performing relaxation techniques is the best nursing action to promote pain management for a client in the postoperative phase.

The nurse is obtaining a history from a client before surgery. Which areas would be important for the nurse to ask about to determine potential risk factors? Select all that apply. a) What the financial situation is and if the client can afford the surgery b) What medications the client is currently taking, including over-the-counter supplements c) If the client has had previous surgeries and any complications from surgery d) Does the client abuse alcohol or any illicit drugs e) Who will be accompanying the client and assisting postoperatively at home f) Has the client used antibiotics previously

b) c) d) e) The client needs to be interviewed regarding his or her medication history, any prior surgeries, abuse of alcohol or illegal substances, and support systems to help determine any risk factors during and after surgery that need to be addressed. The client's financial ability to pay or afford surgery is not a key area to address as a risk factor.

A nurse preparing an older adult client for hip replacement surgery is aware of the surgical risks related to the client's age. Which of the following accurately describes these risks? Select all that apply. a) increased cardiac output b) decreased peripheral circulation c) increased vascular rigidity d) increased oxygenation of blood e) decreased thermoregulation ability

b) c) e) Older adults have decreased cardiac output, decreased peripheral circulation, decreased oxygenation of blood, decreased thermoregulation ability, and decreased skin moisture and elasticity. Older adults have increased vascular rigidity.

A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice? Select all that apply. a) administering inhalation anesthetics b) positioning the client on the operating table c) administering regional nerve blocks d) counting sponges before and after surgery e) monitoring the client's vital signs

b) d) e) The RN's role is a supportive one for the client, monitoring vital signs and positioning the client on the operating room table. The RN also helps maintain safety by counting sponges and instruments that may have been used during the surgery. The RN is unable to administer anesthetics, such as inhalation agents or regional nerve blocks, without an advanced practice degree.

Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply. a) Inhalation b) Spinal block c) Intravenous d) Oral route e) Nerve block f) Epidural block

b) e) f) Regional anesthesia occurs when an anesthetic agent is injected near a nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors. Regional anesthesia includes spinal blocks, nerve blocks, and epidural blocks. Inhalation and intravenous administration of anesthesia are associated with general anesthesia. Anesthesia is not administered via the oral route.

When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease? a) fluid and electrolyte imbalance b) slow wound healing c) respiratory depression from anesthesia d) altered metabolism and excretion of drugs

b) slow wound healing Due to impaired circulation and high glucose levels, the client with diabetes is at an increased risk for slow wound healing. The surgical risk of fluid and electrolyte imbalances is often associated with clients who have kidney and liver disease. The risk of respiratory depression from surgery increases for clients with existing respiratory disorders. Altered metabolism may occur as a result of surgery for clients with kidney and liver diseases.

The nurse recognizes that palliative surgery is performed for what purpose? a) to remove a part of the body that is diseased b) to lessen the intensity of an illness c) to make or confirm a diagnosis d) to restore function to tissue that is traumatized

b) to lessen the intensity of an illness Palliative surgery is performed to help lessen the intensity of an illness; it is not meant to be curative but will help improve the client's quality of life. A diagnostic surgery makes or confirms a diagnosis such as with a biopsy to check for cancer. A removal of a body part that is diseased is ablative surgery, such as an appendectomy. Restoring function to traumatized tissue is reconstructive surgery, such as with plastic surgery.

A nurse from the ambulatory surgical center is preparing discharge instructions for a client who has had pelvic surgery. Which criterion would the client need to demonstrate to ensure that she is ready for discharge? a) verbalize absence of pain b) void normally c) eat without nausea d) exhibit no bleeding

b) void normally Before discharge from an ambulatory surgical unit, the client should be able to void normally after a pelvic surgery. It is natural for the client to experience pain after surgery; however, the client should also have the comfort level to control it. The client may not be in a position to eliminate nausea and vomiting completely before discharge, but should suffer minimally from them. The client may have some bleeding or drainage, which should not be excessive at the time of discharge from an ambulatory surgical unit.

A nurse is caring for an obese patient who has had surgery. The nurse monitors this patient for what postoperative complication? a) Anesthetic agent interactions b) Impaired wound healing c) Hemorrhage d) Gas pains

b. Fatty tissue has a poor blood supply and, therefore, has less resistance to infection. As a result, postoperative complications of delayed wound healing, wound infection, and disruption in the integrity of the wound are more common. Patients with a large habitual intake of alcohol require larger doses of anesthetic agents and postoperative analgesics, increasing the risk for drug-related complications. Patients who use illicit drugs are at risk for interactions with anesthetic agents. These are specific to the illicit drug used and should be noted on the medical record for safe anesthetic management. Patients taking anticoagulants are at increased risk for hemorrhage. Gas pains are a common postoperative discomfort.

A patient tells the nurse she is having pain in her right lower leg. How does the nurse determine if the patient has developed a deep vein thrombosis (DVT)? a) By palpating the skin over the tibia and fibula b) By documenting daily calf circumference measurements c) By recording vital signs obtained four times a day d) By noting difficulty with ambulation

b. Manifestations of DVT are pain and cramping in the calf or thigh of the involved extremity, redness and swelling in the affected area, elevated temperature, and an increase in the diameter of the involved extremity. This increase in extremity circumference (typically the calf) is the most significant sign of a DVT and the provider should be notified. The priority for the patient with a known DVT is preventing a clot from breaking loose and becoming a VTE that propagates (travels) to the heart, brain, or lungs called a pulmonary embolism. Thrombophlebitis is an inflammation of a vein associated with thrombus (blood clot) formation. Thrombophlebitis is typically superficial and, in patients without an underlying condition, is often related to IV catheters.

Older adults often have reduced vital capacity as a result of normal physiologic changes. Which nursing intervention would be most important for the postoperative care of an older surgical patient specific to this change? a) Take and record vital signs every shift b) Turn, cough, and deep breathe every 4 hours c) Encourage increased intake of oral fluids d) Assess bowel sounds daily

b. Reduced vital capacity in older adults increases the risk for respiratory complications, including pneumonia and atelectasis. Having the patient turn, cough, and deep breathe every 4 hours maintains respiratory function and helps to prevent complications.

A 70-year-old male is scheduled for surgery. He says to the nurse, "I am so frightened—what if I don't wake up?" What would be the nurse's best response? a) "You have a wonderful doctor." b) "Let's talk about how you are feeling." c) "Everyone wakes up from surgery!" d) "Don't worry, you will be just fine."

b. This answer allows the patient to talk about feelings and fears, and is therapeutic.

A client postoperative from an appendectomy reports feeling cold and has a temperature of 96.2°F (35.7°C). Which action should the nurse perform first? a) Check the client's blood pressure. b) Apply an oxygen saturation monitor. c) Apply warm blankets to the client. d) Notify the health care provider.

c) Apply warm blankets to the client. The nurse should apply warm blankets to the client because the client is hypothermic with a temperature of 96.2°F (35.7°C). The client can be assessed further by checking vital signs and using an oxygen saturation monitor. The health care provider should be notified about the client's temperature but an intervention should be done first to ensure the client begins warming immediately.

A nurse is teaching a client about the rationale for fasting from food and fluids prior to surgery. What condition does this measure attempt to avoid? a) Infection b) Respiratory distress c) Aspiration d) Bowel alterations

c) Aspiration Food and fluid are restricted before surgery to ensure that the stomach contains a minimal amount of gastric secretions. This restriction is important to reduce the risk of aspiration.

A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client? a) Position the client in bed with pillows placed under his knees to hasten venous return. b) Keep the client from ambulating until the day after surgery. c) Implement leg exercises and turn the client in bed every 2 hours. d) Keep the client cool and uncovered to prevent elevated temperature.

c) Implement leg exercises and turn the client in bed every 2 hours. Ambulation and leg exercises increase circulation, which prevents cardiovascular complications. The nurse should provide covers, forced warm air, or other warming devices/techniques as necessary to prevent shivering and hypothermia caused by the surgical procedure, the procedure's length, anesthetic agents, a cool environment, the client's age, or the use of cool irrigating/infusion fluids. Pillows placed under the knees can cause venous pooling, leading to thrombophlebitis.

After a client receives morphine sulfate for pain in the postanesthesia care unit (PACU), which assessment finding would the nurse obtain as a priority? a) Auscultate bowel sounds. b) Obtain temperature. c) Measure respiratory rate. d) Check the neurologic status.

c) Measure respiratory rate. The client who is receiving morphine sulfate for pain has a potential for decreased respiratory effort because of the side effect of respiratory depression; the client may also have constipation as a side effect, but this would not be a priority over respiratory depression. The postoperative client needs to be monitored for changes in their neurologic status and temperature, but this would not be a priority over the respiratory status.

A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client? a) Attempt to overhydrate the client with fluids. b) Instruct the client to perform Valsalva maneuver. c) Place the client in semi-Fowler's position. d) Assist the client to ambulate every 2 to 3 hours.

c) Place the client in semi-Fowler's position. Nursing interventions include notifying the physician immediately, calling the medical intervention team, maintaining the client on bed rest in the semi-Fowler's position, assessing vital signs frequently, administering oxygen, administering medications (e.g., anticoagulants, analgesics), and instructing the client to avoid Valsalva maneuver (this prevents increased intrathoracic pressure and, possibly, increased emboli).

A nurse is caring for an older adult following hip surgery. When teaching the client to use an incentive spirometer, the nurse should explain that this reduces the risk of what complication? a) Bronchitis b) DVT c) Pneumonia d) Asthma

c) Pneumonia In the older adult client, postoperative pneumonia can be a very serious complication resulting in death. Therefore, it is especially important to encourage and assist the client in using the incentive spirometer and with deep-breathing exercises. These exercises do not address the client's risk of DVT, bronchitis, or asthma.

When an older adult client is brought to the recovery room and presents with irregular, loud respirations, the nurse determines that this is most likely a result of: a) the effects of anesthesia. b) the normal return of reflexes. c) a partial airway obstruction. d) the type of surgery.

c) a partial airway obstruction. loud, irregular respirations may indicate obstruction of the airway, possibly from emesis, accumulated secretions, or client positioning that allows the tongue to fall to the back of the throat.

The nurse is assessing clients who are scheduled for surgical procedures. Which clients are at greatest risk due to medications taken at home? Select all that apply. a) The client who is taking diuretics due to the risk of hemorrhage b) The client taking anticoagulants due to the risk of electrolyte imbalance c) The client with a narcotic patch that may cause respiratory depression from anesthesia d) The client taking tranquilizers, which may increase the hypotensive effect of anesthetic agents e) The client taking adrenal steroids for Addison disease, which may cause respiratory paralysis f) The client who abruptly withdrawals from adrenal steroid use, which may cause cardiovascular collapse in long-term users

c) d) f) Drugs that increase the surgical risk for complications include: · Anticoagulants (may precipitate hemorrhage) · Diuretics (may cause electrolyte imbalances, with resulting respiratory depression from anesthesia) · Tranquilizers (may increase the hypotensive effect of anesthetic agents) · Adrenal steroids (abrupt withdrawal may cause cardiovascular collapse in long-term users) · Antibiotics in the mycin group (when combined with certain muscle relaxants used during surgery, these antibiotics may cause respiratory paralysis)

A client scheduled for surgery has been taking aspirin since his heart attack in 1997. The client is at risk for: a) infection. b) thrombophlebitis. c) hemorrhage. d) blood clots.

c) hemorrhage. Current medication use, especially use of medications that can affect coagulation status (warfarin, nonsteroidal anti-inflammatory drugs, aspirin), is important and should be reported to the surgeon.

The nurse has delegated to the unlicensed assistive personnel (UAP) the application of antiembolism stockings to a client who had an endarterectomy earlier in the day. Which UAP action requires the nurse to immediately intervene? a) cleanses hands with alcohol-based hand rub b) measures calf circumference c) massages legs prior to application d) elevates the legs 15 minutes after applying stockings

c) massages legs prior to application Massaging the legs can dislodge clots. Other actions are appropriate and do not require intervention.

As a circulating nurse caring for a 45-year-old man undergoing left knee arthroscopic exploratory surgery, which task ensures that the team is on the same page and will perform the procedure on the right client and at the right site? a) operative site marking b) preoperative checklist c) procedural pause (time-out) d) informed consent

c) procedural pause (time-out) The procedural pause (time-out) must be done prior to any procedure to ensure client safety and to verify the client identity, staff roles, and procedure being performed.

A nurse is preparing a patient for a cesarean section and teaches her the effects of the regional anesthesia she will be receiving. Which effects would the nurse expect? Select all that apply. a) Loss of consciousness b) Relaxation of skeletal muscles c) Reduction or loss of reflex action d) Localized loss of sensation e) Prolonged pain relief after other anesthesia wears off f) Infiltrates the underlying tissues in an operative area

c, d. A localized loss of sensation and possible loss of reflexes occur with a regional anesthetic. Loss of consciousness and relaxation of skeletal muscles occur with general anesthesia. Prolonged pain relief after other anesthesia wears off and infiltration of the underlying tissues in an operative area occur with topical anesthesia.

A perioperative nurse is preparing a patient for surgery for treatment of a ruptured spleen as the result of an automobile crash. For what type of surgery would the nurse prepare this patient? a) Minor, diagnostic b) Minor, elective c) Major, emergency d) Major, palliative

c. This surgery would involve a major body organ, has the potential for postoperative complications, requires hospitalization, and must be done immediately to save the patient's life. Elective surgery is a procedure that is preplanned by essentially healthy people. Diagnostic surgery is performed to confirm a diagnosis. Palliative surgery is not curative, rather it is done to relieve or reduce the intensity of an illness.

The nurse is talking with a client who wishes to have a tattoo removed. Which client statement indicates that the client understands how the procedure will be accomplished? a) "I will talk with the anesthesiologist about anesthesia." b) "I will plan to be hospitalized several days following the procedure." c) "This inpatient surgical procedure requires me to be at the hospital the morning of surgery." d) "The provider will perform this laser surgery in an ambulatory care setting."

d) "The provider will perform this laser surgery in an ambulatory care setting." Tattoos are often removed via laser surgery in an ambulatory setting. This type of outpatient procedure does not commonly require anesthesia, nor hospitalization.

A 2-year-old toddler just underwent a tonsillectomy and adenoidectomy surgery. The postanesthesia care unit (PACU) nurse is checking on him. What is the best course of action regarding the developmental care of this child? a) Give the child a new teddy bear. b) Extubate the child as soon as possible. c) Administer acetaminophen before the child wakes. d) Allow the parents into the PACU before the child wakes.

d) Allow the parents into the PACU before the child wakes. Toddlers are prone to separation anxiety. Allowing the child to be with the parents will lower anxiety levels for all members of the family. This will subsequently ease the care for the bedside nurse.

The nurse is teaching the client who recently experienced abdominal surgery to deep breathe and cough effectively. What observable action serves to best minimize pain that may result from the intervention? a) Supporting the head and shoulders effectively to prevent muscle strain b) Exhaling through the mouth with lips pursed to slowly empty the lungs c) Offering emotional support to help minimize concern of abdominal pain d) Providing support to abdominal and accessory respiratory muscles

d) Providing support to abdominal and accessory respiratory muscles Coughing and deep breathing uses abdominal and accessory respiratory muscles, which may have been cut during surgery. Splinting, in this case with a pillow, supports the incision and surrounding tissues and reduces pain during coughing and deep breathing exercises. While providing emotional support is appropriate, doing so will not affect physiological pain resulting from the intervention. Exhaling with lips pursed increases resistance in the airways, which helps them stay open during exhalation. Supporting the head and shoulders adds to the client's comfort, but doing so does not address the primary source of pain produced by therapuetic coughing and deep breathing.

A client is scheduled for elective hernia surgery. While taking a medical history, the nurse learns that the client is taking antibiotics for an infection. Which surgical risk should the nurse monitor based on this antibiotic use? a) Hemorrhage b) Electrolyte imbalances c) Cardiovascular collapse d) Respiratory paralysis

d) Respiratory paralysis Some antibiotics, especially those belonging to the mycin group, may cause respiratory paralysis when combined with certain muscle relaxants used during surgery. Hemorrhage, electrolyte imbalances, and cardiovascular collapse are not associated with antibiotics during surgery.

Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse? a) a 30-year-old client who is drowsy and reporting pain b) a 6-year-old client who is crying for a parent to visit c) an 80-year-old client who is disoriented to place and time d) a 26-year-old client who is exhibiting a crowing sound

d) a 26-year-old client who is exhibiting a crowing sound A client with a crowing sound is exhibiting stridor, which is an indication of an airway obstruction and can be a respiratory emergency. This client needs immediate attention. The client with disorientation needs to be frequently reoriented and observed for safety reasons but is not a priority over respiratory distress. The client who needs pain medication or the pediatric client requesting a parent are also not priority over a client in respiratory distress.

In the postoperative phase of abdominal surgery, the client reports severe abdominal pain. In the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect? a) normal response b) abdominal infection c) hernia development d) paralytic ileus

d) paralytic ileus A potential complication after surgery is paralytic ileus, a condition in which there is decreased bowel functioning.

The nurse has been waiting until after the administration of a toddler's anesthesia before removing the child's clothing and applying monitoring equipment. Doing these actions after the administration of anesthesia will: a) minimize blood loss. b) enhance thermoregulation. c) provide more accurate baseline vital signs. d) prevent anxiety.

d) prevent anxiety. Relaxation can be enhanced by removing the child's clothing, applying the grounding pad, and applying monitoring devices after the child is anesthetized. This action has no effect on vital signs, thermoregulation, or blood loss.

While assessing a patient in the PACU, a nurse notes increased wound drainage, restlessness, a decreasing blood pressure, and an increase in the pulse rate. The nurse interprets these findings as most likely indicating: a) Thrombophlebitis b) Atelectasis c) Infection d) Hemorrhage

d. Increased wound drainage, restlessness, decreasing blood pressure, and increasing pulse rate are assessment findings that indicate hemorrhage. Thrombophlebitis is an inflammation of a vein associated with thrombus (blood clot) formation. Thrombophlebitis is typically superficial and, in patients without an underlying condition, is often related to IV catheters. Manifestations of atelectasis include decreased lung sounds over the affected area, dyspnea, cyanosis, crackles, restlessness, and apprehension. Signs of infection include elevated white blood count and fever.

A nurse is explaining the rationale for performing leg exercises after surgery. Which reason would the nurse include in the explanation? a) Promote respiratory function b) Maintain functional abilities c) Provide diversional activities d) Increase venous return

d. Leg exercises assist in preventing muscle weakness, promote venous return, and decrease complications related to venous stasis. As a result, the patient has a decreased risk for thrombophlebitis, DVT, and emboli.

A nurse is explaining pain control methods to a patient undergoing a bowel resection. The patient is interested in the PCA pump and asks the nurse to explain how it works. What would be the nurse's correct response? a) "The pump allows the patient to be completely free of pain during the postoperative period." b) "The pump allows the patient to take unlimited amounts of medication as needed." c) "The pump allows the patient to choose the type of medication given postoperatively." d) "The pump allows the patient to self-administer limited doses of pain medication."

d. PCA infusion pumps allow patients to self-administer doses of pain-relieving medication within health care provider- prescribed time and dose limits. Patients activate the delivery of the medication by pressing a button on a cord connected to the pump or a button directly on the pump.

A nurse is providing teaching for a patient scheduled to have same-day surgery. Which teaching method would be most effective in preoperative teaching for ambulatory surgery? a) Lecture b) Discussion c) Audiovisuals d) Written instructions

d. Written instructions are most effective in providing information for same-day surgery.