chapter 31: perioperative nursing prep-u

A client is undergoing surgery for an appendectomy. This would be considered what type of surgery?

emergency surgery

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?

"The operating table is a firm surface; we need to be sure your skin looks okay."

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?

Apply pressure to the surgical site to decrease bleeding.

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?

Apply warm blankets to the client.

A preoperative client reports having a latex allergy. Which action does the nurse take to communicate this allergy to hospital staff caring for the client?

Note the allergy on the client's record.

Which nursing action will best promote pain management for a client in the postoperative phase?

Performing relaxation techniques

Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction?

"After this fasting, I am looking forward to a hamburger and fries once I wake up."

The nurse is preparing a client for a total hip arthroplasty and is obtaining data preoperatively. Which statement made by the client is most important for the nurse to immediately report to the health care provider?

"I have been taking ibuprofen for my hip pain twice a day."

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?

"Try to do your exercises every 1 to 2 hours."

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?

"Use a pillow to splint the incision."

The circulating nurse calls for a time-out prior to the surgical procedure and the surgeon states, "I don't have time for this. I have another case to follow and need to get busy." What is the best response by the circulator?

"We all have the same goal and that is the safety of the client, so let's do the time-out."

The nurse is caring for a client after breast augmentation. Before performing a bowel assessment, what education will the nurse provide the client?

"You can have decreased or absent bowel movement, called peristalsis because of administration of anesthetic agents or opioids. By listening for bowel sounds, I can check for a return of peristalsis."

The nurse is caring for the postoperative client in the postanesthesia care unit (PACU). The client is concerned the staples on the incision failing or becoming infected. What is an appropriate response(s) by the nurse? Select all that apply

-"Please inform us immediately if you observe any redness, drainage, or opening between the staples " -"Staples are actually considered to be more secure than sutures." -"There is always a small possibility of this, but we will work together to protect your incision."

What information must be provided to a client to obtain informed consent? Select all that apply.

-A description of the procedure or treatment, along with potential alternative therapies -The underlying disease process and its natural course -Explanation of the risks involved and how often they occur

A nurse is giving preoperative information to a client scheduled for outpatient surgery. What are recommended education guidelines? Select all that apply.

-Notify the surgeon's office if a cold or infection develops before surgery. -List allergies and be sure the operating staff is aware of these. -Have someone available for transportation home after recovery from anesthesia.

Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply.

-Spinal block -Nerve block -Epidural block

The nurse is caring for a client who is postoperative day 1 following gastric bypass surgery. When assessing for paralytic ileus, the nurse will perform which assessment(s)? Select all that apply.

-auscultation of bowel sounds -pain assessment -abdominal girth

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.

-counting sponges before and after surgery -monitoring the client's vital signs -positioning the client on the operating table

The nurse is caring for a preoperative client whose surgery is scheduled for later that afternoon. What action(s) will the nurse perform in regard to the client's informed consent? Select all that apply.

-witnessing the client's signature on the consent forms -checking that the consent form contains the necessary information -notifying the surgeon if the client expresses a lack of understanding about the consent they have signed

A nurse is preparing to receive a client in post-anesthesia care unit (PACU). The client is diabetic and has undergone knee surgery. Which information would be most important for the receiving nurse to obtain to develop an appropriate plan of care for this client?

Amount of blood loss

A nurse is assigned to be the circulating nurse during a surgical procedure. The nurse would be responsible for which activity?

Anticipating the needs of other members of the surgical team

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?

Aspiration

An older adult client is brought to the recovery room following a hysterectomy and presents with irregular, loud respirations. In addition to promptly reporting this finding, what action will the nurse take?

Assess for partial airway obstruction.

Which preoperative task can the nurse delegate to the UAP (unlicensed assistive personnel)?

Assisting the client to the bathroom before surgery

A postoperative client is experiencing decreased lung sounds, dyspnea, cyanosis, crackles, restlessness, and apprehension. Which condition would the nurse suspect?

Atelectasis

The nurse is caring for a client in the postanesthesia care unit (PACU). The nurse uses specific interventions to avoid complications for each body system. Complete the table by selecting the intervention associated with each body system.

Cardiac: Provide verbal stimulation. Respiratory: Assess skin color. Neurologic: Gently touch the client.

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?

Explore the client's feelings and inform the surgeon.

The nurse educates a client about what to expect after abdominal surgery. How will the nurse explain the progression of a client's diet in the postoperative period?

Food and liquids will be withheld in the immediate postoperative period.

A 9-month-old infant is scheduled for heart surgery. When preparing this client for surgery, the nurse should consider which surgical risk associated with infants?

Impaired thermoregulation

A nurse is caring for an older adult client who had surgery for the removal of a cataract in the left eye. Which issue would prevent the client from being discharged on the day of surgery?

Inability to ambulate

A nurse is preparing a client for endotracheal intubation. The anesthesiologist has ordered an anticholinergic medication for this client. What is an action of this medication?

It decreases respiratory secretions.

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?

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.

The nurse cares for an adult client following surgery to repair an abdominal aortic aneurysm. Which nursing intervention should the nurse perform to assist with healing and maintaining client comfort?

Maintain a calm environment.

A nurse asks a preoperative client which medications he is currently taking. Which statement describes an accurate guideline for client teaching regarding these medications?

Many respiratory drugs may be taken the day of surgery per health care provider's order.

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?

Monitor the client closely and promote fluid intake.

The healthy adult client is given an opioid 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?

Notify the health care provider of the oversight.

A nurse caring for clients in a PACU assesses a client who is displaying signs and symptoms of shock. What is the priority nursing intervention for this client?

Place the client in a flat position with legs elevated 45 degrees. (helps with blood flow to vital organs)

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 and the client has just been diagnosed with paralytic ileus. What action will the nurse take?

Prepare for nasogastric tube insertion.

The nurse is providing postoperative education to a client with an abdominal incision and is coaching the client to perform coughing exercises, as pictured above. What is the nurse's best action?

Provide the client with a pillow or folded blanket to hug.

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?

Providing support to abdominal and accessory respiratory muscles

Which nursing action will assist in pain management for a client in the postoperative phase?

Relaxation techniques

A nurse is providing education to a client having same-day surgery. Which statement would be accurate regarding this type of surgery?

Some major surgeries can be done as same-day surgery.

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?

Teach the client how to splint the abdomen while coughing.

A nurse is reviewing postoperative protocols with the client, including an explanation and a demonstration of how to use an incentive spirometer. How does the nurse know that the teaching on the use of the incentive spirometer was effective?

The client completes a return demonstration and inhales with lips tightly sealed around the mouthpiece while sitting upright in bed.

The nurse is caring for a client who had a procedure under moderate sedation at the ambulatory surgical center. Which assessment finding indicates to the nurse that the client may be ready for discharge to home?

The client is alert and oriented with a blood pressure 118/70 mm Hg and respirations 18 breaths/minute, is able to ambulate, is not nauseated or vomiting, pain is controlled with medication, and has no excessive bleeding and drainage is as expected.

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?

The client will be admitted the day of surgery and return home the same day.

A nurse is teaching an older adult client to use an incentive spirometer following hip replacement surgery when the client asks why using this machine is necessary. How will the nurse respond?

The exercise helps prevent pneumonia.

The nurse is teaching a preoperative client about turning in bed after her surgery. Which picture demonstrates the appropriate action?

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.

In which position would the surgical nurse place a client undergoing minimally invasive surgery of the lower abdomen or pelvis?

Trendelenburg position

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?

Type of surgery

Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?

a 26-year-old client who is exhibiting a crowing sound (stridor; airway obstruction!)

The nurse is assessing an obese client scheduled for heart surgery. Which priority surgical risk related to obesity should the nurse monitor?

delayed wound healing and wound infection (fatty tissue=poor blood supply)

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?

massages legs prior to application

Which perioperative client will the nurse monitor most closely for signs and symptoms of hypothermia?

older adult client having hip replacement surgery

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur?

preoperative

The nurse recognizes the value of leg exercises in the prevention of postoperative thrombophlebitis. When should the nurse teach the correct technique for leg exercises to a client?

prior to surgery

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?

procedural pause (time-out)

The nurse is helping to prepare a client for surgery. Who is legally responsible for obtaining the client's informed consent for the surgical procedure?

surgeon

The nurse recognizes that palliative surgery is performed for what purpose?

to lessen the intensity of an illness