Med-Surg 3 Ch. 17 Prep U
The nurse recognizes that which of the following clients is at least risk for perioperative complications?
Answer: A 65-year-old Caucasian man who has a history of arthritis Why? A history of arthritis does not increase the risk for complications during the perioperative period.
A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications?
Answer: Osteoporosis Why? Osteoporosis is likely not going to contribute to complications related to a cholecystectomy. Pregnancy decreases maternal reserves. Diabetes increases wound-healing problems and risks for infection. Urinary tract infection decreases the immune system's effectiveness, increasing the chance for infections.
The nurse 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?
Answer: Place the side rails in the up position and make sure the call button is in reach. Why? Immediately after giving the medications, the nurse instructs the client to remain in bed; he or she places side rails in the up position and ensures that the call button is within easy reach. Once the client has been preoperatively medicated you do not get them up to the bathroom. The nurses' immediate responsibility after preoperatively medicating the client is not to take the clients' vital signs or to send the family to the waiting room.
A perioperative nurse is assigned to complete a preoperative assessment on a patient who is scheduled for surgery for kidney stones. The nurse knows that the surgery is scheduled the following day and would therefore be classified as:
Answer: Urgent
A client has been transported to the operating room for emergent surgery. Which statement by the nurse best supports the need for emergent surgery?
Answer: "The client was unresponsive, had a distended abdomen, and had unstable vital signs after a motor vehicle accident." Why? Emergency surgery means that the client requires immediate attention and the disorder may be life threatening. A client with unstable vital signs and a distended abdomen after a motor vehicle accident requires immediate attention. A client with left abdominal pain may not need surgery. Epigastric pain with vomiting for 1 day is usually not an indication for emergent surgery. Lacerations to the face require sutures, not emergent surgery. A thyroidectomy to treat hyperthyroidism is a required surgery, not an emergent one.
A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?
Answer: A blood urea nitrogen level of 42 mg/dL Why? The kidneys are involved in excreting anesthetic medications and their metabolites; therefore, surgery is contraindicated if a patient has acute nephritis, acute renal insufficiency with oliguria or anuria, or other acute renal problems (see Chapter 54). A blood urea nitrogen level of 42 mg/dL (significantly elevated) is an indicator of renal failure. The other levels are normal.
The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?
Answer: A safe environment Why? 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.
The potential effects of prior medication therapy must be evaluated before surgery. Which of the following drug classifications may cause respiratory depression from an associated electrolyte imbalance during anesthesia?
Answer: Diuretics
Which nursing assessment finding indicates the preoperative client has not met expected outcomes?
Answer: Sobs uncontrollably about pending amputation of foot. Why? Expected outcomes for the preoperative client include demonstrating how to use incentive spirometry, remaining in bed after receiving preanesthetic medication, and discussing financial concerns with the social worker. The client who sobs uncontrollably about pending amputation of foot is coping ineffectively.
Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern?
Answer: Surgeon Why? It is the surgeon's responsibility to explain the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts in obtaining informed consent from the client.
Which would be considered to require an urgent surgical procedure?
Answer: Acute gallbladder infection Why? An acute gallbladder infection is considered to require an urgent surgical procedure. Cosmetic surgery and cataract surgery are not considered urgent surgical procedures. Severe bleeding could be considered an emergent surgical procedure.
You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear?
Answer: Anxious clients have a poor response to surgery and are prone to complications. Why? Anxiety and fear, if extreme, can affect a client's condition during and after surgery. Anxious clients have a poor response to surgery and are prone to complications. The scenario does not indicate an increased need for anesthesia or postoperative medications in the anxious and fearful client. Anxious clients do not generally need psychological counseling after surgery. Anxiety and fear do not affect a client positively during and after surgery.
The nurse recognizes that the client most at risk for mortality associated with surgery is the:
Answer: Client with chronic alcoholism Why? The client with chronic alcoholism who experiences alcohol withdrawal symptoms is at significant risk for mortality, which can be attributed to cardiac dysrthymias, cardiomyopathy, and bleeding tendencies.
The nurse is assigned a client scheduled for an outpatient colonoscopy in an ambulatory care setting. During which phase of perioperative care would the nurse document the admission vital signs in the recovery room?
Answer: During the postoperative phase Why? The nurse realizes that documentation of vital signs in the recovery room begins the postoperative phase of perioperative care. The preoperative phase occurs until the client reaches the operating area. The intra operative phase includes the entire surgical procedure until the transfer to the recovery area. There is no transfer phase of perioperative care.
The nurse is physically preparing a client for surgery. What area does the nurse know needs to be addressed before the client is taken to the operating room?
Answer: Elimination Why? When physically preparing a client for surgery these areas need to be addressed: skin preparation; elimination; attire/grooming; prosthesis; foods and fluids; and care of valuables. The physical preparation of a client for surgery does not include the areas of medication, activity, or the client's support system.
The nurse is conducting a preoperative assessment on a client scheduled for gallbladder surgery. The client reports a frequent cough producing green sputum for 3 days and denies fever. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiratory wheeze. Respiratory rate is 20, temperature is 99.8 (taken orally), heart rate is 87, and blood pressure is 124/70. What is the best action by the nurse?
Answer: Notify the surgeon to possibly delay the surgery. Why? A respiratory infection can delay a nonemergent surgical procedure because the infection can increase the risk for respiratory complications. Therefore, the nurse should notify the surgeon about delaying the surgery. The primary physician may be called to provide care based on the assessment findings, but that should be done only after the surgeon has been notified. Continuing through the preoperative phase without notifying the surgeon and waiting 1 hour then repeating the assessment are not appropriate.
During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse?
Answer: Notify the surgical team to remove all latex-based items. Why? Allergies to avocados and bananas may indicate an allergy to latex. Although it is necessary to notify the dietary department and physician, it is not an immediate threat, as the patient is receiving nothing by mouth and pain medication will be ordered postoperatively. The nurse manager does not need to be notified of the client's allergies.
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?
Answer: Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. Why? 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.
When caring for a patient with alcoholism, when should the nurse assess for symptoms of alcoholic withdrawal?
Answer: On the second or third day Why? The person with a history of chronic alcoholism often suffers from malnutrition and other systemic problems or metabolic imbalances that increase surgical risk. In patients who are alcohol dependent, alcohol withdrawal syndrome may be anticipated 2 to 4 days after the last drink and is associated with a significant mortality rate when it occurs postoperatively.
Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period?
Answer: The 35-year-old client with non-insulin dependent diabetes. Why? The client with diabetes is at risk for complications during the intraoperative or postoperative period. Hypoglycemia can develop during anesthesia or from inadequate carbohydrate intake or excess insulin administration postoperatively. Hyperglycemia can increase the risk for wound infection and delay wound healing. Smokers are encouraged to stop 4 to 8 weeks before surgery. Recent ilicit drug use can increase the risk for adverse reactions to anesthesia. Healthy older adults are not at increased risk.
A 72-year-old woman will be having total hip arthroplasty this morning to repair a fracture that she suffered in a recent fall. What patient teaching should the nurse prioritize during the preoperative phase of this patient's care?
Answer: The positioning that the patient will be asked to adopt postoperatively. Why? Some patients require instruction about special positions that are required after surgery (in this case, abduction of lower extremities). Reviewing the process before surgery is helpful, because the patient may be too uncomfortable or drowsy after surgery to absorb new information. This information is vital to the patient's safety, pain levels, and course of recovery. As such, it would likely be prioritized over teaching about nutrition or IV therapy. It is not likely necessary for the nurse to provide an overview of the relationship between aging and recovery.
The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. Which of the following is the most important function?
Answer: Verifies that operative consent is signed
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
Answer: 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 nurse recognizes that written informed consent is required for insertion of a(n):
Aswer: Peripherally-inserted central catheter. Why? Nonsurgical invasive procedures, such as insertion of a peripherally-inserted central catheter, that carry more than a slight risk to the client require written informed consent.