N400 Ch 30: Perioperative nursing

The nurse is caring for a postoperative client. During the past hour, there is 20 mL of dark, concentrated amber urine. Which actions should the nurse choose? Select all that apply

-Determine if the indwelling urinary catheter is kinked. -Assess skin turgor and mucous membranes. -Obtain vital signs and compare to baseline measurements. -Examine intake and output, including estimated blood loss from the operative report.

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?

"After surgery, deep-breathing exercises help to remove anesthetic gases and mucus and improve oxygen supply to body tissues."

A client who has been experiencing a gradual decrease in mobility has been scheduled for elective knee replacement surgery in 3 weeks. Which teaching points should the nurse choose for the outpatient group education session? Select all that apply.

-How to cleanse skin with a special soap solution -Time for limitations with eating and drinking -When and where to arrive for surgery -What to expect before, during, and after surgery

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.

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

Which surgical client does the nurse in the preoperative setting anticipate having the greatest potential for surgical complications?

76-year-old client with a history of renal failure and chronic bronchitis

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?

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?

A nurse is educating a preoperative client on how to cough effectively. What can the nurse tell the client to do to facilitate coughing A. "Hold a pillow or folded bath blanket over the incision." B. "Get up and walk before you try to cough." C. "It would be best if you do not cough until you feel better." D. "When you cough, cover your nose and mouth with a tissue."

A. "Hold a pillow or folded bath blanket over the incision." Feedback: Because postoperative coughing is often painful, the client should be taught how to splint the incision by supporting it with a pillow or folded bath blanket.

In order to prevent the possibility of venous stasis, a nurse is teaching a surgical client how to perform leg exercises. Which of the client's following statements indicates a sound understanding of leg exercises? A. "I'll practice these now and try to start them as soon as I can after my surgery." B. "I'll try to do these lying on my stomach so that I can bend my knees more fully." C. "I'll make sure to do these, as long as my doctor doesn't tell me to stay on bed rest after my operation." D. "I'm pretty sure my stomach muscles are strong enough to lift both of my legs off the bed at the same time."

A. "I'll practice these now and try to start them as soon as I can after my surgery." Feedback: Leg exercises should be begun as soon as possible after surgery, unless contraindications exist. Bed rest does not preclude the performance of leg exercises and the legs should be lifted individually, not simultaneously. The client should perform leg exercises in a semi-Fowler's, not prone, position.

Which of the following nursing interventions occurs in the postoperative phase of the surgical experience? A. Airway/oxygen therapy/pulse oximetry B. Teaching deep breathing exercises C. Reviewing the meaning of p.r.n. orders for pain medications D. Putting in IV lines and administering fluids

A. Airway/oxygen therapy/pulse oximetry Feedback: Airway/oxygen therapy/pulse oximetry occur in the postanesthesia unit in the postoperative phase. Teaching deep-breathing exercises and reviewing the meaning of p.r.n. orders for medications occur in the preoperative phase. Putting in IV lines and administering fluids occurs in the intraoperative phase.

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?

Pneumonia

A client returning to the floor after orthopedic surgery is complaining of nausea. The nurse is aware that an appropriate intervention is to do which of the following? A. Avoid strong smelling foods. B. Provide clear liquids with a straw. C. Avoid oral hygiene until the nausea subsides. D. Hold all medications.

A. Avoid strong smelling foods. Feedback: Nursing care for a client with nausea includes avoiding strong smelling foods, providing oral hygiene, administering prescribed medications (especially medications ordered for nausea and vomiting), and avoiding use of a straw.

The nurse is preparing to send a client to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent for the procedure on the client's chart. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the client. What is the nurse's best action to the physician's request? A. Inform the physician that it is his or her responsibility to obtain the signature. B. Obtain the signature and ask another nurse to cosign the signature. C. Inform the physician that the nurse manager will need to obtain the signature. D. Call the house officer to obtain the signature.

A. Inform the physician that it is his or her responsibility to obtain the signature. Feedback: The responsibility for securing informed consent from the client lies with the person who will perform the procedure. The nurse's best action is to inform the physician that it is his or her responsibility to obtain the signature.

A female client is scheduled for liposuction surgery to reduce her weight. Based on urgency, how is this surgery classified? A. Urgent B. Elective C. Emergency D. Emergent

B. Elective Feedback: A liposuction procedure is classified as elective surgery, in which the procedure is preplanned and based on the client's choice. Other classifications are urgent (surgery is necessary for the client's health but not an emergency) and emergency (the surgery must be done immediately to preserve life, body part, or body function).

A nurse in an outpatient surgical center is teaching a client about what will be necessary for discharge to home. What information should the nurse include about transportation? A. The client is not allowed to drive a car home. B. If the client is not dizzy, driving a car is allowed. C. Only adults over the age of 25 may drive home. D. None; this is not necessary information.

A. The client is not allowed to drive a car home. Feedback: After outpatient surgery, clients may go home when they are no longer dizzy or drowsy, have stable vital signs, and have voided. Clients are not allowed to drive a car home.

Which of the following interventions is of major importance during preoperative education? A. Performing skills necessary for gastrointestinal preparation B. Encouraging the client to identify and verbalize fears C. Discussing the site and extent of the surgical incision D. Telling the client not to worry or be afraid of surgery

B. Encouraging the client to identify and verbalize fears Feedback: A surgical procedure causes anxiety and fear. The nurse should encourage the client to identify and verbalize fears; often simply talking about fears helps to diminish their magnitude.

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 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

A client has presented to the outpatient surgical center for a scheduled procedure. Which action should the nurse perform prior to the procedure?

Assess the client's allergy status

Which nursing action should the PACU nurse take to prevent postoperative complications in clients?

Assist the client to do leg exercises to increase venous return.

A nurse is assisting a physician during a cesarean section for a client. The client is administered epidural anesthesia. Which of the following is an advantage of epidural anesthesia? A. It counteracts the effects of conscious sedation. B. It decreases the risk of gastrointestinal complications. C. It prevents clients from remembering the initial recovery period. D. It acts on the central nervous system to produce loss of sensation

B. It decreases the risk of gastrointestinal complications. Feedback: Epidural anesthesia is a regional anesthesia administered to a client before surgery; it decreases the risk of gastrointestinal complications in clients. Reversal drugs are medications that counteract the effects of those used for conscious sedation. General anesthesia acts on the central nervous system to produce loss of sensation; it prevents clients from remembering their initial recovery period.

A nurse is taking care of a client during the immediate post-operative period. Which of the following duties performed during the immediate post-operative period is most important? A. Ensure the safe recovery of surgical clients. B. Monitor the client for complications. C. Prepare a room for the client's return. D. Assess the client's health constantly.

B. Monitor the client for complications. Feedback: The immediate post-operative period refers to the first 24 hours after surgery. During this time, the nurse monitors the client for complications as he or she recovers from anesthesia. Once the client is stable, the nurse prepares a room for the client's return and assesses the client to prevent or minimize potential complications. The nurse ensures the safe recovery of the client after the client has stabilized.

A physician has ordered a nurse to administer conscious sedation to a client. Which of the following is possible after administering conscious sedation to a client? A. Client can respond verbally despite physical immobility. B. Client can tolerate long therapeutic surgical procedures. C. Client is relaxed, emotionally comfortable, and conscious. D. Client's consciousness level can be monitored by equipment.

C. Client is relaxed, emotionally comfortable, and conscious. Feedback: Conscious sedation refers to a state in which the client is sedated in a state of relaxation and emotional comfort, but is not unconscious. The client is free of pain, fear, and anxiety and can tolerate unpleasant diagnostic and short therapeutic surgical procedures, such as an endoscopy or bone marrow aspiration. The client can respond verbally and physically. However, no equipment can replace a nurse's careful observations for monitoring clients.

A nurse is caring for a client who is scheduled to undergo a breast biopsy. Which of the following major tasks does the nurse perform immediately during the pre-operative period? A. Obtain a signature on the consent form. B. Review the surgical checklist. C. Conduct a nursing assessment. D. Reduce the dosage of toxic drugs

C. Conduct a nursing assessment. Feedback: During the immediate pre-operative period, the nurse conducts a nursing assessment. Nurses obtain the signature of the client, nearest blood relative, or someone with durable power of attorney before the administration of any pre-operative sedatives. They also administer medications as ordered by the physician regardless of their toxicity. They assist the client with psychosocial preparation and complete the surgical checklist, which is reviewed by the operating room personnel.

A preoperative assessment finds a client to be 75 pounds overweight. The client is to have abdominal surgery. What nursing diagnosis would be appropriate based on the client's weight? A. Risk for Aspiration B. Risk for Imbalanced Body Temperature C. Risk for Infection D. Risk for Falls

C. Risk for Infection Feedback: Fatty tissue in obese clients has a poor blood supply and, therefore, has less resistance to infections. Postoperative complications of delayed wound healing, wound infection, and disruption of the wound are more common in obese clients.

A nurse is educating a surgical client on postoperative p.r.n. pain control. Which of the following should be included? A. "We will bring you pain medications; you don't need to ask." B. "Even if you have pain, you may get addicted to the drugs." C. "You won't have much pain so just tough it out." D. "You need to ask for the medication before the pain becomes severe."

D. "You need to ask for the medication before the pain becomes severe."

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

A client with abdominal incisions experiences excruciating pain when he tries to cough. What should the nurse do to reduce the client's discomfort when coughing? A. Administer prescribed pain medication just before coughing. B. Ask the client to drink plenty of water before coughing. C. Ask the client to lie in a lateral position when coughing. D. Administer prescribed pain medication 30 minutes before deliberately attempting to cough.

D. Administer prescribed pain medication 30 minutes before deliberately attempting to cough. Feedback: Coughing is painful for clients with abdominal or chest incisions. Administering pain medication approximately 30 minutes before coughing, or splinting the incision when coughing, can reduce discomfort. Making the client lie in a lateral position or asking the client to drink plenty of water is not helpful because it will make breathing and coughing even more difficult for the client.

A nurse working in a PACU is responsible for conducting assessments on immediate postoperative clients. What is the purpose of these assessments? A. To determine the length of time to recover from anesthesia B. To use intraoperative data as a basis for comparison C. To focus on cardiovascular data and findings D. To prevent complications from anesthesia and surgery

D. To prevent complications from anesthesia and surgery Feedback: Immediate postoperative care in the PACU involves assessing the postoperative client with emphasis on preventing complications from the surgery.

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

Relaxation techniques

Which surgical clients will return to activities in their everyday lives more quickly?

Laparoscopic cholecystectomy

The nurse knows the term perioperative phase refers to care given to the client:

before, during, and after the operative phase.

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?

the same day

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

to lessen the intensity of an illness

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?

void normally

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

"I can have a hamburger and French fries as soon as I wake up."

Which client will see the greatest permanent changes in lifestyle following surgery?

ileostomy

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?

paralytic ileus

The nurse is preparing a client for surgery and asks if the client has an advance directive. The client asks "What is an advance directive?" What is the nurse's best response to this?

"An advance directive will communicate your wishes for health care postoperatively in case you are unable to do so."

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?

"I will need to check with your health care provider about that."

The nurse is providing education to a client regarding pain control after surgery. What time does the nurse inform the client is the best time to request pain medication? A. Before the pain becomes severe B. When the client experiences a pain rating of "10" on a 1-to-10 pain scale C. When there is no pain, but it is time for the medication to be administered D. After the pain becomes severe and relaxation techniques have failed

A. Before the pain becomes severe Feedback: If a pain medication is ordered p.r.n., the client should be instructed to ask for the medication before the pain becomes severe.

The telemetry unit nurse is reviewing laboratory results for a client who is scheduled for an operative procedure later in the day. The nurse notes on the laboratory report that the client has a serum potassium level of 6.5 mEq/L, indicative of hyperkalemia. The nurse informs the physician of this laboratory result because the nurse recognizes hyperkalemia increases the client's operative risk for which of the following? A. Cardiac problems B. Infection C. Bleeding and anemia D. Fluid imbalances

A. Cardiac problems Feedback: Hyperkalemia or hypokalemia increases the client's risk for cardiac problems. A decrease in the hematocrit and hemoglobin level may indicate the presence of anemia or bleeding. An elevated white blood cell count occurs in the presence of infection. Abnormal urine constituents may indicate infection or fluid imbalances.

A nurse is providing ongoing postoperative care to a client who has had knee surgery. The nurse assesses the dressing and finds it saturated with blood. The client is restless and has a rapid pulse. What should the nurse do next? A. Document the data and apply a new dressing. B. Apply a pressure dressing and report findings. C. Reassure the family that this is a common problem. D. Make assessments every 15 minutes for four hours.

B. Apply a pressure dressing and report findings. Feedback: Hemorrhage is an excessive internal or external loss of blood. Common indications of hemorrhage include a rapid, thready pulse. If bleeding occurs, the nurse should apply a pressure dressing to the site, report findings to the physician, and be prepared to return the client to the operating room if bleeding cannot be stopped or is massive.

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

patient grabbing rail, protecting incisional area with pillow or blanket, nurse with hand behind patient's lower thigh

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

preoperative

Which of the following interventions are recommended guidelines for meeting client postoperative elimination needs? A. Assess abdominal distention, especially if bowel sounds are audible or are low pitched. B. Assess for the return of peristalsis by auscultating bowel sounds every four hours when the client is awake. C. Encourage food and fluid intake when ordered, especially dairy products and low-fiber foods. D. Assess for bladder distention by Palpating below the symphysis pubis if the client has not voided within eight hours after surgery.

B. Assess for the return of peristalsis by auscultating bowel sounds every four hours when the client is awake. Feedback: Assess for the return of peristalsis by auscultating bowel sounds every four hours when the client is awake. Assess abdominal distention, especially if bowel sounds are inaudible or are high pitched. Encourage food and fluid intake when ordered, especially fruit juices and high-fiber foods. Assess for bladder distention by palpating above the symphysis pubis if the client has not voided within eight hours after surgery.

A nurse is assisting a postoperative client with deep-breathing exercises. Which of the following is an accurate step for this procedure? A. Place the client in prone position, with the neck and shoulders supported. B. Ask the client to place the hands over the stomach, so he or she can feel the chest rise as the lungs expand. C. Ask the client to exhale rapidly and completely, and inhale through the nose rapidly and completely. D. Ask the client to hold his or her breath for three to five seconds and mentally count "one, one thousand, two, one thousand" and so forth.

D. Ask the client to hold his or her breath for three to five seconds and mentally count "one, one thousand, two, one thousand" and so forth. Feedback: The nurse should place the client in semi-Fowler's position, with the neck and shoulders supported, and ask the client to place the hands over the rib cage, so he or she can feel the chest rise as the lungs expand. Then, ask the patient to exhale gently and completely, inhale through the nose gently and completely, hold his or her breath for three to five seconds, and mentally count "one, one thousand, two, one thousand" etc., then exhale as completely as possible through the mouth with lips pursed (as if whistling).

A student is assessing a postoperative client who has developed pneumonia. The plan of care includes positioning the client in the Fowler's or semi-Fowler's position. What is the rationale for this position? A. It increases blood flow to the heart. B. The client will be more comfortable and have less pain. C. It facilitates nursing assessments of skin color and temperature. D. It promotes full aeration of the lungs.

D. It promotes full aeration of the lungs. Feedback: Pneumonia may occur in the postoperative client from aspiration, immobilization, depressed cough reflex, infection, increased secretions from anesthesia, or dehydration. Nursing interventions include positioning the client in the Fowler or semi-Fowler position to promote full aeration of the lungs.

After conducting a preoperative health assessment, the nurse documents that the client has physical assessments supporting the medical diagnosis of emphysema. Based on this finding, what postoperative interventions would be included on the plan of care? A. Perform sterile dressing changes each morning. B. Administer pain medications as needed. C. Conduct a head-to-toe assessment each shift. D. Monitor respirations and breath sounds.

D. Monitor respirations and breath sounds.

A cleansing enema is ordered for a client who is scheduled to have colon surgery. What is the rationale for this procedure? A. Surgical clients routinely are given a cleansing enema. B. Cleansing enemas are given before surgery at the client's request. C. There will be less flatus and discomfort postoperatively. D. Peristalsis does not return for 24 to 48 hours after surgery.

D. Peristalsis does not return for 24 to 48 hours after surgery. Feedback: If the client is scheduled for gastrointestinal tract surgery, a cleansing enema is usually ordered. Peristalsis does not return for 24 to 48 hours after the bowel is handled, so preoperative cleansing helps decrease postoperative constipation.

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 is caring for a 4-month-old client on the pediatric unit following repair of an umbilical hernia repair. The infant just woke up from anesthesia and is crying. What would be appropriate initial interventions? Select all that apply.

Have the parent hold the infant in a rocking chair. Offer a pacifier. Use distraction with a stuffed toy

The nurse monitors the urine output of a postoperative client. The results of this assessment allow the nurse to monitor for signs of what complication?

Impaired tissue perfusion

A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client?

Implement leg exercises and turn the client in bed every 2 hours.

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 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?

Notify the physician of the oversight.

Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?

Place graduated compression stockings on the client.

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

Potential for hypothermia or hyperthermia

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

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:

prevent anxiety.

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)

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) Void normally b) Exhibit no bleeding c) Eat without nausea d) Verbalize absence of pain.

a) Void normally Feedback: 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 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 procedural physician has initiated performance of a time-out in the operating room before surgery. The student nurse asks the operating room nurse why this is important. What is the operating room nurse's best response?

The time-out checks to be sure that we have the right client and procedure."

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."

A client has arrived in the same‐day surgery suite. He 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) "Have you ever had surgery before?" b) "I will have the anesthesiologist talk to you." c) "Tell me what you are most worried about." d) "You don't have to worry. It will be fine."

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

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?

While my pneumatic compression device is on, I don't need to do leg exercises."

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

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 partial airway obstruction.

Which client most likely requires special preoperative assessment and treatment as a result of the existing medication regimen?

a woman who takes daily anticoagulants to treat atrial fibrillation

Which of the following statements, 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) "When I can eat again, the best meal would be steak and orange juice." c) "I might be sick to my stomach and throw up after surgery." d) "The better I eat before surgery, the more likely I will heal."

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

Which of the following clients most likely requires special pre‐operative assessment and treatment as a result of his or her 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 regularly treats his rheumatoid arthritis with over ‐the ‐counter nonsteroidal anti‐inflammatory drugs (NSAIDs) d) A man who takes an angiotensin‐converting enzyme (ACE) inhibitor because he has hypertension

a) A woman who takes daily anticoagulants to treat atrial fibrillation Feedback: Anticoagulants present a risk of hemorrhage. This risk supersedes that posed by thyroid supplements, ACE inhibitors, or most NSAIDs.

The nurse is preparing a patient for a colonoscopy. The nurse is familiar with the colonoscopy procedures at the hospital and is aware that which type of anesthesia is commonly used for this procedure? a) Conscious sedation b) Spinal anesthesia c) Nerve block d) Epidural anesthesia

a) Conscious sedation Feedback: Moderate sedation/analgesia is also known as conscious sedation or procedural sedation. It is used for short‐term and minimally invasive procedures such as endoscopy procedures (e.g., colonoscopy).

A pediatric nurse is preparing a child for cleft palate repair surgery. The nurse recognizes that this type of surgery is categorized as which of the following? a) Constructive surgery b) Palliative surgery c) Transplantation surgery d) Reconstructive surgery

a) Constructive surgery Feedback: Cleft palate repair is considered constructive surgery because the goal is to restore function in congenital anomalies. Reconstructive surgery serves to restore function to traumatized or malfunctioning tissues and includes plastic surgery or skin grafting. Transplant surgery replaces organs or structures that are diseased or malfunctioning, such as a liver or kidney transplant. Palliative surgery is not curative and seeks to relieve or reduce the intensity of an illness, such as debridement of necrotic tissue.

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 a) Prior to surgery b) When early signs of venous stasis are evident c) In postanesthetic recovery d) Upon transfer from postanesthetic care unit to the postsurgical unit

a) Prior to surgery Feedback: Though leg exercises are begun after surgery, such preventative measures should ideally be taught to the patient during the preoperative period.

The recovery nurse is caring for a surgical client in the PACU. The client's blood pressure is dropping and the heart rate is increasing. The nurse suspects the client is:

developing shock.

A scrub nurse is assisting a surgeon with a kidney transplant. What are the patient responsibilities of this surgical team member? 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. Maintaining sterile technique b. Draping and handling instruments and supplies Feedback: 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 operating room 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 post anesthesia care, and integrates case management, critical paths, and research into care of the surgical patient.

A patient had a surgical procedure that necessitated a thoracic incision. The nurse anticipates that he 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. Respiratory system Feedback: 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.

The nurse has entered the room of a client who is postoperative day one and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of PRN analgesia, and on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. How should the nurse respond to the client's concerns? a) "The hospital has excellent resources for dealing with any addiction that might result from the medications you take to control your pain." b) "Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery." c) "Actually, people who are not addicted to drugs before their surgery never develop a tolerance or addiction during their recovery." d) "You should remind yourself that treating your pain is important now, and that dealing with any resulting dependency can come later."

b) "Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery." Feedback: There is little danger of addiction to pain medications used in the postoperative management of pain.

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

b) An advance directive Feedback: 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.

A client has been taking aspirin since his heart attack in 1997. The client is at risk for what? a) Infection b) Hemorrhage c) Thrombophlebitis d) Blood clots

b) Hemorrhage Feedback: 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.

A client states he has a latex allergy. What action should the nurse take? a) Inform the client to tell the anesthesiologist. b) Place an allergy identification band on the client. c) Have the client take a Benadryl before surgery. d) Send the client to the OR with epinephrine.

b) Place an allergy identification band on the client. Feedback: Assist the client with allergies to medications, food, and latex before the surgical procedure, and clearly mark them on the client record, and on the client identification band.

What is the rationale for having the client void before surgery? a) To assess for pregnancy in women b) To prevent bladder distention c) To prevent electrolyte imbalance d) To assess for urinary tract infection

b) To prevent bladder distention Feedback: Having the client void before surgery will assist in the prevention of bladder distention during or after the procedure.

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. "Let's talk about how you are feeling." Feedback: This answer allows the patient to talk about his feelings and fears, and is therapeutic.

A nurse has been asked to witness a patient signature on an informed consent form for surgery. For which of these patients would the document be valid? Select all that apply. a. A 92-year-old patient who is severely confused b. A 45-year-old patient who is oriented and alert c. A 10-year-old patient who is oriented and alert d. A 36-year-old patient who has had a narcotic premedication e. A 45-year-old mentally ill patient who has been ruled incompetent f. A 22-year old patient having an abortion against her partner's wishes

b. A 45-year-old patient who is oriented and alert f. A 22-year old patient having an abortion against her partner's wishes Feedback: A consent form is not legal if the patient signing the form is confused, sedated, unconscious, or a minor.

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

b. Impaired wound healing Feedback: Fatty tissue is less vascular and, therefore, less resistant to infection and more prone to delayed wound healing.

The nurse is caring for a client who had an outpatient procedure. Which assessment finding indicates to the nurse that the client may be ready for discharge to home?

blood pressure 118/70 mmHg, respirations 18 breaths per minute

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

emergency surgery

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? a) Chronic disease history b) Environment of the operating room c) Amount of blood loss d) Information about allergic agents

c) Amount of blood loss Feedback: To plan care effectively in the postoperative period, the nurse needs to know about the amount of blood lost during the surgery, the type of surgery that was performed on the client, and whether there were any surgical or anesthetic complications. Information on chronic disease history and allergy history are done in the pre‐operative period, not in the postoperative period. Information on the environment in the operation room is checked by the circulatory nurse during the intra‐ operative care plan; it is not associated with the postoperative care plan.

A nurse is reinforcing wound edges and applying a blinder to the separated incisions of a client after a surgery. Which of the following postoperative complications has the client developed? a) Hypoxemia b) Evisceration c) Dehiscence d) Shock

c) Dehiscence Feedback: The nurse is taking care of a client with dehiscence. Hypoxemia develops when there is inadequate oxygenation of blood. Evisceration occurs when there is protrusion of abdominal organs through a separated wound. A client has shock when there is inadequate blood flow.

A nurse is applying a pneumatic compression device to a client. What is the purpose of a pneumatic compression device? a) Enables the client to void b) Reduces swelling and pain c) Promotes circulation of venous blood d) Pumps liquid diet to the client

c) Promotes circulation of venous blood

A nurse is caring for an older adult client who has been prescribed fluid restriction before surgery. Which of the following should the nurse check to assess the risks of fluid restriction in elderly clients? a) Anxiety level b) Self‐therapy c) Vital signs d) Cardiac status

c) Vital signs Feedback: The nurse should assess the client's vital signs, weight, and sternal skin turgor prior to fluid restriction to serve as a baseline for comparison. The period of fluid restriction before surgery may be shortened for older adults to reduce their risk of dehydration and hypotension. Nurses check a client's self‐therapy practices and cardiac status to avoid any complications of bleeding and elimination of intravenous fluids given at a standard rate.

A perioperative nurse is preparing a patient for surgery for treatment of a ruptured spleen as the result of an automobile crash. The nurse knows that this type of surgery belongs in what category? a. Minor, diagnostic b. Minor, elective c. Major, emergency d. Major, palliative

c. Major, emergency Feedback: 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.

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. Reduction or loss of reflex action d. Localized loss of sensation Feedback: A localized loss of sensation and possible loss of reflexes occurs with a regional anesthetic. Loss of consciousness and relaxation of skeletal muscles occurs 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.

The operating room nurse is aware that which of the following clients is at a greater risk related to a surgical procedure? a) A man 48 years of age b) A boy 8 years of age c) A woman 34 years of age d) A woman 83 years of age

d) A woman 83 years of age Ans: D Infants and older adults are at a greater risk from surgery than are children and young or middle‐age adults. Physiologic changes associated with aging increase the surgical risk for older clients.

In the postoperative phase of abdominal surgery, the client complains of severe abdominal pain. In the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect? a) Abdominal infection b) Hernia development c) Normal response d) Paralytic ileus

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

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which of the following perioperative phases would this action occur? a) None of the above b) Intraoperative c) Postoperative d) Pre‐operative

d) Pre‐operative Feedback: Exercises and physical activities occurring in the pre‐operative phase include deep‐breathing exercises, coughing, incentive spirometry, turning, leg exercises, and pneumatic compression stockings.

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. "The pump allows the patient to self-administer limited doses of pain medication." Feedback: PCA infusion pumps allow patients to self-administer doses of pain-relieving medication within physician-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 teaching a man 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 Feedback: Written instructions are most effective in providing information for same-day surgery.

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?

delirium