NUR 1021 exam 2

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." An advance directive allows the client to communicate instructions for health care postoperatively in case of an inability to do so. Although an advance directive is either a living will or a durable power of attorney for health care, and the hospital does like to determine if the client has them, these are not the best answers to the client's question. The nurse would not want to explain to the client that he or she may not wake up after surgery.

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure?

"Let me explain to you what will happen next." Many clients feel fearful of knowing little about the operative procedure and what to expect. This fear causes anxiety and can lead to a poorer response to surgery and surgical complications. Explanations of what the client is to expect can help to decrease anxiety. False reassurance of being fine does not diminish anxiety. Deep breathing and relaxation techniques can be helpful to the client, but addressing the source of the anxiety is more beneficial. Keeping the family informed helps the family and is not client focused.

You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply?

"Many people have diagnostic or short therapeutic surgical procedures." Many diagnostic or short therapeutic surgical procedures—such as bone marrow biopsy, endoscopy, or cardiac catheterization—are now performed in outpatient settings and ambulatory surgical centers. Options B, C, and D seem to minimize the teenager's question.

The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response?

"The anesthetic may last for 3 hours." Local anesthesia is the injection of a solution containing the anesthetic agent into the tissues at the planned incision site. Often it is combined with a local regional block by injecting around the nerves immediately supplying the area. It is ideal for short (3 hours) and minor surgical procedures.

The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed?

"The nurse will explain the details of the surgery before I sign a consent." Further instruction would be needed to clarify that the physician, not the nurse, explains the details of the surgery and obtains voluntary consent for the procedure. It is correct that preoperative instructions must be followed prior to surgery for the safety of the client, medical records are present for review prior to surgery, and the physician speaks with the family following the procedure and provides instructions for discharge.

The nurse is working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks the nurse why these medications are needed. What would be the nurse's best answer?

"These medications decrease gastric acidity and volume." The anesthesiologist frequently orders preoperative medications. Common preoperative medications include the following: anticholinergics, which decrease respiratory tract secretions, dry mucous membranes, and interrupt vagal stimulation; anti anxiety drugs, which reduce preoperative anxiety, slow motor activity, and promote induction of anesthesia; histamine2-receptor antagonists, which decrease gastric acidity and volume; narcotics, which decrease the amount of anesthesia needed, help reduce anxiety and pain, and promote sleep; sedatives, which promote sleep, decrease anxiety, and reduce the amount of anesthesia needed; and tranquilizers, which reduce nausea, prevent emesis, and enhance preoperative sedation.

A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery?

7 to 10 days Aspirin, a common OTC medication that inhibits platelet aggregation, should be prudently discontinued 7 to 10 days before surgery; otherwise, the client may be at increased risk for bleeding.

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?

80 to 110 mg/dL Although the surgical risk in the client with controlled diabetes is no greater than in the client without diabetes, strict glycemic control (80 to 110 mg/dL) leads to better outcomes. Frequent monitoring of blood glucose levels is important before, during, and after surgery.

A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery?

A history of diabetes As a chronic condition that affects many body systems, diabetes is a risk factor for surgical complications. The client's blood glucose level and insulin requirements need to be closely monitored before and after surgery. Being sensitive to aspirin does not pose a risk for the client in surgery. Osteoarthritis is not a systemic condition and does not place the client at risk during surgery. Chronic low back pain is not a systemic condition that places the client at risk during surgery; however, it can be exacerbated by positioning on the operating room table.

Which would be considered to require an urgent surgical procedure?

Acute gallbladder infection 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.

What is the most important teaching point for a client after surgery when the client had epidural anesthesia?

Ambulate with assistance. The most important teaching point is to ambulate with assistance to decrease the risk of falls. A client who has had an epidural may not recover full mobility of the lower extremities right away.

A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a "blood thinner like warfarin." What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant?

Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. Anticoagulants are more effective in preventing venous thrombosis than arterial thrombosis. Antiplatelet drugs are used to prevent arterial thrombosis. CAD has an arterial rather than venous etiology. The rationale for the use of antiplatelet agents in CAD is not likely related to the need for blood work or the presence of adverse effects.

A client undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The client is ready for rewarming procedures. Which action by the nurse is appropriate?

Apply a warm air blanket, gradually increasing body temperature. A warm air blanket can be used to treat hypothermia. The body temperature should be increased gradually. A sudden increase in body temperature could cause complications. The OR temperature should not exceed 26.6°C to prevent pathogen growth. Only dry materials should be placed on the client because wet materials promote heat loss. IV fluids should be warmed to body temperature, not room temperature.

What is one of the registered nurse's primary roles in the administration of general anesthetic?

Assessing the client's status during recovery from anesthetic Nursing roles in the care of clients under general anesthetic consist primarily of support and assessment. These medications are generally administered by anesthesiologists, not registered nurses. As with other medications, the care provider primarily determines the best medication.

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. Leg exercises increase venous return in order to prevent the postoperative complication of clot formation in the lower extremities. Coughing, while splinting the incision, and deep breathing is encouraged to prevent respiratory complications such as pneumonia and atelectasis. Turning the client stimulates the circulatory and respiratory system, and prevents skin breakdown.

A 60-year-old client experienced a sudden onset of chest pain and shortness of breath and was subsequently diagnosed with a pulmonary embolism in the emergency department. The client has been started on an intravenous heparin infusion. How does this drug achieve therapeutic effect?

By inactivating clotting factors and thus stopping the coagulation cascade Heparin, along with antithrombin, rapidly promotes the inactivation of factor X, which, in turn, prevents the conversion of prothrombin to thrombin. Heparin does not achieve its therapeutic effect through the excretion or inhibition of vitamin K or by inhibiting platelet aggregation.

A patient admitted to a health care facility for appendicitis surgery is administered methohexital as a general anesthesia. Which condition should the nurse observe in the patient as the effect of the administration of methohexital?

CNS depression The nurse is most likely to observe CNS depression. Methohexital is an ultrashort-acting barbiturate that depresses the CNS to produce hypnosis and anesthesia, but it does not produce analgesia. Skeletal muscle relaxation is caused by skeletal muscle relaxants, halothane and enflurane. An anesthetic state characterized by profound analgesia is produced by ketamine, which is a rapid-acting general anesthetic. Neuroleptanalgesia is caused by a combination of fentanyl and droperidol.

A patient is in the operating room for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented?

Circulating nurse The circulating nurse is responsible for ensuring that the second verification of the surgical procedure and site takes place and is documented. Each member of the surgical team verifies the patient's name, procedure, and surgical site using objective documentation and data before beginning the surgery.

The nurse is assisting in the care of a client during surgery. The nurse will be prepared to administer which drug if the client develops malignant hyperthermia?

Dantrolene sodium

A 70-year-old patient who is to undergo surgery arrives at the operating room (OR). The nurse, when reviewing the patient's medical record, understands that this patient will require a lower dose of anesthetic agent because of which of the following?

Decreased lean tissue mass Elderly patients require lower doses of anesthetic agents because of decreased tissue elasticity and reduced lean tissue mass. An increased amount of anesthetic would be needed with an increased anxiety level. Impaired thermoregulation increases the patient's susceptibility to hypothermia.

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?

During the postoperative phase 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.

What action by the nurse best encompasses the preoperative phase?

Educating clients on signs and symptoms of infection Educating clients on preventing or recognizing complications begins in the preoperative phase. Applying SCDs and frequently monitoring vital signs happen after the preoperative phase. Only electric clippers should be used to remove hair.

As a nurse is aspirating the contents during a tube feeding, the nurse finds that the tube is clogged. What would be appropriate nursing interventions in this situation? Select all that apply.

Ensure that adequate flushing is completed after each feeding. Use warm water and gentle pressure to remove clog. If necessary, replace the tube. The nurse would use warm water and gentle pressure to remove the clog. The nurse would replace the tube, if necessary. The nurse would ensure that adequate flushing is completed after each feeding. It is not evidence based practice to flush the feeding tube with a carbonated beverage. The nurse would not use a stylet to unclog the tube. This could cause damage to the feeding tube. The nurse would not administer an antiemetic to the client because the tube is clogged. This would not help the situation.

The nurse is caring for a woman who received epidural anesthesia during the labor and delivery of her baby. The client is anxious to get up and take a shower. What is the nurse's best action in this situation?

Ensure the woman has return of normal feelings and movement in the lower extremities. The nurse must ensure that feeling and movement have returned to the client's legs before allowing the client to get out of the bed to prevent the client from falling and becoming injured.

When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate?

Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff In the operating room, the sleeves of a gown are considered sterile from 2 inches above the elbow to the stockinette cuff. In addition, the gown is considered sterile in front from the chest to the level of the sterile field. When draping a table or patient, the sterile drape is held well above the surface to be covered and positioned from front to back. Circulating nurses and unsterile items contact only unsterile areas.

A patient is to receive general anesthesia. The nurse anticipates that which of the following would be used for induction?

Etomidate Anesthesia induction begins with IV anesthesia, such as etomidate, and then is maintained at the desired stage by inhalation methods, such as isoflurane or nitrous oxide. Tetracaine is used for local or regional anesthesia.

A client has been administered ketamine for moderate sedation. What is the priority nursing intervention?

Frequently monitoring vital signs Vital signs must be monitored frequently to assess for respiratory depression and to enable quick intervention. Oxygen may need to be administered if respiratory depression occurs; therefore, monitoring vital signs is a higher priority nursing intervention. Providing a dark quiet room is appropriate after the procedure is completed and the client is recovering. Hallucinations may occur as a side effect of the medication.

The nurse recognizes the client has reached stage III of general anesthesia when the client:

Has small pupils that react to light Stage III of general anesthesia is characterized by dilation and reaction of pupils. Respirations are regular, the pulse rate and volume are normal, and the skin is pink or slightly flushed.

A client is receiving general anesthesia. The nurse anesthetist starts to administer the anesthesia. The client begins giggling and kicking her legs. What stage of anesthesia would the nurse document related to the findings?

II Stage II is the excitement stage, which is characterized by struggling, shouting, and laughing. Stage I is the beginning of anesthesia, during which the client breathes in the anesthetic mixture and feelings of warmth, dizziness, and detachment occur. Stage III is surgical anesthesia characterized by unconsciousness and quietness. Surgical anesthesia is achieved by continued administration of anesthetic vapor and gas. Stage IV is medullary depression.

A surgical client has been transferred to the holding area. What nursing intervention(s) promote safe and effective nursing care? Select all that apply.

Identify the client using two identifiers. Verify the surgical site and mark it appropriately. Review the medical records. Identifying the client, verifying and marking the surgical site, and reviewing the medical records all promote safe and effective care while the client is in the holding area. Maintaining an aseptic environment and applying grounding devices are part of the intraoperative phase.

When preparing a client for the application of a local anesthetic, what would be most important?

Inspecting the application area for intactness When a local anesthetic is to be applied, it is important to ensure that the area is intact and free of breakdown to prevent inadvertent systemic absorption of the drug.

A 30-year-old client is to receive tetracaine via spinal anesthesia for an abdominal procedure. What should the nurse do to prevent side effects of this type of anesthesia?

Maintain the client in a supine position following the procedure. By maintaining the client in a supine position, this will help to treat or prevent a headache caused by spinal anesthesia. Venodyne boots aid in the prevention of deep vein thrombosis in the lower extremities. A Foley catheter is to drain the bladder. Monitoring the vital signs will not prevent a spinal headache.

A client has presented to the radiology department for a scheduled bronchoscopy. What drug will meet the client's needs for amnesia and sedation during this invasive procedure?

Midazolam Midazolam is widely used to produce amnesia or sedation for many diagnostic, therapeutic, and endoscopic procedures. Ketamine carries a higher risk of adverse effects. Nitrous oxide is not used for this purpose, and could not be inhaled during a bronchoscopy. Bupivacaine only provides local anesthesia.

A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?

NSAIDs NSAIDs, which are commonly used by older adults, also have antiplatelet effects. Clients who take an NSAID daily may not need low-dose aspirin for antithrombotic effects.

A client is undergoing preoperative assessment. During admission paperwork, the client reports having enjoyed a hearty breakfast this morning to be ready for the procedure. What is the nurse's next action?

Notify the surgeon. If the client has not carried out a specific portion of preoperative instructions, such as withholding foods and fluids, the nurse immediately notifies the surgeon. This scenario does not include information to support documentation of the client's food intake or giving the client water at this point. It is not the nurse's responsibility to cancel the surgery.

A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored?

PT and INR The warfarin dose is regulated according to the INR. The INR is based on the prothrombin time. The red blood cell count is not indicative of warfarin dosage. The aPTT is utilized to determine heparin dose. The platelet count is required to determine warfarin dose.

A client is receiving heparin. Which would the nurse use to monitor the effects of the drug?

Partial thromboplastin time Heparin's effectiveness is monitored by the results of the partial thromboplastin time. The INR and PT are used to monitor warfarin. Vitamin K is the antidote for warfarin, and levels are not monitored to evaluate the effects of any anticoagulant.

A client is to receive bupivacaine for a skin repair. Which assessments will the nurse perform prior to the procedure? Select all that apply.

Perform a physical examination. Ask the client about known allergies. Monitor vital signs. Monitor laboratory values. An interview about known allergies and a physical examination are all part of the assessment. Assessing vital signs and laboratory values are also part of the assessment. Providing skin care is a nursing intervention.

The surgical client is at risk for injury related to positioning. Which of the following clinical manifestations exhibited by the client would indicate the goal was met of avoiding injury?

Peripheral pulses palpable Surgical clients are at risk for pressure ulcers and damage to nerves and blood vessels as a result of awkward positioning required for surgical procedures. Palpable peripheral pulses indicate integrity of the blood vessels.

The client received ketamine during a surgical procedure. What intervention by the nurse will assist with an optimal recovery period?

Place the client in a darkened, quiet part of the recovery area

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?

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

When is the ideal time to discuss preoperative teaching

Preadmission visit The ideal timing for preoperative teaching is not on the day of surgery but during the preadmission visit, when diagnostic tests are performed. Teaching should be done long before the patient enters the preop area. Preoperative teaching should not be done when the patient is sedated.

The scrub nurse is responsible for:

Preparing the sterile instruments for the surgical procedure

A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?

Protamine sulfate If a client who receives IV heparin is found to be highly anticoagulated, protamine sulfate may be prescribed. Protamine sulfate, which is a strong base, reacts with heparin, which is a strong acid, to form a stable salt, thereby neutralizing the anticoagulant effects of heparin. Protamine sulfate does not produce the same effects for coumadin, alteplase, or ticlopidine.

Prior to administering morphine sulfate to a client in the postanesthesia recover unit (PACU), what information must the nurse obtain? (Select all that apply.)

Pulse Blood pressure Respirations The nurse must check the client's pulse, respiratory rate and blood pressure before an opioid such as morphine sulfate is administerd in the PACU. The client's IV rate and urinary output are not neccesary information to administer an opioid.

The nurse is using a large syringe to administer an intermittent feeding to a client who has a nasogastric feeding tube. Which method should the nurse use to increase the flow rate of the formula?

Raise the height of the syringe Syringe feedings are infused via gravity. Raising the syringe will increase the rate of infusion. Syringe pumps are used for IV infusions rather than gastric feeding. Feeding through a syringe should be done by gravity, not by positive pressure using the plunger. The client bearing down will likely have little effect on the rate of infusion.

The nurse observes that a postsurgical client has hemorrhaged and is in hypovolemic shock. Which nursing intervention will manage and minimize hemorrhage and shock?

Reinforcing the dressing or applying pressure if bleeding is frank The nurse should reinforce the dressing or apply pressure if bleeding is frank. The nurse should keep the head of the bed flat unless it is contraindicated. Encouraging the client to breathe deeply will not help manage and minimize hemorrhage and shock. Monitoring vital signs every 15 minutes is an appropriate nursing intervention but will not minimize hemorrhage and shock; it will just help to determine the extent and progression of the problem.

The circulating nurse is unsure whether proper technique was followed when an object was placed in the sterile field during a surgical procedure. What is the best action by the nurse?

Remove the entire sterile field from use. If any doubt exists about the maintenance of sterility, the field should be considered not sterile. Because the object in question was placed in the sterile field, the sterile field must be removed from use. Removing the individual item is not appropriate, as the entire field was potentially contaminated. Reviewing the client's chart at a later date does not decrease the chance of infection. Although another nurse could observe the technique used to put objects in a sterile field, it does not resolve the immediate concern.

A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse?

Report the infection to an immediate supervisor. The infection needs to be reported immediately because of the aseptic environment of the operating room. The usual barriers may not protect the client when an infection is present. The employee needs to follow the policy of the operating room regarding infections. Covering the infected area with a dressing may be necessary, but the infection must be reported first. The scrub nurse may still be able to work depending on the policy; therefore, returning to work after 24 hours is not the priority action. Even if the nurse requests a role change to circulating nurse, the policy for infections in the operating room must be followed; therefore, it must be reported first.

The post-anesthetic recovery unit nurse is caring for a client whose balanced anesthesia included midazolam. The nurse should prioritize assessments for what health problems?

Respiratory depression and CNS suppression Respiratory depression and CNS suppression may occur during recovery from midazolam, making these areas priorities for post-operative assessment.

The nurse is caring for a confused older adult client who requires surgery for a broken hip. What steps does the nurse take to determine if the client has a durable power of attorney for health care and how to contact that person?

Review the medical chart for a copy of a durable power of attorney for health care or permission for disclosure contact. The client cannot give consent due to confusion. In most cases, the durable power of attorney for health care document is discussed and obtained during the admission process. The nurse should act as a client advocate by seeking someone with durable power of attorney to sign the informed consent form. It is the surgeon's responsibility to explain the surgical procedure and obtain the appropriate signature on the consent form; however, the nurse still acts as the client advocate to locate the designated person. A living will specifies the types of medical treatment the client wants should the client become unable to speak in a terminal or permanently unconscious medical condition, but it does not address matters related to client confusion. Telling visitors about the need for surgery may violate client confidentiality. If the nurse identifies who they have permission to disclose medical information to, they can ask that person about a durable power of attorney for health care.

Which of the following is the most effective intervention for preventing progression of vascular disease?

Risk factor modification Risk factor modification is the most effective intervention for preventing progression of vascular disease. Measures to prevent tissue loss and amputation are a high priority. Patients are taught to avoid trauma; wear sturdy, well-fitting shoes or slippers; and use pH neutral soaps and body lotions.

A 55-year-old patient arrives at the operating room. The nurse is reviewing the medical record and notes that the patient has a history of osteoporosis in her lower back and hips. The patient is scheduled to receive epidural anesthesia. Which of the following nursing diagnoses would be a priority for this patient?

Risk for perioperative positioning injury related to operative position Although any of the nursing diagnoses might apply for this patient, the priority would be risk for perioperative positioning injury related to the patient's history of osteoporosis. The bone loss associated with this condition necessitates careful manipulation and positioning during surgery.

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications?

Splint the incision site using a pillow during deep breathing and coughing exercises. Splinting the incision site will help decrease pain and support the incision. This will increase compliance with the deep breathing and coughing exercises that assist in preventing respiratory complications. Pain medication should be taken regularly, not only before deep breathing and coughing exercises. Deep breathing and coughing exercises should be done at least every 2 hours, more frequently if possible. While some clients will find the exercises relaxing, most clients find it painful to complete them.

There are four stages of general anesthesia. Select the stage during which the OR nurse knows not to touch the patient (except for safety reasons) because of possible uncontrolled movements.

Stage II: excitement The excitement stage, characterized variously by struggling, shouting, talking, singing, laughing, or crying, is often avoided if the anesthetic is administered smoothly and quickly. Because of the possibility of uncontrolled movements, the patient should not be touched except for purposes of restraint.

The client is having a kidney removed due to a tumor. The circulating nurse in the operating room knows that which stage of anesthesia will be most dangerous to the client?

Stage IV Stage IV is the stage of respiratory paralysis and is a rare and dangerous stage of anesthesia. At this stage, respiratory arrest and cessation of all vital signs may occur. Stages I, II, and III are not as dangerous to the client.

Which clinical manifestation is often the earliest sign of malignant hyperthermia?

Tachycardia (heart rate >150 beats per minute) Tachycardia is often the earliest sign of malignant hyperthermia. Hypotension is a later sign of malignant hyperthermia. The rise in temperature is actually a late sign that develops quickly. Scant urinary output is a later sign of malignant hyperthermia.

What should the nurse do to manage persistent swelling in a client with severe lymphangitis and lymphadenitis?

Teach the client how to apply a graduated compression stocking. In severe cases of lymphangitis and lymphadenitis with persistent swelling, the nurse teaches the client how to apply a graduated compression stocking. The nurse informs the physician if the client's temperature remains elevated. The nurse recommends elevating the area to reduce the swelling and provides warmth to promote comfort and to enhance circulation.

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately?

Temperature of 102.5°F (39°C) Intra operative hyperthermia can indicate a life-threatening condition called malignant hyperthermia. The circulating nurse closely monitors the client for signs of hyperthermia. The pulse rate, respiratory rate, and blood pressure did not indicate a significant concern.

A client asks the nurse how an inhalant general anesthesic is expelled by the body. What is the bestresponse by the nurse?

The lungs primarily eliminate the anesthesia." When inhalant anesthetic administration is discontinued, the vapor or gas is eliminated through the lungs.

a 30 year old woman is in labor and has been provided with nitrous oxide. before administering this gas, the nurse should provide what teaching point?

This will help with your pain without making you very drowsy

A client requires local anesthesia to be administered. The nurse identifies that the anesthetic may be administered by which route? Select all that apply.

Topical anesthesia Regional anesthesia Local-infiltration anesthesia The different methods of administering local anesthesia are topical, regional, and local infiltration. General anesthesia is used to provide a pain-free state for the entire body and may involve inhalation of gases or volatile liquid vapors.

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period?

Up to 72 hours after alcohol withdrawal Alcohol withdrawal delirium is associated with a significant mortality rate when it occurs postoperatively. Onset of symptoms depends on when alcohol was last consumed. Twenty-four hours is too short a time frame to consider alcohol withdrawal delirium as no longer a threat to a chronic alcoholic.

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

Use diaphragmatic breathing. In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

Prior to elective hip replacement surgery, the nurse is explaining the basic characteristics of general anesthesia to the client. The nurse should perform this education in the understanding that general anesthesia is best understood as what result?

a state of reversible unconsciousness General anesthesia is defined as a medication-induced reversible unconsciousness with loss of protective reflexes. There is the misconception that general anesthesia is a deep sleep.

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency?

adrenal Clients who have received corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids does not occur in the pituitary, thyroid, or parathyroid glands.

The nurse instructs a client to use benzocaine to soothe the itching and pain related to an insect bite. Benzocaine is considered to be what type of dermatologic agent?

anesthetic Anesthetics are sprays, lotions, or creams used for pruritus (itching) and pain from wounds, minor burns, prickly heat, chickenpox, insect bites, and sunburn. Pain relief drugs are lotions and solutions that provide temporary pain relief, soothing emollients relieve itching and aid in healing mild skin irritations, and antiseptics are germicidal agents.

A surgical client's balanced anesthesia includes the use of vecuronium. What nursing action should the operating room nurses prioritize?

assessing and protecting the client's airway The maintenance of the client's airway and respiratory function following the administration of neuromuscular blocking agents such as vecuronium is the most important nursing implication. The importance of airway protection supersedes that of DTR assessment, assessing LOC, and maintaining skin integrity, though each of these is a valid consideration.

A client with a foreign body embedded in her hand requires local anesthesia for removal. What drug would be most appropriate?

benzocaine Benzocaine is a local ester anesthetic. Methohexital is a barbiturate general anesthetic. Enflurane is a volatile liquid general anesthetic. Propofol is a nonbarbiturate general anesthetic.

A client, taking warfarin after open heart surgery, tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what should the nurse suspect is the cause of the pain?

bleeding the main adverse effect of warfarin is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the client for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.

Which medication used for local and regional anesthesia has the longest duration of action?

bupivacaine Bupivacaine is used for local, regional, and spinal anesthesia for diagnostic and therapeutic procedures. The drug is more potent and has a longer duration of action than lidocaine, procaine, or mepivacaine.

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:

circulating nurse

The nurse administered morphine 30 minutes ago to a client in the postanesthesia recovery unit (PACU), and now notes that the client vital signs are: Temp: 97.9 F, Pulse: 98 bpm, Respirations: 9 breaths/min, and BP: 107/69. What is the nurse's next best action?

contact healthcare provider The health care provider is contacted if the client's respiratory rate is below 10 breaths/min before or after the nurse administers an opioid medication. The client's respiratory rate is 9 breaths/min; it would not be appropriate to document the findings or to recheck in five minutes. Also, the client's temperature does not indicate the need for a warm blanket.

A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:

continuously monitors the sedated client. Intraoperative care includes the entire surgical procedure. During sedation, the nurse continuously evaluates the client. Assessment of heart rate, respiratory rate, BP, oxygen saturation, and level of consciousness occurs during all phases of perioperative care. Obtaining consent would occur during the preoperative phase of perioperative care. During the postoperative phase the nurse would assess how the client is recovering from anesthesia.

The nurse is caring for a client in the emergency department who will need sutures. The health care provider plans to use lidocaine. The nurse prepares the suture tray and places lidocaine and what other drug on the tray that helps prolong the local anesthetic effects?

epinephrine Epinephrine is used to prolong the effects of lidocaine.

The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching?

headache

A client develops malignant hyperthermia. What client symptom would the nurse most likely observe as the first indicator of the disorder?

heart rate over 150 beats per minute With malignant hyperthermia, tachycardia with a heart rate greater than 150 beats per minute is often the earliest sign because of an increase in end-tidal carbon dioxide. Generalized muscle rigidity and tetanus-like movement occurs often in the jaw are not the first signs for health care providers to note with malignant hyperthermia. The rise in body temperature is a late sign that develops rapidly.

Which genetic clinical condition will likely, over the course of the client's lifetime, require the pharmaceutical introduction of clotting factors to assure the client's safety?

hemophilia Hemophilia is a genetic lack of clotting factors that leaves the patient vulnerable to excessive bleeding with any injury. Treatment of classic hemophilia with antihemophilic factor provides temporary replacement of clotting factors to correct or prevent bleeding episodes or to allow necessary surgery. Bone marrow disorders are disorders in which platelets are not formed in sufficient quantity to be effective. Neither diabetes nor cystic fibrosis is treated with antihemophilic agents.

A client scheduled for surgery has been taking aspirin since his heart attack in 1997. The client is at risk for:

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.

A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?

heparin Heparin is frequently used to prevent postsurgical venous thromboembolism. Antiplatelet drugs do not have this indication, and vitamin K would increase the client's risks.

A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for?

hypoglycemia The patient with diabetes who is undergoing surgery is at risk for both hypoglycemia and hyperglycemia. Hypoglycemia may develop during anesthesia or postoperatively from inadequate carbohydrates or excessive administration of insulin. Hyperglycemia, which can increase the risk of surgical wound infection, may result from the stress of surgery, which can trigger increased levels of catecholamine. Other risks are acidosis and glucosuria, but hypoglycemia is a bigger risk. Dehydration is a lesser risk for a patient with diabetes than is hypoglycemia.

In advance of a client's scheduled appendectomy, the nurse spends significant time explaining to the client what will happen,both before the procedure and after the procedure is complete. The primary reason the nurse puts so much effort into preoperative teaching is to:

increase the likelihood of a successful recovery. Teaching clients about their surgical procedure and expectations before and after surgery is best done during the preoperative period. Clients and family members can better participate in recovery if they know what to expect. Although preoperative teaching may minimize the time spent postoperatively on questions and help nurses improve their teaching skills, these are not the primary reasons for spending significant preoperative time on teaching. Clients must participate in their recovery process. Education encourages clients to participate in their own care in addition to giving important information to family. Absolving the hospital of legal responsibility would not be a primary nursing goal.

The nurse at an urgent care clinical is reviewing local anesthetics. What drug should the nurse recognize as an amide?

lidocaine Lidocaine is an amide local anesthetic. The others are ester local anesthetics.

The nurse is working in a dental clinic assisting the dentist with a tooth extraction. The dentist numbs the gum with lidocaine before removing the tooth. This type of anesthetic is:

local infiltration. Local infiltration anesthesia is the injection of a local anesthetic drug into tissues. This type of anesthesia may be used for dental procedures, the suturing of small wounds, or making an incision into a small area.

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication?

malignant hyperthermia Malignant hyperthermia is an inherited disorder that occurs when body temperature, muscle metabolism, and heat production increase rapidly, progressively, and uncontrollably in response to stress and some anesthetic agents. If the client's temperature begins to rise rapidly, anesthesia is discontinued, and the OR team implements measures to correct physiologic problems, such as fever or dysrhythmias. Hypothermia is a lower than expected body temperature. Signs of infection would not present during the procedure. Increased body temperature would not indicate fluid volume excess.

Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care:

may result in the administration of general anesthesia.

The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is:

notify the surgeon Preoperative medication can impair the thinking ability of the client. FFor informed consent to be valid, the client must be competent to give consent. The surgery will be canceled.

Which is a risk factor for venous disorders of the lower extremities?

obesity Careful assessment is invaluable in detecting early signs of venous disorders of the lower extremities. Clients with a history of varicose veins, hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at high risk. Other clients at high risk include those who are obese or older adults and women taking oral contraceptives.

A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications?

osteoporosis 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.

Gas anesthetics such as nitrous oxide must be combined with what element before they can be administered to the client?

oxygen Gas anesthetics such as nitrous oxide and cyclopropane must be combined with oxygen, and then administered by inhalation to the client to produce anesthesia. Nitrous oxide is not combined with water, nitrogen, or helium.

The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:

peptic ulcer disease Contraindications of heparin include GI ulcerations (e.g., peptic ulcer disease, ulcerative colitis), active bleeding, severe kidney or liver disease, severe hypertension, and recent surgery of the eye, spinal cord, or brain. The drug should be used cautiously in clients with non-severe hypertension.

After the administration of procaine to a client with a history that suggests a possible hypersensitivity to the drug, the nurse should prioritize what assessment?

respiratory Excessive doses of procaine can result in respiratory depression; respiratory assessment is consequently indicated. It is less important to assess the client's temperature, neurological function, or musculoskeletal status. To determine therapeutic effects, it is necessary to assess for cutaneous sensation in the client's integumentary system.

A patient who has suffered a crushing injury to his thumb and two fingers in an accident at a factory is relieved to be administered a local anesthetic prior to treatment. The drugs that were administered decrease the permeability of the nerve cell membrane to:

sodium Local anesthetics decrease the permeability of the nerve cell membrane to ions, especially sodium

There are different stages of anethesia the client will go through in surgery. The circulating nurse is aware that extra caution is needed during which stage of general anesthesia, when the client may experience brief periods of delirium and excitement?

stage II During Stage II, the client may experience delirium and excitement. During Stage I, anesthesia induction is accomplished. During Stage III, the client is usually ready for the surgical procedure. Stage IV is a stage of respiratory paralysis and the client may lose all vital signs.

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?

surgeon 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.

An older adult client has been admitted to the emergency department with severe chest pain. Onset of symptoms is within the last 60 minutes. What medication would the nurse expect the health care provider to prescribe for this acute disorder?

thrombolytic drugs The scenario suggests that the client's chest pain may be a result of a thromboembolism. The main use of thrombolytic agents is for management of acute, severe thromboembolic disease, such as myocardial infarction or pulmonary embolism since they dissolve blood clots. None of the other options can dissolve an existing blood clot.

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?

verify consent Surgery cannot be performed without consent. Documentation of the start of surgery can only happen once the surgery has started. Blood products must be administered within an allotted time frame and therefore should not be acquired unless needed. The sponge and syringe count is a safety issue that should be completed before surgery and while the wound is being sutured, but if the client has not consented, the surgery should not take place.

A circulating nurse is preparing a client for a surgical procedure. What are the primary responsibilities of the circulating nurse in the perioperative experience? Select all that apply.

verifying informed consent ensuring proper lighting coordinating the efforts of the surgical team The responsibilities of the circulating nurse include verifying consent, ensuring proper lighting, and coordinating the surgical team. The marking the operative site is done by the surgeon. The passing of instruments is done by the scrub nurse.

The nurse is caring for a 73-year-old client receiving warfarin. When the nurse performs the initial shift assessment, the nurse observes blood in the client's urinary drainage bag. After reporting the observation to the physician, which substance will the nurse likely administer?

vitamin k Genitourinary bleeding is an adverse effect of warfarin. Vitamin K, a hemostatic agent that controls bleeding caused by warfarin overdose, will likely be administered to this patient.

The nurse's assessment of a postop client reveals a temperature of 103.2°F, tachycardia, and client complaints of increased incisional pain. What does the nurse recognize that this client is experiencing?

wound infection Clinical manifestations of a wound infection include fever, tachycardia, an elevated white blood cell count, and increased incisional pain.