Nursing 403 Ch 17 PrepU
A fractured skull would be classified under which category of surgery based on urgency? - Elective - Required - Urgent - Emergent
Correct response: Emergent Explanation: Emergent surgery occurs when the client requires immediate attention. An elective surgery is classified as a surgery that the client should have. A required surgery means that the client needs to have surgery. An urgent surgery occurs when the client requires prompt attention.
A nurse is caring for a bariatric client prior to a surgical procedure. What surgical complications would the nurse monitor the bariatric client for postoperatively? Select all that apply. - cardiovascular complications - gastrointestinal complications - pulmonary complications - renal complications - nervous system complications
Correct response: - cardiovascular complications - pulmonary complications Explanation: Like age, obesity increases the risk and severity of complications associated with surgery. The cardiovascular system is at risk for complications with obese surgical clients because of hypertension and diabetes complications. The client tends to have shallow respirations when supine, increasing the risk of hypoventilation and postoperative pulmonary complications. The acquired physical characteristics-a short, thick neck; large tongue; recessed chin; and redundant pharyngeal tissue, associated with increased oxygen demand and decreased pulmonary reserves-impede intubation. Obesity should not cause postoperative complications with the gastrointestinal system, renal system, or nervous system.
A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results? - A blood urea nitrogen level of 42 mg/dL - A creatine kinase level of 120 U/L - A serum creatinine level of 0.9 mg/dL - A urine creatinine level of 1.2 mg/dL
Correct response: A blood urea nitrogen level of 42 mg/dL Explanation: The kidneys are involved in excreting anesthetic medications and their metabolites; therefore, surgery is contraindicated if a patient has acute nephritis, acute renal insufficiency with oliguria or anuria, or other acute renal problems (see Chapter 54). A blood urea nitrogen level of 42 mg/dL (significantly elevated) is an indicator of renal failure. The other levels are normal.
Which would be considered to require an urgent surgical procedure? - Loose facial skin - Cataract - Acute gallbladder infection - Severe bleeding
Correct response: Acute gallbladder infection Explanation: 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.
During the preoperative assessment, the nurse learns that the client has been taking prednisone. The nurse realizes that the client is at risk for: - Cardiovascular collapse. - Respiratory depression. - Decreased blood pressure. - Increased blood loss.
Correct response: Cardiovascular collapse. Explanation: Prednisone, a corticosteroid, can result in cardiovascular collapse if suddenly discontinued. A bolus of corticosteroid may be given intravenously immediately before and after surgery. Hydrochlorothiazide and anesthetics may interact, resulting in respiratory depression. Phenothiazines may potentiate the hypotensive action of anesthetics. Anticoagulants can increase the risk of bleeding.
Which of the following activities are nursing activities in the preoperative phase of care? Select all that apply. - Discussing and reviewing the advanced directive document - Establishing an intravenous line - Ensuring that the sponge, needle, and instrument counts are correct - Administering medications, fluid, and blood component therapy, if prescribed - Beginning discharge planning
Correct response: - Discussing and reviewing the advanced directive document - Establishing an intravenous line - Beginning discharge planning Explanation: Of the activities listed, discussing and reviewing the advanced directive document, establishing an intravenous line, and beginning discharge planning are preoperative nursing activities.
The nurse is witnessing a surgical consent for an adolescent client who is deemed an emancipated minor. What are the nursing considerations with client's rights as an emancipated minor? Select all that apply. - Each state has laws defining an emancipated minor. - The adolescent can be legally married and be considered an emancipated minor. - The adolescent must be self-supporting as an emancipated minor. - The hospital defines the emancipated minor abilities. - The emancipated minor is often incapable to make health care decisions .
Correct response: - Each state has laws defining an emancipated minor. - The adolescent can be legally married and be considered an emancipated minor. - The adolescent must be self-supporting as an emancipated minor. Explanation: Each state has laws defining an emancipated minor. An emancipated minor as an adolescent can be legally married and must be self-supporting. Each state has laws that defines an emancipated minor not the hospital. The emancipated minor is often capable to make health care decisions.
The nurse is reviewing a preoperative informed consent when preparing the client for surgery. Which contents of the informed consent are required? Select all that apply. - Explanation of procedure - Estimated time of procedure - Potential risks - Benefits of surgery - Personnel present - Description of alternatives
Correct response: - Explanation of procedure - Potential risks - Benefits of surgery - Description of alternatives Explanation: Informed consents should be in writing and contain an explanation of procedure and risks, description of benefits and alternative, an offer to answer questions about procedure, ability to withdraw consent, and statement informing the client if the protocol differs from customary procedure. An estimated time of procedure and personnel present are not required in the informed consent.
A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply. - The client will leave the hospital sooner than in the past. - Need for teaching is increased. - The client must be prepared to take on more self-care than he or she may have done in the past. - Discharge planning is minimal because the stay is so short. - Home care and other referrals are unlikely because same-day surgeries are usually minor.
Correct response: - The client will leave the hospital sooner than in the past. - Need for teaching is increased. - The client must be prepared to take on more self-care than he or she may have done in the past. Explanation: The increasing use of ambulatory, same-day, or short-stay surgery, means that clients leave the hospital sooner, which increases the need for teaching, discharge planning, preparation for self-care, and referral for home care and rehabilitation services.
What is the blood glucose level goal for a diabetic patient who will be having a surgical procedure? - 3.5 and 5.5 mmol/L - 8 to 13 mmol/L - 13 to 16 mmol/L - 16 to 19 mmol/L
Correct response: 3.5 and 5.5 mmol/L Explanation: Although the surgical risk in the patient with controlled diabetes is no greater than in the patient without diabetes, strict glycemic control (3.5 to 5.5 mmol/L) leads to better outcomes (Alvarex et al., 2010). Frequent monitoring of blood glucose levels is important before, during, and after surgery.
Which of the following medications may increases the hypotensive action of anesthesia? - Chlorpromazine - Prednisone - Warfarin - Hydrochlorothiazide
Correct response: Chlorpromazine Explanation: Chlorpromazine (Thorazine) may increase the hypotensive action of anesthetics. Prednisone (Deltasone) may cause cardiovascular collapse and should be discontinued immediately. Warfarin (Coumadin) can increase the risk of bleeding during the intraoperative and postoperative periods. Hydrochlorothiazide (HydroDIURIL) may cause respiratory depression resulting from an associated electrolyte imbalance during anesthesia.
At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period? - During the preoperative period - Upon arrival to the surgical unit - Following the surgical procedure - At the time of discharge instructions
Correct response: During the preoperative period Explanation: The best time to begin teaching about care needed in the postoperative period is during the preoperative time. At this time, the client is more alert and focused on the information provided by the nurse. Clients and family members can better be prepared and participate in the recovery period if they know what to expect. Anxiety is a factor on arrival to the surgical unit that could interfere with learning. Pain could interfere with the learning process, following a surgical procedure. At the time of discharge, both pain and timeliness may be an issue in understanding and obtaining care needed during the postoperative time.
You are admitting an insulin-dependent patient to the same-day surgical suite for carpal tunnel surgery. You know that this patient may be at risk for which metabolic disorder? - Adrenal insufficiency - Thyrotoxicosis - Impaired acid base balance - Hyperglycemia
Correct response: Hyperglycemia Explanation: The patient with diabetes who is undergoing surgery is at risk for hypoglycemia and hyperglycemia. Hyperglycemia during the surgical procedure is a risk based on the body's defense mechanism to raise the blood sugar in the event of stress. Patients who have received corticosteroids are at risk of adrenal insufficiency. Patients with uncontrolled thyroid disorders are at risk for thyrotoxicosis. Because the kidneys are involved in excreting anesthetic medications and their metabolites and because acid-base status and metabolism are also important considerations in anesthesia administration, surgery is contraindicated when a patient has acute nephritis, acute renal insufficiency with oliguria or anuria, or other renal problems.
A client taking chlorpromazine is preparing to undergo surgery. Which of the following complications does the surgical team need to prepare to deal with before anesthetics are administered? - Cardiovascular collapse - Seizures - Hypotension - Apnea from respiratory paralysis
Correct response: Hypotension Explanation: Chlorpromazine (Thorazine) may increase the hypotensive action of anesthetics. Seizures are a potential interaction if diazepam (Valium) is withdrawn suddenly before surgery. The client who takes prednisone (Deltasone) is at risk for cardiovascular collapse if the medication is discontinued suddenly. The combination of erythromycin (Ery-Tab) and a curariform muscle relaxant can lead to apnea from muscle paralysis.
The nurse is conducting a preoperative assessment on a client scheduled for gallbladder surgery. The client reports a frequent cough producing green sputum for 3 days and denies fever. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiratory wheeze. Respiratory rate is 20, temperature is 99.8 (taken orally), heart rate is 87, and blood pressure is 124/70. What is the best action by the nurse? - Notify the surgeon to possibly delay the surgery. - Notify the primary physician about the assessment findings. - Document the findings and continue moving the client through the preoperative phase. - Wait 1 hour and complete the assessment again.
Correct response: Notify the surgeon to possibly delay the surgery. Explanation: A respiratory infection can delay a nonemergent surgical procedure because the infection can increase the risk for respiratory complications. Therefore, the nurse should notify the surgeon about delaying the surgery. The primary physician may be called to provide care based on the assessment findings, but that should be done only after the surgeon has been notified. Continuing through the preoperative phase without notifying the surgeon and waiting 1 hour then repeating the assessment are not appropriate.
The nurse recognizes that written informed consent is required for insertion of a(n): - Nasogastric tube. - Urinary catheter. - Peripherally-inserted central catheter. - Oral airway.
Correct response: Peripherally-inserted central catheter. Explanation: Nonsurgical invasive procedures, such as insertion of a peripherally-inserted central catheter, that carry more than a slight risk to the client require written informed consent.
The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery? - Effective coughing and deep breathing - Types of postoperative pain medication - Post-discharge diet - Knowledge of surgical procedure
Correct response: Post-discharge diet Explanation: The least helpful postoperative teaching that could be omitted due to the need to obtain emergency surgery is explaining the post-discharge diet. This is not essential information to improve client participation in their postoperative recovery. Coughing and deep breathing is essential in the immediate postoperative period. Clients are often concerned about postoperative pain so instruction on pain medication can decrease anxiety. Knowledge of the surgical procedure must be explained by a physician when signing a surgical consent.
A client is scheduled for elective surgery. To prevent the complications of hypotension and cardiovascular collapse, the nurse should report the use of which medication? - Hydrochlorothiazide - Prednisone - Warfarin - Erythromycin
Correct response: Prednisone Explanation: Clients who receive corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids such as prednisone can cause circulatory collapse and hypotension. Hydrochlorothiazide and erythromycin can cause respiratory complications. Warfarin increases the risk of bleeding.
As a nurse working in an ambulatory surgery center, you are admitting a client who is going to have a biopsy of a skin lesion. What is an important part of the preoperative process? - Review preoperative instructions. - Give postoperative instructions. - Teach dressing changes. - Give caregiver instructions.
Correct response: Review preoperative instructions. Explanation: On admission, the nurse reviews preoperative instructions, such as diet restrictions and skin preparations, to ensure the client has followed them. The preoperative nurse does not give postoperative instructions; teach dressing changes or give instructions to caregivers.
The nurse is aware that the amino acid, arginine, - Stimulates T-cell response - Is essential for antibody formation - Is involved in capillary formation - Is important for normal blood clotting
Correct response: Stimulates T-cell response Explanation: Arginine is necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response.
The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities? - The client breathes through her nose, holds her breath, and then exhales slowly before coughing. - The client takes short, panting breaths and coughs from the throat to expectorate sputum. - The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times. - The client takes three deep breaths and then coughs forcefully.
Correct response: The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times. Explanation: Taking a deep abdominal breath and then "huff" coughing is the most effective manner of coughing. This technique helps facilitate removal of secretions and conserves energy for the client. The client should breathe slowly but not hold her breath. Short, panting breaths and then coughing from the throat do not promote expectoration of sputum from the lungs. Coughing forcefully can cause alveoli to collapse; "huff" coughing prevents this.
How does the nurse determine that the patient may have hidden fears about the impending surgical procedure? (Select all that apply.) - The patient tells the nurse of concerns with the outcome of the procedure. - The patient informs the nurse of problems with postoperative nausea in the past and that it was a bad experience. - The patient avoids communication with the nurse. - The patient repeatedly asks questions that have previously been answered. - The patient talks incessantly.
Correct response: The patient avoids communication with the nurse. The patient repeatedly asks questions that have previously been answered. The patient talks incessantly. Explanation: People express fear in different ways. Some patients may ask repeated questions, regardless of information already shared with them. Others may withdraw, deliberately avoiding communication by reading, watching television, or talking about trivialities. Consequently, the nurse must be empathetic, listen well, and provide information that helps alleviate concerns. If the patient talks about his or her fears, then they are no longer hidden.
Sudden withdrawal of which of the following may result in seizures? - Tranquilizers - Steroids - Monoamine-oxidase inhibitors - Thiazide diuretics
Correct response: Tranquilizers Explanation: Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly. Abrupt withdrawal of steroids may precipitate cardiovascular collapse. Monoamine oxidase inhibitors increase the hypotensive effects of anesthetics. Thiazide diuretics may cause excessive respiratory depression during anesthesia due to an associated electrolyte imbalance.
The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure? - Up to 8 hours before surgery - Up to 6 hours before surgery - Up to 4 hours before surgery - Up to 2 hours before surgery
Correct response: Up to 2 hours before surgery Explanation: The major purpose of withholding food and fluid before surgery is to prevent aspiration. Until recently, fluid and food were restricted preoperatively overnight and often longer. The American Society of Anesthesiologists reviewed this practice and made new recommendations for people undergoing elective surgery who are otherwise healthy. Specific recommendations depend on the age of the patient and the type of food eaten. For example, adults may be advised to fast for 8 hours after eating fatty food and 4 hours after ingesting milk products. Healthy patients are allowed clear liquids up to 2 hours before an elective procedure (Crenshaw, 2011).
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? - Make inhalation longer than exhalation. - Exhale through an open mouth. - Use diaphragmatic breathing. - Use chest breathing.
Correct response: Use diaphragmatic breathing. Explanation: 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.
The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. Which of the following is the most important function? - Completes preoperative assessment - Develops a plan of care - Verifies that operative consent is signed - Provides psychological support
Correct response: Verifies that operative consent is signed Explanation: All choices listed are essential but, without a signed consent form, surgery cannot occur.
The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician? - When the patient's blood ammonia concentration reaches 180 mg/dL - When a lactate dehydrogenase concentration is 300 units - When a serum albumin concentration is 5.0 g/dL - When a serum globulin concentration reaches 2.8 g/dL
Correct response: When the patient's blood ammonia concentration reaches 180 mg/dL Explanation: The liver is important in the biotransformation of anesthetic compounds. Disorders of the liver may substantially affect how anesthetic agents are metabolized. Acute liver disease is associated with high surgical mortality; preoperative improvement in liver function is a goal. Careful assessment may include various liver function tests (see Chapter 49).
A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia? - corticosteroids - diuretics - insulin - anticoagulants
Correct response: diuretics Explanation: Diuretics during anesthesia may cause excessive respiratory depression resulting from an associated electrolyte imbalance. Corticosteroids, insulin, and anticoagulants are not known to cause respiratory depression during anesthesia.
Regarding the surgical client, which phase refers to the period of time that spans the entire surgical experience? - Preoperative - Intraoperative - Postoperative - Perioperative
Perioperative period includes the preoperative, intraoperative, and postoperative phases. The preoperative phase is the period of time from when the decision for surgical intervention is made to when the client is transferred to the operating room. The intraoperative phase is the period of time from when the client is transferred to the operating room to when he or she is admitted to the postanesthesia care unit. The postoperative phase is the period of time that begins with the admission of the client to the postanesthesia care unit and ends after a follow-up evaluation in the clinical setting or home.
