PeriOperative Care chap. 14, 15, 16,

A postoperative client has just been admitted to the postanesthesia care unit (PACU). What assessment by the PACU nurse takes priority? a. Airway b. Bleeding c. Breathing

ANS: A Assessing the airway always takes priority, followed by breathing and circulation. Bleeding is part of the circulation assessment, as is cardiac rhythm.

A postoperative client has respiratory depression after receiving midazolam (Versed) for sedation. Which IV-push medication and dose does the nurse prepare to administer? a. Flumazenil (Romazicon) 0.2 to 1 mg b. Flumazenil (Romazicon) 2 to 10 mg c. Naloxone (Narcan) 0.4 to 2 mg d. Naloxone (Narcan) 4 to 20 mg

ANS: A Flumazenil is a benzodiazepine antagonist and would be the correct drug to use in this situation. The correct dose is 0.2 to 1 mg. Naloxone is an opioid antagonist.

Curative surgical procedure

Performed to resolve a health problem or removing the cause ex. cholecystectomy, appendectomy, hysterectomy

A registered nurse (RN) is watching a nursing student change a dressing and perform care around a Penrose drain. What action by the student warrants intervention by the RN? a. Cleaning around the drain per agency protocol b. Placing a new sterile gauze under the drain c. Securing the drains safety pin to the sheets d. Using sterile technique to empty the drain

ANS: C The safety pin that prevents the drain from slipping back into the clients body should be pinned to the clients gown, not the bedding. Pinning it to the sheets will cause it to pull out when the client turns. The other actions are appropriate.

Urgency of Surgery, Emergent

-Requires immediate intervention because of life-threatening consequences Gunshot or stab wound Severe bleeding Abdominal aortic aneurysm Compound fracture Appendectomy

A postoperative nurse is caring for a client whose oxygen saturation dropped from 98% to 95%. What action by the nurse is most appropriate? a. Assess other indicators of oxygenation. b. Call the Rapid Response Team. c. Notify the anesthesia provider. d. Prepare to intubate the client.

ANS: A If a postoperative clients oxygen saturation (SaO2) drops below 95% (or the clients baseline), the nurse should notify the anesthesia provider. If the SaO2 drops by 10% or more, the nurse should call the Rapid Response Team. Since this is approximately a 3% drop, the nurse should further assess the client. Intubation (if the client is not intubated already) is not warranted.

A nurse is admitting an older client for surgery to the inpatient surgical unit. The client relates a prior history of acute confusion after a previous operation. What interventions does the nurse include on the clients plan of care to minimize the potential for this occurring? (Select all that apply.) a. Allow family and friends to visit as the client desires. b. Ask the client about coping techniques frequently used. c. Instruct the nursing assistant to ensure the client is bathed. d. Place the client in a room secluded at the end of the hall. e. Provide the client with uninterrupted periods of sleep.

ANS: A, B, C, E Older clients may have difficulty adjusting to the stress of the hospital environment and illness or surgery. Techniques that are helpful include allowing liberal visitation, assisting the client to use successful coping techniques, and keeping the client bathed and groomed. Sleep deprivation can contribute to confusion, so the nurse ensures the client receives adequate sleep. Secluding the client at the end of the hall may lead to sensory deprivation and loneliness.

A nurse answers a call light on the postoperative nursing unit. The client states there was a sudden gush of blood from the incision, and the nurse sees a blood spot on the sheet. What action should the nurse take first? a. Assess the clients blood pressure. b. Perform hand hygiene and apply gloves. c. Reinforce the dressing with a clean one. d. Remove the dressing to assess the wound.

ANS: B Prior to assessing or treating the drainage from the wound, the nurse performs hand hygiene and dons gloves to protect both the client and nurse from infection.

A nurse is caring for a postoperative client who reports discomfort, but denies serious pain and does not want medication. What action by the nurse is best to promote comfort? a. Assess the clients pain on a 0-to-10 scale. b. Assist the client into a position of comfort. c. Have the client sit up in a recliner. d. Tell the client when pain medication is due.

ANS: B Several nonpharmacologic comfort measures can help postoperative clients with their pain, including distraction, music, massage, guided imagery, and positioning. The nurse should help this client into a position of comfort considering the surgical procedure and position of any tubes or drains. Assessing the clients pain is important but does not improve comfort. The client may be more uncomfortable in a recliner. Letting the client know when pain medication can be given next is important but does not improve comfort.

A postoperative client vomited. After cleaning and comforting the client, which action by the nurse is most important? a. Allow the client to rest. b. Auscultate lung sounds. c. Document the episode. d. Encourage the client to eat dry toast.

ANS: B Vomiting after surgery has several complications, including aspiration. The nurse should listen to the clients lung sounds. The client should be allowed to rest after an assessment. Documenting is important, but the nurse needs to be able to document fully, including an assessment. The client should not eat until nausea has subsided.

A nurse on the postoperative nursing unit provides care to reduce the incidence of surgical wound infection. What actions are best to achieve this goal? (Select all that apply.) a. Administering antibiotics for 72 hours b. Disposing of dressings properly c. Leaving draining wounds open to air d. Performing proper hand hygiene e. Removing and replacing wet dressings

ANS: B, D, E Interventions necessary to prevent surgical wound infection include proper disposal of soiled dressings, performing proper hand hygiene, and removing wet dressings as they can be a source of infection. Prophylactic antibiotics are given to clients at risk for infection, but are discontinued after 24 hours if no infection is apparent. Draining wounds should always be covered.

A nurse orienting to the postoperative area learns which principles about the postoperative period? (Select all that apply.) a. All phases require the client to be in the hospital. b. Phase I care may last for several days in some clients. c. Phase I requires intensive care unit monitoring. d. Phase II ends when the client is stable and awake. e. Vital signs may be taken only once a day in phase III.

ANS: B, D, E There are three phases of postoperative care. Phase I is the most intense, with clients coming right from surgery until they are completely awake and hemodynamically stable. This may take hours or days and can occur in the intensive care unit or the postoperative care unit. Phase II ends when the client is at a presurgical level of consciousness and baseline oxygen saturation, and vital signs are stable. Phase III involves the extended care environment and may continue at home or in an extended care facility if needed.

A client had a surgical procedure with spinal anesthesia. The nurse raises the head of the clients bed. The clients blood pressure changes from 122/78 mm Hg to 102/50 mm Hg. What action by the nurse is best? a. Call the Rapid Response Team. b. Increase the IV fluid rate. c. Lower the head of the bed. d. Nothing; this is expected.

ANS: C A client who had epidural or spinal anesthesia may become hypotensive when the head of the bed is raised. If this occurs, the nurse should lower the head of the bed to its original position. The Rapid Response Team is not needed, nor is an increase in IV rate.

The postanesthesia care unit (PACU) charge nurse notes vital signs on four postoperative clients. Which client should the nurse assess first? a. Client with a blood pressure of 100/50 mm Hg b. Client with a pulse of 118 beats/min c. Client with a respiratory rate of 6 breaths/min d. Client with a temperature of 96 F (35.6 C)

ANS: C The respiratory rate is the most critical vital sign for any client who has undergone general anesthesia or moderate sedation, or has received opioid analgesia. This respiratory rate is too low and indicates respiratory depression. The nurse should assess this client first. A blood pressure of 100/50 mm Hg is slightly low and may be within that clients baseline. A pulse of 118 beats/min is slightly fast, which could be due to several causes, including pain and anxiety. A temperature of 96 F is slightly low and the client needs to be warmed. But none of these other vital signs take priority over the respiratory rate.

Ten hours after surgery, a postoperative client reports that the antiembolism stockings and sequential compression devices itch and are too hot. The client asks the nurse to remove them. What response by the nurse is best? a. Let me call the surgeon to see if you really need them. b. No, you have to use those for 24 hours after surgery. c. OK, we can remove them since you are stable now. d. To prevent blood clots you need them a few more hours.

ANS: D According to the Surgical Care Improvement Project (SCIP), any prophylactic measures to prevent thromboembolic events during surgery are continued for 24 hours afterward. The nurse should explain this to the client. Calling the surgeon is not warranted. Simply telling the client he or she has to wear the hose and compression devices does not educate the client. The nurse should not remove the devices.

A client on the postoperative nursing unit has a blood pressure of 156/98 mm Hg, pulse 140 beats/min, and respirations of 24 breaths/min. The client denies pain, has normal hemoglobin, hematocrit, and oxygen saturation, and shows no signs of infection. What should the nurse assess next? a. Cognitive status b. Family stress c. Nutrition status d. Psychosocial status

ANS: D After ensuring the clients physiologic status is stable, these manifestations should lead the nurse to assess the clients psychosocial status. Anxiety especially can be demonstrated with elevations in vital signs. Cognitive and nutrition status are not related. Family stress is a component of psychosocial status.

A nurse is preparing a client for discharge after surgery. The client needs to change a large dressing and manage a drain at home. What instruction by the nurse is most important? a. Be sure you keep all your postoperative appointments. b. Call your surgeon if you have any questions at home. c. Eat a diet high in protein, iron, zinc, and vitamin C. d. Wash your hands before touching the drain or dressing.

ANS: D All options are appropriate for the client being discharged after surgery. However, for this client who is changing a dressing and managing a drain, infection control is the priority. The nurse should instruct the client to wash hands often, including before and after touching the dressing or drain.

An older adult has been transferred to the postoperative inpatient unit after surgery. The family is concerned that the client is not waking up quickly and states She needs to get back to her old self! What response by the nurse is best? a. Everyone comes out of surgery differently. b. Lets just give her some more time, okay? c. She may have had a stroke during surgery. d. Sometimes older people take longer to wake up.

ANS: D Due to age-related changes, it may take longer for an older adult to metabolize anesthetic agents and pain medications, making it appear that they are taking too long to wake up and return to their normal baseline cognitive status. The nurse should educate the family on this possibility. While everyone does react differently, this does not give the family any objective information. Saying Lets just give her more time, okay? sounds patronizing and again does not provide information. While an intraoperative stroke is a possibility, the nurse should concentrate on the more common occurrence of older clients taking longer to fully arouse and awake.

A client has arrived in the postoperative unit. What action by the circulating nurse takes priority? a. Assessing fluid and blood output b. Checking the surgical dressings c. Ensuring the client is warm d. Participating in hand-off report

ANS: D Hand-offs are a critical time in client care, and poor communication during this time can lead to serious errors. The postoperative nurse and circulating nurse participate in hand-off report as the priority. Assessing fluid losses and dressings can be done together as part of the report. Ensuring the client is warm is a lower priority.

Diagnostic surgical procedure

Performed to determine the origin & cause of a disorder or the cell type for cancer surgical exploration that confirms diagnoses. ex. exploratory laporotomy, breast biopsy, arthroscopy

restorative surgical procedure

Performed to improve a patients functional ability ex. total knee replacement, finger reimplantation

Urgency of Surgery, Elective:

Planned for correction of a nonacute problem ex. cataract removal, hernia repair, hemorrhoidectomy, total joint replacement

The nurse reviews a routine discharge teaching plan concerning postoperative care with a client. Which statement by the client indicates that teaching about wound care was effective? a. "I may need to restrict my activities for several months." b. "I should remove the dressing if the wound is draining." c. "Some bleeding from the incision is normal for several weeks." d. "The wound will completely heal in about 2 months.

a. "I may need to restrict my activities for several months." To protect the integrity of the wound, activities may need to be restricted.The wound is usually open to air for healing, but draining wounds need to be covered. Bleeding and serosanguineous drainage is not normal after 5 days. The length of time it takes for a wound to heal varies, and can take up to 2 years to heal.

The RN has just received reports about all of these clients on the inpatient surgical unit. Which client does the nurse care for first? a. A 43-year-old who had a bowel resection 7 days ago and has new serosanguineous drainage on the dressing b. A 46-year-old who had a thoracotomy 5 days ago and needs discharge teaching before going home c. A 48-year-old who had bladder surgery earlier in the day and is reporting pain when coughing d. A 49-year-old who underwent repair of a dislocated shoulder this morning and has a temperature of 100.4°F (38°C)

a. A 43-year-old who had a bowel resection 7 days ago and has new serosanguineous drainage on the dressing The nurse would first care for the 7-day postoperative client who has new serosanguineous drainage. New drainage on the seventh postoperative day is unusual and suggests a complication that would require further assessment and possible immediate action.The client awaiting discharge teaching is not a priority. A temperature of 100.4°F (38°C) and pain upon coughing following bladder surgery are normal on the first postsurgical day.

In conducting a postoperative assessment of a client, what is important for the nurse to examine first? a. Breathing pattern b. Level of consciousness c. Oxygen saturation d. Surgical site

a. Breathing pattern Respiratory assessment is the first and most important.Assessing level of consciousness, oxygen saturation, and the surgical site are important, but not the priority.

An unidentified client from the emergency department requires immediate surgery, but he is not conscious and no one is with him. What must the nurse, who is verifying the informed consent, do? a. Ensure written consultation of two noninvolved physicians. b. Read the surgeon's consult to determine whether the client's condition is life-threatening. c. Sign the operative permit. d. Withhold surgery until the next of kin is notified.

a. Ensure written consultation of two noninvolved physicians. In a life-threatening situation in which every effort has been made to contact the person with medical power of attorney, consent is desired but not essential. In place of written or oral consent, written consultation by at least two physicians who are not associated with the case may be requested by the health care provider.It is not within the nurse's role to make a judgment about the client's life-threatening status based on the surgeon's consult. Signing documents on the client's behalf is not legal. Withholding surgery is not in this client's best interests.

A client has an acute case of opioid depression and receives a dose of naloxone (Narcan). Which statement is true about this client? a. Supplemental pain reduction is needed. b. One dose is needed. c. This is an acute emergency. d. The client will be hostile.

a. Supplemental pain reduction is needed. Supplemental pain reduction is needed. The client has breakthrough pain after the opioid antagonist is given, so other interventions to promote comfort are needed.Several doses of naloxone may be needed because the drug has a short half-life. Opioid depression is a manageable situation, not an acute emergency. The client with opioid depression usually is not fully conscious.

Which client is at greatest risk for slow wound healing? a. A 12-year-old healthy girl b. A 47-year-old obese man with diabetes c. A 48-year-old woman who smokes d. A 98-year-old healthy man

b. A 47-year-old obese man with diabetes Obesity and diabetes would significantly put a client at greatest risk for slow wound healing.The healthy 12-year-old would likely heal quickly. The 48-year-old smoker will experience delayed wound healing, but is not as high a risk as an obese client who is diabetic. The healthy 98-year-old is not at risk for delayed wound healing

As the nurse obtains informed consent, the client asks, "Now what exactly are they going to do to me?" What is the nurse's response? a. Contact the anesthesiologist. b. Contact the surgeon. c. Explain the procedure. d. Have the client sign the form.

b. Contact the surgeon. The nurse will contact the surgeon to convey the client's question. The nurse is not responsible for explaining or providing detailed information about the surgical procedure. Rather, the nurse's role is to clarify facts that have been presented by the health care provider and dispel myths that the client or family may have heard about the surgical experience.The anesthesiologist is responsible for the anesthesia, not the surgical details. Although the nurse is only witnessing the signature, it is the nurse's role to ensure that the facts are clarified before the consent form is signed.

Which action does the nurse implement for a client with wound evisceration? a. Apply direct pressure to the wound. b. Cover the wound with a sterile, warm, moist dressing. c. Irrigate the wound with warm, sterile saline. d. Replace tissue protruding into the opening.

b. Cover the wound with a sterile, warm, moist dressing. Covering the wound with a sterile, warm, moist dressing protects the organs until the surgeon can repair the wound. Evisceration occurs when a wound opens up and body organs are exposed.Applying direct pressure to a wound traumatizes the organs. Irrigating the wound is not necessary. Replacing protruding tissue could induce infection.

An RN and an LPN/LVN are working together in caring for a client who needs all of these interventions after orthopedic surgery. Which action(s) would be best for the RN to accomplish? a. Reinforce the need to cough and deep-breathe every 2 to 4 hours. b. Develop the discharge teaching plan in conjunction with the client. c. Administer narcotic pain medications before assisting the client with ambulation. d. Listen for bowel sounds and monitor the abdomen for distention and pain.

b. Develop the discharge teaching plan in conjunction with the client. The best and most appropriate action for the nurse to take is to develop the discharge teaching plan with the client. Education and preparation for discharge are within the scope of practice of the RN, but not within that of the LPN/LVN.Reinforcing the need to cough and deep-breathe and monitoring the client are within the scope of the LPN/LVN nurse. LPN/LVNs can also administer pain medications.

The nurse assesses a client's wound 24 hours postoperatively. Which finding causes the nurse the greatest concern and should be reported to the surgeon? a. Crusting along the incision line b. Redness and swelling around the incision c. Sanguineous drainage at the suture site d. Serosanguineous drainage on the dressing

b. Redness and swelling around the incision The nurse's greatest concern is redness and swelling around the incision. This needs to be reported to the surgeon because these signs could indicate an infection.Crusting along the incision line, sanguineous drainage, and serosanguineous drainage are normal.

During a preoperative assessment, which statement by a client requires further investigation by the nurse to assess surgical risks? a. "I am taking vitamins." b. "I drink a glass of wine a night." c. "I had a heart attack 4 months ago." d. "I quit smoking 10 years ago."

c. "I had a heart attack 4 months ago." The statement by the client that he or she had a heart attack 4 months ago requires further investigation. Cardiac problems increase surgical risks, and the risk for a myocardial infarction during surgery is higher in clients who have heart problems.The type of vitamins the client takes should be assessed, but this is not the highest risk. Moderate alcohol consumption is not considered high-risk behavior. A past history of smoking should be noted, but current or more recent smoking is of greater concern.

The nurse is instructing a client about the use of antiembolism stockings. Which statement by the client indicates the need for further teaching? a. "I will take off my stockings one to three times a day for 30 minutes." b. "My stockings are too loose." c. "It's better if they are too tight rather than too loose." d. "These stockings help promote blood flow.

c. "It's better if they are too tight rather than too loose." Antiembolism stockings should fit properly to achieve the desired result. Stockings that are too tight will impede blood flow.Frequent removal of the stockings is appropriate to allow for hygiene and a break from their wear. Stockings that are too loose are ineffective. Antiembolism stockings may be used during and after surgery to promote venous return.

The nurse completes the preoperative checklist on a client scheduled for general surgery. Which factor contributes the greatest risk for the planned procedure? a. Age 59 years b. General anesthesia complications experienced by the client's brother c. Diet-controlled diabetes mellitus d. Ten pounds (4.5 kg) over the client's ideal body weight

c. Diet-controlled diabetes mellitus The client's greatest risk factor is diabetes mellitus. Diabetes contributes an increased risk for surgery or postsurgical complications.Older adults are at greater risk for surgical procedures, but this client is not classified as an older adult. Family medical history and problems with anesthetics may indicate possible reactions to anesthesia, but this is not the best answer. Obesity increases the risk for poor wound healing, but being 10 pounds (4.5 kg) overweight does not categorize this client as obese.

At 8:00 a.m., the registered nurse is admitting a client scheduled for sinus surgery to the outpatient surgery department. Which information given by the client is of most immediate concern to the nurse? a. An allergy to iodine and shellfish b. Being nauseated after a previous surgery c. Having a small glass of juice at 7:00 a.m. d. Expressing anxiety about the surgery

c. Having a small glass of juice at 7:00 a.m. Clients need to be NPO for a sufficient length of time before surgery to prevent aspiration of fluid into the lungs. Intake of food or fluids may delay the start time of the surgery, so the nurse must notify the surgeon and anesthesiologist for possible rescheduling.The nurse would confirm that all allergies are charted, and that the client has the correct allergy band identification. Many clients experience nausea after surgery; the nurse would document this in the client's information as well. The nurse would talk with the client and explore the anxiety; this is a normal feeling before surgery.

Which assessment finding in a postoperative client after general anesthesia requires immediate intervention? a. Heart rate of 58 beats/min b. Pale, cool extremities c. Respiratory rate of 6 breaths/min d. Suppressed gag reflex

c. Respiratory rate of 6 breaths/min The most immediate postoperative assessment is respiratory assessment, and a rate less than 10 breaths/min is too low.A heart rate of 58 beats/min, pale and cool extremities, and a suppressed gag reflex are all normal postoperative findings.

How does the nurse position a client with postoperative nausea and vomiting? a. Flat in bed, with the head in alignment with the body b. Prone, with the head of the bed flat c. Side-lying, with the head in a neutral position d. Supine in bed, with the neck flexed

c. Side-lying, with the head in a neutral position The side-lying position with the client's head in a neutral position helps reduce postoperative nausea and vomiting.The flat-in-bed position with the head in alignment is not a neutral position. The prone position with the head of the bed flat is unnatural, as is the supine position with the neck flexed.

A client has just undergone a surgical procedure with general anesthesia. Which finding indicates that the client needs further assessment in the post-anesthesia care unit? a. Pain at the surgical site b. Requirement for verbal stimuli to awaken c. Snoring sounds when inhaling d. Sore throat on swallowing

c. Snoring sounds when inhaling Snoring sounds when inhaling may indicate respiratory depression.Postsurgical pain at the surgical site is normal. Requiring verbal stimuli to awaken and a sore throat on swallowing are normal post-sedation.

A preoperative client smokes a pack of cigarettes a day. What is the nurse's teaching priority for the best physical outcomes? a. Instruct the client to quit smoking. b. Teach about the dangers of tobacco. c. Teach the importance of incentive spirometry. d. Tell the client that smoking increases postoperative complications.

c. Teach the importance of incentive spirometry. The nurse would first teach the importance of incentive spirometry. Incentive spirometry is good for lung hygiene and it encourages deep breathing.The nurse can suggest quitting or advice about the dangers of tobacco, but it is not therapeutic to instruct it at this time. Telling the client that smoking causes increased complications is not helpful or therapeutic just prior to surgery.

Perioperative assess for and report other clinical conditions that many need further evaluation before proceeding with surgical plans including:

change in mental status vomitting rash recent administration of an anticoagulant drug

The nurse is educating a client who is about to undergo cardiac surgery with general anesthesia. Which statement by the client indicates the need for further instruction? a. "I will wake up with a tube in my throat." b. "I will have a bandage on my chest." c. "My family will not be able to see me right away." d. "Pain medication will take away my pain."

d. "Pain medication will take away my pain." The client's statement that, "Pain medication will take away my pain," indicates the need for further instruction. Pain medication will reduce pain, but will not take it away completely.The client statement about waking up with a tube in the throat is accurate, because the client will be intubated. Following heart surgery, a dressing is placed on the chest. The client will not be able to see family immediately because he or she will go to recovery first.

What pain management does a client who has been admitted to the post-anesthesia care unit typically receive? a. Intramuscular nonopioid analgesics b. Intramuscular opioid analgesics c. Intravenous nonopioid analgesics d. Intravenous opioid analgesics

d. Intravenous opioid analgesics Intravenous (IV) opioid analgesics are given in small doses to provide pain relief, but not to mask an anesthetic reaction.Intramuscular nonopioid analgesics and opioid analgesics are too long-acting. IV nonopioid analgesics usually are not given within the first 48 hours after surgery.

The nurse is providing preoperative care for a client who will have an arthroscopy of the left knee. As part of the Joint Commission National Patient Safety Goals (NPSG), what will the nurse be required to do? a. Ensure that the correct procedure is noted in the client's history. b. Remind the surgeon that the client will have a left knee arthroscopy. c. Verify with the client that a left knee arthroscopy will be performed. d. Mark the left knee site with the client awake and the surgeon present.

d. Mark the left knee site with the client awake and the surgeon present. The nurse will be required to mark the left knee site with the client awake and the surgeon present. The Joint Commission NSPG requires that the surgical site be marked by an independent licensed professional and should, when possible, involve the client. The surgeon is accountable and should be present.The EMR should identify the correct procedure, but is not a specific JCAHO requirement. The nurse will verify the procedure with the client when possible, but this is not a requirement. Communication with the surgeon is ideal, but is not specifically required.

The nurse is performing a dressing change on a client who underwent abdominal surgery 6 days prior. The nurse notes a moderate amount of serosanguineous drainage on the old dressing. What will the nurse do? a. Apply extra gauze to the new dressing. b. Contact the surgeon to discuss the need for antibiotics. c. Notify the surgeon about possible wound dehiscence. d. Perform the dressing change according to unit protocol.

d. Notify the surgeon about possible wound dehiscence. Serosanguineous discharge persisting past the 5th postoperative day may indicate wound dehiscence and would be reported to the surgeon.The nurse would not just reinforce the dressing, but would notify the surgeon. Serosanguineous discharge does not indicate infection. Persistent serosanguineous discharge is an abnormal finding and to be reported.

Colostomy surgery is categorized as what type of surgery? a. Cosmetic b. Curative c. Diagnostic d. Palliative

d. Palliative Colostomy surgery is categorized as palliative. Palliative surgery is performed to relieve symptoms of a disease process, but does not cure the disease.Cosmetic surgery is performed primarily to alter or enhance personal appearance. Curative surgery is performed to resolve a health problem by repairing or removing the cause. Diagnostic surgery is performed to determine the origin and cause of a disorder or the cell type for cancer.

An older client's adult child tells the nurse that the client does not want life support. What does the nurse do first? a. Call the legal department to draft the paperwork. b. Document this in the chart. c. Thank the person and do nothing else. d. Talk to the client.

d. Talk to the client. The nurse would first talk to the client in order to determine the client's wishes and state of mind.The nurse should not call the legal department or document in the client's chart before speaking with the client. Doing nothing is not appropriate.

A client is being prepared for gastrointestinal surgery and undergoes a bowel preparation. This preoperative procedure is done to a. decrease expected blood loss during surgery. b. eliminate any risk of infection. c. ensure that the bowel is sterile. d. reduce the number of intestinal bacteria.

d. reduce the number of intestinal bacteria. Bowel or intestinal preparations are performed to empty the bowel to minimize the leaking of bowel contents, prevent injury to the colon, and reduce the number of intestinal bacteria.Decreasing expected blood loss and sterilizing the bowel are not the goals of a bowel preparation. While the bowel prep may reduce the number of intestinal bacteria, it will not completely eliminate the risk of infection.

A diabetic client who is scheduled for vascular surgery is admitted on the day of surgery with several orders. a. Which order does the nurse accomplish first? b. Use electric clippers to cut hair at the surgical site. c. Start an infusion of lactated Ringer's solution at 75 mL/hr. d. Administer one-half of the client's usual lispro insulin dose. e. Draw blood for glucose, electrolyte, and complete blood count values.

e. Draw blood for glucose, electrolyte, and complete blood count values. The blood sample needs to be drawn and sent to the laboratory first to confirm that results are within normal limits. If blood work is abnormal, the surgery may be rescheduled.Removal of hair can be accomplished in the operating room directly before the start of surgery. The IV infusion can be accomplished after the laboratory orders have been completed. The nurse should check blood glucose with the laboratory orders before administration of lispro.

Perioperative assess for and report signs or symptoms of infection, including

fever purulent sputum dysuria or cloudy, foul-smelling urine any red, swollen, draining IV or wound site increased white blood cell count

As part of the cardiopulmonary assessment, take and record vital signs; report:

hypotension or hypertension heart rate less than 60 or more than 120 beats/min irregular heart rate chest pain shortness of breath or dyspnea tachypnea pulse oximetry less than 94%

Perioperative Assess for and report signs or symptoms that could contraindicate surgery, including

increased PT, INR, aPTT Hypokalemia or hyperkalemia possible pregnancy or pregnancy test

Palliative surgical procedure

performed to relieve symptoms of a disease process but does not cure ex. colostomy, nerve root resection, tumor debulking, ileostomy

Urgency of Surgery, Urgent:

requires prompt intervention; may be life threatening if treatment is delayed more than 24-48 hr ex. intestinal obstruction, bladder obstruction, kidney or ureteral stones, bone fracture, eye injury