Perioperative Nursing

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

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

The nurse enters a postoperative client's room and finds that the client is bleeding profusely from the surgical incision. What would be the nurse's most appropriate initial response?

Apply pressure to the surgical site to decrease bleeding.

A client states having a latex allergy. Which action does the nurse take to communicate this allergy to hospital staff caring for the client?

Note the allergy on the client's record.

A nurse is caring for an older adult following hip surgery. When teaching the client to use an incentive spirometer, the nurse should explain that this reduces the risk of what complication?

Pneumonia

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

Potential for hypothermia or hyperthermia

When an older adult client is brought to the recovery room and presents with irregular, loud respirations, the nurse determines that this is most likely a result of:

a partial airway obstruction.

A nurse from the ambulatory surgical center is preparing discharge instructions for a client who has had pelvic surgery. Which criterion would the client need to demonstrate to ensure that she is ready for discharge?

void normally

A nurse is discussing a surgical procedure with a client who needs to sign his informed consent. Which of these tasks is part of the nursing role?

witnessing the client signature with their consent for surgery

The preoperative nurse is teaching a client about deep-breathing exercises. The client asks, "Why do I need to learn about this?" Which response by the nurse is correct?

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

A client has been transported to the operating suite and is positioned on the operating table. Suddenly, the client states, "I do not want to do this. Get me out of here now!" Which statement would the nurse make to reassure the client?

"Can you tell me what your concerns are about this procedure?"

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

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

The graduate nurse will be orienting to the role of circulator in perioperative services. What statements made by the nurse requires further education regarding the role of the circulator? Select all that apply.

"I will be responsible for preparing the sterile surgical table for the procedure." "I will be responsible for assisting the surgeon with instruments and exposure during the procedure"

A client who is scheduled to undergo coronary bypass surgery in a week asks the nurse whether he should discontinue taking his cholesterol medicine ahead of the surgery. Which should be the nurse's response?

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

A nurse is caring for a client in the same-day surgery unit. The client asks the nurse, "Do I really need to be put to sleep for this surgery?" Which would be the nurse's best response?

"Tell me what you are most worried about."

The nurse is providing education about deep-breathing exercises to a postoperative client whose surgery took place earlier today. Which instruction should the nurse provide?

"Try to do your exercises every 1 to 2 hours."

The nurse assists a client to turn in the bed. The client has just returned from abdominal surgery. How does the nurse instruct the client?

"Use a pillow to splint the incision."

The nurse needs to evaluate the effectiveness of a preoperative teaching session with a client scheduled for abdominal surgery. Which client statement indicates the need for further clarification?

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

The nurse is caring for a client after breast augmentation. Before performing a bowel assessment, what education will the nurse provide the client?

"You can have decreased or absent bowel movement, called peristalsis because of administration of anesthetic agents or opioids. By listening for bowel sounds, I can check for a return of peristalsis."

The licensed practical nurse (LPN) is observed by the registered nurse (RN) engaging in the reinforcement of teaching related to therapeutic deep breathing and coughing with a client who is recovering from abdominal surgery. Which statement by the RN best supports the LPN's role in the implementation of this intervention?

"You served as a good role model while showing the client the proper technique for this intervention."

A nurse is teaching a client about the rationale for fasting from food and fluids prior to surgery. What condition does this measure attempt to avoid?

Aspiration

The acute care nurse is preparing a client for surgery. Which action is essential to complete before transferring the client to surgery?

Assure that diagnostic testing has been completed and results are available.

A nurse is interacting with a client in the outpatient surgical unit intraoperatively. What is the nurse's priority responsibility?

Client safety

An older adult client underwent a hip replacement and now states to the nurse, "My parents are coming to visit me today. I need to mow the lawn and run errands." The client is trying to get out of the bed. What does the nurse identify is occurring with this client?

Delirium

The nurse is performing a preoperative assessment of a client who has been scheduled for a reduction mammoplasty (breast reduction). The client states, "I'm starting to wonder if I made the right decision in going ahead with this." What should the nurse do next?

Explore the client's feelings and inform the surgeon.

The nurse educates a client about what to expect after abdominal surgery. How will the nurse explain the progression of a client's diet in the postoperative period?

Food and liquids will be held in the immediate postoperative period.

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

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

A client in the immediate postoperative period begins to report nausea and begins vomiting. Which is the priority nursing action?

Make client NPO and auscultate bowel sounds

The preoperative nurse has prepared a client for surgery and has been notified that the operating room staff is ready for the client. The client states, "My bladder feels full. I need to go to the bathroom!" Which action by the nurse is appropriate?

Inform the operating room staff and assist the client to the bathroom.

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

Laparoscopic cholecystectomy

A nurse is caring for a postoperative client. What intervention(s) will help prevent thrombophlebitis? Select all that apply.

Leg range of motion exercises Sequential compression devices (SCDs) and antiembolic stockings Early ambulation as tolerated Frequent turning and positioning

The nurse cares for a client following surgery to repair an abdominal aortic aneurysm. Which nursing intervention assists with healing and maintaining client comfort?

Maintaining a calm environment

A client had an open cholecystectomy (gallbladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding?

Monitor the client closely and promote fluid intake.

The healthy adult client is given an opioid prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first?

Notify the physician of the oversight.

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

Performing relaxation techniques

The nurse is caring for a client who just returned from the postanesthesia care unit following surgery to repair a fractured arm. Place the following interventions in order of highest priority to lowest priority.

Place the client in a position that facilitates breathing. Measure pulse, blood pressure, respirations, and temperature. Measure oxygen saturation. Assess neurovascular status to the affected arm. Assess dressing for bleeding or other drainage. Assess for pain and administer prescribed analgesics, if indicated.

A nurse is assessing clients in the Post Anesthesia Care Unit (PACU). Which nursing actions would the nurse perform in this phase of the perioperative period? Select all that apply.

Prepare the client for home care. Assess the client's ability to return to the inpatient room when arousable Assess for complications as the client emerges from anesthesia.

The circulating nurse is caring for an older adult client undergoing removal of a liver tumor. The spouse is waiting in the family waiting area. Which actions by the nurse would be appropriate during the intraoperative phase? Select all that apply.

Provide emotional support to the client and spouse immediately before the surgery. Notify the client's spouse when the procedure is over. Bring the client's spouse to be with the client as soon as possible.

The nurse is teaching the client who recently experienced abdominal surgery to deep breathe and cough effectively. What observable action serves to best minimize pain that may result from the intervention?

Providing support to abdominal and accessory respiratory muscles

The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?

Respiratory obstruction

A client is scheduled for elective hernia surgery. While taking a medical history, the nurse learns that the client is taking antibiotics for an infection. Which surgical risk should the nurse monitor based on this antibiotic use?

Respiratory paralysis

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.

A nurse is providing education to a client having same-day surgery. Which statement would be accurate regarding this type of surgery?

Some major surgeries can be done as same-day surgery.

The nurse is caring for a client who had abdominal surgery yesterday and is reluctant to cough and perform deep breathing. Which strategy will most likely increase the client's willingness to cough and perform deep breathing?

Teach the client how to splint the abdomen while coughing.

The nurse is caring for a client who had a procedure under moderate sedation at the ambulatory surgical center. Which assessment finding indicates to the nurse that the client may be ready for discharge to home?

The client is alert and oriented with a blood pressure 118/70 mm Hg and respirations 18 breaths/minute, is able to ambulate, is not nauseated or vomiting, pain is controlled with medication, and has no excessive bleeding and drainage is as expected.

A female client age 54 years has been scheduled for a bunionectomy (removal of bone tissue from the base of the great toe) which will be conducted on an ambulatory basis. Which characteristic applies to this type of surgery?

The client will be admitted the day of surgery and return home the same day.

A nurse is caring for a postoperative client and preparing to apply a pneumatic compression device. How does the nurse explain the device to the client prior to application?

The device fills with air and squeezes the legs, which increases blood flow through the veins of the legs and helps to prevent blood clots.

The nurse is teaching a client about postoperative pain management. The client states, "I would like to use as little medication as possible after surgery. Will anything else help to relieve my pain?" Which response is appropriate?

There are several nonpharmacologic methods to reduce pain and anxiety. Let me teach you about some of them."

A client has arrived to the postanesthesia care unit (PACU) and is drowsy with a respiratory rate of 12 breaths per minute. What would be an accurate interpretation by the nurse?

This is an expected finding in the immediate postoperative period.

Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?

a 26-year-old client who is exhibiting a crowing sound

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

before, during, and after the operative phase.

A nurse preparing an older adult client for hip replacement surgery is aware of the surgical risks related to the client's age. Which of the following accurately describes these risks? Select all that apply.

decreased peripheral circulation increased vascular rigidity decreased thermoregulation ability

A nurse is reinforcing wound edges and applying a blinder to the separated incisions of a client after a surgery. Which postoperative complication has the client developed?

dehiscence

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

developing shock.

A client will be having a surgical procedure requiring general anesthesia. Which desired outcomes of general anesthesia does the nurse expect to observe? Select all that apply.

loss of consciousness analgesia relaxed skeletal muscles depressed reflexes

The nurse has delegated to the unlicensed assistive personnel (UAP) the application of antiembolism stockings to a client who had an endarterectomy earlier in the day. Which UAP action requires the nurse to immediately intervene?

massages legs prior to application

In the postoperative phase of abdominal surgery, the client reports severe abdominal pain. In the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect?

paralytic ileus

A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice? Select all that apply.

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

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

preoperative

The nurse has been waiting until after the administration of a toddler's anesthesia before removing the child's clothing and applying monitoring equipment. Doing these actions after the administration of anesthesia will:

prevent anxiety.

The nurse recognizes the value of leg exercises in the prevention of postoperative thrombophlebitis. When should the nurse teach the correct technique for leg exercises to a client?

prior to surgery

As a circulating nurse caring for a 45-year-old man undergoing left knee arthroscopic exploratory surgery, which task ensures that the team is on the same page and will perform the procedure on the right client and at the right site?

procedural pause (time-out)

When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease?

slow wound healing