Prep U chapter 17 preoperative Nursing Management
An inappropriate nursing action implemented to keep the client safe includes: 1. Protecting bony prominences 2. Moving the client swiftly 3. Screening for latex allergy 4. Accurately identifying the client
2. Moving the client swiftly National Patient Safety goals for the surgical client include verification of the client and protecting the client from physical harm.
Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? 1. Thyroid 2. Parathyroid 3. Adrenal 4. Pituitary
3. 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.
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. A history of diabetes b. A history of sensitivity to aspirin c. A history of chronic low back pain d. A history of osteoarthritis
a. 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.
In preparing the client for transfer to the operating room, which of the following actions by the nurse is inappropriate? a. Allow the client to wear dentures. b. Remove all jewelry. c. Have client wear hospital gown. d. Have the client void.
a. Allow the client to wear dentures. Dentures, jewelry, glasses, and prosthetic devices are removed prior to surgery.
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? a. Upon awakening in the postanesthesia care unit b. Up to 24 hours after alcohol withdrawal c. Up to 72 hours after alcohol withdrawal d. Immediately upon admission
c. 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.
The nurse is preparing a client for surgery. The nurse would notify the surgeon if the client made which of the following statements? "I took two Tylenol last evening for a headache." "I took my lisinopril this morning." "I took my Coumadin as usual last evening." "I have not had any metformin for the past week." "I took two aspirins for joint pain this morning."
"I took my Coumadin as usual last evening." "I took two aspirins for joint pain this morning." Explanation: The nurse needs to alert the surgeon to any medications the client has taken that increase the client's risk for bleeding. Aspirin inhibits platelet aggregation and should be stopped at least 7 to 10 days prior to surgery. Coumadin (warfarin) interferes with the synthesis of vitamin K-dependent clotting factors. The type of surgical procedure and the medical condition of the client determine when the Coumadin should be stopped prior to surgery.
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." "Lots of people have cancer and need tumors removed." "You know, we have a lot of sick people in the world." "Not everyone has to go to the hospital to have surgery anymore."
"Many people have diagnostic or short therapeutic surgical procedures." Explanation: 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 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? "If I do not follow the instructions, my surgery could be cancelled." "The nurse will explain the details of the surgery before I sign a consent." "My medical records will be sent to the ambulatory care center prior to my surgery." "The physician will update my family after the procedure and provide specific discharge instructions."
"The nurse will explain the details of the surgery before I sign a consent." Explanation: 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.
A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? 1. Osteoporosis 2. Diabetes 3. Urinary tract infection 4. Pregnancy
1. 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.
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as 1. urgent. 2. emergency. 3. elective. 4. required.
2. emergency. Emergency surgery means that the client requires immediate attention and the disorder may be life threatening. Urgent surgery means that the client requires prompt attention within 24 to 30 hours. Required surgery means that the client needs to have surgery, and it should be planned within a few weeks or months. Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic.
A patient is scheduled for a reduction mammoplasty. What classification of surgery does the nurse understand that this is? 1. Urgent 2. Reconstructive 3. Optional 4. Required
3. Optional Cosmetic surgery, including reduction mammoplasties, is optional, as the decision to have the surgery rests with the patient.
The nurse recognizes that written informed consent is required for insertion of a(n): 1. Urinary catheter. 2. Nasogastric tube. 3. Oral airway. 4. Peripherally-inserted central catheter.
4. Peripherally-inserted central catheter. 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.
Which nursing assessment finding indicates the preoperative client has not met expected outcomes? 1. Discusses financial concerns with the social worker. 2. Demonstrates how to use incentive spirometry. 3. Remains in bed after receiving preanesthetic medication. 4. Sobs uncontrollably about pending amputation of foot.
4. Sobs uncontrollably about pending amputation of foot. Expected outcomes for the preoperative client include demonstrating how to use incentive spirometry, remaining in bed after receiving preanesthetic medication, and discussing financial concerns with the social worker. The client who sobs uncontrollably about pending amputation of foot is coping ineffectively.
The nurse is educating a community group about types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true? 1. A biopsy 2. Placement of gastrostomy tube 3. Tumor excision 4. A face-lift
An example of a curative surgical procedure is tumor excision. A biopsy, a face-lift, and the placement of a gastrostomy tube are not examples of curative surgical procedures.
A nurse knows that she must obtain a signed informed consent for which of the following procedures? Select all that apply. Arteriography Open reduction of a fracture Insertion of a urethral catheter Cystoscopy Insertion of a peripheral intravenous line Paracentesis
Arteriography Open reduction of a fracture Cystoscopy Paracentesis Explanation: Informed consent is not currently required for insertion of an intravenous or urethral catheter.
Which of the following activities are nursing activities in the preoperative phase of care? Select all that apply. Establishing an intravenous line Administering medications, fluid, and blood component therapy, if prescribed Discussing and reviewing the advanced directive document Ensuring that the sponge, needle, and instrument counts are correct Beginning discharge planning
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 monitoring a presurgical patient for electrolyte imbalance. Which classification of medication may cause electrolyte imbalance? Diuretics Corticosteroids Phenothiazines Insulin
Diuretics Explanation: During anesthesia, diuretics may cause excessive respiratory depression resulting from an associated electrolyte imbalance. The other drugs listed do not cause an electrolyte imbalance.
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 preoperative phase During the intraoperative phase During the transfer phase During the postoperative phase
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.
A gunshot wound would be classified under which category of surgery based on urgency? 1. Elective 2. Emergent 3. Required 4. Urgent
Emergent surgery occurs when the patient requires immediate attention. An elective surgery is classified as a surgery that the patient should have. A required surgery means that the patient needs to have surgery. An urgent surgery is one which the patient required prompt attention.
Which of the following nursing activities would not be part of the preoperative phase of care? Select all that apply. Administering medications, fluid, and blood component therapy, if prescribed Discussing and reviewing the advanced directive document Beginning discharge planning Ensuring that the sponge, needle, and instrument counts are correct Establishing an intravenous line
Ensuring that the sponge, needle, and instrument counts are correct Administering medications, fluid, and blood component therapy, if prescribed Explanation: Of the activities listed, discussing and reviewing the advanced directive document, establishing an intravenous line, and beginning discharge planning are preoperative nursing activities.
Which domain of perioperative nursing practice focuses on clinical processes and outcomes? Health care systems Safety Behavioral responses Physiological responses
Health care systems Explanation: The health care system consists of structural data elements and focuses on clinical processes and outcomes. Safety, behavioral responses, and physiological responses reflect phenomena of concern to perioperative nurses and comprise nursing diagnoses, interventions, and outcomes.
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? 1. Cancel the surgery. 2. Document what foods the client ate. 3. Notify the surgeon. 4. Give the client plenty of water to aid digestion
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 patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign? 1. An open reduction of a fracture 2. Urethral catheterization 3. Irrigation of the external ear canal 4. An insertion of an intravenous catheter
Informed consent is necessary in the following circumstances: invasive procedures, such as a surgical incision (such as would be involved in an open reduction of a fracture), a biopsy, a cystoscopy, or paracentesis; procedures requiring sedation and/or anesthesia (see Chapter 18 for a discussion of anesthesia); a nonsurgical procedure, such as an arteriography, that carries more than a slight risk to the patient; and procedures involving radiation. Non-invasive procedures such as insertion of an intravenous or urethral catheter or irrigation of the external ear canal would not require informed consent.
The nurse is providing preoperative care to a client who is anxious about total hip replacement surgery. "What if I can never walk again? I don't want to end up like my father!" What are some ways the nurse might help alleviate the client's anxiety? Select all that apply. Make sure the client understands what will happen during surgery. Listen empathetically to the client's concerns about the procedure. Remind the client that the chances of something going wrong are statistically low. Offer a sedative to help the client relax and feel more comfortable. Review the client's postoperative goals following the procedure. Ask the client if he would like to speak with a clergyperson.
Make sure the client understands what will happen during surgery. Listen empathetically to the client's concerns about the procedure. Review the client's postoperative goals following the procedure. Ask the client if he would like to speak with a clergyperson. Explanation: Preparing the client emotionally and spiritually is as important as doing so physically. Anxiety and fear, if extreme, can affect a client's condition during and after surgery. Careful preoperative teaching and listening by the nurse about what will happen and what to expect can help allay some of these fears and anxieties.
When caring for a patient with alcoholism, when should the nurse assess for symptoms of alcoholic withdrawal? Within the first 12 hours About 24 hours postoperatively On the second or third day 4 days after a surgical procedure
On the second or third day Explanation: The person with a history of chronic alcoholism often suffers from malnutrition and other systemic problems or metabolic imbalances that increase surgical risk. In patients who are alcohol dependent, alcohol withdrawal syndrome may be anticipated 2 to 4 days after the last drink and is associated with a significant mortality rate when it occurs postoperatively.
The nurse has administered preanesthetic medication. What action should the nurse take next? Obtain the client's signature on the consent form. Place the client on bed rest with the side rails up. Review the client's list of home medications. Educate the client on discharge instructions.
Place the client on bed rest with the side rails up. Explanation: Preanesthetic medication can make the client lightheaded and dizzy. Safety is a priority, so the client should remain in bed with the side rails up. The consent form should be signed before the client is medicated. Consents signed after the client is medicated are not legal. Reviewing the home medications and educating the client should take place before the client is medicated.
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
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.
The on-call perioperative team is called for an urgent surgery to be performed as soon as they arrive. What surgical procedure is considered emergent? 1. An exploratory laparotomy 2. A repair of multiple stab wounds 3. A face lift 4. Removal of kidney stones
Repair of multiple stab wounds is emergent. Removal of kidney stones is urgent. An exploratory laparotomy is required. A face lift is optional.
A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate? Answer the client's questions. Request that the surgeon come and answer the questions. Place the consent form in the client's medical record. Notify the nurse manager of the client's questions.
Request that the surgeon come and answer the questions. Explanation: It is the physician's responsibility to provide information pertaining to risks and benefits of surgery. It is not the responsibility of the nurse or nurse manager to discuss risks and benefits. The consent form should not be placed in the medical record until all of the client's questions are answered fully.
The nurse recognizes that the client who takes hydrochlorothiazide to manage hypertension is predisposed for which interaction with anesthesia? Respiratory depression Hypotension Increased risk of bleeding Seizures
Respiratory depression Explanation: Common interaction effects of hydrochlorothiazide (HydroDIURIL) and anesthesia include respiration depression.
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.
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 physician schedules an elective surgical procedure for a patient who smokes cigarettes. When should the nurse recommend that the patient cease smoking before the surgical procedure to minimize risks associate with cigarette smoking? a. 1 to 2 months b. 3 weeks c.2 weeks d. 3 to 4 months
a. 1 to 2 months Patients who smoke are urged to stop 4 to 8 weeks before surgery to significantly reduce pulmonary and wound healing complications.
A surgical client has been transferred to the holding area. What nursing intervention(s) promote safe and effective nursing care? Select all that apply. a. Verify the surgical site and mark it appropriately. b. Provide oral fluids to the patient. c. Identify the client using two identifiers. d. Apply grounding devices to the client. e. Review the medical records. f. Maintain an aseptic environment.
a. Verify the surgical site and mark it appropriately. c. Identify the client using two identifiers. e. 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.
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? a. 5 b. 3 c. 7 d. 1
c. 7 Aspirin should be stopped at least 7 to 10 days before surgery. The other time frames are incorrect.
The nurse is aware that which of the following helps to stimulate T-cell response: a. Vitamin D b. Zinc c. Arginine d. Biotin
c. Arginine Arginine is necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response.
Which of the following medications may increases the hypotensive action of anesthesia? a. Hydrochlorothiazide b. Prednisone c. Chlorpromazine d. Warfarin
c. Chlorpromazine 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.
The nurse expects informed consent to be obtained for insertion of: a. An intravenous catheter b. An indwelling urinary catheter c. A nasogastric tube d. A gastrostomy tube
d. A gastrostomy tube Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.
The nurse is educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate? a. Expected pain levels and narcotic medications used to treat the pain b. Risks and benefits of the surgical procedures c. Intraoperative techniques used to perform the surgery d. Three phases of surgery and safety measures for each phase
d. Three phases of surgery and safety measures for each phase The perioperative period includes the preoperative, intraoperative, and postoperative phases. Specific safety guidelines are followed for all surgical clients. The information provided should be general enough to be informative about surgery and should not focus on individual surgeries, as all the clients are having different surgeries. Intraoperative techniques, expected pain levels, and pain medication are specific to the patient and type of surgery. The risks and benefits of the surgical procedure should be discussed by the physician.
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as emergency. urgent. required. elective.
emergency. Explanation: Emergency surgery means that the client requires immediate attention and the disorder may be life threatening. Urgent surgery means that the client requires prompt attention within 24 to 30 hours. Required surgery means that the client needs to have surgery, and it should be planned within a few weeks or months. Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic.
A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply. postoperative pain control cough and deep-breathing exercises the client's spouse's thoughts about the upcoming surgery the surgeon's fee and other hospital charges intravenous fluids and other lines and tubes
postoperative pain control cough and deep-breathing exercises intravenous fluids and other lines and tubes Explanation: Preoperative teaching involves teaching clients about their upcoming surgical procedure and expectations. Topics include preoperative medications (when they are given and their effects); postoperative pain control; explanation and description of the post anesthesia recovery room or postsurgical area; and deep-breathing and coughing exercises.
The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for? 1. A safe environment 2.Probable cataract extractions 3. Referral to an ophthalmologist 4.Restrictions of the patient's unassisted mobility activities
1. A safe environment Sensory limitations, such as impaired vision or hearing and reduced tactile sensitivity, frequently interact with the postoperative environment, so falls are more likely to occur (Meiner, 2011). Maintaining a safe environment for older adults requires alertness and planning.
The nurse recognizes that the client most at risk for mortality associated with surgery is the: 1. Client who is obese 2. Client with controlled diabetes 3. Client with chronic alcoholism 4. Client with controlled hypertension
3. Client with chronic alcoholism The client with chronic alcoholism who experiences alcohol withdrawal symptoms is at significant risk for mortality, which can be attributed to cardiac dysrthymias, cardiomyopathy, and bleeding tendencies.
A fractured skull would be classified under which category of surgery based on urgency? 1. Required 2. Urgent 3. Emergent 4. Elective
3. Emergent 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 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? 2 weeks 4 weeks 7 to 10 days 2 to 3 days
7 to 10 days Explanation: 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.
A client continuously repeats, "I know all will go well." What cognitive coping strategy should the nurse document? a. Imagery b. Distraction c. Optimistic self-recitation d. Music therapy
c. Optimistic self-recitation When the client verbalizes this statement repeatedly, it is an optimistic coping strategy. Imagery occurs when the client concentrates on a pleasant experience or restful scene. Distraction occurs when the client thinks of an enjoyable story or recites a favorite poem or song. Music therapy uses soothing music to help the client cope.
What action by the nurse best encompasses the preoperative phase? 1. Educating clients on signs and symptoms of infection 2. Shaving the client using a straight razor 3. Monitoring vital signs every 15 minutes 4. Documenting the application of sequential compression devices (SCDs)
1. 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.
Which would be considered to require an urgent surgical procedure? 1. Severe bleeding 2. Acute gallbladder infection 3. Loose facial skin 4. Cataract
2. 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.
The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician? 1. When a serum albumin concentration is 5.0 g/dL 2. When the patient's blood ammonia concentration reaches 180 mg/dL 3. When a serum globulin concentration reaches 2.8 g/dL 4. When a lactate dehydrogenase concentration is 300 units
2. When the patient's blood ammonia concentration reaches 180 mg/dL 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).
When caring for a patient with alcoholism, when should the nurse assess for symptoms of alcoholic withdrawal? 1. Within the first 12 hours 2. 4 days after a surgical procedure 3. On the second or third day 4. About 24 hours postoperatively
3. On the second or third day The person with a history of chronic alcoholism often suffers from malnutrition and other systemic problems or metabolic imbalances that increase surgical risk. In patients who are alcohol dependent, alcohol withdrawal syndrome may be anticipated 2 to 4 days after the last drink and is associated with a significant mortality rate when it occurs postoperatively.
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. a. Discharge planning is minimal because the stay is so short. b. Home care and other referrals are unlikely because same-day surgeries are usually minor. c. Need for teaching is increased. d. The client must be prepared to take on more self-care than he or she may have done in the past. e. The client will leave the hospital sooner than in the past.
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.
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse: a. performs a complete assessment of the client. b. assesses how well the client is recovering from anesthesia. c. continuously monitors the sedated client. d.obtains a surgical consent from the client's mother.
c. 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 aware that the amino acid, arginine, a. Is essential for antibody formation b. Is important for normal blood clotting c. Is involved in capillary formation d. Stimulates T-cell response
d. Stimulates T-cell response Arginine is necessary for collagen synthesis and deposition, increases wound strength, and stimulates T-cell response.
When is the ideal time to discuss preoperative teaching 1. Preadmission visit 2. When the patient is comfortable and sedated 3. Day of surgery 4. Prior to entering the pre-op area
1. 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 nurse is triaging surgical clients. Which client would the nurse document as in need of urgent surgical care? 1. A client with severe bleeding 2. A client with an acute gallbladder infection 3. A client scheduled for cosmetic surgery 4. A client needing cataract surgery
2. A client with an acute gallbladder infection An acute gallbladder infection is considered an urgent surgical procedure. Cosmetic surgery and cataract surgery are not considered urgent surgical procedures. Severe bleeding could be considered an emergent surgical procedure.
In which phase of perioperative care will the nurse prepare the client's skin, encourage the client to void, and remove the client's dentures? 1. intraoperative 2. transoperative 3. preoperative 4. postoperative
3. preoperative Preoperative care begins with the decision to perform surgery and continues until the client reaches the operating area. During this time, the nurse will physically prepare the client for surgery, and nursing actions may include skin preparation, hair removal, and food and fluids management.
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? 1. Immediately upon admission 2. Upon awakening in the postanesthesia care unit 3. Up to 24 hours after alcohol withdrawal 4. Up to 72 hours after alcohol withdrawal
4. 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.
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? 1 3 5 7
7 Explanation: Aspirin should be stopped at least 7 to 10 days before surgery. The other time frames are incorrect. Reference:
An obese client is scheduled for open abdominal surgery. What priority education should the nurse provide to this client? Prevention of wound dehiscence Wound care and infection prevention Prevention of venous thromboembolism Prevention of respiratory complications
Prevention of respiratory complications Explanation: All answers are correct, but the obese client has an increased susceptibility to respiratory complications, and maintaining a patent airway would be the priority.
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? a. Cardiovascular collapse b. Seizures c. Hypotension d.Apnea from respiratory paralysis
c. Hypotension 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 assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. 1. age 2. Ethnicity 3. nutritional status 4. gender 5. health status 6. physical condition
1. age 3. nutritional status 5. health status 6. physical condition General surgical risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition.
The nurse recognizes that which of the following clients is at least risk for perioperative complications? 1. A 45-year-old African-American man recently diagnosed with type 2 diabetes 2. A 32-year-old African-American woman who takes prednisone 3. A 65-year-old Caucasian man who has a history of arthritis 4. A 76-year-old Asian man who takes clopidogrel
3. A 65-year-old Caucasian man who has a history of arthritis A history of arthritis does not increase the risk for complications during the perioperative period.
Several of the clients at the clinic are preparing to have surgery within the next 2 weeks. They are completing preoperative paperwork today with their visit. What are some of the reasons that people might need to have surgery? Select all that apply. 1. Normative 2. Cosmetic 3. Causative 4. Palliative 5. Diagnostic
2. Cosmetic 4. Palliative 5. Diagnostic Reasons people have surgery include cosmetic reasons, diagnostic procedures, palliative surgeries, exploratory surgeries, and curative surgeries. Options D and E are distractors.
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? 1. Circulating nurse 2. Registered nurse first assistant 3. Anesthesiologist 4. Surgeon
4. 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.
A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results? 1. A blood urea nitrogen level of 42 mg/dL 2. A creatine kinase level of 120 U/L 3. A serum creatinine level of 0.9 mg/dL 4. A urine creatinine level of 1.2 mg/dL
1. A blood urea nitrogen level of 42 mg/dL 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.
A client with a skull fracture after falling from a ladder requires surgery. The nurse should anticipate transporting the client to surgery during what time frame? 1. In 1 day 2. In 1 week 3. Immediately 4.In 48-72 hours
3. Immediately Emergent surgery occurs when the client requires immediate attention. A fractured skull is an indication for emergent surgery. An urgent surgery occurs when the client requires prompt attention, usually within 24-30 hours. Any surgery scheduled beyond 30 hours is classified as required or elective; a fractured skull does not meet the requirements for elective or required surgery.
What is the major purpose of withholding food and fluid before surgery? a. Prevent overhydration b. Decrease risk of constipation c. Decrease urine output d. Prevent aspiration
d. Prevent aspiration
Sudden withdrawal of which of the following may result in seizures? a. Monoamine-oxidase inhibitors b. Thiazide diuretics c. Steroids d. Tranquilizers
d. Tranquilizers 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.
Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out? 1. Confirm that informed consent has been obtained. 2. Review the scheduled procedure, site, and client. 3. Ensure that sufficient surgical supplies are available. 4. Check that all surgical personnel are properly attired.
2. Review the scheduled procedure, site, and client. According to the 2016 National Patient Safety Goals, accurate identification of the client, procedure, and operative site is essential.
A physically fit 86-year-old is scheduled for right knee replacement. Which factor the client at increased risk for complications during or after surgery? 1. Age 2. Ability to metabolize medication 3. Nutritional status 4. Type of surgery
1. Age General risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition. In this scenario, the risk to the client is age; the other options are incorrect according to the scenario described.
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? 1. 250 to 300 mg/dL 2. 150 to 240 mg/dL 3. 80 to 110 mg/dL 4. 300 to 350 mg/dL
3. 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.
Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery? 1. Physician 2. Certified nurse's aide 3. Nurse 4. Case manager
1. Physician It is the physician's responsibility to provide appropriate information. It is not the responsibility of the nurse, case manager, or certified nurse's aide to gain informed consent.
The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following? 1. Cheeseburger, french fries, coleslaw, and ice cream 2. Baked chicken, mashed potatoes, broccoli, and strawberries 3. Turkey breast, baked sweet potato, asparagus, and an orange 4. Grilled salmon, rice pilaf, green beans, and cantaloupe
1. Cheeseburger, french fries, coleslaw, and ice cream Important nutrients for wound healing include protein; vitamins A, B-complex, C, and K; arginine, magnesium, copper, and zinc; and water. The diet should be sufficient in carbohydrates and low to moderate in fats. The cheeseburger option is high in fat and low in vitamin C.
A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply. 1. intravenous fluids and other lines and tubes 2. cough and deep-breathing exercises 3. the surgeon's fee and other hospital charges 4. the client's spouse's thoughts about the upcoming surgery postoperative pain control
1. intravenous fluids and other lines and tubes 2. cough and deep-breathing exercises 4. the client's spouse's thoughts about the upcoming surgery postoperative pain control Preoperative teaching involves teaching clients about their upcoming surgical procedure and expectations. Topics include preoperative medications (when they are given and their effects); postoperative pain control; explanation and description of the post anesthesia recovery room or postsurgical area; and deep-breathing and coughing exercises.
The nurse has just admitted a 12-year-old client who is going to have an above-the-knee amputation of their left leg due to osteosarcoma. The nurse knows that adequate preoperative teaching and learning is important for what reason? 1. Client will have a shorter recovery period. 2. Client will understand after surgery they will not have a left leg. 3. Client will understand they have cancer. 4. Client's family will understand their child will lose their leg in the surgery.
1. Client will have a shorter recovery period. The purpose of adequate preoperative teaching/learning is for the client to have an uncomplicated and shorter recovery period. He or she will be more likely to deep breathe and cough, move as directed, and require less pain medication. Options B, C, and D are incorrect because preoperative teaching does not ensure that a 12-year-old client understands they are losing their leg or understand that they will have cancer. Preoperative teaching also does not ensure the client's family understands the child will lose their leg. This is the responsibility of the physicians who are treating the child and their family
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? 1. "My medical records will be sent to the ambulatory care center prior to my surgery." 2. "The nurse will explain the details of the surgery before I sign a consent." 3. "If I do not follow the instructions, my surgery could be cancelled." 4. "The physician will update my family after the procedure and provide specific discharge instructions."
2. "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.
A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? 1. Remove the ring once the client is sedated. 2. Allow the client to wear the ring and cover it with tape. 3. Notify the surgeon to cancel surgery. 4. Discuss the risk for infection caused by wearing the ring.
2. Allow the client to wear the ring and cover it with tape. Most facilities will allow a client to wear a wedding band during a surgical procedure. The nurse must secure the ring with tape. Although it is appropriate to discuss the risk for infection, the client has already refused to remove the ring. The surgery should not be canceled and the ring should not be removed without permission.
During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse? 1. Notify the nurse manager to follow up on the procedure. 2. Notify the surgical team to remove all latex-based items. 3. Notify the dietary department. 4. Notify the physician regarding postoperative pain medications.
2. Notify the surgical team to remove all latex-based items. Allergies to avocados and bananas may indicate an allergy to latex. Although it is necessary to notify the dietary department and physician, it is not an immediate threat, as the patient is receiving nothing by mouth and pain medication will be ordered postoperatively. The nurse manager does not need to be notified of the client's allergies.
The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery? 1. Types of postoperative pain medication 2. Post-discharge diet 3. Effective coughing and deep breathing 4. Knowledge of surgical procedure
2. Post-discharge diet 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.
At what point does the preoperative period end? 1. When the client signs the consent form 2. When the client is transferred onto the operating table 3. When the decision is made to proceed with surgery 4. When the client is admitted to the PACU
2. When the client is transferred onto the operating table The preoperative phase begins when the decision to proceed with surgical intervention is made and ends with the transfer of the client onto the OR table. The intraoperative phase begins when the client is transferred onto the operating table and ends with admission to the PACU.
You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear? 1. Anxiety and fear increases the need for anesthesia and postoperative medications. 2. Anxious clients need psychological counseling after surgery. 3. Anxious clients have a poor response to surgery and are prone to complications. 4. Anxiety and fear can affect a client positively during and after surgery.
3. Anxious clients have a poor response to surgery and are prone to complications. Anxiety and fear, if extreme, can affect a client's condition during and after surgery. Anxious clients have a poor response to surgery and are prone to complications. The scenario does not indicate an increased need for anesthesia or postoperative medications in the anxious and fearful client. Anxious clients do not generally need psychological counseling after surgery. Anxiety and fear do not affect a client positively during and after surgery.
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? 1. During the preoperative phase 2. During the intraoperative phase 3. During the postoperative phase 4. During the transfer phase
3. 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.
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? 1. Document the findings and continue moving the client through the preoperative phase. 2. Notify the primary physician about the assessment findings. 3. Notify the surgeon to possibly delay the surgery. 4. Wait 1 hour and complete the assessment again.
3. Notify the surgeon to possibly delay the surgery. 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.
Regarding the surgical client, which phase refers to the period of time that spans the entire surgical experience? 1. Intraoperative 2. Postoperative 3. Perioperative 4. Preoperative
3. 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.
An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults? 1. All older people face similar risks when undergoing surgeries. 2. Aging processes reduce the chances that surgery will be successful for these clients. 3. Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. 4. Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.
4. Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. The underlying principle that guides preoperative assessment, surgical care, and postoperative care is that elderly clients have less physiologic reserve (the ability of an organ to return to normal after a disturbance in its equilibrium) than younger clients. The hazards of surgery for the elderly are proportional to the number and severity of coexisting health problems and the nature and duration of the operative procedure. Respiratory and cardiac complications are the leading causes of postoperative morbidity and mortality in older adults.
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? 1. Take the client to the bathroom. 2. Have the family go to the waiting room. 3. Take the client's vital signs. 4. Place the side rails in the up position and make sure the call button is in reach.
4. 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.
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: 1. absolve the hospital of legal responsibility should complications arise. 2. minimize the time that will need to be spent on postoperative questions. 3. decrease the client's participation and allow the family to take on the caregiver role. 4. increase the likelihood of a successful recovery.
4. 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.
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? 1. Deep breathing and coughing exercises should be completed every 8 hours. 2. Splint the incision site using a pillow during deep breathing and coughing exercises. 3. Deep breathing and coughing exercises may be used as relaxation techniques. 4. Pain medication should be taken before completing 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.
How does the nurse determine that the patient may have hidden fears about the impending surgical procedure? (Select all that apply.) The patient avoids communication with the nurse. 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 repeatedly asks questions that have previously been answered. The patient talks incessantly.
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.
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse: 1. obtains a surgical consent from the client's mother. 2. performs a complete assessment of the client. 3. continuously monitors the sedated client. 4. assesses how well the client is recovering from anesthesia.
3. 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.
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? 1. Teach dressing changes. 2. Review preoperative instructions. 3. Give postoperative instructions. 4. Give caregiver instructions.
2. Review preoperative instructions. 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.
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? 1. Use chest breathing. 2. Use diaphragmatic breathing. 3. Make inhalation longer than exhalation. 4. Exhale through an open mouth.
2. 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.
Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? 1. "Let me explain to you what will happen next." 2. "It is best to take deep breaths and relax before the procedure." 3. "We will keep your family informed of your progress." 4. "You will be just fine; the operating room nurses will take good care of you."
1. "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.
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? 1. Completes preoperative assessment 2. Verifies that operative consent is signed 3. Provides psychological support 4. Develops a plan of care
2. Verifies that operative consent is signed All choices listed are essential but, without a signed consent form, surgery cannot occur.
When does the nurse understand the patient is knowledgeable about the impending surgical procedure? a. The patient expresses concern about postoperative pain. b. The patient discusses stress factors causing the patient to feel depressed. c. The patient verbalizes fears to family. d. The patient participates willingly in the preoperative preparation
4. The patient participates willingly in the preoperative preparation. The nurse knows that the patient understands the surgical intervention when the patient participates in preoperative preparation. The other answers pertain to the patient experiencing decreased fear or anxiety, not knowledge about the procedure
Regarding the surgical client, which phase refers to the period of time that spans the entire surgical experience? Preoperative Intraoperative Postoperative Perioperative
Perioperative Explanation: 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.
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 6 hours before surgery Up to 2 hours before surgery Up to 8 hours before surgery Up to 4 hours before surgery
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).
During the preoperative assessment, the nurse learns that the client has been taking prednisone. The nurse realizes that the client is at risk for: a. Decreased blood pressure. b. Increased blood loss. c. Respiratory depression. d. Cardiovascular collapse.
d. Cardiovascular collapse. 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.
Following diagnostic testing, a patient requires a cholecystectomy. This surgical procedure would be categorized as which of the following? a. Emergent b. Required c. Elective d. Urgent
d. Urgent Acute gallbladder infection would be categorized as an urgent surgery. Emergent surgeries include severe bleeding, bladder or intestinal obstruction, and a fractured skull. Required surgeries include thyroid disorders and cataracts. Elective surgeries include repair of scars, simple hernia, and vaginal repair.
The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities? a. The client takes three deep breaths and then coughs forcefully. b. The client breathes through her nose, holds her breath, and then exhales slowly before coughing. c. The client takes short, panting breaths and coughs from the throat to expectorate sputum. d.The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times.
d.The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times. 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.
You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility? 1. Tell the physician and anesthesiologist. 2. Explain that the client cannot go into the operating room with jewelry on. 3. Place gauze under and over the ring and apply adhesive tape over it. 4. Medicate the client and then remove the ring.
3. Place gauze under and over the ring and apply adhesive tape over it. If the client is reluctant to remove a wedding band, the nurse may slip gauze under the ring, then loop the gauze around the finger and wrist or apply adhesive tape over a plain wedding band. You would not tell the client that he or she cannot go to the operating room wearing the ring. You would never medicate the client and then remove the ring against his or her will. It is not necessary to tell the physician and the anesthesiologist that the client does not want to remove the wedding band.
A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for? 1. Hypoglycemia 2. Hypertension 3. Glucosuria 4. Dehydration
1. 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.