Adult Nursing - Chapter 17: Preoperative Nursing Management - PrepU

A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results? - A creatine kinase level of 120 U/L - A serum creatinine level of 0.9 mg/dL - A blood urea nitrogen level of 42 mg/dL - A urine creatinine level of 1.2 mg/dL

- A blood urea nitrogen level of 42 mg/dL

Which health care profession has the ultimate responsibility to provide appropriate information regarding a non-emergent surgery? - Certified nurse's aide - Case manager - Nurse - Physician

- Physician

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period? - Up to 72 hours after alcohol withdrawal - Up to 24 hours after alcohol withdrawal - Immediately upon admission - Upon awakening in the post-anesthesia care unit

- Up to 72 hours after alcohol withdrawal

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as - required. - elective. - emergency. - urgent.

- emergency.

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? - Pituitary - Thyroid - Parathyroid - Adrenal

- Adrenal

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? - Circulating nurse - Anesthesiologist - Registered nurse first assistant - Surgeon

- Surgeon

In preparing the client for transfer to the operating room, which of the following actions by the nurse is inappropriate? - Allow the client to wear dentures. - Remove all jewelry. - Have client wear hospital gown. - Have the client void.

- Allow the client to wear dentures.

A gunshot wound would be classified under which category of surgery based on urgency? - Urgent - Elective - Required - Emergent

- Emergent

A physically fit older adult is scheduled for right knee replacement. What factor for the client creates an increased risk for postoperative complications? - ability to metabolize medication - current smoking history - surgical site - type of surgery

- current smoking history

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? - Ability to metabolize medication - Nutritional status - Type of surgery - Age

- Age

A fractured skull would be classified under which category of surgery based on urgency? - Emergent - Elective - Required - Urgent

- Emergent

At what point does the preoperative period end? - When the decision is made to proceed with surgery - When the client is admitted to the PACU - When the client is transferred onto the operating table - When the client signs the consent form

- When the client is transferred onto the operating table

A 17-year-old client is having same-day surgery. Solely during the intra-operative phase of peri-operative care, the nurse: - assesses how well the client is recovering from anesthesia. - continuously monitors the sedated client. - obtains a surgical consent from the client's mother. - performs a complete assessment of the client.

- continuously monitors the sedated client.

A client is scheduled for an invasive procedure. What priority documentation is needed regarding the procedure? - A health history obtained by the primary physician - A signed consent form from the client - Prescriptions for postoperative medications - The medication reconciliation form

- A signed consent form from the client

The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which laboratory value would be of greatest concern to the nurse? - potassium 6.2 mEq/L - calcium 9.8 mg/dL - white blood cell count 7.2 cells/mm - sodium 138 mEq/L

- potassium 6.2 mEq/L

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? - Use diaphragmatic breathing. - Use chest breathing. - Make inhalation longer than exhalation. - Exhale through an open mouth.

- Use diaphragmatic breathing.

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? - "Let me explain to you what will happen next." - "We will keep your family informed of your progress." - "It is best to take deep breaths and relax before the procedure." - "You will be just fine; the operating room nurses will take good care of you."

- "Let me explain to you what will happen next."

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? - 80 to 110 mg/dL - 300 to 350 mg/dL - 150 to 240 mg/dL - 250 to 300 mg/dL

- 80 to 110 mg/dL

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? - Urethral catheterization - An open reduction of a fracture - An insertion of an intravenous catheter - Irrigation of the external ear canal

- An open reduction of a fracture

A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery? - A history of sensitivity to aspirin - A history of osteoarthritis - A history of diabetes - A history of chronic low back pain

- A history of diabetes

The on-call peri-operative team is called for an urgent surgery to be performed as soon as they arrive. What surgical procedure is considered emergent? - A repair of multiple stab wounds - A face lift - An exploratory laparotomy - Removal of kidney stones

- A repair of multiple stab wounds

A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? - Allow the client to wear the ring and cover it with tape. - Notify the surgeon to cancel surgery. - Remove the ring once the client is sedated. - Discuss the risk for infection caused by wearing the ring.

- Allow the client to wear the ring and cover it with tape.

A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective? - "I will support my incision with my hands when I cough and do my deep breathing exercises." - "The pain from my incision will be very similar to my arthritis pain." - "I will need to learn how to give myself pain medication by injection for when I go home." - "I will ask for pain medication when the pain becomes unbearable."

- "I will support my incision with my hands when I cough and do my deep breathing exercises."

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."

The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed? - "The nurse will explain the details of the surgery before I sign a consent." - "If I do not follow the instructions, my surgery could be cancelled." - "The physician will update my family after the procedure and provide specific discharge instructions." - "My medical records will be sent to the ambulatory care center prior to my surgery."

- "The nurse will explain the details of the surgery before I sign a consent."

Which question is most important for the nurse to ask the client when obtaining the preoperative admission history? - "Who is here with you?" - "Did you bring any valuables with you?" - "Did you bring a copy of your health care power of attorney?" - "When is the last time you ate or drank?"

- "When is the last time you ate or drank?"

The parent of a 16-year-old client asks the nurse, "How could the surgeon operate without my consent?" What is the best response by the nurse? - "We obtained consent from your child after your child requested the surgery." - "Your child had life-threatening injuries that required immediate surgery." - "The surgical procedure being performed does not require consent." - "Two doctors decided your child needed the surgery, therefore we did not need to get consent."

- "Your child had life-threatening injuries that required immediate surgery."

For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? - 5 - 7 - 1 - 3

- 7

A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery? - 7 to 10 days - 2 to 3 days - 4 weeks - 2 weeks

- 7 to 10 days

The nurse expects informed consent to be obtained for insertion of: - A gastrostomy tube - An indwelling urinary catheter - A nasogastric tube - An intravenous catheter

- A gastrostomy tube

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? - Anxiety and fear increases the need for anesthesia and postoperative medications. - Anxious clients have a poor response to surgery and are prone to complications. - Anxiety and fear can affect a client positively during and after surgery. - Anxious clients need psychological counseling after surgery.

- Anxious clients have a poor response to surgery and are prone to complications.

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? - Grilled salmon, rice pilaf, green beans, and cantaloupe - Turkey breast, baked sweet potato, asparagus, and an orange - Baked chicken, mashed potatoes, broccoli, and strawberries - Cheeseburger, french fries, coleslaw, and ice cream

- Cheeseburger, french fries, coleslaw, and ice cream

The client is scheduled for a biopsy for suspected cancer of the prostate. The nurse recognizes the purpose of this surgical procedure is: - Reparative - Diagnostic - Curative - Palliative

- Diagnostic

At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period? - Following the surgical procedure - During the preoperative period - At the time of discharge instructions - Upon arrival to the surgical unit

- During the preoperative period

What action by the nurse best encompasses the preoperative phase? - Shaving the client using a straight razor - Educating clients on signs and symptoms of infection - Documenting the application of sequential compression devices (SCDs) - Monitoring vital signs every 15 minutes

- Educating clients on signs and symptoms of infection

In which instance may a surgeon operate without informed consent? - Radiologic procedures - Emergency situations - Invasive procedures - Procedures requiring sedation

- Emergency situations

Informed consent from the surgical client is essential in all of the following categories of surgery except: - Urgent surgery - Emergent surgery - Elective surgery - Required surgery

- Emergent surgery

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

- Hypoglycemia

An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used? - Imagery - Progressive muscular relaxation - Optimistic self-recitation - Distraction

- Imagery

A client asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate? - It prevents over-hydration and hypertension. - It decreases urine output so that a catheter will not be needed. - It prevents aspiration and respiratory complications. - It decreases the risk of elevated blood sugar and slow wound healing.

- It prevents aspiration and respiratory complications.

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? - Give the client plenty of water to aid digestion. - Document what foods the client ate. - Cancel the surgery. - Notify the surgeon.

- Notify the surgeon.

A nurse knows that she must obtain a signed informed consent for which of the following procedures? Select all that apply. - Open reduction of a fracture - Arteriography - Cystoscopy - Insertion of a peripheral intravenous line - Insertion of a urethral catheter - Paracentesis

- Open reduction of a fracture - Arteriography - Cystoscopy - Paracentesis

A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? - Diabetes - Osteoporosis - Urinary tract infection - Pregnancy

- Osteoporosis

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? - Place gauze under and over the ring and apply adhesive tape over it. - Tell the physician and anesthesiologist. - Explain that the client cannot go into the operating room with jewelry on. - Medicate the client and then remove the ring.

- Place gauze under and over the ring and apply adhesive tape over it.

When is the ideal time to discuss preoperative teaching - Pre-admission visit - Day of surgery - When the patient is comfortable and sedated - Prior to entering the pre-op area

- Pre-admission visit

An obese client is scheduled for open abdominal surgery. What priority education should the nurse provide to this client? - Prevention of respiratory complications - Prevention of wound dehiscence - Prevention of venous thromboembolism - Wound care and infection prevention

- Prevention of respiratory complications

A client is preparing to undergo a curative surgical procedure. Which of the following is the type of surgery the client could be having? Select all that apply. - Skin biopsy - Insertion of a gastrostomy tube - Removal of a diseased appendix - Removal of a tumor - Mammoplasty

- Removal of a diseased appendix - Removal of a tumor

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? - Request that the surgeon come and answer the questions. - Answer the client's questions. - Notify the nurse manager of the client's questions. - Place the consent form in the client's medical record.

- Request that the surgeon come and answer the questions.

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? - Review the scheduled procedure, site, and client. - Check that all surgical personnel are properly attired. - Ensure that sufficient surgical supplies are available. - Confirm that informed consent has been obtained.

- Review the scheduled procedure, site, and client.

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? - Pain medication should be taken before completing deep breathing and coughing exercises. - Deep breathing and coughing exercises should be completed every 8 hours. - Splint the incision site using a pillow during deep breathing and coughing exercises. - Deep breathing and coughing exercises may be used as relaxation techniques.

- Splint the incision site using a pillow during deep breathing and coughing exercises.

When does the nurse understand the patient is knowledgeable about the impending surgical procedure? - The patient participates willingly in the preoperative preparation. - The patient expresses concern about postoperative pain. - The patient verbalizes fears to family. - The patient discusses stress factors causing the patient to feel depressed.

- The patient participates willingly in the preoperative preparation.

The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is: - To notify the surgeon - To have the client sign the consent immediately - For the nurse to sign the consent with verbal permission of the client - To have the client's next of kin sign the consent

- To notify the surgeon

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? - Tumor excision - A face-lift - Placement of gastrostomy tube - A biopsy

- Tumor excision

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 8 hours before surgery - Up to 4 hours before surgery - Up to 2 hours before surgery

- Up to 2 hours before surgery

The nurse assesses a client to determine if there is increased risk for complications intra-operatively or postoperatively. Which are general risk factors? Select all that apply. - health status - physical condition - gender - Ethnicity - nutritional status - age

- health status - physical condition - nutritional status - age

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: - absolve the hospital of legal responsibility should complications arise. - increase the likelihood of a successful recovery. - minimize the time that will need to be spent on postoperative questions. - decrease the client's participation and allow the family to take on the caregiver role.

- increase the likelihood of a successful recovery.

A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply. - intravenous fluids and other lines and tubes - cough and deep-breathing exercises - postoperative pain control - 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 - cough and deep-breathing exercises - postoperative pain control

An example of a curative surgical procedure is - tumor excision. - placement of gastrostomy tube. - a biopsy. - a face-lift.

- tumor excision.

A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which client surgical risk factor would decrease if the surgical client maintained strict blood glycemic control? - nutrient deficiencies - liver dysfunction - respiratory complications - wound healing

- wound healing