Ch. 14- Care of Preoperative Patients

c. Patient Safety

1. Which is the top priority for nurses during the perioperative period? a. Patient teaching b. Patient diagnostic testing c. Patient safety d. Patient care documentation

b. Emergent

10. A patient with an abdominal aortic aneurysm is having surgical repair. What is the correct classification for this surgery? a. Restorative b. Emergent c. Urgent d. Minor

c. Elective

11. A 76-year-old patient is having a bilateral cataract removal. What is the correct classification for this surgery? a. Major b. Cosmetic c. Elective d. Emergent

d. Urgent

12. A 47-year-old patient is having surgery to remove kidney stones. What is the correct classification for this surgery? a. Restorative b. Emergent c. Palliative d. Urgent

b. Minimally invasive

13. The patient is scheduled for same-day surgery for an uncomplicated cholecystectomy. Which surgical approach will most likely be used? a. Simple b. Minimally invasive c. Open d. Radical

b. Age 67 c. Obesity e. Pulmonary disease f. Hypertension

14. The nurse screens a preoperative patient for conditions that may increase the risk for complications during the perioperative period. Which conditions are possible risk factors? Select all that apply. a. Emotionally stable b. Age 67 c. Obesity d. Marathon runner e. Pulmonary disease f. Hypertension

d. ASA class IV

15. A patient scheduled for surgery has a history of myocardial infarction 6 weeks ago. Which classification will this patient meet preoperatively based on the ASA Physical Status Classification system? a.ASA class I b. ASA class II c. ASA class III d. ASA class IV

a. b. c. f.

17. The nurse has received a patient in the holding area who is scheduled for a left femoral-popliteal bypass. What are the priority safety measures for this patient before surgery? Select all that apply. a. The operative limb is marked by the surgeon. b. The patient is positively identified by checking the name and date of birth. c. The patient is asked to confirm the marked operative limb. d. The patient is identified by checking the name and room number. The patient is instructed to verify any family members waiting. e. The patient is kept on NPO status

b. Develops a plan to keep the patient safe

16. A 75-year-old patient is having an exploratory laparotomy tomorrow. The wife tells the nurse that at night the patient gets up and walks around his room. What priority action does the nurse take after hearing this information? a. Notifies the provider b. Develops a plan to keep the patient safe c. Obtains an order for sleep medication d. Tells the patient not to get out of bed at night

b. Urinalysis c. Electrolyte levels e. Clotting studies f. Serum creatinine

21. The nurse is preparing the patient for surgery. Which common laboratory tests does the nurse anticipate being ordered? Select all that apply. a. Total cholesterol b. Urinalysis c. Electrolyte levels d. Uric acid e. Clotting studies f. Serum creatinine

a. Raise the side rails. b. Place the call light within the patient's d. Instruct the patient not to get out of bed. e. Place the bed in its lowest position. f. Tell the patient that he or she may become drowsy.

26. The nurse has given the ordered preoperative medications to the patient. What actions must the nurse take after administering these drugs? Select all that apply. a. Raise the side rails. b. Place the call light within the patient's c. Ask the patient to sign the consent form. d. Instruct the patient not to get out of bed. e. Place the bed in its lowest position. f. Tell the patient that he or she may become drowsy.

ANS: B Splinting an incision provides extra support during coughing and activity and helps decrease pain. If the client is otherwise comfortable, no more analgesia is required. Shallow breathing can lead to atelectasis and pneumonia. The client should know some pain is normal and expected after surgery, but that answer alone does not provide any interventions to help the client.

A client has a great deal of pain when coughing and deep breathing after abdominal surgery despite having pain medication. What action by the nurse is best? a. Call the provider to request more analgesia. b. Demonstrate how to splint the incision. c. Have the client take shallower breaths. d. Tell the client a little pain is expected.

ANS: A Tachycardia increases the workload of the heart and requires more oxygen delivery to the myocardial tissues. This added strain is not needed on top of the physical and emotional stress of surgery. The other statements are not accurate.

A student is caring for clients in the preoperative area. The nurse contacts the surgeon about a client whose heart rate is 120 beats/min. After consulting with the surgeon, the nurse administers a beta blocker to the client. The student asks why this was needed. What response by the nurse is best? a. "A rapid heart rate requires more effort by the heart." b. "Anesthesia has bad effects if the client is tachycardic." c. "The client may have an undiagnosed heart condition." d. "When the heart rate goes up, the blood pressure does too."

C. Point toes of one foot toward bottom of bed; then point toes of same leg toward his or her face. Repeat several times; then switch legs.

What client teaching will the nurse provide regarding postoperative leg exercises to minimize the risk for development of deep vein thrombosis after surgery? A. Only perform each exercise one time to prevent overuse. B. Begin exercises by sitting at a 90-degree angle on the side of the bed. C. Point toes of one foot toward bottom of bed; then point toes of same leg toward his or her face. Repeat several times; then switch legs. D. Bend knee, and push heel of foot into the bed until the calf and thigh muscles contract. Repeat several times; then switch legs.

B. The serum potassium level is 3.0 mEq/L (3.0 mmol/L). C. The client took a total of 1300 mg of aspirin yesterday. F. After receiving the preoperative medications, the client tells the nurse that he lied on the assessment form and that he really is a current smoker.

Which assessment data finding for a client scheduled for total knee replacement surgery is most important for the nurse to communicate to the surgeon and the anesthesia provider before the procedure? Select all that apply. A. The oxygen saturation is 97%. B. The serum potassium level is 3.0 mEq/L (3.0 mmol/L). C. The client took a total of 1300 mg of aspirin yesterday. D. The client requests to talk with a registered dietitian about weight loss. E. The client took a regularly scheduled antihypertensive drug with a sip of water 2 hours ago. F. After receiving the preoperative medications, the client tells the nurse that he lied on the assessment form and that he really is a current smoker.

a. Presence of chronic illnesses b. Problems with healing d. Dehydration e. Electrolyte imbalances

18. The 79-year-old patient with type 2 diabetes is scheduled for surgery to remove his left great toe. Which risk factors for complications of surgery does the nurse assess in this patient? Select all that apply. a. Presence of chronic illnesses b. Problems with healing c. Absence of smoking history d. Dehydration e. Electrolyte imbalances f. Daily exercise routine

a. Notifies the surgeon

19. During preoperative screening, the nurse dis- covers that the patient is allergic to shellfish. What is the nurse's best first action? a. Notifies the surgeon b. Develops a plan to keep the patient safe c. Obtains an order for a shellfish-free diet d. Asks the patient if any other family members have the same allergy

b. Centers for Medicare and Medicaid Services (CMS)

2. During the perioperative period a patient receives surgery on the wrong extremity. To which agency must this occurrence be reported? a. Association of periOperative Registered Nurses (AORN) b. Centers for Medicare and Medicaid Services (CMS) c. The Joint Commission (TJC) d. American Society of Anesthesiologists (ASA)

b. "You could donate some of your own blood (autologous donation) a few weeks before your surgery."

20. The preoperative patient tells the nurse that she is afraid that she may experience a reaction if she must receive blood during or after her surgery. What is the nurse's best response to the patient's concern? a. "The likelihood that you will need a blood transfusion for your surgery is minimal, so do not worry about this." b. "You could donate some of your own blood (autologous donation) a few weeks before your surgery." c. "With today's technology and procedures, it is very unlikely that you would have a reaction to donated blood." d. "The nursing staff follows strict proce- dures to prevent such an event from ever happening."

a. Information necessary to understand the nature of and reason for the surgery has been provided.

22. Which statement is true regarding the patient who has given consent for a surgical procedure? a. Information necessary to understand the nature of and reason for the surgery has been provided. b. The length of stay in the hospital has been preapproved by the managed care provider. c. Information about the surgeon's experience has been provided. d. The nurse has provided detailed information about the surgical procedure.

c. The nurse may serve as witness to the patient's signature after the HCP has the consent form signed before preoperative sedation is given and before surgery is performed.

23. Which statement best describes the collaborative roles of the nurse and surgeon when obtaining the informed consent? a. The nurse is responsible for having theinformed consent form on the chart for the health care provider (HCP) to witness. b. The nurse may serve as a witness that the patient has been informed by the HCP before surgery is performed. c. The nurse may serve as witness to the patient's signature after the HCP has the consent form signed before preoperative sedation is given and before surgery is performed. d. The nurse has no duties regarding the consent form if the patient has signed the informed consent form for the HCP, even if the patient then asks additional questions about the surgery.

a. Modify the dose of insulin given based on the patient's blood glucose as ordered. b. Complete the preoperative checklist before transfer to the surgical suite. d. Delegate obtaining the patient's fingerstick blood glucose and vital signs to the UAP e. Check if the patient is wearing any jewelry and call security to secure valuables if necessary. f. Place the patient on NPO status for the period ordered by the surgeon.

24. A patient with type 1 diabetes mellitus is scheduled for surgery at 0700. Which actions must the nurse perform for this patient before he goes to the operating room? Select all that apply a. Modify the dose of insulin given based on the patient's blood glucose as ordered. b. Complete the preoperative checklist before transfer to the surgical suite. c. Teach the patient about foot care and properly fitted shoes. d. Delegate obtaining the patient's fingerstick blood glucose and vital signs to the UAP e. Check if the patient is wearing any jewelry and call security to secure valuables if necessary. f. Place the patient on NPO status for the period ordered by the surgeon.

a. Assist the patient to empty his or her bladder.

25. After a patient is prepared for surgery and before preoperative drugs are given and the patient is transported to surgery, which essential intervention can the nurse delegate to the unlicensed assistive personnel (UAP) at this time? a. Assist the patient to empty his or her bladder. b. Help the patient to remove all clothing. c. Ask the patient if he or she wants to brush teeth d. Recheck the patient's identity

a. Range-of-motion exercises d. Incision splinting e. Deep-breathing exercises f. Use of incentive spirometry

27. Which postoperative interventions will the nurse typically teach a patient to prevent complications following surgery? Select all that apply. a. Range-of-motion exercises b. Massaging of lower extremities c. Taking pain medication only when experiencing severe pain d. Incision splinting e. Deep-breathing exercises f. Use of incentive spirometry

c. Antiseizure drug

28. Which drug may the surgeon allow the patient to take prior to surgery? a. Daily vitamin b. Stool softener c. Antiseizure drug d. Daily baby aspirin

a. "Yes, but your signature will need to have two witnesses."

29. A blind patient is to have a surgical procedure. She asks the nurse whether she will be able to sign her own consent form. What is the nurse's best response? a. "Yes, but your signature will need to have two witnesses." b. "No, but your next of kin can sign the consent form for you." c. "Yes, but you will need to make an X instead of signing your name." d. "No, but you can give instructions to sign for you to any responsible adult."

b. It ends at the time of transfer to the surgical suite. d. It begins when the patient is scheduled for surgery. e. It is a time during which the patient receives testing and education related to impending surgery.

3. Which statements best describe the preopera- tive period? Select all that apply. a.It begins when the patient makes the appointment with the surgeon to discuss the need for surgery. b. It ends at the time of transfer to the surgical suite. c. It is a time during which the patient's need for surgery is established. d. It begins when the patient is scheduled for surgery. e. It is a time during which the patient receives testing and education related to impending surgery. f. It is a time when patients and families receive discharge instructions.

a. Poor fluid and nutrition status

30. An older adult is scheduled for an elective surgical procedure. On assessment the nurse notes brittle nails, dry flaky skin, muscle wasting, and dry sparse hair. The patient's BP is 82/48 and heart rate is 112/minute. How does the nurse interpret this assessment data? a. Poor fluid and nutrition status b. Improper care in the home c. Expected physiological changes of aging d. Depression related to aging processes

c. Call and notify the surgeon immediately.

31. A preoperative patient is scheduled for surgery at 7:30 am. At 0600, the patient's vital signs are BP 90/60, HR 110 and irregular, respirations 22/minute, and oral temperature 100.9oF (38.3 oC). The patient's oxygen saturation is 92% and he has a productive cough. What is the nurse's priority action at this time? a. Administer acetaminophen (Tylenol) with just a sip of water. b. Recheck the vital signs at 7:00 am. c. Call and notify the surgeon immediately. d. Have the patient cough and take some deep breaths.

a. The patient understands the nature of and the reason for surgery. c. The patient understands who will do the surgery and who will be present during surgery. d. The patient understands the risks associated with the surgical procedure and its potential outcomes. f. The patient is informed of all available options and the benefits and risks associated with each option.

32. Which are implied with informed consent? Select all that apply. a. The patient understands the nature of and the reason for surgery. b. The patient is informed of what type of anesthesia drugs will be used. c. The patient understands who will do the surgery and who will be present during surgery. d. The patient understands the risks associated with the surgical procedure and its potential outcomes. e. The patient understands that blood and blood products must be available during surgery. f. The patient is informed of all available options and the benefits and risks associated with each option.

a. Prevention of infection c. Prevention of serious cardiac events d. Prevention of venous thromboembolism f. Maintenance of normothermia

4. Which are the focus areas for the Surgical Care Improvement Project (SCIP)? Select all that apply. a. Prevention of infection b. Prevention of respiratory complications c. Prevention of serious cardiac events d. Prevention of venous thromboembolism e. Prevention of acute kidney injury f. Maintenance of normothermia

d. Diagnostic

5. A female patient is having a biopsy of a nodule found in the right breast. Which classification identifies this surgery? a. Urgent b. Minor c. Cosmetic d. Diagnostic

b. Restorative

6. A patient who can barely ambulate with a walker at home is having a left total knee replacement. What is the most appropriate category for this surgery? a. Urgent b. Restorative c. Simple d. Palliative

a. Palliative

7. A colostomy is scheduled to be done on a patient who has severe Crohn's disease. What is the correct classification for this surgery? a. Palliative b. Minor c. Restorative d. Curative

c. Cosmetic

8. A male patient is having revision of a scar on his forehead from a third-degree burn. What is the correct classification for this surgery? a. Major b. Restorative c. Cosmetic d. Curative

a. Curative

9. An appendectomy is being performed on a patient with appendicitis. What is the correct classification for this surgery? a. Curative b. Diagnostic c. Urgent d. Radical

ANS: B All actions are appropriate for a preoperative client. However, for client safety, the nurse should raise the siderails on the bed because hydroxyzine can make the client sleepy.

A client has been given hydroxyzine (Atarax) in the preoperative holding area. What action by the nurse is most important for this client? a. Document giving the drug. b. Raise the siderails on the bed. c. Record the client's vital signs. d. Teach relaxation techniques.

ANS: C Although possibly uncomfortable or embarrassing for the client, the client should not be allowed out of bed after receiving sedation. The nurse should get the client a bedpan or urinal. The client may or may not need a urinary catheter.

A client in the preoperative holding room has received sedation and now needs to urinate. What action by the nurse is best? a. Allow the client to walk to the bathroom. b. Delegate assisting the client to the nurse's aide. c. Give the client a bedpan or urinal to use. d. Insert a urinary catheter now instead of waiting.

ANS: A, B, D, E There are many nonpharmacologic comfort measures the nurse can employ, such as allowing the client to remain in the position that is most comfortable, letting the family stay with the client, providing warmth or cooling measures as requested by the client, and providing privacy. The client in the preoperative holding area is NPO, so drinks should not be provided.

A client is clearly uncomfortable and anxious in the preoperative holding room waiting for emergent abdominal surgery. What actions can the nurse perform to increase comfort? (Select all that apply.) a. Allow the client to assume a position of comfort. b. Allow the client's family to remain at the bedside. c. Give the client a warm, non-caffeinated drink. d. Provide warm blankets or cool washcloths as desired. e. Pull the curtains around the bed to provide privacy.

ANS: A The preoperative antibiotic must be given within 60 minutes of the surgical start time to ensure the proper amount is in the tissues when the incision is made. The nurse should explain the rationale to the client for this timing. The other options do not take this timing into consideration and do not give the client the information needed to be cooperative.

A client is on the phone when the nurse brings a preoperative antibiotic before scheduled surgery. The circulating nurse has requested the antibiotic be started. The client wants the nurse to wait before starting it. What response by the nurse is most appropriate? a. Explain the rationale for giving the medicine now. b. Leave the room and come back in 15 minutes. c. Provide holistic client care and come back later. d. Tell the client you must start the medication now.

ANS: B A back rub reduces anxiety and can be delegated to the UAP. Once teaching has been done, the UAP can remind the client to turn, but this is not related to relieving anxiety. Assessing anxiety and teaching are not within the scope of practice for the UAP.

A client waiting for surgery is very anxious. What intervention can the nurse delegate to the unlicensed assistive personnel (UAP)? a. Assess the client's anxiety. b. Give the client a back rub. c. Remind the client to turn. d. Teach about postoperative care.

C. Adjust the administration time to be given within 1 hour before surgery.

A client was originally scheduled for surgery at noon. The surgeon is delayed, and the surgery has been rescheduled for 3:00 PM. How will the nurse plan to administer the preoperative prophylactic antibiotic? A. Give at noon as originally prescribed. B. Cancel orders; preoperative prophylactic antibiotics are given optionally. C. Adjust the administration time to be given within 1 hour before surgery. D. Hold the preoperative antibiotic so it can be administered immediately following surgery.

ANS: C Reglan increases gastric emptying, an important issue for this client who was eating just prior to the operation. The other drugs are appropriate for any surgical client.

A client who collapsed during dinner in a restaurant arrives in the emergency department. The client is going to surgery to repair an abdominal aortic aneurysm. What medication does the nurse prepare to administer as a priority for this client? a. Hydroxyzine (Atarax) b. Lorazepam (Ativan) c. Metoclopramide (Reglan) d. Morphine sulfate

ANS: A Anxiety can interfere with learning and cooperation. The nurse should assess the client for anxiety. The other actions are appropriate too, and can be included in the teaching plan, but effective teaching cannot occur if the client is highly anxious.

A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best? a. Assess the client for anxiety. b. Break the information into smaller bits. c. Give the client written information. d. Review the information again.

ANS: B, C, E The SCIP project includes core measures to prevent infection, serious cardiac events, and thromboembolic events such as deep vein thrombosis.

A new perioperative nurse is receiving orientation to the surgical area and learns about the Surgical Care Improvement Project (SCIP) goals. What major areas do these measures focus on preventing? (Select all that apply.) a. Hemorrhage b. Infection c. Serious cardiac events d. Stroke e. Thromboembolism

ANS: A This client has signs of malnutrition, which can impact recovery from surgery. The nurse should consult the surgeon about prescribing a consultation with a dietitian in the postoperative period. The nurse should document the findings but needs to do more. Encouraging the client to eat more may be helpful, but the client needs a professional nutritional assessment so that the appropriate diet and supplements can be ordered. The client may or may not need Meals on Wheels after discharge.

A nurse assesses a client in the preoperative holding area and finds brittle nails and hair, dry skin turgor, and muscle wasting. What action by the nurse is best? a. Consult the surgeon about a postoperative dietitian referral. b. Document the findings thoroughly in the client's chart. c. Encourage the client to eat more after recovering from surgery. d. Refer the client to Meals on Wheels after discharge.

ANS: A, C, D, E Although the client will be on NPO status before surgery, the nurse should check with the provider about allowing the client to take medications prescribed for diabetes, hypertension, cardiac disease, seizure disorders, depression, glaucoma, anticoagulation, or depression. Metformin is used to treat diabetes; phenytoin is for seizures; pilocarpine is for glaucoma, and warfarin is an anticoagulant. The omega-3 fatty acids can be held the day of surgery.

A nurse is caring for several clients prior to surgery. Which medications taken by the clients require the nurse to consult with the physician about their administration? (Select all that apply.) a. Metformin (Glucophage) b. Omega-3 fatty acids (Sea Omega 30) c. Phenytoin (Dilantin) d. Pilocarpine hydrochloride (Isopto Carpine) e. Warfarin (Coumadin)

ANS: A The nurse needs to conduct further assessment of the client's anxiety. Asking open-ended questions about current feelings is an appropriate way to begin. The client may want a chaplain, but the nurse needs to do more for the client. Reassurance can be good, but false hope is not, and simply reassuring the client may not be helpful. Telling the client not to be anxious belittles the client's feelings.

A nurse is concerned that a preoperative client has a great deal of anxiety about the upcoming procedure. What action by the nurse is best? a. Ask the client to describe current feelings. b. Determine if the client wants a chaplain. c. Reassure the client this surgery is common. d. Tell the client there is no need to be anxious.

ANS: B The entire proposed surgical site needs to be washed thoroughly and completely with the antimicrobial soap. Shaving, if absolutely necessary, should be done in the operative suite immediately before the operation begins, using sterile equipment. The client needs a full shower or bath (shower preferred). The client should wash the surgical site last; dirty water from shampooing will run over the cleansed site if the site is washed first.

A nurse is giving a client instructions for showering with special antimicrobial soap the night before surgery. What instruction is most appropriate? a. "After you wash the surgical site, shave that area with your own razor." b. "Be sure to wash the area where you will have surgery very thoroughly." c. "Use a washcloth to wash the surgical site; do not take a full shower or bath." d. "Wash the surgical site first, then shampoo and wash the rest of your body."

ANS: B Ulcer prophylaxis is common for clients undergoing long procedures or for whom high stress is likely. The nurse is not being truthful by saying all clients get this medication. If the nurse does not know the information, it is appropriate to find out, but this is a common medication for which the nurse should know the rationale prior to administering it. Simply stating that the physician prescribed the medication does not give the client any useful information.

A nurse is giving a preoperative client a dose of ranitidine (Zantac). The client asks why the nurse is giving this drug when the client has no history of ulcers. What response by the nurse is best? a. "All preoperative clients get this medication." b. "It helps prevent ulcers from the stress of the surgery." c. "Since you don't have ulcers, I will have to ask." d. "The physician prescribed this medication for you."

ANS: B, C, D, E All surgical clients should be assessed for VTE risk. Those considered at higher risk include those who are obese; are over 40; have cancer; have decreased mobility, immobility, or a spinal cord injury; have a history of any thrombotic event, varicose veins, or edema; take oral contraceptives or smoke; have decreased cardiac output; have a hip fracture; or are having total hip or knee surgery. Prolonged surgical time increases risk due to mobility and positioning needs.

A nurse recently hired to the preoperative area learns that certain clients are at higher risk for venous thromboembolism (VTE). Which clients are considered at high risk? (Select all that apply.) a. Client with a humerus fracture b. Morbidly obese client c. Client who underwent a prolonged surgical procedure d. Client with severe heart failure e. Wheelchair-bound client

ANS: B, C, D, E Providing for client safety is a priority function of the preoperative nurse. Checking for appropriately completed consent, verifying the client's identity, having the client assist in marking the surgical site if applicable, and allowing the client to use the toilet prior to sedating him or her are just some examples of important safety measures. The preoperative client should be NPO, so water should not be provided.

A nurse working in the preoperative holding area performs which functions to ensure client safety? (Select all that apply.) a. Allow small sips of plain water. b. Check that consent is on the chart. c. Ensure the client has an armband on. d. Have the client help mark the surgical site. e. Allow the client to use the toilet before giving sedation.

ANS: C The older adult has the most potentially complex discharge needs. With memory loss, the client may not be able to follow the prescribed home regimen. The client's physical abilities may be limited by chronic illness. This client has several safety needs that should be assessed. The other clients all have evidence of a support system and no known potential for serious safety issues.

A nurse works on the postoperative floor and has four clients who are being discharged tomorrow. Which one has the greatest need for the nurse to consult other members of the health care team for post-discharge care? a. Married young adult who is the primary caregiver for children b. Middle-aged client who is post knee replacement, needs physical therapy c. Older adult who lives at home despite some memory loss d. Young client who lives alone, has family and friends nearby

ANS: B, E A diagnostic procedure is used to determine cell type of cancer and to determine the cause of a problem. An example is a liver biopsy. A restorative procedure aims to improve functional ability. An example would be a total shoulder replacement or a spinal cord decompression (not palliative). A curative procedure either removes or repairs the causative problem. An example would be a mastectomy (not restorative) or a hemicolectomy (not diagnostic). A palliative procedure relieves symptoms but will not cure the disease. An example is an ileostomy. A cosmetic procedure is done to improve appearance. An example is rhinoplasty (a "nose job").

A nursing instructor is teaching students about different surgical procedures and their classifications. Which examples does the instructor include? (Select all that apply.) a. Hemicolectomy: diagnostic b. Liver biopsy: diagnostic c. Mastectomy: restorative d. Spinal cord decompression: palliative e. Total shoulder replacement: restorative

ANS: D Some herbs and supplements can interact with medications, so this information needs to be reported as the priority. An allergy to bee and wasp stings should not affect the client during surgery. Lactose intolerance should also not affect the client during surgery but will need to be noted before a postoperative diet is ordered. Lack of experience with surgery may increase anxiety and may require higher teaching needs, but is not the priority over client safety.

A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team? a. Allergy to bee and wasp stings b. History of lactose intolerance c. No previous experience with surgery d. Use of multiple herbs and supplements

ANS: C A potassium of 2.9 mEq/L is critically low and can affect cardiac and respiratory status. The nurse should communicate this laboratory value immediately. The creatinine is at the high end of normal, the hemoglobin is normal, and the sodium is only slightly low (normal low being 136 mEq/L), so these values do not need to be reported immediately.

A preoperative nurse is reviewing morning laboratory values on four clients waiting for surgery. Which result warrants immediate communication with the surgical team? a. Creatinine: 1.2 mg/dL b. Hemoglobin: 14.8 mg/dL c. Potassium: 2.9 mEq/L d. Sodium: 134 mEq/L

ANS: A, B, C, D Older adults have many age-related physiologic changes that put them at higher risk of falling and other complications after surgery. Some of these include decreased cardiac output, decreased oxygenation of tissues, nocturia, and mobility alterations. They also have a decreased ability to adapt to new surroundings, but that is not the same as being unable to adapt.

A student nurse asks why older adults are at higher risk for complications after surgery. What reasons does the registered nurse give? (Select all that apply.) a. Decreased cardiac output b. Decreased oxygenation c. Frequent nocturia d. Mobility alterations e. Inability to adapt to changes

ANS: A, C, D, E Malnutrition can lead to poorer surgical outcomes for several reasons, including fragile skin that might break down, altered pharmacokinetics, poorer wound healing, and weakness or fatigue that can interfere with recovery. Malnutrition can exist without other comorbidities.

A student nurse is caring for clients on the postoperative unit. The student asks the registered nurse why malnutrition can lead to poor surgical outcomes. What responses by the nurse are best? (Select all that apply.) a. "A malnourished client will have fragile skin." b. "Malnourished clients always have other problems." c. "Many drugs are bound to protein in the body." d. "Protein stores are needed for wound healing." e. "Weakness and fatigue are common in malnutrition."

ANS: B The priority client problem related to a surgical drain is the potential for infection. An insertion site that is free of redness, warmth, and drainage indicates that goals for this client problem are being met. The other assessments are normal, but not related to the drain.

ANS: B The entire proposed surgical site needs to be washed thoroughly and completely with the antimicrobial soap. Shaving, if absolutely necessary, should be done in the operative suite immediately before the operation begins, using sterile equipment. The client needs a full shower or bath (shower preferred). The client should wash the surgical site last; dirty water from shampooing will run over the cleansed site if the site is washed first.

ANS: B In order to give informed consent, the client needs sufficient information. Questions about potential complications should be answered by the surgeon. The nurse should notify the surgeon to come back and answer the client's questions before the client signs the consent form. The other actions are not appropriate.

An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best? a. Answer the questions and document that teaching was done. b. Do not have the client sign the consent and call the surgeon. c. Have the client sign the consent, then call the surgeon. d. Remind the client of what teaching the surgeon has done.

ANS: A Older people have an age-related decrease in immune system functioning and may not show classic signs of infection such as increased white blood cell count, fever and chills, or obvious localized signs of infection. A change in behavior often signals an infection or onset of other illness in the older client.

An older client is hospitalized after an operation. When assessing the client for postoperative infection, the nurse places priority on which assessment? a. Change in behavior b. Daily white blood cell count c. Presence of fever and chills d. Tolerance of increasing activity

ANS: A The SCIP project contains core measures that are mandatory for all surgical clients and focuses on preventing infection, serious cardiac events, and venous thromboembolism. The managers should start by reviewing charts to see if the guidelines of this project were implemented. The other actions may be necessary too, but first the managers need to assess the situation.

The perioperative nurse manager and the postoperative unit manager are concerned about the increasing number of surgical infections in their hospital. What action by the managers is best? a. Audit charts to see if the Surgical Care Improvement Project (SCIP) outcomes were met. b. Encourage staff on both units to provide peer pressure to adhere to hand hygiene policy. c. Hold educational meetings with the nursing and surgical staff on infection prevention. d. Monitor staff on both units for consistent adherence to established hand hygiene practices.