Ch. 17: Preoperative Nursing Management PrepU
The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for? Restrictions of the patient's unassisted mobility activities A safe environment Probable cataract extractions Referral to an ophthalmologist
A safe environment
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? Deep breathing and coughing exercises should be completed every 8 hours. Pain medication should be taken before completing 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.
Splint the incision site using a pillow during deep breathing and coughing exercises.
A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia? corticosteroids diuretics insulin anticoagulants
diuretics
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? Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults. All older people face similar risks when undergoing surgeries. Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. Aging processes reduce the chances that surgery will be successful for these clients.
Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.
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? liver dysfunction nutrient deficiencies respiratory complications wound healing
wound healing
The nurse recognizes that which of the following clients is at least risk for perioperative complications? A 65-year-old Caucasian man who has a history of arthritis A 32-year-old African-American woman who takes prednisone A 76-year-old Asian man who takes clopidogrel A 45-year-old African-American man recently diagnosed with type 2 diabetes
A 65-year-old Caucasian man who has a history of arthritis
The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for? A safe environment Referral to an ophthalmologist Restrictions of the patient's unassisted mobility activities Probable cataract extractions
A safe environment
Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? Pituitary Adrenal Thyroid Parathyroid
Adrenal
A client refuses to remove her wedding band when preparing for surgery. What is the bestaction for the nurse to take? 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. Notify the surgeon to cancel surgery.
Allow the client to wear the ring and cover it with tape.
A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? Pregnancy Diabetes Urinary tract infection Osteoporosis
Osteoporosis
The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery? Knowledge of surgical procedure Types of postoperative pain medication Effective coughing and deep breathing Post-discharge diet
Post-discharge diet
When is the ideal time to discuss preoperative teaching When the patient is comfortable and sedated Prior to entering the pre-op area Preadmission visit Day of surgery
Preadmission visit
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. Removal of a diseased appendix Skin biopsy Mammoplasty Removal of a tumor Insertion of a gastrostomy tube
Removal of a tumor Removal of a diseased appendix
When does the nurse understand the patient is knowledgeable about the impending surgical procedure? The patient expresses concern about postoperative pain. The patient discusses stress factors causing the patient to feel depressed. The patient participates willingly in the preoperative preparation. The patient verbalizes fears to family.
The patient participates willingly in the preoperative preparation.
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse: continuously monitors the sedated client. assesses how well the client is recovering from anesthesia. performs a complete assessment of the client. obtains a surgical consent from the client's mother.
continuously monitors the sedated client.
A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for kidney stones the next day. What category of surgery does this procedure fall into? required emergent elective urgent
urgent
A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client? hypoglycemia obstruction surgical site infection adrenal insufficiency
adrenal insufficiency
During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse? Notify the dietary department. Notify the nurse manager to follow up on the procedure. Notify the surgical team to remove all latex-based items. Notify the physician regarding postoperative pain medications.
Notify the surgical team to remove all latex-based items.
A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for? Hypertension Glucosuria Hypoglycemia Dehydration
Hypoglycemia
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. Have the client void. Have client wear hospital gown. Remove all jewelry.
Allow the client to wear dentures.
Which question is most important for the nurse to ask the client when obtaining the preoperative admission history? "Did you bring any valuables with you?" "Who is here with you?" "When is the last time you ate or drank?" "Did you bring a copy of your health care power of attorney?"
"When is the last time you ate or drank?"
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? 1 to 2 months 3 weeks 2 weeks 3 to 4 months
1 to 2 months
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 weeks 4 weeks 2 to 3 days
7 to 10 days
The nurse expects informed consent to be obtained for insertion of: An indwelling urinary catheter A gastrostomy tube A nasogastric tube An intravenous catheter
A gastrostomy tube
A fractured skull would be classified under which category of surgery based on urgency? Required Urgent Elective Emergent
Emergent
A gunshot wound would be classified under which category of surgery based on urgency? Urgent Elective Required Emergent
Emergent
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? Placement of gastrostomy tube A face-lift Tumor excision A biopsy
Tumor excision
The nurse recognizes that the client most at risk for mortality associated with surgery is the: Client with controlled hypertension Client who is obese Client with chronic alcoholism Client with controlled diabetes
Client with chronic alcoholism
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. Causative Cosmetic Diagnostic Palliative Normative
Cosmetic Diagnostic Palliative
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? Ensure that sufficient surgical supplies are available. Review the scheduled procedure, site, and client. Confirm that informed consent has been obtained. Check that all surgical personnel are properly attired.
Review the scheduled procedure, site, and client.
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? Develops a plan of care Provides psychological support Completes preoperative assessment Verifies that operative consent is signed
Verifies that operative consent is signed
A physically fit older adult is scheduled for right knee replacement. What factor for the client creates an increased risk for postoperative complications? type of surgery ability to metabolize medication surgical site current smoking history
current smoking history
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as emergency. urgent. required. elective.
emergency
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? sodium 138 mEq/L potassium 6.2 mEq/L white blood cell count 7.2 cells/mm calcium 9.8 mg/dL
potassium 6.2 mEq/L
The patient asks the nurse why food is withheld before surgery. What is the best response by the nurse? "Infection may occur if food or fluid is taken prior to surgery." "Aspiration is a concern and can be a complication if food or fluid is taken close to the surgery time." "Distention is a severe complication if food or fluid is taken close to the surgery time." "Obstruction will occur if food or fluid is taken prior to surgery."
"Aspiration is a concern and can be a complication if food or fluid is taken close to the surgery time."
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? Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients. All older people face similar risks when undergoing surgeries. Aging processes reduce the chances that surgery will be successful for these clients. Neurologic and musculoskeletal complications are the leading cause of postoperative morbidity and mortality for older adults.
Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients
The nurse is preparing a client for surgery. The nurse would notify the surgeon if the client made which of the following statements? Select all that apply. "I took my lisinopril this morning." "I took two Tylenol last evening for a headache." "I took two aspirins for joint pain this morning." "I took my Coumadin as usual last evening." "I have not had any metformin for the past week."
"I took my Coumadin as usual last evening." "I took two aspirins for joint pain this morning."
Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? "You will be just fine; the operating room nurses will take good care of you." "We will keep your family informed of your progress." "It is best to take deep breaths and relax before the procedure." "Let me explain to you what will happen next."
"Let me explain to you what will happen next."
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? "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." "The physician will update my family after the procedure and provide specific discharge instructions." "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."
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? "Your child had life-threatening injuries that required immediate surgery." "Two doctors decided your child needed the surgery, therefore we did not need to get consent." "We obtained consent from your child after your child requested the surgery." "The surgical procedure being performed does not require consent."
"Your child had life-threatening injuries that required immediate surgery."
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? 300 to 350 mg/dL 150 to 240 mg/dL 80 to 110 mg/dL 250 to 300 mg/dL
80 to 110 mg/dL
A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results? A urine creatinine level of 1.2 mg/dL A blood urea nitrogen level of 42 mg/dL 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 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 insertion of an intravenous catheter An open reduction of a fracture Irrigation of the external ear canal
An open reduction of a fracture
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. Anxiety and fear can affect a client positively during and after surgery. Anxious clients have a poor response to surgery and are prone to complications. Anxious clients need psychological counseling after surgery.
Anxious clients have a poor response to surgery and are prone to complications.
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? Anxious clients need psychological counseling after surgery. Anxiety and fear can affect a client positively during and after surgery. Anxiety and fear increases the need for anesthesia and postoperative medications. Anxious clients have a poor response to surgery and are prone to complications.
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? Cheeseburger, french fries, coleslaw, and ice cream 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
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 postoperative phase During the transfer phase During the intraoperative phase During the preoperative phase
During the postoperative phase
At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period? At the time of discharge instructions Following the surgical procedure During the preoperative period 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
Informed consent from the surgical client is essential in all of the following categories of surgery except: Elective surgery Urgent surgery Required surgery Emergent surgery
Emergent surgery
The nurse is conducting a health history of a preoperative client. The client shares that she experienced vaginal itching and burning and labial swelling after her partner tried a new brand of condoms. The nurse suspects that the client: Is susceptible to the lubricant. Needs to change her position during intercourse. May have a sexually transmitted disease. May have a latex allergy.
May have a latex allergy.
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? Document the findings and continue moving the client through the preoperative phase. Wait 1 hour and complete the assessment again. Notify the primary physician about the assessment findings. Notify the surgeon to possibly delay the surgery.
Notify the surgeon to possibly delay the surgery.
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. Notify the surgeon. Document what foods the client ate. Cancel the surgery.
Notify the surgeon.
Regarding the surgical client, which phase refers to the period of time that spans the entire surgical experience? Preoperative Intraoperative Postoperative Perioperative
Perioperative
The nurse recognizes that written informed consent is required for insertion of a(n): Oral airway. Urinary catheter. Nasogastric tube. Peripherally-inserted central catheter.
Peripherally-inserted central catheter.
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? Place the side rails in the up position and make sure the call button is in reach. Have the family go to the waiting room. Take the client to the bathroom. Take the client's vital signs.
Place the side rails in the up position and make sure the call button is in reach.
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? Surgeon Registered nurse first assistant Anesthesiologist Circulating nurse
Surgeon
Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period? The 72-year-old client who takes no routine medications. The 28-year-old client who occasionally smoked marijuana in high school. The 35-year-old client with non-insulin dependent diabetes. The 47-year-old client who stopped smoking 2 years ago.
The 35-year-old client with non-insulin dependent diabetes.
Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period? The 72-year-old client who takes no routine medications. The 47-year-old client who stopped smoking 2 years ago. The 28-year-old client who occasionally smoked marijuana in high school. The 35-year-old client with non-insulin dependent diabetes.
The 35-year-old client with non-insulin dependent diabetes.
A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed? The client exhales forcefully with a short expiration. The client breathes in deeply through the nose and mouth. The client places the hands on the lower chest to feel the rise and fall with breathing. The client performs diaphragmatic breathing in a semi-Fowler's position.
The client exhales forcefully with a short expiration.
How does the nurse determine that the patient may have hidden fears about the impending surgical procedure? (Select all that apply.) The patient talks incessantly. The patient avoids communication with the nurse. The patient repeatedly asks questions that have previously been answered. The patient informs the nurse of problems with postoperative nausea in the past and that it was a bad experience. The patient tells the nurse of concerns with the outcome of the procedure.
The patient avoids communication with the nurse. The patient repeatedly asks questions that have previously been answered. The patient talks incessantly.
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? Make inhalation longer than exhalation. Use diaphragmatic breathing. Use chest breathing. Exhale through an open mouth.
Use diaphragmatic breathing.
The nurse is educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate? Intraoperative techniques used to perform the surgery Expected pain levels and narcotic medications used to treat the pain Risks and benefits of the surgical procedures Three phases of surgery and safety measures for each phase
Three phases of surgery and safety measures for each phase
Sudden withdrawal of which of the following may result in seizures? Steroids Thiazide diuretics Monoamine-oxidase inhibitors Tranquilizers
Tranquilizers
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 4 hours before surgery Up to 2 hours before surgery Up to 6 hours before surgery Up to 8 hours before surgery
Up to 2 hours before surgery
The nurse would identify which vitamin deficiency to prevent hemorrhaging during surgery? Vitamin K Magnesium Zinc Vitamin A
Vitamin K
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. physical condition age health status gender Ethnicity nutritional status
nutritional status age physical condition health status
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 intravenous fluids and other lines and tubes the surgeon's fee and other hospital charges
postoperative pain control cough and deep-breathing exercises intravenous fluids and other lines and tubes