Ch 29 periop practice questions - the point

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

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

The nurse is preparing for a client for laser procedure. Which nursing intervention is appropriate?

Apply goggles to client.

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

Apply pressure to the surgical site to decrease bleeding.

A client postoperative from an appendectomy reports feeling cold and has a temperature of 96.2°F (35.7°C). Which action should the nurse perform first?

Apply warm blankets to the client.

A nurse caring for patients in a PACU assesses a patient who is displaying signs and symptoms of shock. What is the priority nursing intervention for this patient?

Place the patient in a flat position with legs elevated 45 degrees.

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

witnessing the client signature with their consent for surgery

A client states he has a latex allergy. Which action should the nurse take?

Place an allergy identification band on the client.

The nurse is preparing a client for surgery and asks if the client has an advance directive. The client asks "What is an advance directive?" What is the nurse's best response to this?

"An advance directive will communicate your wishes for health care postoperatively in case you are unable to do so."

A client who came in through the emergency department with a severely fractured leg will be transported to surgery within the hour. When the client asks how long hospitalization will occur after surgery, what is the appropriate nursing response?

"Because you are having inpatient surgery, you will be at least 1 day after surgery."

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about leg exercises. When the client asks, "Why am I practicing leg exercises when I'm having hernia surgery", what is the appropriate nursing response?

"Doing this reduces your risk of developing blood clots."

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

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

The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about deep breathing. When the client asks, "Why am I practicing breathing when I'm having hernia surgery," what is the appropriate nursing response?

"It decreases the postoperative risk for respiratory complications."

The nurse has entered the room of a client who is postoperative day 1 and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of p.r.n. analgesia and, on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. How should the nurse respond to the client's concerns?

"Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery."

A postoperative client states "I don't understand why you are checking my skin on my back. My surgery was on my stomach." What is the nurse's best response?

"The operating table is a firm surface; we need to be sure your skin looks okay."

The nurse is talking with a client who wishes to have a tattoo removed. Which client statement indicates that the client understands how the procedure will be accomplished?

"The provider will perform this laser surgery in an ambulatory care setting."

A client is undergoing a knee replacement tomorrow morning. She is ordered nothing by mouth (n.p.o.) prior to surgery. She asks the nurse how long she can drink water prior to the procedure. Based on the nurse's knowledge of standard protocols, what is the nurse's best response?

2 hours

The nurse is obtaining a history from a client before surgery. Which areas would be important for the nurse to ask about to determine potential risk factors?

Alcohol use Support systems Current medications Previous surgeries

A 2-year-old toddler just underwent a tonsillectomy and adenoidectomy surgery. The postanesthesia care unit (PACU) nurse is checking on him. What is the best course of action regarding the developmental care of this child

Allow the parents into the PACU before the child wakes.

Which preoperative task can the nurse delegate to the UAP (unlicensed assistive personnel)?

Assisting the client to the bathroom before surgery

What is the best action for the nurse in determining return of peristalsis in the postoperative client?

Auscultate the bowel sounds.

The nurse is preparing a client for a colonoscopy. The nurse is familiar with the colonoscopy procedures at the hospital and is aware that which type of anesthesia is commonly used for this procedure?

Conscious sedation

A pediatric nurse is preparing a child for cleft palate repair surgery. The nurse recognizes that this type of surgery is categorized as which of the following?

Constructive surgery

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

Dehiscence

Ames is an 87-year-old man who underwent a hip replacement today. He is telling the nurse that his parents, who are deceased, are coming to visit him today. He continues to tell the nurse that he needs to cut the lawn and run errands. The last time the nurse entered the room, Ames was trying to climb over the bed rail. Which term best describes Ames' condition?

Delirium

A client is undergoing surgery for an appendectomy. This would be considered what type of surgery?

Emergency surgery

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

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

Which fact should the nurse keep in mind when obtaining consent forms from clients scheduled to undergo surgery?

In emergency situations, the doctor may obtain consent over the telephone.

The nurse-anesthetist is monitoring the client during surgery. He notices a ventricular dysrhythmia and unstable blood pressure. He notifies the surgeon. The operative team suspects:

Malignant hyperthermia

After a client receives morphine sulfate for pain in the postanesthesia care unit (PACU), which assessment finding would the nurse obtain as a priority?

Measure respiratory rate.

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

Monitor the client closely and promote fluid intake.

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

Notify the physician of the oversight.

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

Paralytic ileus

Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?

Place graduated compression stockings on the client.

A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client?

Place the client in semi-Fowler's position.

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

Preoperative

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

Procedural pause (time-out)

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

Relaxation techniques

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

Respiratory obstruction

The nurse is caring for a confused elderly client who requires surgery for a broken hip. Which nursing intervention regarding consent is appropriate?

Seek someone with durable power of attorney to sign the informed consent form.

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

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

Which personnel are legally responsible for obtaining the client's informed consent for a surgical procedure?

The surgeon

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

This is an expected finding in the immediate postoperative period.

A nurse assists a client with leg exercises. What condition does this intervention help to prevent?

Thrombophlebitis

The nurse is taking a history on Kumar, who informs her that he has an allergy to adhesive tape. When the nurse asks Kumar to describe his reaction to the tape, he describes it as "blotchy and reddened." What type of allergic reaction is this?

Type IV

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

Void normally

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

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

Which client would a nurse monitor most closely for postoperative respiratory complications?

a 55 year old client with a history of asthma who had a colon resection

Surgery can lead to hypothermia. Which client is at greatest risk for hypothermia?

an older adult man with a fractured hip

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

before, during, and after the operative phase.

The nurse is caring for a client who had an outpatient procedure. Which assessment finding indicates to the nurse that the client may be ready for discharge to home?

blood pressure 118/70 mm Hg, respirations 18 breaths per minute

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

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

A client scheduled for surgery has been taking aspirin since his heart attack in 1997. The client is at risk for:

hemorrhage.

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

massages legs prior to application

What is the rationale for having the client void before surgery?

to prevent bladder distention

A client is undergoing conscious sedation for an endoscopy. When the client becomes overly sedated, which medication does the nurse anticipate will be required?

naloxone

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

partial airway obstruction.

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

prevent anxiety.

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

prior to surgery

When educating a client in the postoperative period, it is important to educate the client to consume a diet high in:

protein.

A nurse is caring for an infant who is postoperative following cardiac surgery. What is the most common postoperative complication found in this age group?

respiratory complications

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

slow wound healing

When reviewing a client's history prior to surgery to correct a wrist fracture, which factors does the nurse identify that place the client at a higher risk for perioperative complications? Select all that apply.

smokes cigarettes, ½ pack per day skin turgor 4 seconds

A client in the immediate postoperative period begins to report nausea and ultimately begins vomiting. The nausea and vomiting are most likely related to:

the effects of anesthetic agents.

The nurse recognizes that palliative surgery is performed for what purpose?

to lessen the intensity of an illness

A surgical client has been ordered a dose of IV cephalosporin. Why is it important that this drug be administered as close as possible to the time of surgery?

to maximize serum levels of the medication during surgery.