Chapter 14: Preoperative Nursing Management
A clinic nurse is conducting a preoperative interview with an adult client who will soon be scheduled to undergo cardiac surgery. What interview question most directly addresses the client's safety?
"What prescription and nonprescription medications do you currently take?"
A nurse in the preoperative holding area is admitting a woman prior to reduction mammoplasty. What should the nurse include in the care given to this client? Select all that apply.
Establishing an IV line, Verifying the surgical site with the client, Taking measures to ensure the client's comfort
The nurse is planning the care of a client who has type 1 diabetes and who will be undergoing knee replacement surgery. This client's care plan should reflect an increased risk of what postsurgical complication(s)? Select all that apply.
Hypoglycemia, Acidosis, Glucosuria
The nurse is providing preoperative teaching to a client scheduled for hip replacement surgery in 1 month. During the preoperative teaching, the client gives the nurse a list of medications the client takes, along with their dosage and frequency. What intervention provides the client with the most accurate information?
Instruct the client to stop taking St. John's wort at least 2 weeks prior to surgery due to its interaction with anesthetic agents.
The PACU nurse is caring for a client who had minimally invasive knee surgery. Which actions are the responsibility of the nurse in the PACU? Select all that apply.
Monitoring the safe recovery from anesthesia, Answering family questions about recovery, Providing light nourishment, Assessing the operative site for hemorrhage
A client is on call to the OR for an aortobifemoral bypass and the nurse administers the prescribed preoperative medication. After administering a preoperative medication to the client, what should the nurse do?
Place the bed in a low position with the side rails up.
A 90-year-old client is scheduled to undergo surgery. Prevention of which potential complication should the nurse prioritize when planning this client's postoperative care?
Pneumonia due to reduced respiratory reserve
The nurse is doing preoperative client education with a client who has a 40 pack-year history of cigarette smoking. The client will undergo an elective bunionectomy at a time that fits his work schedule in a few months. What would be the best instruction to give to this client?
Stop smoking as soon as possible before the scheduled surgery to enhance pulmonary function and decrease infection.
The nurse is caring for a client who anticipates pain and anxiety following surgery. Which intervention should the nurse implement in the postoperative period to reduce the client's pain and anxiety?
Use guided imagery along with pain medication.
The nurse is performing a preadmission assessment of a client scheduled for a bilateral mastectomy. The nurse should recognize which purpose as a valid reason for preadmission assessment?
Verifies completion of preoperative diagnostic testing
A client's coronary artery bypass graft has been successful, and discharge planning is underway. When planning the client's subsequent care, the nurse should know that the postoperative phase of perioperative nursing ends at what time?
When a follow-up evaluation in the clinical or home setting is done
The nurse is caring for a trauma victim in the ED who will require emergency surgery due to injuries. Before the client leaves the ED for the OR, the client goes into cardiac arrest. The nurse assists in a successful resuscitation and proceeds to release the client to the OR staff. When can the ED nurse perform the preoperative assessment?
When assisting with the resuscitation
A client is admitted to the ED reporting severe abdominal pain and vomiting "coffee-ground" like emesis. The client is diagnosed with a perforated gastric ulcer and is informed that they need surgery. When can the client most likely anticipate that the surgery will be scheduled?
Without delay
The admitting nurse in a short-stay surgical unit is responsible for numerous aspects of care. What must the nurse verify before the client is taken to the preoperative holding area?
That preoperative teaching was performed
The nurse is admitting a client who is insulin dependent to the same-day surgical suite for carpal tunnel surgery. How should this client's diagnosis of type 1 diabetes affect the care that the nurse plans?
The nurse should assess the client's blood glucose levels frequently.
The nurse in the preoperative area places a warmed blanket on a client. Which reason does the nurse give the client for this action?
The risk of bleeding is increased with hypothermia.
The nurse is providing preoperative teaching to a client scheduled for surgery. The nurse is instructing the client on the use of deep breathing, coughing, and the use of incentive spirometry when the client states, "I don't know why you're focusing on my breathing. My surgery is on my hip, not my chest." What rationale for these instructions should the nurse provide?
To promote optimal lung expansion
The nurse is preparing a client for surgery prior to her hysterectomy without oophorectomy. The nurse is witnessing the client's signature on a consent form. Which comment by the client would best indicate informed consent?
"The health care provider is going to remove my uterus and told me about the risk of bleeding."
One of the things a nurse has taught to a client during preoperative teaching is to have nothing by mouth for a specified time before surgery. The client asks the nurse why this is important. What is the most appropriate response for the client?
"You will need to have food and fluid restricted before surgery so you are not at risk for aspiration."
The nurse in preadmission testing is educating a client about a scheduled surgery. Which response should the nurse give when the client asks about pain management following surgery?
"Your nurse will use a pain assessment scale to help rate and treat your pain."
The nurse is planning teaching for a client who is scheduled for an open hemicolectomy. The nurse intends to address the topics of incision splinting and leg exercises during this teaching session. When is the best time for the nurse to provide teaching?
As soon as possible, and before the surgical procedure
The nurse is preparing a client for surgery. The client reports being nervous and not really understanding the surgical procedure or its purpose. What is the most appropriate action for the nurse to take?
Call the health care provider to review the procedure with the client.
The surgical nurse is preparing to send a client from the presurgical area to the OR and is reviewing the client's informed consent form. What are the criteria for legally valid informed consent? Select all that apply.
Consent must be freely given, Consent must be obtained by a health care provider, Signature must be witnessed by a professional staff member.
The nurse is caring for a client who is admitted to the ER with the diagnosis of acute appendicitis. The nurse notes during the assessment that the client's ribs and xiphoid process are prominent. The client reports exercising two to three times daily, and the client's parent indicates that the client is being treated for anorexia nervosa. How should the nurse best follow up on these assessment data?
Facilitate a detailed analysis of the client's electrolyte levels.
The nurse is performing a preoperative assessment on a client going to surgery. The client reports to the nurse drinking approximately two bottles of wine each day for the last several years. What postoperative difficulties should the nurse anticipate for this client?
Increased risk for postoperative complications
The clinic nurse is doing a preoperative assessment of a client who will be undergoing outpatient cataract surgery with lens implantation in 1 week. While taking the client's medical history, the nurse notes that this client had a kidney transplant 8 years ago and that the client is taking immunosuppressive drugs. For what is this client at increased risk when having surgery?
Infection
The nurse is creating the care plan for a 70-year-old obese client who has been admitted to the postsurgical unit following a colon resection. This client's age and body mass index increase the risk for what complication in the postoperative period?
Infection
A nurse is providing preoperative teaching to a client who will soon undergo a cardiac bypass. The nurse's teaching plan includes exercises of the extremities. What is the purpose of teaching a client leg exercises prior to surgery?
Leg exercises improve circulation and prevent venous thrombosis.
An OR nurse will be participating in the intraoperative phase of a client's kidney transplant. What action will the nurse prioritize in this aspect of nursing care?
Monitoring the client's physiologic status
The nurse is caring for a hospice client who is scheduled for a surgical procedure to reduce the size of a spinal tumor in an effort to relieve pain. The nurse should plan this client care with the knowledge that this surgical procedure is classified as which of the following?
Palliative
The nurse in preadmission testing learns that a client scheduled for a total hip replacement in three weeks smokes one pack of cigarettes per day. Which action(s) should the nurse take? Select all that apply.
Notify the surgeon that the client is a cigarette smoker., Encourage smoking cessation before surgery, Explain the increased risk for venous thromboembolism after surgery., Provide resources for smoking cessation
During the care of a preoperative client, the nurse has given the client a preoperative benzodiazepine. The client is now requesting to void. What action should the nurse take?
Offer the client a bedpan or urinal.
A client is scheduled for a bowel resection in the morning and the client's orders are for a cleansing enema be administered tonight. The client wants to know why this is necessary. The nurse should explain that the cleansing enema will have what therapeutic effect?
Preventing potential contamination of the peritoneum
The ED nurse is caring for an 11-year-old brought in by ambulance after having been hit by a car. The child's parents are thought to be en route to the hospital but have not yet arrived. No other family members are present, and attempts to contact the parents have been unsuccessful. The child needs emergency surgery to survive. How should the need for informed consent be addressed?
Surgery should be done without informed consent.
The nurse is caring for an unconscious trauma client who needs emergency surgery. The client has an adult child, is legally divorced, and is planning to marry a partner in a few weeks. The client's parents are at the hospital with the other family members. The health care provider has explained the need for surgery, the procedure to be done, and the risks to the child, the parents, and the partner. Who should be asked to sign the surgery consent form?
The child
The nurse is checking the informed consent for an older adult client who requires surgery and who has recently been diagnosed with Alzheimer disease. When obtaining informed consent, who is legally responsible for signing?
The client
In anticipation of a client's scheduled surgery, the nurse is teaching the client to perform deep breathing and coughing to use postoperatively. What action should the nurse teach the client?
The client should take a deep breath in through the mouth and exhale through the mouth, take a short breath, and cough from deep in the lungs.