Chapter 17, 18, 19: Preoperative, Intraoperative, Postoperative

A client asks the nurse about possible ill effects from general anesthesia. What is the best response by the nurse?

"Some possible negative effects include difficulty waking up and slow heart rate."

The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response?

"The anesthetic may last for 3 hours."

A PACU nurse is caring for a postoperative client who received general anesthesia and has a hard, plastic oral airway in place. The patient has clear lung sounds, even and unlabored respirations of 16, and 98% oxygen saturation. The client is minimally responsive to painful stimuli. What action by the nurse is most appropriate?

Continue with frequent client assessments.

Which is the most common cause of anaphylaxis?

Medications

What is an example of an intravenous anesthetic that is a hypnotic and produces excellent amnesia?

Midazolam

The surgical client is at risk for injury related to positioning. Which of the following clinical manifestations exhibited by the client would indicate the goal was met of avoiding injury?

Peripheral pulses palpable

What complication is the nurse aware of that is associated with deep venous thrombosis?

Pulmonary embolism

Sudden withdrawal of which of the following may result in seizures?

Tranquilizers

The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician?

When the patient's blood ammonia concentration reaches 180 mg/dL

Using the PACU room scoring guide, a nurse would give a patient an admission cardiovascular score of 2 if the patient's blood pressure is what percentage of his or her preanesthetic level?

20% The patient would receive a cardiovascular/circulation score of 2 if the blood pressure is 20% of the preanesthetic level.

The nurse is caring for a client in the postanesthesia care unit (PACU). The client has the following vital signs: pulse 115, respirations 20, oral temperature 97.2°F, blood pressure 84/50. What should the nurse do first?

Assess for bleeding.

A nurse is caring for a client with a chest tube connected to a dry suction water seal drainage system. The nurse notes 2cm of water and intermittent bubbling in the water seal chamber. Which action will the nurse take?

Document the findings.

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:

Circulating nurse

During the preoperative assessment, the nurse learns that the client has been taking prednisone. The nurse realizes that the client is at risk for:

Cardiovascular collapse.

To prevent pneumonia and promote the integrity of the pulmonary system, an essential postoperative nursing intervention includes:

Ambulating the client as soon as possible

A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention?

Mask is placed over nose and extends to bottom lip.

Following diagnostic testing, a patient requires a cholecystectomy. This surgical procedure would be categorized as which of the following?

Urgent

A patient who has received general anesthesia has reached stage II. Which of the following would the nurse expect the patient to exhibit?

Pupillary dilation and rapid pulse

Which is a classic sign of hypovolemic shock?

Pallor The classic signs of hypovolemic shock are pallor, rapid, weak thready pulse, low blood pressure, and rapid breathing

The nurse is planning care for a client following abdominal surgery. Which outcome demonstrates a return of functioning to the gastrointestinal tract?

The client reports a small bowel movement.

The nurse is educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate?

Three phases of surgery and safety measures for each phase

A nurse is reviewing the medical record of a patient who is to receive general anesthesia and notes a nursing diagnosis of anxiety related to surgical concerns. The nurse implements measures to reduce the patient's anxiety based on the understanding of which of the following?

Increased anxiety can increase the patient's postoperative pain level.

A nurse is caring for a client in the PACU after surgery requiring general anesthesia. The client tells the nurse, "I think I'm going to be sick." What is the primary action taken by the nurse?

Position the client in the side-lying position.

Adequate hourly urine output for a client with an indwelling urinary catheter is

2.0 mL/kg/h.

A postoperative client is being discharged home after minor surgery. The PACU nurse is reviewing discharge instructions with the client and the client's spouse. What actions by the nurse are appropriate? Select all that apply.

Educate on activity limitations. Discuss wound care. Have the spouse review when to notify the physician. Provide information on health promotion topics.

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as

Emergency

Informed consent from the surgical client is essential in all of the following categories of surgery except:

Emergent surgery

When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate?

Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff

During the first 24 hours after surgery, how often will the nurse evaluate the client's temperature?

Every 4 hours

A client taking chlorpromazine is preparing to undergo surgery. Which of the following complications does the surgical team need to prepare to deal with before anesthetics are administered?

Hypotension

What complication in the immediate postoperative period should the nurse understand requires early intervention to prevent?

Hypoxemia and hypercapnia

The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of:

Hypoxemia and hypercapnia.

When planning care for a client in the postoperative period, prioritize nursing diagnoses in the sequence from highest to lowest priority?

Impaired Gas Exchange Fluid Volume Deficit Altered Comfort Anxiety Risk for Infection

The nurse is caring for a postoperative client with an indwelling urinary catheter. The hourly urinary output is 80 mL at 9 am. At 10 am, the nurse assesses the hourly urinary output as 20 mL. What is the priority action by the nurse?

Notify the primary care provider immediately.

A patient is scheduled for a reduction mammoplasty. What classification of surgery does the nurse understand that this is?

Optional

On postoperative day 2, a client requires care for a surgical wound using second-intention healing. What type of dressing change should the nurse anticipate doing?

Packing the wound bed with sterile saline-soaked dressing and covering it with a dry dressing

Nursing assessment findings reveal a temperature of 96.2°F, pulse oximetry 90%, shivering, and client complains of chilling. Which of the following actions by the nurse would be inappropriate?

Restrict oral fluids.

When is the ideal time to discuss preoperative teaching

Preadmission visit

A nurse is reviewing the medications of a postoperative client. What medication related to the recent surgery may be of concern to the nurse?

Prednisone

The scrub nurse is responsible for:

Preparing the sterile instruments for the surgical procedure

The nurse cares for a client who is three hours post op abdominal hysterectomy and begins to develop hiccups. What nursing assessment will the nurse monitor more closely with the client's new symptoms?

Wound approximation

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.

nutritional status age physical condition health status

Which findings would be indicative of a nursing diagnosis of decreased cardiac output?

tachycardia; hemoglobin 10.9 gm/dL; BP 88/56

A client develops a hemorrhage one hour post surgery. The nurse knows this is most likely an intermediary hemorrhage from a vein because it occurred:

within the first few hours, and has darkly colored blood that flows quickly.

A novice nurse provides aftercare instructions to a client who has just had sutures removed. Which statement by the novice nurse requires the nurse preceptor to clarify?

"If the wound edges are red or raised, you should call your doctor."

The nurse suspects the client is developing postoperative pneumonia. Which clinical manifestation would support the nurse's conclusion? Select all that apply.

Chills Crackles Tachypnea

The client is experiencing intractable hiccups following surgery. What would the nurse expect the surgeon to order?

Chlorpromazine (Thorazine) is used to treat intractable hiccups.

A nurse is caring for a client who is scheduled to have a thoracotomy. When planning care for this client, what mobility teaching will the nurse include in the plan of care?

Shoulder and upper arm range-of-motion exercises

When the nurse observes that a postoperative client demonstrates a constant low level of oxygen saturation, although the patient's breathing appears normal, the nurse identifies that the patient may be suffering from which type of hypoxemia?

Subacute

A client is postoperative day 3 after surgical repair of an open abdominal wound and traumatic amputation of the right lower leg following a motorcycle crash. What is the highest priority nursing intervention?

Assessing WBC count, temperature, and wound appearance

Which statement by the client indicates further teaching about epidural anesthesia is necessary?

"I will become unconscious."

After teaching a patient scheduled for ambulatory surgery using moderate sedation, the nurse determines that the patient has understood the teaching based on which of the following statements?

"I'll be sleepy but able to respond to your questions."

What is the most important postoperative instruction a nurse must give to a client who has just returned from the operating room after receiving a subarachnoid block?

"Remain supine for the time specified by the physician."

A client asks the nurse how an inhalant general anesthesic is expelled by the body. What is the best response by the nurse?

"The lungs primarily eliminate the anesthesia."

A new scrub technician is being oriented to the operating room. The scrub technician states to the nurse, "You can skip the fire safety information because I have worked in hospitals for the past 10 years." What is the best response by the nurse?

"The operating room has some unique circumstances that increases the chances of fire."

A nurse is teaching a client who is at risk for malignant hyperthermia subsequent to general anesthesia. What should the nurse include in the teaching?

"The surgical team is aware of the risk, so the team is prepared."

Which question is most important for the nurse to ask the client when obtaining the preoperative admission history?

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

A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate?

"You will be lying on your side with your knees to your chest."

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

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

7

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?

80 to 110 mg/dL

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 patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?

A blood urea nitrogen level of 42 mg/dL

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?

A safe environment

Sudden withdrawal of which of the following may result in seizures?

Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly.

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 have a poor response to surgery and are prone to complications.

A client undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The client is ready for rewarming procedures. Which action by the nurse is appropriate?

Apply a warm air blanket, gradually increasing body temperature.

The nurse is aware that which of the following helps to stimulate T-cell response:

Arginine

Which intervention should the nurse plan to implement to decrease the client's risk for injury during the intraoperative period?

Assess the client for allergies.

A nurse is reviewing the intraoperative record of a patient who has just returned from surgery. The patient received general anesthesia with intravenous agents. Which of the following would the nurse identify as a nondepolarizing muscle relaxant?

Atracurium

The nurse has just admitted a 12-year-old client who is going to have an above-the-knee amputation of their left leg due to osteosarcoma. The nurse knows that adequate preoperative teaching and learning is important for what reason?

Client will have a shorter recovery period.

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.

Cosmetic Diagnostic Palliative

Nursing assessment findings reveal urinary output < 30 ml/hr, tachycardia, tachypnea, decreased hemoglobin, and acute confusion. The findings are indicative of which nursing diagnosis?

Decreased cardiac output

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

What action by the nurse best encompasses the preoperative phase?

Educating clients on signs and symptoms of infection

A gunshot wound would be classified under which category of surgery based on urgency?

Emergent

Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic?

Halothane is an example of an inhalation anesthetic. Fentanyl, succinylcholine, and propofol are commonly used intravenous agents for anesthesia.

Which of the following nursing activities would not be part of the preoperative phase of care? Select all that apply.

Ensuring that the sponge, needle, and instrument counts are correct Administering medications, fluid, and blood component therapy, if prescribed

A client requires minor surgery for removal of a basal cell tumor. The anesthesiologist administers the anesthetic ketamine hydrochloride. What effects should the nurse monitor the client for after the administration? Select all that apply.

Hallucinations Respiratory depression

The nurse is planning care for a client in the postoperative period. Place the following nursing diagnoses in sequence, from highest to lowest priority.

Impaired Gas Exchange Fluid Volume Deficit Altered Comfort Anxiety Risk for Infectionstruve

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?

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?

Notify the surgeon.

During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse?

Notify the surgical team to remove all latex-based items. Allergies to avocados and bananas may indicate an allergy to latex.

A client is administered succinylcholine and propofol for induction of anesthesia. One hour after administration, the client demonstrates muscle rigidity with a heart rate of 180. What should the nurse do first?

Notify the surgical team.

A list of commonly used medications for a particular surgical procedure is provided to the nurse. The anesthesiologist announces the administration of a nondepolarizing muscle relaxant. Which medication should the nurse document as having been administered?

Pancuronium is a nondepolarizing muscle relaxant

An intravenous anesthetic that, in large doses, has a powerful respiratory depressant effect sufficient to cause apnea and cardiovascular depression is:

Pentothal Thiopental sodium (Pentothal) is commonly used for induction anesthesia. It may cause laryngospasm. Large doses can cause apnea and cardiovascular depression.

A patient is scheduled for surgery with spinal anesthesia. When explaining this type of anesthesia to the patient, which body area would the nurse describe as being affected first?

Perineum

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.

The circulating nurse is unsure whether proper technique was followed when an object was placed in the sterile field during a surgical procedure. What is the best action by the nurse?

Remove the entire sterile field from use.

A 76-year-old client had surgery for an abdominal hernia. The PACU nurse observes that the client is confused and is trying to climb out of the bed and pull at the cardiac monitor lines. At this time, what interventions by the nurse are appropriate? Select all that apply.

Reorient the client. Assess for hypoxia. Assess urine output.

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.

The nurse recognizes that the client who takes hydrochlorothiazide to manage hypertension is predisposed for which interaction with anesthesia?

Respiratory depression

As a nurse working in an ambulatory surgery center, you are admitting a client who is going to have a biopsy of a skin lesion. What is an important part of the preoperative process?

Review preoperative instructions.

A postanesthesia care unit (PACU) nurse is preparing to discharge a client home following ankle surgery. The client keeps staring at the ceiling while being given discharge instructions. What action by the nurse is appropriate?

Review the instructions with the client and an accompanying adult.

The physician is concerned about aspiration during a surgical procedure and orders a medication to increase gastric pH. Which medication would the nurse document as being administered?

Sodium citrate Sodium citrate increases gastric pH, thereby reducing damage to the respiratory tract if aspiration should occur. Vecuronium is a muscle relaxant, famotidine decreases gastric acid production, and midazolam is an anesthetic agent.

The surgical client has been intubated and general anesthesia has been administered. The client exhibits cyanosis, shallow respirations, and a weak, thready pulse. The nurse recognizes that the client is in which stage of general anesthesia?

Stage IV medullary depression is characterized by shallow respirations, a weak, thready pulse, dilated pupils that do not react to light, and cyanosis.

Which clinical manifestation is often the earliest sign of malignant hyperthermia?

Tachycardia (heart rate >150 beats per minute)

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply.

The client will leave the hospital sooner than in the past. Need for teaching is increased. The client must be prepared to take on more self-care than he or she may have done in the past

A perioperative nurse is conducting an in-service education program about maintaining surgical asepsis during the intraoperative period. Which of the following would the nurse emphasize?

The edges of a sterile package, once opened, are considered unsterile.

What action during a surgical procedure requires immediate intervention by the circulating nurse?

The scrub nurse calling the blood bank to obtain blood products

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

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

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

Use diaphragmatic breathing.

A client had a nephrectomy 2 days ago and is now complaining of abdominal pressure and nausea. The first nursing action should be to:

auscultate bowel sounds.

When the surgeon performs an appendectomy, the nurse recognizes that the surgical category will be identified as

clean contaminated.

Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care:

may result in the administration of general anesthesia.

A client is to receive general anesthesia with sevoflurane. What does the nurse anticipate would be given with the inhaled anesthesia?

oxygen Sevoflurane is an inhalation anesthetic always combined with oxygen to decrease the risk of coughing and laryngospasm.

The nurse is teaching the client about patient-controlled analgesia. Which of the following would be appropriate for the nurse to include in the teaching plan?

therapeutic drug levels can be maintained more evenly with patient-controlled analgesia.

Which of the following medications may increases the hypotensive action of anesthesia?

Chlorpromazine Chlorpromazine (Thorazine) may increase the hypotensive action of anesthetics. Prednisone (Deltasone) may cause cardiovascular collapse and should be discontinued immediately. Warfarin (Coumadin) can increase the risk of bleeding during the intraoperative and postoperative periods. Hydrochlorothiazide (HydroDIURIL) may cause respiratory depression resulting from an associated electrolyte imbalance during anesthesia.

The nurse recognizes the client has reached stage III of general anesthesia when the client:

Has small pupils that react to light

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.

A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications?

Osteoporosis

In what phase of postanesthesia care (PACU) is the client prepared for self-care or care in the hospital or an extended care setting?

Phase II PACU In some hospitals and ambulatory surgical centers, postanesthesia care is divided into three phases. In the phase I PACU, used during the immediate recovery phase, intensive nursing care is provided. In the phase II PACU, the patient is prepared for self-care or care in the hospital or an extended care setting. In phase III PACU, the patient is prepared for discharge. There is no phase IV PACU.

A postoperative client is experiencing a flash pulmonary edema. What finding in the client's sputum is consistent with this problem?

Pink color Flash pulmonary edema that occurs when protein and fluid accumulate in the alveoli unrelated to elevated pulmonary artery occlusive pressure. Signs and symptoms include agitation, tachypnea, tachycardia, decreased pulse oximetry readings, frothy, pink sputum, and crackles on auscultation.

A nurse documents the presence of granulation tissue in a healing wound. Which of the following is the best description for the tissue?

Pink to red and soft, noting that it bleeds easily

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.

Which of the following clinical manifestations increase the risk for evisceration in the postoperative client?

Valsalva maneuver: produces tension on abdominal wounds, which increases the risk for evisceration.

Which intervention should the nurse implement during the intraoperative period to protect the client from injury? Select all that apply.

Verify scheduled procedure with client. Assess the client for allergies. Confirm the consent form is signed.

The nurse's assessment of a postop client reveals a temperature of 103.2°F, tachycardia, and client complaints of increased incisional pain. What does the nurse recognize that this client is experiencing?

Wound infection Clinical manifestations of a wound infection include fever, tachycardia, an elevated white blood cell count, and increased incisional pain.

A nurse is caring for a client who underwent a skin biopsy and has three stitches in place. This wound is healing by:

Wounds with a small amount of tissue damage that are the result of procedures that use sterile technique and that are properly closed, such as with stitches, heal by first intention. Granulation tissue is generally not visible and scar formation is minimal. Second intention healing occurs in infected wounds or wounds with edges that aren't approximated. These wounds are usually packed with moist dressings. Third intention healing occurs with deep wounds that aren't sutured together, resulting in a deep, wide scar. There is no fourth intention of wound healing.