Chapter 17 Preoperative Nursing Management
A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective? A.) "I will support my incision with my hands when I cough and do my deep breathing exercises." B.) "I will ask for pain medication when the pain becomes unbearable." C.) "I will need to learn how to give myself pain medication by injection for when I go home." D.) "The pain from my incision will be very similar to my arthritis pain."
Answer: A.) "I will support my incision with my hands when I cough and do my deep breathing exercises."
A client has been transported to the operating room for emergent surgery. Which statement by the nurse best supports the need for emergent surgery? A.) "The client was unresponsive, had a distended abdomen, and had unstable vital signs after a motor vehicle accident." B.) "The client had epigastric abdominal pain, an elevated white blood count, and vomiting for 1 day." C.) "The client had severe pain and a laceration to the face with minimal bleeding after being attacked by a dog 1 hour ago." D.) "The client was tachycardic, had progressive weight loss, and experienced bouts of insomnia as a result of hyperthyroidism."
Answer: A.) "The client was unresponsive, had a distended abdomen, and had unstable vital signs after a motor vehicle accident."
A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for? A.) Dehydration B.) Hypertension C.) Hypoglycemia D.) Glucosuria
Answer: C.) Hypoglycemia
A client asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate? A.) It prevents overhydration and hypertension. B.) It decreases urine output so that a catheter will not be needed. C.) It prevents aspiration and respiratory complications. D.) It decreases the risk of elevated blood sugar and slow wound healing.
Answer: C.) It prevents aspiration and respiratory complications.
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? A.) Ensure that sufficient surgical supplies are available. B.) Check that all surgical personnel are properly attired. C.) Review the scheduled procedure, site, and client. D.) Confirm that informed consent has been obtained.
Answer: C.) Review the scheduled procedure, site, and client. Rationale: According to the 2016 National Patient Safety Goals, accurate identification of the client, procedure, and operative site is essential.
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 Coumadin as usual last evening." - "I took two Tylenol last evening for a headache." - "I have not had any metformin for the past week." - "I took my lisinopril this morning." - "I took two aspirins for joint pain this morning."
Answer: - "I took my Coumadin as usual last evening." - "I took two aspirins for joint pain this morning." Rationale: The nurse needs to alert the surgeon to any medications the client has taken that increase the client's risk for bleeding. Aspirin inhibits platelet aggregation and should be stopped at least 7 to 10 days prior to surgery. Coumadin (warfarin) interferes with the synthesis of vitamin K-dependent clotting factors. The type of surgical procedure and the medical condition of the client determine when the Coumadin should be stopped prior to 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? A.) Notify the surgeon. B.) Document what foods the client ate. C.) Give the client plenty of water to aid digestion. D.) Cancel the surgery.
Answer: A.) Notify the surgeon.
The client is scheduled for a biopsy for suspected cancer of the prostate. The nurse recognizes the purpose of this surgical procedure is: A.) Curative B.) Diagnostic C.) Palliative D.) Reparative
Answer: B.) Diagnostic
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? A.) 1 B.) 3 C.) 5 D.) 7
Answer: D.) 7
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? A.) An insertion of an intravenous catheter B.) Irrigation of the external ear canal C.) Urethral catheterization D.) An open reduction of a fracture
Answer: D.) An open reduction of a fracture
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 - gender - health status - Ethnicity
Answer: - nutritional status - age - physical condition - health status
You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply? A.) "Many people have diagnostic or short therapeutic surgical procedures." B.) "Lots of people have cancer and need tumors removed." C.) "You know, we have a lot of sick people in the world." D.) "Not everyone has to go to the hospital to have surgery anymore."
Answer: A.) "Many people have diagnostic or short therapeutic surgical procedures."
Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? A.) Pituitary B.) Adrenal C.) Thyroid D.) Parathyroid
Answer: B.) Adrenal RATIONALE: Clients who have received corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids does not occur in the pituitary, thyroid, or parathyroid glands.
The nurse is completing a preoperative assessment. The nurse notices the client is tearful and constantly wringing their hands. The client states, "I'm really nervous about this surgery. Do you think it will be ok?" What is the nurse's best response? A.) "You have nothing to worry about; you have the best surgical team." B.) "No one has ever died from the procedure you are having." C.) "What family support do you have after the surgery?" D.) "What are your concerns?"
Answer: D.) "What are your concerns?"
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? A.) obstruction B.) surgical site infection C.) hypoglycemia D.) adrenal insufficiency
Answer: D.) adrenal insufficiency
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? A.) sodium 138 mEq/L B.) calcium 9.8 mg/dL C.) white blood cell count 7.2 cells/mm D.) potassium 6.2 mEq/L
Answer: D.) potassium 6.2 mEq/L
When is the ideal time to discuss preoperative teaching A.) Preadmission visit B.) Day of surgery C.) Prior to entering the pre-op area D.) When the patient is comfortable and sedated
Answer: A.) Preadmission visit
The nurse expects informed consent to be obtained for insertion of: A.) An indwelling urinary catheter B.) An intravenous catheter C.) A gastrostomy tube D.) A nasogastric tube
Answer: C.) A gastrostomy tube Rationale: Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.
Regarding the surgical client, which phase refers to the period of time that spans the entire surgical experience? A.) Preoperative B.) Intraoperative C.) Postoperative D.) Perioperative
Answer: D.) Perioperative Rationale: Perioperative period includes the preoperative, intraoperative, and postoperative phases. The preoperative phase is the period of time from when the decision for surgical intervention is made to when the client is transferred to the operating room. The intraoperative phase is the period of time from when the client is transferred to the operating room to when he or she is admitted to the postanesthesia care unit. The postoperative phase is the period of time that begins with the admission of the client to the postanesthesia care unit and ends after a follow-up evaluation in the clinical setting or home.
When does the nurse understand the patient is knowledgeable about the impending surgical procedure? A.) The patient participates willingly in the preoperative preparation. B.) The patient discusses stress factors causing the patient to feel depressed. C.) The patient expresses concern about postoperative pain. D.) The patient verbalizes fears to family.
Answer: A.) The patient participates willingly in the preoperative preparation.
A client is scheduled for a surgical procedure. When planning the client's care, the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery? A.) A history of diabetes B.) A history of sensitivity to aspirin C.) A history of osteoarthritis D.) A history of chronic low back pain
Answer: A.) A history of diabetes Rationale: As a chronic condition that affects many body systems, diabetes is a risk factor for surgical complications. The client's blood glucose level and insulin requirements need to be closely monitored before and after surgery. Being sensitive to aspirin does not pose a risk for the client in surgery. Osteoarthritis is not a systemic condition and does not place the client at risk during surgery. Chronic low back pain is not a systemic condition that places the client at risk during surgery; however, it can be exacerbated by positioning on the operating room table.
What action by the nurse best encompasses the preoperative phase? A.) Educating clients on signs and symptoms of infection B.) Documenting the application of sequential compression devices (SCDs) C.) Monitoring vital signs every 15 minutes D.) Shaving the client using a straight razor
Answer: A.) Educating clients on signs and symptoms of infection Rationale: Educating clients on preventing or recognizing complications begins in the preoperative phase. Applying SCDs and frequently monitoring vital signs happen after the preoperative phase. Only electric clippers should be used to remove hair.
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? A.) Splint the incision site using a pillow during deep breathing and coughing exercises. B.) Pain medication should be taken before completing deep breathing and coughing exercises. C.) Deep breathing and coughing exercises should be completed every 8 hours. D.) Deep breathing and coughing exercises may be used as relaxation techniques.
Answer: A.) Splint the incision site using a pillow during deep breathing and coughing exercises.
The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician? A.) When the patient's blood ammonia concentration reaches 180 mg/dL B.) When a lactate dehydrogenase concentration is 300 units C.) When a serum albumin concentration is 5.0 g/dL D.) When a serum globulin concentration reaches 2.8 g/dL
Answer: A.) When the patient's blood ammonia concentration reaches 180 mg/dL Rationale: The liver is important in the biotransformation of anesthetic compounds. Disorders of the liver may substantially affect how anesthetic agents are metabolized. Acute liver disease is associated with high surgical mortality; preoperative improvement in liver function is a goal. Careful assessment may include various liver function tests (see Chapter 49).
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse: A.) continuously monitors the sedated client. B.) performs a complete assessment of the client. C.) obtains a surgical consent from the client's mother. D.) assesses how well the client is recovering from anesthesia.
Answer: A.) continuously monitors the sedated client.
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as A.) emergency. B.) urgent. C.) required. D.) elective.
Answer: A.) emergency. RATIONALE: Emergency surgery means that the client requires immediate attention and the disorder may be life threatening. Urgent surgery means that the client requires prompt attention within 24 to 30 hours. Required surgery means that the client needs to have surgery, and it should be planned within a few weeks or months. Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic.
A client with a history of alcoholism is scheduled for urgent surgery. The client asks the nurse, "Why is everyone so concerned about how much I drink?" What is the best response by the nurse? A.) "The amount of alcohol you drink determines the amount of pain medication you will need postoperatively." B.) "It is important for us to know how much and how often you drink to help prevent surgical complications." C.) "It is a required screening question for all clients having surgery." D.) "We can have counselors available after surgery if it is determined you need help with your drinking."
Answer: B.) "It is important for us to know how much and how often you drink to help prevent surgical complications." Rationale: Alcohol use and alcoholism can contribute to serious postoperative complications. If the medical and nursing staff is aware of the use or abuse, measures can be implemented proactively to prevent complications. Although alcohol may interfere with a medication's effectiveness, it does not determine the amount of pain medications that are prescribed after surgery. Even though this is a required screening question and counselors can be made available for those who want help, those are not the best responses to answer the client's question.
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? A.) "If I do not follow the instructions, my surgery could be cancelled." B.) "The nurse will explain the details of the surgery before I sign a consent." C.) "My medical records will be sent to the ambulatory care center prior to my surgery." D.) "The physician will update my family after the procedure and provide specific discharge instructions."
Answer: B.) "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? A.) "Two doctors decided your child needed the surgery, therefore we did not need to get consent." B.) "Your child had life-threatening injuries that required immediate surgery." C.) "We obtained consent from your child after your child requested the surgery." D.) "The surgical procedure being performed does not require consent."
Answer: B.) "Your child had life-threatening injuries that required immediate surgery."
A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? A.) Discuss the risk for infection caused by wearing the ring. B.) Allow the client to wear the ring and cover it with tape. C.) Notify the surgeon to cancel surgery. D.) Remove the ring once the client is sedated.
Answer: B.) Allow the client to wear the ring and cover it with tape. Rationale: Most facilities will allow a client to wear a wedding band during a surgical procedure. The nurse must secure the ring with tape. Although it is appropriate to discuss the risk for infection, the client has already refused to remove the ring. The surgery should not be canceled and the ring should not be removed without permission.
The nurse recognizes that the client most at risk for mortality associated with surgery is the: A.) Client who is obese B.) Client with chronic alcoholism C.) Client with controlled diabetes D.) Client with controlled hypertension
Answer: B.) Client with chronic alcoholism Rationale: The client with chronic alcoholism who experiences alcohol withdrawal symptoms is at significant risk for mortality, which can be attributed to cardiac dysrhythmias, cardiomyopathy, and bleeding tendencies.
Informed consent from the surgical client is essential in all of the following categories of surgery except: A.) Elective surgery B.) Emergent surgery C.) Required surgery D.) Urgent surgery
Answer: B.) Emergent surgery
Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery? A.) Nurse B.) Physician C.) Case manager D.) Certified nurse's aide
Answer: B.) Physician
At what point does the preoperative period end? A.) When the decision is made to proceed with surgery B.) When the client is transferred onto the operating table C.) When the client is admitted to the PACU D.) When the client signs the consent form
Answer: B.) When the client is transferred onto the operating table
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? A.) corticosteroids B.) diuretics C.) insulin D.) anticoagulants
Answer: B.) diuretics Rationale: Diuretics during anesthesia may cause excessive respiratory depression resulting from an associated electrolyte imbalance. Corticosteroids, insulin, and anticoagulants are not known to cause respiratory depression during anesthesia.
Which nursing statement would best decrease a client's anxiety before an emergency operative procedure? A.) "You will be just fine; the operating room nurses will take good care of you." B.) "It is best to take deep breaths and relax before the procedure." C.) "Let me explain to you what will happen next." D.) "We will keep your family informed of your progress."
Answer: C.) "Let me explain to you what will happen next."
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? A.) 2 weeks B.) 4 weeks C.) 7 to 10 days D.) 2 to 3 days
Answer: C.) 7 to 10 days
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? A.) Make inhalation longer than exhalation. B.) Exhale through an open mouth. C.) Use diaphragmatic breathing. D.) Use chest breathing.
Answer: C.) Use diaphragmatic breathing. Rationale: In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.
A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which post-surgical risk factor would decrease if the surgical client maintained strict blood glycemic control? A.) nutrient deficiencies B.) respiratory complications C.) wound healing D.) liver dysfunction
Answer: C.) wound healing Rationale: In caring for a postoperative client, the nurse is correct to correlate hyperglycemia with an increased risk of surgical incision infections and delayed wound healing. Strict control of glycemic blood levels at the therapeutic range of 80-110 mg/dL would reduce this risk factor. There is no direct correlation between blood glucose levels and nutrient deficiencies, respiratory complications, or liver dysfunction.
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? A.) Baked chicken, mashed potatoes, broccoli, and strawberries B.) Grilled salmon, rice pilaf, green beans, and cantaloupe C.) Turkey breast, baked sweet potato, asparagus, and an orange D.) Cheeseburger, french fries, coleslaw, and ice cream
Answer: D.) Cheeseburger, french fries, coleslaw, and ice cream
