Chapter 17

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?

Diuretics

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

Emergent 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

The nurse is caring for the client in the preoperative period and documenting rationale for a palliative surgical procedure. Which rationale is most appropriate?

The client and physician are focusing on symptom relief not a cure

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

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 history of diabetes

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

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

When does the nurse understand the patient is knowledgeable about the impending surgical procedure?

The patient participates willingly in the preoperative preparation

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure?

"Let me explain to you what will happen next."

You are the nurse working the ambulatory surgery center. A teenage son of your clients asks you why so many people have surgery. What would be your best reply?

"Many people have diagnostic or short therapeutic surgical procedures."

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?

"The nurse will explain the details of the surgery before I sign a consent"

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 associated 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

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

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

The nurse expects informed consent to be obtained for the insertion of:

A gastronomy tube

A client is scheduled for an invasive procedure. What should the nurse document in the chart regarding the procedure?

A signed consent form from the client

A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?

Allow the client to wear the ring and cover it with tape

A physically fit older adult is scheduled for right knee replacement. What factor for the client creates an increased risk for postoperative complications?

Current smoking history

An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used?

Imagery

In advance of a client's scheduled appendectomy, the nurse spends a significant time explaining to the client what will happen, both before the procedure and after the procedure is complete. The primary reason the nurse puts so much effort into preoperative teaching is to:

Increase the likelihood of a successful recovery

A client asks about the purpose of withholding food and fluid before surgery. Which response by the nurse is appropriate?

It prevents aspiration and respiratory complications

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:

May have a latex allergy

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 clients 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

The nurse recognizes that written informed consent is required for insertion of a(n):

Peripherally-inserted central catheter

Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery?

Physician

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

The nurse is reviewing the pre-admission laboratory findings of the client's scheduled for surgery. Which laboratory value would be of greatest concern to the nurse?

Potassium 6.2 mEq/L

When is the ideal time to discuss preoperative teaching

Preadmission visit

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 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

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?

Review the scheduled procedure, site, and client

Which nursing assessment finding indicates the preoperative client has not met expected outcomes?

Sobs uncontrollably about pending amputation of foot

The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical center. Which of the following is the most important function?

Verifies that operative consent is signed

Which nutrient plays an important role in normal blood clotting?

Vitamin K

Which of the following activities are nursing activities in the preoperative phase of care? Select all that apply.

discussing and reviewing the advanced directive document, Establishing an intravenous line, Beginning discharge planning

Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency

Adrenal

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?

Adrenal insufficiency

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.

Age, Nutritional status, Physical condition, Health status

A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent for the surgeon to sign?

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?

Anxious clients have a poor response to surgery and are prone to complications

At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period?

During the preoperative period

What action by the nurse best encompasses the preoperative phase?

Educating clients on signs and symptoms of infection

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

Emergency

A fractured skull would be classified under which category of surgery based on urgency?

Emergent

Which domain of perioperative nursing practice focuses on clinical processes and outcomes?

Health care systems

A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for?

Hypoglycemia

A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective?

I will support my incision with my hands when I cough and do my deep breathing exercises

An inappropriate nursing action implemented to keep the client safe includes:

Moving the client swiftly

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications?

Splint the incision site using a pillow during deep breathing and coughing exercises

Nursing assessment findings reveal that the client is afraid of dying during the procedure. Which surgical team member would be most helpful in addressing the client's concern?

Surgeon

Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period?

The 35-year-old client with non-insulin dependent diabetes

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 2 hours before surgery

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?

Urgent

The nurse would identify which vitamin deficiency to prevent hemorrhaging during surgery?

Vitamin K

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?

At what point does the preoperative period end?

When the client is transferred onto the operating table

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?

Wound healing

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

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

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?

Tumor excision

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

Use diaphragmatic breathing