Chapter 29 Funds Perioperative Nursing

A client is undergoing surgery for an appendectomy. This would be considered what type of surgery? a) Emergency surgery b) Diagnostic surgery c) Elective surgery d) Palliative surgery

Ans: A An appendectomy is considered emergency or urgent surgery. Elective surgery can be scheduled in advance, and delay has no ill effects. Palliative surgery is done to relieve or reduce the intensity of an illness, and diagnostic surgery is done to make or confirm a diagnosis.

Which of the following clients most likely requires special pre‐operative assessment and treatment as a result of his or her existing medication regimen? a) A woman who takes daily anticoagulants to treat atrial fibrillation b) A woman who takes daily thyroid supplements to treat her longstanding hypothyroidism c) A man who regularly treats his rheumatoid arthritis with over ‐the ‐counter nonsteroidal anti‐inflammatory drugs (NSAIDs) d) A man who takes an angiotensin‐converting enzyme (ACE) inhibitor because he has hypertension

Ans: A Anticoagulants present a risk of hemorrhage. This risk supersedes that posed by thyroid supplements, ACE inhibitors, or most NSAIDs.

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? a) Void normally b) Exhibit no bleeding c) Eat without nausea d) Verbalize absence of pain

Ans: A Before discharge from an ambulatory surgical unit, the client should be able to void normally after a pelvic surgery. It is natural for the client to experience pain after surgery; however, the client should also have the comfort level to control it. The client may not be in a position to eliminate nausea and vomiting completely before discharge, but should suffer minimally from them. The client may have some bleeding or drainage, which should not be excessive at the time of discharge from an ambulatory surgical unit.

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? a) Constructive surgery b) Palliative surgery c) Transplantation surgery d) Reconstructive surgery

Ans: A Cleft palate repair is considered constructive surgery because the goal is to restore function in congenital anomalies. Reconstructive surgery serves to restore function to traumatized or malfunctioning tissues and includes plastic surgery or skin grafting. Transplant surgery replaces organs or structures that are diseased or malfunctioning, such as a liver or kidney transplant. Palliative surgery is not curative and seeks to relieve or reduce the intensity of an illness, such as debridement of necrotic tissue.

A client, scheduled for open-heart surgery, tells the nurse he does not want to be "saved" if he dies during surgery. What should the nurse do next? A. Discuss with and document the wishes of the client and family B. Administer the ordered oral and intravenous preoperative medications C. Notify the physician after completion of the surgical procedure D. Verbally report the client's wishes to the operating room supervisor

Ans: A Feedback: Advance directives allow the client to specify instructions for health care treatment if unable to communicate these wishes during or after surgery. It is important for the nurse to discuss and document exact do not resuscitate (DNR) wishes of the client and family before surgery.

A nurse in an outpatient surgical center is teaching a client about what will be necessary for discharge to home. What information should the nurse include about transportation? A. The client is not allowed to drive a car home. B. If the client is not dizzy, driving a car is allowed. C. Only adults over the age of 25 may drive home. D. None; this is not necessary information.

Ans: A Feedback: After outpatient surgery, clients may go home when they are no longer dizzy or drowsy, have stable vital signs, and have voided. Clients are not allowed to drive a car home.

Which of the following nursing interventions occurs in the postoperative phase of the surgical experience? A. Airway/oxygen therapy/pulse oximetry B. Teaching deep breathing exercises C. Reviewing the meaning of p.r.n. orders for pain medications D. Putting in IV lines and administering fluids

Ans: A Feedback: Airway/oxygen therapy/pulse oximetry occur in the postanesthesia unit in the postoperative phase. Teaching deep-breathing exercises and reviewing the meaning of p.r.n. orders for medications occur in the preoperative phase. Putting in IV lines and administering fluids occurs in the intraoperative phase.

A nurse is educating a preoperative client on how to cough effectively. What can the nurse tell the client to do to facilitate coughing A. "Hold a pillow or folded bath blanket over the incision." B. "Get up and walk before you try to cough." C. "It would be best if you do not cough until you feel better." D. "When you cough, cover your nose and mouth with a tissue."

Ans: A Feedback: Because postoperative coughing is often painful, the client should be taught how to splint the incision by supporting it with a pillow or folded bath blanket.

Upon assessment, a client reports that he drinks five to six bottles of beer every evening after work. Based upon this information, the nurse is aware that the client may require which of the following? A. Larger doses of anesthetic agents and larger doses of postoperative analgesics B. Larger doses of anesthetic agents and lower doses of postoperative analgesics C. Lower doses of anesthetic agents and lower doses of postoperative analgesics D. Lower doses of anesthetic agents and larger doses of postoperative analgesics

Ans: A Feedback: Clients with a large habitual intake of alcohol require larger doses of anesthetic agents and postoperative analgesics, increasing the risk for drug-related complications.

A client scheduled for major surgery will receive general anesthesia. Why is inhalation anesthesia often used to provide the desired actions? A. Rapid excretion and reversal of effects B. Safe administration in the client's own room C. Involves only the respiratory system and skin D. Slow onset of action and maintains reflexes

Ans: A Feedback: General anesthesia involves the administration of drugs by inhalation and intravenous routes to produce central nervous system depression. Inhalation anesthesia is often used because it has the advantage of rapid excretion and reversal of effects.

The telemetry unit nurse is reviewing laboratory results for a client who is scheduled for an operative procedure later in the day. The nurse notes on the laboratory report that the client has a serum potassium level of 6.5 mEq/L, indicative of hyperkalemia. The nurse informs the physician of this laboratory result because the nurse recognizes hyperkalemia increases the client's operative risk for which of the following? A. Cardiac problems B. Infection C. Bleeding and anemia D. Fluid imbalances

Ans: A Feedback: Hyperkalemia or hypokalemia increases the client's risk for cardiac problems. A decrease in the hematocrit and hemoglobin level may indicate the presence of anemia or bleeding. An elevated white blood cell count occurs in the presence of infection. Abnormal urine constituents may indicate infection or fluid imbalances.

The nurse is providing education to a client regarding pain control after surgery. What time does the nurse inform the client is the best time to request pain medication? A. Before the pain becomes severe B. When the client experiences a pain rating of "10" on a 1-to-10 pain scale C. When there is no pain, but it is time for the medication to be administered D. After the pain becomes severe and relaxation techniques have failed

Ans: A Feedback: If a pain medication is ordered p.r.n., the client should be instructed to ask for the medication before the pain becomes severe.

In order to prevent the possibility of venous stasis, a nurse is teaching a surgical client how to perform leg exercises. Which of the client's following statements indicates a sound understanding of leg exercises? A. "I'll practice these now and try to start them as soon as I can after my surgery." B. "I'll try to do these lying on my stomach so that I can bend my knees more fully." C. "I'll make sure to do these, as long as my doctor doesn't tell me to stay on bed rest after my operation." D. "I'm pretty sure my stomach muscles are strong enough to lift both of my legs off the bed at the same time."

Ans: A Feedback: Leg exercises should be begun as soon as possible after surgery, unless contraindications exist. Bed rest does not preclude the performance of leg exercises and the legs should be lifted individually, not simultaneously. The client should perform leg exercises in a semi-Fowler's, not prone, position.

A client returning to the floor after orthopedic surgery is complaining of nausea. The nurse is aware that an appropriate intervention is to do which of the following? A. Avoid strong smelling foods. B. Provide clear liquids with a straw. C. Avoid oral hygiene until the nausea subsides. D. Hold all medications.

Ans: A Feedback: Nursing care for a xlient with nausea includes avoiding strong smelling foods, providing oral hygiene, administering prescribed medications (especially medications ordered for nausea and vomiting), and avoiding use of a straw.

The nurse is preparing to send a client to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent for the procedure on the client's chart. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the client. What is the nurse's best action to the physician's request? A. Inform the physician that it is his or her responsibility to obtain the signature. B. Obtain the signature and ask another nurse to cosign the signature. C. Inform the physician that the nurse manager will need to obtain the signature. D. Call the house officer to obtain the signature.

Ans: A Feedback: The responsibility for securing informed consent from the client lies with the person who will perform the procedure. The nurse's best action is to inform the physician that it is his or her responsibility to obtain the signature.

A postoperative home care client has developed thrombophlebitis in her right leg. What category of medications will probably be prescribed for this cardiovascular complication? A. Anticoagulants B. Antibiotics C. Antihistamines D. Antigens

Ans: A Feedback: Thrombophlebitis is an inflammation of a vein associated with thrombus formation. Thrombophlebitis from venous stasis is most commonly seen in the legs of postoperative clients. Nursing interventions include administering ordered medications, most often anticoagulants.

The nurse is preparing a patient 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? a) Conscious sedation b) Spinal anesthesia c) Nerve block d) Epidural anesthesia

Ans: A Moderate sedation/analgesia is also known as conscious sedation or procedural sedation. It is used for short‐term and minimally invasive procedures such as endoscopy procedures (e.g., colonoscopy).

Which of the following statements, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction? a) "I can have a hamburger and French fries as soon as I wake up." b) "When I can eat again, the best meal would be steak and orange juice." c) "I might be sick to my stomach and throw up after surgery." d) "The better I eat before surgery, the more likely I will heal."

Ans: A Oral fluid and food may be withheld until intestinal motility resumes.

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 a) Prior to surgery b) When early signs of venous stasis are evident c) In postanesthetic recovery d) Upon transfer from postanesthetic care unit to the postsurgical unit

Ans: A Though leg exercises are begun after surgery, such preventative measures should ideally be taught to the patient during the preoperative period.

Upon admission for an appendectomy, the client provides the nurse with a document that specifies instructions his health care team should follow in the event he is unable to communicate these wishes postoperatively. What is the document best known as? a) An informed consent b) An advance directive c) An insurance card d) A Patient's Bill of Rights

Ans: B An advance directive, a legal document, allows the client to specify instructions for his or her health care treatment should he or she be unable to communicate these wishes postoperatively. The advance directive allows the client to discuss his or her wishes with the family members in advance of the surgery. Two common forms of advance directives include living wills and durable powers of attorney for health care.

A client states he has a latex allergy. What action should the nurse take? a) Inform the client to tell the anesthesiologist. b) Place an allergy identification band on the client. c) Have the client take a Benadryl before surgery. d) Send the client to the OR with epinephrine.

Ans: B Assist the client with allergies to medications, food, and latex before the surgical procedure, and clearly mark them on the client record, and on the client identification band.

A client has been taking aspirin since his heart attack in 1997. The client is at risk for what? a) Infection b) Hemorrhage c) Thrombophlebitis d) Blood clots

Ans: B Current medication use, especially use of medications that can affect coagulation status (warfarin, nonsteroidal anti‐inflammatory drugs, aspirin) is important and should be reported to the surgeon.

A female client is scheduled for liposuction surgery to reduce her weight. Based on urgency, how is this surgery classified? A. Urgent B. Elective C. Emergency D. Emergent

Ans: B Feedback: A liposuction procedure is classified as elective surgery, in which the procedure is preplanned and based on the client's choice. Other classifications are urgent (surgery is necessary for the client's health but not an emergency) and emergency (the surgery must be done immediately to preserve life, body part, or body function).

Which of the following interventions is of major importance during preoperative education? A. Performing skills necessary for gastrointestinal preparation B. Encouraging the client to identify and verbalize fears C. Discussing the site and extent of the surgical incision D. Telling the client not to worry or be afraid of surgery

Ans: B Feedback: A surgical procedure causes anxiety and fear. The nurse should encourage the client to identify and verbalize fears; often simply talking about fears helps to diminish their magnitude.

A diabetic client is undergoing surgery to amputate a gangrenous foot. This procedure would be considered which of the following categories of surgery based on purpose? A. Diagnostic B. Ablative C. Palliative D. Reconstructive

Ans: B Feedback: Ablative surgery is performed to remove a diseased body part. Diagnostic surgery is performed to make or confirm a diagnosis. Palliative surgery involves relieving or reducing intensity of an illness. Reconstructive surgery restores function to traumatized or malfunctioning tissue.

Which of the following interventions are recommended guidelines for meeting client postoperative elimination needs A. Assess abdominal distention, especially if bowel sounds are audible or are low pitched. B. Assess for the return of peristalsis by auscultating bowel sounds every four hours when the client is awake. C. Encourage food and fluid intake when ordered, especially dairy products and low-fiber foods. D. Assess for bladder distention by Palpating below the symphysis pubis if the client has not voided within eight hours after surgery.

Ans: B Feedback: Assess for the return of peristalsis by auscultating bowel sounds every four hours when the client is awake. Assess abdominal distention, especially if bowel sounds are inaudible or are high pitched. Encourage food and fluid intake when ordered, especially fruit juices and high-fiber foods. Assess for bladder distention by palpating above the symphysis pubis if the client has not voided within eight hours after surgery.

A nurse is assisting a physician during a cesarean section for a client. The client is administered epidural anesthesia. Which of the following is an advantage of epidural anesthesia? A. It counteracts the effects of conscious sedation. B. It decreases the risk of gastrointestinal complications. C. It prevents clients from remembering the initial recovery period. D. It acts on the central nervous system to produce loss of sensation.

Ans: B Feedback: Epidural anesthesia is a regional anesthesia administered to a client before surgery; it decreases the risk of gastrointestinal complications in clients. Reversal drugs are medications that counteract the effects of those used for conscious sedation. General anesthesia acts on the central nervous system to produce loss of sensation; it prevents clients from remembering their initial recovery period.

A nurse is providing ongoing postoperative care to a client who has had knee surgery. The nurse assesses the dressing and finds it saturated with blood. The client is restless and has a rapid pulse. What should the nurse do next? A. Document the data and apply a new dressing. B. Apply a pressure dressing and report findings. C. Reassure the family that this is a common problem. D. Make assessments every 15 minutes for four hours.

Ans: B Feedback: Hemorrhage is an excessive internal or external loss of blood. Common indications of hemorrhage include a rapid, thready pulse. If bleeding occurs, the nurse should apply a pressure dressing to the site, report findings to the physician, and be prepared to return the client to the operating room if bleeding cannot be stopped or is massive.

A young woman has been in an automobile crash that resulted in an amputation of her left lower leg. She verbalizes grief and loss. What knowledge by the nurse is used to provide interventions to help the client cope? A. The client should be grateful to be alive. B. This is a normal, appropriate response. C. This is an abnormal, inappropriate response. D. Tissue healing will help the client adapt.

Ans: B Feedback: Many surgical clients have the same reaction to loss of a body part as they would to a death. A surgical client's grief is a normal, appropriate response. The nurse must be aware of the client's needs and provide interventions to meet those needs in coping with change.

A nurse is taking care of a client during the immediate post-operative period. Which of the following duties performed during the immediate post-operative period is most important? A. Ensure the safe recovery of surgical clients. B. Monitor the client for complications. C. Prepare a room for the client's return. D. Assess the client's health constantly.

Ans: B Feedback: The immediate post-operative period refers to the first 24 hours after surgery. During this time, the nurse monitors the client for complications as he or she recovers from anesthesia. Once the client is stable, the nurse prepares a room for the client's return and assesses the client to prevent or minimize potential complications. The nurse ensures the safe recovery of the client after the client has stabilized.

A nurse has been asked to ensure informed consent for a surgical procedure. What might be a role of the nurse A. Securing informed consent from the client B. Signing the consent form as a witness C. Ensuring the client does not refuse treatment D. Refusing to participate based on legal guidelines

Ans: B Feedback: The responsibility for securing informed consent from the client lies with the person who will perform the procedure, usually the physician. The nurse may sign as a witness, signifying that the client signed the consent form without coercion, and was alert and aware of the act.

What is the rationale for having the client void before surgery? a) To assess for pregnancy in women b) To prevent bladder distention c) To prevent electrolyte imbalance d) To assess for urinary tract infection

Ans: B Having the client void before surgery will assist in the prevention of bladder distention during or after the procedure.

The nurse has entered the room of a client who is postoperative day one and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of PRN 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? a) "The hospital has excellent resources for dealing with any addiction that might result from the medications you take to control your pain." b) "Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery." c) "Actually, people who are not addicted to drugs before their surgery never develop a tolerance or addiction during their recovery." d) "You should remind yourself that treating your pain is important now, and that dealing with any resulting dependency can come later."

Ans: B There is little danger of addiction to pain medications used in the postoperative management of pain.

A nurse is assisting a physician in an emergency surgery for a client with intestinal perforation. Which of the following descriptions is most suitable to the type of surgery performed a) Surgery performed at the client's request b) Surgery required within one or two days c) Surgery required immediately for survival d) Surgery planned as per client's convenience

Ans: C An emergency surgery is a surgery required immediately for survival. Elective surgery is planned at the client's convenience; whereas, an optional surgery is performed at the client's request. When urgent surgery is required, it is necessary and done within one or two days.

A physician has ordered a nurse to administer conscious sedation to a client. Which of the following is possible after administering conscious sedation to a client? A. Client can respond verbally despite physical immobility. B. Client can tolerate long therapeutic surgical procedures. C. Client is relaxed, emotionally comfortable, and conscious. D. Client's consciousness level can be monitored by equipment.

Ans: C Feedback: Conscious sedation refers to a state in which the client is sedated in a state of relaxation and emotional comfort, but is not unconscious. The client is free of pain, fear, and anxiety and can tolerate unpleasant diagnostic and short therapeutic surgical procedures, such as an endoscopy or bone marrow aspiration. The client can respond verbally and physically. However, no equipment can replace a nurse's careful observations for monitoring clients.

A nurse is caring for a client who is scheduled to undergo a breast biopsy. Which of the following major tasks does the nurse perform immediately during the pre-operative period? A. Obtain a signature on the consent form. B. Review the surgical checklist. C. Conduct a nursing assessment. D. Reduce the dosage of toxic drugs.

Ans: C Feedback: During the immediate pre-operative period, the nurse conducts a nursing assessment. Nurses obtain the signature of the client, nearest blood relative, or someone with durable power of attorney before the administration of any pre-operative sedatives. They also administer medications as ordered by the physician regardless of their toxicity. They assist the client with psychosocial preparation and complete the surgical checklist, which is reviewed by the operating room personnel.

A nurse is reviewing results of preoperative screening tests and notes the client's potassium level is dangerously low. What should the nurse do next? A. Nothing; potassium levels have no influence on surgical outcome. B. Include the information in the postoperative end of shift report. C. Document the data and notify the physician who will do the surgery. D. Ask the client and family members why the potassium is low.

Ans: C Feedback: Either high or low levels of potassium put the surgical client at increased risk for cardiac problems during and after surgery. The nurse's role includes recording the data in the client's record and reporting abnormal findings.

A preoperative assessment finds a client to be 75 pounds overweight. The client is to have abdominal surgery. What nursing diagnosis would be appropriate based on the client's weight? A. Risk for Aspiration B. Risk for Imbalanced Body Temperature C. Risk for Infection D. Risk for Falls

Ans: C Feedback: Fatty tissue in obese clients has a poor blood supply and, therefore, has less resistance to infections. Postoperative complications of delayed wound healing, wound infection, and disruption of the wound are more common in obese clients.

An operating room nurse is preparing for a surgical procedure on an infant. The nurse's perioperative care is based on what physiologic factor that puts infants at greater risk from surgery than adults? A. Increased vascular rigidity B. Diminished chest expansion C. Lower total blood volume D. Decreased peripheral circulation

Ans: C Feedback: Infants are at a greater risk from surgery as a result of various physiologic factors. A major factor is that the infant has a lower total blood volume, making even a small loss of blood a serious consideration because of the risk for dehydration and the inability to respond to the need for increased oxygen during surgery.

Which of the following nursing interventions is most likely to prevent respiratory complications such as pneumonia and atelectasis in a postsurgical client? a) Adequate pain control b) Control of anxiety and agitation c) Use of incentive spirometry d) Adequate nutrition and fluids

Ans: C Incentive spirometry improves lung expansion, helps expel anesthetic gases and mucus from the airway, and facilitates oxygenation of body tissues. Pain control and hydration may facilitate lung expansion and mobilization of secretions, but incentive spirometry directly increases lung volume and alveolar expansion.

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 of the following characteristics applies to this type of surgery? a) The surgery is classified as urgent rather than elective. b) The client must be previously healthy with low surgical risks. c) The client will be admitted the day of surgery and return home the same day. d) The surgery will be conducted using moderate sedation rather than general anesthesia.

Ans: C Outpatient surgeries, also known as ambulatory surgeries, are conducted with admission and discharge on the same day. Such surgeries have become increasingly common in recent years, and some surgeries of increasing complexity and risk are conducted on an outpatient basis. General anesthesia is possible, and common. This approach is more common for elective surgeries than urgent surgeries.

A nurse is reinforcing wound edges and applying a blinder to the separated incisions of a client after a surgery. Which of the following postoperative complications has the client developed a) Hypoxemia b) Evisceration c) Dehiscence d) Shock

Ans: C The nurse is taking care of a client with dehiscence. Hypoxemia develops when there is inadequate oxygenation of blood. Evisceration occurs when there is protrusion of abdominal organs through a separated wound. A client has shock when there is inadequate blood flow.

A nurse is caring for an older adult client who has been prescribed fluid restriction before surgery. Which of the following should the nurse check to assess the risks of fluid restriction in elderly clients? a) Anxiety level b) Self‐therapy c) Vital signs d) Cardiac status

Ans: C The nurse should assess the client's vital signs, weight, and sternal skin turgor prior to fluid restriction to serve as a baseline for comparison. The period of fluid restriction before surgery may be shortened for older adults to reduce their risk of dehydration and hypotension. Nurses check a client's self‐therapy practices and cardiac status to avoid any complications of bleeding and elimination of intravenous fluids given at a standard rate.

A client has arrived in the same‐day surgery suite. He states to the nurse, "I am so worried about being put to sleep and having the surgery." What would be the nurse's best response? a) "Have you ever had surgery before?" b) "I will have the anesthesiologist talk to you." c) "Tell me what you are most worried about." d) "You don't have to worry. It will be fine."

Ans: C The nurse should first assess what the client is most worried about, and then provide emotional support.

A nurse is preparing to receive a client in post‐anesthesia care unit (PACU). The client is diabetic and has undergone knee surgery. Which information would be most important for the receiving nurse to obtain to develop an appropriate plan of care for this client? a) Chronic disease history b) Environment of the operating room c) Amount of blood loss d) Information about allergic agents

Ans: C To plan care effectively in the postoperative period, the nurse needs to know about the amount of blood lost during the surgery, the type of surgery that was performed on the client, and whether there were any surgical or anesthetic complications. Information on chronic disease history and allergy history are done in the pre‐operative period, not in the postoperative period. Information on the environment in the operation room is checked by the circulatory nurse during the intra‐ operative care plan; it is not associated with the postoperative care plan.

In the postoperative phase of abdominal surgery, the client complains of severe abdominal pain. In the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect? a) Abdominal infection b) Hernia development c) Normal response d) Paralytic ileus

Ans: D A potential complication after surgery is paralytic ileus, a condition in which there is decreased bowel functioning.

A nurse is preparing a client for endotracheal intubation. The anesthesiologist has ordered an anticholinergic medication for this client. Which of the following is an action of this medication? a) It promotes induction of anesthesia. b) It promotes sleep or conscious sedation. c) It decreases gastric acidity and volume. d) It decreases respiratory secretions.

Ans: D An anticholinergic medication decreases respiratory secretions and prevents vagal nerve stimulation during endotracheal intubation. Antianxiety drugs slow motor activity and promote the induction of anesthesia. Histamine‐2 receptor antagonists decrease gastric acidity and volume. Sedatives promote sleep or conscious sedation.

A nurse teaches deep breathing exercises to a client scheduled for surgery. In which of the following perioperative phases would this action occur? a) None of the above b) Intraoperative c) Postoperative d) Pre‐operative

Ans: D Exercises and physical activities occurring in the pre‐operative phase include deep‐breathing exercises, coughing, incentive spirometry, turning, leg exercises, and pneumatic compression stockings.

Which statement accurately represents a recommended guideline when providing postoperative care for the following clients? A. Force fluids for an adult client who has a urine output of less that 30 mL per hour. B. If client is febrile within 12 hours of surgery, notify the physician immediately. C. If the dressing was clean but now has a large amount of fresh blood, remove the dressing and reapply it. D. If vital signs are progressively increasing or decreasing from baseline, notify the physician of possible internal bleeding.

Ans: D Feedback: A continued decrease in blood pressure or an increase in heart rate could indicate internal bleeding, and the physician should be notified. If an adult client has a urine output of less than 30 mL per hour, the physician should be notified, unless this is expected. If the client is febrile within 12 hours of surgery, the nurse should assist the client with coughing and deep-breathing exercises. When large amounts of fresh blood are present, the dressing should be reinforced with more bandages and the physician notified.

A client with abdominal incisions experiences excruciating pain when he tries to cough. What should the nurse do to reduce the client's discomfort when coughing A. Administer prescribed pain medication just before coughing. B. Ask the client to drink plenty of water before coughing. C. Ask the client to lie in a lateral position when coughing. D. Administer prescribed pain medication 30 minutes before deliberately attempting to cough.

Ans: D Feedback: Coughing is painful for clients with abdominal or chest incisions. Administering pain medication approximately 30 minutes before coughing, or splinting the incision when coughing, can reduce discomfort. Making the client lie in a lateral position or asking the client to drink plenty of water is not helpful because it will make breathing and coughing even more difficult for the client.

A nurse is educating a surgical client on postoperative p.r.n. pain control. Which of the following should be included? A. "We will bring you pain medications; you don't need to ask." B. "Even if you have pain, you may get addicted to the drugs." C. "You won't have much pain so just tough it out." D. "You need to ask for the medication before the pain becomes severe."

Ans: D Feedback: If medication for pain is ordered p.r.n., there is a time restriction between doses. The client needs to ask for the medication and should do so before the pain becomes severe.

A cleansing enema is ordered for a client who is scheduled to have colon surgery. What is the rationale for this procedure? A. Surgical clients routinely are given a cleansing enema. B. Cleansing enemas are given before surgery at the client's request. C. There will be less flatus and discomfort postoperatively. D. Peristalsis does not return for 24 to 48 hours after surgery.

Ans: D Feedback: If the client is scheduled for gastrointestinal tract surgery, a cleansing enema is usually ordered. Peristalsis does not return for 24 to 48 hours after the bowel is handled, so preoperative cleansing helps decrease postoperative constipation.

A nurse working in a PACU is responsible for conducting assessments on immediate postoperative clients. What is the purpose of these assessments? A. To determine the length of time to recover from anesthesia B. To use intraoperative data as a basis for comparison C. To focus on cardiovascular data and findings D. To prevent complications from anesthesia and surgery `

Ans: D Feedback: Immediate postoperative care in the PACU involves assessing the postoperative client with emphasis on preventing complications from the surgery.

A student is assessing a postoperative client who has developed pneumonia. The plan of care includes positioning the client in the Fowler's or semi-Fowler's position. What is the rationale for this position? A. It increases blood flow to the heart. B. The client will be more comfortable and have less pain. C. It facilitates nursing assessments of skin color and temperature. D. It promotes full aeration of the lungs.

Ans: D Feedback: Pneumonia may occur in the postoperative client from aspiration, immobilization, depressed cough reflex, infection, increased secretions from anesthesia, or dehydration. Nursing interventions include positioning the client in the Fowler or semi-Fowler position to promote full aeration of the lungs.

A nurse is educating a client about regional anesthesia. Which of the following statements is accurate about this type of anesthesia? A. "You will be asleep and won't be aware of the procedure." B. "You will be asleep but may feel some pain during the procedure." C. "You will be awake but will not be aware of the procedure." D. "You will be awake and will not have sensation of the procedure."

Ans: D Feedback: Regional anesthesia occurs when an anesthetic agent is injected near a nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors. The client remains awake but loses sensation in a specific area or region of the body.

After conducting a preoperative health assessment, the nurse documents that the client has physical assessments supporting the medical diagnosis of emphysema. Based on this finding, what postoperative interventions would be included on the plan of care? A. Perform sterile dressing changes each morning. B. Administer pain medications as needed. C. Conduct a head-to-toe assessment each shift. D. Monitor respirations and breath sounds.

Ans: D Feedback: Respiratory disorders, including emphysema, increase the risk for respiratory depression from anesthesia as well as postoperative pneumonia and atelectasis.

A nurse is assisting a postoperative client with deep-breathing exercises. Which of the following is an accurate step for this procedure? A. Place the client in prone position, with the neck and shoulders supported. B. Ask the client to place the hands over the stomach, so he or she can feel the chest rise as the lungs expand. C. Ask the client to exhale rapidly and completely, and inhale through the nose rapidly and completely. D. Ask the client to hold his or her breath for three to five seconds and mentally count "one, one thousand, two, one thousand" and so forth.

Ans: D Feedback: The nurse should place the client in semi-Fowler's position, with the neck and shoulders supported, and ask the client to place the hands over the rib cage, so he or she can feel the chest rise as the lungs expand. Then, ask the patient to exhale gently and completely, inhale through the nose gently and completely, hold his or her breath for three to five seconds, and mentally count "one, one thousand, two, one thousand" etc., then exhale as completely as possible through the mouth with lips pursed (as if whistling).

The PACU nurse has received a semiconscious client from the operating room and reviews the chart for orders related to positioning of the client. There are no specific orders on the chart related to the client's position. In this situation, in what position will the nurse place the patient? a) Supine position b) Trendelenburg position c) Prone position d) Side‐lying position

Ans: D If the client is not fully conscious, place the client in the side‐lying position, unless there is an ordered position on the client's chart.

The operating room nurse is aware that which of the following clients is at a greater risk related to a surgical procedure? a) A man 48 years of age b) A boy 8 years of age c) A woman 34 years of age d) A woman 83 years of age

Ans: D Infants and older adults are at a greater risk from surgery than are children and young or middle‐age adults. Physiologic changes associated with aging increase the surgical risk for older clients.

A scrub nurse is assisting a surgeon with a kidney transplant. What are the patient responsibilities of this surgical team member? Select all that apply. a. Maintaining sterile technique b. Draping and handling instruments and supplies c. Identifying and assessing the patient on admission d. Integrating case management e. Preparing the skin at the surgical site f. Providing exposure of the operative area

Ans: a, b. The scrub nurse is a member of the sterile team who maintains sterile technique while draping and handling instruments and supplies. Two duties of the circulating nurse are to identify and assess the patient on admission to the operating room and prepare the skin at the surgical site. The RNFA actively assists the surgeon by providing exposure of the operative area. The APRN coordinates care activities, collaborates with physicians and nurses in all phases of perioperative and post anesthesia care, and integrates case management, critical paths, and research into care of the surgical patient.

A responsibility of the nurse is the administration of preoperative medications to patients. Which statements describe the action of these medications? Select all that apply. a. Diazepam is given to alleviate anxiety. b. Ranitidine is given to facilitate patient sedation. c. Atropine is given to decrease oral secretions. d. Morphine is given to depress respiratory function. e. Cimetidine is given to prevent laryngospasm. f. Fentanyl citrate-droperidol is given to facilitate a sense of calm

Ans: a, c, f. Sedatives, such as diazepam (Valium), midazolam (Versed), or lorazepam (Ativan) are given to alleviate anxiety and decrease recall of events related to surgery. Anticholinergics, such as atropine and glycopyrrolate (Robinul) are given to decrease pulmonary and oral secretions and to prevent laryngospasm. Neuroleptanalgesic agents, such as fentanyl citrate-droperidol (Innovar) are given to cause a general state of calm and sleepiness. Histamine-2 receptor blockers, such as cimetidine (Tagamet) and ranitidine (Zantac) are given to decrease gastric acidity and volume. Narcotic analgesics, such as morphine, are given to facilitate patient sedation and relaxation and to decrease the amount of anesthetic agent needed.

A patient had a surgical procedure that necessitated a thoracic incision. The nurse anticipates that he will have a higher risk for postoperative complications involving which body system? a. Respiratory system b. Circulatory system c. Digestive system d. Nervous system

Ans: a. A thoracic incision makes it more painful for the patient to take deep breaths or cough. Shallow respirations and ineffective coughing increase the risk for respiratory complications.

A 72-year-old woman who is scheduled for a hip replacement is taking several medications on a regular basis. Which drug category might create a surgical risk for this patient? a. Anticoagulants b. Antacids c. Laxatives d. Sedatives

Ans: a. Anticoagulant drug therapy would increase the risk for hemorrhage during surgery

A nurse has been asked to witness a patient signature on an informed consent form for surgery. For which of these patients would the document be valid? Select all that apply. a. A 92-year-old patient who is severely confused b. A 45-year-old patient who is oriented and alert c. A 10-year-old patient who is oriented and alert d. A 36-year-old patient who has had a narcotic premedication e. A 45-year-old mentally ill patient who has been ruled incompetent f. A 22-year old patient having an abortion against her partner's wishes

Ans: b, f. A consent form is not legal if the patient signing the form is confused, sedated, unconscious, or a minor.

A nurse is caring for an obese patient who has had surgery. The nurse monitors this patient for what postoperative complication? a. Hunger b. Impaired wound healing c. Hemorrhage d. Gas pains

Ans: b. Fatty tissue is less vascular and, therefore, less resistant to infection and more prone to delayed wound healing.

A patient tells the nurse she is having pain in her right lower leg. How does the nurse assess for the presence of thrombophlebitis? a. By palpating the skin over the tibia and fibula b. By documenting daily calf circumference measurements c. By recording vital signs obtained four times a day d. By noting difficulty with ambulation

Ans: b. Inflammation from thrombophlebitis increases the size of the affected extremity and can be assessed by measuring circumference on a regular basis.

Older adults often have reduced vital capacity as a result of normal physiologic changes. Which nursing intervention would be most important for the postoperative care of an older surgical patient specific to this change? a. Take and record vital signs every shift. b. Turn, cough, and deep breathe every 4 hours. c. Encourage increased intake of oral fluids. d. Assess bowel sounds daily.

Ans: b. Reduced vital capacity in older adults increases the risk for respiratory complications, including pneumonia and atelectasis. Having the patient turn, cough, and deep breathe every 4 hours maintains respiratory function and helps to prevent complications.

A 70-year-old male is scheduled for surgery. He says to the nurse, "I am so frightened—what if I don't wake up?" What would be the nurse's best response? a. "You have a wonderful doctor." b. "Let's talk about how you are feeling." c. "Everyone wakes up from surgery!" d. "Don't worry, you will be just fine."

Ans: b. This answer allows the patient to talk about his feelings and fears, and is therapeutic.

A nurse is applying a pneumatic compression device to a client. What is the purpose of a pneumatic compression device? a) Enables the client to void b) Reduces swelling and pain c) Promotes circulation of venous blood d) Pumps liquid diet to the client

Ans: c A pneumatic compression device promotes the circulation of venous blood and relocation of excess fluid into the lymphatic vessels. The device does not pump a liquid diet to the client, help the client to void, or reduce swelling and pain.

A nurse is preparing a patient for a cesarean section and teaches her the effects of the regional anesthesia she will be receiving. Which effects would the nurse expect? Select all that apply. a. Loss of consciousness b. Relaxation of skeletal muscles c. Reduction or loss of reflex action d. Localized loss of sensation e. Prolonged pain relief after other anesthesia wears off f. Infltrates the underlying tissues in an operative area

Ans: c, d. A localized loss of sensation and possible loss of reflexes occurs with a regional anesthetic. Loss of consciousness and relaxation of skeletal muscles occurs with general anesthesia. Prolonged pain relief after other anesthesia wears off and infiltration of the underlying tissues in an operative area occur with topical anesthesia.

A perioperative nurse is preparing a patient for surgery for treatment of a ruptured spleen as the result of an automobile crash. The nurse knows that this type of surgery belongs in what category? a. Minor, diagnostic b. Minor, elective c. Major, emergency d. Major, palliative

Ans: c. This surgery would involve a major body organ, has the potential for postoperative complications, requires hospitalization, and must be done immediately to save the patient's life. Elective surgery is a procedure that is preplanned by essentially healthy people. Diagnostic surgery is performed to confirm a diagnosis. Palliative surgery is not curative, rather it is done to relieve or reduce the intensity of an illness.

While assessing a patient in the PACU, a nurse notes increased wound drainage, restlessness, a decreasing blood pressure, and an increase in the pulse rate. The nurse interprets these findings as most likely indicating: a. Thrombophlebitis b. Atelectasis c. Infection d. Hemorrhage

Ans: d. Increased wound drainage, restlessness, decreasing blood pressure, and increasing pulse rate are assessment findings that indicate hemorrhage. Manifestations of thrombophlebitis are pain and cramping in the calf or thigh of the involved extremity, redness and swelling in the affected area, elevated temperature, and an increase in the diameter of the involved extremity. Manifestations of atelectasis include decreased lung sounds over the affected area, dyspnea, cyanosis, crackles, restlessness, and apprehension. Signs of infection include elevated white blood count and fever.

A nurse is explaining the rationale for performing leg exercises after surgery. Which reason would the nurse include in the explanation? a. Promote respiratory function b. Maintain functional abilities c. Provide diversional activities d. Increase venous return

Ans: d. Leg exercises in the postoperative period increase venous return. As a result, the patient has a decreased risk for thrombophlebitis and emboli.

A nurse is explaining pain control methods to a patient undergoing a bowel resection. The patient is interested in the PCA pump and asks the nurse to explain how it works. What would be the nurse's correct response? a. "The pump allows the patient to be completely free of pain during the postoperative period." b. "The pump allows the patient to take unlimited amounts of medication as needed." c. "The pump allows the patient to choose the type of medication given postoperatively." d. "The pump allows the patient to self-administer limited doses of pain medication."

Ans: d. PCA infusion pumps allow patients to self-administer doses of pain-relieving medication within physician-prescribed time and dose limits. Patients activate the delivery of the medication by pressing a button on a cord connected to the pump or a button directly on the pump.

A nurse is teaching a man scheduled to have same-day surgery. Which teaching method would be most effective in preoperative teaching for ambulatory surgery? a. Lecture b. Discussion c. Audiovisuals d. Written instructions

Ans: d. Written instructions are most effective in providing information for same-day surgery.