Chapter 29 Perioperative Nursing
Respiratory obstruction
The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?
respiratory obstruction
The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?
gastric pH
Older adults have an increased _________ and require monitoring of nutritional status during the perioperative period.
Seek someone with durable power of attorney to sign the informed consent form.
The nurse is caring for a confused elderly client who requires surgery for a broken hip. Which nursing intervention regarding consent is appropriate?
Apply goggles to the client.
The nurse is preparing for a client for laser procedure. Which nursing intervention is appropriate?
The provider will perform this laser surgery in an ambulatory care setting
The nurse is talking with a client who wishes to have a tattoo removed. Which client statement indicates that the client understands how the procedure will be accomplished?
impaired tissue perfusion
The nurse monitors the urine output of a postoperative client. The results of this assessment allow the nurse to monitor for signs of what complication?
Keep the client in the preoperative area and inform the surgeon that it is the physician's responsibility to obtain consent for surgery.
The preoperative nurse is reviewing the chart of a client whose surgery is scheduled to begin in the next 15 minutes and notices that the consent form is not signed. The nurse contacts the surgeon who states, "We have already reviewed this procedure extensively, so ask the client to sign the consent form and I will verify it in the operating room." Which action by the nurse is most appropriate?
side lying position
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 client?
"That practice is no longer standard as shaving may cause breaks in the skin."
The adult male client with significant body hair is being prepared for abdominal surgery. The client states his dad had the same surgery many years ago and was shaved prior to the procedure. The nurse would explain to the client:
Allow the parents into the PACU before the child wakes
A 2-year-old toddler just underwent a tonsillectomy and adenoidectomy surgery. The postanesthesia care unit (PACU) nurse is checking on him. What is the best course of action regarding the developmental care of this child?
hemorrhage
A client scheduled for surgery has been taking aspirin since his heart attack in 1997. The client is at risk for:
It interferes less with the client's daily routine.
A nurse is dressing the wound of a client who is admitted to the outpatient surgical unit. What is a major advantage of outpatient surgery?
- positioning the client on the operating table - counting sponges before and after surgery - monitoring the client's vital signs
A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice?
Implement leg exercises and turn the client in bed every 2 hours.
A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client?
Delirium
Ames is an 87-year-old man who underwent a hip replacement today. He is telling the nurse that his parents, who are deceased, are coming to visit him today. He continues to tell the nurse that he needs to cut the lawn and run errands. The last time the nurse entered the room, Ames was trying to climb over the bed rail. Which term best describes Ames' condition?
Procedural pause (time out)
As a circulating nurse caring for a 45-year-old man undergoing left knee arthroscopic exploratory surgery, which task ensures that the team is on the same page and will perform the procedure on the right client and at the right site?
Balloons Condoms Underwear Gloves
Clients with a latex allergy may have intolerance to which items? Select all that apply.
middle age
Infants are at a greater risk from surgery than are __________ adults.
renal biotransformation
Infants experience a slower metabolism of drugs that require______________.
Ileostomy
Which client will see the greatest permanent changes in lifestyle following surgery?
place graduated compression stockings on the client
Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?
•Spinal block •Epidural block •Nerve block
Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply.
maintaining a restful environment
Which nursing action provides the greatest assistance in healing?
relaxation techniques
Which nursing action will assist in pain management for a client in the postoperative phase?
use of incentive spirometry
Which nursing intervention is most likely to prevent respiratory complications such as pneumonia and atelectasis in a postoperative client?
Type of surgery
Which of the following factors is most important in the nurse's decision on assessment data, outcomes, and the monitoring needs of a client in preparing for surgery?
Check that the client is able to drink liquids without nausea.
A client is being prepared for discharge home from the postanesthesia care unit (PACU). What action is essential for the nurse to take?
Apply warm blankets to the client
A client postoperative from an appendectomy reports feeling cold and has a temperature of 96.2°F (35.7°C). Which action should the nurse perform first?
place an allergy identification band on the client
A client states he has a latex allergy. Which action should the nurse take?
"Because you are having inpatient surgery, you will be at least 1 day after surgery."
A client who came in through the emergency department with a severely fractured leg will be transported to surgery within the hour. When the client asks how long hospitalization will occur after surgery, what is the appropriate nursing response?
heart rate and BP
A client comes to the postoperative area and complains of chest pain and palpitations. Which assessment information does the nurse need to obtain?
Ensure that the client is well nourished and hydrated.
What intervention would a nurse perform when physically preparing a client undergoing surgery?
monitor closely and promote fluid intake
A client had an open cholecystectomy (gall bladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding?
allowing clear liquids up to 2 hours before surgery
A client has presented to a clinic for a preoperative consult, during which the client has expressed concern about having to fast before surgery. Current recommendations for preoperative fasting include:
Local infiltration with lidocaine
A nurse anesthetist administers regional anesthesia to a client being prepared for facial surgery. Which type of regional anesthesia would be the appropriate choice for this client?
Place the patient in a flat position with legs elevated 45 degrees
A nurse caring for patients in a PACU assesses a patient who is displaying signs and symptoms of shock. What is the priority nursing intervention for this patient?
Void normally
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?
Correct response: Promotes circulation of venous blood Explanation: 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 applying a pneumatic compression device to a client. What is the purpose of a pneumatic compression device?
promotes circulation of venous blood
A nurse is applying a pneumatic compression device to a client. What is the purpose of a pneumatic compression device?
place the client in semi-Fowler's position
A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client?
Anticipating the needs of other members of the surgical team
A nurse is assigned to be the circulating nurse during a surgical procedure. The nurse would be responsible for which activity?
The surgeon may sit with the family while the client is prepped for surgery as long as the procedure is not delayed.
A nurse is caring for a 4-year-old undergoing a laparoscopy for a ruptured appendix. His blood pressure is unstable and his abdomen is dusky in appearance. Which best describes the use of informed consent in this case?
respiratory complications
A nurse is caring for an infant who is postoperative following cardiac surgery. What is the most common postoperative complication found in this age group?
It decreases respiratory secretions.
A nurse is preparing a client for endotracheal intubation. The anesthesiologist has ordered an anticholinergic medication for this client. What is an action of this medication?
Amount of blood loss
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?
Some major surgeries can be done as a same-day surgery
A nurse is providing education to a client having same-day surgery. Which statement would be accurate regarding this type of surgery?
raising the stretcher side rails prior to giving a sedative
A nurse is working with a group of clients in the preoperative area. Which client task would be the highest priority?
Instruct the client to exhale gently and completely before breathing in.
A nurse teaches deep-breathing exercises to a preoperative client. What accurately describes a step in this exercise?
"The operating table is a firm surface; we need to be sure your skin looks okay."
A postoperative client states "I don't understand why you are checking my skin on my back. My surgery was on my stomach." What is the nurse's best response?
Explain to the client the practice of autologous blood donation.
A preoperative client has called the nurse about his upcoming surgical procedure, 6 weeks from now. He is concerned about receiving blood after surgery for fear of acquiring a bloodborne disease. What is the nurse's most appropriate response?
measure respiratory rate
After a client receives morphine sulfate for pain in the postanesthesia care unit (PACU), which assessment finding would the nurse obtain as a priority?
The anesthesiologist, circulating nurse, and surgeon
Following a surgical procedure, who is generally responsible for moving the client to the recovery area?
Paralytic ileus
In the postoperative phase of abdominal surgery, the client reports severe abdominal pain. In the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect?
renal blood flow and reduced bladder capacity
Older adults have decreased ______ and a reduced ____________ , necessitating careful monitoring of fluid and electrolyte status and input and output.
an older adult man with a fractured hip
Surgery can lead to hypothermia. Which client is at greatest risk for hypothermia?
notify the physician of the oversight
The healthy adult client is given a narcotic prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first?
Apply pressure
The nurse enters a postoperative client's room and finds that the client is bleeding profusely from the surgical incision. What would be the nurse's most appropriate initial response?
prevent anxiety
The nurse has been waiting until after the administration of a toddler's anesthesia before removing the child's clothing and applying monitoring equipment. Doing these actions after the administration of anesthesia will:
massages leg prior to application
The nurse has delegated to the unlicensed assistive personnel (UAP) the application of antiembolism stockings to a client who had an endarterectomy earlier in the day. Which UAP action requires the nurse to immediately intervene?
Malignant hyperthermia
The nurse-anesthetist is monitoring the client during surgery. He notices a ventricular dysrhythmia and unstable blood pressure. He notifies the surgeon. The operative team suspects:
-The underlying disease process and its natural course -Explanation of the risks involved and how often they occur -A description of the procedure or treatment, along with potential alternative therapies
What information must be provided to a patient to obtain informed consent? (Select all that apply.)
witnessing the signed informed consent document
What is the nurse's role in the informed consent process for a surgical procedure?
to prevent bladder distention
What is the rationale for having the client void before surgery?
smokes cigarettes, ½ pack per day skin turgor 4 seconds
When reviewing a client's history prior to surgery to correct a wrist fracture, which factors does the nurse identify that place the client at a higher risk for perioperative complications? Select all that apply
a 26-year-old client who is exhibiting a crowing sound (stridor)
Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?
a woman who takes anticoagulants to treat a fib
Which client most likely requires special preoperative assessment and treatment as a result of the existing medication regimen?
in emergency situations, the doctor may obtain consent over the telephone
Which fact should the nurse keep in mind when obtaining consent forms from clients scheduled to undergo surgery?
Assisting the client to the bathroom before surgery
Which preoperative task can the nurse delegate to the UAP (unlicensed assistive personnel)?