Chapter 30: Perioperative Nursing

Which nursing action will best promote pain management for a client in the postoperative phase?

Performing relaxation techniques Explanation: Performing relaxation techniques is the best nursing action to promote pain management for a client in the postoperative phase.

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?

"The operating table is a firm surface; we need to be sure your skin looks okay." Explanation: The client who has been on the operating table should be examined to ensure skin breakdown hasn't occurred. The client would not be told that his covers looked messy, or that the nurse was concerned about sponges or syringes underneath. The client's skin should be assessed on admission; after surgery would not be the time to do this initial assessment to document skin breakdown.

The nurse is providing education about deep-breathing exercises to a postoperative client whose surgery took place earlier today. Which instruction should the nurse provide?

"Try to do your exercises every 1 to 2 hours." Explanation: Instruct the client that deep-breathing exercises should be performed every 1 to 2 hours for the first 24 hours after surgery.

A nurse is teaching a client about the rationale for fasting from food and fluids prior to surgery. What condition does this measure attempt to avoid?

Aspiration Explanation: Food and fluid are restricted before surgery to ensure that the stomach contains a minimal amount of gastric secretions. This restriction is important to reduce the risk of aspiration.

A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client?

Implement leg exercises and turn the client in bed every 2 hours. Explanation: Ambulation and leg exercises increase circulation, which prevents cardiovascular complications. The nurse should provide covers, forced warm air, or other warming devices/techniques as necessary to prevent shivering and hypothermia caused by the surgical procedure, the procedure's length, anesthetic agents, a cool environment, the client's age, or the use of cool irrigating/infusion fluids. Pillows placed under the knees can cause venous pooling, leading to thrombophlebitis.

The nurse cares for a client following surgery to repair an abdominal aortic aneurysm. Which nursing intervention assists with healing and maintaining client comfort?

Maintaining a calm environment Explanation: The nurse should plan for adequate periods of rest and sleep and maintain a quiet, restful environment. Nursing interventions that can help promote rest include maintaining a calm environment and limiting interruptions to the client's sleep (including frequent family visits). Providing solid food and keeping the client recumbent will not assist with healing and maintaining client comfort and may be contraindicated.

A nurse caring for a client postoperatively notes that the dressing on the client's incision was recently clean and dry but is now saturated with a large amount of fresh blood. What intervention should be taken by the nurse in this situation, along with notifying the primary care provider?

Reinforce the dressing. Explanation: The nurse should not remove the dressing, but instead should reinforce the dressing with more bandages. Removing the bandage could dislodge any clot that is forming and lead to further blood loss.

The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?

Respiratory obstruction Explanation: Respiratory obstruction may occur as a result of secretion accumulation, obstruction by the tongue, laryngospasm (a sudden, violent contraction of the vocal cords), or laryngeal edema. Cardiac distress, wound infection, and dehydration are all possible postoperative complications, but respiratory obstruction is most common.

The nurse is teaching a preoperative client about turning in bed after her surgery. Which picture demonstrates the appropriate action?

The nurse should teach the client to turn in bed by raising one knee, reaching across to grasp the side rail on the side toward which she is turning, and rolling over while pushing with the bent leg and pulling on the side rail. The nurse will not be pulling on the client's arm or pushing her.

A nurse is employed in an operative setting. Which of these roles is within the registered nurse (RN) scope of practice? Select all that apply.

positioning the client on the operating table counting sponges before and after surgery monitoring the client's vital signs Explanation: The RN's role is a supportive one for the client, monitoring vital signs and positioning the client on the operating room table. The RN also helps maintain safety by counting sponges and instruments that may have been used during the surgery. The RN is unable to administer anesthetics, such as inhalation agents or regional nerve blocks, without an advanced practice degree.

A nurse is discussing a surgical procedure with a client who needs to sign his informed consent. Which of these tasks is part of the nursing role?

witnessing the client signature with their consent for surgery Explanation: The nursing role with informed consent is to witness the client signature on the form. The procedural physician is responsible for explaining the procedure, any alternative treatment, and the risks and benefits of having the surgery. The nurse may clarify information, but if in-depth explanation is needed, the procedural physician should be notified.

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?

Apply pressure to the surgical site to decrease bleeding. Explanation: It is essential that the nurse be prepared to address life-threatening needs of the client. Excessive bleeding is a life-threatening issue. Determining the cause of the client's bleeding, assessing the vital signs, and notifying the health care provider are important, but the life-threatening issue must be addressed first.

A nurse is caring for a postoperative client. What intervention(s) will help prevent thrombophlebitis? Select all that apply.

Leg range of motion exercises Sequential compression devices (SCDs) and antiembolic stockings Early ambulation as tolerated Frequent turning and positioning Explanation: During surgery, venous blood return from the legs slows; in addition, some surgical positions decrease venous return. Thrombophlebitis and resultant emboli are potential complications from this circulatory stasis in the legs. Leg exercises, frequent turning and positioning, the use of SCDs and antiembolic stockings, adequate hydration, early ambulation, and anticoagulant prophylaxis increase venous return. Deep breathing and coughing improve postoperative gas exchange and prevent respiratory complications such as atelectasis. Using weights would not help prevent thrombophlebitis.

Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?

a 26-year-old client who is exhibiting a crowing sound Explanation: A client with a crowing sound is exhibiting stridor, which is an indication of an airway obstruction and can be a respiratory emergency. This client needs immediate attention. The client with disorientation needs to be frequently reoriented and observed for safety reasons but is not a priority over respiratory distress. The client who needs pain medication or the pediatric client requesting a parent are also not priority over a client in respiratory distress.

The nurse is performing a preoperative assessment for a client prior to surgery in the morning. What statement made by the client alerts the nurse that there is a potential for latex allergy? Select all that apply.

"I am allergic to banana's" "I had a rash after using a condom." "I broke out in hives after eating sliced avocado" Explanation: Clients that have an allergy to latex may have an associated allergy to banana's and avocado's. Client's developing a rash to a condom should be considered allergic to latex since the condom is latex. Bloating and gas after drinking milk or eating cheese may be attributed to a lactose intolerance. Aspirin allergy does not predispose a client to a latex allergy.

Which surgical client does the nurse in the preoperative setting anticipate having the greatest potential for surgical complications?

76-year-old client with a history of renal failure and chronic bronchitis Explanation: The client who is elderly with renal and lung disease has the most risk factors preoperatively for surgery. This client will have concerns over administration of anesthesia and medication, with the kidneys being able to clear these from the body, as well as with the lungs and potential postoperative complications of atelectasis and pneumonia. Clients who are young, have chronic disease, or are obese have risk factors as well, but not as many as the elderly client with both renal and pulmonary disease.

What information must be provided to a client to obtain informed consent? Select all that apply.

A description of the procedure or treatment, along with potential alternative therapies The underlying disease process and its natural course Explanation of the risks involved and how often they occur Explanation: The informed consent provides a description of the procedure or treatment (its name, site, and side effects if applicable), along with potential alternative therapies; the underlying disease process and its natural course; the name and qualifications of the person performing the procedure or treatment; explanation of the common risks involved, including risk for damage, disfigurement, or death, and how often they occur; explanation that the client has the right to refuse treatment and that consent can be withdrawn; and explanation of expected outcome, recovery, and rehabilitation plan and course.

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?

Apply warm blankets to the client. Explanation: The nurse should apply warm blankets to the client because the client is hypothermic with a temperature of 96.2°F (35.7°C). The client can be assessed further by checking vital signs and using an oxygen saturation monitor. The health care provider should be notified about the client's temperature but an intervention should be done first to ensure the client begins warming immediately.

A perioperative nurse is determining a plan of care for the client in the operating room. Which client outcome has priority?

Be free from injury and adverse effects. Explanation: All of these outcomes are appropriate for the client who is having surgery. Of all of these, safety is the priority for the nurse in making sure the client does not have injury or adverse effects from positioning and use of equipment in the operating room. Maintaining a normal body temperature and receiving age-appropriate care are also expected outcomes of the client in the operating room, but are not a higher priority. Although the client needs an environment that is aseptic to prevent infection, this is not as high a priority as the risk of injury.

A nurse is interacting with a client in the outpatient surgical unit intraoperatively. What is the nurse's priority responsibility?

Client safety Explanation: Client safety is the most important nurse responsibility during the intraoperative phase. Safety concerns include equipment, electrical, chemical, radiation, surgical verification, client transport and positioning, and continuous asepsis. Postoperative protocol education is done preoperatively. Establishing a nurse-client rapport and providing emotional support are important, but they are not the most important nursing responsibility during the intraoperative phase.

An older adult client underwent a hip replacement and now states to the nurse, "My parents are coming to visit me today. I need to mow the lawn and run errands." The client is trying to get out of the bed. What does the nurse identify is occurring with this client?

Delirium Explanation: Delirium refers to acute confusion that is reversible. It is common in the acute postoperative period.

The nurse educates a client about what to expect after abdominal surgery. How will the nurse explain the progression of a client's diet in the postoperative period?

Food and liquids will be held in the immediate postoperative period. Explanation: Intestinal manipulation, pain medications, and anesthetic agents may result in a decrease in intestinal motility. The client may experience nausea and vomiting. Therefore, after surgery, fluids and food are often withheld until gastric motility returns. A diet with sufficient amounts of protein and vitamins A and C (not vitamin B) helps to rebuild tissues and promotes wound healing. A soft diet with adequate (not high) carbohydrates for energy is started after the client has demonstrated tolerance to liquids well. Clients are not able to eat anything they want following surgery; the diet is usually progressed from NPO, to clear then full liquids, a soft diet, and finally a regular diet.

A client is scheduled for hip replacement surgery this morning but admits to the nurse that he had a small piece of toast and some water after waking up. What is the nurse's most appropriate response?

Inform the anesthesiologist or surgeon of this fact. Explanation: The surgeon or anesthesiologist must be informed if a client has not adhered to preoperative fasting instructions, since this constitutes a risk for aspiration. There is no benefit to assessing the client's abdomen or exploring the rationale for his actions.

The healthy adult client is given an opioid 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?

Notify the physician of the oversight. Explanation: Do not administer any medications that might alter judgment or perception before the client signs the consent form because many drugs commonly administered as preoperative medications, such as opioids or barbiturates, can alter cognitive abilities and invalidate informed consent.

A nurse caring for clients in a PACU assesses a client who is displaying signs and symptoms of shock. What is the priority nursing intervention for this client?

Place the client in a flat position with legs elevated 45 degrees. Explanation: Placing the client in a flat position with the legs elevated 45 degrees uses gravity to help direct blood to the vital organs. Removing extra coverings would cause the client's temperature to drop further during the blood loss occurring during shock. Medications will likely be ordered to help treat the shock. Prone position would be contraindicated.

A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client?

Place the client in semi-Fowler's position. Explanation: Nursing interventions include notifying the physician immediately, calling the medical intervention team, maintaining the client on bed rest in the semi-Fowler's position, assessing vital signs frequently, administering oxygen, administering medications (e.g., anticoagulants, analgesics), and instructing the client to avoid Valsalva maneuver (this prevents increased intrathoracic pressure and, possibly, increased emboli).

A client is scheduled for elective hernia surgery. While taking a medical history, the nurse learns that the client is taking antibiotics for an infection. Which surgical risk should the nurse monitor based on this antibiotic use?

Respiratory paralysis Explanation: Some antibiotics, especially those belonging to the "mycin" group, may cause respiratory paralysis when combined with certain muscle relaxants used during surgery. Hemorrhage, electrolyte imbalances, and cardiovascular collapse are not associated with antibiotics during surgery.

The nurse is caring for a client who had abdominal surgery yesterday and is reluctant to cough and perform deep breathing. Which strategy will most likely increase the client's willingness to cough and perform deep breathing?

Teach the client how to splint the abdomen while coughing. Explanation: Splinting the abdomen decreases discomfort while coughing. Telling the client about complications will be less effective than teaching splinting techniques. Respiratory treatments are not indicated for cough production. Side-lying position is less effective than upright positioning to clear secretions and expand the lungs.

Following a surgical procedure, who is generally responsible for moving the client to the recovery area?

The anesthesiologist, circulating nurse, and surgeon Explanation: After the intraoperative phase of the surgical procedure has been completed, the circulating nurse, the anesthesia provider, and the surgeon safely transport the client to the PACU, taking care to maintain the client's airway during this critical time.

The nurse is teaching a preoperative client about turning in bed after her surgery. Which picture demonstrates the proper technique?

The nurse will instruct the client to turn in bed by raising one knee, reaching across to grasp the side rail on the side toward which she is turning, and rolling over while pushing with the bent leg and pulling on the side rail. The nurse will not be pulling on the client's arm or torso

The nurse is teaching a client about postoperative pain management. The client states, "I would like to use as little medication as possible after surgery. Will anything else help to relieve my pain?" Which response is appropriate?

There are several nonpharmacologic methods to reduce pain and anxiety. Let me teach you about some of them." Explanation: Nonpharmacologic measures may reduce anxiety and reduce the need for pain medication at any time during the postoperative period. Asking about fear of addiction does not address the client's question. Nonpharmacologic methods can be implemented postoperatively regardless of prior client experience.

When an older adult client is brought to the recovery room and presents with irregular, loud respirations, the nurse determines that this is most likely a result of:

a partial airway obstruction. Explanation: Loud, irregular respirations may indicate obstruction of the airway, possibly from emesis, accumulated secretions, or client positioning that allows the tongue to fall to the back of the throat.

A nurse is reinforcing wound edges and applying a blinder to the separated incisions of a client after a surgery. Which postoperative complication has the client developed?

dehiscence Explanation: 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.

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?

prior to surgery Explanation: Though leg exercises are begun after surgery, such preventive measures should ideally be taught to the client during the preoperative period. In the postanesthesia care areas, the client has just arrived from the operating room where local or general anesthesia has been used. The client will be sedated but arousable and teaching would be inappropriate. Early signs of venous status is too late for leg exercises to begin, as the clot may have formed.

The preoperative nurse is teaching a client about deep-breathing exercises. The client asks, "Why do I need to learn about this?" Which response by the nurse is correct?

"After surgery, deep-breathing exercises help to remove anesthetic gases and mucus and improve oxygen supply to body tissues." Explanation: Deep-breathing exercises are intended to help prevent postoperative complications, such as low oxygen levels, accumulation of secretions, and atelectasis.

Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction?

"I can have a hamburger and French fries as soon as I wake up." Explanation: Oral fluid and food may be withheld until intestinal motility resumes.

The nurse is preparing a client for a total hip arthroplasty and is obtaining data preoperatively. Which statement made by the client is most important for the nurse to immediately report to the health care provider?

"I've been taking ibuprofen for my hip pain twice a day." Explanation: The nurse should immediately report the use of ibuprofen twice daily for the hip pain since this medication can cause the complication of postoperative bleeding. The history of hip pain and the inability to perform activities that were previously enjoyed are not relevant in determining complications. The intake of food or fluids is relevant, but the amount of time the client has been NPO is acceptable and reduces the risk of complications from anesthesia.

The nurse assists a client to turn in the bed. The client has just returned from abdominal surgery. How does the nurse instruct the client?

"Use a pillow to splint the incision." Explanation: The client needs to use a pillow to splint the incision during movement to reduce pain. The client needs to change position every 2 hours or less; "frequently" could be misinterpreted by the client. It is easier to turn laterally when the head of the bed is flat. Independence is encouraged, so if the client feels capable, he or she may move in the bed on his or her own.

A nurse is assigned to be the circulating nurse during a surgical procedure. The nurse would be responsible for which activity?

Anticipating the needs of other members of the surgical team Explanation: The circulating nurse identifies and assesses the client on admission to the operating room; collaborates with multiple surgical team members to provide safe client care (including carefully positioning the client on the OR bed); uses an approved antimicrobial agent to prepare the skin at the surgical site (prep); places a Foley catheter (if indicated); assists with monitoring the client during surgery; provides additional supplies; anticipates needs of the surgical team to facilitate the procedure; maintains environmental safety; and counts the number of instruments (sharp items such as needles and soft goods such as sponges) used during the surgery to prevent the accidental loss of an item in the surgical site.

Which nursing action should the PACU nurse take to prevent postoperative complications in clients?

Assist the client to do leg exercises to increase venous return. Explanation: Leg exercises increase venous return in order to prevent the postoperative complication of clot formation in the lower extremities. Coughing, while splinting the incision, and deep breathing is encouraged to prevent respiratory complications such as pneumonia and atelectasis. Turning the client stimulates the circulatory and respiratory system, and prevents skin breakdown.

The nurse is providing care for a client who is postoperative day zero following abdominal surgery. Which image demonstrates the correct action the nurse will instruct the postoperative client to take to engage in deep breathing and coughing exercises during the postoperative period?

Because deep breathing and coughing is often painful, the nurse should teach the client how to splint the incision (i.e., support the incision with a pillow or folded bath blanket). The client cannot cough effectively when supine or in a low Fowler position. The orthopneic position is used to facilitate respiratory expansion for clients who are short of breath. Grasping the side rails in a high-Fowler position is likely to put traction on the incision.

The preoperative nurse has prepared a client for surgery and has been notified that the operating room staff is ready for the client. The client states, "My bladder feels full. I need to go to the bathroom!" Which action by the nurse is appropriate?

Inform the operating room staff and assist the client to the bathroom. Explanation: Clients should empty the bowel and bladder before surgery. A urinary catheter is not indicated. The remaining statements are untrue.

The nurse is supervising a nursing student who is providing postoperative education to a client with an abdominal incision. The nurse sees the student coaching the client to perform coughing exercises, as pictured above. What is the nurse's best action?

Instruct the student to provide the client with a pillow or folded blanket to hug. Explanation: Because coughing is often painful, the student should teach the client how to splint the incision (i.e., support the incision with a pillow or folded bath blanket). It is not normally necessary to physically support the client, and it may be unsafe for the client to dangle. The client should not be in a supine or in a low Fowler's position, but the client does not necessarily need to be fully upright.

A client states having a latex allergy. Which action does the nurse take to communicate this allergy to hospital staff caring for the client?

Note the allergy on the client's record. Explanation: Assessing the client for allergies to medications, food, and latex when in a health care facility is an important task of the nurse. Clearly marking the client's allergies on the client's record will communicate to all health care personnel who interact with the client. It is not the client's responsibility to notify the anesthesiologist; the allergy should be clearly noted on the medical record. Obtaining latex-free gloves for the client's room is an appropriate intervention, but it will not communicate to all hospital staff the client's allergy. Placing a sign on the client's bed will inform bedside caregivers of the allergy, but clearly marking the medical record will inform all health care staff of the client's allergy.

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 characteristic applies to this type of surgery?

The client will be admitted the day of surgery and return home the same day. Explanation: 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 caring for a postoperative client and preparing to apply a pneumatic compression device. How does the nurse explain the device to the client prior to application?

The device fills with air and squeezes the legs, which increases blood flow through the veins of the legs and helps to prevent blood clots. Explanation: A pneumatic compression device promotes the circulation of venous blood and relocation of excess fluid into the lymphatic vessels. The device is used on the legs and is worn while the client is in bed.

Which factor is most important in the nurse's decision on assessment data, outcomes, and the monitoring needs of a client in preparing for surgery?

Type of surgery Explanation: Although all of these factors would need to be taken into account in planning care for a client going to surgery, the type of surgery is the most important influence on what type of care the client will require after surgery. Anesthesia and age play a role in monitoring needs postoperatively. The client needs an adequate support system when leaving the hospital, but the type of surgery influences the client's needs overall.

Surgery can lead to hypothermia. Which client is at greatest risk for hypothermia?

an older adult man with a fractured hip Explanation: The risk of hypothermia increases in the very young and the very old.

The nurse is assessing an obese client scheduled for heart surgery. Which priority surgical risk related to obesity should the nurse monitor?

delayed wound healing and wound infection Explanation: Fatty tissue has a poor blood supply and, therefore, has less resistance to infection. As a result, postoperative complications of delayed wound healing, wound infection, and disruption in the integrity of the wound are more common. Alterations in fluid and electrolyte balance are more likely to occur with the malnourished client. Respiratory distress is a high risk for clients with preexisting respiratory conditions. Clients with cardiovascular disease are at an increased risk for hemorrhage.

A nurse is caring for an inpatient client scheduled to undergo a surgery for the removal of a malignant tumor. What risk factors does the nurse identify that increase the occurrence of perioperative complications? Select all that apply.

obesity bleeding tendencies low hemoglobin Explanation: Certain surgical risk factors, such as obesity, bleeding tendencies, low hemoglobin, smoking, diabetes, cardiopulmonary disease, drug and alcohol use, and diabetes, increase the likelihood of perioperative complications. Raised temperature and anxiety are causes for postponing or cancelling the surgery.

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:

prevent anxiety. Explanation: Relaxation can be enhanced by removing the child's clothing, applying the grounding pad, and applying monitoring devices after the child is anesthetized. This action has no effect on vital signs, thermoregulation, or blood loss.

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?

procedural pause (time-out) Explanation: The procedural pause (time-out) must be done prior to any procedure to ensure client safety and to verify the client identity, staff roles, and procedure being performed.

What is the nurse's role in the informed consent process for a surgical procedure?

witnessing the signed informed consent document Explanation: The nurse may witness the signed informed consent document. The health care provider will explain what takes place during the procedure, and provide benefits and risks. The client grants permission for surgery to be done.

A client had an open cholecystectomy (gallbladder 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?

Monitor the client closely and promote fluid intake. Explanation: Bowel function does not typically return immediately after surgery, but it can be promoted by encouraging fluid and fiber intake as appropriate to the client and his or her surgery. A medical assessment is likely unnecessary at this early postoperative stage, and an enema would likely be premature. The nurse may not independently increase the client's IV infusion, and doing so would not necessarily promote a bowel movement.

Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?

Place graduated compression stockings on the client. Explanation: Use of graduated compression stockings and/or pneumatic compression devices on the client will help with prevention of DVT, which is a risk for clients after surgery. Elevating the client's legs will passively improve venous return but not prevent DVT if a client is not up and walking (to more actively promote the venous return). Elevating the head of the bed and using the incentive spirometer help prevent postoperative complications of atelectasis or pneumonia.

A 9-month-old baby is scheduled for heart surgery. When preparing this client for surgery, the nurse should consider which surgical risk associated with infants?

Potential for hypothermia or hyperthermia Explanation: Infants have difficulty maintaining stable body temperature during surgery because the shivering reflex is not well developed, making hypothermia or hyperthermia more likely. They are not at an increased risk for prolonged wound healing, congestive heart failure, or gastrointestinal upset.

Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply.

Spinal block Nerve block Epidural block Explanation: 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. Regional anesthesia includes spinal blocks, nerve blocks, and epidural blocks. Inhalation and intravenous administration of anesthesia are associated with general anesthesia. Anesthesia is not administered via the oral route.

The nurse is caring for a confused older adult client who requires surgery for a broken hip. What steps does the nurse take to determine if the client has a durable power of attorney for health care and how to contact that person?

Review the medical chart for a copy of a durable power of attorney for health care or permission for disclosure contact. Explanation: The client cannot give consent due to confusion. In most cases, the durable power of attorney for health care document is discussed and obtained during the admission process. The nurse should act as a client advocate by seeking someone with durable power of attorney to sign the informed consent form. It is the surgeon's responsibility to explain the surgical procedure and obtain the appropriate signature on the consent form; however, the nurse still acts as the client advocate to locate the designated person. A living will specifies the types of medical treatment the client wants should the client become unable to speak in a terminal or permanently unconscious medical condition, but it does not address matters related to client confusion. Telling visitors about the need for surgery may violate client confidentiality. If the nurse identifies who they have permission to disclose medical information to, they can ask that person about a durable power of attorney for health care.

A client who is scheduled to undergo coronary bypass surgery in a week asks the nurse whether he should discontinue taking his cholesterol medicine ahead of the surgery. Which should be the nurse's response?

"I will need to check with your health care provider about that." Explanation: The client may be permitted to take certain medications before surgery. The health care provider, not the nurse, should provide guidance about which medications should be taken and which ones should be held.

The nurse is educating a client who is preparing for abdominal surgery tomorrow. A teaching demonstration has just been completed by the nurse related to splinting the incision site with a pillow. Which statement by the client best indicates the instructions provided by the nurse were effective?

"I will put the pillow on the incision then cough." Explanation: Splinting the incision site when moving helps to minimize pain or discomfort postoperatively when coughing or moving. Clients should not hold their breath when trying to cough or move to prevent the Valsalva maneuver, which can change the heart rate and blood pressure of a client. Placing the pillow on the incision site after coughing is ineffective at reducing pain. The pillow should remain over the incision until the coughing exercises are completed.

The nurse is caring for a client who had a procedure under moderate sedation at the ambulatory surgical center. Which assessment finding indicates to the nurse that the client may be ready for discharge to home?

The client is alert and oriented with a blood pressure 118/70 mm Hg and respirations 18 breaths/minute, is able to ambulate, is not nauseated or vomiting, pain is controlled with medication, and has no excessive bleeding and drainage is as expected. Explanation: Stable vital signs, being alert and oriented, ability to ambulate, minimal nausea and vomiting, adequate pain control, and no excessive bleeding or drainage may indicate that the client is ready for discharge to home. The ability to void is a criterion after a spinal anesthesia or after pelvic surgery. Dizziness or inadequate pain control indicate that the client still needs to be monitored before discharge. Elevated blood pressure should be monitored and the client should not be discharged until stable.

Who is legally responsible for obtaining the client's informed consent for a surgical procedure?

the surgeon Explanation: The surgeon is legally responsible for obtaining the client's informed consent; however, the nurse should ensure the signed form has been obtained and is present in the client's chart and answer any questions or concerns the client may have concerning the upcoming procedure.

The nurse working in the holding area is performing an assessment on a client scheduled for surgery. Which question will the nurse ask prior to the client receiving general anesthesia?

"When was the last time you had anything to eat or drink?" Explanation: Determining when the last time the client had anything by mouth is important when undergoing anesthesia. The client ideally should be NPO, nothing by mouth, at least 8 hours prior to a general anesthesia to avoid aspiration during intubation. Assessing daily medications is done before surgery, not in the holding area. Asking the client to verify orientation should have been completed prior to arriving in the holding area. Asking the client if a chaplain should be called is not an appropriate action to take in the holding area.

The nurse needs to evaluate the effectiveness of a preoperative teaching session with a client scheduled for abdominal surgery. Which client statement indicates the need for further clarification?

"While my pneumatic compression device is on, I don't need to do leg exercises." Explanation: Compression stockings and pneumatic compression devices help to decrease the formation of thrombus by helping to promote venous return to the heart. The nurse needs to clarify that the pneumatic compression device does not replace leg exercises because the exercises help keep the joints flexible and help strengthen muscles while the client is in bed. The client is correct that splinting the incision when coughing is important. The client should sit up in bed when using the incentive spirometer, taking deep breaths and coughing. The client should take deep breaths and cough at least every 2 hours while awake to help expand lungs, loosen secretions, and help prevent atelectasis and pneumonia.

When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease?

slow wound healing Explanation: Due to impaired circulation and high glucose levels, the client with diabetes is at an increased risk for slow wound healing. The surgical risk of fluid and electrolyte imbalances is often associated with clients who have kidney and liver disease. The risk of respiratory depression from surgery increases for clients with existing respiratory disorders. Altered metabolism may occur as a result of surgery for clients with kidney and liver diseases.