Exam 1 Study Set - Chapter 14

A client scheduled for surgery asks why blood tests are being done to evaluate liver function. Which response will the nurse make?

• "It is because the anesthesia you will receive is cleared through the liver."

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

• Adrenal

The nurse is creating a plan of care for a client who is about to undergo surgery. When should the nurse provide teaching to the client about care needed during the postoperative period?

• At discharge with an adult who will be responsible for the client

A client is scheduled for a surgical procedure. When planning the client's care the nurse should consider that which of the following conditions will increase the client's risk of complications after surgery?

• A history of diabetes

The policies and procedures on a preoperative unit are being amended to bring them closer into alignment with the focus of the Surgical Care Improvement Project (SCIP). What intervention most directly addresses the priorities of the SCIP?

• Actions aimed at preventing surgical site infections

The nurse is evaluating the client's understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following?

• Cheeseburger, french fries, coleslaw, and ice cream

The nurse is doing a preoperative assessment of an 87-year-old man who is slated to have a right lung lobe resection to treat lung cancer. What underlying principle should guide the nurse's preoperative assessment of an elderly client?

• Elderly clients have less physiologic reserve than younger clients.

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

• Let the client wear the ring and cover it with tape.

A client scheduled for surgery has a blood pressure of 186/90 mm Hg. After documenting this in the medical record which action will the nurse take?

• Notify the health care provider of the blood pressure.

An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment as well as surgical care and postoperative care for older adults?

• Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.

For the client who is taking aspirin: it is important to stop taking this medication at least how many day(s) before surgery?

• 7

An obese client is scheduled for open abdominal surgery. What priority education should the nurse provide to this client?

• Prevention of respiratory complications

A client is scheduled to have surgery to address a cleft palate. What type of surgery would the nurse be preparing this client for?

• Reconstructive

Once the operating team has assembled in the room the circulating nurse calls for a "time out." What action should the nurse take during the time out?

• Review the scheduled procedure, site, and client.

A nurse knows that she must obtain a signed informed consent for which of the following procedures?

Paracentesis, Cystoscopy, Open reduction of a fracture, and arteriography

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

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

A client is having surgery through an ambulatory surgical center. Which information will the nurse provide to the client's family?

• "The client will go to the postanesthesia care unit after the surgery."

The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement made by the client would indicate that further instruction is needed?

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

Which question is most important for the nurse to ask the client when obtaining the preoperative admission history?

• "When is the last time you ate or drank?"

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?

• 80 to 110 mg/dL Explanation: Although the surgical risk in the client with controlled diabetes is no greater than in the client without diabetes, strict glycemic control (80 to 110 mg/dL) leads to better outcomes. Frequent monitoring of blood glucose levels is important before, during, and after surgery.

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

• A gastrostomy tube

A client scheduled for surgery follows a vegan eating plan. For which potential postoperative complication will the nurse plan care for this client?

• Delayed wound healing

A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia?

• Diuretics

What action by the nurse best encompasses the preoperative phase?

• Educating clients on signs and symptoms of infection

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

• Physician

The nurse is providing preoperative teaching to a client scheduled for surgery. Place in order the instructions the nurse will provide the client to perform diaphragmatic breathing.

• Place bed in at 30- to 45-degree angle. • Place the hands on the front of the lower ribs. • Breathe out gently and fully to feel the ribs sink downward. • Take a deep breath through the nose and mouth to make the abdomen rise. • Hold the breath for a count of five. • Exhale and let all the air out through the nose and mouth. • Repeat the exercise 15 times with a rest after each group of five. • Practice this breathing twice a day before the surgery.

You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility?

• Place gauze under and over the ring and apply adhesive tape over it.

A client who is deaf without bilateral hearing aids has them removed in preparation for a surgical procedure. Which action(s) will the nurse take to communicate with this client?

• Plan for a sign language interpreter, speak slowly so the client can lip read, use hand gestures to communicate, provide written information

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

• Use diaphragmatic breathing.

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

• emergency.

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

• potassium 6.2 mEq/L

A nurse is assessing a postoperative client with hyperglycemic blood glucose levels. Which post-surgical risk factor would decrease if the surgical client maintained strict blood glycemic control?

• wound healing

A client with osteoarthritis receives a recommendation to have joint replacement surgery. For which type of surgery will the nurse plan teaching for this client?

• Elective

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

• Emergent

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

• Emergent

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

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

A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed?

• The client exhales forcefully with a short expiration.

The nurse is educating a community group about types of surgery. A member of the group asks the nurse to describe a type of surgery that is curative. What response by the nurse is true?

• Tumor excision Explanation: An example of a curative surgical procedure is tumor excision. A biopsy, a face-lift, and the placement of a gastrostomy tube are not examples of curative surgical procedures.

The nurse is caring for a client who has just arrived for surgery. Which assessment finding indicates to the nurse that the client may be experiencing dehydration because of taking nothing by mouth after midnight for the surgery?

• Blood pressure 80/50 mm Hg Explanation: Assessment of a client's hydration status is essential preoperatively. The client's NPO (nothing by mouth or nil per os) status should be confirmed preoperatively. Preoperative fasting helps prevent the risk of aspiration but it also induces stress on the body, including the loss of glycogen stores, and the body sacrifices lean muscle to meet the energy needs of the surgery. This may lead to dehydration, which may be exhibited day of surgery by low blood pressure. A urine output of 60 mL/hr is within normal limits. A pulse of 88 beats per minute is within normal limits. A respiratory rate of 20 breaths per minute is within normal limits.

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

• Emergent surgery

A client is scheduled for a spinal fusion to treat spinal stenosis. For which reason might the nurse anticipate surgery being delayed because of the risk for postoperative complications?

• Smoking