Periop supplemental study questions

The nurse should be well versed with all these to safeguard the safety and quality to patient delivery outcome. Which of the following should be given highest priority when receiving patient in the OPERATING ROOM? Assess level of consciousness Verify patient identification and informed consent Assess vital signs

Verify patient identification and informed consent

A patient is scheduled for surgery. What factor plays an important role in determining the dose and type of anesthesia to be given?1Patient gender2Duration of the procedure3Patient ethnicity4Number of hospital personnel present

2. The type and dosage of anesthesia to be given depend on multiple factors, one of which is the duration of the procedure. Anesthetic agents can be short-acting or long-acting; therefore, the anesthesiologist determines which drug to use based on the length of the procedure. The patient's sex or ethnicity and number of hospital personnel present do not play a major role in deciding which drug and dosage to use.

Which vital sign is most important for the nurse to monitor in a patient receiving general anesthesia in the postanesthesia care unit?

A patient receiving general anesthesia must be regularly monitored for respiratory rate because the medication may lead to respiratory depression. Pulse, blood pressure, and body temperature are evaluated and recorded in the patient's medical record but are not the most important vital sign to monitor. (MOST IMPORTANT=key word)

The nurse assesses a patient who had a total abdominal hysterectomy 2 days ago. Which information about the patient is most important to communicate to the health care provider?a.The right calf is swollen, warm, and painful.b.The patient's temperature is 100.3° F (37.9° C).c.The 24-hour oral intake is 600 mL greater than the total output.d.The patient complains of abdominal pain at level 6 (0 to 10 scale) when ambulating.

ANS: A The calf pain, swelling, and warmth suggest that the patient has a deep vein thrombosis, which will require the health care provider to order diagnostic tests and/or anticoagulants. Because the stress response causes fluid retention for the first 2 to 5 days postoperatively, the difference between intake and output is expected. A temperature elevation to 100.3° F on the second postoperative day suggests atelectasis, and the nurse should have the patient deep breathe and cough. Pain with ambulation is normal, and the nurse should administer the ordered analgesic before patient activities.

. The nurse is completing a medication history for the surgical patient in preadmission testing. Which of the following medications should the nurse instruct the patient to hold in preparation for surgery?a.Ibuprofenb.Acetaminophenc. Vitamin Cd. Miconazole

ANS: ANonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen inhibit platelet aggregation and prolong bleeding time, increasing susceptibility to postoperative bleeding. Acetaminophen is a pain reliever that has no special implications for surgery. Vitamin C actually assists in wound healing and has no special implications for surgery. Miconazole is an antifungal and has no special implications for surgery.

The surgical unit nurse has just received a patient with a history of smoking from the postanesthesia care unit. Which action is most important at this time? a.Auscultate for adventitious breath sounds b.Obtain the patient's blood pressure and temperature. c.Remind the patient about harmful effects of smoking. d.Ask the health care provider about prescribing a nicotine patch

ANS: AThe nurse should first ensure a patent airway and check for breathing and circulation (airway, breathing, and circulation [ABCs]). Circulation and temperature can be assessed after a patent airway and breathing have been established. The immediate postoperative period is not the optimal time for patient teaching about the harmful effects of surgery. Requesting a nicotine patch may be appropriate, but is not a priority at this time.

After receiving change-of-shift report about these postoperative patients, which patient should the nurse assess first? a. Obese patient who had abdominal surgery 3 days ago and whose wound edges are separating b. Patient who has 30 mL of sanguineous drainage in the wound drain 10 hours after hip replacement surgery c. Patient who has bibasilar crackles and a temperature of 100°F (37.8°C) on the first postoperative day after chest surgery d. Patient who continues to have incisional pain 15 minutes after hydrocodone and acetaminophen (Vicodin) administration

ANS: AThe patient's history and assessment suggests possible wound dehiscence, which should be reported immediately to the surgeon. Although the information about the other patients indicates a need for ongoing assessment and/or possible intervention, the data do not suggest any acute complications. Small amounts of red drainage are common in the first postoperative hours. Bibasilar crackles and a slightly elevated temperature are common after surgery, although the nurse will need to have the patient cough and deep breathe. Oral medications typically take more than 15 minutes for effective pain relief.

An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best? a. Answer the questions and document that teaching was done. b. Do not have the client sign the consent and call the surgeon. c. Have the client sign the consent, then call the surgeon. d. Remind the client of what teaching the surgeon has done.

ANS: B Do not have the client sign the consent and call the surgeon. In order to give informed consent, the client needs sufficient information. Questions about potential complications should be answered by the surgeon. The nurse should notify the surgeon to come back and answer the client's questions before the client signs the consent form. The other actions are not appropriate.

A patient who is just waking up after having hip replacement surgery is agitated and confused. Which action should the nurse take first?a. Administer the ordered opioid.b. Check the oxygen (O2) saturation.c. Take the blood pressure and pulse.d. Apply wrist restraints to secure IV lines.

ANS: B Emergence delirium may be caused by a variety of factors. However, the nurse should first assess for hypoxemia. The other actions also may be appropriate, but are not the best initial action.

An older patient who had knee replacement surgery 2 days ago can only tolerate being out of bed with physical therapy twice a day. Which collaborative problem should the nurse identify as a priority for this patient?a.Potential complication: hypovolemic shockb.Potential complication: venous thromboembolismc.Potential complication: fluid and electrolyte imbalanced.Potential complication: impaired surgical wound healing

ANS: B The patient is older and relatively immobile, which are two risk factors for development of deep vein thrombosis. The other potential complications are possible postoperative problems, but they are not supported by the data about this patient

In the postanesthesia care unit (PACU), a patient's vital signs are blood pressure 116/72, pulse 74, respirations 12, and SpO2 91%. The patient is sleepy but awakens easily. Which action should the nurse take first?a.Place the patient in a side-lying position.b.Encourage the patient to take deep breaths.c.Prepare to transfer the patient to a clinical unit.d.Increase the rate of the postoperative IV fluids

ANS: B The patient's borderline SpO2 and sleepiness indicate hypoventilation. The nurse should stimulate the patient and remind the patient to take deep breaths. Placing the patient in a lateral position is needed when the patient first arrives in the PACU and is unconscious. The stable blood pressure and pulse indicate that no changes in fluid intake are required. The patient is not fully awake and has a low SpO2, indicating that transfer from the PACU to a clinical unit is not appropriate.

The nurse is preparing to witness the patient signing the operative consent form when the patient says, "I do not really understand what the doctor said." Which action is best for the nurse to take? a.Provide an explanation of the planned surgical procedure .b.Notify the surgeon that the informed consent process is not complete. c.Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications. d.Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.

ANS: B The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurse's legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient understands the surgical procedure and signs the consent form.

On admission of a patient to the postanesthesia care unit (PACU), the blood pressure (BP) is 122/72. Thirty minutes after admission, the BP falls to 114/62, with a pulse of 74 and warm, dry skin. Which action by the nurse is most appropriate? a.Increase the IV fluid rate. b.Continue to take vital signs every 15 minutes. c.Administer oxygen therapy at 100% per mask. d.Notify the anesthesia provider immediately.

ANS: BA slight drop in postoperative BP with a normal pulse and warm, dry skin indicates normal response to the residual effects of anesthesia and requires only ongoing monitoring. Hypotension with tachycardia and/or cool, clammy skin would suggest hypovolemic or hemorrhagic shock and the need for notification of the ACP, increased fluids, and high-concentration oxygen administration.

Which nursing action or statement is most likely to reduce anxiety in a client being brought to the surgical suite? A. Asking the client if he or she has talked with the hospital chaplain B. Asking the client what specific surgery he or she is having done today C. Asking the client if he or she wants family members to be with them in the holding area D. Explaining to the client that the surgical area is the most technologically advanced in the city

ANS: C Most anxious clients would feel some relief by having one or more familiar persons waiting with them until surgery begins. In addition, asking the client what he or she wants allows the client to have more control over the situation. Asking the client if he or she has visited with the hospital chaplain and telling the client about the advanced technology can imply to the client that the procedure is dangerous. Although the client must be asked what procedure he or she is having (to ascertain that the client does know what is to be done), this question may make the client worry about the competency of the staff.

A 78-year-old patient is in the recovery room after having a lengthy surgery on his hip. As he is gradually awakening, he requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, he is very lethargic and his respirations are shallow, with a rate of 7 per minute. The nurse prepares for which priority action at this time?a. Assessment of the patient's pain levelb. Immediate intubation and artificial ventilationc. Administration of naloxone (Narcan)

ANS: C Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression. This situation is describing an opioid overdose, not opioid tolerance. Intubation and artificial ventilation are not appropriate because the patient is still breathing at 7 breaths per minute. It would be inappropriate to assess the patient's level of pain.

The nurse is caring for a patient the first postoperative day following a laparotomy for a small bowel obstruction. The nurse notices new bright-red drainage about 5 cm in diameter on the dressing. Which action should the nurse take first?a.Reinforce the dressing.b.Apply an abdominal binder.c.Take the patient's vital signs.d.Recheck the dressing in 1 hour for increased drainage

ANS: C New bright-red drainage may indicate hemorrhage, and the nurse should initially assess the patient's vital signs for tachycardia and hypotension. The surgeon should then be notified of the drainage and the vital signs. The dressing may be changed or reinforced, based on the surgeon's orders or institutional policy. The nurse should not wait an hour to recheck the dressing.

A postoperative patient has a nursing diagnosis of ineffective airway clearance. The nurse determines that interventions for this nursing diagnosis have been successful if which is observed?a.Patient drinks 2 to 3 L of fluid in 24 hours.b.Patient uses the spirometer 10 times every hour.c.Patient's breath sounds are clear to auscultation.d.Patient's temperature is less than 100.4° F orally

ANS: C One characteristic of ineffective airway clearance is the presence of adventitious breath sounds such as rhonchi or crackles, so clear breath sounds are an indication of resolution of the problem. Spirometer use and increased fluid intake are interventions for ineffective airway clearance but may not improve breath sounds in all patients. Elevated temperature may occur with atelectasis, but a normal or near-normal temperature does not always indicate resolution of respiratory problems.

Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for abdominal surgery for an open cholecystectomy? a. Care for the surgical incision b. Medications used during surgery c. Deep breathing and coughing techniques d. Oral antibiotic therapy after discharge home

ANS: C Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this information. The patient does not usually need information about medications that are used intraoperatively.

Which actions will the nurse include in the surgical time-out procedure before surgery (select all that apply)?a. Check for placement of IV lines.b. Have the surgeon identify the patient.c. Have the patient state name and date of birth.d. Verify the patient identification band number.e. Ask the patient to state the surgical procedure.f. Confirm the hospital chart identification number.

ANS: C, D, E, FThese actions are included in surgical time out. IV line placement and identification of the patient by the surgeon are not included in the surgical time-out procedure.

The most appropriate resources to include when planning to provide patient education related to a goal in the psychomotor domain would bea.diagnosis-related support groups.b.Internet resources.c.manikin practice sessions.d.self-directed learning modules.

ANS: CA teaching goal in the psychomotor domain should be matched with teaching strategies in the psychomotor domain, such as demonstration, practice sessions with a manikin, and return demonstrations. Diagnosis-related support groups would be most effective with goals in the affective domain. Internet resources would be most effective for goals in the cognitive domain. Self-directed learning modules would be most effective for goals in the cognitive domain.

The nurse is monitoring a patient in the postanesthesia care unit (PACU) for postoperative fluid and electrolyte imbalance. Which of the following actions would be most appropriate for this patient?a.Encourage copious amounts of water.b. Weigh the patient and compare with preoperative weight.c. Measure and record all intake and output.d. Start an additional intravenous (IV) line.

ANS: CAccurate recording of intake and output assesses renal and circulatory function. Measure and record all sources of intake and output. Encouraging copious amounts of water in a postoperative patient might encourage nausea and vomiting. In the PACU, it is impractical to weigh the patient while waking from surgery, but in the days afterward, it is a good assessment parameter for fluid imbalance. Starting an additional IV is not necessary and is not important at this juncture.

The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits. His wife usually answers most questions that are directed to the patient. Which action should the nurse take when doing the teaching? a.Use printed materials for instruction so that the patient will have more time to review the material .b.Direct the teaching toward the wife because she is the obvious support and caregiver for the patient. c.Provide additional time for the patient to understand postoperative instructions and carry out procedures. d.Ask the patient's wife to wait in the hall in order to focus preoperative teaching with the patient himself.

ANS: CThe nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because the patient has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the patient and the wife because both will need to understand preoperative procedures and teaching.

When caring for a patient who has received a general anesthetic, the circulating nurse notes red, raised wheals on the patient's arms. Which action should the nurse take immediately?a.Apply lotion to the affected areas.b.Cover the arms with sterile drapes.c.Recheck the patient's arms in 30 minutes.d.Notify the anesthesia care practitioner (ACP) immediately.

ANS: D The presence of wheals indicates a possible allergic or anaphylactic reaction, which may have been caused by latex or by medications administered as part of general anesthesia. Because general anesthesia may mask anaphylaxis, the nurse should report this to the ACP. The other actions are not appropriate at this time.

The anesthetized client with an open abdomen suddenly develops malignant hyperthermia. What intervention should the nurse be prepared to initiate or assist with? A. Discontinue mechanical ventilation. B. Administer intravenous potassium chloride. C. Administer intravenous calcium chloride. D. Administer intravenous dantrolene (Dantrium).

ANS: D Dantrolene is a skeletal muscle relaxant and can help lower body temperature by reducing metabolic heat production by the muscles. Clients become hyperkalemic and hypercalcemic; therefore, neither of these electrolytes should be administered. The client's gas exchange is severely compromised. If the client is not already receiving mechanical ventilation, it is initiated.

Two hours after abdominal surgery, the nurse auscultates the client's abdomen. No bowel sounds are present. What is the nurse's best first action? A. Position the client on the right side with the bed flat. B. Check the dressing and apply an abdominal binder. C. Palpate the bladder and measure abdominal girth. D. Document the finding as the only action.

ANS: D Absence of bowel sounds 2 hours after abdominal surgery is an expected finding that should be documented. No intervention specific to this finding is needed at this time.

Who is responsible for accompanying the surgical client to the postanesthesia recovery area after surgery and for giving a report of the client's intraoperative experience to the PACU nurse? A. The surgeon and scrub nurse B. The surgeon and circulating nurse C. The anesthesiologist and scrub nurse D. The anesthesiologist and circulating nurse

ANS: D The anesthesiologist (or certified registered nurse anesthetist) and the circulating nurse are responsible for accompanying the client to the postoperative recovery area and giving a report of the client's intraoperative experience.

A patient is undergoing abdominal surgery and has been anesthetized for 3 hours. Which nursing diagnosis would be appropriate for this patient? a.Anxiety related to the use of an anesthetic b. Risk for injury related to increased sensorium from general anesthesia c.Decreased cardiac output related to systemic effects of local anesthesia d.Impaired gas exchange related to central nervous system depression produced by general anesthesia

ANS: D The nursing diagnosis of impaired gas exchange is appropriately worded for this patient. Anxiety would not be appropriate while the patient is in surgery. Sensorium would be decreased during surgery, not increased. Cardiac output is affected by general anesthesia, not local anesthesia.

A patient undergoing hip replacement surgery suddenly develops unexplained bradycardia. The anesthetist administers epinephrine to the patient. Which complication is the anesthetist trying to prevent?

Cardiac arrest is a common complication of spinal anesthesia, which is manifested as unexplained bradycardia and can be managed by administering epinephrine.

Mr. Baltazar will be undergoing surgery with general anesthesia. The client should be given which of the following instructions preoperatively? Eat big breakfast Expect to be incontinent of urine postoperatively Double your medication doses Expect nausea, vomiting, shivering, and pain postoperatively.

Expect nausea, vomiting, shivering, and pain postoperatively. Explanation: These responses should be expected, and the client should be prepared for them. Food is contraindicated before surgery. Urinary retention, not incontinence is likely. Medication is more likely to be held on the day of surgery.

The most dangerous metabolic side effect of general anesthesia that can occur during surgery is: Hyperglycemia Hyperthermia Hypoglycemia Hypothermia

Hyperthermia Explanation: Malignant hyperthermia is the most dangerous metabolic side effect of general anesthesia.

What would the nurse expect to find when assessing a patient with a postoperative wound infection?

Purulent drainage is the collection of pus in the draining fluid, which is an indication of infection in a postoperative patient. (INFECTION was key word)

The nurse receives the client in the postanesthesia care unit (PACU) following a procedure requiring general anesthesia. The most important assessment made by the nurse relates to the client's: Level of consciousness. Pain. Vital signs. Respiratory status.

Respiratory status. Explanation: General anesthesia causes relaxation of all muscles, including respiratory muscles, requiring mechanical ventilation. The client's respiratory status must be monitored closely following general anesthesia.

What is the priority nursing diagnosis for the client under general anesthesia during surgery? A. Acute Pain related to surgical procedure B. Risk for Infection related to surgical wound C. Risk for Impaired Skin Integrity related to prolonged static position D. Disturbed Body Image related to presence of surgical wound or scar

Risk for Impaired Skin Integrity related to prolonged static positionANS: C (KEY WORD-during SURGERY)The problem that nursing is most responsible for with this client is ensuring maintenance of skin integrity.

The nurse is attending to an older patient scheduled for heart surgery. What intervention by the nurse is most appropriate to ensure skin integrity?

The older patient is likely to have reduced hydration and risk for skin damage, which can be reduced by padding bony prominences.Assisting the patient with ambulation, allowing extra time to teach the patient, and preventing the risk for falls indirectly help to maintain skin integrity (note:keyword was skin integrity, not safety or teaching!)

A patient in a medical-surgical unit reports that something popped out from his surgical wound while coughing. Which nursing intervention may benefit the patient?

The patient could have an evisceration, or protrusion of the internal organs, so the nurse should apply a sterile nonadherent dressing or a saline dressing to the wound and notify the primary health care provider or surgeon immediately.

Ten hours after surgery, a postoperative client reports that the antiembolism stockings and sequential compression devices itch and are too hot. The client asks the nurse to remove them. What response by the nurse is best? a. "Let me call the surgeon to see if you really need them." b. "No, you have to use those for 24 hours after surgery." c. "OK, we can remove them since you are stable now." d. "To prevent blood clots you need them a few more hours."

d. "To prevent blood clots you need them a few more hours." According to the Surgical Care Improvement Project (SCIP), any prophylactic measures to prevent thromboembolic events during surgery are continued for 24 hours afterward. The nurse should explain this to the client. Calling the surgeon is not warranted. Simply telling the client he or she has to wear the hose and compression devices does not educate the client. The nurse should not remove the devices.

The nurse interviews a patient scheduled to undergo general anesthesia for a hernia repair. Which information is most important to communicate to the surgeon and anesthesiologist before surgery? a. The patient drinks 3 or 4 cups of coffee every morning before going to work. b. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago. c. The patient drank 4 ounces of apple juice 3 hours before coming to the hospital. d. The patient's father died after receiving general anesthesia for abdominal surgery.

d. The patient's father died after receiving general anesthesia for abdominal surgery. The information about the patient's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.

A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team? a. Allergy to bee and wasp stings b. History of lactose intolerance c. No previous experience with surgery d. Use of multiple herbs and supplements

d. Use of multiple herbs and supplementsSome herbs and supplements can interact with medications, so this information needs to be reported as the priority. An allergy to bee and wasp stings should not affect the client during surgery. Lactose intolerance should also not affect the client during surgery but will need to be noted before a postoperative diet is ordered. Lack of experience with surgery may increase anxiety and may require higher teaching needs, but is not the priority over client safety.**side note:pt taking St. John's wort may prolong the effects of anesthetic agents and increase the time to waken completely after surgery.*

If your client smokes 3 packs of cigarettes a day for the part 10 years, you will anticipate increased risk for: perioperative anxiety and stress delayed coagulation time delayed wound healing postoperative respiratory dysfunction

postoperative respiratory dysfunction