perioprative

A nurse is assessing a client who is 2 days postoperative following a total prostatectomy. The nurse notes the client's right calf is red, edematous, and warm to the touch. Which of the following actions should the nurse take?

Elevate the client's right extremity.

A nurse is caring for a client who is postoperative and has a Jackson-Pratt drain in place. Which of the following interventions should the nurse use to ensure proper functioning of the drain?

Empty and compress the drain reservoir as needed.

A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of the following assessment data indicates the client is at an increased risk for infection?

Long-term use of corticosteroids

A nurse is caring for a client during surgery. To help prevent neuromuscular complications during the surgical procedure, the nurse should take which of the following actions?

Support the client's bony prominences with foam padding.

A nurse is providing preoperative teaching for a client. Which of the following prescribed medications should the nurse instruct the client to discontinue 48 hr prior to the surgery?

Warfarin

A nurse is receiving afternoon report on four clients who have returned from the PACU this morning. The nurse should assess which of the following clients first?

A client who is postoperative following a thoracotomy has a chest tube with 150 mL bright-red of blood in the collection chamber from the past hour.

A nurse is providing teaching for a client who is scheduled to undergo moderate (conscious) sedation for a bronchoscopy. The nurse should verify that the client understands the procedure when the client states which of the following?

"I can expect to feel sleepy for several hours after the procedure."

A nurse is caring for a client receiving moderate (conscious) sedation with midazolam and fentanyl. The client's respirations decrease from 16/min to 6/min, and the oxygen saturation decreases from 92% to 85%. Which of the following actions should the nurse take first?

Administer reversal agents.

A nurse is providing teaching for a client who is in the immediate postoperative period and has a PCA pump. Which of the following statements should the nurse include in the teaching?

"Do not allow your family to push the PCA button if you are sleeping."

A nurse is providing preoperative teaching for a client who is scheduled to have a mastectomy. Which of the following statements by the client indicates a need for further teaching?

"I'll wait until a week after surgery to start hand strengthening exercises."

A nurse is monitoring a client receiving succinylcholine during a surgical procedure. Which of the following actions should the nurse take if the client develops malignant hyperthermia?

Administer dantrolene.

A nurse is caring for a client who is postoperative following abdominal surgery. Which of the following nursing interventions should the nurse perform to prevent respiratory complications?

Advise the client to splint the surgical incision when coughing and deep breathing.

A nurse is preparing a client for surgery. The client appears apprehensive and asks multiple questions about the risks of the procedure. Which of the following actions should the nurse take before witnessing the client's signing of the informed consent form?

Ask the surgeon to speak to the client for clarification.

A nurse is taking a preoperative medication history on a client who is scheduled for surgery. Which of the following medications should the nurse recognize as placing the client at risk for complications due to interaction with anesthetic agents?

Captopril

A nurse is caring for a client who has an NG tube set to continuous low suction following a gastrectomy. Which of the following findings should the nurse report to the provider?

Gastric distention

A nurse is caring for a client who is postoperative. To prevent formation of thrombi in the postoperative period, the nurse should do which of the following?

Have the client perform dorsal and plantar flexion of the feet every hour.

A client had an open transverse colectomy 5 days ago. The nurse enters the client's room and recognizes that the wound has eviscerated. After covering the wound with a sterile, saline-soaked dressing, which of the following actions should the nurse take?

Obtain vital signs to assess for shock.

A nurse is reviewing the medical record of a client who is to undergo general anesthesia for surgery. The nurse should report which of the following findings to the provider?

Potassium level 2.8 mEq/L

A nurse is providing preoperative teaching to a client who is scheduled for a gastrectomy in 1 week. The client is anxious about the upcoming surgery. Which of the following is an appropriate action for the nurse to take?

Provide concise, factual information.

A nurse is completing a preoperative assessment for a client who is a Jehovah's Witness. Which of the following should the nurse recognize as a situation that could pose special care needs for this client?

Providing informed consent to receive blood products

A nurse is providing discharge instructions for a client who is postoperative following abdominal surgery. Which of the following client statements indicates a need for further teaching?

Remaining on bed rest places the client at risk for development of venous thrombosis. The nurse should encourage ambulation and activity.

A nurse who is working in the surgical suite should check that the rooms are maintained at a cool temperature with low humidity to decrease which of the following?

Risk of infection

A nurse is assessing a client in the PACU to determine if he is ready for discharge. Which of the following assessment findings indicates that the client is ready for discharge?

The client is able to move all four extremities on command.

A nurse is completing an initial PACU assessment of a client who is postoperative following a total knee arthroplasty and received spinal anesthesia. Which of the following findings indicates the need to notify the provider?

The client reports chest pain.

A nurse is caring for a client who is 2 days postoperative following a cholecystectomy. The client has been vomiting for the past 24 hr and reports a pain level of 8 on a scale from 0 to 10. The nurse notes a hard, distended abdomen and absent bowel sounds. After conferring with the provider, which of the following actions should the nurse take first?

The greatest risk to the client is fluid and electrolyte imbalance as a result of accumulated fluid and gas in the gastrointestinal tract. The first action the nurse should take is to insert an NG tube to begin decompression of the bowel.

A surgical nurse enters the surgical suite to ensure surgical asepsis is maintained. Which of the following observations requires an intervention?

The scrub technologist is wearing a watch under his scrubs.

A nurse is assessing a client who is 2 hr postoperative following an appendectomy. Which of the following findings should the nurse report to the provider?

Urine output 20 mL/hr

A nurse is caring for a client who has a surgical wound with a Penrose drain in place. Which of the following interventions should the nurse plan to perform?

Use sterile technique when performing dressing changes.

A client is transferred from the surgical suite to the PACU following oral surgery. While monitoring the client's vital signs, the nurse finds that the tongue has become swollen and is obstructing the airway. Which of the following actions should the nurse take first?

Use the head-tilt, chin-lift method to open the airway.

a nurse is creating a plan of care for a client who is preoperative for a total hip arthroplasty, practices judaism, adheres to a kosher diet, which of the following interventions is the nurses priority?

determine if the clients faith conflicts with the treatment plan

A nurse is assessing a client's recovery from spinal anesthesia. Which of the following sensations should the nurse expect to return to the client first?

touch