Prep U: Chapter 14 Questions (Brunner)
Clients who have received corticosteroids preoperatively are at risk for which type of insufficiency? A) Thyroid B) Adrenal C) Pituitary D) Parathyroid
B) Adrenal Explanation: Clients who have received corticosteroids are at risk of adrenal insufficiency. Insufficiency related to corticosteroids does not occur in the pituitary, thyroid, or parathyroid glands.
A fractured skull would be classified under which category of surgery based on urgency? A) Urgent B) Required C) Elective D) Emergent
D) Emergent Explanation: Emergent surgery occurs when the client requires immediate attention. An elective surgery is classified as a surgery that the client should have. A required surgery means that the client needs to have surgery. An urgent surgery occurs when the client requires prompt attention.
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? A) insulin B) corticosteroids C) diuretics D) anticoagulants
C) diuretics Explanation: Diuretics during anesthesia may cause excessive respiratory depression resulting from an associated electrolyte imbalance. Corticosteroids, insulin, and anticoagulants are not known to cause respiratory depression during anesthesia.
Informed consent from the surgical client is essential in all of the following categories of surgery except: A) Required surgery B) Urgent surgery C) Elective surgery D) Emergent surgery
D) Emergent surgery Explanation: In an emergency, a physician may perform surgery without a client's informed consent in order to save the client's life.
A patient is scheduled for a reduction mammoplasty. What classification of surgery does the nurse understand that this is? A) Urgent B) Optional C) Required D) Necessary
B) Optional Explanation: Cosmetic surgery, including reduction mammoplasties, is optional, as the decision to have the surgery rests with the patient. *** -plasty is comestic.***
Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern? A) Registered nurse first assistant B) Anesthesiologist C) Circulating nurse D) Surgeon
D) Surgeon Explanation: It is the surgeon's responsibility to explain the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts in obtaining informed consent from the client.
For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery? A) 1 B) 3 C) 5 D) 7
D) 7 Explanation: Aspirin should be stopped at least 7 to 10 days before surgery. The other time frames are incorrect.
The nurse expects informed consent to be obtained for insertion of: A) A gastrostomy tube B) An indwelling urinary catheter C) A nasogastric tube D) An intravenous catheter
A) A gastrostomy tube Explanation: Informed consent is required for invasive procedures that require sedation and are associated with more than usual risk to the client.
What is the blood glucose level goal for a diabetic client who will be having a surgical procedure? A) 300 to 350 mg/dL B) 80 to 110 mg/dL C) 250 to 300 mg/dL D) 150 to 240 mg/dL
B) 80 to 120mg/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.
A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery? A) 2 weeks B) 4 weeks C) 2 to 3 days D) 7 to 10 days
D) 7 to 10 days Explanation: Aspirin, a common OTC medication that inhibits platelet aggregation, should be prudently discontinued 7 to 10 days before surgery; otherwise, the client may be at increased risk for bleeding.
A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client? A) obstruction B) surgical site infection C) hypoglycemia D) adrenal insufficiency
D) adrenal insufficiency Explanation: Clients who have received corticosteroids are at risk for adrenal insufficiency. They are not at greater risk for obstruction, infection, or hypoglycemia during the operative experience.
The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. A) health status B) age C) gender D) physical condition E) ethnicity F) nutritional status
A) health status B) age D) physical condition F) nutritional status Explanation: General surgical risk factors are related to age; nutritional status; use of alcohol, tobacco, and other substances; and physical condition.
A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take? A) Notify the surgeon to cancel surgery. B) Allow the client to wear the ring and cover it with tape. C) Discuss the risk for infection caused by wearing the ring. D) Remove the ring once the client is sedated.
B) Allow the client to wear the ring and cover it with tape. Explanation: Most facilities will allow a client to wear a wedding band during a surgical procedure. The nurse must secure the ring with tape. Although it is appropriate to discuss the risk for infection, the client has already refused to remove the ring. The surgery should not be canceled and the ring should not be removed without permission.
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? A) A face-lift B) A biopsy C) Placement of gastrostomy tube D) Tumor excision
D) 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 preparing a client for surgery. The nurse would notify the surgeon if the client made which of the following statements? Select all that apply. A) "I took my Coumadin as usual last evening." B) "I took two Tylenol last evening for a headache." C) "I have not had any metformin for the past week." D) "I took my lisinopril this morning." E) "I took two aspirins for joint pain this morning."
A) "I took my Coumadin as usual last evening." E) "I took two aspirins for joint pain this morning." Explanation: The nurse needs to alert the surgeon to any medications the client has taken that increase the client's risk for bleeding. Aspirin inhibits platelet aggregation and should be stopped at least 7 to 10 days prior to surgery. Coumadin (warfarin) interferes with the synthesis of vitamin K-dependent clotting factors. The type of surgical procedure and the medical condition of the client determine when the Coumadin should be stopped prior to surgery.
A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective? A) "I will support my incision with my hands when I cough and do my deep breathing exercises." B) "I will ask for pain medication when the pain becomes unbearable." C) "I will need to learn how to give myself pain medication by injection for when I go home." D) "The pain from my incision will be very similar to my arthritis pain."
A) "I will support my incision with my hands when I cough and do my deep breathing exercises." Explanation: Splinting of the incision provides support to the incision and helps to control pain, so this client statement is correct. Clients should take pain medication routinely and frequently after surgery. Pain medications for postoperative clients are given orally at home. Pain is a subjective feeling, so comparison is difficult.
The nurse is completing a preoperative assessment. The nurse notices the client is tearful and constantly wringing their hands. The client states, "I'm really nervous about this surgery. Do you think it will be ok?" What is the nurse's best response? A) "What are your concerns?" B) "What family support do you have after the surgery?" C) "You have nothing to worry about; you have the best surgical team." D) "No one has ever died from the procedure you are having."
A) "What are your concerns?" Explanation: Asking the client about their concerns is an open-ended therapeutic technique. It allows the client to guide the conversation and address their emotional state. Asking about family support changes the subject and is not therapeutic. Discussing the surgical team and the low death rate associated with a procedure minimizes the client's feelings and is not therapeutic.
The nurse is reviewing information collected from a client during a preoperative assessment. Which condition(s) will the nurse highlight that increases the client's risk for a surgical complication? Select all that apply. A) Asthma B) Arthritis C) Diabetes D) Urinary incontinence E) Body mass index 32
A) Asthma B) Arthritis C) Diabetes E) Body mass index 32 Explanation: The goal in the preoperative period is for the client to be as healthy as possible. Every attempt is made to assess for and address risk factors that may contribute to postoperative complications and delay recovery. The preoperative assessment provides information regarding underlying conditions that may affect the client's response to surgery techniques and anesthesia. During the physical examination, many conditions that have the potential to affect the client undergoing surgery are considered and include asthma, arthritis, diabetes, and obesity (BMI 32). Urinary incontinence is not identified as a condition that could lead to a postoperative complication.
The nurse is preparing the medical record for a client scheduled for surgery. Which item(s) will the nurse ensure are in the history and physical? Select all that apply. A) Current medications B) Surgical history C) Home care needs D) Medical history E) Allergies F) History of present illness
A) Current medications B) Surgical history E) Allergies F) History of present illness Explanation: A completed, updated and signed history and physical must be present prior to the client entering the operating room. Not more than 30 days before the date of the scheduled surgery, each client must have a comprehensive medical history and physical assessment. The primary provider is required to update the form within 24 hours of scheduled surgery on all non-inpatient clients. The history and physical consists of allergies, surgical history, medical history, current medications, and history of present illness. Home care needs are not a part of the history and physical.
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as A) Emergency B) Urgent C) Required D) Elective
A) Emergency Explanation: Emergency surgery means that the client requires immediate attention and the disorder may be life threatening. Urgent surgery means that the client requires prompt attention within 24 to 30 hours. Required surgery means that the client needs to have surgery, and it should be planned within a few weeks or months. Elective surgery means that there is an indication for surgery, but failure to have surgery will not be catastrophic.
A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications? A) Splint the incision site using a pillow during deep breathing and coughing exercises. B) Deep breathing and coughing exercises should be completed every 8 hours. C) Deep breathing and coughing exercises may be used as relaxation techniques. D) Pain medication should be taken before completing deep breathing and coughing exercises.
A) Splint the incision site using a pillow during deep breathing and coughing exercises. Explanation: Splinting the incision site will help decrease pain and support the incision. This will increase compliance with the deep breathing and coughing exercises that assist in preventing respiratory complications. Pain medication should be taken regularly, not only before deep breathing and coughing exercises. Deep breathing and coughing exercises should be done at least every 2 hours, more frequently if possible. While some clients will find the exercises relaxing, most clients find it painful to complete them.
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching? A) Use diaphragmatic breathing. B) Use chest breathing. C) Exhale through an open mouth. D) Make inhalation longer than exhalation.
A) Use diaphragmatic breathing Explanation: In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.
A client will undergo abdominal surgery. The nurse provides preoperative education regarding the importance of diaphragmatic breathing exercises to prevent postoperative complications. The nurse will educate the client about the risk for developing BLANK, BLANK, and BLANK, if the client does not implement diaphragmatic breathing exercises in the postoperative period of care. Select all that apply. A) pneumonia B) pain C) atelectasis D) bronchospasm E) hemorrhage
A) pneumonia C) atelectasis D) bronchospasm Explanation: One goal of preoperative nursing care is to educate the client how to promote optimal lung expansion and resulting blood oxygenation after anesthesia to prevent respiratory complications. Postoperative complications may occur for clients who do not implement diaphragmatic breathing exercises that are taught during the preoperative period of care. If the client does not implement deep breathing that facilitates a cough, the client is at risk for developing atelectasis, pneumonia, and bronchospasm. Although pain and hemorrhage are both complications associated with surgical procedures that can occur during the postoperative period of care, these complications are not decreased with the implementation of diaphragmatic breathing exercises that are meant to elicit a cough.
Which nursing statement would best ease a client's anxiety before an emergency operative procedure? A) "You will be just fine; the operating room nurses will take good care of you." B) "Let me explain to you what will happen next." C) "We will keep your family informed of your progress." D) "It is best to take deep breaths and relax before the procedure."
B) "Let me explain to you what will happen next." Explanation: Many clients feel fearful of knowing little about the operative procedure and what to expect. This fear causes anxiety and can lead to a poorer response to surgery and surgical complications. Explanations of what the client is to expect can help to decrease anxiety. False reassurance of being fine does not diminish anxiety. Deep breathing and relaxation techniques can be helpful to the client, but addressing the source of the anxiety is more beneficial. Keeping the family informed helps the family and is not client focused.
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? A) "My medical records will be sent to the ambulatory care center prior to my surgery." B) "The nurse will explain the details of the surgery before I sign a consent." C) "If I do not follow the instructions, my surgery could be cancelled." D) "The physician will update my family after the procedure and provide specific discharge instructions."
B) "The nurse will explain the details of the surgery before I sign a consent." Explanation: Further instruction would be needed to clarify that the physician, not the nurse, explains the details of the surgery and obtains voluntary consent for the procedure. It is correct that preoperative instructions must be followed prior to surgery for the safety of the client, medical records are present for review prior to surgery, and the physician speaks with the family following the procedure and provides instructions for discharge.
When is the ideal time to discuss preoperative teaching A) Day of surgery B) Preadmission visit C) Prior to entering the pre-op area D) When the patient is comfortable and sedated
B) Preadmission visit Explanation: The ideal timing for preoperative teaching is not on the day of surgery but during the preadmission visit, when diagnostic tests are performed. Teaching should be done long before the patient enters the preop area. Preoperative teaching should not be done when the patient is sedated.
A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate? A) Answer the client's questions. B) Request that the surgeon come and answer the questions. C) Place the consent form in the client's medical record. D) Notify the nurse manager of the client's questions.
B) Request that the surgeon come and answer the questions. Explanation: It is the physician's responsibility to provide information pertaining to risks and benefits of surgery. It is not the responsibility of the nurse or nurse manager to discuss risks and benefits. The consent form should not be placed in the medical record until all of the client's questions are answered fully.
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? A) At the time of discharge instructions B) On arrival to the surgical unit C) At discharge with an adult who will be responsible for the client D) Following the surgical procedure
C) At discharge with an adult who will be responsible for the client Explanation: Because sedative medications affect memory for events surrounding their administration, the nurse must review discharge instructions with an adult who will be responsible for the client after discharge. Clients and family members can better be prepared and participate in the recovery period if they know what to expect. Anxiety is a factor on arrival to the surgical unit, which could interfere with learning. Pain could interfere with the learning process following a surgical procedure.
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? A) Required B) Emergent C) Elective D) Urgent
C) Elective Explanation: Elective surgery means that the client should have the surgery even though failure to have the surgery is not catastrophic. Urgent surgery means that prompt attention is required within 24 to 30 hours. Required surgery means that the client needs to have surgery within a few weeks or months. Emergent surgery means that the client requires immediate attention for a life-threatening disorder without delay.
Which domain of perioperative nursing practice focuses on clinical processes and outcomes? A) Physiological responses B) Behavioral responses C) Health care systems D) Safety
C) Health care systems Explanation: The health care system consists of structural data elements and focuses on clinical processes and outcomes. Safety, behavioral responses, and physiological responses reflect phenomena of concern to perioperative nurses and comprise nursing diagnoses, interventions, and outcomes.
An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used? A) Progressive muscular relaxation B) Optimistic self-recitation C) Imagery D) Distraction
C) Imagery Explanation: Imagery has proven effective for anxiety in surgical clients. Optimistic self-recitation is practiced when the client recites optimistic thoughts such as, "I know all will go well." Distraction is used when the client is encouraged to think of an enjoyable story or recite a favorite poem. Progressive muscular relaxation requires contracting and relaxing muscle groups and is a physical coping strategy as opposed to a cognitive strategy.
A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed? A) The client places the hands on the lower chest to feel the rise and fall with breathing. B) The client performs diaphragmatic breathing in a semi-Fowler's position. C) The client exhales forcefully with a short expiration. D) The client breathes in deeply through the nose and mouth.
C) The client exhales forcefully with a short expiration. Explanation: Diaphragmatic breathing should be performed gently and fully. Placing the hands on the lower chest to feel the rise and fall with breathing, performing diaphragmatic breathing in a semi-Fowler's position, and breathing deeply through the nose and mouth are all aspects of diaphragmatic breathing.
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? A) nutrient deficiencies B) respiratory complications C) wound healing D) liver dysfunction
C) wound healing Explanation: In caring for a postoperative client, the nurse is correct to correlate hyperglycemia with an increased risk of surgical incision infections and delayed wound healing. Strict control of glycemic blood levels at the therapeutic range of 80-110 mg/dL would reduce this risk factor. There is no direct correlation between blood glucose levels and nutrient deficiencies, respiratory complications, or liver dysfunction.
A client scheduled for surgery asks why blood tests are being done to evaluate liver function. Which response will the nurse make? A) "It is just a routine test done before every surgery." B) "It is done to determine if you need antibiotics prior to surgery." C) "It is to make sure that you haven't had any alcohol before the surgery." D) "It is because the anesthesia you will receive is cleared through the liver."
D) "It is because the anesthesia you will receive is cleared through the liver." Explanation: The liver is one body organ that eliminates drugs and toxins and is important in the biotransformation of anesthetic compounds. Disorders of the liver may substantially affect how anesthetic agents are metabolized. Acute liver disease is associated with high surgical mortality. Careful assessment may include various liver function tests. Preoperative liver function tests may be routine but that does not explain the reason for the test to the client. Liver function tests are not done to determine prophylactic antibiotic therapy or to determine if the client had any alcohol before the surgery.
The nurse is teaching leg exercises to the client preoperatively. The client asks why the exercises are important. The best response by the nurse is: A) "Leg exercises help prevent pneumonia while you are on bed rest." B) "Your intestinal tract slows down following surgery, and the exercises will help restore normal intestinal activity." C) "Clients are often on bed rest following surgery, and the exercises can help prevent pressure ulcers." D) "Leg exercises help prevent blood clots in your legs."
D) "Leg exercises help prevent blood clots in your legs." Explanation: Leg exercises improve circulation of the lower extremities by preventing venous stasis, which can lead to deep vein thrombosis in the postoperative client.
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? A) Urine output 60 mL/hr B) Respiratory rate 20 breaths per minute C) Pulse 88 beats per minute D) Blood pressure 80/50 mm Hg
D) 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.
What action by the nurse best encompasses the preoperative phase? A) Monitoring vital signs every 15 minutes B) Documenting the application of sequential compression devices (SCDs) C) Shaving the client using a straight razor D) Educating clients on signs and symptoms of infection
D) Educating clients on signs and symptoms of infection Explanation: Educating clients on preventing or recognizing complications begins in the preoperative phase. Applying SCDs and frequently monitoring vital signs happen after the preoperative phase. Only electric clippers should be used to remove hair.
The patient is NPO prior to having a colonoscopy. The patient is to take a daily blood pressure pill prior to the procedure. Until when may water be given prior to the procedure? A) Up to 6 hours before surgery B) Up to 8 hours before surgery C) Up to 4 hours before surgery D) Up to 2 hours before surgery
D) Up to 2 hours before surgery Explanation: The major purpose of withholding food and fluid before surgery is to prevent aspiration. Until recently, fluid and food were restricted preoperatively overnight and often longer. The American Society of Anesthesiologists reviewed this practice and made new recommendations for people undergoing elective surgery who are otherwise healthy. Specific recommendations depend on the age of the patient and the type of food eaten. For example, adults may be advised to fast for 8 hours after eating fatty food and 4 hours after ingesting milk products. Healthy patients are allowed clear liquids up to 2 hours before an elective procedure (Crenshaw, 2011).
