Surgery Unit 1

The nurse is preparing to change a patient's abdominal dressing. The nurse recognizes the first step is to provide the patient with information regarding the procedure. Which of the following explanations should the nurse provide to the patient?

"During the dressing change, I will provide privacy at a time of your choosing, it should not be painful, and you can look at the incision and help with the procedure if you want to."

The nurse is providing teaching about tissue repair and wound healing to a patient who has a leg ulcer. Which of the following statements by the patient indicates that teaching has been effective?

"I'll eat plenty of fruits and vegetables."

You are working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks you why these medications are needed. What would be your best answer?

"These medications decrease gastric acidity and volume."

One of the things a nurse has taught to a patient during preoperative teaching is to have nothing by mouth for the specified time before surgery. The patient asks the nurse why this is important. What is the most appropriate response for the patient?

"You will need to have food and fluid restricted before surgery so you are not at risk for choking."

What are the primary effects on the circulatory and resp system?

*May cause respiratory depression *Vomiting/aspiration *Since pain response lost - could suffer nerve trauma or paralysis or positioning injuries *Malignant hyperthermia *Anesthesia awareness - more common in cardiac, OB or trauma pts.

What 4 things to assess your client during preop?

*Surgical risk factors * Legal/Ethical issues with informed consent *Preventative measures for postop complications * Preop preparations

Stages of General Anesthesia Stage __ = (administration of anesthetic agents & ends with loss of consciousness, relaxation).

1

What drug is used for antibiotic?

1. Ancef (Cefazolin)

What drugs are used as analgesic?

1. Demerol (meperidine) (opioid) 2. Morphine (opioid) 3. Valium (Benzo) 4. Versed (Midazolam Hydrochloride) (Benzo) 5. Dantrium (Dantrolene) (Stroke, Spinal cord injury) 6. Toradol (Ketorolac Tromethamine)

What are the 5 categories of surgery?

1. Emergent 2. Urgent 3. Required 4. Elective 5. Optional

What drugs are used as anesthetic?

1. Nitrous Oxide 2. Propofol (Diprivan) 3. Succinylcholine (Anectine) 4. Vecuronium (Norcuron)

What drugs are used for n/v?

1. Zofran (Ondansetron) 2. Reglan (Metoclopramide) Refractory GERD

Obesity is considered what percent over ideal body weight?

10

How many weeks should a patient stop smoking before a surgery?

2

Stages of General Anesthesia Stage __ = Excitement (loss of consciousness, referred to as excitement or delirium phase because it is often accompanied by involuntary motor activity).

2

Stages of General Anesthesia Stage __ = Surgical Anesthesia (cessation of breathing, pt unconscious, with proper adm of anesthetic administration this stage can be maintained for hrs).

3

Stages of General Anesthesia Stage __ = Medullary Depression (too much anesthesia - leads to cessation of respiration & leads to death if not reversed).

4

A patient having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the patient stop taking the aspirin before the surgery?

7 to 10 days

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

80 to 110 mg/dL

A nurse is receiving after noon report on 4 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 tracheotomy has a chest tube with 150 mL bright-red of blood in the collection chamber from the past hour.

A patient who appears cachectic is schedule for emergency surgery. A preoperative nutritional assessment should be performed by the nurse for which of these reasons? A. A malnourished patient is prone to postoperative infection B. Poor nutrition predisposes a patient to respiratory complications C. Poor nutrition increases the risk of post-op hemorrhage in a patient D. A malnourished patient has increased metabolic needs

A malnourished patient is prone to post op infection

What is the least desirable method of hair removal? A. Electric clippers B. A depilatory cream in nonsensitive patients C. A razor with an extruded blade D. Scissors for long hair (more than 3 mm)

A razor with an extrude blade

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?

A safe environment

The nurse is concerned that a postoperative patient may have a paralytic ileus. What assessment data may indicate that the patient does have a paralytic ileus?

Absence of peristalsis

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

What is an example of urgent?

Acute gallbladder infection

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 receiving mod (conscious) sedation with midazolam and fentanyl. The client's resp 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

__________ of inhalation- pt totally unconscious; less anxiety, prevention of pain. ANESTHESIA

Advantages

A nurse is caring for a client who is post op 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.

Which of the following may indicate hidden fears by a patient? A. Avoiding communication B. Repeatedly asking questions that have previously been answered C. Talking incessantly D. All of the above

All of the above

Why is epinephrine often used in combination with a local infiltration anesthetic? A. Causes vasoconstriction B. Prevents rapid absorption of the anesthetic drug C. Prolongs the local action of the anesthetic agent D. All of the above

All of the above

What is the name of a surgery that does not require an overnight hospital stay?

Ambulatory surgeries

What are some potential intraoperative complications?

Anesthesia awareness Nausea & vomiting Anaphylaxis Hypoxia & other respiratory complications Hypothermia Malignant hyperthermia

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

What is the primary goal in withholding food before surgery? Prevention of A. Aspiration B. Distention C. Infection D. Obstruction

Aspiration

The perioperative nurse is providing care for a patient who is recovering on the postsurgical unit following a transurethral prostate resection (TUPR). The patient is reluctant to ambulate, citing the need to recover in bed. For what complication is the patient most at risk?

Atelectasis

A client has an abdominal hysterectomy. The M.D.'s orders include progressive diet when awake. To reduce gas formation and abdominal discomfort in the postop period, the nurse should encourage the client to A. Limit walking and physical activity B. Eat bulk producing foods such as fruits and legumes C. Avoid chewing ice and sipping liquids through a straw D. Begin a regular diet as soon as recovered from anesthesia

Avoid chewing ice and sipping liquids through a straw

A nurse is taking a pre op medication hx on a client who is scheduled for surgery. Which of the following meds should the nurse recognize a placing the client at risk for complications due to interaction and anesthetic agents.?

Captopril

A patient is in the operating room for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented?

Circulating nurse

The nurse just received a postoperative patient from the PACU to the medical-surgical unit. The patient is an 84-year-old woman who had surgery for a left hip replacement. Which of the following concerns should the nurse prioritize for this patient in the first few hours on the unit?

Close monitoring of neurologic status

What medication should the nurse prepare to administer in the event the patient has malignant hyperthermia?

Dantrolene sodium (Dantrium)

The nurse should recognize that older adult clients are at high risk for postop pulmonary complications r/t which of these developmental changes? A. Increased pain tolerance B. Increased respiratory alkalosis C. Decreased reaction time D. Decreased chest expansion

Decreased chest expansion

Which of the following actions by the nurse is appropriate?

Discarding an object that comes in contact with the 1-inch border

A postoperative client is being evaluated for discharge and currently has an Aldrete score of 8. Which of the following is the most likely outcome for this client?

Discharge from PACU

Which medication classification must be assessed during the pre op period because it can cause an electrolyte imbalance during surgery? A. Corticosteroids B. Diuretics C. Phenothiazines D. Insulin

Diuretics

A nurse is providing teaching for a client who is in the immediate post op 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 postoperative patient who has had general anesthesia asks the nurse. "Why must I be on a clear liquid diet? Which of these responses would be appropriate for the nurse to make? A. This diet simulates the return of bowel fx B. It must be difficult for you to follow this diet C. Consult your doctor about this matter D. Eating solids too soon after surgery could lead to nausea and vomiting

Eating solids too soon after surgery could lead to nausea and vomiting

What action by the nurse best encompasses the preoperative phase?

Educating the patients on signs and symptoms of infection

What classification of surgery is Patient should have surgery?

Elective Failure to have surgery not catastrophic

A nurse is assessing a client who is 2 days post op following a total protectorate. 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

What classification is Patient requires immediate attention; disorder may be life threatening? Surgery

Emergent Without delay

A nurse is caring for a client who is post op 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

The surgeon's preoperative assessment of a patient has identified that the patient is at a high risk for venous thromboembolism. Once the patient is admitted to the postsurgical unit, what intervention should the nurse prioritize to reduce the patient's risk of developing this complication?

Encourage early ambulation.

________ - achieved by injecting local anesthesia into epidural space surrounding the dura of spinal cord. Doesn't go through the dura

Epidural

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

Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic?

Halothane

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

Have the client perform dorsal and plantar flexion of the ft every hr

The nurse admits a patient to the PACU with a blood pressure of 132/90 mm Hg and a pulse of 68 beats per minute. After 30 minutes, the patient's blood pressure is 94/47 mm Hg, and the pulse is 110. The nurse documents that the patient's skin is cold, moist, and pale. Of what is the patient showing signs?

Hypovolemic shock

A nurse is providing teaching for a client who is scheduled to undergo mod (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 providing discharge instructions for a client who is post op following abdominal surgery. Which of the following client statements indicates a need for further teaching?

I will remain on bed rest until my follow up apt with my doc

A nurse is providing per op 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

Which of these nursing diagnoses should be included in the care plan of a patient during the first 24 hrs after an exploratory laparotomy? A. Body image disturbance B. Fluid volume excess C. Ineffective airway clearance D. Chronic pain

Ineffective airway clearance

What is the patient's autonomous decision about whether to undergo a surgical procedure, based on the nature of the condition, the treatment options, and the risks and benefits involved?

Informed consent

_______ - delivered thru mask or endotracheal tube, most commonly used agent is nitrous oxide given with oxygen. Impacts the hypothalamus causing shivering after surg.ery. Awakening is rapid between 15-20 mins. Once the gas is turned off, the gas is reversed by ventilating the lungs with 100% oxygen.

Inhalation

A nurse is caring for a client who is 2 day post op following a cholecystectomy. The client has been vomiting for 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?

Insert an NG tube

What is the period of time that begins with transfer of the patient to the operating room area and continues until the patient is admitted to the postanesthesia care unit?

Intraoperative phase

Procaine, lidocaine, and zylocaine is used in what type of anesthesia?

Local

What kind of anesthesia that a nurse can monitor?

Local

______ Anesthesia can be used alone or in conjunction with other types anesthesia.

Local

___________ - nerve block achieved with injection of a local anesthetic into or around a nerve or group of nerves that innervates the operative site. Intercostal, axillary & digital blocks are examples.

Local conduction blocks

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

Long term uses of corticosteroids

How is general anesthesia most commonly excreted postoperatively? A. Kidneys B. Lungs C. Skin D. All of these routes

Lungs

With cardiac disorders: use caution with patients with a hx of what 3 things?

MI HTN CHF

A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all needed attire to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention?

Mask is placed over nose and extends to bottom lip.

When planning care for a preop patient, the nurse instructs the patient to shower the evening before surgery. The purposed of this action is to A. Reduce preparation time in the morning B. Minimize the risk of postop wound infection C. Relax the patient D. Eliminate body odor

Minimize the risk of postop wound infection

A postoperative client is moving from the bed to a chair when blood drips from the dressing. The nurse assesses the incision and notes evisceration. What does the nurse do first?

Moisten sterile gauze with normal saline and place on any organ.

A client had an open transverse colostomy 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

Fentanyl (Sublimaze) is categorized as which type of intravenous anesthetic agent?

Opioid

Which of the following is a classic sign of hypovolemic shock?

Pallor

What are some complications for Spinal anesthetic?

Paresthesias Paralysis Hypotension Bradycardia Spinal Headache

The nurse recognizes that written informed consent is required for insertion of a(n):

Peripherally-inserted central catheter.

What classification of surgery is Decision rests with patient?

Personal preference

What does the nurse recognize as one of the most common postoperative respiratory complications in elderly patients?

Pneumonia

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

What are some disadvantages of Moderate Sedation?

Powerful depressant of breathing Poor muscle relaxant Wide variance of tolerance

What is the term for diagnostic testing performed before admission to the hospital?

Preadmission testing

The nurse assists a post op patient to dangle legs and ft over the side of the bed prior to the first ambulation. The purpose of this measure is to A. Permit the patient to relax before walking B. Prevent the patient from experiencing postural hypotension C. Allow the patient's pulse rate to normalize D. Minimize the development of nausea in the patient

Prevent the patient from experiencing postural hypotension

What are some advantages to Moderate Sedation?

Produces pleasant, rapid (within 30 seconds) Relief of fear Maintenance of consciousness Protective reflexes Quick return to normal activities

What is an example of required?

Prostatic hyperplasia without bladder obstruction

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 from the nurse to take?

Provide concise, factual information

A nurse is completing a pre op 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

What complication is the nurse aware of that is associated with deep venous thrombosis?

Pulmonary embolism

The nurse is caring for a patient on the medical-surgical unit postoperative day 5. During each patient assessment, the nurse evaluates the patient for infection. Which of the following would be most indicative of infection?

Red, warm, tender incision

A nurse is witnessing a patient sign the consent form for surgery. After the patient signs the consent form, the patient starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?

Request that the surgeon come and answer the questions.

What classification of surgery is Patient needs to have surgery?

Required Plan within a few weeks or months

These are what kind of disorders: Obstructive Disease Restrictive Disorder Respiratory Infection

Respiratory

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

Risk of infection

A client is placed on the operating room table for the surgical procedure. Which surgical team member is responsible for handing sterile instruments to the surgeon and assistants?

Scrub nurse

What is an example of emergent?

Severe bleeding

_________- anesthetic agent is introduced into the subarachnoid space; usually at L4-L5.

Spinal

What are some tx for complications of Spinal anesthetic?

Strict bedrest (supine) 24-48 hr hydration analgesia quiet environment epidural blood patch

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

The ED nurse is caring for an 11-year-old brought in by ambulance after having been hit by a car. The child's parents are thought to be en route to the hospital but have not yet arrived. No other family members are present and attempts to contact the parents have been unsuccessful. The child needs emergency surgery to save her life. How should the need for informed consent be addressed?

Surgery should be done without informed consent.

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately?

Temperature of 102.5° F

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 post op following a total knee arthroscopy and received spinal anesthesia. Which of the following finding indicates the need to notify the provider?

The client reports chest pain

The nurse admitting a patient who is insulin dependent to the same-day surgical suite for carpal tunnel surgery. How should this patient's diagnosis of type 1 diabetes affect the care that the nurse plans?

The nurse should assess the patient's blood glucose levels vigilantly.

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

The scrub technologist is wearing a watch under his scrubs

What is the definition of surgery?

The tx of injuries or disorders of the body by incision or manipulation, especially with instruments.

You are caring for a client who needs to ambulate. What considerations should be included when planning the postoperative ambulatory activities for the older adult?

Tolerance

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

The most important nursing intervention when vomiting occurs postoperatively is to turn the patient's head to prevent aspiration of vomitus into the lungs. A. True B. False

True

An adult patient is in the recovery room following a nephrectomy performed for the treatment of renal cell carcinoma. The patient's vital signs and level of consciousness stabilized, but the patient then complains of severe nausea and begins to retch. What should the nurse do next?

Turn the patient completely to one side.

What classification is Patient requires prompt attention? Surgery

Urgent Within 24-30 h

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

Urine output 20 mL/hr

You are caring for a client 6 hours post surgery. You observe that the client voids urine frequently and in small amounts. You know that this most probably indicates what?

Urine retention

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

Use diaphragmatic breathing.

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. Which 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 patient is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?

Verify consent.

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

Warfarin

Choose the appropriate response to the statement, "I'm so nervous about my surgery" A. "Relax. Your recovery period will be shorter if you're less nervous" B. "Stop worrying. It only makes you more nervous" C. "You needn't worry. Your doctor has done this surgery many times before" D. "You seem nervous about your surgery"

You seem nervous about your surgery

What is the recommendation for smoking cessation prior to surgery and why? A. at least 2 months B. at least 3 months C. at least 2 weeks D. at least 3 weeks

at least 2 weeks

Local ______ blocks- nerve block achieved with injection of a local anesthetic into or around a nerve or group of nerves that innervates the operative site. Intercostal, axillary & digital blocks are examples.

conduction

What is an example of optional?

cosmetic surgery

Common surgical suffix: otomy

cutting in to

Potential complications during ______________ - laryngospasm, vomiting, slow spontaneous respirations & uncontrolled reflex movement.

extubation

Common surgical suffix: plasty

formation or plastic repair

What is bariatrics?

having to do with patients who are obese

If the surgery is over 3 hours, there is a ______ risk of respiratory issues.

increased

Obesity is prone to __________, positioning challenges, and post op complications.

infections

A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse bases her next action on the principle that:

it may be necessary to raise the head of this client's bed

Common surgical suffix: scopy

looking in to

Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care:

may result in the administration of general anesthesia.

Spinal anesthesia = If ________ reaches the upper thorax and cervical areas, partial or complete respiratory paralysis could result requiring ventilator assistance

medication

State of ________ - severe CNS depression produced by pharmacologic agents. Not arousable, even to pain, lost ability to maintain ventilation function, require assistance to maintain patent airway.

narcosis

A patient who is scheduled for surgery at 10 am has an oral temp of 101 degrees F at 0700. Because of this finding.the nurse should A. Auscultate the patient's lungs B. Notify the surgeon C. Take the patient's tem in one hour D. Check the room temp

notify the surgeon

What period of time that constitutes the surgical experience; includes the preoperative, intraoperative, and postoperative phases of nursing care? Name the phase

perioperative phase

What period of time that begins with the admission of the patient to the postanesthesia care unit and ends after follow-up evaluation in the clinical setting or home? Name the phase

postoperative phase

What is the period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table?

preoperative phase

Common surgical suffix: ostomy

providing

Common surgical suffix: ectomy

removal of an organ or gland

Common surgical suffix: rrhaphy

repair

What is an example of elective?

repair of scars