Taylor's Chapter 29: Perioperative (Prep U)
The nurse is preparing a client for surgery and asks if the client has an advance directive. The client asks "What is an advance directive?" What is the nurse's best response to this?
"An advance directive will communicate your wishes for health care postoperatively in case you are unable to do so."
The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about leg exercises. When the client asks, "Why am I practicing leg exercises when I'm having hernia surgery", what is the appropriate nursing response?
"Doing this reduces your risk of developing blood clots."
Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction?
"I can have a hamburger and French fries as soon as I wake up."
The nurse is teaching a client who will undergo abdominal surgery to repair a hernia about deep breathing. When the client asks, "Why am I practicing breathing when I'm having hernia surgery," what is the appropriate nursing response?
"It decreases the postoperative risk for respiratory complications."
The nurse has entered the room of a client who is postoperative day 1 and finds the client grimacing and guarding her incision. The client refuses the nurse's offer of p.r.n. analgesia and, on discussion, states that this refusal is motivated by his fear of becoming addicted to pain medications. How should the nurse respond to the client's concerns?
"Research has shown that there is very little risk of clients becoming addicted to painkillers after they have surgery."
Question 9 See full question 32s The adult male client with significant body hair is being prepared for abdominal surgery. The client states his dad had the same surgery many years ago and was shaved prior to the procedure. The nurse would explain to the client:
"That practice is no longer standard as shaving may cause breaks in the skin."
A postoperative client states "I don't understand why you are checking my skin on my back. My surgery was on my stomach." What is the nurse's best response?
"The operating table is a firm surface; we need to be sure your skin looks okay."
The nurse is talking with a client who wishes to have a tattoo removed. Which client statement indicates that the client understands how the procedure will be accomplished?
"The provider will perform this laser surgery in an ambulatory care setting."
A client who is in the holding area awaiting knee replacement surgery tells the nurse, "I am afraid of getting HIV if I have to have a blood transfusion during this surgery." What is the appropriate nursing response?
"The risk of acquiring a blood-borne disease from a blood transfusion is very small."
A 17-year-old client who is married wishes to have a breast reduction. She has insurance through her job as a cashier. Which information will the nurse provide to the client?
"You can sign the consent form on this line."
The nursing instructor is discussing the role of the circulating nurse in the operative suite with the student nurses. What would the nursing instructor include as duties of the circulating nurse? Select all that apply.
-The circulating nurse is included in the responsibility of accounting for all sponges and instruments following the surgical procedure. -The surgical nurse is responsible for maintaining the client's rights during the surgical procedure.
Which surgical client does the nurse in the preoperative setting anticipate having the greatest potential for surgical complications?
76-year-old client with a history of renal failure and chronic bronchitis
What information must be provided to a patient to obtain informed consent? (Select all that apply.)
A description of the procedure or treatment, along with potential alternative therapies The underlying disease process and its natural course Explanation of the risks involved and how often they occur
A 2-year-old toddler just underwent a tonsillectomy and adenoidectomy surgery. The postanesthesia care unit (PACU) nurse is checking on him. What is the best course of action regarding the developmental care of this child?
Allow the parents into the PACU before the child wakes.
A nurse is preparing to receive a client in post-anesthesia care unit (PACU). The client is diabetic and has undergone knee surgery. Which information would be most important for the receiving nurse to obtain to develop an appropriate plan of care for this client?
Amount of blood loss
A nurse is assigned to be the circulating nurse during a surgical procedure. The nurse would be responsible for which activity?
Anticipating the needs of other members of the surgical team
The nurse is preparing for a client for laser procedure. Which nursing intervention is appropriate?
Apply goggles to client.
The nurse enters a postoperative client's room and finds that the client is bleeding profusely from the surgical incision. What would be the nurse's most appropriate initial response?
Apply pressure to the surgical site to decrease bleeding.
Which nursing action should the PACU nurse take to prevent postoperative complications in clients?
Assist the client to do leg exercises to increase venous return.
A perioperative nurse is determining a plan of care for the client in the operating room. Which client outcome has priority?
Be free from injury and adverse effects.
The nurse is preparing a client for a colonoscopy. The nurse is familiar with the colonoscopy procedures at the hospital and is aware that which type of anesthesia is commonly used for this procedure?
Conscious sedation
The nurse is obtaining a history from a client before surgery. Which areas would be important for the nurse to ask about to determine potential risk factors?
Current medications Previous surgeries Alcohol use Support systems
A nurse is reinforcing wound edges and applying a blinder to the separated incisions of a client after a surgery. Which postoperative complication has the client developed?
Dehiscence
A 51-year-old woman with a diagnosis of breast cancer has been scheduled for a unilateral mastectomy during which biopsies of her axillary lymph nodes will be taken. Which categorizations of surgical procedures are represented in this client's case? Select all that apply.
Diagnostic Curative
A client is undergoing surgery for an appendectomy. This would be considered what type of surgery?
Emergency surgery
What intervention would a nurse perform when physically preparing a client undergoing surgery
Ensure that the client is well nourished and hydrated.
Which client will see the greatest permanent changes in lifestyle following surgery?
Ileostomy
The nurse monitors the urine output of a postoperative client. The results of this assessment allow the nurse to monitor for signs of what complication?
Impaired tissue perfusion
A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client?
Implement leg exercises and turn the client in bed every 2 hours.
A nurse is preparing a client for endotracheal intubation. The anesthesiologist has ordered an anticholinergic medication for this client. What is an action of this medication?
It decreases respiratory secretions.
Which surgical clients will return to activities in their everyday lives more quickly?
Laparoscopic cholecystectomy
A nurse administers anticholinergics to a patient as a postoperative medication. What condition does this medication help to prevent?:
Laryngospasm
A nurse anesthetist administers regional anesthesia to a client being prepared for facial surgery. Which type of regional anesthesia would be the appropriate choice for this client?
Local infiltration with lidocaine
A client had an open cholecystectomy (gall bladder removal) 36 hours earlier, and the nurse's assessment this morning confirms that the client has not yet had a bowel movement since prior to surgery. How should the nurse best respond to this assessment finding?
Monitor the client closely and promote fluid intake.
The healthy adult client is given a narcotic prior to a surgical procedure. The nurse is completing the chart and notices the consent form was not signed by the client. Which of the following should the nurse do first?
Notify the physician of the oversight.
A nurse is caring for an inpatient client scheduled to undergo a surgery for the removal of a malignant tumor. What are the risk factors that increase the likelihood of perioperative complications? Select all that apply.
Obesity Bleeding tendencies Low hemoglobin
In the postoperative phase of abdominal surgery, the client reports severe abdominal pain. In the second postoperative day, the client's bowel sounds are absent. What does the nurse suspect?
Paralytic ileus A potential complication after surgery is paralytic ileus, a condition in which there is decreased bowel functioning.
Which factors should the nurse consider when assessing patients for postsurgical risks? (Select all that apply.)
Patients with respiratory disease may experience alterations in acid-base balance after surgery. Kidney and liver diseases influence the patient's response to anesthesia. Endocrine diseases increase the risk for slow surgical wound healing.
Which nursing action will best promote pain management for a client in the postoperative phase?
Performing relaxation techniques
Anya is a 2-year-old who is undergoing a surgical repair of a fractured radius and ulna. What action is developmentally appropriate care for Anya?
Place an IV after Anya has received a rectal anxiolytic agent.
Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client?
Place graduated compression stockings on the client.
A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client?
Place the client in semi-Fowler's position.
A nurse caring for patients in a PACU assesses a patient who is displaying signs and symptoms of shock. What is the priority nursing intervention for this patient?
Place the patient in a flat position with legs elevated 45 degrees.
A 9-month-old baby is scheduled for heart surgery. When preparing this patient for surgery, the nurse should consider which surgical risk associated with infants?
Potential for hypothermia or hyperthermia
A nurse teaches deep breathing exercises to a client scheduled for surgery. In which perioperative phase would this action occur?
Preoperative
A nurse is assessing clients in a PACU. Which nursing actions would the nurse perform in this phase of the perioperative period? Select all that apply.
Prepare the client for home care. Admit the client to the postoperative care unit. Assess for complications as the client emerges from anesthesia.
Which nursing action will assist in pain management for a client in the postoperative phase?
Relaxation techniques
Avery is a 15-year-old client with acute lymphocytic leukemia (ALL). Avery is a practicing Jehovah's Witness and has asked not to receive blood products. You know that the prognosis for ALL is very good but clients often require blood products during treatment. What is the most appropriate action?
Request an ethics consultation.
The nurse is assessing clients for postoperative complications. What is the most commonly assessed postanesthesia recovery emergency?
Respiratory obstruction
Which methods would the nurse anesthetist use when administering regional anesthesia to surgical clients? Select all that apply.
Spinal block Nerve block Epidural block Regional anesthesia occurs when an anesthetic agent is injected near a nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors Inhalation and intravenous administration of anesthesia are associated with general anesthesia. Anesthesia is not administered via the oral route.
Following a surgical procedure, who is generally responsible for moving the client to the recovery area?
The anesthesiologist, circulating nurse, and surgeon
A female client age 54 years has been scheduled for a bunionectomy (removal of bone tissue from the base of the great toe) which will be conducted on an ambulatory basis. Which characteristic applies to this type of surgery?
The client will be admitted the day of surgery and return home the same day.
Which personnel are legally responsible for obtaining the client's informed consent for a surgical procedure?
The surgeon
A nurse is caring for a 4-year-old undergoing a laparoscopy for a ruptured appendix. His blood pressure is unstable and his abdomen is dusky in appearance. Which best describes the use of informed consent in this case?
The surgeon may sit with the family while the client is prepped for surgery as long as the procedure is not delayed.
A client has arrived to the postanesthesia care unit (PACU) and is drowsy with a respiratory rate of 12 breaths per minute. What would be an accurate interpretation by the nurse?
This is an expected finding in the immediate postoperative period.
A nurse assists a client with leg exercises. What condition does this intervention help to prevent?
Thrombophlebitis
The nurse is taking a history on Kumar, who informs her that he has an allergy to adhesive tape. When the nurse asks Kumar to describe his reaction to the tape, he describes it as "blotchy and reddened." What type of allergic reaction is this?
Type IV
Which of the following factors is most important in the nurse's decision on assessment data, outcomes, and the monitoring needs of a client in preparing for surgery?
Type of surgery
A nurse from the ambulatory surgical center is preparing discharge instructions for a client who has had pelvic surgery. Which criterion would the client need to demonstrate to ensure that she is ready for discharge?
Void normally
Which client in the postanesthesia care unit (PACU) requires the most immediate attention by the nurse?
a 26-year-old client who is exhibiting a crowing sound A client with a crowing sound is exhibiting stridor, which is an indication of an airway obstruction and can be a respiratory emergency.
Which client would a nurse monitor most closely for postoperative respiratory complications?
a 55-year-old client with a history of asthma who had a colon resection
Which client most likely requires special preoperative assessment and treatment as a result of the existing medication regimen?
a woman who takes daily anticoagulants to treat atrial fibrillation
A client has presented to a clinic for a preoperative consult, during which the client has expressed concern about having to fast before surgery. Current recommendations for preoperative fasting include:
allowing clear liquids up to 2 hours before surgery.
Surgery can lead to hypothermia. Which client is at greatest risk for hypothermia?
an older adult man with a fractured hip
The nurse is educating an older adult about products that cause bleeding that should be avoided before surgery. Which products should the nurse include? Select all that apply.
baby aspirin ibuprofen warfarin ginko
The postanesthesia care unit (PACU) nurse has just received a client who underwent coronary artery bypass grafting (CABG). Which will the nurse assess while the client is in the PACU? Select all that apply.
condition of incision drains and drainage characteristics ease of breathing pain level urine output
The recovery nurse is caring for a surgical client in the PACU. The client's blood pressure is dropping and the heart rate is increasing. The nurse suspects the client is:
developing shock
When preparing a client for surgery, it is essential for the nurse to take which actions?
educating client about postoperative care measuring baseline vital signs having the client void immediately before surgery checking that all diagnostic tests are completed
A client scheduled for surgery has been taking aspirin since his heart attack in 1997. The client is at risk for:
hemorrhage.
The nurse has delegated to the unlicensed assistive personnel (UAP) the application of antiembolism stockings to a client who had an endarterectomy earlier in the day. Which UAP action requires the nurse to immediately intervene?
massages legs prior to application Massaging the legs can dislodge clots.
An operating room nurse is bringing a client to the nurse in the postanesthesia care unit (PACU). Which information would the operating room nurse provide during a hand-off report? Select all that apply.
medications given in operating room length of surgery drains inserted in surgery
When an older adult client is brought to the recovery room and presents with irregular, loud respirations, the nurse determines that this most likely a result of:
partial airway obstruction.
The nurse has been waiting until after the administration of a toddler's anesthesia before removing the child's clothing and applying monitoring equipment. Doing these actions after the administration of anesthesia will:
prevent anxiety.
The nurse recognizes the value of leg exercises in the prevention of postoperative thrombophlebitis. When should the nurse teach the correct technique for leg exercises to a client?
prior to surgery
When educating a client in the postoperative period, it is important to educate the client to consume a diet high in:
protein
A nurse is working with a group of clients in the preoperative area. Which client task would be the highest priority?
raising the stretcher side rails when administering a sedative
The PACU nurse has received a semiconscious client from the operating room and reviews the chart for orders related to positioning of the client. There are no specific orders on the chart related to the client's position. In this situation, in what position will the nurse place the client?
side-lying position
A client is scheduled for cardiac surgery in an acute-care facility. What intervention would occur in the intraoperative phase of this client's perioperative care?
skin preparation
When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease?
slow wound healing
Question 5 See full question 1m 13s When reviewing a client's history prior to surgery to correct a wrist fracture, which factors does the nurse identify that place the client at a higher risk for perioperative complications? Select all that apply.
smokes cigarettes, ½ pack per day skin turgor 4 seconds
A nurse is assisting a physician in an emergency surgery for a client with intestinal perforation. Which description is most suitable to the type of surgery performed?
surgery required immediately for survival
A client in the immediate postoperative period begins to report nausea and ultimately begins vomiting. The nausea and vomiting are most likely related to:
the effects of anesthetic agents.
The nurse recognizes that palliative surgery is performed for what purpose?
to lessen the intensity of an illness
What is the rationale for having the client void before surgery?
to prevent bladder distention
A nurse is discussing a surgical procedure with a client who needs to sign his informed consent. Which of these tasks is part of the nursing role?
witnessing the client signature with their consent for surgery
