Ch 29: Perioperative Nursing – Flashcards
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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? a) Paralytic ileus b) Normal response c) Abdominal infection d) Hernia development
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Paralytic ileus Explanation: A potential complication after surgery is paralytic ileus, a condition in which there is decreased bowel functioning.
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Which statement, if made by an adolescent preparing for abdominal surgery, would indicate to the nurse that the client requires additional instruction? a) "I might be sick to my stomach and throw up after surgery." b) "The better I eat before surgery, the more likely I will heal." c) "I can have a hamburger and French fries as soon as I wake up." d) "When I can eat again, the best meal would be steak and orange juice."
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"I can have a hamburger and French fries as soon as I wake up." Explanation: Oral fluid and food may be withheld until intestinal motility resumes.
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The procedural physician has initiated performance of a time-out in the operating room before surgery. The student nurse asks the operating room nurse why this is important. What is the operating room nurse's best response? a) "The time-out allows us to make sure that the client has had adequate anesthesia." b) "The time-out checks to be sure that we have the right client and procedure." c) "We need to be sure the client has had the preoperative antibiotic." d) "We are checking the client's baseline vital signs during time-out."
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"The time-out checks to be sure that we have the right client and procedure." Explanation: The time-out is a safety measure performed before any surgical procedure and allows the operating room staff to determine they have the right client, procedure, and side
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Which measure would the nurse implement for prevention of deep vein thrombosis (DVT) in a postoperative client? a) Encourage the client to elevate the head of bed. b) Place graduated compression stockings on the client. c) Elevate bilateral legs when client is lying in bed. d) Educate the client about the use of incentive spirometer.
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Place graduated compression stockings on the client. Explanation: Use of graduated compression stockings and/or pneumatic compression devices on the client will help with prevention of DVT, which is a risk for clients after surgery.
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A nurse is dressing the wound of a client who is admitted to the outpatient surgical unit. What is a major advantage of outpatient surgery? a) It interferes less with the client's daily routine. b) It requires intensive preoperative education in a short time. c) It reduces the time for establishing a nurse-client rapport. d) It allows less opportunity for family contact and support.
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It interferes less with the client's daily routine. Explanation: A major advantage of outpatient surgery is that it interferes less with the client's daily routine. It also allows more opportunity for family contact and support. Some disadvantages are that it reduces the time for establishing a nurse-client relationship and requires intensive preoperative education in a short time.
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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? a) Assess the client's vital signs. b) Apply pressure to the surgical site to decrease bleeding. c) Notify the health care provider. d) Determine the possible cause of the client's bleeding.
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Apply pressure to the surgical site to decrease bleeding. Explanation: It is essential that the nurse be prepared to address life-threatening needs of the client. Excessive bleeding is a life-threatening issue.
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A client is undergoing conscious sedation for an endoscopy. When the client becomes overly sedated, which medication does the nurse anticipate will be required? a) midazolam b) lorazepam c) morphine d) naloxone
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naloxone Explanation: Naloxone is a reversal drug, as it is the antagonist for opiates like morphine. The other medications are inappropriate choices.
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Which client most likely requires special preoperative assessment and treatment as a result of the existing medication regimen? a) a woman who takes daily anticoagulants to treat atrial fibrillation b) a woman who takes daily thyroid supplements to treat her longstanding hypothyroidism c) a man who takes an angiotensin-converting enzyme (ACE) inhibitor because he has hypertension d) a man who regularly treats his rheumatoid arthritis with over-the-counter nonsteriodal anti-inflammatory drugs (NSAIDs)
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a woman who takes daily anticoagulants to treat atrial fibrillation Explanation: Anticoagulants present a risk of hemorrhage. This risk supersedes that posed by thyroid supplements, ACE inhibitors, or most NSAIDs.
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After a client receives morphine sulfate for pain in the postanesthesia care unit (PACU), which assessment finding would the nurse obtain as a priority? a) Obtain temperature. b) Check the neurological status. c) Auscultate bowel sounds. d) Measure respiratory rate.
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Measure respiratory rate. Explanation: The client who is receiving morphine sulfate for pain has a potential for decreased respiratory effort because of the side effect of respiratory depression; the client may also have constipation as a side effect but this would not be a priority over respiratory depression. The postoperative client needs to be monitored for changes in their neurological status and temperature but this would not be a priority over the respiratory status.
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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? a) This is an expected finding in the immediate postoperative period. b) The client needs to have the neurological status fully evaluated. c) The client should be returned to the operating room for further evaluation. d) The procedural physician should be notified immediately of client findings.
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This is an expected finding in the immediate postoperative period. Explanation: Having drowsiness and a respiratory rate of 12 breaths/minute are normal findings in the immediate postoperative period. The client needs to be monitored to ensure that there is no deterioration in respiratory status, and the client awakens readily. As the anesthetics wear off, the client should return to a normal level of consciousness. The nurse would not need to notify the procedural physician or return the client to the operating room because this is not an emergent situation.
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What information must be provided to a patient to obtain informed consent? (Select all that apply.) a) Explanation that a signed consent form is binding and cannot be withdrawn b) The name and qualifications of the nurse providing perioperative care c) The underlying disease process and its natural course d) A description of the procedure or treatment, along with potential alternative therapies e) Customary insurance coverage for the Procedure f) Explanation of the risks involved and how often they occur
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• The underlying disease process and its natural course • A description of the procedure or treatment, along with potential alternative therapies • Explanation of the risks involved and how often they occur Explanation: The informed consent provides a description of the procedure or treatment (its name, site and side if applicable), along with potential alternative therapies; the underlying disease process and its natural course; the name and qualifications of the person performing the procedure or treatment; explanation of the common risks involved, including risk for damage, disfigurement, or death, and how often they occur; explanation that the patient has the right to refuse treatment and that consent can be withdrawn; and explanation of expected outcome, recovery, and rehabilitation plan and course
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Which surgical client does the nurse in the preoperative setting anticipate having the greatest potential for surgical complications? a) 6-month-old client who has just been introduced to solid food b) 76-year-old client with a history of renal failure and chronic bronchitis c) 50-year-old overweight client with controlled hypertension d) 40-year-old client with type 2 diabetes mellitus and a history of anxiety
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76-year-old client with a history of renal failure and chronic bronchitis Explanation: The client who is elderly with renal and lung disease has the most risk factors preoperatively for surgery. This client will have concerns over administration of anesthesia and medication with the kidneys being able to clear these from the body, as well as with the lungs and potential postoperative complications of atelectasis and pneumonia. Clients who are young, have chronic disease, or obese have risk factors as well, but not as many as the elderly client with both renal and pulmonary disease
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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? a) Potential for hypothermia or hyperthermia b) Prolonged wound healing c) Congestive heart failure d) Gastrointestinal upset
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Potential for hypothermia or hyperthermia Explanation: Infants have difficulty maintaining stable body temperature during surgery because the shivering reflex is not well developed, making hypothermia or hyperthermia more likely. They are not at an increased risk for prolonged wound healing, congestive heart failure, or gastrointestinal upset.
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A client comes to the postoperative area and complains of chest pain and palpitations. Which assessment information does the nurse need to obtain? a) temperature and urine output b) prior medical history c) heart rate and blood pressure d) current medications
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heart rate and blood pressure Explanation: A client having chest pain and palpitations needs to have his vital signs (particularly blood pressure and heart rate) checked to ensure that he is hemodynamically stable. These symptoms may indicate cardiac problems so the client must be examined closely for any complications such as a myocardial infarction. Urine output and temperature would not indicate the client's stability related to the symptoms being experienced. Although prior medical history and medications may give indications on why the client is experiencing chest pain, the client needs an accurate assessment of the hemodynamic status first.
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Which nursing action will best promote pain management for a client in the postoperative phase? a) Providing food and medication b) Performing relaxation techniques c) Breathing into a paper bag d) Dimming the lights
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Performing relaxation techniques Explanation: Performing relaxation techniques is the best nursing action to promote pain management for a client in the postoperative phase
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What is the nurse's role in the informed consent process for a surgical procedure? a) granting permission for surgery to be done b) providing benefits and risks of procedure c) witnessing the signed informed consent document d) explaining what takes place during the procedure
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witnessing the signed informed consent document Explanation: The nurse may witness the signed informed consent document. The healthcare provider will explain what takes place during the procedure, and provide benefits and risks. The client grants permission for surgery to be done
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When preparing a client who has diabetes mellitus for surgery, the nurse should be aware of what surgical risk associated with this disease? a) respiratory depression from anesthesia b) altered metabolism and excretion of drugs c) slow wound healing d) fluid and electrolyte imbalance
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slow wound healing Explanation: Due to impaired circulation and high glucose levels, the client with diabetes is at an increased risk for slow wound healing. The surgical risk of fluid and electrolyte imbalances is often associated with clients who have kidney and liver disease. The risk of respiratory depression from surgery increases for clients with existing respiratory disorders. Altered metabolism may occur as a result of surgery for clients with kidney and liver diseases.
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A client is undergoing surgery for an appendectomy. This would be considered what type of surgery? a) Elective surgery b) Diagnostic surgery c) Emergency surgery d) Palliative surgery
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Emergency surgery Explanation: An appendectomy is considered emergency or urgent surgery. Elective surgery can be scheduled in advance, and delay has no ill effects. Palliative surgery is done to relieve or reduce the intensity of an illness. Diagnostic surgery is done to make or confirm a diagnosis.
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There is a circulating nurse caring for a 72-year-old man undergoing removal of a liver tumor. His wife is waiting in the family waiting area. Which are appropriate actions by the circulating nurse in the intraoperative period? Select all that apply. a) Notify the client's wife when the procedure is over. b) Bring the client's wife to be with him as soon as possible. c) Provide emotional support immediately before the surgery. d) Explain in detail to the client's wife what is happening during the surgery.
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• Provide emotional support immediately before the surgery. • Notify the client's wife when the procedure is over. • Bring the client's wife to be with him as soon as possible. Explanation: The job of the circulating nurse is to manage the client. This requires the nurse to be present in the operating room during the procedure.
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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? a) "I will plan to be hospitalized several days following the procedure." b) "I will talk with the anesthesiologist about anesthesia." c) "This inpatient surgical procedure requires me to be at the hospital the morning of surgery." d) "The provider will perform this laser surgery in an ambulatory care setting."
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"The provider will perform this laser surgery in an ambulatory care setting." Explanation: Tattoos are often removed via laser surgery in an ambulatory setting. This type of outpatient procedure does not commonly require anesthesia, nor hospitalization.
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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? a) Give the child a new teddy bear. b) Extubate the child as soon as possible. c) Administer acetaminophen before the child wakes. d) Allow the parents into the PACU before the child wakes
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Allow the parents into the PACU before the child wakes. Explanation: Toddlers are prone to separation anxiety. Allowing the child to be with the parents will lower anxiety levels for all members of the family. This will subsequently ease the care for the bedside nurse
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The nurse knows the term perioperative phase refers to care given to the client: a) before, during, and after the operative phase. b) from the start of surgery until its conclusion. c) immediately after the operative phase. d) immediately before an operative procedure.
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before, during, and after the operative phase. Explanation: Perioperative nursing includes three distinct phases: preoperative, intraoperative, and postoperative.
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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? a) Informed consent should be obtained when the surgeon meets with the family after the procedure. b) Informed consent will be waived because the procedure is emergent. c) The surgeon will meet with the client and his parents prior to surgery, explain the procedure, and answer any questions they may have. d) The surgeon may sit with the family while the client is prepped for surgery as long as the procedure is not delayed.
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The surgeon may sit with the family while the client is prepped for surgery as long as the procedure is not delayed. Explanation: Although the procedure is emergent and informed consent can be waived, it is the better choice for the surgeon to sit with the family while the client is prepped for surgery. Even in an emergency, the client or family should have the opportunity to ask questions if it will not delay the procedure
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Which client would a nurse monitor most closely for postoperative respiratory complications? a) a 55-year-old client with a history of asthma who had a colon resection b) a 75-year-old client with a history of hypertension who had a colonoscopy c) a 31-year-old client with no medical problems who had an appendectomy d) an 8-year-old client with no medical problems who had a tonsillectomy
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a 55-year-old client with a history of asthma who had a colon resection Explanation: All of these clients have a potential for respiratory complications, which can occur with chest or abdominal surgery, preexisting cardiovascular or respiratory disease, and in older adults or obese clients. The client who has had abdominal surgery and has preexisting respiratory disease would be at the greatest risk for observation of any respiratory complications (due to having two factors instead of only one). The pediatric client having a tonsillectomy would need to be observed for any airway problems but would not be a greater risk than the client with two risk factors.
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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? a) Hypoxemia b) Evisceration c) Dehiscence d) Shock
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Dehiscence Explanation: The nurse is taking care of a client with dehiscence. Hypoxemia develops when there is inadequate oxygenation of blood. Evisceration occurs when there is protrusion of abdominal organs through a separated wound. A client has shock when there is inadequate blood flow.
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A nurse is assessing a client who is experiencing pulmonary embolus. What would be the priority nursing intervention for this client? a) Attempt to overhydrate the client with fluids. b) Place the client in semi-Fowler's position. c) Instruct the client to perform Valsalva maneuver. d) Assist the client to ambulate every 2 to 3 hours.
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Place the client in semi-Fowler's position. Explanation: Nursing interventions include notifying the physician immediately, calling the medical intervention team, maintaining the client on bed rest in the semi-Fowler's position, assessing vital signs frequently, administering oxygen, administering medications (e.g., anticoagulants, analgesics), and instructing the client to avoid Valsalva maneuver (this prevents increased intrathoracic pressure and, possibly, increased emboli)
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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? a) The client must be previously healthy with low surgical risks. b) The surgery is classified as urgent rather than elective. c) The surgery will be conducted using moderate sedation rather than general anesthesia. d) The client will be admitted the day of surgery and return home the same day.
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The client will be admitted the day of surgery and return home the same day. Explanation: Outpatient surgeries, also known as ambulatory surgeries, are conducted with admission and discharge on the same day. Such surgeries have become increasingly common in recent years, and some surgeries of increasing complexity and risk are conducted on an outpatient basis. General anesthesia is possible, and common. This approach is more common for elective surgeries than urgent surgeries.
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A client has been taking aspirin since his heart attack in 1997. The client is at risk for: a) hemorrhage. b) infection. c) blood clots. d) thrombophlebitis.
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hemorrhage. Explanation: Current medication use, especially use of medications that can affect coagulation status (warfarin, nonsteroidal anti-inflammatory drugs, aspirin) is important and should be reported to the surgeon
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The nurse recognizes that palliative surgery is performed for what purpose? a) to lessen the intensity of an illness b) to make or confirm a diagnosis c) to remove a part of the body that is diseased d) to restore function to tissue that is traumatized
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to lessen the intensity of an illness Explanation: Palliative surgery is performed to help lessen the intensity of an illness; it is not meant to be curative but will help improve the client's quality of life.
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A client is in the preoperative area and states, "I am not sure about having surgery." What is the nurse's best response? a) "You really need to have this surgery done." b) "I will tell the surgeon you changed your mind." c) "Why wouldn't you want the surgery so you can feel better?" d) "Can you tell me what your feelings are about the surgery?"
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"Can you tell me what your feelings are about the surgery?" Explanation: The client who is unsure about surgery needs their feelings explored to determine why the client doubts the decision. After exploring these feelings, the nurse can then contact the procedural physician and make this person aware of the client's concerns. Asking the client why the client wouldn't want the surgery is phrased negatively and implies a judgment by the nurse on the client's feelings; likewise, the client wouldn't be told to have the surgery done without allowing the client to express feelings
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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? a) Verbalize absence of pain b) Eat without nausea c) Void normally d) Exhibit no bleeding
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Void normally Explanation: Before discharge from an ambulatory surgical unit, the client should be able to void normally after a pelvic surgery. It is natural for the client to experience pain after surgery; however, the client should also have the comfort level to control it.
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A nurse is preparing an obese male client for gastric banding surgery. What would the nurse be least likely to include in the client's preoperative education plan? a) techniques for effective deep breathing and turning b) information about medications that will control nausea and pain c) appropriate procedure to care for the surgical site d) information about bowel preparation and skin preparation
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appropriate procedure to care for the surgical site Explanation: Preoperative client education helps the client understand what will occur during each phase of the surgical experience and how he can participate in his own recovery. Preoperative education includes a general orientation and explanation of the surgical experience, discussion of preoperative activities to prepare the client for surgery, and description of postoperative care to promote optimal function and recovery. Educating the client about the appropriate procedure to care for the surgical site would be more appropriate in the postoperative phase.
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Which nursing action should the PACU nurse take to prevent postoperative complications in clients? a) Encourage the client to breathe shallowly to prevent collapse of the alveoli. b) Avoid turning the client in bed until the incision is no longer painful. c) Instruct the client to avoid coughing to prevent injury to the incision. d) Assist the client to do leg exercises to increase venous return.
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Assist the client to do leg exercises to increase venous return. Explanation: Leg exercises increase venous return in order to prevent the postoperative complication of clot formation in the lower extremities.
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Ames is an 87-year-old man who underwent a hip replacement today. He is telling the nurse that his parents, who are deceased, are coming to visit him today. He continues to tell the nurse that he needs to cut the lawn and run errands. The last time the nurse entered the room, Ames was trying to climb over the bed rail. Which term best describes Ames' condition? a) Narcotic overuse b) Delirium c) Boredom d) Dementia
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Delirium Explanation: Delirium refers to acute confusion that is reversible. It is common in the acute postoperative period.
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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.) a) ginko b) cetirizine c) baby aspirin d) milk of magnesia e) ibuprofen f) warfarin
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• baby aspirin • ibuprofen • warfarin • ginko Explanation: Baby aspirin, ibuprofen, warfarin, and ginkgo may increase bleeding and should be avoided prior to surgery, unless otherwise specified by the healthcare provider. Cetirizine and milk of magnesia are not associated with bleeding.
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The nurse is assessing an obese client scheduled for heart surgery. Which surgical risk related to obesity should the nurse monitor? a) delayed wound healing and wound infection b) hemorrhage c) respiratory distress d) alterations in fluid and electrolyte balance
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delayed wound healing and wound infection Explanation: Fatty tissue has a poor blood supply and, therefore, has less resistance to infection. As a result, postoperative complications of delayed wound healing, wound infection, and disruption in the integrity of the wound are more common
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A nurse is caring for an infant who is postoperative following cardiac surgery. What is the most common postoperative complication found in this age group? a) renal complications b) respiratory complications c) circulatory complications d) infection
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respiratory complications Explanation: According to Dunn (2005), most postoperative complications are related to the respiratory system in infants. After receiving general anesthesia, premature infants are at greater risk for apnea.
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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? a) "You should have given your own blood preoperatively." b) "The risk of acquiring a blood-borne disease from a blood transfusion is very small." c) "Knee replacement surgeries usually do not require blood transfusions." d) "Perhaps we can have one of your siblings donate blood in case you need it."
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"The risk of acquiring a blood-borne disease from a blood transfusion is very small." Explanation: The nurse will teach that the chance of acquiring a blood-borne disease from a blood transfusion is very small. Giving blood preoperatively may have been ideal, but that does not address the client's immediate concern. Although transfusions are not commonly associated with knee replacement surgery, this does not address the client's concern. Siblings should not donate blood for a client because antigens in the transfused blood sensitizes the client recipient, which would rule them out as a future organ or tissue donator for the client.
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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? a) Environment of the operating room b) Amount of blood loss c) Information about allergic agents d) Chronic disease history
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Amount of blood loss Explanation: To plan care effectively in the postoperative period, the nurse needs to know about the amount of blood lost during the surgery, the type of surgery that was performed on the client, and whether there were any surgical or anesthetic complications. Information on chronic disease history and allergy history are done in the preoperative period, not in the postoperative period. Information on the environment in the operation room is checked by the circulatory nurse during the intraoperative care plan; it is not associated with the postoperative care plan.
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The nurse is preparing for a client for laser procedure. Which nursing intervention is appropriate? a) Remove client's nail polish with acetone before procedure. b) Cleanse procedure area with alcohol. c) Prepare surgical tray with silver instruments. d) Apply goggles to client
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Apply goggles to client. Explanation: The client, and all who are involved in the procedure, will wear goggles. Alcohol and acetone should not be used around lasers due to flammability. Therefore, the nurse should not remove the client's nail polish with acetone, nor clean the area with alcohol, before the procedure. Surgical instruments used should be coated in black to avoid heat retention. Therefore, they the surgical tray should not be prepared with silver instruments. (l
