Deck 50: Care of Surgical Clients

Question 1

The client is scheduled for abdominal surgery and has just received the preoperative medications.The nurse should:
1) Keep the client quiet
2) Obtain the consent
3) Prepare the skin at the surgical site
4) Place the side rails up on the bed or stretcher

Answer 1

4
After administering preoperative medications,the nurse should raise the side rails on the bed or stretcher and keep the bed or stretcher in low position.Preanesthetic medications will help reduce the client's anxiety.Consent must be obtained before preoperative medications are administered or the consent is invalid.Preparing the skin at the surgical site is often done in the operating room.

Question 2

The client tells the nurse that "blowing into this tube thing (incentive spirometer)is a ridiculous waste of time." The nurse explains that the specific purpose of the therapy is to:
1) Directly remove excess secretions from the lungs
2) Increase pulmonary circulation
3) Promote lung expansion
4) Stimulate the cough reflex

Answer 2

3
The primary purpose of using an incentive spirometer is to promote lung expansion.Coughing exercises are used to remove excess secretions from the lungs.Ambulation helps increase pulmonary circulation as the respiratory rate increases.The primary purpose of incentive spirometry is not to stimulate the cough reflex,but to promote lung expansion.

Question 3

In the postoperative period,the nurse recognizes that an early sign of malignant hyperthermia is:
1) Fever
2) Tachycardia
3) Muscle relaxation
4) Skin pallor

Answer 3

2
Malignant hyperthermia should be suspected when there is unexpected tachycardia and tachypnea;jaw muscle rigidity;body rigidity of limbs,abdomen,and chest;or hyperkalemia.Temperature elevation is a late sign of malignant hyperthermia.Muscle rigidity,not relaxation,is an early sign of malignant hyperthermia.Skin pallor is not an early sign of malignant hyperthermia.Skin pallor may be seen in the immediate postoperative period,because the body is cool.

Question 4

An appendectomy is appropriately documented by the nurse as:
1) Diagnostic surgery
2) Palliative surgery
3) Ablative surgery
4) Reconstructive surgery

Question 5

The nurse is evaluating the outcome "Client describes surgical procedures and postoperative treatment" and determines that the client has not achieved this outcome.The nurse should:
1) Obtain the consent,because this is expected with preoperative anxiety
2) Teach the client all about the procedure
3) Ask the unit manager to assist with a teaching plan
4) Inform the surgeon so that information can be provided

Question 6

The client asks the nurse the purpose of having medications (Demerol and Vistaril)given before surgery.The nurse should inform the client that these particular medications:
1) Reduce preoperative fear
2) Promote emptying of the stomach
3) Reduce body secretions
4) Ease the induction of the anesthesia

Question 7

A 92-year-old client is scheduled for a colectomy.Which normal physiological change that accompanies the aging process increases this client's risk for surgery?
1) An increased tactile sensation
2) An increased metabolic rate
3) A relaxation of arterial walls
4) Reduced glomerular filtration rate

Question 8

After discharge from the postanesthesia care unit (PACU),the client returned to the surgical nursing unit at 10:00 AM.It is now 11:30 AM,and the client is not experiencing any complications or difficulties.The nurse will plan to measure the client's vital signs:
1) Every 15 minutes
2) Every 30 minutes
3) Every 1 hour
4) Every 4 hours

Question 9

A 43-year-old client is scheduled to have a gastrectomy.Which of the following is a major preoperative concern?
1) The client's brother had a tonsillectomy at age 11.
2) The client smokes a pack of cigarettes a day.
3) The client has an intravenous (IV)infusion.
4) The client has a history of employment as a computer programmer.

Question 10

Following abdominal surgery,the nurse suspects that the client may be having internal bleeding.Which of the following findings is indicative of this complication?
1) Increased blood pressure
2) Incisional pain
3) Abdominal distention
4) Increased urinary output

Question 11

Which of the following statements most accurately reflects nursing accountability in the intraoperative phase?
1) "I would like to see the client have a regional anesthetic rather than a general anesthetic."
2) "There seems to be a missing sponge,so a recount should be done of all the sponges that have been removed."
3) "Did the client receive the medications and sign the consent?"
4) "The client looks to be reactive and stable."

Question 12

A client who receives general or regional anesthesia in an ambulatory surgery center:
1) Has to meet identified criteria in order to be discharged home
2) Will remain in the phase I recovery area longer than a hospitalized client
3) Is allowed to ambulate as soon as being admitted to the recovery area
4) Is immediately given liberal amounts of fluid to promote the excretion of the anesthesia

Question 13

The female client on the surgical unit is being prepared for abdominal surgery with general anesthesia.In preparing this client for surgery,the nurse should:
1) Leave all of her jewelry intact
2) Provide her with sips of water for a dry mouth
3) Remove her makeup and nail polish
4) Remove her hearing aid before transport to the operating room

Question 14

The nurse is evaluating the client in the hospital's postanesthesia care unit (PACU)and determines that the Aldrete score is 8.Based on this assessment,the nurse anticipates that the client will:
1) Be sent to the intensive care unit
2) Be discharged back to his or her room on the nursing unit
3) Remain in the PACU until the score improves
4) Return to the operating room for surgical evaluation

Question 15

An obese client is admitted for abdominal surgery.The nurse recognizes that this client is more susceptible to the postoperative complication of:
1) Anemia
2) Seizures
3) Protein loss
4) Dehiscence

Question 16

The client will have an incision in the lower left abdomen.Which of the following measures by the nurse will help decrease discomfort in the incisional area when the client coughs postoperatively?
1) Applying a splint directly over the lower abdomen
2) Keeping the client flat with her feet flexed
3) Turning the client onto the right side
4) Applying pressure above and below the incision

Question 17

The nurse is working in a postoperative care unit in an ambulatory surgery center.Of the following clients that have come to have surgery,the client at the greatest risk during surgery is a:
1) 78-year-old taking an analgesic agent
2) 43-year-old taking an antihypertensive agent
3) 27-year-old taking an anticoagulant agent
4) 10-year-old taking an antibiotic agent

Question 18

The nurse is completing the preoperative checklist for an adult client who is scheduled for an operative procedure later in the morning.Which of the following preoperative assessment findings for this client indicates a need to contact the anesthesiologist?
1) Temperature is 100° F.
2) Pulse is 90 beats per minute.
3) Respiratory rate is 20 breaths per minute.
4) Blood pressure is 130/74 mm Hg.

Question 19

A client is in the postanesthesia care unit (PACU)recovering from a vagotomy and pyloroplasty.Which of the following is a normal expectation of the client in this stage of recovery?
1) Returned normal bowel sounds on auscultation
2) Pain that is relieved with noninvasive comfort measures
3) Voluntary bladder control and function
4) A subdued level of consciousness and neurological function

Question 20

The nurse is completing the preoperative checklist for an adult female client who is scheduled for an operative procedure later in the morning.Which of the following preoperative assessment findings for this client indicates a need to contact the surgeon?
1) Hemoglobin (Hgb)14 g/100 mL
2) Blood urea nitrogen (BUN)15 mg/100 mL
3) Platelets 300,000/mm³
4) Serum creatinine 3.2 mg/100 mL

Question 21

The perioperative nurse realizes that the most effective means of evaluating the client's understanding of previous teaching is to:
1) Provide written material on the subject to be reviewed after discharge
2) Reinforce the material with family as the procedure is being performed
3) Discuss it with the client and family in the immediate preoperative period
4) Offer to answer any questions that the client or family have just before discharge

Question 22

Which of the following client evaluations is most reflective of compliance for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information?
1) Client will present for scheduled blood laboratory work 48 hours before surgery.
2) Client's preoperative blood laboratory work results are present on preoperative chart.
3) Client will share the preoperative routines of surgical care with family to facilitate compliance.
4) Client will understand the preoperative routines of surgical care before leaving provider's office.

Question 23

Which of the following client outcomes is most therapeutic for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information?
1) Client will share the preoperative routines of surgical care with family to facilitate compliance.
2) Client will understand the preoperative routines of surgical care before leaving provider's office.
3) Client will call laboratory to schedule appointment for preoperative blood draw for required testing.
4) Client will present for drawing of preoperative laboratory blood at least 48 hours before scheduled surgery.

Question 24

A client scheduled for an ambulatory surgery procedure requiring anesthetics arrives with a low-grade fever and a productive sough.The postponement of the procedure is most likely a result of the:
1) Client's increased risk for a respiratory tract infection
2) Possibility of a respiratory complication during anesthesia
3) Increased risk for the client's infecting staff and other clients
4) Client's impaired resistance as a result of a respiratory tract infection

Question 25

The client had surgery in the morning that involved the right femoral artery.To assess the client's circulation status to the right leg,the nurse will make sure to check the pulse at the:
1) Radial artery
2) Ulnar artery
3) Brachial artery
4) Dorsalis pedis artery

Question 26

The initial client education-related nursing action by the preadmission nurse is to:
1) Respond to questions presented by the family regarding the client's surgery
2) Call the client before the surgery to restate presurgery routine
3) Provide the client with a list of preoperative requirements
4) Arrange a time for presurgical blood work to be drawn

Question 27

Which of the following statements made by a nurse reflects the greatest insight into the responsibility an ambulatory care nurse has to the client's family?
1) "A client's family deserves the attention of the nursing staff."
2) "Family is important to my client,and so family is important to me."
3) "I consider myself as having several clients: the surgical client and all the family that's present."
4) "I am responsible for keeping the family informed of the status of their loved one both during and after the procedure."

Question 28

Which of the following goals is most appropriate for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information?
1) Client will understand the need for scheduled surgery before leaving the provider's office.
2) Client will understand the preoperative routines of surgical care before leaving provider's office.
3) Client will present for drawing of preoperative laboratory blood at least 48 hours before scheduled surgery.
4) Client will be able to successfully accomplish the preoperative bowel preparation by morning of scheduled surgery.

Question 29

Upon admission to the postanesthesia care unit (PACU),the client who has no orthopedic or neurological restrictions is positioned with the:
1) Bed flat and the client's arms to the sides
2) Client's neck flexed and body positioned laterally
3) Head of the bed slightly elevated with the client's head to the side
4) Client's arms crossed over the chest and the bed in high-Fowler's position

Question 30

Which of the following preoperative assessment findings would most likely delay a planned procedure requiring general anesthetic?
1) A cough and low-grade fever
2) The pulse oximetry reading of 97% on room air
3) A blood pressure that is 10 systolic points higher than baseline
4) The client's report of "being so nervous about this procedure"

Question 31

A client who has type 2 diabetes is scheduled for the removal of a skin lesion on his right shoulder at an ambulatory surgery unit.The nursing diagnosis the client is at greatest risk for postoperatively is:
1) Risk for injury
2) Risk for infection
3) Impaired wound healing
4) Imbalanced nutrition: less than body requirements

Question 32

Which of the following best describes the primary nursing role regarding a client's consent to surgery immediately before surgery?
1) Explaining the procedure to the client in a fashion that is easily understood
2) Placing the signed consent in the client's medical record
3) Ensuring that the client understands the possible risks of the procedure before signing the consent
4) Reviewing the client's surgical consent as a part of the routine preoperative checklist

Question 33

A 74-year-old is accompanied by his daughter to the ambulatory surgery department for the surgical removal of a suspicious skin lesion.The client has experienced dysphasia since a cerebral vascular accident 3 years ago.The most effective way for the nurse to secure the necessary preoperative interview information is to:
1) Question the client's daughter
2) Review the client's past medical records
3) Present the questions in a simple format
4) Rely on the client's preadmission survey

Question 34

Which of the following statements made by the nurse shows the most informed understanding of the role of family in the client's postoperative recovery?
1) "The family will be the ones you will be dealing with regarding postoperative needs."
2) "When the family is more relaxed about caring for the client,the client is more relaxed."
3) "The more the family understands what to expect during recovery,the more comfortable they are in caring for the client."
4) "Teaching the family what they need to know before the surgery will maximize their effectiveness regarding the client's postoperative care."

Question 35

The nurse recognizes which of the following as the greatest barrier to meeting a preoperative client's nursing diagnosis of deficient knowledge regarding surgical procedure?
1) Effects of preoperative medication
2) Complicated nature of the information
3) Fear or anxiety regarding the procedure
4) Emotional denial regarding surgical outcomes

Question 36

The nurse knows that the client is most likely going to arrive for the surgical procedure having adhered to the required bowel preparation if:
1) The client understands the need for the laxative
2) The laxative ordered is pleasant tasting
3) The bowel preparation is an uncomplicated process
4) The client has the appropriate support at home

Question 37

A client with a history of sleep apnea has had a same-day surgery procedure that will require the administration of morphine postoperatively to manage pain.This client will be assessed most appropriately by the perioperative nurse for the risk for respiratory complications by frequently:
1) Listening to breath sounds
2) Monitoring pulse oximetry
3) Evaluating spirometer use
4) Counting respirations per minute

Question 38

Which of the following statements made by a nurse reflects the greatest insight into the planning needs of a same-day surgical experience?
1) "Time is a precious resource in same-day surgery units;being organized allows for the best utilization of time."
2) "Everything must be checked and verified as being ready before the client is admitted into the surgical area."
3) "With only a few hours from time of admission to the beginning of the procedure,things have to be effectively organized."
4) "I take the time to review the client's preadmission and preoperative data in order to formulate the most individualized plan of care possible."

Question 39

A prostate biopsy is an acceptable procedure to be performed as an ambulatory surgery on an otherwise healthy adult male because the American Society of Anesthesiologists (ASA)considers that a:
1) Physical status class 1
2) Physical status class 2
3) Physical status class 4
4) Physical status class 5

Question 40

A client who is scheduled for surgery is found to have thrombocytopenia.A specific postoperative concern for the nurse for this client is:
1) Hemorrhage
2) Wound infection
3) Fluid imbalance
4) Respiratory depression

Question 41

Given a rationale for preoperative and postoperative procedures,the client is better prepared to participate in care.For which of the following should the nurse provide instruction and rationale?
1) Incentive spirometry
2) Specific details regarding the progression of diet
3) Working the call button for the nurse
4) Using the patient-controlled analgesia (PCA)pump

Question 42

A 36-year-old female diabetic client is having an elective breast augmentation procedure done.Which of the following tests must be done on the day of surgery?
1) Complete blood count (CBC)
2) Blood glucose
3) Serum electrolytes
4) Coagulation studies

Question 43

A 24-year-old male client has been scheduled to undergo surgery for an ACL repair of his right knee.The client states that he is confused about what the surgeon will be doing.The best response from the nurse is:
1) "The surgeon went over this procedure with you in his office"
2) "Let me get the surgeon to talk with you before we proceed so that you fully understand what will be happening"
3) To share with the client what he can expect in regard to the procedure
4) "This is just a simple procedure-you should feel much better afterwards"

Question 44

The nurse is very busy and needs to delegate some tasks to the nursing assistive personnel (NAP).Which of the following would be the most appropriate task to delegate?
1) Postoperative client teaching
2) Demonstrating postoperative exercises
3) Transporting the preoperative client from the unit to the holding area
4) Reviewing the preoperative assessment to make sure that the client's vital signs have been documented

Question 45

A 48-year-old male client with a history of chronic obstructive pulmonary disease (COPD)is scheduled for an inguinal hernia repair.The nurse instructs that client that he can expect the health care provider to order which of the following tests before surgery?
1) Human immunodeficiency virus (HIV)antibody
2) Prolactin level
3) Pulmonary function test
4) Glucose tolerance test

Question 46

A 64-year-old male client has been scheduled to undergo surgery for a total knee replacement.The client would like to be able to use his own blood for the surgery,if needed.The nurse explains that there are several advantages to the client's having an autologous infusion,but there are some drawbacks as well.Which of the following would be considered a drawback to an autologous infusion?
1) The client has a decreased risk for contracting HIV.
2) There is an decreased risk for infection.
3) The client has less risk for a transfusion reaction.
4) The client may have a decreased hemoglobin and hematocrit level on the day of surgery.

Question 47

Which surgical classification would be the most appropriate for a cardiac catheterization scheduled on a 44-year-old male client who is in the hospital with chest pain?
1) Major
2) Minor
3) Ablative
4) Elective

Question 48

A 47-year-old female client has been scheduled to undergo surgery for removal of her gallbladder.Preoperatively the nurse is teaching the client what to expect when she wakes up in the postanesthesia care center.The nurse tells the client that her vision may be blurry due to which of the following reasons?
1) The client's blood pressure may be high from the postoperative pain.
2) The client may be slow to arouse from the anesthesia,causing her vision to be blurred upon waking.
3) The anesthesia provider applies ointment to clients' eyes to prevent corneal damage.
4) The lighting in the postanesthesia area will be subdued,causing the client to have blurred vision upon waking.