Deck 39: Perioperative Care

Question 1

The client is scheduled for outpatient cholecystectomy (gall bladder removal) in 2 weeks. Based on the client's history, the nurse includes which of the following in the preoperative plan of care?
1)Tell the client to avoid smoking on the day of surgery.
2)Use a safety razor to shave the abdomen the day before surgery.
3)Ask the surgeon to prescribe antibiotics to be given preoperatively.
4)Tell the client to inform the surgeon of allergies and chronic health conditions.

Answer 1

4

Question 2

A client is to have a sequential compression device (SCD) applied on the postoperative unit. The client is wearing knee-high elastic (antiembolism) stockings. When applying the SCD, what should the nurse do?
1)Remove the antiembolism stockings and not replace them.
2)Replace the knee-high stockings with thigh-high stockings.
3)Notify the surgeon that the client is wearing antiembolism stockings.
4)Apply the SCD over the knee-high antiembolism stockings.

Answer 2

4

Question 3

A client had a hiatal hernia repair earlier today and is now in the postanesthesia care unit (PACU). The family asks the nurse why the client is in the PACU rather than back in his room on the postsurgical unit. What should the nurse inform the family?
1)Clients who have had surgical complications are observed in the PACU until they are stable enough to return to the floor.
2)Clients recover from the effects of anesthesia in the PACU and then return to the postsurgical unit for further care.
3)The PACU is a holding area for clients awaiting a surgical unit bed or awaiting adequate staff to provide care on the postsurgical unit.
4)The nurse will ask the surgeon to explain to them why the client is not on the postsurgical unit as per usual procedure.

Answer 3

2

Question 4

The nurse is assessing a client admitted for a total hip arthroplasty under general anesthesia. The client reports that her spouse had a "nasty cold" last week and states she now has a cough and "little tickle" in their throat. The nurse notes mild rhonchi in both bases of the lung fields. Which of the following nursing diagnoses would best explain why the nurse contacted the surgeon and anesthesiologist for a possible postponement of the surgery?
1)Risk for pneumonia due to cough and rhonchi in lungs
2)Risk for infection related to exposure to infection and cough
3)Risk for noncompliance related to inability to follow instructions
4)Risk for caregiver role strain due to spouse's acute illness

Question 5

The nurse is preparing client care for several surgical cases. The nurse is aware that knowing the type of surgery helps identify needs to plan client care. Which of the following surgeries would pose a higher risk for infection?
1)Repair of a stab wound to the lower leg
2)Tonsillectomy of a preschool-age client
3)Cardiac catheterization via the femoral artery
4)Laparoscopic cholecystectomy

Question 6

The client is scheduled for a bronchoscopy. The client states that they are mildly anxious but is afraid of "going to sleep and never waking up." Which type of anesthesia would be most appropriate for the client?
1)General anesthesia
2)Peripheral block
3)Regional block
4)Conscious sedation

Question 7

The nurse is providing care to the client in the preoperative phase. Which of the following are the nurse's activities related to this phase?
1)Admit the client to the surgical suite.
2)Prepare the client mentally and physically for surgery.
3)Set up the sterile field in the operating room.
4)Perform the primary surgical scrub to the surgical site.

Question 8

The preoperative nurse is preparing clients for surgery. Which client does the nurse classify as facing the highest surgical risk?
1)A 40-year-old with hepatitis secondary to past IV drug use
2)An 83-year-old smoker with medically controlled hypertension
3)A 6-month-old with congenital heart anomaly and early stage liver disease
4)A 28-year-old taking anticoagulants secondary to mitral valve prolapse

Question 9

The staff RN is assigned to an operation with an operating room LPN. The physician employs another RN who will be first assistant for the operation. What role will the staff RN play?
1)Scrub nurse
2)Anesthesiologist
3)Circulating nurse
4)Technician

Question 10

A client has chronic confusion secondary to dementia. As a result, he is unable to sign an informed consent for surgery. What is required in this situation?
1)An informed consent is not needed.
2)Two nurses may witness the client's signature.
3)The surgeon must sign the informed consent.
4)The person with power of attorney should sign the informed consent.

Question 11

The nurse is gathering preoperative data on a client that is scheduled for abdominal surgery tomorrow. The nurse learns that the client takes the following medications daily: warfarin, a multivitamin, and vitamin E. The client reports that he stopped taking the anticoagulant 4 days ago, as instructed by the surgeon. He has continued to take the multivitamin and vitamin E. Based on the information given, why does the nurse notify the surgeon?
1)Needs an order to restart the anticoagulant
2)Is concerned about continued use of the multivitamin
3)Is concerned about the vitamin E
4)Has canceled the surgery to evaluate lab values

Question 12

To promote deep breathing, coughing, and turning by a postoperative client on the first postoperative day, what would be the best action by the nurse?
1)Teach the client the purpose of respiratory care and ambulation.
2)Provide constant reinforcement for accomplishing these activities.
3)Assess the client's pain level before these activities.
4)Emphasize the complications of immobility and poor cough effort.

Question 13

Identify the type of surgery a terminally ill client will undergo if the purpose is removal of tissue to relieve pain.
1)Procurement
2)Ablative
3)Palliative
4)Diagnostic

Question 14

The client tells the nurse, "I'm so nervous. I want to be knocked out for the surgery so that I don't know what is going on." When the nurse communicates with the surgeon and anesthetist, she tells them that the client desires which type of anesthesia?
1)Conscious sedation
2)General anesthesia
3)Local anesthesia
4)Regional anesthesia

Question 15

The client asks the preoperative nurse why all of the team members took a time-out before starting the procedure. Which of the following is the nurse's best response?
1)"This is one of our safety steps to verify you and your surgical procedure."
2)"This gives the team a chance to rest before performing your procedure."
3)"This is one way that we prevent complications prior to your surgery."
4)"This verifies that you have signed the consent form and agree to the surgery."

Question 16

A 2-year-old child is scheduled for a tonsillectomy. When determining the plan of care, what should the nurse do?
1)Include the parents or caregivers in the plan of care.
2)Explain to the child that she will have a sore throat after surgery.
3)Tell the child that she can have her favorite foods for the first 24 hours after surgery.
4)Prepare the child for discharge from the hospital as soon as she is alert.

Question 17

The nurse is assessing the client who is status 4 hours post total knee arthroplasty. The assessment is as follows: blood pressure (BP) 90/60 mm Hg, pulse (P) 94 beats/min; respirations (R) 16 breaths/min; temperature (T) 98.6 $\degree$ F, dressing is saturated with frank red blood. The nurse reinforces the dressing and contacts the surgeon. What is the nurse's main concern regarding this client?

A)The client may be hemorrhaging.
B)The client may be hypovolemic.
C)The client is developing an infection.
D)The client is developing a thrombus.

Question 18

A client is admitted from a local skilled nursing facility to the outpatient surgery center for surgical debridement of a stage 4 sacral pressure ulcer. The perioperative nurse discovers that the client does not have a signed consent form for the surgery on the chart or in the surgery center. The client says that she has not talked to the surgeon and that she has many questions regarding her surgery. When informed of this, the surgeon tells the nurse to have the client sign the informed consent form, and he will review it prior to the surgery. What should the nurse do?
1)Follow the surgeon's orders, and ask the client to sign the surgical consent form.
2)Inform the surgeon that she will have the client sign after he discusses the surgery with the client.
3)Ensure that the signed surgical consent is witnessed by two nurses because the surgeon is not available.
4)Cancel the surgery and transfer the client back to the long-term care facility.

Question 19

The nurse is providing care to a client scheduled for repair of a torn rotator cuff. The nurse understands that this surgery will be classified as what?
1)Reconstructive, minor, elective
2)Cosmetic, minor, urgent
3)Ablative, major, emergent
4)Reconstructive, major, urgent

Question 20

The preoperative phase encompasses which period of time?
1)Entry to the operating suite until admission to postanesthesia care
2)Entry into the operating suite until discharge from the hospital
3)The decision to have surgery until admission to postanesthesia care
4)The decision to have surgery until entry to the operating suite

Question 21

The nurse is preparing the client for general anesthesia. The client asks what the desired effects of general anesthesia are. Select all that apply.
1)Risk reduction
2)Analgesia
3)Amnesia
4)Muscle relaxation
5)Reduced Infection

Question 22

The surgical nurse manager is preparing the schedule based on classification. Surgeries are commonly classified by which of the following? Select all that apply.
1)Acuity
2)Level of urgency
3)Length of surgery
4)Body system
5)Type of anesthesia

Question 23

The postoperative client is admitted to the postanesthesia care unit (PACU) with an oral airway in place, an indwelling urinary catheter, IV fluid infusing via two different sites, and a Jackson-Pratt drain pinned to the gown near the wound dressing. What is the nurse's priority action after the client is moved to the bed?
1)Check the wound dressing.
2)Obtain vital signs.
3)Turn the client's head to the side.
4)Hang the urinary drainage bag on the bed frame.

Question 24

A client had a colon resection for removal of a cancerous tumor. Postoperatively, on the surgical floor, which of the following activities would the nurse perform for the purpose of decreasing the risk of postoperative complications? Select all that apply.
1)Assist the client to turn, breathe deeply, and cough every 2 hours.
2)Teach the client about the type of tumor removed.
3)Assess the drainage from the surgical site.
4)Monitor vital signs on a regular basis.
5)Instruct how to change the sterile dressings.

Question 25

The nurse is caring for a client who is wearing antiembolism compression stockings. The client repeatedly complains of discomfort caused by the stockings. What actions will the nurse take to improve comfort? Select all that apply.
1)Assess to determine whether the stockings are the correct size.
2)Remove the stockings for the remainder of the shift.
3)Ensure there are no wrinkles or rolled areas in the stockings.
4)Check that the stockings are on straight and the heel is in the right place.
5)Make sure the closed toe is molded to the toes.

Question 26

The postoperative client returned to the surgical nursing unit at 1:30 p.m. The evening shift nurse receives the report and begins working at 3:30 p.m. How often will the evening shift nurse take this client's vital signs?
1)Immediately, then every 30 minutes for the next 2 hours
2)Immediately, then every hour for the next 4 hours
3)Every hour beginning 30 minutes from now until end of shift
4)Immediately, then every 30 minutes 2 more times, then hourly

Question 27

The nurse is caring for a client who had abdominal surgery 3 days ago and will be discharged home later today. The nurse will know that teaching is effective if the client does which of the following? Select all that apply.
1)Describes clinical findings associated with infection
2)Performs the dressing change as prescribed
3)Demonstrates absence of surgical incision pain
4)Completes the regimen of prescribed antibiotics
5)Completes bowel management regimen

Question 28

The nurse admits a client who is scheduled for surgery tomorrow morning. The nursing admission assessment indicates that the client is mildly anxious about the procedure, does not drink alcohol or smoke, is married with two children, and is allergic to kiwi, avocados, and penicillin. The nurse identifies the priority nursing diagnosis for this client as:
1)Fear
2)Anxiety
3)Risk for Latex Allergy Response
4)Ineffective Airway Clearance

Question 29

The perioperative nurse maintains the safety of the client during surgery with which of the following goals? Select all that apply.
1)Preventing infection
2)Improving the accuracy of client identification
3)Preventing mistakes in surgery
4)Obtaining signed consent for surgery
5)Keeping the family informed of the client's status

Question 30

In the emergency department (ED), the client is diagnosed with a dislocated humerus. What type of anesthesia would the nurse anticipate will be used to repair the dislocation in the ED?
1)General
2)Epidural
3)Conscious sedation
4)Local

Question 31

Which of the following describes the Perioperative Nursing Data Set (PNDS)? Select all that apply.
1)A standardized tool for assessing high-risk surgical clients
2)A standardized vocabulary encompassing all surgical client outcomes
3)The first specialized nursing language recognized by the American Nurses Association (ANA)
4)A standardized language designed to describe the care of perioperative clients
5)The standard for safety in staffing levels of perioperative nurses

Question 32

The intraoperative nurse observes the anesthesiologist administer general anesthesia, insert the endotracheal tube, and take control of the airway. The nurse understands that the next important nursing intervention for this client is to:
1)Prepare the surgical site.
2)Shave the surgical site.
3)Position the client.
4)Pad bony prominences.

Question 33

The nurse is caring for a client with a Salem-sump double-lumen nasogastric (NG) tube to suction. The client complains of nausea and has mild abdominal distention. What is the nurse's priority action?
1)Administer an antiemetic.
2)Replace the nasogastric tube.
3)Check placement of the NG tube.
4)Irrigate the NG tube.

Question 34

The circulating nurse is providing care to the surgical client during the interoperative phase. Which of the following are components of the circulating nurse's focus to prevent complications during the surgery? Select all that apply.
1)Monitor the client's intake and output.
2)Create the operative field, cleanse the site.
3)Maintain the "nontouch" field prior to surgery.
4)Send the pathology specimens to the laboratory.
5)Apply antiembolism stockings in recovery.

Question 35

The preoperative nurse is preparing a client for surgery. Identify the interventions the nurse will perform. Select all that apply.
1)Inform the family to wait in the surgical waiting room.
2)Prepare the surgical suite for the operation.
3)Remove the client's dentures and contact lenses.
4)Assist the client to complete a living will.
5)Describe who will be in the operating suite.

Question 36

The nurse admits a client to the postoperative unit following gastric bypass surgery for weight loss. Based on the client's history, what is the priority nursing diagnosis for this client?
1)Risk for Infection
2)Delayed Surgical Recovery
3)Chronic Pain
4)Risk for Deficient Fluid Volume

Question 37

A client returns from surgery with a nasogastric tube and intermittent gastric suction to provide abdominal decompression. Which of the following are correct nursing activities for managing the equipment and drainage? Select all that apply.
1)Wear nonsterile gloves when emptying the drainage container.
2)When irrigating the nasogastric tube, use sterile water.
3)Wear sterile gloves when irrigating the nasogastric tube.
4)Apply water-soluble lubricant if the client's lips are dry.
5)Document the consistency and amount of drainage.