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?

Accepted Answer

Informing the surgeon of allergies and chronic health conditions is crucial for safe surgical planning and anesthesia management, ensuring that any potential complications can be anticipated and avoided.

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?

Accepted Answer

Sequential Compression Devices (SCD) can be applied over knee-high antiembolism stockings to enhance venous return and prevent deep vein thrombosis (DVT) in postoperative patients. This combination is often used in clinical practice to maximize patient safety and comfort.

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?

Accepted Answer

Clients are taken to the Postanesthesia Care Unit (PACU) to recover from the effects of anesthesia. This is a standard procedure to ensure that they are stable and to monitor for any immediate postoperative complications before they return to their room or the postsurgical unit for further recovery and care.

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?

Accepted Answer

The presence of a cough and rhonchi in the lungs, along with the recent exposure to a cold, suggests a risk for infection, which could complicate both the surgery and anesthesia. This is why the nurse would contact the surgeon and anesthesiologist to consider postponing the surgery.

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?

Accepted Answer

Repair of a stab wound to the lower leg poses a higher risk for infection due to the nature of the injury. Stab wounds are open, traumatic injuries that can easily become contaminated with bacteria from the environment or the object that caused the wound. This increases the risk of infection compared to the controlled environments of the other listed procedures.

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?

Accepted Answer

Conscious sedation is most appropriate for a client who is mildly anxious and fears "going to sleep and never waking up" during a bronchoscopy. It allows the client to be sedated yet remain awake and able to follow commands, reducing the fear associated with general anesthesia.

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?

Accepted Answer

Preparing the client mentally and physically for surgery is a key responsibility of the nurse during the preoperative phase. This includes providing information about the procedure, ensuring informed consent is obtained, and preparing the body area where the surgery will be performed.

Question 8

The preoperative nurse is preparing clients for surgery. Which client does the nurse classify as facing the highest surgical risk?

Accepted Answer

The 6-month-old with a congenital heart anomaly and early stage liver disease faces the highest surgical risk due to the combination of a significant heart condition and liver disease at a very young age, which complicates anesthesia and surgery.

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?

Accepted Answer

The staff RN will play the role of the circulating nurse, who is responsible for managing the nursing care within the operating room and coordinating the needs of the surgical team.

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?

Accepted Answer

In cases where a client is unable to provide informed consent due to mental incapacity, such as chronic confusion secondary to dementia, the responsibility falls to the person who has been legally designated to make decisions on behalf of the client. This is typically someone who holds a power of attorney for healthcare decisions. They are authorized to sign the informed consent for surgery or any other medical treatment on the client's behalf.

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?

Accepted Answer

Vitamin E can act as a blood thinner and may increase the risk of bleeding during surgery. The nurse would notify the surgeon about the continued use of vitamin E due to its potential to affect bleeding and healing.

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?

Accepted Answer

Assessing the client's pain level before these activities is crucial because pain can inhibit the client's ability to perform deep breathing, coughing, and turning. Managing pain effectively will facilitate these activities and promote recovery.

Question 13

Identify the type of surgery a terminally ill client will undergo if the purpose is removal of tissue to relieve pain.

Accepted Answer

Palliative surgery is performed to relieve symptoms or to improve the quality of life for patients, but not necessarily to cure the disease, making it the correct choice for a terminally ill patient seeking relief from pain.

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?

Accepted Answer

The client's request to be "knocked out" so they are unaware of what is happening during surgery indicates a desire for general anesthesia, which renders the patient unconscious and eliminates sensation over the entire body.

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?

Accepted Answer

The time-out procedure is a safety protocol used to verify the patient's identity, the surgical procedure, and the surgical site to prevent errors.

Question 16

A 2-year-old child is scheduled for a tonsillectomy. When determining the plan of care, what should the nurse do?

Accepted Answer

Including the parents or caregivers in the plan of care is crucial for a 2-year-old child, as they provide comfort and support, and are essential in understanding and managing the child's needs and responses to the surgery.

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?

Accepted Answer

The saturated dressing with frank red blood and low blood pressure suggest the client may be hemorrhaging, which is a priority concern.

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?

Accepted Answer

The nurse should ensure that the client has all the necessary information and has had the opportunity to ask questions before signing the consent form. It is the responsibility of the surgeon to provide this information and answer any questions the client may have.

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?

Accepted Answer

Repair of a torn rotator cuff is considered reconstructive because it aims to restore function to the shoulder. It is classified as minor because it involves less risk than major surgeries and is elective because it is planned in advance rather than being an emergency procedure.

Question 20

The preoperative phase encompasses which period of time?

Accepted Answer

The preoperative phase refers to the period from the decision to proceed with surgical intervention until the patient is transferred into the operating suite. This phase includes preparation for surgery, such as assessments, education, and any necessary preoperative procedures.

Quiz 39: Perioperative Care