The nurse requests the client to sign a surgical informed consent form for an emergency appendectomy. Which statement by the client indicates further teaching is needed? Show 1."I will be glad when this is over so I can go home today." 1 The client will be in the hospital for a few days. This is not a day-surgery procedure. The client needs more teaching. The nurse in the holding area of the surgery department is interviewing a client who requests to keep his religious medal on during surgery. Which intervention should the nurse implement? 1.Notify the surgeon about the client's request to wear the medal. 2 The medal should be taped and the client should be allowed to wear themedal because meeting spiritual needs is essential to this client's care. The nurse must obtain surgical consent forms for the scheduled surgery. Which client would not be able to consent legally to surgery? 1.The 65-year-old client who cannot read or write. 3 A 16-year-old client is not legally able togive permission for surgery unless the adolescent has been given an emancipated status by a judge. This information was not given in the stem. The nurse is preparing a client for surgery. Which intervention should the nurse implement first? 1.Check the permit for the spouse's signature. 4 Completing the preoperative checklist has the highest priority to ensure all details are completed without omissions. The
nurse is interviewing a surgical client in the holding area. Which information should the nurse report to the anesthesiologist? Select all that apply. 1 Loose teeth or caries need to be re-ported to the anesthesiologist so he or she can make provisions to prevent breaking the teeth and causing the client to possibly aspirate pieces. Which task would be most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)? 1.Complete the preoperative checklist. 4 The UAP can remove clothing and jewelry. The nurse is assessing a client in the day surgery unit who states, "I am really afraid of having this surgery. I'm afraid of what they will find." Which statement would be the best therapeutic response by the nurse? 1."Don't worry about your surgery. It is safe." 3 This statement focuses on the emotion which the client identified and is therapeutic. The 68-year-old client scheduled for intestinal surgery does not have clear fecal contents after three (3) tap water enemas. Which intervention should the nurse implement first? 1.Notify the surgeon of the client's status. 1 The nurse should contact the surgeon because the client is at risk for fluid and electrolyte imbalance after three (3) enemas. Clients who are NPO, elderly clients, and pediatric clients are more likely to have these imbalances. The nurse is caring for a male client scheduled for abdominal surgery. Which interventions should the nurse include in the plan of care? Select ALL that apply. 1.Perform passive range-of-motion exercises. 2, 4, 5 Coughing effectively aids in the removal of pooled secretions which can cause pneumonia. Deep-breathing exercises keep the alveoli inflated and prevent atelectasis. The client's postoperative pain should be kept within a tolerable range. These interventions help decrease the client's anxiety. The nurse is caring for a client scheduled for total hip replacement. Which behavior indicates the need for further preoperative teaching? 1.The client uses the diaphragm and abdominal muscles to inhale through the nose and exhale
through the mouth. 4 The correct way to get out of bed postoperatively is to roll onto the side,grasp the side rail to maneuver to the side, and then push up with one hand while swinging the legs over the side. The client needs further teaching. The nurse is completing a preoperative assessment on a male client who states, "I am allergic to codeine." Which intervention should the nurse implement first? 1.Apply an allergy bracelet on the client's wrist. 3 The nurse should first assess the events which occurred when the client took this medication because many clients think a side effect, such as nausea, is an allergic reaction. Which laboratory result would require immediate intervention by the nurse for the client scheduled for surgery? 1.Calcium
9.2 mg/dL. 4 This potassium level is low and should be reported to the health-care provider because potassium is important for muscle function, including the cardiac muscle. Which activities are the circulating nurse's responsibilities in the operating room? 1.Monitor the position of the client, prepare the surgical
site, and ensure the client's safety. 1 The circulating nurse has many responsibilities in the OR, including coordinating the activities in the OR;keeping the OR clean; ensuring the safety of the client; and maintaining the humidity, lighting, and safety of the equipment. The circulating nurse observes the surgical scrub technician remove a sponge from the edge of the sterile field with a clamp and place the sponge and clamp in a designated area. Which action should the nurse implement? 1.Place the sponge back where it was. 3 The technician followed the correct procedure. Sponges are counted to maintain client safety, so all sponges must be kept together to repeat the count before the incision site is sutured. The sponge must be removed,not used, and placed in a designated area to be counted later. The circulating nurse and the scrub technician find a discrepancy in the sponge count. Which action should the circulating nurse take first? 1.Notify the client's surgeon. 4 A re-count of sponges may lead to the discovery of the cause of the presumed error. Usually it is just a miscount or a result of a sponge being placed in a location other than the sterile field,such as the floor or a lower shelf. Which violation of surgical asepsis would require immediate intervention by the circulating nurse? 1.Surgical supplies were cleaned and sterilized prior to the case. 4 According to the Centers for Disease Control and Prevention (CDC),the Association of Operating Room Nurses (AORN), and the Association for Practitioners in Infection Control,artificial nails harbor microorganisms, which increase the risk for infection. The nurse identifies the nursing diagnosis "risk for injury related to positioning"for the client in the operating room. Which nursing intervention should the nurse implement? 1.Avoid using the cautery unit which does not have a biomedical tag on it. 2 Padding the elbows decreases pressure so nerve damage and pressure ulcers are prevented. This addresses the etiology of the nursing diagnosis. The circulating nurse is positioning clients for surgery. Which client has the greatest potential for nerve damage? 1.The 16-year-old client in the dorsal recumbent position having an appendectomy. 2 The client's age, along with positioning with increased weight and pressure on the shoulders, puts this client at higher risk. Which situation demonstrates the circulating nurse acting as the client's advocate? 1.Plays the client's favorite audio book during surgery. 3 This would keep the client's dignity by maintaining privacy. With this action,the nurse is speaking for the client while the client cannot speak as a result of anesthesia; this is an example of client advocacy. The circulating nurse is planning the care for an intraoperative client. Which statement is the expected outcome?
1.The client has no injuries from the OR equipment. 1 This expected outcome addresses the safety of the client while in the OR. Which nursing intervention has the highest priority when preparing the client for a surgical procedure? 1.Pad the client's elbows
and knees. 2 This action would prevent the client from falling off the table, which is the highest priority. The nursing manager is making assignments for the OR. Which case should the manager assign to the inexperienced nurse? 1.The client having open-heart
surgery 2 The case of a client having a biopsy of the breast would be a good case for an inexperienced nurse because it is simple. The circulating nurse assesses tachycardia and hypotension in the client. Which interventions should the nurse implement? 1.Prepare
ice packs and mix dantrolene sodium. 1 Unexplained tachycardia, hypotension,and elevated temperature are signs of malignant hyperthermia, which is treated with ice packs and dantrolene sodium. The nurse is planning the care of the surgical client having conscious sedation. Which intervention has highest priority? 1.Assess the client's respiratory status. 1 Assessing the respiratory rate, rhythm,and depth is the most important action. The PACU nurse is receiving the client from the OR. Which intervention should the nurse implement first? 1.Assess the client's breath sounds. 1 The airway should be assessed first. When caring for a client, the nurse should follow the ABCs: airway,breathing, and circulation. Which assessment data indicate the postoperative client who had spinal anesthesia is suffering a complication of the anesthesia? 1.Loss of sensation at the lumbar (L5) dermatome. 3 If the effects of the spinal anesthesia move up rather than down the spinal cord, respirations can be depressed and even blocked. The surgical client's vital signs are T 98˚F, P 106, R 24, and BP 88/40. The client is awake and oriented times three (3) and the skin is pale and damp. Which intervention should the nurse implement first? 1.Call the surgeon and report the vital signs. 3 By lowering the head of the bed and raising the feet, the blood is shunted to the brain until volume-expanding fluids can be administered, which is the first intervention for a client who is hemorrhaging. The PACU nurse administers Narcan, an opioid antagonist, to a postoperative client. Which client problem should the nurse include to the plan of care based on this medication? 1.Alteration in comfort. 2 A client with respiratory depression treated with Narcan can have another episode within 15 minutes after receiving the drug as a result of the short half-life of the medication. The 26-year-old male client in the PACU has a heart rate of 110 and a rising temperature, and complains of muscle stiffness. Which interventions should the nurse implement? Select all apply. 1.Give a back rub to the client to relieve
stiffness. 2, 4 Ice packs should be applied to the axillary and groin areas for a client experiencing malignant hyperthermia. Dantrolene is the drug of choice for treatment. Which data indicate to the nurse the client who is one (1) day postoperative right total hip replacement is progressing as expected? 1.Urine output was 160 mL in the past eight (8) hours. 4 Lung sounds which are clear bilaterally in all lobes indicate the client has adequate gas exchange, which prevents postoperative complications and indicates effective nursing care. The nurse and the unlicensed assistive personnel (UAP) are working on the surgical unit. Which task can the nurse delegate to the UAP? 1.Take routine vital signs on clients. 1 Taking the vital signs of the stable client may be delegated to the UAP. The charge nurse is making shift assignments. Which postoperative client should be assigned to the most experienced nurse? 1.The 4-year-old client who had a tonsillectomy and is able to swallow fluids. 4 An older client with a chronic disease would be a complicated case, requiring the care of a more experienced nurse. Which statement would be an expected outcome for the postoperative client who had general anesthesia? 1.The client will be able to sit in the chair for 30 minutes. 2 The anesthesia machine takes over the function of the lungs during surgery, so the expected outcome should directly reflect the client's respiratory status;the alveoli can collapse, causing atelectasis. The postoperative client is transferred from the PACU to the surgical floor. Which action should the nurse implement first? 1.Apply anti-embolism hose to the client. 3 Assessing the client's status after transfer from the PACU should be the nurse's first intervention. Which problem should the nurse identify as priority for client who is one (1) day postoperative? 1.Potential for hemorrhaging. 1 All clients who undergo surgery are at risk for hemorrhaging, which is the priority problem. The unlicensed assistive personnel (UAP) reports the vital signs for a first-day postoperative client as T 100.8˚F, P 80, R 24, and BP 148/80. Which intervention would be most appropriate for the nurse to implement? 1.Administer the antibiotic earlier than scheduled. 3 Having the client turn, cough, and deep breathe is the best intervention for the nurse to implement because, if a client has a fever within the first day,it is usually caused by a respiratory problem. Which client would the nurse identify as having the highest risk for developing postoperative complications? 1.The 67-year-old client who is obese, has diabetes, and takes insulin. 1 This client has comorbid conditions—advanced age, obesity, and diabetes— which put this client at a higher risk for postoperative complications. The nurse is completing the preoperative checklist on a client going to surgery. Which information should the nurse report to the surgeon? 1.The client understands the purpose of the surgery. 3 Licorice and garlic can interfere with coagulation; therefore, the surgeon should be notified. Which statement explains the nurse's responsibility when obtaining informed consent for the client undergoing a surgical procedure? 1.The nurse should provide detailed
information about the procedure. 4 The nurse is responsible for ensuring the client voluntarily signs the surgical consent form giving permission for the surgery without coercion. Which client outcome would the nurse identify for the preoperative client? 1.The client's abnormal laboratory data will be reported to the anesthesiologist. 3 This would be the expected outcome for the client during the preoperative phase. After the teaching has been completed,the client should be able to demonstrate how to splint with the pillow while deep breathing and coughing. Which problem would be appropriate for the nurse to identify for the preoperative client having an open reduction and internal fixation of the right ankle? 1.Alteration in skin integrity. 2 This would be an appropriate client problem for the preoperative client who is scheduled for ankle repair. Teaching is priority. The nurse and an unlicensed assistive personnel (UAP) are caring for clients on a surgery unit. Which task would be most appropriate to delegate to the UAP? 1.Explain to the client how to cough and deep
breathe. 4 The UAP can assist a stable client to take a shower whether or not it is with Betadine. Which action by the client indicates to the nurse preoperative teaching has been effective? 1.The
client demonstrates how to use the incentive spirometer device. 1 The teaching is effective if the client is able to demonstrate the use of the spirometer prior to surgery. Which intervention has priority for the nurse in the surgical holding area? 1.Verify the surgical checklist. 1 The surgical checklist is assessed when the client arrives in the surgery department holding area where clients wait for a short time before entering the operating room. The client in the surgical holding area tells the nurse "I am so scared. I have never had surgery before." Which statement would be the nurse's most appropriate response? 1."Why are you afraid of the surgery?" 3 This response is therapeutic and promotes communication of feelings. The unlicensed assistive personnel (UAP) can be overheard talking loudly to the scrub technologist discussing a problem which occurred during one (1) of the surgeries. Which intervention should the nurse in the surgical holding area with a female client implement? 1.Close the curtains around the client's stretcher. 2 The UAP and scrub tech are violating HIPAA and should be told to stop the conversation immediately. The nurse is completing the preoperative checklist. Which laboratory value should be reported to the health care provider immediately? 1.Hemoglobin 13.1 g/dL. 2 This glucose level indicates hypoglycemia, which requires medical intervention. Which problem is appropriate for the nurse to identify for a client in the intraoperative phase of surgery? 1.Alteration in comfort. 3 This problem would be appropriate for the intraoperative phase. The circulating nurse would strap and carefully padareas to prevent damage to tissues and nerves. The client is in the lithotomy position during surgery. Which nursing intervention should be implemented to decrease a complication from the positioning? 1.Increase the intravenous fluids. 2 The lithotomy position has both legs elevated and placed in stirrups. The legs should be lowered one leg at a time to prevent hypotension from the shift of the blood. The circulating nurse observes the surgeon tossing a bloody gauze sponge onto thesterile field. Which action should the circulating nurse implement first? 1.Include the sponge in the sponge count. 3 The circulating nurse should inform the surgical technologist of any break in sterile technique or field. This is the first intervention because the field is now contaminated. The circulating nurse notes a discrepancy in the needle count. What intervention should the nurse implement first? 1.Inform the other members of the surgical team about the problem. 1 If the needle count does not correlate,the surgical technologist and the other surgical team members should be informed. After repeating the count,a search for the missing needle should be conducted. The client in the surgery holding area identifies the left arm as the correct surgical site, but the operative permit designates surgery to be performed on the right arm. Which interventions should the nurse implement? Select all that apply. 1.Review the client's chart. 1, 2, 3, 5 When the client in the holding area states the surgery site differs from the scheduled surgery, the nurse should identify the client and review the client's chart. If there is a discrepancy, the nurse should notify the surgeon to explain the situation and resolve the issue. The Joint Commission surgical standards state a "time-out" period is called and everything stops until the discrepancy is resolved. Clients are encouraged to mark the correct side or site with indelible ink. The nurse received a male client from the post-anesthesia care unit. Which assessment data would warrant immediate intervention? 1.The client's vital signs are T 97˚F, P 108, R 24, and BP 80/40. 1 These are symptoms of hypovolemic shock and require immediate intervention The client received naloxone (Narcan), an opioid antagonist, in the post-anesthesiacare unit. Which nursing intervention should the nurse include in the care plan? 1.Measure the client's intake and output hourly. 4 Narcan is given to reverse respiratory depression from opioid analgesic medications and has a short half-life. The client may experience a rebound respiratory depression in 15 to 20 minutes, so this nursing intervention of monitoring respirations every 15 to 30 minutes is appropriate. Which nursing task would be most appropriate to delegate to the unlicensed assistive personnel (UAP) on a postoperative unit? 1.Change the dressing over the surgical site. 3 Emptying the drainage devices and recording the amounts on the bedside intake and output forms can be delegated. Which client assessment data are priority for the post-anesthesia care nurse? 1.Bowel sounds. 2 The post-anesthesia care unit nurse should follow the ABCs format described by the American Heart Association. "A" is for airway, "B" is for breathing, and "C" is for circulation. Vital signs assess for hemodynamic stability; this is priority in the PACU. The male client in the day surgery unit complains of difficulty urinating postoperatively. Which intervention should the nurse implement? 1.Insert
an indwelling catheter. 3 Helping the male client to stand can offer the assistance needed to void. The safety of the client should been sured. The postoperative client complains of hearing a "popping sound" and feeling"something opening" when ambulating in the room. Which intervention should the nurse implement first? 1.Notify the surgeon the client has had an evisceration. 3 The nurse should assess the surgical site and, if the site has eviscerated,cover the opening with a sterile dressing moistened with sterile 0.9% saline. This will prevent the tissues from becoming dry and infected. The nurse received a report the elderly postoperative client became confused duringthe previous shift. Which client problem would the nurse include in the plan of care? 1.Risk for injury. 1 Anytime the nurse has a client who is disoriented, the nurse must initiate fall fall/safety precautions. The client one (1) day postoperative develops an elevated temperature. Whichintervention would have priority for the client? 1.Encourage the client to deep breathe and cough every hour. 1 When a postoperative client develops a fever within the first 24 hours, the cause is usually in the respiratory system. The client should increase deep breathing and coughing to assist the client to expand the lungs and decrease pulmonary complications. Which statement made by the client who is postoperative abdominal surgery indicates the discharge teaching has been effective?
1."I will take my temperature each week and report any elevation." 3 This statement about taking all the antibiotics ordered indicates the teaching is effective. The client diagnosed with appendicitis has undergone an appendectomy. At two (2)hours postoperative, the nurse takes the vital signs and notes T 102.6˚F, P 132, R 26,and BP 92/46. Which interventions should the nurse implement? List in order of priority. 1.Increase the IV rate. 1, 3, 4, 5, 2 1. An overweight patient (BMI 28.1 kg/m^2) is scheduled for a laparoscopic cholecystectomy at an outpatient surgery setting. The nurse knows that: 1. surgery will involve multiple small incisions. 1 Many operative procedures are performed as ambulatory surgery (i.e., same-day or outpatient surgery). Obesity is not a contraindication to surgery in the outpatient setting. This patient is not classified as obese on the bases of BMI. The case implied that a laparoscopic technique will be used that involves several small incisions and meets the requirement of a minimally invasive technique. The patient tells the nurse in the preoperative setting that she has noticed she has a reaction when wearing rubber gloves. What is the most appropriate intervention? 1. Notify the surgeon so the case can be cancelled. 2 The nurse should ask additional screening questions to determine the patient's risk for a latex allergy. Latex precaution protocols should be used for patients identified as having a positive latex allergy test result or a history of signs and symptoms related to latex exposure. Many health care facilities have created latex-free product carts that can be used for patients with latex allergies. A 59-year old man is scheduled for a herniorrhaphy in 2 days. During the preoperative evaluation he reports that he takes ginkgo daily. What is the priority intervention? 1. Inform the surgeon, since the procedure may need to be rescheduled. 1 Ginkgo can increase bleeding during and after surgery. The surgeon should determine how long it should be discontinued before surgery. A 17-year old patient with a leg fracture is scheduled for surgery. She reports that she is living with a friend and is an emancipated minor. She has a statement from the court for verification. Which intervention is the most appropriate? 1. Witness the permit after consent is obtained by the surgeon. 1 An emancipated minor may sign his or her own permit. The nurse should be available to witness the signature, but no further action is required. A priority nursing intervention to assist a preoperative patient coping with fear of postoperative pain would be to: 1. inform the patient that pain medication will be available. 4 If a patient has a fear of pain and discomfort after surgery, the nurse should reassure the patient that a pain management plan will be in place. The nurse should teach the patient to ask for medication after surgery when pain is present and assure him or her that taking these medications will not contribute to an addiction. The nurse should instruct the patient on the use of some form of pain rating scale (e.g., 0 to 10, FACES) and to request pain medication before the pain becomes severe. A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center. The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. What should the nurse do first? 1.Tell the patient to come back
tomorrow, since he ate a meal. 3 The nothing-by-mouth (NPO) protocol of each surgical facility should be followed. Restriction on fluids and food is designed to minimize the potential risk of postoperative nausea and vomiting. If a patient has not followed the NPO instructions, surgery may be delayed or canceled. The nurse should notify the anesthesia care provider immediately. A patient who normally takes 40 units of glargine insulin (long acting) at bedtime asks the nurse what to do about her dose the night before surgery. The best response would be to have her: 1. skip her insulin altogether the night before surgery. 4 Insulin is not usually omitted completely. The patient should obtain instructions from her health care provider or surgeon about any dosage adjustments that she should make the day before and the morning of surgery (if applicable). Preoperative considerations for older adults include (select all that apply) 1. only using large-print educational materials. 3, 4 Many older adults have sensory deficits. Preoperative and operating rooms are cool; warm blankets should be provided as needed. Proper attire for the semirestricted area of the surgery department is: 1. street clothing. 2 The semi-restricted area includes the surroundings support areas and corridors. Only authorized staff members are allowed access to the semi-restricted areas. All staff in the semi-restricted area must wear surgical attire and cover all head and facial hair. Activities that the nurse might perform in the role of a scrub nurse during surgery include (select all that apply): 1. checking electrical equipment. 2, 3, 5 Maintaining accurate counts of sponges, needles, and instruments is a shared responsibility of the scrub nurse and circulating nurse. (Note: It is listed as an activity for both in table 19-1). The nurse is caring for a patient undergoing surgery for a knee replacement. What is critical to the patient's safety during the procedure (select all that apply)? 1. Universal protocol is followed. 1, 5 Intraoperative nursing care includes determining the patient's allergy status in response to food, drugs, and latex. Preventing use of the wrong site, wrong procedure, and wrong surgery has become known as the UNIVERSAL PROTOCOL. The Universal Protocol is part of a global patient safety initiative. The nurse's primary responsibility for the care of the patient under going surgery is: 1. developing an individualized plan of nursing care for the patient. 1 A primary role of the nurse is to assess the patient to develop an individual plan of care. When scrubbing at the scrub sink, the nurse should: 1. scrub from the elbows to hands. 4 To perform a surgical scrub, the fingers and hands should be scrubbed first, progressing to the forearms and elbows. The hands should be held away from surgical attire and higher than the elbows at all times to prevent contamination from clothing or from detergent suds and water draining from the unclean area above the elbows to the clean and previously scrubbed areas of hands and fingers. When positioning a patient in preparation for surgery, the nurse understands that injury to the patient is most likely to occur as a result of: 1. incorrect musculoskeletal alignment. 1 Whatever position is required for the procedure, great care is taken to prevent injury to the patient. Because anesthesia blocks the sensory nerve impulses, the patient does nto feel pain or discomfort or sense stress placed on the nerves, muscles, bones, and skin. Improper positioning can result in muscle strain, joint damage, pressure ulcers, nerve damage, and other untoward effects. Intravenous induction for general anesthesia is the method of choice for most patients because: 1. the patient is not
intubated. 3 Routine general anesthesia is usually established with an intravenous (IV) induction agent, which may be hypnotic, anxiolytic, or dissociative agent. When used during the initial period of anesthesia, these agents induce a pleasant sleep with a rapid onset of action that patients find desirable. When a patient is admitted to the PACU, what are the priority interventions the nurse performs? 1. Assess the surgical site, noting presence and character of drainage. 3 Assessment in the postanesthesia care unit (PACU) begins with evaluation of the airway, breathing, and circulation (ABC) status of the patient. Identificaiton of inadequate oxygenation and ventilation or respiratory compromise necessitates prompt intervention. A patient is admitted to the PACU after major abdominal surgery. During the initial assessment the patient tells the nurse he thinks he is going to "throw up." A priority nursing intervention would be to: 1. increase the rate of the IV fluids. 3 If the patient is nauseated and may vomit, place the patient in a lateral recovery position to keep the airway open and reduce the risk of aspiration if vomiting occurs. After admission of the postoperative patient to the clinical unit, which assessment data require the most immediate attention? 1. Oxygen saturation of 85% 1 During the initial assessment, identify signs of inadequate oxygenation and ventilation. Pulse oximetry monitoring is initiated because if provides a noninvasive means of assessing the adequacy of oxygenation. Pulse oximetry may indicate low oxygen saturation (<90% to 92%) with respiratory compromise. This necessitates prompt intervention. A 70-kg postoperative patient has an average urine output of 25 mL/hr during the first 8 hours. The priority nursing intervention(s) given this assessment would be to: 1. perform a straight catheterization to measure the amount of urine in the bladder. 4 Because of the possibility of infection associated with catheterization, the nurse should first try to validate that the bladder is full. The nurse should consider fluid intake during and after surgery and should determine bladder fullness by percussion, by palpation, or by a portable bladder ultrasound study to assess the volume of urine in the bladder and avoid unnecessary catheterization. Discharge criteria for the phase II patient include (select all that apply): 1. no nausea or vomiting. 3, 4, 5 Phase II discharge criteria that must be met include the following: all PACU discharge criteria (phase I) met; no intravenous opioid drugs administered for the past 30 minutes; patient's ability to void (if appropriate with regard to surgical procedure or orders); patient's ability to ambulate if it is not contraindicated; presence of a responsible adult to accompany or drive patient home; and written discharge instructions given and understood. Which procedures are done for the curative purposes (select all that apply)? 1. Gastroscopy 4, 5 Gastroscopy is for the purpose of diagnosis. Rhinoplasty is done for a cosmetic improvement. A tracheotomy is palliative. A patient is scheduled for a hemorrhoidectomy at an ambulatory day-surgery center. An advantage of performing surgery at an ambulatory center is a decreased need for: 1. lab tests and perioperative medications 1 ambulatory surgery is usually less expensive and more convenient, generally involving fewer laboratory tests, fewer preoperative and postoperative medications, less psychologic stress, and less susceptibility to hospital acquired infections. Howerver, the nurse is still responsible for assessing, supporting, and teaching the patient who is undergoing surgery, regardless of where the surgery is performed. A patient who is being admitted to the surgical unit for a hysterectomy paces the floor, repeatedly saying "I just want this over." What should the nurse do to promote a positive surgical outcome for the patient? 1. Ask the patient what her specific concerns are about the surgery. 1 Excessive anxiety and stress can affect surgical recovery and the nurse's role in psychologically preparing the patient for surgery is to assess for potential stressors that could negatively affect surgery. Specific fears should be identified and addressed by the nurse listening and by explaining planned postoperative care. Many herbal products that are commonly taken cause surgical problems. Which herbs listed below should the nurse teach the patient to avoid before surgery to prevent an increase in bleeding for the surgical patient (select all that apply)? 1. garlic 1, 2, 4, 6 Valerian may cause excess sedation. Astragalus may increase blood pressure before and during surgery. When the nurse asks a preoperative patient about allergies, the patient reports a history of seasoned environmental allergies and allergies to a variety of fruits. What should the nurse do next? 1. Note this information in the patient's record as hay fever and food allergies. 3 Risk factors for latex allergies include a history of hay fever and allergies to foods such as avocados, kiwi, bananas, potatoes, peaches, and apricots. When a patient identifies such allergies, the patient should be further questioned about exposure to latex and specific reactions to allergens. During a preoperative review of systems, the patient reveals a history of renal disease. This finding suggests the need for which preoperative diagnostic tests? 1. ECG and chest x-ray 4 BUN, serum creatinine, and electrolytes are used to assess renal function and should be evaluated before surgery. Other tests are often evaluated in the presence of diabetes, bleeding tendencies, and respiratory or heart disease. During a preoperative physical examination, the nurse is alerted to the possibility of compromised respiratory function during or after surgery in a patient with which problem? 1. obesity 1 Obesity, as well as spinal, chest, and airway deformities, may compromise respiratory function during and after surgery. What type of procedural information should be given to a patient in preparation for ambulatory surgery (select all that apply)? 1. how pain will be controlled 1, 2, 5 Procedural information includes what will or should be done for surgical preparation, including what to bring and what to wear to the surgery center, length and type of food and fluid restriction, physical preparation required, pain control, need for coughing and deep breathing, and procedures done before and during surgery (such as vital signs, IV lines, and hwo anesthesia is administered). The other options are sensory and process information (SEE TABLE 18-6). The nurse asks a preoperative patient to sign a surgical consent form as specified by the surgeon and then signs the form after the patient does so. By this action, what is the nurse doing? 1. witnessing the patient's signature 1 The health care provider is ultimately responsible for obtaining informed consent. However, the nurse may be responsible for obtaining and witnessing the patient's signature on the consent form.The nurse may be a patient advocate during the signing of the consent form, verifying that consent is voluntary and that the patient understands the implications of consent, but the primary legal actoin by the nurse is witnessing the patient's signature. A patient scheduled for hip replacement surgery in the early afternoon is NPO but receives and ingests a breakfast tray with clear liquids on the morning of surgery. What response does the nurse expect when the anesthesia care provider is notified? 1. surgery will be done as scheduled 1 The preoperative fasting recommendations of the American Society of Anesthesiology indicate that clear liquids may be taken up to 2 hours before surgery for healthy patients undergoing elective procedures. There is evidence that longer fasting is not necessary. What is the rationale for using preoperative checklists on the day of surgery? 1. the patient is correctly identified 2 Preoperative checklists are a tool used to ensure that the many preparations and precautions performed before surgery have been completed and documented. Patient identification, instructions to the family, and administration of preoperative medications are often documented on the checklist, which ensures that no details are omitted. A common reason that a nurse may need extra time when preparing older adults for surgery is their: 1. ineffective coping 3 One of the major reasons that older adults need increased time preoperatively is the presence of impaired vision and hearing that slows understanding of preoperative instructions and preparation for surgery. The nurse is reviewing the laboratory results for a preoperative patient. Which test result should be brought to the attention of the surgeon immediately? 1. serum K+ of 3.8 mEq/L 4 Finding this may indicate infection. The surgeon will probably postpone the surgery until the cause of the elevated WBC count has been found. The nurse is preparing a patient for transport to the operating room. The patient is scheduled for a right knee arthroscopy. What actions should the nurse take at this time (select all that apply)? 1. ensure that the patient has voided 1, 2, 3, 4, 5 All of these are actions that are needed to ensure that the patient is ready for surgery. The nurse is providing preoperative teaching to the following patients. To which patient should the nurse plan to teach coughing and deep breathing exercises? 1. A 20-year-old man who is scheduled for a tonsillectomy 2 Patients with abdominal surgeries should be taught how to cough and deep breathe to prevent pulmonary complications such as atelectasis and pneumonia. Coughing and deep breathing is contraindicated in cranial surgeries (e.g., subdural hematoma evacuation or trans-sphenoidal hypophysectomy) and tonsillectomies. A 58-year-old man with a recent diagnosis of prostate cancer is scheduled for a radical prostatectomy. Before signing the consent, the patient tells the nurse, "I am not sure if this surgery is safe." Which response by the nurse is the most appropriate? 1. "Tell me what you know about your surgery and the risks involved." 1 The health care provider performing the surgery is responsible for obtaining the patient's consent. The nurse may witness the patient's signature on the consent form. As a patient advocate, the nurse should verify that the patient understands the surgery and the risks involved. If the nurse determines that the patient is unclear about operative plans, the nurse should contact the health care provider about the patient's need for more information. The other options provide false reassurance or do not respond to the patient's concern. The nurse is assigned to provide preoperative teaching to a 54-year-old man who is scheduled for coronary artery bypass surgery. The patient speaks only Spanish but the nurse only speaks English. What is the best method for the nurse to teach the patient how to use an incentive spirometer? 1. Give the patient a pamphlet written in Spanish with directions on the use of the incentive spirometer. 3 If the patient does not speak English, it is essential that the services of a competent translator be obtained. Hospitals are required to provide translators for common languages other than English. Demonstration and return demonstration is the most effective teaching method for use of equipment such as the incentive spirometer and should be done in the preoperative period if possible. Lorazepam (Ativan) 1 mg IV is ordered for a 45-year-old male patient before a scheduled surgery. Which of the following is the most appropriate action for the nurse to take before the administration of this medication? 1. Ask the
patient about an allergy to iodine or shellfish. 2 The nurse should instruct the patient to void before administering preoperative medications that may interfere with balance and increase the fall risk when ambulating to the bathroom. Lorazepam is a benzodiazepine that may be used for sedation and amnesia before surgery. Lorazepam does not affect serum potassium, is not contraindicated in patients with allergies to iodine or shellfish, and is not indicated to prevent or treat nausea. The nurse in an ambulatory surgery center has administered the following preoperative medications to a 42-year-old female patient scheduled for general surgery: diazepam (Valium), cefazolin (Ancef), and famotidine (Pepcid). What mode of transportation to the operating room (OR) would be the most appropriate for the nurse to arrange for this patient? 1.Seated in a wheelchair accompanied by a responsible family member 3 The patient has received a sedative (diazepam) and should be transported either by stretcher (with side rails raised) or wheelchair and accompanied by either OR staff, OR transport personnel, or the nurse. Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. What is the most appropriate action for the nurse to take? 1. Offer the patient to use the
urinal/bedpan after explaining the need to maintain safety. 1 The prime issue after administration of either sedative or opioid analgesic medications is safety. Because the medications affect the central nervous system, the patient is at risk for falls and should not be allowed out of bed, even with assistance. The other options would not be safe for the patient. What is the primary reason for accurately recording the patient's current medications during a preoperative assessment? 1. Some medications may alter the patient's perceptions about surgery. 3 Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that they have been communicated to the anesthesia care provider. Routine medications may or may not be prescribed for use the day of surgery. While performing preoperative teaching, the patient asks when she needs to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, the nurse tells the patient that 1. she must be NPO
after breakfast. 3 Practice guidelines for preoperative fasting state the minimum fasting period for clear liquids is 2 hours. Evidence-based practice no longer supports the long-standing practice of requiring patients to be NPO after midnight.
The nurse is admitting a patient to the same-day surgery unit. The patient tells the nurse that he was so nervous he had to take kava last evening to help him sleep. Which nursing action would be most appropriate? 1. Tell the patient that using kava to help sleep is often helpful. 2 Kava may prolong the effects of certain anesthetics. Thus the anesthesiologist needs to be informed of recent ingestion of this herbal supplement. Patients should not take anything before surgery without the health care provider's knowledge. Which preoperative patient has the greatest risk of bleeding as a result of his or her medication? 1. A woman who takes metoprolol (Lopressor) for the treatment of hypertension 3 Any drug that inhibits platelet aggregation, such as clopidogrel (Plavix), represents a bleeding risk. Insulin, metoprolol (Lopressor), and finasteride (Proscar) are less likely to contribute to a risk for bleeding. A 70-year-old woman has been admitted prior to having surgery for a bilateral mastectomy and breast reconstruction. What should the nurse include in the patient's preoperative teaching (select all that apply)? 1. Information about various options for reconstructive surgery 4, 5 During preoperative teaching, it is important to introduce the role of deep-breathing and coughing exercises and to inform the patient about the different locations involved in her hospital stay. The specific risks and benefits of her surgery and reconstruction options should be addressed by her surgeon. Teaching about breast cancer screening would be inappropriate, and likely insensitive, at this point in her disease trajectory. The patient is having a mole removed that has changed appearance. What does the nurse teach the patient about the rationale for this surgical procedure? 1. It is to prevent malignancy. 1 Removing a mole that is changing is to prevent as well as diagnose malignancy. There are no symptoms to alleviate mentioned or cosmetic problems for this patient. This will be the patient's first surgical experience and the patient states, "I am nervous about this." The vital signs show BP 158/88, HR 96, RR 24. In the assessment, the nurse finds that the lungs are clear, bowel tones are evident, peripheral pulses are strong, and the patient is fidgeting nervously. The patient took alprazolam (Xanax) at bedtime last night and takes acetaminophen (Tylenol) for tension headaches. Related to this assessment information, what should the nurse do before the patient goes to surgery? 1. Review the surgery with the patient. 2 In determining the psychologic status of the patient, the nurse notes the patient's anxiety, which is supported by the elevated BP and heart rate and fidgeting. The nurse should notify the anesthesia care provider (ACP) after assessing the cause of the anxiety or fear the patient is experiencing. The patient may only need to talk about the surgery related to the situation, concerns with the unknown or body image, or past experiences to relieve the anxiety, but the nurse cannot assume that lack of knowledge is the cause of the anxiety. Medication administration will be prescribed by the ACP if needed, but medications can also be administered during surgery. Reassuring the patient is not taking the patient's needs into account. A 75-year-old patient is being prepared for surgery. What assessment data needs to be included for this patient (select all that apply)? 1. Fluid balance history 1, 4, 5 Preoperative fluid balance history is especially critical for older adults as they have reduced adaptive capacity that puts them at greater risk for over- and under-hydration. Mobility problems must be assessed to assist with intraoperative and postoperative positioning and ambulation. Preoperative assessment of the older person's baseline cognition function is especially crucial for intraoperative and postoperative evaluation as they are more prone to adverse outcomes during and after surgery from the stressors of the surgery, dehydration, hypothermia, and anesthesia. Attitude about surgery and opinion or faith in the surgeon is important for all patients. Foods the patient dislikes are not important unless the patient is allergic to them, but this is no more important for older patients than it is for all patients. When reviewing the preoperative forms, the nurse notices that the informed consent form is not present or signed. What is the best action for the nurse to take? 1. Have the patient sign the consent form. 3 The informed consent for the surgery must be obtained by the physician. The nurse can witness the signature on the consent form and verify that the patient (or caregiver if patient is a minor, unconscious, or mentally incompetent to sign) understands the informed consent. Verbal consents are not enough. The state's nurse practice act and agency policies must be followed. As the nurse is preparing a patient for outpatient surgery, the patient wants to give his hearing aid to his wife so it will not be lost during surgery. Which action by the nurse should be taken in this situation? 1. Give the hearing aid to the wife as he wishes. 3 Although jewelry is removed before surgery, hearing aids should be left in place to allow the patient to better follow instructions given in the surgical suite and the postanesthesia care unit (PACU), as well as the dismissal instructions that will be given before he returns home for recovery. It is 6:00 AM. The anesthesiologist prescribes preoperative medications for a patient who is scheduled for surgery at 7:30 AM: cefazolin (Ancef) IV to be infused 30 minutes before surgery; midazolam (Versed) before surgery and scopolamine patch (Transderm Scop) behind the ear. Which medication should the nurse administer first? 1. Cefazolin (Ancef) 4 The scopolamine patch (Transderm Scop) will be administered first to allow enough time for the serum level to become therapeutic. The cefazolin (Ancef) will be given at 7:00 AM to allow infusion 30 minutes before surgery. Fentanyl (Sulimaze) is a narcotic and was not ordered preoperatively. The midazolam (Versed), a short-acting benzodiazepine, is used as a sedative. An alert male patient needs a tracheostomy because he has been intubated for 7 days with an endotracheal tube and cannot be weaned from the ventilator. The patient does not want the tracheostomy, but his family insists that the surgery be performed. What is the best action for the nurse to take? 1. Advocate for the patient's rights. 1 The nurse must act as the patient's advocate and assist the patient with fulfilling his wishes. However, as the patient's advocate the nurse must be sure he knows the risks and benefits of refusing a tracheostomy. Trying to change the patient's mind is unethical because it is contrary to acting as an advocate. As long as the patient is lucid, he retains the right of self-determination. Canceling the procedure is not indicated until discussion with the patient and surgeon has occurred. Telling the family they cannot interfere can aggravate or escalate the situation.
The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes mellitus, weighs 146 kg, and is 5 feet 8 inches tall. Which patient assessment is a priority related to anesthesia? 1. Has hemoglobin A1C of 8.5% 3 The patient's body mass index is the priority because it indicates the patient is severely obese. The patient's size may impair the anesthesiologist's ability to ventilate and medicate the patient properly, as well as the surgery room staff's ability to position the patient safely. The other factors are not the priority. While the perioperative nurse is transporting a 34-year-old female patient to the operating room for general surgery, the patient states, "I am a Jehovah's Witness and I am worried about blood transfusions." What would be the best response by the nurse to this patient's statement? 1."I will make sure that you do not receive a blood transfusion during this surgery." 4 The perioperative nurse should identify what the patient's concern is related to a blood transfusion. In addition, the nurse should clarify whether the patient wants a blood transfusion. The Jehovah's Witness community member may refuse blood transfusions, but each patient should be consulted to determine an individualized plan related to receiving or refusing blood transfusions. The perioperative nurse is supervising the surgical technologist before the arrival of the patient in the operating room for an exploratory laparotomy. Which action, if taken by the surgical technologist, would require the nurse to intervene? 1. The surgical technologist holds hands away from the body and above the elbows at all times. 3 Once a surgical hand scrub is completed, the surgical technologist should put on a sterile surgical gown and two pairs of gloves to prevent the transmission of microorganisms. Surgical hand antisepsis is completed by scrubbing fingers and hands first followed by progression to forearms and elbows. The hands should be held away from surgical attire and higher than the elbows at all times to prevent contamination. After performing a surgical hand scrub and applying a sterile gown and two pairs of sterile gloves, the person may manipulate and organize all sterile items for use during the procedure. The surgical team in the operating room performs a surgical time-out just before starting hip replacement surgery for a 62-year-old woman. Which action would be part of the surgical time-out? 1. Assess the patient's vital signs and oxygen saturation level. 4 During a surgical time-out, the surgery team will stop all activities right before the procedure to verify the patient identification, surgical procedure, and surgical site. Proper identification will be accomplished by asking the patient to state name, birth date, and operative procedure and location. In addition, the surgical team will compare the hospital ID number with the patient's own ID band and chart. The nurse administered midazolam (Versed) to a 58-year-old male patient during a colonoscopy. What nursing action is appropriate if the patient's respiratory rate changes from 14 breaths/minute to 3 breaths/minute? 1. Give a dose of naloxone (Narcan). 2 Midazolam is a benzodiazepine administered during monitored anesthesia care to patients having procedures such as a colonoscopy. The nurse should monitor the level of consciousness and assess for respiratory depression, hypotension, and tachycardia. To reverse severe benzodiazepine-induced respiratory depression, the nurse would administer flumazenil. Naloxone would reverse opioid-induced respiratory depression. Oxygen should be initiated based on pulse oximetry but at a higher concentration than what is provided with a nasal cannula at 4 L/min. The patient with severe respiratory depression should receive 100% oxygen with a non-rebreather mask. Repositioning the patient will not reverse the effects of sedation and may interfere with the procedure in progress. The perioperative nurse is reviewing the chart of a 48-year-old male patient who is being admitted into the operating room for a laminectomy. What information obtained from the chart review should be immediately discussed with the anesthesiologist? 1. The patient's grandmother developed hypothermia during a craniotomy. 4 Malignant hyperthermia (MH) is an autosomal dominant disorder characterized by hyperthermia with rigidity of skeletal muscles that can result in death. It may occur if an affected individual is exposed to certain general anesthetic agents. To prevent MH, it is important for the nurse to obtain a careful family history. The patient known or suspected to be at risk for MH can be anesthetized with minimal risks if appropriate precautions are taken. The nurse would be alerted to the occurrence of malignant hyperthermia when the patient demonstrates what manifestation? 1. Hypocapnia 2 Malignant hyperthermia is a metabolic disease characterized by hyperthermia with rigidity of skeletal muscles from altered control of intracellular calcium occurring as a result of exposure to certain anesthetic agents in susceptible patients. Hypoxemia, hypercapnia, and ventricular dysrhythmias may also be seen with this disorder. Before admitting a patient to the operating room, which forms or results must the nurse make sure are in the chart of all patients (select all that apply)? 1. Electrocardiogram 2, 5 The National Patient Safety Goals (NPSG) require documentation of a history and physical, signed consent form, and nursing and preanesthesia assessment in the chart of a patient going for surgery. The physical examination explains in detail the overall status of the patient before surgery for the surgeon and other members of the surgical team. Which intraoperative nursing responsibilities should be performed by the scrub nurse (select all that apply)? 1. Documenting intraoperative care 2, 3, 5 Both the scrub nurse and circulating nurse will participate in the counting of surgical sponges, needles, and instruments, whereas passing instruments to the surgeon and other sterile activities are the exclusive responsibility of the scrub nurse. The circulating nurse takes primary responsibility for the coordination of the surgical suite and documentation. What event in the surgical suite represents a violation of aseptic technique? 1. A glove contacts the leg of the table that supports the sterile field. 1 Tables are sterile only at tabletop level. Areas below this are considered contaminated. The sterile gown below the point 2 inches above the elbow is considered sterile. The passage of time in and of itself does not necessarily render a field contaminated. Bacteria are inevitable in the respiratory passages of team members, but they present a threat to sterility only if they are not confined by attire. The perioperative nurse would recognize the need to monitor the patient for hallucinations and agitation when which anesthetic agent is administered? 1. Nitrous oxide 2 A disadvantage of ketamine (Ketalar) is the associated risk of agitation, hallucinations, and nightmares. These unwanted effects are not associated with the use of thiopental (Pentothal), halothane (Fluothane), or nitrous oxide. A 71-year-old male patient who is currently undergoing coronary artery bypass graft (CABG) surgery has just experienced intraoperative vomiting. The nurse should consequently anticipate the use of which drug? 1. Midazolam (Versed) 4 Ondansetron (Zofran) is an antiemetic, whereas midazolam (Versed) is a benzodiazepine, and fentanyl (Sublimaze) and meperidine (Demerol) are opioid analgesics. A surgical patient's premedication regimen includes midazolam (Versed). What are the most likely desired effects of this medication? 1. Monitored anesthesia care and amnesia 1 Midazolam is a benzodiazepine that is widely used for its ability to induce amnesia and provide moderate sedation (conscious sedation). Nitrous oxide is a gaseous agent that potentiates volatile agents to speed induction and reduce total dosage and side effects. Antiemetics prevent intraoperative vomiting. Neuromuscular blocking agents facilitate endotracheal intubation. The new nursing student is confused about where the patient's family (who are wearing street clothes) can be with the patient in the surgical suite. Which explanation should the perioperative nurse give to the student nurse? 1. The family is not allowed to talk to the nurse at the nursing station. 2 The perioperative nurse should explain to the student nurse that the family can be in the preoperative holding area before the patient goes to surgery, but this includes talking to the nurse at the nursing station. They are also taken to the conference room for preoperative and postoperative meetings with staff, including teaching. Which National Patient Safety Goal (NPSG) requirement is enacted immediately before surgery with a surgical time-out? 1. Prevention of infection 4 During the surgical time-out the Universal Protocol is used to verify the patient's identity, surgical procedure, and site to prevent mistakes in surgery. Prevention of infection is to be done at all times. Improved staff communication relates to getting important test results to the right staff on time. Identifying patient's safety risks for suicide is not usually vital before surgery and does not occur during the time-out. A patient having an open reduction internal fixation (ORIF) of a left lower leg fracture will receive regional anesthesia during the procedure. As the patient is prepared in the operating room, what should the nurse implement to maintain patient safety during surgery that is directly related to the type of anesthesia being used? 1. Apply grounding pad to unaffected leg. 4 Regional anesthesia decreases sensation to the anesthetized area without impairing level of consciousness, which means the affected leg will be without sensation while the anesthetic is effective. A double tourniquet on the affected leg is used to restrict blood flow. This increases the patient's risk of impaired skin integrity because the patient does not have sensation and cannot identify discomfort or foreign objects and will not be moving during surgery. The nurse's role includes positioning the patient for correct alignment, exposure of the surgical site, and preventing injury. The other options will be occurring but are not directly related to the regional anesthesia. A 78-year-old patient is having surgery. What risk areas will the nurse need to be especially aware of for this patient during surgery? 1. Sterility 4 Skin of older adults has lost elasticity and is at increased risk for injury from tape, electrodes, warming or cooling blankets, and dressings. Pooling cleansing solution may create skin burns or abrasions. The nurse is responsible for monitoring patient safety and adjusting patient position as necessary to prevent pressure or misalignment. Sterility and urine output would be monitored for all patients. Paralysis would not be unusual during some types of surgery but would have an impact on any patient's skin integrity. The patient is going to have a colonoscopy. Which type of anesthesia should the nurse expect to be used? 1. Local anesthesia 4 The nurse should expect monitored anesthesia care (MAC) to be used for the patient having a colonoscopy because it can match the sedation level to the patient needs and procedural requirements. Local anesthesia would not be used because the area affected by a colonoscopy is larger than loss of sensation could be provided for with topical, intracutaneous, or subcutaneous application. Moderate sedation is used for procedures performed outside the OR, and the patient remains responsive. General anesthesia is not needed for a colonoscopy, and it requires advanced airway management. In which surgical area will the patient's skin be prepped for surgery, and what clothing will the person doing the prepping be wearing? 1. Surgical
suite wearing a lab coat 4 Surgical attire includes pants and shirts (or scrubs), a cap or hood, masks, and protective eyewear. All surgical attire is worn when the patient's skin is being prepped in the operating room to avoid contamination of the site. The surgical suite includes all unrestricted, semirestricted, and restricted areas of the controlled surgical environment. A lab coat is usually worn by the staff over their scrubs when they leave the surgical area. The staff will not wear street clothes in the preoperative holding area, although the family may. The holding area and PACU will not include prepping the patient for surgery. A 67-year-old male patient is admitted to the postanesthesia care unit (PACU) after abdominal surgery. Which assessment, if made by the nurse, is the best indicator of respiratory depression? 1. Increased respiratory rate 3 Transcutaneous carbon dioxide pressure (PtcCO2) monitoring is a sensitive indicator of respiratory depression. Increased CO2 pressures would indicate respiratory depression. Clinical manifestations of inadequate oxygenation include increased respiratory rate, dysrhythmias (e.g., premature ventricular contractions), and decreased oxygen saturation. The nurse is caring for a 54-year-old unconscious female patient who has just been admitted to the postanesthesia care unit after abdominal hysterectomy. How should the nurse position the patient? 1. Left lateral position with head supported on a pillow 1 The unconscious patient should be placed in the lateral "recovery" position to keep the airway open and reduce the risk of aspiration. Once conscious, the patient is usually returned to a supine position with the head of the bed elevated to maximize expansion of the thorax by decreasing the pressure of the abdominal contents on the diaphragm. Which patient would be at highest risk for hypothermia after surgery? 1. A 42-year-old patient who had a laparoscopic appendectomy 4 Patients at highest risk for hypothermia are those who are older, debilitated, or intoxicated. Also, long surgical procedures and prolonged anesthetic administration place the patient at increased risk for hypothermia. The nurse is providing discharge teaching to a 51-year-old female patient who has had a laparoscopic cholecystectomy at an ambulatory surgery center. Which statement, if made by the patient, indicates an understanding of the discharge instructions? 1. "I will have someone stay with me for 24 hours in case I feel dizzy." 1 The nurse must assess understanding of discharge instructions and the ability of the patient and caregiver to provide for home care needs. The patient must be accompanied by a responsible adult caregiver. The patient may not drive after receiving anesthetics or sedatives. The patient should understand how to manage pain, and pain medication should be taken before the pain becomes severe. The patient should understand symptoms to be reported, such as a fever. The nurse cares for a 72-year-old Native American male patient 2 days after a thoracotomy for tumor resection. What would be the most appropriate action if the patient does not report any pain? 1. Contact the health care provider. 2 Encourage the older adult to report pain, especially those who are reluctant to discuss pain or deny pain when it is likely present, such as after surgery. Older patients may be hesitant to request pain medication, believe pain is an inevitable consequence of surgery, and may not understand how to use patient-controlled machines. Some cultures discourage the expression of pain. The nurse should encourage the use of analgesics, explaining to the patient that untreated pain has a negative effect on recovery. Assessment of pain and administration of medications are within the scope of practice of a nurse. An older patient may have decreased renal and liver function that may lead to drug toxicity. However, this would not be a reason for denial of pain. Administration of pain medication must be based on the patient assessment. Unless contraindicated by the surgical procedure, which position is preferred for the unconscious patient immediately postoperative? 1. Supine 2 Unless contraindicated by the surgical procedure, the unconscious patient is positioned in a lateral "recovery" position. This recovery position keeps the airway open and reduces the risk of aspiration if the patient vomits. Once conscious, the patient is usually returned to a supine position with the head of the bed elevated. The nurse is working on a surgical floor and is preparing to receive a postoperative patient from the postanesthesia care unit (PACU). What should the nurse's initial action be upon the patient's arrival? 1. Assess the patient's pain. 2 The highest priority action by the nurse is to assess the physiologic stability of the patient. This is accomplished in part by taking the patient's vital signs. The other actions can then take place in rapid sequence. When assessing a patient's surgical dressing on the first postoperative day, the nurse notes new, bright-red drainage about 5 cm in diameter. In response to this finding, what should the nurse do first? 1. Recheck in 1 hour for increased drainage. 3 The first action by the nurse is to gather additional assessment data to form a more complete clinical picture. The nurse can then report all of the findings. Continued reassessment will be done. Agency policy determines whether the nurse may change the dressing for the first time or simply reinforce it. In planning postoperative interventions to promote repositioning, ambulation, coughing, and deep breathing, which action should the nurse recognize will best enable the patient to achieve the desired outcomes? 1. Administering adequate analgesics to promote relief or control of pain 1 Even when a patient understands the importance of postoperative activities and demonstrates them correctly, it is unlikely that the best outcome will occur unless the patient has sufficient pain relief to cooperate with the activities. Bronchial obstruction by retained secretions has contributed to a postoperative patient's recent pulse oximetry reading of 87%. Which health problem is the patient probably experiencing? 1. Atelectasis 1 The most common cause of postoperative hypoxemia is atelectasis, which may be the result of bronchial obstruction caused by retained secretions or decreased respiratory excursion. Bronchospasm involves the closure of small airways by increased muscle tone, whereas hypoventilation is marked by an inadequate respiratory rate or depth. Pulmonary emboli do not involve blockage by retained secretions.
In caring for the postoperative patient on the clinical unit after transfer from the PACU, which care can be delegated to the unlicensed assistive personnel (UAP)? 1. Monitor the patient's pain. 3 The UAP can encourage and assist the patient to do deep breathing and coughing exercises and report complaints of pain to the nurse caring for the patient. The RN should do the admission vital signs for the patient transferring to the clinical unit from the PACU. The LPN or RN will monitor and treat the patient's pain and change the dressings. The patient had abdominal surgery. The estimated blood loss was 400 mL. The patient received 300 mL of 0.9% saline during surgery. Postoperatively, the patient is hypotensive. What should the nurse anticipate for this patient? 1. Blood administration 2 The nurse should anticipate restoring circulating volume with IV infusion. Although blood could be used to restore circulating volume, there are no manifestations in this patient indicating a need for blood administration. An ECG may be done if there is no response to the fluid administration, or there is a past history of cardiac disease, or cardiac problems were noted during surgery. Returning to surgery to check for internal bleeding would only be done if patient's level of consciousness changes or the abdomen becomes firm and distended. The patient donated a kidney, and early ambulation is included in her plan of care. But the patient refuses to get up and walk. What rationale should the nurse explain to the patient for early ambulation? 1. "Early walking keeps your legs limber and strong." 4 The best rationale is that early ambulation will prevent postoperative complications that can then be discussed. Ambulating increases muscle tone, stimulates circulation that prevents venous stasis and VTE, speeds wound healing, and increases vital capacity and maintains normal respiratory function. These things help the patient be ready for discharge, but early ambulation does not eliminate syncope and pain. Pain management should always occur before walking. An older patient who had surgery is displaying manifestations of delirium. What should the nurse do first to provide the best care for this new patient? 1. Check his chart for intraoperative complications. 4 If the patient's ABCs are okay, it is important to first know if the patient was mentally alert without cognitive impairments before surgery. Then intraoperative complications, anesthesia medications, and pain will be assessed as these can all contribute to delirium. The patient had surgery at an ambulatory surgery center. Which criteria support that this patient is ready for discharge (select all that apply)? 1. Vital signs baseline or stable 1, 2, 4 Ambulatory surgery discharge criteria includes meeting Phase I PACU discharge criteria that includes vital signs baseline or stable and minimal nausea and vomiting. Phase II criteria includes a responsible adult driving patient, no IV opioid drugs for last 30 minutes, able to void, able to ambulate if not contraindicated, and received written discharge instruction with patient understanding confirmed. A patient is having elective cosmetic surgery performed on her face. The surgeon will keep her at the surgery center for 24 hours after surgery. What is the nurse's postoperative priority for this patient? 1. Manage patient pain. 4 The nurse's priority is to manage the patient's oxygenation status by maintaining an airway and ventilation. With surgery on the face, there may be swelling that could compromise her ability to breathe. Pain, bleeding, and fluid imbalance from the surgery may increase her risk for upper airway edema causing airway obstruction and respiratory suppression, which also indicate managing oxygenation status as the priority. Which priority intervention should the nurse in the preoperative waiting area implement?The key nursing intervention during the preoperative period is patient and family education. Take every opportunity during the patient assessment and preparation for surgery, to provide information that will increase the patient's familiarity with the procedure, which will decrease anxiety.
What do nurses do to prepare patients for surgery?Preparing for Surgery
Stop drinking and eating for a certain period of time before the time of surgery. Bathe or clean, and possibly shave the area to be operated on. Undergo various blood tests, X-rays, electrocardiograms, or other procedures necessary for surgery.
What is surgical intervention in nursing?Surgical intervention may be needed to diagnose or cure a specific disease process, correct a deformity, restore a functional process or reduce the level of dysfunction. Although surgery is generally elective or pre-planned, potentially life-threatening conditions can arise, requiring emergency intervention.
When preparing a patient for surgery the primary purpose of the preoperative assessment is to?Historically, the goal of preoperative assessment has been to determine patient factors that significantly increase the risk for perioperative complications. Overall, the perioperative complication rate has declined during the past 30 years because of improved anesthetic and surgical techniques.
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