Pre-Op
A toddler who has not had surgery before is being prepared for a surgical procedure. The child's mother expresses concern about the child's psychological adaptation to surgery. While planning for postoperative care, the nurse recognizes that the child is likely to have which greatest concern based on age?
a. anticipated pain
b. body image changes
c. communication difficulties
d. separation from parents
D
the child fears separation from her parents during the toddler years. The child has no previous experiences to compare to this experience so she will not anticipate pain before the surgery. A toddler cannot anticipate any changes in her body. A toddler does not worry about communication.
The nurse is preparing a client for surgery. Prior to completing the skin preparation, the nurse assesses the surgical site for which finding?
a. presence of pustules or abrasions
b. absence of hair growth
c. presence of lanugo
d. absence of pulsation
A
Abrasions, pustules, or other skin conditions have to be assessed and documented because they can interfere with wound healing or incrase the risk of infection.
While planning post op care for an obese client prior to surgery, the nurse should be most concerned about which risk that is increased by obesity during the post surgical recovery period
a. impaired wound healing
b. fluid overload
c. pressure ulcer development
d. inability to regulate body temperature
A
Wound and cardiovascular complications are more common among clients who are obese. Skinny people need to be more concerned about pressure ulcer.
The nurse must serve as a witness for informed consent to ensure which of the following? Select all that apply
a. The client has the capacity to make informed consent
b. The client has the authority to consent
c. The client's family is present during consent
d. The consent is being given voluntarily
e. The nurse can answer follow up questions about the surgery
A B D
Family does not need to be present if the client is able to make informed consent. It is not the nurse's responsibility to explain the surgery to the patient
The following clients are in the pre op holding area. The nurse determines that the client undergoing which procedure is having the most serious major surgery
a. tonsillectomy
b. breast biopsy
c. arthroscopy
d. nephrectomy
D
A nephrectomy is a marjo type of surgery because the kidney is a major vital organ, loss of blood is likely to be greater, and there is greater likelihood of complications
The nurse is caring for clients in the preop holding area. The nurse notes that one client, who is an older adult, has an increased surgical risk based on which factor?
a. decreased kidney function, leading to potential fluid and electrolyte imbalances
b. increased hunger sensations, leading to post op complications from hyperacidity
c. inability to comprehend the seriousness of surgical interventions, leading to noncompliance
d. poor cardiovascular status, leading to decreased pain sensation
With increased age, there is a greater likelihood that the kidneys start to degenerate. This can lead to reduced glomerular filtration rate and makes the client generally more at risk for fluid and electrolyte imbalances
A client who arrives for an outpatient surgical procedure has the odor of alcohol on the breath. Before completing the pre op assessment, the nurse reports this finding to the surgeon after drawing which conclusion about the significance of this finding?
a. alcohol can affect the client's response to anesthesia and surgery
b. alcohol can increase the risk for respiratory complications
c. alcohol can decrease the effectiveness of preop sedatives or hypnotics
d. physiological and psychological responses are slowed down by recent alcohol intake
A
Alcohol affects the central nervous system, and therefore the clients response to surgery and the anesthetic itself. It can also add to the effects of the pre op sedatives or hypnotics
The postsurgical unit nurse is implementing measures to prevent thrombophlebitis. Which measure should be the priority action by the nurse?
a. apply prescribed SCDs
b. reinforce importance of smoking cessation
c. assess the legs with each set of vital signs
d. teach the client to report homan's sign
A
SCDs facilitate venous return from the lower extremities by alternately inflating and deflating. Homans sign is pain on dorsiflexion indicating a DVT
What are the elements of informed consent? Select all that apply
a. Consent is implied by law
b. Consent is voluntary
c. Consent can only be given by an adult
d. Consent is given by someone who can understand the reason for the procedure
e. Client must be given enough information to make an informed decision
B, D, E
Consent can be given by emancipated minor, a minor with a child, or a minor with an STD. Consent is not implied by law unless in an emergency where the client needs lifesaving surgery and no next of kin can be found.
Each of the following clients will be having surgery this morning. The nurse concludes that which client is most likely to be at higher overall surgical risk?
a. a client who has dementia
b. a client who is culturally different than the medical personnel
c. a client who has mild anxiety
d. a client who has had previous surgeries
A
Dementia affects the person's understanding of the proposed surgery and ability to cooperate with the perioperative care. It also affects the medications given.
A client who takes numerous medications is being prepared for surgery. The nurse reviewing the client medication list is most concerned about which medication that increases surgical risk?
a. an antidysrhythmic
b. a sedative-hypnotic
c. a corticosteroid
d. an oral hypoglycemic
C
Corticosteroids can lead to salt and water retention, and can also delay wound healing.
When the staff nurse asks questions about the preop client's vision and hearing, a family member asks why these questions are important. What reply by the nurse provides the primary reason for seeking this information?
a. "this will help us determine the need for additional resources after discharge"
b. "this will help assess the risk of accidents in the home after surgery, which could affect the surgical outcome"
c. "this helps identify any unanticipated needs prior to beginning the surgery"
d. This will help us to individualize how we provide pre op and post op teaching
D
The ability of the client to see and hear could affect the preop and post op teaching methods used. The need for referrals for post discharge resources depends not only on the client's vision and hearing, but also on family supports and the client's physical and mental status.
A client has been admitted for surgery for resection of nerve roots. The client, observing the written comment that the surgery is palliative, asks what this means. The nurse should offer which explanation?
a. the surgery schedule is overbooked so the client's surgery could be delayed
b. the surgeon is against performing the surgery
c. the exact surgical procedure has not been decided
d. the procedure will be done to relieve pain, but will not cure the problem
D
a surgical procedure that relieves symptoms of disease or pain but does not cure is described as palliative
A surgeon has been in the room speaking to your patient. The surgeon comes to find you in the nurse's station and asks you to sign consent. What is your response?
a. You sign the consent
b. You go to the patient's room to ask if they understand the procedure before signing the consent
c. You refuse to sign the consent because you did not witness the teaching
d. You report the surgeon to the board of ethics
C
When the nurse asks the client about previous surgeries, the client asks why this information is important. The nurse responds that previous surgeries can have which effect on the client?
a. interfere with the absorption of anesthetic agents
b. affect the ability of the client to comprehend the instructions prior to surgery
c. affect the central nervous system
d. alter the client's responses to surgery
D
Previous surgeries can affect the physiological or psychological responses of the client to the planned surgery.
A client is admitted for surgery. During the pre op assessment, the nurse learns the client was taking warfarin but stopped it a few days ago per surgeon instructions. The nurse should include assessing for which specific problem when developing the post op plan of care?
a. delirium tremens
b. respiratory depression
c. bleeding or oozing at the surgical wound site
d. hypovolemia
C
Anticoagulants inhibit clotting of the blood, putting the client at increased risk for bleeding post op.
A client is scheduled for surgery and has been placed on NPO status. The client reports thirst and hunger and asks for breakfast. The nurse should explain that NPO status is for which purpose?
a. to make anesthesia induction easier
b. to avoid the risk of aspiration
c. to prevent excessive bleeding
d. to allow for more rapid wound healing
B
By keeping the stomach empty during surgery, the risk of vomiting and aspiration is decreased
The nurse assesses the wound of a post op client to have moderate drainage with a greenish tinge. The nurse should take which priority action next?
a. document the expected findings
b. check for bleeding at the base of the wound
c. take the pulse and blood pressure, and compare with previous readings
d. note the latest temp and WBC count
D
Purulent drainage, which often indicates wound infection, is made up of tissue debris, WBCs, and bacteria, and can have different colors, depending on the type of bacteria. The next step would be to gather additional data.
You witness the surgeon talking to the patient and the patient signing the consent. When the surgeon leaves, the patient says, "I have no idea what I just signed." What do you do?
a. repeat what the surgeon said about the surgery to the patient
b. Call the surgeon and have them come back
c. Call the OR to cancel the surgery
d. You don't have to explain, the patient signed the consent in the presence of you and the surgeon
B
The progress note in the health record indicates a plan to let a client's wound heal by tertiary intention. The nurse concludes that healing has occurred after making which observation of the wound?
a. the wound is smaller but irregular
b. very little scarring has occurred
c. tissue loss prevents the edges from approximating
d. a wide scar is present over the area of wound closure
D
A wise scar occurs in tertiary intention because the edges are not approximated, and they regenerate via granulation.
A client is being prepared for surgery. When the nurse asks that the client remove a wedding ring, the client refuses. What would be an appropriate response by the nurse? Select all that apply
a. encourage the client to use soapy water to remove the ring if it is tight
b. explain that the hospital cannot be responsible for jewelry worn during surgery
c. notify the surgeon's office that the surgeon must see the client in the preoperative holding area
d. tape the ring in place before the client is transported to the preoperative holding area
e. make a notation on the preoperative checklist that the ring is in place
D and E
Taping a wedding band in place is acceptable for the client who does not wish to remove it, unless there is danger the finger might swell during or after surgery. Documenting the presence of the ring on the pre op checklist alerts staff in the surgical suite of its presence
The nurse is taching a client about wound care in preparation for discharge. How should the nurse evaluate the effectiveness of home care teaching on wound care? Select all that apply
a. give a paper and pencil quiz
b. have the caregiver or client demonstrate the procedure
c. have the caregiver or client explain the procedure
d. have the caregiver or client critique a video on the procedure
e. ask the client detailed questions while demonstrating the procedure
B and C
Return demonstration is the best way to evaluate teaching of a procedure. Ideally, the teaching id sone over a few days and is then evaluated. Having the client explain the procedure is also appropriate because it indicates that the client has the necessary knowledge to perform the procedure.
A 78-year-old client with COPD has had abdominal surgery and suddenly feels something "let go" in the incision underneath the dressing when coughing. What should be the nurse's immediate actions? Select all that apply
a. have someone notify the healthcare provider
b. open the dressing and view the problem
c. apply pressure over the site
d. use a sterile dressing and sterile saline to keep the open incision moist
e. sit the client upright in bed
A, B, D
The nurse should have someone else notify the healthcare provider so the nurse can stay with the patient. The symptoms are of possible dehiscence and evisceration. The nurse needs to assess the problem before taking quick follow up action. A sterile dressing and sterile saline are used to maintain a moist environment until the client goes back to surgery. The client should be placed in the low fowler position with the knees slightly elevated to relieve tension in the abdomen
Can nurses witness phone consent?
Yes. You sit with the surgeon during the explanation. Then you get on the phone and ask the person if they understand. Then you can witness the consent
The nurse has taught the client to perform deep-breathing and coughing exercises. The nurse determines that the client needs additional teaching when the client is observed doing which activities? Select all that apply
a. sitting upright before deep breathing and coughing
b. taking deep breaths before attempting to cough
c. placing both hands vertically and slightly on either side of the incision
d. using a pillow for splinting during coughing
e. using coughing efforts that sound like clearing the throat
C and E
Placing the hands directly on the incision during coughing (instead of sightly to each side) will diminish the discomfort associated with coughing The client should cough forcefully (instead of weakly as in clearing the throat) to eliminate secretions effectively,