To Be A Nurse, You Gotta Crack This Perioperative Quiz

The major preoperative concern in this case is the client's smoking habit. Smoking can have detrimental effects on the healing process and increase the risk of complications during and after surgery. It can impair lung function, decrease oxygen levels in the blood, impair immune function, and delay wound healing. Therefore, it is important to address the client's smoking habit prior to the gastrectomy to optimize their surgical outcomes and reduce the risk of complications.

The best response from the nurse is to offer to get the surgeon to talk with the client before proceeding so that the client fully understands what will be happening. This response shows that the nurse values the client's understanding and wants to ensure that they are well-informed about the procedure. It also demonstrates good communication and patient-centered care, as the nurse recognizes the client's confusion and takes steps to address it. This approach promotes trust and collaboration between the healthcare team and the client, leading to better outcomes and patient satisfaction.

Obese clients are at a higher risk for postoperative complications such as dehiscence. Dehiscence is the separation or opening of the surgical incision. The excess adipose tissue in obese clients can impair wound healing due to poor blood supply and increased tension on the incision site. This can lead to the incision opening up and increasing the risk of infection. Therefore, it is important for nurses to closely monitor obese clients postoperatively to prevent and promptly manage any signs of dehiscence.

After surgery involving the right femoral artery, the nurse needs to assess the client's circulation status to the right leg. The dorsalis pedis artery is located on the top of the foot and is a good indicator of blood flow to the lower extremities. Checking the pulse at the dorsalis pedis artery will provide information about the circulation in the right leg. The radial artery is located in the wrist and does not provide information specific to the leg. The ulnar artery is also located in the wrist and is not relevant to assessing circulation in the leg. The brachial artery is located in the upper arm and is not specific to the leg either.

A 48-year-old male client with a history of chronic obstructive pulmonary disease (COPD) is scheduled for an inguinal hernia repair. Given the client's history of COPD, it is important to assess his pulmonary function before surgery. A pulmonary function test is a diagnostic test that evaluates lung function by measuring how much air the client can inhale and exhale, how quickly they can exhale, and how well their lungs deliver oxygen to the bloodstream. This test helps determine the severity of COPD and assesses the client's lung capacity and respiratory efficiency, which is crucial information for the healthcare provider to ensure the client's safety during surgery.

The statement "There seems to be a missing sponge, so a recount should be done of all the sponges that have been removed" reflects nursing accountability in the intraoperative phase because it demonstrates the nurse's responsibility for ensuring patient safety during surgery. The nurse is recognizing a potential error or missing item and taking action to address it, which is an important aspect of accountability in the operating room.

The incentive spirometer is a device used to promote lung expansion. By blowing into the tube, the client can take deep breaths and expand their lungs fully. This helps to prevent atelectasis, a condition where the lungs collapse or become partially collapsed. By promoting lung expansion, the client can improve their lung function and prevent complications such as pneumonia. Therefore, the specific purpose of using the incentive spirometer is to promote lung expansion.

An autologous infusion involves using the client's own blood for the surgery. One drawback of this method is that the client may have a decreased hemoglobin and hematocrit level on the day of surgery. This is because the client's blood is collected in advance and stored, which can lead to a decrease in these levels over time. This may result in a higher risk of anemia or other complications during and after the surgery.

Placing the side rails up on the bed or stretcher is the correct answer because it ensures the client's safety during and after the surgery. The side rails provide support and prevent the client from falling off the bed or stretcher while they are under the influence of the preoperative medications. This is important as the medications can cause drowsiness and disorientation. Keeping the client quiet, obtaining consent, and preparing the skin at the surgical site are also important steps in the preoperative process, but ensuring the client's safety takes priority in this situation.

A temperature of 100° F indicates a mild fever, which may be a sign of an underlying infection. Infection can increase the risk of complications during surgery and may require adjustments in anesthesia management. Therefore, the nurse should contact the anesthesiologist to inform them about the client's elevated temperature and seek further guidance.

The 27-year-old taking an anticoagulant agent is at the greatest risk during surgery because anticoagulant medications can increase the risk of bleeding. Surgery involves cutting tissues and can result in bleeding, so the anticoagulant agent can further increase the risk of excessive bleeding during and after surgery. The other clients taking analgesic, antihypertensive, and antibiotic agents do not have the same level of risk as the client taking an anticoagulant agent.

Thrombocytopenia refers to a low platelet count, which can impair the clotting process and increase the risk of bleeding. Therefore, the specific postoperative concern for a client with thrombocytopenia would be hemorrhage, as their blood may not clot properly, leading to excessive bleeding during or after surgery.

Applying a splint directly over the lower abdomen helps decrease discomfort in the incisional area when the client coughs postoperatively because it provides support and stability to the incision site. By holding the incision together, the splint reduces tension and prevents the incision from pulling apart when the client coughs. This can help minimize pain and promote proper healing of the incision.

A client with type 2 diabetes is at greatest risk for impaired wound healing postoperatively. Diabetes can affect the body's ability to heal wounds due to high blood sugar levels, which can impair the function of white blood cells and decrease the production of collagen. Additionally, diabetes can lead to poor circulation and nerve damage, further hindering the healing process. Therefore, impaired wound healing is the nursing diagnosis that the client is at greatest risk for.

As people age, their kidneys undergo changes that can lead to a reduced glomerular filtration rate. Glomerular filtration rate refers to the rate at which the kidneys filter waste and excess fluid from the blood. A reduced glomerular filtration rate means that the kidneys are not able to filter blood as efficiently, leading to a buildup of waste products in the body. This can increase the risk for surgery as it may affect the body's ability to eliminate anesthesia and medications, and can also increase the risk for complications such as fluid overload and electrolyte imbalances.

The nurse should inform the surgeon so that information can be provided. This is the appropriate action because the nurse has determined that the client has not achieved the outcome of describing surgical procedures and postoperative treatment. By informing the surgeon, the nurse can ensure that the necessary information is provided to the client, which will help them understand the procedures and treatment better. This will ultimately contribute to the client's overall well-being and satisfaction with their healthcare experience.

A cough and low-grade fever can indicate an underlying respiratory infection, such as bronchitis or pneumonia. These conditions can increase the risk of complications during a general anesthesia procedure, such as a higher risk of developing respiratory distress or pneumonia postoperatively. Therefore, the presence of a cough and low-grade fever would most likely delay a planned procedure requiring general anesthesia to ensure that the infection is properly treated and the client's respiratory status is optimized before undergoing the procedure.

An appendectomy is appropriately documented as ablative surgery because it involves the removal of the appendix. Ablative surgery refers to a procedure that removes or excises a diseased or non-functioning part of the body. In the case of an appendectomy, the appendix is surgically removed due to inflammation or infection. This procedure aims to alleviate symptoms and prevent complications associated with appendicitis. Therefore, the term "ablative surgery" accurately describes the nature of an appendectomy.

Abdominal distention is indicative of internal bleeding after abdominal surgery. It occurs when blood accumulates in the abdominal cavity, causing the abdomen to become swollen and distended. This can be a sign of bleeding because the blood collects in the abdominal space, leading to increased pressure and distention. Increased blood pressure may not necessarily indicate internal bleeding, as it can be a normal response to surgery or other factors. Incisional pain is common after surgery and may not specifically indicate bleeding. Increased urinary output is not directly related to internal bleeding and may be influenced by other factors such as hydration or medications.

The nurse knows that the client is most likely going to arrive for the surgical procedure having adhered to the required bowel preparation if the client understands the need for the laxative. This is because if the client understands the purpose and importance of the laxative in the bowel preparation process, they are more likely to follow the instructions and take it as directed. Understanding the need for the laxative indicates that the client is informed and motivated to comply with the bowel preparation, increasing the likelihood of adherence.

In preparing a client for abdominal surgery with general anesthesia, it is important to remove her makeup and nail polish. This is because during surgery, the healthcare team needs to monitor the client's skin color and nail beds to ensure proper oxygenation and circulation. Makeup and nail polish can interfere with this assessment and may also increase the risk of infection. Additionally, removing makeup and nail polish helps to maintain a sterile environment in the operating room.

A client who receives general or regional anesthesia in an ambulatory surgery center has to meet identified criteria in order to be discharged home. This means that they need to fulfill certain requirements, such as stable vital signs, ability to tolerate oral intake, absence of complications, and adequate pain control, before they can be allowed to go home. This is important to ensure the client's safety and well-being after the anesthesia wears off and to minimize the risk of post-operative complications.

A cardiac catheterization is a procedure that involves inserting a catheter into the heart to diagnose and treat various heart conditions. It is considered a major surgical classification because it involves invasive techniques and carries a certain level of risk. Additionally, the fact that the patient is in the hospital with chest pain suggests that the procedure is being done to address a potentially serious cardiac issue. Therefore, major is the most appropriate surgical classification for this cardiac catheterization.

The most appropriate task to delegate in this situation would be transporting the preoperative client from the unit to the holding area. This task does not require any specialized medical knowledge or skills and can be safely and effectively performed by the nursing assistive personnel (NAP). Postoperative client teaching and demonstrating postoperative exercises require the expertise of a nurse, while reviewing the preoperative assessment requires careful attention to detail and accuracy, which is best done by the nurse.

A prostate biopsy is an acceptable procedure to be performed as an ambulatory surgery on an otherwise healthy adult male because the American Society of Anesthesiologists (ASA) considers it as a physical status class 1. This means that the patient is a normal healthy individual without any systemic disease and is able to carry out normal daily activities without any limitations. Therefore, the patient is at a low risk for complications during the procedure and can safely undergo the biopsy as an outpatient.

Upon admission to the postanesthesia care unit (PACU), the client is positioned with the head of the bed slightly elevated and the client's head to the side. This position helps to maintain a clear airway and prevent aspiration in case of vomiting or regurgitation. It also promotes optimal oxygenation and ventilation. Additionally, positioning the head to the side helps to prevent airway obstruction and facilitates drainage of oral secretions.

The postponement of the procedure is most likely a result of the possibility of a respiratory complication during anesthesia. Anesthesia can have a negative impact on the respiratory system, and if the client already has a low-grade fever and a productive cough, it indicates the presence of a respiratory tract infection. Performing the procedure under anesthesia in such a condition increases the risk of further complications, such as respiratory distress or infection. Therefore, it is safer to postpone the procedure to allow the client's respiratory tract infection to improve and reduce the risk of complications during anesthesia.

Demerol and Vistaril are given before surgery to ease the induction of anesthesia. This means that these medications help to make the process of administering anesthesia smoother and more comfortable for the patient. They may help to relax the patient and reduce anxiety, which can make it easier for the anesthesia to be administered.

The nurse's statement that teaching the family what they need to know before the surgery will maximize their effectiveness regarding the client's postoperative care demonstrates the most informed understanding of the role of family in the client's recovery. By educating the family about what to expect during the recovery process, they will be better prepared to provide appropriate care and support to the client. This knowledge will not only increase the family's comfort in caring for the client but also enhance their effectiveness in meeting the client's postoperative needs.

Fear or anxiety regarding the procedure can be the greatest barrier to meeting a preoperative client's nursing diagnosis of deficient knowledge regarding the surgical procedure because it can hinder the client's ability to process and retain information. When a client is fearful or anxious, they may have difficulty focusing, comprehending, and remembering the information provided by the nurse. This can prevent them from fully understanding the surgical procedure, potential risks, and postoperative care instructions. Therefore, addressing and alleviating the client's fear or anxiety is crucial in order to effectively educate them about the surgical procedure.

The preoperative assessment finding of a serum creatinine level of 3.2 mg/100 mL indicates a need to contact the surgeon. A normal serum creatinine level is typically between 0.6-1.3 mg/100 mL, indicating proper kidney function. A level of 3.2 mg/100 mL suggests impaired kidney function, which can increase the risk of complications during surgery. The surgeon should be notified to evaluate the client's kidney function and determine if any adjustments to the surgical plan or anesthesia are necessary.

After a vagotomy and pyloroplasty, the client may experience a subdued level of consciousness and neurological function due to the effects of anesthesia and the surgical procedure. This is a normal expectation during the immediate postoperative period. The other options, such as returned normal bowel sounds, pain relief, and voluntary bladder control, are not specific to this stage of recovery and may vary depending on the individual client's condition.

Malignant hyperthermia is a potentially life-threatening reaction to certain medications used during general anesthesia. It is characterized by a rapid rise in body temperature, muscle rigidity, and increased heart rate. Tachycardia, or a fast heart rate, is an early sign of malignant hyperthermia. It occurs due to the release of excessive calcium from muscle cells, leading to increased metabolism and heat production. Therefore, tachycardia is a crucial indicator that allows the nurse to identify and take immediate action to manage this dangerous condition.

The nurse should provide instruction and rationale for incentive spirometry. Incentive spirometry is a preoperative and postoperative procedure that helps the client improve lung function and prevent complications such as atelectasis and pneumonia. By providing instruction and rationale, the nurse can educate the client on the importance of using the incentive spirometer and how it can help them breathe deeply and expand their lungs. This will empower the client to actively participate in their care and improve their postoperative outcomes.

Based on an Aldrete score of 8, the nurse anticipates that the client will be discharged back to his or her room on the nursing unit. The Aldrete score is a tool used to assess the client's readiness for discharge from the PACU after anesthesia. A score of 8 or higher indicates that the client has met the criteria for safe discharge, including stable vital signs, ability to breathe adequately, and ability to move all extremities. Therefore, the client does not require further monitoring in the PACU and can be safely transferred to a regular nursing unit for continued care and recovery.

The correct answer reflects the greatest insight into the planning needs of a same-day surgical experience because it emphasizes the importance of reviewing the client's preadmission and preoperative data. This shows that the nurse understands the need for a thorough assessment and individualized plan of care, which is crucial in ensuring a successful surgical experience. By taking the time to review the client's data, the nurse can identify any potential risks or special considerations that need to be taken into account during the procedure, thus enhancing the overall quality of care provided.

Blood glucose levels must be tested on the day of surgery for a diabetic client undergoing an elective breast augmentation procedure. This is important because diabetes can affect blood sugar levels, and high blood glucose levels can increase the risk of complications during surgery, such as delayed wound healing and infection. By monitoring blood glucose levels, the healthcare team can ensure that the client's blood sugar is well-controlled before proceeding with the surgery.

The most appropriate goal for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information is for the client to understand the preoperative routines of surgical care before leaving the provider's office. This goal focuses on providing the client with the necessary knowledge and information about the preoperative process, which is essential for their understanding and preparation for surgery. By understanding the preoperative routines, the client will be better equipped to follow the necessary steps and requirements for a successful surgical outcome.

The nurse will plan to measure the client's vital signs every 1 hour because the client has been in the surgical nursing unit for 1.5 hours without experiencing any complications or difficulties. This time interval allows for regular monitoring of the client's vital signs while also allowing the client to rest and recover without unnecessary interruptions.

Discussing the previous teaching with the client and family in the immediate preoperative period is the most effective means of evaluating their understanding. This allows for a direct conversation where any misunderstandings or questions can be addressed in real-time. Providing written material to review after discharge may not ensure that the client and family fully comprehend the information. Reinforcing the material with family during the procedure may be distracting and not allow for a focused discussion. Offering to answer questions just before discharge may not provide enough time for the client and family to fully process the information.

The primary nursing role regarding a client's consent to surgery immediately before surgery is to review the client's surgical consent as a part of the routine preoperative checklist. This ensures that all necessary documentation is in place and that the client has provided informed consent for the procedure. This step is important to ensure patient safety and to prevent any legal or ethical issues. The other options mentioned, such as explaining the procedure to the client, placing the signed consent in the client's medical record, and ensuring that the client understands the possible risks, are also important aspects of the nursing role but not specifically related to immediately before surgery.

Presenting the questions in a simple format would be the most effective way for the nurse to secure the necessary preoperative interview information. The client has dysphasia, which is a difficulty in understanding and expressing language, due to a cerebral vascular accident. By using a simple format, the nurse can ensure that the client understands the questions and can provide accurate information. Questioning the client's daughter may not be as effective, as she may not have all the necessary information or may not accurately convey the client's responses. Reviewing the client's past medical records or relying on the preadmission survey may not provide the specific information needed for the preoperative interview.

The client with a history of sleep apnea is at risk for respiratory complications postoperatively, especially when administered morphine for pain management. Listening to breath sounds is the most appropriate assessment technique to monitor for any changes or abnormalities in the client's respiratory status. This allows the nurse to detect any signs of respiratory distress, such as decreased breath sounds, wheezing, or crackles, which may indicate a complication related to sleep apnea or the administration of morphine. Monitoring pulse oximetry, evaluating spirometer use, and counting respirations per minute are important assessments but may not provide as direct and immediate information about the client's respiratory status as listening to breath sounds.

The correct answer is "Client’s preoperative blood laboratory work results are present on preoperative chart." This answer reflects compliance with the nursing diagnosis of deficient knowledge regarding preoperative requirements because it indicates that the client has followed the requirement to have blood laboratory work done before surgery and that the results are available for review. This demonstrates that the client has received the necessary information and has taken the appropriate steps to meet the preoperative requirements.

The correct answer reflects the greatest insight into the responsibility an ambulatory care nurse has to the client's family because it acknowledges the importance of not only caring for the surgical client but also recognizing the family as clients as well. This shows an understanding of the nurse's role in providing support, communication, and information to the family members during and after the procedure. It demonstrates a holistic approach to care that includes the client's family as an integral part of the healthcare team.

The initial client education-related nursing action by the preadmission nurse is to call the client before the surgery to restate the presurgery routine. This action ensures that the client is aware of the necessary preparations and understands what needs to be done before the surgery. It allows the nurse to provide specific instructions tailored to the client's individual needs and address any concerns or questions they may have. By initiating this communication, the nurse can help alleviate anxiety and ensure that the client is well-prepared for the upcoming procedure.

The correct answer is that the anesthesia provider applies ointment to clients' eyes to prevent corneal damage. This is because during surgery, the client's eyes are often closed and not able to blink, which can lead to dryness and potential damage to the cornea. The ointment helps to keep the eyes lubricated and prevent any complications.

The most therapeutic client outcome for a preoperative client with deficient knowledge regarding preoperative requirements is for the client to present for drawing of preoperative laboratory blood at least 48 hours before scheduled surgery. This outcome ensures that the client understands the importance of preoperative testing and follows the necessary steps to prepare for surgery. It also indicates that the client has gained the necessary knowledge and is taking proactive steps towards meeting the preoperative requirements.

The nurse includes the following as advantages of having a procedure done in a facility's ambulatory surgery department:
- Facilitates faster postsurgical recovery: Ambulatory surgery allows patients to recover at home, which can lead to a quicker recovery compared to staying in the hospital.
- Reduces hospital-oriented expenses: Ambulatory surgery is typically less costly than a hospital stay, resulting in reduced expenses.
- Minimizes risk for acquiring a nosocomial infection: Ambulatory surgery reduces the exposure to hospital-acquired infections since the patient spends less time in the hospital.
- The anesthetic drugs used result in faster "wake-up" time: The anesthetic drugs used in ambulatory surgery allow patients to wake up faster after the procedure.