fundamentals

Question 1

Preoperative care:

Answer 1

Teach clients to stop taking anticoagulants, NSAIDs, and herbal supplements, including
ginkgo and St. John’s wort, before surgery to decrease bleeding risk. Screen for malignant hyperthermia
by asking the client about a personal or family history of adverse reactions to anesthesia.

Question 2

Anesthesia
history

Answer 2

Ask about client and family history of adverse
reactions to anesthesia, including malignant
hyperthermia (Life-threatening genetic
condition causing hypermetabolism 
Muscle rigidity and dangerously high fever).

Question 3

Personal
belongings &
implants

Answer 3

Remove contact lenses, glasses, and
dentures.
Remove jewelry to prevent burns.
Notify team of any implanted medical
devices (pacemakers, artificial joints), hearing
aids or cochlear implants (may interfere with
electrosurgical equipment), and any loose
teeth or dental crowns

Question 4

Cultural

Answer 4

Identify cultural practices that could affect
the client’s care.
Jehovah’s Witnesses do not accept
certain types of transfusions (whole blood).

Question 5

INCENTIVE SPIROMETER USE

Answer 5

1. Seal lips around mouthpiece.
2. Inhale slowly and deeply; hold breath.
3. Remove mouthpiece and exhale normally.
4. Repeat 10 times/hr.

Question 6

Time out:

Answer 6

The surgical site must be marked to prevent wrong-site surgery. A final “time-out” should be
conducted just before surgery to confirm the correct client, procedure, and surgical site with the
surgical team.

Question 7

Paralytic ileus

Answer 7

Absent bowel sounds
Inability to pass
gas or have a bowel
movement
Abdominal distension

Encourage ambulation.
Insert an NG tube for
gastric compression

Question 8

Atelectasis.

Answer 8

Fine crackles

Encourage deep
breathing and incentive
spirometer use

Question 9

Infection

Answer 9

Fever
Redness, warmth,
swelling, or purulent
drainage at the
incision site

Obtain cultures as
ordered.
Administer antibiotics.

Question 10

Bleeding at incision
site

Answer 10

Apply pressure to the
site.
Administer IV fluids and
blood products.

Question 11

Surgical site infection:

Answer 11

If hair removal is necessary
preoperatively, use electric clippers instead of
razors to avoid micro-cuts and contamination.
Postoperatively, monitor the surgical site for
infection and notify HCP of redness, warmth,
and swelling.

Question 12

Postoperative care:

Answer 12

Support oxygenation by
administering oxygen to keep oxygen saturation
>90% and encouraging incentive spirometer use.
Prevent atelectasis, paralytic ileus, and DVT by
encouraging early ambulation. Regularly assess for
hypotension and tachycardia, indicating bleeding
or shock.

Question 13

Wound dehiscence and evisceration:

Answer 13

If wound
edges of an abdominal incision separate
(dehiscence) or organs protrude through the
incision (evisceration), immediately cover the
area with sterile saline-soaked gauze, bend the
client’s knees, and notify the HCP.