UNIT 1 CHAPTER 9 PERIOPERATIVE CARE

Question 1

1. 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?
   A. “I will be glad when this is over so I can go home today.”
   B. “I will not be able to eat or drink anything prior to my surgery.”
   C. “I can practice relaxing by listening to my favorite music.”
   D. “I will need to get up and walk as soon as possible.”

Answer 1

A. “I will be glad when this is over so I can go home today.”

The client will be in the hospital for a few days. This is not a day-surgery procedure. The client needs more teaching.

Question 2

3. The nurse must obtain surgical consent forms for the scheduled surgery. Which client would not be able to consent legally to surgery?
   A. The 65-year-old client who cannot read or
   write.
   B. The 30-year-old client who does not
   understand English.
   C. The 16-year-old client who has a fractured
   ankle.
   D. The 80-year-old client who is not oriented to
   the day.

Answer 2

C. The 16-year-old client who has a fractured
ankle.

A 16-year-old client is not legally able to give permission for surgery unless the adolescent has been given an emancipated status by a judge. This information was not given in the stem.

Question 3

4. The nurse is preparing a client for surgery. Which intervention should the nurse implement first?
   A. Check the permit for the spouse’s signature.
   B. Take and document intake and output.
   C. Administer the “on call” sedative.
   D. Complete the preoperative checklist.

Answer 3

D. Complete the preoperative checklist.

Completing the preoperative checklist has the highest priority to ensure all details are completed without omissions.

A client should never be sedated until the permit has been verified and all legal issues are settled. The test taker should not read into a question by inserting facts not in the stem. For example, the test taker may think option “1” could be a correct answer if the client is confused, but the stem does not include this information.

Question 4

6. Which task would be most appropriate for the nurse to delegate to the unlicensed assistive personnel (UAP)?
   A. Complete the preoperative checklist.
   B. Assess the client’s preoperative vital signs.
   C. Teach the client about coughing and deep
   breathing.
   D. Assist the client to remove clothing and
   jewelry.

Answer 4

D. Assist the client to remove clothing and
jewelry.

LEAST INVASIVE

YOU CANNOT DELEGATE WHAT YOU CAN EAT
EVALUATE
ASSESS
TEACH

Question 5

7. 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 most therapeutic response by the nurse?
   A. “Don’t worry about your surgery. It is safe.”
   B. “Tell me why you’re worried about your
   surgery.”
   C. “Tell me about your fears of having this
   surgery.”
   D. “I understand how you feel. Surgery is
   frightening.”

Answer 5

3. “Tell me about your fears of having this
   surgery.”

This statement focuses on the emotion which that the client identified and is therapeutic.

NEVER ASK THE PATIENT WHY

Question 6

8. 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?
   A. Notify the surgeon of the client’s status.
   B. Continue giving enemas until clear.
   C. Increase the client’s IV fluid rate.
   D. Obtain STAT serum electrolytes.

Answer 6

A. Notify the surgeon of the client’s status.

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.

Question 7

9. 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.
   A. Perform passive range-of-motion exercises.
   B. Discuss how to cough and deep breathe
   effectively.
   C. Tell the client he can have a meal in the PACU.
   D. Teach ways to manage postoperative pain.
   E. Discuss events which occur in the
   postanesthesia care unit.

Answer 7

B. Discuss how to cough and deep breathe
effectively.

D. Teach ways to manage postoperative pain.

E. Discuss events which occur in the
postanesthesia care unit.

Question 8

12. Which laboratory result would require immediate intervention by the nurse for the client scheduled for surgery?
    A. Calcium 9.2 mg/dL.
    B. Bleeding time two (2) minutes.
    C. Hemoglobin 15 g/dL.
    D. Potassium 2.4 mEq/L.

Answer 8

D. Potassium 2.4 mEq/L.

This potassium level is low and should be reported to the health-care provider be- cause potassium is important for muscle function, including the cardiac muscle.

Question 9

25. The PACU nurse is receiving the client from the OR. Which intervention should the nurse implement first?
    A. Assess the client’s breath sounds.
    B. Apply oxygen via nasal cannula.
    C. Take the client’s blood pressure.
    D. Monitor the pulse oximeter reading.

Answer 9

A. Assess the client’s breath sounds.

The airway should be assessed first. When caring for a client, the nurse should fol- low the ABCs: airway, breathing, and circulation.

Question 10

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.
2. Absence of the client’s posterior tibial pulse.
3. The client has a respiratory rate of eight (8).
4. The blood pressure is within 20% of the
   client’s baseline.

Answer 10

3. The client has a respiratory rate of eight (8).

If the effects of the spinal anesthesia
move up rather than down the spinal cord, respirations can be depressed and even blocked.

The test taker must know normal rates for vital signs, and a respira- tory rate of eight (8) would be significantly low for any client and indicate a possible complication.

Question 11

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.
2. Start an IV of D5RL with 20 mEq KCl at
   125 mL/hr.
3. Elevate the feet and lower the head.
4. Monitor the vital signs every 15 minutes.

Answer 11

3. Elevate the feet and lower the head.

. By lowering the head of the bed and rais- ing the feet, the blood is shunted to the brain until volume-expanding fluids can be administered, which is the first inter- vention for a client who is hemorrhaging.
TRENSDELENBURG POSITITION

Question 12

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.
2. Paralysis and paresthesia of the right leg.
3. T 99.0 ̊F, P 98, R 20, and BP 100/60.
4. Lungs are clear bilaterally in all lobes.

Answer 12

4. Lungs are clear bilaterally in all lobes.

Lung sounds which are clear bilaterally in all lobes indicate the client has adequate gas exchange, which prevents postopera- tive complications and indicates effective nursing care.

Question 13

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.
2. The 74-year-old client with a repair of the left
   hip who is unable to ambulate.
3. The 24-year-old client who had an
   uncomplicated appendectomy the previous
   day.
4. The 80-year-old client with small bowel
   obstruction and congestive heart failure.

Answer 13

4. The 80-year-old client with small bowel
   obstruction and congestive heart failure.

An older client with a chronic disease would be a complicated case, requiring the care of a more experienced nurse.

Question 14

3. A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best?
   a. Assess the client for anxiety.
   b. Break the information into smaller bits.
   c. Give the client written information.
   d. Review the information again.

Answer 14

ANS: A
Anxiety can interfere with learning, coping, and cooperation. The nurse should assess the client for anxiety. The other actions are appropriate too, and can be included in the teaching plan, but effective teaching cannot occur if the client is highly anxious.

Question 15

4. A preoperative nurse is reviewing morning laboratory values on four clients waiting for surgery. Which result warrants immediate communication with the surgical team?
   a. Creatinine: 1.2 mg/dL (106.1 umol/L)
   b. Hemoglobin: 14.8 mg/dL (148 mmol/L)
   c. Potassium: 2.9 mEq/L (2.9 mmol/L)
   d. Sodium: 134 mEq/L (134 mmol/L)

Answer 15

ANS: C
The potassium level is critically low and can affect cardiac and respiratory status. The nurse would communicate this laboratory value immediately. The creatinine is at the high end of normal, the hemoglobin is normal, and the sodium is only slightly low so these values do not need to be reported immediately.

Question 16

5. An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best?
   a. Answer the questions and document that teaching was done.
   b. Do not have the client sign the consent and call the primary health care provider.
   c. Have the client sign the consent, and then call the primary health care provider.
   d. Remind the client of what teaching the primary health care provider has done.

Answer 16

ANS: B
In order to give informed consent, the client needs sufficient information. Questions about potential complications should be answered by the primary health care provider. The nurse can repeat some facts taught by the primary health care provider, but this topic is too broad for the nurse to address alone. The nurse should notify the primary health care provider to come back and answer the client9s questions before the client signs the consent form. The other actions are not appropriate.

Question 17

What is the PACU’s Nurse Greatest concern in post op patient?
A. respiratory function
B. Speaking function
C. Eating
D. drinking

Answer 17

A. respiratory function

Question 18

What is 3 Stages of Perioperative/Surgical Care?

Answer 18

Preoperative- Before Surgery
Intraoperative- During Surgery
Postoperative- After Surgery

All three are known as Perioperative Experience

Question 19

What is the MOST important thing for the Nurse to witness before her patient goes into surgery?

Answer 19

CONSENT

The nurse must verify that the consent form is signed, dated, and timed, and he or she may serve as a witness to the signature, not to the adequacy of the patient’s

Question 20

A patient who has a planned surgery 24HRS from now has questions about the procedure? What is the priority action of the nurse?
A. Immediately explain the procedure and complications to the patient
B. Refer the patient to the designated surgeon/Physician to explain the procedure
C. describe the in and outs of the surgery because you will not be expelling out of your scope
D. Tell the patient to search on Web MD

Answer 20

B. Refer the patient to the designated surgeon/Physician to explain the procedure

FROM THE BOOK

It is the surgeon’s responsibility to provide a complete explanation of the planned surgical procedure and to have the consent form signed before sedation is given and before surgery is performed.

The perioperative nurse is not responsible for providing detailed information about the surgical procedure. The nurse’s role is to clarify facts that have been presented by the surgeon and dispel myths that the patient, family, or caregiver may have about the surgical experience. T

Question 21

What is the Preoperatove Nurse responsible for doing before the patient begins the surgery?

Answer 21

1. PREOPERATIVE CHECKLIST
2. GETTING LABS CBC(HEMOGLOBIN AND HEMATOCRIT), COAGULATION, BMP, URINE SPECIFIC GRAVITY
3. GET AND ANALAYZE PATIENT HEALTH HISTORY
4. ASSESS THE PATIENTS (VITAL SIGNS , HEAD TO TOE ASSESSMENT)
   5.DISCHARGE PLANNING -Discharge planning is started before surgery. Assess the patient’s home environment, self-care capabilities, and support systems, and anticipate postoperative needs before surgery. All patients, regardless of how minor the procedure or how often they have had surgery, should have discharge planning.
5. TEACHING OF USE OF INCENTIVE SPIROMETER
6. ALLERGY BAND IN PLACE
7. DENTURES ARE NOT GOING TO SURGERY
8. Consent

Question 22

When is site marking done?
A. During Surgery Intraoperatively
B. After Surgery Postoperatively
C. Before Surgery Preoperatively
D. Never

Answer 22

C. Before Surgery Preoperatively

The surgeon is accountable to mark the surgical site. This is to take place in a se ing prior to the patient being moved to the surgical suite. If this is done in your sett ing (e.g., on a medical-surgical unit before transport to surgery), document this in the electronic health record.

Surgical procedures that are site specific, such as left, right, or bilateral, require identification before surgery. Marking the surgical site is the role and responsibility of the surgeon (with the patient, when the patient is able); all operative team members are accountable to confirm this site marking during the “time-out” process before surgery commences. This marking should take place outside of the surgical suite and before the patient has been given any sedation.

Question 23

What Preps should be on the Preop Checklist?
A. Skin Prep
B. Foot Prep
C. NPO Status
D. Intestinal/Bowel Prep

Answer 23

A. Skin Prep
C. NPO Status
D. Intestinal/Bowel Prep

NPO: Regardless of the type of surgery and anesthesia planned, the patient is restricted to NPO status before surgery. NPO means no eating, drinking (including water), smoking (nicotine stimulates gastric secretions), or intake of oral medication (unless directed by the surgeon).

Skin Prep: The skin is the body’s first line of defense against infection. A break in this barrier increases the risk for infection, especially for older patients. Skin preparation before surgery is the first step to reduce the risk for surgical site infection (SSI). INVOLVES SHOWERS

Intestinal Prep: Bowel or intestinal preparations are performed to prevent injury to the colon and reduce the number of intestinal bacteria. Bowel evacuation is needed for major abdominal, pelvic, perineal, or perianal surgery. The surgeon’s preference and the type of procedure to be performed determine the type of bowel preparation. Recognize that enemas given until clear, or potent laxatives, can be stressful to a patient. Electrolyte imbalance, fluid volume imbalances, vagal stimulation, and postural (orthostatic) hypotension can occur

Question 24

How to use an Incentive Spirometer?

Answer 24

With all types of spirometers, the patient must be able to seal the lips tightly around the mouthpiece, inhale spontaneously, and hold his or her breath for 3 to 5 seconds for effective lung expansion. Goals (e.g., gaining specific volumes) can be set according to the patient’s ability and the type of incentive spirometer. Seeing a ball move up a column or bellows expanding reinforces and motivates the patient to continue performance.

Question 25

Coughing and Splinting

Answer 25

The purposes of coughing are to expel secretions, keep the lungs clear, allow full aeration, and prevent pneumonia and atelectasis. Coughing may be uncomfortable for the patient but when performed correctly should not harm the incision.

Splinting (i.e., holding) the incision area with a folded bath blanket or pillow while coughing provides support, promotes a feeling of security, and reduces pain.

Question 26

Can Splinting reduce abdominal pain?
A. Yes
B. No

Answer 26

A. Yes

Splinting (i.e., holding) the incision area with a folded bath blanket or pillow while coughing provides support, promotes a feeling of security, and reduces pain.

Question 27

How to Properly Splint an Incision with Steps

Answer 27

Splinting of the Surgical Incision
1. Unless coughing is contraindicated, place a pillow, towel, or folded blanket over your surgical incision and hold the item firmly in place.
2. Take three slow, deep breaths to stimulate your cough reflex.
3. Inhale through your nose and exhale through your mouth.
4. On your third deep breath, cough to clear secretions from your lungs
while firmly holding the pillow, towel, or folded blanket against your incision.

Question 28

What should a PACU nurse closely asses in a post op patient?

Answer 28

During the postoperative phase, recognize that all patients remain at risk for pneumonia, shock, cardiac arrest, respiratory arrest, venous thromboembolism (VTE), and GI bleeding. These serious complications can be prevented, or consequences reduced, by using prudent clinical judgment. If any signs or symptoms of these conditions are noted, respond by immediately notifying the surgeon.

Question 29

What is malignant hyperthermia

Answer 29

Ask if there is a history of malignant hyperthermia (MH), an inherited muscle disorder, which is an acute, life-threatening complication of certain drugs used for general anesthesia.

Question 30

Physiological Integrity: Reduction of Risk Potential9.5
The nurse is caring for a client who has been readmi ed to the medical- surgical unit following surgery for a hernia repair completed under general anesthesia. What is the priority nursing assessment?
A. Perform thorough auscultation of the lungs
B. Assess response to pinprick stimulation from feet to mid-chest level
C. Determine level of consciousness and response to environmental
stimuli
D. Compare blood pressure findings from preoperative assessment to
the present
CHAPTER 9

Answer 30

A. Perform thorough auscultation of the lungs

Question 31

Regional Anesthetic - Epidural

Answer 31

Headache can occur post
injection; usually result of
leakage
Hypotension

• Care taken to NOT enter subarachnoid space; can result in anesthesia
  higher in the cord causing severe hypotension, respiratory depression

Question 32

General Anesthesia

Answer 32

PT MAY BE INCUBATED CHECK FOR AIRWAY PATENCY , NO OCCLUSION

State of severe CNS depression,
analgesia, relaxation and reflex
loss.
 Lose ability to maintain ventilatory
function; impaired cardiovascular
function
 Agents used in General anesthesia
are inhaled or administered by IV
 Agents delivered to the brain at a
high partial pressure; enables them
to cross the blood brain barrier
3
General Anesthesia
All OR staff must be vigilant for anesthesia awareness