Prep-U Chapter 17: Preoperative Nursing Management

An example of a curative surgical procedure is
the excision of a tumor.
The nurse concludes that further teaching about diaphragmatic breathing is needed when the client:
Exhales forcefully with a short expiration
A client is scheduled for a surgical procedure. When planning the client’s care, the nurse should consider that which of the following conditions will increase the client’s risk of complications after surgery?
A history of diabetes
When assessing a postoperative client, the nurse is correct to relate which surgical risk factor that would decrease if the surgical client maintained a blood glucose level under 150 mg/dL?
Wound healing
You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility?
Place gauze under and over the ring and apply adhesive tape over it.
When is the ideal time to discuss preoperative teaching
Preadmission visit
A patient with a history of alcoholism and scheduled for an urgent surgery asks the nurse, “Why is everyone so concerned about how much I drink?” What is the best response by the nurse?
“It is important for us to know how much and how often you drink to help prevent surgical complications.”
What is the best response by the nurse when the patient states, “I’m so nervous about my surgery”?
“Would you like to discuss the concerns that you have?”
A client will be undergoing an appendectomy tomorrow morning. The nurse spends significant time explaining to the client what will happen, including before and after the procedure is complete. What is the primary reason the nurse puts so much effort into preoperative teaching?
It increases the likelihood of a successful recovery.
The nurse is caring for the client in the preoperative period and documenting rationale for a palliative surgical procedure. Which rationale is most appropriate?
The client and physician are focusing on symptom relief not a cure.
An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults?
Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.
A gunshot wound would be classified under which category of surgery based on urgency?
Emergent
You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply?
“Many people have diagnostic or short therapeutic surgical procedures.”
Once the operating team has assembled in the room, the circulating nurse calls for a “time out.” What action should the nurse take during the time out?
Review the scheduled procedure, site, and client.
When does the nurse understand the patient is knowledgeable about the impending surgical procedure?
The patient participates willingly in the preoperative preparation.
The nurse expects informed consent to be obtained for insertion of:
A gastrostomy tube
When is the ideal time to discuss preoperative teaching
Preadmission visit
For the patient who is taking aspirin, it is important to stop taking this medication at least how many day(s) prior to surgery?
7
A 57-year-old client is undergoing preoperative assessment before surgical repair of a fractured ulna. During admission paperwork, the client reveals that she enjoyed a hearty breakfast this morning to be ready for her procedure. What is the nurse’s next action?
Notify the surgeon.
Patients who have received corticosteroids preoperatively are at risk for which type of insufficiency?
Adrenal
Informed consent from the surgical client is essential in all of the following categories of surgery except:
Emergent surgery
A physically fit 86-year-old is scheduled for right knee replacement. What factor in this client makes them at increased risk for surgery?
Age
A fractured skull would be classified under which category of surgery based on urgency?
Emergent
A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?
Use diaphragmatic breathing.
The nurse concludes that teaching about pain management was effective when the client states:
“I will support my incision with my hands when I do my coughing and deep breathing exercises.”
When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as
Emergency
A parent of a 16-year-old patient asks the nurse, “How could the surgeon operate without my consent?” What is the best response given by the nurse?
“Your child had life-threatening injuries that required immediate surgery.”
At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period?
During the preoperative period
A nurse is witnessing a patient sign the consent form for surgery. After the patient signs the consent form, the patient starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?
Request that the surgeon come and answer the questions.
When a person with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the patient may show signs of alcohol withdrawal delirium during which time period?
Up to 72 hours after alcohol withdrawal
The nurse is aware that the amino acid, arginine,
Stimulates T-cell response
The nurse is evaluating the client’s understanding of diet teaching aimed at promoting wound healing following surgery. The nurse would conclude teaching was ineffective if the client selects which of the following?
Cheeseburger, french fries, coleslaw, and ice cream
A patient is scheduled for elective surgery. To prevent the complication of hypotension and cardiovascular collapse, the nurse should report the use of what medication?
Prednisone (Deltasone)
The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is:
To notify the surgeon
A patient refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?
Allow the ring to stay on the patient and cover it with tape.
The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed?
“The nurse will explain the details of the surgery before I sign a consent.”
The nurse would identify which of the following vitamin deficiencies to prevent the complication of hemorrhaging during surgery?
Vitamin K
Following diagnostic testing, a patient requires a cholecystectomy. This surgical procedure would be categorized as which of the following?
Urgent
In which instance may a surgeon operate without informed consent?
Emergency situations
The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which of the following values would be of greatest concern to the nurse?
Potassium 6.2 mEq/L
The patient asks the nurse why food is withheld before surgery. What is the best response by the nurse?
“Aspiration is a concern and can be a complication if food or fluid is taken close to the surgery time.”
In preparing the client for transfer to the operating room, which of the following actions by the nurse is inappropriate?
Allow the client to wear dentures.
The nurse is assisting the client with imagery as a relaxation strategy. Which statement by the client describes imagery?
“I am lying on the beach in Florida.”
A patient is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications?
Splint the incision site using a pillow during deep breathing and coughing exercises.
The hazards of surgery for the aged increase as the number and severity of coexisting health problems increase. Which of the following are structural or functional changes in the elderly that impact the surgical experience? Select all that apply.
• b. Increased fatty tissue prolongs elimination of anesthesia.
• c. Decreased ability to compensate for hypoxia increases the risk of an embolism.
• e. Loss of collagen increases the risk of skin complications.
• f. Reduced tactile sensitivity can lead to assessment and communication problems.
The nurse is teaching leg exercises to the client preoperatively. The client asks why the exercises are important. The best response by the nurse is:
“Leg exercises help prevent blood clots in your legs.”
A patient with uncontrolled diabetes is scheduled for a surgical procedure. What chief life-threatening hazard should the nurse monitor for?
Hypoglycemia
When the patient is encouraged to concentrate on a pleasant experience or restful scene, the cognitive coping strategy being employed by the nurse is
imagery
A 17-year-old male client is having same-day surgery to remove a neuroma from his foot. Which of the following nursing interventions would occur during the intra operative phase of peri operative care?
The nurse continuously monitors the sedated client.
A client will be undergoing an appendectomy tomorrow morning. The nurse spends significant time explaining to the client what will happen, including before and after the procedure is complete. What is the primary reason the nurse puts so much effort into preoperative teaching?
It increases the likelihood of a successful recovery.
A fractured skull would be classified under which category of surgery based on urgency?
Emergent
The nurse expects informed consent to be obtained for insertion of:
A gastrostomy tube
An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults?
You selected: Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.

For the patient who is taking aspirin, it is important to stop taking this medication at least how many day(s) prior to surgery?
You selected: 7

A client taking chlorpromazine (Thorazine) is preparing to undergo surgery. Which of the following complications does the surgical team need to prepare to deal with before anesthetics are administered?
You selected: Hypotension

An anxious preoperative surgical patient is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used?
You selected: Imagery

What action by the nurse best encompasses the preoperative phase?
Correct response: Educating the patients on signs and symptoms of infection

Completing your preoperative assessment, you mentally rehearse your client’s needs to determine if there is increased risk for complications intra operatively or postoperatively. Which of the following are general risk factors? Select all that apply.
You selected: • Nutritional status
• Age
• Physical condition
• Health status

The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities?
You selected: The client takes a deep abdominal breath and then “huff” or “hack” coughs three or four times.

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as
You selected: emergency.

A nurse is witnessing a patient sign the consent form for surgery. After the patient signs the consent form, the patient starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?
You selected: Request that the surgeon come and answer the questions.

Which nursing assessment finding indicates the preoperative client has not met expected outcomes?
You selected: Sobs uncontrollably about pending amputation of foot.

A surgical patient has been transferred to the holding area. What nursing intervention(s) promote safe and effective nursing care? Select all that apply.
• Identify the patient using two identifiers.
• Verify the surgical site and mark it appropriately.
• Review the medical records.

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply.
• The client will leave the hospital sooner than in the past.
• Need for teaching is increased.
• The client must be prepared to take on more self-care than he or she may have done in the past.

The nurse discovers that the client did not sign the operative consent before receiving the preoperative medication. The appropriate nursing action is:
You selected: To notify the surgeon

The physician schedules an elective surgical procedure for a patient who smokes cigarettes. When should the nurse recommend that the patient cease smoking before the surgical procedure to minimize risks associate with cigarette smoking?
You selected: 1 to 2 months

The nurse recognizes that written informed consent is required for insertion of a(n):
Peripherally-inserted central catheter.
Which of the following nursing activities would not be part of the preoperative phase of care? Select all that apply
• Ensuring that the sponge, needle, and instrument counts are correct
• Administering medications, fluid, and blood component therapy, if prescribed
A patient having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the patient stop taking the aspirin before the surgery?
7 to 10 days
The potential effects of prior medication therapy must be evaluated before surgery. Which of the following drug classifications may cause respiratory depression from an associated electrolyte imbalance during anesthesia?
Diuretics
What is the best response by the nurse when the patient states, “I’m so nervous about my surgery”?
“Would you like to discuss the concerns that you have?”

A patient is scheduled to have a cholecystectomy. Which of the nurse’s finding is least likely to contribute to surgical complications?
Osteoporosis

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for? A safe environment

What is the blood glucose level goal for a diabetic patient who will be having a surgical procedure?
80 to 110 mg/dL

Informed consent from the surgical client is essential in all of the following categories of surgery except: Emergent surgery

A 17-year-old male client is having same-day surgery to remove a neuroma from his foot. Which of the following nursing interventions would occur during the intra operative phase of peri operative care?
The nurse continuously monitors the sedated client.

A patient refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?
You selected: Allow the ring to stay on the patient and cover it with tape.

Which nursing statement would best decrease a client’s anxiety before an emergency operative procedure?
You selected: “Let me explain to you w8hat will happen next.”

A patient is scheduled for elective surgery. To prevent the complication of hypotension and cardiovascular collapse, the nurse should report the use of what medication?
Prednisone (Deltasone)

Sudden withdrawal of which of the following may result in seizures?
Tranquilizers

The nurse recognizes that the client most at risk for mortality associated with surgery is the:
Client with chronic alcoholism

The nurse concludes that teaching about pain management was effective when the client states:
You selected: “I will support my incision with my hands when I do my coughing and deep breathing exercises.”

A client is scheduled for a surgical procedure. When planning the client’s care, the nurse should consider that which of the following conditions will increase the client’s risk of complications after surgery?
You selected: A history of diabetes

A client is being prepared for a same-day surgical procedure and is discussing with the nurse what potential ramifications this type of surgery has. Which of the following would the nurse correctly identify? Select all that apply.
You selected:
• The client will leave the hospital sooner than in the past.
• The client must be prepared to take on more self-care than he or she may have done in the past.
• Need for teaching is increased.

The nurse is aware that a religious group that refuses blood transfusions for religious reasons is:
You selected: Jehovah’s Witnesses

A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign?
You selected: An open reduction of a fracture

The nurse recognizes that written informed consent is required for insertion of a(n):
You selected: Peripherally-inserted central catheter.

The nurse would identify which of the following vitamin deficiencies to prevent the complication of hemorrhaging during surgery?
You selected: Vitamin K

You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client’s anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear?
Anxious clients have a poor response to surgery and are prone to complications.

The nurse recognizes that which of the following clients is at least risk for perioperative complications?
You selected: A 65-year-old Caucasian man who has a history of arthritis

The on-call perioperative team is called for an urgent surgery to be performed as soon as they arrive. What surgical procedure is considered emergent?
You selected: A repair of multiple stab wounds

What action by the nurse best encompasses the preoperative phase?
You selected: Educating the patients on signs and symptoms of infection

A nurse knows that she must obtain a signed informed consent for which of the following procedures? Select all that apply.
• Arteriography
• Open reduction of a fracture
• Cystoscopy
• Paracentesis

When assessing a postoperative client, the nurse is correct to relate which surgical risk factor that would decrease if the surgical client maintained a blood glucose level under 150 mg/dL?
You selected: Wound healing

The patient asks the nurse why food is withheld before surgery. What is the best response by the nurse?
You selected: “Aspiration is a concern and can be a complication if food or fluid is taken close to the surgery time.”

When a patient recites, “I know all will go well,” what is the cognitive coping strategy he or she is using?
You selected: Optimistic self-recitation

Once the operating team has assembled in the room, the circulating nurse calls for a “time out.” What action should the nurse take during the time out?
You selected: Review the scheduled procedure, site, and client.

During the admission history the client reports to the nurse of taking the usual dose of warfarin (Coumadin) the previous day. The appropriate nursing action is:
You selected: Notify the surgeon that the client took warfarin the day before surgery.

You are physically preparing a client for surgery and instruct the person to remove any jewelry. The client refuses to remove a wedding band. What should you do in this situation with approval from your facility?
Place gauze under and over the ring and apply adhesive tape over it.

Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client’s concern? Surgeon