Chapter 20Preoperative Nursing Management My Nursing Test Banks

Chapter 20Preoperative Nursing Management

MULTIPLE CHOICE

1.The nurse is identifying diagnoses appropriate for a client scheduled for a surgical procedure. Which of the following is a diagnosis commonly used for preoperative client?

1.

Anxiety

2.

Sleep deprivation

3.

Excess fluid volume

4.

Disturbed body image

ANS: 1

The preoperative experience may be one of the most tension-producing periods of hospitalization. The nursing diagnosis anxiety is commonly used for preoperative clients. The other diagnoses are not commonly used as preoperative diagnoses.

PTS:1DIF:Apply

REF:Nursing Diagnoses Used During Preoperative Assessment

2.The preoperative nurse cares for the client until the client progresses into the intraoperative phase of care which begins when the client:

1.

signs the surgical consent form.

2.

arrives at the surgical suite doors.

3.

is transferred to the postanesthesia care unit.

4.

accepts that surgery is pending.

ANS: 2

The preoperative period ends and the intraoperative period begins when the patient and family are at the door to the surgical suites. Intraoperative care does not begin when the client signs the surgical consent form, is transferred to the postanesthesia care unit, or accepts that surgery is pending.

PTS: 1 DIF: Analyze REF: Introduction

3.The nurse is ensuring that a client is able to make knowledgeable decisions regarding an upcoming surgery and can provide informed consent. What is the responsibility of the nurse regarding informed consent?

1.

Explain the surgical options

2.

Explain the operative risks

3.

Describe the operative procedure to be done

4.

Witness a patients signature

ANS: 4

The nurse may concurrently sign that he has witnessed a patients signature. It is the physicians responsibility to explain the other answer choices.

PTS: 1 DIF: Apply REF: Decision Strategies and Informed Consent

4.A client being prepared for surgery has a pulse oximeter placed on one digit of his hand. The nurse is applying this device to monitor the clients:

1.

oxygen level.

2.

heart rate.

3.

blood pressure.

4.

urine output.

ANS: 1

Pulse oximeters are used to precisely identify the clients peripheral tissue oxygenation. Pulse oximeters are not to measure heart rate, blood pressure, or urine output.

PTS: 1 DIF: Analyze REF: Trends

5.A client is scheduled for surgery in 2 weeks. Which of the following should the nurse instruct the client regarding healthy lifestyle behaviors?

1.

Eat nutritious meals.

2.

If obese, cut calories before the surgery.

3.

If sedentary, exercise more before the surgery.

4.

Stop all prescribed medications.

ANS: 1

The client should be encouraged to adopt healthy dietary, rest, and exercise habits before the surgery. A client who has not followed healthy lifestyle habits should not suddenly make these changes before a surgical procedure. The nurse should encourage the client to eat nutritious meals. A client who is obese should not be encouraged to cut calories before the surgery. The client who is sedentary should not be encouraged to suddenly exercise before the surgery. The client should not be instructed to stop prescribed medications unless a physician has prescribed this action.

PTS: 1 DIF: Apply REF: Time Frames and Tasks

6.The nurse wants to reduce the stress level for a preoperative client. Which of the following communication techniques can the nurse use to achieve this result?

1.

Allow the client to be alone before the surgery.

2.

Observe and ask the client if there is anything that can be done to help reduce her anxiety.

3.

Refer to the client by her first name.

4.

Make tasteful jokes or comments to help the client laugh.

ANS: 2

Strategies to reduce preoperative stress include observing and asking the client if there is anything that can be done to help reduce her anxiety. Leaving the client alone before the surgery will not help reduce stress. Referring to the client by her first name might be considered unprofessional and should not be done. Making jokes is also not a professional behavior and should not be done by the nurse.

PTS: 1 DIF: Apply REF: Nurse/Patient Communication

7.Which of the following can the nurse do to help an elderly client scheduled for a surgical procedure?

1.

Work at a slower pace.

2.

Speed up the pace so the client has time to rest.

3.

Talk to family members and leave the client alone.

4.

Send them to the surgical holding area in advance.

ANS: 1

When caring for elderly clients, pace is important. Nurses should slow the pace. The nurse should not ignore the client. The nurse should also not send the client to the surgical holding area in advance since this could prove to be uncomfortable for the elderly client.

PTS:1DIF:ApplyREF:Age-Related Issues

8.The nurse is concerned that a client scheduled for surgery will be at risk for hypothermia. Which of the following did the nurse assess in this client to determine the risk?

1.

Client is a vegetarian.

2.

Client exercises 5 days a week for 30 minutes.

3.

Client has a history of congestive heart failure.

4.

Clint is 48 years old.

ANS: 3

Clients at risk for hypothermia include the very young, the very old, those with a history of heart disease, those with a bleeding tendency, having complex surgery, and having surgery on a large body area that will be exposed. Being a vegetarian or exercising does not predispose a client to developing hypothermia during surgery.

PTS:1DIF:AnalyzeREF:Environmental Safety

9.The nurse is concerned that a client may have an undocumented allergy to latex when which of the following is assessed?

1.

Recent episode of appendicitis

2.

Recovered from bronchitis 3 months ago

3.

Allergy to specific foods

4.

Does not like to wear wool clothing

ANS: 3

Risk factors for latex allergy include a history of allergies, for example, food allergies or contact dermatitis (eczema). Appendicitis and bronchitis do not increase the clients risk of a latex allergy. The clients not wearing wool clothing does not increase the clients risk of a latex allergy.

PTS: 1 DIF: Analyze REF: Personal Patient Safety

10.The nurse is providing a medication to reduce the preoperative clients anxiety. Which of the following medications is the nurse most likely providing to the client?

1.

Hydrogen ion antagonist

2.

Anticholinergic

3.

Calcium channel blocker

4.

Opioid

ANS: 4

Opioids provide analgesia, decrease anxiety, and provide sedation. Calcium channel blockers treat specific heart problems. Hydrogen ion antagonists are used to reduce gastric secretions. Anticholinergics are used to reduce oral and respiratory tract secretions.

PTS:1DIF:ApplyREFharmacology

11.An elderly client scheduled for surgery is concerned that his wife is not going to be able to manage at home alone. Which of the following can the nurse do to help this client and spouse?

1.

Encourage the client to not worry about his spouse.

2.

Ask the client if the spouse would agree to having some help while he is hospitalized.

3.

Encourage the spouse to come and stay with the client in the hospital.

4.

Suggest the spouse stay in a hotel until the client is discharged.

ANS: 2

When the frail elderly and spouse live together, they depend on each other for daily existence. When one is hospitalized, it places both at risk. The nurse should ask the client if the spouse would agree to having some help while the client is hospitalized. Encouraging the client not to worry does not take into consideration the risk to the spouse. Having the spouse stay with the client in the hospital could cause additional health problems for both the client and spouse. The clients finances might not support the spouse staying in a hotel until the client is discharged.

PTS:1DIF:Apply

REF: Population Based Care; Box 20-5 Couples at Risk: The Frail Elderly

12.A client needs emergency surgery after sustaining injuries from a natural gas explosion. The client is not attended by any family member and the surgery cannot wait. Which of the following can be done to ensure the best and safest care is provided to the client?

1.

Hold the surgery until a family member arrives to the hospital to provide consent.

2.

Contact a pastor to pray with the client before the surgery.

3.

Instruct the client in postoperative exercises while waiting for anesthesia to take effect.

4.

Have a member of the nursing staff try to reach the family at home to provide consent for the surgery.

ANS: 4

In the case of an unaccompanied trauma client, the team should make every effort to reach the family; however, preservation of life and function is a priority. A member of the nursing staff can attempt to reach the family for consent, but the surgery should not be delayed until a family member arrives to provide consent. Since the surgery takes precedence, the clients instruction, psychosocial, and spiritual needs will need to be addressed afterwards.

PTS: 1 DIF: Apply REF: Urgent and Emergent Care

13.A client who smokes one pack of cigarettes per day tells the nurse that she will need to be taken outside to have a cigarette while recovering from surgery. Which of the following can the nurse respond to this client?

1.

That can be arranged.

2.

You really should stop smoking before the surgery.

3.

Your physician will prescribe medication to help reduce the nicotine cravings.

4.

I can assign someone who will be responsible for transporting you to the smoking section.

ANS: 3

The client who smokes will have concerns about nicotine withdrawal. The nurse should respond that medications are available and can be prescribed to help the client through this difficult time. The nurse should not support the clients smoking by saying that being taken out of doors can be arranged or that someone will be assigned to transport the client to the smoking section. The response you really should stop smoking before the surgery does not address the clients concern.

PTS: 1 DIF: Apply REF: Population-Based Care

MULTIPLE RESPONSE

1.A client tells the nurse that he has been told that he needs surgery but does not know who to select as his surgeon. Which of the following should the nurse instruct the client regarding important attributes to consider when choosing a surgeon? (Select all that apply.)

1.

Board certification

2.

Graduation from a reputable school

3.

Personality or bedside manner

4.

Location of office

5.

Word of mouth from trusted others

6.

The car he or she drives

ANS: 1, 2, 3, 5

When choosing a surgeon, a client should consider board certification, graduation from a reputable school of medicine, personality and bedside manner, and the opinion of others through word of mouth. Where the office is located and the car the physician drives are not signs of the surgeons talent.

PTS: 1 DIF: Apply REF: Box 20-1 Choosing a Surgeon

2.A client tells the nurse that the surgeon has provided the client with a choice of several hospitals in which to have a surgical procedure performed, but the client does not know which one to choose. Which of the following can the nurse instruct the client to consider when choosing a hospital or surgical center? (Select all that apply.)

1.

Does the facility have a national reputation?

2.

Is there an ICU in the hospital?

3.

Is it close to family?

4.

Will insurance pay for the stay?

5.

Does the hospital have magnet status?

6.

Does it have good food?

ANS: 1, 2, 4, 5

The client should consider the facilitys reputation, the presence of an intensive care unit, if the facility accepts the clients health insurance coverage, and if the facility has magnet status. Proximity to family and the food served are not good reasons to choose a place to have surgery.

PTS: 1 DIF: Apply REF: Box 20-2 Choosing a Hospital or Surgical Center

3.A client scheduled for surgery is instructed on the use of a patient-controlled analgesic device that she will use after the procedure. What are the advantages this device for pain control? (Select all that apply.)

1.

The client controls the timing of medication delivery.

2.

The client does not have to wait for a nurse to provide pain medication.

3.

The nurse does not have to check on the client as frequently.

4.

The physician does not need to prescribe various pain medication after the surgery.

5.

The medication is delivered intravenously.

6.

Pain control improves client comfort after surgery.

ANS: 1, 2, 5, 6

Advantages to the use of a patient-controlled analgesic device for a client include client paces the timing of medication delivery, client has control and immediate relief from medications, medications are delivered instantly, medications are delivered intravenously, client has improved comfort. The nurse not needing to check on the client as frequently is not an advantage for this type of analgesic device. The physician not needing to prescribe various pain medications is not an advantage for this type of device.

PTS: 1 DIF: Analyze REF: Trends

4.A client is scheduled for a same-day surgical procedure in which he will be discharged afterwards, and he tells the nurse that he does not know what to bring to the hospital. Which of the following should the nurse instruct the client? (Select all that apply.)

1.

Bring identification, but send it home after it is used.

2.

Bring personal sleepwear to put on after the surgery.

3.

Bring work-related items.

4.

Leave important jewelry at home.

5.

Make a list of all medications and bring the list to the hospital.

6.

Books and puzzles to be entertained while waiting for the surgery.

ANS: 1, 4, 5

On the day of the surgery, the nurse should instruct the client to bring identification, but to send it home after it is used; and a list of medications. Important jewelry should be left at home to reduce the risk of its being lost. Personal sleepwear is most likely not going to be used since the client will be wearing a hospital gown. Work-related items are not recreational and could be anxiety producing.  Books and puzzles would be appropriate if the client is expecting to be admitted, but they are not necessary for a same-day surgical procedure and discharge.

PTS:1DIF:Apply

REFatient Playbook: What to Bring to the Hospital or Surgicenter

5.The preoperative nurse has a variety of activities to complete when preparing a client for surgery. Which of the following are activities of this nurse? (Select all that apply.)

1.

Awareness of safety considerations

2.

Assessment of vital signs during the surgery

3.

Physical assessment of the client

4.

Assessment of the environment

5.

Postoperative care in the recovery room

6.

Awareness of best practices

ANS: 1, 3, 4, 6

The nurses role in preparing a client for surgery includes the following activities: awareness of safety considerations, physical assessment of the client, assessment of the environment, and awareness of best practices. The preoperative nurse will not assess vital signs during the surgery nor provide postoperative care in the recovery room.

PTS: 1 DIF: Analyze REF: Planning and Implementation

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