Question 1

The nurse is preparing a client the morning of surgery and the client refuses to remove a wedding ring, saying, "I have never taken it off since the day I was married." Which of the following actions should the nurse implement?

Accepted Answer

The ring can be taped to the client's finger and noted on the preoperative checklist. There is no need for a release form or to discuss liability with the client. Wearing the ring is obviously important to the client, so the nurse should tape the ring in place rather than have a family member keep the ring for the client.

Question 2

The nurse is preparing a client for abdominal surgery who takes a diuretic and a ?-blocker pill to control blood pressure. Which of the following client information is most important for the nurse to communicate to the health care provider before surgery?

Accepted Answer

The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of client anxiety. The heart rate would be expected in a client taking a ?-blocker. The hematocrit is in the low normal range but does not require any intervention before surgery.

Question 3

The nurse is completing a preoperative assessment of a client scheduled for a colon resection and the client tells the nurse about using St. John's wort to prevent depression. Which of the following information should the nurse alert the staff in the postanaesthesia recovery area about?

Accepted Answer

St. John's wort may prolong the effects of anaesthetic agents and increase the time to waken completely after surgery. It is not associated with increased bleeding risk, hypertension, or increased pain.

Question 4

Which of the following topics is most important for the nurse to discuss preoperatively with a client who is scheduled for a colon resection?

Accepted Answer

Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on clients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the client will be more likely to retain this information. The client does not usually need information about medications that are used intraoperatively.

Question 5

The nurse is admitting a female client for an outpatient surgery procedure. Which of the following information is most important to report to the anaesthesiologist before surgery?

Accepted Answer

This statement suggests that the client may be pregnant, and pregnancy testing is needed before administration of anaesthetic agents. Although the other data also may be communicated with the surgeon and anaesthesiologist, they will affect postoperative care and do not indicate a need for further assessment before surgery.

Question 6

According to the ASA Physical Status Classification System, which of the following assessments is consistent with a rating of ASA III?

Accepted Answer

A client assessed as a rating of III on the ASA Physical Status Classification System has a history of chronic asthma controlled with ?-adrenergic agonist inhaler and inhaled corticosteroids and is not wheezing. Poorly controlled asthma and wheezing is a rating of
IV. No significant health problems, past or present, is a rating of I. A client in status asthmaticus, intubated and on a ventilator, receiving corticosteroids intravenously, is rated as a V.

Question 7

The nurse is caring for a client with diabetes who is scheduled for a mastectomy at 1:00 PM today and it is now 8:30 AM. The client uses insulin to control blood glucose and has been NPO since midnight. Which of the following actions should the nurse take?

Accepted Answer

Preoperative insulin administration is individualized to the client, and the current blood glucose will provide the most reliable information about insulin needs. It is not possible to predict whether the client will require no insulin, a lower dose, or a higher dose without blood glucose monitoring.

Question 8

Ten minutes after the nurse administered the ordered preoperative opioid byintravenous (IV) injection, the client asks to get up to go to the bathroom to urinate. Which of the following actions is best for the nurse to implement?

Accepted Answer

The client will be at risk for a fall after receiving the opioid, so the best nursing action is to have the client use a bedpan or urinal. Having the client get up either with assistance or independently increases the risk for a fall. The client will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room.

Question 9

The nurse is preparing a client for surgery. Which of the following information about medication use is most important for the nurse to communicate to the health care provider?

Accepted Answer

Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome.

Question 10

Before the administration of preoperative medications, the nurse is preparing to witness the client signing the operative consent form when the client says, "I do not really understand what the doctor said." Which of the following actions is best for thenurseto take?

Accepted Answer

The surgeon is responsible for explaining the surgery to the client, and the nurse should wait until the surgeon has clarified the surgery before having the client sign the consent form. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurse's legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the client signs the consent form.

Question 11

Aclient who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwifruit, and latex products. Which of the following actions is most important for the nurse to take?

Accepted Answer

When a client is allergic to latex, special nonlatex materials are used during surgical procedures and the staff will need to know about the allergy in advance to obtain appropriate nonlatex materials and have them available on the surgical date. The other actions also may be appropriate, but prevention of allergic reaction (either contact dermatitis or anaphylaxis) during surgery is the most important action.

Question 12

On the day of surgery, the nurse is admitting a client with a history of cigarette smoking. Which of the following actions is most important at this time?

Accepted Answer

Abnormal breath sounds may indicate the presence of an acute respiratory infection or chronic lung disease that will affect the choice of anaesthesia or proceeding with the scheduled surgery. The other nursing actions also are appropriate but will not affect the immediate surgical procedure as much as the presence of abnormal breath sounds.

Question 13

The nurse is preparing to administer atropine to a client before surgery. Which of the following symptoms should the nurse teach the client to expect?

Accepted Answer

Anticholinergic medications decrease oral and respiratory secretions, so the client is taught that a dry mouth is an expected adverse effect. Weakness, forgetfulness, and dizziness are adverse effects associated with other preoperative medications such as opioids and benzodiazepines.

Question 14

The nurse is providing preoperative teaching to an older-adult client who has poor hearing and vision. The partner answers most questions directed to the client. Which of the following actions should the nurse take when implementing client teaching?

Accepted Answer

The nurse should allow more time when doing preoperative teaching and preparation for older clients with sensory deficits. Because the client has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the client and the wife because both will need to understand preoperative procedures and teaching.

Question 15

Aclient is seen at the health care provider's office several weeks before hip surgery for preoperative assessment. The client reports use of Echinacea, ginseng, glucosamine, and chondroitin. Which of the following actions should the nurse take?

Accepted Answer

The nurse should discuss the medication use with the client's health care provider because ginseng may increase bleeding, heart rate, and blood pressure. The nurse should not advise the client to stop the supplements or to continue them without consulting with the health care provider. Determining the interactions between the supplements and anaesthetics is not within the nurse's scope of practice.

Question 16

The nurse is obtaining the health history for a client who is scheduled for outpatient knee surgery. Which of the following statements by the client is most important for the nurse to report to the health care provider?

Accepted Answer

A client with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may affect whether the client should have surgery, but a history of pneumonia is not a reason to postpone surgery. The client's knee pain is the likely reason for the surgery. A family history of breast cancer does not have any implications for the current surgery.

Question 17

The clinic nurse is reviewing the complete blood cell count (CBC) results for a client who is scheduled for surgery in a few days. The results are white blood cell count (WBC)
10)2*10^9/L; hemoglobin 150 g/L; hematocrit 45%; platelets 150*10^9/L. Which of the
Following actions should the nurse take?

Accepted Answer

The nurse should be sure that the CBC results, which are normal, are available at the surgical facility to avoid delay of the procedure. With normal results, there is no need to notify the surgeon or anaesthesiologist, discuss blood transfusion, or ask about recent infection.

Question 18

The nurse is interviewing a client who is to have outpatient surgery using a general anaesthetic. Which of the following information is most important to communicate to the surgeon and anaesthesiologist before surgery?

Accepted Answer

The information about the client's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most clients. Clients are instructed to discontinue Aspirin 1-2 weeks before surgery. The client should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.

Question 19

Aclient arrives at the ambulatory surgery centre for a scheduled outpatient surgery. Which of the following information is of most concern to the nurse?

Accepted Answer

After outpatient surgery, the client should not drive home and will need assistance with transportation and home care. The client's experience with outpatient surgery is assessed, but it does not have as much application to the client's physiological safety. The client's insurance coverage is important to establish, but this is not usually the nurse's role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually increase risk for aspiration as the guideline indicates that clear fluids can be taken up to two hours before surgery.

Question 20

The nurse is conducting a preoperative interview with a client who is scheduled for an elective hysterectomy and the client tells the nurse, "I am afraid that I will die in surgery like my mother did!" Which of the following responses by the nurse is most appropriate?

Accepted Answer

The client's statement may indicate an unusually high anxiety level or a family history of problems such as malignant hyperthermia, which will require precautions during surgery. The other statements also may address the client's concerns, but further assessment is needed first.

Quiz 20: Nursing Management Preoperative Care