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Chapter 16: Care of Preoperative Patients

Test Bank
MULTIPLE CHOICE
1. A client voluntarily signed the operative consent form. What is the nurse’s next action?
a. Teach the client about the surgery.
b. Have family members witness the signature.
c. Sign under the client’s name as a witness.
d. Call for the physician to sign the form.
ANS: C

The nurse’s signature as a witness indicates that the consent form was signed by the client
voluntarily. None of the other steps are necessary.
DIF: Cognitive Level: Application/Applying or higher
REF: N/A
TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Informed
Consent)
MSC: Integrated Process: Communication and Documentation
2. The nurse is caring for an older adult client with a history of chronic lung disease who will be

undergoing surgery the following day. When postoperative care is planned, which potential
problem is the highest priority for this client?
a. Maintaining oxygenation
b. Tolerating activity
c. Anxiety and fear
d. Hypovolemia
ANS: A

Breathing problems take priority over the other problems listed. This would be compounded
in a client with any chronic lung disorder.
DIF: Cognitive Level: Application/Applying or higher
REF: N/A
TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for
Complications From Surgical Procedures and Health Alterations)
MSC: Integrated Process: Nursing Process (Analysis)
3. The nurse is completing preoperative teaching for a client, and it becomes apparent that the

client does not understand the surgery that will be performed. What is the priority action for
the nurse?
a. Obtain informed consent from the client.
b. Continue teaching the client about the surgery.
c. Revise the teaching plan for the client.
d. Notify the surgeon and document the finding.
ANS: D

The surgeon should be notified right away so that the client can be instructed about the
surgery to be performed. The client cannot give informed consent unless he or she understands
the procedure.
DIF: Cognitive Level: Application/Applying or higher

REF: N/A

” What is the nurse’s best response? “The doctor ordered this medication so you should take it.” “I will make a note that you refused to take the medication. ANS: C Smoking increases the client’s risk for atelectasis and hypoxia. When the nurse brings a client’s preoperative medications. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Intervention) 5. This would be a critical piece of information for the surgical team to know. Perform a respiratory assessment. “I don’t need that. Have baseline laboratory studies drawn. d. A client receiving preoperative medication tells the nurse that she took all the following vitamins and herbs last night before going to bed. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies— Expected Actions/Outcomes) MSC: Integrated Process: Communication and Documentation 6. Baseline laboratory studies need to be ordered by the physician. Which action by the nurse is best? Call the surgeon to cancel the surgery. Give a nebulizer treatment.” “Let me teach you about your medications for surgery. There is no indication for giving a nebulizer to this client. During the preoperative assessment. a. The physician will need to know this information but will not necessarily cancel the operation. The client must be fully aware of the rationale for all medications and the risks of not taking them. John’s wort c. Which one does the nurse report to the surgical team as a priority? a.” a. ANS: D Preoperative medications can include sedatives but are often given to prevent laryngospasm and to help reduce pharyngeal and gastric secretions. DIF: Cognitive Level: Application/Applying or higher REF: N/A . Chamomile ANS: C Garlic interferes with coagulation. increasing the client’s risk for bleeding during and after the surgical procedure. Valerian root b. b. I had a good night’s sleep last night. Garlic d. b.TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Informed Consent) MSC: Integrated Process: Teaching/Learning 4. St. c. d. The nurse should assess the client for signs of respiratory disease. the client tells the nurse that he smokes three packs of cigarettes daily. c.” “I will ask your surgeon if you have to take the medication. the client responds.

b. A client is brought to the emergency department (ED) after a motorcycle accident. and potassium (K+) of 3. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Physiological Adaptation—Medical Emergencies) MSC: Integrated Process: Nursing Process (Implementation) 9. c.” a. I will be sure to spit out the water. Which statement by the client indicates that additional teaching is needed? “When I brush my teeth before surgery. b.” “I won’t have to worry about putting my makeup on tomorrow morning. c. The blood glucose level is elevated but not critically so. Record laboratory results on the preoperative assessment. The surgeon and the anesthesiologist should be notified of this laboratory test result right away. Increase the IV infusion of D5W to 100 mL/hr.” “I will go to the bathroom as soon as I receive all my preoperative medications. d. ANS: B The client should void before receiving any preoperative medication. c. ANS: A Emergent surgery is indicated when the client may die without immediate intervention. a prothrombin time (PT) of 25 seconds. What is the immediate priority? Emergent surgery to control bleeding Aggressive pain control Calling the family members Assessment of neurologic status a. The surgeon should be notified of all laboratory work. b. Administer a potassium supplement of 20 mEq.” “I will remember to wear my glasses tomorrow instead of my contact lenses. d. Which action by the nurse is best? a. which could lead to bleeding during or after surgery. The nurse has just completed preoperative teaching with a client who will be having surgery the following day. and additional coagulation studies will be needed. and the client may need an IV solution without glucose. The potassium is within normal limits. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Analysis) 8.8 mEq/L.TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies— Adverse Effects/Contraindications/Side Effects/Interactions) MSC: Integrated Process: Nursing Process (Intervention) 7. which is the priority concern with this client. The other statements are correct. Ask the surgeon for additional laboratory studies. but the surgery will likely be cancelled owing to the coagulation problem. The nurse reviews a client’s laboratory results before surgery and notes a fasting blood glucose of 120 mg/dL. ANS: A The prothrombin time is elevated. The client has suffered a ruptured spleen. Other interventions are appropriate but do not have the priority because controlling hemorrhage via surgery is the priority. The results should be recorded. d. . The medication could make the client sleepy and at risk for falling.

so that team members can use alternative means to ensure accurate communication with the client. would be administered with a sip of water. The client would not be encouraged to drink juice. but this is not the priority. notifying the surgeon is the priority. The finding should be documented. What recently learned information about a client who is scheduled to have surgery within the next 2 hours is the nurse certain to communicate to the surgical team? An allergy to cats Hearing problem Consumption of a glass of wine 12 hours ago Taking 2000 mg of vitamin C each day a. Tell the client not to get up and go to the bathroom alone. b. b.5 to 5. Administer antibiotics with a sip of water. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Implementation) 12. A value of 2. if ordered.9 mEq/mL. d. c. and in the postanesthesia recovery unit. Which action is a priority? a. Teach the client to eat only low-fat foods the night before surgery. Increase the IV flow rate. in the operating room. b. ANS: B The team will need to communicate with the client in the surgical holding area. Notify the surgeon.0 mEq/L or mmol/L. The surgeon should be notified of this finding. Antibiotics. When examining an adult client’s preoperative laboratory results. however. The nurse is performing preoperative teaching with an older adult client who will be having colon resection surgery the following day.DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control— Accident/Injury Prevention) MSC: Integrated Process: Teaching/Learning 10. a. c. such as a hearing impairment. and the older adult client can become exhausted and may fall. ANS: D The normal range for serum potassium is 3. the nurse notes that the potassium level is 2. which must be corrected before surgery. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control— Accident/Injury Prevention) MSC: Integrated Process: Nursing Process (Implementation) 11.9 represents hypokalemia. Encourage the client to drink plenty of juice. . d. because this is not a clear liquid. c. should be stressed. The surgeon has ordered bowel preparation the night before. ANS: D Safety is the priority. Alter the client’s diet to include fruit. What is the nurse’s priority action? Document the finding. d. Any problem with communication.

d. ANS: B Although these are expected physiologic responses to the preoperative medication.” “There are fewer risks with this type of surgery. Notify the surgeon and the anesthesiologist. 242 TOP: Client Needs Category: Physiological Integrity (Basic Care and Comfort—NonPharmacological Comfort Measures) MSC: Integrated Process: Communication and Documentation 14. b. he should be assessed. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies— Expected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Implementation) 15. b. Administer diphenhydramine (Benadryl). DIF: Cognitive Level: Comprehension/Understanding REF: Table 16-1. Document the information in the client’s record. b. the client tells the nurse that he must be allergic to the medication because his mouth is dry and his heart seems to be beating faster than normal. Twenty minutes after a client has received a preoperative injection of atropine and midazolam (Versed). What is the nurse’s priority action? a. Tell the client not to take the medication on the day of surgery. A client will be undergoing palliative surgery. The client’s daughter asks what this means. d.” a. c. c. What is the nurse’s best action? a. d. Assess the client’s pulse and blood pressure. whenever the client states that he or she can feel a change in normal cardiac function.” “The surgery must be performed immediately to save your father’s life. Explain to the client that these symptoms are expected.DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Implementation) 13.” “There is no guarantee of the outcome of the surgery. Tell the client to take medications preoperatively with a sip of water. A client undergoing preoperative assessment informs the nurse that he takes medication for high blood pressure and for asthma. Document the findings. p. c. What is the nurse’s best response? “The surgery will relieve the symptoms but will not cure your father. ANS: A The purpose of palliative surgery is to improve the client’s quality of life by reducing or eliminating distressing symptoms. It does not cure a health problem and often does not prolong life. ANS: B .

nor should the marks be washed off the surgical site. d. b. b. “There will be no effect on your surgery. DIF: Cognitive Level: Comprehension/Understanding REF: p. Documentation should occur. Which action is most appropriate during a preoperative chart review? a. What is the nurse’s best response? a. The client should be taught about the procedure before the preoperative chart review. and witnessed. d.” . 259 TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Assessment) 17. ANS: A During the preoperative chart review. ANS: C With only a few minutes before surgery. A client tells the nurse that he has an advance directive with durable power of attorney for health care. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Implementation) 16. Although the other information is important. but only after the nurse has consulted with the physician and anesthesiologist and has spoken to the client.Medications for cardiac and respiratory problems usually are given with sips of water before surgery.” b. Make sure the client understands the procedure. c. The nurse is caring for a client who will be undergoing emergency surgery as soon as possible. Ensure that the consent form is signed. However. The nurse does not have to call the surgeon for food allergies. the nurse needs to start with what is vital for the client to know right now. Call the surgeon if the client has any food allergies. Make sure all marks are washed off the surgical site. the nurse should tell the client what to expect in the operating room and in the recovery room to minimize his or her anxiety. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication) MSC: Integrated Process: Teaching/Learning 18. The client asks how the advance directive will affect the surgery. the nurse should make sure that the consent form is signed. the nurse should notify the surgeon and the anesthesiologist before giving the client any advice. c. While some medications can be given with a sip of water. dated. Which information is most important for the nurse to teach the client at this time? How the surgery will be performed Importance of early ambulation after surgery What to expect in the operating and recovery rooms Complications that may occur after surgery a. dated. and witnessed. “You will not be intubated during general anesthesia for the surgery. other medications must be held for a specified time before surgery.

Four clients are scheduled for surgery. 252 TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Advance Directives MSC: Integrated Process: Communication and Documentation 19. Older adults often have multiple medical conditions. c. simply acknowledging that fact does not help the client understand. “If you are unable to make a decision. Obtain written consultation with two surgeons that the surgery is needed. take several medications. d. Contact the family member by phone and obtain verbal consent with two witnesses. Although the document does not affect the procedure. A client is brought to the hospital unconscious and needs emergency surgery.c. If the client’s heart stops during the operation and the client has not made his or her wishes known about that situation. Have the hospital administrator appoint a temporary legal guardian. The client’s only family member cannot come to the hospital before the surgery.” ANS: D The advance directive with durable power of attorney indicates whom the client wishes to designate for medical decisions if he is unable to make decisions for himself. c.” d. your designee will be asked. Which is the best option for obtaining informed consent for the client’s emergent surgery? a. b. are slightly dehydrated. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Assessment) . and may have cognitive or physical impairments that potentially could hinder their recovery from an operation. “The surgical staff will resuscitate only if your heart stops during the operation. d. the power of attorney would be consulted. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Safe and Effective Care Environment (Management of Care—Informed Consent) MSC: Integrated Process: Communication and Documentation 20. Proceed with surgery and have the family member sign the consent as soon as possible. verbal consent should be obtained over the phone with two witnesses. b. ANS: A The older client is at highest risk for postoperative complications. ANS: B In the event that a family member cannot come to the hospital before the surgery needs to begin. DIF: Cognitive Level: Comprehension/Understanding REF: p. An advance directive with power of attorney does not eliminate the need for intubation during surgery. Which client does the nurse determine is at highest risk for postsurgical complications? 89-year-old scheduled for a knee replacement 40-year-old requiring gallbladder surgery 19-year-old requiring a laparoscopy 10-year-old admitted for a tonsillectomy a.

d. and normal platelet count would not contradict surgery. The nurse should not remove the stockings nor pull them down. d. b. The nurse is assessing a client before surgery. ANS: D Thromboembolic disease (TED) stockings should feel slightly tight on the legs to promote venous return and prevent the client from developing venous thromboembolism (VTE).) Potassium level of 2. B. d. Pull the stockings down so that they are not constricting. Measure the client’s calf to ensure that they are the correct size. DIF: Cognitive Level: Application/Applying or higher REF: N/A . ANS: A.2 Client undergoing hip replacement surgery a. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations) MSC: Integrated Process: Nursing Process (Assessment) 22. The nurse is conducting preoperative assessments. e. b. E Hypokalemia. The other conditions will not increase the risk of VTE. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning) MSC: Integrated Process: Teaching/Learning MULTIPLE RESPONSE 1. b.000 a. and a positive pregnancy test could all contradict the client having surgery as scheduled and could lead to complications. a.21.8 mEq/L International normalized ratio (INR) of 4 Prothrombin time (PTT) of 30 seconds Calcium level of 8. Which assessments contraindicate the client having surgery as scheduled? (Select all that apply. Normal PTT. Which client does the nurse teach about the possibility of developing a venous thromboembolism (VTE)? Client with a latex allergy Client with body mass index (BMI) of 19 Client with an international normalized ratio (INR) of 2. c. normal calcium. c. what is the nurse’s best action? Remove the stockings for an hour to relieve the pressure. f. When the client says that they are uncomfortably tight. The nurse applies antiembolism stockings to a client preoperatively. Teach the client the purpose of wearing the stockings. c. The calf would have been measured before the stockings were obtained. increasing the risk of postoperative venous thromboembolism (VTE). elevated bleeding times. ANS: D The client will have limited mobility following hip replacement surgery.8 mEq/dL Positive pregnancy test Platelet count of 150.

Lorazepam (Ativan) for anxiety c.” “Coughing and deep breathing will help to decrease postoperative complications.” “You will need to have your abdomen shaved before surgery. f. Hydromorphone is given for pain. after surgery. B. Coughing and deep breathing will help to decrease postoperative respiratory complications. Turning and moving legs after surgery will also help prevent clots. c. Vistaril) for sedation b.) a. D A pneumatic compression device and elastic stockings will help prevent clots after pelvic surgery. c. g. f. Which medications does the nurse correctly administer preoperatively? (Select all that apply. C. e. and shaving would not be necessary.TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Laboratory Values) MSC: Integrated Process: Nursing Process (Assessment) 2. Extended bedrest is not helpful. What data are essential for the nurse to assess on a client who is scheduled for surgery? (Select all that apply. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning) MSC: Integrated Process: Teaching/Learning 4. Hydromorphone (Dilaudid) to decrease postoperative secretions d. and metoclopramide (Reglan) to increase stomach emptying. Cimetidine (Tagamet) to prevent infection ANS: A. d.) Use of tobacco Current medications Use of herbal or over-the-counter therapy Mental status examination Power of attorney Allergies Date of last tetanus shot a. Hearing aids can be worn into the surgical suite because this will help communication before surgery.) a. . Metoclopramide (Reglan) to increase stomach emptying e. D The nurse will administer hydroxyzine (Atarax) for sedation. Hydroxyzine (Atarax. e. b. Aspirin would not be administered preoperatively because it can increase bleeding. and cimetidine (Tagamet) decreases histamine. What teaching is essential for this client? (Select all that apply. DIF: Cognitive Level: Application/Applying or higher REF: N/A TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies— Expected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Assessment) 3.” “You cannot wear your hearing aid into the surgical suite. d. “Wearing elastic stockings and using pneumatic compression devices are essential b.” ANS: A.” “Turning and moving your legs after surgery will help prevent clots from forming. The nurse is conducting preoperative teaching with a client who will be undergoing pelvic surgery. lorazepam (Ativan) for anxiety.” “Extended bedrest will help you heal after this type of surgery. Aspirin to decrease blood clotting postoperatively f.

C. The nurse is preparing to transfer a client to the operating room for surgery. b. Administer ordered preoperative sedation. The date of the client’s last tetanus shot is not required information from a preoperative chart review. the nurse should assist the client to the bathroom. Next. Put the interventions in order for the nurse to perform. 242 TOP: Client Needs Category: Physiological Integrity (Reduction of Risk Potential—Potential for Complications From Surgical Procedures and Health Alterations) MSC: Integrated Process: Communication and Documentation OTHER 1. Have the client go to the bathroom to void. DIF: Cognitive Level: Comprehension/Understanding REF: p. Mental status examination is essential to determine competency and ability to teach. B. certain medications and herbs. and allergies may increase a client’s risk. D. ANS: c. c. d. Smoking. DIF: Cognitive Level: Application/Applying or higher TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection Control— Accident/Injury Prevention) MSC: Integrated Process: Nursing Process (Implementation) . d First. Take a full set of vital signs. F The client should be screened for things that may increase the risk of complications during surgery. a. b. then take vital signs.) a. then finally administer preoperative sedation once the client is in bed. Ask the client to state his or her name and check the ID band.ANS: A. the nurse should identify the client using two identifiers to ensure that the correct client is being prepped for surgery. (List in order of priority.