A 43-year-old client is scheduled to have a gastrectomy. Which of the following is a major
preoperative concern?
a. The client's brother had a tonsillectomy at age 11.
b. The client smokes a pack of cigarettes a day.
c. The client has an intravenous (IV)
ANS: The client smokes a pack of cigarettes a day.
The client who smokes is at greater risk for postoperative pulmonary complications than a client who does not. An IV should be in place for surgery so access is available to administer medications, fluids
An appendectomy is appropriately documented by the nurse as:
a. Diagnostic surgery
b. Palliative surgery
c. Ablative surgery
d. Reconstructive surgery
ANS: Ablative surgery
Ablative surgery is the excision or removal of a diseased body part, such as an appendectomy. Diagnostic surgery is surgical exploration that allows the health care provider to confirm a diagnosis. This type of surgery may involve re
An obese client is admitted for abdominal surgery. The nurse recognizes that this client is more susceptible to the postoperative complication of:
a. Anemia
b. Seizures
c. Protein loss
d. Dehiscence
ANS: Dehiscence
An obese client is susceptible to poor wound healing and wound infection because of the structure of fatty tissue, which contains a poor blood supply. This increases the risk for dehiscence. A client who is malnourished is more susceptible
The nurse is working in a postoperative care unit in an ambulatory surgery center. Of the following clients that have come to have surgery, the client at the greatest risk during surgery is a:
a. 78-year-old taking an analgesic agent
b. 43-year-old taking
ANS: 27-year-old taking an anticoagulant agent
Anticoagulants alter normal clotting factors and thus increase the risk for hemorrhaging during surgery. Aminoglycosides (a type of antibiotic) may cause mild respiratory depression from depressed neuromuscul
A 92-year-old client is scheduled for a colectomy. Which normal physiological change that accompanies the aging process increases this client's risk for surgery?
a. An increased tactile sensation
b. An increased metabolic rate
c. A relaxation of arterial
ANS: Reduced glomerular filtration rate
An older adult is likely to have a reduced glomerular filtration rate. This limits the body's ability to eliminate drugs or toxic substances. An older adult has reduced tactile sense, which decreases the client's ab
The nurse is completing the preoperative checklist for an adult female client who is scheduled for an operative procedure later in the morning. Which of the following preoperative assessment findings for this client indicates a need to contact the surgeon
ANS: Serum creatinine 3.2 mg/100 mL
The normal serum creatinine in women is 0.5 to 1.1 mg/100 mL. A serum creatinine of 3.2 mg/100 mL should be reported to the health care provider, because it can be an indication of renal failure. A Hgb of 14 g/100 mL is
The nurse is evaluating the outcome "Client describes surgical procedures and postoperative
treatment" and determines that the client has not achieved this outcome. The nurse should:
a. Obtain the consent, because this is expected with preoperative anxiet
ANS: Inform the surgeon so that information can be provided
When the client has little or no understanding about the surgery, the health care provider will need to be notified to reinform the client. If the client does not understand the surgical procedur
Which of the following statements most accurately reflects nursing accountability in the intraoperative phase?
a. "I would like to see the client have a regional anesthetic rather than a general anesthetic."
b. "There seems to be a missing sponge, so a re
ANS: "There seems to be a missing sponge, so a recount should be done of all the sponges that have been removed."
The scrub nurse counts the sponges and instruments, and the circulating nurse verifies the counts. This statement by the nurse reflects accou
The client will have an incision in the lower left abdomen. Which of the following measures by the nurse will help decrease discomfort in the incisional area when the client coughs postoperatively?
a. Applying a splint directly over the lower abdomen
b. K
ANS: Applying a splint directly over the lower abdomen
Deep-breathing and coughing exercises place additional stress on the suture line and cause discomfort. Splinting the incision with hands or a pillow provides firm support and reduces incisional pullin
The nurse is evaluating the client in the hospital's postanesthesia care unit (PACU) and determines that the Aldrete score is 8. Based on this assessment, the nurse anticipates that the client will:
a. Be sent to the intensive care unit
b. Be discharged b
ANS: Be discharged back to his or her room on the nursing unit
The client must receive a composite Aldrete score of 8 to 10 before being discharged from the PACU. The nurse may anticipate that the client with an Aldrete score of 8 will be discharged back
A client is in the postanesthesia care unit (PACU) recovering from a vagotomy and pyloroplasty. Which of the following is a normal expectation of the client in this stage of recovery?
a. Returned normal bowel sounds on auscultation
b. Pain that is relieve
ANS: A subdued level of consciousness and neurological function
In the PACU the client is often drowsy. The effects of anesthetic agents subdue the client's level of consciousness and neurological function. Normally during the immediate recovery phase in
The client is scheduled for abdominal surgery and has just received the preoperative medications. The nurse should:
a. Keep the client quiet
b. Obtain the consent
c. Prepare the skin at the surgical site
d. Place the side rails up on the bed or stretcher
ANS: Place the side rails up on the bed or stretcher
After administering preoperative medications, the nurse should raise the side rails on the bed or stretcher and keep the bed or stretcher in low position. Preanesthetic medications will help reduce the
The nurse is completing the preoperative checklist for an adult client who is scheduled for an operative procedure later in the morning. Which of the following preoperative assessment findings for this client indicates a need to contact the anesthesiologi
ANS: Temperature is 100� F.
An elevated temperature before surgery is a cause for concern. If the client has an underlying infection, the surgeon may choose to postpone surgery until the infection has been treated. An elevated body temperature increases t
In the postoperative period, the nurse recognizes that an early sign of malignant hyperthermia is:
a. Fever
b. Tachycardia
c. Muscle relaxation
d. Skin pallor
ANS: Tachycardia
Malignant hyperthermia should be suspected when there is unexpected tachycardia and tachypnea; jaw muscle rigidity; body rigidity of limbs, abdomen, and chest; or hyperkalemia. Temperature elevation is a late sign of malignant hyperthermi
The client tells the nurse that "blowing into this tube thing (incentive spirometer) is a ridiculous waste of time." The nurse explains that the specific purpose of the therapy is to:
a. Directly remove excess secretions from the lungs
b. Increase pulmona
ANS: Promote lung expansion
The primary purpose of using an incentive spirometer is to promote lung expansion. Coughing exercises are used to remove excess secretions from the lungs. Ambulation helps increase pulmonary circulation as the respiratory rate
The female client on the surgical unit is being prepared for abdominal surgery with general anesthesia. In preparing this client for surgery, the nurse should:
a. Leave all of her jewelry intact
b. Provide her with sips of water for a dry mouth
c. Remove
ANS: Remove her makeup and nail polish
All makeup, including nail polish, should be removed to expose normal skin and nail color to determine the client's level of oxygenation and circulation during and after surgery. Jewelry and other valuables should be
The client asks the nurse the purpose of having medications (Demerol and Vistaril) given before surgery. The nurse should inform the client that these particular medications:
a. Reduce preoperative fear
b. Promote emptying of the stomach
c. Reduce body se
ANS: Ease the induction of the anesthesia
Preoperative medications such as Demerol and Vistaril help reduce the client's anxiety, the amount of general anesthesia required, the risk for nausea and vomiting and resulting aspiration, and the amount of respi
A client who receives general or regional anesthesia in an ambulatory surgery center:
a. Has to meet identified criteria in order to be discharged home
b. Will remain in the phase I recovery area longer than a hospitalized client
c. Is allowed to ambulate
ANS: Has to meet identified criteria in order to be discharged home
Ambulatory surgical clients are discharged to home when they meet certain criteria. With new anesthetic agents and techniques, many ambulatory surgery clients are able to bypass phase I.
Following abdominal surgery, the nurse suspects that the client may be having internal bleeding. Which of the following findings is indicative of this complication?
a. Increased blood pressure
b. Incisional pain
c. Abdominal distention
d. Increased urinar
ANS: Abdominal distention
Signs of internal bleeding following abdominal surgery may include abdominal distention; swelling or bruising around the incision; increased pain; a drop in blood pressure; elevated heart and respiratory rates; thready pulse; coo
After discharge from the postanesthesia care unit (PACU), the client returned to the surgical nursing unit at 10:00 AM. It is now 11:30 AM, and the client is not experiencing any complications or difficulties. The nurse will plan to measure the client's v
ANS: Every 1 hour
Vital sign monitoring on the postoperative nursing unit should initially be hourly for 4 hours and then every 4 hours. As the client's condition stabilizes, the frequency of assessment will usually decrease to once a shift until discharg
The client had surgery in the morning that involved the right femoral artery. To assess the
client's circulation status to the right leg, the nurse will make sure to check the pulse at the:
a. Radial artery
b. Ulnar artery
c. Brachial artery
d. Dorsalis p
ANS: Dorsalis pedis artery
The nurse should assess peripheral pulses and capillary refill distal to the site of surgery. After surgery to the femoral artery, the nurse assesses posterior tibial and dorsalis pedis pulses. The nurse also compares pulses in
Upon admission to the postanesthesia care unit (PACU), the client who has no orthopedic or neurological restrictions is positioned with the:
a. Bed flat and the client's arms to the sides
b. Client's neck flexed and body positioned laterally
c. Head of th
ANS: Head of the bed slightly elevated with the client's head to the side
To promote a patent airway, the head of the bed may be slightly elevated and the client's neck slightly extended, with the client's head turned to the side. The client's head should
A client who is scheduled for surgery is found to have thrombocytopenia. A specific postoperative concern for the nurse for this client is:
a. Hemorrhage
b. Wound infection
c. Fluid imbalance
d. Respiratory depression
ANS: Hemorrhage
A client with thrombocytopenia is at risk for hemorrhaging during and after surgery. Clients with immunological disorders or diabetes mellitus have an increased risk for wound infection after surgery. A client who has a fever is at risk fo
A prostate biopsy is an acceptable procedure to be performed as an ambulatory surgery on an
otherwise healthy adult male because the American Society of Anesthesiologists (ASA)
considers that a:
a. Physical status class 1
b. Physical status class 2
c. Phy
ANS: Physical status class 1
ASA physical status classes 1 and 2 and also stable class 3 are now acceptable for ambulatory surgery. Classes 4 and 5 require inpatient surgery.
Which of the following statements made by a nurse reflects the greatest insight into the responsibility an ambulatory care nurse has to the client's family?
a. "A client's family deserves the attention of the nursing staff."
b. "Family is important to my
ANS: "I consider myself as having several clients: the surgical client and all the family that's present."
Family members attempt to provide support through their presence but face many of the same stressors as the client. You need to effectively communic
Which of the following statements made by a nurse reflects the greatest insight into the planning needs of a same-day surgical experience?
a. "Time is a precious resource in same-day surgery units; being organized allows for the best utilization of time.
ANS: "I take the time to review the client's pre-admission and preoperative data in order to formulate the most individualized plan of care possible."
Ambulatory and same-day surgical programs offer challenges in gathering a complete assessment in a limit
The perioperative nurse realizes that the most effective means of evaluating the client's
understanding of previous teaching is to:
a. Provide written material on the subject to be reviewed after discharge
b. Reinforce the material with family as the proc
ANS: Discuss it with the client and family in the immediate preoperative period
In the immediate preoperative period, assess the client's understanding of previous teaching. The other options are not truly evaluations of the client's knowledge.
Which of the following preoperative assessment findings would most likely delay a planned
procedure requiring general anesthetic?
a. A cough and low-grade fever
b. The pulse oximetry reading of 97% on room air
c. A blood pressure that is 10 systolic point
ANS: A cough and low-grade fever
Preoperative assessment occasionally reveals an abnormality that delays or cancels surgery. A client who presents with a cough and low-grade fever on admission would require the nurse to notify the surgeon immediately. The
A 74-year-old is accompanied by his daughter to the ambulatory surgery department for the surgical removal of a suspicious skin lesion. The client has experienced dysphasia since a cerebral vascular accident 3 years ago. The most effective way for the nur
ANS: Question the client's daughter
If a client is unable to relate all of the necessary information, rely on family members as resources. The remaining options are not reliable, effective methods of securing information regarding this client.
A client who has type 2 diabetes is scheduled for the removal of a skin lesion on his right shoulder at an ambulatory surgery unit. The nursing diagnosis the client is at greatest risk for postoperatively is:
a. Risk for injury
b. Risk for infection
c. Im
ANS: Impaired wound healing
Diabetes increases susceptibility to infection and impairs wound healing from altered glucose metabolism and associated circulatory impairment. The stress of surgery often causes increases in blood glucose levels. Although all
A client with a history of sleep apnea has had a same-day surgery procedure that will require
the administration of morphine postoperatively to manage pain. This client will be assessed most appropriately by the perioperative nurse for the risk for respir
ANS: Listening to breath sounds
Administration of opioids increases risk for airway obstruction postoperatively. Clients will desaturate as revealed by a drop in oxygen saturation by pulse oximetry. The remaining options are not as specific for this parti
A client scheduled for an ambulatory surgery procedure requiring anesthetics arrives with a
low-grade fever and a productive sough. The postponement of the procedure is most likely a
result of the:
a. Client's increased risk for a respiratory tract infect
ANS: Possibility of a respiratory complication during anesthesia
Cough and low-grade fever increases the risk for respiratory complications during anesthesia (e.g., pneumonia and spasm of laryngeal muscles). Although the other options are not incorrect, t
Which of the following goals is most appropriate for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information?
a. Client will understand the need for scheduled sur
ANS: Client will understand the preoperative routines of surgical care before leaving provider's office.
Understanding the need for the surgery is not as directly related to preoperative requirements as is the understanding of preoperative routines. The r
Which of the following client outcomes is most therapeutic for a preoperative client with a
nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information?
a. Client will share the preoperative rout
ANS: Client will present for drawing of preoperative laboratory blood at least 48 hours before scheduled surgery.
The answer provides for behavior that is measurable and pertinent to the preoperative goals. Sharing the information and calling for the appo
Which of the following client evaluations is most reflective of compliance for a preoperative client with a nursing diagnosis of deficient knowledge regarding preoperative requirements related to lack of exposure to information?
a. Client will present for
ANS: Client's preoperative blood laboratory work results are present on preoperative chart.
The answer shows proof of the client's compliance, whereas the remaining options are either goals or outcomes.
Which of the following best describes the primary nursing role regarding a client's consent to surgery immediately before surgery?
a. Explaining the procedure to the client in a fashion that is easily understood
b. Placing the signed consent in the client
ANS: Reviewing the client's surgical consent as a part of the routine preoperative checklist
It is the surgeon's responsibility to explain the procedure and obtain the informed consent. After the client completes the consent form, place it in the medical
The initial client education-related nursing action by the preadmission nurse is to:
a. Respond to questions presented by the family regarding the client's surgery
b. Call the client before the surgery to restate presurgery routine
c. Provide the client w
ANS: Call the client before the surgery to restate presurgery routine
Preadmission nurses call clients up to 1 week before surgery to clarify questions and reinforce explanations. The remaining options are directed toward either facilitating compliance wi
Which of the following statements made by the nurse shows the most informed understanding of the role of family in the client's postoperative recovery?
a. "The family will be the ones you will be dealing with regarding postoperative needs."
b. "When the f
ANS: "Teaching the family what they need to know before the surgery will maximize their effectiveness regarding the client's postoperative care."
Often a family member is the caregiver when the client recovers from surgery. Perioperative preparation of fa
The nurse recognizes which of the following as the greatest barrier to meeting a preoperative
client's nursing diagnosis of deficient knowledge regarding surgical procedure?
a. Effects of preoperative medication
b. Complicated nature of the information
c.
ANS: Fear or anxiety regarding the procedure
Anxiety and fear are barriers to learning, and both emotions heighten as surgery approaches. Education should be provided before any preoperative sedation is administered; the information should be introduced i
The nurse knows that the client is most likely going to arrive for the surgical procedure having adhered to the required bowel preparation if:
a. The client understands the need for the laxative
b. The laxative ordered is pleasant tasting
c. The bowel pre
ANS: The client understands the need for the laxative
Given a rationale for preoperative and postoperative procedures, the client is better prepared to participate in care. The remaining options may have an effect on compliance but not to the degree that
Which surgical classification would be the most appropriate for a cardiac catheterization scheduled on a 44-year-old male client who is in the hospital with chest pain?
a. Major
b. Minor
c. Ablative
d. Elective
ANS: Major
Major surgery involves extensive reconstruction or alteration in body parts and poses great risks to well-being. Minor surgery involves minimal alteration in body parts, is often designed to correct deformities, and involves minimal risks compa
A 36-year-old female diabetic client is having an elective breast augmentation procedure done. Which of the following tests must be done on the day of surgery?
a. Complete blood count (CBC)
b. Blood glucose
c. Serum electrolytes
d. Coagulation studies
ANS: Blood glucose
Blood glucose level can be obtained by either a finger stick or peripheral blood sample. Clients often require treatment of low or high levels preoperatively and postoperatively.
A 48-year-old male client with a history of chronic obstructive pulmonary disease (COPD) is
scheduled for an inguinal hernia repair. The nurse instructs that client that he can expect the health care provider to order which of the following tests before s
ANS: Pulmonary function test
Pulmonary function testing and occasionally arterial blood gas analysis are often performed before surgery on clients with preexisting lung disease. An HIV-antibody test diagnoses HIV. It is not a test that is normally ordered
A 64-year-old male client has been scheduled to undergo surgery for a total knee replacement. The client would like to be able to use his own blood for the surgery, if needed. The nurse explains that there are several advantages to the client's having an
ANS: The client may have a decreased hemoglobin and hematocrit level on the day of surgery.
The client must plan ahead in plenty of time in order to be able to donate his own blood. In addition, the client who does self-donation sometimes exhibits a lower
A 24-year-old male client has been scheduled to undergo surgery for an ACL repair of his right knee. The client states that he is confused about what the surgeon will be doing. The best response from the nurse is:
a. "The surgeon went over this procedure
ANS: "Let me get the surgeon to talk with you before we proceed so that you fully understand what will be happening"
The surgeon is responsible for making sure that the client completely understands the procedure before the client gives informed consent.
A 47-year-old female client has been scheduled to undergo surgery for removal of her gallbladder. Preoperatively the nurse is teaching the client what to expect when she wakes up in the postanesthesia care center. The nurse tells the client that her visio
ANS: The anesthesia provider applies ointment to clients' eyes to prevent corneal damage.
The anesthesia provider applies ointment to clients' eyes to prevent corneal damage. Warning clients about sensations of blurred vision will reduce their anxiety on
Given a rationale for preoperative and postoperative procedures, the client is better prepared to participate in care. For which of the following should the nurse provide instruction and rationale?
a. Incentive spirometry
b. Specific details regarding the
ANS: Incentive spirometry
Given a rationale for preoperative and postoperative procedures, the client is better prepared to participate in care. The diet progression should be discussed with the client by the unit nurse as the postsurgical diet progresses
The nurse is very busy and needs to delegate some tasks to the nursing assistive personnel (NAP). Which of the following would be the most appropriate task to delegate?
a. Postoperative client teaching
b. Demonstrating postoperative exercises
c. Transport
ANS: Transporting the preoperative client from the unit to the holding area
In many hospitals a nursing orderly or transporter brings a stretcher for transporting the client. The transporter checks the client's identification bracelet for two identifiers
When discussing the details of having a procedure done in a facility's ambulatory surgery department, the nurse includes which of the following as advantages? (Select all that apply.)
a. Facilitates faster postsurgical recovery
b. Reduces hospital-oriente
ANS: Facilitates faster postsurgical recovery; Reduces hospital-oriented expenses; Minimizes risk for acquiring a nosocomial infection; The anesthetic drugs used result in faster "wake-up" time
There are distinct benefits for the client who has ambulatory