Chi 30: PERIOP NUR

The nurse is preparing to send a client to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent for the procedure on the client’s chart. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the client. What is the nurse’s best action to the physician’s request?

• Inform the physician that it is his or her responsibility to obtain the signature.

• Obtain the signature and ask another nurse to cosign the signature

• Inform the physician that the nurse manager will need to obtain the signature.

• Call the house officer to obtain the signature.

Answer explanation

The responsibility for securing informed consent from the client lies with the person who will perform the procedure. The nurse’s best action is to inform the physician that it is his or her responsibility to obtain the signature.

Upon assessment, a client reports that he drinks five to six bottles of beer every evening after work. Based upon this information, the nurse is aware that the client may require which of the following?

• Larger doses of anesthetic agents and larger doses of postoperative analgesics

•  Larger doses of anesthetic agents and lower doses of postoperative analgesics

• Lower doses of anesthetic agents and lower doses of postoperative analgesics

• Lower doses of anesthetic agents and larger doses of postoperative analgesics

Answer explanation

Clients with a large habitual intake of alcohol require larger doses of anesthetic agents and postoperative analgesics, increasing the risk for drug-related complications.

The telemetry unit nurse is reviewing laboratory results for a client who is scheduled for an operative procedure later in the day. The nurse notes on the laboratory report that the client has a serum potassium level of 6.5 mEq/L, indicative of hyperkalemia. The nurse informs the physician of this laboratory result because the nurse recognizes hyperkalemia increases the client’s operative risk for which of the following?

•  Cardiac problems

• Infection

• Bleeding and anemia

• Fluid imbalances

Answer explanation

Hyperkalemia or hypokalemia increases the client’s risk for cardiac problems. A decrease in the hematocrit and hemoglobin level may indicate the presence of anemia or bleeding. An elevated white blood cell count occurs in the presence of infection. Abnormal urine constituents may indicate infection or fluid imbalances.

The nurse is providing education to a client regarding pain control after surgery. What time does the nurse inform the client is the best time to request pain medication?

• Before the pain becomes severe

• When the client experiences a pain rating of “10” on a 1-to-10 pain scale

• When there is no pain, but it is time for the medication to be administered

• After the pain becomes severe and relaxation techniques have failed

Answer explanation

If a pain medication is ordered p.r.n., the client should be instructed to ask for the medication before the pain becomes severe.

A client returning to the floor after orthopedic surgery is complaining of nausea. The nurse is aware that an appropriate intervention is to do which of the following?

• Avoid strong smelling foods.

• Provide clear liquids with a straw.

• Avoid oral hygiene until the nausea subsides.

• Hold all medications.

Answer explanation

Nursing care for a xlient with nausea includes avoiding strong smelling foods, providing oral hygiene, administering prescribed medications (especially medications ordered for nausea and vomiting), and avoiding use of a straw.

In order to prevent the possibility of venous stasis, a nurse is teaching a surgical client how to perform leg exercises. Which of the client’s following statements indicates a sound understanding of leg exercises?

• “I’ll practice these now and try to start them as soon as I can after my surgery.”

•  “I’ll try to do these lying on my stomach so that I can bend my knees more fully.”

• “I’ll make sure to do these, as long as my doctor doesn’t tell me to stay on bed rest after my operation.”

• “I’m pretty sure my stomach muscles are strong enough to lift both of my legs off the bed at the same time.”

Answer explanation

Leg exercises should be begun as soon as possible after surgery, unless contraindications exist. Bed rest does not preclude the performance of leg exercises and the legs should be lifted individually, not simultaneously. The client should perform leg exercises in a semi-Fowler’s, not prone, position.

A female client is scheduled for liposuction surgery to reduce her weight. Based on urgency, how is this surgery classified?

• Urgent

• Elective

• Emergency

• Emergent

Answer explanation

A liposuction procedure is classified as elective surgery, in which the procedure is preplanned and based on the client’s choice. Other classifications are urgent (surgery is necessary for the client’s health but not an emergency) and emergency (the surgery must be done immediately to preserve life, body part, or body function).

A client scheduled for major surgery will receive general anesthesia. Why is inhalation anesthesia often used to provide the desired actions?

• Rapid excretion and reversal of effects

• Safe administration in the client’s own room

• Involves only the respiratory system and skin

• Slow onset of action and maintains reflexes

Answer explanation

General anesthesia involves the administration of drugs by inhalation and intravenous routes to produce central nervous system depression. Inhalation anesthesia is often used because it has the advantage of rapid excretion and reversal of effects.

A nurse is educating a client about regional anesthesia. Which of the following statements is accurate about this type of anesthesia?

• “You will be asleep and won’t be aware of the procedure.”

•  “You will be asleep but may feel some pain during the procedure.”

• “You will be awake but will not be aware of the procedure.”

• “You will be awake and will not have sensation of the procedure.”

Answer explanation

Regional anesthesia occurs when an anesthetic agent is injected near a nerve or nerve pathway in or around the operative site, inhibiting the transmission of sensory stimuli to central nervous system receptors. The client remains awake but loses sensation in a specific area or region of the body.

A nurse has been asked to ensure informed consent for a surgical procedure. What might be a role of the nurse?

• Securing informed consent from the client

• Signing the consent form as a witness

• Ensuring the client does not refuse treatment

•  Refusing to participate based on legal guidelines

Answer explanation

The responsibility for securing informed consent from the client lies with the person who will perform the procedure, usually the physician. The nurse may sign as a witness, signifying that the client signed the consent form without coercion, and was alert and aware of the act.