Legal and Ethical Issues Associated with Surgery
5. This is the correct surgical site
CN: Physiological adaptation; CL: Apply
6.
1. A pimple close to the incision site may be reason for the surgeon to cancel the surgical proce- dure because it increases the risk of infection. If the client had an abnormal ECG, the nurse would notify the anesthesiologist who will be administering the anesthesia. The anesthesiologist is the decision maker regarding the implications of the anesthesia on the cardiac system. The surgical team should be notifi ed of the client’s hearing disability, but the surgeon, who has already met the client, does notBillings_Part 2_Chap 3_Test 14.indd 653
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of diabetes receiving D5LR I.V. fl uids does not need to have the serum glucose level checked unless other clinical manifestations are present. The client who has a high carbohydrate diet should be able to metabolize the glucose unless there are other health problems.
CN: Reduction of risk potential;
CL: Analyze
15.
3. The nurse should notify the physician directly for specifi c orders based on the client’s glucose level. The nurse cannot ignore the elevated glucose level. The surgical experience is stressful and the client needs specifi c insulin coverage dur- ing the perioperative period. The nurse should not administer the insulin without checking with the surgeon because there are specifi c orders to with- hold all medications. It is not necessary to notify the surgery department unless the physician cancels the surgery.CN: Pharmacological and parenteral therapies; CL: Synthesize
16.
3. Psychosocial integrity issues, including coping mechanisms, situational role changes, and body image changes, are more common in a client who undergoes elective cosmetic surgical proce- dures. Reduction of risk potential, physiologic adaptation, and health promotion and maintenance are greater needs for clients who are undergoing surgical correction of functional, anatomic, or physi- ologic defects in nonelective surgical procedures.CN: Psychosocial adaptation;
CL: Analyze
17.
1. A client should not elect surgery to meet someone else’s needs. The nurse should encourage the client to share his feelings and his perception of the deformity and to clarify his reasons for elect- ing to have the surgery. It is normal to be somewhat afraid, and it is good if a client says he feels “OK”about the surgery. The fact that a client believes that his wife will help him after surgery and that he will also be relatively independent refl ects appropriate adaptation. It is a common feeling among preop- erative clients that they are ready to “get this over with,” indicating that the waiting period is stressful.
CN: Psychosocial adaptation;
CL: Evaluate
18.
2. Brittle nails indicate poor nutrition. Poor posture indicates that the client does not stand up straight and use her muscles to support herself.A dull expression refl ects the client’s affect and emotional status. The client’s weight of 128 lb is within normal range.
CN: Health promotion and maintenance;
CL: Analyze at a specifi c time related to the scheduled time of
the surgical procedure, it is imperative that the anti- biotic is given on time. Legally, the nurse considers 30 minutes on either side of the scheduled time to be acceptable for administering medications; how- ever, in this situation, giving the antibiotic 30 min- utes too soon can make the prophylactic antibiotic ineffective. The postoperative dose of antibiotic is not timed according to the preoperative dose. Peak and titer levels are measured for some antibiotics, but in this case the primary reason is to have the antibiotic infused before the time of the incision.
CN: Reduction of risk potential;
CL: Apply
11.
3. Nurses should provide the preoperative client individual and sincere attention by meeting the client at eye level and introducing themselves by name and role. The nurse should ask the client to tell her full name rather than asking if she is Mrs. Smith because there might be another client by that name on the schedule. Nurses should not start the physical assessment or ask the client’s name without fi rst identifying themselves and their role out of courtesy and to relieve the client’s anxiety in the new environment of the surgical experience.CN: Psychosocial adaptation; CL: Apply
12.
4. The nurse should notify the anesthesiolo- gist because a serum potassium level of 5.8 mEq/L places the client at risk for arrhythmias when under general anesthesia. The surgeon may be notifi ed;however, the anesthesiologist will make the decision about whether to proceed with surgery. The nurse should not automatically send a client with abnor- mal laboratory fi ndings to surgery because the pro- cedure may be canceled. Once the client is inside the operating room and sterile supplies have opened up for the procedure, the client is usually charged.
The nurse should call ahead of time to communicate the abnormal laboratory result instead of placing a note on the front of the chart. A note would not be seen until after the client has been transported to the operating room and the supplies have been opened.
CN: Reduction of risk potential;
CL: Synthesize
13.
4. Clients should be made aware that some questions are asked for verifi cation and safety with each new phase of treatment.CN: Psychosocial adaptation;
CL: Synthesize
14.
1, 2, 3. Clients who have diabetes mellitus controlled by diet, those with a high stress response to surgery, or those who have been on steroid treat- ment for the last 3 months should have their serum glucose level assessed. A client with a family historyBillings_Part 2_Chap 3_Test 14.indd 654
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23.
1. Clients who have had long-term multiple exposures to latex products, such as would occur with six previous surgeries and recoveries, are at increased risk for latex allergies. The nurse should explore what types of surgeries these were, how involved the client’s recoveries were, and whether signs of latex allergies have occurred in the past.Working as a sales clerk, having type 2 diabetes, or undergoing laser surgery does not expose a client to latex or increase the risk of latex allergy.
CN: Health promotion and maintenance;
CL: Analyze
24.
3. The nurse should assess the vital signs of the client who exhibits urticaria, rhinitis, and conjunctivitis a few seconds after coming in contact with rubber gloves, a plastic catheter, plastic I.V.tubing, and a plastic I.V. solution bag. The nurse should recognize that these symptoms indicate that a type I allergic reaction is occurring, that the client is responding to the latex, and that the reaction can proceed into anaphylactic shock. The client does not need to be distracted or assessed for pain. It is not necessary to lower the head of the bed.
CN: Physiological adaptation;
CL: Synthesize
25.
4. The nurse would ask the client whether he wears glasses to evaluate his preoperative cog- nitive-perceptual pattern. Asking about the client’s swallowing pattern would evaluate his nutritional- metabolic pattern. Asking about his need for special equipment to walk would evaluate his activity- exercise pattern. Asking the client about his history of smoking would evaluate his health perception–health management pattern.
CN: Physiological adaptation;
CL: Analyze
26.
3. The client is at risk for a diffi cult intu- bation because the neck must be hyperextended to pass the endotracheal tube. Assessment of the pupils should not be limited. If the client is posi- tioned appropriately during surgery, there is no risk of postoperative neck pain or limited neck move- ment.CN: Reduction of risk potential;
CL: Analyze
27.
1, 2, 3, 4. Splinting the incision is important to avoid stress on the surgical site and to promote comfort so that the client will adhere to the plan of care. Inhaling and exhaling are important to bring in adequate oxygen and clear out carbon dioxide;however, closing one nostril when inhaling would be inappropriate and ineffective. The most impor- tant step is asking the client to hold the inhaled breath for about 5 seconds, which keeps the alveoli
19.
4. The Joint Commission requires that dis- charge instructions be written for the postoperative client. The nurse will review all instructions orally and will demonstrate any skill. Clients need to be given discharge instructions orally and in written form because of stress, medications, and the volume of material to be learned. Explaining all the instruc- tions to a family member is important but does not replace the need for written instructions.CN: Health promotion and maintenance;
CL: Synthesize
20.
1. The preadmission nurse, the fi rst person in contact with the client, starts the discharge plan- ning for the client undergoing surgery. All nurses involved with the client, from preadmission through postoperative recovery, should continue to reinforce the discharge plan.CN: Health promotion and maintenance;
CL: Apply
21.
3. The nurse should have the client empty his bladder before the premedication is adminis- tered. This will be more comfortable and safe for the client. The purpose of the premedication is to decrease anxiety and promote a relaxed state. The client must have an empty bladder before being transferred to the operating room, where he will be immobilized and receive I.V. fl uids. The family does not have to be present, but it is usually desired.Shaving the operative area is not generally recom- mended because it can cause small nicks that harbor bacteria. If the client must be shaved, it is usually done in the operating room holding area. The client should be comfortable at all times and offered a warm blanket whenever he is cool, before or after the premedication.
CN: Basic care and comfort;
CL: Synthesize
22.
4. The nurse should immediately think of the congenital metabolic tendency for malignant hyperthermia, which occurs in the presence of cer- tain kinds of anesthetics. Whenever a preoperative client states that a family member has had problems with anesthesia or surgery, the nurse should inquire about the nature of the problems and whether other family members have had similar problems. Reas- suring the client that technology has changed will do little to affect her fears and misses the opportu- nity to evaluate the risk for malignant hyperthermia.Encouraging the client to further express her con- cerns and reassuring her that her feelings are normal are important, but missing a familial tendency of malignant hyperthermia could be fatal.
CN: Reduction of risk potential;
CL: Synthesize
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33.
3. Glycopyrrolate is an anticholinergic given for its ability to reduce oral and respiratory secre- tions before general anesthesia. Increased heart rate and respiratory rate would be adverse effects of the drug. Amnesia should not be an effect of the drug.CN: Pharmacological and parenteral therapies; CL: Apply
34.
1. The nurse can administer atropine sulfate, an anticholinergic, to a client with diabetes. Atro- pine is contraindicated in clients with glaucoma because it increases intraocular pressure. It is con- traindicated in clients with urine retention because it relaxes smooth muscle in the urinary tract and can exacerbate the problem. It is contraindicated in clients with gastrointestinal obstruction because it relaxes smooth muscle in the gut and may worsen the obstruction.CN: Pharmacological and parenteral therapies; CL: Apply
35.
3. Because droperidol causes tachycardia and orthostatic hypotension, the client should be moved slowly after receiving this medication. Inapsine produces a tranquilizing effect and does affect the central nervous, respiratory, or psychoneurologic system, but the primary reason for moving the cli- ent slowly is the potential cardiovascular effects of hypotension.CN: Pharmacological and parenteral therapies; CL: Apply
36.
2. Research fi ndings have shown that enox- aparin and low-dose heparin given 6 to 12 hours preoperatively reduce the incidence of deep vein thrombosis and pulmonary emboli by 60% in cli- ents who are at risk for deep vein thrombosis, such as those who are placed in the lithotomy position.Lovenox has no effect on red blood cell production, postoperative bleeding, or tissue healing.
CN: Pharmacological and parenteral therapies; CL: Evaluate
37.
4. The nurse does not need to ask about all drugs used in the last 18 months unless the client is still taking them. The nurse does need to know all drugs the client is currently taking, including herbs and vitamins, over-the-counter medications such as aspirin taken in the past 6 weeks, the amount of alcohol consumed, and use of illegal drugs, because these can interfere with the anesthetic and analge- sic agents. Steroid use is of concern because it can suppress the adrenal cortex for up to 1 year, and supplemental steroids may need to be administered in times of stress such as surgery.CN: Reduction of risk potential;
CL: Apply expanded. This step should be stressed the most.
Repeating the exercise 5 to 10 times hourly is the second most important point to emphasize in this teaching plan.
CN: Reduction of risk potential;
CL: Create
28.
2. The nurse should call the surgeon for a serum creatinine level of 2.6 mg/dL, which is higher than the normal range of 0.5 to 1.0 mg/dL.An elevated serum creatinine value indicates that the kidneys are not fi ltering effectively and has important implications for the surgical client because many anesthesia and analgesia medications need to be fi ltered out through the renal system.
The red blood cell count, hemoglobin level, and blood urea nitrogen level are within normal limits and do not need to be reported to the surgeon.
CN: Reduction of risk potential;
CL: Analyze
29.
1. Midazolam hydrochloride causes ante- grade amnesia or decreased ability to remember events that occurred around the time of sedation.Nausea, mild agitation, and blurred vision are adverse effects of Versed.
CN: Pharmacological and parenteral therapies; CL: Evaluate
30.
3. The client should be encouraged to take slow, deep breaths because midazolam hydrochlo- ride is a respiratory depressant. The nurse should assess the client’s blood pressure, monitor the pulse oximeter, and keep the client calm and relaxed, but the client will slip into very shallow, ineffective breathing if not encouraged to deep-breathe.CN: Pharmacological and parenteral therapies; CL: Synthesize
31.
1. The nurse should have an Ambu bag in the client’s room because midazolam hydrochloride can lead to respiratory arrest if it is administered too quickly. The client does not need to be shocked back into a normal rhythm or to receive epineph- rine unless cardiac compromise developed after the respiratory arrest. The client would receive titrated dosing of fl umazenil to reverse the Versed, but fi rst the nurse should ventilate the client.CN: Pharmacological and parenteral therapies; CL: Synthesize
32.
2. Metoclopramide is an antiemetic given because of its gastric emptying ability, which is necessary in gastrointestinal procedures. It does not increase gastric pH, reduce anxiety, or inhibit respi- ratory secretions.CN: Pharmacological and parenteral therapies; CL: Evaluate
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42.
1. The 68-year-old client is at greater risk because an older adult client is more likely to have comorbid conditions, a less-effective immune sys- tem, and less collagen in the integumentary system.CN: Physiological adaptation;
CL: Analyze
43.
1. The child having her 15th laser procedure for a hemangioma should not have a balloon unless it is latex free because this child has had numerous exposures to latex thus far. If she has not already developed some sensitivity, the nurse should help the family be aware of latex products to avoid when possible. A client who is having a tonsillectomy, inguinal hernia repair, or orchiopexy is probably having surgery for the fi rst time and has not been exposed to latex, although it is a good practice to use latex-free products whenever possible and to inquire about past exposure.CN: Safety and infection control;
CL: Synthesize
44.
2. An autotransfusion is acceptable for the client who is in danger of cardiac arrest. An auto- transfusion cannot be collected from a client who has cancer, a contaminated wound, or contamination from Escherichia coli because of a ruptured bowel.CN: Pharmacological and parenteral therapies; CL: Apply
45.
2. After a scope or catheter has been inserted into the urethra, the mucosal membrane is irritated and the client feels the need to void even though the bladder may not be full. The nurse should encour- age the client to force fl uids to make the urine dilute. The client should not ignore the urge to void.The client should be encouraged to use the bath- room; there is no need to use the bedpan. The client does not need assistance to the bathroom because this procedure does not require any anesthesia except a topical anesthetic for the male client.
CN: Basic care and comfort;
CL: Synthesize
46.
4. Early ambulation is the most signifi cant general nursing measure to prevent postoperative complications and has been advocated for more than 40 years. Walking the client increases vital capacity and maintains normal respiratory functioning, stimu- lates circulation, prevents venous stasis, improves gastrointestinal and genitourinary function, increases muscle tone, and increases wound healing. The client should maintain a healthy diet, manage pain, and have regular bowel movements. However, early ambulation is the most important intervention.CN: Reduction of risk potential;
CL: Synthesize
38.
2. The nurse should notify the surgery department and document the past surgery in the chart in the preoperative notes so that the client’s hip is not externally rotated and the hip dislocated while she is in the lithotomy position. The prosthe- sis should not be a problem as long as the periop- erative nurse places the grounding pad away from the prosthesis site. The perioperative nurse will inform the rest of the team, but the primary reason to inform the perioperative nurse is related to safe positioning of the client. The surgeon can hand- write an addendum to the history and initial and date the entry. The history and physical information can then be retyped at a later date.CN: Reduction of risk potential;
CL: Apply
39.
3. The nurse should notify the anesthesiolo- gist because supplemental prednisone suppresses the adrenal cortex’s natural ability to produce increased corticosteroids in times of stress such as surgery. The anesthesiologist may need to order supplemental steroid coverage during the periop- erative period. The nurse should document the prednisone with current medications, but it is a priority to inform the anesthesiologist. Because the poison ivy is not in the surgical fi eld, the surgeon does not need to be called regarding the skin dis- ruption.CN: Pharmacological and parenteral therapies; CL: Synthesize
40.
2. The client who has a signifi cant cigarette smoking history and an operative manipulation close to the diaphragm (the gallbladder is against the liver) is at increased risk for atelectasis and pneumonia. Postoperatively this client will be reluc- tant to deep-breathe because of pain, in addition to having residual lung damage from smoking. There- fore, the client is at greater-than-average risk for pulmonary complications. The client does not have an increased risk of prolonged immobility (unless slowed by a respiratory problem), deep vein throm- bosis (as long as the client performs leg exercises), or delayed wound healing (as long as the client maintains appropriate nutrition).CN: Reduction of risk potential;
CL: Analyze
41.
4. The purpose of separating the public from the restricted-attire area of the operating room is to provide an aseptic environment and prevent con- tamination of the environment by organisms. The client’s privacy is protected, but the main purpose is infection control.CN: Safety and infection control;
CL: Apply
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