Chapter 49: Care of Surgical Clients Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. A 43-year-old client is scheduled to have a gastrectomy. Which of the following is a major preoperative concern?

a.

The clients brother had a tonsillectomy at age 11 years

b.

The client smokes a pack of cigarettes a day

c.

The presence of an intravenous (IV) infusion

d.

A history of employment as a computer programmer

ANS: b

b. The client who smokes is at greater risk for postoperative pulmonary complications than is a client who does not.

a. This does not place the client at risk for surgery.

c. The presence of an IV infusion does not place the client at risk for surgery. An IV should be in place for surgery, so access is available to administer medications, fluids, or blood products if necessary. Keeping the client well hydrated will help prevent postoperative thrombophlebitis.

d. A history of employment as a computer programmer does not make the client a surgical risk.

REF: Text Reference: p. 1602

2. An appendectomy is appropriately documented by the nurse as:

a.

Diagnostic surgery

b.

Palliative surgery

c.

Ablative surgery

d.

Reconstructive surgery

ANS: c

c. Ablative surgery is the excision or removal of a diseased body part, such as an appendectomy.

a. Diagnostic surgery is surgical exploration that allows the physician to confirm a diagnosis. This type of surgery may involve removal of tissue for further diagnostic testing. An example would be a breast-mass biopsy.

b. Palliative surgery relieves or reduces the intensity of disease symptoms. It will not produce a cure. An example is resection of nerve roots.

d. Reconstructive surgery restores function or appearance to traumatized or malfunctioning tissues. An example is internal fixation of a hip fracture.

REF: Text Reference: p. 1596

3. 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: d

d. 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. An obese client is not at greater risk for anemia. A client who is malnourished is more susceptible to being anemic.

b. An obese client is not more susceptible to seizures.

c. An obese client is not more susceptible to protein loss. A client with liver disease may have altered protein metabolism.

REF: Text Reference: p. 1601

4. 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 an antihypertensive agent

c.

27-year-old taking an anticoagulant agent

d.

10-year-old taking an antibiotic agent

ANS: c

c. Anticoagulants alter normal clotting factors and thus increase the risk of hemorrhaging during surgery.

a. This client would not be at the greatest risk during surgery.

b. This client would not be at greatest risk during surgery.

d. Aminoglycosides (a type of antibiotic) may cause mild respiratory depression from depressed neuromuscular transmission. However, the client who has been taking anticoagulants is at greater risk during surgery.

REF: Text Reference: p. 1602

5. A 92-year-old client is scheduled for a colectomy. Which normal physiologic change that accompanies the aging process increases this clients risk for surgery?

a.

An increased tactile sensation

b.

An increased metabolic rate

c.

A relaxation of arterial walls

d.

Reduced glomerular filtration

ANS: d

d. An older adult is likely to have a reduced glomerular filtration rate. This limits the bodys ability to eliminate drugs or toxic substances.

a. An older adult has reduced tactile sense which decreases the clients ability to respond to early warning signs of surgical complications, including sensing pressure over bony prominences.

b. An older adult has a lower basal metabolic rate, reducing total oxygen consumption.

c. The nurse should ensure that the client obtains adequate nutritional intake when diet is resumed, but avoids intake of excess calories.

REF: Text Reference: p. 1600

6. The nurse is completing the preoperative checklist for an adult female client is 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?

a.

Hgb, 14 g/100 ml

b.

BUN, 15 mg/100 ml

c.

Platelets, 300,000/mm3

d.

Serum creatinine, c.2 mg/100 ml

ANS: d

d. The normal serum creatinine in women is 0.5 to a.1 mg/100 ml. A serum creatinine of c.2 mg/100 ml should be reported to the physician, as it can be an indication of renal failure.

a. A Hgb of 14 g/100 ml is within the normal limits of 12 to 16 g/100 ml for women.

b. A BUN of 15 mg/100 ml is within the normal limits of 10 to 20 mg/100 ml.

c. A platelet count of 300,000/mm3 is within the normal limits of 150,000 to 400,000/mm3.

REF: Text Reference: p. 1606

7. The nurse is evaluating the following: Client describes surgical procedures and postoperative treatment and determines that the client has not achieved this outcome. The nurse should:

a.

Obtain the consent, as this is expected with preoperative anxiety

b.

Teach the client all about the procedure

c.

Ask the unit manager to assist with a teaching plan

d.

Inform the surgeon so that information can be provided

ANS: d

d. When the client has little or no understanding about the surgery, the physician will need to be notified to reinform the client.

a. If the client did not understand the surgical procedure, the client would not be giving informed consent. It is the surgeons responsibility to explain the procedure and obtain the informed consent.

b. The nurse can augment the physicians explanations, but it is the physicians responsibility to teach the client about the procedure. This teaching includes the need for the procedure, steps involved, risks, expected results, and alternative treatments.

c. It is not the unit managers responsibility to inform the client about the procedure and obtain consent. That is the responsibility of the surgeon.

REF: Text Reference: p. 1611

8. 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.

A sponge seems to be missing, so a recount should be done of all the sponges that have been removed.

c.

Did the client receive the medications and sign the consent?

d.

The client looks to be reactive and stable.

ANS: b

b. The scrub nurse counts the sponges and instruments, and the circulating nurse verifies the counts. This statement by the nurse reflects accountability in the intraoperative phase.

a. This statement does not reflect nursing accountability in the intraoperative phase. The nurse is not accountable for the choice of anesthetic the client receives.

c. This statement reflects nursing accountability in the preoperative phase, not the intraoperative phase.

d. This statement reflects nursing accountability in the postoperative phase, not the intraoperative phase.

REF: Text Reference: p. 1625

9. 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.

Keeping the client flat with her feet flexed

c.

Turning the client onto the right side

d.

Applying pressure above and below the incision

ANS: a

a. 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 pulling.

b. Keeping the client flat will not decrease discomfort in the incisional area when the client coughs. Having the knees bent slightly will aid in relaxing the abdominal muscles, causing less discomfort.

c. Turning the client onto the right side will not decrease discomfort in the incisional area when the client coughs. The client should turn from side to side at least every 2 hours and may splint the incision to decrease discomfort when doing so.

d. Splinting should be done directly over the incision to provide firm support and reduce incisional pulling as the client coughs postoperatively.

REF: Text Reference: p. 1616, Text Reference: p. 1639

10. The nurse is evaluating the client in the hospitals 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 back to his room on the nursing unit

c.

Remain in the PACU until the score improves

d.

Return to the operating room for surgical evaluation

ANS: b

b. 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 to his room on the nursing unit.

a. If the clients condition is still poor after 2 to 3 hours (an Aldrete score below 8), the physician may transfer the client to an intensive care unit.

c. If the clients condition is still poor after 2 to 3 hours (an Aldrete score below 8), the physician may lengthen the clients stay in the PACU until the score improves.

d. A client with an Aldrete score of 8 is unlikely to return to the operating room for surgical evaluation.

REF: Text Reference: p. 1629

11. A client is in the 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 relieved with noninvasive comfort measures

c.

Voluntary bladder control and function

d.

A subdued level of consciousness and neurologic function

ANS: d

d. In the PACU, the client is often drowsy. The effects of anesthetic agents subdue the clients level of consciousness and neurological function.

a. Normally during the immediate recovery phase in the PACU, faint or absent bowel sounds are auscultated in all four quadrants. Clients who have had abdominal surgery may develop paralytic ileus, with a return of bowel sounds 24 to 48 hours later.

b. The acute incisional pain experienced in this stage of recovery is usually not relieved with noninvasive comfort measures, but will recover with pharmacological measures of pain relief.

c. Depending on the surgery, a client may not regain voluntary control over urinary function for 6 to 8 hours after anesthesia.

REF: Text Reference: p. 1633

12. 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: d

d. 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.

a. Keeping the client quiet is not a safety priority. Preanesthetic medications will help reduce the clients anxiety.

b. Consent must be obtained before preoperative medications are administered or the consent is invalid.

c. Preparing the skin at the surgical site is often done in the operating room. It is not a safety priority after the administration of preoperative medications.

REF: Text Reference: p. 1622

13. 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 anesthesiologist?

a.

Temperature, 100 F

b.

Pulse, 90

c.

Respirations, 20

d.

Blood pressure, 130/74

ANS: a

a. 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 the risk of fluid and electrolyte imbalance after surgery.

b. Anxiety and fear commonly cause elevations in heart rate and blood pressure. A pulse rate of 90 is not a concern.

c. A respiratory rate of 20 is normal for an adult.

d. Anxiety and fear commonly cause elevations in heart rate and blood pressure. A blood pressure of 130/74 is not excessively elevated.

REF: Text Reference: p. 1605

14. 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: b

b. Malignant hyperthermia should be suspected when unexpected tachycardia and tachypnea, jaw muscle rigidity, body rigidity of limbs, abdomen and chest, or hyperkalemia is found.

a. Temperature elevation is a late sign of malignant hyperthermia.

c. Muscle rigidity, not relaxation, is an early sign of malignant hyperthermia.

d. Skin pallor is not an early sign of malignant hyperthermia. Skin pallor may be seen in the immediate postoperative period, as the body is cool.

REF: Text Reference: p. 1639

15. The client tells the nurse, 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 pulmonary circulation

c.

Promote lung expansion

d.

Stimulate the cough reflex

ANS: c

c. The primary purpose of using an incentive spirometer is to promote lung expansion.

a. Coughing exercises are used to remove excess secretions from the lungs.

b. The specific purpose of using an incentive spirometer is not to increase pulmonary circulation. Ambulation helps increase pulmonary circulation as the respiratory rate increases.

d. The primary purpose of incentive spirometry is not to stimulate the cough reflex, but to promote lung expansion.

REF: Text Reference: p. 1638

16. The female client is on the surgical unit and being readied for abdominal surgery with general anesthesia early in the afternoon. 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 her make-up and nail polish

d.

Remove her hearing aid before transport to the operating room

ANS: c

c. All makeup, including nail polish, should be removed to expose normal skin and nail color to determine the clients level of oxygenation and circulation during and after surgery.

a. Jewelry and other valuables should be given to family members or secured for safekeeping. A wedding band can be taped in place unless the client might experience swelling of the hand or fingers. For safety, metal items, such as for pierced areas, should be removed.

b. The client should be NPO before surgery to prevent vomiting and aspiration with general anesthesia.

d. Clients may be allowed to keep personal items such as a hearing aid until they reach the preoperative area.

REF: Text Reference: p. 1621

17. The client asks the nurse the purpose of having medications [meperidine (Demerol) and hydroxyzine (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 secretions

d.

Ease the induction of the anesthesia

ANS: d

d. Preoperative medications such as meperidine (Demerol) and hydroxyzine pamoate (Vistaril) help reduce the clients anxiety, the amount of general anesthesia required, the risk of nausea and vomiting and resultant aspiration, and respiratory secretions.

a. Meperidine (Demerol) and hydroxyzine pamoate (Vistaril) may help the client feel drowsy and lessen his or her anxiety associated with fear. The purpose is to ease the induction of anesthesia, which includes reducing the clients anxiety.

b. Meperidine (Demerol) and hydroxyzine pamoate (Vistaril) will not promote emptying of the stomach, but may reduce the risk of nausea and vomiting. Hydroxyzine pamoate is often given to control nausea and vomiting by suppressing the CNS.

c. Hydroxycodone pamoate (Vistaril) will have an anticholinergic affect, reducing body secretions. These medications given together will ease the induction of anesthesia.

REF: Text Reference: p. 1622

18. A client who receives general or regional anesthesia in an ambulatory surgery center:

a.

Has to meet identified criteria to be discharged home

b.

Will remain in the phase I recovery area longer than a hospitalized client

c.

Is allowed to ambulate as soon as being admitted to the recovery area

d.

Is immediately given liberal amounts of fluid to promote the excretion of the anesthesia

ANS: a

a. Ambulatory surgical clients are discharged to home when they meet certain criteria.

b. With new anesthetic agents and techniques, many ambulatory surgery clients are able to bypass Phase I. However, if the client is in need of close monitoring, the client is assessed and cared for in the same fashion as inpatient clients in Phase I.

c. Whether the client will be able to ambulate as soon as being admitted to the recovery area depends on the ambulatory clients condition, type of surgery, and anesthesia.

d. This is not a true statement for all ambulatory surgery clients. The administration of fluids is dependent on the clients condition and type of surgery. The excretion of anesthetic depends on many factors, including the route of administration (e.g., fluids will not promote the excretion of anesthetic gases). Oral fluids cannot be given until it is determined that the client has a gag reflex and bowel sounds. Fluids are often given to prevent circulatory complications.

REF: Text Reference: p. 1631

19. After 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 urinary output

ANS: c

c. Signs of internal bleeding after abdominal surgery may include abdominal distention; swelling or bruising around the incision; increased pain; a fall in blood pressure; elevated heart and respiratory rate; thready pulse; cool, clammy, pale skin; and restlessness.

a. The client who is hemorrhaging will have a decreased blood pressure.

b. Incisional pain may occur as a result of surgery. A continuous increase in pain in conjunction with other symptoms of bleeding may indicate internal hemorrhaging.

d. A client who is bleeding will have a decreased urinary output.

REF: Text Reference: p. 1632

20. After discharge from the 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 clients vital signs:

a.

Every 15 minutes

b.

Every 30 minutes

c.

Every 1 hour

d.

Every 4 hours

ANS: c

c. Vital sign monitoring on the postoperative nursing unit should initially be hourly for 4 hours and then every 4 hours. As the clients condition stabilizes, frequency of assessment will usually decrease to once a shift until discharge.

a. On the clients arrival in recovery, the nurse repeats vital signs every 15 minutes, but not for the client who is stable on the surgical nursing unit.

b. The client who is not experiencing any complications or difficulties does not require vital sign measurement every 30 minutes.

d. After the clients vital signs are obtained hourly for 4 hours and remain stable, the client may have his or her vital signs measured every 4 hours.

REF: Text Reference: p. 1631, Text Reference: p. 1632

21. The client had surgery in the morning that involved the right femoral artery. To assess the clients 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 pedis artery

ANS: d

d. 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 the affected extremity with those in the nonaffected extremity.

a. The radial pulse is not distal to the femoral artery.

b. The ulnar pulse is not distal to the femoral artery.

c. The brachial artery is not distal to the femoral artery.

REF: Text Reference: p. 1632

22. On admission to the PACU, the client who has no orthopedic or neurologic restrictions is positioned with the:

a.

Bed flat and the clients arms to the sides

b.

Clients neck flexed and body positioned laterally

c.

Head of the bed slightly elevated with the clients head to the side

d.

Clients arms crossed over the chest and the bed in high-Fowlers position

ANS: c

c. To promote a patent airway, the head of the bed may be slightly elevated and the clients neck slightly extended, with the head turned to the side.

a. This position would not best facilitate a patent airway.

b. The clients head should not be flexed, as this may occlude the airway.

d. This is not the best position to promote respirations. The clients arms should never be positioned over or across the chest, because this reduces maximal chest expansion.

REF: Text Reference: p. 1635, Text Reference: p. 1638

23. 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: a

a. A client with thrombocytopenia is at risk for hemorrhaging during and after surgery.

b. Clients with immunological disorders or diabetes mellitus have an increased risk of wound infection after surgery.

c. A client who has a fever is at risk for fluid imbalance.

d. A client who has chronic respiratory disease may be at increased risk for respiratory depression, but not the client with thrombocytopenia.

REF: Text Reference: p. 1599

Copyright 2005 by Mosby, Inc. All rights reserved.

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