Perioperative Care NCLEX Qs over Iggy

Perioperative Care NCLEX Qs over Iggy Ch. 14, 15, 16 Already Passed

ANS: A

Older people have an age-related decrease in immune system functioning and may not show classic signs of infection such as increased white blood cell count, fever and chills, or obvious localized signs of infection. A change in behavior often signals an infection or onset of other illness in the older client. ✔✔An older client is hospitalized after an operation. When assessing the client for postoperative infection, the nurse places priority on which assessment?

• Change in behavior
• Daily white blood cell count
• Presence of fever and chills
• Tolerance of increasing activity

ANS: D

Some herbs and supplements can interact with medications, so this information needs to be reported as the priority. An allergy to bee and wasp stings should not affect the client during surgery. Lactose intolerance should also not affect the client during surgery but will need to be noted before a postoperative diet is ordered. Lack of experience with surgery may increase anxiety and may require higher teaching needs, but is not the priority over client safety. ✔✔A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team?

• Allergy to bee and wasp stings
• History of lactose intolerance
• No previous experience with surgery
• Use of multiple herbs and supplements

ANS: C

The older adult has the most potentially complex discharge needs. With memory loss, the client may not be able to follow the prescribed home regimen. The client's physical abilities may be

limited by chronic illness. This client has several safety needs that should be assessed. The other clients all have evidence of a support system and no known potential for serious safety issues.✔✔A nurse works on the postoperative floor and has four clients who are being discharged tomorrow. Which one has the greatest need for the nurse to consult other members of the health care team for post-discharge care?

• Married young adult who is the primary caregiver for children
• Middle-aged client who is post knee replacement, needs physical therapy
• Older adult who lives at home despite some memory loss
• Young client who lives alone, has family and friends nearby

ANS: A

Anxiety can interfere with learning and cooperation. The nurse should assess the client for anxiety.The other actions are appropriate too, and can be included in the teaching plan, but effective teaching cannot occur if the client is highly anxious. ✔✔A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best?

• Assess the client for anxiety.
• Break the information into smaller bits.
• Give the client written information.
• Review the information again.

ANS: C

A potassium of 2.9 mEq/L is critically low and can affect cardiac and respiratory status. The nurse should communicate this laboratory value immediately. The creatinine is at the high end of normal, the hemoglobin is normal, and the sodium is only slightly low (normal low being 136 mEq/L), so these values do not need to be reported immediately. ✔✔A preoperative nurse is reviewing morning laboratory values on four clients waiting for surgery. Which result warrants immediate communication with the surgical team?

a. Creatinine: 1.2 mg/dL

b. Hemoglobin: 14.8 mg/dL

c. Potassium: 2.9 mEq/L

d. Sodium: 134 mEq/L

ANS: B

In order to give informed consent, the client needs sufficient information. Questions about potential complications should be answered by the surgeon. The nurse should notify the surgeon to come back and answer the client's questions before the client signs the consent form. The other actions are not appropriate. ✔✔An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best?

• Answer the questions and document that teaching was done.
• Do not have the client sign the consent and call the surgeon.
• Have the client sign the consent, then call the surgeon.
• Remind the client of what teaching the surgeon has done.

ANS: B

Splinting an incision provides extra support during coughing and activity and helps decrease pain.If the client is otherwise comfortable, no more analgesia is required. Shallow breathing can lead to atelectasis and pneumonia. The client should know some pain is normal and expected after surgery, but that answer alone does not provide any interventions to help the client. ✔✔A client has a great deal of pain when coughing and deep breathing after abdominal surgery despite having pain medication. What action by the nurse is best?

• Call the provider to request more analgesia.
• Demonstrate how to splint the incision.
• Have the client take shallower breaths.
• Tell the client a little pain is expected.

ANS: B

The entire proposed surgical site needs to be washed thoroughly and completely with the antimicrobial soap. Shaving, if absolutely necessary, should be done in the operative suite immediately before the operation begins, using sterile equipment. The client needs a full shower or bath (shower preferred). The client should wash the surgical site last; dirty water from

shampooing will run over the cleansed site if the site is washed first. ✔✔A nurse is giving a client instructions for showering with special antimicrobial soap the night before surgery. What instruction is most appropriate?

• "After you wash the surgical site, shave that area with your own razor."
• "Be sure to wash the area where you will have surgery very thoroughly."
• "Use a washcloth to wash the surgical site; do not take a full shower or bath."
• "Wash the surgical site first, then shampoo and wash the rest of your body."

ANS: B

The priority client problem related to a surgical drain is the potential for infection. An insertion site that is free of redness, warmth, and drainage indicates that goals for this client problem are being met. The other assessments are normal, but not related to the drain. ✔✔A postoperative client has an abdominal drain. What assessment by the nurse indicates that goals for the priority client problems related to the drain are being met?

• Drainage from the surgical site is 30 mL less than yesterday.
• There is no redness, warmth, or drainage at the insertion site.
• The client reports adequate pain control with medications.
• Urine is clear yellow and urine output is greater than 40 mL/hr.

ANS: B

A back rub reduces anxiety and can be delegated to the UAP. Once teaching has been done, the UAP can remind the client to turn, but this is not related to relieving anxiety. Assessing anxiety and teaching are not within the scope of practice for the UAP. ✔✔A client waiting for surgery is very anxious. What intervention can the nurse delegate to the unlicensed assistive personnel

(UAP)?

• Assess the client's anxiety.
• Give the client a back rub.
• Remind the client to turn.
• Teach about postoperative care.

ANS: C