Nokea
Splinting an incision is an intervention to accomplish what goal?
- A. Provide extra support during coughing
- B. Reduce the need for analgesia
- C. Prevent shallow breathing
- D. Explain that some pain is normal
Correct Answer: A
Rationale: 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.
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A nurse assesses a client in the preoperative holding area and finds brittle nails and hair, dry skin, and muscle wasting. What action by the nurse is best?
- A. Consult the surgeon about a postoperative dietitian referral
- B. Document the findings thoroughly in the client's chart
- C. Encourage the client to eat more after recovering from surgery
- D. Refer the client to Meals on Wheels after discharge
Correct Answer: A
Rationale: This client has signs of malnutrition, which can impact recovery from surgery. The nurse should consult the surgeon about prescribing a consultation with a dietitian in the preoperative period to optimize the client's nutritional status. Documenting findings is important but not sufficient alone. Encouraging the client to eat more may be helpful, but a professional nutritional assessment is needed. Meals on Wheels may not address immediate preoperative needs.
A client who collapsed during dinner in a restaurant arrives in the emergency department. The client is going to surgery to repair an abdominal aortic aneurysm. What medication does the nurse prepare to administer as a priority with this client?
- A. Hydrocodone (Vicodin)
- B. Lorazepam (Ativan)
- C. Metoclopramide (Reglan)
- D. Morphine sulfate (Morphine)
Correct Answer: C
Rationale: Metoclopramide (Reglan) increases gastric emptying, an important issue for this client who was eating just prior to the operation to reduce the risk of aspiration. The other drugs are appropriate for pain or anxiety management but are not the priority in this scenario.
A student nurse is caring for clients on the postoperative unit. The student asks the registered nurse why malnutrition can lead to poor surgical outcomes. What responses by the nurse are best?
- A. Malnourished clients will have fragile skin
- B. Malnourished clients always have other problems
- C. Many drugs are bound to protein in the body
- D. Poorer wound healing
- E. Weakness and fatigue are common in malnutrition
Correct Answer: A,C,D,E
Rationale: Malnutrition can lead to poorer surgical outcomes for several reasons, including fragile skin that might break down, altered pharmacokinetics due to protein binding, poorer wound healing, and weakness or fatigue that can interfere with recovery. Malnutrition is not always associated with other comorbidities.
The perioperative nurse manager and the postoperative unit manager are concerned about the increasing number of surgical infections in their hospital. What action by the managers is best?
- A. Audit charts to see if the Surgical Care Improvement Project (SCIP) outcomes were met
- B. Encourage staff on both units to provide peer pressure to adhere to hand hygiene policy
- C. Hold educational meetings with the nursing and surgical staff on infection prevention
- D. Monitor staff on both units for consistent adherence to established hand hygiene practices
Correct Answer: A
Rationale: The SCIP project contains core measures that are mandatory for all surgical clients and focuses on preventing infection, serious cardiac events, and venous thromboembolism. The managers should start by reviewing charts to see if the guidelines of this project were implemented. The other actions may be necessary too, but first the managers need to assess the situation.
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?
- A. Assess the client for anxiety
- B. Break the information into smaller bits
- C. Give the client written information
- D. Request the provider to repeat the information
Correct Answer: A
Rationale: 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.