Needs of the Perioperative Client

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Sample questions from Needs of the Perioperative Client

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 62-year-old client is in the preoperative holding area for a colectomy. The consent form is signed, but the client tells the nurse, "I thought the surgeon was removing a polyp, not part of my bowel." BP is 138/78 mm Hg and HR is 84/min. What should the nurse do first?

   • A.Explain the surgical technique and obtain a second signature
   • B.Pause preparation and notify the surgeon that the client needs clarification
   • C.Ask the client's spouse to confirm that the procedure was discussed
   • D.Administer the prescribed midazolam to reduce anxiety

   Rationale: The client's statement indicates that informed understanding may be absent, so the nurse should pause preparation and notify the surgeon. Explaining procedural risks and alternatives to obtain consent is the procedural provider's responsibility, and a spouse cannot substitute for a capable client's understanding. Midazolam could impair decision-making and should not precede resolution of the consent concern. A signed form does not replace informed, voluntary consent.

2. 2.A 45-year-old client arrives at an ambulatory surgery center for elective knee arthroscopy under general anesthesia. The client reports eating scrambled eggs and toast 2 hours ago; BP is 124/76 mm Hg and HR is 72/min. Which action is most appropriate?

   • A.Proceed because the meal did not contain meat
   • B.Give an antacid and continue the planned schedule
   • C.Notify the anesthesia professional and anticipate postponement
   • D.Induce vomiting before administering preoperative medications

   Rationale: Recent solid food intake increases aspiration risk, requiring notification of the anesthesia professional and likely postponement of elective surgery. Eggs and toast are not clear liquids, and an antacid does not empty the stomach. Inducing vomiting is unsafe and does not establish an acceptable fasting interval. Fasting violations require individualized anesthesia assessment rather than independent nursing clearance.

3. 3.A 70-year-old client scheduled for abdominal surgery takes metoprolol daily for coronary artery disease. In preoperative holding, BP is 132/74 mm Hg and HR is 68/min; the client has not taken today's dose. The medication orders direct continuation of the beta blocker. What should the nurse do?

   • A.Administer the prescribed dose with a small sip of water
   • B.Hold the medication because the client is fasting
   • C.Double the postoperative dose to replace the missed dose
   • D.Request replacement with an intravenous vasodilator

   Rationale: Chronic beta blockers are generally continued perioperatively when ordered and when assessment does not identify a contraindication. Fasting does not automatically prohibit essential medications with a small sip of water. Doubling a later dose risks bradycardia and hypotension, while a vasodilator is not an equivalent replacement. Reconcile chronic medications and follow individualized perioperative instructions.

4. 4.A 58-year-old client with type 2 diabetes is scheduled for elective hernia repair tomorrow. During a telephone assessment, the client reports taking empagliflozin this morning; glucose is 146 mg/dL, and the client feels well. Which instruction is most appropriate?

   • A.Continue the medication because the glucose is above normal
   • B.Take an extra dose tonight to prevent stress hyperglycemia
   • C.Skip breakfast tomorrow but otherwise follow the usual medication schedule
   • D.Contact the surgical and anesthesia teams today because the medication was not held sufficiently in advance

   Answer and rationale are in the full material.

5. 5.A 67-year-old client taking warfarin for atrial fibrillation arrives for elective hip arthroplasty. The INR is 3.1, platelets are 225,000/mm3, and there is no active bleeding. Which action should the preoperative nurse take?

   • A.Document that the platelet count permits surgery
   • B.Notify the surgical and anesthesia teams before the client proceeds
   • C.Administer the next warfarin dose with a sip of water
   • D.Prepare to give protamine sulfate

   Answer and rationale are in the full material.