ATI Caring for the Surgical Client Assessment

A transplant nurse is part of a multidisciplinary care team creating a documented plan of care for a client in need of a heart transplant. Which of the following standards of professional performance for transplant nursing is the nurse demonstrating by being part of the team? Collaboration A surgical nurse receives additional training to become a transplant nurse. When the nurse administers postoperative care to a transplant client for the first time, which element of care will be new for that nurse? Monitoring for signs of organ rejection A transplant nurse is providing care related to a client's kidney transplant. Which priority nursing action would be most likely to take place during the preoperative phase? Educating the client's caregivers about the transplant process. An experienced transplant nurse is describing the transplant nursing process to a student nurse. Which statement should the experienced nurse make? Transplant nursing is similar to other type of perioperative nursing. A nurse teaches a surgical client about breathing and relaxation exercises during the preoperative phase. Which of the following postoperative complications would breathing and relaxation exercises help? Pain A nurse is preparing a client scheduled for right knee arthroplasty surgery. Which of the following interventions should be the priority for the nurse to address to ensure client safety? Have the surgeon mark the surgical site. A nurse administers IV medication and reviews breathing and relaxation techniques with a client recovering from a mastectomy. Which element of postoperative care is the nurse performing? Managing postoperative pain. A nurse observes a client signing their informed consent for surgery. The client says to the nurse, “I am not sure why I have to have this surgery.” Which of the following actions should the nurse take first? Contact the provider and notify them that the informed consent process is not complete, then notify the perioperative staff that the surgery is on hold. A nurse is providing information to a client being admitted to the surgical clinic for a right knee arthroscopy. The nurse explains to the client that they will be receiving perioperative care. The client asks, "When does that care occur?" Which of the following statements made by the nurse is correct? Perioperative care occurs before, during, and after surgery. A nurse is using the SBAR communication tool when handing off a client to the PACU nurse. Which of the following sections of the tool is the nurse using when describing the client's comorbidities? Background A nurse is caring for a client in the PACU following a surgical procedure during which they received moderate sedation. Which of the following interventions should the nurse implement? Monitor level of consciousness A nurse is preparing a client for a surgical procedure. During which of the following timeframes should the nurse initiate the prescribed antibiotic to help decrease surgical site infections? 60 minutes before performing the surgical incision A nurse is caring for a client who is having a total abdominal hysterectomy. The nurse prepares to teach the surgical client about minimizing the pain and discomfort postoperatively. Which of the following priority instructions should the nurse give the client? Ensure the client understands splinting the incision and performing deep breathing exercises. A nurse is using the "I Pass the Baton" hand-off tool when transferring a client to the operating room. Which of the following steps of the tool should the nurse use when reporting the client has allergies to latex and penicillin? Safety A nurse is preparing to admit a client to an outpatient surgical center. Which of the following will assist in collecting data that can be used to plan care during the preoperative phase? Physical assessment A nurse is completing a preassessment for a surgical client. The nurse asks the client whether they or anyone in their family has a history of complications from anesthesia. Which of the following assessment findings is most concerning? Malignant hyperthermia A nurse transfers a client to the PACU postoperatively. During the hand-off report, the nurse states that, "Dr. Jones performed a bowel resection." Which of the following sections of the SBAR communication tool does this statement address? Situation A nurse is preparing a client for surgery when the client expresses how nervous and anxious they are about the surgery. Which of the following responses by the nurse would help initiate assessment of the client's need for further preoperative instruction? "Tell me what you have already been told about the surgery." A nurse documents how much solution is administered to a postoperative client intravenously, as well as how much output is collected in the client's catheter bag. Which of the following elements of postoperative care is the nurse directly performing? Maintain adequate fluid balance