Postoperative Management Exam (PREP U)
A client had a nephrectomy 2 days ago and is now complaining of abdominal pressure
and nausea. The first nursing action should be to:
Auscultate bowel sounds.
-If abdominal distention is accompanied by nausea, the nurse must first auscultate
bowel sounds. If bowel sounds are absent, the nurse should suspect gastric or small
intestine dilation and these findings must be reported to the physician. Palpation should
be avoided postoperatively with abdominal distention. If peristalsis is absent, changing
positions and inserting a rectal tube won't relieve the client's discomfort.
When the surgeon performs an appendectomy, the nurse recognizes that the surgical
category will be identified as
Clean-contaminated.
-Clean-contaminated cases are those with a potential, limited source for infection, the
exposure to which, to a large extent, can be controlled. Clean cases are those with no
apparent source of potential infection. Contaminated cases are those that contain an
open and obvious source of potential infection. A traumatic wound with foreign bodies,
fecal contamination, or purulent drainage would be considered a dirty case.
The nursing assessment of the postoperative client reveals an incision that is well-
approximated with sutures intact, minimal redness and edema, and absence of
drainage. The nurse recognizes the wound is healing by:
First intention
-First-intention healing is characterized by a closed incision with little tissue reaction and
the absence of signs and symptoms of infection.
When should the nurse encourage the postoperative patient to get out of bed?
As soon as it's indicated.
-Postoperative activity orders are checked before the patient is assisted to get out of
bed, in many instances, on the evening following surgery. Sitting up at the edge of the
bed for a few minutes may be all that the patient who has undergone a major surgical
procedure can tolerate at first.
The nurse determines that a patient has postoperative abdominal distention. What does
the nurse determine that the distention may be directly related to?
A temporary loss of peristalsis and gas accumulation in the intestines.
,-Any postoperative patient may suffer from distention. Postoperative distention of the
abdomen results from the accumulation of gas in the intestinal tract. Manipulation of the
abdominal organs during surgery may produce a loss of normal peristalsis for 24 to 48
hours, depending on the type and extent of surgery. Even though nothing is given by
mouth, swallowed air and GI tract secretions enter the stomach and intestines; if not
propelled by peristalsis, they collect in the intestines, producing distention and causing
the patient to complain of fullness or pain in the abdomen. Most often, the gas collects
in the colon. Abdominal distention is further increased by immobility, anesthetic agents,
and the use of opioid medications.
A nurse asks a client who had abdominal surgery 3 days ago if he has moved his
bowels since surgery. The client states, "I haven't moved my bowels, but I am passing
gas." How should the nurse intervene?
Encourage the client to ambulate at least three times per day.
-The nurse should encourage the client to ambulate at least three times per day.
Ambulating stimulates peristalsis, which helps the bowels to move. It isn't appropriate to
apply heat to a surgical wound. Moreover, heat application can't be initiated without a
physician order. A tap water enema is typically administered as a last resort after other
methods fail. A physician's order is needed with a tap water enema as well. Notifying
the physician isn't necessary at this point because the client is exhibiting bowel function
by passing flatus.
Which method of wound healing is one in which wound edges are not surgically
approximated and integumentary continuity is restored by granulation?
First-intention healing
Primary-intention healing
Third-intention healing
Second-intention healing
-When wounds dehisce, they will be allowed to heal by secondary intention. Primary or
first-intention healing is the method of healing in which wound edges are surgically
approximated and integumentary continuity is restored without granulating. Third-
intention healing is a method of healing in which surgical approximation of wound edges
is delayed and integumentary continuity is restored by bringing apposing granulations
together.
The client is experiencing nausea and vomiting following surgery. The nurse expects
the surgeon to order:
Propofol (Diprivan)
Warfarin (Coumadin)
Prednisone (Deltasone)
Ondansetron (Zofran)
, -It's used to treat nausea and vomiting.
The nurse is caring for a client who develops an evisceration. What nursing intervention
is most appropriate when an evisceration occurs in the surgical wound of a client who
has undergone surgery?
Place sterile dressings moistened with normal saline over the protruding organs and
tissues.
-If evisceration occurs, the nurse should place sterile dressings moistened with normal
saline over the protruding organs and tissues and should inform the physician. If wound
disruption is suspected, the nurse should place the client in a position that puts the least
strain on the operative area. Analgesics help reduce pain. Avoiding any movement will
not help recover from the wound evisceration.
What does the nurse recognize as one of the most common postoperative respiratory
complications in elderly patients?
Pneumonia
-Older patients recover more slowly, have longer hospital stays, and are at greater risk
for development of postoperative complications. Delirium, pneumonia, decline in
functional ability, exacerbation of comorbid conditions, pressure ulcers, decreased oral
intake, GI disturbance, and falls are all threats to recovery in the older adult (Tabloski,
2009; Tolson, Morley, Rolland, et al., 2011).
A nurse is caring for a client who underwent a skin biopsy and has three stitches in
place. This wound is healing by:
first intention.
third intention.
second intention.
fourth intention.
-Wounds with a small amount of tissue damage that are the result of procedures that
use sterile technique and that are properly closed, such as with stitches, heal by first
intention. Granulation tissue is generally not visible and scar formation is minimal.
Second intention healing occurs in infected wounds or wounds with edges that aren't
approximated. These wounds are usually packed with moist dressings. Third intention
healing occurs with deep wounds that aren't sutured together, resulting in a deep, wide
scar. There is no fourth intention of wound healing.
Which of the following terms refers to a protrusion of abdominal organs through the
surgical incision?
Evisceration
-Evisceration is a surgical emergency. A hernia is a weakness in the abdominal wall.
