Ch 17: Preoperative Care

Minimum fasting period for clear liquids (water, clear tea, black coffee, carbonated, fruit juice without pulp)

2 hours

Minimum fasting period for breast milk

4 hours

Minimum fasting period for light meal (toast and clear liquids)

6 hours

P6

A declared brain-dead patient whose organs are being removed for donor purposes

P5

A moribund patient who is not expected to survive without the operation

P2

A patient with mild systemic disease

P3

A patient with severe systemic disease

The nurse is working on a surgical floor and is preparing to receive a postoperative patient from the postanesthesia care unit (PACU). What should the nurse's initial action be upon the patient's arrival? Assess the patient's pain. Assess the patient's vital signs. Check the rate of the IV infusion. Check the physician's postoperative orders.

B The highest priority action by the nurse is to assess the physiologic stability of the patient. This is accomplished in part by taking the patient's vital signs. The other actions can then take place in rapid sequence.

-ostomy

creation of opening into

-lysis

destruction

-plasty

repair or reconstruction of

-orrhaphy

repair or suture of

arnica is a homeopathic remedy useful in:

soft tissue repair

multivitamins can be taken until when before surgery?

the day before

Minimum fasting period for nonhuman milk, including infant formula

6 hours

Minimum fasting period for regular meal

8 or more hours

A 17-year-old patient with a leg fracture who is scheduled for surgery is an emancipated minor. She has a statement from the court for verification. Which intervention is MOST appropriate? a. Witness the permit after consent is obtained by the surgeon. b. call a parent or legal guardian to sign the permit, since the patient is under 18 c. obtain verbal consent, since written consent is not necessary for emancipated minors. d. investigate your state's nurse practice act related to emancipated minors and informed consent.

A An emancipated minor may sign his or her own permit. The nurse should be available to witness the signature, but no further action is required.

A patient who normally takes 40 units of glargine insulin (long activing) at bedtime asks the nurse what to do about her dose the night before surgery. the BEST response would be to have her a. skip her insulin altogether the night before surgery b. get instructions from her surgeon or HCP on any insulin adjustments c. take her usual dose at bedtime and eat a light breakfast in the morning d. eat a moderate meal before bedtime and then take half her usual insulin donse

B Insulin is not usually omitted completely. The patient should obtain instructions from her HCP or surgeon about any dosage adjustments that she should make the day before and the morning of surgery (if applicable).

When reviewing the preoperative forms, the nurse notices that the informed consent form is not present or signed. What is the best action for the nurse to take? A. Have the patient sign the consent form. B. Have the family sign the form for the patient. C. Call the surgeon to obtain consent for surgery. D. Teach the patient about the surgery and get verbal permission.

C. Call the surgeon to obtain consent for surgery. The informed consent for the surgery must be obtained by the physician. The nurse can witness the signature on the consent form and verify that the patient (or caregiver if patient is a minor, unconscious, or mentally incompetent to sign) understands the informed consent. Verbal consents are not enough. The state's nurse practice act and agency policies must be followed.

A patient undergoing an emergency appendectomy has been using St. John's wort to prevent depression. Which complication would the nurse expect in the postanesthesia care unit? a. Increased pain b. Hypertensive episodes c. Longer time to recover from anesthesia d. Increased risk for postoperative bleeding

C. Longer time to recover from anesthesia

A priority nursing intervention to assist a preoperative patient in coping with fear of postoperative pain would be to a. inform the patient that pain medication will be available b. teach the patient to use guided imagery to help manage pain c. describe the type of pain expected with the patient's particular surgery d. explain the pain management plan, including the use of a pain rating scale

D If a patient has fear of pain and discomfort after surgery, the nurse should reassure the patient that a pain management plan will be in place. The nurse should teach the patient to ask for medications after surgery when pain is present and assure him or her that taking these medications will not contribute to an addiction. The nurse should instruct the patient on the use of some form of pain rating scale (e.g., 0 to 10, FACES) and to request pain medication before the pain becomes severe.

At 0600, the anesthesiologist prescribes preoperative medications for a patient who is scheduled for surgery at 0730: cefazolin IV to be infused 30 minutes before surgery; midazolam before surgery, and scopolamine patch behind the ear. Which medication should the nurse administer first? A. Cefazolin B. Fentanyl C. Midazolam D. Scopolamine

D. Scopolamine The scopolamine patch will be administered first to allow enough time for the serum level to become therapeutic. The cefazolin will be given at 0700 to allow infusion 30 minutes before surgery. Fentanyl is an opioid and was not ordered preoperatively. Midazolam, a short-acting benzodiazepine, is used as a sedative.

A nurse is caring for an unconscious patient who has just been admitted to the postanesthesia care unit after abdominal hysterectomy. How should the nurse position the patient? Left lateral position with head supported on a pillow Prone position with a pillow supporting the abdomen Supine position with head of bed elevated 30 degrees Semi-Fowler's position with the head turned to the right

A An unconscious patient should be placed in the lateral "recovery" position to keep the airway open and reduce the risk of aspiration. When conscious, the patient is usually returned to a supine position with the head of the bed elevated to maximize expansion of the thorax by decreasing the pressure of the abdominal contents on the diaphragm.

In planning postoperative interventions to promote repositioning, ambulation, coughing, and deep breathing, which action should the nurse recognize will best enable the patient to achieve the desired outcomes? Administering adequate analgesics to promote relief or control of pain Asking the patient to demonstrate the postoperative exercises every 1 hour Giving the patient positive feedback when the activities are performed correctly Warning the patient about possible complications if the activities are not performed

A Even when a patient understands the importance of postoperative activities and demonstrates them correctly, it is unlikely that the best outcome will occur unless the patient has sufficient pain relief to cooperate with the activities.

A 59-year-old man scheduled for a herniorrhaphy in 2 days reports that he takes ginkgo daily. What is the PRIORITY intervention? a. inform the surgeon, since the procedure may have to be rescheduled. b. notify the anesthesia care provider, since this herb interferes with anesthetics c. ask the patient if he has noticed any side effects from taking this herbal supplement d. tell the patient to continue to take the herbal supplement up to the day before surgery

A Ginkgo can increase bleeding during and after surgery. The surgeon should determine how long it should be discontinued before surgery.

An overweight patient (BMI 28.1 kg/m2) is scheduled for a laparoscopic cholecystectomy at an outpatient surgery setting. The nurse knows that: a. surgery will involve multiple small incisions. b. This setting is not appropriate for this procedure. c. Surgery will involve removing a portion of the liver. d. The patient will need special preparation because of obesity.

A Many operative procedures are performed as ambulatory surgery (i.e., same-day or outpatient surgery). Obesity is not a contraindication to surgery in the outpatient setting. This patient is not classified as obese on the basis of the BMI. The case implied that a laparoscopic technique will be used that involves several small incisions and meets the requirement of a minimally invasive technique.

A postoperative patient has a bronchial obstruction resulting from retained secretions and an oxygen saturation of 87%. What condition does the nurse suspect is occurring? Atelectasis Bronchospasm Hypoventilation Pulmonary embolism

A The most common cause of postoperative hypoxemia is atelectasis, which may be the result of bronchial obstruction caused by retained secretions or decreased respiratory excursion. Bronchospasm involves the closure of small airways by increased muscle tone, whereas hypoventilation is marked by an inadequate respiratory rate or depth. Pulmonary emboli do not involve blockage by retained secretions.

The nurse is providing discharge teaching to a patient who has had a laparoscopic cholecystectomy at an ambulatory surgery center. Which statement, if made by the patient, indicates an understanding of the discharge instructions? "I will have someone stay with me for 24 hours in case I feel dizzy." "I should wait for the pain to be severe before taking the medication." "Because I did not have general anesthesia, I will be able to drive home." "It is expected after this surgery to have a temperature up to 102.4º F."

A The nurse must assess understanding of discharge instructions and the ability of the patient and caregiver to provide for home care needs. A responsible adult caregiver must accompany the patient. The patient may not drive after receiving anesthetics or sedatives. The patient should understand how to manage pain, and pain medication should be taken before the pain becomes severe. The patient should understand symptoms to be reported, such as a fever.

P4

A patient with severe systemic disease that is a constant threat to life

A patient had surgery at an ambulatory surgery center. Which criteria support that this patient is ready for discharge (select all that apply.)? Vital signs baseline or stable Minimal nausea and vomiting Wants to go to the bathroom at home Responsible adult taking patient home Comfortable after IV opioid 15 minutes ago

A, B, D Ambulatory surgery discharge criteria includes meeting phase I PACU discharge criteria that includes vital signs baseline or stable and minimal nausea and vomiting. Phase II criteria include a responsible adult driving patient, no IV opioid drugs for the past 30 minutes, able to void, able to ambulate if not contraindicated, and received written discharge instruction with patient understanding confirmed.

An older adult patient is being prepared for surgery. What assessment data needs to be included for this patient (select all that apply.)? A. Fluid balance history B. Attitude about surgery C. Foods the patient dislikes D. Current mobility problems E. Current cognitive function F. Patient's opinion about the surgeon

A, D, E Preoperative fluid balance history is especially critical for older adults because they have reduced adaptive capacity that puts them at greater risk for over- and underhydration. Mobility problems must be assessed to assist with intraoperative and postoperative positioning and ambulation. Preoperative assessment of the older person's baseline cognition function is especially crucial for intraoperative and postoperative evaluation because they are more prone to adverse outcomes during and after surgery from the stressors of the surgery, dehydration, hypothermia, and anesthesia. Attitude about surgery and opinion or faith in the surgeon are important for all patients. Foods the patient dislikes are not important unless the patient is allergic to them, but this is no more important for older patients than it is for all patients.

A patient scheduled for an elective hysterectomy tells the nurse, "I am afraid that I will die in surgery like my mother did!" Which response by the nurse is most appropriate? a. "Tell me more about what happened to your mother." b. "You will receive medications to reduce your anxiety." c. "You should talk to the doctor again about the surgery." d. "Surgical techniques have improved a lot in recent years."

A. "Tell me more about what happened to your mother."

A patient with a recent diagnosis of prostate cancer is scheduled for a radical prostatectomy. Before signing the consent, the patient tells the nurse, "I am not sure if this surgery is safe." Which response by the nurse is the most appropriate? A. "Tell me what you know about your surgery and the risks involved." B. "Any surgery has risks, but we will be here to take good care of you." C. "You seem anxious. After you sign the consent, I can give you a sedative." D. "You do not need to be concerned. Your surgeon has not had any complaints."

A. "Tell me what you know about your surgery and the risks involved." The health care provider performing the surgery is responsible for obtaining the patient's consent. The nurse may witness the patient's signature on the consent form. As a patient advocate, the nurse should verify that the patient understands the surgery and the risks involved. If the nurse determines that the patient is unclear about operative plans, the nurse should contact the health care provider about the patient's need for more information. The other options provide false reassurance or do not respond to the patient's concern.

An alert patient does not want to have a tracheostomy inserted because of extended endotracheal intubation, although family members state that they want it done. What is the best action for the nurse to take? A. Advocate for the patient's rights. B. Try to change the patient's mind. C. Call surgery to cancel the procedure. D. Tell the family they cannot interfere.

A. Advocate for the patient's rights. The nurse must act as the patient's advocate and assist the patient with fulfilling his wishes. However, as the patient's advocate, the nurse must be sure he knows the risks and benefits of refusing a tracheostomy. Trying to change the patient's mind is unethical because it is contrary to acting as an advocate. As long as the patient is lucid, he retains the right of self-determination. Canceling the procedure is not indicated until discussion with the patient and surgeon has occurred. Telling the family they cannot interfere can aggravate or escalate the situation.

The patient is having a mole removed that has changed appearance. What does the nurse teach the patient about the rationale for this surgical procedure? A. It is to prevent malignancy. B. It is to alleviate symptoms. C. It is to cure the malignancy. D. It is to provide cosmetic improvement.

A. It is to prevent malignancy. Removing a mole that is changing is to prevent as well as diagnose malignancy. There are no symptoms to alleviate mentioned or cosmetic problems for this patient.

Five minutes after receiving a preoperative sedative medication by IV injection, a patient asks to get up to go to the bathroom to urinate. What is the most appropriate action for the nurse to take? A. Offer the patient to use a urinal or bedpan after explaining the need to maintain safety. B. Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. C. Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes. D. Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room.

A. Offer the patient to use a urinal or bedpan after explaining the need to maintain safety. The prime issue after administration of either sedative or opioid analgesic medications is safety. Because the medications affect the central nervous system, the patient is at risk for falls and should not be allowed out of bed, even with assistance. The other options would not be safe for the patient.

A patient arrives at the ambulatory surgery center for a scheduled laparoscopy procedure in outpatient surgery. Which information is of most concern to the nurse? a. The patient is planning to drive home after surgery. b. The patient had a sip of water 4 hours before arriving. c. The patient's insurance does not cover outpatient surgery. d. The patient has not had surgery using general anesthesia before.

A. The patient is planning to drive home after surgery.

A patient who is scheduled for a therapeutic abortion tells the nurse, "Having an abortion is not right." Which functional health pattern should the nurse further assess? a. Value-belief b. Cognitive-perceptual c. Sexuality-reproductive d. Coping-stress tolerance

A. Value-belief

The nurse is caring for a Native American patient 2 days after a thoracotomy for tumor resection. What would be the most appropriate action if the patient does not report any pain? Contact the health care provider. Identify possible reasons for denial of pain. Administer the prescribed pain medication. Assess the renal and liver function test results.

B Encourage older adults to report pain, especially those who are reluctant to discuss pain or deny pain when it is likely present, such as after surgery. Older patients may be hesitant to request pain medication, believe pain is an inevitable consequence of surgery, and may not understand how to use patient-controlled machines. Some cultures discourage the expression of pain. The nurse should encourage the use of analgesics, explaining to the patient that untreated pain has a negative effect on recovery. Assessment of pain and administration of medications are within the scope of practice of a nurse. An older patient may have decreased renal and liver function that may lead to drug toxicity. However, this would not be a reason for denial of pain. Administration of pain medication must be based on the patient assessment.

A patient having abdominal surgery had an estimated blood loss of 400 mL and received 300 mL of 0.9% normal saline. Postoperatively, the patient's blood pressure is 70/48 mm Hg. What treatment does the nurse anticipate administering? Blood administration IV fluid administration An ECG to check circulatory status Return to surgery to check for internal bleeding

B The nurse should anticipate restoring circulating volume with IV infusion. Although blood could be used to restore circulating volume, there are no manifestations in this patient indicating a need for blood administration. An ECG may be done if there is no response to the fluid administration, there is a past history of cardiac disease, or cardiac problems were noted during surgery. Returning to surgery to check for internal bleeding would only be done if patient's level of consciousness changes or the abdomen becomes firm and distended.

The patient tells the nurse in the preoperative setting that she has noticed she has a reaction when wearing rubber gloves. What is the MOST appropriate intervention? a. Notify the surgeon so that the case can be cancelled. b. ask additional questions to assess for a possible latex allergy c. notify the OR staff immediately so that latex-free supplies can be used. d. no intervention Is needed because the patient's rubber sensitivity has no bearing on surgery

B The nurse should ask additional screening questions to determine the patient's risk for a latex allergy. Latex precaution protocols should be used for patients identified as having a positive latex allergy test result or a history of signs and symptoms related to latex exposure. Many health care facilities have created latex-free product carts that can be used for patients with latex allergies.

The nurse is positioning a patient after a surgical procedure. What is the best position unless contraindicated, for this patient to be placed in to prevent respiratory complications? Supine Lateral Semi-Fowler's High-Fowler's

B Unless contraindicated by the surgical procedure, an unconscious patient is positioned in a lateral "recovery" position. This recovery position keeps the airway open and reduces the risk of aspiration if the patient vomits. Once conscious, the patient is usually returned to a supine position with the head of the bed elevated.

A patient who has never had any prior surgeries tells the nurse doing the preoperative assessment about an allergy to bananas and avocados. Which action is most important for the nurse to take? a. Notify the dietitian about the food allergies. b. Alert the surgery center about a possible latex allergy. c. Reassure the patient that all allergies are noted on the medical record. d. Ask whether the patient uses antihistamines to reduce allergic reactions.

B. Alert the surgery center about a possible latex allergy.

The nurse is providing preoperative teaching to a group of patients. To which patient should the nurse plan to teach coughing and deep breathing exercises? A. A 20-yr-old man who is scheduled for a tonsillectomy B. A 40-yr-old woman who is scheduled for an open cholecystectomy C. A 30-yr-old woman who is scheduled for a transsphenoidal hypophysectomy D. A 50-yr-old man who is scheduled for an evacuation of a subdural hematoma

B. A 40-yr-old woman who is scheduled for an open cholecystectomy Patients with abdominal surgeries should be taught how to cough and deep breathe to prevent pulmonary complications such as atelectasis and pneumonia. Coughing and deep breathing is contraindicated in cranial surgeries (e.g., subdural hematoma evacuation or transsphenoidal hypophysectomy) and tonsillectomies.

Which preoperative patient has the greatest risk of bleeding as a result of prescribed medication? A. A woman who takes metoprolol for the treatment of hypertension B. A man who is taking clopidogrel after the placement of a coronary artery stent C. A man whose type 1 diabetes is controlled with insulin injections four times daily D. A man who recently started taking finasteride for the treatment of benign prostatic hyperplasia

B. A man who is taking clopidogrel after the placement of a coronary artery stent Any drug that inhibits platelet aggregation, such as clopidogrel, represents a bleeding risk. Insulin, metoprolol, and finasteride are less likely to contribute to a risk for bleeding.

Lorazepam (Ativan) 1 mg IV is ordered for a patient before surgery. What is the most appropriate action for the nurse to take before the administration of this medication? A. Ask the patient about an allergy to iodine or shellfish. B. Encourage or assist the patient to the bathroom to void. C. Explain that the medication is used to prevent postoperative nausea. D. Check the laboratory results for the most recent serum potassium level.

B. Encourage or assist the patient to the bathroom to void. The nurse should instruct the patient to void before administering preoperative medications that may interfere with balance and increase the fall risk when ambulating to the bathroom. Lorazepam is a benzodiazepine that may be used for sedation and amnesia before surgery. Lorazepam does not affect serum potassium, is not contraindicated in patients with allergies to iodine or shellfish, and is not indicated to prevent or treat nausea.

The nurse is admitting a patient to the same-day surgery unit and the patient informs the nurse they took kava last evening to sleep. Which nursing action would be most appropriate? A. Tell the patient that using kava to help sleep is often helpful. B. Inform the anesthesiologist of the patient's recent use of kava. C. Tell the patient that the kava should continue to help him relax before surgery. D. Inform the patient about the dangers of taking herbal medicines without consulting his health care provider.

B. Inform the anesthesiologist of the patient's recent use of kava. Kava may prolong the effects of certain anesthetics. Thus, the anesthesiologist needs to be informed of recent ingestion of this herbal supplement. Patients should not take anything before surgery without the health care provider's knowledge.

A patient informs the nurse prior to the surgical procedure that she is so nervous about the procedure and had to take a Xanax last night, but it did not relieve the anxiety. What is the priority action by the nurse? A. Review the surgery with the patient. B. Notify the anesthesia care provider (ACP). C. Administer another dose of alprazolam (Xanax). D. Tell the patient that everything will be okay with the surgery.

B. Notify the anesthesia care provider (ACP). In determining the psychologic status of the patient, the nurse notes the patient's anxiety. The nurse should notify the ACP after assessing the cause of the anxiety or fear the patient is experiencing. The patient may only need to talk about the surgery related to the situation, concerns with the unknown or body image, or past experiences to relieve the anxiety, but the nurse cannot assume that lack of knowledge is the cause of the anxiety. Medication administration will be prescribed by the ACP if needed, but medications can also be administered during surgery. Reassuring the patient is not taking the patient's needs into account.

The nurse is preparing to witness the patient signing the operative consent form when the patient says, "I do not really understand what the doctor said." Which action is best for the nurse to take? a. Provide an explanation of the planned surgical procedure. b. Notify the surgeon that the informed consent process is not complete. c. Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications. d. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.

B. Notify the surgeon that the informed consent process is not complete.

A 38-year-old female is admitted for an elective surgical procedure. Which information obtained by the nurse during the preoperative assessment is most important to report to the anesthesiologist before surgery? a. The patient's lack of knowledge about postoperative pain control measures b. The patient's statement that her last menstrual period was 8 weeks previously c. The patient's history of a postoperative infection following a prior cholecystectomy d. The patient's concern that she will be unable to care for her children postoperatively

B. The patient's statement that her last menstrual period was 8 weeks previously

In caring for the postoperative patient on the clinical unit after transfer from the PACU, which care can the nurse delegate to the unlicensed assistive personnel (UAP)? Monitor the patient's pain. Do the admission vital signs. Assist the patient to take deep breaths and cough. Change the dressing when there is excess drainage.

C The UAP can encourage and assist the patient to do deep breathing and coughing exercises and report complaints of pain to the nurse caring for the patient. The RN should do the admission vital signs for the patient transferring to the clinical unit from the PACU. The LPN or RN will monitor and treat the patient's pain and change the dressings.

When assessing a patient's surgical dressing on the first postoperative day, the nurse notes new, bright-red drainage about 5 cm in diameter. What is the priority action by the nurse? Recheck in 1 hour for increased drainage. Notify the surgeon of a potential hemorrhage. Assess the patient's blood pressure and heart rate. Remove the dressing and assess the surgical incision.

C The first action by the nurse is to gather additional assessment data to form a more complete clinical picture. The nurse can then report all of the findings. Continued reassessment will be done. Agency policy determines whether the nurse may change the dressing for the first time or simply reinforce it.

A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center. The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. What should the nurse do first? a. tell the patient ot come back tomorrow, since he at a meal. b. proceed with the preoperative checklist, including site identification. c. notify the anesthesia care provider of when and what the patient last ate. d. have the patient void before administering any preoperative medications

C The nothing-by-mouth (NPO) protocol of each surgical facility should be followed. Restriction of fluids and food is designed to minimize the potential risk of pulmonary aspiration and to decrease the risk of postoperative nausea and vomiting. If a patient has not followed the NPO instructions, surgery may be delayed or cancelled. The nurse should notify the anesthesia care provider immediately.

A patient is admitted to the postanesthesia care unit (PACU) after abdominal surgery. Which assessment, if made by the nurse, is the best indicator of respiratory depression? Increased respiratory rate Decreased oxygen saturation Increased carbon dioxide pressure Frequent premature ventricular contractions (PVCs)

C Transcutaneous carbon dioxide pressure (PtcCO2) monitoring is a sensitive indicator of respiratory depression. Increased CO2 pressures would indicate respiratory depression. Clinical manifestations of inadequate oxygenation include increased respiratory rate, dysrhythmias (e.g., premature ventricular contractions), and decreased oxygen saturation.

Preoperative considerations for older adults include (select all that apply) a. only using large-print educational materials b. speaking louder for patients with hearing aids c. recognizing that sensory deficits may be present d. providing warm blankets to prevent hypothermia e. teaching important information early in the morning

C, D Many older adults have sensory deficits. Preoperative and operating rooms are cool; warm blankets should be provided as needed.

While performing preoperative teaching, the patient asks when he is no longer able to eat or drink. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, what is the best response by the nurse? A. "Stay NPO after midnight." B. "Maintain NPO status until after breakfast." C. "You may drink clear liquids up to 2 hours before surgery." D. "You may drink clear liquids up until she is moved to the OR."

C. "You may drink clear liquids up to 2 hours before surgery." Practice guidelines for preoperative fasting state the minimum fasting period for clear liquids is 2 hours. Evidence-based practice no longer supports the long-standing practice of requiring patients to be NPO after midnight.

A patient requests that the nurse give his hearing aid to a family member so it will not be lost in surgery. What is the appropriate action by the nurse? A. Give the hearing aid to the wife as he wishes. B. Tape the hearing aid to his ear to prevent loss. C. Encourage the patient to wear it for the surgery. D. Tell the surgery nurse that he has his hearing aid out.

C. Encourage the patient to wear it for the surgery. Although jewelry is removed before surgery, hearing aids should be left in place to allow the patient to better follow instructions given in the surgical suite and the postanesthesia care unit (PACU), as well as the dismissal instructions that will be given before he returns home for recovery.

The nurse is doing a preoperative assessment on a male patient who has type 2 diabetes mellitus; weighs 146 kg; and is 5 feet 8, inches tall. Which patient assessment is a priority related to anesthesia? A. Has hemoglobin A1C of 8.5% B. Has several seasonal allergies C. Has a body mass index of 48.8 kg/m2 D. Has a history of postoperative vomiting

C. Has a body mass index of 48.8 kg/m2 The patient's body mass index is the priority because it indicates the patient is severely obese. The patient's size may impair the anesthesiologist's ability to ventilate and medicate the patient properly, as well as the surgery room staff's ability to position the patient safely. The other factors are not the priority.

A nurse is assigned to provide preoperative teaching to a patient scheduled for coronary artery bypass surgery who only speaks Spanish. What is the best method for the nurse to teach the patient how to use an incentive spirometer? A. Give the patient a pamphlet written in Spanish with directions on the use of the incentive spirometer. B. Ask another Spanish-speaking patient in the preoperative area to translate as the nurse describes the procedure. C. Have the hospital interpreter available while the nurse demonstrates the procedure and the patient returns the demonstration. D. Notify the postoperative unit to have a Spanish-speaking nurse provide teaching on the incentive spirometer after surgery.

C. Have the hospital interpreter available while the nurse demonstrates the procedure and the patient returns the demonstration. If the patient does not speak English, it is essential that the services of a competent interpreter be obtained. Hospitals are required to provide interpreters for common languages other than English. Demonstration and return demonstration is the most effective teaching method for use of equipment such as the incentive spirometer and should be done in the preoperative period if possible.

The nurse is performing a preoperative assessment for a patient scheduled for a surgical procedure. What is the rationale for the nurse's careful documentation of the patient's current medication list? A. Some medications may alter the patient's perceptions about surgery. B. Many anesthetics alter renal and hepatic function, causing toxicity of other drugs. C. Some medications may interact with anesthetics, altering the potency and effect of the drugs. D. Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery.

C. Some medications may interact with anesthetics, altering the potency and effect of the drugs. Drug interactions may occur between prescribed medications and anesthetic agents used during surgery. For this reason, it is important to take a careful medication history and check that it has been communicated to the anesthesia care provider. Routine medications may or may not be prescribed for use the day of surgery.

A patient is having elective cosmetic surgery performed on the face and will be staying in the facility for 24 hours after surgery. What is the nurse's postoperative priority for this patient? Manage patient pain. Control the bleeding. Maintain fluid balance. Manage oxygenation status.

D The nurse's priority is to manage the patient's oxygenation status by maintaining an airway and ventilation. With surgery on the face, there may be swelling that could compromise her ability to breathe. Pain, bleeding, and fluid imbalance from the surgery may increase her risk for upper airway edema causing airway obstruction and respiratory suppression, which also indicate managing oxygenation status as the priority.

The nurse in an ambulatory surgery center has administered the following preoperative medications to a patient scheduled for general surgery: diazepam, cefazolin, and famotidine. What mode of transportation to the operating room (OR) would be the most appropriate for the nurse to arrange for this patient? A. Seated in a wheelchair accompanied by a responsible family member B. Ambulatory and accompanied by a hospital escort and a family member C.Stretcher with side rails up and accompanied by OR transportation personnel D. Ambulatory accompanied by an OR staff member or transportation personnel

C. Stretcher with side rails up and accompanied by OR transportation personnel The patient has received a sedative (diazepam) and should be transported either by stretcher (with side rails raised) or wheelchair and accompanied by either OR staff, OR transport personnel, or the nurse.

An older adult patient who had surgery is displaying manifestations of delirium. What priority action would benefit this patient? Check the chart for intraoperative complications. Check which medications were used for anesthesia. Check the effectiveness of the analgesics received. Check the preoperative assessment for previous delirium or dementia.

D If the patient's ABCs are okay, it is important to first know if the patient was mentally alert without cognitive impairments before surgery. Then intraoperative complications, anesthesia medications and pain will be assessed as these can all contribute to delirium.

Which patient would be at highest risk for hypothermia after surgery? A 42-yr-old patient who had a laparoscopic appendectomy A 38-yr-old patient who had a lumpectomy for breast cancer A 20-yr-old patient with an open reduction of a fractured radius A 75-yr-old patient with repair of a femoral neck fracture after a fall

D Patients at highest risk for hypothermia are those who are older, debilitated, or intoxicated. Also, long surgical procedures and prolonged anesthetic administration increase the patient's risk for hypothermia.

The patient donated a kidney, and early ambulation is included in the plan of care, but the patient refuses to get up and walk. What rationale should the nurse explain to the patient for early ambulation? "Early walking keeps your legs limber and strong." "Early ambulation will help you be ready to go home." "Early ambulation will help you get rid of your syncope and pain." "Early walking is the best way to prevent postoperative complications."

D The best rationale is that early ambulation will prevent postoperative complications that can then be discussed. Ambulating increases muscle tone, stimulates circulation that prevents venous stasis and venous thromboembolism, speeds wound healing, and increases vital capacity and maintains normal respiratory function. These things help the patient be ready for discharge, but early ambulation does not eliminate syncope and pain. Pain management should always occur before walking.

An older adult patient has been admitted before having surgery for a bilateral mastectomy and breast reconstruction. What should the nurse include in the patient's preoperative teaching (select all that apply.)? A. Information about various options for reconstructive surgery B. Information about the risks and benefits of her particular surgery C. Information about risk factors for breast cancer and the role of screening D. Information about where in the hospital she will be taken postoperatively E. Information about performing postoperative deep-breathing and coughing exercises

D, E During preoperative teaching, it is important to introduce the role of deep-breathing and coughing exercises and to inform the patient about the different locations involved in her hospital stay. The specific risks and benefits of her surgery and reconstruction options should be addressed by her surgeon. Teaching about breast cancer screening would be inappropriate, and likely insensitive, at this point in her disease trajectory.

The nurse obtains a health history from a patient who is scheduled for elective hip surgery in 1 week. The patient reports use of garlic and ginkgo biloba. Which action by the nurse is most appropriate? a. Ascertain that there will be no interactions with anesthetic agents. b. Teach the patient that these products may be continued preoperatively. c. Advise the patient to stop the use of all herbs and supplements at this time. d. Discuss the herb and supplement use with the patient's health care provider.

D. Discuss the herb and supplement use with the patient's health care provider.

An older adult female patient has come to the ambulatory surgery center for surgery. When reviewing the assessment record, what test should the nurse seek an order for before this patient has surgery? Assessment Record: Past Health History Laboratory and Diagnostic Results Medications Smoker for past 25 years (last cigarette yesterday) Has hypertension CBC within normal limits Chest x-ray clear UA within normal limits No other lab work drawn Takes hydrochlorothiazide 50 mg every morning A. Blood glucose B. Pregnancy test C. Serum albumin D. Serum potassium

D. Serum potassium The nurse should seek a serum potassium level because the patient takes hydrochlorothiazide. An ECG would also be appropriate to seek with the history of hypertension and cigarette smoking. There are not indications for the need of a blood glucose, pregnancy, or serum albumin test..

-oscopy

looking into

common antiemetics preop

metoclopramide (Reglan) - increase gastric emptying ondansetron (Zofran) - prevent nausea and vomiting

common benzodiazepines given preop

midazolam diazepam (Valium) lorazepam (Ativan) All decrease anxiety, induce sedation, amnesic effects

P1

normal health patient

common anticholinergics given preop

atropine - decrease oral/resp secretions glycopyrrolate (Robinul) - decrease oral/resp secretions scopolamine - prevent nausea and vomiting

-otomy

cutting into or incision of

-ectomy

excision, removal

Common Histamine 2 Receptor Antagonists given preop

famotidine (Pepcid) ranitidine (Zantac) All decrease HCl acid secretion, increase pH, decrease gastric volume