Preoperative Care Evolve

The nurse is conducting a preoperative class for a group of older adults who are scheduled for hip replacement surgery. During the planning meeting for this class, which of the nurse's statements reflects a correct understanding of the older adult surgical patient?

"I will watch the participants for signs of excessive anxiety."

The nurse is preparing to administer a preoperative dose of cefazolin prior to an open cholecystectomy. What is the best explanation to the patient about why they are receiving this medication?

"It will prevent postoperative surgical-site infection."

The nurse is performing a preoperative assessment for a patient scheduled for surgery. What does the nurse explain to the patient is the reason for obtaining accurate documentation of the current medications being taken?

"Some medications may interact with anesthetics, altering the potency and effect of the drugs."

The nurse is preparing to give a dose of cefazolin 1.5 g intravenous piggyback (IVPB) to a patient before surgery. The vials available on the unit contain 500 mg in powder form. The instructions state to "dilute each 500 mg with 5 mL of sterile water." After reconstituting the medication, the nurse should draw up ____ total milliliters of solution for dosage preparation? Record your answer using a whole number.

15 ml

A nurse is preparing a patient for cataract surgery. The nurse needs to instill different eye drops into the patient's eyes. How many minutes should the nurse wait between each set of eye drops?

5 mins

A patient with an abdominal mass is scheduled for surgery today. Before the patient is admitted to the operating room, which preoperative documentation must be attached to the chart?

A complete physical examination

A patient with obesity (BMI 26.1 kg/m 2) is scheduled for a laparoscopic hernia repair at an outpatient surgery setting. What should the nurse be prepared for prior to the surgery?

Explain to the patient that surgery will use minimally invasive techniques.

A patient due for surgery expresses concern about choosing between ambulatory surgery and inpatient regular surgery. Which information should the nurse include when comparing ambulatory to inpatient surgery for the patient?

It involves minimal laboratory tests. It requires fewer preoperative medications. It reduces the risk of hospital-acquired infections.

Five minutes after the patient receives preoperative sedative medication by intramuscular (IM) injection, they ask to get up to go to the bathroom to urinate. What is the most appropriate action by the nurse?

Offer the patient a urinal and provide privacy.

A patient is scheduled for an appendectomy. During the preoperative assessment, the patient states they developed allergic skin rashes when exposured to rubber gloves when admitted to the hospital a few years ago. The nurse should review the patient's medical record for a history of what?

Reactions to latex

The nurse is preparing a patient for surgery. What nursing actions are important to carry out prior to surgery?

Remove jewelry in piercings if electrocautery devices will be used. Remove all prosthetics, including dentures, contact lenses, and glasses. Ascertain that the patient has an empty bladder before going to operating room. Remove cosmetics, nail polish, and artificial nails.

A patient is scheduled for knee replacement surgery. The patient states that 5 years ago their father died due to sudden cardiac arrest. What is the most appropriate action by the nurse?

Review the electrocardiogram of the patient.

The nurse is transporting a patient to the operating room. What concern should be the first priority for the nurse?

Safety of the patient

The nurse is to administer preoperative medications for a patient who is scheduled for surgery at 7:30: cefazolin intravenously (IV) to be infused 30 minutes before surgery, midazolam IV before surgery, and a scopolamine patch behind the ear. Which medication should the nurse administer first?

Scopolamine

An older adult female patient has come to the ambulatory surgery center for surgery. Based on the assessment record below, what test should the nurse obtain for the health care provider before this patient's surgery?

Serum potassium

The nurse is taking a detailed history preoperatively about a patient's medications. What is the highest priority regarding the patient's medication history?

Some medications are contraindicated for use with anesthetics.

A nurse is providing teaching about the risk of postoperative bleeding to a patient who is scheduled for surgery in two weeks. What information should the nurse include?

Stop taking herbal medicines; they may increase the risk of postoperative bleeding.

While performing preoperative teaching, the patient asks when to stop drinking water before the surgery. Based on the most recent practice guidelines established by the American Society of Anesthesiologists, what is the best response by the nurse?

The patient can drink clear liquids up to 2 hours before surgery.

The nurse is assessing a patient who is scheduled for an appendectomy and orders a serum potassium analysis. What is the reason for the nurse's action?

The patient is on diuretic therapy.

A patient has provided an informed consent for an elective tubal ligation under general anesthesia. The nurse recalls that the patient can revoke the consent for the surgery at what stage?

When the patient is partially informed Just before the scheduled surgery time After the patient has signed the consent form When the patient is in the preoperative holding area

The patient scheduled for a colectomy asks the nurse why cefazolin has been prescribed by the health care provider. What is the most appropriate response by the nurse?

"Cefazolin is being given for two days to prevent postoperative infection."

A patient with diabetes is waiting in the preoperative holding area for a hernia operation. The patient asks the nurse if the daily insulin dose should be taken. Which response is the most appropriate?

"I will check with the surgeon and let you know."

A patient is instructed not to have anything to eat or drink eight hours prior to surgery. When arriving to the preoperative holding area, the patient informs the nurse they ate eggs and toast about 2 hours ago. What is the best response by the nurse?

"I will inform the anesthesia care provider and surgeon to see what the options are."

A preoperative patient with suspected bowel obstruction asks why his or her dose of warfarin is being withheld. Which response by the nurse is most accurate?

"This medication could cause excessive bleeding during surgery if it is not stopped beforehand."

A public health nurse is advising a group of patients to regularly exercise and take multivitamin tablets. What should the nurse tell them about multivitamin use if they need a surgical intervention?

Multivitamin tablets can be taken until the day before surgery

The nurse is caring for a patient scheduled to undergo a coronary artery bypass graft (CABG). The patient reveals fearful feelings about the projected length of time off work, as the patient is the source of primary income for the family. What is the nurse's best course of action?

Consult a social worker to identify financial options for the patient.

A patient with Alzheimer's disease arrives via ambulance from a long-term care center to the preoperative area for placement of a feeding tube. The ambulance service hands the nurse a chart and states the nursing home did not obtain consent for the procedure. The patient is confused. What is the nurse's best course of action?

Contact the family member identified as the patient's power of attorney on the patient's medical record to obtain consent.

An older adult patient is undergoing preoperative assessment and teaching. What nursing interventions are appropriate during the education process?

Coordinate assessment with the team of health care providers. Speak slowly when giving preoperative instructions to the patient. Understand that the patient may have sensory and cognitive deficits.

As the nurse is preparing a patient for outpatient surgery, the patient wants to give the patient's hearing aid to the spouse so it will not be lost during surgery. Which action by the nurse should be taken in this situation?

Encourage the patient to wear it for the surgery.

A patient taking warfarin and digoxin for treatment of atrial fibrillation is instructed to discontinue the use prior to surgery. What should the nurse closely monitor this patient for?

Pulmonary embolism

A patient who normally takes an oral antidiabetic agent twice a day, at morning and at bedtime, asks the nurse what to do about the dose the morning of the surgery. What is the best response by the nurse?

Get instructions from the health care provider for any special instructions.

The nurse is administering a preoperative medication orally. What nursing action is appropriate when performing this intervention?

Give the medicine with a small sip of water.

The nurse is doing a preoperative assessment on a 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?

Has body mass index of 48.8

A patient is scheduled for surgery to repair a deviated nasal septum and is to have nothing by mouth (NPO) orders since midnight and now surgery is delayed for several hours. The patient tells the nurse, "I am very hungry and thirsty, and I have a headache because I missed my morning coffee." Which nursing actions are appropriate in this case?

Keep the patient apprised of the situation. Tell the anesthesia care provider about the situation.

The nurse is preparing several patients for surgical procedures. What patient should the nurse most closely monitor for bleeding as a result of medication being taken?

A man who is taking clopidogrel after the placement of a coronary artery stent

An alert patient needs a tracheostomy after being intubated for seven days with an endotracheal tube and cannot be weaned from the ventilator. The patient does not want the tracheostomy, but their family insists that the surgery be performed. What is the best action for the nurse to take?

Advocate for the patient's rights.

Five minutes after receiving a preoperative sedative medication by intravenous (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?

Allow the patient to use the urinal/bedpan after explaining the need to maintain safety.

The patient tells the nurse in the preoperative setting that they have noticed diffuse skin rashes when hospitalized in the past and have food allergies to bananas and avocados. What is the priority action by the nurse?

Ask additional questions to assess for a possible latex allergy.

The nurse is caring for a patient with valvular heart disease who is scheduled for surgery. Which preoperative medication does the nurse anticipate administering to prevent complications related to this condition?

Antibiotics

The nurse is preparing a patient for surgery when they state, "I am terrified to be put to sleep. What if I don't wake up?" What is the priority action by the nurse?

Inform the anesthesia care provider (ACP) so that he or she can talk further to the patient.

The nurse is admitting a patient to the same-day surgery unit and informs the nurse that they took kava last night to help them sleep. Which nursing action would be most appropriate?

Inform the anesthesiologist of the patient's recent use of kava.

A patient is scheduled for a prostatectomy in one week. During the preoperative meeting he reports that he takes a fish oil capsule daily. Which of the following is the priority intervention?

Inform the health care provider because the procedure may need to be rescheduled.

When completing a preoperative assessment before surgery, the nurse finds that the patient is taking the herb ginkgo. What is the most appropriate nursing action?

Inform the surgeon because the surgery would need to be rescheduled.

A patient who is being prepared for surgery tells the nurse: "I am afraid I may die during surgery without being able to confess my sins. I don't want to die without receiving absolution." Which action by the nurse would best meet this patients needs?

Inform the surgeon of the patient's fears and contact the appropriate religious leader to talk with the patient before surgery if possible.

A patient asks the nurse whether it is alright to take regularly scheduled insulin on the morning of surgery. What is the most appropriate nursing action?

Inform the surgeon of the patient's insulin use and ask whether the dose needs to be adjusted.

A patient gives consent for surgery to the surgeon and a nurse witnesses the consent. The patient then states they do not want to have the surgery. The patient has one adult child but no other immediate family. What action should the nurse take next?

Inform the surgeon.

A patient is scheduled for a gastrectomy. During the preoperative evaluation, the patient reports taking ginseng regularly. What should the nurse do?

Inform the surgeon.

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?

Information about where in the hospital she will be taken postoperatively Information about performing postoperative deep breathing and coughing exercises

A patient is scheduled for gastrointestinal surgery. Upon checking the patient's history, it is found that the patient is on long-term anticoagulation therapy. What action should the nurse take?

Instruct the patient to discontinue the anticoagulation therapy and expect to administer IV heparin during the perioperative period.

A patient is about to undergo surgery for the first time and reports anxiety and taking alprazolam at bedtime last night. The vital signs show blood pressure (BP) 158/88, heart rate (HR) 96, and respiratory rate (RR) 24. What is the priority action by the nurse?

Notify the anesthesia care provider (ACP).

The nurse asks the patient scheduled for a total hip replacement to sign the operative permit as directed in the health care provider's preoperative prescriptions. The patient states that the health care provider has not really explained what is involved in the surgical procedure. What is the most appropriate action by the nurse?

Notify the health care provider about the conversation with the patient and delay the signature.

When reviewing the preoperative forms, the nurse notices that the informed consent form is not signed. What is the best action for the nurse to take?

Notify the health care provider to obtain consent for surgery.

A nurse discusses pain medications when providing preoperative teaching to a patient. The patient asks the nurse about the effects of opioid medications. What should the nurse include in the explanation?

Opioids relieve pain during preoperative procedures. Opioids decrease intraoperative anesthetic requirements. Opioids decrease intraoperative pain.

The nurse is caring for a patient with renal dysfunction who is scheduled for surgery. What are the priority nursing interventions in this situation?

Order renal function test preoperatively. Report to perioperative team if the patient has a problem voiding.

The nurse is to administer preoperative antibiotics to a group of patients. What patients are determined to require this medication?

Patients undergoing gastrointestinal surgery Patients undergoing joint replacement surgery Patients with a history of valvular heart diseases

A school-age child is scheduled for a tonsillectomy. In the preoperative area, the child is crying and shaking. Which is the best nursing intervention by the nurse to decrease the child's preoperative anxiety?

Permit the parent to remain with the child until the child is taken to the operation suite.

An unconscious patient needs to undergo emergency surgery. There are no family members or friends available. What action should the nurse take regarding obtaining consent for the surgery?

Proceed with plans for surgery; consent is not required for a true medical emergency.

The patient who is a devout Catholic is having surgery the following day for a heart valve replacement. The patient voices general concern about the surgery. Which is the best method for the nurse to use to help decrease the patient's anxiety?

Provide web-based and audiovisual teaching materials about the surgery.

An older adult patient is admitted to the surgical unit for a right hemicolectomy. The nurse is concerned regarding the hydration status of this patient. What reason does the nurse have for this concern?

There is a narrow margin of safety between overhydration and underhydration in elderly patients.

The nurse is preparing a patient who is scheduled to undergo surgery in the morning. The patient states they will eat a garlic-saturated dinner since they won't be able to eat this favourite food for a while. What should the nurse inform the patient they may be at risk for?

The patient may experience excessive bleeding during the surgery.

A patient with a body mass index (BMI) of 45 is admitted for abdominal surgery. The nurse explains to the patient the potential complications of abdominal surgery caused by obesity. Which statements should the nurse include in the explanation?

The risk of wound infection is higher Anesthesia administration is more difficult. The risk of a postoperative incisional hernia may be higher.