Preoperative Chapter 17

Which information in the preoperative patient's medication history is most important to communicate to the health care provider? a. The patient takes garlic capsules every day. b. The patient quit using cocaine 10 years ago. c. The patient took a prescribed sedative the previous night. d. The patient uses acetaminophen (Tylenol) for aches and pains.

ANS: A Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome.

The nurse interviews a patient scheduled to undergo general anesthesia for a bilateral hernia repair. Which information is most important to communicate to the surgeon and anesthesiologist before surgery? a. The patient's father died after general anesthesia for abdominal surgery. b. The patient drinks 3 cups of coffee every morning before going to work. c. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago. d. The patient drank 4 ounces of apple juice 3 hours before coming to the hospital.

ANS: A The information about the patient's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.

The surgical unit nurse has just received a patient with a history of smoking from the postanesthesia care unit. Which action is most important at this time? a. Auscultate for adventitious breath sounds. b. Obtain the blood pressure and temperature. c. Remind the patient about harmful effects of smoking. d. Ask the health care provider to prescribe a nicotine patch.

ANS: A The nurse should first ensure a patent airway and check for breathing and circulation (airway, breathing, and circulation [ABCs]) in a responsive patient. Circulation and temperature can be assessed after a patent airway and breathing have been established. The immediate postoperative period is not the optimal time for patient teaching about the harmful effects of smoking. Requesting a nicotine patch may be appropriate but is not a priority at this time.

A patient who is scheduled for a therapeutic abortion tells the nurse, "Having an abortion is wrong." Which functional health pattern should the nurse further assess? a. Value-belief c. Sexuality-reproductive b. Cognitive-perceptual d. Coping-stress tolerance

ANS: A The value-belief pattern includes information about conflicts between a patient's values and proposed medical care. In the cognitive-perceptual pattern, the nurse will ask questions about pain and sensory intactness. The sexuality-reproductive pattern includes data about the impact of the surgery on the patient's sexuality. The coping-stress tolerance pattern assessment will elicit information about how the patient feels about the surgery.

A patient who has not had any prior surgeries tells the nurse doing the preoperative assessment about allergies to avocados and bananas. Which action is most important for the nurse to take? a. Notify the dietitian about the specific food allergies. b. Alert the surgery center about a possible latex allergy. c. Reassure the patient that all allergies are noted on the health record. d. Ask whether the patient uses antihistamines to reduce allergic reactions.

ANS: B Certain food allergies (e.g., eggs, avocados, bananas, chestnuts, potatoes, peaches) are related to latex allergies. When a patient is allergic to latex, special nonlatex materials are used during surgical procedures. The staff will need to know about the allergy in advance to obtain appropriate nonlatex materials and have them available during surgery. The other actions also may be appropriate, but prevention of allergic reaction during surgery is the most important action

The nurse is preparing to witness the patient signing the operative consent form when the patient says, "I don't understand what the doctor said about the surgery." Which action should the nurse take next? a. Provide a thorough explanation of the planned surgical procedure. b. Notify the surgeon that the informed consent process is not complete. c. Give the prescribed preoperative antibiotics and withhold sedative medications. d. Notify the operating room nurse to give a more complete explanation of the procedure.

ANS: B The surgeon is responsible for explaining the surgery to the patient. The nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurse's legal scope of practice to explain the surgical procedure. No preoperative medications should be given until the patient understands the surgical procedure and signs the consent form.

Which statement by a patient scheduled for surgery is most important to report to the health care provider? a. "I have a strong family history of cancer." b. "I had a heart valve replacement last year." c. "I had bacterial pneumonia 3 months ago." d. "I have knee pain whenever I walk or jog."

ANS: B A patient with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may affect whether the patient should have surgery, but a history of pneumonia is not a reason to postpone surgery. The patient's knee pain is the likely reason for the surgery. A family history of cancer does not have implications for the current surgery.

A patient arrives at the outpatient surgical center for a scheduled laparoscopy under general anesthesia. Which information requires the nurse's preoperative intervention to maintain patient safety? a. The patient has never had general anesthesia. b. The patient is planning to drive home after surgery. c. The patient had a sip of water 4 hours before arriving. d. The patient's insurance does not cover outpatient surgery.

ANS: B After outpatient surgery, the patient should not drive that day and will need assistance with transportation and home care. Clear liquids only require a minimum preoperative fasting period of 2 hours. The patient's experience with anesthesia and the patient's insurance coverage are important to establish, but these are not safety issues.

. A patient who has diabetes and uses insulin to control blood glucose has been NPO since midnight before having a knee replacement surgery. Which action should the nurse take? a. Withhold the usual scheduled insulin dose because the patient is NPO. b. Obtain a blood glucose measurement before any insulin administration. c. Give the patient the usual insulin dose because stress will increase the blood glucose. d. Give half the usual dose of insulin because there will be no oral intake before surgery.

ANS: B Preoperative insulin administration is individualized to the patient, and the current blood glucose will provide the most reliable information about insulin needs. It is not possible to predict whether the patient will require no insulin, a lower dose, or a higher dose without blood glucose monitoring.

Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for an open cholecystectomy? a. Care for the surgical incision b. Deep breathing and coughing c. Oral antibiotic therapy after discharge d. Medications to be used during surgery

ANS: B Preoperative teaching, demonstration, and re-demonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this information. The patient does not usually need information about medications that are used intraoperatively.

Five minutes after receiving the ordered preoperative midazolam by IV injection, the patient asks to get up to go to the bathroom to urinate. Which action by the nurse is most appropriate? a. Assist the patient to the bathroom. b. Offer the patient a urinal or bedpan. c. Ask the patient to wait until the drug has been fully metabolized. d. Tell the patient that a bladder catheter will be placed in the operating room.

ANS: B The patient will be at risk for a fall after receiving the sedative, so the best nursing action is to have the patient use a bedpan or urinal. Having the patient get up either with assistance or independently increases the risk for a fall. The drug is timed to be in effect during transportation to the operating room. The patient will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room.

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

ANS: B The patient's statement may indicate an unusually high anxiety level or a family history of problems such as malignant hyperthermia, which will require precautions during surgery. The other statements may also address the patient's concerns, but further assessment is needed first.

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 discomfort b. Increased blood pressure c. Increased anesthesia recovery time d. Increased postoperative wound bleeding

ANS: C St. John's wort may prolong the effects of anesthetic agents and increase the time to waken completely after surgery. It is not associated with increased bleeding risk, hypertension, or increased pain.

A 38-yr-old woman is admitted for an elective surgical procedure. Which information obtained by the nurse during the preoperative assessment is most important to communicate to the anesthesiologist and surgeon before surgery? a. The patient's lack of knowledge about postoperative pain control b. The patient's history of an infection following a cholecystectomy c. The patient's report that her last menstrual period was 8 weeks ago d. The patient's concern about being able to resume lifting heavy items

ANS: C This statement suggests that the patient may be pregnant and pregnancy testing is needed before administration of anesthetic agents. Although the other data may also be communicated with the surgeon and anesthesiologist, they will affect postoperative care and do not indicate a need for further assessment before surgery.

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. Teach the patient that these products may be continued preoperatively. b. Advise the patient to stop the use of herbs and supplements at this time. c. Discuss the herb and supplement use with the patient's health care provider. d. Reassure the patient that there will be no interactions with anesthetic agents

ANS: C Both garlic and ginkgo biloba increase the risk for bleeding. The nurse should discuss the herb and supplement use with the patient's health care provider. The nurse should not advise the patient to stop the supplements or to continue them without consulting with the health care provider and the anesthesia care provider.

The nurse is preparing a patient on the morning of surgery. The patient refuses to remove a wedding ring, saying, "I've never taken it off since the day I was married." Which response by the nurse is best? a. Have the patient sign a release form and leave the ring on. b. Tell the patient that the hospital is not liable for loss of the ring. c. Suggest that the patient give the ring to a family member to keep. d. Inform the operating room personnel that the patient is wearing a ring

ANS: C Jewelry is not allowed to be worn by the patient, especially if electrocautery will be used. Safety is the issue here. There is no need for a release form or to discuss liability with the patient.

The outpatient surgery nurse reviews the complete blood cell (CBC) count results for a patient who is scheduled for surgery. The results are white blood cell (WBC) count 10.2 103 /µL; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 103 /µL. Which action should the nurse take? a. Notify the surgeon and anesthesiologist immediately. b. Ask the patient about any symptoms of a recent infection. c. Continue to prepare the patient for the surgical procedure. d. Discuss the possibility of blood transfusion with the patient.

ANS: C The CBC count results are normal. With normal results, the patient can go to the holding area when the operating room is ready for the patient. There is no need to notify the surgeon or anesthesiologist, discuss blood transfusion, or ask about recent infection.

A patient who takes a diuretic and a -blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is most important to communicate to the health care provider before surgery? a. Hematocrit 36% c. Serum potassium 3.2 mEq/L b. Blood pressure 144/82 d. Pulse rate 54-58 beats/minute

ANS: C The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of anxiety. The lower heart rate would be expected in a patient taking a -blocker. The hematocrit is in the low normal range but does not require any intervention before surgery.

The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits. His wife answers most questions that are directed to the patient. Which action should the nurse take when doing the teaching? a. Use printed materials for instruction so that the patient will have more time to review the material. b. Direct all the teaching toward the wife because she is the obvious support and caregiver for the patient. c. Provide additional time for the patient to understand preoperative instructions and carry out procedures. d. Ask the patient's wife to wait in the hall in order to focus preoperative teaching with the patient himself.

ANS: C The nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because the patient has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the patient and wife because both will need to understand preoperative procedures and teaching.

When caring for a preoperative patient on the day of surgery, which actions included in the plan of care can the nurse delegate to unlicensed assistive personnel (UAP) (select all that apply)? a. Teach incentive spirometer use. b. Explain routine preoperative care. c. Obtain and document baseline vital signs. d. Remove nail polish and apply pulse oximeter. e. Transport the patient by stretcher to the operating room

ANS: C, D, E Obtaining vital signs, removing nail polish, pulse oximeter placement, and transport of the patient are routine skills that are appropriate to delegate. Teaching patients about the preoperative routine and incentive spirometer use require critical thinking and should be done by the registered nurse.

A patient has received atropine before surgery and complains of dry mouth. Which action by the nurse is most appropriate? a. Check for skin tenting. b. Notify the health care provider. c. Ask the patient about any weakness or dizziness. d. Explain that dry mouth is an expected side effect.

ANS: D Anticholinergic medications decrease oral secretions, so the patient is taught that a dry mouth is an expected side effect. The dry mouth is not a symptom of dehydration in this case. Therefore there is no immediate need to check for skin tenting. The health care provider does not need to be notified about an expected side effect. Weakness, forgetfulness, and dizziness are side effects associated with other preoperative medications such as opioids and benzodiazepines.

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? - "Tell me what you know about your surgery and the risks involved." - "Any surgery has risks, but we will be here to take good care of you." - "You seem anxious. After you sign the consent, I can give you a sedative." - "You do not need to be concerned. Your surgeon has not had any complaints."

Correct Answer: "Tell me what you know about your surgery and the risks involved." Rationale: 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.

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? -"Stay NPO after midnight." -"Maintain NPO status until after breakfast." -"You may drink clear liquids up to 2 hours before surgery." -"You may drink clear liquids up until she is moved to the OR."

Correct Answer: "You may drink clear liquids up to 2 hours before surgery." Rationale: 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.

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

Correct Answer: A 40-yr-old woman who is scheduled for an open cholecystectomy Rationale: 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.

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

Correct Answer: A body mass index of 48.8 kg/m2 Rationale: 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.

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

Correct Answer: A man who is taking clopidogrel after the placement of a coronary artery stent. Rationale: 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.

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 action should the nurse take? Advocate for the patient's rights. Try to change the patient's mind. Call surgery to cancel the procedure. Tell the family they cannot interfere.

Correct Answer: Advocate for the patient's rights. Rationale: 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.

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

Correct Answer: Call the surgeon to obtain consent for surgery. Rationale: 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.

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

Correct Answer: Encourage or assist the patient to the bathroom to void. Rationale: The nurse should have the patient 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.

An older adult patient is being prepared for surgery. What assessment data needs to be obtained from the patient? (Select all that apply.) - Fluid balance history - Attitude about surgery - Foods the patient dislikes - Current mobility problems - Current cognitive function - Patient's opinion about the surgeon

Correct Answer: Fluid balance history Current mobility problems Current cognitive function Rationale: 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 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? - Give the patient a pamphlet written in Spanish with directions on the use of the incentive spirometer. - Ask another Spanish-speaking patient in the preoperative area to translate as the nurse describes the procedure. - Notify the postoperative unit to have a Spanish-speaking nurse provide teaching on the incentive spirometer after surgery. - Have the hospital interpreter available while the nurse demonstrates the procedure and the patient returns the demonstration.

Correct Answer: Have the hospital interpreter available while the nurse demonstrates the procedure and the patient returns the demonstration. Rationale: 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.

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

Correct Answer: Inform the anesthesia care provider of the patient's recent use of kava. Rationale: 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.

The patient is having a mole removed that has changed appearance. What does the nurse teach the patient about the reason for this surgical procedure? - It will prevent cancer. - It will alleviate symptoms. - It will cure the patient's cancer. - It will provide cosmetic improvement.

Correct Answer: It will prevent cancer. Rationale: Removing a mole that is changing is to prevent as well as diagnose cancer. There are no symptoms to alleviate mentioned or cosmetic problems for this patient.

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

Correct Answer: Notify the anesthesia care provider (ACP). Rationale: 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.

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? - Offer the patient to use a urinal or bedpan after explaining the need to maintain safety. - Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. - Allow the patient to go to the bathroom since the onset of the medication will be more than 5 minutes. - Ask the patient to hold the urine for a short period since a urinary catheter will be placed in the operating room.

Correct Answer: Offer the patient to use a urinal or bedpan after explaining the need to maintain safety. Rationale: 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.

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? Cefazolin Fentanyl Midazolam Scopolamine

Correct Answer: Scopolamine Rationale: 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.

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? Past Health History: Smoker for past 25 years; last cigarette yesterday. Has hypertension Laboratory and Diagnostic Results: CBC within normal limits. Chest x-ray clear. UA within normal limits. No other lab work drawn Medications: Takes hydrochlorothiazide 50 mg every morning -Blood glucose -Pregnancy test -Serum albumin -Serum potassium

Correct Answer: Serum potassium Rationale: 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.

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? -Some medications may alter the patient's perceptions about surgery. -Many anesthetics alter renal and hepatic function, causing toxicity of other drugs. -Some medications may interact with anesthetics, altering the potency and effect of the drugs. -Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery.

Correct Answer: Some medications may interact with anesthetics, altering the potency and effect of the drugs. Rationale: 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.

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? - Seated in a wheelchair accompanied by a responsible family member. - Ambulatory and accompanied by a hospital escort and a family member. - Stretcher with side rails up and accompanied by OR transportation personnel. - Ambulatory accompanied by an OR staff member or transportation personnel.

Correct Answer: Stretcher with side rails up and accompanied by OR transportation personnel. Rationale: 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 has been admitted before having surgery for a bilateral mastectomy and breast reconstruction. What information should the nurse include in the patient's preoperative teaching? (Select all that apply.) - Various options for reconstructive surgery - The risks and benefits of her particular surgery - Risk factors for breast cancer and the role of screening - Where in the hospital she will be taken after surgery is over - How to perform postoperative deep-breathing and coughing exercises

Correct Answer: Where in the hospital she will be taken after surgery is over How to perform postoperative deep-breathing and coughing exercises Rationale: 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 surgeon would address specific risks and benefits of surgery and reconstruction options. Teaching about breast cancer screening would be inappropriate, and insensitive at this point in her disease trajectory.

4. A 17-yr-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 the surgeon obtains consent. b. Call a parent or legal guardian to sign the permit since the patient is under 18. c. Notify the hospital attorney that an emancipated minor is consenting for surgery. d. Obtain verbal consent since written consent is not necessary for emancipated minors.

Correct answer: a Rationale: An emancipated minor may sign his or her own permit. The nurse should be available to witness the signature, but no further action is needed.

3. A 59-yr-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.

Correct answer: a Rationale: Ginkgo can increase bleeding during and after surgery. The surgeon should decide how long to discontinue it before surgery.

1. 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 part of the liver. d. the patient will need special preparation because of obesity.

Correct answer: a Rationale: 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 based on 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.

7. A patient who normally takes 40 units of glargine insulin (long acting) 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 dose.

Correct answer: b Rationale: 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).

2. 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 action? a. Notify the surgeon so that the surgery can be cancelled. b. Ask additional questions to assess for a possible latex allergy. c. Notify the OR staff at once so they can use latex-free supplies. d. No action is needed because the patient's rubber sensitivity has no bearing on surgery.

Correct answer: b Rationale: The nurse should ask additional screening questions to determine the patient's risk for a latex allergy. Use latex precaution protocols for patients found 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 to use with patients with latex allergies

6. 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 to come back tomorrow, since he ate a meal. b. Have the patient void before giving any preoperative medications. c. Proceed with the preoperative checklist, including site identification. d. Notify the anesthesia care provider of when and what the patient last ate.

Correct answer: d Rationale: Follow the nothing-by-mouth (NPO) protocol of each surgical facility. Restricting fluids and food is designed to minimize the potential risk of pulmonary aspiration and 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 at once

5. A priority nursing intervention to aid 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.

Correct answer: d Rationale: If a patient fears 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 teach the patient how to use some form of pain rating scale (e.g., 0 to 10, FACES) and to request pain medication before the pain becomes severe

8. Preoperative considerations for older adults include (select all that apply) a. using only 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.

Correct answers: c, d Rationale: Many older adults have sensory deficits. Preoperative and operating rooms are cool; provide warm blankets as needed