Week 2 chapter 17
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? 1 The patient needs to be NPO after midnight. 2 The patient must be nothing by mouth (NPO) after breakfast. 3 The patient can drink clear liquids up to 2 hours before surgery. 4 The patient can drink clear liquids up until the patient is moved to the operating room.
3 • 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 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? Select all that apply. 111 Opioids cause amnesia. 2 Opioids decrease intraoperative pain. 3 Opioids decrease the risk of infections. 4 Opioids relieve pain during preoperative procedures. 5 Opioids decrease intraoperative anesthetic requirements.
5 • Opioid drugs are often used before surgery to decrease intraoperative pain and anesthetic requirements. They also help relieve pain during preoperative procedures. Opioids do not have amnestic or sedative actions. Opioids have no effect on the risk of postoperative infections.
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? 1 "I will watch the participants for signs of excessive anxiety." 2 "This handout will do the explaining for me during the class." 3 "I will make sure the lights are bright so that they can see the materials easily." 4 "Older people are usually able to face surgeries more easily than younger people."
1 • Be particularly alert when assessing and caring for the older adult surgical patient. An event that has little effect on a younger adult may be overwhelming to the older patient. Emotional reactions to impending surgery and hospitalization often intensify in the older adult. Help to decrease anxieties and fears, as well as maintain and restore the self-esteem of the older adult during the surgical experience. Simply reading a handout may not be sufficient. Consider that sensory deficits may be present, and bright lights may bother those with eye problems. These and other changes may require more time for the older adult to complete preoperative testing and understand preoperative instructions.
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? 1 5 minutes 2 10 minutes 3 30 minutes 4 There is no wait time between instillations.
1 • It is important to administer the drugs as ordered and on time to adequately prepare the eye for surgery. If there are multiple sets of eyedrops, the nurse has to maintain at least 5 minutes of interval between each set of drops.
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? 1 Advocate for the patient's rights. 2 Try to change the patient's mind. 3 Tell the family they cannot interfere. 4 Call surgery to cancel the procedure.
1 • 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 or she knows the risks and benefits of refusing 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 or she retains the right of self-determination. Canceling the procedure is not indicated until discussion with the patient and health care provider has occurred. Telling the family they cannot interfere can aggravate or escalate the situation.
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? 1 Offer the patient a urinal and provide privacy. 2 Insert a Foley catheter in preparation for surgery. 3 Request a second nurse to help transport the patient to the bathroom. 4 Ask the patient to try to hold it because the patient will have a catheter soon
1 • The prime issue after administration of a sedative or opioid analgesic medication is safety. Providing the patient with a urinal and providing privacy allows the patient to stay in bed, but also allows the patient to void. Because these medications affect the central nervous system, the patient is at risk for falls and should not be allowed out of bed, even with assistance. A Foley catheter is not indicated at this time, and it is not reasonable to ask the patient to wait until the surgery is underway.
A patient is scheduled for a gastrectomy. During the preoperative evaluation, the patient reports taking ginseng regularly. What should the nurse do? 1 Inform the surgeon. 2 Advise the patient to decrease the dose of ginseng. 3 Advise the patient to take vitamin E in addition to the ginseng. 4 Advise the patient to replace the ginseng with another herbal drug.
1 • The priority intervention is to inform the surgeon. The gastrectomy needs to be rescheduled. The next priority is to suggest that the patient discontinue the use of ginseng because ginseng increases blood pressure before and during surgery. Vitamin E should not be taken because it can increase bleeding. Decreasing the dose of ginseng will not remove the risk. Use of any herbal product should be discontinued 2 to 3 weeks before surgery because such medicines may increase the risk of postoperative bleeding.
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? 1 Pulmonary embolism 2 Increased blood pressure 3 Excessive bleeding from incision sites 4 Increased peripheral vascular resistance
1 • Warfarin is an anticoagulant that is used to prevent mural thrombi from forming on the walls of the atria during atrial fibrillation. Once the medication is terminated, thrombi could form again. If one or more detach from the atrial wall, they could travel as arterial emboli from the left atrium or as pulmonary emboli from the right atrium. Excessive bleeding would occur from excess warfarin administration, not withholding. Blood pressure and peripheral vascular resistance are not affected by warfarin.
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? 1 Inform the surgeon. 2 Inform the adult child. 3 Try to persuade the patient to continue with the surgery. 4 Inform the senior nurse who witnessed the consent from the patient.
1 (• The patient has the right to revoke the consent at any time; however, this should be reported to the concerned medical staff who obtained the consent, because knowing this would help in planning the next steps. The information need not be given to the patient's son if he did not witness the informed consent. The nurse should not try to persuade the patient to change his or her mind; all the pertinent information should already have been provided to the patient earlier. The senior nurse need not be notified.)
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? Select all that apply. 1 It involves minimal laboratory tests. 2 It requires fewer preoperative medications. 3 It reduces the risk of hospital-acquired infections. 4 It helps patients recover comfortably in the hospital. 5 It is more expensive for both patients and insurers
1,2,3
An older adult patient is being prepared for a cholecystectomy. What assessment data need to be included for this patient? Select all that apply. 1 Fluid balance history 2 Foods the patient dislikes 3 Current mobility problems 4 Current cognitive function
1,3,4 • Preoperative fluid balance history is especially critical for older adults because they have reduced adaptive capacity that puts them at greater risk for overhydration and underhydration. Mobility problems must be assessed to assist with intraoperative and postoperative positioning and ambulation. Preoperative assessment of the older person's baseline cognitive function is especially crucial for intraoperative and postoperative evaluation, because the older patient is more prone to adverse outcomes during and after surgery from the stressors of the surgery, dehydration, hypothermia, and anesthesia. 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.
The nurse is preparing a patient for surgery. What nursing actions are important to carry out prior to surgery? Select all that apply. 1 Remove cosmetics, nail polish, and artificial nails. 2 Remove hearing aids to prevent damage or loss of the devices. 3 Remove jewelry in piercings if electrocautery devices will be used. 4 Remove all prosthetics, including dentures, contact lenses, and glasses. 5 Ascertain that the patient has an empty bladder before going to operating room.
1,3,4,5 • The patient should remove all cosmetics to facilitate observation of skin color during surgery. Nail polish and artificial nails should be removed to help in assessing capillary refill and pulse oximetry. If electrocautery devices will be used, all jewelry in piercings should be removed as a safety measure. All prostheses, including dentures, contact lenses, and glasses should be removed to prevent loss and damage. The nurse should ascertain that the patient's bladder is empty before going to the operating room because involuntary voiding can happen under the effect of sedatives administered during surgery. If the patient uses a hearing aid, it should be left intact to help the patient hear properly and follow instructions.
The nurse is caring for a patient with renal dysfunction who is scheduled for surgery. What are the priority nursing interventions in this situation? Select all that apply. 1 Order renal function test preoperatively. 2 Order coagulation studies preoperatively. 3 Check for the serum potassium levels preoperatively. 4 Report to perioperative team if the patient has a problem voiding. 5 Ready the sequential compression device in the preoperative holding area.
1,4 • Many drugs are metabolized and excreted by the kidneys. A decrease in renal function can lead to altered drug response and unpredictable drug elimination. Hence, a renal function test is necessary before the surgery. If the patient has a problem voiding, the nurse should inform the perioperative team because the patient might exhibit improper voiding postoperatively. Coagulation studies of the patient should be on the chart before the patient is brought in for surgery in case of cardiovascular problems. Serum potassium levels of a patient are checked in case the patient is on diuretic medication to check the electrolyte imbalance. A sequential compression device is used preoperatively with patients who are predisposed to venous thromboembolism (VTE).
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 how many total milliliters of solution for dosage preparation? Record your answer using a whole number. ______ mL
15 • Because the dose is 1.5 g and each vial contains 500 mg, the nurse needs to first convert grams to milligrams. 1.5 grams is equal to 1500 mg. Dividing 1500 by 500, the nurse needs to use a total of three vials. The nurse then adds 5 mL of sterile water to each vial of powder on the basis of the direction to "add 5 mL of sterile water per 500 mg of medication." Once all vials are reconstituted, the concentration of each solution is 500 mg/5 mL. The nurse then needs to draw up the contents of all three vials, making the total volume 15 mL.
A 17-year-old patient that is an emancipated minor with an arm fracture is scheduled for surgery and shows the nurse a statement from the court for verification. Which intervention by the nurse is most appropriate? 1 Notify the health care provider that the patient is below 18 years old. 2 Witness the operative permit after the health care provider obtains consent. 3 Call a parent or legal guardian to sign the permit because the patient is under 18. 4 Investigate the state's nurse practice act related to emancipated minors and informed consent.
2 • 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. The health care provider does not need to know the patient is under 18. The parent or guardian does not have the legal right to sign the consent. The nurse practice act for each state may vary, but an emancipated minor may sign for himself or herself legally.
The nurse is taking a detailed history preoperatively about a patient's medications. What is the highest priority regarding the patient's medication history? 1 All medications are held on the day of surgery. 2 Some medications are contraindicated for use with anesthetics. 3 Medications may cause the patient to be unable to make informed decisions. 4 The patient's healing may be delayed if medications are taken before surgery.
2 • 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 anesthesiologist. Although most medications are not administered on the day of surgery, and some medications (mainly steroids) may delay healing or cause the patient to be unable to make informed decisions, the greatest priority is to ensure prescribed medications will not interact with anesthesia used.
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? 1 Notify the anesthetist to evaluate the patient. 2 Ask additional questions to assess for a possible latex allergy. 3 No intervention is needed because the patient needs to have this surgery. 4 Notify the operating room (OR) staff immediately so that latex-free supplies can be used.
2 • 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 anesthesiologist does not need to evaluate the patient. If the patient does have a latex allergy, the OR staff would need to be notified, but it is not a priority. The nurse would not ignore the situation and do nothing.
The nurse is administering a preoperative medication orally. What nursing action is appropriate when performing this intervention? 1 Give the medicine with a glass of milk. 2 Give the medicine with a small sip of water. 3 Give the medicine the night before surgery. 4 Give the medicine 5 minutes before going to the operating room.
2 • The preoperative medication should be given with a small sip of water 60 to 90 minutes before shifting the patient to the operating room. The medication should not be given only 5 minutes before going to the operating room, because effects of the medication will not begin to potentiate yet. The patient should not be given large amounts of fluid or milk orally, because it can increase the chances of regurgitation and asphyxia during surgery under the effects of anesthetics.
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? 1 An electrocardiogram 2 A complete physical examination 3 Laboratory-test findings, including kidney- and liver-function parameters 4 All nursing subjective objective assessment plan (SOAP) notes for this admission
2 (• It is essential that a physical examination report be attached to the chart of a patient going into surgery. This document explains in detail the overall status of the patient for the surgeon and other members of the surgical team. Laboratory test findings, SOAP notes, and electrocardiograms also may be included in the chart; however, the physical examination must always be completed and in the chart before surgery.)
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? Select all that apply. 1 After the surgery has started 2 When the patient is partially informed 3 Just before the scheduled surgery time 4 After the patient has signed the consent form 5 When the patient is in the preoperative holding area
2,3,4,5 • The patient can revoke the consent at any time before the scheduled surgery. The patient can refuse the surgery even when she is in the preoperative holding room, assuming she is conscious and able to make the decision for herself. The informed consent can be revoked whether she has received full or partial information, even at the very last minute. Once the surgery has started and the patient is under general anesthesia, obviously she will not be able to revoke the consent.
During preoperative nursing assessment of a patient, what questions should the nurse ask to determine if the patient has a latex allergy? Select all that apply. 1 "Do you take any herbal supplements?" 2 "Have you ever had hay fever or asthma?" 3 "Do you have a history of allergy to any specific drug?" 4 "Do you work or have you worked in the rubber industry?" 5 "Are you allergic to food items like eggs and chestnuts?"
2,4,5 • To assess the patient for latex allergy, the nurse should ask the patient whether the patient has a history of working in the rubber industry, is allergic to any specific food, or has a history of hay fever or asthma. People coming in contact with latex, such as health professionals and those working in the rubber industry, are at highest risk of developing latex allergy. People who have a history of hay fever and asthma and have food allergies to eggs, bananas, avocados, and chestnuts may also be at risk. Questions about herbal supplements and hypersensitivity are asked in order to gather data about any potential drug interactions and drug allergies but are not specifically relevant to latex allergy.
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? 1 "It will prevent postoperative pneumonia." 2 "It will treat your urinary tract infection (UTI)." 3 "It will prevent postoperative surgical-site infection." 4 "It will remove harmful bacteria from your intestines before surgery."
3 • Cefazolin has enhanced activity against a wide variety of gram-negative organisms and is being used for perioperative prophylaxis against infection at the surgical site. The bowel has a wide variety of bacterial flora that could contaminate the abdominal cavity during surgery. This antibiotic is not used to prevent pneumonia. If the patient has a current infection (UTI), surgery may be postponed. The antibiotic will not remove all bacteria from the intestines but will reduce the risk of postoperative infection from intestinal bacteria.
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? 1 "Some medications may alter the patient's perceptions about surgery." 2 "Some anesthetics alter renal and hepatic function, causing toxicity of other drugs." 3 "Some medications may interact with anesthetics, altering the potency and effect of the drugs." 4 "Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery."
3 • 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 they have been communicated to the anesthesia care provider. Medications generally do not alter the patient's perceptions about surgery. The anesthetics may interact with the other medications, but they are not likely to alter renal and hepatic function. Routine medications are not always held during surgery, and dosage and schedule adjustments are not always necessary. Routine medications may or may not be prescribed for use the day of surgery.
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? 1 Tell the patient that consuming herbs is an unhealthy practice. 2 Inform the patient to discontinue the herb and return the next day. 3 Inform the surgeon because the surgery would need to be rescheduled. 4 Tell the patient that the herb is safe and continue with surgery preparation.
3 • Ginkgo tends to cause increased bleeding; therefore, the nurse should inform the surgeon if the patient has been using it so that the surgery can be rescheduled. Any herb should be discontinued 2 to 3 weeks before the surgery because it may have adverse effects. The nurse should not comment on whether the practice of taking the herb is healthy or not.
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? 1 Share the surgical story of a neighbor who is also a devout Catholic. 2 Assure the patient that it is normal to have fears of dying during surgery. 3 Provide web-based and audiovisual teaching materials about the surgery. 4 Reassure the patient that this surgery doesn't usually result in a large blood loss.
3 • Providing web-based and audiovisual teaching materials about the surgery is an effective way to help address and individualize the patient's concerns and to decrease anxiety. Assuring the patient that it is normal to have fears of dying during surgery does not individualize this patient's experience. Sharing the surgical story of a neighbor takes the focus off the patient and doesn't address the patient's needs, which may be different from the neighbor's. The nurse does not know what the blood loss will be during surgery and should therefore not provide false reassurances.
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? 1 Have the patient sign a consent form. 2 Have the family sign the form for the patient. 3 Notify the health care provider to obtain consent for surgery. 4 Teach the patient about the surgery and get verbal permission.
3 • The informed consent for the surgery must be obtained by the health care provider. 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 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? 1 Reassure the patient that the surgery is minor and the risk of death is minimal. 2 Inform the surgeon that the patient wants to cancel the surgery until he or she can receive absolution from his religious leader. 3 Inform the surgeon of the patient's fears and contact the appropriate religious leader to talk with the patient before surgery if possible. 4 Inform the patient that it is too late at this point; the room is scheduled, the surgical team is waiting, and any delays will delay surgeries for other patients.
3 • The nurse must acknowledge the patient's fears, inform the surgeon, and make efforts to have the appropriate spiritual leader speak with the patient to allay his or her fears before surgery. Assuring the patient that the risk of death is minor ignores the patient's fears. Informing the surgeon that the surgery is canceled would not be appropriate at this point in time; the patient may be able to have his or her fears allayed without unduly delaying the surgery. Informing the patient that it is too late is an inappropriate response that dismisses his or her fears.
The nurse is transporting a patient to the operating room. What concern should be the first priority for the nurse? 1 Premedication 2 Laboratory tests 3 Safety of the patient 4 Preoperative assessments
3 • When transporting the patient to the operating room, the nurse's primary concern should be the patient's safety. The nurse should help the patient to move from the hospital bed to the stretcher. The side rails should be raised. The patient may be transported to the operating room by stretcher or wheelchair. If no sedatives have been given, the patient may even walk accompanied to the operating room. Premedication, assessments, and laboratory values are major concerns during the preoperative period but not when transporting the patient.
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? 1 Herbal use 2 Sulfur allergy 3 Reactions to latex 4 Respiratory diseases
3 (A patient with a history of any allergic reactions has a greater potential for hypersensitivity to drugs given during anesthesia. Patients need to be screened specifically for latex allergies by checking the history of reactions that suggest an allergy to latex. Checking the history of sulfur allergy, herbal medication, and respiratory diseases would not help, because these conditions do not cause skin reactions.)
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? 1 Arnica 2 Heparin 3 Antibiotics 4 Vasoactive drugs
3 (• If a patient has a history of valvular heart disease, antibiotics are administered before the surgery to decrease the risk of bacterial endocarditis. Arnica is a homeopathic remedy used in soft-tissue healing. Heparin is given to patients who are on long-term anticoagulation therapy. The anticoagulation therapy is withheld and heparin is administered intravenously during the perioperative period. Vasoactive drugs are given to patients who have a history of hypertension to maintain blood pressure.)
A patient is a chronic smoker and is scheduled to have a benign tumor on the neck removed. To prevent perioperative complications, the nurse should instruct the patient to refrain from smoking for how many weeks before surgery? 1 The patient may smoke up until the day of surgery. 2 The patient should stop smoking 1 week before surgery. 3 The patient should stop smoking at least 6 weeks before surgery. 4 The patient should stop smoking at least 6 months before surgery.
3 (• Smokers are at increased risk for respiratory complications during and after surgery. The health care professions should encourage smokers to quit smoking permanently or for at least 6 weeks before surgery to decrease the complications.)
An older adult patient is undergoing preoperative assessment and teaching. What nursing interventions are appropriate during the education process? Select all that apply. 1 Administer a sedative to relieve fear and anxiety. 2 Help the patient walk safely to the operating room. 3 Coordinate assessment with the team of health care providers. 4 Speak slowly when giving preoperative instructions to the patient. 5 Understand that the patient may have sensory and cognitive deficits.
3,4,5 (Older adults need careful preoperative assessments and teaching, because they are more prone to surgery-related complications. Sensory and cognitive deficits may make their learning slow; therefore, the nurse should go slowly when teaching about preoperative care. Because older adults may have many physical and neurosensory problems, the nurse should coordinate with a team of health care providers to provide a complete assessment. The older patient should never be made to walk to the operating room; a stretcher or wheelchair should be used. Administering a sedative is a general measure and not specific to older adults.)
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? 1 Call the local magistrate to get consent for the surgery. 2 Obtain consent from a legally appointed representative. 3 Avoid giving any treatment because it is illegal to treat without consent. 4 Proceed with plans for surgery; consent is not required for a true medical emergency.
4 • A true medical emergency may override the need to obtain consent. When immediate medical treatment is needed to preserve life and the patient is incapable of giving consent, the next of kin may give consent. If reaching the next of kin is not possible, the physician may begin treatment without written consent. Calling the local magistrate to get consent for the surgery is not necessary. Treatment should not be avoided; the priority should be to save the life of the patient. If a patient is unconscious, a legally appointed representative or responsible family member may give written permission, but in this case, no one is available.
A diabetic patient taking insulin is scheduled for a thyroidectomy. What should the nurse tell the patient about insulin injections around the time of the surgery? 1 Insulin should be given only after the surgery. 2 Insulin should be stopped one day before surgery. 3 Insulin should be stopped at least one week before surgery. 4 Insulin will be given after arrival in the preoperative holding area.
4 • Blood glucose levels should be well maintained in diabetic patients, so they should be given a dose of insulin in the preoperative holding room or operating room. Insulin is injected subcutaneously. If insulin is given only after surgery, maintaining the sugar level during surgery would be difficult. Stopping insulin one day or one week before surgery is not advised.
A patient reports a history of drinking whiskey in large quantities for 10 years during a preoperative assessment. Which nursing intervention would help prevent postoperative complications related to the patient's alcohol history? 1 Instruct the patient to replace whiskey with a less potent beverage. 2 Permit the patient to consume alcohol until the day before surgery. 3 Recommend to the patient reducing the frequency of alcohol intake. 4 Instruct the patient to stop consuming alcohol under medical supervision.
4 • Chronic alcohol use can place the surgical patient at risk due to existing lung, gastrointestinal, or liver damage. When liver function is decreased, metabolism of anesthetic agents is prolonged, nutritional status is altered, and the chances for postoperative complications are increased. Refraining from alcohol consumption may lead to fewer complications during lengthy surgery or in the postoperative period, but alcohol withdrawal can be dangerous. The risks can be avoided with appropriate planning and management, and doing so under a provider's care. Replacement of the beverage is not an option because doing so may have unintended negative consequences. Reducing the frequency of alcohol intake also increases the chances of complications. If the patient continues to consume alcohol before the day of surgery, he may experience complications during the perioperative period.
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? 1 Administer an antianxiety medication to the patient. 2 Teach the patient to use guided imagery to help manage fear. 3 Describe the type of anesthesia expected with the patient's particular surgery. 4 Inform the anesthesia care provider (ACP) so that he or she can talk further to the patient.
4 • If the nurse identifies that the patient has fear of anesthesia, inform the ACP immediately so that he or she can talk further with the patient. Reassure the patient that a nurse and ACP will be present at all times during surgery. The nurse could use guided imagery to help manage fear or administer an antianxiety medication (if prescribed), but these interventions do not address directly the reason behind the patient's fear, so they would not be the priority. It is not within the nurse's scope of practice to describe the type of anesthesia that the patient will receive.
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? 1 "We will do the surgery, but it will increase your risk of complications." 2 "You were provided with strict instructions on what to do before surgery." 3 "We will keep you in the hospital overnight to be sure you don't do that again." 4 "I will inform the anesthesia care provider and surgeon to see what the options are."
4 • The nurse should inform the anesthesia care provider and surgeon that the patient has ingested solid foods 2 hours prior to surgery so that the options for surgery can be discussed. The surgery will most likely be delayed since this increases the patient's risk for complications such as aspiration. The patient should not be demeaned or chastised about eating and will not be kept the hospital overnight to ensure they do not eat again.
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.
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 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."
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.