CH 17 EAQ Preoperative Care

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.

ANS: 15 mL 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 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? a. 5 minutes b. 10 minutes c. 30 minutes d. There is no wait time between instillations.

ANS: A

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? a. Have the patient sign a consent form. b. Have the family sign the form for the patient. c. Notify the health care provider to obtain consent for surgery. d. Teach the patient about the surgery and get verbal permission.

ANS: C 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.

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? a. Encourage the patient to wear it for the surgery. b. Tape the hearing aid to the patient's ear to prevent loss. c. Give the hearing aid to the spouse as the patient wishes. d. Tell the surgery nurse that the patient has the hearing aid out.

ANS: A Although jewelry is removed before surgery, hearing aids should be left in place to allow the patient to better follow instructions given in the surgical suite and the postanesthesia care unit (PACU), as well as the dismissal instructions that will be given before the patient returns home for recovery. Removing the hearing aid could cause issues for the patient in following instructions in the surgical suite and PACU. Taping the hearing aid to the patient's ear is not necessary to prevent loss.

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? a. "I will watch the participants for signs of excessive anxiety." b. "This handout will do the explaining for me during the class." c. "I will make sure the lights are bright so that they can see the materials easily." d. "Older people are usually able to face surgeries more easily than younger people."

ANS: A 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 woman is admitted to the hospital for an elective surgery. Her laboratory reports reveal that she is pregnant. An ultrasound of the abdomen shows that the fetus is 4 weeks old. What action should the nurse take immediately? a. Inform the surgeon. b. Inform the anesthetist. c. Inform the patient's husband. d. Continue preparation for surgery.

ANS: A Because anesthetics can put the mother and fetus at risk, exposure to anesthetics should be avoided. In this case, the priority is safety of the patient and fetus, so the nurse should immediately inform the surgeon. The surgeon will make the decision regarding the surgery. The husband and the anesthetist can be informed later. Congratulating the woman is important but is not the first priority.

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? a. "Cefazolin is being given for two days to prevent postoperative infection." b. "Cefazolin is an antiinflammatory drug that will help the surgical site to heal effectively." c. "Cefazolin will prevent you from getting a stomach ulcer until you are eating a full diet again." d. "Cefazolin is an analgesic that will make it easier to tolerate the continuous passive-motion machine after surgery on the knee."

ANS: A Cefazolin is a cephalosporin-type antibiotic that reduces the risk of postoperative infection. When used as prophylaxis, it commonly is used for 48 hours. It is not an antiinflammatory, an analgesic, or an acid-reducer.

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? a. Explain to the patient that surgery will use minimally invasive techniques. b. Explain to the patient that this setting is not appropriate for this procedure. c. Explain to the patient that surgery will involve removing a portion of the colon. d. Explain to the surgical services team that the patient will need special preparation.

ANS: A Many operative procedures are performed as ambulatory surgery (i.e., same-day or outpatient surgery). The case implied that a laparoscopic technique will be used that involves several small incisions and meets the requirement of a minimally invasive technique. No portions of the colon will be removed during this type of surgery. Obesity is not a contraindication for surgery in the outpatient setting. This patient is not classified as obese based on the BMI.

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? a. Advocate for the patient's rights. b. Try to change the patient's mind. c. Tell the family they cannot interfere. d. Call surgery to cancel the procedure.

ANS: A 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.

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? a. Inform the surgeon. b. Inform the adult child. c. Try to persuade the patient to continue with the surgery. d. Inform the senior nurse who witnessed the consent from the patient.

ANS: A 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.

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 priorityrelated to anesthesia? a. Has body mass index of 48.8 b. Has several seasonal allergies c. Has hemoglobin A1C of 8.5 percent d. Has history of postoperative vomiting

ANS: A 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. An elevated hemoglobin A1C is important, but not a priority. Seasonal allergies are not a priority. History of postoperative vomiting is important when determining which postoperative drugs to give, but is not a priority.

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 mostappropriate action by the nurse? a. Offer the patient a urinal and provide privacy. b. Insert a Foley catheter in preparation for surgery. c. Request a second nurse to help transport the patient to the bathroom. d. Ask the patient to try to hold it because the patient will have a catheter soon.

ANS: A 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.

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 mostappropriate action for the nurse to take? a. Allow the patient to use the urinal/bedpan after explaining the need to maintain safety. b. Assist the patient to the bathroom and stay next to the door to assist patient back to bed when done. c. Allow the patient to go to the bathroom because the onset of the medication will be more than five minutes. d. Ask the patient to hold the urine for a short period because a urinary catheter will be placed in the operating room.

ANS: A 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. Assisting the patient to the bathroom, allowing the patient to go to the bathroom, or asking the patient to hold the urine for a short period would not be safe for the patient.

A patient is scheduled for a gastrectomy. During the preoperative evaluation, the patient reports taking ginseng regularly. What should the nurse do? a. Inform the surgeon. b. Advise the patient to decrease the dose of ginseng. c. Advise the patient to take vitamin E in addition to the ginseng. d. Advise the patient to replace the ginseng with another herbal drug.

ANS: A 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? a. Pulmonary embolism b. Increased blood pressure c. Excessive bleeding from incision sites d. Increased peripheral vascular resistance

ANS: A 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 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. a. It involves minimal laboratory tests. b. It requires fewer preoperative medications. c. It reduces the risk of hospital-acquired infections. d. It helps patients recover comfortably in the hospital. e. It is more expensive for both patients and insurers.

ANS: A B C Ambulatory surgeries are often preferred over inpatient surgeries. These surgeries are usually minimally invasive, involve minimal laboratory tests, and require fewer preoperative medications. Because the patient recovers comfortably at home, there is no risk of hospital-acquired infections. These surgeries are less costly for both patients and insurers.

An older adult patient is being prepared for a cholecystectomy. What assessment data need to be included for this patient? Select all that apply. a. Fluid balance history b. Foods the patient dislikes c. Current mobility problems d. Current cognitive function

ANS: A C D 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.

A patient is refusing to remove their wedding ring on the morning of surgery. What action is most appropriate by the nurse? a. Ask the patient's husband to convince her to remove the ring. b. Tape the ring securely to the finger and document the encounter. c. Have the patient's mental status assessed in preparation for surgery. d. Note the presence of the ring in the nurses' notes section of the chart.

ANS: B It is customary to tape a patient's wedding band to the finger and make a notation on the preoperative checklist that the ring has been taped in place. This request does not imply altered mental status. It is not appropriate to ask the husband to convince his wife to remove the ring, because the patient has the right to refuse to remove the ring. It should be documented in the chart after the ring is taped securely to the finger.

The nurse is preparing a patient for surgery. What nursing actions are important to carry out prior to surgery? Select all that apply. a. Remove cosmetics, nail polish, and artificial nails. b. Remove hearing aids to prevent damage or loss of the devices. c. Remove jewelry in piercings if electrocautery devices will be used. d. Remove all prosthetics, including dentures, contact lenses, and glasses. e. Ascertain that the patient has an empty bladder before going to operating room.

ANS: A C D E 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. a. Order renal function test preoperatively. b. Order coagulation studies preoperatively. c. Check for the serum potassium levels preoperatively. d. Report to perioperative team if the patient has a problem voiding. e. Ready the sequential compression device in the preoperative holding area.

ANS: A D 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 assessing a patient who is scheduled for an appendectomy and orders a serum potassium analysis. What is the reason for the nurse's action? a. The patient is a chronic smoker. b. The patient is on diuretic therapy. c. The patient has a prosthetic heart valve. d. The patient is on antihypertensive medication.

ANS: B A patient who is on diuretic therapy needs to be evaluated for serum potassium levels to assess if there is an electrolyte imbalance. A patient who is a chronic smoker may develop pulmonary complications during or after the surgery and should stop smoking at least 6 weeks before the surgery. A serum potassium analysis is not required. Patients with prosthetic heart valves are at risk of developing valvular heart disease; therefore, a cardiology consultation is often required before the surgery. Patients who are on antihypertensive medication must discontinue the medication before the surgery. The antihypertensive medication taken with anesthetic agents will predispose the patient to shock.

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? a. Notify the health care provider that the patient is below 18 years old. b. Witness the operative permit after the health care provider obtains consent. c. Call a parent or legal guardian to sign the permit because the patient is under 18. d. Investigate the state's nurse practice act related to emancipated minors and informed consent.

ANS: B 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 preparing several patients for surgical procedures. What patient should the nurse most closely monitor for bleeding as a result of medication being taken? a. A woman who takes metoprolol for the treatment of hypertension b. A man who is taking clopidogrel after the placement of a coronary artery stent c. A man whose type 1 diabetes is controlled with insulin injections four times daily d. A man who recently started taking finasteride for the treatment of benign prostatic hyperplasia

ANS: B 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.

The nurse is taking a detailed history preoperatively about a patient's medications. What is the highest priority regarding the patient's medication history? a. All medications are held on the day of surgery. b. Some medications are contraindicated for use with anesthetics. c. Medications may cause the patient to be unable to make informed decisions. d. The patient's healing may be delayed if medications are taken before surgery.

ANS: B 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.

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? a. "Replace the insulin with an oral drug." b. "I will check with the surgeon and let you know." c. "Take half of the dose of insulin because you are fasting." d. "Avoid taking insulin because it may cause hypoglycemia."

ANS: B If a diabetic patient on insulin is due for surgery, it is important to get clear instructions from the surgeon regarding the insulin administration. The surgeon may choose to avoid the dose or give an adjusted dose based on the blood sugar levels. The nurse should not suggest taking a reduced dose, because it may cause a fluctuation in blood sugar levels. The insulin should not be replaced with oral drugs unless advised by the surgeon. The insulin dose may be skipped if the surgeon advises that.

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. An electrocardiogram b. A complete physical examination c. Laboratory-test findings, including kidney- and liver-function parameters d. All nursing subjective objective assessment plan (SOAP) notes for this admission

ANS: B 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.

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? a. Tell the patient that using kava to help sleep often is helpful. b. Inform the anesthesiologist of the patient's recent use of kava. c. Tell the patient that the kava should continue to help with relaxation before surgery. d. Inform the patient about the dangers of taking herbal medicines without consulting a health care provider.

ANS: B 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.

During the preoperative assessment of a patient, the nurse finds that the patient is taking diuretics. What is the mostimportant nursing intervention before surgery? a. Administer antibiotic prophylaxis. b. Have a serum potassium level drawn. c. Apply a compression device to the legs. d. Administer vasoactive drugs as advised.

ANS: B People who take diuretics are at risk of developing low potassium levels due to fluid and sodium loss. Low potassium levels may be detrimental to cardiac health, and surgery may pose additional harm. Antibiotic prophylaxis is given if the patient has valvular heart disease. Compression devices can be applied to the legs if the patient has a risk of deep vein thrombosis. Vasoactive drugs are administered if the patient has hypertension.

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? a. Notify the anesthetist to evaluate the patient. b. Ask additional questions to assess for a possible latex allergy. c. No intervention is needed because the patient needs to have this surgery. d. Notify the operating room (OR) staff immediately so that latex-free supplies can be used.

ANS: B The nurse should ask additional screening questions to determine the patient's risk for a latex allergy. Latex precaution protocols should be used for patients identified as having a positive latex allergy test result or a history of signs and symptoms related to latex exposure. Many health care facilities have created latex-free product carts that can be used for patients with latex allergies. The 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? a. Give the medicine with a glass of milk. b. Give the medicine with a small sip of water. c. Give the medicine the night before surgery. d. Give the medicine 5 minutes before going to the operating room.

ANS: B 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 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? a. "This medication is contraindicated with the type of anesthesia you are receiving." b. "This medication could cause excessive bleeding during surgery if it is not stopped beforehand." c. "All unnecessary medications are stopped before surgery to prevent you from vomiting under anesthesia." d. "This medication may increase respiratory depression associated with anesthetic agents and must be avoided."

ANS: B Warfarin is an anticoagulant that could cause excessive bleeding during surgery if clotting times are not corrected before surgery. For this reason, the patient's clotting parameters are monitored as a means of ensuring that the effects of the medication are reversed. Warfarin is not associated with respiratory depression and does not interact with anesthesia. Medications are held before surgery; the most correct reason for holding this medication is related to the increased risk of bleeding during and following 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. a. After the surgery has started b. When the patient is partially informed c. Just before the scheduled surgery time d. After the patient has signed the consent form e. When the patient is in the preoperative holding area

ANS: B C D E 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.

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. a. Opioids cause amnesia. b. Opioids decrease intraoperative pain. c. Opioids decrease the risk of infections. d. Opioids relieve pain during preoperative procedures. e. Opioids decrease intraoperative anesthetic requirements.

ANS: B D E 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.

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. a. "Do you take any herbal supplements?" b. "Have you ever had hay fever or asthma?" c. "Do you have a history of allergy to any specific drug?" d. "Do you work or have you worked in the rubber industry?" e. "Are you allergic to food items like eggs and chestnuts?"

ANS: B D E 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.

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? a. Herbal use b. Sulfur allergy c. Reactions to latex d. Respiratory diseases

ANS: C 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.

A patient is admitted to the hospital for elective surgery. The patient is taking nonsteroidal antiinflammatory drugs (NSAIDs) for knee pain. The nurse recognizes that NSAID use will have what effect on a postoperative patient? a. It may increase the risk of infections. b. It may cause atelectasis postoperatively. c. It may increase risk of postoperative bleeding. d. It may cause clotting of blood in the deep veins of legs.

ANS: C Although analgesics are required for surgical patients, the use of NSAIDS should be stopped before surgery because these drugs are associated with increased postoperative bleeding. NSAIDS do not increase the risk of infections. NSAIDS do not cause atelectasis postoperatively. NSAIDS do not increase blood clotting.

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? a. Check the platelet count of the patient. b. Check the hematocrit level of the patient. c. Review the electrocardiogram of the patient. d. Determine that the patient will be unaffected.

ANS: C Because the patient's father died due to sudden cardiac arrest, there is a chance that the patient may have a similar predisposition or condition. Reviewing the electrocardiogram of the patient is essential because it can give information about cardiac disease. Some diseases run in families, and the patient's risk of developing them should be determined. The platelet count report gives information about coagulation status. The hematocrit report gives information about anemia, immune status, and infection.

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? a. "It will prevent postoperative pneumonia." b. "It will treat your urinary tract infection (UTI)." c. "It will prevent postoperative surgical-site infection." d. "It will remove harmful bacteria from your intestines before surgery."

ANS: C 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? a. "Some medications may alter the patient's perceptions about surgery." b. "Some anesthetics alter renal and hepatic function, causing toxicity of other drugs." c. "Some medications may interact with anesthetics, altering the potency and effect of the drugs." d. "Routine medications are withheld the day of surgery, requiring dosage and schedule adjustments after surgery."

ANS: C 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.

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? a. The patient may experience excessive sedation. b. The patient may experience excessive nausea after the surgery. c. The patient may experience excessive bleeding during the surgery. d. The patient may experience an increase in blood pressure during the surgery.

ANS: C Garlic bread contains garlic, and there is a potential risk associated with the consumption of garlic. Garlic increases bleeding tendency in the patient. Increased bleeding could result in reduced blood volume and lead to shock. Patients taking kava and valerian may experience excessive sedation. Garlic does not cause excess sedation. Patients taking multivitamins on an empty stomach on the day of the surgery may experience excessive nausea and vomiting after the surgery. Patients who eat astragalus and ginseng will have increased blood pressure before and during the 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? a. Tell the patient that consuming herbs is an unhealthy practice. b. Inform the patient to discontinue the herb and return the next day. c. Inform the surgeon because the surgery would need to be rescheduled. d. Tell the patient that the herb is safe and continue with surgery preparation.

ANS: C 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.

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? a. Fish oils help prevent postoperative bleeding. b. Vitamin E helps prevent postoperative bleeding. c. Stop taking herbal medicines; they may increase the risk of postoperative bleeding. d. Aspirin is an appropriate medication to take for pain; it does not affect postoperative bleeding.

ANS: C Herbal medicines increase the risk of bleeding, so the patient should be advised to stop all herbal supplements 2 to 3 weeks before any surgical procedure. Aspirin has antiplatelet action and can cause bleeding, so it should be avoided during perioperative care. Other supplements that increase the risk of bleeding include fish oil, garlic, vitamin E, and ginkgo.

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? a. Arnica b. Heparin c. Antibiotics d. Vasoactive drugs

ANS: C 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 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? a. Review the surgery with the patient. b. Administer another dose of alprazolam. c. Notify the anesthesia care provider (ACP). d. Tell the patient that everything will be okay with the surgery.

ANS: C In determining the psychologic status of the patient, the nurse notes the patient's anxiety, which is supported by the elevated BP and heart rate, and restlessness. 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 surgery, about concerns with the unknown or with body image, or about 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 also can be administered during surgery. Reassuring the patient is not taking the patient's needs into account.

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? a. Multivitamin tablets can be taken until the day of surgery. b. Multivitamin tablets can be taken until 1 week before surgery. c. Multivitamin tablets can be taken until the day before surgery. d. Multivitamin tablets should be avoided for several days after surgery.

ANS: C Multivitamin tablets can help increase nutritional status, and they can be taken until the day before surgery. If multivitamins are taken on the day of surgery on an empty stomach, they may contribute to nausea and vomiting after surgery. There is no need to stop the use of multivitamins any sooner than a day before surgery. Multivitamins need not be stopped after surgery, because they may help in recovery.

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? a. The patient needs to be NPO after midnight. b. The patient must be nothing by mouth (NPO) after breakfast. c. The patient can drink clear liquids up to 2 hours before surgery. d. The patient can drink clear liquids up until the patient is moved to the operating room.

ANS: C 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 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? a. Share the surgical story of a neighbor who is also a devout Catholic. b. Assure the patient that it is normal to have fears of dying during surgery. c. Provide web-based and audiovisual teaching materials about the surgery. d. Reassure the patient that this surgery doesn't usually result in a large blood loss.

ANS: C 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.

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? a. The patient may smoke up until the day of surgery. b. The patient should stop smoking 1 week before surgery. c. The patient should stop smoking at least 6 weeks before surgery. d. The patient should stop smoking at least 6 months before surgery.

ANS: C 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.

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? a. Reassure the patient that the surgery is minor and the risk of death is minimal. b. Inform the surgeon that the patient wants to cancel the surgery until he or she can receive absolution from his religious leader. c. Inform the surgeon of the patient's fears and contact the appropriate religious leader to talk with the patient before surgery if possible. d. 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.

ANS: C 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.

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? a. Help the patient sign an "X" on the consent form representing his or her legal signature. b. Send the patient back to the nursing home and reschedule the procedure for a future date. c. Contact the family member identified as the patient's power of attorney on the patient's medical record to obtain consent. d. Notify the nursing supervisor of the lack of consent and request special permission for emergent status so the surgical procedure can be completed.

ANS: C The nurse should review the patient's medical record to locate next of kin or power of attorney to request consent. If the legal guardian has not been informed by the surgeon of the need for the procedure, possible complications, and alternative treatments, the consent cannot be obtained. Sending the patient back to the nursing home and rescheduling the procedure does not assist the patient in receiving appropriate care. It is illegal to obtain consent from a confused patient by getting him or her to sign an "X." Placement of a feeding tube is not an emergent surgery that can forego legal consent.

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 mostappropriate action by the nurse? a. Ask family members to clarify the information for the patient. b. Have the patient sign the form and explain the procedure to the patient. c. Notify the health care provider about the conversation with the patient and delay the signature. d. Have the patient sign the consent form and ask the health care provider to discuss again before surgery.

ANS: C The patient should not be asked to sign a consent form unless the procedure has been explained to his or her satisfaction. The nurse should notify the health care provider, who has the responsibility for obtaining consent. The health care provider must provide the information and clarify any confusion. It is not acceptable for the family to explain the procedure. The nurse cannot explain the procedure or ask the patient to sign the form without proper instruction and information.

The nurse is transporting a patient to the operating room. What concern should be the first priority for the nurse? a. Premedication b. Laboratory tests c. Safety of the patient d. Preoperative assessments

ANS: C 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.

The nurse is to administer preoperative antibiotics to a group of patients. What patients are determined to require this medication? Select all that apply. a. Patients undergoing cataract surgery b. Patients with known coronary artery disease c. Patients undergoing gastrointestinal surgery d. Patients undergoing joint replacement surgery e. Patients with a history of valvular heart diseases

ANS: C D E In patients with a history of valvular heart disease, antibiotics may be administered to prevent infective endocarditis. Gastrointestinal surgery carries a risk of wound contamination and calls for antibiotic treatment. In joint replacement surgeries, wound infections can have serious consequences; therefore, it is prudent to give antibiotics. Patients undergoing cataract surgery may require eyedrops, and patients with a history of coronary artery disease may require beta blockers but not antibiotics.

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? Select all that apply. a. Access to the surgical site is easy. b. Recovery from anesthesia is faster. c. The risk of wound infection is higher. d. Anesthesia administration is more difficult. e. The risk of a postoperative incisional hernia may be higher.

ANS: C D E It is difficult to administer anesthesia in obese patients due to the stress on the cardiopulmonary system caused by the increased body weight. Postoperatively, there is a high risk of incisional hernia due to increased stress on the sutures in obese patients. Because adipose tissue is less vascular than other tissue, the healing of the incisional site is slow, creating a high risk of wound infection. Due to fat deposits, access to the surgical site may be difficult in an obese patient. Some anesthetic agents are stored by adipose tissue and stay in the body for longer time, so the patient may recover slowly from anesthesia.

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? PMH: Smoker for past 24 years, last cigarette yesterday. Has hypertension Lab: CBC & UA WNL, Clear CXR, Meds: Hydrochlorothiazide 50 mg QAM a. Blood glucose b. Pregnancy test c. Serum albumin d. Serum potassium

ANS: D The nurse should seek a serum potassium level because the patient takes a diuretic. An electrocardiogram (ECG) also would be appropriate to seek with a history of hypertension and cigarette smoking. There are no indications for the need of blood glucose, pregnancy, or serum albumin tests.

An older adult patient is undergoing preoperative assessment and teaching. What nursing interventions are appropriate during the education process? Select all that apply. a. Administer a sedative to relieve fear and anxiety. b. Help the patient walk safely to the operating room. c. Coordinate assessment with the team of health care providers. d. Speak slowly when giving preoperative instructions to the patient. e. Understand that the patient may have sensory and cognitive deficits.

ANS: C D E 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? a. Call the local magistrate to get consent for the surgery. b. Obtain consent from a legally appointed representative. c. Avoid giving any treatment because it is illegal to treat without consent. d. Proceed with plans for surgery; consent is not required for a true medical emergency.

ANS: D 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? a. Insulin should be given only after the surgery. b. Insulin should be stopped one day before surgery. c. Insulin should be stopped at least one week before surgery. d. Insulin will be given after arrival in the preoperative holding area.

ANS: D 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? a. Instruct the patient to replace whiskey with a less potent beverage. b. Permit the patient to consume alcohol until the day before surgery. c. Recommend to the patient reducing the frequency of alcohol intake. d. Instruct the patient to stop consuming alcohol under medical supervision.

ANS: D 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.

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 priorityintervention? a. Tell the patient to stop taking the dietary supplement on the day before surgery. b. Notify the anesthesia care provider because this product interferes with anesthetics. c. Ask the patient if he has noticed any side effects from taking this dietary supplement. d. Inform the health care provider because the procedure may need to be rescheduled.

ANS: D Fish oil dietary supplements can increase bleeding during and after surgery. The health care provider should determine how long it should be discontinued before surgery. Telling the patient to stop taking the fish oil 1 day before surgery would still place the patient at risk for bleeding. Fish oil does not interfere with anesthetics. The nurse could ask the patient if he has any side effects from the fish oil, but it is not a priority.

A patient who is scheduled for thyroid surgery reports amenorrhea that began two months ago. How should the nurse ensure the patient is not pregnant? a. By taking an x-ray b. By checking hematocrit level c. By checking international normalized ratio level d. By checking human chorionic gonadotropin level

ANS: D Human chorionic gonadotropin (hCG) levels are measured to check for pregnancy status. X-rays of the abdomen are harmful to a fetus, so they should always be avoided in women of reproductive age if pregnancy is suspected. Hematocrit levels indicate the hemoglobin level in the blood. International normalized ratio (INR) is used to check for coagulation status.

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? a. Administer an antianxiety medication to the patient. b. Teach the patient to use guided imagery to help manage fear. c. Describe the type of anesthesia expected with the patient's particular surgery. d. Inform the anesthesia care provider (ACP) so that he or she can talk further to the patient.

ANS: D 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 asks the nurse whether it is alright to take regularly scheduled insulin on the morning of surgery. What is the most appropriate nursing action? a. Inform the patient to skip the insulin dose on the morning of surgery. b. Tell the patient to take half the usual dose on the morning of surgery. c. Tell the patient to take the same dose as he or she is currently taking every day. d. Inform the surgeon of the patient's insulin use and ask whether the dose needs to be adjusted.

ANS: D If the patient is taking insulin for diabetes, the nurse should inform the surgeon in order to obtain prescriptions concerning the insulin dose to be given on the day of surgery. Low or high blood sugar can lead to complications during surgery; therefore, blood sugar should be strictly controlled. The patient should not skip or reduce the dose himself or herself but should consult the surgeon and adjust the dose, if advised.

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? a. Provide herbal therapy to minimize b. the risk of postoperative bleeding. c. Instruct the patient to discontinue the anticoagulation therapy 1 week before the surgery. d. Provide the patient with information to resume anticoagulation therapy 1 month after surgery. e. Instruct the patient to discontinue the anticoagulation therapy and expect to administer IV heparin during the perioperative period.

ANS: D In the case of a patient on long-term anticoagulant therapy, IV heparin therapy can be used during the perioperative period in place of the anticoagulants. Herbal therapy increases the risk of postoperative bleeding, so should not be used. Discontinuing the anticoagulation therapy 1 week before surgery and continuing the anticoagulation therapy 1 month after surgery could increase the chance of complications.

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? a. Skip taking the drug the morning of surgery. b. Take the medication with a small sip of water. c. Eat a light snack for breakfast and take the medication. d. Get instructions from the health care provider for any special instructions.

ANS: D Insulin or oral hypoglycemic agents may require dose or agent adjustments during the perioperative period because of increased body metabolism, decreased oral intake, stress, and anesthesia. Health care providers may instruct patients to withhold these medications before surgery. The nurse will need to contact the health care provider for any special instructions. It is not within the nurse's scope of practice to tell the patient to skip the dose or take the medication.

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? a. It is difficult to find intravenous access in older patients. b. Skin turgor assessment is not a reliable measure for dehydration in this patient. c. There is an increased loss of water and electrolytes through sweating in old people. d. There is a narrow margin of safety between overhydration and underhydration in elderly patients.

ANS: D The capacity to adapt to changes in fluid levels is low in elderly patients. The safety margin is very low between dehydration and over hydration, so the nurse should focus on the preoperative fluid balance history of this patient. Finding intravenous access in older patients may not be difficult. Old people do not sweat more than young people. Skin turgor assessment is a reliable measure for dehydration in this patient.

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? a. Notify the health care provider about the patient's concerns. b. Notify family members that the patient is afraid to have surgery. c. Consult a psychiatrist to speak with the patient about these fears. d. Consult a social worker to identify financial options for the patient.

ANS: D The nurse should consult a social worker. Social services can identify financial assistance for the patient and the family during recovery. The social worker can also help identify financial assistance for hospital charges. The health care provider explains the procedure and possible physical consequences of the surgical procedure. Notifying a family member that the patient is afraid to have surgery would not communicate an accurate account of the situation and could betray the patient's confidence. Consulting a psychiatrist is not necessary, as fear is a normal part of the presurgical and postsurgical phases.

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? a. "We will do the surgery, but it will increase your risk of complications." b. "You were provided with strict instructions on what to do before surgery." c. "We will keep you in the hospital overnight to be sure you don't do that again." d. "I will inform the anesthesia care provider and surgeon to see what the options are."

ANS: D 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 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? a. Notify the surgeon that the child is crying and shaking. b. Administer a pediatric dosage of sedation to calm the child. c. Give the child a warm glass of milk for relaxation and sleep promotion. d. Permit the parent to remain with the child until the child is taken to the operation suite.

ANS: D The nurse should permit the parent to remain with the child until the child is taken to the operating suite. The presence of a parent or loved one helps to decrease anxiety without use of sedation. The child should not be given anything by mouth prior to a surgical procedure. Nonpharmacologic measures should be tried before sedation is given in this situation. Notifying the surgeon will not address the child's anxiety.

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? a. Cefazolin b. Fentanyl c. Midazolam d. Scopolamine

ANS: D The scopolamine patch will be administered first to allow enough time for the serum level to become therapeutic. The cefazolin will be given at 7 to allow infusion 30 minutes before surgery. Fentanyl is a narcotic and was not prescribed preoperatively. The midazolam, a short-acting benzodiazepine, is used as a sedative.

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

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

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? Select all that apply. a. Give heavy food to the patient. b. Give black coffee to the patient. c. Give clear liquids to the patient. d. Keep the patient apprised of the situation. e. Tell the anesthesia care provider about the situation.

ANS: D E Nothing by mouth (NPO) restrictions are given to the patient to prevent aspiration and vomiting during surgery. Patients who are NPO from midnight frequently complain of hunger and thirst while waiting for surgery. Keep the patient updated on the situation and let them know they have not been forgotten. Patients who regularly drink caffeine in the morning often experience a "caffeine withdrawal" headache when fasting. The nurse should talk to the anesthesia care provider and ask if the patient can consume clear liquids; if he says yes, clear liquids and coffee should be offered, but not until after the anesthesia care provider has approved it. A heavy meal should be avoided before surgery because it can lead to the above-mentioned complications.