Chapter 17: Preoperative Care

Which statement by a patient scheduled for knee surgery is most important to report to the health care provider before surgery?

b. "I had a heart valve replacement last year."

6. A patient undergoing an emergency appendectomy has been using St. John's wort to prevent depression. Which complication should the nurse expect in the postanesthesia care unit?

c. Increased anesthesia recovery time

A patient who takes a diuretic and a Beta-blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is most important to communicate to the health care provider before surgery?

c. Serum potassium 3.2 mEq/L The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of anxiety. The lower heart rate would be expected in a patient taking a -blocker. The hematocrit is in the low normal range but does not need any intervention before surgery.

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 most appropriate?

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

The surgical unit nurse has just received a patient with a history of smoking from the postanesthesia care unit. Which action is most important at this time?

a. Auscultate for adventitious breath sounds.

Which information in the preoperative patient's medication history is most important to communicate to the health care provider before surgery?

a. The patient takes garlic capsules every day.

A patient who is scheduled for a therapeutic abortion tells the nurse, "Having an abortion is wrong." Which functional health pattern should the nurse further assess?

a. Value-belief

A patient who has not had any prior surgeries tells the nurse doing the preoperative assessment about allergies to avocados and bananas. Which action is most important for the nurse to take?

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

Which topic should the nurse discuss preoperatively with a patient who is scheduled for an open cholecystectomy?

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

The nurse is preparing to witness the patient signing the operative consent form when the patient says, "I don't understand what the doctor said about the surgery." Which action should the nurse take next?

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

A patient who has diabetes and uses insulin to control blood glucose has been NPO since midnight before having a knee replacement surgery. Which action should the nurse take?

b. Obtain a blood glucose measurement before any insulin administration

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?

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

The outpatient surgery nurse reviews the complete blood cell (CBC) count results for a patient who is scheduled for surgery. The results are white blood cell (WBC) count 10.2 x 103 /µL; hemoglobin 15 g/dL; hematocrit 45%; platelets 150 x 103 /µL. Which action should the nurse take?

c. Continue to prepare the patient for the surgical procedure.

The nurse obtains a health history from a patient who is scheduled for elective hip surgery in 1 week. The patient reports use of garlic and Ginkgo biloba. Which action by the nurse is appropriate?

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

When caring for a preoperative patient on the day of surgery, which actions can the nurse delegate to unlicensed assistive personnel (UAP)? (Select all that apply.)

c. Obtain and document baseline vital signs. d. Remove nail polish and apply pulse oximeter. e. Transport the patient by stretcher to the operating room. Obtaining vital signs, removing nail polish, pulse oximeter placement, and transport of the patient are routine skills that are appropriate to delegate. Teaching patients about the preoperative routine and incentive spirometer use require critical thinking and should be done by the registered nurse.

Five minutes after receiving the ordered preoperative midazolam by IV injection, the patient asks to get up to go to the bathroom to urinate. Which action by the nurse is most appropriate?

c. Offer the patient a urinal or bedpan.

The nurse plans to provide preoperative teaching to an alert older man who has hearing and vision deficits. His wife answers most questions that are directed to the patient. Which action should the nurse take when doing the teaching?

c. Provide additional time for the patient to understand preoperative instructions and carry out procedures.

The nurse is preparing a patient on the morning of surgery. The patient prefers not to remove a wedding ring, saying, "I've never taken it off since the day I was married." How should the nurse respond?

c. Suggest that the patient give the ring to a family member to hold.

The nurse interviews a patient scheduled to undergo general anesthesia for a bilateral hernia repair. Which information is most important to communicate to the surgeon and anesthesiologist before surgery?

c. The patient's father died after general anesthesia for abdominal surgery.

A 38-yr-old woman is admitted for an elective surgical procedure. Which information obtained by the nurse during the preoperative assessment must be communicated to the anesthesiologist and surgeon before surgery?

c. The patient's report that her last menstrual period was 8 weeks ago

A patient has received atropine before surgery and reports a dry mouth. Which action by the nurse is appropriate?

d. Explain that dry mouth is an expected side effect.