Nokea
A patient arrives at the ambulatory surgery centre for a scheduled outpatient surgery. Which of the following information is of most concern to the nurse?
- A. The patient has not had outpatient surgery before.
- B. The patient is planning to drive home after surgery.
- C. The patient may not have paid sick leave from work.
- D. The patient had a glass of water a few hours before arriving.
Correct Answer: B
Rationale: After outpatient surgery, the patient should not drive home and will need assistance with transportation and home care. The patient's experience with outpatient surgery is assessed, but it does not have as much application to the patient's physiological safety. The patient's insurance coverage is important to establish, but this is not usually the nurse's role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually increase risk for aspiration as the guideline indicates that clear fluids can be taken up to two hours before surgery.
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Before the administration of preoperative medications, the nurse is preparing to witness the patient signing the operative consent form when the patient says, 'I do not really understand what the doctor said.' Which of the following actions is best for the nurse to take?
- A. Provide an explanation of the planned surgical procedure.
- B. Notify the surgeon that the informed-consent process is not complete.
- C. Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications.
- D. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.
Correct Answer: B
Rationale: The surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurse's legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient signs the consent form.
According to the ASA Physical Status Classification System, which of the following assessments is consistent with a rating of ASA III?
- A. Persistent asthma, controlled with an inhaler and corticosteroids
- B. Poorly controlled asthma and is wheezing
- C. Is in status asthmaticus and on a ventilator
- D. Has no significant health problems
Correct Answer: A
Rationale: A patient assessed as a rating of III on the ASA Physical Status Classification System has a history of persistent asthma controlled with β-adrenergic agonist inhaler and inhaled corticosteroids and is not wheezing. Poorly controlled asthma and wheezing is a rating of IV. No significant health problems, past or present, is a rating of I. A patient in status asthmaticus, intubated and on a ventilator, receiving corticosteroids intravenously, is rated as a V.
Ten minutes after the nurse administered the ordered preoperative opioid by intravenous (IV) injection, the patient asks to get up to go to the bathroom to urinate. Which of the following actions is best for the nurse to implement?
- A. Assist the patient to the bathroom and ensure a call bell is within reach.
- B. Offer a urinal or bedpan and position the patient in bed to promote voiding.
- C. Allow the patient up to the bathroom because the onset of the medication takes more than 10 minutes.
- D. Ask the patient to wait because catheterization is performed at the beginning of the surgical procedure.
Correct Answer: B
Rationale: The patient will be at risk for a fall after receiving the opioid, so the best nursing action is to have the patient use a bedpan or urinal. Having the patient get up either with assistance or independently increases the risk for a fall. The patient will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room.
The clinic nurse is reviewing the complete blood cell count (CBC) results for a patient who is scheduled for surgery in a few days. The results are white blood cell count (WBC) 10.2 ?? 10/1, hemoglobin 150 g/1, hematocrit 45%, platelets 150 ?? 10/1. Which of the following actions should the nurse take?
- A. Send the CBC results to the surgery facility.
- B. Call the surgeon and anaesthesiologist immediately.
- C. Ask the patient about any symptoms of a recent infection.
- D. Discuss the possibility of blood transfusion with the patient.
Correct Answer: A
Rationale: The nurse should be sure that the CBC results, which are normal, are available at the surgical facility to avoid delay of the procedure. With normal results, there is no need to notify the surgeon or anaesthesiologist, discuss blood transfusion, or ask about recent infection.
A patient who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwfruit, and latex products. Which of the following actions is most important for the nurse to take?
- A. Notify the dietitian about the food allergies.
- B. Alert the surgery centre about the latex allergy.
- C. Reassure the patient that all allergies are noted on the medical record.
- D. Ask whether the patient uses antihistamines to reduce allergic reactions.
Correct Answer: B
Rationale: When a patient is allergic to latex, special nonlatex materials are used during surgical procedures and the staff will need to know about the allergy in advance to obtain appropriate nonlatex materials and have them available on the surgical date. The other actions also may be appropriate, but prevention of allergic reaction (either contact dermatitis or anaphylaxis) during surgery is the most important action.