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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.
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The nurse is obtaining the health history for a patient who is scheduled for outpatient knee surgery. Which of the following statements by the patient is most important for the nurse to report to the health care provider?
- A. I had a heart valve replacement last year.
- B. I had bacterial pneumonia 6 months ago.
- C. I have knee pain whenever I walk or jog.
- D. I have a strong family history of breast cancer.
Correct Answer: A
Rationale: A patient with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may affect whether the patient should have surgery, but a history of pneumonia is not a reason to postpone surgery. The patient's knee pain is the likely reason for the surgery. A family history of breast cancer does not have any implications for the current surgery.
The nurse is analyzing a patient's preoperative blood studies. Which of the following blood studies should the nurse review to assess for anemia and infection in a patient with no known health problems?
- A. Red blood cell count
- B. White blood cell count
- C. Serum potassium
- D. Hematocrit
- E. Prothrombin (INR) time
Correct Answer: A,B,D
Rationale: Preoperative blood studies for assessing anemia, immune status, and infection include RBC, Hgb, Hct, platelets, WBC, and WBC differential. Prothrombin (INR) time would be used to assess bleeding tendencies. Serum potassium would not be assessed as part of anemia or infection but would be assessed in a patient who is taking a diuretic.
The nurse is preparing to administer atropine to a patient before surgery. Which of the following symptoms should the nurse teach the patient to expect?
- A. Dizziness
- B. Weakness
- C. Dry mouth
- D. Forgetfulness
Correct Answer: C
Rationale: Anticholinergic medications decrease oral and respiratory secretions, so the patient is taught that a dry mouth is an expected adverse effect. Weakness, forgetfulness, and dizziness are adverse effects associated with other preoperative medications such as opioids and benzodiazepines.
The nurse is conducting a preoperative interview with a patient who is scheduled for an elective hysterectomy and the patient tells the nurse, 'I am afraid that I will die in surgery like my mother did!' Which of the following responses by the nurse is most appropriate?
- A. Tell me more about what happened to your mother.
- B. You will receive medications to reduce your anxiety.
- C. You should talk to the doctor again about the surgery.
- D. Surgical techniques have improved a lot in recent years.
Correct Answer: A
Rationale: 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 also may address the patient's concerns, but further assessment is needed first.
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.