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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.
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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.
The nurse is providing preoperative teaching to an older-adult patient who has poor hearing and vision. The partner answers most questions directed to the patient. Which of the following actions should the nurse take when implementing patient teaching?
- A. Use printed materials for instruction so that the patient will have more time to review the material.
- B. Direct the teaching toward the partner as the patient's support person and caregiver.
- C. Provide additional time for the patient to understand preoperative instructions and carry out procedures.
- D. Ask the partner to wait in the hall in order to focus preoperative teaching with the patient.
Correct Answer: C
Rationale: The nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because the patient has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the patient and the wife because both will need to understand preoperative procedures and teaching.
The nurse is preparing a patient for abdominal surgery who takes a diuretic and a β-blocker pill to control blood pressure. Which of the following patient information is most important for the nurse to communicate to the health care provider before surgery?
- A. Pulse rate 59 beats/minute
- B. Hematocrit 35%
- C. Blood pressure 142/78 mm/Hg
- D. Serum potassium 3.3 mmol/L
Correct Answer: D
Rationale: The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of patient anxiety. The heart rate would be expected in a patient taking a β-blocker. The hematocrit is in the low normal range but does not require any intervention before surgery.
Which of the following topics is most important for the nurse to discuss preoperatively with a patient who is scheduled for a colon resection?
- A. Care for the surgical incision
- B. Medications used during surgery
- C. Deep-breathing and coughing techniques
- D. Oral antibiotic therapy after discharge home
Correct Answer: C
Rationale: Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this information. The patient does not usually need information about medications that are used intraoperatively.
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.