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On the day of surgery, the nurse is admitting a patient with a history of cigarette smoking. Which of the following actions is most important at this time?
- A. Auscultate for adventitious breath sounds.
- B. Ask whether the patient has smoked recently.
- C. Remind the patient about harmful effects of smoking.
- D. Calculate the cigarette smoking history in pack-years.
Correct Answer: A
Rationale: Abnormal breath sounds may indicate the presence of an acute respiratory infection or persistent lung disease that will affect the choice of anaesthesia or proceeding with the scheduled surgery. The other nursing actions also are appropriate but will not affect the immediate surgical procedure as much as the presence of abnormal breath sounds.
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The nurse is completing a preoperative assessment of a patient scheduled for a colon resection and the patient tells the nurse about using St. John's wort to prevent depression. Which of the following information should the nurse alert the staff in the postanaesthesia recovery area about?
- A. Increased pain
- B. Hypertensive episodes
- C. Increased postanaesthesia waking time
- D. Increased postoperative bleeding
Correct Answer: C
Rationale: St. John's wort may prolong the effects of anaesthetic agents and increase the time to waken completely after surgery. It is not associated with increased bleeding risk, hypertension, or increased pain.
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 admitting a female patient for an outpatient surgery procedure. Which of the following information is most important to report to the anaesthesiologist before surgery?
- A. The patient's lack of knowledge about postoperative pain control measures
- B. The patient's statement that her last menstrual period was 8 weeks previously
- C. The patient's history of a postoperative infection following a prior cholecystectomy
- D. The patient's concern that she will be unable to care for her children postoperatively
Correct Answer: B
Rationale: This statement suggests that the patient may be pregnant, and pregnancy testing is needed before administration of anaesthetic agents. Although the other data also may be communicated with the surgeon and anaesthesiologist, they will affect postoperative care and do not indicate a need for further assessment before surgery.
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.
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.