Nokea
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.
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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.
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 surgery. Which of the following information about medication use is most important for the nurse to communicate to the health care provider?
- A. The patient uses acetaminophen occasionally for aches and pains.
- B. The patient takes garlic capsules daily but did not take any on the surgical day.
- C. The patient has a history of cocaine use but quit using the drug over 10 years ago.
- D. The patient took a sedative medication the previous night to assist in falling asleep.
Correct Answer: B
Rationale: Persistent use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome.
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.
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.