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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.
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The nurse is providing preoperative teaching to a patient who is scheduled for surgery in 3 days. Which of the following information should the nurse include when addressing preoperative sensory information?
- A. Warming blankets are available as the operating room is often cold
- B. Lighting in the operating room is low that may cause the patient to have blurred vision.
- C. The operating room bed is narrow and a safety strap is used to secure the patient to the bed.
- D. Not to be alarmed by the quiet environment as there is no conversation in the operating room.
- E. Machines may be making 'ticking and pinging noises' that can be heard.
Correct Answer: A,C,E
Rationale: When providing preoperative teaching related to sensory information the nurse should include that warming blankets will be available as the operating room is often cold, a safety strap will be applied over the patients knees as the operating room bed is narrow, and the operating room machines make noises that the patient may hear when they are awake. Lighting in the OR is very bright, not dull although the patient may have blurred vision related to the preoperative medication it would not be related to the OR. Talking may be heard in the OR but is often distorted because of the masks and patients should be directed to ask any questions that they may have.
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.
The nurse is interviewing a patient who is to have outpatient surgery using a general anaesthetic. Which of the following information is most important to communicate to the surgeon and anaesthesiologist before surgery?
- A. The patient drinks three or four cups of coffee every morning before going to work.
- B. The patient takes a baby Aspirin daily but stopped taking Aspirin 2 weeks ago.
- C. The patient drank 120 mL of apple juice 3 hours before coming to the hospital.
- D. The patient's father died after receiving general anaesthesia for abdominal surgery.
Correct Answer: D
Rationale: The information about the patient's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue Aspirin 1-2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.
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.
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.