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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.
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A patient is seen at the health care provider's office several weeks before hip surgery for preoperative assessment. The patient reports use of Echinacea, ginseng, glucosamine, and chondroitin. Which of the following actions should the nurse take?
- A. Ascertain that there will be no interactions with anaesthetic agents.
- B. Discuss the supplement use with the patient's health care provider.
- C. Teach the patient that these products may be continued preoperatively.
- D. Advise the patient to stop the use of all herbs and supplements at this time.
Correct Answer: B
Rationale: The nurse should discuss the medication use with the patient's health care provider because ginseng may increase bleeding, heart rate, and blood pressure. The nurse should not advise the patient to stop the supplements or to continue them without consulting with the health care provider. Determining the interactions between the supplements and anaesthetics is not within the nurse's scope of practice.
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.
The nurse is caring for a patient with diabetes who is scheduled for a mastectomy at 1:00 PM today and it is now 8:30 AM. The patient uses insulin to control blood glucose and has been NPO since midnight. Which of the following actions should the nurse take?
- A. Withhold the usual scheduled insulin dose because the patient is NPO.
- B. Obtain a blood glucose measurement before any insulin administration.
- C. Administer the usual insulin dose because stress will increase the blood glucose.
- D. Administer a lower dose of insulin because there will be no oral intake before surgery.
Correct Answer: B
Rationale: Preoperative insulin administration is individualized to the patient, and the current blood glucose will provide the most reliable information about insulin needs. It Sp?³??
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 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.