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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.
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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.
The nurse is preparing to administer atropine to a patient before surgery. Which of the following symptoms should the nurse teach the patient to expect?
- A. Dizziness
- B. Weakness
- C. Dry mouth
- D. Forgetfulness
Correct Answer: C
Rationale: Anticholinergic medications decrease oral and respiratory secretions, so the patient is taught that a dry mouth is an expected adverse effect. Weakness, forgetfulness, and dizziness are adverse effects associated with other preoperative medications such as opioids and benzodiazepines.
A patient arrives at the ambulatory surgery centre for a scheduled outpatient surgery. Which of the following information is of most concern to the nurse?
- A. The patient has not had outpatient surgery before.
- B. The patient is planning to drive home after surgery.
- C. The patient may not have paid sick leave from work.
- D. The patient had a glass of water a few hours before arriving.
Correct Answer: B
Rationale: After outpatient surgery, the patient should not drive home and will need assistance with transportation and home care. The patient's experience with outpatient surgery is assessed, but it does not have as much application to the patient's physiological safety. The patient's insurance coverage is important to establish, but this is not usually the nurse's role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually increase risk for aspiration as the guideline indicates that clear fluids can be taken up to two hours before surgery.
The nurse is analyzing a patient's preoperative blood studies. Which of the following blood studies should the nurse review to assess for anemia and infection in a patient with no known health problems?
- A. Red blood cell count
- B. White blood cell count
- C. Serum potassium
- D. Hematocrit
- E. Prothrombin (INR) time
Correct Answer: A,B,D
Rationale: Preoperative blood studies for assessing anemia, immune status, and infection include RBC, Hgb, Hct, platelets, WBC, and WBC differential. Prothrombin (INR) time would be used to assess bleeding tendencies. Serum potassium would not be assessed as part of anemia or infection but would be assessed in a patient who is taking a diuretic.
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.