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The nurse is preparing a patient the morning of surgery and the patient refuses to remove a wedding ring, saying, 'I have never taken it off since the day I was married.' Which of the following actions should the nurse implement?
- A. Have the patient sign a release and leave the ring on.
- B. Tape the wedding ring securely to the patient's finger.
- C. Tell the patient that the hospital is not liable for loss of the ring.
- D. Suggest that the patient give the ring to a family member to keep.
Correct Answer: B
Rationale: The ring can be taped to the patient's finger and noted on the preoperative checklist. There is no need for a release form or to discuss liability with the patient. Wearing the ring is obviously important to the patient, so the nurse should tape the ring in place rather than have a family member keep the ring for the patient.
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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.
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.
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.
A patient who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwfruit, and latex products. Which of the following actions is most important for the nurse to take?
- A. Notify the dietitian about the food allergies.
- B. Alert the surgery centre about the latex allergy.
- C. Reassure the patient that all allergies are noted on the medical record.
- D. Ask whether the patient uses antihistamines to reduce allergic reactions.
Correct Answer: B
Rationale: When a patient is allergic to latex, special nonlatex materials are used during surgical procedures and the staff will need to know about the allergy in advance to obtain appropriate nonlatex materials and have them available on the surgical date. The other actions also may be appropriate, but prevention of allergic reaction (either contact dermatitis or anaphylaxis) during surgery is the most important action.
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.