Patient cannot describe the planned procedure or expresses misunderstanding; stop and notify the surgeon before proceeding.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A child with asthma uses a peak expiratory flow meter at home. The reading falls in the red zone (less than 50% of the personal best). Which instruction should the nurse reinforce with the family?
Answer: B. A red-zone peak flow reading signals a medical alert: the child should take the prescribed quick-relief (short-acting beta agonist) medication and seek medical care immediately. Continuing routine activity, doubling the controller, or waiting to recheck delays needed treatment.
Question 2 of 3
A client passes a renal calculus and reports severe flank pain radiating to the groin. Nursing care includes:
Answer: B. Provide pain relief, encourage fluids (unless contraindicated) to help pass the stone, strain all urine to capture the stone for analysis, and monitor output. Restricting fluids and discarding urine are incorrect.
Question 3 of 3
A home care nurse reviews the chart of a client receiving warfarin. The most recent INR is 5.8. What is the nurse's PRIORITY action?
Answer: B. A therapeutic INR for most indications is about 2 to 3. An INR of 5.8 is critically high and places the client at serious risk for bleeding, so the nurse must withhold the dose and notify the provider. Continuing the dose or adding aspirin would increase bleeding risk.
Keep the streak going with more questions like these, each with a full rationale.
What is preoperative care?
The goals are to confirm informed consent, reduce surgical risk, and prevent complications such as aspiration, infection, and wrong-site surgery. Key concerns include NPO status, baseline vitals and labs, allergy verification, and a complete preoperative checklist.
Key points to remember
- Informed consent must be signed before any sedation is given and must be obtained by the surgeon, not the nurse; the nurse witnesses the signature and confirms understanding.
- Patients are typically NPO 6-8 hours for solids and about 2 hours for clear liquids to reduce aspiration risk under anesthesia.
- A surgical time-out (correct patient, correct procedure, correct site) is performed in the OR to prevent wrong-site/wrong-patient surgery.
- Allergies, current medications, anticoagulants, and herbal supplements must be documented because many increase bleeding or interact with anesthesia.
- Baseline vital signs, height/weight, and labs (CBC, electrolytes, coagulation, type and crossmatch) establish a comparison point for the postoperative period.
- Removal of dentures, jewelry, contact lenses, nail polish, and prostheses, plus voiding before transfer, are standard safety steps.
Nursing priorities
- Verify a properly signed and witnessed informed consent is in the chart before giving any preoperative sedative.
- Confirm and reinforce NPO status; report any recent intake immediately as it may delay or cancel surgery.
- Complete the preoperative checklist: ID band, allergy band, vitals, labs, consent, site marking, and removal of valuables/prostheses.
- Hold or administer ordered medications appropriately (e.g., insulin and anticoagulant adjustments per provider orders).
- Provide teaching on coughing, deep breathing, incentive spirometer, leg exercises, and pain control to lower postoperative complications.
Labs & values
Patient teaching
- Demonstrate splinting the incision while coughing and deep breathing and using the incentive spirometer 10 times each hour while awake.
- Explain that early ambulation and leg exercises prevent blood clots and pneumonia.
- Report all medications, supplements, and allergies, and follow NPO instructions exactly to keep surgery on schedule.
Red flags: report now
- Patient cannot describe the planned procedure or expresses misunderstanding; stop and notify the surgeon before proceeding.
- Patient ate or drank within the NPO window; report immediately as aspiration risk may require postponement.
- Consent signed after a sedative was already given is invalid; notify the provider and do not proceed.
- New or undocumented allergy (especially latex or anesthesia agents) must be reported and banded before surgery.
References
Clinical references for this topic
