A 25-year-old patient is admitted to the ambulatory surgery unit to receive two units of whole blood.

The patient has anemia, systemic lupus erythematosus, hypertension, schizophrenia, and primary hypothyroidism.

The patient’s vital signs are BP 100/68, P 110, R 24, T 99.1 °F, O2-97%. The patient reports experiencing shortness of breath with exertion, fatigue, dizziness when standing, and an intolerance to cold temperatures.

Initial labs indicate an Hgb of 6.8, an Hct of 21.2, a CRP of 38, an albumin of 14, and an iron level of 9. The patient’s current medications include hydroxychloroquine 200 mg one BID, amlodipine 10 mg one PO daily, Citalopram 20 mg one PO daily, Lisinopril 20 mg one PO daily, sertraline 50 mg one daily, levothyroxine 75 mg one PO daily, Ferrous sulfate 30 mg one PO TID, and quetiapine 100 mg one PO HS. Which patient assessment findings require immediate follow-up by the nurse at this time? (Select all that apply)

Choice A rationale:
Anaphylaxis risk: A history of allergy to bee and wasp stings indicates a potential risk for anaphylaxis, a severe and life- threatening allergic reaction. This information is crucial for the surgical team to be aware of, as it can influence their choice of anesthesia, medications, and other interventions during the surgery. They will need to be prepared to manage any potential allergic reactions promptly and effectively.
Cross-reactivity potential: Allergies to insect stings can sometimes cross-react with other substances, such as medications used during surgery (e.g., antibiotics, muscle relaxants, latex). It's essential for the surgical team to be aware of these potential cross-reactions to take necessary precautions and avoid triggering an allergic reaction.
Preoperative planning: Knowing about the patient's allergy to bee and wasp stings allows the surgical team to make informed decisions regarding:
Premedication: The patient may need to receive antihistamines or corticosteroids before surgery to reduce the risk of an allergic reaction.
Monitoring: The patient's vital signs and symptoms will be closely monitored during and after surgery for any signs of an allergic reaction.
Emergency preparedness: The surgical team will have medications and equipment readily available to treat anaphylaxis if it occurs.
Choice B rationale:
Lactose intolerance is not typically a significant concern during surgery. It's a digestive issue that can cause discomfort after consuming dairy products, but it doesn't typically pose immediate risks during surgical procedures. The surgical team may adjust the patient's diet after surgery to accommodate lactose intolerance, but it's not crucial information for the immediate surgical planning.
Choice C rationale:
Herb and supplement use is important to communicate to the surgical team. Some herbs and supplements can interact with medications used during surgery, increasing the risk of bleeding, heart problems, or other complications. However, it's not as immediately critical as an allergy to bee and wasp stings, which carries a risk of life-threatening anaphylaxis.
Choice D rationale:
While a patient's previous experience with surgery can be helpful for the surgical team to understand their anxiety levels and expectations, it's not as critical as information about allergies or potential medication interactions.

Choice A rationale:
While working in a facility affiliated with a medical or nursing school can offer opportunities for professional development and collaboration, it is not the most important factor to consider when choosing a new job.
Affiliation with a school does not guarantee a positive work environment, strong nursing leadership, or a commitment to quality patient care, which are all hallmarks of Magnet hospitals.
It's essential to consider other factors that directly impact job satisfaction, patient outcomes, and overall nursing excellence.
Choice B rationale:
Having the latest technology can be beneficial, but it does not ensure a supportive work environment or a high standard of nursing care.
Technology is only one aspect of a hospital's operations, and it should not be the primary focus when making a career decision. It's crucial to prioritize factors that directly influence the quality of nursing practice and patient outcomes.
Choice C rationale:
Inquiring about nurse-client ratios is important, as it can provide insight into the workload and staffing levels at a hospital. However, it's not the most comprehensive indicator of a hospital's commitment to nursing excellence.
Magnet status, in contrast, signifies a broader commitment to quality nursing care, professional development, and positive work environments.
Choice D rationale:
Magnet status is a prestigious designation awarded by the American Nurses Credentialing Center (ANCC) to hospitals that demonstrate excellence in nursing care, leadership, and innovation.
Magnet hospitals are known for:
Attracting and retaining highly qualified nurses Fostering a culture of collaboration and teamwork Investing in professional development and growth
Promoting evidence-based practice and quality improvement Demonstrating outstanding patient outcomes
Seeking employment at a Magnet hospital is strongly recommended for nurses who prioritize professional growth, job satisfaction, and the delivery of exceptional patient care.