A nurse is caring for several clients in the morning prior to surgery. Which medications taken by the clients necessitate a consultation with the primary health care provider regarding their administration? (Select all that apply.)

Prednisone

Metoprolol

Warfarin

Insulin

Phenytoin

Omega-3 fatty acid

Answer and Explanation

Correct Answer : A,C,D,E

Choice A rationale:
Prednisone:
Corticosteroid that suppresses the immune system: It's crucial to consult with the primary healthcare provider (PCP) because prednisone can impair wound healing and increase the risk of infection after surgery. The PCP may need to adjust the dosage or temporarily discontinue prednisone prior to surgery.
Potential for adrenal insufficiency: Abrupt cessation of prednisone can lead to adrenal insufficiency, a life-threatening condition. The PCP will provide guidance on how to taper the medication safely before surgery.
Interaction with anesthesia: Prednisone can interact with certain anesthetic agents, potentially increasing the risk of complications. The PCP and anesthesiologist will need to coordinate care to ensure safe medication management during surgery.
Choice B rationale:
Metoprolol:
Beta-blocker that lowers blood pressure and heart rate: While metoprolol is generally safe to continue before surgery, it's still essential to inform the PCP and anesthesiologist about its use. They will monitor heart rate and blood pressure closely during and after surgery, as metoprolol can interact with certain medications used during the procedure.
Choice C rationale:
Warfarin:
Blood thinner that prevents blood clots: Warfarin requires careful management around surgery due to its significant bleeding risk. The PCP will typically recommend holding warfarin for several days before surgery to allow for normalization of blood clotting. They may also bridge with a shorter-acting anticoagulant if necessary.
Potential for bleeding complications: If warfarin is not managed appropriately, it can lead to excessive bleeding during or after surgery. The PCP will closely monitor the patient's INR (international normalized ratio), a measure of blood clotting, to ensure it's within the safe range for surgery.
Choice D rationale:
Insulin:
Hormone that regulates blood sugar: Patients with diabetes who take insulin require careful blood sugar control around surgery to prevent complications. The PCP will provide specific instructions on how to adjust insulin doses before, during, and after surgery, as insulin needs often change due to the stress of surgery and the impact of anesthesia.
Risk of hypoglycemia and hyperglycemia: Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) can have serious consequences during and after surgery. The PCP will work with the patient to manage blood sugar levels and prevent these complications.
Choice E rationale:
Phenytoin:
Anticonvulsant medication that controls seizures: Phenytoin has a narrow therapeutic window, meaning that blood levels must be closely monitored to ensure efficacy and prevent toxicity. Surgery can affect phenytoin levels, so the PCP will likely recommend checking a blood level before surgery and adjusting the dose as needed.
Potential for drug interactions: Phenytoin interacts with many medications, including some commonly used during surgery. The PCP will need to review the patient's medication list carefully and make any necessary adjustments to prevent interactions.
Choice F rationale:
Omega-3 fatty acid:
Generally safe to continue before surgery: Omega-3 fatty acids are not known to have significant interactions with medications used during surgery or to pose risks for wound healing or bleeding. However, it's always best to inform the PCP about any supplements being taken.

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Correct Answer is D

Explanation

Rationale for Choice A:

Arranging for a bedside commode can be helpful for patients who have difficulty ambulating to the bathroom. However, it is not the most effective intervention for preventing falls in an ambulatory and independent patient. In fact, it could potentially increase the risk of falls if the patient attempts to use the commode without assistance or if they become disoriented in the dark.

Research has shown that bedside commodes are associated with an increased risk of falls in hospitalized patients. This is because patients may try to get out of bed to use the commode without assistance, or they may become disoriented in the dark and fall.

Additionally, bedside commodes can be a tripping hazard, especially for patients with impaired mobility.

Rationale for Choice B:

Ensuring the bathroom light is kept on during the night can help to reduce the risk of falls by making it easier for the patient to see. However, it is not the most effective intervention for preventing falls.

Patients may still fall even if the bathroom light is on, especially if they are weak, unsteady, or have impaired vision. Additionally, keeping the bathroom light on all night can disrupt the patient's sleep, which can also increase the risk of falls.

Rationale for Choice C:

Using side rails to keep the patient in bed is not an effective intervention for preventing falls. In fact, it can actually increase the risk of falls by making it more difficult for the patient to get out of bed safely.

Patients may try to climb over the side rails, which can lead to falls.

Additionally, side rails can restrict the patient's movement and make them feel trapped, which can lead to agitation and an increased risk of falls.

Rationale for Choice D:

Implementing a toileting schedule is the most effective intervention for preventing falls in an ambulatory and independent patient. This is because it helps to reduce the patient's need to get out of bed at night to use the bathroom.

When a patient has a scheduled time to toilet, they are less likely to try to get out of bed on their own and risk a fall. Additionally, a toileting schedule can help to prevent incontinence, which can also lead to falls.

A. Massage the site with scented oils B. Apply warm compresses to the site C. Administer topical lidocaine to the site D. Administer prescribed oral pain medication

Correct Answer is B

Explanation

Choice A rationale:
Massaging the site with scented oils is not recommended for pain relief after removal of a peripheral vascular access device. There is no evidence to support the effectiveness of scented oils in this context.
Additionally, some scented oils can be irritating to the skin, which could potentially worsen the pain, redness, and swelling.
It's crucial to use products that are specifically designed for wound care and pain management, and to follow the healthcare provider's instructions.
Choice B rationale:
Applying warm compresses to the site is an effective and recommended intervention to alleviate pain, redness, and swelling after removal of a peripheral vascular access device.
Warm compresses have the following beneficial effects:
Vasodilation: They promote blood flow to the area, which helps to reduce inflammation and pain. Muscle relaxation: The warmth helps to relax tense muscles, further easing discomfort.
Pain relief: Warmth can directly inhibit pain signals, providing a soothing sensation.
Increased circulation: Improved blood flow can help to remove inflammatory substances and promote healing. It's important to use a clean, warm compress and to apply it for 15-20 minutes at a time, several times a day.
Choice C rationale:
Topical lidocaine is a local anesthetic that can temporarily numb the skin.
While it can be used for pain relief, it's not typically the first-line intervention for pain associated with removal of a peripheral vascular access device.
Warm compresses are often preferred as they provide a more natural and non-invasive approach to pain management.
Choice D rationale:
Oral pain medication may be necessary if warm compresses do not provide adequate pain relief.
However, it's important to follow the healthcare provider's instructions regarding the type and dosage of pain medication to use.
Over-the-counter pain relievers, such as acetaminophen or ibuprofen, may be sufficient in some cases. Stronger prescription pain medication may be needed for more severe pain.

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A nurse is caring for several clients in the morning prior to surgery. Which medications taken by the clients necessitate a consultation with the primary health care provider regarding their administration? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

An elderly patient, who is ambulatory and independent, is admitted to the hospital. What intervention by the nurse would be most effective in preventing falls for this patient?

Correct Answer is D

Explanation

Rationale for Choice A:

Rationale for Choice B:

Rationale for Choice D:

A nurse is attending to a client with a peripheral vascular access device who is experiencing pain, redness, and swelling at the site. What action should the nurse take to alleviate the pain after removing the device?

Correct Answer is B

Explanation

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