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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Administering an antipyretic would lower the client's fever, but it would not address the underlying cause of the sepsis. Antipyretics can mask important signs and symptoms of infection, making it more difficult to diagnose and treat the sepsis. It's important to identify the causative organism of sepsis to initiate appropriate antibiotic therapy.
Therefore, obtaining cultures to identify the causative organism is the priority action.
Choice B rationale:
Obtaining specified cultures is the most important action for a client with possible sepsis because it allows for the identification of the causative organism.
This information is essential for selecting the appropriate antibiotic therapy. Cultures should be obtained as soon as possible, before antibiotics are administered.
Choice C rationale:
While administering antibiotics is an important part of the treatment for sepsis, it is not the first action that the nurse should take.
Antibiotics should be administered after the causative organism has been identified.
Administering antibiotics before cultures are obtained can make it more difficult to identify the causative organism.
Choice D rationale:
Placing the client in isolation is important to prevent the spread of infection, but it is not the first action that the nurse should take.
The priority is to identify the causative organism and initiate appropriate treatment. The client can be placed in isolation after cultures have been obtained.
Correct Answer is D
Explanation
Choice A rationale:
While adequate hydration is important for overall health and urinary function, it does not directly address the priority nursing diagnosis of urinary incontinence. Increased fluid intake without addressing the underlying incontinence can actually exacerbate the problem by increasing urine output.
It's crucial to assess for signs of urinary retention or incomplete bladder emptying, as excessive fluid intake can worsen these conditions.
Individualized fluid intake goals should be established based on the client's overall health status, bladder capacity, and fluid balance.
Choice B rationale:
Satisfaction with incontinence products can improve comfort and quality of life, but it does not necessarily indicate that the underlying issue of incontinence has been resolved.
It's important to evaluate the effectiveness of incontinence products in managing leakage and preventing skin breakdown, but they should not be considered a definitive solution for incontinence.
Explore other interventions to address the root cause of incontinence, such as bladder training, pelvic floor muscle exercises, or medications.
Choice C rationale:
Increased activity and socialization can be positive outcomes of effective incontinence management, but they are not direct measures of the priority nursing diagnosis.
Improved social engagement and activity levels might reflect a reduction in incontinence episodes and increased confidence, but they should not be the sole indicators of success.
Assess for specific changes in incontinence frequency, severity, and impact on daily life to more accurately gauge progress.
Choice D rationale:
Intact, healthy skin in the perineal area is a direct and objective indicator that a priority nursing diagnosis of urinary incontinence has been met.
It demonstrates that the interventions implemented to manage incontinence have been effective in preventing skin breakdown and irritation, which are common complications of incontinence.
This finding aligns with the goal of maintaining skin integrity and preventing infection, which are essential aspects of incontinence care.
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