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ep%20breathing%20because%20it%20hurts%20the%20incision)%2C%20immobility%20(reduced%20chest%20wall%20expansion)%2C%20and%20diaphragmatic%20dysfunction%20(from%20upper%20abdominal%20manipulation)%20creates%20a%20high%20risk%20for%20atelectasis%2C%20mucus%20retention%2C%20and%20pneumonia.%20Teaching%20these%20techniques%20preoperatively%20is%20essential%20because%20the%20patient%20is%20alert%2C%20pain-free%2C%20and%20able%20to%20learn%20and%20practice%20effectively.%20Postoperatively%2C%20pain%2C%20sedation%2C%20and%20cognitive%20effects%20of%20anesthesia%20significantly%20impair%20the%20ability%20to%20learn%20new%20skills.%20The%20incentive%20spirometer%20provides%20visual%20feedback%20to%20encourage%20sustained%20maximal%20inspiration%2C%20which%20inflates%20alveoli%20and%20prevents%20atelectasis.%22%2C%22rationales%22%3A%7B%22A%22%3A%22While%20understanding%20anesthesia%20may%20reduce%20anxiety%2C%20anxiety%20reduction%20alone%20does%20not%20prevent%20atelectasis%20and%20pneumonia.%20The%20physical%20techniques%20of%20deep%20breathing%20and%20coughing%20are%20the%20direct%20interventions%20that%20prevent%20pulmonary%20complications.%20Students%20may%20pick%20this%20because%20reducing%20anxiety%20seems%20like%20it%20would%20improve%20overall%20outcomes.%22%2C%22B%22%3A%22This%20is%20the%20correct%20answer.%20Preoperative%20instruction%20in%20deep%20breathing%2C%20incentive%20spirometry%2C%20and%20coughing%20techniques%20directly%20prevents%20postoperative%20pulmonary%20complications.%22%2C%22C%22%3A%22While%20family%20support%20is%20valuable%2C%20visiting%20hours%20information%20does%20not%20address%20the%20physiological%20causes%20of%20postoperative%20pulmonary%20complications.%20Students%20may%20choose%20this%20because%20emotional%20support%20seems%20beneficial%20for%20recovery.%22%2C%22D%22%3A%22While%20nutrition%20supports%20healing%2C%20it%20does%20not%20directly%20prevent%20the%20immediate%20postoperative%20pulmonary%20complications%20that%20result%20from%20anesthesia%2C%20pain%2C%20and%20immobility.%20Students%20may%20pick%20this%20because%20nutrition%20is%20important%20for%20overall%20recovery.%22%7D%7D%2C%7B%22scenario%22%3A%22A%20registered%20nurse%20on%20a%20surgical%20unit%20is%20completing%20the%20preoperative%20assessment%20for%20a%2070-year-old%20female%20patient%20scheduled%20for%20a%20total%20hip%20replacement%20the%20next%20morning.%20During%20the%20assessment%2C%20the%20nurse%20identifies%20the%20following%3A%20the%20patient%20takes%20warfarin%205%20mg%20daily%20for%20atrial%20fibrillation%20(INR%20today%20is%202.8)%2C%20she%20takes%20metformin%201000%20mg%20twice%20daily%20for%20type%202%20diabetes%2C%20she%20takes%20lisinopril%2020%20mg%20daily%20for%20hypertension%2C%20she%20has%20a%20documented%20penicillin%20allergy%20(anaphylaxis)%2C%20she%20reports%20taking%20St.%20John's%20Wort%20daily%20for%20mild%20depression%2C%20she%20had%20a%20glass%20of%20wine%20with%20dinner%20tonight%2C%20and%20her%20fasting%20blood%20glucose%20this%20morning%20was%20185%20mg%2FdL.%20The%20surgeon%20wants%20to%20proceed%20with%20surgery%20tomorrow%20morning.%22%2C%22question%22%3A%22Which%20preoperative%20concerns%20require%20the%20nurse%20to%20notify%20the%20surgeon%20and%20potentially%20delay%20surgery%20if%20not%20addressed%3F%22%2C%22options%22%3A%7B%22A%22%3A%22Only%20the%20penicillin%20allergy%20needs%20to%20be%20communicated%20because%20drug%20allergies%20are%20the%20only%20preoperative%20medication%20concern%20that%20affects%20surgical%20safety%22%2C%22B%22%3A%22Multiple%20concerns%20require%20surgeon%20notification%3A%20the%20INR%20of%202.8%20on%20warfarin%20poses%20significant%20surgical%20bleeding%20risk%20(warfarin%20typically%20must%20be%20held%205-7%20days%20preoperatively%20with%20INR%20below%201.5%20for%20surgery)%2C%20the%20St.%20John's%20Wort%20can%20potentiate%20anesthesia%20effects%20and%20interacts%20with%20multiple%20perioperative%20medications%20(typically%20held%202%20weeks%20preoperatively)%2C%20the%20blood%20glucose%20of%20185%20should%20be%20optimized%20preoperatively%20because%20hyperglycemia%20increases%20surgical%20site%20infection%20risk%2C%20the%20metformin%20must%20be%20held%20on%20the%20day%20of%20surgery%20to%20prevent%20lactic%20acidosis%20risk%20with%20anesthesia%20and%20potential%20contrast%20dye%20use%2C%20and%20the%20penicillin%20anaphylaxis%20allergy%20must%20be%20prominently%20communicated%20to%20anesthesia%20and%20the%20surgical%20team%20to%20prevent%20cross-reactive%20antibiotic%20administration%22%2C%22C%22%3A%22The%20nurse%20should%20not%20contact%20the%20surgeon%20about%20medication%20concerns%20because%20medication%20management%20is%20solely%20the%20pharmacist's%20responsibility%20in%20the%20preoperative%20period%22%2C%22D%22%3A%22Only%20the%20warfarin%20needs%20to%20be%20addressed%20because%20it%20is%20the%20only%20medication%20that%20directly%20affects%20the%20surgical%20procedure%2C%20and%20all%20other%20concerns%20are%20routine%22%7D%2C%22correct%22%3A%22B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