You are preparing a patient for a major surgery. Which of the following medications the physician may remove from the medication order of this patient?

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

Warfarin is an anticoagulant medication that significantly increases the risk of bleeding.
To ensure patient safety and minimize the risk of hemorrhage during major surgery, anticoagulants are routinely discontinued several days before the procedure.
The effect of Warfarin is monitored by the INR (International Normalized Ratio), and surgery typically proceeds only when the INR is at a safe, near-normal level.
Unlike other medications that might be adjusted or continued, the high risk of bleeding makes stopping Warfarin a critical preoperative step.

Option A: Digoxin is a cardiac medication used to control heart rate and rhythm. Abruptly stopping it could lead to cardiac instability (like atrial fibrillation with a rapid ventricular response). It is usually continued.
Option C: Famotidine is an H2 blocker that reduces stomach acid. It is often given preoperatively to decrease the risk of aspiration pneumonitis if the patient vomits under anesthesia. It is beneficial, not harmful.
Option D: Furosemide is a diuretic. While it might be held on the morning of surgery to prevent dehydration or electrolyte imbalance, it is not 'removed' from the overall plan in the same way as Warfarin. Its use is managed, not eliminated, based on the patient's fluid status.

Clinical Relevance

Nursing practice connection: Use the key finding related to Perioperative medication management and patient safety to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role in perioperative care is to perform a thorough medication reconciliation, identifying all prescription, over-the-counter, and herbal medications the patient is taking.
It is critical to educate the patient on which medications to stop and when. This includes specific instructions for anticoagulants and antiplatelets.
The nurse must ensure that any required preoperative lab results, such as an INR for a patient on Warfarin, are drawn, resulted, and communicated to the surgical and anesthesia teams.

How to Approach the Question

First, identify the core of the question: which medication poses the most significant risk in the context of a 'major surgery'.
Consider the primary risk of major surgery, which is bleeding (hemorrhage).
Review the medication options and classify each one by its primary action: Digoxin (cardiac), Warfarin (anticoagulant), Famotidine (acid reducer), Furosemide (diuretic).
Evaluate which medication class directly impacts the risk of bleeding. Anticoagulants are designed to prevent clotting, which is the opposite of what is needed for surgical hemostasis.
Conclude that the anticoagulant, Warfarin, is the medication that must be managed and likely removed from the order to prevent a life-threatening complication.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 174-176

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 60-62

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