A nurse in the surgical admitting unit is preparing a client for elective coronary artery bypass surgery. Which statement by the client should the nurse report immediately to the health care provider (HCP)? A)"I haven't had anything to eat or drink since 8 PM yesterday." B)"I took my prasugrel this morning with just a tiny sip of water." C)"I'm really nervous about this surgery." D)"It always takes several attempts to start my IV."

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Antiplatelet medication (eg, prasugrel [Effient], clopidogrel [Plavix], ticagrelor [Brilinta]) are often prescribed to a client after a percutaneous coronary intervention such as angioplasty or stent placement. These agents should be stopped at least 5-7 days prior to the surgery to reduce the chance of intraoperative and postoperative bleeding. The nurse should immediately report to the HCP that the client is still taking prasugrel and took it the morning of the surgery. Unless the surgery is emergent, it will most likely be postponed at least a week. (Option A) Nothing by mouth for at least 6-8 hours prior to surgery is typical. (Option C) The nurse can assist the client in discussing reasons for the anxiety. Anxiety is common prior to surgery; unless the client refuses to go through with the surgery or requests to speak with the HCP, the nurse can usually deal with this issue. (Option D) Difficult IV sticks can be handled by the nurse. Educational objective: Medications that cause increased risk for bleeding include anticoagulants (eg, warfarin, heparin) and antiplatelets (eg, aspirin, clopidogrel, prasugrel, ticagrelor, dipyridamole).

A Nurse in the Surgical Admitting Unit Is Preparing a Client