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NCLEX · General

A patient is ordered NPO (nothing by mouth) after midnight for morning surgery. The patient asks for their routine blood pressure medication at 6 AM. What should the nurse do?

Correct answer

Clarify the order with the surgeon or anaesthesiologist — many medications (especially antihypertensives, cardiac drugs, and seizure medications) are specifically ordered to be given WITH A SIP OF WATER even when NPO for surgery; never assume

  1. A Withhold all medications — NPO means nothing by mouth
  2. B Clarify the order with the surgeon or anaesthesiologist — many medications (especially antihypertensives, cardiac drugs, and seizure medications) are specifically ordered to be given WITH A SIP OF WATER even when NPO for surgery; never assume
  3. C Give all routine medications with a full glass of water
  4. D Hold only solid food; give all medications as ordered

Why this is the answer

NPO FOR SURGERY typically means NPO after midnight for solid foods. Many surgical NPO orders specifically state 'NPO except medications with sip of water' or list specific medications to continue. For antihypertensives specifically: uncontrolled hypertension creates surgical risk — most anaesthesiologists want the patient's BP controlled; abrupt withdrawal of some medications (especially beta-blockers) creates rebound risk. NURSE'S RESPONSIBILITY: Check the surgical NPO order carefully — it may specify which medications to hold vs give; if unclear, contact the surgeon or anaesthesiologist for clarification before surgery; document the clarification and action taken. Never assume 'NPO means nothing' without checking — holding critical medications pre-operatively can create dangerous conditions.
Source: NCLEX-PN, NPO and Medication Administration

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