On the day of surgery, the nurse is admitting a patient with a history of cigarette smoking. Which action is most important at this time?

• A. Auscultate for adventitious breath sounds.
• B. Ask whether the patient has smoked recently.
• C. Remind the patient about harmful effects of smoking.
• D. Calculate the cigarette smoking history in pack-years.

Answer: (A)

Assessing current pulmonary status to identify immediate airway risk is the key step. On the day of surgery, lung sounds provide crucial information about how well the lungs are functioning right now and whether there is active airway inflammation, infection, secretions, or chronic disease that could complicate anesthesia or recovery. Auscultating for adventitious breath sounds—such as wheezes, crackles, or rhonchi—helps detect bronchospasm, pneumonia, atelectasis, or COPD exacerbation. Detecting these findings allows the team to optimize the plan before surgery, such as using bronchodilators, adjusting anesthesia management, or intensifying postoperative pulmonary care like incentive spirometry and chest physiotherapy. While asking about recent smoking and calculating pack-years offer useful history, they do not reveal the patient’s current respiratory status as immediately as auscultation does. Reminding the patient about harmful effects is educational but not an immediate clinical assessment.