The nurse is obtaining the health history for a patient who is scheduled for outpatient knee surgery. Which statement by the patient is most important to report to the health care provider?

• A. I had a heart valve replacement last year.
• B. I had bacterial pneumonia 6 months ago.
• C. I have knee pain whenever I walk or jog.
• D. I have a strong family history of breast cancer.

Answer: (A)

The key concept is how implanted cardiac devices influence perioperative planning, especially anticoagulation management. A heart valve replacement means the patient likely has a prosthetic valve that requires ongoing anticoagulation to prevent valve thrombosis. In the perioperative period for knee surgery, stopping or adjusting anticoagulants can significantly affect both bleeding risk and the chance of a thromboembolic event. Knowing this history helps the care team coordinate with anesthesia and possibly a cardiologist to determine whether to continue, bridge, or temporarily stop anticoagulants, adjust INR targets, and plan for safe timing of the procedure.

The other statements don’t alter the immediate perioperative approach as directly. A prior pneumonia, while clinically relevant in different contexts, isn’t an active issue driving current surgical risk here. Knee pain is a common symptom and not a risk modifier for the scheduled outpatient procedure. A family history of breast cancer doesn’t impact perioperative management for knee arthroplasty.