Ch. 18: Intraoperative Nursing Management Prep U
A nurse is teaching a client who is at risk for malignant hyperthermia subsequent to general anesthesia. What should the nurse include in the teaching? "Your vital signs will indicate if you need more inhalant medication." "There are reversal agents that will lessen the occurrence of the malignant hyperthermia." "The surgical team is aware of the risk, so the team is prepared." "The surgery can continue as long as your temperature is controlled."
"The surgical team is aware of the risk, so the team is prepared."
The client who had spinal anesthesia complains of a headache. Which of the following is an inappropriate action by the nurse? Administer morphine sulfate. Keep the head of the bed flat. Increase fluid intake. Maintain a quiet environment.
Administer morphine sulfate.
The nurse is completing a postoperative assessment for a patient who has received a depolarizing neuromuscular blocking agent. The nursing assessment includes careful monitoring of which body system? Cardiovascular system Genitourinary system Endocrine system Gastrointestinal system
Cardiovascular system
The nurse is completing a postoperative assessment for a patient who has received a depolarizing neuromuscular blocking agent. The nursing assessment includes careful monitoring of which body system? Gastrointestinal system Endocrine system Cardiovascular system Genitourinary system
Cardiovascular system
What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound? Label the tissue specimen. Hand equipment to the surgeon as needed. Count the sponges. Prepare the necessary sutures.
Count the sponges.
The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered? Unresponsive to verbal or tactile stimuli Yelling and pulling at equipment No movement in right lower leg Denies sensation to perineum and lower abdomen
Denies sensation to perineum and lower abdomen
Which of the following actions by the nurse is appropriate? Discarding an object that comes in contact with the 1-inch border Touching the edges of an open sterile package Touching sterile items with a clean-gloved hand Reaching over the sterile field
Discarding an object that comes in contact with the 1-inch border
Which stage of surgical anesthesia is also known as excitement? III I II IV
II
The nursing instructor is talking with her class about spinal anesthesia. What would be the nursing care intervention required when caring for a client recovering from spinal anesthesia? Instruct the client to remain flat for 6 to 12 hours. Turn the client from side to side at least every 2 hours. Assist the client to a sitting position at the side of the bed. Monitor vital signs every 2 hours.
Instruct the client to remain flat for 6 to 12 hours.
Which is the most common cause of anaphylaxis? Medications Fibrin sealants Plastic Latex
Medications
After teaching a class about agents commonly associated with the development of malignant hyperthermia, the instructor determines that additional teaching is needed when the students identify which drug as a possible cause? Halothane Succinylcholine Epinephrine Morphine
Morphine
A client is administered succinylcholine and propofol for induction of anesthesia. One hour after administration, the client demonstrates muscle rigidity with a heart rate of 180. What should the nurse do first? Obtain cooling blankets. Document the assessment findings. Notify the surgical team. Administer dantrolene sodium.
Notify the surgical team.
What is the priority action when the circulating nurse is completing a second verification of the surgical procedure and surgical site? Ask the surgeon whether the marked surgical site is correct. Discuss the surgical procedure and surgical site with the client. Obtain the attention of all members of the surgical team. Review complications and allergies with the anesthesiologist.
Obtain the attention of all members of the surgical team.
A list of commonly used medications for a particular surgical procedure is provided to the nurse. The anesthesiologist announces the administration of a nondepolarizing muscle relaxant. Which medication should the nurse document as having been administered? Morphine sulfate Fentanyl Pancuronium Succinylcholine
Pancuronium
A list of commonly used medications for a particular surgical procedure is provided to the nurse. The anesthesiologist announces the administration of a nondepolarizing muscle relaxant. Which medication should the nurse document as having been administered? Succinylcholine Pancuronium Morphine sulfate Fentanyl
Pancuronium
Which drug is a nondepolarizing muscle relaxant? Fentanyl Pancuronium Succinylcholine Morphine sulfate
Pancuronium
An intravenous anesthetic that, in large doses, has a powerful respiratory depressant effect sufficient to cause apnea and cardiovascular depression is: Pentothal Versed Ketalar Amidate
Pentothal
The client received ketamine during a surgical procedure. What intervention by the nurse will assist with an optimal recovery period? The client does not require a recovery period and may go back to the hospital room. Make sure that the client is stimulated frequently. Speak to the client in a loud, clear voice. Place the client in a darkened, quiet part of the recovery area.
Place the client in a darkened, quiet part of the recovery area.
The scrub nurse is responsible for: Monitoring the operating-room personnel for breaks in sterile technique Monitoring the administration of the anesthesia Calling the "time-out" to verify the surgical site and procedure Preparing the sterile instruments for the surgical procedure
Preparing the sterile instruments for the surgical procedure
A nurse suspects malignant hyperthermia in a patient who underwent surgery approximately 18 hours ago. Which of the following would the nurse identify as a late, ominous sign? Oliguria Rapid rise in body temperature Tachycardia Muscle rigidity
Rapid rise in body temperature
The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to: Need an endotracheal tube Respond verbally during the procedure Be anxious throughout the procedure Need pain control throughout the procedure
Respond verbally during the procedure
The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? Respiratory rate of 18 breaths/min Pulse rate of 110 beats/min Blood pressure of 104/62 mm Hg Temperature of 102.5°F (39°C)
Temperature of 102.5°F (39°C)
A client is having a surgical procedure that requires the client to be in the prone position. What is an expected client outcome? The client will not experience signs of an allergic reaction. The client remains free of perioperative positioning injury. The client will not experience anxiety during the preoperative phase. The client will not experience signs and symptoms of infection.
The client remains free of perioperative positioning injury.
A perioperative nurse is conducting an in-service education program about maintaining surgical asepsis during the intraoperative period. Which of the following would the nurse emphasize? The edges of a sterile package, once opened, are considered unsterile. Circulating nurses may come in contact with the sterile field without contaminating it. If a tear occurs in a sterile drape, a new sterile drape is applied on top of it. A distance of 3 feet must be maintained when moving around a sterile field.
The edges of a sterile package, once opened, are considered unsterile.
A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? Count sponges and syringes. Document the start of surgery. Verify consent. Acquire ordered blood products.
Verify consent.
A client requires minor surgery for removal of a basal cell tumor. The anesthesiologist administers the anesthetic ketamine hydrochloride 60 g IV. After administration, the nurse will monitor the client for what symptom? extrapyramidal reactions hiccups temperature elevation hallucinations
hallucinations
A client is to receive general anesthesia with sevoflurane. What does the nurse anticipate would be given with the inhaled anesthesia? lidocaine alfentanil oxygen rocuronium
oxygen
A client asks the nurse how an inhalant general anesthetic is expelled by the body. What is the best response by the nurse? "The lungs primarily eliminate the anesthesia." "The kidneys will eliminate the inhalant with urination." "The liver will eliminate the inhalant anesthesia." "The skin will eliminate the anesthesia through evaporation."
"The lungs primarily eliminate the anesthesia."
The OR personnel responsible for maintaining the safety of the client and the surgical environment is the: Anesthesiologist Surgeon Circulating nurse Scrub nurse
Circulating nurse
The nurse is assisting with positioning the patient on the operating table. The nurse understands that the most commonly used position is which of the following? Dorsal recumbent Trendelenburg Sims Lithotomy
Dorsal recumbent
An obese client is undergoing abdominal surgery. During the procedure a surgical resident states, "The amount of fat we have to cut through is disgusting." What is the best response by the nurse? Ignore the comment. Discuss concerns regarding the comments with the charge nurse. Report the resident to the attending surgeon. Inform the resident that all communication needs to remain professional.
Inform the resident that all communication needs to remain professional.
A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention? Shoe covers are used. Scrub top and drawstring are tucked into pants. Hair is pulled back and covered by a cap. Mask is placed over nose and extends to bottom lip.
Mask is placed over nose and extends to bottom lip.
An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position? Flat on his back with his arms next to his sides On his side, with his uppermost leg adducted and flexed at the knee On his back, with his legs and thighs flexed at right angles On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle
On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle
The nurse positions the client in the lithotomy position in preparation for Abdominal surgery Renal surgery Pelvic surgery Perineal surgery
Perineal surgery
A patient is scheduled for surgery with spinal anesthesia. When explaining this type of anesthesia to the patient, which body area would the nurse describe as being affected first? Chest Legs Abdomen Perineum
Perineum
A patient is to receive local anesthesia in combination with epinephrine. The nurse understands that epinephrine is used for which reason? Prevents anaphylaxis Enhances the anesthetic's absorption Prolongs the local action Reduces the amount of anesthetic needed
Prolongs the local action
A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first? Suction the mouth. Provide a basin. Administer an antiemetic medication. Roll the client onto his or her side.
Roll the client onto his or her side.
The surgical client has been intubated and general anesthesia has been administered. The client exhibits cyanosis, shallow respirations, and a weak, thready pulse. The nurse recognizes that the client is in which stage of general anesthesia? Stage IV Stage II Stage I Stage III
Stage IV
A client at risk for malignant hyperthermia returns to the surgical unit. For what time period will the nurse monitor the client for development of malignant hyperthermia? Malignant hyperthermia occurs in the operating room only. The client will need to be discharged with special instructions. A client can develop malignant hyperthermia only with intravenous anesthesia after surgery. The client can develop malignant hyperthermia up to 24 hours after surgery.
The client can develop malignant hyperthermia up to 24 hours after surgery.
Which of the following is an inappropriate nursing action by the surgical nurse? Wearing a surgical jacket with knitted cuffs on the sleeves Changing shoe covers that become torn Covering the hair with a surgical cap Wearing sterile gloves over artificial nails
Wearing sterile gloves over artificial nails
During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer: an acetaminophen suppository potassium chloride dantrolene sodium (Dantrium) verapamil (Isoptin)
dantrolene sodium (Dantrium)
Hypothermia may occur as a result of the infusion of warm fluids. open body wounds. being young. increased muscle activity.
open body wounds.
The physician is concerned about aspiration during a surgical procedure and orders a medication to increase gastric pH. Which medication would the nurse document as being administered? Midazolam Sodium citrate Famotadine Vecuronium
Sodium citrate
A nurse is working as a registered nurse first assistant as defined by the state's nurse practice act. This nurse practices under the direct supervision of which surgical team member? Circulating nurse Anesthetist Scrub nurse Surgeon
Surgeon
The circulating nurse is unsure whether proper technique was followed when an object was placed in the sterile field during a surgical procedure. What is the best action by the nurse? Remove the item from the sterile field. Mark the client's chart for future review of infections. Ask another nurse to review the technique used. Remove the entire sterile field from use.
Remove the entire sterile field from use.
A client is undergoing surgery with a brachial plexus block to the right wrist. The client voices concern about anesthesia awareness. What is the best response by the nurse? "Anesthesia awareness is not a concern with type of surgery you are having." "The entire surgical team will monitor for anesthesia awareness and treat it appropriately." "Because of the type of anesthesia used, you may be aware of what is going on around you." "Advances in medicines used decrease the chance of anesthesia awareness. What are your major concerns?"
"Because of the type of anesthesia used, you may be aware of what is going on around you."
Which statement by the client indicates further teaching about epidural anesthesia is necessary? "A needle will deliver the anesthetic into the area around my spinal cord." "I will be able to hear the surgeon during the surgery." "I will lose the ability to move my legs." "I will become unconscious."
"I will become unconscious."
Which position is used for perineal surgical procedures? Sims Dorsal recumbent Lithotomy Trendelenburg
Lithotomy
Which position should the patient undergoing pelvis surgery be positioned? Trendelenburg Lithotomy Reverse Trendelenburg Sim's
Trendelenburg
A circulating nurse is preparing a client for a surgical procedure. What are the primary responsibilities of the circulating nurse in the perioperative experience? Select all that apply. passing the surgical instruments coordinating the efforts of the surgical team ensuring proper lighting marking the surgical site verifying informed consent
verifying informed consent ensuring proper lighting coordinating the efforts of the surgical team
A new scrub technician is being oriented to the operating room. The scrub technician states to the nurse, "You can skip the fire safety information because I have worked in hospitals for the past 10 years." What is the best response by the nurse? "I know this information is not exciting but I'm required to cover it with you." "This is a requirement of your job; just tough through it." "The operating room has some unique circumstances that increases the chances of fire." "OK, but you will be required to review the hospital's policy on fire safety on your own."
"The operating room has some unique circumstances that increases the chances of fire."
When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate? Allowing circulating nurses to contact sterile equipment Considering the gown sterile from mid-thigh to neck Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff Positioning the sterile drape on a table from back to front
Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff
An instructor is developing for a class a teaching plan about agents used for intravenous (IV) anesthesia. Which of the following would the instructor include in this plan about these agents and this type of anesthesia? Select all that apply. Associated with more nausea Ease of administration Long duration of action More pleasant onset of anesthesia Need for little equipment
More pleasant onset of anesthesia Ease of administration Need for little equipment
Fentanyl is categorized as which type of intravenous anesthetic agent? Neuroleptanalgesic Dissociative agent Opioid Tranquilizer
Opioid
A patient who has received general anesthesia has reached stage II. Which of the following would the nurse expect the patient to exhibit? Weak, thready pulse and cyanosis Dizziness and a feeling of detachment Pupillary dilation and rapid pulse Unconsciousness and regular respirations
Pupillary dilation and rapid pulse
A patient has received general anesthesia and is progressing through the stages. Using the manifestations below, place them in the proper sequence from stage I to stage IV. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Shallow respirations 4Unconsciousness 2Pupil dilation 3Ringing in the ears
Ringing in the ears Pupil dilation Unconsciousness Shallow respirations
The physician requests lidocaine 2% with epinephrine for use in local infiltration anesthesia. What does the nurse understand is the purpose of adding epinephrine to the lidocaine? (Select all that apply.) The epinephrine prevents rapid absorption of the anesthetic drug. The epinephrine will prevent the patient from having an allergic reaction to the lidocaine. The lidocaine will not anesthetize the area locally without the epinephrine. The epinephrine prolongs the local action of the anesthetic agent. The epinephrine causes vasoconstriction.
The epinephrine causes vasoconstriction. The epinephrine prevents rapid absorption of the anesthetic drug. The epinephrine prolongs the local action of the anesthetic agent.
What action during a surgical procedure requires immediate intervention by the circulating nurse? The anesthesiologist monitoring blood gas levels The registered nurse's first assistant suturing the surgical wound The surgeon reaching within the sterile field to obtain equipment The scrub nurse calling the blood bank to obtain blood products
The scrub nurse calling the blood bank to obtain blood products
Which position should the patient undergoing pelvis surgery be positioned? Lithotomy Sim's Trendelenburg Reverse Trendelenburg
Trendelenburg
A patient begins to vomit during surgery. Place the actions below in the order in which they would be performed. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Turn the patient to the side. 2Lower the head of the surgical table. 4Provide a basin for collection. 3Suction to remove saliva.
Turn the patient to the side. Lower the head of the surgical table. Provide a basin for collection. Suction to remove saliva.
A patient undergoes induction for general anesthesia at 8:30 a.m. and is being assessed continuously for the development of malignant hyperthermia. At which time would the patient be most likely to exhibit manifestations of this condition? 9:00 to 9:10 a.m. 8:40 to 8:50 a.m. 10:00 to 10:10 a.m. 9:30 to 9:40 a.m.
8:40 to 8:50 am Malignant hyperthermia usually manifests about 10 to 20 minutes after the induction of anesthesia, which in this case would 8:40 to 8:50 a.m.
A client who is scheduled for knee surgery is anxious about the procedure, saying, "You hear stories on the news all the time about doctors working on the wrong body part. What if that happens to me?" What is the nurse's best response? Select all that apply. "The surgeon on the team has never been involved in such a mix-up." "The surgical team performs a 'time-out' prior to surgery to conduct a final verification." "Our surgical team would never make that mistake." "The client can be involved in marking the knee, the site for the surgery." "The client will be involved in the verification process prior to surgery."
"The client can be involved in marking the knee, the site for the surgery." "The surgical team performs a 'time-out' prior to surgery to conduct a final verification." "The client will be involved in the verification process prior to surgery."
A 70-year-old patient who is to undergo surgery arrives at the operating room (OR). The nurse, when reviewing the patient's medical record, understands that this patient will require a lower dose of anesthetic agent because of which of the following? Impaired thermoregulation Increased anxiety level Increased tissue elasticity Decreased lean tissue mass
Decreased lean tissue mass
A nurse is teaching a client about airway control with inhalant anesthesia. What does the nurse include in the client teaching? Propofol will be used as an inhalant through a laryngeal mask airway. Oxygen at high concentrations are used for rapid induction. Fentanyl will be used as an inhalant through an endotracheal tube. Halothane will be used with a endotracheal tube for a rapid smooth induction.
Halothane will be used with a endotracheal tube for a rapid smooth induction.
Which would be included as a responsibility of the scrub nurse? Keeping all records and adjusting lights Obtaining and opening wrapped sterile equipment Coordinating activities of other personnel Handing instruments to the surgeon and assistants
Handing instruments to the surgeon and assistants
The nurse recognizes the client has reached stage III of general anesthesia when the client: Exhibits shallow respirations and a weak, thready pulse Exhibits no change in behavior Complains of ringing or buzzing in the ears Has small pupils that react to light
Has small pupils that react to light
Which stage of anesthesia is referred to as surgical anesthesia? II IV I III
III
A nurse is reviewing the medical record of a patient who is to receive general anesthesia and notes a nursing diagnosis of anxiety related to surgical concerns. The nurse implements measures to reduce the patient's anxiety based on the understanding of which of the following? Anxiety interferes with progression through the stages of general anesthesia. The anesthetic will result in a more potent effect on the patient. Increased anxiety can increase the patient's postoperative pain level. The patient is at risk for additional complications.
Increased anxiety can increase the patient's postoperative pain level.
The anesthesiologist is administering a stable and safe nondepolarizing muscle relaxant. What medication does the nurse anticipate will be administered? Syncurine (decamethonium) Pavulon (pancuronium bromide) Anectine (succinylcholine chloride) Norcuron (vecuronium bromide)
Pavulon (pancuronium bromide)
The surgical client is at risk for injury related to positioning. Which of the following clinical manifestations exhibited by the client would indicate the goal was met of avoiding injury? Vital signs within normal limits for client Peripheral pulses palpable Pulse oximetry 98% Absence of itching
Peripheral pulses palpable
Which nursing diagnosis is most important for the client who is undergoing a surgical procedure expected to last several hours? Risk of latex allergy response related to possible exposure in the OR environment Anxiety related to ineffective coping with surgical concerns Disturbed sensory perception related to the effects of general anesthesia Risk for perioperative positioning injury related to positioning in the OR
Risk for perioperative positioning injury related to positioning in the OR
The client vomits during the surgical procedure. The best action by the nurse is: Lower the head of the operating table to promote circulation to the brain. Increase the IV infusion rate to compensate for lost fluids. Suction the client to remove saliva and gastric secretions. Administer an anti-emetic to alleviate nausea.
Suction the client to remove saliva and gastric secretions.
Which of the following techniques least exhibits surgical asepsis? Suctioning the nasopharyngeal cavity of a client Adding only sterile items to a sterile field Keeping sterile gloved hands above the waist Placing the sterile field at least one foot away from personnel
Suctioning the nasopharyngeal cavity of a client
Which clinical manifestation is often the earliest sign of malignant hyperthermia? Elevated temperature Oliguria Hypotension Tachycardia (heart rate >150 beats per minute)
Tachycardia (heart rate >150 beats per minute)
Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care: is a type of regional anesthesia. is used as an adjunct to spinal anesthesia. requires the introduction of an anesthetic agent into the epidural space. may result in the administration of general anesthesia.
may result in the administration of general anesthesia
After teaching a patient scheduled for ambulatory surgery using moderate sedation, the nurse determines that the patient has understood the teaching based on which of the following statements? "I'm so glad that I will be unconscious during the surgery." "Only the surgical area will be numb." "I won't feel it, but I'll have a tube to help me breathe." "I'll be sleepy but able to respond to your questions."
"I'll be sleepy but able to respond to your questions."
The nurse recognizes older adults require lower doses of anesthetic agents due to: increased liver mass. increased tissue elasticity. decreased bone mass. decreased lean tissue mass.
decreased lean tissue mass.
Which intervention should the nurse plan to implement to decrease the client's risk for injury during the intraoperative period? Allow the client to verbalize fears. Keep the family informed of the client's status. Assess the client for allergies. Verify the client's preoperative vital signs.
Assess the client for allergies.
Which intervention should the nurse plan to implement to decrease the client's risk for injury during the intraoperative period? Assess the client for allergies. Allow the client to verbalize fears. Verify the client's preoperative vital signs. Keep the family informed of the client's status.
Assess the client for allergies.
The circulating nurse is performing a skin preparation for a client who is unconscious from general anesthesia when the scrub nurse states, "I know her, she sure has gotten fat!" What is the best response by the circulating nurse? "She sure has gained weight. I hope that she will heal after the surgery." "Be sure you don't say anything like that when she is coming out of the anesthesia in case she hears you." "It is inappropriate to make comments even when clients appear to be unconscious from anesthesia." "If you say anything like that again, I will report you to the nurse manager."
"It is inappropriate to make comments even when clients appear to be unconscious from anesthesia."
What is the most important postoperative instruction a nurse must give to a client who has just returned from the operating room after receiving a subarachnoid block? "Avoid drinking liquids until the gag reflex returns." "Remain supine for the time specified by the physician." "Avoid eating milk products for 24 hours." "Notify a nurse if you experience blood in your urine."
"Remain supine for the time specified by the physician."
A client asks the nurse about possible ill effects from general anesthesia. What is the bestresponse by the nurse? "Clients can experience pain and loss of consciousness." "Amnesia and analgesia are some of the negative effects of anesthesia." "Few negative effects occur with general anesthesia." "Some possible negative effects include difficulty waking up and slow heart rate."
"Some possible negative effects include difficulty waking up and slow heart rate."
A client asks the nurse about possible ill effects from general anesthesia. What is the bestresponse by the nurse? "Few negative effects occur with general anesthesia." "Some possible negative effects include difficulty waking up and slow heart rate." "Clients can experience pain and loss of consciousness." "Amnesia and analgesia are some of the negative effects of anesthesia."
"Some possible negative effects include difficulty waking up and slow heart rate."
The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response? "The anesthetic may last for 1 hour." "The anesthetic may last for 3 hours." "The anesthetic may last for 7 hours." "The anesthetic may last for 5 hours."
"The anesthetic may last for 3 hours."
The nurse is working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks the nurse why these medications are needed. What would be the nurse's best answer? "These medications decrease gastric acidity and volume." "These medications slow motor activity." "These medications decrease anxiety before surgery." "These medications decrease the amount of anesthesia you will need."
"These medications decrease gastric acidity and volume."
The nurse is working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks the nurse why these medications are needed. What would be the nurse's best answer? "These medications slow motor activity." "These medications decrease anxiety before surgery." "These medications decrease the amount of anesthesia you will need." "These medications decrease gastric acidity and volume."
"These medications decrease gastric acidity and volume."
A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate? "You will be placed flat on the table, face down." "You will be lying on your side with your knees to your chest." "You will be on your back with the head of the bed at 30 degrees." "You will be flat on your back with the table slanted so your head is below your feet."
"You will be lying on your side with your knees to your chest.
The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate? Alert personnel who break sterile technique. Allow unnecessary personnel to enter the OR environment. Maintain the positive pressure OR environment. Monitor for faulty electrical equipment.
Allow unnecessary personnel to enter the OR environment.
A 78-year-old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase? Withhold pain medication due to decreased renal function. Appropriately position the client using adequate padding and support. Maintain an operating room temperature of 18°C to prevent hypothermia. Discuss with the anesthesiologist the need for higher doses of anesthetic agents.
Appropriately position the client using adequate padding and support.
The nurse is aware that infection is a potential complication of surgery. Which intervention should the nurse implement to prevent infection? Select all that apply. Keep artificial nails clean and in good repair. Wear a long-sleeved, sterile gown and gloves. Alert the surgical team of any breaches of sterile technique. Remove hair from the surgical site using a razor. Avoid touching sterile items unless necessary.
Avoid touching sterile items unless necessary. Alert the surgical team of any breaches of sterile technique. Wear a long-sleeved, sterile gown and gloves.
Why should the nurse be vigilant with assessment of perioperative risks on the older adult client? Select all that apply. Fatty tissue increases, prolonging the effects of anesthesia. Liver size decreases, reducing the metabolism of anesthetics. The elasticity of skin increases and decreases the risk of shearing. Ciliary action decreases, reducing the cough reflex. Peristalsis increases.
Ciliary action decreases, reducing the cough reflex. Fatty tissue increases, prolonging the effects of anesthesia. Liver size decreases, reducing the metabolism of anesthetics.
A patient is in the operating room for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented? Surgeon Circulating nurse Scrub nurse Registered nurse first assistant
Circulating nurse
What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities?
Coordinating the surgical team
What medication should the nurse prepare to administer in the event the client has malignant hyperthermia? Fentanyl citrate Thiopental sodium Naloxone Dantrolene sodium
Dantrolene sodium
A client has been administered ketamine for moderate sedation. What is the priority nursing intervention? Frequently monitoring vital signs Administering oxygen Providing a quiet dark room for recovery Assessing for hallucinations
Frequently monitoring vital signs
Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic? Succinylcholine Propofol Halothane Fentanyl
Halothane
A client is receiving general anesthesia. The nurse anesthetist starts to administer the anesthesia. The client begins giggling and kicking her legs. What stage of anesthesia would the nurse document related to the findings? III IV II I
II
A nurse is reviewing the medical record of a patient who is to receive general anesthesia and notes a nursing diagnosis of anxiety related to surgical concerns. The nurse implements measures to reduce the patient's anxiety based on the understanding of which of the following? The anesthetic will result in a more potent effect on the patient. Anxiety interferes with progression through the stages of general anesthesia. Increased anxiety can increase the patient's postoperative pain level. The patient is at risk for additional complications.
Increased anxiety can increase the patient's postoperative pain level.
As a circulating nurse, what task are you solely responsible for? Handing instruments to the surgeon. Keeping records. Estimating the client's blood loss. Counting sponges and needles.
Keeping records.
A client is undergoing a perineal surgical procedure. The nurse should place the client in which position? Sims Dorsal recumbent Trendelenburg Lithotomy
Lithotomy
The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in? Lithotomy position Left lateral Sim's Trendelenburg Prone position
Lithotomy position
A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention? Oxygen saturation (SaO2) of 85% Heart rate of 84 beats/minute Decreased cough and gag reflexes Blood-tinged stools
Oxygen saturation (SaO2) of 85%
The nurse is educating new employees about wearing masks in the operating room. What information should the nurse provide? Select all that apply. Masks can be worn outside the surgical department if the surgery is less than 5 minutes away. You must change masks between treating clients. When not using the mask, you can wear it around your neck. Masks should cover the nose and mouth completely. Masks should fit tightly. Masks must be worn at all times in the semi-restricted zone.
Masks should cover the nose and mouth completely. You must change masks between treating clients. Masks should fit tightly.
What is an example of an intravenous anesthetic that is a hypnotic and produces excellent amnesia? Etomidate Ketamine Midazolam Propofol
Midazolam
An instructor is developing for a class a teaching plan about agents used for intravenous (IV) anesthesia. Which of the following would the instructor include in this plan about these agents and this type of anesthesia? Select all that apply. Need for little equipment Associated with more nausea Ease of administration Long duration of action More pleasant onset of anesthesia
More pleasant onset of anesthesia Ease of administration Need for little equipment
What is the priority action when the circulating nurse is completing a second verification of the surgical procedure and surgical site? Discuss the surgical procedure and surgical site with the client. Obtain the attention of all members of the surgical team. Ask the surgeon whether the marked surgical site is correct. Review complications and allergies with the anesthesiologist.
Obtain the attention of all members of the surgical team
A nurse who is part of the surgical team is involved in setting up the sterile tables. The nurse is functioning in which role? Scrub role Registered nurse first assistant Anesthetist Circulating nurse
Scrub role
Which conduction block anesthetizes the nerves supplying the chest, abdominal wall, and extremities? Brachial plexus block Lumbar puncture Transsacral block Paravertebral anesthesia
Paravertebral anesthesia
During the surgical procedure, the client's temperature falls to 96.6°F. Which of the following nursing actions is inappropriate? Increase the temperature of the OR environment. Remove wet gowns and drapes. Place a cooling blanket under the client. Warm IV and irrigating fluids.
Place a cooling blanket under the client.
A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priorityaction by the nurse? Report the infection to an immediate supervisor. Ensure the infection is covered with a dressing. Request a role change to circulating nurse. Return to work after taking antibiotics for 24 hours.
Report the infection to an immediate supervisor.
A 55-year-old patient arrives at the operating room. The nurse is reviewing the medical record and notes that the patient has a history of osteoporosis in her lower back and hips. The patient is scheduled to receive epidural anesthesia. Which of the following nursing diagnoses would be a priority for this patient? Risk for injury related to effects of anesthetic agents Risk for perioperative positioning injury related to operative position Anxiety related to the surgical experience Disturbed sensory perception related to sedation
Risk for perioperative positioning injury related to operative position
Which of the following consequences may result if tranquilizers are withdrawn suddenly? Cardiovascular collapse Seizures Hypotension Respiratory depression
Seizures Abrupt withdrawal of tranquilizers may result in anxiety, tension, and even seizures if withdrawn suddenly
Which zone of the surgical area only requires attire in the form of scrub clothes and caps? Operative zone Unrestricted zone Semi-restricted zone Restricted zone
Semi-restricted zone
Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery? Supine position Lithotomy position Trendelenburg position Sims position
Sims position
There are four stages of general anesthesia. Select the stage during which the OR nurse knows not to touch the patient (except for safety reasons) because of possible uncontrolled movements. Stage III: surgical anesthesia Stage II: excitement Stage I: beginning anesthesia Stage IV: medullary depression
Stage II: excitement
An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia? Beginning anesthesia Excitement Surgical anesthesia Medullary depression
Surgical anesthesia
The nurse recognizes that the older adult is at risk for surgical complications due to: increased cardiac output decreased adipose tissue decreased renal function increased skeletal mass
decreased renal function
A client develops malignant hyperthermia. What client symptom would the nurse most likely observe as the first indicator of the disorder? tetanus-like jaw movements body temperature increase of 1 °C to 2 °C (2 °F to 4 °F) heart rate over 150 beats per minute generalized muscle rigidity
heart rate over 150 beats per minute
A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse bases her next action on the principle that: this client may need intubation. it may be necessary to raise the head of this client's bed. administering I.V. antibiotics can prevent pneumonia. inserting a Foley catheter can decrease fluid retention.
it may be necessary to raise the head of this client's bed.
The nurse recognizes the client has reached stage III of general anesthesia when the client:
lies quietly on the table
During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication? hypothermia infection fluid volume excess malignant hyperthermia
malignant hyperthermia