Chapter 18 - Intraoperative Nursing Management

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.

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 lying on your side with your knees to your chest

Which statement by the client indicates further teaching about epidural anesthesia is necessary?

"I will become unconscious" is incorrect statement

Which stage of anesthesia is referred to as surgical anesthesia?

III

The nurse positions the client in the lithotomy position in preparation for

Perineal surgery

Which of the following techniques least exhibits surgical asepsis?

Suctioning the nasopharyngeal cavity of a client

The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching?

Headache

Hypothermia may occur as a result of

open body wounds

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'll be sleepy but able to respond to your questions."

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 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."

Which nursing diagnosis should the nurse plan to address first in the client upon arrival in the intraoperative setting?

Anxiety related to ineffective coping with surgical concerns

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?

Circulating nurse

What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound?

Count sponges

The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered?

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

When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate?

Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff

A client has been administered ketamine for moderate sedation. What is the priority nursing intervention?

Frequently monitoring vital signs

Which would be included as a responsibility of the scrub nurse?

Handing instruments to the surgeon and assistants

A medical student scheduled to observe surgery enters the restricted surgical zone wearing jeans, a t-shirt, and tennis shoes. What is the best action by the nurse?

Immediately escort the medical student out of the area

A client receiving general anesthesia has an increase in body temperature during the procedure. Which medication will the nurse recognize as a likely contributor to malignant hyperthermia?

Isoflurane

As a circulating nurse, what task are you solely responsible for?

Keeping records

A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first?

Roll the client onto his or her side.

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

The nurse is caring for a client during an intraoperative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately?

Temperature of 102.5°F (39°C)

In which zone of the surgical area are street clothes allowed?

Unrestricted

Which of the following is an inappropriate nursing action by the surgical nurse?

Wearing artificial nails under gloves

A client develops malignant hyperthermia. What client symptom would the nurse most likely observe as the first indicator of the disorder?

heart rate over 150 beats per minute

Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care:

may result in the administration of general anesthesia.

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."

During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer:

dantrolene sodium (Dantrium)

A client is to receive general anesthesia with sevoflurane. What does the nurse anticipate would be given with the inhaled anesthesia?

oxygen

The scrub nurse is responsible for:

preparing the sterile instruments for surgical procedure

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?

"Remain supine for the time specified by the physician."

A client asks the nurse about possible ill effects from general anesthesia. What is the best response by the nurse?

"Some possible negative effects include difficulty waking up and slow heart rate."

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?

"The surgical team is aware of the risk, so the team is prepared."

A 78-year-old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase?

Appropriately position the client using adequate padding and support.

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

What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities?

Coordinating the surgical team

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?

Decreased lean tissue mass

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?

Halothane

The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in?

Lithotomy position

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication?

Malignant Hyperthermia

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?

Mask is placed over nose and extends to bottom lip is incorrect

The nurse is entering the restricted zone of the operating room (OR) and observes another nurse wearing a mask. What is the correct action by the nurse?

Nothing - mask should be worn at all times

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?

Surgeon

A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse?

Report the infection to an immediate supervisor.

The client is undergoing a surgical procedure that is expected to last several hours. Which nursing diagnosis is most related to the duration of the procedure?

Risk for perioperative positioning injury related to positioning in the OR

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 II: excitement

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?

The client can develop malignant hyperthermia up to 24 hours after surgery.

The nurse recognizes that the older adult is at risk for surgical complications due to:

decreased renal function

The nurse recognizes the client has reached stage III of general anesthesia when the client:

lies quietly on the table

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?

verify consent