Adult Health Intraop PrepU

Which clinical manifestation is often the earliest sign of malignant hyperthermia? Oliguria Tachycardia (heart rate >150 beats per minute) Hypotension Elevated temperature

Tachycardia Tachycardia is often the earliest sign of malignant hyperthermia. Hypotension is a later sign of malignant hyperthermia. The rise in temperature is actually a late sign that develops quickly. Scant urinary output is a later sign of malignant hyperthermia.

!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.) 1. The epinephrine causes vasoconstriction. 2. The epinephrine prevents rapid absorption of the anesthetic drug. 3. The epinephrine prolongs the local action of the anesthetic agent. 4. The lidocaine will not anesthetize the area locally without the epinephrine. 5. The epinephrine will prevent the patient from having an allergic reaction to the lidocaine.

1, 2, 3

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. 1 Avoid touching sterile items unless necessary. 2 Wear a long-sleeved, sterile gown and gloves. 3 Alert the surgical team of any breaches of sterile technique. 4 Remove hair from the surgical site using a razor. 5 Keep artificial nails clean and in good repair.

1, 2, 3 Nursing interventions to prevent infection during the intraoperative phase include wearing appropriate attire; avoiding touching sterile items; and alerting the surgical team of breaches of sterile technique. Artificial nails are banned for OR personnel, because they can harbor microorganisms. Excess hair is removed with clippers, not a razor.

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? Verify consent. Acquire ordered blood products. Count sponges and syringes. Document the start of surgery.

A. Surgery cannot be performed without consent. Documentation of the start of surgery can only happen once the surgery has started. Blood products must be administered within an allotted time frame and therefore should not be acquired unless needed. The sponge and syringe count is a safety issue that should be completed before surgery and while the wound is being sutured, but if the client has not consented, the surgery should not take place.

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." "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."

A. With moderate sedation, the patient can maintain a patent airway (ie, doesn't need a tube to help breathing), retain protective airway reflexes, and respond to verbal and physical stimuli. The patient is not unconscious with moderate sedation. Local anesthesia involves anesthetizing or numbing the area of the surgery.

! The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to: A. Respond verbally during the procedure B. Need an endotracheal tube C. Be anxious throughout the procedure D. Need pain control throughout the procedure

A. Clients can respond to verbal and physical stimuli and maintain an oral airway and protective reflexes during moderate sedation.

The nurse recognizes older adults require lower doses of anesthetic agents due to: A. decreased lean tissue mass. B. increased tissue elasticity. C. increased liver mass. D. decreased bone mass.

A. Lower doses of anesthetic agents are required in older adults, as they have decreased lean tissue mass, decreased tissue elasticity, and decreased liver mass. Bone mass is unrelated to doses of anesthesia.

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication? A. malignant hyperthermia B. fluid volume excess C. hypothermia D. infection

A. Malignant hyperthermia is an inherited disorder that occurs when body temperature, muscle metabolism, and heat production increase rapidly, progressively, and uncontrollably in response to stress and some anesthetic agents. If the client's temperature begins to rise rapidly, anesthesia is discontinued, and the OR team implements measures to correct physiologic problems, such as fever or dysrhythmias. Hypothermia is a lower than expected body temperature. Signs of infection would not present during the procedure. Increased body temperature would not indicate fluid volume excess.

The nurse recognizes that the older adult is at risk for surgical complications due to: A. decreased renal function B. increased cardiac output C. decreased adipose tissue D. increased skeletal mass

A. Renal function declines with age, resulting in slowed excretion of waste products and anesthetic agents.

The client asks the nurse how the spinal anesthesia will be administered. The best response by the nurse is: A. "The anesthesiologist will inject the anesthetic into the space around your lower spinal cord." B. "The anesthesiologist will inject the anesthetic through your IV." C. "You will inhale the medication through a mask the anesthesiologist will place over your face." D. "The medication will be injected into the muscle by the anesthesiologist."

A. The L4-L5 subarachnoid space is the usual location for the administration of spinal anesthesia.

Which statement by the client indicates further teaching about epidural anesthesia is necessary? A. "I will become unconscious." B. "I will lose the ability to move my legs." C. "I will be able to hear the surgeon during the surgery." D. "A needle will deliver the anesthetic into the area around my spinal cord."

A. The client receiving epidural anesthesia will remain conscious during the procedure.

A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse? A. Report the infection to an immediate supervisor. B. Ensure the infection is covered with a dressing. C. Return to work after taking antibiotics for 24 hours. D. Request a role change to circulating nurse.

A. The infection needs to be reported immediately because of the aseptic environment of the operating room. The usual barriers may not protect the client when an infection is present. The employee needs to follow the policy of the operating room regarding infections. Covering the infected area with a dressing may be necessary, but the infection must be reported first. The scrub nurse may still be able to work depending on the policy; therefore, returning to work after 24 hours is not the priority action. Even if the nurse requests a role change to circulating nurse, the policy for infections in the operating room must be followed; therefore, it must be reported first.

Which of the following is often the earliest sign of malignant hyperthermia? A. Tachycardia B. Hypotension C. Oliguria D. Decreased cardiac output

A. The initial symptoms of malignant hyperthermia are related to cardiovascular and musculoskeletal activity. Tachycardia (heart rate >150 bpm) is often the first sign. In addition to tachycardia, sympathetic nervous system stimulation leads to ventricular arrhythmia, hypotension, decreased cardiac output, oliguria, and later, cardiac arrest.

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. 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. Circulating nurses may come in contact with the sterile field without contaminating it.

A. To maintain surgical asepsis, the edges of a sterile package, once opened, are considered unsterile. When moving around a sterile field, individuals must maintain a distance of at least 1 foot from the sterile field. If a tear occurs in a sterile drape, it must be replaced. Only scrubbed personnel and sterile items may come in contact with sterile areas. Circulating nurses can only contact unsterile areas.

A patient develops malignant hyperthermia. Which of the following most likely would be the first indicator of this complication? Generalized muscle rigidity Heart rate over 150 beats per minute Body temperature rise of 2 degrees F Tentanus-like jaw movements

B.

Which would be included as a responsibility of the scrub nurse? Keeping all records and adjusting lights Handing instruments to the surgeon and assistants Coordinating activities of other personnel Obtaining and opening wrapped sterile equipment

B.

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? A. Increased tissue elasticity B. Decreased lean tissue mass C. Impaired thermoregulation D. Increased anxiety level

B. Elderly patients require lower doses of anesthetic agents because of decreased tissue elasticity and reduced lean tissue mass. An increased amount of anesthetic would be needed with an increased anxiety level. Impaired thermoregulation increases the patient's susceptibility to hypothermia.

How would the operating room nurse place a patient in the Trendelenburg position? A. Flat on his back with his arms next to his sides B. On his back with his head lowered so that the plane of his body meets the horizontal on an angle C. On his back with his legs and thighs flexed at right angles D. On his side with his uppermost leg adducted and flexed at the knee

B. The Trendelenburg position usually is used for surgery on the lower abdomen and pelvis to obtain good exposure by displacing the intestines into the upper abdomen. In this position, the head and body are lowered. The patient is supported in position by padded shoulder braces (see Fig. 18-5B), bean bags, and foam padding.

The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered? Yelling and pulling at equipment Denies sensation to perineum and lower abdomen No movement in right lower leg Unresponsive to verbal or tactile stimuli

B. A transsacral block anesthetizes the perineum and occasionally the lower abdomen. Yelling and pulling at equipment can be related to the excitement phase of general anesthesia. Lack of response to verbal or tactile stimuli and no movement in the right lower leg are not consistent with a transsacral conduction block.

Fentanyl is categorized as which type of intravenous anesthetic agent? A. Tranquilizer B. Opioid C. Dissociative agent D. Neuroleptanalgesic

B. Fentanyl is 75 to 100 times more potent than morphine and has about 25% of the duration of morphine (IV). Examples of tranquilizers include midazolam and diazepam. Ketamine is a dissociative agent.

A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention? A. Heart rate of 84 beats/minute B. Oxygen saturation (SaO2) of 85% C. Decreased cough and gag reflexes D. Blood-tinged stools

B. Normal SaO2 is 95% to 100%. Oxygen saturation of 85% indicates inadequate oxygenation, which may be a consequence of the moderate sedation. Appropriate nursing actions include rousing the client, if necessary, assisting the client with coughing and deep breathing, and evaluating the need for additional oxygen. A heart rate of 84 beats/minute is within normal limits. Colonoscopy doesn't affect cough and gag reflexes, although these reflexes may be slightly decreased from the administration of sedation. These findings don't require immediate intervention. Blood-tinged stools are a normal finding after colonoscopy, especially if the client had a biopsy.

The nurse positions the client in the lithotomy position in preparation for A. Abdominal surgery B. Perineal surgery C. Renal surgery D. Pelvic surgery

B. The client undergoing perineal surgery will be placed in the lithotomy position.

Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery? A. Lithotomy position B. Sims position C. Supine position D. Trendelenburg position

B. The client undergoing renal surgery will be placed in the Sims position.

A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse? Request a role change to circulating nurse. Report the infection to an immediate supervisor. Return to work after taking antibiotics for 24 hours. Ensure the infection is covered with a dressing.

B. The infection needs to be reported immediately because of the aseptic environment of the operating room. The usual barriers may not protect the client when an infection is present. The employee needs to follow the policy of the operating room regarding infections. Covering the infected area with a dressing may be necessary, but the infection must be reported first. The scrub nurse may still be able to work depending on the policy; therefore, returning to work after 24 hours is not the priority action. Even if the nurse requests a role change to circulating nurse, the policy for infections in the operating room must be followed; therefore, it must be reported first.

What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities? Passing instruments Coordinating the surgical team Assisting the surgeon Setting up the sterile tables

B. The person in the scrub role, either a nurse or a surgical technician, provides sterile instruments and supplies to the surgeon during the procedure by anticipating the surgical needs as the surgical case progresses. The circulating nurse coordinates the care of the patient in the OR. Care provided by the circulating nurse includes planning for and assisting with patient positioning, preparing the patient's skin for surgery, managing surgical specimens, anticipating the needs of the surgical team, and documenting intraoperative events.

What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities? A. Assisting the surgeon B. Coordinating the surgical team C. Setting up the sterile tables D. Passing instruments

B. The person in the scrub role, either a nurse or a surgical technician, provides sterile instruments and supplies to the surgeon during the procedure by anticipating the surgical needs as the surgical case progresses. The circulating nurse coordinates the care of the patient in the OR. Care provided by the circulating nurse includes planning for and assisting with patient positioning, preparing the patient's skin for surgery, managing surgical specimens, anticipating the needs of the surgical team, and documenting intraoperative events.

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? A. Scrub nurse B. Surgeon C. Anesthetist D. Circulating nurse

B. The registered nurse first assistant practices under the direct supervision of the surgeon. The circulating nurse works in collaboration with other members of the health care team to plan the best course of action for each patient. The scrub nurse assists the surgeon during the procedure as well as setting up sterile tables and preparing equipment. The anesthetist administers the anesthetic medications.

A client is placed on the operating room table for the surgical procedure. Which surgical team member is responsible for handing sterile instruments to the surgeon and assistants? A. Circulating nurse B. Scrub nurse C. Certified registered nurse anesthetist D. First assistant

B. The scrub nurse is sterile and assists the surgical team by handing instruments to the surgeon, preparing sutures, receiving specimens to be sent to the lab, and counting sponges and needles. The circulating nurse is not sterile and obtains and opens sterile equipment, adjusts lights, and keeps records. The first assistant is involved with the client's preoperative care. The certified registered nurse anesthetist assists in the client's anesthesia.

Which of the following techniques least exhibits surgical asepsis? A. Adding only sterile items to a sterile field B. Suctioning the nasopharyngeal cavity of a client C. Placing the sterile field at least one foot away from personnel D. Keeping sterile gloved hands above the waist

B. To maintain surgical asepsis, only sterile items should touch sterile items.

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)

C. The client is exhibiting clinical manifestations of malignant hyperthermia. Dantrolene sodium, a skeletal muscle relaxant, is administered.

A 78-year-old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase? A. Discuss with the anesthesiologist the need for higher doses of anesthetic agents. B. Withhold pain medication due to decreased renal function. C. Appropriately position the client using adequate padding and support. D. Maintain an operating room temperature of 18°C to prevent hypothermia.

C. Adequate padding and support should be used to prevent positioning injuries. Older adults have lower bone mass, which increases the risk of intraoperative positioning injuries. Pain medication can still be used, just in smaller doses, due to decreased liver and kidney function. For the same reason, lower doses of anesthetic agents are used with older adults. The operating room is usually maintained from 20°C to 24°C; 18°C is lower than the recommended temperature and can promote hypothermia in an older adult who already has impaired thermoregulation and is prone to hypothermia.

A patient is to receive general anesthesia. The nurse anticipates that which of the following would be used for induction? Tetracaine Isoflurane Etomidate Nitrous oxide

C. Anesthesia induction begins with IV anesthesia, such as etomidate, and then is maintained at the desired stage by inhalation methods, such as isoflurane or nitrous oxide. Tetracaine is used for local or regional anesthesia.

A patient is to receive local anesthesia in combination with epinephrine. The nurse understands that epinephrine is used for which reason? Reduces the amount of anesthetic needed Enhances the anesthetic's absorption Prolongs the local action Prevents anaphylaxis

C. Epinephrine is added to a local anesthetic to constrict the blood vessels, which prevents rapid absorption of the local anesthetic agent and thus prolongs its local action. Rapid absorption of the anesthetic into the blood stream could cause seizures. Epinephrine does not reduce the amount of anesthetic needed. It also does not prevent anaphylaxis.

A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate? A. "You will be placed flat on the table, face down." B. "You will be flat on your back with the table slanted so your head is below your feet." C. "You will be lying on your side with your knees to your chest." D. "You will be on your back with the head of the bed at 30 degrees."

C. For the lumbar puncture procedure, the client usually lies on the side in a knees-to-chest position. A position flat on the table, face down does not open the vertebral spaces to allow access for the lumbar puncture. Having the client lie on their back does not allow access to the surgical site.

! 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? A. Remove the item from the sterile field. B. Mark the client's chart for future review of infections. C. Remove the entire sterile field from use. D. Ask another nurse to review the technique used.

C. If any doubt exists about the maintenance of sterility, the field should be considered not sterile. Because the object in question was placed in the sterile field, the sterile field must be removed from use. Removing the individual item is not appropriate, as the entire field was potentially contaminated. Reviewing the client's chart at a later date does not decrease the chance of infection. Although another nurse could observe the technique used to put objects in a sterile field, it does not resolve the immediate concern.

A medical student scheduled to observe surgery enters the unrestricted surgical zone wearing jeans, a t-shirt, and tennis shoes. What is the best action by the nurse? Provide the medical student a cap and mask. No action is needed. Educate the medical student on required attire for each surgical zone. Immediately escort the medical student out of the area.

C. It would be best to educate the medical student on the required attire for each surgical zone. Because the student will be observing a surgery, he or she will need to dress appropriately in each zone to decrease the risk of introducing pathogens. The unrestricted zone allows for street clothes; therefore, the student does not need to be removed. If no action is taken by the nurse, the student could enter the semirestricted or restricted zone without appropriate attire. Providing a cap and mask does not address the need to change out of the street clothes to observe the surgery.

An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia? Excitement Medullary depression Surgical anesthesia Beginning anesthesia

C. Surgical anesthesia is reached by administration of anesthetic vapor or gas and supported by IV agents as necessary. The patient is unconscious and lies quietly on the table. The pupils are small but contract when exposed to light. Respirations are regular, the pulse rate and volume are normal, and the skin is pink or slightly flushed. In beginning anesthesia, as the patient breathes in the anesthetic mixture, warmth, dizziness, and a feeling of detachment may be experienced. The patient may have a ringing, roaring, or buzzing in the ears and, although still conscious, may sense an inability to move the extremities easily. The excitement stage, characterized variously by struggling, shouting, talking, singing, laughing, or crying, is often avoided if IV anesthetic agents are administered smoothly and quickly. The pupils dilate, but they contract if exposed to light; the pulse rate is rapid, and respirations may be irregular. Medullary depression is reached if too much anesthesia has been administered. Respirations become shallow, the pulse is weak and thready, and the pupils become widely dilated and no longer contract when exposed to light.

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? A. Absence of itching B. Pulse oximetry 98% C. Peripheral pulses palpable D. Vital signs within normal limits for client

C. Surgical clients are at risk for pressure ulcers and damage to nerves and blood vessels as a result of awkward positioning required for surgical procedures. Palpable peripheral pulses indicate integrity of the blood vessels.

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 anxiety before surgery." "These medications slow motor activity." "These medications decrease gastric acidity and volume." "These medications decrease the amount of anesthesia you will need."

C. The anesthesiologist frequently orders preoperative medications. Common preoperative medications include the following: anticholinergics, which decrease respiratory tract secretions, dry mucous membranes, and interrupt vagal stimulation; anti anxiety drugs, which reduce preoperative anxiety, slow motor activity, and promote induction of anesthesia; histamine2-receptor antagonists, which decrease gastric acidity and volume; narcotics, which decrease the amount of anesthesia needed, help reduce anxiety and pain, and promote sleep; sedatives, which promote sleep, decrease anxiety, and reduce the amount of anesthesia needed; and tranquilizers, which reduce nausea, prevent emesis, and enhance preoperative sedation.

A patient is in the OR for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented? A. Registered nurse first assistant B. Scrub nurse C. Circulating nurse D. Surgeon

C. The circulating nurse is responsible for ensuring that the second verification of the surgical procedure and site takes place and is documented. Each member of the surgical team verifies the patient's name, procedure, and surgical site using objective documentation and data before beginning the surgery.

The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate? A. Monitor for faulty electrical equipment. B. Alert personnel who break sterile technique. C. Allow unnecessary personnel to enter the OR environment. D. Maintain the positive pressure OR environment.

C. The circulating nurse restricts the admittance of unnecessary personnel in the OR environment.

A client is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid) block during surgery. In the operating room, the nurse positions the client according to the anesthesiologist's instructions. Why does the client require special positioning for this type of anesthesia? A. To prevent confusion B. To prevent seizures C. To prevent cerebrospinal fluid (CSF) leakage D. To prevent cardiac arrhythmias

C. The client receiving a subarachnoid block requires special positioning to prevent CSF leakage and headache and to ensure proper anesthetic distribution. Proper positioning doesn't help prevent confusion, seizures, or cardiac arrhythmias.

A client is undergoing a perineal surgical procedure. The nurse should place the client in which position? A. Trendelenburg B. Sims C. Lithotomy D. Dorsal recumbent

C. The lithotomy position is used for nearly all perineal, rectal, and vaginal surgeries. The Trendelenburg position is usually used for surgery on the lower abdomen and pelvis. The Sims' or lateral position is used for renal surgery. The dorsal recumbent position is the usual position for surgical procedures.

The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in? A. Left lateral Sim's B. Prone position C. Lithotomy position D. Trendelenburg

C. The lithotomy position is used for nearly all perineal, rectal, and vaginal surgical procedures (see Fig. 18-5C). The patient is positioned on the back with the legs and thighs flexed. The position is maintained by placing the feet in stirrups.

The nurse understands that the purpose of the "time out" is to: A. verify all necessary supplies are available. B. identify the client's allergies. C. maintain the safety of the client. D. clarify the roles of the OR personnel.

C. Verification of the identification of the client, procedure, and operative site are essential to maintain the safety of the client.

Which of the following is an inappropriate nursing action by the surgical nurse? Changing shoe covers that become torn Covering the hair with a surgical cap Wearing a surgical jacket with knitted cuffs on the sleeves Wearing sterile gloves over artificial nails

D. Artificial nails are prohibited in the clinical setting, because they can cause nosocomial infections.

Which of the following is the appropriate response to the statement, "I'm so nervous about my surgery"? A. "Relax. Your recovery period will be shorter if you're less nervous." B. "Stop worrying. It only makes you more nervous." C. "You needn't worry. Your doctor has done this surgery many times before." D. "You seem nervous about your surgery."

D. Use of the communication technique of "restating" is recommended as a way to encourage the patient to expand his or her thoughts and feelings.

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? Muscle rigidity Oliguria Tachycardia Rapid rise in body temperature

D. A rise in body temperature is a late sign that develops rapidly, with the temperature possibly increasing 1 degree to 2 degrees C every 5 minutes and body core temperature exceeding 42 degrees C (107 degrees F). Tachycardia is often the earliest sign; muscle rigidity also is an early sign. Oliguria occurs with sympathetic nervous system stimulation.

What medication should the nurse prepare to administer in the event the patient has malignant hyperthermia? Narcan Thiopental sodium (Pentobarbital) Fentanyl citrate (Sublimaze) Dantrolene sodium (Dantrium)

D. Anesthesia and surgery should be postponed. However, if end-tidal carbon dioxide (CO2) monitoring and dantrolene sodium (Dantrium) are available and the anesthesiologist is experienced in managing malignant hyperthermia, the surgery may continue using a different anesthetic agent (Barash et al., 2009).

-The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching? A. Sore throat B. Itching C. Seizures D. Headache

D. Headache is a common effect following spinal anesthesia.

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? A. Pulse rate of 110 beats/min B. Respiratory rate of 18 breaths/min C. Blood pressure of 104/62 mm Hg D. Temperature of 102.5°F (39°C)

D. Intra operative hyperthermia can indicate a life-threatening condition called malignant hyperthermia. The circulating nurse closely monitors the client for signs of hyperthermia. The pulse rate, respiratory rate, and blood pressure did not indicate a significant concern.

Which of the following actions by the nurse is appropriate? 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

D. The 1-inch border of a sterile field is considered unsterile.

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? A. "These medications slow motor activity." B. "These medications decrease the amount of anesthesia you will need." C. "These medications decrease anxiety before surgery." D. "These medications decrease gastric acidity and volume."

D. The anesthesiologist frequently orders preoperative medications. Common preoperative medications include the following: anticholinergics, which decrease respiratory tract secretions, dry mucous membranes, and interrupt vagal stimulation; anti anxiety drugs, which reduce preoperative anxiety, slow motor activity, and promote induction of anesthesia; histamine2-receptor antagonists, which decrease gastric acidity and volume; narcotics, which decrease the amount of anesthesia needed, help reduce anxiety and pain, and promote sleep; sedatives, which promote sleep, decrease anxiety, and reduce the amount of anesthesia needed; and tranquilizers, which reduce nausea, prevent emesis, and enhance preoperative sedation.

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. A. Stage III: surgical anesthesia B. Stage IV: medullary depression C. Stage I: beginning anesthesia D. Stage II: excitement

D. The excitement stage, characterized variously by struggling, shouting, talking, singing, laughing, or crying, is often avoided if the anesthetic is administered smoothly and quickly. Because of the possibility of uncontrolled movements, the patient should not be touched except for purposes of restraint.

The nurse caring for a patient who is at risk for malignant hyperthermia subsequent to general anesthesia would assess for the most common early sign of: A. Hypertension (BP >130/90). B. Oliguria (urinary output <400 mL/day). C. Tachypnea (>35 breaths/min). D. Tachycardia (HR >150 bpm).

D. The initial symptoms of malignant hyperthermia are related to cardiovascular and musculoskeletal activity. In addition to the tachycardia (often the earliest sign), sympathetic nervous stimulation leads to ventricular arrhythmia, hypotension, decreased cardiac output, oliguria, and, eventually, cardiac arrest.

!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? A. Hair is pulled back and covered by a cap. B. Scrub top and drawstring are tucked into pants. C. Shoe covers are used. D. Mask is placed over nose and extends to bottom lip.

D. The mask should fit tightly, covering the nose and mouth. The mask should extend down past the chin. The mask may not effectively cover the mouth if extended only to the bottom lip. The hair, scrub top, drawstring, and shoe covering are all appropriate and do not require intervention.

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: A. inserting a Foley catheter can decrease fluid retention. B. administering I.V. antibiotics can prevent pneumonia. C. this client may need intubation. D. it may be necessary to raise the head of this client's bed.

D. The nurse should consider positioning when caring for a client who has COPD and difficulty breathing. Elevating the head of the bed assists these clients in breathing. There's no indication that it's necessary to intubate the client. A Foley catheter isn't indicated. Prophylactic I.V. antibiotics aren't administered with moderate sedation.

A nurse who is part of the surgical team is involved in setting up the sterile tables. The nurse is functioning in which role? A. Registered nurse first assistant B. Circulating nurse C. Anesthetist D. Scrub role

D. The scrub role includes performing a surgical hand scrub, setting up the sterile tables, and preparing sutures, ligatures, and special equipment. The circulating nurse manages the operating room and protects patient safety. The registered nurse first assistant functions under the direct supervision of the surgeon. Responsibilities may include handling tissue, providing exposure of the operative field, suturing, and maintaining hemostasis. The anesthetist administers the anesthetic medications.

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? Propofol Halothane Succinylcholine Fentanyl

Halothane Halothane is an example of an inhalation anesthetic. Fentanyl, succinylcholine, and propofol are commonly used intravenous agents for anesthesia.

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? I IV III II

II Stage II is the excitement stage, which is characterized by struggling, shouting, and laughing. Stage I is the beginning of anesthesia, during which the client breathes in the anesthetic mixture and feelings of warmth, dizziness, and detachment occur. Stage III is surgical anesthesia characterized by unconsciousness and quietness. Surgical anesthesia is achieved by continued administration of anesthetic vapor and gas. Stage IV is medullary depression.

Which stage of surgical anesthesia is also known as excitement? II I IV III

II Stage II is the excitement stage, which is characterized by struggling, shouting, and laughing. Stage II is often avoided if the anesthetic is administered smoothly and quickly. Stage I is the beginning of anesthesia, during which the client breathes in the anesthetic mixture and feelings of warmth, dizziness, and detachment occur. Stage III is surgical anesthesia, which is achieved by continued administration of anesthetic vapor and gas. Stage IV is medullary depression, in which the client is unconscious and lies quietly on the table.

Which stage of anesthesia is referred to as surgical anesthesia? II III I IV

III Stage III may be maintained for hours with proper administration of the anesthetic. Stage I is beginning anesthesia, where the client breathes in the anesthetic mixture and experiences warmth, dizziness, and a feeling of detachment. Stage II is the excitement stage, which may be characterized by struggling, singing, laughing, or crying. Stage IV is a state of medullary depression and is reached when too much anesthesia has been administered.

As a circulating nurse, what task are you solely responsible for? Keeping records. Handing instruments to the surgeon. Counting sponges and needles. Estimating the client's blood loss.

Keeping records The circulating nurse wears OR attire but not a sterile gown. Responsibilities include obtaining and opening wrapped sterile equipment and supplies before and during surgery, keeping records, adjusting lights, receiving specimens for laboratory examination, and coordinating activities of other personnel, such as the pathologist and radiology technician. It is the responsibility of the scrub nurse to hand instruments to the surgeon and count sponges and needles. It is the responsibility of the surgeon to estimate blood loss.

A patient is to receive general anesthesia with sevoflurane. The nurse anticipates the need for which of the following? Rocuronium Oxygen Alfentanil Lidocaine

O2 Sevoflurane is an inhalation anesthetic always combined with oxygen. It would not be combined with alfentanil, rocuronium, or lidocaine. Alfentanil and rocuronium are intravenous anesthetics. Lidocaine is a local anesthetic.

The nurse recognizes the client has reached stage III of general anesthesia when the client: Ability to respond to verbal commands Paralysis of the lower extremities Loss of consciousness Exhibits no change in behavior Has small pupils that react to light Unable to maintain airway Exhibits shallow respirations and a weak, thready pulse Complains of ringing or buzzing in the ears

Stage III of general anesthesia is characterized by dilation and reaction of pupils. Respirations are regular, the pulse rate and volume are normal, and the skin is pink or slightly flushed.

A patient is to undergo surgery on his kidney. The patient would be placed in which position for the surgery? A. Dorsal recumbent B. Trendelenburg C. Lithotomy D. Sims or lateral position

The Sims' or lateral position as shown in Option D would be used for renal surgery. The dorsal recumbent position (Option A) is used for most abdominal surgeries, except those for the gallbladder or pelvis. The Trendelenburg position (Option B) is used for surgery on the lower abdomen and pelvis. The lithotomy position (Option C) is used for nearly all perineal, rectal, and vaginal surgical procedures.

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the: Scrub nurse Circulating nurse Anesthesiologist Surgeon

The circulating nurse is responsible for maintaining the safety of the client and the surgical environment.

The scrub nurse is responsible for: Calling the "time-out" to verify the surgical site and procedure Monitoring the operating-room personnel for breaks in sterile technique Monitoring the administration of the anesthesia Preparing the sterile instruments for the surgical procedure

The scrub nurse is responsible for preparing the sterile instruments for the surgical procedure.