AH Exam 1: Chapter 18
Which statement by the client indicates further teaching about epidural anesthesia is necessary?
"I will become unconscious."
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."
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 patient is undergoing a lumbar puncture. The nurse educates the patient about surgical positioning. Which of the following statements by the nurse is appropriate?
"You will be lying on your side with your knees to your chest."
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'
The client asks the nurse how the spinal anesthesia will be administered. The best response by the nurse is:
'The anesthesiologist will inject the anesthetic into the space around your lower spinal cord'
Which of the following characteristics should the nurse include when teaching the client about moderate sedation?
Ability to respond to verbal commands
The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate?
Allow unnecessary personnel to enter the OR environment
The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate?
Allow unnecessary personnel to enter the OR environment.
A patient undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The patient is ready for rewarming procedures. Which of the following actions by the nurse is appropriate?
Apply a warm air blanket, gradually increasing body temperature.
A 78-year-old woman is undergoing right hip surgery to repair a hip fracture. What nursing action is appropriate during the intraoperative phase?
Appropriately position the patient using adequate padding and support.
A nurse is reviewing the intraoperative record of a patient who has just returned from surgery. The patient received general anesthesia with intravenous agents. Which of the following would the nurse identify as a nondepolarizing muscle relaxant?
Atracurium
Which of the following medications would the nurse expect to be used to facilitate intubation of the client?
Attacurium (Tracrium)
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.
Avoid touching sterile items unless necessary. Alert the surgical team of any breaches of sterile technique. Wear a long-sleeved, sterile gown and gloves.
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
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
The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:
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 patient has malignant hyperthermia?
Dantrolene sodium (Dantrium) [usually anesthesia and surgery should be postponed]
32. 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 muscle tissue
The nurse recognizes that the older adult is at risk for surgical complications due to:
Decreased renal function
The anesthesiologist administered a transsacral conduction block. Which of the following 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
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
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 cuff
The circulating nurse is documenting all medications administered during a surgical procedure. The anesthesiologist administers an opioid analgesic. What medication would the nurse check as having being administered?
Fentanyl (Sublimaze)
A patient has been administered ketamine (Ketalar) for moderate sedation. What is the priority nursing intervention?
Frequent monitoring of vital signs
A client requires minor surgery for removal of a basal cell tumor. The anesthesiologist administers the ketamine hydrochloride (Ketalar), 60 g I.V. After ketamine administration, the nurse should monitor the client for:
Hallcuinations and respiratory depression
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
Which of the following would be included as a responsibility of the scrub nurse?
Handing instruments to the surgeon and assistants
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
A patient is undergoing general anesthesia. The nurse anesthetist starts to administer the anesthesia. The patient starts giggling and kicking her legs. What stage of anesthesia would the nurse document related to the findings?
II
Which stage of surgical anesthesia is also known as excitement?
II
Which stage of anesthesia is termed surgical anesthesia?
III
A nurse who works in the OR is required to assess the patient continuously and protect the patient from potential complications. Which of the following would not be included as a symptom of malignant hyperthermia?
Increased urine output
An obese patient is undergoing abdominal surgery. A surgical resident states, "The amount of fat we have to cut through is disgusting" during the procedure. What is the best response by the nurse?
Inform the resident that all communication needs to remain professional.
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.
A nurse is administering moderate sedation to a client with glosschronic obstructive pulmonary disease!gloss (COPD). The nurse bases her action on the principle that:
It may be necessary to raise the head of the client's bed
As a circulating nurse, what task are you solely responsible for?
Keeping records
Which of the following should not be allowed with regards to the wearing of masks in the operating room?
Let masks hang around the neck
The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in?
Lithotomy position
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 needed attire to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention?
Mask is placed over nose and extends to bottom lip.
The nurse is educating new employees regarding the wearing of masks in the operating room. What information should the nurse provide? Select all that apply.
Mask should cover the nose and mouth completely You must change mask between treating patients Masks should be tight fitting
The nurse is educating new employees regarding the wearing of masks in the operating room. What information should the nurse provide? Select all that apply.
Masks should cover the nose and mouth completely. You must change masks between treating patients. Masks should be tight fitting.
Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care:
May result in the administration of general anesthesia
During surgery a patient develops hypothermia. The circulating nurse would monitor the patient closely for which of the following?
Metabolic acidosis
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.
More pleasant onset of anesthesia Ease of administration Need for a little equipment
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.
More pleasant onset of anesthesia Ease of administration Need for little equipment
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?
Morphine
What is the priority action by the scrub nurse when the surgeon is starting to close the surgical wound?
Obtain sponge count
How would the operating room nurse place a patient in the Trendelenburg position?
On his back with his head lowered so that the plane of his body meets the horizontal on an angle
Fentanyl (Sublimaze) is categorized as which type of intravenous anesthetic agent?
Opiod
A patient is to receive general anesthesia with sevoflurane. The nurse anticipates the need for which of the following?
Oxygen
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%
What intravenous anesthetic administered by the anesthesiologist has a powerful respiratory depressant effect sufficient to cause apnea and cardiovascular depression?
Pentothal
The nurse positions the client in the lithotomy position in preparation for
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?
Perineum
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?
Peripheral pulses palpable
The patient received ketamine (Ketalar) during a surgical procedure. What intervention by the nurse will assist with an optimal recovery period?
Place the patient in a darkened, quiet part of the recovery area
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?
Rapid rise in body temperature
The circulating nurse is unsure if proper technique was followed when placing an object in the sterile field during a surgical procedure. What is the best action by the nurse?
Remove the entire sterile field from use.
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 anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to:
Respond verbally during the procedure
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.
Ringing in the ears Pupil dilation Unconsciousness Shallow respirations
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 perioperative positioning injury related to operative positioning
Which nursing diagnosis is most important for the client who is undergoing a surgical procedure expected to last several hours?
Risk for perioperative positioning injury related to positioning in the OR
A patient receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first?
Roll the patient on 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
Which zone of the surgical area only allows for attire in the form of scrub clothes and caps?
Semirestricted zone
Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery?
Sims position
The physician, concerned about aspiration during a surgical procedure, orders a medication to increase gastric pH. Which of the following medications would the nurse document as given?
Sodium citrate
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
Which of the following techniques least exhibits surgical asepsis?
Suctioning the nasopharyngeal cavity of a client
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 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 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 patient is having a surgical procedure that requires the patient to be in the prone position. What is an expected patient outcome?
The patient remains free of perioperative positioning injury
What action during a surgical procedure requires immediate intervention by the circulating nurse?
The scrub nurse calling the blood bank to obtain blood products
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?
To prevent cerebrospinal fluid (CSF) leakage
Which position should the patient undergoing pelvis surgery be positioned?
Trendelenburg
A patient begins to vomit during surgery. Place the actions below in the order in which they would be performed.
Turn the patient to the side. Lower the head of the surgical table. Provide a basin for collection. Suction to remove saliva.
A patient is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?
Verify consent
Which of the following is an inappropriate nursing action by the surgical nurse?
Wearing sterile gloves over artificial nails
Which of the following is often the earliest sign of malignant hyperthermia?
Which of the following is often the earliest sign of malignant hyperthermia?
The operating nurse is caring for a patient who is receiving general anesthesia. Organize the nursing interventions in chronological order of the stages of general anesthesia, beginning with Stage I (1) and ending with Stage IV (4).
a. Keep discussion about the client to a minimum b. Avoid auditory and physical stimuli c. Place client into operative position d. Prepare for and assist in treatment of cardiac and/or respiratory arrest
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.)
a. The epinephrine causes vasoconstriction b. The epinephrine prevents rapid absorption of the anesthetic drug c. The epinephrine prolongs the local action of the anesthetic agent
The nurse understands that the purpose of the "time out" is to:
maintain the safety of the client.
Hypothermia may occur as a result of
open body wounds.
