Care of Intraoperative Patients

Immediately after receiving spinal anesthesia a client develops hypotension. To what physiologic change does the nurse attribute the decreased blood pressure? 1. Dilation of blood vessels 2. Decreased response of chemoreceptors 3. Decreased strength of cardiac contractions 4. Disruption of cardiac accelerator pathways

1. Dilation of blood vessels

Which interventions must the operating room (OR) nurses provide for patient physiological integrity during the intraoperative period? (select all that apply) A. Apply padding to the OR bed to protect skin integrity. B. Communicate patient's fears about anesthesia to the nurse anesthetist. C. Monitor patient's airway, vital signs, electrocardiogram (ECG), and oxygen saturation during and after sedation. D. Assess and document skin condition before transferring patient to PACU. E. Ensure that patient's wishes with regard to advance directives are respected.

A. Apply padding to the OR bed to protect skin integrity C. Monitor patient's airway, vital signs, electrocardiogram (ECG), and oxygen saturation during and after sedation D. Assess and document skin condition before transferring patient to the post anesthesia care unit (PACU).

Which patient would be a candidate for moderate sedation? (select all that apply) A. Endoscopy B. C-section delivery C. Closed fracture reduction D. Cardiac catheterization E. Suturing a laceration F. Abdominal surgery G. Cardioversion

A. Endoscopy C. Closed fracture reduction D. Cardiac catheterization G. Cardioversion

During surgery, what things do anesthesia personnel monitor, measure, and assess? (select all that apply) A. Intake and output B. Room Temperature C. Cardiopulmonary function D. Level of anesthesia E. Family concerns F. Vital signs

A. Intake and output C. Cardiopulmonary function D. Level of anesthesia F. Vital signs

To reduce the incidence of patients with a known history or risk of malignant hyperthermia (MH), what best practices are put in place in the operating room? (select all apply) A. List of medications available for emergency treatment of MH B. Genetic counseling after each episode of MH C. Dedicated MH cart with treatment medications D. Treatment before, during, and after surgery if the patient has a known history or risk E. Additional nursing support on call if MH develops F. Available MH hotline number.

A. List of medications available for emergency treatment of MH. C. Dedicated MH cart with treatment medications D. Treatment before, during, and after surgery if the patient has a known history or risk. E. Additional nursing support on call if MH develops F. Available MH hotline number.

A Patient has an MH incident during surgery. To whom does the nurse report this incident? A. North American Malignant Hyperthermia Registry B. The Joint Commission C. Centers for Disease Control D. Occupational Safety and Health Administration

A. North American Malignant Hyperthermia Registry

Which clinical features are found in an MH crisis? (select all that apply) A. Sinus tachycardia B. Tightness and rigidity of the patient's jaw area C. Lowering of the blood pressure D. A decrease in the end-tidal carbon dioxide level E. Skin mottling and cyanosis F. An extremely elevated temperature at onset G. Tachypnea

A. Sinus tachycardia B. Tightness and rigidity of the patient's jaw area C. Lowering of the blood pressure E. Skin mottling and cyanosis G. Tachypnea

What techniques are essential to performing a proper surgical scrub of the hands by the surgeon, assistants, and scrub nurse? ( select all that apply) A. Use a broad-spectrum, surgical antimicrobial solution. B. Scrub for 2 minutes, followed by a rinse with water. C. Use an alcohol-based antimicrobial solution D. Hold hands higher than the elbows during the scrub and rinse. E. Scrub for 3-5 minutes, followed by a rinse with water. F. Hold hands below the elbows during the scrub and rinse.

A. Use a broad-spectrum, surgical antimicrobial solution. D. Hold hands higher than the elbows during the scrub and rinse. E. Scrub for 3-5 minutes, followed by a rinse with water.

A patient is requesting moderate sedation for repair of a torn meniscus and has no medical contraindications. How does the nurse respond to this patient's request? A. "Your surgeon will decide if you will receive moderate sedation or general anesthesia" B. "You can discuss your request for moderate sedation with your surgeon and anesthesiologist" C. "Most patients prefer general anesthesia. Can you tell me why you want moderate sedation?" D. "It can be frightening to see surgery done on yourself. You need to think about that."

B. "You can discuss your request for moderate sedation with your surgeon and anesthesiologist"

In which situations is regional anesthesia used instead of general anesthesia? (select all that apply) A. For an endoscopy or cardiac catheterization B. In patients who have had an adverse reaction to general anesthesia C. In some cases when pain management after surgery is enhanced by regional anesthesia D. In patients with serious medical problems E. When the patient has a preference and a choice is possible

B. In patients who have had an adverse reaction to general anesthesia C. In some cases when pain management after surgery is enhanced by regional anesthesia D. In patients with serious medical problems E. When the patient has a preference and a choice is possible

A patient with breast cancer is scheduled for a left mastectomy. The patient has informed the surgeon and nurse that she is a Jehovah's Witness and does not want any blood transfusions. In preparation for intraoperative care of this patient, what measures does the nurse take? (select all that apply) A. Obtain 2 units of packed red blood cells, typed and crossmatched. B. Make provider aware of patient's request for no blood transfusions. C. Ensure autotransfusion device is in place intraoperatively. D. Ensure patient has a medical necessity order for emergency blood transfusion. E. Inform the patient of potential risks if blood transfusion is not given.

B. Make provider aware of patient's request for no blood transfusions. C. Ensure autotransfusion device is in place intraoperatively.

Which factors may lead to an anesthetic over-dose in a patient? (select all that apply) A. Amount of anesthesia retained by fat cells B. Patient who is older C. Slowed metabolism and drug elimination D. an uncooperative patient E. Liver or kidney disease

B. Patient who is older C. Slowed metabolism and drug elimination E. Liver or kidney disease

Which nursing interventions will prevent the potential intraoperative complication of radial joint stiffness, pain, and inflammation? A. Support the wrist with padding; do not over tighten wrist straps. B. Place pillow or foam padding under bony prominences; maintain good body alignment; slightly flex joints and support with pillows, trochanter rolls, and pads. C. Pad the elbow, avoid excessive abduction, secure the area firmly on an arm board positioned at shoulder level. D. Place a safety strap above or below the area. Place a pillow or padding under the knees.

B. Place pillow or foam padding under bony prominences; maintain good body alignment; slightly flex joints and support with pillows, trochanter rolls, and pads.

Which nursing interventions are appropriate during stage 2 of anesthesia? A. Prepare for and assist in treatment of cardiovascular and/or pulmonary arrest. Document and record. B. Shield patient from extra noise and physical stimuli. Protect the patients extremities. Assist anesthesia personnel as needed. Stay with patient. C. Close OR doors and control traffic in and out of room. Position patient securely with safety belts. Maintain minimal discussion in OR. D. Assist anesthesia personnel with intubation of patient. Place the patient in position for surgery. Prep the patient's skin in area of operative site.

B. Shield patient from extra noise and physical stimuli. Protect the patients extremities. Assist anesthesia personnel as needed. Stay with patient.

The acute, life-threatening complication of MH results from the use of which agents? A. Hypnotics and neuromuscular blocking agents. B. Succinylcholine and inhalation agents C. Nitrous oxide and pancuronium for muscle relaxation D. Fentanyl and regional anesthesia for spinal block

B. Succinylcholine and inhalation agents

The patient is scheduled to have minimally invasive surgery (MIS) for a laparoscopic cholecystectomy. Part of this surgrey is the injection of air (insufflation) into the abdomen to separate and better see the organs. What patient teaching must the nurse do about the insufflation? A. "Your surgeon will make several small incisions instead of one large one" B. "You will be able to go home once your surgery is completed and you are awake" C. "You may experience some abdominal discomfort from the air injected with the surgery" D. "You will have a tube for drainage for a few days after your surgery is completed."

C. "You may experience some abdominal discomfort from the air injected with the surgery"

Which medical condition increases a patient's risk for surgical wound infection? A. Anxiety B. Hiatal hernia C. Diabetes mellitus D. Amnesia

C. Diabetes mellitus

To avoid electrical safety problems during surgery, what does the nurse do? A. Observes for breaks in sterile technique. B. Continuously assists the anesthesia provider C. Ensures proper placement of the grounding pads D. Monitors the operating room with available cameras

C. Ensures proper placement of the grounding pads

Which definition is appropriate for local anesthesia? A. Injection of anesthetic agent into or around a nerve or group of nerves, resulting in blocked sensation and monitor impulse transmission. B. Injection of the anesthetic agent into the epidural space; the spinal cord areas are never entered. C. Injection of an anesthetic agent directly into the tissue around an incision, wound, or lesion. D. Injection of anesthetic agent into or around a nerve or group of nerves, resulting in blocked sensation and motor impulse transmission.

C. Injection of an anesthetic agent directly into the tissue around an incision, wound, or lesion.

Once the OR team has assembled in the room, the circulating nurse calls for a time out. (HESI) What action should the nurse take during the time out? A. Ensure that sufficient surgical supplies are available. B. Check that al surgical personnel are properly attired. C. Review the scheduled procedure, site, and client. D. Confirm that informed consent has been obtained.

C. Review the scheduled procedure, site, and client.

Ms. Jackson is transferred to a stretcher and taken to the operating room. The nurse assists Ms. Jackson off the stretcher and onto the OR table. After general anesthesia is induced, the nurse positions Ms. Jackson for surgery. (HESI) Which nursing diagnosis has the highest priority at this time? A. Ineffective protection. B. Ineffective tissue perfusion. C. Risk for perioperative-positioning injury. D. Risk for imbalanced body temperature.

C. Risk for perioperative-positioning injury

The patient received moderate sedation (conscious sedation) by IV prior to a bronchoscopy procedure. Before allowing the patient to have oral liquids, what must the nurse assess in this patient? A. The patient is arousable B. The patient is able to speak C. The patient's gag reflex is working D. The patient is able to rotate his head

C. The patient's gag reflex is working

Which duties are within the scope of practice of the circulating nurse in the operative setting? A. Manages the patient's care while the patient is in this area and initiates documentation on a perioperative nursing record. B. Sets up the sterile field; assists with the draping of the patient; and hands sterile supplies, equipment, and instruments to the surgeon. C. Assumes responsibility for the surgical procedure and any surgical judgements about the patient. D. Coordinates, oversees, and participates in the patient's nursing care while the patient is in the OR.

D. Coordinates, oversees, and participates in the patient's nursing care while the patient is in the operating room.

The surgical team understands that time is crucial in recognizing and treating an MH crisis. Once recognized, what is the treatment of choice? A. Danazol gluconate (Danocrine) B. Phenytoin sodium (Dilantin) C. Diazepam sulfate (Valium) D. Dantrolene sodium (Dantrium)

D. Dantrolene sodium (Dantrium)

Which characteristics are appropriate to the anesthetic agent ketamine HCI? A. Can depress respiratory and cardiac functions B. May increase heart rate and lower blood pressure during induction. C. Short-acting; patient becomes responsive quickly postoperatively D. Dissociative emergence reactions; can induce nausea and vomiting

D. Dissociative emergence reactions; can induce nausea and vomiting

The patient in the OR holding area tells the nurse that his surgery is for the right foot. The patient's chart states that the surgery is for his left foot. What is the nurse's best action? A. Do nothing because the patient is confused after receiving premedications B. Make a note about this in the nursing notes of the patient's chart C. Call the nurse anesthetist to check whether the chart or the patient is correct D. Notify the surgeon immediately before the patient goes into the OR about this discrepancy

D. Notify the surgeon immediately before the patient goes into the OR about this discrepancy

A patient experiences MH immediately after induction of anesthesia. What is the nurse anesthetist's first priority action? A. Administer IV dantrolene sodium 2 to 3 mg/kg B. Apply a cooling blanket over the torso C. Assess arterial blood gases and serum chemistries. D. Stop all inhalation anesthetic agents and succinylcholine. E. Monitor cardiac rhythm by electrocardiography to assess for dysrhythmias.

D. Stop all inhalation anesthetic agents and succinylcholine.

Which nursing intervention is most appropriate for the patient in the operative setting? A. Provide a climate of privacy, comfort, and confidentiality when caring for the patient. B. Instruct the patient that after the preoperative medication has taken effect, he or she will be drowsy. C. Avoid discussing the activities taking place around the patient while in the holding area. D. Assist members of the surgical team readying the operating room suite.

Provide a climate of privacy, comfort, and confidentiality when caring for the patient.