Ch. 15

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?

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

The patient is scheduled to have minimally invasive surgery (MIS) for a laparoscopic cholecystectomy. Part of this surgery 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?

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

Which interventions must the operating room (OR) nurses provide for patient physiological integrity during the intraoperative period? (select all that apply)

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

Which intervention takes priority when a patient is emerging and recovering from general anesthesia?

Be prepared to suction the patient.

The patient is transferred to the OR for right foot surgery. How does the nurse safely assure the patient's identification?

Check the patient's armband and ask the patient to state his or her name and birth date

Which duties are within the scope of practice of the circulating nurse in the operative setting?

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 malignant hyperthermia (MH) crisis. Once recognized, what is the treatment of choice?

Dantrolene sodium

Which medical condition increases a patient's risk for surgical wound infection?

Diabetes mellitus

Immediately after receiving spinal anesthesia a client develops hypotension. To what physiologic change does the nurse attribute the decreased blood pressure?

Dilation of blood vessels

Which patient would be a candidate for moderate sedation? (select all that apply)

Endoscopy Closed fracture reduction Cardiac catheterization Cardioversion

To avoid electrical safety problems during surgery, what does the nurse do?

Ensures proper placement of the grounding pads

In which situations is regional anesthesia used instead of general anesthesia? (select all that apply)

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

Which definition is appropriate for local anesthesia?

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

During surgery, what things do anesthesia personnel monitor, measure, and assess? (select all that apply)

Intake and output Cardiopulmonary function Level of anesthesia 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)

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

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)

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

A patient has an malignant hyperthermia (MH) incident during surgery. To whom does the nurse report this incident?

North American Malignant Hyperthermia Registry

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?

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

Which factors may lead to an anesthetic overdose in a patient? (select all that apply)

Older age of patient Slowed metabolism and drug elimination Liver or kidney disease Drugs that alter metabolism

Which nursing intervention is most appropriate for the patient in the operative setting?

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

Which characteristics are appropriate to moderate sedation drugs? select all that apply

Reduce sensory perception Amnesia action is short Return to normal function is rapid

The older overweight patient is being placed on the operating table for an appendectomy. What is the priority medical-surgical concept for this patient?

Safety

Which member of the operating room team is responsible for setting up the sterile field?

Scrub nurse

Which nursing interventions are appropriate during stage 2 of anesthesia?

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

Which clinical features are found in an malignant hyperthermia (MH) crisis? (select all that apply)

Sinus tachycardia Jaw muscle rigidity Hypotension Skin mottling and cyanosis An extremely elevated temperature at onset

The patient is to receive regional anesthesia for injured knee repair surgery. Which type of regional anesthesia is the patient likely to receive?

Spinal anesthesia

A patient experiences malignant hyperthermia (MH) immediately after induction of anesthesia. What is the nurse anesthetist's first priority action?

Stop all inhalation anesthetic agents and succinylcholine

The acute, life-threatening complication of malignant hyperthermia (MH) results from the use of which agents?

Succinylcholine and inhalation agents

Which nursing interventions will prevent the potential intraoperative complication of radial nerve complications (wrist drop)?

Support the wrist with padding; do not overtighten wrist straps.

The patient received moderate sedation (conscious sedation) intravenously prior to a bronchoscopy procedure. Before allowing the patient to have oral liquids, what must the nurse assess in this patient?

The patient's gag reflex is working

What techniques are essential to performing a proper surgical scrub of the hands by the surgeon, assistance, and scrub nurse?

Use a broad-spectrum, surgical antimicrobial solution. Hold hands and arms so that water runs off, not up or down the arms Scrub for 3-5 minutes, followed by a rinse with water