Med Surg Lewis 17-19
A patient who was on mechanical ventilation through an endotracheal tube develops inspiratory stridor and sternal retraction upon removal of the endotracheal tube. How should the nurse manage this patient and ensure oxygenation? Suction the airway. Administer oxygen therapy. Administer muscle relaxants. Tilt the head and thrust the jaw. Provide positive pressure ventilation.
Administer muscle relaxants. Tilt the head and thrust the jaw. Provide positive pressure ventilation. Inspiratory stridor and sternal retraction are due to laryngospasm associated with removal of the endotracheal tube. Oxygen therapy helps maintain the perfusion levels in the patient. Skeletal muscle relaxants help relax the muscles and relieve laryngospasm. Positive pressure ventilation helps keep the patient oxygenated. Suctioning may increase laryngospasm. Tilting the head and thrusting the jaw does not help relieve laryngospasm. p. 333
Which member of the intraoperative team remains in the unsterile field? Scrub nurse Circulating nurse Surgeon's assistant Registered nurse first assistant
The circulating nurse is not gowned and gloved and handles unsterile activities in the unsterile field during the intraoperative period. The scrub nurse is gowned and gloved and remains in the sterile field. The surgeon's assistant and registered nurse first assistant may handle and prepare surgical instruments and therefore remain in the sterile field during the intraoperative period. p. 319
The nurse is preparing to prep the patient's skin for surgery. In which surgical area will the patient's skin be prepped for surgery and what clothing will the person doing the prepping be wearing? <p>The nurse is preparing to prep the patient’s skin for surgery. In which surgical area will the patient's skin be prepped for surgery and what clothing will the person doing the prepping be wearing?</p> Surgical suite, wearing a lab coat Preoperative holding area, wearing street clothes Postanesthesia care unit (PACU), wearing scrubs Operating room, wearing surgical attire and masks
Operating room, wearing surgical attire and masks Surgical attire includes pants and shirts (or scrubs), a cap or hood, masks, and protective eyewear. All surgical attire is worn when the patient's skin is being prepped in the operating room to avoid contamination of the site. The surgical suite includes all unrestricted, semirestricted, and restricted areas of the controlled surgical environment. Lab coats are usually worn by the staff over their scrubs when they leave the surgical area. The staff will not wear street clothes in the preoperative holding area, although the family might. The holding area and PACU will not include prepping the patient for surgery.
A patient with diabetes is admitted for a prostatectomy. The patient will receive an antibiotic 60 minutes prior to the surgery, their usual dose of insulin, and etomidate IV for anesthesia. Considering the patient's diabetes, the nurse expects that which component of the preoperative plan will be revised? The route of administration of etomidate The administration of the preoperative antibiotic The type of drug used to regulate the patient's glucose levels The dosage of insulin used to regulate the patient's glucose levels
The dosage of insulin used to regulate the patient's glucose levels Etomidate is an intravenous anesthetic agent. It is a nonbarbiturate hypnotic and can cause hypoglycemia. Therefore the nurse should consider revising the dosage of insulin with the surgeon to prevent hypoglycemia. It is not appropriate to change the route of administration of etomidate, because it is an IV drug. Changing the drug or omitting administration of the antibiotic is not advised. Antibiotics are administered 30 to 60 minutes prior to surgery to reduce the incidence of postoperative infections. p. 325
The nurse is to administer preoperative medications for a patient who is scheduled for surgery at 7:30: cefazolin intravenously (IV) to be infused 30 minutes before surgery, midazolam IV before surgery, and a scopolamine patch behind the ear. Which medication should the nurse administer first? Cefazolin Fentanyl Midazolam Scopolamine
The scopolamine patch will be administered first to allow enough time for the serum level to become therapeutic. The cefazolin will be given at 7 to allow infusion 30 minutes before surgery. Fentanyl is a narcotic and was not prescribed preoperatively. The midazolam, a short-acting benzodiazepine, is used as a sedative. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. p. 311
The nurse receives an unconscious postoperative patient in the post anesthesia care unit (PACU). What position would be the safest to place this patient immediately after the operation? Supine Lateral Semi-Fowler's High Fowler's
Unless contraindicated by the surgical procedure, the unconscious patient is positioned in lateral "recovery" position. This recovery position keeps the airway open and reduces the risk of aspiration if the patient vomits. Once conscious, the patient usually is returned to a supine position with the head of the bed elevated. Supine, semi-Fowler's, and high Fowler's positions are all supine; they are not as helpful in keeping the airway open and reducing the risk of aspiration. p. 336
