Med surg Quiz 2 (Ch. 15)
A patient has an malignant hyperthermia (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
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, her 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
A
immediately after receiving spinal anesthesia a client develops hypotension. to what physiologic change does the nurse attribute the decreased blood pressure? A. dilation of blood vessels B. decreased response of chemoreceptors C. decreased strength of cardiac contractions D. disruption of cardiac accelerator pathways
A
the older overweight patient is being placed on the operating table for an appendectomy. what is the priority medical-surgical concept for this patient? A. safety B. tissue integrity C. immunity D. gas exchange
A
which nursing interventions will prevent the potential intraoperative complication of radial nerve complications (wrist drop)? A. support the wrist with padding; do not over tighten wrist straps B. place pillows or foam padding under bony prominences, maintain good body alignment, and slightly flex joints and support with pillows and pads C. pad the elbow, avoid excessive abduction, and secure the arm 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
A
which clinical features are found in a malignant hyperthermia (MH) crisis? (SATA) A. sinus tachycardia B. jaw muscle rigidity C. hypotension D. a decrease in end-tidal-carbon dioxide E. skin mottling and cyanosis F. an extremely elevated temperature
A, B, C, E, F
Which interventions must the operating room (OR) nursed provide for patient physiological integrity during the intraoperative period? (SATA) A. Apply padding to the OR bed to protect skin integrity B. communicate patients fears about anesthesia to the nurse anesthetist C. monitor patients airway, vital signs, electrocardiogram (ECG), and oxygen saturation during and after sedation D. assess and document skin condition before transferring patient to the postanesthesia care unit (PACU) E. ensure that patients wishes about advance directives are respected F. reposition the patient every 2 hours, especially for very long surgeries
A, C, D
which characteristics are appropriate to moderated sedation drugs? (SATA) A. reduce sensory perception B. require placement of an artificial airway C. amnesia action is short D. return to normal function is rapid E. increase level of consciousness F. may be administered only by a physician
A, C, D
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? (SATA) 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, C, D, E, F
during surgery, what things to anesthesia personnel monitor, measure, and assess? (SATA) A. intake and output B. room temperature C. cardiopulmonary function D. level of anesthesia E. family concerns F. Vital signs
A, C, D, F
which patient would be a candidate for moderate sedation? (SATA) A. endoscopy B. cesarean section delivery C. closed fracture reduction D. cardiac catheterization E. abdominal surgery F. cardio version
A, C, D, F
what techniques are essential to performing a proper surgical scrub of the hands by the surgeon, assistants, and scrub nurse? (SATA) 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 and arms so that water runs off, not up or down the arms E. scrub for 3-5 minutes, followed by a rinse with water F. keep hands below the elbows during the scrub and rinse
A, D, E
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
the acute, life-threatening complication of malignant hyperthermia (MH) results from the use of which agents? A. hypnotic 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
which intervention takes priority when a patient is emerging and recovering from general anesthesia? A. check vital signs every 5 minutes B. be prepared to suction the patient C. increase the rate of IV fluid administration D. check the patients pupil size
B
which nursing interventions are appropriate during stage 2 of anesthesia? A. prepare for and assist in treatment of cardiovascular and/or pulmonary arrest. document in record B. shield patient from extra noise and physical stimuli. protect the patients extremities. assist anesthesia personnel as needed. stay with patient C. close operating room doors and control traffic in an out of room. position patient securely with safety belts. maintain minimal discussion in operating room. D. assist anesthesia personnel with incubation of patient. place the patient in position for surgery. prep the patients skin in area of operative site
B
A patient with breast cancer is schedules 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 measure does the nurse take? (SATA) A. obtain two units of packed red blood cells, typed and cross-matched B. make provider aware of patients 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 F. Tell the patient that in case of emergency she may receive blood to save her life
B, C
in which situations is regional anesthesia used instead of general anesthesia? (SATA) 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 F. when the patient is having surgery or the head, neck, upper torso, and abdomen
B, C, D, E
Which factors may lead to an anesthetic overdose in a patient? (SATA) A. amount of anesthesia retained by fat cells B. older age of patient C. slowed metabolism and drug elimination D. and uncooperative patient E. liver or kidney disease F. drugs that alter metabolism
B, C, E, F
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
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? A. "your surgeon will make several small incisions instead of a 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
the patient is to receive regional anesthesia for injured knee repair surgery. which type of regional anesthesia is this patient likely to receive? A. field block B. nerve block C. spinal anesthesia D. epidural anesthesia
C
the patient is transferred to the operating room for right foot surgery. how does the nurse safely assure the patients identification? A. ask the patient what type of surgery is scheduled B. state the patients name ask the patient if he or she is that person C. check the patients armband and ask the patient to state his or her name and birth date D. check the patients chart and armband to assure that these match
C
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? A. the patient is arousable B. the patient is able to speak C. the patients gag reflex is working D. the patient is able to rotate his head
C
which definition is appropriate for local anesthesia? A. injection of anesthetic agent into or around a nerve or group of nerves, resting in blocked sensation and motor 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 that clocks multiple peripheral nerves and reduces sensation in a specific body region
C
which medical condition increases a patients risk for surgical wound infection? A. anxiety B. hiatal hernia C. diabetes mellitus D. amnesia
C
The patient in the OR holding area tells the nurse that his surgery is for the right foot. The patients chart states that the surgery is for his left foot. What is the nurses 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 patients chart C. Call the nurse anesthetist to check whether the chart or patient is correct D. Notify the surgeon immediately before the patient goes into the OR about this discrepancy
D
Which duties are within the scope of practice of the circulating nurse in the operative setting? A. manages the patients care while the patient is in this area and initiates documentation on a preoperative nurse 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 reasonability for the surgical procedure and any surgical judgments about the patient D. coordinate, oversees, and participates in the patients nursing care while the patient is in the operating room
D
a patient experiences malignant hyperthermia (MH) immediately after induction of anesthesia. what is the nurse anesthetists PRIORITY action? A. administer IV dantrolen sodium (Dantrium) 2-3 mg/kg B. apply a cooling blanket over the torso C. assess arterial blood gases (ABG's) and serum chemistries D. stop all inhalation anesthetic agents and succinylcholine
D
the surgical team understands that time is crucial in recognizing and treating a malignant hyperthermia (MH) crisis. once recognized, what is the treatment of choice? A. danazol gluconate B. phenytoin sodium C. diazepam sulfate D. dantrolene sodium
D
which member of the operating room team is responsible for setting up the sterile field? A. nurse anesthetist (CRNA) B. surgical assistant C. circulating nurse D. scrub nurse
D
