Prep U Chapter 18

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? Fentanyl Succinylcholine Halothane Propofol

Halothane

A patient undergoes induction for general anesthesia at 8:30 a.m. and is being assessed continuously for the development of malignant hyperthermia. At which time would the patient be most likely to exhibit manifestations of this condition? 10:00 to 10:10 a.m. 8:40 to 8:50 a.m. 9:00 to 9:10 a.m. 9:30 to 9:40 a.m.

8:40-8:50

Which stage of anesthesia is referred to as surgical anesthesia? III I II IV

III

A patient is scheduled to have a heart valve replacement with a porcine valve. Which patient does the nurse understand may refuse the use of any porcine-based product? A patient of Baptist faith A patient of Jewish faith A patient of Lutheran faith A patient of Catholic faith

A patient of Jewish faith

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? Surgeon Scrub nurse Circulating nurse Registered nurse first assistant

Circulating nurse

What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities? Assisting the surgeon Coordinating the surgical team Passing instruments Setting up the sterile tables

Coordinating the surgical team

During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer: potassium chloride an acetaminophen suppository dantrolene sodium (Dantrium) verapamil (Isoptin)

Dantrium

The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered? Unresponsive to verbal or tactile stimuli Yelling and pulling at equipment No movement in right lower leg Denies sensation to perineum and lower abdomen

Denies sensation to perineum and lower abdomen

The nurse recognizes the client has reached stage III of general anesthesia when the client: Loss of consciousness Exhibits shallow respirations and a weak, thready pulse Has small pupils that react to light Unable to maintain airway Ability to respond to verbal commands Complains of ringing or buzzing in the ears Exhibits no change in behavior Paralysis of the lower extremities

Has small pupils that react to life

The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching? Seizures Itching Sore throat Headache

Headache

A patient develops malignant hyperthermia. Which of the following most likely would be the first indicator of this complication? Tentanus-like jaw movements Body temperature rise of 2 degrees F Heart rate over 150 beats per minute Generalized muscle rigidity

Heart rate over 150 beats per minute

Which statement by the client indicates further teaching about epidural anesthesia is necessary? "I will be able to hear the surgeon during the surgery." "I will become unconscious." "I will lose the ability to move my legs." "A needle will deliver the anesthetic into the area around my spinal cord."

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'm so glad that I will be unconscious during the surgery." "I'll be sleepy but able to respond to your questions." "Only the surgical area will be numb." "I won't feel it, but I'll have a tube to help me breathe."

I'll be sleepy, but able to respond to your questions.

An obese client is undergoing abdominal surgery. During the procedure a surgical resident states, "The amount of fat we have to cut through is disgusting." What is the best response by the nurse? Discuss concerns regarding the comments with the charge nurse. Report the resident to the attending surgeon. Inform the resident that all communication needs to remain professional. Ignore the comment.

Inform the resident that all communication needs to remain professional

As a circulating nurse, what task are you solely responsible for? Estimating the client's blood loss. Handing instruments to the surgeon. Counting sponges and needles. Keeping records.

Keeping records.

The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in? Prone position Trendelenburg Lithotomy position Left lateral Sim's

Lithotomy

The nurse understands that the purpose of the "time out" is to: maintain the safety of the client. verify all necessary supplies are available. identify the client's allergies. clarify the roles of the OR personnel.

Maintain the safety of the client

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 attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention? Shoe covers are used. Hair is pulled back and covered by a cap. Scrub top and drawstring are tucked into pants. Mask is placed over nose and extends to bottom lip.

Mask is placed over nose and extends to bottom lip

An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position? On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle On his side, with his uppermost leg adducted and flexed at the knee Flat on his back with his arms next to his sides On his back, with his legs and thighs flexed at right angles

On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle.

Fentanyl is categorized as which type of intravenous anesthetic agent? Dissociative agent Neuroleptanalgesic Tranquilizer Opioid

Opioid

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 Pulse oximetry 98% Absence of itching Vital signs within normal limits for client

Peripheral pulses palpable (less of a risk for pressure ulcers)

The scrub nurse is responsible for: Monitoring the administration of the anesthesia Monitoring the operating-room personnel for breaks in sterile technique Calling the "time-out" to verify the surgical site and procedure Preparing the sterile instruments for the surgical procedure

Preparing the sterile instruments for the surgical procedure.

A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse? Return to work after taking antibiotics for 24 hours. Ensure the infection is covered with a dressing. Report the infection to an immediate supervisor. Request a role change to circulating nurse.

Report the infection to an immediate supervisor

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 Registered nurse first assistant Anesthetist Circulating nurse

Scrub Nurse

There are four stages of general anesthesia. Select the stage during which the OR nurse knows not to touch the patient (except for safety reasons) because of possible uncontrolled movements. Stage III: surgical anesthesia Stage IV: medullary depression Stage I: beginning anesthesia Stage II: excitement

Stage 2: excitement

A client is receiving general anesthesia. The nurse anesthetist starts to administer the anesthesia. The client begins giggling and kicking her legs. What stage of anesthesia would the nurse document related to the findings? I III II IV

Stage II

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 I Stage III Stage II Stage IV

Stage IV

The client vomits during the surgical procedure. The best action by the nurse is: Increase the IV infusion rate to compensate for lost fluids. Lower the head of the operating table to promote circulation to the brain. Suction the client to remove saliva and gastric secretions. Administer an anti-emetic to alleviate nausea.

Suction the client to remove saliva and gastric secretions

Which of the following techniques least exhibits surgical asepsis? Suctioning the nasopharyngeal cavity of a client Adding only sterile items to a sterile field Keeping sterile gloved hands above the waist Placing the sterile field at least one foot away from personnel

Suctioning the nasopharangeal cavity of a client.

The nurse is caring for a patient who is at risk for malignant hyperthermia subsequent to general anesthesia. What is the most common early sign that the nurse should assess for? Muscle rigidity ("tetanylike" movements) Hypertension Oliguria Tachycardia

Tachycardia

Which clinical manifestation is often the earliest sign of malignant hyperthermia? Elevated temperature Hypotension Tachycardia (heart rate >150 beats per minute) Oliguria

Tachycardia (>150 beats per minute)

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? Pulse rate of 110 beats/min Temperature of 102.5°F (39°C) Respiratory rate of 18 breaths/min Blood pressure of 104/62 mm Hg

Temperature of 102.5

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the: Anesthesiologist Surgeon Scrub nurse Circulating nurse

The circulating nurse

In developing the plan of care for the intraoperative client, the nurse recognizes that it is essential to consider: the wishes of the client's family the surgeon's skill in performing the procedure the schedule of the operating room the client's cultural beliefs

The client's cultural beliefs

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. If a tear occurs in a sterile drape, a new sterile drape is applied on top of it. Circulating nurses may come in contact with the sterile field without contaminating it. A distance of 3 feet must be maintained when moving around a sterile field.

The edges of a sterile package, once opened, are considered unsterile

Which of the following is the appropriate response to the statement, "I'm so nervous about my surgery"? "You seem nervous about your surgery." "Relax. Your recovery period will be shorter if you're less nervous." "Stop worrying. It only makes you more nervous." "You needn't worry. Your doctor has done this surgery many times before."

You seem nervous about your surgery