PrepU-Chapter 15: Intraoperative Nursing Management
What is the most important postoperative instruction a nurse must give to a client who has just returned from the operating room after receiving a subarachnoid block?
"Remain supine for the time specified by the physician."
A client asks the nurse about possible ill effects from general anesthesia. What is the best response by the nurse?
"Some possible negative effects include difficulty waking up and slow heart rate."
An instructor is developing for a class a teaching plan about agents used for intravenous (IV) anesthesia. Which of the following would the instructor include in this plan about these agents and this type of anesthesia? Select all that apply. -Associated with more nausea -Long duration of action -More pleasant onset of anesthesia -Ease of administration -Need for little equipment
-More pleasant onset of anesthesia -Ease of administration -Need for little equipment
What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities?
Coordinating the surgical team
A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?
Verify consent
Which of the following is an inappropriate nursing action by the surgical nurse?
Wearing sterile gloves over artificial nails
A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:
continuously monitors the sedated client
During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer:
dantrolene sodium (Dantrium)
The nurse recognizes that the older adult is at risk for surgical complications due to:
decreased renal function
A client develops malignant hyperthermia. What client symptom would the nurse most likely observe as the first indicator of the disorder?
heart rate over 150 beats per minute
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'll be sleepy but able to respond to your questions."
The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response?
"The anesthetic may last for 3 hours."
A client asks the nurse how an inhalant general anesthetic is expelled by the body. What is the best response by the nurse?
"The lungs primarily eliminate the anesthesia."
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?
8:40 to 8:50 a.m.
The nurse would intervene when making which of the following observations in the surgical environment?
A staff member dressed in street clothes enters the semirestricted zone
A client undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The client is ready for rewarming procedures. Which action by the nurse is appropriate?
Apply a warm air blanket, gradually increasing body temperature.
A 78-year-old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase?
Appropriately position the client using adequate padding and support
Which intervention should the nurse plan to implement to decrease the client's risk for injury during the intraoperative period?
Assess the client for allergies
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?
Circulating nurse
The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:
Circulating nurse
What medication should the nurse prepare to administer in the event the client has malignant hyperthermia?
Dantrolene sodium
A 70-year-old patient who is to undergo surgery arrives at the operating room (OR). The nurse, when reviewing the patient's medical record, understands that this patient will require a lower dose of anesthetic agent because of which of the following?
Decreased lean tissue mass
Which of the following actions by the nurse is appropriate?
Discarding an object that comes in contact with the 1-inch border
The nurse is assisting with positioning the patient on the operating table. The nurse understands that the most commonly used position is which of the following?
Dorsal recumbent
When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate?
Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff
A client has been administered ketamine for moderate sedation. What is the priority nursing intervention?
Frequently monitoring vital signs
The nurse is aware that loss of consciousness occurs with which type of anesthesia?
General
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?
Halothane
A nurse is teaching a client about airway control with inhalant anesthesia. What does the nurse include in the client teaching?
Halothane will be used with a endotracheal tube for a rapid smooth induction
Which would be included as a responsibility of the scrub nurse?
Handing instruments to the surgeon and assistants
The nurse recognizes the client has reached stage III of general anesthesia when the client:
Has small pupils that react to light
The perioperative nurse has completed the presurgical assessment of an 82-year-old female client who is scheduled for a left total knee replacement. When planning this client's care, the nurse should address the consequences of the client's aging cardiovascular system. These include an increased risk of which of the following?
Hypervolemia
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?
II
Which stage of surgical anesthesia is also known as excitement?
II
Which stage of anesthesia is referred to as surgical anesthesia?
III
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?
Inform the resident that all communication needs to remain professional
The nursing instructor is talking with her class about spinal anesthesia. What would be the nursing care intervention required when caring for a client recovering from spinal anesthesia?
Instruct the client to remain flat for 6 to 12 hours
A client is undergoing a perineal surgical procedure. The nurse should place the client in which position?
Lithotomy
Which is the most common cause of anaphylaxis?
Medications
A laser is being used to excise tissue during a client's surgical procedure. Which item will the nurse apply to minimize personal risk due to the smoke from the device?
N95 respiratory mask
A client is administered succinylcholine and propofol for induction of anesthesia. One hour after administration, the client demonstrates muscle rigidity with a heart rate of 180. What should the nurse do first?
Notify the surgical team
What is the priority action when the circulating nurse is completing a second verification of the surgical procedure and surgical site?
Obtain the attention of all members of the surgical team
How would the operating room nurse place a patient in the Trendelenburg position?
On his back with his head lowered so that the plane of his body meets the horizontal on an angle
A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention?
Oxygen saturation (SaO2) of 85%
The nurse positions the client in the lithotomy position in preparation for
Perineal surgery
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
During the surgical procedure, the client's temperature falls to 96.6°F. Which of the following nursing actions is inappropriate?
Place a cooling blanket under the client
A patient who has received general anesthesia has reached stage II. Which of the following would the nurse expect the patient to exhibit?
Pupillary dilation and rapid pulse
A nurse suspects malignant hyperthermia in a patient who underwent surgery approximately 18 hours ago. Which of the following would the nurse identify as a late, ominous sign?
Rapid rise in body temperature
The circulating nurse is unsure whether proper technique was followed when an object was placed in the sterile field during a surgical procedure. What is the best action by the nurse?
Remove the entire sterile field from use
A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse?
Report the infection to an immediate supervisor
A 55-year-old patient arrives at the operating room. The nurse is reviewing the medical record and notes that the patient has a history of osteoporosis in her lower back and hips. The patient is scheduled to receive epidural anesthesia. Which of the following nursing diagnoses would be a priority for this patient?
Risk for perioperative positioning injury related to operative position
The client is undergoing a surgical procedure that is expected to last several hours. Which nursing diagnosis is most related to the duration of the procedure?
Risk for perioperative positioning injury related to positioning in the OR
A client is placed on the operating room table for the surgical procedure. Which surgical team member is responsible for handing sterile instruments to the surgeon and assistants?
Scrub nurse
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
Which of the following consequences may result if tranquilizers are withdrawn suddenly?
Seizures
Which zone of the surgical area only requires attire in the form of scrub clothes and caps?
Semi-restricted zone
Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery?
Sims position
The physician is concerned about aspiration during a surgical procedure and orders a medication to increase gastric pH. Which medication would the nurse document as being administered?
Sodium citrate
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 IV
Which of the following techniques least exhibits surgical asepsis?
Suctioning the nasopharyngeal cavity of a client
A nurse is working as a registered nurse first assistant as defined by the state's nurse practice act. This nurse practices under the direct supervision of which surgical team member?
Surgeon
An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia?
Surgical anesthesia
Which clinical manifestation is often the earliest sign of malignant hyperthermia?
Tachycardia (heart rate >150 beats per minute)
What does the circulating nurse monitor?
The circulating nurse: -manages the OR and protects the patient's safety and health by monitoring the activities of the surgical team -checking the OR conditions, and continually assessing the patient for signs of injury and implementing appropriate interventions -A foremost responsibility includes verifying consent; if not obtained, surgery may not commence -The team is coordinated by the circulating nurse, who ensures cleanliness, proper temperature, humidity, appropriate lighting, safe function of equipment, and the availability of supplies and materials. -The circulating nurse monitors aseptic practices to avoid breaks in technique while coordinating the movement of related personnel (medical, x-ray, and laboratory), as well as implementing fire safety precautions (Seifert, Peterson, & Graham, 2015). The circulating nurse also monitors the patient and documents specific activities throughout the operation to ensure the patient's safety and well-being.
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
What intravenous anesthetic administered by the anesthesiologist has a powerful respiratory depressant effect sufficient to cause apnea and cardiovascular depression?
Thiopental sodium
A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse bases her next action on the principle that:
it may be necessary to raise the head of this client's bed
The nurse recognizes the client has reached stage III of general anesthesia when the client:
lies quietly on the table
During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication?
malignant hyperthermia
Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care:
may result in the administration of general anesthesia
Hypothermia may occur as a result of
open body wounds
A new scrub technician is being oriented to the operating room. The scrub technician states to the nurse, "You can skip the fire safety information because I have worked in hospitals for the past 10 years." What is the best response by the nurse?
"The operating room has some unique circumstances that increases the chances of fire."
A nurse is teaching a client who is at risk for malignant hyperthermia subsequent to general anesthesia. What should the nurse include in the teaching?
"The surgical team is aware of the risk, so the team is prepared."
When developing a teaching plan for a patient scheduled for ambulatory surgery with epidural anesthesia, which of the following would the nurse include?
"You shouldn't experience a headache after this type of anesthesia."
A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate?
"You will be lying on your side with your knees to your chest."
What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound?
Count the sponges
The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered?
Denies sensation to perineum and lower abdomen
The nurse is preparing an older adult for a surgical procedure. Which action will the nurse take to protect the client from injury during the operative period?
Protect bony prominences with extra padding
