PrepU Med-Surg Chapter 18
A 78-year-old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase? A-Withhold pain medication due to decreased renal function. B-Maintain an operating room temperature of 18°C to prevent hypothermia. C-Discuss with the anesthesiologist the need for higher doses of anesthetic agents. D-Appropriately position the client using adequate padding and support.
D-Appropriately position the client using adequate padding and support.
A client is having a surgical procedure that requires the client to be in the prone position. What is an expected client outcome? A-The client will not experience anxiety during the preoperative phase. B-The client will not experience signs and symptoms of infection. C-The client will not experience signs of an allergic reaction. D-The client remains free of perioperative positioning injury.
D-The client remains free of perioperative positioning injury.
A client is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid) block during surgery. In the operating room, the nurse positions the client according to the anesthesiologist's instructions. Why does the client require special positioning for this type of anesthesia? A-To prevent confusion B-To prevent cardiac arrhythmias C-To prevent seizures D-To prevent cerebrospinal fluid (CSF) leakage
D-To prevent cerebrospinal fluid (CSF) leakage
The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching? A-Headache B-Sore throat C-Seizures D-Itching
A-Headache
Hypothermia may occur as a result of A-Open body wounds. B-Increased muscle activity. C-Being young. D-The infusion of warm fluids
A-Open body wounds.
What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities? A-Passing instruments B-Coordinating the surgical team C-Assisting the surgeon D-Setting up the sterile tables
B-Coordinating the surgical team
A client is undergoing a perineal surgical procedure. The nurse should place the client in which position? A-Sims B-Lithotomy C-Dorsal recumbent D-Trendelenburg
B-Lithotomy
A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate? A-"You will be on your back with the head of the bed at 30 degrees." B-"You will be placed flat on the table, face down." C-"You will be lying on your side with your knees to your chest." D-"You will be flat on your back with the table slanted so your head is below your feet."
C-"You will be lying on your side with your knees to your chest."
A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first? A-Suction the mouth. B-Administer an antiemetic medication. C-Roll the client onto his or her side. D-Provide a basin.
C-Roll the client onto his or her side.
After teaching a class about agents commonly associated with the development of malignant hyperthermia, the instructor determines that additional teaching is needed when the students identify which drug as a possible cause? A-Succinylcholine B-Halothane C-Epinephrine D-Morphine
Morphine Morphine is not associated with malignant hyperthermia.
Which of the following techniques least exhibits surgical asepsis? A-Placing the sterile field at least one foot away from personnel. B-Suctioning the nasopharyngeal cavity of a client. C-Adding only sterile items to a sterile field. D-Keeping sterile gloved hands above the waist.
B-Suctioning the nasopharyngeal cavity of a client.
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? A-II B-I C-III D-IV
A-II Stage II is the excitement stage that is characterized by struggling, shouting, and laughing. Stage I is the beginning of anesthesia during which the patient breathes in the anesthetic mixture and feelings of warmth, dizziness, and detachment occur. Stage III is surgical anesthesia characterized by unconsciousness and quietness. Surgical anesthesia is reached by continued administration of anesthetic vapor and gas. Stage IV is medullary depression.
The scrub nurse is responsible for: A-Preparing the sterile instruments for the surgical procedure. B-Monitoring the operating-room personnel for breaks in sterile technique. C-Monitoring the administration of the anesthesia. D-Calling the "time-out" to verify the surgical site and procedure.
A-Preparing the sterile instruments for the surgical procedure.
Which of the following is an inappropriate nursing action by the surgical nurse? A-Wearing sterile gloves over artificial nails . B-Wearing a surgical jacket with knitted cuffs on the sleeves. C-Covering the hair with a surgical cap. D-Changing shoe covers that become torn
A-Wearing sterile gloves over artificial nails .
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? A-Hair is pulled back and covered by a cap. B-Mask is placed over nose and extends to bottom lip. C-Shoe covers are used. D-Scrub top and drawstring are tucked into pants.
B-Mask is placed over nose and extends to bottom lip.
The nurse recognizes the client has reached stage III of general anesthesia when the client: A-Exhibits no change in behavior. B-Paralysis of the lower extremities. C-Has small pupils that react to light. D-Complains of ringing or buzzing in the ears. E-Unable to maintain airway. F-Ability to respond to verbal commands. G-Loss of consciousness. H-Exhibits shallow respirations and a weak, thready pulse.
C-Has small pupils that react to light. Stage III of general anesthesia is characterized by dilation and reaction of pupils. Respirations are regular, the pulse rate and volume are normal, and the skin is pink or slightly flushed.
An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position? A-Flat on his back with his arms next to his sides B-On his back, with his legs and thighs flexed at right angles C-On his side, with his uppermost leg adducted and flexed at the knee D-On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle
D-On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle. The Trendelenburg position usually is used for surgery on the lower abdomen and pelvis to obtain good exposure by displacing the intestines into the upper abdomen. In this position, the head and body are lowered. The patient is held in position by padded shoulder braces.
A client who is scheduled for knee surgery is anxious about the procedure, saying, "You hear stories on the news all the time about doctors working on the wrong body part. What if that happens to me?" What can the nurse tell this client to help alleviate this concern? A-The surgical team performs a "time-out" prior to surgery to conduct a final verification. B-The client will be involved in the verification process prior to surgery. C-The client can be involved in marking the knee, the site for the surgery. D-The surgeon on the team has never been involved in such a mix-up.
The client can be involved in marking the knee, the site for the surgery. The surgical team performs a "time-out" prior to surgery to conduct a final verification. The client will be involved in the verification process prior to surgery. There is an increased emphasis on making sure that the right client has the right procedure at the right site. To prevent "wrong site, wrong procedure, wrong person surgery," The Joint Commission (2016) established a universal protocol to achieve this goal. Included in this checklist are steps to verify the preoperative process, mark the operative site, and perform a "time-out."
