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."

The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in?

Lithotomy position

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?

2

What action during a surgical procedure requires immediate intervention by the circulating nurse?

The scrub nurse calling the blood bank to obtain blood products

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?

Verify consent.

A registered nurse who is responsible for coordinating and documenting client care in the operating room is a

circulating nurse.

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

The client vomits during the surgical procedure. The best action by the nurse is:

Suction the client to remove saliva and gastric secretions.

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."

Which stage of surgical anesthesia is also known as excitement?

2

A circulating nurse provides care in a surgical department that has multiple surgeries scheduled for the day. The nurse should know to monitor which patient most closely during the intraoperative period because of the increased risk for hypothermia?

A 74-year-old woman with a low body mass index Feedback: Elderly patients are at greatest risk during surgical procedures because they have an impaired ability to increase their metabolic rate and impaired thermoregulatory mechanisms, which increase susceptibility to hypothermia.

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 nurse is reviewing the intraoperative record of a patient who has just returned from surgery. The patient received general anesthesia with intravenous agents. Which of the following would the nurse identify as a nondepolarizing muscle relaxant?

Atracurium

The nurse positions the client in the lithotomy position in preparation for: A) Renal surgery B) Pelvic surgery C) Perineal surgery D) Abdominal surgery

C) Perineal surgery

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 are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities?

Coordinating the surgical team

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

A patient who has undergone surgery and received spinal anesthesia is reporting a headache. Which of the following would be most appropriate?

Encourage increased fluid intake.

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

The nurse is preparing an elderly patient for a scheduled removal of orthopedic hardware, a procedure to be performed under general anesthetic. For which adverse effect should the nurse most closely monitor the patient?

Hypothermia Feedback: Inadvertent hypothermia may occur as a result of a low temperature in the OR, infusion of cold fluids, inhalation of cold gases, open body wounds or cavities, decreased muscle activity, advanced age, or the pharmaceutical agents used (e.g., vasodilators, phenothiazines, general anesthetics).

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.

A 21-year-old patient is positioned on the OR bed prior to knee surgery to correct a sports-related injury. The anesthesiologist administers the appropriate anesthetic. The OR nurse should anticipate which of the following events as the teams next step in the care of this patient?

Intubating Feedback: When the patient arrives in the OR, the anesthesiologist or anesthetist reassesses the patients physical condition immediately prior to initiating anesthesia. The anesthetic is administered, and the patients airway is maintained through an intranasal intubation, oral intubation, or a laryngeal mask airway.

The anesthetist is coming to the surgical admissions unit to see a patient prior to surgery scheduled for tomorrow morning. Which of the following is the priority information that the nurse should provide to the anesthetist during the visit?

Latex allergy Feedback: Due to the increased number of patients with latex allergies, it is essential to identify this allergy early on so precautions can be taken in the OR. The anesthetist should be informed of any allergies.

Which position is used for perineal surgical procedures?

Lithotomy

An OR nurse is teaching a nursing student about the principles of surgical asepsis as a requirement in the restricted zone of the operating suite. What personal protective equipment should the nurse wear at all times in the restricted zone of the OR?

Mask covering the nose and mouth Feedback: Masks are worn at all times in the restricted zone of the OR.

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?

Mask is placed over nose and extends to bottom lip.

During surgery a patient develops hypothermia. The circulating nurse would monitor the patient closely for which of the following?

Metabolic acidosis

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

The OR nurse acts in the circulating role during a patients scheduled cesarean section. For what task is this nurse solely responsible?

Performing documentation Feedback: Main responsibilities of the circulating nurse include verifying consent; coordinating the team; and ensuring cleanliness, proper temperature and humidity, 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 as well as implementing fire safety precautions. The circulating nurse also monitors the patient and documents specific activities throughout the operation to ensure the patients safety and well-being.

The scrub nurse is responsible for:

Preparing the sterile instruments for the surgical procedure

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.

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

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 client scheduled for open heart surgery has hair on the chest. Which action will the nurse take to prepare the skin for the procedure?

Remove the hair with electric clippers.

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.

The surgical patient is a 35-year-old woman who has been administered general anesthesia. The nurse recognizes that the patient is in stage II (the excitement stage) of anesthesia. Which intervention would be most appropriate for the nurse to implement during this stage?

Restrain the patient. Feedback: In stage II, the patient may struggle, shout, or laugh. The movements of the patient may be uncontrolled, so it is essential the nurse help to restrain the patient for safety.

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

An OR nurse is participating in an interdisciplinary audit of infection control practices in the surgical department. The nurse should know that a basic guideline for maintaining surgical asepsis is what?

Sterile surfaces or articles may touch other sterile surfaces. Feedback: Basic guidelines for maintaining sterile technique include that sterile surfaces or articles may touch other sterile surfaces only.

A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first?

Roll the client onto their side.

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

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 II: excitement

Which of the following techniques least exhibits surgical asepsis?

Suctioning the nasopharyngeal cavity of a client

A patient is to undergo surgery on his kidney. The patient would be placed in which position for the surgery?

The Sims' or lateral position as shown in would be used for renal surgery.

A client at risk for malignant hyperthermia returns to the surgical unit. For what time period will the nurse monitor the client for development of malignant hyperthermia?

The client can develop malignant hyperthermia up to 24 hours after surgery.

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?

To prevent cerebrospinal fluid (CSF) leakage

Which of the following is an inappropriate nursing action by the surgical nurse?

Wearing sterile gloves over artificial nails

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication?

malignant hyperthermia