Chapter 5: Perioperative Nursing ~ Nursing 1 Medical Surgical

The nurse is aware that the amino acid, arginine:

Stimulates T-cell response

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."

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.

The nurse is completing a postoperative assessment for a patient who has received a depolarizing neuromuscular blocking agent. The nursing assessment includes careful monitoring of which body system?

Cardiovascular system

What medication should the nurse prepare to administer in the event the client has malignant hyperthermia?

Dantrolene sodium - Anesthesia and surgery should be postponed. However, if end-tidal carbon dioxide (CO2) monitoring and dantrolene sodium (Dantrium) are available and the anesthesiologist is experienced in managing malignant hyperthermia, the surgery may continue using a different anesthetic agent.

The nurse recognizes that the older adult is at risk for surgical complications due to:

Decreased renal function

The nurse recognizes that the older adult is at risk for surgical complications due to:

Decreased renal function.

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as

Emergency

A nurse on the surgical team has been assigned the role of scrub nurse. What action by the scrub nurse is appropriate?

Handing instruments to the surgeon and assistants

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. With malignant hyperthermia, tachycardia with a heart rate greater than 150 beats per minute is often the earliest sign because of an increase in end-tidal carbon dioxide. Side note - The rise in body temperature is a late sign that develops rapidly.

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

Laying on side (Sim's or lateral position)

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.

More pleasant onset of anesthesia. Ease of administration. Need for little equipment.

An inappropriate nursing action implemented to keep the client safe includes:

Moving the client swiftly

The nurse documents the presence of granulation tissue in a healing wound. How should the nurse describe the tissue?

Pink to red and soft, bleeding easily. This tissue is composed of minute, thin-walled capillaries and buds that later form connective tissue. These buds, called granulations, enlarge until they fill the area left by the destroyed tissue.

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

Roll the client onto his or her side.

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. - Struggling, shouting, talking, singing, laughing, or crying, is often avoided if the anesthetic is administered smoothly and quickly. Because of the possibility of uncontrolled movements, the patient should not be touched except for purposes of restraint.

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?

Temperature of 102.5°F (39°C) -Intra operative hyperthermia can indicate a life-threatening condition called malignant hyperthermia. The circulating nurse closely monitors the client for signs of hyperthermia.

The nurse is caring for the client in the preoperative period and documenting rationale for a palliative surgical procedure. Which rationale is most appropriate?

The client and physician are focusing on symptom relief not a cure.

An example of a curative surgical procedure is

Tumor excision