Class 23 and 24
What is the primary advantage of the use of midazolam (versed) as an adjunct to general anesthesia? a. amnestic effect b. analgesic effect c. prolonged action d. antiemetic effect
a. amnestic effect Midazolam (Versed) is a rapid, short-acting, sedative-hypnotic benzodiazepine that is used to prevent recall of events under anesthesia because of its amnestic properties.
A patient who is being admitted to the surgical unit for a hysterectomy paces the floor, repeatedly saying, "I just want this over." What should the nurse do to promote a positive surgical outcome for the patient? a. ask the patient what her specific concerns are about the surgery b. reassure the patient that the surgery will be over soon and she will be fine c.redirect the patient's attention to the necessary pre-op preparations d. tell the patient she should not be so anxious because she is having a common, safe surgery
a. ask the patient what her specific concerns are about the surgery excessive anxiety and stress can affect surgical recovery and the nurse's role in psychologically preparing the patient for surgery is to assess for potential stressors that could negatively affect surgery. Specific fears should be identified and addressed by the nurse by listening and explaining planned post-op care. Falsely reassuring the patient, ignoring her behavior, and telling her not to be anxious are not therapeutic
What is the primary goal of the circulating nurse during preparation of the operating room, transferring and positioning patient, and assisting the anesthesia team? a. avoiding any type of injury to the patient b. maintaining a clean environment for the patient c. providing for patient comfort and sense of well-being d. preventing breaks in aseptic technique by the sterile members of the team
a. avoiding any type of injury to the patient The protection of the patient from injury in the OR environment is maintained by the circulating nurse by ensuring functioning equipment, preventing falls and injury during transport and transfer, monitoring asepsis, and providing supportive care for the anesthetized patient
What does progression of patients through various phases of care in a postanesthesia care unit (PACU) primarily depend on? a. condition of patient b. type of anesthesia used c. respiratory adequacy d. type of surgical procedure
a. condition of patient Although some surgical procedures and drug administration require more intensive postanesthesia care, how fast and through which levels of care patients are moved depend on the condition of the patient. A physiologically unstable outpatient may stay an extended time in Phase I, whereas a patient requiring hospitalization but who is stable and recovering may well be transferred quickly to an inpatient unit.
The nurse is obtaining the health history for a patient who is scheduled for outpatient knee surgery. Which statement by the patient is most important to report to the health care provider? a. "I had a heart valve replacement last year." b. "I had bacterial pneumonia 6 months ago." c. "I have knee pain whenever I walk or jog." d. "I have a strong family history of breast cancer."
ANS: A "I had a heart valve replacement last year." A patient with a history of valve replacement is at risk for endocarditis associated with invasive procedures and may need antibiotic prophylaxis. A current respiratory infection may affect whether the patient should have surgery, but a history of pneumonia is not a reason to postpone surgery. The patient's knee pain is the likely reason for the surgery. A family history of breast cancer does not have any implications for the current surgery.
During the preoperative interview, a patient scheduled for an elective hysterectomy tells the nurse, "I am afraid that I will die in surgery like my mother did!" Which response by the nurse is most appropriate? a. "Tell me more about what happened to your mother." b. "You will receive medications to reduce your anxiety." c. "You should talk to the doctor again about the surgery." d. "Surgical techniques have improved a lot in recent years."
ANS: A "Tell me more about what happened to your mother." The patient's statement may indicate an unusually high anxiety level or a family history of problems such as malignant hyperthermia, which will require precautions during surgery. The other statements also may address the patient's concerns, but further assessment is needed first.
On the day of surgery, the nurse is admitting a patient with a history of cigarette smoking. Which action is most important at this time? a. Auscultate for adventitious breath sounds. b. Ask whether the patient has smoked recently. c. Remind the patient about harmful effects of smoking. d. Calculate the cigarette smoking history in pack-years.
ANS: A Auscultate for adventitious breath sounds. Abnormal breath sounds may indicate the presence of an acute respiratory infection or chronic lung disease that will affect the choice of anesthesia and/or proceeding with the scheduled surgery. The other nursing actions also are appropriate but will not affect the immediate surgical procedure as much as the presence of abnormal breath sounds.
The clinic nurse reviews the complete blood cell count (CBC) results for a patient who is scheduled for surgery in a few days. The results are white blood cell count (WBC)10.2k ; hemoglobin 15 g/dL; hematocrit 45%; platelets 150Which action should the nurse take? a. Send the CBC results to the surgery facility. b. Call the surgeon and anesthesiologist immediately. c. Ask the patient about any symptoms of a recent infection. d. Discuss the possibility of blood transfusion with the patient.
ANS: A Send the CBC results to the surgery facility. The nurse should be sure that the CBC results, which are normal, are available at the surgical facility to avoid delay of the procedure. With normal results, there is no need to notify the surgeon or anesthesiologist, discuss blood transfusion, or ask about recent infection.
Any patient guilt about having a therapeutic abortion may be identified when the nurse assesses the functional health pattern of a. value-belief. b. cognitive-perceptual. c. sexuality-reproductive. d. coping-stress tolerance.
ANS: A value-belief. The value-belief pattern includes information about conflicts between a patient's values and proposed medical care. In the cognitive-perceptual pattern, the nurse will ask questions about pain and sensory intactness. The sexuality-reproductive pattern includes data about the impact of the surgery on the patient's sexuality. The coping-stress tolerance pattern assessment will elicit information about how the patient feels about the surgery.
A patient who is scheduled for surgery in a week tells the nurse doing the preoperative assessment about an allergy to bananas, kiwifruit, and latex products. Which action is most important for the nurse to take? a. Notify the dietitian about the food allergies. b. Alert the surgery center about the latex allergy. c. Reassure the patient that all allergies are noted on the medical record. d. Ask whether the patient uses antihistamines to reduce allergic reactions.
ANS: B Alert the surgery center about the latex allergy. When a patient is allergic to latex, special nonlatex materials are used during surgical procedures and the staff will need to know about the allergy in advance to obtain appropriate nonlatex materials and have them available on the surgical date. The other actions also may be appropriate, but prevention of allergic reaction (either contact dermatitis or anaphylaxis) during surgery is the most important action.
Before the administration of preoperative medications, the nurse is preparing to witness the patient signing the operative consent form when the patient says, "I do not really understand what the doctor said." Which action is best for the nurse to take? a. Provide an explanation of the planned surgical procedure. b. Notify the surgeon that the informed consent process is not complete. c. Administer the prescribed preoperative antibiotics and withhold any ordered sedative medications. d. Notify the operating room staff that the surgeon needs to give a more complete explanation of the procedure.
ANS: B Notify the surgeon that the informed consent process is not complete. surgeon is responsible for explaining the surgery to the patient, and the nurse should wait until the surgeon has clarified the surgery before having the patient sign the consent form. The nurse should communicate directly with the surgeon about the consent form rather than asking other staff to pass on the message. It is not within the nurse's legal scope of practice to explain the surgical procedure. No preoperative medications should be administered until the patient signs the consent form.
A patient arrives at the ambulatory surgery center for a scheduled outpatient surgery. Which information is of most concern to the nurse? a. The patient has not had outpatient surgery before. b. The patient is planning to drive home after surgery. c. The patient's insurance does not cover outpatient surgery. d. The patient had a glass of water a few hours before arriving.
ANS: B The patient is planning to drive home after surgery. After outpatient surgery, the patient should not drive home and will need assistance with transportation and home care. The patient's experience with outpatient surgery is assessed, but it does not have as much application to the patient's physiologic safety. The patient's insurance coverage is important to establish, but this is not usually the nurse's role or a priority in nursing care. Having clear liquids a few hours before surgery does not usually increase risk for aspiration.
Which information about medication use in a preoperative patient is most important to communicate to the health care provider? a. The patient uses acetaminophen (Tylenol) occasionally for aches and pains. b. The patient takes garlic capsules daily but did not take any on the surgical day. c. The patient has a history of cocaine use but quit using the drug over 10 years ago. d. The patient took a sedative medication the previous night to assist in falling asleep.
ANS: B The patient takes garlic capsules daily but did not take any on the surgical day. Chronic use of garlic may predispose to intraoperative and postoperative bleeding. The use of a sedative the previous night, occasional acetaminophen use, and a distant history of cocaine use will not usually affect the surgical outcome.
A 36-year-old woman is admitted for an outpatient surgery. Which information obtained by the nurse during the preoperative assessment is most important to report to the anesthesiologist before surgery? a. The patient's lack of knowledge about postoperative pain control measures b. The patient's statement that her last menstrual period was 8 weeks previously c. The patient's history of a postoperative infection following a prior cholecystectomy d. The patient's concern that she will be unable to care for her children postoperatively
ANS: B The patient's statement that her last menstrual period was 8 weeks previously This statement suggests that the patient may be pregnant, and pregnancy testing is needed before administration of anesthetic agents. Although the other data also may be communicated with the surgeon and anesthesiologist, they will affect postoperative care and do not indicate a need for further assessment before surgery.
A patient is seen at the health care provider's office several weeks before hip surgery for preoperative assessment. The patient reports use of echinacea, saw palmetto, and glucosamine/chondroitin. The nurse should a. ascertain that there will be no interactions with anesthetic agents. b. discuss the supplement use with the patient's health care provider. c. teach the patient that these products may be continued preoperatively. d. advise the patient to stop the use of all herbs and supplements at this time.
ANS: B discuss the supplement use with the patient's health care provider. The nurse should discuss the medication use with the patient's health care provider because saw palmetto is used to decrease prostatic hyperplasia, and the patient may need to continue taking the medication or a prescription medication to prevent urinary retention. The nurse should not advise the patient to stop the supplements or to continue them without consulting with the health care provider. Determining the interactions between the supplements and anesthetics is not within the nurse's scope of practice.
A diabetic patient who uses insulin to control blood glucose has been NPO since midnight before having a mastectomy. The nurse will anticipate the need to a. withhold the usual scheduled insulin dose because the patient is NPO. b. obtain a blood glucose measurement before any insulin administration. c. give the patient the usual insulin dose because stress will increase the blood glucose. d. administer a lower dose of insulin because there will be no oral intake before surgery.
ANS: B obtain a blood glucose measurement before any insulin administration. Preoperative insulin administration is individualized to the patient, and the current blood glucose will provide the most reliable information about insulin needs. It is not possible to predict whether the patient will require no insulin, a lower dose, or a higher dose without blood glucose monitoring.
Ten minutes after receiving the ordered preoperative opioid by intravenous (IV) injection, the patient asks to get up to go to the bathroom to urinate. The most appropriate action by the nurse is to a. assist the patient to the bathroom and stay with the patient to prevent falls. b. offer a urinal or bedpan and position the patient in bed to promote voiding. c. allow the patient up to the bathroom because the onset of the medication takes more than 10 minutes. d. ask the patient to wait because catheterization is performed at the beginning of the surgical procedure.
ANS: B offer a urinal or bedpan and position the patient in bed to promote voiding. The patient will be at risk for a fall after receiving the opioid, so the best nursing action is to have the patient use a bedpan or urinal. Having the patient get up either with assistance or independently increases the risk for a fall. The patient will be uncomfortable and risk involuntary incontinence if the bladder is full during transport to the operating room.
As the nurse prepares a patient the morning of surgery, the patient refuses to remove a wedding ring, saying, "I have never taken it off since the day I was married." The nurse should a. have the patient sign a release and leave the ring on. b. tape the wedding ring securely to the patient's finger. c. tell the patient that the hospital is not liable for loss of the ring. d. suggest that the patient give the ring to a family member to keep.
ANS: B tape the wedding ring securely to the patient's finger. The ring can be taped to the patient's finger and noted on the preoperative checklist. There is no need for a release form or to discuss liability with the patient. Wearing the ring is obviously important to the patient, so the nurse should tape the ring in place rather than have a family member keep the ring for the patient.
Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for a colon resection? a. Care for the surgical incision b. Medications used during surgery c. Deep breathing and coughing techniques d. Oral antibiotic therapy after discharge home
ANS: C Deep breathing and coughing techniques Preoperative teaching, demonstration, and redemonstration of deep breathing and coughing are needed on patients having abdominal surgery to prevent postoperative atelectasis. Incisional care and the importance of completing antibiotics are better discussed after surgery, when the patient will be more likely to retain this information. The patient does not usually need information about medications that are used intraoperatively.
An alert 82-year-old who has poor hearing and vision is receiving preoperative teaching from the nurse. His wife answers most questions directed to the patient. Which action should the nurse take when doing the teaching? a. Use printed materials for instruction so that the patient will have more time to review the material. b. Direct the teaching toward the wife because she is the obvious support and caregiver for the patient. c. Provide additional time for the patient to understand preoperative instructions and carry out procedures. d. Ask the patient's wife to wait in the hall in order to focus preoperative teaching with the patient himself.
ANS: C Provide additional time for the patient to understand preoperative instructions and carry out procedures. The nurse should allow more time when doing preoperative teaching and preparation for older patients with sensory deficits. Because the patient has visual deficits, he will not be able to use written material for learning. The teaching should be directed toward both the patient and the wife because both will need to understand preoperative procedures and teaching.
A patient is to receive atropine before surgery. The nurse teaches the patient to expect a. dizziness. b. weakness. c. dry mouth. d. forgetfulness.
ANS: C dry mouth. Anticholinergic medications decrease oral secretions, so the patient is taught that a dry mouth is an expected side effect. Weakness, forgetfulness, and dizziness are side effects associated with other preoperative medications such as opioids and benzodiazepines.
During the preoperative assessment of a patient scheduled for a colon resection, the patient tells the nurse about using St. John's wort to prevent depression. The nurse should alert the staff in the postanesthesia recovery area that the patient may a. experience increased pain. b. have hypertensive episodes. c. take longer to recover from the anesthesia. d. have more postoperative bleeding than expected.
ANS: C take longer to recover from the anesthesia. St. John's wort may prolong the effects of anesthetic agents and increase the time to waken completely after surgery. It is not associated with increased bleeding risk, hypertension, or increased pain.
A 24-year-old who takes a diuretic and a β-blocker to control blood pressure is scheduled for abdominal surgery. Which patient information is most important to communicate to the health care provider before surgery? a. Pulse rate 59 b. Hematocrit 35% c. Blood pressure 142/78 d. Serum potassium 3.3 mEq/L
ANS: D Serum potassium 3.3 mEq/L The low potassium level may increase the risk for intraoperative complications such as dysrhythmias. Slightly elevated blood pressure is common before surgery because of patient anxiety. The heart rate would be expected in a patient taking a β-blocker. The hematocrit is in the low normal range but does not require any intervention before surgery.
When the nurse interviews a patient who is to have outpatient surgery using a general anesthetic, which information is most important to communicate to the surgeon and anesthesiologist before surgery? a. The patient drinks 3 or 4 cups of coffee every morning before going to work. b. The patient takes a baby aspirin daily but stopped taking aspirin 10 days ago. c. The patient drank 4 ounces of apple juice 3 hours before coming to the hospital. d. The patient's father died after receiving general anesthesia for abdominal surgery.
ANS: D The patient's father died after receiving general anesthesia for abdominal surgery. The information about the patient's father suggests that there may be a family history of malignant hyperthermia and that precautions may need to be taken to prevent this complication. Current research indicates that having clear liquids 3 hours before surgery does not increase the risk for aspiration in most patients. Patients are instructed to discontinue aspirin 1 to 2 weeks before surgery. The patient should be offered caffeinated beverages postoperatively to prevent a caffeine-withdrawal headache, but this does not have preoperative implications.
The nurse is preparing a patient for transport to the OR. the patient is scheduled for a right knee arthoscopy. What actions should the nurse take at this time (SELECT ALL THAT APPLY)? a. ensure that the patient has voided b. verify that the informed consent is signed c. complete pre-op nursing documentation d. verify that the right knee is marked with indelible marker e. ensure that the H&P, diagnostic reports, and vital signs are on the chart
a. ensure that the patient has voided b. verify that the informed consent is signed c. complete pre-op nursing documentation d. verify that the right knee is marked with indelible marker e. ensure that the H&P, diagnostic reports, and vital signs are on the chart all of these actions are needed to ensure that the pt is ready for surgery. in addition, the nurse should verify that the identification band and allergy band (if applicable) are on; the pt is not wearing any cosmetics; nail polish has been removed; valuables have been removed and secured; and prosthetics, such as eyeglasses, have been removed and secured
Many herbal products that are commonly taken cause surgical problems. Which herbs listed below should the nurse teach the patient to avoid before surgery to prevent an increase in bleeding for the surgical patient (SELECT ALL THAT APPLY)? a. garlic b. fish oil c. valerian d. vitamin e e. astragalus f. ginko biloba
a. garlic b. fish oil d. vitamin e f. ginko biloba valerian may cause excess sedation; astragalus may increase blood pressure before and during surgery
What type of procedural info should be given to a patient in preparation for ambulatory surgery (SELECT ALL THAT APPLY) a. how pain will be controlled b. any fluid and food restrictions c. characteristics of monitoring equipment d. what odors and sensations may be expected e. technique and practice of coughing and deep breathing, if appropriate
a. how pain will be controlled b. any fluid and food restrictions e. technique and practice of coughing and deep breathing, if appropriate Procedural information includes what will or should be done for surgical prep, including what to bring and wear to surgery, length and type of food/fluid restrictions, physical prep required, pain control, need for coughing and deep breathing (if appropriate), and procedures done before and during surgery. The other options are sensory and process information
With what are the post-op respiratory complications of atelectasis and aspiration of gastric contents associated? a. hypoxemia b. hypercapnia c. hypoventilation d. airway obstruction
a. hypoxemia Hypoxemia occurs with atelectasis and aspiration as well as pulmonary edema, pulmonary embolism, and bronchospasm. Hypercapnia is caused by decreased removal of CO2 from the respiratory system that could occur with airway obstruction or hypoventilation. Hyperventilation may occur with depression of central respiratory drive, poor respiratory muscle tone due to disease or anesthesia, mechanical restriction, or pain. Airway obstruction could occur with the tongue blocking the airway, restrained thick secretions, laryngospasm, or laryngeal edema.
A patient in the PACU has emergence delirium manifested by agitation and thrashing. What should the nurse assess for first in the patient? a. hypoxemia b. neurologic injury c. distended bladder d. cardiac dysrhythmias
a. hypoxemia The most common cause of emergence delirium is hypoxemia and initial assessment should evaluate respiratory function. When hypoxemia is ruled out, other causes, such as distended bladder, pain, and fluid and electrolyte disturbances, should be considered. Delayed awakening may result from neurologic injury and cardiac dysrhythmias most often result from specific respiratory, electrolyte, or cardiac problems.
A patient is scheduled for a hemorrhoidectomy at an ambulatory day-surgery center. An advantage of performing surgery at an ambulatory center is a decreased need for a. lab tests and peri-op meds b. pre-op and post-op teaching by the nurse c. psychologic support to alleviate fears of pain and discomfort d. pre-op nursing assessment related to possible risks and complications
a. lab tests and peri-op meds ambulatory surgery is usually less expensive and more convenient, generally involving fewer lab tests, fewer pre/post op meds, less psychological stress, and less susceptibility to hospital acquired infections. However, the nurse is still responsible for assessing, supporting, and teaching the patient who is undergoing surgery, regardless of where the surgery is performed
During a pre-op physical assessment, the nurse is alerted to the possibility of compromised respiratory function during or after surgery in a patient with which problem? a. obesity b. dehydration c. enlarged liver d. decreased peripheral pulses
a. obesity as well as spinal, chest, and airway deformities, may compromise respiratory function during and after surgery. Dehydration may require pre-op fluid therapy and an enlarged liver may indicate hepatic dysfunction that will increase peri-op risk r/t glucose control, coagulation, amd drug interactions. Weak peripheral pulses may reflect circulatory problems that could affect healing
The PACU nurse applies warm blankets to a post-op patient who is shivering and has a body temperature of 96 degrees Fahrenheit. What treatment also may be used to treat the patient? a. oxygen b. vasodilating drugs c. antidysrhythmic drugs d. analgesics or sedatives
a. oxygen During hypothermia, oxygen demand is increased and metabolic processes slow down. Oxygen therapy is used to treat the increased demand for oxygen. Antidysrhythmics and vasodilating drugs would be used only if the hypothermia caused symptomatic cardiac dysrhythmias and vasoconstriction. Sedatives and analgesics and not indicated for hypothermia.
Which nursing actions are completed by the scrub nurse (SELECT ALL THAT APPLY) a. prepares instrument table b. documents intraoperative care c. remains in the sterile area d. checks mechanical and electrical equipment e. passes instruments to surgeon and assistants f. monitors blood and other fluid loss and urine output
a. prepares instrument table c. remains in the sterile area e. passes instruments to surgeon and assistants The circulating nurse documents intraoperative care, checks mechanical and electrical equipment, and monitors blood and other fluid loss and urine output
A patient is scheduled for hip replacement surgery in the early afternoon is NPO but receives and ingests a breakfast tray with clear liquids on the morning of surgery. What response does the nurse expect when the ACP is notified? a. surgery will be done as scheduled b. surgery will be rescheduled for the following day c. surgery will be postponed for 8 hours after the fluid intake d. a NG tube will be inserted to remove the fluids from the stomach
a. surgery will be done as scheduled the pre-op fasting recommendations of the american society of anesthesiology indicated that clear liquids can be taken up to 2 hours before surgery for healthy patients undergoing elective procedures. There is evidence that longer fasting is not necessary
A break in sterile technique occurs during surgery when the scrub nurse touches a. the mask with sterile gloved hands b. sterile gloved hands to the gown at chest level c. the drape at the incision site with sterile gloved hands d. the lower arm to the instruments on the instrument tray
a. the mask with sterile gloved hands The mask covering the face is not considered sterile and if in contact with sterile gloved hands, it contaminates the gloves. The gown at chest level and 2 inches above the elbows is considered sterile, as is the drape placed at the surgical area
When the nurse prepares to administer a pre-op med to a patient, the patient tells the nurse that she really does not understand what the surgeon plans to do. a. what action should be taken by the nurse? b. what criterion of informed consent has not been met in this situation?
a. the nurse should notify the health care provider because the patient needs further explanation of the planned surgery b. sufficient comprehension
The nurse asks a pre-op patient to sign a surgical consent form as specified by the surgeon and then sign the form after the patient does so. By this action, what is the nurse doing? a. witnessing the patient's signature b. obtaining informed consent from the patient for the surgery c. verifying that the consent for surgery is truly voluntary and informed d. ensuring that the patient is mentally competent to sign the consent form
a. witnessing the patient's signature the health care provider is ultimately responsible for obtaining informed consent. However, the nurse may be responsible for obtaining and witnessing the patient's signature. The nurse may be a patient advocate during the signing of the consent form, verifying the consent is voluntary and that the patient understands the implications of consent, but the primary legal action by the nurse is witnessing the patient's signature
What is included in the routine assessment of the patient's cardiovascular function on admission to the PACU? a.monitoring arterial blood gases b. ECG monitoring c. determining fluid and electrolyte status d. direct arterial blood pressure monitoring
b. ECG monitoring ECG monitoring is performed on patients to assess initial cardiovascular problems during anesthesia recovery. Fluid and electrolyte status is an indication of renal function and determinations of arterial blood gases and direct arterial blood pressure monitoring are used only in special cardiovascular or respiratory problems.
What is the rationale for using pre-op checklists on the day of surgery? a. the patient is correctly ID'd b. all pre-op orders and procedures have been carried out and records are complete c. patients' families have been informed as to where they can accompany and wait for patients d. pre-op meds are the last procedure before the patient is transported to the OR
b. all pre-op orders and procedures have been carried out and records are complete pre-op checklists are a tool used to ensure that the many preparations and precautions performed before surgery have been completed and documented. Patient ID, instructions to the family, and administeration of pre-op meds are often documented on the checklist, which ensures no details are omitted
Because of the rapid elimination of volatile liquids used for general anesthesia, what should the nurse anticipate the patient will need early in the anesthesia recovery period? a. warm blankets b. analgesic meds c. observation for respiratory depression d. airway protection in anticipation of vomiting
b. analgesic meds The volatile liquid inhalation agents have very little residual analgesia and patients experience early onset of pain when the agents are discontinued. These agents are associated with a low incidence of nausea and vomiting. Prolonged respiratory depression is not common because of their rapid elimination. Hypothermia is not related to use of these agents but they may precipitate malignant hyperthermia in conjunction with neuromuscular blocking agents.
When transporting an inpatient to the surgical department, which area is a nurse from another area of the hospital able to access? a. clean core b. holding area c. corridors of surgical suite d. unprepared operating room
b. holding area Persons in street clothes or attire other than surgical scrub clothing can interact with personnel of the surgical suite in unrestricted areas, such as the holding area, nursing station, control desk, or locker rooms. Only authorized personnel in surgical attire and hair covering are allowed in semirestricted areas, such as corridors, and masks must be worn in restriced areas, such as OR, clean core, and scrub sinks
What condition should the nurse anticipate that might occur during epidural and spinal anesthesia? a. spinal headache b. hypotension and bradycardia c. loss of consciousness and seizures d. downward extension of nerve block
b. hypotension and bradycardia During epidural and spinal anesthesia, a sympathetic nervous system blockade may occur that results in hypotension, bradycardia, and nausea and vomiting. A spinal headache may occur after, not during, spinal anesthesia and loss of consciousness and seizures are indicative of IV absorption overdose. Upward extension of the effect of the anesthesia results in inadequate respiratory excursion and apnea.
For which nursing diagnoses or collaborative problems common in post-op patients has ambulation been found to be an appropriate intervention (SELECT ALL THAT APPLY) a. impaired skin integrity r/t incision b. impaired mobility r/t decreased muscle strength c. risk for aspiration r/t decreased muscle strength d. ineffective airway clearance r/t decreased respiratory excursion e. constipation r/t decreased physical activity and impaired GI motility f. venous thromboembolism r/t dehydration, immobility, vascular manipulation, or injury
b. impaired mobility r/t decreased muscle strength d. ineffective airway clearance r/t decreased respiratory excursion e. constipation r/t decreased physical activity and impaired GI motility f. venous thromboembolism r/t dehydration, immobility, vascular manipulation, or injury These problems are improved with ambulation. Other collaborative problems could be potential complications: urinary retention, atelectasis, and pneumonia.
What is the physical environment of a surgery suite primarily designed to promote? a. electrical safety b. medical and surgical asepsis c. comfort and privacy of the patient d. communication among the surgical team
b. medical and surgical asepsis Although all of the factors listed are important to the safety and well-being of the patient, the first consideration in the physical environment of the surgical suite is prevention of transmission of infection to the patient
A pre-op patient reveals that an uncle died during surgery because of a fever and cardiac arrest. Knowing the patient is at risk for malignant hyperthermia, the pre-op nurse alerts the surgical team. What is likely to happen next? a. the surgery will have to be canceled b. specific precautions can be taken to safely anesthetize the patient c. dantrolene (dantrium) must be given to prevent hyperthermia during surgery d. the patient should be placed on a cooling blanket during the surgical procedure
b. specific precautions can be taken to safely anesthetize the patient Although malignant hyperthermia can result in cardiac arrest and dealth, if the patient is known or suspected to be at risk for the disorder, appropriate precautions taken by the ACP can provide a safe anesthesia for the patient. Because preventive measure are possible if the risk is known, it is critical that preoperative assessment include a careful family history of surgical events. Dantrolene (Dantrium) is given as a treatment for malignant hyperthermia, not as a preventive measure. The cooling blanket would have no effect.
To prevent agitation during the patient's recovery from anesthesia, when should the nurse begin orientation explanations? a. when the patient is awake b. when the patient first arrives in the PACU c. when the patient becomes frightened or agitated d. when the patient can be aroused and recognizes where he or she is
b. when the patient first arrives in the PACU Even before patients awaken from anesthesia, their sense of hearing returns and all activities should be explained by the nurse from the time of admission to the PACU to assist in orientation and decrease confusion.
While assessing a patient in the PACU, the nurse finds that the patient's blood pressure is below the pre-op baseline. The nurse determines that the patient has residual vasodilating effects of anesthesia when what is assessed? a. a urinary output >30 mL/hr b. an oxygen saturation of 88% c. a normal pulse with warm, dry, pink skin d. a narrowing pulse pressure with normal pulse
c. a normal pulse with warm, dry, pink skin Hypotension with normal pulse and skin assessment is typical of residual vasodilating effects of anesthesia and requires continued observation. An oxygen saturation of 88% indicates hypoxemia, whereas a narrowing pulse pressure accompanies hypoperfusion. A urinary output >30 mL/hr is desirable and indicates normal renal function.
How is the initial information given to the PACU nurses about the surgical patient? a. a copy of the written operative report b. a verbal report from the circulating nurse c. a verbal report from the ACP d. an explanation of the surgical procedure from the surgeon
c. a verbal report from the ACP The admission of the patient to the PACU is a joint effort between the ACP, who is responsible for supervising the postanesthesia recovery of the patient, and the PACU nurse, who provides care during anesthesia recovery. The ACP gives a verbal report that presents the details of the surgical and anesthetic course, preoperative conditions influencing the surgical and anesthetic outcome, and PACU treatment plans to ensure patient safety and continuity of care.
When the nurse asks a pre-op patient about allergies, the patient reports a history of seasonal environmental allergies and allergies to a variety of fruits. What should the nurse do next? a. note this information in the patient's record as hay fever and food allergies b. place an allergy alert wristband that ID's the specific allergies on the patient c. ask the patient to describe the nature and severity of any allergic responses experienced from these agents d. notify the anesthesia care provider because the patient may have an increased risk for allergies to anesthetics
c. ask the patient to describe the nature and severity of any allergic responses experienced from these agents risk factors for latex allergies include a history of hay fever and allergies to foods such as avocados, kiwi, bananas, potatoes, peaches, and apricots. When a patient identifies with such allergies, the patient should be further questioned about exposure to latex and specific reactions to allergens. A history of any allergic responsiveness increases the risk for hypersensitivity reactions to drugs and during anesthesia but the hay fever and fruit allergies are specifically r/t latex allergy. After IDing the allergic reaction, the ACP should be notified , the allergy alert wristband should be applied, and the note in the record will include the allergies and reactions as well asthe nursing actions r/t the allergies
Which patient is ready for discharge from Phase 1 PACU care to the clinical unit? a. arouses easily, pulse is 112 bpm, respiratory rate is 24, dressing is saturated, SaO2 is 88% b. difficult to arouse, pulse is 52, respiratory rate is 22, dressing is dry and intact, SaO2 is 91% c. awake, vital signs stable, dressing is dry and intact, no respiratory depression, SaO2 is 92% d. arouses, blood pressure higher than pre-op and respiratory rate is 10 no excess bleeding, SaO2 is 90%
c. awake, vital signs stable, dressing is dry and intact, no respiratory depression, SaO2 is 92% On initial assessment in PACU the airway, breathing, and circulation (ABC) status is assessed using a standardized tool that usually includes consciousness, respiration, oxygen saturation, circulation, and activity. Increased or decreased respiratory rate, hypertension, and a SaO2 below 90% indicate inadequate oxygenation that will be treated or managed in the PACU before discharging the patient to the next phase.
A common reason that a nurse may need extra time when preparing older adults for surgery is their a. ineffective coping b. limited adaptation to stress c. diminished vision and hearing d. need to include caregivers in activities
c. diminished vision and hearing one of the major reasons that older adults need increased time pre-op is the presence of impaired vision/hearing that slows understanding of pre-op instructions and prep for surgery. Thought processes and cognitive abilities may also be impaired. the older adult's decreased adaptation to stress because of physiologic changes may increase surgical risks and overwhelming surgery related losses may result in ineffective coping that is not directly r/t time needed for pre-op preparation. the involvement of caregivers in pre-op activities may be appropriate for pts of all ages
A patient who had major surgery is experiencing emotional stress as well as physiologic stress from the effects of surgery. What can this stress cause? a. diuresis b. hyperkalemia c. fluid retention d. impaired blood coagulation
c. fluid retention The stress response causes fluid retention during the first 1 to 3 days postoperatively and fluid overload is possible during this time. Fluid retention results from secretion and release of antidiuretic hormone (ADH) and adrenocorticotropic hormone (ACTH) by the pituitary and activation of the renin-angiotensin-aldosterone system (RAAS). ACTH stimulates that adrenal cortex to secrete cortisol and aldosterone. The RAAS increases aldosterone release, which also increases fluid retention. Aldosterone causes renal potassium loss with possible hypokalemia and blood coagulation is enhanced by cortisol.
During surgery, a patient has a nursing diagnosis of risk for peri-op positioning injury. What is a common risk factor for this nursing diagnosis? a. skin lesions b. break in sterile technique c. musculoskeletal deformities d. electrical or mechanical equipment failure
c. musculoskeletal deformities Musculoskeletal deformities can be a risk factor for positioning injuries and require special padding and support on the operating table. Skin lesions and break in sterile technique are risk factors for infection and electrical or mechanical equipment failure may lead to other types of injury
Which tubes drain gastric contents (SELECT ALL THAT APPLY)? a. T-tube b. hemovac c. nasogastric tube d. indwelling catheter e. gastrointestinal tube
c. nasogastric tube e. gastrointestinal tube The nasogastric tube and gastrointestinal tube drain gastric contents. The T-tube drains bile, the Hemovac drains blood from the surgical site, and the indwelling catheter drains urine form the bladder.
To promote effective coughing, deep breathing, and ambulation in the post-op patient, what is most important for the nurse to do? a. teach the patient controlled breathing b. explain the rationale for these activities c. provide adequate and regular pain meds d. use an incentive spirometer to motivate the patient
c. provide adequate and regular pain meds Incisional pain is often the greatest deterrent to patient participation in effective ventilation and ambulation and adequate and regular analgesic medications should be provided to encourage these activities. Controlled breathing may help the patient to manage pain but does not promote coughing and deep breathing. Explanations and use of an incentive spirometer help to gain patient participation but are more effective if pain is controlled.
Upon admission of a patient to the PACU, the nurse's priority nursing assessment is a. vital signs b. surgical site c. respiratory adequacy d. level of consciousness
c. respiratory adequacy Physiologic status of the patient is always prioritized with regard to airway; breathing, and circulation, and respiratory adequacy is the first assessment priority of the patient on admission to the PACU from the operating room. Following assessment of respiratory function, cardiovascular, neurologic and renal function should be assessed as well as the surgical site.
The patient will be placed under moderate sedation to allow realignment of a fracture in the emergency department. When the family asks about this anesthesia, what should the nurse tell them? a. includes inhalation agents b. induces high level of sedation c. frequently used for traumatic injuries d. patients remain responsive and breathe without assistance
d. patients remain responsive and breathe without assistance Moderate sedation uses sedative, anxiolytic, and/or analgesic medications. Inhalation agents are not used. It is not expected to induce levels of sedation that would impair a patient's ability to protect the airway.
In addition to ambulation, which nursing intervention could be implemented to prevent or treat the post-op complication of syncope? a. monitor vital signs after ambulation b. do not allow the patient to eat before ambulation c. slowly progress to ambulation with slow changes in position d. have the patient deep breathe and cough before getting out of bed
c. slowly progress to ambulation with slow changes in position Slow progression to ambulation by slowly changing the patient's position will help to prevent syncope. Monitoring vital signs after walking will not prevent or treat syncope. Monitor the patient's pulse and blood pressure (BP) before, during, and after position changes. Elevate the patient's head, then slowly have the patient dangle, then stand by the bed to help determine if the patient is safe for walking. Eating will not have an effect on syncope. Deep breathing and coughing will not decrease syncope, although it will prevent respiratory complications.
What should be included in the instructions given to the post-op patient before discharge? a. need for follow-up care with home care nurses b. directions for maintaining routine post-op diet c. written information about self-care during recuperation d. need to restrict all activity until surgical healing is complete
c. written information about self-care during recuperation All postoperative patients need discharge instructions regarding what to expect and what self-care can be assumed during recovery. Diet, activities, follow-up care, symptoms to report, and instructions about medications are individualized to the patient.
During a pre-op review of systems, the patient reveals a history of renal disease. This finding suggests the need for which pre-op diagnostic tests? a. ECG and chest x-ray b. serum glucose and CBC c. ABGs and coagulation tests d. BUN, serum creatinine, and electrolytes
d. BUN, serum creatinine, and electrolytes are used to assess renal function and should be evaluated before surgery. Other tests are often evaluated in the presence of diabetes, bleeding tendencies, and respiratory or heart disease
Goals for patient safety in the OR include the Universal Protocol. What is included in this protocol? a. all surgical centers of any type must submit reports on patient safety infractions to the accreditation b. members of the surgical team stop whatever they are doing to check that all sterile items have been prepared properly c. members of the surgical team pause right before surgery to meditate for 1 minute to decrease stress and possible errors d. a surgical timeout is performed just before the procedure is started to verify patient identity, surgical procedure, and surgical site
d. a surgical timeout is performed just before the procedure is started to verify patient identity, surgical procedure, and surgical site The universal protocol supported by the joint commission is used to prevent wrong site, wrong procedure, and wrong surgery in view of a high rate of these problems nationally. It involves pausing just before the procedure starts to verify patient identity, surgical site, and surgical procedure.
The health care provider has ordered IV morphine q2-4hr PRN for a patient following major abdominal surgery. When should the nurse plan to administer the morphine? a. before all planned painful activities b. every 2 to 4 hours during the first 48 hours c. every 4 hours as the patient requests the medication d. after assessing the nature and intensity of the patient's pain
d. after assessing the nature and intensity of the patient's pain Before administering all analgesic medication, the nurse should first assess the nature and intensity of the patient's pain to determine if the pain is expected, prior doses of the medication have been effective, and any undesirable side effects are occurring. The administration of PRN analgesic medication is based on the nursing assessment. If possible, pain medication should be in effect during painful activities but activities may be scheduled around medication administration.
Which procedures are done for curative purposes (SELECT ALL THAT APPPLY)? a. gastroscopy b. rhinoplasty c. tracheotomy d. hysterectomy e. herniorrhaphy
d. hysterectomy e. herniorrhaphy Gastroscopy is done for the purpose of diagnosis; rhinoplasty is done for a cosmetic improvement; a tracheotomy is palliative.
Thirty-six hours post-op a patient has a temperature of 100 degrees Fahrenheit. What is the most likely cause of this temperature elevation? a. dehydration b. wound infection c. lung congestion and atelectasis d. normal surgical stress response
d. normal surgical stress response During the first 24 to 48 postoperative hours, temperature elevations to 100.4 F are a result of the inflammatory response to surgical stress. Dehydration and lung congestion or atelectasis in the first 2 days will cause a temperature elevation above 100.4 F. Wound infections usually do not become evident until 3 to 5 days postoperatively and manifest with temperatures about 100 F.
To prevent airway obstruction in the post-op patient who is unconscious or semiconscious, what will the nurse do? a. encourage deep breathing b. elevate the head of the bed c.administer oxygen per mask d. position the patient in a side-lying position
d. position the patient in a side-lying position An unconscious or semiconscious patient should be placed in a lateral position to protect the airway from obstruction by the tongue. Deep breathing and elevation of the head of the bed are implemented to facilitate gas exchange when the patient is responsive. Oxygen administration is often used but the patient must first have a patent airway.
Monitored anesthesia care (MAC) is being considered for a patient undergoing a cervical dilation and endometrial biopsy in the health care clinic. The patient asks the nurse, "What is this MAC?" The nurse's response is based on the knowledge that MAC a. can be administered only by anesthesiologists or nurse anesthetists b. should never be used outside of the OR because of the risk of serious complications c. is so safe that it can be administered by nurses with direction from health care providers d. provides maximum flexibility to match the sedation level with the patient and procedure needs
d. provides maximum flexibility to match the sedation level with the patient and procedure needs MAC refers to sedation that is similar to general anesthesia using sedative, anxiolytic, and/or analgesic medication. It can be administered by an ACP. The patient must be assessed and the physiologic problems that may develop must be managed because of the high risk of complications.
At the end of the surgical procedure, the peri-op nurse evaluates the patient's response to the nursing care delivered during the peri-op period. What reflects a positive outcome related to the patient's physical status? a. the patient's right to privacy is maintained b. the patient's care is consistent with the peri-op plan of care c. the patient receives consistent and comparable care regardless of the setting d. the patient's respiratory function is consistent with or improved from baseline levels established pre-op.
d. the patient's respiratory function is consistent with or improved from baseline levels established pre-op. The peri-op nursing data set includes outcome statements that reflect standards and recommended practices of peri-op nursing. Outcomes r/t physiologic responses include those of physiologic function; peri-op safety includes the patient's freedom from any type of injury; and behavioral responses include knowledge and actions of the patient and family, including the consistency of the patient's care with the peri-op plan and the patient's right to privacy
Which short-acting barbiturates are most commonly used for induction of general anesthesia (SELECT ALL THAT APPLY)? a. nitrous oxide b. propofol (diprivan) c. isoflurane (florane) d. thiopental sodium (pentothal) e. sodium methohexital (brevital)
d. thiopental sodium (pentothal) e. sodium methohexital (brevital) Nitrous oxide is a weak gaseous anesthetic. Propfol (Diprivan) is a nonbarbituate hypnotic that has a rapid onset any may be used for induction. Isoflurane (Forane) is a volatile liquid inhalation agent.
The nurse is reviewing the lab results for a pre-op patient. Which test result should be brought to the attention of the surgeon immediately? a. serum K+ of 3.8 mEq/L b. hemoglobin of 15 g/dL c. blood glucose of 100 mg/dL d. white blood cell count of 18,500/uL
d. white blood cell count of 18,500/uL finding may indicate an infection. the surgeon will probably postpone the surgery until the cause of the elevated WBC count had been found
Which drainage is drained with a Hemovac? a. bile b. urine c. gastric contents d. wound drainage
d. wound drainage Bile is drained by a T-tube, urine is drained by an indwelling urinary catheter, and gastric contents are drained by a nasogastric tube or a gastrointestinal tube.
