med surg-1 exam 1

general anesthesia.

*patient at risk for Circulatory and respiratory depression *patient unable to be stimulated, and will need support with ventilation

Which actions with the nurse take for a patient in the post anesthesia care unit to ensure that this patient has a patent airway? Select all that apply

Suction airway, Putting artificial airway Tilting head and thrusting the jaw

A client is recovering well 24 hours after cranial surgery but is fatigued. The surgeon advances the client from nothing-by-mouth status to clear liquids. The nurse knows that which information is least reliable in determining the client's readiness to take in fluids? 1.Appetite 2.Absence of nausea 3.Presence of bowel sounds 4.Presence of a swallow reflex

1.Appetite

Which action what is the nurse take to assess an older adult post operative patient has difficulty with memory and the ability to concentrate? Select all that apply A. Provide adequate nutrition B. Encourage delayed mobility C. Provide bowel and bladder care D sedate the patient for a long duration's E.Monitor fluid and electrolyte disturbance

A,C, E

Which Nursing care measures are useful in the prevention of post operative respiratory complications? Select all that apply A. Monitor her oxygen saturation B. Measure intake and output C.Assess bilateral lung sounds D. Instruct on incentive spirometer use E. Ambulate the halls with patient

A,C,D,E

the nurse is caring for a patient with renal dysfunction who is scheduled for surgery. Which nursing interventions are a priority in this situation? select all that apply. a. obtain renal function test preoperatively b. evaluate coagulation studies preoperatively c. check for the serum potassium levels preoperatively D. report to the preoperative team if the patient has a problem voiding E. ready the sequential compression device in the pre operative holding area

A,D

Which actions would the nurse take when administering an analgesic to a post op patient. Select all that apply A. Assess the location, quality, and intensity of pain B. Monitor the patient for nausea, vomiting and respiratory depression C. Assess the patient sleep wake cycle and sensory and motor D. Assess the patient's level of orientation and ability to follow commands E. Time the analgesic administration for effectiveness during painful activities

A,B, E

Which action(s) would the nurse take to maintain a patient's body temperature during surgery?select all that apply. a.cover patient in thermal drapes b. warm any required saline irrigations c.increase temperature of the OR suite d. warm IV fluids prior to administration e. place patient on a warm water mattress

A,B,D,E

which anesthetics provide regional anesthesia? a. spinal b. epidural c. balanced d..bier block e. nerve block

A,B,D,E bier block= a type of regional anesthesia, it involves injecting anesthetic agents into the venous circulation and using tourniquets to prevent blood from entering systemic circulatio.

A client is admitted to a surgical unit postoperatively with a wound drain in place. Which actions should the nurse take in the care of the drain? Select all that apply. a. .Check the drain for patency. b. Observe for bright red bloody drainage. c.Clamp the drain for 15 minutes every hour. d.Curl the drain tightly, and tape it firmly to the body. e.Maintain aseptic technique when emptying the drain.

A,B,E

A patients BP increase from 110/76 to 160/90 two hours after surgery. Which action would the nurse take first. A. Assess pain level B. Reasses the BP in 15 minutes C. Decrease the IV fluid rate D. Restart the patients antihypertensive medication.

A. Assess pain level

The nurse is reviewing the surgeon's prescription sheet for a preoperative client, which states that the client must be NPO (nothing by mouth) after midnight. Which medication should the nurse clarify to be given and not withheld? A. Atenolol B. Atorvastatin C. Cyclobenzaprine D. Conjugated estrogen

A. Atenolol

A patient taking warfarin and digoxin for treatment of atrial fibrillation is instructed to discontinue the use prior to surgery. The nurse would closely monitor this patient for which complication? A. Pulmonary embolism B. increased BP C.Excessive bleeding from incision sites D. increased peripheral vascular resistance

A. Pulmonary embolism rationale: warfarin is an anticoagulant that is used to prevent mural thrombi from forming on the walls of the atria during atrial fibrillation.

Which type of surgical procedure will a patient undergo to restore appearance following breast removal for cancer? A. Reconstructive B. ablative C. palliative D. constructive

A. Reconstructive rationale: Reconstructive surgery is performed to restore appearance or function. Breast reconstruction following breast surgery is the type of surgery this patient will undergo.

The nurse is caring for a postoperative client who has just returned from the postanesthesia care unit after having nasal surgery. What priorityaction is essential for the nurse to perform? A. assessing how often the client swallows B. Checking vital signs per agency protocol C. Viewing the external packing for bleeding D. Determining if the client can breathe through the unaffected nostril

A. assessing how often the client swallows

When a patient's condition is serious but not life-threatening, which type of procedure will be scheduled? A.urgent B.elective C.palliative. D. emergency

A. urgent rationale: Urgent surgery is required when the health condition is not immediately life-threatening. However, the surgery must be performed within 24 hours or the condition can become life-threatening.

Which action(s) would the nurse take to maintain a patient's body temperature during surgery? a. Cover patient in thermal drapes. b. Warm any required saline irrigations. c. Increase temperature of the OR suite. d. Warm IV fluids prior to administration E. Place patient on a warm water mattress.

A.Cover patient in thermal drapes. B. Warm any required saline irrigations. D. Warm IV fluids prior to administration E. Place patient on a warm water mattress.

When the nurse is addressing surgical risk during the preoperative phase of surgery, which cultural factor takes priority? A.Language barrier B.pain control C. smoking D.obesity

A.Language barrier rationale: The patient's language barrier is the cultural factor that takes priority during the preoperative phase of surgery. The patient's inability to understand teaching and understand what is happening can increase stress and anxiety and thereby increase the patient's surgical risk.

Which special precautions do intraoperative nurses take when positioning intraoperative patients?select all that apply. A.Padding any pressure points B. Using supine patient position C. Removing OR table attachments D. Ensuring correct body alignment E. Placing grounding pad under patient

A.Padding any pressure points D. Ensuring correct body alignment E. Placing grounding pad under patient

Phase I or Phase II of PACU discharge criteria? Responsible adult driving patient home No IV opioid drugs for the last 30 mins Ability to void Ability to ambulated if not C/I Ability to receive/understand written discharge instructions.

Ambulatory surgery discharge. Phase II PACU discharge

Which surgery requires a sensory level L2-L3 anesthesia? A. Hip surgery B. Foot surgery C. Appendectomy D. Hemorrhoidectomy

B foot surgery

A patient is admitted to the post anesthesia care unit after bowel surgery and tells the nurse that he or she is going to throw up. Which statement by the nurse reflects a priority nursing intervention. A. I need to check your vital signs B. Let me help you turn to your side C. Here is a sip of Ginger ale for you D. I can give you some anti-nausea medication

B let me help you turn to your side

which duties are specific to a scrub nurse? select all that apply. a. monitor the draping procedure b. assist in the draping procedure c. assist in the induction of anesthesia d. assist in preparing the operating room e. provide a hand off report to the post anesthesia care unit (PACU) nurse

B, D rationale: a scrub nurse always remains in a sterile environments. scrub nurse duties include:assist in the draping procedure, assist in preparing the operating room, and passing instruments to the surgeons and assistants by anticipating their needs. preparing the instrument table and maintaining a sterile enviornment are also the responsibilities of the scrub nurse.

Which Action what is the nurse take to ensure oxygenation and a patient who develops inspiratory strider and sternal retraction upon removal of the endotracheal tube? Select all that apply A. Suction airway B administer oxygen therapy C tilt the head and thrust the jaw D. Administer muscle relaxants E. Provide positive pressure ventilation

B, D, E

Which criteria must a patient meet in order to be discharged from the post anesthesia care unit to the clinical unit? Select all that apply A. No nausea or vomiting B no respiratory depression C oxygen saturation above 90 D written discharge instructions understood E. Patient reports pain level of four on a 1 to 10 scale

B, c , e

a certified registered nurse anesthetist would be responsible for which functions related to surgery? select all that apply. a.passing instruments to the surgeons and assistants b. managing a patient's airway and pulmonary status c. preparing the operating room and the instrument table d. selecting and initiating the planned anesthetic technique e. monitoring the patient's emergence and recovery from the anesthesia

B,D,E

which activities would the circulating nurse be responsible for? select all that apply. a.preparing the instrument table b.documenting intraoperative care c.passing instruments to the surgeon and assistants d.monitoring practices of aseptic technique in self and others e. maintaining accurate counts of sponges, needles and instruments

B,D,E rationale: Documenting intraoperative care is a responsibility of the circulating nurse during surgery. monitoring practices of aseptic technique in self and others, and maintaining accurate counts of sponges, needles and instruments is also a responsibility of the circulating nurse and is scarred by the scrub nurse as well. preparing the instruments and passing the instruments to the surgeon are the responsibilities of the scrub nurse

which intraoperative nursing responsibilities would be performed by the scrub nurse? Select all that apply. a. documenting intraoperative care b. keeping track of irrigation solutions for monitoring of blood loss c. coordinating the flow and activities of members of the surgical team d. passing instruments and supplies to the health care provider by anticipating his or her needs e. performing count of sponges, needles, and instruments used during the surgical procedure

B,D,E scrub nurse is responsible for keeping track of irrigation solutions for monitoring of blood loss. Both the scrub nurse and the circulating nurse all participate in counting surgical sponges,needles, and instruments, where asp passing instruments to the surgeons and other sterile activities are the exclusive responsibility of the scrub nurse.

The circulating nurse is responsible for which assessments during the intraoperative phase of surgery? A. vital signs B.urinary output C. respiratory status D.electrocardiogram E.patient positioning

B,E rationale: The circulating nurse assesses urinary output when the patient has an indwelling catheter in place for long or complicated surgical procedures. Scrubbed personnel have no access to view catheter drainage, and their viewing of it would contaminate the sterile field. the circulating nurse frequently assesses the patient's position during surgery. The patient cannot change positions while anesthetized, but movements of the OR table, surgeon, scrub person, and equipment can cause patient movement.

Which occurrence might cause secondary heart dysfunction? A. Cardiac tamponade B. Certain medications C. Pulmonary embolus D. Myocardial infarction

B. Certain medications

which member of the intraoperative team remains in the unsterile field? a.scrub nurse b.circulating nurse c.surgeon's assistant d. registered nurse first assistant

B. Circulating nurse rationale: circulating nurse is not gowned and gloved and handles unsterile activities in the unsterile field during the intraoperative period. The scrub nurse is gowned and gloved and remains in the sterile field. The surgeon's assistant and registered nurse first assistant may handle and prepare surgical instruments and therefore remain in the sterile field during the intra op period

which step occurs in the initial stage when a patient is receiving general anesthesia? a. the patient is intubated immediately b.induction is performed with an IV agent c. the patient is given an oral tablet before the procedure d. induction is performed by delivering an inhalation agent via a face mask

B. Induction is performed with an IV agent rationale: routine general anesthesia usually beings with an IV induction agent, which may be a hypnotic ,anxiolytic or dissociative agent.

The nurse is caring for an abdominal surgical client who has a Jackson-Pratt drain in place. Which interventions should the nurse include in the plan of care for this drain? Select all that apply. A.Secure the drain to the sheet. B. Make sure suction is maintained. C. Check that the drains are sutured in place. D. Use clean technique to empty the reservoir. E. Compress the reservoir to restore suction after emptying. F. Record the amount and color of drainage according to agency protocol or surgeon's prescription.

B. Make sure suction is maintained. C. Check that the drains are sutured in place. E. Compress the reservoir to restore suction after emptying. F. Record the amount and color of drainage according to agency protocol or surgeon's prescription.

What is the focus during the intraoperative phase of surgery? A. Admitting the patient to the surgical unit B. Preventing patient injuries and complications C. Assessing for and treating patient complications D. Evaluating patient conditions and risk factors

B. Preventing patient injuries and complications Preventing patient injuries and complications is the focus of all team members during the intraoperative phase of surgery.

In which way does nutrition deficiency increase patient surgical risk? A. Interferes with anesthesia induction B. Increases risk of poor wound healing C. Increases risk for respiratory depression D. Increases risk of fluid and electrolyte imbalance

B. Vitamin K deficiencies can contribute to poor wound healing, increasing surgical risk.

Lasik eye surgery that corrects vision and eliminates the need for eye glasses is which type of procedure? A.ablative B. constructive C. diagnostic D.reconstructive

B. constructive Rationale: restores visions

the nurse is preparing to administer flumazenil to a patient having severe respiratory depression. For which reason is the nurse administering this antidote. a. morphine overdose b. lorazepam overdose c. ondansetron overdose d. promethazine overdose

B. lorazepam overdose rationale: lorazepam is a benzodiazepine and flumazenil is the antidote for benzodiazepines,

which nursing diagnosis would the nurse select for a patient with a blanched area over the coccyx immediately following surgery? A. altered tissue perfusion r/t blanched coccyx B. preoperative positioning injury related to blanched coccyx c. risk for ineffective tissue perfusion with risk factor of blanched coccyx d. risk for preoperative positioning injury with risk factor of blanched coccyx

B. preoperative positioning injury related to blanched coccyx rationale: Perioperative Positioning Injury related to blanched coccyx is the nursing diagnosis the nurse would select for the patient. The blanched area over the patient's coccyx is the data that supports this nursing diagnosis.

The nurse is caring for a 25-year-old client who will undergo bilateral orchidectomy for testicular cancer. Which statement by the nurse would be helpful in exploring the client's concerns about loss of reproductive ability? A. "You must be sad that you won't be able to have children after surgery." B."Can you share with me any concerns about how this surgery will affect you in the future?" C."Has the surgeon told you that you will not be able to have children?" D."Do you feel that the surgeon has told you all you need to know about the upcoming surgery?"

B."Can you share with me any concerns about how this surgery will affect you in the future?"

which assessment finding help assure the nurse of patient safety for general anesthesia following correct positioning on the OR table? A.safety straps tightly fitted B. patient limbs well covered C.peripheral circulation intact D.pressure points well padded E. airway accessible to anesthesia

C,D,E

which nursing interventions would be included in preoperative assessment and teaching plan for an older adult?select all that apply. A. administer a sedative to relieve fear and anxiety B. help patient walk safely to the operating room c. coordinate assessment with the team of health care providers D. speak slowly when giving preoperative instructions to the patient E. understand that the patient may have sensory and cognitive deficits

C,D,E

Two days after Dominos surgery, the patient reports gas pains in abdominal distention. The nurse plans care for the patient on the basis of the knowledge that these symptoms occur as a result of which condition A. Constipation B hiccups C slowed gastric emptying D. Inflammation of the bowel at the anastomoses site

C- slowed gastric emptying

A client is admitted to the ambulatory surgery center for elective surgery. The nurse asks the client whether any food, fluid, or medication was taken today. Which medication, if taken by the client, should indicate to the nurse the need to contact the surgeon? A. beta-blocker B. An antibiotic C. An anticoagulant D. calcium-channel blocker

C. An anticoagulant

Which cultural factor has the potential for increasing surgical risk? A. Need for strong family support B. Stoic attitude toward pain control C. Disbelief in traditional medications D. Same-gender surgeon requirement

C. Disbelief in traditional medications

What is the focus during the preoperative phase of surgery? A. Protection of patient privacy during surgery B. Prevention of patient injury during procedure C. Patient assessment and preparation for surgery D. Intervention for complications after the procedure

C. Patient assessment and preparation for surgery

A client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which action should the nurse include in the client's postoperative plan of care? A.Positioning the client on the affected side B.Irrigating the Penrose drain using sterile procedure C.Changing dressings frequently around the Penrose drain D.Weighing dressings and adding the amount to the output

C.Changing dressings frequently around the Penrose drain rationale: to prevent skin breakdown

The nurse has instructed a preoperative client using an incentive spirometer to sustain the inhaled breath for 3 seconds. When the client asks about the rationale for this action, the nurse explains that this action achieves which function? A.Dilates the major bronchi B.Increases surfactant production C.Maintains inflation of the alveoli D.Enhances ciliary action in the tracheobronchial tree

C.Maintains inflation of the alveoli

Which position with the nurse place a patient who is still drowsy from anesthesia and has been vomiting? A. High Fowlers B. prone C. Supine D lateral recovery position

D lateral recovery position

Post operative patient has absence of breath sounds on the left lung and an oxygen saturation of 86%. Which interventions would the nurse take to maintain adequate oxygen saturation. Select all that apply. A. Administer diuretic B. Allow delayed ambulatory C. Instruct shallow breathing D. Encourage incentive spirometry E. Provide humidified oxygen therapy

D, E Incentive spirometry helps long expansion and promote removal of secretions. Humidified oxygen therapy helps maintain the oxygen saturation levels.

which admission assessment is documented accurately by the intra op nurse? a. "no evidence of anxiety. anesthesia induction initiated." b. patient admitted. CRNA adjusting IV fluids. Vial signs stable. c.pre op check list completed. patient admitted for appendectomy D. patient placed in supine position on OR table. Assessment per flowsheet.

D. "Patient placed in supine position on OR table. Assessment per flowsheet." rationale: This statement correctly documents patient admission to the OR and patient assessment. Patient position is indicated and reference to documentation of assessment findings is also indicated.

In which way does smoking increase a patient's surgical risk? A.Increases risk for excessive bleeding B. Increases overall cellular metabolism C. Decreases overall inflammatory response D. Decreases ability to maintain a clear airway

D. Decreases ability to maintain a clear airway

Which age-related characteristic increases surgical risk for infants? A. Increased risk for hemorrhage B. Decreased physiologic reserves C. A smaller body water percentage D. Immature physiological mechanisms

D. Immature physiological mechanisms

Which goal is correct for a patient at risk for intraoperative positioning injury? A. Patient's skin will remain intact. B. Patient will maintain tissue perfusion C. Patient will be free of skin breakdown after surgery. D. Patient will maintain correct position during surgery.

D. Patient will maintain correct position during surgery.

during surgery, tow home or what does the surgical technologist legally need access at all times? a. surgeon b. computer c. anesthesiologist d. RN

D. RN rationale: depending on the individual state rules and regulations, if the surgical technologist are permitted to perform duties in the operating room, there must be access to an RN at all times. The RN is responsible for supervising the surgical technologist in performance of all delegated nursing tasks.

Which patient admission assessment is documented accurately by the intraoperative nurse? A."No evidence of anxiety. Anesthesia induction initiated." B. "Patient admitted. CRNA adjusting IV fluids. Vital signs stable." C."Preoperative checklist completed. Patient admitted for appendectomy." D."Patient placed in supine position on OR table. Assessment per flowsheet."

D."Patient placed in supine position on OR table. Assessment per flowsheet."

During surgery, which patient parameters are continually assessed? Heart rate Temperature Urinary output Respiratory rate Patient position

Heart rate Temperature Respiratory rate

Which nursing diagnosis would the nurse select for a patient who is scheduled for heart surgery that is projected to last eight hours? Ineffective Tissue Perfusion Impaired Skin Integrity Perioperative Positioning Injury Risk for Perioperative Positioning Injury

Risk for Perioperative Positioning Injury rationale: The longer the procedure, the greater risk the patient has of developing a positioning injury, regardless of the weight of the patient.

Coarse crackles/ noisy respiration's are caused by....what and how do you treat it?

Increased secretions due to use of irritant anesthetic drugs To treat=provide IV hydration / suction airway

Which actual intraoperative nursing diagnosis is stated correctly? Nausea related to effects from anesthesia Injury from Equipment related to failure of OR table Risk of Ineffective Tissue Perfusion with Risk Factor of Immobility Pain related to tissue injury at the surgical site

Injury from Equipment related to failure of OR table rationale: Injury from Equipment is an actual nursing diagnosis for the intraoperative patient. It is correctly stated.

In the post anesthesia care unit which position will be the safest place an unconscious postoperative patient immediately after that operation? A. Supine B.lateral C.semi Fowler's D. High Fowler's

Lateral

Ambulatory surgery discharge. Phase I or Phase II? Vital signs stable/at baseline Minimal nausea or vomiting

Phase I

A risk intraoperative nursing diagnosis would be selected for a patient with which finding? Abnormal blood gas results Protruding bony prominences Acute surgical site pain after a procedure Nausea and vomiting following anesthesia

Protruding bony prominences rationale: A risk intraoperative nursing diagnosis would be selected for a patient with protruding body prominences. The patient is at risk for postoperative injury from positioning but does not yet have an injury.

Tachycardia, tachypnea, dyspnea , agitation , chest pain, hypotension are s/sx of:

Pulmonary embolism

what are the 3 types of anesthesia?

Regional general moderate

which activities would be included in a surgical time-out prior to surgery? select all that apply. a. verify patient identification b. complete fire risk assessment c. verify surgical sit end procedure d. ensure that consent for the specific procedure was obtained e. ensure that a significant other is available if needed for consultation

a,c,d

Difference between urgent and emergency surgery?

Urgent: Urgent surgery is required when the health condition is not immediately life-threatening. However, the surgery must be performed within 24 hours or the condition can become life-threatening. Emergency: Emergency surgery is an immediate surgery required for a life-threatening medical condition. The surgery cannot be delayed.

The circulating nurse is responsible for which assessments during the intraoperative phase of surgery? Vital signs Urinary output Respiratory status Electrocardiogram Patient positioning

Urinary output Patient positioning

in which surgical area will the patient's skin be prepped for surgery, and which clothing will the person doing the prepping wear? a. surgical suite, wearing a lab coat b. preoperative holding area, wearing street clothes c. post anesthesia care unit (PACU), wearing scrubs d. operating room, wearing surgical attire and masks

d. operating room, wearing surgical attire and masks

a patient begins having hallucinations and agitation after receiving dissociative anesthesia. Which anesthetic agent is associated with this complication. a. ketamine b. halothane c. thiopental d. nitrous oxide

a. ketamine rationale: a disadvantage of ketamine is the associated risk of agitation, hallucinations and nightmares. These unwanted effects are not associated with he use of thiopental,halothan, or nitrous oxide.

which type of anesthesia is a nurse able to administer without the presence of an anesthesia care provider (ACP) a. moderate sedation b. general anesthesia c. regional anestesia d. monitored anesthesia care

a. moderate sedation rationale: moderate sedation involves administering sedatives, anxiolytics, or analgesics

which member of the surgical team would inform the blood bank regarding the need for blood transfusion? a. scrub nurse b. circulating nurse c. nurse anesthetist d. anesthesiologist assistant

b. circulating nurse rationale: a circulating nurse remains in an unsterile environment and performs activities involving touching unsterile equipment and patients. the nurse also forms and important link between anesthetic care providers and other departments like a blood bank. the scrub nurse, nurse anesthetist, and anesthesiologist assistant remain in a sterile environment

which complication will the nurse assess for following spinal anesthesia? a.amnesia b.headache c.hypertension d. over-sedation

b. headache rationale: Post-spinal headache is a common patient complaint following spinal anesthesia. The nurse will assess for this complication.

the preoperative patient asks why the dose of warfarin is being withheld. Which response by the nurse is most accurate? a." the medication is contraindicated with he type of anesthesia you are receiving" b.this medication could cause excessive bleeding during surgery if it is not stopped beforehand. c. All unnecessary medications are stopped before surgery to prevent you from vomiting under anesthesia? D. this medication may increase respiratory depression associated with anesthetic agents and must be avoided

b.this medication could cause excessive bleeding during surgery if it is not stopped beforehand.

which type of anesthesia places patient in an altered state of consciousness but allows them to respond to verbal cues and maintain there own airways? A. topical anesthesia B. general anesthesia c.moderate sedation d. medullary paralysis

c

which patients would require administration of preoperative antibiotics? select all that apply? a. patients undergoing cataract surgery b. patients with known coronary artery disease c. patients undergoing gastrointestinal surgery d. patients undergoing joint replacement surgery e. patients with a history of valvular heart diseases

c,d,e rationale: in patients with a history of valvular heart disease, antibiotics may be administered to prevent infective endocarditis. gastrointestinal surgery carried a risk of wound contamination and calls for antibiotic treatment. joint replacement surgeries, wound infections can have serious consequences; therefore it is prudent to give antibiotics.

which goal would the nurse add to the intraoperative plan of care for a patient at risk for the ineffective tissue perfusion ? a. Patient's airway will remain patent during surgery. b. Patient will maintain correct position during surgery. c. Patient will remain hemodynamically stable during surgery. D. Patient will remain free from hypothermia throughout surgery.

c. Patient will remain hemodynamically stable during surgery. rationale: the nursing diagnosis of risk for ineffective tissue perfusion. The nurse would add this goal to the patient's plan of care.

In which phase of general anesthesia are H2 blockers used? A. Induction B. emergence C. preinduction D.Maintenance

c. preinduction radtionale: to precent aspiration of gastric contents during surgery, the surgeon administers H2 blockers in the pre induction phase of anesthesia. The induction phase is the period in which medications are given to render the past unconscious. Benzodiazepines, opioids, and barbiturates are administered in the induction phase.

which assessment finding is a side effect of ketamine? a. bradycardia b. bronchoconstriction c. hallucinations d. increased alertness postoperatively

d. increased alertness postoperatively rationale: Ketamine is a common dissociative anesthetic. it is a phyla cyclohexyl piperidine (PCP) derivative and can cause hallucinations and nightmares.

which goal is correct for a patient at risk for intraoperative positioning injury? a. patient's skin will remain intact b. patient will maintain tissue perfusion c. patient will be free of skin breakdown after surgey d. patient will maintain correct position during surgery

d. patient will maintain correct position during surgery rationale: Patient position can change during surgery, not by the patient, but from movements of the surgeon and scrub person, use of equipment, and adjustments in OR table level and angles. Patient position is assessed frequently during surgery.

An unconscious patient needs to undergo emergency surgery and has no family members or friends available. Which action would the nurse take regarding obtaining consent for the surgery? a. call the local magistrate to get consent for the surgery. b. obtain consent form a legally appointment representative c. avoid giving any treatment because it is illegal to treat without consent d. proceed with plans for surgery; consent is not required for a true medical emergency.

d. proceed with plans for surgery; consent is not required for a true medical emergency. Rationale: a true medical emergency may override the need to obtain consent.

which area is of special concern for the older adult who is having surgery? a. sterility b. paralysis c. urine output d. skin integrity

d. skin integrity

which type of anesthesia would be used for a colonoscopy in the endoscopy clinic? a. local anesthesia b. moderate sedation c.general sedation d.monitored anesthesia care

d.monitored anesthesia care monitored anesthesia care would be used for the patient having a colonoscopy done in endoscopy because it can match the sedation level to the patient needs and procedural requirements. local anesthesia would not be used b/c the area affected by the colonoscopy is larger than loss of sensation could be provided with topical, intracutaneous, or subcutaneous application. Moderate sedation is used for the procedures performed outside the operating room and the patient remains responsive.

Which type of surgery is conducted to determine or confirm a diagnosis, such as malignancy. ex. removal of tumor to determine if malignant or benign A. palliative B,diagnostic C. reconstructive D. ablative

diagnostic

Diuretics increases risk of _______ ?

fluid and electrolyte imbalance

When is a "time out" called? Who can call a "time out?" What is identified in a "time out?"

in the operating room right before the procedure starts. Circulating nurse right patient is in the room, the right surgical site is identified, and the correct procedure is about to be performed

Which anesthetic drug combination is most appropriate for a patient who requires emergency surgery following a motor vehicle crash?

ketamine and midazolam Why? ketamine is preferred in trauma patients because it increases HR and helps improve cardiac output Midazolam reduces/eliminates hallucinations associated with ketamine

Circulating nurse duties

non sterile patient safe positioning calls time out documenting patient care and OR activities in EHR Communicates with anesthesiologist/CRNA about patient physiologic status Coordinates the needs of the surgical team by obtaining supplies and carrying out the nursing care plan

Moderate sedation

patients able to respond to verbal cues and independently maintain cardiac/respiratory function useful for short, diagnostic, or ambulatory surgical procedures. RN can administer under supervision of HCP

regional anesthesia

prevents pain sensation in a specific area of the body through the injection or application of local anesthetics that interrupt the transmission of nerve impulses. patients remains awake and maintain their own airway preferred for patients who are hemodynamically compromised.

4 stages of general anesthesia

stage 1 - analgesia stage 2 -excitement "loss of consciousness stage 3 - surgical anesthesia stage 4 - medullary paralysis - death can occur if anesthesia is not immediately reversed