MED SURG I Chapter 15: Intraoperative Nursing Management

A nurse is working as a registered nurse first assistant as defined by the state's nurse practice act. This nurse practices under the direct supervision of which surgical team member? Surgeon Circulating nurse Scrub nurse Anesthetist

Surgeon

Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery? Trendelenburg position Supine position Lithotomy position Sims position

Sims position

A client asks the nurse how an inhalant general anesthetic is expelled by the body. What is the best response by the nurse? "The lungs primarily eliminate the anesthesia." "The liver will eliminate the inhalant anesthesia." "The skin will eliminate the anesthesia through evaporation." "The kidneys will eliminate the inhalant with urination."

"The lungs primarily eliminate the anesthesia."

A client is undergoing surgery with a brachial plexus block to the right wrist. The client voices concern about anesthesia awareness. What is the best response by the nurse? "Because of the type of anesthesia used, you may be aware of what is going on around you." "Anesthesia awareness is not a concern with type of surgery you are having." "Advances in medicines used decrease the chance of anesthesia awareness. What are your major concerns?" "The entire surgical team will monitor for anesthesia awareness and treat it appropriately."

"Because of the type of anesthesia used, you may be aware of what is going on around you."

Which statement by the client indicates further teaching about epidural anesthesia is necessary? "I will lose the ability to move my legs." "A needle will deliver the anesthetic into the area around my spinal cord." "I will become unconscious." "I will be able to hear the surgeon during the surgery."

"I will become unconscious." Epidural anesthesia = sedation at specific region of body

A client asks the nurse about possible ill effects from general anesthesia. What is the best response by the nurse? "Some possible negative effects include difficulty waking up and slow heart rate." "Amnesia and analgesia are some of the negative effects of anesthesia." "Few negative effects occur with general anesthesia." "Clients can experience pain and loss of consciousness."

"Some possible negative effects include difficulty waking up and slow heart rate."

The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response? "The anesthetic may last for 1 hour." "The anesthetic may last for 3 hours." "The anesthetic may last for 7 hours." "The anesthetic may last for 5 hours."

"The anesthetic may last for 3 hours."

A client who is scheduled for knee surgery is anxious about the procedure, saying, "You hear stories on the news all the time about doctors working on the wrong body part. What if that happens to me?" What is the nurse's best response? Select all that apply. "The client will be involved in the verification process prior to surgery." "The surgical team performs a 'time-out' prior to surgery to conduct a final verification." "The surgeon on the team has never been involved in such a mix-up." "The client can be involved in marking the knee, the site for the surgery." "Our surgical team would never make that mistake."

"The client can be involved in marking the knee, the site for the surgery." "The surgical team performs a 'time-out' prior to surgery to conduct a final verification." "The client will be involved in the verification process prior to surgery."

The nurse would intervene when making which of the following observations in the surgical environment? A staff member is wearing scrub clothes in the semirestricted zone. A staff member fails to wear a mask in the semirestricted zone. A staff member dressed in street clothes enters the semirestricted zone. A staff member is wearing a surgical mask and shoe covers in the restricted zone.

A staff member dressed in street clothes enters the semirestricted zone.

The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate? Monitor for faulty electrical equipment. Maintain the positive pressure OR environment. Allow unnecessary personnel to enter the OR environment. Alert personnel who break sterile technique.

Allow unnecessary personnel to enter the OR environment.

A 78-year-old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase? Maintain an operating room temperature of 18°C to prevent hypothermia. Appropriately position the client using adequate padding and support. Withhold pain medication due to decreased renal function. Discuss with the anesthesiologist the need for higher doses of anesthetic agents.

Appropriately position the client using adequate padding and support.

Which intervention should the nurse plan to implement to decrease the client's risk for injury during the intraoperative period? Allow the client to verbalize fears. Assess the client for allergies. Keep the family informed of the client's status. Verify the client's preoperative vital signs.

Assess the client for allergies.

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the: Circulating nurse Anesthesiologist Surgeon Scrub nurse

Circulating nurse

What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound? Label the tissue specimen. Count the sponges. Prepare the necessary sutures. Hand equipment to the surgeon as needed.

Count the sponges.

A 70-year-old patient who is to undergo surgery arrives at the operating room (OR). The nurse, when reviewing the patient's medical record, understands that this patient will require a lower dose of anesthetic agent because of which of the following? Impaired thermoregulation Decreased lean tissue mass Increased tissue elasticity Increased anxiety level

Decreased lean tissue mass

The nurse recognizes the client has reached stage III of general anesthesia when the client: Exhibits shallow respirations and a weak, thready pulse Exhibits no change in behavior Complains of ringing or buzzing in the ears Has small pupils that react to light

Has small pupils that react to light

What medication should the nurse prepare to administer in the event the client has malignant hyperthermia? Fentanyl citrate Naloxone Thiopental sodium Dantrolene sodium

Dantrolene sodium

The nurse is caring for a client undergoing conscious sedation. The nurse knows the client is at risk for ineffective breathing patterns. What nursing intervention will help the client demonstrate a normal breathing pattern? Encourage progressive activity. Reinforce use of incentive spirometer. Encourage the client to take deep breaths and cough at least every hour. Encourage the client to drink plenty of fluids.

Encourage the client to take deep breaths and cough at least every hour.

When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate? Allowing circulating nurses to contact sterile equipment Positioning the sterile drape on a table from back to front Considering the gown sterile from mid-thigh to neck Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff

Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff

A client has been administered ketamine for moderate sedation. What is the priority nursing intervention? Administering oxygen Providing a quiet dark room for recovery Assessing for hallucinations Frequently monitoring vital signs

Frequently monitoring vital signs

Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic? Halothane Succinylcholine Fentanyl Propofol

Halothane

A client is receiving general anesthesia. The nurse anesthetist starts to administer the anesthesia. The client begins giggling and kicking her legs. What stage of anesthesia would the nurse document related to the findings? III IV I II

II Stage I: Analgesia -Analgesia without amnesia Stage II: Excitement -N/V, hyperreactivity, irregular respiration Stage III: Surgical anesthesia -Sleep, normal resp and B/P Stage IV: Medullary Depression -Depression of vasomotor and resp. centers - coma and death

As a circulating nurse, what task are you solely responsible for? Estimating the client's blood loss. Keeping records. Handing instruments to the surgeon. Counting sponges and needles.

Keeping records.

A client is undergoing a perineal surgical procedure. The nurse should place the client in which position? Sims Lithotomy Trendelenburg Dorsal recumbent

Lithotomy

A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention? Mask is placed over nose and extends to bottom lip. Shoe covers are used. Scrub top and drawstring are tucked into pants. Hair is pulled back and covered by a cap.

Mask is placed over nose and extends to bottom lip.

Surgical asepsis is a requirement in the restricted zone of the operating suite. What personal protective equipment should the nurse wear at all times in the restricted zone of the operating room? Goggles Gloves Masks covering the nose and mouth Gown

Masks covering the nose and mouth

An example of an intravenous anesthetic that is a hypnotic and produces excellent amnesia is: Diprivan Amidate Ketalar Midazolam

Midazolam

How would the operating room nurse place a patient in the Trendelenburg position? On his side with his uppermost leg adducted and flexed at the knee Flat on his back with his arms next to his sides On his back with his head lowered so that the plane of his body meets the horizontal on an angle On his back with his legs and thighs flexed at right angles

On his back with his head lowered so that the plane of his body meets the horizontal on an angle

A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention? Heart rate of 84 beats/minute Oxygen saturation (SaO2) of 85% Blood-tinged stools Decreased cough and gag reflexes

Oxygen saturation (SaO2) of 85%

The nurse positions the client in the lithotomy position in preparation for Abdominal surgery Perineal surgery Renal surgery Pelvic surgery

Perineal surgery

The surgical client is at risk for injury related to positioning. Which of the following clinical manifestations exhibited by the client would indicate the goal was met of avoiding injury? Pulse oximetry 98% Absence of itching Vital signs within normal limits for client Peripheral pulses palpable

Peripheral pulses palpable

The client received ketamine during a surgical procedure. What intervention by the nurse will assist with an optimal recovery period? Speak to the client in a loud, clear voice. The client does not require a recovery period and may go back to the hospital room. Make sure that the client is stimulated frequently. Place the client in a darkened, quiet part of the recovery area.

Place the client in a darkened, quiet part of the recovery area.

The scrub nurse is responsible for: Calling the "time-out" to verify the surgical site and procedure Preparing the sterile instruments for the surgical procedure Monitoring the operating-room personnel for breaks in sterile technique Monitoring the administration of the anesthesia

Preparing the sterile instruments for the surgical procedure

A 55-year-old patient arrives at the operating room. The nurse is reviewing the medical record and notes that the patient has a history of osteoporosis in her lower back and hips. The patient is scheduled to receive epidural anesthesia. Which of the following nursing diagnoses would be a priority for this patient? Anxiety related to the surgical experience Risk for perioperative positioning injury related to operative position Risk for injury related to effects of anesthetic agents Disturbed sensory perception related to sedation

Risk for perioperative positioning injury related to operative position

Which of the following techniques least exhibits surgical asepsis? Placing the sterile field at least one foot away from personnel Adding only sterile items to a sterile field Keeping sterile gloved hands above the waist Suctioning the nasopharyngeal cavity of a client

Suctioning the nasopharyngeal cavity of a client

The nurse is caring for a client during an intraoperative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? Blood pressure of 104/62 mm Hg Temperature of 102.5°F (39°C) Respiratory rate of 18 breaths/min Pulse rate of 110 beats/min

Temperature of 102.5°F (39°C)

A client is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid) block during surgery. In the operating room, the nurse positions the client according to the anesthesiologist's instructions. Why does the client require special positioning for this type of anesthesia? To prevent cardiac arrhythmias To prevent seizures To prevent cerebrospinal fluid (CSF) leakage To prevent confusion

To prevent cerebrospinal fluid (CSF) leakage

Which position should the patient undergoing pelvis surgery be positioned? Trendelenburg Reverse Trendelenburg Sim's Lithotomy

Trendelenburg

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? Acquire ordered blood products. Verify consent. Count sponges and syringes. Document the start of surgery.

Verify consent.

During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer: potassium chloride dantrolene sodium (Dantrium) verapamil (Isoptin) an acetaminophen suppository

dantrolene sodium (Dantrium)

During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 40 C. The nurse should prepare to administer: verapamil (Isoptin) potassium chloride an acetaminophen suppository dantrolene sodium (Dantrium)

dantrolene sodium (Dantrium)

The nurse recognizes that the older adult is at risk for surgical complications due to: decreased adipose tissue increased skeletal mass increased cardiac output decreased renal function

decreased renal function

A client develops malignant hyperthermia. What client symptom would the nurse most likely observe as the first indicator of the disorder? body temperature increase of 1 °C to 2 °C (2 °F to 4 °F) heart rate over 150 beats per minute generalized muscle rigidity tetanus-like jaw movements

heart rate over 150 beats per minute

A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse bases her next action on the principle that: administering I.V. antibiotics can prevent pneumonia. inserting a Foley catheter can decrease fluid retention. it may be necessary to raise the head of this client's bed. this client may need intubation.

it may be necessary to raise the head of this client's bed.

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication? malignant hyperthermia infection fluid volume excess hypothermia

malignant hyperthermia

In developing the plan of care for the intraoperative client, the nurse recognizes that it is essential to consider: the surgeon's skill in performing the procedure the wishes of the client's family the client's cultural beliefs the schedule of the operating room

the client's cultural beliefs