Ch. 15 Intraop
After teaching a patient scheduled for ambulatory surgery using moderate sedation, the nurse determines that the patient has understood the teaching based on which of the following statements?
"I'll be sleepy but able to respond to your questions."
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."
A nurse is teaching a client who is at risk for malignant hyperthermia subsequent to general anesthesia. What should the nurse include in the teaching?
"The surgical team is aware of the risk, so the team is prepared."
A client undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The client is ready for rewarming procedures. Which action by the nurse is appropriate?
Apply a warm air blanket, gradually increasing body temperature.
The nurse is completing a postoperative assessment for a patient who has received a depolarizing neuromuscular blocking agent. The nursing assessment includes careful monitoring of which body system?
Cardiovascular system
Why should the nurse be vigilant with assessment of perioperative risks on the older adult client? Select all that apply.
Ciliary action decreases, reducing the cough reflex. Fatty tissue increases, prolonging the effects of anesthesia. Liver size decreases, reducing the metabolism of anesthetics.
A patient is in the operating room for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented?
Circulating nurse
When practicing perioperative care, the nurse monitors clients for what symptoms that are indicative of malignant hyperthermia? Select all that apply.
Cyanosis Muscle rigidity Diaphoresis Irregular heart rate
A 70-year-old patient who is to undergo surgery arrives at the operating room (OR). The nurse, when reviewing the patient's medical record, understands that this patient will require a lower dose of anesthetic agent because of which of the following?
Decreased lean tissue mass
Which of the following actions by the nurse is appropriate?
Discarding an object that comes in contact with the 1-inch border
When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate?
Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff
A nurse is teaching a client about airway control with inhalant anesthesia. What does the nurse include in the client teaching?
Halothane will be used with a endotracheal tube for a rapid smooth induction.
Which would be included as a responsibility of the scrub nurse?
Handing instruments to the surgeon and assistants
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?
II
Which stage of surgical anesthesia is also known as excitement?
II
Which stage of anesthesia is referred to as surgical anesthesia?
III
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
A laser is being used to excise tissue during a client's surgical procedure. Which item will the nurse apply to minimize personal risk due to the smoke from the device?
N95 respiratory mask
An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position?
On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle.
How would the operating room nurse place a patient in the Trendelenburg position?
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?
Oxygen saturation (SaO2) of 85%
The client received ketamine during a surgical procedure. What intervention by the nurse will assist with an optimal recovery period?
Place the client in a darkened, quiet part of the recovery area
A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse?
Report the infection to an immediate supervisor
The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to:
Respond verbally during the 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?
Risk for perioperative positioning injury related to operative position
The client is undergoing a surgical procedure that is expected to last several hours. Which nursing diagnosis is most related to the duration of the procedure?
Risk for perioperative positioning injury related to positioning in the OR
The surgical client has been intubated and general anesthesia has been administered. The client exhibits cyanosis, shallow respirations, and a weak, thready pulse. The nurse recognizes that the client is in which stage of general anesthesia?
Stage IV
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
An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia?
Surgical anesthesia
What does the circulating nurse monitor?
The circulating nurse monitors aseptic practices to avoid breaks in technique while coordinating the movement of related personnel. Implements fire safety precautions. Monitors the patient and documents specific activities throughout the operation to ensure the patient's safety and well-being. Ensures cleanliness, proper temperature, humidity, appropriate lighting, safe function of equipment, and the availability of supplies and materials.
A perioperative nurse is conducting an in-service education program about maintaining surgical asepsis during the intraoperative period. Which of the following would the nurse emphasize?
The edges of a sterile package, once opened, are considered unsterile
A client is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid) block during surgery. In the operating room, the nurse positions the client according to the anesthesiologist's instructions. Why does the client require special positioning for this type of anesthesia?
To prevent cerebrospinal fluid (CSF) leakage
Which of the following is an inappropriate nursing action by the surgical nurse?
Wearing sterile gloves over artificial nails
A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate?
You will by lying on your side with your knees to your chest.
Which of the following medications would the nurse expect to be used to facilitate intubation of the client?
atracurium (tracrium)
What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities?
coordinating the surgical team
What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound?
count the sponges
What medication should the nurse prepare to administer in the event the client has malignant hyperthermia?
dantrolene sodium
The nurse recognizes that the older adult is at risk for surgical complications due to:
decreased renal function
The nurse is assisting with positioning the patient on the operating table. The nurse understands that the most commonly used position is which of the following?
dorsal recumbant
A patient who has undergone surgery and received spinal anesthesia is reporting a headache. Which of the following would be most appropriate?
encourage increased fluid intake
The circulating nurse is documenting all medications administered during a surgical procedure. The anesthesiologist administers an opioid analgesic. What medication would the nurse check as being administered?
fentanyl
Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic?
halothane
The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching?
headache
A client develops malignant hyperthermia. What client symptom would the nurse most likely observe as the first indicator of the disorder?
heart rate over 150 bpm
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:
it may be necessary to raise the head of this client's bed
The nurse recognizes the client has reached stage III of general anesthesia when the client:
lies quietly on the table
A client is undergoing a perineal surgical procedure. The nurse should place the client in which position?
lithotomy
The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in?
lithotomy position
During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication?
malignant hypothermia
Which is the most common cause of anaphylaxis?
medications
During surgery a patient develops hypothermia. The circulating nurse would monitor the patient closely for which of the following?
metabolic acidosis
A client is administered succinylcholine and propofol for induction of anesthesia. One hour after administration, the client demonstrates muscle rigidity with a heart rate of 180. What should the nurse do first?
notify the surgical team
A client is to receive general anesthesia with sevoflurane. What does the nurse anticipate would be given with the inhaled anesthesia?
oxygen
An intravenous anesthetic that, in large doses, has a powerful respiratory depressant effect sufficient to cause apnea and cardiovascular depression is:
pentothal
The nurse positions the client in the lithotomy position in preparation for
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?
peripheral pulses palpable
A nurse suspects malignant hyperthermia in a patient who underwent surgery approximately 18 hours ago. Which of the following would the nurse identify as a late, ominous sign?
rapid rise in body temperature
The nurse is entering the restricted zone of the operating room (OR) and observes another nurse wearing a mask. What is the correct action by the nurse?
say nothing as a mask should be worn at all times
Which of the following consequences may result if tranquilizers are withdrawn suddenly?
seizures
Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery?
sims
The physician is concerned about aspiration during a surgical procedure and orders a medication to increase gastric pH. Which medication would the nurse document as being administered?
sodium citrate
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 3 hours
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
A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?
verify consent