Chapter 18: Intraoperative Nursing Management

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'm so glad that I will be unconscious during the surgery." "I won't feel it, but I'll have a tube to help me breathe." "Only the surgical area will be numb." "I'll be sleepy but able to respond to your questions."

"I'll be sleepy but able to respond to your questions."

What is the most important postoperative instruction a nurse must give to a client who has just returned from the operating room after receiving a subarachnoid block? "Avoid drinking liquids until the gag reflex returns." "Avoid eating milk products for 24 hours." "Notify a nurse if you experience blood in your urine." "Remain supine for the time specified by the physician."

"Remain supine for the time specified by the physician."

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." "Few negative effects occur with general anesthesia." "Amnesia and analgesia are some of the negative effects of 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 5 hours." "The anesthetic may last for 7 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 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 surgeon on the team has never been involved in such a mix-up." "The client will be involved in the verification process prior to 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."

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

"The lungs primarily eliminate the anesthesia."

A new scrub technician is being oriented to the operating room. The scrub technician states to the nurse, "You can skip the fire safety information because I have worked in hospitals for the past 10 years." What is the best response by the nurse? "I know this information is not exciting but I'm required to cover it with you." "The operating room has some unique circumstances that increases the chances of fire." "OK, but you will be required to review the hospital's policy on fire safety on your own." "This is a requirement of your job; just tough through it."

"The operating room has some unique circumstances that increases the chances of fire."

The client who had spinal anesthesia complains of a headache. Which of the following is an inappropriate action by the nurse? Increase fluid intake. Keep the head of the bed flat. Maintain a quiet environment. Administer morphine sulfate.

Administer morphine sulfate.

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. Alert personnel who break sterile technique. Allow unnecessary personnel to enter the OR environment. Maintain the positive pressure OR environment.

Allow unnecessary personnel to enter the OR environment.

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? Temporarily set the OR temperature to 30°C. Place warm damp drapes on the client, replacing them every 5 minutes. Administer IV fluids warmed to room temperature. Apply a warm air blanket, gradually increasing body temperature.

Apply a warm air blanket, gradually increasing body temperature.

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

Appropriately position the client using adequate padding and support.

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 Endocrine system Gastrointestinal system Genitourinary system

Cardiovascular system

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

Circulating nurse

What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities? Assisting the surgeon Coordinating the surgical team Setting up the sterile tables Passing instruments

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. Label the tissue specimen. Prepare the necessary sutures. Hand equipment to the surgeon as needed.

Count the sponges

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

Dantrolene sodium

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? Increased anxiety level Increased tissue elasticity Decreased lean tissue mass Impaired thermoregulation

Decreased lean tissue mass

The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered? Unresponsive to verbal or tactile stimuli Denies sensation to perineum and lower abdomen Yelling and pulling at equipment No movement in right lower leg

Denies sensation to perineum and lower abdomen

Which of the following actions by the nurse is appropriate? Touching the edges of an open sterile package Touching sterile items with a clean-gloved hand Reaching over the sterile field Discarding an object that comes in contact with the 1-inch border

Discarding an object that comes in contact with the 1-inch border

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? Lithotomy Sims Trendelenburg Dorsal recumbent

Dorsal recumbent

When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate? Considering the gown sterile from mid-thigh to neck Positioning the sterile drape on a table from back to front Allowing circulating nurses to contact sterile equipment 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? Assessing for hallucinations Frequently monitoring vital signs Administering oxygen Providing a quiet dark room for recovery

Frequently monitoring for vital signs

The nurse is aware that loss of consciousness occurs with which type of anesthesia? General Local Moderate sedation Regional

General

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 Fentanyl Succinylcholine Propofol

Halothane

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

Has small pupils that react to light

The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching? Sore throat Itching Seizures Headache

Headache

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? I II III IV

II

Which stage of surgical anesthesia is also known as excitement? I II III IV

II

Which stage of anesthesia is referred to as surgical anesthesia? II I III IV

III

A medical student scheduled to observe surgery enters the restricted surgical zone wearing jeans, a t-shirt, and tennis shoes. What is the best action by the nurse? Immediately escort the medical student out of the area. No action is needed. Provide the medical student a cap and mask. Educate the medical student on required attire for each surgical zone.

Immediately escort the medical student out of the area.

An obese client is undergoing abdominal surgery. During the procedure a surgical resident states, "The amount of fat we have to cut through is disgusting." What is the best response by the nurse? Ignore the comment. Report the resident to the attending surgeon. Discuss concerns regarding the comments with the charge nurse. Inform the resident that all communication needs to remain professional.

Inform the resident that all communication needs to remain professional.

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

Keeping records

A patient is complaining of a headache after receiving spinal anesthesia. What does the nurse understand may be the cause of the headache related to the spinal anesthesia? (Select all that apply.) The patient lying in the supine position Leakage of spinal fluid from the subarachnoid space Size of the spinal needle used Degree of patient hydration An allergic reaction to the medication used

Leakage of spinal fluid from the subarachnoid space Size of the spinal needle used Degree of patient hydration

The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in? Left lateral Sim's Prone position Lithotomy position Trendelenburg

Lithotomy position

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? Hair is pulled back and covered by a cap. Scrub top and drawstring are tucked into pants. Shoe covers are used. Mask is placed over nose and extends to bottom lip.

Mask is placed over nose and extends to bottom lip.

Which is the most common cause of anaphylaxis? Latex Medications Fibrin sealants Plastic

Medications

An instructor is developing for a class a teaching plan about agents used for intravenous (IV) anesthesia. Which of the following would the instructor include in this plan about these agents and this type of anesthesia? Select all that apply. Associated with more nausea Long duration of action More pleasant onset of anesthesia Ease of administration Need for little equipment

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

What is the priority action when the circulating nurse is completing a second verification of the surgical procedure and surgical site? Ask the surgeon whether the marked surgical site is correct. Obtain the attention of all members of the surgical team. Discuss the surgical procedure and surgical site with the client. Review complications and allergies with the anesthesiologist.

Obtain the attention of all members of the surgical team.

An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position? 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 side, with his uppermost leg adducted and flexed at the knee

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% Decreased cough and gag reflexes Blood-tinged stools

Oxygen saturation (SaO2) of 85%

The anesthesiologist is administering a stable and safe nondepolarizing muscle relaxant. What medication does the nurse anticipate will be administered? Anectine (succinylcholine chloride) Norcuron (vecuronium bromide) Pavulon (pancuronium bromide) Syncurine (decamethonium)

Pavulon (pancuronium bromide)

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

Perineal surgery

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

Preparing the sterile instruments for the surgical procedure

A patient who has received general anesthesia has reached stage II. Which of the following would the nurse expect the patient to exhibit? Dizziness and a feeling of detachment Pupillary dilation and rapid pulse Unconsciousness and regular respirations Weak, thready pulse and cyanosis

Pupillary dilation and rapid pulse

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. Ensure the infection is covered with a dressing. Return to work after taking antibiotics for 24 hours. Request a role change to circulating nurse.

Report the infection to an immediate supervisor.

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 injury related to effects of anesthetic agents Risk for perioperative positioning injury related to operative position Anxiety related to the surgical experience Disturbed sensory perception related to sedation

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 Risk of latex allergy response related to possible exposure in the OR environment Disturbed sensory perception related to the effects of general anesthesia Anxiety related to ineffective coping with surgical concerns

Risk for perioperative positioning injury related to positioning in the OR

A client is placed on the operating room table for the surgical procedure. Which surgical team member is responsible for handing sterile instruments to the surgeon and assistants? Scrub nurse Circulating nurse First assistant Certified registered nurse anesthetist

Scrub nurse

Which of the following consequences may result if tranquilizers are withdrawn suddenly? Seizures Cardiovascular collapse Hypotension Respiratory depression

Seizures

In which position would a client undergoing a lumbar puncture be placed? Supine Semi-Fowler's Side-lying, knees to chest Trendelenburg

Side-lying, knees to chest

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

Sims position

There are four stages of general anesthesia. Select the stage during which the OR nurse knows not to touch the patient (except for safety reasons) because of possible uncontrolled movements. Stage I: beginning anesthesia Stage II: excitement Stage III: surgical anesthesia Stage IV: medullary depression

Stage II: excitement

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 I Stage II Stage III Stage IV

Stage IV

The client vomits during the surgical procedure. The best action by the nurse is: Increase the IV infusion rate to compensate for lost fluids. Suction the client to remove saliva and gastric secretions. Lower the head of the operating table to promote circulation to the brain. Administer an anti-emetic to alleviate nausea.

Suction the client to remove saliva and gastric secretions.

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

An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia? Beginning anesthesia Excitement Surgical anesthesia Medullary depression

Surgical anesthesia

Which clinical manifestation is often the earliest sign of malignant hyperthermia? Tachycardia (heart rate >150 beats per minute) Hypotension Elevated temperature Oliguria

Tachycardia (heart rate >150 beats per minute)

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 distance of 3 feet must be maintained when moving around a sterile field. If a tear occurs in a sterile drape, a new sterile drape is applied on top of it. Circulating nurses may come in contact with the sterile field without contaminating it.

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 confusion To prevent seizures To prevent cerebrospinal fluid (CSF) leakage To prevent cardiac arrhythmias

To prevent cerebrospinal fluid (CSF) leakage

The nursing instructor is talking with her class about spinal anesthesia. What would be the nursing care intervention required when caring for a client recovering from spinal anesthesia? Select all that apply. Turn the client from side to side at least every 2 hours, if permitted. Assist the client to a sitting position at the side of the bed. Instruct the client to stay in bed until sensation and movement returns. Monitor respiratory rate and sensation every 2 hours or as per ordered. Encourage the client to increase activity if complaining of a headache.

Turn the client from side to side at least every 2 hours, if permitted. Assist the client to a sitting position at the side of the bed. Instruct the client to stay in bed until sensation and movement returns. Monitor respiratory rate and sensation every 2 hours or as per ordered.

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

Verify consent

Which of the following is an inappropriate nursing action by the surgical nurse? Covering the hair with a surgical cap Wearing a surgical jacket with knitted cuffs on the sleeves Wearing sterile gloves over artificial nails Changing shoe covers that become torn

Wearing sterile gloves over artificial nails

Which of the following medications would the nurse expect to be used to facilitate intubation of the client? diazepam (Valium) pancuronium (Pavulon) fentanyl (Sublimaze) atracurium (Tracrium)

atracurium (Tracrium)

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 Scrub nurse Surgeon Registered nurse first assistant

circulating nurse

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

dantrolene sodium (Dantrium)

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

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) tetanus-like jaw movements generalized muscle rigidity heart rate over 150 beats per minute

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: inserting a Foley catheter can decrease fluid retention. administering I.V. antibiotics can prevent pneumonia. this client may need intubation. it may be necessary to raise the head of this client's bed.

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 displays agitation due to noise shouts, talks, or sings exhibits shallow respirations and a weak, thready pulse

lies quietly on the table

The nurse understands that the purpose of the "time out" is to: verify all necessary supplies are available. identify the client's allergies. clarify the roles of the OR personnel. maintain the safety of the client.

maintain the safety of the client.

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

malignant hyperthermia

Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care: is used as an adjunct to spinal anesthesia. may result in the administration of general anesthesia. is a type of regional anesthesia. requires the introduction of an anesthetic agent into the epidural space

may result in the administration of general anesthesia.