Exam 1: Prep U questions

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period?

72 hours after withdrawal *Alcohol withdrawal delirium is associated with a significant mortality rate when it occurs postoperatively.

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

The __________________ is used for renal surgery.

Sims or lateral position

__________manages the operating room and protects patient safety.

The circulating nurse

The ___________________ is used for nearly all perineal, rectal, and vaginal surgeries.

The lithotomy position

The nurse recognizes that written informed consent is required for insertion of a(n): a. Nasogastric tube. b. Urinary catheter. c. Peripherally-inserted central catheter. d. Oral airway.

c.

The __________________ position is the usual position for surgical procedures.

dorsal recumbent

A transsacral block anesthetizes the _______________

perineum and, occasionally, the lower abdomen.

The___________ functions under the direct supervision of the surgeon. Responsibilities may include handling tissue, providing exposure of the operative field, suturing, and maintaining hemostasis.

registered nurse first assistant

During a lumbar puncture, anesthesia is injected into the ____________________ at the lumbar level, usually between_______

subarachnoid space L4 and L5.

Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out? a. Ensure that sufficient surgical supplies are available. b. Check that all surgical personnel are properly attired. c. Review the scheduled procedure, site, and client. d. Confirm that informed consent has been obtained.

c. Review the scheduled procedure, site, and client.

A fractured skull would be classified under which category of surgery based on urgency?

emergent

Adequate hourly urine output for a client with an indwelling urinary catheter is 0.5 mL/kg/h. 1.0 mL/kg/h. 1.5 mL/kg/h. 2.0 mL/kg/h.

2.0 mL/kg/h. If the client has an indwelling urinary catheter, output is monitored hourly and rates <0.5 mL/kg/h are reported.

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

Use Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. -In chronic bronchitis the diaphragm is flat and weak. - Exhalation should be longer than inhalation to prevent collapse of the bronchioles. - exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. - increases lung expansion.

The nurse is assigned a client scheduled for an outpatient colonoscopy in an ambulatory care setting. During which phase of perioperative care would the nurse document the admission vital signs in the recovery room?

Postoperative phase Rationale: The nurse realizes that documentation of vital signs in the recovery room begins the postoperative phase of perioperative care. The preoperative phase occurs until the client reaches the operating area. The intra operative phase includes the entire surgical procedure until the transfer to the recovery area. There is no transfer phase of perioperative care.

The nurse is aware that infection is a potential complication of surgery. Which intervention should the nurse implement to prevent infection? Select all that apply. a. Avoid touching sterile items unless necessary. b. Keep artificial nails clean and in good repair. c. Alert the surgical team of any breaches of sterile technique. d. Wear a long-sleeved, sterile gown and gloves. e. Remove hair from the surgical site using a razor.

a, c, d

A patient undergoes induction for general anesthesia at 8:30 a.m. and is being assessed continuously for the development of malignant hyperthermia. At which time would the patient be most likely to exhibit manifestations of this condition? a. 8:40 to 8:50 a.m. b. 9:00 to 9:10 a.m. c. 9:30 to 9:40 a.m. d. 10:00 to 10:10 a.m.

a. Malignant hyperthermia usually manifests about 10 to 20 minutes after the induction of anesthesia, which in this case would 8:40 to 8:50 a.m

An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position? a. Flat on his back with his arms next to his sides b. On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle c. On his back, with his legs and thighs flexed at right angles d. On his side, with his uppermost leg adducted and flexed at the knee

b. The Trendelenburg position usually is used for surgery on the lower abdomen and pelvis to obtain good exposure by displacing the intestines into the upper abdomen. I

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? a. Increased anxiety level b. Increased tissue elasticity c. Decreased lean tissue mass d. Impaired thermoregulation

c. Elderly patients require lower doses of anesthetic agents because of decreased tissue elasticity and reduced lean tissue mass. An increased amount of anesthetic would be needed with an increased anxiety level. Impaired thermoregulation increases the patient's susceptibility to hypothermia.

Informed consent from the surgical client is essential in all of the following categories of surgery except:

emergent sx a physician may perform surgery without a client's informed consent in order to save the client's life.

A brachial plexus block anesthetizes ___________

the arm

A nurse who is part of the surgical team is involved in setting up the sterile tables. The nurse is functioning in which role?

the scrub role he scrub role includes performing a surgical hand scrub, setting up the sterile tables, and preparing sutures, ligatures, and special equipment

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 Cerberal spinal fluid from leaking

Which conduction block anesthetizes the nerves supplying the chest, abdominal wall, and extremities? a. Paravertebral anesthesia b. Brachial plexus block c. Transsacral block d. Lumbar puncture

Paravertebral anesthesia - Paravertebral anesthesia anesthetizes the nerves supplying the chest, abdominal wall, and extremities

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? a. Sodium citrate b. Famotadine c. Midazolam d. Vecuronium

Sodium citrate increases gastric pH, thereby reducing damage to the respiratory tract if aspiration should occur. - Vecuronium is a muscle relaxant, -famotidine decreases gastric acid production, - and midazolam is an anesthetic agent.

The nurse recognizes the client has reached stage III of general anesthesia when the client: a. Exhibits no change in behavior b. Loss of consciousness c. Exhibits shallow respirations and a weak, thready pulse d.Ability to respond to verbal commands e. Paralysis of the lower extremities f. Complains of ringing or buzzing in the ears g. Has small pupils that react to light h. Unable to maintain airway

Stage III of general anesthesia is characterized by dilation and reaction of pupils. Respirations are regular, the pulse rate and volume are normal, and the skin is pink or slightly flushed.

The nurse is working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks the nurse why these medications are needed. What would be the nurse's best answer?

These medications decrease gastric acidity and volume."

The ________________ is usually used for surgery on the lower abdomen and pelvis. T

Trendelenburg position

A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications? a. Pregnancy b. Diabetes c. Urinary tract infection d. Osteoporosis

d. - Pregnancy decreases maternal reserves. -Diabetes increases wound-healing problems and risks for infection. -Urinary tract infection decreases the immune system's effectiveness, increasing the chance for infections.

The nurse is caring for a patient who is at risk for malignant hyperthermia subsequent to general anesthesia. What is the most common early sign that the nurse should assess for? a. Hypertension b. Muscle rigidity ("tetanylike" movements) c. Oliguria d.Tachycardia

d. The initial symptoms of malignant hyperthermia are related to cardiovascular and musculoskeletal activity. Tachycardia (an abnormally high heart rate) is often the earliest sign. Sympathetic nervous stimulation also leads to ventricular dysrhythmia, hypotension, decreased cardiac output, oliguria, and, later, cardiac arrest. With the abnormal transport of calcium, rigidity or tetanuslike movements occur, often in the jaw. Generalized muscle rigidity is one of the earliest signs.

Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern? a. Anesthesiologist b. Circulating nurse c. Registered nurse first assistant d. Surgeon

d. It is the surgeon's responsibility to explain the benefits, alternatives, possible risks, complications, disfigurement, disability, and removal of body parts in obtaining informed consent from the client.

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

d. Verification of the identification of the client, procedure, and operative site are essential to maintain the safety of the client.