115 PrepU Ch.15 Intraoperative Nursing Management
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
Which would be included as a responsibility of the scrub nurse?
Handing instruments to the surgeon and assistants
Which statement by the client indicates further teaching about epidural anesthesia is necessary?
"I will become unconscious."
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?
"Remain supine for the time specified by the physician."
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 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."
Which nursing diagnosis should the nurse plan to address first in the client upon arrival in the intraoperative setting?
Anxiety related to ineffective coping with surgical concerns
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
The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:
Circulating nurse
What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities?
Coordinating the surgical team
What medication should the nurse prepare to administer in the event the client has malignant hyperthermia?
Dantrolene sodium
The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered?
Denies sensation to perineum and lower abdomen
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 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
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?
Inform the resident that all communication needs to remain professional.
As a circulating nurse, what task are you solely responsible for?
Keeping records
Which position is used for perineal surgical procedures?
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.
During surgery a patient develops hypothermia. The circulating nurse would monitor the patient closely for which of the following?
Metabolic acidosis
The nurse positions the client in the lithotomy position in preparation for
Perineal surgery
The scrub nurse is responsible for:
Preparing the sterile instruments for the surgical procedure
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
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
A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first?
Roll the client onto his or her side.
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 II: excitement
Which clinical manifestation is often the earliest sign of malignant hyperthermia?
Tachycardia (heart rate >150 beats per minute)
A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?
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:
dantrolene sodium (Dantrium)
The nurse recognizes that the older adult is at risk for surgical complications due to:
decreased renal function
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.
Hypothermia may occur as a result of
open body wounds.
The nurse recognizes the client has reached stage III of general anesthesia when the client:
lies quietly on the table
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
A 78-year-old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase?
Appropriately position the client using adequate padding and support.
A nurse is caring for a postoperative client who started shivering. What is the best action for the nurse?
Ensure that the room temperature is set at 25°C to 26.6°C (78°F to 80°F).
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 client is to receive general anesthesia with sevoflurane. What does the nurse anticipate would be given with the inhaled anesthesia?
Oxygen
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 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
The client vomits during the surgical procedure. The best action by the nurse is:
Suction the client to remove saliva and gastric secretions.
Which of the following techniques least exhibits surgical asepsis?
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?
Temperature of 102.5°F (39°C)
A client at risk for malignant hyperthermia returns to the surgical unit. For what time period will the nurse monitor the client for development of malignant hyperthermia?
The client can develop malignant hyperthermia up to 24 hours after surgery.
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.
