Chapter 15: Intraoperative nursing management

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."

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."

The circulating nurse is performing a skin preparation for a client who is unconscious from general anesthesia when the scrub nurse states, "I know her, she sure has gotten fat!" What is the best response by the circulating nurse?

"It is inappropriate to make comments even when clients appear to be unconscious from anesthesia."

When developing a teaching plan for a patient scheduled for ambulatory surgery with epidural anesthesia, which of the following would the nurse include?

"You shouldn't experience a headache after this type of anesthesia."

The client who had spinal anesthesia complains of a headache. Which of the following is an inappropriate action by the nurse?

Administer morphine sulfate.

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

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 who has undergone surgery and received spinal anesthesia is reporting a headache. Which of the following would be most appropriate?

Encourage increased fluid intake.

A patient is to receive general anesthesia. The nurse anticipates that which of the following would be used for induction?

Etomidate

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.

The nurse recognizes the client has reached stage III of general anesthesia when the client:

Has small pupils that react to light

A client is being prepared in the operating room for a surgical procedure. Which assessment parameter(s) will the surgical nurse use to monitor the client's status when receiving general anesthesia? Select all that apply.

Heart rate Pupil response Blood pressure Respiratory rate

A nurse is reviewing the medical record of a patient who is to receive general anesthesia and notes a nursing diagnosis of anxiety related to surgical concerns. The nurse implements measures to reduce the patient's anxiety based on the understanding of which of the following?

Increased anxiety can increase the patient's postoperative pain level.

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?

Instruct the client to remain flat for 6 to 12 hours.

A client receiving general anesthesia has an increase in body temperature during the procedure. Which medication will the nurse recognize as a likely contributor to malignant hyperthermia?

Isoflurane

A client is undergoing a perineal surgical procedure. The nurse should place the client in which position?

Lithotomy

The nurse is educating new employees about wearing masks in the operating room. What information should the nurse provide? Select all that apply

Masks should cover the nose and mouth completely. You must change masks between treating clients. Masks should fit tightly.

A client is to receive general anesthesia with sevoflurane. What does the nurse anticipate would be given with the inhaled anesthesia?

Oxygen

Which drug is a nondepolarizing muscle relaxant?

Pancuronium

The anesthesiologist is administering a stable and safe nondepolarizing muscle relaxant. What medication does the nurse anticipate will be administered?

Pavulon (pancuronium bromide)

During the surgical procedure, the client's temperature falls to 96.6°F. Which of the following nursing actions is inappropriate?

Place a cooling blanket under the client.

A patient is to receive local anesthesia in combination with epinephrine. The nurse understands that epinephrine is used for which reason?

Prolongs the local action

A patient who has received general anesthesia has reached stage II. Which of the following would the nurse expect the patient to exhibit?

Pupillary dilation and rapid pulse

A client scheduled for open heart surgery has hair on the chest. Which action will the nurse take to prepare the skin for the procedure?

Remove the hair with electric clippers.

A patient has received general anesthesia and is progressing through the stages. Which would be a symptom of stage I?

Ringing in the ears

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.

The physician requests lidocaine 2% with epinephrine for use in local infiltration anesthesia. What does the nurse understand is the purpose of adding epinephrine to the lidocaine? (Select all that apply.)

The epinephrine causes vasoconstriction. The epinephrine prevents rapid absorption of the anesthetic drug. The epinephrine prolongs the local action of the anesthetic agent.

What action during a surgical procedure requires immediate intervention by the circulating nurse?

The scrub nurse calling the blood bank to obtain blood products

Which position should the patient undergoing pelvis surgery be positioned?

Trendelenburg

A patient begins to vomit during surgery. Place the actions below in the order in which they would be performed.

Turn the patient to the side. Lower the head of the surgical table. Provide a basin for collection. Suction to remove saliva.

A client is being prepared for a surgical procedure. The circulating nurse is specifically responsible for which piece of the surgical timeout?

Verification of the timeout

Which intervention should the nurse implement during the intraoperative period to protect the client from injury? Select all that apply.

Verify scheduled procedure with client. Assess the client for allergies. Confirm the consent form is signed.

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 recumbent

A client is being prepared for a surgical procedure. Which medication will the nurse anticipate being administered during surgery to decrease gastric acid production?

famotidine

A client requires minor surgery for removal of a basal cell tumor. The anesthesiologist administers the anesthetic ketamine hydrochloride 60 g IV. After administration, the nurse will monitor the client for what symptom?

hallucinations

After teaching a class about agents commonly associated with the development of malignant hyperthermia, the instructor determines that additional teaching is needed when the students identify which drug as a possible cause?

morphine

A patient is scheduled for surgery with spinal anesthesia. When explaining this type of anesthesia to the patient, which body area would the nurse describe as being affected first?

perineum

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

A circulating nurse is preparing a client for a surgical procedure. What are the primary responsibilities of the circulating nurse in the perioperative experience? Select all that apply.

verifying informed consent ensuring proper lighting coordinating the efforts of the surgical team