Chapter 15: Intraoperative Nursing Management
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? Endocrine system Cardiovascular system Gastrointestinal system Genitourinary system
Cardiovascular system Explanation: Depolarizing muscle relaxants can cause cardiac dysrhythmias. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 426.
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? a) Circulating nurse b) Surgeon c) Scrub nurse d) Anesthetist
Surgeon Explanation: The registered nurse first assistant practices under the direct supervision of the surgeon. The circulating nurse works in collaboration with other members of the health care team to plan the best course of action for each patient. The scrub nurse assists the surgeon during the procedure as well as setting up sterile tables and preparing equipment. The anesthetist administers the anesthetic medications. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 420.
Which statement by the client indicates further teaching about epidural anesthesia is necessary? "I will lose the ability to move my legs." "A needle will deliver the anesthetic into the area around my spinal cord." "I will be able to hear the surgeon during the surgery." "I will become unconscious."
"I will become unconscious." Explanation: The client receiving epidural anesthesia will remain conscious during the procedure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 428.
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 skin will eliminate the anesthesia through evaporation." "The lungs primarily eliminate the anesthesia." "The liver will eliminate the inhalant anesthesia."
"The lungs primarily eliminate the anesthesia." Explanation: When inhalant anesthetic administration is discontinued, the vapor or gas is eliminated through the lungs. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 425.
A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate? a) "You will be on your back with the head of the bed at 30 degrees." b) "You will be lying on your side with your knees to your chest." c) "You will be placed flat on the table, face down." d) "You will be flat on your back with the table slanted so your head is below your feet."
"You will be lying on your side with your knees to your chest." Explanation: For the lumbar puncture procedure, the client usually lies on the side in a knees-to-chest position. A position flat on the table, face down does not open the vertebral spaces to allow access for the lumbar puncture. Having the client lie on their back does not allow access to the surgical site. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, pp. 424-429.
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 Registered nurse first assistant Surgeon
Circulating nurse Explanation: The circulating nurse is responsible for ensuring that the second verification of the surgical procedure and site takes place and is documented. Each member of the surgical team verifies the patient's name, procedure, and surgical site using objective documentation and data before beginning the surgery. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 417.
The OR personnel responsible for maintaining the safety of the client and the surgical environment is the: Anesthesiologist Scrub nurse Surgeon Circulating nurse
Circulating nurse Explanation: The circulating nurse is responsible for maintaining the safety of the client and the surgical environment. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 417.
What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities? a) Assisting the surgeon b) Coordinating the surgical team c) Passing instruments d) Setting up the sterile tables
Coordinating the surgical team Explanation: The person in the scrub role, either a nurse or a surgical technician, provides sterile instruments and supplies to the surgeon during the procedure by anticipating the surgical needs as the surgical case progresses. The circulating nurse coordinates the care of the patient in the OR. Care provided by the circulating nurse includes planning for and assisting with patient positioning, preparing the patient's skin for surgery, managing surgical specimens, anticipating the needs of the surgical team, and documenting intraoperative events. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 420.
What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound? Hand equipment to the surgeon as needed. Count the sponges. Prepare the necessary sutures. Label the tissue specimen.
Count the sponges. Explanation: Standards call for the scrub nurse and the circulating nurse to count the sponges at the beginning of the surgery, when the surgical wound is being sutured, and when the skin is being sutured. Tissue specimens should be labeled when obtained. The sutures should be ready before the surgeon needs them. Although the scrub nurse does hand equipment to the surgeon, the sponge count is a higher priority action. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Scrub Role, p. 420.
What medication should the nurse prepare to administer in the event the client has malignant hyperthermia? Dantrolene sodium Thiopental sodium Fentanyl citrate Naloxone
Dantrolene sodium Explanation: Anesthesia and surgery should be postponed. However, if end-tidal carbon dioxide (CO2) monitoring and dantrolene sodium (Dantrium) are available and the anesthesiologist is experienced in managing malignant hyperthermia, the surgery may continue using a different anesthetic agent. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Potential Intraoperative Complications, p. 432.
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 tissue elasticity Impaired thermoregulation Increased anxiety level Decreased lean tissue mass
Decreased lean tissue mass Explanation: 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. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 418.
The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching? a) Headache b) Itching c) Seizures d) Sore throat
Headache Explanation: Headache is a common effect following spinal anesthesia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 428.
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? IV I III II
II Explanation: Stage II is the excitement stage, which is characterized by struggling, shouting, and laughing. Stage II is often avoided if the anesthetic is administered smoothly and quickly. Stage I is the beginning of anesthesia, during which the client breathes in the anesthetic mixture and feelings of warmth, dizziness, and detachment occur. Stage III is surgical anesthesia, which is achieved by continued administration of anesthetic vapor and gas. Stage IV is medullary depression, in which the client is unconscious and lies quietly on the table. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 424.
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. Turn the client from side to side at least every 2 hours. Monitor vital signs every 2 hours. Assist the client to a sitting position at the side of the bed.
Instruct the client to remain flat for 6 to 12 hours. Explanation: The client who has received spinal anesthesia should remain flat for 6 to 12 hours unless ordered otherwise. If permitted, the nurse should turn the client from side to side at least every 2 hours. The client who has received spinal anesthesia should be permitted to sit. It is not required to monitor the vital signs every 2 hours. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 429.
Which position is used for perineal surgical procedures? Dorsal recumbent Sims Lithotomy Trendelenburg
Lithotomy Explanation: The lithotomy position is used for nearly all perineal, rectal, and vaginal surgeries. The Trendelenburg position is usually used for surgery on the lower abdomen and pelvis. The Sims or lateral position is used for renal surgery. The dorsal recumbent position is the usual position for surgical procedures. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Malignant Hyperthermia, pp. 432-435.
A client is undergoing a perineal surgical procedure. The nurse should place the client in which position? Dorsal recumbent Sims Trendelenburg Lithotomy
Lithotomy Explanation: The lithotomy position is used for nearly all perineal, rectal, and vaginal surgeries. The Trendelenburg position is usually used for surgery on the lower abdomen and pelvis. The Sims' or lateral position is used for renal surgery. The dorsal recumbent position is the usual position for surgical procedures. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Malignant Hyperthermia, pp. 432-435.
The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in? a) Left lateral Sim's b) Prone position c) Lithotomy position d) Trendelenburg
Lithotomy position Explanation: The lithotomy position is used for nearly all perineal, rectal, and vaginal surgical procedures (see Fig. 18-5C). The patient is positioned on the back with the legs and thighs flexed. The position is maintained by placing the feet in stirrups. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Potential Intraoperative Complications, p. 435.
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? a) Scrub top and drawstring are tucked into pants. b) Shoe covers are used. c) Mask is placed over nose and extends to bottom lip. d) Hair is pulled back and covered by a cap.
Mask is placed over nose and extends to bottom lip. Explanation: The mask should fit tightly, covering the nose and mouth. The mask should extend down past the chin. The mask may not effectively cover the mouth if extended only to the bottom lip. The hair, scrub top, drawstring, and shoe covering are all appropriate and do not require intervention. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Surgical Attire, p. 421.
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? Second surgical mask Face shield N95 respiratory mask Goggles
N95 respiratory mask Explanation: Health care workers are exposed to surgical smoke. This smoke is created from thermal destruction of tissue. Smoke plumes may contain toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, bioaerosols, dead and live cellular material, and viruses. Smoke evacuators are used in some procedures to remove the plume from the operative field. If a smoke evacuator is not available, surgical team members should don an N95 respirator mask rather than a surgical mask, which does not prevent smoke from entering the airway orifices. Goggles and a face shield will not prevent the potential damage from exposure to surgical smoke. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Health Hazards Associated with the Surgical Environment, p. 423.
How would the operating room nurse place a patient in the Trendelenburg position? On his back with his legs and thighs flexed at right angles 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 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 Explanation: 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. In this position, the head and body are lowered. The patient is supported in position by padded shoulder braces (see Fig. 18-5B), bean bags, and foam padding. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Potential Intraoperative Complications, p. 434.
The anesthesiologist is administering a stable and safe nondepolarizing muscle relaxant. What medication does the nurse anticipate will be administered? Norcuron (vecuronium bromide) Pavulon (pancuronium bromide) Syncurine (decamethonium) Anectine (succinylcholine chloride)
Pavulon (pancuronium bromide) Explanation: Pancuronium (Pavulon) is a nondepolarizing muscle relaxant with a longer onset and duration. Succinylcholine (Anectine) and decamethonium (Syncurine) are depolarizing muscle relaxants. Vercuronium (Norcuron) is a nondepolarizing muscle relaxant that requires mixing. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 427.
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? Legs Abdomen Perineum Chest
Perineum Explanation: After induction of spinal anesthesia, anesthesia and paralysis affect the toes and perineum, then gradually the legs and abdomen. If the anesthetic reaches the upper thoracic and cervical spinal cord in high concentrations, a temporary or complete respiratory paralysis occurs. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 429.
A patient is to receive local anesthesia in combination with epinephrine. The nurse understands that epinephrine is used for which reason? a) Prolongs the local action b) Reduces the amount of anesthetic needed c) Prevents anaphylaxis d) Enhances the anesthetic's absorption
Prolongs the local action Explanation: Epinephrine is added to a local anesthetic to constrict the blood vessels, which prevents rapid absorption of the local anesthetic agent and thus prolongs its local action. Rapid absorption of the anesthetic into the blood stream could cause seizures. Epinephrine does not reduce the amount of anesthetic needed. It also does not prevent anaphylaxis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 430.
The nurse is preparing an older adult for a surgical procedure. Which action will the nurse take to protect the client from injury during the operative period? a) Protect bony prominences with extra padding. b) Estimate amount of blood loss during the procedure. c) Apply a warm blanket after the procedure. d) Provide antiembolic stockings to be applied postoperatively.
Protect bony prominences with extra padding. Explanation: Older adult clients are at higher risk for complications from anesthesia and surgery compared with younger adult clients due to several factors. One factor is age-related decline in physiological reserve that weakens the normal response to stressors, acute illness, anesthesia, and surgery. Nursing management for the older surgical client in the intraoperative period includes careful transferring and positioning in the OR bed by protecting pressure points and bony prominences with extra padding. Intraoperative warming techniques should be used to reduce unintentional hypothermia during the case. Blood loss is to be accurately measured and not estimated. Antiembolic stockings are to be used during the case to prevent the development of venous thromboemboli. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 418.
A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse? a) Request a role change to circulating nurse. b) Return to work after taking antibiotics for 24 hours. c) Ensure the infection is covered with a dressing. d) Report the infection to an immediate supervisor.
Report the infection to an immediate supervisor. Explanation: The infection needs to be reported immediately because of the aseptic environment of the operating room. The usual barriers may not protect the client when an infection is present. The employee needs to follow the policy of the operating room regarding infections. Covering the infected area with a dressing may be necessary, but the infection must be reported first. The scrub nurse may still be able to work depending on the policy; therefore, returning to work after 24 hours is not the priority action. Even if the nurse requests a role change to circulating nurse, the policy for infections in the operating room must be followed; therefore, it must be reported first. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Principles of Surgical Asepsis and Sterile Technique, p. 422.
The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to: Need an endotracheal tube Be anxious throughout the procedure Respond verbally during the procedure Need pain control throughout the procedure
Respond verbally during the procedure Explanation: Clients can respond to verbal and physical stimuli and maintain an oral airway and protective reflexes during moderate sedation. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 430.
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? a) Risk of latex allergy response related to possible exposure in the OR environment b) Risk for perioperative positioning injury related to positioning in the OR c) Disturbed sensory perception related to the effects of general anesthesia d) Anxiety related to ineffective coping with surgical concerns
Risk for perioperative positioning injury related to positioning in the OR Explanation: Pressure ulcers, nerve and blood vessel damage, impeded respiration, hyperextended joints, and discomfort are risks associated with the prolonged, awkward positioning required for some surgical procedures. The other choices are also potential nursing diagnoses or concerns related to surgery, but they are not related to the duration of the surgery. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Potential Intraoperative Complications, p. 432.
A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first? Provide a basin. Roll the client onto their side. Suction the mouth. Administer an antiemetic medication.
Roll the client onto their side. Explanation: The client must be rolled to the side to prevent aspiration. All the other interventions are correct for a sedated client who is vomiting, but the highest priority is preventing aspiration. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, pp. 424-430.
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? First assistant Certified registered nurse anesthetist Scrub nurse Circulating nurse
Scrub nurse Explanation: The scrub nurse is sterile and assists the surgical team by handing instruments to the surgeon, preparing sutures, receiving specimens to be sent to the lab, and counting sponges and needles. The circulating nurse is not sterile and obtains and opens sterile equipment, adjusts lights, and keeps records. The first assistant is involved with the client's preoperative care. The certified registered nurse anesthetist assists in the client's anesthesia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 420.
A nurse who is part of the surgical team is involved in setting up the sterile tables. The nurse is functioning in which role? a) Registered nurse first assistant b) Scrub role c) Anesthetist d) Circulating nurse
Scrub role Explanation: The scrub role includes performing a surgical hand scrub, setting up the sterile tables, and preparing sutures, ligatures, and special equipment. The circulating nurse manages the operating room and protects patient safety. The registered nurse first assistant functions under the direct supervision of the surgeon. Responsibilities may include handling tissue, providing exposure of the operative field, suturing, and maintaining hemostasis. The anesthetist administers the anesthetic medications. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 420.
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. a) Stage II: excitement b) Stage IV: medullary depression c) Stage III: surgical anesthesia d) Stage I: beginning anesthesia
Stage II: excitement Explanation: The excitement stage, characterized variously by struggling, shouting, talking, singing, laughing, or crying, is often avoided if the anesthetic is administered smoothly and quickly. Because of the possibility of uncontrolled movements, the patient should not be touched except for purposes of restraint. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 424.
Which clinical manifestation is often the earliest sign of malignant hyperthermia? a) Tachycardia (heart rate >150 beats per minute) b) Elevated temperature c) Oliguria d) Hypotension
Tachycardia (heart rate >150 beats per minute) Explanation: Tachycardia is often the earliest sign of malignant hyperthermia. Hypotension is a later sign of malignant hyperthermia. The rise in temperature is actually a late sign that develops quickly. Scant urinary output is a later sign of malignant hyperthermia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Malignant Hyperthermia, p. 432.
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? a) Respiratory rate of 18 breaths/min b) Blood pressure of 104/62 mm Hg c) Pulse rate of 110 beats/min d) Temperature of 102.5°F (39°C)
Temperature of 102.5°F (39°C) Explanation: Intraoperative hyperthermia can indicate a life-threatening condition called malignant hyperthermia. The circulating nurse closely monitors the client for signs of hyperthermia. The pulse rate, respiratory rate, and blood pressure did not indicate a significant concern. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Potential Intraoperative Complications, p. 431.
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? Malignant hyperthermia occurs in the operating room only. A client can develop malignant hyperthermia only with intravenous anesthesia after surgery. The client can develop malignant hyperthermia up to 24 hours after surgery. The client will need to be discharged with special instructions.
The client can develop malignant hyperthermia up to 24 hours after surgery. Explanation: Although malignant hyperthermia usually manifests about 10 to 20 minutes after induction of anesthesia, it can also occur during the first 24 hours after surgery. Malignant hyperthermia can be triggered by inhalant anesthesia with muscle relaxants. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Potential Intraoperative Complications, p. 432.
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? 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 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.
The edges of a sterile package, once opened, are considered unsterile. Explanation: To maintain surgical asepsis, the edges of a sterile package, once opened, are considered unsterile. When moving around a sterile field, individuals must maintain a distance of at least 1 foot from the sterile field. If a tear occurs in a sterile drape, it must be replaced. Only scrubbed personnel and sterile items may come in contact with sterile areas. Circulating nurses can only contact unsterile areas. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Principles of Surgical Asepsis and Sterile Technique, p. 422.
What action during a surgical procedure requires immediate intervention by the circulating nurse? The surgeon reaching within the sterile field to obtain equipment The anesthesiologist monitoring blood gas levels The registered nurse's first assistant suturing the surgical wound The scrub nurse calling the blood bank to obtain blood products
The scrub nurse calling the blood bank to obtain blood products Explanation: The scrub nurse is "scrubbed" in and should only come in contact with sterile equipment. Using the phone to call the blood bank is the responsibility of the circulating nurse and it would break the sterility of the scrub nurse. The surgeon has "scrubbed" in and should only touch items within the sterile field. The anesthesiologist should monitor blood gas levels as needed, and it is appropriate for the registered nurse's first assistant to suture the surgical wound. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Circulating Nurse, pp. 419-420.
A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? Document the start of surgery. Acquire ordered blood products. Count sponges and syringes. Verify consent.
Verify consent. Explanation: Surgery cannot be performed without consent. Documentation of the start of surgery can only happen once the surgery has started. Blood products must be administered within an allotted time frame and therefore should not be acquired unless needed. The sponge and syringe count is a safety issue that should be completed before surgery and while the wound is being sutured, but if the client has not consented, the surgery should not take place. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Circulating Nurse, p. 419.
The nurse recognizes that the older adult is at risk for surgical complications due to: decreased renal function decreased adipose tissue increased cardiac output increased skeletal mass
decreased renal function Explanation: Renal function declines with age, resulting in slowed excretion of waste products and anesthetic agents. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 418.
The nurse recognizes the client has reached stage III of general anesthesia when the client: displays agitation due to noise shouts, talks, or sings lies quietly on the table exhibits shallow respirations and a weak, thready pulse
lies quietly on the table Explanation: Understanding the stages of anesthesia is necessary for nurses because of the emotional support that the client may need. Stage III or surgical anesthesia is reached when the patient is unconscious and lies quietly on the table. The pupils are small but constrict when exposed to light. Respirations are regular, the pulse rate and volume are normal, and the skin is pink or slightly flushed. Clients in stage I of anesthesia may have a ringing, roaring, or buzzing in the ears and, although still conscious, may sense an inability to move the extremities easily. These sensations can result in agitation. Stage II of anesthesia is characterized variously by struggling, shouting, talking, singing, laughing, or crying, and is often avoided if IV anesthetic agents are given smoothly and quickly. Stage IV is reached if too much anesthesia is given. Respirations become shallow, the pulse is weak and thready, and the pupils become widely dilated and no longer constrict when exposed to light. Cyanosis develops and, without prompt intervention, death rapidly follows. If this stage develops, the anesthetic agent is discontinued immediately and respiratory and circulatory support is initiated to prevent death. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 424.
During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication? infection fluid volume excess hypothermia malignant hyperthermia
malignant hyperthermia Explanation: Malignant hyperthermia is an inherited disorder that occurs when body temperature, muscle metabolism, and heat production increase rapidly, progressively, and uncontrollably in response to stress and some anesthetic agents. If the client's temperature begins to rise rapidly, anesthesia is discontinued, and the OR team implements measures to correct physiologic problems, such as fever or dysrhythmias. Hypothermia is a lower than expected body temperature. Signs of infection would not present during the procedure. Increased body temperature would not indicate fluid volume excess. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Potential Intraoperative Complications, p. 432.
Hypothermia may occur as a result of the infusion of warm fluids. open body wounds. increased muscle activity. being young.
open body wounds. Explanation: Inadvertent hypothermia may occur as a result of a low temperature in the OR, infusion of cold fluids, inhalation of cold gases, open wounds or cavities, decreased muscle activity, advanced age, or particular pharmaceutical agents. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Hypothermia, p. 431.
A client is to receive general anesthesia with sevoflurane. What does the nurse anticipate would be given with the inhaled anesthesia? rocuronium oxygen alfentanil lidocaine
oxygen Explanation: Sevoflurane is an inhalation anesthetic always combined with oxygen to decrease the risk of coughing and laryngospasm. It would not be combined with alfentanil, rocuronium, or lidocaine. Alfentanil and rocuronium are intravenous anesthetics. Lidocaine is a local anesthetic. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, Types of Anesthesia and Sedation, p. 425.
In developing the plan of care for the intraoperative client, the nurse recognizes that it is essential to consider: the wishes of the client's family the schedule of the operating room the surgeon's skill in performing the procedure the client's cultural beliefs
the client's cultural beliefs Explanation: A client's cultural beliefs may influence whether medical and nursing interventions are acceptable or unacceptable to the client. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 15th ed., Philadelphia, Wolters Kluwer, 2022, Chapter 15: Intraoperative Nursing Management, The Surgical Team, p. 418.