Chapter 19 - Intraoperative Care

Which action should the perioperative nurse take to best protect the patient from burn injury during surgery? a. Ensure correct placement of the grounding pad. b. Check all emergency sprinklers in the operating room. c. Verify that a fire extinguisher is available during surgery. d. Confirm that all electrosurgical equipment has been properly serviced.

ANS: A Care must be taken to correctly place the grounding pad and all electrosurgical equipment to prevent injury from burns or fire. It is important to ensure that fire extinguishers are available and that sprinklers protect everyone in the operating room in the event of a fire, but placing the grounding pad will best prevent injury to the patient. Verifying that electrosurgical equipment works properly does not protect the patient unless all equipment and the grounding pad is placed correctly

Which statement, if made by a new circulating nurse, is appropriate? a. "I will assist in preparing the operating room for the patient." b. "I will remain gloved while performing activities in the sterile field." c. "I will assist with suturing of incisions and maintaining hemostasis as needed." d. "I must don full surgical attire and sterile gloves while obtaining items from the unsterile field."

ANS: A Preparing the operating room for the patient describes the role of a circulating nurse. All other answer options describe specific types of scrub nurses. The circulating nurse performs activities in the unsterile field and is not scrubbed, gowned, or gloved. The scrub nurse follows the designated scrub procedure, is gowned and gloved in sterile attire, and performs activities in the sterile field

A patient scheduled to undergo total knee replacement surgery under general anesthesia asks the nurse, "Will the doctor put me to sleep with a mask over my face?" Which response by the nurse is most appropriate? a. "A drug may be given to you through your IV line first. I will check with the anesthesia care provider." b. "Only your surgeon can tell you for sure what method of anesthesia will be used. Should I ask your surgeon?" c. "General anesthesia is now given by injecting medication into your veins, so you will not need a mask over your face." d. "Masks are not used anymore for anesthesia. A tube will be inserted into your throat to deliver a gas that will put you to sleep."

ANS: A Routine general anesthesia is usually induced by the IV route with a hypnotic, anxiolytic, or dissociative agent. However, general anesthesia may be induced by IV or by inhalation. The nurse should consult with the anesthesia care provider to determine the method selected for this patient. The anesthesia care provider will select the method of anesthesia, not the surgeon. Inhalation agents may be given through an endotracheal tube or a laryngeal mask airway

Which action included in the perioperative patient plan of care can the charge nurse delegate to a surgical technologist? a. Pass sterile instruments and supplies to the surgeon. b. Teach the patient about what to expect in the operating room (OR). c. Continuously monitor and interpret the patient's echocardiogram (ECG) during surgery. d. Give the postoperative report to the postanesthesia care unit (PACU) nurse.

ANS: A The education and certification for a surgical technologist includes the scrub and circulating functions in the OR. Patient teaching, communication with other departments about a patient's condition, and the admission assessment require registered-nurse (RN) level education and scope of practice. A surgical technologist is not usually trained to interpret ECG rhythms

Which action best describes the role of the certified registered nurse anesthetist (CRNA) on the surgical care team? a. Performs the same responsibilities as the anesthesiologist. b. Releases or discharges patients from the postanesthesia care area. c. Administers intraoperative anesthetics ordered by the anesthesiologist. d. Manages a patient's airway under the direct supervision of the anesthesiologist.

ANS: B A nurse anesthetist is a registered nurse who has graduated from an accredited nurse anesthesia program (minimally a master's degree program) and successfully completed a national certification examination to become a CRNA. The CRNA scope of practice includes, but is not limited to, the following: 1. Performing and documenting a preanesthetic assessment and evaluation 2. Developing and implementing a plan for delivering anesthesia 3. Selecting and initiating the planned anesthetic technique 4. Selecting, obtaining, and administering the anesthesia, adjuvant drugs, and fluids 5. Selecting, applying, and inserting appropriate noninvasive and invasive monitoring devices 6. Managing a patient's airway and pulmonary status 7. Managing emergence and recovery from anesthesia 8. Releasing or discharging patients from a postanesthesia care area

Monitored anesthesia care (MAC) is going to be used for a closed, manual reduction of a dislocated shoulder. What action does the nurse anticipate? a. Securing an airtight fit for the inhalation mask b. Starting a 20-gauge IV in the patient's unaffected arm c. Obtaining a nonocclusive dressing to place over the administration site d. Teaching the patient about epidural patient-controlled anesthesia (PCA) use

ANS: B For MAC, IV sedatives, such as the benzodiazepines, are administered. Therefore the patient needs IV access. Inhaled, epidural, and topical agents are not included in MAC. An occlusive dressing would be placed over a topical agent such as eutectic mixture of local anesthetics (EMLA) cream

While in the holding area, a patient reveals to the nurse that his father had a high fever after surgery. What action by the nurse is a priority? a. Place a medical alert sticker on the front of the patient's chart. b. Alert the anesthesia care provider of the family member's reaction to surgery. c. Reassure the patient that there will be close monitoring during and after surgery. d. Administer 650 mg of acetaminophen (Tylenol) per rectum as a preventive measure.

ANS: B The anesthesia care provider (ACP) needs to be notified and made aware of the patient's family history in regards to anesthesia reactions. Malignant hyperthermia (MH) is a valid concern because the patient's father appears to have had a reaction to surgery. The ACP needs to be notified immediately, rather than waiting for a sticker to be noticed on the chart. Administering acetaminophen may not prevent MH. General anesthesia can be administered to patients with MH as long as precautions to avoid MH are taken and preparations are made to treat MH if it does occur

Which data identified during the perioperative assessment alert the nurse that special protection techniques should be implemented during surgery? a. Stated allergy to cats and dogs b. History of spinal and hip arthritis c. Verbalization of anxiety by the patient d. Having a sip of water 3 hours previously

ANS: B The patient with arthritis may require special positioning to avoid injury and postoperative discomfort. Preoperative anxiety (unless severe) and having a sip of water 3 hours before surgery are not contraindications to having surgery. An allergy to cats and dogs will not impact the care needed during the intraoperative phase

Which nursing action should the operating room (OR) nurse manager delegate to the registered nurse first assistant (RNFA) when caring for a surgical patient? a. Adjust the doses of administered anesthetics. b. Make surgical incision and suture incisions as needed. c. Coordinate transfer of the patient to the operating table. d. Provide postoperative teaching about coughing to the patient.

ANS: B The role of the RNFA includes skills such as making and suturing incisions and maintaining hemostasis. The other actions should be delegated to other staff members such as the circulating nurse, scrub nurse, or surgical technician. The anesthesia care provider should adjust the doses of anesthetics for patients, not the RNFA.

A patient is being prepared for a spinal fusion. While in the holding area, which action by a member of the surgical team requires rapid intervention by the charge nurse? a. Wearing street clothes into the nursing station b. Wearing a surgical mask into the holding room c. Walking into the hallway outside an operating room without the hair covered d. Putting on a surgical mask, cap, and scrubs before entering the operating room

ANS: C The corridors outside the operating room (OR) are part of the semirestricted area where personnel must wear surgical attire and head coverings. Surgical masks may be worn in the holding room, although they are not necessary. Street clothes may be worn at the nursing station, which is part of the unrestricted area. Wearing a mask and scrubs is essential when going into the OR

A patient in surgery receives a neuromuscular blocking agent as an adjunct to general anesthesia. While in the postanesthesia care unit (PACU), what assessment finding is most important for the nurse to report? a. Laryngospasm b. Complaint of nausea c. Weak chest wall movement d. Patient unable to recall the correct date

ANS: C The most serious adverse effect of the neuromuscular blocking agents is weakness of the respiratory muscles, which can lead to postoperative hypoxemia. Nausea and confusion are possible adverse effects of these drugs, but they are not as great of concern as respiratory depression. Because these medications decrease muscle contraction, laryngospasm is not a concern

Which action most effectively demonstrates that a new staff member understands the role of scrub nurse? a. Documents all patient care accurately b. Labels all specimens to send to the lab c. Keeps both hands above the operating table level d. Takes the patient to the postanesthesia recovery area

ANS: C The scrub nurse role includes maintaining asepsis in the operating field. The other actions would be performed by the circulating nurse.

The nurse educator facilitates student clinical experiences in the surgical suite. Which action, if performed by a student, would require the nurse educator to intervene? a. The student wears a mask at the sink area. b. The student wears street clothes in the unrestricted area. c. The student wears surgical scrubs in the semirestricted area. d. The student covers head and facial hair in the semirestricted area.

ANS: C The surgical suite is divided into three distinct areas: unrestricted—staff and others in street clothes can interact with those in surgical attire; semirestricted—staff must wear surgical attire and cover all head and facial hair; restricted—includes the operating room, the sink area, and clean core where masks are required in addition to surgical attire

Which actions will the nurse include in the surgical time-out procedure before surgery (select all that apply)? a. Check for placement of IV lines. b. Have the surgeon identify the patient. c. Have the patient state name and date of birth. d. Verify the patient identification band number. e. Ask the patient to state the surgical procedure. f. Confirm the hospital chart identification number.

ANS: C, D, E, F These actions are included in surgical time out. IV line placement and identification of the patient by the surgeon are not included in the surgical time-out procedure

Which action will the nurse take immediately after surgery for a patient who received ketamine (Ketalar) as an anesthetic agent? a. Administer higher doses of analgesic agents. b. Ensure that atropine is available in case of bradycardia. c. Question the order for benzodiazepines to be administered. d. Provide a quiet environment in the postanesthesia care unit.

ANS: D Hallucinations are an adverse effect associated with the dissociative anesthetics such as ketamine. Therefore the postoperative environment should be kept quiet to decrease the risk of hallucinations. Because ketamine causes profound analgesia lasting into the postoperative period, higher doses of analgesics are not needed. Ketamine causes an increase in heart rate. Benzodiazepine may be used with ketamine to decrease the incidence of hallucinations and nightmares

A patient received inhalation anesthesia during surgery. Postoperatively the nurse should monitor the patient for which complication? a. Tachypnea b. Myoclonus c. Hypertension d. Laryngospasm

ANS: D Possible complications of inhalation anesthetics include coughing, laryngospasm, and increased secretions. Hypertension and tachypnea are not associated with general anesthetics. Myoclonus may occur with nonbarbiturate hypnotics but not with the inhalation agents

When caring for a patient who has received a general anesthetic, the circulating nurse notes red, raised wheals on the patient's arms. Which action should the nurse take immediately? a. Apply lotion to the affected areas. b. Cover the arms with sterile drapes. c. Recheck the patient's arms in 30 minutes. d. Notify the anesthesia care practitioner (ACP) immediately.

ANS: D The presence of wheals indicates a possible allergic or anaphylactic reaction, which may have been caused by latex or by medications administered as part of general anesthesia. Because general anesthesia may mask anaphylaxis, the nurse should report this to the ACP. The other actions are not appropriate at this time.

Which action best describes how the scrub nurse maintains aseptic technique during surgery? a. Uses waterproof shoe covers b. Wears personal protective equipment c. Insists that all operating room (OR) staff perform a surgical scrub d. Changes gloves after touching the upper arm of the surgeon's gown

ANS: D The sleeves of a sterile surgical gown are considered sterile only to 2 inches above the elbows, so touching the surgeon's upper arm would contaminate the nurse's gloves. Shoe covers are not sterile. Personal protective equipment is designed to protect caregivers, not the patient, and is not part of aseptic technique. Staff members such as the circulating nurse do not have to perform a surgical scrub before entering the OR