NUR 340: Prep U (Chapter 18: Intraoperative Nursing Management)

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse? A. Verify consent. B. Document the start of surgery. C. Acquire ordered blood products. D. Count sponges and syringes.

A

A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first? A. Roll the client onto his or her side. B. Suction the mouth. C. Provide a basin. D. Administer an antiemetic medication.

A

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. Surgeon B. Circulating nurse C. Scrub nurse D. Anesthetist

A

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? A. The edges of a sterile package, once opened, are considered unsterile. B. A distance of 3 feet must be maintained when moving around a sterile field. C. If a tear occurs in a sterile drape, a new sterile drape is applied on top of it. D. Circulating nurses may come in contact with the sterile field without contaminating it.

A

A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse? A. Report the infection to an immediate supervisor. B. Ensure the infection is covered with a dressing. C. Return to work after taking antibiotics for 24 hours. D. Request a role change to circulating nurse.

A

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication? A. malignant hyperthermia B. hypothermia C. infection D. fluid volume excess

A

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 for perioperative positioning injury related to positioning in the OR B. Risk of latex allergy response related to possible exposure in the OR environment C. Disturbed sensory perception related to the effects of general anesthesia D. Anxiety related to ineffective coping with surgical concerns

A

When developing a teaching plan for a patient scheduled for ambulatory surgery with epidural anesthesia, which of the following would the nurse include? A. "You shouldn't experience a headache after this type of anesthesia." B. "Normally, the blood pressure drops fairly low initially." C. "The anesthetic is introduced directly into the spinal cord." D. "You won't be able to move, but you'll be able to feel sensations."

A

Which clinical manifestation is often the earliest sign of malignant hyperthermia? A. Tachycardia (heart rate >150 beats per minute) B. Hypotension C. Elevated temperature D. Oliguria

A

Which position should the patient undergoing pelvis surgery be positioned? A. Trendelenburg B. Lithotomy C. Sim's D. Reverse Trendelenburg

A

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? A. Cardiovascular system B. Endocrine system C. Gastrointestinal system D. Genitourinary system

A Depolarizing muscle relaxants can cause cardiac dysrhythmias.

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? A. Halothane B. Fentanyl C. Succinylcholine D. Propofol

A Halothane is an example of an inhalation anesthetic. Fentanyl, succinylcholine, and propofol are commonly used intravenous agents for anesthesia.

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? A. Circulating nurse B. Scrub nurse C. Surgeon D. Registered nurse first assistant

A 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.

As a circulating nurse, what task are you solely responsible for? A. Keeping records. B. Estimating the client's blood loss. C. Handing instruments to the surgeon. D. Counting sponges and needles.

A The circulating nurse wears OR attire but not a sterile gown. Responsibilities include obtaining and opening wrapped sterile equipment and supplies before and during surgery, keeping records, adjusting lights, receiving specimens for laboratory examination, and coordinating activities of other personnel, such as the pathologist and radiology technician. It is the responsibility of the scrub nurse to hand instruments to the surgeon and count sponges and needles. It is the responsibility of the surgeon to estimate blood loss.

A client is undergoing a perineal surgical procedure. The nurse should place the client in which position? A. Lithotomy B. Trendelenburg C. Sims D. Dorsal recumbent

A 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.

The nurse recognizes the client has reached stage III of general anesthesia when the client: A. lies quietly on the table B. displays agitation due to noise C. shouts, talks, or sings D. exhibits shallow respirations and a weak, thready pulse

A 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.

A 55-year-old patient arrives at the operating room. The nurse is reviewing the medical record and notes that the patient has a history of osteoporosis in her lower back and hips. The patient is scheduled to receive epidural anesthesia. Which of the following nursing diagnoses would be a priority for this patient? A. Risk for injury related to effects of anesthetic agents B. Risk for perioperative positioning injury related to operative position C. Anxiety related to the surgical experience D. Disturbed sensory perception related to sedation

B

A client asks the nurse how an inhalant general anesthetic is expelled by the body. What is the best response by the nurse? A. "The kidneys will eliminate the inhalant with urination." B. "The lungs primarily eliminate the anesthesia." C. "The skin will eliminate the anesthesia through evaporation." D. "The liver will eliminate the inhalant anesthesia."

B

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? A. I B. II C. III D. IV

B

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 OR personnel responsible for maintaining the safety of the client and the surgical environment is the: A. Anesthesiologist B. Circulating nurse C. Scrub nurse D. Surgeon

B

The anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered? A. Unresponsive to verbal or tactile stimuli B. Denies sensation to perineum and lower abdomen C. Yelling and pulling at equipment D. No movement in right lower leg

B

The client vomits during the surgical procedure. The best action by the nurse is: A. Increase the IV infusion rate to compensate for lost fluids. B. Suction the client to remove saliva and gastric secretions. C. Lower the head of the operating table to promote circulation to the brain. D. Administer an anti-emetic to alleviate nausea.

B

Which stage of surgical anesthesia is also known as excitement? A. I B. II C. III D. IV

B 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.

During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer: A. verapamil (Isoptin) B. dantrolene sodium (Dantrium) C. potassium chloride D. an acetaminophen suppository

B The client is exhibiting clinical manifestations of malignant hyperthermia. Dantrolene sodium, a skeletal muscle relaxant, is administered.

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 I: beginning anesthesia B. Stage II: excitement C. Stage III: surgical anesthesia D. Stage IV: medullary depression

B 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.

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. Setting up the sterile tables D. Passing instruments

B 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.

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. Circulating nurse D. Anesthetist

B 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.

A client has been administered ketamine for moderate sedation. What is the priority nursing intervention? A. Assessing for hallucinations B. Frequently monitoring vital signs C. Administering oxygen D. Providing a quiet dark room for recovery

B Vital signs must be monitored frequently to assess for respiratory depression and to enable quick intervention. Oxygen may need to be administered if respiratory depression occurs; therefore, monitoring vital signs is a higher priority nursing intervention. Providing a dark quiet room is appropriate after the procedure is completed and the client is recovering. Hallucinations may occur as a side effect of the medication.

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? A. To prevent confusion B. To prevent seizures C. To prevent cerebrospinal fluid (CSF) leakage D. To prevent cardiac arrhythmias

C

The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate? A. Monitor for faulty electrical equipment. B. Alert personnel who break sterile technique. C. Allow unnecessary personnel to enter the OR environment. D. Maintain the positive pressure OR environment.

C

The nurse positions the client in the lithotomy position in preparation for A. Renal surgery B. Pelvic surgery C. Perineal surgery D. Abdominal surgery

C

Which of the following is an inappropriate nursing action by the surgical nurse? A. Covering the hair with a surgical cap B. Wearing a surgical jacket with knitted cuffs on the sleeves C. Wearing sterile gloves over artificial nails D. Changing shoe covers that become torn

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? A. Malignant hyperthermia occurs in the operating room only. B. A client can develop malignant hyperthermia only with intravenous anesthesia after surgery. C. The client can develop malignant hyperthermia up to 24 hours after surgery. D. The client will need to be discharged with special instructions.

C 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.

Which stage of anesthesia is referred to as surgical anesthesia? A. II B. I C. III D. IV

C Stage III may be maintained for hours with proper administration of the anesthetic. Stage I is beginning anesthesia, where the client breathes in the anesthetic mixture and experiences warmth, dizziness, and a feeling of detachment. Stage II is the excitement stage, which may be characterized by struggling, singing, laughing, or crying. Stage IV is a state of medullary depression and is reached when too much anesthesia has been administered.

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

C 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.

An instructor is developing for a class a teaching plan about agents used for intravenous (IV) anesthesia. Which of the following would the instructor include in this plan about these agents and this type of anesthesia? Select all that apply. A. Associated with more nausea B. Long duration of action C. More pleasant onset of anesthesia D. Ease of administration E. Need for little equipment

C, D, E With IV anesthesia, the onset is pleasant. Agents have a brief duration of action, and the patient awakens with little nausea and vomiting. The agents also are nonexplosive, require little equipment, and are easy to administer.

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. Hair is pulled back and covered by a cap. B. Scrub top and drawstring are tucked into pants. C. Shoe covers are used. D. Mask is placed over nose and extends to bottom lip.

D

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? A. Ignore the comment. B. Report the resident to the attending surgeon. C. Discuss concerns regarding the comments with the charge nurse. D. Inform the resident that all communication needs to remain professional.

D

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately? A. Pulse rate of 110 beats/min B. Respiratory rate of 18 breaths/min C. Blood pressure of 104/62 mm Hg D. Temperature of 102.5°F (39°C)

D

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? A. "Avoid drinking liquids until the gag reflex returns." B. "Avoid eating milk products for 24 hours." C. "Notify a nurse if you experience blood in your urine." D. "Remain supine for the time specified by the physician."

D

When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate? A. Considering the gown sterile from mid-thigh to neck B. Positioning the sterile drape on a table from back to front C. Allowing circulating nurses to contact sterile equipment D. Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff

D

Which nursing diagnosis should the nurse plan to address first in the client upon arrival in the intraoperative setting? A. Risk for perioperative positioning injury related to positioning in the OR B. Risk of latex allergy response related to possible exposure in the OR environment C. Disturbed sensory perception related to the effects of general anesthesia D. Anxiety related to ineffective coping with surgical concerns

D

Which of the following actions by the nurse is appropriate? A. Touching the edges of an open sterile package B. Touching sterile items with a clean-gloved hand C. Reaching over the sterile field D. Discarding an object that comes in contact with the 1-inch border

D The 1-inch border of a sterile field is considered unsterile.

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? A. Stage I B. Stage II C. Stage III D. Stage IV

D Stage IV: medullary depression is characterized by shallow respirations, a weak, thready pulse, dilated pupils that do not react to light, and cyanosis.

A patient is to undergo surgery on his kidney. The patient would be placed in which position for the surgery?

Sims or lateral position