Chapter 15: Intraoperative Nursing Management

The circulating nurse is unsure whether proper technique was followed when an object was placed in the sterile field during a surgical procedure. What is the best action by the nurse?

Remove the entire sterile field from use.

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."

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 about possible ill effects from general anesthesia. What is the best response by the nurse?

"Some possible negative effects include difficulty waking up and slow heart rate."

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."

A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate?

"You will be lying on your side with your knees to your chest."

The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate?

Allow unnecessary personnel to enter the OR environment.

A client undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The client is ready for rewarming procedures. Which action by the nurse is appropriate?

Apply a warm air blanket, gradually increasing body temperature.

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?

Cardiovascular system

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

A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:

Continuously monitors the sedated client.

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

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)

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?

Decreased lean tissue mass

The nurse recognizes that the older adult is at risk for surgical complications due to:

Decreased renal function

A client has been administered ketamine for moderate sedation. What is the priority nursing intervention?

Frequently monitoring vital signs

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 perioperative nurse has completed the presurgical assessment of an 82-year-old female client who is scheduled for a left total knee replacement. When planning this client's care, the nurse should address the consequences of the client's aging cardiovascular system. These include an increased risk of which of the following?

Hypervolemia

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

Which stage of surgical anesthesia is also known as excitement?

II

Which stage of anesthesia is referred to as surgical anesthesia?

III

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.

A patient is complaining of a headache after receiving spinal anesthesia. What does the nurse understand may be the cause of the headache related to the spinal anesthesia? (Select all that apply.)

Leakage of spinal fluid from the subarachnoid space Size of the spinal needle used Degree of patient hydration

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

Lies quietly on the table

Which position is used for perineal surgical procedures?

Lithotomy

The nurse understands that the purpose of the "time out" is to:

Maintain the safety of the client.

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication?

Malignant hyperthermia

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.

Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care:

May result in the administration of general anesthesia.

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?

N95 respiratory mask

What is the priority action when the circulating nurse is completing a second verification of the surgical procedure and surgical site?

Obtain the attention of all members of the surgical team.

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 list of commonly used medications for a particular surgical procedure is provided to the nurse. The anesthesiologist announces the administration of a nondepolarizing muscle relaxant. Which medication should the nurse document as having been administered?

Pancuronium

Which conduction block anesthetizes the nerves supplying the chest, abdominal wall, and extremities?

Paravertebral anesthesia

An intravenous anesthetic that, in large doses, has a powerful respiratory depressant effect sufficient to cause apnea and cardiovascular depression is:

Pentothal

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

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 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 their side.

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?

Scrub nurse

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

Which of the following techniques least exhibits surgical asepsis?

Suctioning the nasopharyngeal cavity of a client

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

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.

Which of the following is an inappropriate nursing action by the surgical nurse

Wearing sterile gloves over artificial nails

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?

Verify consent.

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