Chapter 18

Which statement by the client indicates further teaching about epidural anesthesia is necessary?

"I will become unconscious."

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 how an inhalant general anesthetic is expelled by the body. What is the best response by the nurse?

"The lungs primarily eliminate the 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."

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

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:

Circulating nurse

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

The nurse is aware that loss of consciousness occurs with which type of anesthesia?

General

The operating nurse is caring for a patient who is receiving general anesthesia. Organize the nursing interventions in chronological order of the stages of general anesthesia, beginning with Stage I (1) and ending with Stage IV (4).

Keep discussions about the client to a minimum. Avoid auditory and physical stimuli. Place client into operative position. Prepare for and assist in treatment of cardiac and/or respiratory arrest.

As a circulating nurse, what task are you solely responsible for?

Keeping records.

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

Lithotomy

Which position is used for perineal surgical procedures?

Lithotomy

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.

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

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

An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position?

On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle

Fentanyl is categorized as which type of intravenous anesthetic agent?

Opioid

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

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

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

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.

Stage II: excitement

The client vomits during the surgical procedure. The best action by the nurse is:

Suction the client to remove saliva and gastric secretions.

Which of the following techniques least exhibits surgical asepsis?

Suctioning the nasopharyngeal cavity of a client

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.

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

Verify consent.

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)

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

lies quietly on the table

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

oxygen

Which stage of anesthesia is referred to as surgical anesthesia?

III

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

Wearing sterile gloves over artificial nails

A postoperative client returns to a surgical nursing unit. The nurse assesses the client and notes tachycardia and muscle rigidity. What is the most important nursing action?

administering supplemental oxygen

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

decreased renal function

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."

A nurse is teaching a client who is at risk for malignant hyperthermia subsequent to general anesthesia. What should the nurse include in the teaching?

"The surgical team is aware of the risk, so the team is prepared."

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.

The nurse is aware that infection is a potential complication of surgery. Which intervention should the nurse implement to prevent infection? Select all that apply.

Avoid touching sterile items unless necessary. Alert the surgical team of any breaches of sterile technique. Wear a long-sleeved, sterile gown and gloves.

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 anesthesiologist administered a transsacral conduction block. Which documentation by the nurse is consistent with the anesthesia being administered?

Denies sensation to perineum and lower abdomen

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

Which would be included as a responsibility of the scrub nurse?

Handing instruments to the surgeon and assistants

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

The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in?

Lithotomy position

A nurse is monitoring a client recovering from moderate sedation that was administered during a colonoscopy. Which finding requires the nurse's immediate attention?

Oxygen saturation (SaO2) of 85%

A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first?

Roll the client onto his or her 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

A nurse who is part of the surgical team is involved in setting up the sterile tables. The nurse is functioning in which role?

Scrub role

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

Hypothermia may occur as a result of

open body wounds.

The nurse would intervene when making which of the following observations in the surgical environment?

A staff member dressed in street clothes enters the semirestricted zone.

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

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 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

Which clinical manifestation is often the earliest sign of malignant hyperthermia?

Tachycardia (heart rate >150 beats per minute)

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?

Temperature of 102.5°F (39°C)

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

The Sims' or lateral position as shown in Option D would be used for renal surgery.

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.