Chapter 18: 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.
Which would be included as a responsibility of the scrub nurse?
Handing instruments to the surgeon and assistants
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.
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."
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."
Which statement by the client indicates further teaching about epidural anesthesia is necessary?
"I will become unconscious."
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 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 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 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
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
As a circulating nurse, what task are you solely responsible for?
Keeping records.
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.
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
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
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 nurse recognizes older adults require lower doses of anesthetic agents due to:
decreased lean tissue mass.
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 that the older adult is at risk for surgical complications due to:
decreased renal function
Hypothermia may occur as a result of
open body wounds.
The nurse recognizes the client has reached stage III of general anesthesia when the client:
lies quietly on the table
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
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
Which of the following is an inappropriate nursing action by the surgical nurse?
Wearing sterile gloves over artificial nails
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.
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
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
Fentanyl is categorized as which type of intravenous anesthetic agent?
Opioid
The surgical client is at risk for injury related to positioning. Which of the following clinical manifestations exhibited by the client would indicate the goal was met of avoiding injury?
Peripheral pulses palpable
The client received ketamine during a surgical procedure. What intervention by the nurse will assist with an optimal recovery period?
Place the client in a darkened, quiet part of the recovery area.
The scrub nurse is responsible for:
Preparing the sterile instruments for the surgical procedure
A patient who has received general anesthesia has reached stage II. Which of the following would the nurse expect the patient to exhibit?
Pupillary dilation and rapid pulse
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 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
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
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 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 client is having a surgical procedure that requires the client to be in the prone position. What is an expected client outcome?
The client remains free of perioperative positioning injury.
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.