Intraoperative Care and Anesthesia Evolve

A patient is scheduled for a surgery that will be performed under epidural anesthesia. When reviewing the patient's medical record, the nurse notes a surgical history of postoperative immobility following epidural anesthesia. To prevent the postoperative complication, the nurse expects what revision to the anesthesia plan?

A decrease in the dose of the epidural anesthesia

The circulating nurse is observing the area around the patient for continuity of sterility. What event observed by the nurse requires immediate intervention?

A glove contacts the leg of the table that supports the sterile field.

An anesthesia care provider gives a regional block to a patient. The patient was administered ranitidine and metoclopramide IV preoperatively. While receiving the lidocaine injection for the block, the patient's blood pressure drops, and the patient experiences a seizure. The nurse recognizes that the probable cause of the patient's response is what?

Accidental vascular injury

A nurse is preparing a patient for an appendectomy. Shortly after the patient receives fentanyl for anesthesia, the patient experiences severe respiratory depression. What should be the next primary action?

Administer naloxone to the patient.

The anesthesia care provider administers isoflurane and succinylcholine for induction. The nurse observes muscle rigidity in the front and back of the patient's thighs, a heart rate of 130 beats/minute, and skin that feels extremely hot. Which intervention is the priority in this scenario?

Administering dantrolene

An asthmatic patient underwent a splenectomy. During surgery, the patient is administered ketamine as an anesthetic, with ranitidine. Postoperatively, the patient's family members report that the patient is behaving strangely and talking to people who are not present. The patient has a history of depression. The nurse suspects that what is the most probable reason for this behavior?

Administration of ketamine

A patient was administered propofol, ranitidine, and metoclopramide during a tubal ligation. Postoperatively, the nurse assesses the patient's blood pressure is 80/50 mm Hg. What does the nurse correlate with the present blood pressure?

Administration of propofol

The nurse observes a new graduate nurse wearing protective attire when working in the operating room for surgery. The nurse should intervene when the new graduate performs what action?

After surgery, removes the gown before removing the gloves

The circulating nurse is preparing the surgical team for a time out. Which activities should the circulating nurse perform during this time?

Ask the patient to confirm name and date of birth. Compare the hospital identity (ID) number with the patient's own ID band. Ask the patient to confirm the operative procedure and site and to give consent.

A nurse educator discusses career options with a group of nursing students and describes the intraoperative activities of the perioperative nurses. What are the duties of a scrub nurse?

Assist in the draping procedure. Assist in preparing the operating room.

The perioperative nurse is assisting with the induction of anesthesia. What is an appropriate nursing action during the induction stage?

Assist with the application of monitors.

The nurse is caring for a patient receiving epidural anesthesia. The patient reports nausea. Upon assessment, the nurse notes a blood pressure of 80/60 mm Hg and a heart rate of 52. Which condition does the nurse expect the patient is experiencing?

Autonomic nervous system blockade

A patient is scheduled for a gastrectomy. After reviewing the medical reports, the nurse finds that the patient has bone marrow depression. What precaution should be taken with regard to using nitrous oxide as an anesthetic agent?

Avoid the administration of nitrous oxide.

The nurse is to administer ranitidine to a patient scheduled for a cholecystectomy. What would be the best time for the nurse to administer the drug?

Before surgery

A patient undergoing abdominal surgery requires a blood transfusion. Which nurse will inform the blood bank regarding the need for a blood transfusion?

Circulating nurse

Which member of the intraoperative team remains in the unsterile field?

Circulating nurse

A patient undergoing a surgical procedure with general anesthesia exhibits muscle rigidity, temperature of 103° F (39.4° C), pulse 100 beats per minute (beats/minute), and a respiratory rate of 26 breaths per minute. The symptoms subside with the administration of dantrolene. What should the nurse include in the patient's postoperative instructions?

Consider getting genetic testing for malignant hyperthermia.

A patient having an open reduction internal fixation (ORIF) of a left lower leg fracture will receive regional anesthesia during the procedure. Because the patient is prepared in the operating room, what should the nurse implement to maintain patient safety during surgery that is related directly to the type of anesthesia being used?

Ensure a smooth surface under the patient.

A patient is administered a benzodiazepine as an adjunct to general anesthesia. For what should the nurse monitor in this patient?

Hypotension Tachycardia

A patient is scheduled for laparoscopic cholecystectomy. When educating regarding the advantages of minimally invasive surgery over conventional surgery to the patient, what information should the nurse include?

Incisions are smaller. Blood loss is reduced. Postoperative pain is decreased.

A patient is about to have a surgical procedure with general anesthesia. What does the nurse anticipate will be the initial stage?

Induction is performed with an intravenous (IV) agent.

A patient is given dexamethasone to counteract emetic effects of morphine. The nurse should monitor for which medication side effects?

Insomnia Abdominal distention

When preparing for a surgical procedure for a patient, what intraoperative nursing responsibilities should be performed by the scrub nurse?

Keeping track of irrigation solutions for monitoring of blood loss Passing instruments and supplies to the health care provider by anticipating his or her needs Performing the count of sponges, needles, and instruments used during the surgical procedure

The nurse is caring for a patient who requires emergency surgery following a motor vehicle crash. Which anesthetic drug combination is most appropriate for this patient?

Ketamine and midazolam

The nurse is preparing to administer flumazenil to a patient having respiratory depression. What is the reason the nurse is administering this antidote?

Lorazepam overdose

A certified registered nurse anesthetist would be responsible for which functions related to surgery?

Managing a patient's airway and pulmonary status Selecting and initiating the planned anesthetic technique Monitoring the patient's emergence and recovery from the anesthesia

A nurse anesthetist is giving information about the different adjuncts to general anesthesia. To prevent respiratory depression caused by a drug interaction with midazolam, the nurse should avoid administering what medication?

Methadone

The nurse is preparing to administer medication to a patient during a minor surgical procedure. What type of anesthesia is the nurse able to administer without the presence of an anesthesia care provider?

Moderate sedation

The nurse is preparing the patient for a colonoscopy. Which type of anesthesia should the nurse expect to be used?

Monitored anesthesia care

The nurse is preparing in the role of circulator for a surgical procedure. What activities should the nurse prepare for?

Monitoring practices of aseptic technique in self and others. Maintaining accurate counts of sponges, needles, and instruments. Documenting intraoperative care.

A patient has been given spinal anesthesia for knee replacement surgery. The nurse should monitor the patient for which indicators of autonomic nervous system blockade?

Nausea Vomiting Bradycardia Hypotension

A patient being prepared for surgery asks if he or she will be given anything to help avoid nausea and vomiting postoperatively. Which medication does the nurse know can decrease the likelihood of nausea and vomiting?

Ondansetron

The circulating nurse is providing orientation to a group of nurses who are new to the perioperative setting. What should the nurse emphasize to the nurses that the role of the circulating nurse is?

Ongoing assessment of the patient during the surgical procedure

The nurse is preparing to prep the patient's skin for surgery. In which surgical area will the patient's skin be prepped for surgery and what clothing will the person doing the prepping be wearing?

Operating room, wearing surgical attire and masks

The circulating nurse is preparing the patient for a surgical procedure. Prior to beginning, what National Patient Safety Goal (NPSG) requirement is enacted with a surgical time-out?

Patient, surgical procedure, and site checked

In which phase of general anesthesia are H 2 blockers used?

Preinduction

The nurse is positioning a patient for laminectomy. Which position should the nurse place the patient in?

Prone

The nurse is caring for a patient postoperatively after major abdominal trauma sustained during a motor vehicle crash. The patient begins to pick at the air and asks the nurse why there are so many bugs in the room. Which nursing actions are a priority at this time?

Provide a calm, quiet environment. Obtain an order for a benzodiazepine. Monitor the patient for increased heart rate and blood pressure.

The nurse is administering midazolam to a patient during a closed reduction of a shoulder. What outcome does the nurse anticipate achieving from the administration of the medication?

Provided conscious sedation

The perioperative nurse is explaining legal considerations regarding surgical team performance. The nurse tells the team that to whom or what does the surgical technologist need access at all times?

Registered Nurse (RN).

The nurse is preparing to admit a patient to the operating room. According to the National Patient Safety Goals, what documents must be in the chart prior to the surgery beginning?

Signed consent form A H&P report

An older adult patient is scheduled to have a hip replacement. Of what risk areas will the nurse especially need to be aware for this patient during surgery?

Skin integrity

The anesthesia care provider is preparing to administer spinal anesthesia. When assisting with the procedure, where does the nurse determine the anesthetic injection will be administered?

Subarachnoid space

The nurse is providing orientation to new surgical staff employees. What does the nurse inform the employee that proper attire for the restricted area of the surgery department would include?

Surgical attire, head cover, and mask

An older adult patient is admitted to the hospital for hip replacement surgery. What special considerations should be followed during the surgery to prevent complications?

Take greater care in preparing and positioning the patient. Maintain clear and concise communication with the patient. Use warming devices to prevent perioperative hypothermia.

A patient with diabetes is admitted for a prostatectomy. The patient will receive an antibiotic 60 minutes prior to the surgery, their usual dose of insulin, and etomidate IV for anesthesia. Considering the patient's diabetes, the nurse expects that which component of the preoperative plan will be revised?

The dosage of insulin used to regulate the patient's glucose levels

A patient scheduled for surgery asks the nurse where their family can be in the surgical suite. What is the best response by the nurse?

The family can be with the patient in the preoperative holding area.

A patient is having general anesthesia, and the anesthesia care provider administers succinylcholine. The patient begins exhibiting signs of malignant hyperthermia. What indication does the surgical team have that this is occurring?

The patient is experiencing muscle rigidity.

The nurse is caring for a patient undergoing surgery for a below-the-knee amputation. What is critical to the patient's safety before and during the procedure?

The patient's allergies are conveyed to the surgical team. The surgeon marks the surgical site with the patient's involvement. The surgical team confirms the patient's identity before anesthesia is administered.

A nurse is providing immediate postoperative care for a patient who has undergone a thymectomy. What is the primary reason the anesthesia care provider prescribes naloxone for the nurse to administer postoperatively?

To reverse opioid-induced respiratory depression

A circulating nurse is preparing to scrub the skin of a patient who is scheduled for an appendectomy. What technique is appropriate for the nurse to use to ensure proper cleansing?

Use a circular motion from the site of the incision to the area distal to the incision.

To ensure patient safety and reduce risks associated with surgical procedures, the circulating nurse calls a surgical timeout prior to surgery. Which activities should be included in the timeout?

Verify patient identification. Complete a fire risk assessment. Verify surgical site and procedure. Ensure that consent for the specific procedure was obtained.

The circulating nurse observes the scrub nurse washing hands prior to a surgical procedure and sees that the scrub nurse washes the fingers and hands before scrubbing the forearms and elbows, and then hands are placed lower than the level of the elbows. What should the circulator state to the scrub nurse?

"You should have held your hands above the level of your elbows."