Ch. 18-Intraoperative Nursing Management – Flashcards
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Which of the following characteristics should the nurse include when teaching the client about moderate sedation?
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Ability to respond to verbal commands
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Which statement by the client indicates further teaching about epidural anesthesia is necessary?
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"I will become unconscious."
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The nurse recognizes older adults require lower doses of anesthetic agents due to:
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decreased lean tissue mass.
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The circulating nurse must be vigilant in monitoring the surgical environment. Which of the following actions by the nurse is inappropriate?
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Allow unnecessary personnel to enter the OR environment
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As a circulating nurse, what task are you solely responsible for?
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Keeping records
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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?
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Decreased lean tissue mass
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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?
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Surgeon
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Which of the following is often the earliest sign of malignant hyperthermia?
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Tachycardia
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You are working in the preoperative area with a client going to surgery for a cholecystectomy. The client has histamine2-receptor antagonists ordered preoperatively. The client asks you why these medications are needed. What would be your best answer?
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"These medications decrease gastric acidity and volume."
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A patient is undergoing a perineal surgical procedure. Which of the following actions by the nurse is appropriate?
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Place the patient in lithotomy position.
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A 78-year-old woman is undergoing right hip surgery to repair a hip fracture. What nursing action is appropriate during the intraoperative phase?
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Appropriately position the patient using adequate padding and support.
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What is the priority action when the circulating nurse is completing a second verification of the surgical procedure and surgical site?
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Obtain the attention of all members of the surgical team
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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?
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Cardiovascular system
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The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response?
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"The anesthetic may last for 3 hours."
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A patient is scheduled to have a heart valve replacement with a porcine valve. Which patient does the nurse understand may refuse the use of any porcine-based product?
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A patient of Jewish faith
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How would the operating room nurse place a patient in the Trendelenburg position?
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On his back with his head lowered so that the plane of his body meets the horizontal on an angle
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What medication should the nurse prepare to administer in the event the patient has malignant hyperthermia?
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Dantrolene sodium (Dantrium)
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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.
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Stage II: excitement
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An OR nurse needs to assist a patient to the Trendelenburg position. Which of the following is the correct position?
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On his back, with his head lowered, so that the plane of his body meets the horizontal on an angle
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The nurse caring for a patient who is at risk for malignant hyperthermia subsequent to general anesthesia would assess for the most common early sign of:
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Tachycardia (HR >150 bpm)
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Fentanyl (Sublimaze) is categorized as which type of intravenous anesthetic agent?
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Opioid
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Which stage of surgical anesthesia is also known as excitement?
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II
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The nurse positions the client in the lithotomy position in preparation for:
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Perineal surgery
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The scrub nurse is responsible for:
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Preparing the sterile instruments for the surgical procedure
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A patient is to receive general anesthesia with sevoflurane. The nurse anticipates the need for which of the following?
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Oxygen
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Which of the following consequences may result if tranquilizers are withdrawn suddenly?
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Seizures
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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?
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Temperature of 102.5° F
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A patient is undergoing a lumbar puncture. The nurse educates the patient about surgical positioning. Which of the following statements by the nurse is appropriate?
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"You will be lying on your side with your knees to your chest."
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The anesthesiologist administered a transsacral conduction block. Which of the following documentation by the nurse is consistent with the anesthesia being administered?
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Denies sensation to perineum and lower abdomen
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The nurse is caring for a patient who is at risk for malignant hyperthermia subsequent to general anesthesia. What is the most common early sign that the nurse should assess for?
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Tachycardia
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A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse bases her next action on the principle that:
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it may be necessary to raise the head of this client's bed.
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Which of the following clinical manifestations is often the earliest sign of malignant hyperthermia?
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Tachycardia (heart rate above 150 beats per minute)
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Which of the following actions by the nurse is appropriate?
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Discarding an object that comes in contact with the 1-inch border
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Which of the following is an inappropriate nursing action by the surgical nurse?
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Wearing sterile gloves over artificial nails
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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?
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Halothane
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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?
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Circulating nurse
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A patient has received general anesthesia and is progressing through the stages. Using the manifestations below, place them in the proper sequence from stage I to stage IV.
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Ringing in the ears Pupil dilation Unconsciousness Shallow respirations
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During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which of the following complications?
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Malignant hyperthermia
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A patient is undergoing general anesthesia. The nurse anesthetist starts to administer the anesthesia. The patient starts giggling and kicking her legs. What stage of anesthesia would the nurse document related to the findings?
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II
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A patient is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?
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Verify consent.
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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?
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"Remain supine for the time specified by the physician."
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Which stage of anesthesia is termed surgical anesthesia?
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III
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Which of the following would be included as a responsibility of the scrub nurse?
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Handing instruments to the surgeon and assistants
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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?
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Stage IV
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A patient develops malignant hyperthermia. Which of the following most likely would be the first indicator of this complication?
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Heart rate over 150 beats per minute
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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?
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Risk for perioperative positioning injury related to operative position
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A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse?
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Report the infection to an immediate supervisor
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What action during a surgical procedure requires immediate intervention by the circulating nurse?
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The scrub nurse calling the blood bank to obtain blood products
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A patient has been administered ketamine (Ketalar) for moderate sedation. What is the priority nursing intervention?
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Frequent monitoring of vital signs
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The anesthesiologist is administering a stable and safe nondepolarizing muscle relaxant. What medication does the nurse anticipate will be administered?
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Pavulon (pancuronium bromide)
