intraoperative chapter 19 – Flashcards
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The anesthesiologist will use moderate (conscious) sedation during the client's surgical procedure. The circulating nurse will expect the client to:
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Respond verbally during the 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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A patient begins to vomit during surgery. Place the actions below in the order in which they would be performed.
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Turn the patient to the side. Lower the head of the surgical table. Provide a basin for collection. Suction to remove saliva.
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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?
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Apply a warm air blanket, gradually increasing body temperature.
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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) Anesthesia and surgery should be postponed. However, if end-tidal carbon dioxide (CO2) monitoring and dantrolene sodium (Dantrium) are available and the anesthesiologist is experienced in managing malignant hyperthermia, the surgery may continue using a different anesthetic agent (Barash et al., 2009).
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In developing the plan of care for the intraoperative client, the nurse recognizes that it is essential to consider:
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the client's cultural beliefs
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A client is undergoing a perineal surgical procedure. The nurse should place the client in which position?
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Lithotomy
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The physician requests lidocaine 2% with epinephrine for use in local infiltration anesthesia. What does the nurse understand is the purpose of adding epinephrine to the lidocaine?
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-The epinephrine causes vasoconstriction -The epinephrine prevents rapid absorption of the anesthetic drug. -The epinephrine prolongs the local action of the anesthetic agent.
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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 patient is having a surgical procedure that requires the patient to be in the prone position. What is an expected patient outcome?
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The patient remains free of perioperative positioning injury
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A client is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid) block during surgery. In the operating room, the nurse positions the client according to the anesthesiologist's instructions. Why does the client require special positioning for this type of anesthesia?
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To prevent cerebrospinal fluid (CSF) leakage
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Hypothermia may occur as a result of
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open body wounds
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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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When developing a teaching plan for a patient scheduled for ambulatory surgery with epidural anesthesia, which of the following would the nurse include?
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"You shouldn't experience a headache after this type of anesthesia."
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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 is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching?
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headache
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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?
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"I'll be sleepy but able to respond to your questions."
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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 anesthesiologist administered a transsacral conduction block. Which 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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A 78-year-old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase?
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Appropriately position the client using adequate padding and support.
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The nurse understands that the purpose of the "time out" is to:
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maintain the safety of the clien
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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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The nurse is 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 the nurse why these medications are needed. What would be the nurse's best answer?
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"These medications decrease gastric acidity and volume."
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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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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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A client requires minor surgery for removal of a basal cell tumor. The anesthesiologist administers the anesthetic ketamine hydrochloride (Ketalar), 60 g I.V. After ketamine administration, the nurse should monitor the client for:
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hallucinations and respiratory depression
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Which stage of surgical anesthesia is also known as excitement?
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II
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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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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?
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The edges of a sterile package, once opened, are considered unsterile.
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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?
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Inform the resident that all communication needs to remain professional.
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Which position is used for perineal surgical procedures?
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Lithotomy
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Which of the following techniques least exhibits surgical asepsis?
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Suctioning the nasopharyngeal cavity of a client
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The scrub nurse is responsible for:
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Preparing the sterile instruments for the surgical procedure Explanation: The scrub role includes performing a surgical hand scrub, setting up the sterile tables, and preparing sutures, ligatures, and special equipment. The circulating nurse manages the operating room and protects patient safety. The registered nurse first assistant functions under the direct supervision of the surgeon. Responsibilities may include handling tissue, providing exposure of the operative field, suturing, and maintaining hemostasis. The anesthetist administers the anesthetic medications.
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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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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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The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:
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Circulating nurse
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A nurse is working as part of the surgical team in the semi-restricted area. Which of the following would be appropriate to wear? Select all that apply.
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Scrub clothes and caps
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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 client 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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Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery?
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Sims position
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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 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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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?
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Mask is placed over nose and extends to bottom lip.
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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 clinical manifestation is often the earliest sign of malignant hyperthermia?
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Tachycardia (heart rate >150 beats per minute)
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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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During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication?
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malignant hyperthermia
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A patient who has received general anesthesia has reached stage II. Which of the following would the nurse expect the patient to exhibit?
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Pupillary dilation and rapid pulse
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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 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?
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II
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A client has been administered ketamine for moderate sedation. What is the priority nursing intervention?
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Frequently monitoring vital signs
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The nurse is aware that loss of consciousness occurs with which type of anesthesia?
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general
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During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer:
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dantrolene sodium (Dantrium)
