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Hinkle Chapter 18: Intraoperative Nursing Management

Terms in this set (40)

The nurse is preparing an elderly patient for a scheduled removal of orthopedic hardware, a procedure to be performed under general anesthetic. For which adverse effect should the nurse most closely monitor the patient?
A) Hypothermia
B) Pulmonary edema
C) Cerebral ischemia
D) Arthritis
A
Feedback:
Inadvertent hypothermia may occur as a result of a low temperature in the OR, infusion of cold fluids,
inhalation of cold gases, open body wounds or cavities, decreased muscle activity, advanced age, or the
pharmaceutical agents used (e.g., vasodilators, phenothiazines, general anesthetics). The anesthetist
monitors for pulmonary edema and cerebral ischemia. Arthritis is not an adverse effect of surgical
anesthesia.
The OR nurse acts in the circulating role during a patients scheduled cesarean section. For what task is
this nurse solely responsible?
A) Performing documentation
B) Estimating the patients blood loss
C) Setting up the sterile tables
D) Keeping track of drains and sponges
A
Feedback:
Main responsibilities of the circulating nurse include verifying consent; coordinating the team; and
ensuring cleanliness, proper temperature and humidity, lighting, safe function of equipment, and the
availability of supplies and materials. The circulating nurse monitors aseptic practices to avoid breaks in
technique while coordinating the movement of related personnel as well as implementing fire safety
precautions. The circulating nurse also monitors the patient and documents specific activities throughout
the operation to ensure the patients safety and well-being. Estimating the patients blood loss is the
surgeons responsibility; setting up the sterile tables is the responsibility of the first scrub; and keeping
track of the drains and sponges is the joint responsibility of the circulating nurse and the scrub nurse.
A 21-year-old patient is positioned on the OR bed prior to knee surgery to correct a sports-related injury.
The anesthesiologist administers the appropriate anesthetic. The OR nurse should anticipate which of the
following events as the teams next step in the care of this patient?
A) Grounding
B) Making the first incision
C) Giving blood
D) Intubating
D
Feedback:
When the patient arrives in the OR, the anesthesiologist or anesthetist reassesses the patients physical
condition immediately prior to initiating anesthesia. The anesthetic is administered, and the patients
airway is maintained through an intranasal intubation, oral intubation, or a laryngeal mask airway.
Grounding or blood administration does not normally follow anesthetic administration immediately. An
incision would not be made prior to intubation.
A circulating nurse provides care in a surgical department that has multiple surgeries scheduled for the
day. The nurse should know to monitor which patient most closely during the intraoperative period
because of the increased risk for hypothermia?
A) A 74-year-old woman with a low body mass index
B) A 17-year-old boy with traumatic injuries
C) A 45-year-old woman having an abdominal hysterectomy
D) A 13-year-old girl undergoing craniofacial surgery
A
Feedback:
Elderly patients are at greatest risk during surgical procedures because they have an impaired ability to
increase their metabolic rate and impaired thermoregulatory mechanisms, which increase susceptibility to hypothermia. The other patients are likely at a lower risk.
The anesthetist is coming to the surgical admissions unit to see a patient prior to surgery scheduled for
tomorrow morning. Which of the following is the priority information that the nurse should provide to
the anesthetist during the visit?
A) Last bowel movement
B) Latex allergy
C) Number of pregnancies
D) Difficulty falling asleep
B
Feedback:
Due to the increased number of patients with latex allergies, it is essential to identify this allergy early on
so precautions can be taken in the OR. The anesthetist should be informed of any allergies. This is a
priority over pregnancy history, insomnia, or recent bowel function, though some of these may be
relevant.
An OR nurse is teaching a nursing student about the principles of surgical asepsis as a requirement in the
restricted zone of the operating suite. What personal protective equipment should the nurse wear at all
times in the restricted zone of the OR?
A) Reusable shoe covers
B) Mask covering the nose and mouth
C) Goggles
D) Gloves
B
Feedback:
Masks are worn at all times in the restricted zone of the OR. Shoe covers are worn one time only;
goggles and gloves are worn as required, but not necessarily at all times.
An OR nurse is participating in an interdisciplinary audit of infection control practices in the surgical
department. The nurse should know that a basic guideline for maintaining surgical asepsis is what?
A) Sterile surfaces or articles may touch other sterile surfaces.
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 361
B) Sterile supplies can be used on another patient if the packages are intact.
C) The outer lip of a sterile solution is considered sterile.
D) The scrub nurse may pour a sterile solution from a nonsterile bottle.
A
Feedback:
Basic guidelines for maintaining sterile technique include that sterile surfaces or articles may touch other
sterile surfaces only. The other options each constitute a break in sterile technique.
The surgical patient is a 35-year-old woman who has been administered general anesthesia. The nurse
recognizes that the patient is in stage II (the excitement stage) of anesthesia. Which intervention would
be most appropriate for the nurse to implement during this stage?
A) Rub the patients back.
B) Restrain the patient.
C) Encourage the patient to express feelings.
D) Stroke the patients hand.
B
Feedback:
In stage II, the patient may struggle, shout, or laugh. The movements of the patient may be uncontrolled,
so it is essential the nurse help to restrain the patient for safety. None of the other listed actions protects
the patients safety.
A patient waiting in the presurgical holding area asks the nurse, Why exactly do they have to put a
breathing tube into me? My surgery is on my knee. What is the best rationale for intubation during a
surgical procedure that the nurse should describe?
A) The tube provides an airway for ventilation.
B) The tube protects the patients esophagus from trauma.
C) The patient may receive an antiemetic through the tube.
D) The patients vital signs can be monitored with the tube.
A
Feedback:
The anesthetic is administered and the patients airway is maintained through an intranasal intubation,
oral intubation, or a laryngeal mask airway. The tube also helps protect aspiration of stomach contents.
The tube does not protect the esophagus. Because the tube goes into the lungs, no medications are given
through the tube. The patients vital signs are not monitored through the tube.
The circulating nurse in an outpatient surgery center is assessing a patient who is scheduled to receive
moderate sedation. What principle should guide the care of a patient receiving this form of anesthesia?
A) The patient must never be left unattended by the nurse.
B) The patient should begin a course of antiemetics the day before surgery.
C) The patient should be informed that he or she will remember most of the procedure.
D) The patient must be able to maintain his or her own airway.
A
Feedback:
The patient receiving moderate sedation should never be left unattended. The patients ability to maintain
his or her airway depends on the level of sedation. The administration of moderate sedation is not a
counter indication for giving an antiemetic. The patient receiving moderate sedation does not remember
most of the procedure.
A nurse is caring for a patient following knee surgery that was performed under a spinal anesthetic.
What intervention should the nurse implement to prevent a spinal headache?
A) Have the patient sit in a chair and perform deep breathing exercises.
B) Ambulate the patient as early as possible.
C) Limit the patients fluid intake for the first 24 hours postoperatively.
D) Keep the patient positioned supine.
D
Feedback:
Measures that increase cerebrospinal pressure are helpful in relieving headache. These include
maintaining a quiet environment, keeping the patient lying flat, and keeping the patient well hydrated.
Having the patient sit or stand up decreases cerebrospinal pressure and would not relieve a spinal
headache. Limiting fluids is incorrect because it also decreases cerebrospinal pressure and would not
relieve a spinal headache.
The OR will be caring for a patient who will receive a transsacral block. For what patient would the use
of a transsacral block be appropriate for pain control?
A) A middle-aged man who is scheduled for a thoracotomy
B) An older adult man who will undergo an inguinal hernia repair
C) A 50-year-old woman who will be having a reduction mammoplasty
D) A child who requires closed reduction of a right humerus fracture
B
Feedback:
A transsacral block produces anesthesia for the perineum and lower abdomen. Both a thoracotomy and
breast reduction are in the chest region, and a transsacral block would not provide pain control for these procedures. A closed reduction of a right humerus is a procedure on the right arm, and a transsacral block would not provide pain control.
The circulating nurse will be participating in a 78-year-old patients total hip replacement. Which of the
following considerations should the nurse prioritize during the preparation of the patient in the OR?
A) The patient should be placed in Trendelenburg position.
B) The patient must be firmly restrained at all times.
C) Pressure points should be assessed and well padded.
D) The preoperative shave should be done by the circulating nurse.
C
Feedback:
The vascular supply should not be obstructed by an awkward position or undue pressure on a body part.
During surgical procedures, the patient is at risk for impairment of skin integrity due to a stationary
position and immobility. An elderly patient is at an increased risk of injury and impaired skin integrity.
A Trendelenburg position is not indicated for this patient. Once anesthetized for a total hip replacement,
the patient cannot move; restraints are not necessary. A preoperative shave is not performed; excess hair
is removed by means of a clipper.
The OR nurse is taking the patient into the OR when the patient informs the operating nurse that his
grandmother spiked a 104F temperature in the OR and nearly died 15 years ago. What relevance does
this information have regarding the patient?
A) The patient may be experiencing presurgical anxiety.
B) The patient may be at risk for malignant hyperthermia.
C) The grandmothers surgery has minimal relevance to the patients surgery.
D) The patient may be at risk for a sudden onset of postsurgical infection.
B
Feedback:
Malignant hyperthermia is an inherited muscle disorder chemically induced by anesthetic agents.
Identifying patients at risk is imperative because the mortality rate is 50%. The patients anxiety is not
relevant, the grandmothers surgery is very relevant, and all patients are at risk for hypothermia.
While the surgical patient is anesthetized, the scrub nurse hears a member of the surgical team make an
inappropriate remark about the patients weight. How should the nurse best respond?
A) Ignore the comment because the patient is unconscious.
B) Discourage the colleague from making such comments.
C) Report the comment immediately to a supervisor.
D) Realize that humor is needed in the workplace.
B
Feedback:
Patients, whether conscious or unconscious, should not be subjected to excess noise, inappropriate
conversation, or, most of all, derogatory comments. The nurse must act as an advocate on behalf of the
patient and discourage any such remarks. Reporting to a supervisor, however, is not likely necessary.
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