Lewis Chapter 19 Intraoperative Care

The charge nurse is supervising patient care in the surgical suite. Which action, if performed by a nurse, would require the charge nurse to intervene?

a. The nurse wears a mask in the semi-restricted area.

b. The nurse wears a hair cover in the semi-restricted area.

c. The nurse wears street clothes in the semi-restricted area.

d. The nurse wears surgical scrubs in the semi-restricted area.

ANS: C

Wearing street clothes in the semi-restricted area is not permitted. the surgical suite is divided into three distinct areas: unrestricted—staff and others in street clothes can interact with those in surgical attire; semi-restricted—staff must wear surgical attire and cover all head and facial

hair; and restricted—includes the operating room, the sink area, and clean core where masks are required in addition to surgical attire.

Which statement, if made by a new circulating nurse, reflects understanding of the circulating nurse role?

a. ―I will assist in preparing the operating room for the patient.‖

b. ―I will don sterile gloves to obtain items from the unsterile field.‖

c. ―I will assist with suturing of incisions and maintaining hemostasis.‖

d. ―I will remain gloved while performing activities in the sterile field.‖

ANS: A

Preparing the operating room for the patient describes the role of a circulating nurse. All other answer options describe specific roles and actions of scrub nurses. the circulating nurse performs activities in the unsterile field and is not scrubbed, gowned, or gloved. the scrub nurse follows the designated scrub procedure, is gowned and gloved in sterile attire, and performs activities in the sterile field.

Which action describes how the scrub nurse protects the patient with surgical aseptic technique?

a. Uses waterproof shoe covers.

b. Wears personal protective equipment.

c. Changes gloves after touching the upper arm of the surgeon's gown.

d. Requires that all operating room (OR) staff perform a surgical scrub.

ANS: C

The sleeves of a sterile surgical gown are considered sterile only to 2 in above the elbows, so touching the surgeon's upper arm would contaminate the nurse's gloves. Shoe covers are not sterile. Personal protective equipment is designed to protect caregivers, not the patient, and is not part of aseptic technique. Staff members such as the circulating nurse do not have to perform a surgical scrub before entering the OR.

The operating room nurse is providing orientation to a new nurse. Which action would the nurse describe as a routine responsibility of a scrub nurse?

a. Document all patient care accurately.

b. Label all specimens to send to the laboratory.

c. Keep both hands above the operating table level.

d. Take the patient to the post anesthesia recovery area.

ANS: C

The scrub nurse role includes maintaining asepsis in the operating field. the circulating nurse would perform the other actions.

Which data identified during the preoperative assessment alerts the nurse that special protection techniques should be implemented during surgery?

a. Stated allergy to cats and dogs

b. History of spinal and hip arthritis

c. Verbalization of anxiety by the patient

d. Having a sip of water 3 hours previously

ANS: B

Misalignment, pressure, or other insults to arthritic joints desensitized from an anesthetic may create long-term injury and disability; the patient with arthritis may require special positioning to avoid injury and postoperative discomfort. Preoperative anxiety (unless severe) and having a sip of water 3 hours before surgery are not contraindications to having surgery. An allergy to cats and dogs will not affect the care needed during the intraoperative phase

A patient scheduled to undergo total knee replacement surgery under general anesthesia asks the nurse, ―Will the doctor put me to sleep with a mask over my face? Which response would the nurse provide?

a. ―Only your surgeon can tell you what method of anesthesia will be used.

b. ―I will check with the anesthesia care provider to find out what is planned.

c. ―General anesthesia is given by injecting drugs into your veins, so you will not need a mask.

d. ―Masks are no longer used. A tube inserted into your throat will deliver gas that puts you to sleep.

ANS: B

Routine general anesthesia is usually induced by the IV route with a hypnotic, anxiolytic, or dissociative agent. However, general anesthesia may be induced by IV or inhalation. the nurse should consult with the anesthesia care provider to determine the method selected for this patient. the anesthesia care provider will select the method of anesthesia, not the surgeon. Inhalation agents may be given through an endotracheal tube or a laryngeal mask airway.

Which potential complication would the nurse monitor for a patient who received inhalation anesthesia?

a. Tachypnea

b. Myoclonus

c. Hypertension

d. Laryngospasm

ANS: D

Possible complications of inhalation anesthetics include coughing, laryngospasm, and increased secretions. Hypertension and tachypnea are not associated with general anesthetics. Myoclonus may occur with nonbarbiturate hypnotics but not with the inhalation agents.

Which action would the perioperative nurse take to protect the patient from direct burn injury during surgery?

a. Ensure correct placement of the grounding pad.

b. Check emergency sprinklers in theoperating room.

c. Verify that a fire extinguisher is available during surgery.

d. Confirm that electrosurgical equipment is working properly.

ANS: A

When an electrosurgical unit is in use, the patient must be properly grounded to prevent unintended tissue burn injury. It is important to ensure that fire extinguishers and sprinklers are available, and that electrosurgical equipment is working properly, but the patient is at highest risk for burns if the grounding pad is placed incorrectly.

Monitored anesthesia care (MAC) is going to be used for a closed, manual reduction of a patient's dislocated shoulder. Which action would the nurse anticipate?

a. Starting an IV in the patient's unaffected arm

b. Securing an airtight fit for the inhalation mask

c. Preparing for placement of an epidural catheter

d. Giving deep sedation under physician supervision

ANS: A

For MAC, IV sedatives, such as the benzodiazepines, are given. Therefore, the patient needs IV access. Inhaled and epidural agents are not included in MAC. RNs who are trained and are allowed by agency protocols and state nurse practice acts can provide moderate to deep

sedation. However, the provider of MAC must be an anesthesia care provider since it may be necessary to change to general anesthesia during the procedure.

Which action will the perioperative nurse take after surgery is completed for a patient who received ketamine as an anesthetic agent?

a. Question the order for giving a benzodiazepine.

b. Ensure that atropine is available in case of bradycardia.

c. Provide a quiet environment in the post anesthesia care unit.

d. Anticipate the need for higher than usual doses of analgesics

ANS: C

Hallucinations are an adverse effect associated with the dissociative anesthetics such as ketamine. Therefore, the postoperative environment should be kept quiet to decrease the risk of hallucinations. Because ketamine causes profound analgesia lasting into the postoperative period, higher doses of analgesics are not needed. Ketamine causes an increase in heart rate. Benzodiazepine may be used with ketamine to decrease the incidence of hallucinations and

nightmares.

While in the holding area, a patient reveals to the nurse that his father had a high fever after surgery. Which action by the nurse is a priority?

a. Notify the patient that the surgery will be cancelled.

b. Place a medical alert sticker on the front of the patient's chart.

c. Alert the anesthesia care provider of the family member's reaction to surgery.

d. Reassure the patient that his temperature will be monitored closely after surgery.

ANS: C

The anesthesia care provider (ACP) needs to be notified and made aware of the patient's family history of anesthesia reactions. Malignant hyperthermia (MH) is a valid concern because the patient's father appears to have had a reaction to surgery. the ACP needs to be notified immediately rather than waiting for a sticker to be noticed on the chart; a sticker can be placed on the chart after the notification. the surgery may go forward after discussion with the ACP; general anesthesia can be administered to patients with MH if precautions to avoid MH are taken, the temperature is monitored closely, and preparations are made to treat MH if it does occur.

A patient in surgery receives a neuromuscular blocking agent as an adjunct to general anesthesia. While in the post-anesthesia care unit (PACU), which assessment finding is most important for the nurse to report?

a. Lethargy

b. Report of nausea

c. Disorientation to time

d. Weak chest movement

ANS: D

The most serious adverse effect of the neuromuscular blocking agents is weakness of the respiratory muscles, which can lead to postoperative hypoxemia. Nausea, lethargy, and disorientation are possible adverse effects of anesthetic drugs, but they are not as great of concern as respiratory depression.

A patient in the surgical holding area is being prepared for a spinal fusion. Which action by a member of the surgical team requires immediate intervention by the charge nurse?

a. Wearing street clothes into the nursing station

b. Wearing a surgical mask into the holding room

c. Walking into the hallway outside the operating room with hair uncovered

d. Putting on a surgical mask, cap, and scrubs before entering the operating room

ANS: C

The corridors outside the operating room (OR) are part of the semi-restricted area where personnel must wear surgical attire and head coverings. Surgical masks may be worn in the holding room, although they are not necessary. Street clothes may be worn at the nursing station, which is part of the unrestricted area. Wearing a mask and scrubs is essential when going into the OR.

Which action in the perioperative patient plan of care can the charge nurse delegate to a surgical technologist?

a. Teach the patient about what to expect in the operating room (OR).

b. Pass sterile instruments and supplies to the surgeon and scrub technician.

c. Monitor and interpret the patient's echocardiogram (ECG) during surgery.

d. Give the postoperative report to the post-anesthesia care unit (PACU) nurse.

ANS: B

The education and certification for a surgical technologist includes the scrub and circulating functions in the OR. Patient teaching, communication with other departments about a patient's condition, and the admission assessment require registered nurse (RN) level education and scope of practice. A surgical technologist is not usually trained to interpret ECG rhythms.

When caring for a patient who has received a general anesthetic, the circulating nurse notes red, raised wheals on the patient's arms. Which action would the nurse take?

a. Apply lotion to the affected areas.

b. Cover the arms with sterile drapes.

c. Recheck the patient's arms during surgery.

d. Notify the anesthesia care practitioner (ACP).

ANS: D

The presence of wheals indicates a possible allergic or anaphylactic reaction, which may have been caused by latex or by medications administered as part of general anesthesia. Because general anesthesia may mask anaphylaxis, the nurse should report this to the ACP. Applying lotion, covering the wheals, or rechecking later will delay care that may be needed for an allergic reaction.

Which actions will the nurse include in the surgical time-out procedure before surgery? (Select all that apply.)

a. Check for patency of IV lines.

b. Have the surgeon identify the patient.

c. Have the patient state name and date of birth.

d. Verify the patient identification band number.

e. Ask the patient to state the surgical procedure.

ANS: C, D, E

These actions are included in surgical time-out procedure. IV line placement and identification of the patient by the surgeon are not included in the surgical time-out procedure.

Which statements describe the role of the certified registered nurse anesthetist (CRNA) on the surgical care team? (Select all that apply.)

a. Selecting and administering the anesthesia and adjuvant drugs

b. Developing and implementing a plan for delivering anesthesia

c. Managing critically ill surgical patients in the intensive care unit

d. Releasing or discharging patients from the post-anesthesia care area

e. Establishing an airway and monitoring the patient's pulmonary status

ANS: A, B, D, E

A nurse anesthetist is a registered nurse who has graduated from an accredited nurse anesthesia program (minimally a master's degree program) and successfully completed a national certification examination to become a CRNA. the CRNA scope of practice includes, but is not limited to, the following:

1. performing and documenting a preanesthetic assessment and evaluation;

2. developing and implementing a plan for delivering anesthesia;

3. selecting and initiating the planned anesthetic technique;

4. selecting, obtaining, and administering the anesthesia, adjuvant drugs, and fluids;

5. selecting, applying, and inserting appropriate noninvasive and invasive monitoring devices;

6. managing a patient's airway and pulmonary status;

7. managing emergence and recovery from anesthesia;

8. releasing or discharging patients from a post-anesthesia care area. Managing critically ill surgical patients in the intensive care unit is a function of an anesthesiologist.