C18 - ch 18 test bank PDF

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Chapter 18: Intraoperative Care Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. The nurse facilitates student clinical experiences in the surgical suite. Which action, if

performed by a student, would require the nurse to intervene? The student wears a mask in the semirestricted area. The student wears street clothes in the semirestricted area. The student wears surgical scrubs in the semirestricted area. The student covers head and facial hair in the semirestricted area.

a. b. c. d.

ANS: B

Wearing street clothes in the semirestricted 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; semirestricted—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. DIF: Cognitive Level: Apply (application) REF: 315 TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment 2. Which statement, if made by a new circulating nurse, reflects understanding of the circulating

nurse role? “I will assist in preparing the operating room for the patient.” “I will don sterile gloves to obtain items from the unsterile field.” “I will remain gloved while performing activities in the sterile field.” “I will assist with suturing of incisions and maintaining hemostasis as needed.”

a. b. c. d.

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. DIF: Cognitive Level: Understand (comprehension) REF: 319 TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 3. Which action best describes the role of the certified registered nurse anesthetist (CRNA) on

the surgical care team? Performs the same responsibilities as the anesthesiologist. Gives intraoperative anesthetics ordered by the anesthesiologist. Releases or discharges patients from the postanesthesia care area. Manages a patient’s airway under the direct supervision of the anesthesiologist.

a. b. c. d.

ANS: C

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 postanesthesia care area DIF: Cognitive Level: Understand (comprehension) REF: 318 TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment 4. Which action describes how the scrub nurse protects the patient with aseptic technique during

surgery? Uses waterproof shoe covers Wears personal protective equipment Changes gloves after touching the upper arm of the surgeon’s gown Requires that all operating room (OR) staff perform a surgical scrub

a. b. c. d.

ANS: C

The sleeves of a sterile surgical gown are considered sterile only to 2 inches 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. DIF: Cognitive Level: Apply (application) REF: 320 TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment 5. The operating room nurse is providing orientation to a student nurse. Which action would the

nurse list as a major responsibility of a scrub nurse? Document all patient care accurately. Label all specimens to send to the laboratory. Keep both hands above the operating table level. Take the patient to the postanesthesia recovery area.

a. b. c. d.

ANS: C

The scrub nurse role includes maintaining asepsis in the operating field. The other actions would be performed by the circulating nurse. DIF: Cognitive Level: Apply (application) REF: 320 TOP: Nursing Process: Evaluation MSC: NCLEX: Safe and Effective Care Environment 6. 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

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. DIF: Cognitive Level: Apply (application) REF: 327 TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment 7. 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 by the nurse is most appropriate? 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 now given by injecting drugs into your veins, so you will not need a mask over your face.” d. “Masks are no longer used for anesthesia. A tube will be inserted into your throat to deliver gas that will put 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. DIF: Cognitive Level: Apply (application) REF: 322 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 8. Postoperatively, the nurse should monitor the patient who received inhalation anesthesia for

which complication? 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. DIF: Cognitive Level: Apply (application) REF: 323 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 9. Which action should the perioperative nurse take to best protect the patient from burn injury

during surgery? a. Ensure correct placement of the grounding pad. b. Check emergency sprinklers in the operating room. c. Verify that a fire extinguisher is available during surgery. d. Confirm that all electrosurgical equipment is working properly.

ANS: A

Care must be taken to correctly place the grounding pad and all electrosurgical equipment to prevent injury from burns or fire. It is important to ensure that fire extinguishers are available and that sprinklers protect everyone in the operating room in the event of a fire, but placing the grounding pad will best prevent injury to the patient. Verifying that electrosurgical equipment is working properly does not protect the patient unless the grounding pad is placed correctly. DIF: Cognitive Level: Apply (application) REF: 321 TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment 10. Monitored anesthesia care (MAC) is going to be used for a closed, manual reduction of a

dislocated shoulder. What action does the nurse anticipate? Starting an IV in the patient’s unaffected arm Securing an airtight fit for the inhalation mask Preparing for placement of an epidural catheter Giving deep sedation under physician supervision.

a. b. c. d.

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. DIF: Cognitive Level: Apply (application) REF: 322 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 11. 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 postanesthesia care unit. d. Anticipate the need for higher than usual doses of analgesic agents. 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. DIF: Cognitive Level: Apply (application) REF: 323 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 12. While in the holding area, a patient reveals to the nurse that his father had a high fever after

surgery. What action by the nurse is a priority? a. Place a medical alert sticker on the front of the patient’s chart. b. Alert the anesthesia care provider of the family member’s reaction to surgery. c. Give 650 mg of acetaminophen (Tylenol) per rectum as a preventive measure.

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

The anesthesia care provider (ACP) needs to be notified and made aware of the patient’s family history in regards to 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. Administering acetaminophen may not prevent MH. General anesthesia can be administered to patients with MH as long as precautions to avoid MH are taken and preparations are made to treat MH if it does occur. DIF: Cognitive Level: Analyze (analysis) REF: 327 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 13. A patient in surgery receives a neuromuscular blocking agent as an adjunct to general

anesthesia. While in the postanesthesia care unit (PACU), what assessment finding is most important for the nurse to report? a. Lethargy c. Disorientation to time b. Complaint of nausea 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. DIF: Cognitive Level: Analyze (analysis) REF: 326 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 14. 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? Wearing street clothes into the nursing station Wearing a surgical mask into the holding room Walking into the hallway outside the operating room with hair uncovered Putting on a surgical mask, cap, and scrubs before entering the operating room

a. b. c. d.

ANS: C

The corridors outside the operating room (OR) are part of the semirestricted 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. DIF: Cognitive Level: Apply (application) REF: 315 TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment 15. Which nursing action should the operating room (OR) nurse manager delegate to the

registered nurse first assistant (RNFA) when caring for a surgical patient? a. Adjust the doses of administered anesthetics. b. Make surgical incisions and suture as needed. c. Provide postoperative teaching about coughing.

d. Coordinate transfer of the patient to the operating table. ANS: B

The role of the RNFA includes skills such as making and suturing incisions and maintaining hemostasis. The other actions should be delegated to other staff members such as the circulating nurse, scrub nurse, or surgical technician. The anesthesia care provider should adjust the doses of anesthetics for patients, not the RNFA. DIF: Cognitive Level: Apply (application) REF: 317 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 16. Which action in the perioperative patient plan of care can the charge nurse delegate to a

surgical technologist? Teach the patient about what to expect in the operating room (OR). Pass sterile instruments and supplies to the surgeon and scrub technician. Monitor and interpret the patient’s echocardiogram (ECG) during surgery. Give the postoperative report to the postanesthesia care unit (PACU) nurse.

a. b. c. d.

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. DIF: Cognitive Level: Apply (application) REF: 317 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment 17. 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 should the nurse take? Apply lotion to the affected areas. Cover the arms with sterile drapes. Recheck the patient’s arms during surgery. Notify the anesthesia care practitioner (ACP).

a. b. c. d.

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. The other actions are not appropriate at this time. DIF: Cognitive Level: Apply (application) REF: 324 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity MULTIPLE RESPONSE 1. 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. DIF: Cognitive Level: Understand (comprehension) REF: 321 TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment...