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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter18:IntraoperativeNursingManagement  1.

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

Ans:

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.

2.

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

Ans:

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

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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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. 3.

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

Ans:

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.

4.

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

Ans:

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.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

5.

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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

Ans:

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.

6.

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

Ans:

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.

7.

A)

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? Sterilesurfacesorarticlesmaytouchothersterilesurfaces.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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.

Ans:

A

362

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. 8.

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.

Ans:

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.

9.

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.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

363

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.

10. 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.

Ans:

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.

11. 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.

Ans:

D Feedback: Measuresthatincreasecerebrospinalpressurearehelpfulinrelievingheadache.Theseinclude

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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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. 12. 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

Ans:

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.

13. 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.

Ans:

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.

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14. 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.

Ans:

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.

15. 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.

Ans:

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.

16. Youarecaringforamalepatientwhohashadspinalanesthesia.Thepatientisunderaphysiciansorder tolieflatpostoperatively.Whenthepatientaskstogotothebathroom,youencouragehimtoadhereto thephysiciansorder.Whatrationaleforcomplyingwiththisordershouldthenurseexplaintothe patient? A)

Preventingtheriskofhypotension

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Preventingrespiratorydepression

C)

Preventingtheonsetofaheadache

D)

Preventingpainatthelumbarinjectionsite

Ans:

C

366

Feedback: Lyingflatreducestheriskofheadacheafterspinalanesthesia.Hypotensionandrespiratorydepression maybeadverseeffectsofspinalanesthesiaassociatedwiththespreadoftheanesthetic,butlyingflat doesnothelpreducetheseeffects.Painatthelumbarinjectionsitetypicallyisnotaproblem. 17. Thenurseispackingapatientsabdominalwoundwithsterile,half-inchIodoformgauze.Duringthe procedure,thenursedropssomeofthegauzeontothepatientsabdomen2inches(5cm)awayfromthe wound.Whatshouldthenursedo? A)

Applypovidone-iodine(Betadine)tothatsectionofthegauzeandcontinuepackingthewound.

B)

Pickupthegauzeandcontinuepackingthewoundafterirrigatingtheabdominalwoundwith Betadinesolution.

C)

Continuepackingthewoundandinformthephysicianthatanantibioticisneeded.

D)

DiscardthegauzepackingandrepackthewoundwithnewIodoformgauze.

Ans:

D Feedback: Sterilesurfacesorarticlesmaytouchothersterilesurfacesorarticlesandremainsterile;contactwith unsterileobjectsatanypointrendersasterileareacontaminated.Thesterilegauzebecamecontaminated whenitwasdroppedonthepatientsabdomen.ItshouldbediscardedandnewIodoformgauzeshouldbe usedtopackthewound.Betadineshouldnotbeusedinthewoundunlessordered.

18. Thenurseisperformingwoundcareona68-year-oldpostsurgicalpatient.Whichofthefollowing practicesviolatestheprinciplesofsurgicalasepsis? A)

Holdingsterileobjectsabovethelevelofthenurseswaist

B)

Consideringa1inch(2.5cm)edgearoundthesterilefieldasbeingcontaminated

C)

Pouringsolutionontoasterilefieldcloth

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Openingtheoutermostflapofasterilepackageawayfromthebody

Ans:

C

367

Feedback: Wheneverasterilebarrierisbreached,theareamustbeconsideredcontaminated.Pouringsolutiononto asterilefieldclothviolatessurgicalasepsisbecausemoisturepenetratingtheclothcancarry microorganismstothesterilefieldviacapillaryaction.Theotheroptionsarepracticesthathelpensure surgicalasepsis. 19. Apatientisscheduledforsurgerythenextdayandthedifferentphasesofthepatientssurgical experiencewillrequireinputfrommembersofnumeroushealthdisciplines.Howshouldthepatients carebestbecoordinated? A)

Byplanningcareusingasurgicalapproach

B)

Byidentifyingtheprofessionalwiththemostknowledgeofthepatient

C)

Byimplementinganinterdisciplinaryapproachtocare

D)

Byusingthenursingprocesstoguideallaspectsofcareandtreatment

Ans:

C Feedback: Aninterdisciplinaryapproachinvolvingthesurgeon,anesthesiologistoranesthetist,andnurseisbest. Thisissuperiortoeachoftheotherlistedoptions.

20. Priortoapatientsscheduledsurgery,thenursehasdescribedthewaythatmembersofdiversehealth disciplineswillcollaborateinthepatientscare.Whatisthemainrationalefororganizingperioperative careinthiscollaborativemanner? A)

Historicalprecedence

B)

Patientrequests

C)

Physiciansneeds

D)

Evidence-basedpractice

Ans:

D Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

368

Collaborationofthesurgicalteamusingevidence-basedpracticetailoredtoaspecificcaseresultsin optimalpatientcareandimprovedoutcomes.Noneoftheotherlistedfactorsisthebasisforthe collaborationofthesurgicalteam. 21. Anintraoperativenurseisapplyinginterventionsthatwilladdresssurgicalpatientsrisksfor perioperativepositioninginjury.Whichofthefollowingfactorscontributetothisincreasedriskfor injuryintheintraoperativephaseofthesurgicalexperience?Selectallthatapply. A)

Absenceofreflexes

B)

Diminishedabilitytocommunicate

C)

Lossofpainsensation

D)

Nausearesultingfromanesthetic

E)

Reducedbloodpressure

Ans:

A,B,C Feedback: Lossofpainsense,reflexes,an...