Chapter 18: Intraoperative Nursing Management Exam Questions With Complete Solutions
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Chapter 18: Intraoperative Nursing Management
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Chapter 18: Intraoperative Nursing Management
Chapter 18: Intraoperative Nursing Management Exam Questions With Complete Solutions
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 rec...
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?
a) Risk for perioperative positioning injury related to operative position
b) Disturbed sensory perception related to sedation
c) Anxiety related to the surgical experience
d) Risk for injury related to effects of anesthetic agents - Answer-a) Risk for
perioperative positioning injury related to operative position
Explanation:
Although any of the nursing diagnoses might apply for this patient, the priority would be
risk for perioperative positioning injury related to the patient's history of osteoporosis.
The bone loss associated with this condition necessitates careful manipulation and
positioning during surgery.
/.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?
a) Decreased lean tissue mass
b) Increased tissue elasticity
c) Impaired thermoregulation
d) Increased anxiety level - Answer-a) Decreased lean tissue mass
Explanation:
Elderly patients require lower doses of anesthetic agents because of decreased tissue
elasticity and reduced lean tissue mass. An increased amount of anesthetic would be
needed with an increased anxiety level. Impaired thermoregulation increases the
patient's susceptibility to hypothermia.
/.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:
a) hallucinations and respiratory depression.
b) hiccups.
c) respiratory depression.
d) extrapyramidal reactions.
e) hallucinations.
,f) extrapyramidal reactions and hiccups. - Answer-a) hallucinations and respiratory
depression.
Explanation:
The nurse should monitor for hallucinations, which may follow administration of several
of the injection anesthetics, including ketamine and the opioids; the reaction seems to
be directly proportional to the infusion rate. Extrapyramidal manifestations are the most
prominent adverse reactions to droperidol. Thiopental, etomidate, and propofol can
produce airway reflex hyperactivity with hiccups, coughing, and muscle twitching and
jerking. The barbiturates and propofol cause respiratory depression.
/.A list of commonly used medications for a particular surgical procedure is provided to
the nurse. The anesthesiologist announces the administration of a nondepolarizing
muscle relaxant. Which of the following medications should the nurse document as
having been administered?
a) Fentanyl (Sublimaze)
b) Pancuronium (Pavulon)
c) Morphine sulfate
d) Succinylcholine (Anectine) - Answer-b) Pancuronium (Pavulon)
Explanation:
Pavulon is a nondepolarizing muscle relaxant. Succinylcholine is a polarizing muscle
relaxant. Fentanyl and morphine sulfate are opioid analgesic agents.
/.A medical student, scheduled to observe surgery, enters the unrestricted surgical zone
wearing jeans, a t-shirt, and tennis shoes. What is the best action by the nurse?
a) No action is needed.
b) Immediately escort the medical student out of the area.
c) Educate the medical student on required attire for each surgical zone.
d) Provide the medical student a cap and mask. - Answer-c) Educate the medical
student on required attire for each surgical zone.
Explanation:
It would be best to educate the medical student on the required attire for each surgical
zone. Since the student will be observing a surgery, the student will need to dress
appropriately in each zone to decrease the risk of introducing pathogens. The
unrestricted zone allows for street clothes; therefore, the student does not need to be
removed. If no action is taken by the nurse, the student could enter the semirestricted or
restricted zone without appropriate attire. Providing a cap and mask does not address
the need to change out of the street clothes to observe the surgery.
/.A nurse is administering moderate sedation to a client with chronic obstructive
pulmonary disease (COPD). The nurse bases her next action on the principle that:
a) administering I.V. antibiotics can prevent pneumonia.
b) it may be necessary to raise the head of this client's bed.
c) inserting a Foley catheter can decrease fluid retention.
,d) this client may need intubation. - Answer-b) it may be necessary to raise the head of
this client's bed.
Explanation:
The nurse should consider positioning when caring for a client who has COPD and
difficulty breathing. Elevating the head of the bed assists these clients in breathing.
There's no indication that it's necessary to intubate the client. A Foley catheter isn't
indicated. Prophylactic I.V. antibiotics aren't administered with moderate sedation.
/.A nurse is monitoring a client recovering from moderate sedation that was
administered during a colonoscopy. Which finding requires the nurse's immediate
attention?
a) Decreased cough and gag reflexes
b) Heart rate of 84 beats/minute
c) Oxygen saturation (SaO2) of 85%
d) Blood-tinged stools - Answer-c) Oxygen saturation (SaO2) of 85%
Explanation:
Normal SaO2 is 95% to 100%. Oxygen saturation of 85% indicates inadequate
oxygenation, which may be a consequence of the moderate sedation. Appropriate
nursing actions include rousing the client, if necessary, assisting the client with
coughing and deep breathing, and evaluating the need for additional oxygen. A heart
rate of 84 beats/minute is within normal limits. Colonoscopy doesn't affect cough and
gag reflexes, although these reflexes may be slightly decreased from the administration
of sedation. These findings don't require immediate intervention. Blood-tinged stools are
a normal finding after colonoscopy, especially if the client had a biopsy.
/.A nurse is reviewing the intraoperative record of a patient who has just returned from
surgery. The patient received general anesthesia with intravenous agents. Which of the
following would the nurse identify as a nondepolarizing muscle relaxant?
a) Fentanyl
b) Succinylcholine
c) Sufentanil
d) Atracurium - Answer-d) Atracurium
Explanation:
Atracurium is a nondepolarizing muscle relaxant. Succinylcholine is a depolarizing
muscle relaxant. Fentanyl and sufentail are opioid analgesic agents.
/.A nurse is reviewing the medical record of a patient who is to receive general
anesthesia and notes a nursing diagnosis of anxiety related to surgical concerns. The
nurse implements measures to reduce the patient's anxiety based on the understanding
of which of the following?
a) The patient is at risk for additional complications.
b) The anesthetic will result in a more potent effect on the patient.
c) Increased anxiety can increase the patient's postoperative pain level.
, d) Anxiety interferes with progression through the stages of general anesthesia. -
Answer-c) Increased anxiety can increase the patient's postoperative pain level.
Explanation:
Anxiety increases the amount of anesthetic medication needed, the level of
postoperative pain, and overall recovery time. Anxiety may place the patient at risk for
complications, but other factors are usually also involved. When a patient is anxious,
induction is slower and greater quantities of anesthetic agents are required because the
brain receives a smaller quantity of anesthetic agent. Anxiety is unrelated to the
patient's progression through the stages of general anesthesia. Additionally, when
opioid agents and neuromuscular blockers are administered as part of general
anesthesia, several of the stages are absent.
/.A nurse is working as a registered nurse first assistant as defined by the state's nurse
practice act. This nurse practices under the direct supervision of which surgical team
member?
a) Surgeon
b) Scrub nurse
c) Circulating nurse
d) Anesthetist - Answer-a) Surgeon
Explanation:
The registered nurse first assistant practices under the direct supervision of the
surgeon. The circulating nurse works in collaboration with other members of the health
care team to plan the best course of action for each patient. The scrub nurse assists the
surgeon during the procedure as well as setting up sterile tables and preparing
equipment. The anesthetist administers the anesthetic medications.
/.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.
a) Scrub clothes
b) Shoe covers
c) Street clothes
d) Masks
e) Caps - Answer-a) Scrub clothes
e) Caps
Explanation:
Scrub clothes and caps are worn in the semi-restricted area. Street clothes are worn in
the unrestricted area. Scrub clothes, caps, shoe covers, and masks are worn in the
restricted area.
/.A nurse suspects malignant hyperthermia in a patient who underwent surgery
approximately 18 hours ago. Which of the following would the nurse identify as a late,
ominous sign?
a) Muscle rigidity
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