The physical environment of a surgery suite is designed primarily to promote Show a. electrical safety B- Medical and surgical asepsis When transporting an inpatient to the surgical department, the nurse from another area of the hospital has access to a. the clean core B- The holding area The primary goal of the circulating nurse during preparation of the operating room, transferring and positioning the patient, and assisting the anesthesia team is a. avoiding any type of injury to the patient C- Providing for patient comfort and sense of well being Goals for patient safety in the operating room (OR) include the Universal Protocol, in which a. all surgical centers of any type must submit reports on patient safety infractions to the accreditation agencies C- The Universal Protocol supported by The Joint Commission is used to prevent wrong site, wrong procedure, and wrong surgery in view of a high rate of these problems nationally. It involves pausing just before the procedure starts to verify identity, site, and procedure. A break in sterile technique during surgery would occur when the scrub nurse touches a. the mask with gloved hands A- The mask covering the face is not considered sterile, and if in contact with sterile gloved hands, contaminates the gloves. The gown at chest level and to 2 inches above elbows is considered sterile, as is the drape placed at the surgical area. During surgery, a patient has a nursing diagnosis of risk for perioperative positioning injury. A common risk factor for this nursing diagnosis is a. skin lesions C- Musculoskeletal deformities can be a risk factor for positioning injuries and require special padding and support on the operating table. Skin lesions and break in sterile technique are risk factors for infection, and electrical equipment failure may lead to other types of injuries. At the end of the surgical procedure, the perioperative nurse evaluates the patient's response to the nursing care delivered during the perioperative period. Which of the following criteria reflects an outcome related to the patient's physical status? a. the patient's right to privacy is maintained D- The Perioperative Nursing Data Set includes outcome statements that reflect standards and recommended practices or perioperative nursing. Outcomes related to physiologic responses include those of physiologic function, such as respiratory function; perioperative safety includes the patient's freedom from any type of injury; and behavioral responses include knowledge and actions of the patient and family, including the consistency of the patient's care with the perioperative plan and the patient's right to privacy. Because of the rapid elimination of volatile liquids used for general anesthesia, the nurse should anticipate that early in the anesthesia recovery period, the patient will need a. warm blankets B- The volatile liquid inhalation agents have very little residual analgesia, and patients experience early onset of pain when the agents are discontinued. They are associated with a low incidence of nausea and vomiting. Prolonged respiratory depression is not common because of their rapid elimination. Hypothermia is not related to use of these agents, but they may precipitate malignant hyperthermia in conjunction with neuromuscular blocking agents. The primary advantage of the use of midazolam (Versed) as an adjunct to general anesthesia is its a. amnestic effect A- Amnestic effect Monitored anesthesia care (MAC) is being considered for a patient undergoing a cervical dilation and endometrial biopsy in health care provider's office. The patient asks the nurse, "What is the MAC?" The nurse's response is based on the knowledge that MAC a. can be administered only by anesthesiologists or nurse anesthetists B- MAC refers to sedation that allows the patient to manage his or her own airway and respond to commands, and yet the patient can emotionally and physically accept painful procedures. Drugs are used to provide analgesia, relieve anxiety, and/or provide amnesia. It can be administered by personnel other than anesthesiologists, but nurses should be specially trained in the techniques of MAC to carry out this procedure because of the high risk of complications resulting in clinical emergencies During epidural and spinal anesthesia, the nurse should monitor the patient for a. spinal headache B. During epidural and spinal anesthesia, a sympathetic nervous system blockade may occur that results in hypotension, bradycardia, and nausea and vomiting. A spinal headache may occur after, not during, spinal anesthesia, and unconsciousness and seizures are indicative of IV absorption overdose. Upward extension of the effect of the anesthesia results in inadequate respiratory excursion and apnea A preoperative patient reveals that an uncle died during surgery because of a fever and cardiac arrest. The perioperative nurse alerts the surgical team, knowing that if the patient is at risk for malignant hyperthermia, a. the surgery will have to be cancelled B- Although malignant hyperthermia can result in cardiac arrest and death, if the patient is known or suspected to be at risk for the disorder, appropriate precautions taken by the ACP can provide for safe anesthesia for the patient. Because preventive measures are possible if the risk is known, it is critical that the preoperative assessment include a careful family history of surgical events The nurse is circulating for a surgical procedure. What clinical manifestation would indicate to the nurse that the patient may be experiencing malignant hyperthermia? a. hypocapnia B- Malignant hyperthermia is a metabolic disease characterized by hyperthermia with rigidity of skeletal muscles from altered control of intracellular calcium occurring as a result of exposure to certain anesthetic agents in susceptible patients. Hypoxemia, hypercapnia, and ventricular dysrhythmias may also be seen with this disorder. The circulating nurse is caring for a patient during a colon resection. What observation made by the nurse is immediately recognized as a violation of aseptic technique? a. A glove contacts the leg of the table that supports the sterile field. A- Tables are sterile only at tabletop level. Areas below this are considered contaminated. The sterile gown below the point 2 inches above the elbow is considered sterile. The passage of time in and of itself does not necessarily render a field contaminated. Bacteria are inevitable in the respiratory passages of team members, but they present a threat to sterility only if they are not confined by attire. The perioperative nurse would recognize the need to monitor the patient for hallucinations and agitation when which anesthetic agent is administered? a. Ketamine A- A disadvantage of ketamine is the associated risk of agitation, hallucinations, and nightmares. Ketamine is considered dissociative anesthesia. These unwanted effects are not associated with the use of thiopental, halothane, or nitrous oxide. A surgical patient's premedication regimen includes midazolam. What are the most likely desired effects of this medication that the nurse should recognize? a. Monitored anesthesia care and amnesia A- A patient asks a student nurse if his family member may accompany him to the surgical area. What is the best response by the nurse? a."Your family member may not enter the surgical area" B- A patient is being prepared for a surgical procedure. What is the priority intervention by the nurse prior to the start of the procedure according to the National Patient Safety Goal (NPSG)? a. prevention of infection D. A patient having an open reduction internal fixation (ORIF) of a left lower leg fracture will receive regional anesthesia during the procedure. As the patient is prepared in the operating room, what should the nurse implement to maintain patient safety during surgery that is directly related to the type of anesthesia being used? a. apply grounding pad to unaffected leg D. An older adult patient is having surgery. What risk areas will the nurse need to be especially aware of for this patient during surgery? a. Sterility D. The patient is going to have a colonoscopy. Which type of anesthesia should the nurse expect to be used? a. local anesthesia D. In which surgical area will the patient's surgical skin scrub prep be performed for surgery, and what clothing is appropriate for the nurse performing the scrub to wear? a. surgical suite
wearing a lab coat C- While the perioperative nurse is transporting a patient to the operating room for general surgery, the patient states, "I am a Jehovah's Witness, and I am worried about blood transfusions." What would be the bestresponse by the nurse to this patient's statement? a."I will make sure that you do not receive a blood transfusion during this surgery." D- The perioperative nurse is supervising the surgical technologist before the arrival of the patient in the operating room for an exploratory laparotomy. Which action, if taken by the surgical technologist, would require the nurse to intervene? a. The surgical technologist holds hands away from the body and above the elbows at all times. C- The surgical team in the operating room performs a surgical time-out just before starting hip
replacement surgery. Which action would be part of the surgical time-out? D- The nurse administered midazolam to a patient during a colonoscopy. What nursing action is appropriate if the patient's respiratory rate changes from 14 breaths/min to 3 breaths/min? a. administer flumazenil A- The perioperative nurse is reviewing the chart of a patient who is being admitted into the operating room for a laminectomy. What information obtained from the chart review should the nurse discuss with the anesthesiologist? a. The patient's grandmother developed hypothermia during a craniotomy. D- The nurse educator facilitates student clinical experiences in the surgical suite. Which action, if performed by a student, would require the nurse educator to intervene? ANS: C 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; 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." ANS: A Which action best describes the role of the certified registered nurse anesthetist (CRNA) on the surgical care team? a. Performs the same responsibilities as the anesthesiologist. ANS: C 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 ANS: B 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." ANS: B Postoperatively, the nurse should monitor the patient who received inhalation anesthesia for which complication? a.Tachypnea ANS: D 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. ANS: A Monitored anesthesia care (MAC) is going to be used for a closed, manual reduction of a dislocated shoulder. What action does the nurse anticipate? a.
Starting an IV in the patient's unaffected arm ANS: A 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. ANS: C 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. ANS: B 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 ANS: D 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. 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. 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). ANS: B 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? a. Apply lotion to the affected areas. ANS: D 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. 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. A 71-year-old male patient who is currently undergoing coronary artery bypass graft (CABG) surgery has just experienced intraoperative vomiting. The nurse should consequently anticipate the use of which drug? D What event in the surgical suite represents a violation of aseptic technique? A Which intraoperative nursing responsibilities should be performed by the scrub nurse (select all that apply)? B,C,E Which description best defines the role of the nurse anesthetist as a member of the surgical team? ANS: A Which outcome measure will be best for the operating room (OR) nurse manager to use in determining the effectiveness of the physical environment and traffic control measures in the operating room? ANS: D Which action will the scrub nurse use to
maintain aseptic technique during surgery? ANS: D After orienting a new staff member to the scrub nurse role, the nurse preceptor will know that the teaching was effective if the new staff member ANS: C A preoperative patient in the holding area asks the nurse, Will the doctor
put me to sleep with a mask over my face? The most appropriate response by the nurse is, ANS: A When the nurse caring for a patient before surgery has a question about a sedative medication to be given before sending the patient to the surgical suite, the nurse will communicate with the ANS: B A patient with a dislocated shoulder is prepared for a closed, manual reduction of the dislocation with monitored anesthesia care (MAC). The nurse anticipates the administration of ANS: A A patients family history reveals that the patient may be at risk for malignant hyperthermia (MH) during anesthesia. The nurse explains to the patient
that ANS: A Which action by
an inexperienced member of the surgical team requires rapid intervention by the charge nurse? ANS: C When preparing the patient for surgery, which actions will the nurse include in the surgical time-out procedure (select all that apply)? ANS: C, D, E, F 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 The OR nurse acts in the circulating role during a patients scheduled cesarean section. For what task is this
nurse solely responsible? A 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 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? B 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? B 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 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? D 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, B, C What are the surgical team?A surgical team is made up of a surgeon, a surgeon's assistant, an anesthetist, a nurse anesthetist, a circulating nurse, and a surgical technologist. The surgical ward is occupied by those patients who have already undergone surgery, as well as those who are about to or might undergo surgery.
Which would be included as a responsibility of the scrub nurse?Scrub nurses do a surgical scrub and go into the surgery with the surgical patient and doctors. They set up the operating room for the patient, ensure all the tools are sterile and ready to go, hand tools to the doctor during the surgery, and perform other duties inside the surgical room.
What is the role of a circulating nurse in the or?In the operating room, the duties of the circulating nurse are carried out outside the sterile area. The RN Circulator manages all the necessary care inside the surgery room, assisting the team in maintaining and creating a comfortable, safe environment for the patient and observing the team from a wide perspective.
What are the circulating nurse's responsibilities in contrast to the scrub nurse's responsibilities?The scrub role includes performing a surgical hand scrub, setting up the sterile tables, and preparing sutures, ligatures, and special equipment. The circulating nurse manages the operating room and protects patient safety.
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Which description best defines the role of the nurse anesthetist as a member of the surgical team?
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