Deck 18: Intraoperative Nursing

Question 1

A patient who is having surgery in a teaching hospital tells the nurse she wants only the surgeon and other necessary people in the operating room. She does not want the surgeon to be teaching medical students while conducting the surgery. How can the nurse support the patient's request?

A) Ensure that the consent form contains this information and communicate the patient's request to the surgical team.
B) Tell the patient that it really doesn't matter who is in the operating room during the surgery.
C) Explain to the patient that she has no control over who participates in the surgery.
D) Remind the patient that she can refuse the surgery at any time.

Answer 1

Ensure that the consent form contains this information and communicate the patient's request to the surgical team.

Question 2

The surgical team is participating in a surgical time-out. What activities are part of this procedure?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Verification that the correct patient is prepared for surgery
B) Announcement of the name of the surgical procedure planned
C) A pause to allow last-minute preparation of the surgical suite
D) Determination of the body side on which the surgery will occur
E) Final surgical hand scrub

Answer 2

Verification that the correct patient is prepared for surgery
Announcement of the name of the surgical procedure planned
Determination of the body side on which the surgery will occur

Question 3

Prior to bringing a patient into the operating room, the nurse examines an instrument that will be used for the surgical procedure. What is the rationale for this action?

A) To ensure the correct instrument is reflected in the charges to be made to the patient's insurance for the surgical procedure
B) To allow the nurse to efficiently use the instrument as required
C) To ensure the patient's safety when the instrument is used for the procedure
D) To determine if the instrument should be replaced with one that is disposable after use

Answer 3

To ensure the patient's safety when the instrument is used for the procedure

Question 4

At the conclusion of a surgical procedure, it has been determined that one sponge is missing. How should the nurse manage this situation?

A) Ask housekeeping personnel to look for the missing sponge while preparing the surgical suite for the next procedure.
B) Ask the surgeon to recount the sponges along with the nurse.
C) Refer to AORN standards for guidance.
D) Call the nursing supervisor to report the missing sponge.

Question 5

A patient fearful of anesthesia asks the nurse to make sure that she wakes up after surgery just so she can see her family one more time if she is going to die. What should the nurse do to support this patient?

A) Attempt to reduce the patient's fears and discuss these fears with the surgical team.
B) Tell the patient that no one is going to let her die.
C) Explain that everyone who undergoes anesthesia thinks they won't wake up.
D) Tell the patient there is no guarantee that she won't die during the procedure.

Question 6

After the anesthesiologist inserts the anesthetic agent into the patient's spinal column, the nurse assists the patient into a supine position with the neck flexed. What is the rationale for the nurse's action?

A) This position allows for better monitoring of the patient's blood pressure and pulse.
B) Positioning can help the anesthetic agent reach the appropriate level in the spinal column.
C) This position helps to ensure the patient's cardiac function will not be affected by the anesthesia.
D) The patient will be able to breathe more easily in this position.

Question 7

While in the postanesthesia care unit, a patient recovering from spinal surgery tells the nurse that he cannot feel his right hand and that his right shoulder is painful. The nurse's initial concern is in regard to which complication?

A) Thromboembolism in the brachial artery
B) Residual effects of spinal anesthesia
C) Infiltrated intravenous access site
D) Brachial plexus nerve injury

Question 8

The nurse is assigned as the surgical scrub nurse for today's outpatient cases. In addition to regular surgical attire, which equipment will the nurse wear? Select all that apply.

A) Sterile gloves
B) Sterile gown
C) An eye shield
D) A sterile head cover
E) Sterile shoe covers

Question 9

A patient tells the nurse that her brother had surgery done on the wrong hand, and she wants to make sure the surgeon knows she is having surgery on her left shoulder. What should the nurse do to address the patient's concerns?

A) Tell the patient that she should write the words "Left Shoulder" on a piece of paper and take it to the operating room with her.
B) Explain that the surgeon will mark the site of surgery directly on the patient during a preoperative visit.
C) Assure the patient that someone will tell the circulating nurse that the surgery is to be done on the left shoulder.
D) Show the patient where the site of the surgery has been documented on the medical record.

Question 10

A patient who received epidural anesthesia for surgery develops hypotension during the procedure. The nurse anticipates which intervention to support this patient?

A) Increasing pain medication
B) Intubating the patient
C) Increasing the amount of anesthesia being administered
D) Providing normal saline intravenously with medications to stimulate venous return

Question 11

The surgical team is assembled and is preparing to conduct a procedure on a patient. Which health care professional is responsible for the overall functioning of the surgical team?

A) Surgeon
B) Circulating nurse
C) Scrub nurse
D) Registered nurse first assistant

Question 12

A registered nurse is assisting the surgeon in conducting an exploratory laparoscopy. The nurse holds the tissue retractors, biopsies tissue, and sutures the patient at the conclusion of the case. Which role is this nurse fulfilling?

A) Circulating nurse
B) Scrub nurse
C) Certified registered nurse anesthetist
D) Registered nurse first assistant

Question 13

A patient has just had surgery and is being transported to the postanesthesia care unit. Which team member will accompany the nurse when transporting the patient?

A) The scrub nurse
B) The surgeon
C) The circulating nurse
D) The nurse anesthetist

Question 14

The nurse anesthetist stops to see a patient recovering from surgery in the postanesthesia care unit to make sure the patient is not experiencing any untreated side effects from the anesthesia. The nurse anesthetist is conducting which aspect of patient care?

A) Preanesthesia evaluation
B) Emergence
C) Maintenance
D) Postanesthesia care

Question 15

A patient has lost over 1,000 mL of blood during a surgical procedure that is estimated to continue for at least another 2 hours. The nurse anesthetist prepares to administer packed red blood cells during the procedure. Which patient care activity is the nurse anesthetist conducting?

A) Anesthesia maintenance
B) Preanesthetic preparation
C) Postanesthesia care
D) Perianesthetic clinical support

Question 16

The scrub nurse is preparing to access a sterilized item; however, the item is missing the appropriate sterilization tag. What action should the nurse take?

A) Substitute the item with another similar item that has been properly sterilized.
B) Use the item.
C) Request another item be brought that has the appropriate sterilization tag.
D) Inform the physician that the item does not have the sterilization tag and use the item.

Question 17

Before a patient goes into the surgical suite, the nurse anesthetist assesses the patient's previous experience with anesthesia and answers any questions the patient might have about the anesthesia plan for the surgery. In which category of nurse anesthetist practice is this nurse functioning?

A) Maintenance
B) Induction
C) Perianesthetic clinical support
D) Preanesthetic preparation and evaluation

Question 18

During a surgical procedure, the nurse assesses the patient's response to anesthesia and determines the amount of pain medication to provide. Which role is this nurse fulfilling?

A) Scrub nurse
B) Certified registered nurse anesthetist
C) Registered nurse first assistant
D) Circulating nurse

Question 19

A patient is being prepared for surgery on the right arm. Which actions should the nurse take to prevent brachial plexus nerve injury?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Align the arm at a 135-degree angle from the body.
B) Pronate the wrist.
C) Pad the table extension on which the arm is positioned.
D) Protect the arm from pressure exerted by operative equipment.
E) Consider intraoperative position changes if possible.

Question 20

An omission of information occurred when the nurse anesthetist informed the nurse in the postanesthesia care unit about a patient's surgical procedure. The risk management nurse would review the standards of which process?

A) Handoff communication
B) Discharge summary
C) End-of-shift report
D) Surgical time-out

Question 21

The nurse would be concerned that a patient may have a latex allergy if the patient reports allergy to which food?

A) Strawberries
B) Eggs
C) Avocados
D) Peanuts

Question 22

A patient has been received in the preoperative holding area. Which interventions will the nurse perform in this environment?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Review the patient's medical record to ensure all relevant material is present.
B) Instruct the patient to remove all jewelry.
C) Review the medical record to ensure preoperative medications have been administered.
D) Have the patient empty the bladder.
E) Confirm that the patient has been NPO for the prescribed amount of time.

Question 23

The certified nurse anesthetist suspects a patient is experiencing malignant hyperthermia and will administer dantrolene sodium 3 mg/kg IV. The patient's documented weight is 143 pounds. The nurse will administer _____ mg in the first bolus.

Question 24

Nurses who work in the operating room are asked to help design a new preoperative holding area. Which suggestions should the nurses offer?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Colors for the room should be bright and lively.
B) The room should be behind a securable door.
C) The room should be located on the quieter side of the surgical area.
D) The room should be centrally located with windows into the operating theaters.
E) There should be space for an emergency medical cart with a defibrillator.

Question 25

According to national guidelines for surgical wound classification, the nurse would classify which wounds as contaminated?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) A normal hysterectomy incision
B) A gunshot wound to the chest
C) A stab wound to the abdomen that does not enter the bowel
D) A pressure ulcer that has eschar present
E) The skin wound from a compound femur fracture

Question 26

Which nursing actions indicate that a nurse has developed a "surgical conscience"? Select all that apply.

A) The nurse stops a surgeon who has contaminated an instrument before it is used on the patient.
B) The nurse discards a urinary catheter kit because the catheter is the wrong size.
C) The nurse uses an instrument from a sterile package that became outdated yesterday.
D) The nurse changes gloves when a possible contamination occurs.
E) The nurse, working alone, touches the inside of a sterile package with ungloved hands but does not discard the contents.

Question 27

The patient has a documented allergy to latex. Which nursing actions are indicated?

A) Schedule surgery for the last case of the day.
B) Use powdered gloves.
C) Use a stopcock for the injection of intravenous drugs.
D) Disinfect the rubber tops on medication bottles with Betadine rather than alcohol.

Question 28

The patient is scheduled for an operative procedure that will require placement of an additional IV line, an indwelling urinary catheter, and a nasogastric tube. The nurse should advocate for these lines to be placed at what time?

A) Prior to transferring the patient to the preoperative holding area
B) In the preoperative holding area
C) After general anesthesia has been induced
D) In the postanesthesia recovery room

Question 29

The nurse in the preoperative holding area is checking to see if the correct patient has been transferred for the next surgical case. What questions would the nurse ask?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "Are you Mary Smith?"
B) "What is your name?"
C) "What is your social security number?"
D) "What is your birth date?"
E) "What surgery are you having?"

Question 30

The certified nurse anesthetist has administered succinylcholine to a patient during surgery. The surgery has ended and the patient is awakening. The nurse would evaluate which findings as indicating recovery from this agent?.Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The patient can hold the head up.
B) The patient has a strong hand grasp.
C) The patient is still sleepy.
D) The patient is breathing with only minimal stimulation by the nurse.
E) The patient's pupils react to light.