Question 1

What actions by the circulating nurse are important to promote client comfort? (Select all that apply.)

Accepted Answer

The circulating nurse can do many things to promote client comfort,including positioning the client correctly and comfortably,introducing herself or himself to the client,keeping the client warm,and remaining present with the client.Removing hearing aids does not promote comfort and,if the client is still awake when they are removed,may contribute to disorientation and anxiety.

Question 2

A client has received intravenous anesthesia during an operation.What action by the postanesthesia care nurse is most important?

Accepted Answer

Intravenous anesthetic agents have the potential to cause respiratory and circulatory depression.The nurse should ensure the client is on a cardiac monitor and pulse oximeter.Muscle relaxants are not indicated for this client at this time.Intravenous anesthetics have a lower rate of postoperative nausea and vomiting than other types.Shivering can occur in any client,but is more common after inhalation agents.

Question 3

The circulating nurse is plugging in a piece of equipment and notes that the cord is frayed.What action by the nurse is best?

Accepted Answer

The circulating nurse is responsible for client safety.If an electrical cord is frayed,the risk of fire or sparking increases.The nurse should obtain a replacement.The nurse should also tag the original equipment for repair as per agency policy.Checking the equipment is not important as the nurse should not even attempt to use it.Calling maintenance or requesting maintenance per facility protocol is important,but first ensure client safety by having a properly working piece of equipment for the procedure about to take place.The charge nurse probably does need to know of the need for equipment repair,but ensuring client safety is the priority.

Question 4

A client is having surgery.The circulating nurse notes the client's oxygen saturation is 90% and the heart rate is 110 beats/min.What action by the nurse is best?

Accepted Answer

Malignant hyperthermia is a rare but serious reaction to anesthesia.The triad of early signs include decreased oxygen saturation,tachycardia,and elevated end-tidal carbon dioxide (CO₂)level.The nurse should quickly check the end-tidal CO₂ and then report findings to the anesthesia provider and surgeon.Documentation is vital,but not the most important action at this stage.Dantrolene sodium is the drug of choice if the client does have malignant hyperthermia.

Question 5

A client is having robotic surgery.The circulating nurse observes the instruments being inserted,then the surgeon appears to "break scrub" when going to the console and sitting down.What action by the nurse is best?

Accepted Answer

During a robotic operative procedure,the surgeon inserts the articulating arms into the client,then "breaks scrub" to sit at the viewing console to perform the operation.The nurse should document the time the robotic portion of the procedure began.There is no need for the other interventions.

Question 6

A client has developed malignant hyperthermia.The client weighs 136 pounds.What is the safe dose range for one dose of dantrolene sodium (Dantrium)? (Enter your answer using whole numbers,separated by a hyphen with no spaces.)_____ mg

Accepted Answer

The answer of A client has developed malignant hyperthermia.The client...

Question 7

The circulating nurse reviews the day's schedule and notes clients who are at higher risk of anesthetic overdose and other anesthesia-related complications.Which clients does this include? (Select all that apply.)

Accepted Answer

People at higher risk for anesthetic overdose or other anesthesia-related complications include people with a slowed metabolism (older adults generally have slower metabolism than younger adults),those with kidney or liver impairments,and those with mutations of the RYR1 gene.Drinking a 6-pack of beer per day possibly indicates some liver disease; a creatinine of 3.8 is high,indicating renal disease; and the genetic mutation increases the chance of malignant hyperthermia.Taking birth control pills is not a risk factor.

Question 8

A client is having shoulder surgery with regional anesthesia.What actions by the nurse are most important to enhance client safety related to this anesthesia? (Select all that apply.)

Accepted Answer

After regional anesthesia is administered,the client loses all sensation distally.The nurse ensures client safety by assessing distal circulation and padding the shoulder and arm appropriately.Although awake,the client will not be able to report potential injury.Keeping the client warm is not related to this anesthesia,nor is suctioning or speaking quietly.

Question 9

A client in the operating room has developed malignant hyperthermia.The client's potassium is 6.5 mEq/L.What action by the nurse takes priority?

Accepted Answer

For hyperkalemia in a client with malignant hyperthermia,the nurse administers 10 units of regular insulin in 50 mL of 50% dextrose.This will force potassium back into the cells rapidly.Nifedipine is a calcium channel blocker used to treat hypertension and dysrhythmias,and should not be used in a client with malignant hyperthermia.Assessing the urine for blood or myoglobin is important,but does not take priority.Monitoring the client for dysrhythmias is also important due to the potassium imbalance,but again does not take priority over treating the potassium imbalance.

Question 10

A circulating nurse has transferred an older client to the operating room.What action by the nurse is most important for this client?

Accepted Answer

Many older clients have sensory loss.To help prevent disorientation,facilities often allow older clients to keep their eyeglasses on and hearing aids in until the start of anesthesia.The other actions are appropriate for all operative clients.

Question 11

A circulating nurse wishes to provide emotional support to a client who was just transferred to the operating room.What action by the nurse would be best?

Accepted Answer

The nurse can provide emotional support by remaining with the client until anesthesia has been provided.An extremely anxious client may need anxiolytics,but not all clients require this for emotional support.Physical comfort and introductions can also help decrease anxiety.

Question 12

The nursing student observing in the perioperative area notes the unique functions of the circulating nurse,which include which roles? (Select all that apply.)

Accepted Answer

The circulating nurse has several functions,including maintaining client safety and privacy,monitoring traffic in and out of the operating room,assessing fluid losses,reporting findings to the surgeon and anesthesia provider,anticipating needs of the team,and communicating to the family.The circulating nurse and scrub person work together to ensure accurate counts of sharps,sponges,and instruments.The circulating nurse also documents care,but in the perioperative area,the preoperative or holding room nurse would also document care received there.Maintaining the sterile field is a joint responsibility among all members of the surgical team.

Question 13

A student nurse observing in the operating room notes that the functions of the Certified Registered Nurse First Assistant (CRNFA)include which activities? (Select all that apply.)

Accepted Answer

The CRNFA can perform tasks under the direction of the surgeon such as suturing and dressing surgical wounds,cutting away tissue,suctioning the wound to improve visibility,and holding retractors.Reattaching severed nerves and performing grafts would be the responsibility of the surgeon.

Question 14

A client is scheduled for a below-the-knee amputation.The circulating nurse ensures the proper side is marked prior to the start of surgery.What action by the nurse is most appropriate?

Accepted Answer

The Joint Commission now recommends that both the client and the surgeon mark the operative site together in order to prevent wrong-site surgery.The nurse should facilitate this process.

Question 15

A nurse is monitoring a client after moderate sedation.The nurse documents the client's Ramsay Sedation Scale (RSS)score at 3.What action by the nurse is best?

Accepted Answer

An RSS score of 3 means the client is able to respond quickly,but only to commands.The client has not had enough time to fully arouse.The nurse should document the findings and continue to monitor per agency policy.If the client had an oral endoscopy or was intubated,checking the gag reflex would be appropriate prior to permitting eating or drinking.The client is not yet awake enough for teaching.There is no need to increase oxygen and notify the provider.

Question 16

The circulating nurse and preoperative nurse are reviewing the chart of a client scheduled for minimally invasive surgery (MIS).What information on the chart needs to be reported to the surgeon as a priority?

Accepted Answer

All MIS procedures have the potential for becoming open procedures depending on findings and complications.The client's consent should include this possibility.The nurse should report this finding to the surgeon prior to surgery taking place.Having allergies noted and an allergy band applied is standard procedure.Not having any prior surgical or anesthesia exposure is not the priority.Maintaining NPO status as prescribed is standard procedure.

Question 17

The circulating nurse is in the operating room and sees the surgeon don gown and gloves using appropriate sterile procedure.The surgeon then folds the hands together and places them down below the hips.What action by the nurse is most appropriate?

Accepted Answer

The surgical gown is considered sterile from the chest to the level of the surgical field.By placing the hands down by the hips,the surgeon has broken sterile field.The circulating nurse informs the surgeon of this breach.Changing only the gloves or only the gown does not "restore" the sterile sections of the gown.Doing nothing is unacceptable.

Question 18

A client is in stage 2 of general anesthesia.What action by the nurse is most important?

Accepted Answer

During stage 2 of general anesthesia (excitement,delirium),the client can vomit and aspirate.The nurse must be ready to react to this potential occurrence by being prepared to suction the client's airway.Keeping the room quiet and calm does help the client enter the anesthetic state,but is not the priority.Positioning the client usually occurs during stage 3 (operative anesthesia).Keeping the client warm is important throughout to prevent hypothermia.

Quiz 15: Care of Intraoperative Patients