Question 1

A patient has been placed on a ventilator as part of recovery following surgery. After several hours, they begin to show jerking muscle movements and are trying to breathe around the ventilator, causing increased airway pressure. What is the nurse's most appropriate intervention at this point?

Accepted Answer

When a patient becomes agitated and starts bucking the ventilator, the nurse should administer a muscle relaxant to calm the patient and prevent breathing around the ventilator. The patient is not breathing in sequence with the ventilator and may be very anxious about being intubated. A muscle relaxant will provide a calming effect.

Question 2

The perioperative nurse is caring for a patient with a chest tube when they notice an extensive amount of bubbling in the water seal chamber of the device. The patient has developed cyanosis and shallow breathing. What is the nurse's next action?

Accepted Answer

The nurse should notify the physician. If the water seal chamber starts bubbling excessively and there is not an outside leak, the patient could be retaining air within the pleural cavity. Based on the patient's response of cyanosis and shallow breathing, the chest tube is not working correctly and the physician needs to be notified.

Question 3

A patient is admitted for a traumatic abdominal injury, which requires surgery. While in the operating room, the perioperative nurse sets up to insert an indwelling catheter and notices blood coming from the patient's urinary meatus. What is the nurse's next intervention?

Accepted Answer

In this situation, the nurse should not insert the catheter and notify the physician. A patient who is bleeding from the urinary meatus after a traumatic injury may have a pelvic fracture or damage to the bladder. The physician may want to order further imaging studies to rule out the presence of further injuries. The nurse should avoid inserting a catheter until the physician has cleared the patient for this intervention.

Question 4

What is the purpose of critical incident stress debriefing for a patient with an adverse outcome?

Accepted Answer

The purpose of a critical incident stress debriefing is to discuss painful feelings related to a situation with an adverse outcome. When a patient dies tragically or a particularly difficult situation is encountered, healthcare providers may struggle with feelings of helplessness or grief over the situation. Critical incident stress debriefing allows those involved to share their feelings in an effort to cope with the situation.

Question 5

While preparing a patient for surgery, the patient suddenly begins to have a seizure. Sputum is collecting around their mouth and lips. What is the nurse's response?

Accepted Answer

The nurse should stay by the patient and prevent them from injuring themself. Patients who are having seizures should not be restrained, nor should any items be inserted into the mouth. Although this patient is having frothy secretions, the nurse may wipe away some of the drainage and suction when the seizure is complete.

Question 6

In the middle of a surgical procedure, the patient on the table goes into cardiac arrest and needs CPR. What is the first action of the perioperative nurse?

Accepted Answer

Before starting CPR, the nurse should turn on the alarm to notify others of the need for assistance. Even if there are other surgical personnel in the operating room, the alarms notify other nurses on the unit of the emergency. These staff can bring the crash cart and along with it, medications and the cardiac defibrillator to attempt to get the heart beating again and correct cardiac arrhythmias.

Question 7

During a laparoscopic abdominal procedure, a patient has been placed in the reverse Trendelenburg position and given anesthesia. The patient begins to develop hypotension and their blood pressure drops to 96/52 mmHg. What is the first intervention of the nurse?

Accepted Answer

The nurse should change the bed position so the patient's head is level. This condition may have occurred due to insufflation for a laparoscopic procedure. Insufflation may cause increased peripheral resistance and the reverse Trendelenburg position reduces venous return. When changing the patient's position, the nurse should also turn the CO2 rate down on the insufflator.

Question 8

A patient is admitted with severe burns over 50 percent of their body. The nurse inserts an IV to begin fluid administration and for medications. What is the typical process of fluid shift for this type of patient within the first 48 hours?

Accepted Answer

During the first 48 hours following a burn, fluid is pulled out of the blood vessels and into the tissues. The nurse must administer adequate fluids to prevent hypovolemia and subsequent hypotension. The tissues will swell with the excess fluid, but after approximately two to three days, the shift reverses and the fluid returns to circulation.

Question 9

During a surgical procedure, the patient develops an atrial fibrillation. Which of the following conditions is a potential adverse outcome for failing to manage this condition?

Accepted Answer

Failure to manage atrial fibrillation may result in blood clots. When the atria do not beat in sync with the ventricles, the excess blood may pool in the bases instead of passing through the valves into circulation. This blood may clot if it rests in the atria long enough, and small portions may break off into circulation. Atrial fibrillation typically is not life-threatening and often occurs when other, underlying disorders are present.

Question 10

A patient who is normally on blood pressure medication has stopped taking their medicine before having surgery. While in the hospital, they develop a hypertensive emergency, requiring intravenous medication to bring their blood pressure down. Which of the following is a potential complication associated with a hypertensive emergency?

Accepted Answer

A potential complication associated with a hypertensive emergency is a stroke. This occurs when the patient's blood pressure increases to such high levels that one of the small vessels in the brain ruptures. This results in bleeding into the brain, causing memory loss, confusion, and paralysis. The perioperative nurse must respond rapidly to a hypertensive emergency to avoid life-threatening complications.

Question 11

A nurse is assisting with a cesarean section and notes that the fetus appears to be in distress. Upon delivery, the baby is limp and pale, with meconium staining the amniotic fluid. What is the most appropriate action of the nurse?

Accepted Answer

The nurse should provide tracheal suctioning to remove meconium from the airway. This action should be done before stimulating the baby to breathe, as breathing could result in aspiration of meconium into the lungs. The nurse should try to identify the presence of meconium stained fluid before delivery if possible. In some institutions, tracheal suctioning is the physician's responsibility.

Question 12

Which of the following measures is necessary when working with a patient who has been exposed to anthrax?

Accepted Answer

The nurse should wear a positive pressure ventilator or N95 mask when working with this type of patient. For most people, exposure to anthrax is extremely rare, however, some surgical nurses may need to respond for patient care in the case of a bioterrorism event. Anthrax is most commonly spread through inhaling the spores, so respiratory precautions are essential to avoid contamination.

Quiz 4: Emergencies