Question 1

The nurse is preparing a client for surgery. Which of the following actions should the nurse include in the surgical time-out procedure? (Select all that apply.)

Accepted Answer

These actions are included in surgical time out. IV line placement and identification of the client by the surgeon are not included in the surgical time-out procedure.

Question 2

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 implements which of the following actions?

Accepted Answer

The scrub nurse role includes maintaining asepsis in the operating field and both hands must stay above waist level to ensure that they are above the operating table level. The other actions would be appropriate to the circulating nurse role.

Question 3

A client in surgery receives a neuro-muscular blocking agent as an adjunct to general anaesthesia. At completion of the surgery, it is most important that the nurse monitor the client for which of the following adverse effects?

Accepted Answer

The most serious adverse effect of the neuro-muscular blocking agents is weakness of the respiratory muscles leading to postoperative hypoxemia. Nausea and confusion are possible adverse effects of these drugs, but they are as great a concern as respiratory depression. Because these medications decrease muscle contraction, laryngospasm and bronchospasm are not concerns.

Question 4

The nurse is positioning a client in the operating room for a transurethral resection of the prostate. Which of the following client positions should the nurse place this client in?

Accepted Answer

The lithotomy position is used for genito-urinary procedures such as vaginal hysterectomy and transurethral resection of the prostate. Although supine is the most common position, it is not used for this surgery; rather it is appropriate for abdominal, cardiac, and breast surgeries. A variation of the supine is the Trendelenburg position, used in lower abdominal or pelvic surgery, for which it is necessary to see the pelvic organs. The prone position allows easy access for back surgeries (e.g., laminectomies).

Question 5

The nurse is caring for a client before surgery who has a question about the preoperative medication. Which of the following people will the nurse communicate this information to?

Accepted Answer

The anaesthesiologist is responsible for prescribing and answering questions about preoperative medications. The RNFA and surgeon are responsible for the surgery, but not for the preoperative sedation. The circulating nurse does not have authority to make a change in any medication.

Question 6

A client's family history reveals that the client may be at risk for malignant hyperthermia (MH) during anaesthesia. Which of the following information should the nurse include when providing preoperative client teaching?

Accepted Answer

General anaesthesia can be administered to clients with MH as long as precautions to avoid MH are taken and preparations are made to treat MH if it does occur. Other factors besides succinylcholine administration are associated with MH. Predictions about whether MH will occur based on family history are inconsistent, and it may not be possible to delay surgery.

Question 7

Which of the following actions should the nurse include in the plan of care immediately after surgery for a client who received ketamine as an anaesthetic agent?

Accepted Answer

Hallucinations are an adverse effect associated with the dissociative anaesthetics such as ketamine, so the postoperative environment should be kept quiet to decrease the risk of hallucinations. Since ketamine causes profound analgesia lasting into the postoperative period, larger doses of analgesics are not needed. Ketamine causes an increase in heart rate. Benzodiazepine use with ketamine may be used to decrease the incidence of hallucinations and nightmares.

Question 8

The nurse from the general surgical unit is asked to bring the client's hearing aid to the surgical suite. The nurse will take the hearing aid to which one of the following areas?

Accepted Answer

The nurse from the general unit would not be wearing surgical scrub attire or a head covering and would be restricted to the nursing station or communication centre, which are unrestricted areas. The clean care, scrub sink area, and corridors are semirestricted areas that require staff members wear surgical scrub attire and head coverings.

Question 9

Asurgical client received a volatile liquid as an inhalation anaesthetic during surgery. Which of the following symptoms should the nurse monitor for in the immediate postoperative period?

Accepted Answer

Because volatile liquid inhalation agents are rapidly metabolized, postoperative pain occurs soon after surgery. Hypertension and tachypnea are not associated with general anaesthetics. Myoclonia may occur with nonbarbiturate hypnotics but not with the inhaled inhalation agents.

Question 10

Which of the following actions should the scrub nurse use to maintain aseptic technique during surgery?

Accepted Answer

Once gloved, a nurse's hands are not to go below his or her waist; therefore, touching the surgeon's thigh would contaminate the nurse's gloves. Hands are always to be kept above waist level. Shoe covers are not sterile. Personal protective equipment is designed to protect caregivers, not the client, and is not part of aseptic technique. Staff members such as the circulating nurse do not have to perform a surgical scrub before entering the OR.

Question 11

The nurse is completing an inventory of medications on the unit. Which of the following anaesthesia medications should the nurse expect to observe under refrigeration? (Select all that apply.)

Accepted Answer

Succinylcholine and atracurium both require refrigeration. The other medications listed did not require refrigeration.

Question 12

Which of the following nursing actions should the preoperative nurse perform to prepare a client for cranial surgery that requires hair removal?

Accepted Answer

For surgeries that require hair removal, the hair is either clipped or a depilatory agent is used for hair removal. There is no need to consider cancelling the surgery. Shaving the hair is contraindicated.

Question 13

Which of the following descriptions best define the role of the nurse anaesthetist as a member of the surgical team?

Accepted Answer

The registered nurse anaesthesia assistant (RNAA) is able to administer anaesthetic agents. Although the responsibilities of a RNAA and an anaesthesiologist have some overlap, the credentialing and roles are different. Supervision by an anaesthesiologist is necessary during anaesthetic administration by a RNAA as the RNAA works in collaboration with and under the supervision of an anaesthesiologist.

Question 14

The perioperative nurse is encouraging a family member to remain with a client in the preoperative holding area until the client is taken into the operating room. Which of the following reasons is the primary reason for this encouragement?

Accepted Answer

The presence of a family member or friend reduces the client's anxiety and stress associated with the preoperative period. Although the family may give information about the client's name and history, this information is obtained and confirmed by the nurse in other ways. Nursing staff, rather than family members, are responsible for prevention of cross-contamination.

Question 15

The nurse is preparing a client with a dislocated shoulder for a closed, manual reduction of the dislocation with procedural sedation. Which of the following medications should the nurse anticipate administering for this procedure?

Accepted Answer

IV sedatives, such as the benzodiazepines, are administered for procedural sedation. Inhaled, epidural, and topical agents are not included in procedural sedation.

Question 16

Data that were obtained during the perioperative nurse is assessing a client in the preoperative holding area. Which of the following findings would indicate a need for special protection techniques during surgery?

Accepted Answer

The client with arthritis may require special positioning to avoid injury and postoperative discomfort. Preoperative anxiety and having a sip of water 2-3 hours before surgery are not unusual for the preoperative client. An allergy to cats and dogs will not impact the care needed during the intraoperative phase.

Question 17

Which of the following actions by a member of the surgical team requires rapid intervention by the charge nurse?

Accepted Answer

The corridors outside the OR are part of the semirestricted area where personnel must wear surgical attire and head coverings. Surgical masks may be worn in the holding room, although they are not necessary. Street clothes may be worn at the nursing station, which is part of the unrestricted area. Wearing a mask and scrubs is essential when going into the OR.

Question 18

The nurse is caring for a preoperative adult client who is scheduled for a routine surgery and is in the holding area. The client asks the nurse, "Will the doctor put me to sleep with a mask over my face?" Which of the following responses is most appropriate?

Accepted Answer

The first step in virtually all routine surgeries for general anaesthesia is the injection of an intravenous (IV) induction agent, which rapidly induces sleep. The anaesthesiologist (not the surgeon) determines the method of anaesthesia used. Masks may still be used for inhalation, although many clients are intubated. Total IV anaesthesia may be used for some clients but inhalation anaesthetics also are commonly used. The client will have a face mask even if the medication is injected into client veins so telling the client that they will not have a face mask is not accurate.

Question 19

Which of the following outcome measures is 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?

Accepted Answer

The primary focus when setting up the OR is the prevention of cross-contamination and transmission of infection to the client. Client privacy, efficient completion of procedures, and smooth functioning of the OR team are also important, but the priority is protection of the client from infection.

Quiz 21: Nursing Management Intraoperative Care