Chapter 17: Care of Intraoperative Patients Nursing School Test Banks

Chapter 17: Care of Intraoperative Patients

Test Bank

MULTIPLE CHOICE

1. Which observed action indicates that the nurse is performing the surgical scrub correctly?

a.

A small brush is used to scrub under nails and wedding ring.

b.

The surgical mask is put on before starting the surgical scrub.

c.

The soap is rinsed off so that the water runs down to the hands.

d.

A paper towel is used to turn off the faucet handle.

ANS: B

The facemask must be donned before the surgical scrub is started. Jewelry is removed before scrubbing. The hands and the arms are positioned so that water falls away from them and does not run up or down the hands and arms. Water flow is controlled by foot pedals.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 270

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)

MSC: Integrated Process: Nursing Process (Implementation)

2. A client is having epidural anesthesia for knee replacement surgery. Which action by the nurse is the priority during this surgery?

a.

Provide emotional support for the client.

b.

Position the client comfortably and safely.

c.

Stay with the client until sedation is effective.

d.

Teach the client cough and deep-breathing exercises.

ANS: B

The clients safety is the nurses priority during this surgery. The other actions are appropriate but are not the highest priority.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

3. Which action indicates to the operating room supervisor that the scrub nurse requires additional teaching about sterile technique?

a.

A small amount of sterile saline is poured out before it is poured into the basin.

b.

The nurse disposes of any equipment packages that are in poor condition.

c.

Sterile surgical supplies are placed in the center of the sterile field.

d.

The sterile saline bottle cap is placed in the center of the sterile field.

ANS: D

The outside of the bottle cap is not sterile and should not be placed on the sterile field. The other actions indicate good understanding of sterile technique.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)

MSC: Integrated Process: Nursing Process (Implementation)

4. What is the priority action for the scrub person at the conclusion of a surgical procedure?

a.

Assist with transferring the client to the postanesthesia care unit.

b.

Document the procedure in the clients medical record.

c.

Set up the sterile field and drape the client appropriately.

d.

Document how many sponges and sharps have been utilized.

ANS: D

The scrub person or nurse should document how many sponges and sharps are utilized after the procedure. The scrub person may assist with transferring, but the client will not leave the operating room until the counts are correct. Documentation is important and ongoing, but at the conclusion of an operation, counting supplies is vital to prevent accidentally leaving them in the client. Draping the client and setting up the field are done before the surgical procedure is begun.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareAccident/Injury Prevention) MSC: Integrated Process: Nursing Process (Planning)

5. Before a clients surgery begins, the circulating nurse notes that the nurse anesthetist did not perform a surgical scrub before coming into the operating room. Which action by the circulating nurse is most appropriate?

a.

Direct the nurse anesthetist to perform the surgical scrub immediately.

b.

Proceed with positioning the client on the operating bed.

c.

Notify the nursing supervisor that sterile technique has been violated.

d.

Proceed with setting up the instruments to be used during surgery.

ANS: B

The nurse anesthetist does not need to perform a sterile scrub before the clients surgery is performed. The circulating nurse can proceed with positioning the client on the operating room bed.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)

MSC: Integrated Process: Nursing Process (Implementation)

6. A client is having spinal anesthesia for knee surgery. Which statement by the client indicates a good understanding of this type of anesthesia?

a.

I wont have to worry about having an allergic reaction.

b.

I will be able to walk sooner after your surgery.

c.

I will have less risk of developing pneumonia after surgery.

d.

I will have less risk of bleeding with epidural anesthesia.

ANS: C

With epidural anesthesia, the client remains conscious, respiratory function is unaffected, and intubation is not necessary. This results in less risk for atelectasis or pneumonia after surgery.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Principles of Teaching/Learning)

MSC: Integrated Process: Teaching/Learning

7. The client is to have a surgical procedure under (moderate) conscious sedation. The client is anxious and asks the nurse what to expect. What is the nurses best response?

a.

You will be awake and alert during the procedure but you will feel no pain.

b.

You will not be able to move your feet or toes during the procedure.

c.

You will not be able to swallow or talk during the procedure.

d.

You will be very sleepy and we will monitor you closely.

ANS: D

A physician or a specially credentialed registered nurse may administer agents for conscious sedation. This rapid and short-acting type of anesthesia, used for brief but uncomfortable procedures, does not render the client completely unconscious. Clients have a reduction in intensity or awareness of the pain without loss of defensive reflexes.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 276

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)

MSC: Integrated Process: Communication and Documentation

8. The nurse is caring for a client who has had conscious sedation. What is the primary advantage of this type of anesthesia?

a.

The client can talk through the procedure.

b.

The client is able to follow directions.

c.

No respiratory support is needed.

d.

No defensive reflexes are lost.

ANS: C

The client undergoing a moderate sedation procedure will not need respiratory support; this is the first and foremost advantage of this kind of sedation. The client will be able to follow directions during the procedure, but maintaining his or her own airway and not requiring mechanical ventilation decrease potential complications.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 276

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Analysis)

9. Before the nurse brings the client to the operating room (OR) for knee surgery, the client reports to the nurse that he did not mark the operative knee with the surgeon. What is the priority action of the nurse?

a.

Proceed with transferring the client to the OR as planned.

b.

Call a time out so the site can be marked before surgery begins.

c.

Call the surgeon to mark the site with the client before transfer to the OR.

d.

Have the client mark the site before transfer to the OR.

ANS: C

According to The Joint Commission, the surgical site should be marked by both the client and the surgeon before anesthesia is administered and surgery begins when the surgery involves a specific side.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlError Prevention)

MSC: Integrated Process: Nursing Process (Implementation)

10. The nurse is preparing to bring a young female client to the operating room for a total abdominal hysterectomy (TAH). The client says to the nurse, I am so glad that I will still be able to have children after this surgery. What is the nurses best response?

a.

That is very good news. How many children do you want?

b.

Werent you taught about your surgery earlier?

c.

You must have misunderstood your surgeon.

d.

I will call the surgeon to speak with you before surgery.

ANS: D

TAH includes removal of the uterus, which will leave the client unable to have children. The surgeon should be called to speak with the client and explain the surgery before the client is moved to the operating room.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareInformed Consent)

MSC: Integrated Process: Nursing Process (Implementation)

11. An older adult client is being positioned on the operating bed for surgery. Which action is the highest priority for the nurse?

a.

Placing gel pads under the clients shoulders and head

b.

Placing a soft pillow between the clients knees

c.

Ensuring that the head is elevated to working height

d.

Assessing skin condition for the need for additional padding

ANS: D

The older adult client needs to be assessed and skin integrity evaluated. Older adults are at higher risk and need increased precautions. The client may need pads under the shoulders and head and between the knees, but the nurse should assess all areas for the need for additional padding. Raising the bed is not a priority action and in fact might increase risk for the client.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlAccident/Injury Prevention)

MSC: Integrated Process: Nursing Process (Implementation)

12. An anesthetized client must be repositioned from the supine to the prone position midway through a surgical procedure. What is the priority action of the nurse?

a.

Log roll the client to prevent dislocation of the shoulder.

b.

Keep the client covered to maintain dignity and minimize heat loss.

c.

Ensure that the clients endotracheal tube does not become dislodged or kinked.

d.

Make sure that the clients indwelling catheter is kept lower than the bladder.

ANS: C

Maintenance of a secure airway is the highest priority.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Implementation)

13. Which action by the surgical nursing staff indicates that additional teaching is required about nurses roles and responsibilities in the operating room?

a.

The circulating nurse and the anesthesiologist accompany the client to the postanesthesia care unit.

b.

The circulating nurse goes to the blood bank to pick up 2 units of fresh-frozen plasma for the client.

c.

The scrub nurse monitors the amount of irrigation fluid that is used during surgery.

d.

The circulating nurse prepares the surgical site before the client is covered with sterile drapes.

ANS: B

The circulating nurse should not leave the operating room to pick up fresh-frozen plasma and should delegate the job to unlicensed personnel instead. The other actions are appropriate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareDelegation) MSC: Integrated Process: Nursing Process (Implementation)

14. The nurse is helping to position a client on the operating bed when the client states, I am really nervous about having the breathing tube put down my throat. What is the nurses best response?

a.

I will give you some medication so that it wont hurt.

b.

The tube is very small and you will hardly know it is there.

c.

The anesthesiologists are experts at this procedure.

d.

The anesthetist will put the tube in your throat after you are asleep.

ANS: D

Reassuring the client that the endotracheal tube (ET) will be placed after the administration of general anesthesia and will be removed before awakening will help allay the clients fears.

DIF: Cognitive Level: Comprehension/Understanding REF: Table 17-2, p. 272

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC: Integrated Process: Caring

15. Which statement indicates accountability by the scrub nurse during a surgical procedure?

a.

The client should have epidural anesthesia rather than general anesthesia.

b.

The clients endotracheal tube is secured and all monitors are in place.

c.

I will have retention sutures ready for the surgeon.

d.

A surgical sponge is missing so I will do a re-count.

ANS: D

The scrub nurse is responsible (with the circulating nurse) for counting all surgical supplies used during a procedure. Re-counting the surgical sponges demonstrates accountability.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlAccident/Injury Prevention)

MSC: Integrated Process: Nursing Process (Implementation)

16. The nurse is assisting a client to the operating bed and notes that the client is hyperventilating and cannot keep still. The client states, I am really very anxious right now. What is the nurses best action?

a.

Call the chaplain to calm the client down.

b.

Tell the client you will stay with him or her.

c.

Inform the surgeon so the procedure can be cancelled.

d.

Inform the anesthesiologist and suggest antianxiety medication.

ANS: B

The nurse should reassure the client that anxiety is normal before surgery, and that the nurse will stay with the client until anesthesia is administered. Calling the chaplain does not show the nurse acting as a client advocate. The procedure does not need to be cancelled, nor does the client need an antianxiety medication right now. If the client cannot be calmed, other options can be explored at that time.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC: Integrated Process: Caring

17. Surgery is almost completed for an obese client with diabetes, and the surgeon prepares to close a large abdominal incision. What is the scrub nurses best action?

a.

Count the number of sponges used.

b.

Ask the circulating nurse to count sponges.

c.

Assist the surgeon with retention sutures.

d.

Administer an antibiotic.

ANS: C

The obese client with diabetes is at high risk for poor wound healing. Retention sutures would be appropriate to reduce the risk of dehiscence or evisceration. It would not be appropriate to stop and count the sponges now, nor would it be the time to administer an antibiotic.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Planning)

18. The nurse is caring for a client who will be having surgery with spinal anesthesia. The client says to the nurse, I changed my mindI dont want to be awake during surgery! What is the nurses best response?

a.

Spinal anesthesia is safer than being put to sleep with general anesthesia.

b.

The anesthesiologist has already determined this is best for your surgery.

c.

Its too late to change now because all the equipment is in place.

d.

I will call the anesthesiologist to come and talk to you.

ANS: D

The nurse should recognize the clients concerns and pass them on to the anesthesiologist. The nurse should not try to convince the client or to teach him or her at this time.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC: Integrated Process: Nursing Process (Implementation)

19. A client is recovering from abdominal surgery and reports unusual muscle pain. The nurse reviews the operative record and notes that the client received propofol (Diprivan) and ketamine (Ketalar). Which action by the nurse is most appropriate?

a.

Request a physical therapy consult.

b.

Encourage the client to ambulate.

c.

Administer the ordered pain medication.

d.

Call the surgeon and request a potassium level.

ANS: D

Propofol can cause propofol infusion syndrome, which is characterized by rhabdomyolysis, renal failure, hyperkalemia, and cardiovascular collapse. The muscle pain should have alerted the nurse to the possibility of rhabdomyolysis. The other options would be correct once a serious problem has been ruled out.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Analysis)

MULTIPLE RESPONSE

1. Before undergoing general anesthesia, the client states, My brother and my father had bad reactions to anesthesia. I hope that doesnt happen to me! What are the nurses best actions? (Select all that apply.)

a.

Hook up leads to a temporary pacemaker.

b.

Have a nasogastric tube ready for insertion.

c.

Assess the clients chest x-ray before surgery.

d.

Have a cooling blanket ready.

e.

Obtain a chest tube insertion kit.

f.

Have a Foley catheter kit ready.

g.

Provide an emergency tracheostomy kit at the bedside.

h.

Inform the anesthesiologist and the surgeon of the clients statement.

ANS: B, D, F, H

Malignant hyperthermia is a dangerous reaction to general anesthesia that is caused by a genetic disorder and is more common in males. The nurse should be prepared to insert a Foley catheter and nasogastric tube and to apply a cooling blanket for the client if the reaction occurs.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Planning)

2. A client is undergoing an operation under general anesthesia. What are the nurse anesthetists best actions to prevent hypoventilation during the operation? (Select all that apply.)

a.

Monitor breathing and circulation continuously.

b.

Monitor blood pressure and heart rate every 5 minutes.

c.

Make sure the anesthesia provider remains in the room.

d.

Elevate the head of the clients bed or stretcher.

e.

Monitor the cardiac rhythm every 30 minutes.

ANS: A, B, C

Best practice standards to prevent hypoventilation have been established jointly by the American Society of Anesthesiologists and the American Association of Nurse Anesthetists. These standards include continuous monitoring of breathing, circulation, and cardiac rhythms; blood pressure and heart rate recordings every 5 minutes; and the continuous presence of an anesthesia provider during the case. The head of the bed or stretcher may not be able to be elevated, depending on the surgical case. The cardiac rhythm should be monitored continuously.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 282

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems)

MSC: Integrated Process: Nursing Process (Implementation)

3. Which clients does the nurse determine have the highest risk for wound infection? (Select all that apply.)

a.

Client who has psoriasis

b.

Middle-aged woman with a body mass index (BMI) of 30

c.

Older adult client with a creatinine level of 4.0

d.

Client with a family history of malignant hyperthermia

e.

Client with peripheral vascular disease

f.

Teenager with diabetes mellitus type 1

ANS: B, C, E, F

Diabetes mellitus, obesity, and renal failure are all risk factors for wound infection. In addition, peripheral vascular disease can lead to decreased circulation and wound healing.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 281

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

4. A client is having an operation. Which assessment findings concern the nurse the most? (Select all that apply.)

a.

Potassium level of 4.2 mEq/dL

b.

Calcium level of 12 mg/dL

c.

Heart rate of 110 beats/min

d.

Oxygen saturation of 95%

e.

pH of 7.37

f.

Blood pressure of 90/40 mm Hg

ANS: B, C, F

Malignant hyperthermia is an emergency situation for an intraoperative client. Assessment findings in malignant hyperthermia include elevated calcium, dysrhythmias, and hypotension. Potassium, oxygen saturation, and pH levels are all normal.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications From Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Analysis)

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