Chapter 21Intraoperative Nursing Management My Nursing Test Banks

Chapter 21Intraoperative Nursing Management

MULTIPLE CHOICE

1.A nurse is considering additional training to become a perioperative nurse. Which of the following skills are implemented by the perioperative nurse?

1.

Conducts telephone interviews with the preoperative client

2.

Applies principles of aseptic technique

3.

Instructs the preoperative client on exercises to use while recovering from surgery

4.

Plans for the postoperative clients discharge to home

ANS: 2

Skills of the perioperative nurse include applying principles of aseptic technique and explaining how this knowledge applies to other areas within the operating suite. The perioperative nurse does not conduct telephone interviews with the preoperative client, instruct the preoperative client in postoperative exercises, nor plan for the postoperative clients discharge to home.

PTS: 1 DIF: Apply REF: The Role of the Perioperative Nurse

2.Even though the nurse realizes that the ideal time period to plan for postoperative pain management for a pediatric client begins in the operating room, the nurse will begin the assessment process:

1.

at the time the decision is made that the client needs surgery.

2.

in the familys home.

3.

during the admission process.

4.

in the operating room after anesthesia wears off.

ANS: 3

Pain management cannot begin before the patient is admitted, and starting after the surgery is too late. It begins at the admission when the type of surgery indicates which type of medication will be needed, and medication skills will be taught to the client and the family. Planning for pain management cannot begin in the clients home nor at the time the decision is made that the client needs surgery.

PTS: 1 DIF: Apply REF: Pain Management in Pediatric Patients

3.The perioperative nurse realizes that the surgical environment is designed to ensure which of the following?

1.

Calming effect on the client

2.

Ease of use by personnel

3.

Control surgical asepsis

4.

Reduce postoperative pain

ANS: 3

The design of the intraoperative environment is to maintain surgical asepsis. The design is not to have a calming effect on clients. Intraoperative environments are not designs for ease of use by personnel or to reduce postoperative pain.

PTS: 1 DIF: Analyze REF: The Surgical Environment

4.The scrub nurse is preparing the sterile field by opening an instrument package that was sterilized in an autoclave with direct exposure to steam. This type of sterilization is considered to be:

1.

high-pressure/high-temperature steam.

2.

cold chemical.

3.

dry heat.

4.

alcohol.

ANS: 1

High-pressure/high-temperature steam sterilization is the use of an autoclave to directly expose the instruments to steam for a specified period of time. Cold chemical sterilization is the submersion of instruments in a sterilizing solution for a predetermined period of time. Dry heat utilizes static air or forced air to sterilize items. Alcohol is a commonly used disinfectant. It is not an effective sterilant and, therefore, is not acceptable.

PTS: 1 DIF: Analyze REF: Box 21-5 Sterilization Methods

5.Prior to the surgeons making an incision into a client, the clients skin is bathed with a bacteriostatic solution. The nurse realizes that this solution will:

1.

sterilize the clients skin.

2.

disinfect the clients skin.

3.

sanitize the clients skin.

4.

inhibit the number of bacteria on the clients skin.

ANS: 4

A bacteriostatic solution is one that will inhibit the increase in the number of bacteria. Sterilization, disinfection, and sanitization are all methods to reduce or destroy microorganisms on objects. These methods cannot be used on skin.

PTS: 1 DIF: Analyze REF: Table 21-2 Sterilization Terms and Definitions

6.The operating room personnel are applying masks and either goggles or face shields prior to beginning a surgical procedure. The purpose of these items is to:

1.

facilitate vision.

2.

protect against splashes or sprays of blood.

3.

facilitate breathing.

4.

facilitate communication.

ANS: 2

These pieces of personal protective equipment (PPEs) are used to protect personnel from splashes and sprays of blood and body fluids. Masks, goggles, and face shields do not facilitate vision, breathing, or communication.

PTS: 1 DIF: Analyze REF: Personal Protective Equipment

7.The nurse is preparing to participate in a surgical procedure and has completed the surgical scrub. Which of the following should the nurse do now in preparation for the surgery?

1.

Don a surgical gown.

2.

Apply sterile gloves.

3.

Adjust the surgical mask.

4.

Apply covering over the hair.

ANS: 1

Gowns should be put on after completing a surgical scrub and before gloving. The surgical mask should be adjusted before applying sterile gloves. Head covering should be applied before conducting the surgical scrub.

PTS: 1 DIF: Apply REF: Personal Protective Equipment

8.A client with a suspected degenerative brain disease is having surgery to place an intracerebral shunt. Which of the following should be done with the instruments after this surgical procedure?

1.

Sterilize with high-pressure steam.

2.

Sterilize with the special treatment to eliminate prions.

3.

Wash with bacteriostatic solution and submerge in an appropriate chemical bath.

4.

Rinse with disinfectant and place in a gas sterilizer.

ANS: 2

Prion diseases are rare, but they can survive some sterilization processes, and chemical disinfectants are not strong enough to eliminate them. These instruments will need to be sterilized with a special treatment to eliminate the prions. High-pressure steam, bacteriostatic solutions, chemicals, disinfectants, and gas sterilizers are not known sterilization methods to eliminate prions.

PTS: 1 DIF: Apply REF: Personal Protective Equipment

9.A client received general anesthesia for a surgical procedure. Which of the following assessments will the nurse complete first for this client?

1.

Surgical dressing

2.

Intravenous sites

3.

Airway

4.

Pain

ANS: 3

Clients often require assistance in maintaining a patent airway after use of general anesthesia. The first assessment the nurse should make is that of the clients airway. The surgical dressing, intravenous sites, and pain can be assessed after the clients airway has been established.

PTS: 1 DIF: Apply REF: Box 21-7 Types of Anesthesia

10.The student nurse observing a surgical procedure begins to feel lightheaded and nauseated. Which of the following should the student do at this time?

1.

Tell someone she does not feel well.

2.

Leave the operating room immediately.

3.

Nothing since this feeling will pass.

4.

Immediately sit down on the floor.

ANS: 2

If feelings of lightheadedness or nausea occur during an observation of a surgical procedure, the first thing to do is head for the door or at least to a wall away from the surgical field. The student should not tell someone that she is not feeling well. The student should not ignore these feelings since they are signs of fainting. The student should not immediately sit on the floor since this could be in the area of the sterile field and could compromise the surgical procedure.

PTS:1DIF:Apply

REF: Box 21-2 Tips for the Student When Observing in Operating Room

11.A nurse is filling the role of circulator during a surgical procedure. Which of the following will this nurse do to provide care to the client during the case?

1.

Maintain the sterile field.

2.

Assist the surgeon.

3.

Serve as the client advocate.

4.

Assist with the administration of anesthesia.

ANS: 3

The circulating nurse serves as the client advocate while the client is least able to care for himself. Maintaining the sterile field is a responsibility of the scrub nurse. Assisting the surgeon is an activity of the registered nurse first assistant. Assisting with the administration of anesthesia is an activity of the nurse anesthetist.

PTS: 1 DIF: Apply REF: Circulator/Circulating Nurse

12.An elderly client is scheduled for a surgical procedure. The nurse realizes that the outcome of the clients operation will depend upon the clients:

1.

age.

2.

severity of illnesses.

3.

nutritional status.

4.

activity status.

ANS: 2

Severity of illness is a much better predictor of outcome of surgery when compared to age. Nutritional status and activity status would be characteristics that are associated with severity of illness.

PTS: 1 DIF: Analyze REF: Geriatric Considerations

13.During a surgical procedure, the clients body temperature spikes to a dangerous level. Which of the following will be done to help this client?

1.

Reduce the flow of the anesthetic agent.

2.

Provide 50% oxygen.

3.

Stop the surgery for cardiac dysrhythmias.

4.

Administer a Dantrolene infusion.

ANS: 4

Malignant hyperthermia is a medical emergency. The anesthetic agent should be stopped immediately and the client should be hyperventilated with 100% oxygen. The surgery should be stopped if it is an elective case. Dantrolene should be provided.

PTS: 1 DIF: Apply REF: Malignant Hyperthermia

MULTIPLE RESPONSE

1.A perioperative nurse is identified as being the scrub nurse for a surgical procedure. Which of the following is this nurses responsibilities during the surgery? (Select all that apply.)

1.

Don surgical attire and personal protective equipment.

2.

Maintain the sterile field.

3.

Pass instruments and supplies to the surgeon.

4.

Prepare medication.

5.

Remove used instruments.

6.

Organize the sterile field for use.

ANS: 2, 3, 4

Responsibilities of the scrub nurse during a surgical procedure include maintaining the sterile field, passing instruments and supplies to the surgeon, and preparing medication. Donning surgical attire and organizing the sterile field are responsibilities done before the surgery begins. Removing used instruments are done after the surgery has concluded.

PTS: 1 DIF: Apply REF: Box 21-3 Duties of the Scrub Nurse

2.The perioperative nurse is identifying nursing diagnoses appropriate for a client currently having surgery. Which of the following would be appropriate for the client at this time?

1.

Risk for infection

2.

Risk for impaired skin integrity

3.

Risk for injury

4.

Risk for inadequate nutrition

5.

Risk for hypothermia

6.

Risk for fluid volume overload

ANS: 1, 2, 3, 5

Nursing diagnoses for the perioperative client include risk for infection, risk for impaired skin integrity, risk of injury, and risk of hypothermia. Risk for inadequate nutrition and risk for fluid volume overload would be more appropriate during the postoperative period of client care.

PTS: 1 DIF: Analyze REF: NANDA and the Nursing Process

3.Which of the strategies can a perioperative nurse use to make a child feel less anxious prior to a surgical procedure? (Select all that apply.)

1.

Take the client on a tour of the operating room.

2.

Allow the client to bring a toy or stuffed animal.

3.

Allow the parents to stay with the child as much as possible.

4.

Have the chaplain say a prayer with the child.

5.

Use age-appropriate explanations.

6.

Respond to questions in a straightforward manner.

ANS: 1, 2, 3, 5, 6

Strategies to help a preoperative pediatric client feel less anxious prior to a surgical procedure include taking the client on a tour of the operating room, allowing the client to bring a toy or stuffed animal, allowing the parents to stay with the client as much as possible, using age-appropriate explanations, and responding to questions in a straightforward manner. Having a chaplain say a prayer with the child is good, but it may not be age appropriate.

PTS: 1 DIF: Apply REF: Pediatric Considerations

4.The circulating nurse is performing a time out prior to the beginning of a surgical procedure. Which of the following will be assessed during this time out? (Select all that apply.)

1.

Correct client

2.

Correct procedure

3.

Correct site and side

4.

Correct surgeon

5.

Correct day

6.

Correct time

ANS: 1, 2, 3, 4

A correctly performed time out includes verifying the right client; the correct procedure; the correct site and side; the correct surgeon; the correct position; the correct equipment, instruments, and implants if necessary. The correct day and time are not parts of the surgical time out.

PTS: 1 DIF: Apply REF: Time Out

5.The nurse determines that a client is experiencing a risk associated with the use of anesthesia for a surgical procedure. Which of the following are considered risks of anesthesia? (Select all that apply.)

1.

Nausea and vomiting

2.

Sore throat

3.

Seizure

4.

Postoperative myocardial infarction

5.

Surgical wound infection

6.

Hypothermia

ANS: 1, 2, 3, 4, 6

Risks of anesthesia include adverse reaction to the anesthetic, nausea and vomiting, sore throat, seizure, myocardial infarction, hypothermia, malignant hyperthermia, numbness or loss of function of a body part, and disseminated intravascular coagulation. Surgical wound infection is not a risk associated with anesthesia.

PTS: 1 DIF: Analyze REF: Red Flag: Risks of Anesthesia

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