Chapter 18: Intraoperative Nursing Management
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical
Nursing, 13th Edition
MULTIPLE CHOICE
1. The nurse is preparing an elderly patient for a scheduled removal of orthopedic
hardware, a procedure to be performed under general anesthetic. For which
adverse effect should the nurse most closely monitor the patient?
A) Hypothermia
B) Pulmonary edema
C) Cerebral ischemia
D) Arthritis
ANS: A
Inadvertent hypothermia may occur as a result of a low temperature in the OR,
infusion of cold fluids, inhalation of cold gases, open body wounds or cavities,
decreased muscle activity, advanced age, or the pharmaceutical agents used
(e.g., vasodilators, phenothiazines, general anesthetics). The anesthetist monitors
for pulmonary edema and cerebral ischemia. Arthritis is not an adverse effect of
surgical anesthesia.
2. The OR nurse acts in the circulating role during a patient's scheduled cesarean
section. For what task is this nurse solely responsible?
A) Performing documentation
B) Estimating the patient's blood loss
C) Setting up the sterile tables
D) Keeping track of drains and sponges
ANS: A
Main responsibilities of the circulating nurse include verifying consent;
coordinating the team; and ensuring cleanliness, proper temperature and
humidity, lighting, safe function of equipment, and the availability of supplies
, and materials. The circulating nurse monitors aseptic practices to avoid breaks
in technique while coordinating the movement of related personnel as well as
implementing fire safety precautions. The circulating nurse also monitors the
patient and documents specific activities throughout the operation to ensure the
patient's safety and well-being. Estimating the patient's blood loss is the
surgeon's responsibility; setting up the sterile tables is the responsibility of the
first scrub; and keeping track of the drains and sponges is the joint responsibility
of the circulating nurse and the scrub nurse.
3. A 21-year-old patient is positioned on the OR bed prior to knee surgery to
correct a sports-related injury. The anesthesiologist administers the
appropriate anesthetic. The OR nurse should anticipate which of the
following events as the team's next step in the care of this patient?
A) Grounding
B) Making the first incision
C) Giving blood
D) Intubating
ANS: D
When the patient arrives in the OR, the anesthesiologist or anesthetist reassesses
the patient's physical condition immediately prior to initiating anesthesia. The
anesthetic is administered, and the patient's airway is maintained through an
intranasal intubation, oral intubation, or a laryngeal mask airway.
Grounding or blood administration does not normally follow anesthetic
administration immediately. An incision would not be made prior to intubation.
, 4. A circulating nurse provides care in a surgical department that has multiple
surgeries scheduled for the day. The nurse should know to monitor which
patient most closely during the intraoperative period because of the increased
risk for hypothermia?
A) A 74-year-old woman with a low body mass index
B) A 17-year-old boy with traumatic injuries
C) A 45-year-old woman having an abdominal hysterectomy
D) A 13-year-old girl undergoing craniofacial surgery
ANS: A
Elderly patients are at greatest risk during surgical procedures because they have
an impaired ability to increase their metabolic rate and impaired thermoregulatory
mechanisms, which increase susceptibility to hypothermia. The other patients are
likely at a lower risk.
5. The anesthetist is coming to the surgical admissions unit to see a patient prior to
surgery scheduled for tomorrow morning. Which of the following is the priority
information that the nurse should provide to the anesthetist during the visit?
A) Last bowel movement
B) Latex allergy
C) Number of pregnancies
D) Difficulty falling asleep
ANS: B
Due to the increased number of patients with latex allergies, it is essential to
identify this allergy early on so precautions can be taken in the OR. The
anesthetist should be informed of any allergies. This is a priority over pregnancy
history, insomnia, or recent bowel function, though some of these may be
relevant.
6. An OR nurse is teaching a nursing student about the principles of surgical
asepsis as a requirement in the restricted zone of the operating suite. What
personal protective equipment should the nurse wear at all times in the restricted
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical
Nursing, 13th Edition
MULTIPLE CHOICE
1. The nurse is preparing an elderly patient for a scheduled removal of orthopedic
hardware, a procedure to be performed under general anesthetic. For which
adverse effect should the nurse most closely monitor the patient?
A) Hypothermia
B) Pulmonary edema
C) Cerebral ischemia
D) Arthritis
ANS: A
Inadvertent hypothermia may occur as a result of a low temperature in the OR,
infusion of cold fluids, inhalation of cold gases, open body wounds or cavities,
decreased muscle activity, advanced age, or the pharmaceutical agents used
(e.g., vasodilators, phenothiazines, general anesthetics). The anesthetist monitors
for pulmonary edema and cerebral ischemia. Arthritis is not an adverse effect of
surgical anesthesia.
2. The OR nurse acts in the circulating role during a patient's scheduled cesarean
section. For what task is this nurse solely responsible?
A) Performing documentation
B) Estimating the patient's blood loss
C) Setting up the sterile tables
D) Keeping track of drains and sponges
ANS: A
Main responsibilities of the circulating nurse include verifying consent;
coordinating the team; and ensuring cleanliness, proper temperature and
humidity, lighting, safe function of equipment, and the availability of supplies
, and materials. The circulating nurse monitors aseptic practices to avoid breaks
in technique while coordinating the movement of related personnel as well as
implementing fire safety precautions. The circulating nurse also monitors the
patient and documents specific activities throughout the operation to ensure the
patient's safety and well-being. Estimating the patient's blood loss is the
surgeon's responsibility; setting up the sterile tables is the responsibility of the
first scrub; and keeping track of the drains and sponges is the joint responsibility
of the circulating nurse and the scrub nurse.
3. A 21-year-old patient is positioned on the OR bed prior to knee surgery to
correct a sports-related injury. The anesthesiologist administers the
appropriate anesthetic. The OR nurse should anticipate which of the
following events as the team's next step in the care of this patient?
A) Grounding
B) Making the first incision
C) Giving blood
D) Intubating
ANS: D
When the patient arrives in the OR, the anesthesiologist or anesthetist reassesses
the patient's physical condition immediately prior to initiating anesthesia. The
anesthetic is administered, and the patient's airway is maintained through an
intranasal intubation, oral intubation, or a laryngeal mask airway.
Grounding or blood administration does not normally follow anesthetic
administration immediately. An incision would not be made prior to intubation.
, 4. A circulating nurse provides care in a surgical department that has multiple
surgeries scheduled for the day. The nurse should know to monitor which
patient most closely during the intraoperative period because of the increased
risk for hypothermia?
A) A 74-year-old woman with a low body mass index
B) A 17-year-old boy with traumatic injuries
C) A 45-year-old woman having an abdominal hysterectomy
D) A 13-year-old girl undergoing craniofacial surgery
ANS: A
Elderly patients are at greatest risk during surgical procedures because they have
an impaired ability to increase their metabolic rate and impaired thermoregulatory
mechanisms, which increase susceptibility to hypothermia. The other patients are
likely at a lower risk.
5. The anesthetist is coming to the surgical admissions unit to see a patient prior to
surgery scheduled for tomorrow morning. Which of the following is the priority
information that the nurse should provide to the anesthetist during the visit?
A) Last bowel movement
B) Latex allergy
C) Number of pregnancies
D) Difficulty falling asleep
ANS: B
Due to the increased number of patients with latex allergies, it is essential to
identify this allergy early on so precautions can be taken in the OR. The
anesthetist should be informed of any allergies. This is a priority over pregnancy
history, insomnia, or recent bowel function, though some of these may be
relevant.
6. An OR nurse is teaching a nursing student about the principles of surgical
asepsis as a requirement in the restricted zone of the operating suite. What
personal protective equipment should the nurse wear at all times in the restricted
