Test bank for lewis medical surgical nursing 12th edition

Test Bank For Lewis's Medical-Surgical Nursing, 12th Edition by Mariann M. Harding, Jeffrey Kwong, Debra Hagler Chapter 19: Intraoperative Care Harding: Lewis’s Medical-Surgical Nursing, 12th Edition MULTIPLE CHOICE 1. The charge nurse is supervising patient care in the surgical suite. Which action, if performedby a nurse, would require the charge nurse to intervene? A. The nurse wears a mask in the semirestricted area. B. The nurse wears a hair cover in the semirestricted area. C. The nurse wears street clothes in the semirestricted area. D. The nurse wears surgical scrubs in the semirestricted area. ANS: C Wearing street clothes in thesemirestricted area is not permitted. thesurgical suite is divided into three distinct areas: unrestricted—staff and others in street clothes can interact with those in surgical attire; semirestricted—staff must wear surgical attire and cover all head and facial hair; and restricted—includes theoperating room, thesink area, and clean core where masks are required in addition to surgical attire. 2. Which statement, if made by a new circulating nurse, reflects understanding of thecirculating nurse role? A. “Iwill assist in preparing theoperating room forthepatient.” B. “Iwill don sterile gloves to obtain items from theunsterile field.” C. “Iwill assist with suturing of incisions and maintaining hemostasis.” D. “Iwill remain gloved while performing activities in thesterile field.” ANS: A Preparing theoperating room for thepatient describes therole of a circulating nurse. All other answer options describe specific roles and actions of scrub nurses. thecirculating nurse performs activities in theunsterile field and is not scrubbed, gowned, or gloved. thescrub nurse follows thedesignated scrub procedure, is gowned and gloved in sterile attire, and performs activities in thesterile field. 3. Which action describes how thescrub nurse protects thepatient with surgical aseptic technique? A. Uses waterproof shoe covers. B. Wears personal protective equipment. C. Changes gloves after touching theupper arm of thesurgeon‘s gown. D. Requires that all operating room (OR) staff perform a surgical scrub. ANS: C The sleeves of a sterile surgical gown are considered sterile only to 2 in above theelbows, so touching thesurgeon‘s upper arm would contaminate thenurse‘s gloves. Shoe covers are not sterile. Personal protective equipment is designed to protect caregivers, not thepatient, and is not part of aseptic technique. Staff members such as thecirculating nurse do not have to perform a surgical scrub before entering theOR. 4. The operating room nurse is providing orientation to a new nurse. Which action would thenurse describe as a routine responsibility of a scrub nurse? A. Document all patient care accurately. B. Label all specimens to send to thelaboratory. C. Keep both hands above theoperating table level. D. Take thepatient to thepostanesthesia recovery area. ANS: C The scrub nurse role includes maintaining asepsis in theoperating field. thecirculating nurse would perform theother actions. 5. Which data identified during thepreoperative assessment alerts thenurse that special protection techniques should be implemented during surgery? A. Stated allergy to cats and dogs B. History of spinal and hip arthritis C. Verbalization of anxiety by thepatient D. Having a sip of water 3 hours previously ANS: B Misalignment, pressure, or other insults to arthritic joints desensitized from an anesthetic may create long-term injury and disability; thepatient with arthritis may require special positioning to avoid injury and postoperative discomfort. Preoperative anxiety (unless severe) and having a sip of water 3 hours before surgery are not contraindications to having surgery. An allergy to cats and dogs will not affect thecare needed during theintraoperative phase. 6. A patient scheduled to undergo total knee replacement surgery under general anesthesia asks thenurse, “Will thedoctor put me to sleep with a mask over my face?” Which response would thenurse provide? A. “Only yoursurgeon can tell you what method of anesthesia will be used.” B. “Iwill check with theanesthesia care provider to find out what is planned.” C. “General anesthesia is given by injecting drugs into your veins, so you will not need a mask.” D. “Masks are no longer used. A tube inserted into your throat will deliver gas that puts you to sleep.” ANS: B Routine general anesthesia is usually induced by theIV route with a hypnotic, anxiolytic, or dissociative agent. However, general anesthesia may be induced by IV or inhalation. thenurse should consult with theanesthesia care provider to determine themethod selected for this patient. theanesthesia care provider will select themethod of anesthesia, not thesurgeon. Inhalation agents may be given through an endotracheal tube or a laryngeal mask airway. 7. Which potential complication would thenurse monitor for a patient who received inhalation anesthesia? A. Tachypnea B. Myoclonus C. Hypertension D. Laryngospasm ANS: D Possible complications of inhalation anesthetics include coughing, laryngospasm, and increased secretions. Hypertension and tachypnea are not associated with general anesthetics. Myoclonus may occur with nonbarbiturate hypnotics but not with theinhalation agents. 8. Which action would theperioperative nurse take to protect thepatient from direct burn injury during surgery? A. Ensure correct placement of thegrounding pad. B. Check emergency sprinklers in theoperating room. C. Verifythat a fire extinguisher is available during surgery. D. Confirm that electrosurgical equipment is working properly. ANS: A When an electrosurgical unit is in use, thepatient must be properly grounded to prevent unintended tissue burn injury. It is important to ensure that fire extinguishers and sprinklers are available, and that electrosurgical equipment is working properly, but thepatient is at highest risk for burns if thegrounding pad is placed incorrectly. 9. Monitored anesthesia care (MAC) is going to be used for a closed, manual reduction of a patient‘s dislocated shoulder. Which action would thenurse anticipate? A. Starting an IV in thepatient‘s unaffected arm B. Securing an airtight fit for theinhalation mask C. Preparing for placement of an epidural catheter D. Giving deep sedation under physician supervision ANS: A For MAC, IV sedatives, such as thebenzodiazepines, are given. Therefore, thepatient needs IV access. Inhaled and epidural agents are not included in MAC. RNs who are trained and are allowed by agency protocols and state nurse practice acts can provide moderate to deep sedation. However, theprovider of MAC must be an anesthesia care provider since it may be necessary to change to general anesthesia during theprocedure. 10. Which action will theperioperative nurse take after surgery is completed for a patient who received ketamine as an anesthetic agent? A. Question theorder for giving a benzodiazepine. B. Ensure that atropine is available in case of bradycardia. C. Provide a quiet environment in thepostanesthesia care unit. D. Anticipate theneed for higher than usual doses of analgesics. ANS: C Hallucinations are an adverse effect associated with thedissociative anesthetics such as ketamine. Therefore, thepostoperative environment should be kept quiet to decrease therisk of hallucinations. Because ketamine causes profound analgesia lasting into thepostoperative period, higher doses of analgesics are not needed. Ketamine causes an increase in heart rate. Benzodiazepine may be used with ketamine to decrease theincidence of hallucinations and nightmares. 11. While in theholding area, a patient reveals to thenurse that his father had a high fever after surgery. Which action by thenurse is a priority? A. Notify thepatient that thesurgery will be cancelled. B. Place a medical alert sticker on thefront of thepatient‘s chart. C. Alert theanesthesia care provider of thefamily member‘s reaction to surgery. D. Reassure thepatient that his temperature will be monitored closely after surgery. ANS: B The anesthesia care provider (ACP) needs to be notified and made aware of thepatient‘s family history of anesthesia reactions. Malignant hyperthermia (MH) is a valid concern because thepatient‘s father appears to have had a reaction to surgery. theACP needs to be notified immediately rather than waiting for a sticker to be noticed on thechart; a sticker can be placed on thechart after thenotification. thesurgery may go forward after discussion with theACP; general anesthesia can be administered to patients with MH if precautions to avoid MH are taken, thetemperature is monitored closely, and preparations are made to treat MH if it does occur. 12. A patient in surgery receives a neuromuscular blocking agent as an adjunct to general anesthesia. While in thepostanesthesia care unit (PACU), which assessment finding is most important for thenurse to report? A. Lethargy B. Report of nausea C. Disorientation to time D. Weak chest movement ANS: D The most serious adverse effect of theneuromuscular blocking agents is weakness of therespiratorymuscles, which can lead to postoperative hypoxemia. Nausea, lethargy, and disorientation are possible adverse effects of anesthetic drugs, but they are not as great of concern as respiratory depression. 13. A patient in thesurgical holding area is being prepared for a spinal fusion. Which action by a member of thesurgical team requires immediate intervention by thecharge nurse? A. Wearing street clothes into thenursing station B. Wearing a surgical mask into theholding room C. Walking into thehallway outside theoperating room with hair uncovered D. Putting on a surgical mask, cap, and scrubs before entering theoperating room ANS: C The corridors outside theoperating room (OR) are part of thesemirestricted area where personnel must wear surgical attire and head coverings. Surgical masks may be worn in theholding room, although they are not necessary. Street clothes may be worn at thenursing station, which is part of theunrestricted area. Wearing a mask and scrubs is essential when going into theOR. 14. Which action in theperioperative patient plan of care can thecharge nurse delegate to a surgical technologist? A. Teach thepatient about what to expect in theoperating room (OR). B. Pass sterile instruments and supplies to thesurgeon and scrub technician. C. Monitor and interpret thepatient‘s echocardiogram (ECG) during surgery. D. Give thepostoperative report to thepostanesthesia care unit (PACU) nurse. ANS: B The education and certification for a surgical technologist includes thescrub and circulating functions in theOR. Patient teaching, communication with other departments about a patient‘s condition, and theadmission assessment require registered nurse (RN) level education and scope of practice. A surgical technologist is not usually trained to interpret ECG rhythms. 15. When caring for a patient who has received a general anesthetic, thecirculating nurse notes red, raised wheals on thepatient‘s arms. Which action would thenurse take? A. Apply lotion to theaffected areas. B. Cover thearms with sterile drapes. C. Recheck thepatient‘s arms during surgery. D. Notify theanesthesia care practitioner (ACP). ANS: D The presence of wheals indicates a possible allergic or anaphylactic reaction, which may have been caused by latex or by medications administered as part of general anesthesia. Because general anesthesia may mask anaphylaxis, thenurse should report this to theACP. Applying lotion, covering thewheals, or rechecking later will delay care that may be needed for an allergic reaction.