Chapter 21: Nursing Management: Intraoperative Care: Lewis’s Medical-
Surgical Nursing, 5th Edition
1. The nurse is preparing a patient 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?
A. IV midazolam
B. Inhaled desflurane
C. Epidural lidocaine
D. Eutectic mixture of local anaesthetics (EMLA)
Answer: A
Explanation: IV sedatives, such as the benzodiazepines, are administered for procedural
sedation. Inhaled, epidural, and topical agents are not included in procedural sedation.
2. Which of the following actions should the scrub nurse use to maintain aseptic
technique during surgery?
A. Use waterproof shoe covers.
B. Wear personal protective equipment.
C. Insist that all operating room (OR) staff perform a surgical scrub.
D. Change gloves after touching the thigh of a surgeon's sterile gown.
Answer: D
Explanation: 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 patient, 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.
3. The nurse is preparing a patient for surgery. Which of the following actions should
the nurse include in the surgical time-out procedure? (Select all that apply.)
A. Check for placement of IV lines.
B. Have the surgeon identify the patient.
C. Confirm the hospital chart identification (ID) number.
D. Have the patient state name and date of birth.
E. Ask the patient to state the surgical procedure.
F. Verify the patient ID band number.
Answer: C, D, E, F
,Explanation: These actions are included in surgical time out. IV line placement and
identification of the patient by the surgeon are not included in the surgical time-out
procedure.
4. The perioperative nurse is encouraging a family member to remain with a patient in
the preoperative holding area until the patient is taken into the operating room. Which
of the following reasons is the primary reason for this encouragement?
A. Ensure proper identification of the patient before surgery.
B. Protect patient from cross-contamination with other patients.
C. Assist perioperative nurse to obtain a complete patient history.
D. Help relieve the stress of surgery for the patient and family member.
Answer: D
Explanation: The presence of a family member or friend reduces the patient's anxiety and
stress associated with the preoperative period. Although the family may give information
about the patient'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.
5. Which of the following descriptions best define the role of the nurse anaesthetist as a
member of the surgical team?
A. Is able to administer anaesthetics.
B. Has the same credentials and responsibilities as an anaesthesiologist.
C. Is responsible for intraoperative administration of anaesthetics ordered by the
anaesthesiologist.
D. Does not require supervision by the anaesthesiologist while administering anaesthesia to a
patient.
Answer: A
Explanation: 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.
6. 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?
,A. Smooth functioning of the OR team
B. Effective protection of patient privacy
C. Rapid completion of surgical procedure
D. Low incidence of perioperative infection
Answer: D
Explanation: The primary focus when setting up the OR is the prevention of cross-
contamination and transmission of infection to the patient. Patient privacy, efficient
completion of procedures, and smooth functioning of the OR team are also important, but the
priority is protection of the patient from infection.
7. 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?
A. Documents all patient care accurately.
B. Labels all specimens to send to the laboratory.
C. Keeps both hands above the operating table level.
D. Takes the patient to the postanaesthesia recovery area.
Answer: C
Explanation: 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.
8. The perioperative nurse is assessing a patient in the preoperative holding area. Which
of the following findings would indicate a need for special protection techniques during
surgery?
A. A stated allergy to cats and dogs
B. A history of spinal and hip arthritis
C. Verbalization of anxiety by the patient
D. Having a sip of water 2 hours previously
Answer: B
Explanation: The patient 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 patient. An allergy to cats and dogs will not
impact the care needed during the intraoperative phase.
, 9. The nurse from the general surgical unit is asked to bring the patient's hearing aid to
the surgical suite. The nurse will take the hearing aid to which one of the following
areas?
A. Clean core
B. Scrub sink area
C. Nursing station or communication centre
D. Corridors of the operating room area
Answer: C
Explanation: 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.
10. The nurse is caring for a preoperative adult patient who is scheduled for a routine
surgery and is in the holding area. The patient asks the nurse, "Will the doctor put me
to sleep with a mask over my face?" Which of the following responses is most
appropriate?
A. "A drug will be given to you through your IV line, which will cause you to go to sleep
almost immediately."
B. "Only your surgeon can tell you for sure what method of anaesthesia will be used. Should
I ask your surgeon?"
C. "General anaesthesia is now given by injecting medication into your veins, so you will not
need a mask over your face."
D. "Masks are not used anymore for anaesthesia. A tube will be inserted into your throat to
deliver a gas that will put you to sleep."
Answer: A
Explanation: 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 patients are intubated. Total IV anaesthesia may be
used for some patients but inhalation anaesthetics also are commonly used. The patient will
have a face mask even if the medication is injected into patient veins so telling the patient
that they will not have a face mask is not accurate.
11. A surgical patient 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?
Surgical Nursing, 5th Edition
1. The nurse is preparing a patient 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?
A. IV midazolam
B. Inhaled desflurane
C. Epidural lidocaine
D. Eutectic mixture of local anaesthetics (EMLA)
Answer: A
Explanation: IV sedatives, such as the benzodiazepines, are administered for procedural
sedation. Inhaled, epidural, and topical agents are not included in procedural sedation.
2. Which of the following actions should the scrub nurse use to maintain aseptic
technique during surgery?
A. Use waterproof shoe covers.
B. Wear personal protective equipment.
C. Insist that all operating room (OR) staff perform a surgical scrub.
D. Change gloves after touching the thigh of a surgeon's sterile gown.
Answer: D
Explanation: 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 patient, 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.
3. The nurse is preparing a patient for surgery. Which of the following actions should
the nurse include in the surgical time-out procedure? (Select all that apply.)
A. Check for placement of IV lines.
B. Have the surgeon identify the patient.
C. Confirm the hospital chart identification (ID) number.
D. Have the patient state name and date of birth.
E. Ask the patient to state the surgical procedure.
F. Verify the patient ID band number.
Answer: C, D, E, F
,Explanation: These actions are included in surgical time out. IV line placement and
identification of the patient by the surgeon are not included in the surgical time-out
procedure.
4. The perioperative nurse is encouraging a family member to remain with a patient in
the preoperative holding area until the patient is taken into the operating room. Which
of the following reasons is the primary reason for this encouragement?
A. Ensure proper identification of the patient before surgery.
B. Protect patient from cross-contamination with other patients.
C. Assist perioperative nurse to obtain a complete patient history.
D. Help relieve the stress of surgery for the patient and family member.
Answer: D
Explanation: The presence of a family member or friend reduces the patient's anxiety and
stress associated with the preoperative period. Although the family may give information
about the patient'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.
5. Which of the following descriptions best define the role of the nurse anaesthetist as a
member of the surgical team?
A. Is able to administer anaesthetics.
B. Has the same credentials and responsibilities as an anaesthesiologist.
C. Is responsible for intraoperative administration of anaesthetics ordered by the
anaesthesiologist.
D. Does not require supervision by the anaesthesiologist while administering anaesthesia to a
patient.
Answer: A
Explanation: 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.
6. 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?
,A. Smooth functioning of the OR team
B. Effective protection of patient privacy
C. Rapid completion of surgical procedure
D. Low incidence of perioperative infection
Answer: D
Explanation: The primary focus when setting up the OR is the prevention of cross-
contamination and transmission of infection to the patient. Patient privacy, efficient
completion of procedures, and smooth functioning of the OR team are also important, but the
priority is protection of the patient from infection.
7. 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?
A. Documents all patient care accurately.
B. Labels all specimens to send to the laboratory.
C. Keeps both hands above the operating table level.
D. Takes the patient to the postanaesthesia recovery area.
Answer: C
Explanation: 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.
8. The perioperative nurse is assessing a patient in the preoperative holding area. Which
of the following findings would indicate a need for special protection techniques during
surgery?
A. A stated allergy to cats and dogs
B. A history of spinal and hip arthritis
C. Verbalization of anxiety by the patient
D. Having a sip of water 2 hours previously
Answer: B
Explanation: The patient 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 patient. An allergy to cats and dogs will not
impact the care needed during the intraoperative phase.
, 9. The nurse from the general surgical unit is asked to bring the patient's hearing aid to
the surgical suite. The nurse will take the hearing aid to which one of the following
areas?
A. Clean core
B. Scrub sink area
C. Nursing station or communication centre
D. Corridors of the operating room area
Answer: C
Explanation: 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.
10. The nurse is caring for a preoperative adult patient who is scheduled for a routine
surgery and is in the holding area. The patient asks the nurse, "Will the doctor put me
to sleep with a mask over my face?" Which of the following responses is most
appropriate?
A. "A drug will be given to you through your IV line, which will cause you to go to sleep
almost immediately."
B. "Only your surgeon can tell you for sure what method of anaesthesia will be used. Should
I ask your surgeon?"
C. "General anaesthesia is now given by injecting medication into your veins, so you will not
need a mask over your face."
D. "Masks are not used anymore for anaesthesia. A tube will be inserted into your throat to
deliver a gas that will put you to sleep."
Answer: A
Explanation: 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 patients are intubated. Total IV anaesthesia may be
used for some patients but inhalation anaesthetics also are commonly used. The patient will
have a face mask even if the medication is injected into patient veins so telling the patient
that they will not have a face mask is not accurate.
11. A surgical patient 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?
