Nokea
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 teams next step in the care of this patient?
- A. Grounding
- B. Making the first incision
- C. Giving blood
- D. Intubating
Correct Answer: D
Rationale: When the patient arrives in the OR, the anesthesiologist or anesthetist reassesses the patients physical condition immediately prior to initiating anesthesia. The anesthetic is administered, and the patients 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.
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Prior to a patients scheduled surgery, the nurse has described the way that members of diverse health disciplines will collaborate in the patients care. What is the main rationale for organizing perioperative care in this collaborative manner?
- A. Historical precedence
- B. Patient requests
- C. Physicians needs
- D. Evidence-based practice
Correct Answer: D
Rationale: Collaboration of the surgical team using evidence-based practice tailored to a specific case results in optimal patient care and improved outcomes. None of the other listed factors is the basis for the collaboration of the surgical team.
A 68-year-old patient is scheduled for a bilateral mastectomy. The OR nurse has come out to the holding area to meet the patient and quickly realizes that the patient is profoundly anxious. What is the most appropriate intervention for the nurse to apply?
- A. Reassure the patient that modern surgery is free of significant risks.
- B. Describe the surgery to the patient in as much detail as possible.
- C. Clearly explain any information that the patient seeks.
- D. Remind the patient that the anesthetic will render her unconscious.
Correct Answer: C
Rationale: The nurse can alleviate anxiety by supplying information as the patient requests it. The nurse should not assume that every patient wants as much detail as possible and false reassurance must be avoided. Reminding the patient that she will be unconscious is unlikely to reduce anxiety.
An OR nurse is participating in an interdisciplinary audit of infection control practices in the surgical department. The nurse should know that a basic guideline for maintaining surgical asepsis is what?
- A. Sterile surfaces or articles may touch other sterile surfaces.
- B. Sterile supplies can be used on another patient if the packages are intact.
- C. The outer lip of a sterile solution is considered sterile.
- D. The scrub nurse may pour a sterile solution from a nonsterile bottle.
Correct Answer: A
Rationale: Basic guidelines for maintaining sterile technique include that sterile surfaces or articles may touch other sterile surfaces only. The other options each constitute a break in sterile technique.
The OR nurse acts in the circulating role during a patients scheduled cesarean section. For what task is this nurse solely responsible?
- A. Performing documentation
- B. Estimating the patients blood loss
- C. Setting up the sterile tables
- D. Keeping track of drains and sponges
Correct Answer: A
Rationale: 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 patients safety and well-being. Estimating the patients blood loss is the surgeons 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.
A patient will be undergoing a total hip arthroplasty later in the day and it is anticipated that the patient may require blood transfusion during surgery. How can the nurse best ensure the patients safety if a blood transfusion is required?
- A. Prime IV tubing with a unit of blood and keep it on hold.
- B. Check that the patients electrolyte levels have been assessed preoperatively.
- C. Ensure that the patient has had a current cross-match.
- D. Keep the blood on standby and warmed to body temperature.
Correct Answer: C
Rationale: Few patients undergoing an elective procedure require blood transfusion, but those undergoing high-risk procedures may require an intraoperative transfusion. The circulating nurse anticipates this need, checks that blood has been cross-matched and held in reserve, and is prepared to administer blood. Storing the blood at body temperature or in IV tubing would result in spoilage and potential infection.