Nokea
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.
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The circulating nurse will be participating in a 78-year-old patients total hip replacement. Which of the following considerations should the nurse prioritize during the preparation of the patient in the OR?
- A. The patient should be placed in Trendelenburg position.
- B. The patient must be firmly restrained at all times.
- C. Pressure points should be assessed and well padded.
- D. The preoperative shave should be done by the circulating nurse.
Correct Answer: C
Rationale: The vascular supply should not be obstructed by an awkward position or undue pressure on a body part. During surgical procedures, the patient is at risk for impairment of skin integrity due to a stationary position and immobility. An elderly patient is at an increased risk of injury and impaired skin integrity. A Trendelenburg position is not indicated for this patient. Once anesthetized for a total hip replacement, the patient cannot move; restraints are not necessary. A preoperative shave is not performed; excess hair is removed by means of a clipper.
The nurse is caring for a patient who is scheduled to have a needle biopsy of the pleura. The patient has had a consultation with the anesthesiologist and a conduction block will be used. Which local conduction block can be used to block the nerves leading to the chest?
- A. Transsacral block
- B. Brachial plexus block
- C. Peudental block
- D. Paravertebral block
Correct Answer: D
Rationale: Examples of common local conduction blocks include paravertebral anesthesia, which produces anesthesia of the nerves supplying the chest, abdominal wall, and extremities; brachial plexus block, which produces anesthesia of the arm; and transsacral (caudal) block, which produces anesthesia of the perineum and, occasionally, the lower abdomen. A peudental block was used in obstetrics before the almost-routine use of epidural anesthesia.
The OR nurse is participating in the appendectomy of a 20-year-old female patient who has a dangerously low body mass index. The nurse recognizes the patients consequent risk for hypothermia. What action should the nurse implement to prevent the development of hypothermia?
- A. Ensure that IV fluids are warmed to the patients body temperature.
- B. Transfuse packed red blood cells to increase oxygen carrying capacity.
- C. Place warmed bags of normal saline at strategic points around the patients body.
- D. Monitor the patients blood pressure and heart rate vigilantly.
Correct Answer: A
Rationale: Warmed IV fluids can prevent the development of hypothermia. Applying warmed bags of saline around the patient is not common practice. The patient is not transfused to prevent hypothermia. Blood pressure and heart rate monitoring are important, but do not relate directly to the risk for hypothermia.
A patient waiting in the presurgical holding area asks the nurse, Why exactly do they have to put a breathing tube into me? My surgery is on my knee. What is the best rationale for intubation during a surgical procedure that the nurse should describe?
- A. The tube provides an airway for ventilation.
- B. The tube protects the patients esophagus from trauma.
- C. The patient may receive an antiemetic through the tube.
- D. The patients vital signs can be monitored with the tube.
Correct Answer: A
Rationale: The anesthetic is administered and the patients airway is maintained through an intranasal intubation, oral intubation, or a laryngeal mask airway. The tube also helps protect aspiration of stomach contents. The tube does not protect the esophagus. Because the tube goes into the lungs, no medications are given through the tube. The patients vital signs are not monitored through the tube.
As a perioperative nurse, you know that the National Patient Safety Goals have the potential to improve patient outcomes in a wide variety of health care settings. Which of these Goals has the most direct relevance to the OR?
- A. Improve safety related to medication use
- B. Reduce the risk of patient harm resulting from falls
- C. Reduce the incidence of health care-associated infections
- D. Reduce the risk of fires
Correct Answer: D
Rationale: The National Patient Safety Goals all pertain to the perioperative areas, but the one with the most direct relevance to the OR is the reduction of the risk of surgical fires.