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A circulating nurse has transferred an older client to the operating room. What action by the nurse is most important for this client?
- A. Allow the client to keep hearing aids in until anesthesia begins.
- B. Pad the table as appropriate for the surgical procedure.
- C. Position the client for maximum visualization of the site.
- D. Stay with the client, providing emotional comfort and support.
Correct Answer: A
Rationale: Many older clients have sensory loss. To help prevent disorientation, facilities often allow older clients to keep their eyeglasses on and hearing aids in until the start of anesthesia. The other actions are appropriate for all operative clients.
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The circulating nurse and preoperative nurse are reviewing the chart of a client scheduled for minimally invasive surgery (MIS). What information on the chart needs to be reported to the surgeon as a priority?
- A. Call the charge nurse.
- B. Consent for MIS procedure only
- C. Call prior anesthesia exposure
- D. Call prior anesthesia last to hours.
Correct Answer: B
Rationale: All MIS procedures have the potential for becoming open procedures depending on findings and complications. The client's consent should include this possibility. The nurse should report this finding to the surgeon prior to surgery taking place. Having allergies noted and an allergy band applied is standard. Calling the charge nurse is not the priority in this case.
A circulating nurse wishes to provide emotional support to a client who was just transferred to the operating room. What action by the nurse would be best?
- A. Administer an anxiolytic.
- B. Provide warm blankets.
- C. Introduce the surgical staff.
- D. Remain with the client.
Correct Answer: D
Rationale: The nurse can provide emotional support by remaining with the client until anesthesia has been provided. An anxious client may need an anxiolytic, but not all clients require this for emotional support. Physical comfort and introductions can also help decrease anxiety.
A client has developed malignant hyperthermia. The client weighs 113 pounds. What is the safe dose range for one dose of dantrolene sodium (Dantrium)? (Enter your answer using whole numbers, separated by a hyphen.)
- A. 100-150 mg
- B. 124-155 mg
- C. 200-250 mg
- D. 50-75 mg
Correct Answer: B
Rationale: The safe dose range for dantrolene sodium (Dantrium) in treating malignant hyperthermia is 2.5 mg/kg. For a client weighing 113 pounds (51.36 kg), the dose is calculated as 51.36 kg ? 2.5 mg/kg = 128.4 mg. The safe range is typically rounded to whole numbers, making 124-155 mg appropriate for one dose.
A client in the operating room has developed malignant hyperthermia. The client's potassium is 6.5 mEq/L. What action by the nurse is most appropriate?
- A. Administer insulin and glucose.
- B. Administer dantrolene sodium (Dantrium).
- C. Increase intravenous fluids.
- D. Monitor the client's electrocardiogram.
Correct Answer: B
Rationale: Malignant hyperthermia is a medical emergency, and dantrolene sodium (Dantrium) is the drug of choice to treat it. Hyperkalemia (potassium 6.5 mEq/L) may occur, but the priority is to administer dantrolene to reverse the malignant hyperthermia. Administering insulin and glucose or increasing fluids may be part of the treatment protocol, but dantrolene is the most critical. Monitoring the ECG is important but not the priority action.
The circulating nurse is plugging in a piece of equipment and notes that the cord is frayed. What action by the nurse is best?
- A. Call maintenance for repair.
- B. Check the machine before using.
- C. Control the piece of equipment.
- D. Notify the charge nurse.
Correct Answer: C
Rationale: The circulating nurse is responsible for client safety. If an electrical cord is frayed, the risk of fire or sparking increases. The nurse should obtain a replacement. The nurse should also tag the original equipment for repair as per agency policy. Checking the equipment is not important as the nurse should not even attempt to use it. Calling maintenance or requesting maintenance per facility protocol is important, but first ensure client safety by having a properly working piece of equipment for the procedure about to take place. The charge nurse probably does need to know of the need for equipment repair, but ensuring client safety is the priority.