Nokea
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.
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A client is scheduled for a below-the-knee amputation. The circulating nurse ensures the proper side is marked prior to the start of surgery. What action by the nurse is most appropriate?
- A. Facilitate marking the site with the client and surgeon.
- B. Have the client mark the operative site.
- C. Have the client mark the operative site.
- D. Tell the surgeon it is time to mark the surgical site.
Correct Answer: A
Rationale: The Joint Commission now recommends that both the client and the surgeon mark the operative site together in order to prevent wrong-site surgery. The nurse should facilitate this process.
A nurse is monitoring a client after moderate sedation. The nurse documents the client's Ramsay Sedation Scale (RSS) score at 3. What action by the nurse is best?
- A. Assess the client's gag reflex.
- B. Begin providing discharge instructions.
- C. Document findings and continue to monitor.
- D. Increase oxygen and notify the provider.
Correct Answer: C
Rationale: An RSS score of 3 means the client is able to respond quickly, but only to commands. The client has not had enough time to fully arouse. The nurse should document the findings and continue to monitor per agency policy. If the client had an oral endoscope or was intubated, checking the gag reflex would be appropriate prior to permitting eating or drinking. The client is not yet awake enough for teaching. There is no need to increase oxygen and notify the provider.
The nursing student observes the perioperative area and notes the unique functions of the circulating nurse, which include: (Select all that apply.)
- A. Accounting for all sharps
- B. Documenting all care given
- C. Maintaining the sterile field
- D. Monitoring traffic in the room
- E. Anticipating needs of the surgical team
Correct Answer: A,E
Rationale: The circulating nurse has several responsibilities, including maintaining client safety and privacy, monitoring traffic in and out of the operating room, assessing fluid losses, reporting findings to the surgeon and anesthesia provider, anticipating needs of the team, and communicating to the family. The circulating nurse and scrub person work together to ensure accurate counts of sharps, sponges, and instruments. The circulating nurse also documents care, but in the perioperative area, the preoperative or holding room nurse would also document. Maintaining the sterile field is a joint responsibility of all members of the surgical team.
A client is having surgery. The circulating nurse notes the client's oxygen saturation is low and the heart rate is elevated. What is more important?
- A. Assess the client's end-tidal carbon dioxide level
- B. Document the findings in the client's chart.
- C. Inform the anesthesia provider of these findings.
- D. Prepare to administer dantrolene sodium (Dantrium).
Correct Answer: A
Rationale: Malignant hyperthermia is a rare but serious reaction to anesthesia. The triad of early signs includes decreased oxygen saturation, tachycardia, and elevated end-tidal carbon dioxide (CO2) level. The nurse should quickly check the end-tidal CO2 and then report findings to the anesthesia provider and surgeon. Documentation is vital, but not the most important action at this stage. Dantrolene sodium is the drug of choice if the client does have malignant hyperthermia.
What actions by the circulating nurse are important to promote client comfort? (Select all that apply.)
- A. Introducing oneself
- B. Providing warmth
- C. Positioning the client correctly
- D. Remaining present with the client
- E. Removing hearing aids
Correct Answer: A,B,C,D
Rationale: The circulating nurse can do many things to promote client comfort, including positioning the client correctly and comfortably, introducing herself or himself to the client, keeping the client warm, and remaining present with the client. Removing hearing aids does not promote comfort and, if the client is still awake when they are removed, may contribute to disorientation and anxiety.