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As an intraoperative nurse, you know that the patients emotional state can influence the outcome of his or her surgical procedure. How would you best reinforce the patients ability to influence outcome?
- A. Teach the patient strategies for distraction.
- B. Pair the patient with another patient who has better coping strategies.
- C. Incorporate cultural and religious considerations, as appropriate.
- D. Give the patient antianxiety medication.
Correct Answer: C
Rationale: Because the patients emotional state remains a concern, the care initiated by preoperative nurses is continued by the intraoperative nursing staff that provides the patient with information and reassurance. The nurse supports coping strategies and reinforces the patients ability to influence outcomes by encouraging active participation in the plan of care incorporating cultural, ethnic, and religious considerations, as appropriate. Buddying a patient is normally inappropriate and distraction may or may not be effective. Nonpharmacologic measures should be prioritized.
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The patients surgery is nearly finished and the surgeon has opted to use tissue adhesives to close the surgical wound. This requires the nurse to prioritize assessments related to what complication?
- A. Hypothermia
- B. Anaphylaxis
- C. Infection
- D. Malignant hyperthermia
Correct Answer: B
Rationale: Fibrin sealants are used in a variety of surgical procedures, and cyanoacrylate tissue adhesives are used to close wounds without the use of sutures. These sealants have been implicated in allergic reactions and anaphylaxis. There is not an increased risk of malignant hyperthermia, hypothermia, or infection because of the use of tissue adhesives.
The perioperative nurse is implementing a care plan that addresses the surgical patients risk for vomiting. Interventions that address the potential for vomiting reduce the risk of what subsequent surgical complication?
- A. Impaired skin integrity
- B. Hypoxia
- C. Malignant hyperthermia
- D. Hypothermia
Correct Answer: B
Rationale: If the patient aspirates vomitus, an asthma-like attack with severe bronchial spasms and wheezing is triggered. Pneumonitis and pulmonary edema can subsequently develop, leading to extreme hypoxia. Vomiting can cause choking, but the question asks about aspirated vomitus. Malignant hyperthermia is an adverse reaction to anesthesia. Aspirated vomitus does not cause hypothermia. Vomiting does not result in impaired skin integrity.
Verification that all required documentation is completed is an important function of the intraoperative nurse. The intraoperative nurse should confirm that the patients accompanying documentation includes which of the following?
- A. Discharge planning
- B. Informed consent
- C. Analgesia prescription
- D. Educational resources
Correct Answer: B
Rationale: It is important to review the patients record for the following: correct informed surgical consent, with patients signature; completed records for health history and physical examination; results of diagnostic studies; and allergies (including latex). Discharge planning records and prescriptions are not normally necessary. Educational resources would not be included at this stage of the surgical process.
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 nurse is packing a patients abdominal wound with sterile, half-inch Iodoform gauze. During the procedure, the nurse drops some of the gauze onto the patients abdomen 2 inches (5 cm) away from the wound. What should the nurse do?
- A. Apply povidone-iodine (Betadine) to that section of the gauze and continue packing the wound.
- B. Pick up the gauze and continue packing the wound after irrigating the abdominal wound with Betadine solution.
- C. Continue packing the wound and inform the physician that an antibiotic is needed.
- D. Discard the gauze packing and repack the wound with new Iodoform gauze.
Correct Answer: D
Rationale: Sterile surfaces or articles may touch other sterile surfaces or articles and remain sterile; contact with unsterile objects at any point renders a sterile area contaminated. The sterile gauze became contaminated when it was dropped on the patients abdomen. It should be discarded and new Iodoform gauze should be used to pack the wound. Betadine should not be used in the wound unless ordered.