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The circulating nurse in an outpatient surgery center is assessing a patient who is scheduled to receive moderate sedation. What principle should guide the care of a patient receiving this form of anesthesia?
- A. The patient must never be left unattended by the nurse.
- B. The patient should begin a course of antiemetics the day before surgery.
- C. The patient should be informed that he or she will remember most of the procedure.
- D. The patient must be able to maintain his or her own airway.
Correct Answer: A
Rationale: The patient receiving moderate sedation should never be left unattended. The patients ability to maintain his or her airway depends on the level of sedation. The administration of moderate sedation is not a counter indication for giving an antiemetic. The patient receiving moderate sedation does not remember most of the procedure.
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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.
A circulating nurse provides care in a surgical department that has multiple surgeries scheduled for the day. The nurse should know to monitor which patient most closely during the intraoperative period because of the increased risk for hypothermia?
- A. A 74-year-old woman with a low body mass index
- B. A 17-year-old boy with traumatic injuries
- C. A 45-year-old woman having an abdominal hysterectomy
- D. A 13-year-old girl undergoing craniofacial surgery
Correct Answer: A
Rationale: Elderly patients are at greatest risk during surgical procedures because they have an impaired ability to increase their metabolic rate and impaired thermoregulatory mechanisms, which increase susceptibility to hypothermia. The other patients are likely at a lower risk.
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.
An intraoperative nurse is applying interventions that will address surgical patients risks for perioperative positioning injury. Which of the following factors contribute to this increased risk for injury in the intraoperative phase of the surgical experience? Select all that apply.
- A. Absence of reflexes
- B. Diminished ability to communicate
- C. Loss of pain sensation
- D. Nausea resulting from anesthetic
- E. Reduced blood pressure
Correct Answer: A,B,C
Rationale: Loss of pain sense, reflexes, and ability to communicate subjects the intraoperative patient to possible injury. Nausea and low blood pressure are not central factors that contribute to this risk, though they are adverse outcomes.
The perioperative nurse has completed the presurgical assessment of an 82-year-old female patient who is scheduled for a left total knee replacement. When planning this patients care, the nurse should address the consequences of the patients aging cardiovascular system. These include an increased risk of which of the following?
- A. Hypervolemia
- B. Hyponatremia
- C. Hyperkalemia
- D. Hyperphosphatemia
Correct Answer: A
Rationale: The aging heart and blood vessels have decreased ability to respond to stress. Reduced cardiac output and limited cardiac reserve make the elderly patient vulnerable to changes in circulating volume and blood oxygen levels. There is not an increased risk for hyponatremia, hyperkalemia, or hyperphosphatemia because of an aging cardiovascular system.