Nokea
The nurse is caring for a preoperative adult patient who is scheduled for a routine surgery and is in the holding area. The patient asks the nurse, 'Will the doctor put me to sleep with a mask over my face?' Which of the following responses is most appropriate?
- A. A drug will be given to you through your IV line, which will cause you to go to sleep almost immediately.'
- B. Only your surgeon can tell you for sure what method of anaesthesia will be used. Should I ask your surgeon?'
- C. General anaesthesia is now given by injecting medication into your veins, so you will not need a mask over your face.'
- D. Masks are not used anymore for anaesthesia. A tube will be inserted into your throat to deliver a gas that will put you to sleep.'
Correct Answer: A
Rationale: The first step in virtually all routine surgeries for general anaesthesia is the injection of an intravenous (IV) induction agent, which rapidly induces sleep. The anaesthesiologist (not the surgeon) determines the method of anaesthesia used. Masks may still be used for inhalation, although many patients are intubated. Total IV anaesthesia may be used for some patients but inhalation anaesthetics also are commonly used.
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The nurse is positioning a patient in the operating room for a transurethral resection of the prostate. Which of the following patient positions should the nurse place this patient in?
- A. Prone
- B. Supine
- C. Trendelenburg
- D. Lithotomy
Correct Answer: D
Rationale: The lithotomy position is used for genitourinary procedures such as vaginal hysterectomy and transurethral resection of the prostate. Although supine is the most common position, it is not used for this surgery; rather it is appropriate for abdominal, cardiac, and breast surgeries. A variation of the supine is the Trendelenburg position, used in lower abdominal or pelvic surgery, for which it is necessary to see the pelvic organs. The prone position allows easy access for back surgeries (e.g., laminectomies).
The perioperative nurse is assessing a patient in the preoperative holding area. Which of the following findings would indicate a need for special protection techniques during surgery?
- A. A stated allergy to cats and dogs.
- B. A history of spinal and hip arthritis.
- C. Verbalization of anxiety by the patient
- D. Having a sip of water 2 hours previously
Correct Answer: B
Rationale: The patient with arthritis may require special positioning to avoid injury and postoperative discomfort. Preoperative anxiety and having a sip of water 2-3 hours before surgery are not unusual for the preoperative patient. An allergy to cats and dogs will not impact the care needed during the intraoperative phase.
Which of the following nursing actions should the preoperative nurse perform to prepare a patient for cranial surgery that requires hair removal?
- A. Consult with the surgeon to consider cancellation of the surgery.
- B. Use a depilatory agent to remove hair from the surgical area.
- C. Shave the scalp surgical area with a 1 cm border.
- D. No special preoperative action is required.
Correct Answer: B
Rationale: For surgeries that require hair removal, the hair is either clipped or a depilatory agent is used for hair removal. There is no need to consider cancelling the surgery. Shaving the hair is contraindicated.
A surgical patient received a volatile liquid as an inhalation anaesthetic during surgery. Which of the following symptoms should the nurse monitor for in the immediate postoperative period?
- A. Tachypnea
- B. Myoclonia
- C. Hypertension
- D. Incisional pain
Correct Answer: D
Rationale: Because volatile liquid inhalation agents are rapidly metabolized, postoperative pain occurs soon after surgery. Hypertension and tachypnea are not associated with general anaesthetics. Myoclonia may occur with nonbarbiturate hypnotics but not with the inhaled inhalation agents.
The nurse is preparing a patient with a dislocated shoulder for a closed, manual reduction of the dislocation with procedural sedation. Which of the following medications should the nurse anticipate administering for this procedure?
- A. IV midazolam
- B. Inhaled desflurane
- C. Epidural lidocaine
- D. Eutectic mixture of local anaesthetics (EMLA)
Correct Answer: A
Rationale: IV sedatives, such as the benzodiazepines, are administered for procedural sedation. Inhaled, epidural, and topical agents are not included in procedural sedation.