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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.
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Which of the following outcome measures is best for the operating room (OR) nurse manager to use in determining the effectiveness of the physical environment and traffic control measures in the operating room?
- A. Smooth functioning of the OR team.
- B. Effective protection of patient privacy
- C. Rapid completion of surgical procedure
- D. Low incidence of perioperative infection
Correct Answer: D
Rationale: The primary focus when setting up the OR is the prevention of cross-contamination and transmission of infection to the patient. Patient privacy, efficient completion of procedures, and smooth functioning of the OR team are also important, but the priority is protection of the patient from infection.
Which of the following descriptions best define the role of the nurse anaesthetist as a member of the surgical team?
- A. Is able to administer anaesthetics.
- B. Has the same credentials and responsibilities as an anaesthesiologist.
- C. Is responsible for intraoperative administration of anaesthetics ordered by the anaesthesiologist.
- D. Does not require supervision by the anaesthesiologist while administering anaesthesia to a patient.
Correct Answer: A
Rationale: The registered nurse anaesthesia assistant (RNAA) is able to administer anaesthetic agents. Although the responsibilities of a RNAA and an anaesthesiologist have some overlap, the credentialing and roles are different. Supervision by an anaesthesiologist is necessary during anaesthetic administration by a RNAA as the RNAA works in collaboration with and under the supervision of an anaesthesiologist.
A patient's family history reveals that the patient may be at risk for malignant hyperthermia (MH) during anaesthesia. Which of the following information should the nurse include when providing preoperative patient teaching?
- A. Anaesthesia can be administered with minimal risks with the use of appropriate precautions and medications.
- B. As long as succinylcholine is not administered as a muscle relaxant, the reaction should not occur.
- C. Surgery must be performed under local anaesthetic to prevent development of a sudden, extreme increase in body temperature.
- D. Surgery will be delayed until the patient is genetically tested to determine susceptibility to malignant hyperthermia.
Correct Answer: A
Rationale: General anaesthesia can be administered to patients with MH as long as precautions to avoid MH are taken and preparations are made to treat MH if it does occur. Other factors besides succinylcholine administration are associated with MH. Predictions about whether MH will occur based on family history are inconsistent, and it may not be possible to delay surgery.
The perioperative nurse is encouraging a family member to remain with a patient in the preoperative holding area until the patient is taken into the operating room. Which of the following reasons is the primary reason for this encouragement?
- A. Ensure proper identification of the patient before surgery.
- B. Protect patient from cross-contamination with other patients.
- C. Assist perioperative nurse to obtain a complete patient history.
- D. Help relieve the stress of surgery for the patient and family member.
Correct Answer: D
Rationale: The presence of a family member or friend reduces the patient's anxiety and stress associated with the preoperative period. Although the family may give information about the patient's name and history, this information is obtained and confirmed by the nurse in other ways. Nursing staff, rather than family members, are responsible for prevention of cross-contamination.
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.