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The nurse is preparing an elderly patient for a scheduled removal of orthopedic hardware, a procedure to be performed under general anesthetic. For which adverse effect should the nurse most closely monitor the patient?
- A. Hypothermia
- B. Pulmonary edema
- C. Cerebral ischemia
- D. Arthritis
Correct Answer: A
Rationale: Inadvertent hypothermia may occur as a result of a low temperature in the OR, infusion of cold fluids, inhalation of cold gases, open body wounds or cavities, decreased muscle activity, advanced age, or the pharmaceutical agents used (e.g., vasodilators, phenothiazines, general anesthetics). The anesthetist monitors for pulmonary edema and cerebral ischemia. Arthritis is not an adverse effect of surgical anesthesia.
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The anesthetist is coming to the surgical admissions unit to see a patient prior to surgery scheduled for tomorrow morning. Which of the following is the priority information that the nurse should provide to the anesthetist during the visit?
- A. Last bowel movement
- B. Latex allergy
- C. Number of pregnancies
- D. Difficulty falling asleep
Correct Answer: B
Rationale: Due to the increased number of patients with latex allergies, it is essential to identify this allergy early on so precautions can be taken in the OR. The anesthetist should be informed of any allergies. This is a priority over pregnancy history, insomnia, or recent bowel function, though some of these may be relevant.
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 OR nurse is taking the patient into the OR when the patient informs the operating nurse that his grandmother spiked a 104 F temperature in the OR and nearly died 15 years ago. What relevance does this information have regarding the patient?
- A. The patient may be experiencing presurgical anxiety.
- B. The patient may be at risk for malignant hyperthermia.
- C. The grandmothers surgery has minimal relevance to the patients surgery.
- D. The patient may be at risk for a sudden onset of postsurgical infection.
Correct Answer: B
Rationale: Malignant hyperthermia is an inherited muscle disorder chemically induced by anesthetic agents. Identifying patients at risk is imperative because the mortality rate is 50%. The patients anxiety is not relevant, the grandmothers surgery is very relevant, and all patients are at risk for hypothermia.
The OR nurse acts in the circulating role during a patients scheduled cesarean section. For what task is this nurse solely responsible?
- A. Performing documentation
- B. Estimating the patients blood loss
- C. Setting up the sterile tables
- D. Keeping track of drains and sponges
Correct Answer: A
Rationale: Main responsibilities of the circulating nurse include verifying consent; coordinating the team; and ensuring cleanliness, proper temperature and humidity, lighting, safe function of equipment, and the availability of supplies and materials. The circulating nurse monitors aseptic practices to avoid breaks in technique while coordinating the movement of related personnel as well as implementing fire safety precautions. The circulating nurse also monitors the patient and documents specific activities throughout the operation to ensure the patients safety and well-being. Estimating the patients blood loss is the surgeons responsibility; setting up the sterile tables is the responsibility of the first scrub; and keeping track of the drains and sponges is the joint responsibility of the circulating nurse and the scrub nurse.
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.