Nokea
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.
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A nurse is caring for a patient following knee surgery that was performed under a spinal anesthetic. What intervention should the nurse implement to prevent a spinal headache?
- A. Have the patient sit in a chair and perform deep breathing exercises.
- B. Ambulate the patient as early as possible.
- C. Limit the patients fluid intake for the first 24 hours postoperatively.
- D. Keep the patient positioned supine.
Correct Answer: D
Rationale: Measures that increase cerebrospinal pressure are helpful in relieving headache. These include maintaining a quiet environment, keeping the patient lying flat, and keeping the patient well hydrated. Having the patient sit or stand up decreases cerebrospinal pressure and would not relieve a spinal headache. Limiting fluids is incorrect because it also decreases cerebrospinal pressure and would not relieve a spinal headache.
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.
As an intraoperative nurse, you are the advocate for each of the patients who receives care in the surgical setting. How can you best exemplify the principles of patient advocacy?
- A. By encouraging the patient to perform deep breathing preoperatively
- B. By limiting the patients contact with family members preoperatively
- C. By maintaining each of your patients privacy
- D. By eliciting informed consent from patients
Correct Answer: C
Rationale: Patient advocacy in the OR entails maintaining the patients physical and emotional comfort, privacy, rights, and dignity. Deep breathing is not necessary before surgery and obtaining informed consent is the purview of the physician. Family contact should not be limited.
The OR nurse is providing care for a 25-year-old major trauma patient who has been involved in a motorcycle accident. The nurse should know that the patient is at increased risk for what complication of surgery?
- A. Respiratory depression
- B. Hypothermia
- C. Anesthesia awareness
- D. Moderate sedation
Correct Answer: C
Rationale: The Joint Commission has issued an alert regarding the phenomenon of patients being partially awake while under general anesthesia (referred to as anesthesia awareness). Patients at greatest risk of anesthesia awareness are cardiac, obstetric, and major trauma patients. This patient does not likely face a heightened risk of respiratory depression or hypothermia. Moderate sedation is not a complication.
A patient will be undergoing a total hip arthroplasty later in the day and it is anticipated that the patient may require blood transfusion during surgery. How can the nurse best ensure the patients safety if a blood transfusion is required?
- A. Prime IV tubing with a unit of blood and keep it on hold.
- B. Check that the patients electrolyte levels have been assessed preoperatively.
- C. Ensure that the patient has had a current cross-match.
- D. Keep the blood on standby and warmed to body temperature.
Correct Answer: C
Rationale: Few patients undergoing an elective procedure require blood transfusion, but those undergoing high-risk procedures may require an intraoperative transfusion. The circulating nurse anticipates this need, checks that blood has been cross-matched and held in reserve, and is prepared to administer blood. Storing the blood at body temperature or in IV tubing would result in spoilage and potential infection.