Nokea
The perioperative nurse is constantly assessing the surgical patient for signs and symptoms of complications of surgery. Which symptom should first signal to the nurse the possibility that the patient is developing malignant hyperthermia?
- A. Increased temperature
- B. Oliguria
- C. Tachycardia
- D. Hypotension
Correct Answer: C
Rationale: The initial symptoms of malignant hyperthermia are related to cardiovascular and musculoskeletal activity. Tachycardia (heart rate greater than 150 beats per minute) is often the earliest sign. Oliguria, hypotension, and increased temperature are later signs of malignant hyperthermia.
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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.
A 21-year-old patient is positioned on the OR bed prior to knee surgery to correct a sports-related injury. The anesthesiologist administers the appropriate anesthetic. The OR nurse should anticipate which of the following events as the teams next step in the care of this patient?
- A. Grounding
- B. Making the first incision
- C. Giving blood
- D. Intubating
Correct Answer: D
Rationale: When the patient arrives in the OR, the anesthesiologist or anesthetist reassesses the patients physical condition immediately prior to initiating anesthesia. The anesthetic is administered, and the patients airway is maintained through an intranasal intubation, oral intubation, or a laryngeal mask airway. Grounding or blood administration does not normally follow anesthetic administration immediately. An incision would not be made prior to intubation.
Prior to a patients scheduled surgery, the nurse has described the way that members of diverse health disciplines will collaborate in the patients care. What is the main rationale for organizing perioperative care in this collaborative manner?
- A. Historical precedence
- B. Patient requests
- C. Physicians needs
- D. Evidence-based practice
Correct Answer: D
Rationale: Collaboration of the surgical team using evidence-based practice tailored to a specific case results in optimal patient care and improved outcomes. None of the other listed factors is the basis for the collaboration of the surgical team.
A 59-year-old male patient is scheduled for a hemorrhoidectomy. The OR nurse should anticipate assisting the other team members with positioning the patient in what manner?
- A. Dorsal recumbent position
- B. Trendelenburg position
- C. Sims position
- D. Lithotomy position
Correct Answer: D
Rationale: The lithotomy position is used for nearly all perineal, rectal, and vaginal surgical procedures. The Sims or lateral position is used for renal surgery and the Trendelenburg position usually is used for surgery on the lower abdomen and pelvis. The usual position for surgery, called the dorsal recumbent position, is flat on the back, but this would be impracticable for rectal surgery.
A patient is scheduled for surgery the next day and the different phases of the patients surgical experience will require input from members of numerous health disciplines. How should the patients care best be coordinated?
- A. By planning care using a surgical approach
- B. By identifying the professional with the most knowledge of the patient
- C. By implementing an interdisciplinary approach to care
- D. By using the nursing process to guide all aspects of care and treatment
Correct Answer: C
Rationale: An interdisciplinary approach involving the surgeon, anesthesiologist or anesthetist, and nurse is best. This is superior to each of the other listed options.