Verification that all required documentation is completed is an important function of the intraoperative nurse. The intraoperative nurse should confirm that the patients accompanying documentation includes which of the following?
- A. Discharge planning
- B. Informed consent
- C. Analgesia prescription
- D. Educational resources
Correct Answer: B
Rationale: It is important to review the patients record for the following: correct informed surgical consent, with patients signature; completed records for health history and physical examination; results of diagnostic studies; and allergies (including latex). Discharge planning records and prescriptions are not normally necessary. Educational resources would not be included at this stage of the surgical process.
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The nurse knows that elderly patients are at higher risk for complications and adverse outcomes during the intraoperative period. What is the best rationale for this phenomenon?
- A. The elderly patient has a more angular bone structure than a younger person.
- B. The elderly patient has reduced ability to adjust rapidly to emotional and physical stress.
- C. The elderly patient has impaired thermoregulatory mechanisms, which increase susceptibility to hyperthermia.
- D. The elderly patient has an impaired ability to decrease his or her metabolic rate.
Correct Answer: B
Rationale: Factors that affect the elderly surgical patient in the intraoperative period include the following: impaired ability to increase metabolic rate and impaired thermoregulatory mechanisms increase susceptibility to hypothermia. Bone loss (25% in women, 12% in men) necessitates careful manipulation and positioning during surgery. Reduced ability to adjust rapidly to emotional and physical stress influences surgical outcomes and requires meticulous observation of vital functions. Older adults do not have more angular bones than younger people.
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.
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 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.
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.
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