Nokea
Which of the following actions should the nurse include in the plan of care immediately after surgery for a patient who received ketamine as an anaesthetic agent?
- A. Administer larger doses of analgesic agents.
- B. Monitor for severe slowing of the heart rate.
- C. Provide a quiet environment in the postanaesthesia care unit.
- D. Avoid the use of benzodiazepines in the postoperative period.
Correct Answer: C
Rationale: Hallucinations are an adverse effect associated with the dissociative anaesthetics such as ketamine, so the postoperative environment should be kept quiet to decrease the risk of hallucinations. Since ketamine causes profound analgesia lasting into the postoperative period, larger doses of analgesics are not needed. Ketamine causes an increase in heart rate. Benzodiazepine use with ketamine may be used to decrease the incidence of hallucinations and nightmares.
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Which of the following actions should the scrub nurse use to maintain aseptic technique during surgery?
- A. Use waterproof shoe covers.
- B. Wear personal protective equipment.
- C. Insist that all operating room (OR) staff perform a surgical scrub.
- D. Change gloves after touching the thigh of a surgeon's sterile gown.
Correct Answer: D
Rationale: Once gloved, a nurse's hands are not to go below his or her waist, therefore, touching the surgeon's thigh would contaminate the nurse's gloves. Hands are always to be kept above waist level. Shoe covers are not sterile. Personal protective equipment is designed to protect caregivers, not the patient, and is not part of aseptic technique. Staff members such as the circulating nurse do not have to perform a surgical scrub before entering the OR.
Which of the following actions by a member of the surgical team requires rapid intervention by the charge nurse?
- A. Wearing street clothes into the nursing station
- B. Wearing a surgical mask into the holding room
- C. Walking into the hallway outside an operating room without the hair covered
- D. Putting on a surgical mask, cap, and scrubs before entering the operating room
Correct Answer: C
Rationale: The corridors outside the OR are part of the semirestricted area where personnel must wear surgical attire and head coverings. Surgical masks may be worn in the holding room, although they are not necessary. Street clothes may be worn at the nursing station, which is part of the unrestricted area. Wearing a mask and scrubs is essential when going into the OR.
The nurse is completing an inventory of medications on the unit. Which of the following anaesthesia medications should the nurse expect to observe under refrigeration?
- A. Atracurium
- B. Pancuronium
- C. Rocuronium
- D. Neostigmine bromide
- E. Succinylcholine
Correct Answer: A,E
Rationale: Succinylcholine and atracurium both require refrigeration. The other medications listed do not require refrigeration.
The nurse is positioning a patient in the operating room for a transurethral resection of the prostate. Which of the following patient positions should the nurse place this patient in?
- A. Prone
- B. Supine
- C. Trendelenburg
- D. Lithotomy
Correct Answer: D
Rationale: The lithotomy position is used for genitourinary procedures such as vaginal hysterectomy and transurethral resection of the prostate. Although supine is the most common position, it is not used for this surgery; rather it is appropriate for abdominal, cardiac, and breast surgeries. A variation of the supine is the Trendelenburg position, used in lower abdominal or pelvic surgery, for which it is necessary to see the pelvic organs. The prone position allows easy access for back surgeries (e.g., laminectomies).
The nurse is caring for a patient before surgery who has a question about the preoperative medication. Which of the following people will the nurse communicate this information to?
- A. Scrub nurse
- B. Anaesthesiologist
- C. Circulating nurse
- D. Registered nurse first assistant (RNFA)
Correct Answer: B
Rationale: The anaesthesiologist is responsible for prescribing and answering questions about preoperative medications. The RNFA and surgeon are responsible for the surgery, but not for the preoperative sedation. The circulating nurse does not have authority to make a change in any medication.