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Which of the following outcome measures is best for the operating room (OR) nurse manager to use in determining the effectiveness of the physical environment and traffic control measures in the operating room?
- A. Smooth functioning of the OR team.
- B. Effective protection of patient privacy
- C. Rapid completion of surgical procedure
- D. Low incidence of perioperative infection
Correct Answer: D
Rationale: The primary focus when setting up the OR is the prevention of cross-contamination and transmission of infection to the patient. Patient privacy, efficient completion of procedures, and smooth functioning of the OR team are also important, but the priority is protection of the patient from infection.
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A patient in surgery receives a neuromuscular blocking agent as an adjunct to general anaesthesia. At completion of the surgery, it is most important that the nurse monitor the patient for which of the following adverse effects?
- A. Nausea
- B. Confusion
- C. Bronchospasm
- D. Weak chest-wall movement
Correct Answer: D
Rationale: The most serious adverse effect of the neuromuscular blocking agents is weakness of the respiratory muscles leading to postoperative hypoxemia. Nausea and confusion are possible adverse effects of these drugs, but they are not as great a concern as respiratory depression. Because these medications decrease muscle contraction, laryngospasm and bronchospasm are not concerns.
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 caring for a preoperative adult patient who is scheduled for a routine surgery and is in the holding area. The patient asks the nurse, 'Will the doctor put me to sleep with a mask over my face?' Which of the following responses is most appropriate?
- A. A drug will be given to you through your IV line, which will cause you to go to sleep almost immediately.'
- B. Only your surgeon can tell you for sure what method of anaesthesia will be used. Should I ask your surgeon?'
- C. General anaesthesia is now given by injecting medication into your veins, so you will not need a mask over your face.'
- D. Masks are not used anymore for anaesthesia. A tube will be inserted into your throat to deliver a gas that will put you to sleep.'
Correct Answer: A
Rationale: The first step in virtually all routine surgeries for general anaesthesia is the injection of an intravenous (IV) induction agent, which rapidly induces sleep. The anaesthesiologist (not the surgeon) determines the method of anaesthesia used. Masks may still be used for inhalation, although many patients are intubated. Total IV anaesthesia may be used for some patients but inhalation anaesthetics also are commonly used.
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.
The perioperative nurse is assessing a patient in the preoperative holding area. Which of the following findings would indicate a need for special protection techniques during surgery?
- A. A stated allergy to cats and dogs.
- B. A history of spinal and hip arthritis.
- C. Verbalization of anxiety by the patient
- D. Having a sip of water 2 hours previously
Correct Answer: B
Rationale: The patient with arthritis may require special positioning to avoid injury and postoperative discomfort. Preoperative anxiety and having a sip of water 2-3 hours before surgery are not unusual for the preoperative patient. An allergy to cats and dogs will not impact the care needed during the intraoperative phase.