Question 1

What actions by the circulating nurse are important to promote client comfort? (Select all that apply.)&#10;A) Correct positioning&#10;B) Introducing one's self&#10;C) Providing warmth&#10;D) Remaining present&#10;E) Removing hearing aids

Accepted Answer

The circulating nurse can do many things to promote client comfort,including positioning the client correctly and comfortably,introducing herself or himself to the client,keeping the client warm,and remaining present with the client.Removing hearing aids does not promote comfort and,if the client is still awake when they are removed,may contribute to disorientation and anxiety.

Question 2

A client has received intravenous anesthesia during an operation.What action by the postanesthesia care nurse is most important?&#10;A) Assist with administering muscle relaxants to the client.&#10;B) Place the client on a cardiac monitor and pulse oximeter.&#10;C) Prepare to administer intravenous antiemetics to the client.&#10;D) Prevent the client from experiencing postoperative shivering.

Accepted Answer

Intravenous anesthetic agents have the potential to cause respiratory and circulatory depression.The nurse should ensure the client is on a cardiac monitor and pulse oximeter.Muscle relaxants are not indicated for this client at this time.Intravenous anesthetics have a lower rate of postoperative nausea and vomiting than other types.Shivering can occur in any client,but is more common after inhalation agents.

Question 3

The circulating nurse is plugging in a piece of equipment and notes that the cord is frayed.What action by the nurse is best?&#10;A) Call maintenance for repair.&#10;B) Check the machine before using.&#10;C) Get another piece of equipment.&#10;D) Notify the charge nurse.

Accepted Answer

The circulating nurse is responsible for client safety.If an electrical cord is frayed,the risk of fire or sparking increases.The nurse should obtain a replacement.The nurse should also tag the original equipment for repair as per agency policy.Checking the equipment is not important as the nurse should not even attempt to use it.Calling maintenance or requesting maintenance per facility protocol is important,but first ensure client safety by having a properly working piece of equipment for the procedure about to take place.The charge nurse probably does need to know of the need for equipment repair,but ensuring client safety is the priority.

Question 4

A client is having surgery.The circulating nurse notes the client's oxygen saturation is 90% and the heart rate is 110 beats/min.What action by the nurse is best?&#10;A) Assess the client's end-tidal carbon dioxide level.&#10;B) Document the findings in the client's chart.&#10;C) Inform the anesthesia provider of these values.&#10;D) Prepare to administer dantrolene sodium (Dantrium).

Accepted Answer

Malignant hyperthermia is a rare but serious reaction to anesthesia.The triad of early signs include decreased oxygen saturation,tachycardia,and elevated end-tidal carbon dioxide (CO₂)level.The nurse should quickly check the end-tidal CO₂ and then report findings to the anesthesia provider and surgeon.Documentation is vital,but not the most important action at this stage.Dantrolene sodium is the drug of choice if the client does have malignant hyperthermia.

Question 5

A client is having robotic surgery.The circulating nurse observes the instruments being inserted,then the surgeon appears to "break scrub" when going to the console and sitting down.What action by the nurse is best?

A) Call a "time-out" to discuss sterile procedure and scrub technique.
B) Document the time the robotic portion of the procedure begins.
C) Inform the surgeon that the scrub preparation has been compromised.
D) Report the surgeon's actions to the charge nurse and unit manager.

Accepted Answer

During a robotic operative procedure,the surgeon inserts the articulating arms into the client,then "breaks scrub" to sit at the viewing console to perform the operation.The nurse should document the time the robotic portion of the procedure began.There is no need for the other interventions.

Question 6

A client has developed malignant hyperthermia.The client weighs 136 pounds.What is the safe dose range for one dose of dantrolene sodium (Dantrium)? (Enter your answer using whole numbers,separated by a hyphen with no spaces.)_____ mg

Accepted Answer

The answer of A client has developed malignant hyperthermia.The client...

Question 7

The circulating nurse reviews the day's schedule and notes clients who are at higher risk of anesthetic overdose and other anesthesia-related complications.Which clients does this include? (Select all that apply.)

A) A 75-year-old client scheduled for an elective procedure
B) Client who drinks a 6-pack of beer each day
C) Client with a serum creatinine of 3.8 mg/dL
D) Client who is taking birth control pills
E) Young male client with a RYR1 gene mutation

Accepted Answer

People at higher risk for anesthetic overdose or other anesthesia-related complications include people with a slowed metabolism (older adults generally have slower metabolism than younger adults),those with kidney or liver impairments,and those with mutations of the RYR1 gene.Drinking a 6-pack of beer per day possibly indicates some liver disease; a creatinine of 3.8 is high,indicating renal disease; and the genetic mutation increases the chance of malignant hyperthermia.Taking birth control pills is not a risk factor.

Question 8

A client is having shoulder surgery with regional anesthesia.What actions by the nurse are most important to enhance client safety related to this anesthesia? (Select all that apply.)&#10;A) Assessing distal circulation to the operative arm after positioning&#10;B) Keeping the client warm during the operative procedure&#10;C) Padding the client's shoulder and arm on the operating table&#10;D) Preparing to suction the client's airway if the client vomits&#10;E) Speaking in a low, quiet voice as anesthesia is administered

Accepted Answer

After regional anesthesia is administered,the client loses all sensation distally.The nurse ensures client safety by assessing distal circulation and padding the shoulder and arm appropriately.Although awake,the client will not be able to report potential injury.Keeping the client warm is not related to this anesthesia,nor is suctioning or speaking quietly.

Question 9

A client in the operating room has developed malignant hyperthermia.The client's potassium is 6.5 mEq/L.What action by the nurse takes priority?&#10;A) Administer 10 units of regular insulin.&#10;B) Administer nifedipine (Procardia).&#10;C) Assess urine for myoglobin or blood.&#10;D) Monitor the client for dysrhythmias.

Accepted Answer

For hyperkalemia in a client with malignant hyperthermia,the nurse administers 10 units of regular insulin in 50 mL of 50% dextrose.This will force potassium back into the cells rapidly.Nifedipine is a calcium channel blocker used to treat hypertension and dysrhythmias,and should not be used in a client with malignant hyperthermia.Assessing the urine for blood or myoglobin is important,but does not take priority.Monitoring the client for dysrhythmias is also important due to the potassium imbalance,but again does not take priority over treating the potassium imbalance.

Question 10

A circulating nurse has transferred an older client to the operating room.What action by the nurse is most important for this client?&#10;A) Allow the client to keep hearing aids in until anesthesia begins.&#10;B) Pad the table as appropriate for the surgical procedure.&#10;C) Position the client for maximum visualization of the site.&#10;D) Stay with the client, providing emotional comfort and support.

Accepted Answer

Many older clients have sensory loss.To help prevent disorientation,facilities often allow older clients to keep their eyeglasses on and hearing aids in until the start of anesthesia.The other actions are appropriate for all operative clients.

Question 11

A circulating nurse wishes to provide emotional support to a client who was just transferred to the operating room.What action by the nurse would be best?&#10;A) Administer anxiolytics.&#10;B) Give the client warm blankets.&#10;C) Introduce the surgical staff.&#10;D) Remain with the client.

Accepted Answer

The answer of A circulating nurse wishes to provide emotional...

Question 12

The nursing student observing in the perioperative area notes the unique functions of the circulating nurse,which include which roles? (Select all that apply.)&#10;A) Ensuring the client's safety&#10;B) Accounting for all sharps&#10;C) Documenting all care given&#10;D) Maintaining the sterile field&#10;E) Monitoring traffic in the room

Accepted Answer

The answer of The nursing student observing in the perioperative...

Question 13

A student nurse observing in the operating room notes that the functions of the Certified Registered Nurse First Assistant (CRNFA)include which activities? (Select all that apply.)&#10;A) Dressing the surgical wound&#10;B) Grafting new or synthetic skin&#10;C) Reattaching severed nerves&#10;D) Suctioning the surgical site&#10;E) Suturing the surgical wound

Accepted Answer

The answer of A student nurse observing in the operating...

Question 14

A client is scheduled for a below-the-knee amputation.The circulating nurse ensures the proper side is marked prior to the start of surgery.What action by the nurse is most appropriate?&#10;A) Facilitate marking the site with the client and surgeon.&#10;B) Have the client mark the operative site.&#10;C) Mark the operative site with a waterproof marker.&#10;D) Tell the surgeon it is time to mark the surgical site.

Accepted Answer

The answer of A client is scheduled for a below-the-knee...

Question 15

A nurse is monitoring a client after moderate sedation.The nurse documents the client's Ramsay Sedation Scale (RSS)score at 3.What action by the nurse is best?&#10;A) Assess the client's gag reflex.&#10;B) Begin providing discharge instructions.&#10;C) Document findings and continue to monitor.&#10;D) Increase oxygen and notify the provider.

Accepted Answer

The answer of A nurse is monitoring a client after...

Question 16

The circulating nurse and preoperative nurse are reviewing the chart of a client scheduled for minimally invasive surgery (MIS).What information on the chart needs to be reported to the surgeon as a priority?

A) Allergies noted and allergy band on
B) Consent for MIS procedure only
C) No prior anesthesia exposure
D) NPO status for the last 8 hours

Accepted Answer

The answer of The circulating nurse and preoperative nurse are...

Question 17

The circulating nurse is in the operating room and sees the surgeon don gown and gloves using appropriate sterile procedure.The surgeon then folds the hands together and places them down below the hips.What action by the nurse is most appropriate?

A) Ask the surgeon to change the sterile gown.
B) Do nothing; this is acceptable sterile procedure.
C) Inform the surgeon that the sterile field has been broken.
D) Obtain a new pair of sterile gloves for the surgeon to put on.

Accepted Answer

The answer of The circulating nurse is in the operating...

Question 18

A client is in stage 2 of general anesthesia.What action by the nurse is most important?&#10;A) Keeping the room quiet and calm&#10;B) Being prepared to suction the airway&#10;C) Positioning the client correctly&#10;D) Warming the client with blankets

Accepted Answer

The answer of A client is in stage 2 of...

Deck 15: Care of Intraoperative Patients