Chapter 15 Intraoperative Nursing Management
1. The nurse is preparing an elderly patient for a scheduled removal of orthopedic hardware, a
procedure to be performed under general anesthetic. For which adverse effect should the
nurse most closely monitor the patient?
A) Hypothermia
B) Pulmonary edema C) Cerebral ischemia D) Arthritis
Ans: A
Feedback:
Inadvertent hypothermia may occur as a result of a low temperature in the OR, infusion of
cold fluids, inhalation of cold gases, open body wounds or cavities, decreased
muscle activity, advanced age, or the pharmaceutical agents used (e.g., vasodilators,
phenothiazines, general anesthetics). The anesthetist monitors for pulmonary edema and
cerebral ischemia. Arthritis is not an adverse effect of surgical anesthesia.
2. The OR nurse acts in the circulating role during a patient's scheduled cesarean section.
For what task is this nurse solely responsible? A) Performing documentation
B) Estimating the patient's blood loss
C) Setting up the sterile tables
D) Keeping track of drains and sponges
Ans: A
Feedback:
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
patient's safety and well-being. Estimating the patient's blood loss is the surgeon's
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, 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.
3. 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 team's next step in the care of
this patient?
A) Grounding
B) Making the first incision
C) Giving blood D) Intubating Ans: D
Feedback:
When the patient arrives in the OR, the anesthesiologist or anesthetist reassesses the
patient's physical condition immediately prior to initiating anesthesia. The anesthetic is
administered, and the patient's 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.
4. A circulating nurse provides care in a surgical department that has multiple surgeries
scheduled for the day. The nurse should know to monitor which patient most closely during
the intraoperative period because of the increased risk for hypothermia?
A) A 74-year-old woman with a low body mass index
B) A 17-year-old boy with traumatic injuries
C) A 45-year-old woman having an abdominal hysterectomy
D) A 13-year-old girl undergoing craniofacial surgery
Ans: A
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, Feedback:
Elderly patients are at greatest risk during surgical procedures because they have an impaired
ability to increase their metabolic rate and impaired thermoregulatory mechanisms, which
increase susceptibility to hypothermia. The other patients are likely at a lower risk.
5. The anesthetist is coming to the surgical admissions unit to see a patient prior to surgery
scheduled for tomorrow morning. Which of the following is the priority information that the
nurse should provide to the anesthetist during the visit?
A) Last bowel movement
B) Latex allergy
C) Number of pregnancies D) Difficulty falling asleep Ans: B
Feedback:
Due to the increased number of patients with latex allergies, it is essential to identify this
allergy early on so precautions can be taken in the OR. The anesthetist should be informed of
any allergies. This is a priority over pregnancy history, insomnia, or recent bowel function,
though some of these may be relevant.
6. An OR nurse is teaching a nursing student about the principles of surgical asepsis as a
requirement in the restricted zone of the operating suite. What personal protective
equipment should the nurse wear at all times in the restricted zone of the OR?
A) Reusable shoe covers
B) Mask covering the nose and mouth
C) Goggles D) Gloves Ans: B Feedback:
Masks are worn at all times in the restricted zone of the OR. Shoe covers are worn one time
only; goggles and gloves are worn as required, but not necessarily at all times.
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1. The nurse is preparing an elderly patient for a scheduled removal of orthopedic hardware, a
procedure to be performed under general anesthetic. For which adverse effect should the
nurse most closely monitor the patient?
A) Hypothermia
B) Pulmonary edema C) Cerebral ischemia D) Arthritis
Ans: A
Feedback:
Inadvertent hypothermia may occur as a result of a low temperature in the OR, infusion of
cold fluids, inhalation of cold gases, open body wounds or cavities, decreased
muscle activity, advanced age, or the pharmaceutical agents used (e.g., vasodilators,
phenothiazines, general anesthetics). The anesthetist monitors for pulmonary edema and
cerebral ischemia. Arthritis is not an adverse effect of surgical anesthesia.
2. The OR nurse acts in the circulating role during a patient's scheduled cesarean section.
For what task is this nurse solely responsible? A) Performing documentation
B) Estimating the patient's blood loss
C) Setting up the sterile tables
D) Keeping track of drains and sponges
Ans: A
Feedback:
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
patient's safety and well-being. Estimating the patient's blood loss is the surgeon's
Page 1
, 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.
3. 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 team's next step in the care of
this patient?
A) Grounding
B) Making the first incision
C) Giving blood D) Intubating Ans: D
Feedback:
When the patient arrives in the OR, the anesthesiologist or anesthetist reassesses the
patient's physical condition immediately prior to initiating anesthesia. The anesthetic is
administered, and the patient's 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.
4. A circulating nurse provides care in a surgical department that has multiple surgeries
scheduled for the day. The nurse should know to monitor which patient most closely during
the intraoperative period because of the increased risk for hypothermia?
A) A 74-year-old woman with a low body mass index
B) A 17-year-old boy with traumatic injuries
C) A 45-year-old woman having an abdominal hysterectomy
D) A 13-year-old girl undergoing craniofacial surgery
Ans: A
Page 2
, Feedback:
Elderly patients are at greatest risk during surgical procedures because they have an impaired
ability to increase their metabolic rate and impaired thermoregulatory mechanisms, which
increase susceptibility to hypothermia. The other patients are likely at a lower risk.
5. The anesthetist is coming to the surgical admissions unit to see a patient prior to surgery
scheduled for tomorrow morning. Which of the following is the priority information that the
nurse should provide to the anesthetist during the visit?
A) Last bowel movement
B) Latex allergy
C) Number of pregnancies D) Difficulty falling asleep Ans: B
Feedback:
Due to the increased number of patients with latex allergies, it is essential to identify this
allergy early on so precautions can be taken in the OR. The anesthetist should be informed of
any allergies. This is a priority over pregnancy history, insomnia, or recent bowel function,
though some of these may be relevant.
6. An OR nurse is teaching a nursing student about the principles of surgical asepsis as a
requirement in the restricted zone of the operating suite. What personal protective
equipment should the nurse wear at all times in the restricted zone of the OR?
A) Reusable shoe covers
B) Mask covering the nose and mouth
C) Goggles D) Gloves Ans: B Feedback:
Masks are worn at all times in the restricted zone of the OR. Shoe covers are worn one time
only; goggles and gloves are worn as required, but not necessarily at all times.
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