NURSING 150 - EXAM 1 QUESTIONS
AND ANSWERS
legal considerations prior to surgery: - Answer--> all required forms must be in chart &
completed per facility policy.
- Living Will (specific instructions of what the pt. wants to happen in the event that they
can't speak for themselves).
- Power of Attorney (health care; giving someone else the power to make health care
decisions for the pt. in the event that they can't speak for themselves).
- Consent forms.
- DNR orders (unless pt. says otherwise, DNR orders are suspended during operative
phase, & operative phase ends when the pt. leaves the recovery room).
*** Surgical Consent Form:
- must be voluntarily signed by the pt.
- the MD is responsible for explaining all of the info that the pt. needs to know in order to
sign the consent form, such as risks/procedure/other options.
- the nurse is only responsible for witnessing the pt.'s signature on the consent form, &
for verifying the pt.'s knowledge of the procedure.
- it is the DR.'s responsibility for legally obtaining the patient's consent!!!!!! (not the
nurse)
- pt. always has the right to give consent & withdraw consent.
pre-operative checklist: - Answer---> it's a communication tool for the healthcare team!
--> it verifies that the nurse has completed the preparation for the patient....
- consent is signed.
- pre-op meds are given.
- type & cross match for blood.
- NPO status.
--> it provides a baseline of current assessment findings.
*** examples of checklist items....
- pt. only has a gown on.
- make-up/nail polish is removed.
- prosthetic devices are removed.
- verify patient ID band.
- jewelry & valuables are removed.
,types of pre-operative medications that are frequently given: - Answer---> these meds
are used to prepare patients for surgery.
--> these meds can be given on the floor or in the pre-op area by a nurse or
anesthesiologist.
1) Benzodiazepines:
-> used for amnesia & anxiety reduction.
-> commonly used for procedural sedation or adjunctive to anesthesia (the more relaxed
the pt. is, the less anesthesia they require).
-> CNS depressant; causes sedation, lowers BP/respiratory rate, can cause hiccups.
ex. Versed (Midazolam): 1-2.5 mg IV (1+1) over 2 mins each.
ex. Valium (Diazepam): 2-10 mg (5 mg/min).
ex. Ativan (Lorazepam): 1-2 mg diluted with equal amount of normal saline & IV push
over 1 min.
2) Anticholinergics:
-> used to inhibit secretions; causes dry mouth & prevents aspiration by inhibiting
excessive respiratory secretions.
- side effects = dilates pupils, decreases GI motility, may cause urinary retention, & can
increase intraocular pressure (so caution with glaucoma).
ex. Atropine Sulfate, Robinul (glycopyrrolate), scopolamine (transform scop).
3) Antiemetics:
-> used to prevent nausea/vomiting.
ex. Reglan (Metoclopramide): 10 mg IV (given over 1-2 mins); can cause
extrapyramidal effects.
ex. Zofran (Ondansetron): 4 mg IV (given over 30 seconds to 2-5 mins); can cause
dysrhythmias, hypotension, & fainting.
ex. Phenergan (Promethazine): 12.5-25 mg IV (given over 5-10 mins); can cause
burning at site, sedation, bradycardia, & confusion, may act as a CNS depressant &
lower BP.
4) H2 Receptor Antagonist:
-> used to decrease acid in the stomach (NPO patients can have increased stress
which causes increased stomach acid).
-> helps prevent aspiration, or any kind of stomach ulcers/reflux.
ex. Pepcid (Famotidine): 20mg IV in 5-10ml over 2 mins.
ex. Zantac (Ranitidine): 50mg in 20ml NS (normal saline) over 5 mins.
ex. Tagamet (Cimetidine): 300mg in 20ml NS over 5 mins.
5) Narcotics:
transportation to OR: - Answer-- escort the pt. being transported.
- make sure pt. is wearing only their gown & that they have their ID band on.
- the chart & checklist goes with the patient.
- provide the pt.'s family with instructions (waiting room & pt.'s belongings are secured).
,- prepare the room for the pt.'s return, unless otherwise noted.
what are the highest priorities in the pre-operative phase? - Answer-- the assessment.
- pt. teaching.
- identifying risks.
- coming up with a plan of care.
who is responsible for obtaining patient consent? - Answer-- the MD (physician).
what type of monitoring do you need to do for patients after they receive pre-operative
medications? - Answer-- vital signs.
- oxygen saturation.
- level of consciousness.
- making sure they are safe in bed with the side rails up (fall risk).
Before surgery, where is the patient's IV access verified and/or initiated? - Answer---->
in the pre-op holding area.
OR safety measures: - Answer-1) "Time Out":
-> basically everyone stops what they're doing & they pay attention to the physician.
-> the purpose is the verify the correct patient....
- correct person.
- correct procedure.
- correct site & side.
-> this is done prior to anesthesia.
-> the MD is ultimately responsible, however the circulating nurse guides the process &
documents the process.
-> the circulating nurse is not handing instruments but is ultimately the one who is in
charge over the entire patient, & makes sure that everyone has what they need.
-> all personnel are present & are introduce, & they all participate.
-> the scrub tech is the one who hands the instruments.
-> surgeon does the surgery.
-> the anesthesiologist is giving anesthesia & monitoring vital signs.
***consequences of poor time out = over 4,000 wrong site surgeries (WSS) occur in the
US each year; most common events in 2017 are 1) unintended retention of a foreign
body, 2) wrong patient, wrong site, wrong procedure, 3) operative/post-operative
complication.
2) Aseptic Technique:
-> if surgeon drops their hands below their waist, their hands are no longer sterile.
-> the OR has different zones, where some zones require a mask & shoe coverings,
while other zones don't.
3) Patient Positioning:
, -> a pt.'s vitals could be hard to monitor during surgery because of the way they are
positioned.
-> complications could occur because of the way a pt. is positioned.
4) OR Fires:
-> cautery can cause sparking.
-> there is flammable material.
-> there is a lot of oxygen flowing.
5) Prevention of Hypothermia:
-> we don't want the patient to get too cold, as that can cause complications.
Which team members perform a surgical scrub? - Answer---> It is only required for the
surgeon and the scrub nurse.
What parts of the surgical gown are considered sterile? - Answer---> the chest area
down to their waist, & just a few inches above their elbows are all sterile areas.
*** shoulder areas are not sterile !!!!!
What is the difference between PPEs and surgical gowns? - Answer---> PPE serves to
protect the nurse from the infection/disease that the patient has, meanwhile surgical
gowns serve to protect the patient from the nurse's germs.
What other measures in the OR can prevent infection? - Answer-- OR zones.
- different types of air flow.
Intra-Operative Pharmacology: - Answer-1) Anesthesia: step 1
-> General Anesthesia...
- loss of sensation, loss of consciousness, loss of reflex (no cornea/gag reflex).
- starts with an IV induction agent, & the purpose is to induce rapid & pleasant sleep;
these are typically short acting & allow for the patient to be intubated & facilitates
inhalation agents to be used.
- Induction Agents examples...
1) Barbiturates: Pentothal (Sodium Thiopental) &
Brevital (Methohexital Sodium).
2) Hypnotics: Propofol (most common) & Amidate.
2) Inhalation Agents: step 2
-> administered with anesthesia equipment that essentially mixes & vaporizes the
inhalation agents.
- some of them can be volatile (substance is easily evaporated at normal temperatures;
concern for OR fires).
- these agents can be irritating to the bronchiole system.
-> they are absorbed/excreted by the alveoli.
AND ANSWERS
legal considerations prior to surgery: - Answer--> all required forms must be in chart &
completed per facility policy.
- Living Will (specific instructions of what the pt. wants to happen in the event that they
can't speak for themselves).
- Power of Attorney (health care; giving someone else the power to make health care
decisions for the pt. in the event that they can't speak for themselves).
- Consent forms.
- DNR orders (unless pt. says otherwise, DNR orders are suspended during operative
phase, & operative phase ends when the pt. leaves the recovery room).
*** Surgical Consent Form:
- must be voluntarily signed by the pt.
- the MD is responsible for explaining all of the info that the pt. needs to know in order to
sign the consent form, such as risks/procedure/other options.
- the nurse is only responsible for witnessing the pt.'s signature on the consent form, &
for verifying the pt.'s knowledge of the procedure.
- it is the DR.'s responsibility for legally obtaining the patient's consent!!!!!! (not the
nurse)
- pt. always has the right to give consent & withdraw consent.
pre-operative checklist: - Answer---> it's a communication tool for the healthcare team!
--> it verifies that the nurse has completed the preparation for the patient....
- consent is signed.
- pre-op meds are given.
- type & cross match for blood.
- NPO status.
--> it provides a baseline of current assessment findings.
*** examples of checklist items....
- pt. only has a gown on.
- make-up/nail polish is removed.
- prosthetic devices are removed.
- verify patient ID band.
- jewelry & valuables are removed.
,types of pre-operative medications that are frequently given: - Answer---> these meds
are used to prepare patients for surgery.
--> these meds can be given on the floor or in the pre-op area by a nurse or
anesthesiologist.
1) Benzodiazepines:
-> used for amnesia & anxiety reduction.
-> commonly used for procedural sedation or adjunctive to anesthesia (the more relaxed
the pt. is, the less anesthesia they require).
-> CNS depressant; causes sedation, lowers BP/respiratory rate, can cause hiccups.
ex. Versed (Midazolam): 1-2.5 mg IV (1+1) over 2 mins each.
ex. Valium (Diazepam): 2-10 mg (5 mg/min).
ex. Ativan (Lorazepam): 1-2 mg diluted with equal amount of normal saline & IV push
over 1 min.
2) Anticholinergics:
-> used to inhibit secretions; causes dry mouth & prevents aspiration by inhibiting
excessive respiratory secretions.
- side effects = dilates pupils, decreases GI motility, may cause urinary retention, & can
increase intraocular pressure (so caution with glaucoma).
ex. Atropine Sulfate, Robinul (glycopyrrolate), scopolamine (transform scop).
3) Antiemetics:
-> used to prevent nausea/vomiting.
ex. Reglan (Metoclopramide): 10 mg IV (given over 1-2 mins); can cause
extrapyramidal effects.
ex. Zofran (Ondansetron): 4 mg IV (given over 30 seconds to 2-5 mins); can cause
dysrhythmias, hypotension, & fainting.
ex. Phenergan (Promethazine): 12.5-25 mg IV (given over 5-10 mins); can cause
burning at site, sedation, bradycardia, & confusion, may act as a CNS depressant &
lower BP.
4) H2 Receptor Antagonist:
-> used to decrease acid in the stomach (NPO patients can have increased stress
which causes increased stomach acid).
-> helps prevent aspiration, or any kind of stomach ulcers/reflux.
ex. Pepcid (Famotidine): 20mg IV in 5-10ml over 2 mins.
ex. Zantac (Ranitidine): 50mg in 20ml NS (normal saline) over 5 mins.
ex. Tagamet (Cimetidine): 300mg in 20ml NS over 5 mins.
5) Narcotics:
transportation to OR: - Answer-- escort the pt. being transported.
- make sure pt. is wearing only their gown & that they have their ID band on.
- the chart & checklist goes with the patient.
- provide the pt.'s family with instructions (waiting room & pt.'s belongings are secured).
,- prepare the room for the pt.'s return, unless otherwise noted.
what are the highest priorities in the pre-operative phase? - Answer-- the assessment.
- pt. teaching.
- identifying risks.
- coming up with a plan of care.
who is responsible for obtaining patient consent? - Answer-- the MD (physician).
what type of monitoring do you need to do for patients after they receive pre-operative
medications? - Answer-- vital signs.
- oxygen saturation.
- level of consciousness.
- making sure they are safe in bed with the side rails up (fall risk).
Before surgery, where is the patient's IV access verified and/or initiated? - Answer---->
in the pre-op holding area.
OR safety measures: - Answer-1) "Time Out":
-> basically everyone stops what they're doing & they pay attention to the physician.
-> the purpose is the verify the correct patient....
- correct person.
- correct procedure.
- correct site & side.
-> this is done prior to anesthesia.
-> the MD is ultimately responsible, however the circulating nurse guides the process &
documents the process.
-> the circulating nurse is not handing instruments but is ultimately the one who is in
charge over the entire patient, & makes sure that everyone has what they need.
-> all personnel are present & are introduce, & they all participate.
-> the scrub tech is the one who hands the instruments.
-> surgeon does the surgery.
-> the anesthesiologist is giving anesthesia & monitoring vital signs.
***consequences of poor time out = over 4,000 wrong site surgeries (WSS) occur in the
US each year; most common events in 2017 are 1) unintended retention of a foreign
body, 2) wrong patient, wrong site, wrong procedure, 3) operative/post-operative
complication.
2) Aseptic Technique:
-> if surgeon drops their hands below their waist, their hands are no longer sterile.
-> the OR has different zones, where some zones require a mask & shoe coverings,
while other zones don't.
3) Patient Positioning:
, -> a pt.'s vitals could be hard to monitor during surgery because of the way they are
positioned.
-> complications could occur because of the way a pt. is positioned.
4) OR Fires:
-> cautery can cause sparking.
-> there is flammable material.
-> there is a lot of oxygen flowing.
5) Prevention of Hypothermia:
-> we don't want the patient to get too cold, as that can cause complications.
Which team members perform a surgical scrub? - Answer---> It is only required for the
surgeon and the scrub nurse.
What parts of the surgical gown are considered sterile? - Answer---> the chest area
down to their waist, & just a few inches above their elbows are all sterile areas.
*** shoulder areas are not sterile !!!!!
What is the difference between PPEs and surgical gowns? - Answer---> PPE serves to
protect the nurse from the infection/disease that the patient has, meanwhile surgical
gowns serve to protect the patient from the nurse's germs.
What other measures in the OR can prevent infection? - Answer-- OR zones.
- different types of air flow.
Intra-Operative Pharmacology: - Answer-1) Anesthesia: step 1
-> General Anesthesia...
- loss of sensation, loss of consciousness, loss of reflex (no cornea/gag reflex).
- starts with an IV induction agent, & the purpose is to induce rapid & pleasant sleep;
these are typically short acting & allow for the patient to be intubated & facilitates
inhalation agents to be used.
- Induction Agents examples...
1) Barbiturates: Pentothal (Sodium Thiopental) &
Brevital (Methohexital Sodium).
2) Hypnotics: Propofol (most common) & Amidate.
2) Inhalation Agents: step 2
-> administered with anesthesia equipment that essentially mixes & vaporizes the
inhalation agents.
- some of them can be volatile (substance is easily evaporated at normal temperatures;
concern for OR fires).
- these agents can be irritating to the bronchiole system.
-> they are absorbed/excreted by the alveoli.
