Chapter 19: Intraoperative Care

Question 1

The __________ is where people in street clothes interact with those in scrub attire. These areas typically include the points of entry for patients (e.g., preoperative holding area), staff (e.g., locker rooms), and information (e.g., nursing station or control desk).

a. unrestricted zone
b. semi-restricted zone
c. restricted zone

Answer 1

a. unrestricted zone

Question 2

The __________ includes the surrounding support areas and corridors.

a. unrestricted zone
b. semirestricted zone
c. restricted zone

Answer 2

b. semirestricted zone

Question 3

The __________ is found within the semirestricted area. It includes the OR or surgical suite where the procedure takes place and the sterile core.

a. unrestricted zone
b. semirestricted zone
c. restricted zone

Answer 3

c. restricted zone

Question 4

T/F

An AOD unit is designed to allow early morning admission for outpatient surgery, same-day admission, and inpatient holding before surgery.

Answer 4

true

Question 5

__________ in the rooms prevent air from entering the OR from the halls and corridors.

a. filters and controlled airflow
b. positive air pressure
c. furniture
d. temperature and humidity

Answer 5

b. positive air pressure

Question 6

__________ are controlled to prevent bacterial growth.

a. filters and controlled airflow
b. positive air pressure
c. furniture
d. temperature and humidity

Answer 6

d. temperature and humidity

Question 7

T/F

Ultraviolent lighting increases the number of microorganisms in the air.

Answer 7

false; decreases

Question 8

The __________ follows the designated surgical hand antisepsis with sterile glove and gown attire; the prepare and manage the sterile field and instrumentation.

a. scrub nurse
b. circulating nurse
c. post-op nurse
d. med-surge nurse

Answer 8

a. scrub nurse

Question 9

The __________ stays in the unsterile field, facilitates the progress of the procedure, and keeps documentation.

a. scrub nurse
b. circulating nurse
c. post-op nurse
d. med-surge nurse

Answer 9

b. circulating nurse

Question 10

a medical specialty that focuses on clinical management of the patient in the perioperative period, pain management, critical care, trauma, airway management, and cardiopulmonary resuscitation

Answer 10

anesthesiology

Question 11

The __________ is responsible for administering anesthetic agents and managing vital life functions during the perioperative period.

Answer 11

anesthesia care provider

Question 12

T/F

The surgeon is responsible for implementing the intraoperative plan of care and serving as the patient’s advocate.

Answer 12

false; the circulating nurse

Question 13

__________ technique is practiced in the OR to prevent infection.

Answer 13

aseptic

Question 14

T/F

General anesthesia causes peripheral vessels to dilate.

Answer 14

true

Question 15

What is the purpose of skin preparation?

Answer 15

reduce the number of microorganisms available to migrate to the surgical wound

Question 16

T/F

All procedures put the patient at risk for injury.

Answer 16

true

Question 17

Name this type of anesthesia.

used for procedures done outside of the OR, the presence of an ACP is not needed

a. moderate to deep sedation
b. monitored anesthesia care
c. general anesthesia
d. total intravenous anesthesia

Answer 17

a. moderate to deep sedation

Question 18

Name this type of anesthesia.

• used for diagnostic and therapeutic procedures performed in or outside of the OR
• includes varying levels of sedation, analgesia, and anxiolysis

a. local anesthesia
b. monitored anesthesia care
c. general anesthesia
d. total intravenous anesthesia

Answer 18

b. monitored anesthesia care

Question 19

Name this type of anesthesia.

the technique of choice for patients who are having surgical procedures that are of significant duration, require skeletal muscle relaxation, require uncomfortable operative positions because of the surgical site, or require control of ventilation

a. moderate to deep sedation
b. monitored anesthesia care
c. general anesthesia
d. regional anesthesia

Answer 19

c. general anesthesia

Question 20

Name this type of anesthesia.

exhibit a fast onset, fast elimination, and fewer untoward side effects, facilitating early discharge from the PACU and ambulatory surgery centers

a. moderate to deep sedation
b. monitored anesthesia care
c. general anesthesia
d. total intravenous anesthesia

Answer 20

d. total intravenous anesthesia

Question 21

drugs added to an inhalation anesthetic

Answer 21

adjuncts

Question 22

________ interrupts associative brain pathways while blocking sensory pathways.

Answer 22

dissociative anesthesia

Question 23

T/F

Ketamine is a common dissociative anesthetic.

Answer 23

true

Question 24

T/F

Ketamine is being used more often for general anesthesia as research shows it increases ICP.

Answer 24

false; it does not increase ICP

Question 25

Name this type of anesthesia.

interrupts the generation of nerve impulses by changing the flow of sodium into nerve cells

a. local anesthesia
b. monitored anesthesia care
c. general anesthesia
d. total intravenous anesthesia

Answer 25

a. local anesthesia

Question 26

T/F

Local anesthesia involves sedation of LOC.

Answer 26

false

Question 27

Name this type of anesthesia.

always injected; involves a central nerve or group of nerves that innervate a site remote to the point of injection

a. moderate to deep sedation
b. monitored anesthesia care
c. general anesthesia
d. regional anesthesia

Answer 27

d. regional anesthesia

Question 28

T/F

Malignant hyperthermia occurs in affected people exposed to certain anesthetic agents.

Answer 28

true

Question 29

Which items would the nurse wear for proper attire in the semirestricted area of the surgery department?

a. Street clothing
b. Surgical attire and head cover
c. Street clothing and shoe covers
d. Surgical attire, head cover, shoe covers

Answer 29

d. Surgical attire, head cover, shoe covers

Question 30

Which activities might the nurse perform in the role of a scrub nurse during surgery? (SATA)

a. Checking electrical equipment

b. Preparing the instrument table

c. Assisting with draping the patient

d. Passing instruments to the surgeon and assistants

e. Documenting activities occurring in the operating room

Answer 30

b. Preparing the instrument table

c. Assisting with draping the patient

d. Passing instruments to the surgeon and assistants

Question 31

The nurse is caring for a patient undergoing surgery for a knee replacement. Which factors are critical to the patient’s safety during the procedure? (SATA)

a. Universal protocol is followed.

b. The ACP is an anesthesiologist.

c. The patient has adequate health insurance.

d. The patient’s family is in the surgery waiting area.

e. The patient’s allergies are conveyed to the surgical team.

Answer 31

a. Universal protocol is followed.

e. The patient’s allergies are conveyed to the surgical team.

Question 32

Which action is the nurse’s primary responsibility for the care of the patient undergoing surgery?

a. Developing a patient-centered plan of nursing care

b. Carrying out tasks related to surgical policies and procedure

c. Ensuring that the patient has been assessed for safe administration of anesthesia

d. Performing a preoperative history and physical assessment to identify patient needs

Answer 32

a. Developing a patient-centered plan of nursing care

Question 33

Which action would the nurse take when scrubbing at the scrub sink?

a. Scrub from elbows to hands

b. Scrub without mechanical friction

c. Scrub for a minimum of 10 minutes

d. Hold the hands higher than the elbows

Answer 33

d. Hold the hands higher than the elbows

Question 34

Which factors in positioning a patient for surgery increase the risk of patient injury? (SATA)

a. Loss of pain perception

b. Incorrect musculoskeletal alignment

c. Vasoconstriction of the peripheral vessels

d. Hypovolemia contributing to decreased perfusion

e. Inability to sense pressure over bony prominences

Answer 34

a. Loss of pain perception

b. Incorrect musculoskeletal alignment

d. Hypovolemia contributing to decreased perfusion

e. Inability to sense pressure over bony prominences

Question 35

Why is IV induction for general anesthesia the method of choice for most patients?

a. The patient is not intubated.

b. The agents are

d. Emergence is longer but with fewer complications.

Answer 35

c. Induction is rapid and controlled.

Question 36

The charge nurse is supervising patient care in the surgical suite. Which action, if performed by a nurse, would require the charge nurse to intervene?

a. The nurse wears a mask in the semirestricted area.

b. The nurse wears a hair cover in the semirestricted area.

c. The nurse wears street clothes in the semirestricted area.

d. The nurse wears surgical scrubs in the semirestricted area.

Answer 36

c. The nurse wears street clothes in the semirestricted area.

Question 37

Which statement, if made by a new circulating nurse, reflects understanding of the circulating nurse role?

a. “I will assist in preparing the operating room for the patient.”

b. “I will don sterile gloves to obtain items from the unsterile field.”

c. “I will assist with suturing of incisions and maintaining hemostasis.”

d. “I will remain gloved while performing activities in the sterile field.”

Answer 37

a. “I will assist in preparing the operating room for the patient.”

Question 38

Which action describes how the scrub nurse protects the patient with surgical aseptic technique?

a. Uses waterproof shoe covers.

b. Wears personal protective equipment.

c. Changes gloves after touching the upper arm of the surgeon‘s gown.

d. Requires that all operating room (OR) staff perform a surgical scrub.

Answer 38

c. Changes gloves after touching the upper arm of the surgeon‘s gown.

Question 39

The operating room nurse is providing orientation to a new nurse. Which action would the nurse describe as a routine responsibility of a scrub nurse?

a. Document all patient care accurately.

b. Label all specimens to send to the laboratory.

c. Keep both hands above the operating table level.

d. Take the patient to the postanesthesia recovery area.

Answer 39

c. Keep both hands above the operating table level

Question 40

Which data identified during the preoperative assessment alerts the nurse that special protection techniques should be implemented during surgery?

a. Stated allergy to cats and dogs

b. History of spinal and hip arthritis

c. Verbalization of anxiety by the patient

d. Having a sip of water 3 hours previously

Answer 40

b. History of spinal and hip arthritis

Question 41

A patient scheduled to undergo total knee replacement surgery under general anesthesia asks the nurse, “Will the doctor put me to sleep with a mask over my face?” Which response would the nurse provide?

a. “Only your surgeon can tell you what method of anesthesia will be used.”

b. “I will check with the anesthesia care provider to find out what is planned.”

c. “General anesthesia is given by injecting drugs into your veins, so you will not

need a mask.”

d. “Masks are no longer used. A tube inserted into your throat will deliver gas that puts you to sleep.”

Answer 41

b. “I will check with the anesthesia care provider to find out what is planned.”

Question 42

Which potential complication would the nurse monitor for a patient who received inhalation anesthesia?

a. Tachypnea

b. Myoclonus

c. Hypertension

d. Laryngospasm

Answer 42

d. Laryngospasm

Question 43

Which action would the perioperative nurse take to protect the patient from direct burn injury during surgery?

a. Ensure correct placement of the grounding pad.

b. Check emergency sprinklers in the operating room.

c. Verify that a fire extinguisher is available during surgery.

d. Confirm that electrosurgical equipment is working properly.

Answer 43

a. Ensure correct placement of the grounding pad.

Question 44

Monitored anesthesia care (MAC) is going to be used for a closed, manual reduction of a patient‘s dislocated shoulder. Which action would the nurse anticipate?

a. Starting an IV in the patient‘s unaffected arm

b. Securing an airtight fit for the inhalation mask

c. Preparing for placement of an epidural catheter

d. Giving deep sedation under physician supervision

Answer 44

a. Starting an IV in the patient‘s unaffected arm

Question 45

Which action will the perioperative nurse take after surgery is completed for a patient who received ketamine as an anesthetic agent?

a. Question the order for giving a benzodiazepine.

b. Ensure that atropine is available in case of bradycardia.

c. Provide a quiet environment in the postanesthesia care unit.

d. Anticipate the need for higher than usual doses of analgesics.

Answer 45

c. Provide a quiet environment in the postanesthesia care unit.

Question 46

While in the holding area, a patient reveals to the nurse that his father had a high fever after surgery. Which action by the nurse is a priority?

a. Notify the patient that the surgery will be canceled.

b. Place a medical alert sticker on the front of the patient‘s chart.

c. Alert the anesthesia care provider of the family member‘s reaction to surgery.

d. Reassure the patient that his temperature will be monitored closely after surgery.

Answer 46

b. Place a medical alert sticker on the front of the patient‘s chart.

Question 47

A patient in surgery receives a neuromuscular blocking agent as an adjunct to general anesthesia. While in the postanesthesia care unit (PACU), which assessment finding is most important for the nurse to report?

a. Lethargy

b. Report of nausea

c. Disorientation to time

d. Weak chest movement

Answer 47

d. Weak chest movement

Question 48

A patient in the surgical holding area is being prepared for a spinal fusion. Which action by a member of the surgical team requires immediate 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 the operating room with hair uncovered

d. Putting on a surgical mask, cap, and scrubs before entering the operating room

Answer 48

c. Walking into the hallway outside the operating room with hair uncovered

Question 49

Which action in the perioperative patient plan of care can the charge nurse delegate to a surgical technologist?

a. Teach the patient about what to expect in the operating room (OR).

b. Pass sterile instruments and supplies to the surgeon and scrub technician.

c. Monitor and interpret the patient‘s echocardiogram (ECG) during surgery.

d. Give the postoperative report to the postanesthesia care unit (PACU) nurse.

Answer 49

b. Pass sterile instruments and supplies to the surgeon and scrub technician.

Question 50

When caring for a patient who has received a general anesthetic, the circulating nurse notes red, raised wheals on the patient‘s arms. Which action would the nurse take?

a. Apply lotion to the affected areas.

b. Cover the arms with sterile drapes.

c. Recheck the patient‘s arms during surgery.

d. Notify the anesthesia care practitioner (ACP).

Answer 50

d. Notify the anesthesia care practitioner (ACP).

Question 51

Which actions will the nurse include in the surgical time-out procedure before surgery? (Select all that apply.)

a. Check for patency of IV lines.

b. Have the surgeon identify the patient.

c. Have the patient state name and date of birth.

d. Verify the patient identification band number.

e. Ask the patient to state the surgical procedure.

Answer 51

c. Have the patient state name and date of birth.

d. Verify the patient identification band number.

e. Ask the patient to state the surgical procedure.

Question 52

Which statements describe the role of the certified registered nurse anesthetist (CRNA) on the surgical care team? (Select all that apply.)

a. Selecting and administering the anesthesia and adjuvant drugs

b. Developing and implementing a plan for delivering anesthesia

c. Managing critically ill surgical patients in the intensive care unit

d. Releasing or discharging patients from the postanesthesia care area

e. Establishing an airway and monitoring the patient‘s pulmonary status

Answer 52

a. Selecting and administering the anesthesia and adjuvant drugs

b. Developing and implementing a plan for delivering anesthesia

d. Releasing or discharging patients from the postanesthesia care area

e. Establishing an airway and monitoring the patient‘s pulmonary status