Perioperative Nursing

Question 1

Surgery is a unique experience of a planned physical alteration encompassing three phases:

Answer 1

preoperative, intraoperative, and postoperative

Question 2

These three phases are together referred to as the:

Answer 2

perioperative period

Question 3

_________ is the delivery of nursing care through the framework of the nursing process. It also includes collaborating with members of the healthcare team, making nursing referrals, and delegating and supervising nursing care.

Answer 3

Perioperative nursing

Question 4

T/F: Perioperative nursing is practiced in hospital-based inpatient and outpatient surgical, laser, and endoscopy suites, physician office-based surgical suites (outpatient), and freestanding outpatient and ambulatory surgical centers.

Answer 4

T

Question 5

________ do not require an overnight hospital stay. The client goes to the outpatient site on the day of surgery, has the procedure and leaves the same day.

Answer 5

Outpatient procedures

Question 6

The _________ begins when the decision to have surgery is made; it ends when the client is transferred to the operating table. The nursing activities associated with this phase include assessing the client, identifying potential or actual health problems, planning specific care based on the individual’s needs, and providing preoperative teaching for the client, the family, and significant others.

Answer 6

preoperative phase

Question 7

The ________ begins when the client is transferred to the operating table and ends when the client is admitted to the postanesthesia care unit (PACU), also called the postanesthesia room (PAR). The nursing activities related to this phase include a variety of specialized procedures designed to create and maintain a safe therapeutic environment for the client and the healthcare personnel. These activities include interventions that provide for the client’s safety, maintain an aseptic environment, ensure proper functioning of equipment, and provide the surgical team with the instruments and supplies needed during the procedure.

Answer 7

intraoperative phase

Question 8

The _______ begins with the admission of the client to the PACU or PAR and ends when healing is complete. During this phase, nursing activities include assessing the client’s response (physiologic and psychologic) to surgery, performing interventions to facilitate healing and prevent complications, teaching and providing support to the client and support people, and planning for home care. The goal is to assist the client to achieve optimal health status.

Answer 8

postoperative phase

Question 9

Surgical procedures are commonly grouped according to:

Answer 9

(a) purpose
(b) degree of urgency
(c) degree of risk.

Question 10

T/F: Surgery is classified by its urgency and necessity to preserve the client’s life, body part, or body function.

Answer 10

T

Question 11

________ is performed immediately to preserve function or the life of the client. Surgeries to control internal hemorrhage or repair a fracture are examples of this.

Answer 11

Emergency surgery

Question 12

_______ is performed when surgical intervention is the preferred treatment for a condition that is not imminently life-threatening (but may ultimately threaten life or well-being), or to improve the client’s life. Examples of these include cholecystectomy for chronic gallbladder disease, hip replacement surgery, and plastic surgery procedures such as breast reduction.

Answer 12

Elective surgery

Question 13

Confirms or establishes a diagnosis; for example, biopsy of a mass in a breast.

Answer 13

Diagnostic

Question 13

Relieves or reduces pain or symptoms of a disease; it does not cure; for example, resection of nerve roots.

Answer 13

Palliative

Question 14

Removes a diseased body part; for example, removal of a gallbladder (cholecystectomy).

Answer 14

Ablative

Question 15

Restores function or appearance that has been lost or reduced; for example, cleft palate repair.

Answer 15

Constructive

Question 16

Replaces malfunctioning structures; for exam- ple, kidney transplant.

Answer 16

Transplant

Question 17

_________ involves a high degree of risk, for a variety of reasons: It may be complicated or prolonged, large losses of blood may occur, vital organs may be involved, or postoperative complications may be likely. Examples are organ transplant, open heart surgery, and removal of a kidney.

Answer 17

Major surgery

Question 18

In contrast, ________ normally involves little risk, produces few complications, and is often performed in an outpatient setting. Examples are breast biopsy, removal of tonsils, and cataract extraction.

Answer 18

minor surgery

Question 19

The degree of risk involved in a surgical procedure is affected by the (Select all that applies):

• client’s age
• general health
• nutritional status
• presence of sleep apnea
• use of medications
• mental status
• respiratory status

Answer 19

All of the above except respiratory status.

Question 20

T/F: Neonates, infants, and older clients are greater surgical risks than children and adults.

Answer 20

T

Question 21

________ affect a child’s ability to cope with the physiologic and psychologic stresses of surgery.

Answer 21

Age and developmental status

Question 22

T/F: Neonates and infants have a lower metabolic rate and a different physiologic makeup than adults. These differences cause a substantially different response to a surgical procedure.

Answer 22

F - higher

Question 23

Select all the examples that pertain to infant’s high risks for surgery:

• The blood volume in an infant is small, and fluid reserves are limited. This increases the risk of volume depletion during surgery, resulting in inadequate oxygenation of body tissues.
• Because of the infant’s relatively large body surface area and immature temperature regulatory mechanisms, the risk of hypothermia during surgery is significant.
• Other organ systems, such as the kidneys, liver, and immune system, are also immature in infants, affecting their ability to metabolize and eliminate drugs and resist infection.

Answer 23

All of the above

Question 24

T/F: Toddlers and older children are better able to withstand surgery physiologically, but they often fear separation from their parents, strangers, bodily injury, mutilation, and death.

Answer 24

T

Question 25

T/F: The child’s developmental level and age-appropriate communication are important in implementing the pediatric plan of care.

Answer 25

T

Question 26

The ________ often has fewer physiologic reserves to meet the extra demands caused by surgery.

Answer 26

older adult

Question 27

Choose all that shows physiologic deficits of aging that increases the surgical risk for older adults:

• For example, because of a lower percentage of body water, decreased kidney function, and a decreased thirst response, older clients are at greater risk for fluid and electrolyte imbalances.
• Many older clients demonstrate changes in liver and kidney function, both of which can affect responses to anesthesia and other medications that may be administered during the perioperative period.
• The older client may be poorly nourished, which can impair healing. Declines in sensory function (hearing in particular) or the presence of dementia make it more difficult to understand directions and teaching.
• The older client is more likely to have a chronic disease, such as cardiovascular disease, lung disease, or diabetes, that affects healing and responses to medication and surgery.
• The older clients have a healthy mind through experience.

Answer 27

All of the above except the older clients have a healthy mind through experience.

Question 28

T/F: Any infection or pathophysiology increases the risk.

Answer 28

T

Question 29

T/F: It is important for the nurse to assess the client for an upper respiratory tract infection, which together with a general anesthetic can adversely affect respiratory function.

Answer 29

T

Question 30

When a client is at high risk for infection, antibiotics may be administered parenterally within 1 hour of surgery and continued for 24 to 72 hours after surgery. This practice allows time for drugs to reach ________ in the tissues but does not permit bacterial resistance to develop.

Answer 30

therapeutic levels

Question 31

________ can lead to delayed wound healing, infection, and reduced energy. Protein and vitamins are needed for wound healing; vitamin K is essential for blood clotting.

Answer 31

Malnutrition

Question 32

_______ leads to hypertension, impaired cardiac function, and impaired respiratory ventilation. they have more likely to have delayed wound healing and wound infection because adipose tissue impedes blood circulation and its delivery of nutrients, antibodies, and enzymes required for wound healing.

Answer 32

Obesity

Question 33

______ such as angina pectoris, recent myocardial infarction, hypertension, and heart failure weakens the heart. Well-controlled cardiac problems generally pose a minimal operative risk.

Answer 33

Cardiac conditions

Question 34

________ may lead to severe bleeding, hemorrhage, and subsequent shock.

Answer 34

Blood coagulation disorders

Question 35

________ or ________ adversely affects pulmonary function, especially when exacerbated by the effects of general anesthesia. They also predispose the client to postoperative lung infections.

Answer 35

Upper respiratory tract infections; chronic obstructive pulmonary disease (COPD)

Question 36

________ impairs regulation of the body’s fluids and electrolytes and excretion of drugs and other toxins.

Answer 36

Renal disease

Question 37

________ predisposes the client to wound infection and delayed healing.

Answer 37

Diabetes mellitus

Question 38

_______ (e.g., cirrhosis) impairs the liver’s abilities to detoxify medications used during surgery, produce the prothrombin necessary for blood clotting, and metabolize nutrients essential for healing.

Answer 38

Liver disease

Question 39

_______ disease such as epilepsy may result in seizures during surgery or recovery.

Answer 39

Uncontrolled neurologic

Question 40

________ is required for normal tissue repair. Surgery increases the body’s need for nutrients that help with the tissue healing and prevention of infection required during the postoperative period.

Answer 40

Adequate nutrition

Question 41

_______ contributes to postoperative complications such as pneumonia, wound infections, and wound separation.

Answer 41

Obesity

Question 42

Both clients with obesity and those who are under-weight are vulnerable to_______ (previously called pressure ulcers) due to the positioning required for surgery.

Answer 42

perioperative pressure injuries

Question 43

The perioperative nurse provides _______ and other measures to protect the client’s skin over pressure points during surgery.

Answer 43

padding

Question 44

Promotes epithelialization and enhances collagen synthesis

Answer 44

Vitamin A

Question 45

Cofactor of the enzyme system

Answer 45

Vitamin B complex

Question 46

Essential for collagen synthesis affecting wound tensile strength

Answer 46

Vitamin C (ascorbic acid)

Question 47

Essential in the synthesis of prothrombin and thus coagulation

Answer 47

Vitamin K

Question 48

Involved in collagen synthesis

Answer 48

Iron, zinc, and copper

Question 49

________ is a common condition caused by partial or complete obstruction of the upper airway during sleep.

Answer 49

Obstructive sleep apnea (OSA)

Question 50

Breathing is briefly interrupted during sleep with periods of apnea lasting at least _______.

Answer 50

10 seconds

Question 51

The gold standard for diagnosis of OSA is a ________.

Answer 51

sleep study

Question 52

T/F: The STOP-Bang Questionnaire assesses whether the client Snores, is Tired during the day, if anyone has Observed apnea during sleep, and has high blood Pressure.

Answer 52

T

Question 53

Recent studies have shown that clients with _______ who undergo surgery are at increased risk for perioperative complications.

Answer 53

OSA (Obstructive Sleep Apnea)

Question 54

________ increase blood coagulation time.

Answer 54

Anticoagulants

Question 55

_________ may interact with anesthetics, increasing the risk of respiratory depression.

Answer 55

Tranquilizers

Question 56

_________ may interfere with wound healing and increase the risk of infection.

Answer 56

Corticosteroids

Question 57

_______ may affect fluid and electrolyte balance.

Answer 57

Diuretics

Question 58

T/F:

• Clients may be unaware of the potential adverse inter- actions of medications and may fail to report the use of medications for conditions unrelated to the indication for surgery.
• The smart nurse interviewer should question the client and family about the use of commonly prescribed medications, over-the-counter (OTC) preparations, and any herbal remedies for specific conditions mentioned during the nursing history.

Answer 58

Both T

Question 59

T/F: Disorders that affect cognitive function, such as mental illness, intellectual disability, or developmental delay, affect the client’s ability to understand and cope with the stresses of surgery.

Answer 59

T

Question 60

These clients also may require medication such as ________ or________ drugs that can interact with anesthetic and analgesic medications used during and after surgery.

Answer 60

anticonvulsants; antipsychotic

Question 61

These clients also may require medication such as ________ or________ drugs that can interact with anesthetic and analgesic medications used during and after surgery.

Answer 61

anticonvulsants; antipsychotic

Question 62

Clients with ________ may have difficulty understanding proposed surgical procedures and may respond unpredictably to anesthetics.

Answer 62

dementia

Question 63

T/F: Indicators of dementia such as confusion, disorientation, and agitation may be worsened by the change of environment in the hospital, and interfere with the client’s ability to cooperate with pre- and postoperative care.

Answer 63

T

Question 64

Extreme ________ also increases surgical risk and interferes with the client’s ability to process information and respond correctly to instructions.

Answer 64

anxiety

Question 65

Prior to any surgical procedure, _________ is required from the client or legal guardian.

Answer 65

Informed consent

Question 66

T/F:

• Informed consent implies that the client has been informed and involved in decisions affecting his or her health.
• The nurse is responsible for obtaining informed consent by providing the following information to the client or legal guardian:

Answer 66

1st T 2nd F - surgeon is the one responsible

Question 67

The following are included in the informed consent:

• The nature of and the reason for the surgery
• All available options and the risks associated with each option
• The risks of the surgical procedure and its potential outcomes
• Name and qualifications of the surgeon performing the procedure
• The right to refuse consent or later withdraw consent.

Answer 67

All of the above

Question 68

The surgeon documents the informed consent conversation with the client or legal guardian in the _________.

Answer 68

preoperative progress note

Question 69

The _________, provided by the health- care facility where the surgery will be performed, protects the client from incorrect or unwanted procedures and the surgeon and facility from litigation related to unauthorized surgeries or uninformed clients.

Answer 69

surgical consent form

Question 70

T/F: The surgical consent form becomes part of the client’s medical record and goes to the operating room (OR) with the client.

Answer 70

T

Question 71

T/F: The RN ensures consent is in the client’s chart prior to releasing the client to surgery.

Answer 71

T

Question 72

Although the surgeon maintains legal responsibility for ensuring that the client has given informed consent, the _______ may witness the client’s signature on the consent form.

Answer 72

nurse

Question 73

In doing so, the nurse ensures that the consent form is signed and serves as a _______ to the signature, not to the fact that the client is informed.

Answer 73

witness

Question 74

T/F: If the nurse assesses that the client does not understand the procedure to be performed, the surgeon is contacted and requested to speak with the client before surgery can proceed.

Answer 74

T

Question 75

T/F: Informed consent is only possible when the client understands the provided information, that is, speaks the language and is conscious, mentally competent, and not sedated.

Answer 75

T

Question 76

A ______ may not give informed consent. Specific guidelines regarding consent for minors vary among the states.

Answer 76

minor

Question 77

T/F: Preoperative assessment includes collecting and reviewing physical, psychologic, and social client data to determine the client’s needs throughout the three perioperative phases.

Answer 77

T

Question 78

The _________ and ______ should also be assessed in the preoperative phase.

Answer 78

client’s mobility and ability to function

Question 79

T/F: The perioperative nurse collects the data by interviewing the client in the presurgical care unit or by telephone prior to the day of surgery.

Answer 79

T

Question 80

When data cannot be collected directly, the perioperative nurse uses other data sources such as the _________.

Answer 80

nursing admission assessment

Question 81

Preoperatively, the nurse performs a brief but complete physical assessment, paying particular attention to systems that could affect the client’s response to ________ or _______.

Answer 81

anesthesia; surgery

Question 82

A brief or “mini” _______ provides valuable baseline data for evaluating the client’s mental status and alertness after surgery.

Answer 82

mental status examination

Question 83

T/F: It is also important to evaluate the client’s ability to understand what is happening. For example, assessment of hearing and vision helps guide perioperative teaching.

Question 84

Essential information includes general health status and the presence of any chronic diseases, such as diabetes or asthma, which may affect the client’s response to surgery or anesthesia. Note any physical limitations that may affect the client’s mobility or ability to communicate after surgery, as well as any prostheses such as hearing aids or contact lenses.

Answer 84

Current health status

Question 85

Include allergies to prescription and nonprescription drugs, food allergies, and allergies to tape, latex, soaps, or antiseptic agents. Some food allergies may indicate a potential reaction to drugs or substances used during surgery or diagnostic procedures; for example, an allergy to seafood alerts the nurse to a potential allergy to iodine-based dyes or soaps commonly used in hospitals.

Answer 85

Allergies

Question 86

List all current medications (prescribed and OTC). It may be vital to maintain a blood level of some medications (e.g., anticonvulsants) throughout the surgical experience; others, such as anticoagulants or aspirin, increase the risks of surgery and anesthesia and need to be discontinued several days prior to surgery. It is important to include in the list any OTC drugs and herbal remedies the client currently takes.

Answer 86

Medications

Question 87

Previous surgical experiences may influence the client’s physical and psychologic responses to surgery or may reveal unexpected responses to anesthesia.

Answer 87

Previous surgeries

Question 88

The client’s mental status and ability to under- stand and respond appropriately can affect the entire perioperative experience. Note any developmental disabilities, mental illness, history of dementia, or excessive anxiety related to the procedure.

Answer 88

Mental Status

Question 89

The client should have a good understanding of the planned procedure and what to expect during and after surgery as well as the expected outcome of the procedure.

Answer 89

Understanding of the surgical procedure and anesthesia

Question 90

Smokers may have more difficulty clearing respiratory secretions after surgery, increasing the risk of postoperative complications such as pneumonia and atelectasis and delayed wound healing.

Answer 90

Smoking

Question 91

The majority of adults do not know that they have OSA, which puts them at risk for postoperative pulmonary complications. Furthermore, when asked if they have sleep apnea, clients often state that they do not have a sleeping problem.

Answer 91

Obstructive sleep apnea (OSA)

Question 92

Use of substances that affect the central nervous system, liver, or other body systems can affect the client’s response to anesthesia and surgery, and postoperative recovery.

Answer 92

Alcohol and other mind-altering substances

Question 93

Clients with a healthy self-concept who have successfully employed appropriate coping mechanisms in the past are better able to deal with the stressors associated with surgery.

Answer 93

Coping

Question 94

Determine the availability of family or other caregivers as well as the client’s social support network. These resources are important to the client’s recovery, particularly for the client undergoing same-day or short-stay surgery.

Answer 94

Social resources

Question 95

Culture and spirituality influence the client’s response to surgery; respecting cultural and spiritual beliefs and practices can reduce preoperative anxiety and improve recovery.

Answer 95

Cultural and spiritual considerations

Question 96

Rationale: RBCs, hemoglobin (Hgb), and hematocrit (Hct) are important to the oxygen-carrying capacity of the blood; white blood cells (WBCs) are an indicator of immune function

Answer 96

Complete blood count (CBC)

Question 97

Rationale: Determined in case blood transfusion is required during or after surgery

Answer 97

Blood grouping and cross-matching

Question 98

Rationale: To evaluate fluid and electrolyte status

Answer 98

Serum Electrolytes

Question 99

Rationale: High levels may indicate undiagnosed diabetes mellitus

Answer 99

Fasting blood glucose

Question 100

Rationale: To evaluate renal function

Answer 100

Blood urea nitrogen (BUN) and creatinine

Question 101

Rationale: To evaluate liver function

Answer 101

ALT, AST, LDH, and bilirubin

Question 102

Rationale: To evaluate nutritional status

Answer 102

Serum albumin and total protein

Question 103

Rationale: To determine urine composition and possible abnormal components (e.g., protein or glucose) or infection

Answer 103

Urinalysis

Question 104

To evaluate respiratory status and heart size

Answer 104

Chest X-ray

Question 105

Rationale: To identify pre-existing cardiac problems or disease

Answer 105

Electrocardiogram (ECG) (all clients over 40 years of age and clients with pre-existing cardiac conditions)

Question 106

Rationale: To identify if the client is pregnant

Answer 106

Pregnancy test (all female clients of childbearing age)

Question 107

Examples of nursing diagnoses that may be appropriate for the preoperative client can include (choose all that applies):

• lack of knowledge related to no exposure to the specific perioperative experience
• anxiety related to risk of death
• grieving related to loss of body part (specify)
• impaired coping related to previous negative experience with surgery

Answer 107

All of the above

Question 108

The overall goal in the preoperative period is to ensure that the client is ______ and _______ prepared for surgery.

Answer 108

mentally and physically

Question 109

T/F: Planning should involve the client, the family, and significant others.

Answer 109

T

Question 110

T/F: Discharge planning incorporates an assessment of the client’s, family’s, and significant other’s abilities and resources for care, their financial resources, and the need for referrals and home health services.

Answer 110

t

Question 111

_________ is a vital part of nursing care. Studies have shown that it reduces clients’ anxiety and postoperative complications and increases their satisfaction with the surgical experience.

Answer 111

Preoperative teaching

Question 112

T/F: Effective preoperative teaching also facilitates the client’s successful and early return to work and other activities of daily living (ADLs).

Answer 112

T

Question 113

The dimension of preoperative teaching where the nurse focuses on the client identifying specific concerns and fears. This also involves the discussion about pain assessment and management.

Answer 113

Information, including what will happen to the client, when, and what the client will experience, such as expected sensations and discomfort.

Question 114

Choose all the activities you should do for pain assessment and management:

• Explain that the surgeon will order pain medication.
• Describe the 0-to-10 pain scale and how this is used to assess the client’s level of pain.
• Stress the importance of working together to manage the pain because clients are able to move around easier and ambulate quicker when their pain is controlled.

Answer 114

All of the above

Question 115

The dimension of preoperative teaching where the nurse provides support by actively listening and providing accurate information. It is important to correct any misunderstandings the client may have.

Answer 115

Psychosocial support to reduce anxiety

Question 116

The dimension of preoperative teaching where
understanding his or her role during the perioperative experience increases the client’s sense of control and reduces anxiety. This includes what will be expected of the client, desired behaviors, self-care activities, and what the client can do to facilitate recovery.

Answer 116

The roles of the client and support people in preoperative preparation, the surgical procedure, and during the postoperative phase.

Question 117

The dimension of preoperative teaching that includes moving, deep breathing, coughing, splinting incisions with the hands or a pillow, and using an incentive spirometer.

Answer 117

Skills training

Question 118

If the client is scheduled for ______, preoperative teaching is often provided before the day of surgery using some combination of videos and verbal and written instructions.

Answer 118

outpatient surgery

Question 119

T/F:

• Written instructions are always provided to reinforce verbal teaching.
• Teaching is further reinforced on admission the day of surgery and before discharge from the postanesthesia unit.

Answer 119

Both T

Question 120

Select the following that is/are true:

• When the client is a child, addressing the fears and anxieties of both the child and the family is important.
• Parents need to know what to expect and to be able to express their concerns.
• Parents should be considered members of the perioperative team and allowed to participate in providing as much care as possible.

Answer 120

All of the above

Question 121

T/F: Preoperative preparation includes the following areas: nutrition and fluids, elimination, hygiene, medications, sleep, care of valuables and prostheses, special orders, surgical skin preparation, temperature, safety protocols, vital signs, anti embolic stockings, and sequential compression devices.

Answer 121

T

Question 122

Adequate hydration and nutrition promote healing. Nurses need to identify and record any signs of malnutrition or fluid imbalance.

Answer 122

Preparation of Nutrition and Balance

Question 123

T/F: If the client is on IV fluids or on measured fluid intake, nurses must ensure that the fluid intake and output are accurately measured and recorded.

Answer 123

T

Question 124

The order ________ has been a long-standing tradition because it was believed that anesthetics depress gastrointestinal functioning and there was a danger the client would vomit and aspirate during the administration of a general anesthetic.

Answer 124

“NPO after midnight”

Question 125

The consumption of clear liquids (no alcohol) up to ________ before surgery

Answer 125

2 hours

Question 126

The consumption of breast milk up to ________ before surgery; infant formula may be ingested up to ________ before surgery

Answer 126

4 hours; 6 hours

Question 127

A light meal may be ingested up to ______ before the procedure

Answer 127

6 hours

Question 128

A heavier meal (fried or fatty foods) may be eaten up to ________ before surgery.

Answer 128

8 hours

Question 129

_______ before surgery are no longer routine, but ________ may be ordered if bowel surgery is planned.

Answer 129

Enemas; cleansing enemas

Question 130

The ________ help prevent postoperative constipation and contamination of the surgical area (during surgery) by feces.

Answer 130

enemas

Question 131

After surgery involving the intestines, peristalsis often does not return for ________.

Answer 131

24 to 48 hours

Question 132

Prior to surgery, a straight catheterization or an ________ may be ordered to ensure that the bladder remains empty. This helps prevent inadvertent injury to the bladder, particularly during pelvic surgery.

Answer 132

indwelling Foley catheter

Question 133

T/F: If the client does not have a catheter, it is not important to empty the bladder prior to receiving preoperative medications.

Answer 133

T - it is important

Question 134

T/F:

• In some settings, clients are asked to bathe or shower the evening or morning of surgery (or both) with either soap or an antiseptic solution.
• The purpose of hygienic measures is to reduce the risk of wound infection by reducing the amount of bacteria on the client’s skin. The bath includes shampoo whenever possible.

Answer 134

T

Question 135

The client’s nails should be trimmed and free of pol- ish, and all cosmetics should be removed so that the nail beds, skin, and lips are visible when ________ is assessed during the perioperative phases.

Answer 135

circulation

Question 136

Intraoperatively the client will be required to wear a ________. It contains the client’s hair and any microorganisms on the hair and scalp.

Answer 136

surgical cap

Question 137

T/F: Before going into the OR the client should remove all hairpins and clips because they may cause pressure or accidental damage to the scalp when the client is unconscious. The client also removes personal clothing and puts on an OR gown.

Answer 137

T

Question 138

The ______ or_______ may order routinely taken medications to be held the day of surgery.

Answer 138

anesthetist or anesthesiologist

Question 139

________ such as midazolam (Versed) may be administered IV prior to surgery (Adams, Holland, & Urban, 2020) to reduce anxiety and ease anesthetic induction.

Answer 139

Benzodiazepines

Question 140

___________ such as morphine provide clients sedation and reduce the required amount of anesthetic.

Answer 140

Opioid analgesics

Question 141

__________ such as atropine, scopolamine, and glycopyrrolate (Robinul) reduce oral and pulmonary secretions and prevent laryngospasm.

Answer 141

Anticholinergics

Question 142

__________such as droperidol (Inapsine) are administered parenterally to prevent nausea and vomiting; reduce anxiety, and relax muscles

Answer 142

Dopamine blockers

Question 143

________ antihistamines such as cimetidine (Tagamet) and ranitidine (Zantac) reduce gastric fluid volume and gastric acidity.

Answer 143

Histamine-receptor

Question 144

Neurolept analgesic agents such as Innovar induce general calmness and sleepiness.

Answer 144

Neurolept analgesic

Question 145

Nurses should do everything to help the client sleep the night before surgery. Often a _______ is ordered. Ade- quate sleep helps the client manage the stress of surgery and helps healing.

Answer 145

sedative

Question 146

T/F:

• Valuables such as jewelry and money should be sent home with the client’s family or significant other.
• If valuables and money cannot be sent home, they need to be labeled and placed in a locked storage area per the agency’s policy.

Answer 146

Both T

Question 147

If a client wishes not to remove a wedding band, the nurse can _______ it in place. Unless there is a danger of selling afterwards.

Answer 147

tape

Question 148

T/F: All prostheses (artificial body parts, such as partial or complete dentures, contact lenses, artificial eyes, and artificial limbs) and eyeglasses, wigs, and false eyelashes must be removed before surgery.

Answer 148

T

Question 149

_________ is a Christian religion that believes that taking blood into the body causes loss of eternal life and that members who accept blood should be shunned by the congregation and denied the church’s sacraments.

Answer 149

Jehovah’s Witness

Question 150

This refers to surgeon’s orders for special requirements (e.g., the insertion of a nasogastric tube prior to surgery; the administration of medications, such as insulin; or the application of antiemboli stockings).

Answer 150

Special orders

Question 151

T/F: In most agencies, skin preparation is carried out during the intraoperative phase.

Answer 151

T

Question 152

The _______ is cleansed with an antimicrobial to remove soil and reduce the resident micro- bial count to subpathogenic levels.

Answer 152

surgical site

Question 153

Surgical clients are at risk of losing _______; therefore, temperature management is an important aspect of peri-operative client safety and comfort.

Answer 153

body heat

Question 154

Choose all that shows causes of hypothermia in the peri-operative stage:

• minimal clothing (i.e., only a hospital gown)
• inactivity while in the holding area
• skin exposure during insertion of IV and during surgery
• low temperatures in the OR
• inactivity after the surgery
• the administration of anesthesia impairs both thermoregulation and the ability of the body to generate and retain heat

Answer 154

All of the above except inactivity after the surgery

Question 155

Complications associated with perioperative hypothermia include (choose all that applies):

• increased blood loss
• delayed wound healing
• fluid imbalance
• increased risk of an SSI
• increased length of stay in the hospital.

Answer 155

All of the above except fluid imbalance

Question 156

T/F: It is important for the client’s temperature to be assessed during the entire perioperative experience to prevent unintended hypothermia.

Answer 156

T

Question 157

One method to prevent complications of hypothermia is to use a ________, which consists of a power unit that generates warmed air and a fan that blows the warmed air through a hose into a disposable blanket that has direct contact with the client.

Answer 157

forced-air warming system

Question 158

Postoperatively, it is important to monitor temperature every ________.

Answer 158

hour

Question 159

The first step requires ________. The frequency and scope of the verification process depends on the type and complexity of the procedure.

Answer 159

preoperative verification

Question 160

The Joint Commission established the Universal Protocol for Preventing_______, _______, and _______ Surgery in 2004.

Answer 160

Wrong Site, Wrong Procedure, and Wrong Person

Question 161

The following are possibilities included in checking preoperative verification:

• When the procedure is scheduled
• The time of preadmission testing and assessment
• The time of admission for the procedure
• After Surgery
• Before the client leaves the preprocedure area or enters the procedure room

Answer 161

all of the above except after surgery

Question 162

The second step involve:

Answer 162

marking of the operative site

Question 163

T/F: The essential focus is that the mark must be unambiguous and a clear communication to all involved. The mark must be permanent and visible after the client has been prepped and draped for surgery.

Answer 163

T

Question 164

The third step is called_________. Before surgery begins the surgical team takes a time-out to conduct a final verification of the correct client, procedure, and site. Any questions or concerns must be resolved before the procedure can begin.

Answer 164

“time-out”

Question 165

In the preoperative phase the nurse assesses and documents _______ for baseline data. The nurse reports any abnormal findings, such as elevated blood pressure or elevated temperature.

Answer 165

vital signs

Question 166

_________ are firm elastic hose that compress the veins of the legs and thereby facilitate the return of venous blood to the heart. They also prevent edema of the legs and feet.

Answer 166

Antiemboli (elastic) stockings

Question 167

These stockings are frequently applied to surgical clients to prevent the potential postoperative problem of________.

Answer 167

venous thromboembolism (VTE)

Question 168

T/F:

• One type extends from the foot to the knee and another from the foot to midthigh.
• These stockings usually have a partial foot that exposes the heel or toes so that extremity circulation can be assessed.
• Elastic stockings usually don’t come in sizes

Answer 168

1st T 2nd T 3rd F - Elastic stockings come in small, medium, and large sizes

Question 169

Clients who are undergoing surgery may benefit from a ________ to promote venous return from the legs. It inflate and deflate plastic sleeves wrapped around the legs to promote venous flow.

Answer 169

sequential compression device (SCD)

Question 170

T/F: The intraoperative nurse uses the nursing process to design, coordinate, and deliver care to meet the identified needs of clients whose protective reflexes or self-care abilities are potentially compromised because they are having operative or other invasive procedures.

Answer 170

T

Question 171

An anesthesiologist or a ________ administer anesthetic agents.

Answer 171

certified registered nurse anesthetist (CRNA)

Question 172

__________ is the loss of all sensation and consciousness. Under it, protective reflexes such as cough and gag reflexes are lost.

Answer 172

General anesthesia

Question 173

A general anesthetic acts by blocking_________ centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur.

Answer 173

awareness

Question 174

T/F: General anesthetics are usually administered by IV infusion or by inhalation of gases through a mask or through an endotracheal tube inserted into the trachea.

Answer 174

T

Question 175

Select all that shows the advantages of general anesthesia:

• Because the client is unconscious rather than awake and anxious, respiration and cardiac function are readily regulated.
• Also, the anesthesia can be adjusted to the length of the operation and the client’s age and physical status.
• It depresses the respiratory and circulatory systems.

Answer 175

T/F: Some clients become more anxious about a general anesthetic than about the surgery itself. Often this is because they fear losing the capacity to control their own bodies.

Question 176

The temporary interruption of the transmission of nerve impulses to and from a specific area or region of the body. The client loses sensation in an area of the body but remains conscious.

Answer 176

Regional anesthesia

Question 177

Applied directly to the skin and mucous membranes, open skin surfaces, wounds, and burns. The most commonly used are lidocaine (Xylocaine) and benzocaine. Topical anesthetics are readily absorbed and act rapidly.

Answer 177

Topical (surface) anesthesia

Question 178

_______ refers to minimal depression of the level of consciousness such that the client retains the ability to maintain a patent airway and respond appropriately to commands.

Answer 178

Conscious sedation

Question 179

On the day of surgery, after the client has been admitted to the hospital, the client’s family members or significant others are escorted to a surgical holding area located outside of the OR. This area is also known as a ________.

Answer 179

presurgical care unit (PSCU)

Question 180

The following are what the perioperative nurse assesses during the intraoperative phase (choose all that apply)

• the client’s identity
• the client’s physical and emotional status
• the nurse verifies the information on the preoperative checklist and evaluates the client’s knowledge about the surgery and events to follow
• the client’s response to preoperative medications is assessed, as well as the placement and patency of tubes such as IV lines, nasogastric tubes, and urinary catheters

Answer 180

All of the above

Question 181

Assessment continues throughout surgery, as the anesthesiologist or the CRNA continuously monitors the following (select all that apply):

• client’s vital signs (including blood pressure, heart rate, respiratory rate, and temperature), ECG, and oxygen saturation.
• fluid intake and urinary output are monitored throughout surgery, and blood loss is estimated.
• arterial and venous pressures, pulmonary artery pressures, and laboratory values such as blood glucose, hemoglobin, hematocrit, serum electrolytes, and arterial blood gases may be evaluated during surgery.

Answer 181

All of the above

Question 182

The following are the diagnoses that might be included in the intraoperative phase:

• potential for developing pressure injury related to peri- operative positioning
• potential for hypothermia related to low temperatures in the OR
• potential for surgical site infection related to altered skin integrity.
• potential for grieving

Answer 182

all of the above except potential for grieving

Question 183

Choose one that doesn’t apply for the planning phase of the intraoperative phase:

• Position the client appropriately for surgery.
• Perform preoperative skin preparation.
• Assist in preparing and maintaining the sterile field.
• Open and dispense sterile supplies during surgery.
• Provide medications and solutions for the sterile field.
• Monitor and maintain a safe, aseptic environment.
• Manage catheters, tubes, drains, and specimens.
• Perform sponge, sharp, and instrument counts.
• Document nursing care provided and the client’s
  response to interventions.

Answer 183

none of the above

Question 184

Intraoperative interventions are carried out by the:

Answer 184

circulating nurse, the scrub person, and the registered nurse’s first assistant.

Question 185

The ________ coordinates activities and manages client care by continually assessing client safety (e.g., client positioning) and by monitoring aseptic practice and the environment (e.g., temperature, humidity, and lighting).

Answer 185

circulating nurse

Question 186

The ________ is usually an RN, LPN, or certified surgical technologist (CST). They wear sterile gowns, gloves, caps, and eye protection. Their role is to assist the surgeons. Their responsibilities include draping the client with sterile drapes and handling sterile instruments and supplies.

Answer 186

scrub person

Question 187

The ________has additional education and training and functions in an expanded perioperative nursing role. The RNFA assists the surgeon by controlling bleeding, using instruments, handling and cutting tissues, and suturing during the procedure.

Answer 187

registered nurse first assistant (RNFA)

Question 188

The _________ and _______ are responsible for accounting for all sponges, needles, and instruments at the close of surgery. This precaution prevents foreign bodies from being left inside the client.

Answer 188

circulating nurse and the scrub person

Question 189

________ involves cleaning the surgical site, removing hair only if necessary, and applying an antimicrobial agent

Answer 189

Surgical skin preparation

Question 190

Should the surgery personnel perform skin preparation near the time of surgery?

Answer 190

Yes

Question 191

T/F: Hair removal with a razor is not recommended.

Answer 191

T

Question 192

T/F: The NURSE is responsible for minimizing the client’s risk of perioperative complications related to positioning.

Answer 192

F - entire operating room team

Question 193

The client’s position should provide (CHOOSE ALL THAT APPLY):

• Optimal visualization of and access to the surgical site
• Optimal access to IV lines and monitoring devices
• Protection of the client from harm (anatomic and physiologic considerations).

Answer 193

All of the above

Question 194

Positioning is performed BEFORE anesthesia is induced and before surgical draping of the client.

Answer 194

F - after

Question 195

______ maintains positions on the operating table, and body prominences are frequently padded. The position should consider a normal joint range of motion and good body alignment, thereby avoiding strain or injury to muscles, bones, and ligaments.

Answer 195

Straps