Chapter 19 Med/surg

Front 1

a controlled environment designed to
minimize the spread of pathogens and allow a smooth "ow of
patients, sta#, and equipment needed to provide safe patient
care.

Back 1

Surgical suite

Front 2

The suite is divided into three distinct areas:

Back 2

unrestricted,
semirestricted, and restricted areas.

Front 3

The unrestricted area is

Back 3

where people in street clothes can interact with those in surgical
attire.

Front 4

The semirestricted
area includes?

Back 4

the surrounding support areas and
corridors.

Front 5

In the restricted
area masks are required to supplement surgical attire.1 !e
restricted area can include?

Back 5

OR, scrub sink area, and clean core

Front 6

Surgical Care Improvement Project (SCIP)?

Back 6

is a national
quality partnership of organizations focused on improving
surgical care by signi%cantly reducing the number of complications
from surgery3

Front 7

!e National Patient Safety Goals (NPSGs) require?

Back 7

a preprocedure
process, including the veri%cation of relevant documentation
(e.g., history and physical examination, signed consent
form, nursing and preanesthesia assessment)

Front 8

In addition, the NPSGs require that the surgeon mark the?

Back 8

procedure site

Front 9

registered nurse (RN) who implements
patient care during the perioperative period. !rough
close collaboration with the other members of the surgical
team, you prepare the OR for patients before they arrive

Back 9

perioperative nurse

Front 10

works in collaboration
with the surgeon to produce an optimal surgical outcome
for the patient.?

Back 10

RNFA registered nurse first assistant

Front 11

RNFAs states that the
perioperative nurse must have formal education for this role
and works collaboratively with the surgeon, patient, and surgical
team by?

Back 11

handling tissue, using instruments, providing
exposure to the surgical site, assisting with hemostasis, and
suturing

Front 12

Anesthesiology is a
discipline within the practice of medicine that specializes in
the following?

Back 12

Medically managing patients who are unconscious or
insensible to pain and emotional stress during surgical
and other medical procedures

Front 13

A nurse anesthetist is an RN who has?

Back 13

graduated from an
accredited nurse anesthesia program (minimally a master’s
degree program) and successfully completed a national certi%-
cation examination

Front 14

Speci%c SCIP measures may include a prophylactic
antibiotic started within?

Back 14

30 to 60 minutes

Front 15

!e Universal Protocol, one of the NPSGs, is followed to
prevent?

Back 15

wrong site, wrong procedure, and wrong surgery

Front 16

When positioning for the surgical
procedure, take care to?

Back 16

(1) provide correct musculoskeletal
alignment; (2) prevent undue pressure on nerves, skin over
bony prominences, earlobes, and eyes; (3) provide for adequate
thoracic excursion; (4) prevent occlusion of arteries and veins;
(5) provide modesty in exposure; and (6) recognize and respect
individual needs such as previously assessed aches, pains, or
deformities.

Front 17

One study
showed that the rate of culture-positive surgical site infections
among those with mild perioperative hypothermia was?

Back 17

three
times higher than among normothermic patients.

Front 18

A scale of P1 to P6 is used,
with a rating of P6 reserved for

Back 18

a brain dead patient

Front 19

!e ASA classi%es anesthesia according to the e#ect that it has
on the patient’s sensorium and pain perception. !ese classi%cations
include?

Back 19

general anesthesia, regional anesthesia, local
anesthesia, monitored anesthesia care (MAC), and moderate
sedation

Front 20

Monitored anesthesia care (MAC) is used for

Back 20

diagnostic or
therapeutic procedures performed in or outside of the OR

Front 21

!e present goals of anesthesiology include? (2)

Back 21

control of
excessive biologic responses induced by a variety of stressors
and (2) protection of patients from stress-induced complications.

Front 22

technique of choice for patients
who are having surgical procedures that are of signi%cant duration,
require skeletal muscle relaxation, require uncomfortable
operative positions because of the location of the incision site,
or require control of ventilation?

Back 22

General anethesia

Front 23

balanced technique?

Back 23

using adjunctive
drugs to complement the induction, is the most common
approach used for general anesthesia.

Front 24

(TIVA)?

Back 24

total intravenous anesthesia

Front 25

Drugs added
to an inhalation anesthetic (other than an IV induction agent)
are termed?

Back 25

adjuncts

Front 26

Dissociative anesthesia interrupts?

Back 26

associative brain pathways while blocking sensory pathways.
!e patient may appear catatonic, is amnesic, and experiences
profound analgesia that lasts into the postoperative period. Ketamine
(Ketalar) is a commonly administered dissociative anesthetic.
Ketamine

Front 27

interrupts the generation of nerve impulses
by altering the "ow of sodium into nerve cells through cell
membranes?

Back 27

local anethesia

Front 28

!ere are two classes of
local anesthetics:

Back 28

esters and amides

Front 29

involves the injection of a local anesthetic into the
cerebrospinal "uid found in the subarachnoid space, usually
below the level of L2?

Back 29

Spinal anesthesia

Front 30

involves injection of a local anesthetic
into the epidural space via a thoracic or lumbar approach?

Back 30

EPIDURAL BLOCK

Front 31

!e fundamental defect of malignant hyperthermia is?

Back 31

hypermetabolism
of skeletal muscle resulting from altered control of
intracellular calcium.

Front 32

!e de%nitive treatment of
MH is prompt administration of?

Back 32

dantrolene (Dantrium

Front 33

Hydroxyethyl starch (Voluven, Hespan) is an?

Back 33

IV synthetic
starch solution approved for use as a blood volume expander
during and a&er surgery.

Front 34

Proper attire for the semirestricted area of the surgery department
is
a. street clothing.
b. surgical attire and head cover.
c. surgical attire, head cover, and mask.
d. street clothing with the addition of shoe covers.

Back 34

B

Front 35

Activities that the nurse might perform in the role of a scrub nurse
during surgery include (select all that apply)
a. checking electrical equipment.
b. preparing the instrument table.
c. passing instruments to the surgeon and assistants.
d. coordinating activities occurring in the operating room.
e. maintaining accurate counts of sponges, needles, and
instruments.

Back 35

B
C
E

Front 36

!e nurse is caring for a patient undergoing surgery for a knee
replacement. What is critical to the patient’s safety during the procedure
(select all that apply)?
a. Universal protocol is followed.
b. !e ACP is an anesthesiologist.
c. !e patient has adequate health insurance.
d. !e circulating nurse is a registered nurse.
e. !e patient’s allergies are conveyed to the surgical team.

Back 36

A

E

Front 37

!e nurse’s primary responsibility for the care of the patient undergoing
surgery is
a. developing an individualized plan of nursing care for the patient.
b. carrying out speci%c tasks related to surgical policies and
procedures.
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.

Back 37

A

Front 38

When scrubbing at the scrub sink, the nurse should
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.

Back 38

D

Front 39

When positioning a patient in preparation for surgery, the nurse
understands that injury to the patient is most likely to occur as a
result of
a. incorrect musculoskeletal alignment.
b. loss of perception of pain or pressure.
c. pooling of blood in peripheral vessels.
d. disregarding the patient’s need for modesty.

Back 39

A

Front 40

Intravenous induction for general anesthesia is the method of
choice for most patients because
a. the patient is not intubated.
b. the agents are nonexplosive.
c. induction is rapid and pleasant.
d. emergence is longer but with fewer complications

Back 40

C

Front 41

The nurse would be alerted to the occurrence of malignant hyperthermia when the patient demonstrates what manifestation?
A. Hypocapnia
B. Muscle rigidity
C. Decreased body temperature
D. Confusion upon arousal from anesthesia

Back 41

B

Front 42

Which intraoperative nursing responsibilities should be performed by the scrub nurse (select all that apply)?
A. Documenting intraoperative care
B. Keeping track of irrigation solutions for monitoring of blood loss
C. Passing instruments and supplies to the surgeon by anticipating his or her needs
D. Coordinating the flow and activities of members of the surgical team in the surgical suite
E. Performing the count of sponges, needles, and instruments used during the surgical procedure

Back 42

B
E

Front 43

What event in the surgical suite represents a violation of aseptic technique?
A. A glove contacts the leg of the table that supports the sterile field.
B. The cuff of the scrub nurse's sterile gown contacts the sterile field.
C. The sterile field was established at 0650, and the current time is 0900.
D. Bacteria are present in the nares and upper respiratory passages of the nurse.

Back 43

A

Front 44

The perioperative nurse would recognize the need to monitor the patient for hallucinations and agitation when which anesthetic agent is administered?
A. Nitrous oxide
B. Ketamine (Ketalar)
C. Thiopental (Pentothal)
D. Halothane (Fluothane)

Back 44

B

Front 45

A 71-year-old male patient who is currently undergoing coronary artery bypass graft (CABG) surgery has just experienced intraoperative vomiting. The nurse should consequently anticipate the use of which drug?
A. Midazolam (Versed)
B. Fentanyl (Sublimaze)
C. Meperidine (Demerol)
D. Ondansetron (Zofran)

Back 45

D

Front 46

A surgical patient's premedication regimen includes midazolam (Versed). What are the most likely desired effects of this medication?
A. Monitored anesthesia care and amnesia
B. Potentiates volatile agents to speed induction
C. Analgesia and prevention of intraoperative vomiting
D. Relaxation of skeletal muscles and facilitation of endotracheal intubation

Back 46

A

Front 47

The new nursing student is confused about where the patient's family (who are wearing street clothes) can be with the patient in the surgical suite. Which explanation should the perioperative nurse give to the student nurse?
A. The family is not allowed to talk to the nurse at the nursing station.
B. The family can be with the patient in the preoperative holding area.
C. The family cannot be with the patient until the postanesthesia care unit.
D. The family is only allowed in the conference room for preoperative teaching.

Back 47

B

Front 48

Which National Patient Safety Goal (NPSG) requirement is enacted immediately before surgery with a surgical time-out?
A. Prevention of infection
B. Improved staff communication
C. Identify patients at risk for suicide.
D. Patient, surgical procedure, and site are checked.

Back 48

D

Front 49

A patient having an open reduction internal fixation (ORIF) of a left lower leg fracture will receive regional anesthesia during the procedure. As the patient is prepared in the operating room, what should the nurse implement to maintain patient safety during surgery that is directly related to the type of anesthesia being used?
A. Apply grounding pad to unaffected leg.
B. Assess peripheral pulses and skin color.
C. Verify the last oral intake before surgery.
D. Ensure a smooth surface under the patient.

Back 49

D

Front 50

A 78-year-old patient is having surgery. What risk areas will the nurse need to be especially aware of for this patient during surgery?
A. Sterility
B. Paralysis
C. Urine output
D. Skin integrity

Back 50

D

Front 51

The patient is going to have a colonoscopy. Which type of anesthesia should the nurse expect to be used?
A. Local anesthesia
B. Moderate sedation
C. General anesthesia
D. Monitored anesthesia care (MAC)

Back 51

D

Front 52

In which surgical area will the patient's skin be prepped for surgery, and what clothing will the person doing the prepping be wearing?
A. Surgical suite wearing a lab coat
B. Preoperative holding area wearing street clothes
C. Postanesthesia care unit (PACU) wearing scrubs
D. Operating room wearing surgical attire and masks

Back 52

D

Front 53

Which intraoperative nursing responsibilities should be performed by the scrub nurse (select all that apply)?
A. Documenting intraoperative care
B. Keeping track of irrigation solutions for monitoring of blood loss
C. Passing instruments and supplies to the surgeon by anticipating his or her needs
D. Coordinating the flow and activities of members of the surgical team in the surgical suite
E. Performing the count of sponges, needles, and instruments used during the surgical procedure

Back 53

B
C
E