Perioperative Nursing Flashcards
(196 cards)
1
Q
Surgery is a unique experience of a planned physical alteration encompassing three phases:
A
preoperative, intraoperative, and postoperative
2
Q
These three phases are together referred to as the:
A
perioperative period
3
Q
_________ 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.
A
Perioperative nursing
4
Q
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.
A
T
5
Q
________ 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.
A
Outpatient procedures
6
Q
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.
A
preoperative phase
7
Q
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.
A
intraoperative phase
8
Q
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.
A
postoperative phase
9
Q
Surgical procedures are commonly grouped according to:
A
(a) purpose
(b) degree of urgency
(c) degree of risk.
10
Q
T/F: Surgery is classified by its urgency and necessity to preserve the client’s life, body part, or body function.
A
T
11
Q
________ 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.
A
Emergency surgery
12
Q
_______ 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.
A
Elective surgery
13
Q
Confirms or establishes a diagnosis; for example, biopsy of a mass in a breast.
A
Diagnostic
13
Q
Relieves or reduces pain or symptoms of a disease; it does not cure; for example, resection of nerve roots.
A
Palliative
14
Q
Removes a diseased body part; for example, removal of a gallbladder (cholecystectomy).
A
Ablative
15
Q
Restores function or appearance that has been lost or reduced; for example, cleft palate repair.
A
Constructive
16
Q
Replaces malfunctioning structures; for exam- ple, kidney transplant.
A
Transplant
17
Q
_________ 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.
A
Major surgery
18
Q
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.
A
minor surgery
19
Q
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
A
All of the above except respiratory status.
20
Q
T/F: Neonates, infants, and older clients are greater surgical risks than children and adults.
A
T
21
Q
________ affect a child’s ability to cope with the physiologic and psychologic stresses of surgery.
A
Age and developmental status
22
Q
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.
A
F - higher
23
Q
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.
A
All of the above
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.
T
25
T/F: The child’s developmental level and age-appropriate communication are important in implementing the pediatric plan of care.
T
26
The ________ often has fewer physiologic reserves to meet the extra demands caused by surgery.
older adult
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.
All of the above except the older clients have a healthy mind through experience.
28
T/F: Any infection or pathophysiology increases the risk.
T
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.
T
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.
therapeutic levels
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.
Malnutrition
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.
Obesity
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.
Cardiac conditions
34
________ may lead to severe bleeding, hemorrhage, and subsequent shock.
Blood coagulation disorders
35
________ or ________ adversely affects pulmonary function, especially when exacerbated by the effects of general anesthesia. They also predispose the client to postoperative lung infections.
Upper respiratory tract infections; chronic obstructive pulmonary disease (COPD)
36
________ impairs regulation of the body’s fluids and electrolytes and excretion of drugs and other toxins.
Renal disease
37
________ predisposes the client to wound infection and delayed healing.
Diabetes mellitus
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.
Liver disease
39
_______ disease such as epilepsy may result in seizures during surgery or recovery.
Uncontrolled neurologic
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.
Adequate nutrition
41
_______ contributes to postoperative complications such as pneumonia, wound infections, and wound separation.
Obesity
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.
perioperative pressure injuries
43
The perioperative nurse provides _______ and other measures to protect the client’s skin over pressure points during surgery.
padding
44
Promotes epithelialization and enhances collagen synthesis
Vitamin A
45
Cofactor of the enzyme system
Vitamin B complex
46
Essential for collagen synthesis affecting wound tensile strength
Vitamin C (ascorbic acid)
47
Essential in the synthesis of prothrombin and thus coagulation
Vitamin K
48
Involved in collagen synthesis
Iron, zinc, and copper
49
________ is a common condition caused by partial or complete obstruction of the upper airway during sleep.
Obstructive sleep apnea (OSA)
50
Breathing is briefly interrupted during sleep with periods of apnea lasting at least _______.
10 seconds
51
The gold standard for diagnosis of OSA is a ________.
sleep study
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.
T
53
Recent studies have shown that clients with _______ who undergo surgery are at increased risk for perioperative complications.
OSA (Obstructive Sleep Apnea)
54
________ increase blood coagulation time.
Anticoagulants
55
_________ may interact with anesthetics, increasing the risk of respiratory depression.
Tranquilizers
56
_________ may interfere with wound healing and increase the risk of infection.
Corticosteroids
57
_______ may affect fluid and electrolyte balance.
Diuretics
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.
Both T
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.
T
60
These clients also may require medication such as ________ or________ drugs that can interact with anesthetic and analgesic medications used during and after surgery.
anticonvulsants; antipsychotic
61
These clients also may require medication such as ________ or________ drugs that can interact with anesthetic and analgesic medications used during and after surgery.
anticonvulsants; antipsychotic
62
Clients with ________ may have difficulty understanding proposed surgical procedures and may respond unpredictably to anesthetics.
dementia
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.
T
64
Extreme ________ also increases surgical risk and interferes with the client’s ability to process information and respond correctly to instructions.
anxiety
65
Prior to any surgical procedure, _________ is required from the client or legal guardian.
Informed consent
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:
1st T 2nd F - surgeon is the one responsible
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.
All of the above
68
The surgeon documents the informed consent conversation with the client or legal guardian in the _________.
preoperative progress note
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.
surgical consent form
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.
T
71
T/F: The RN ensures consent is in the client’s chart prior to releasing the client to surgery.
T
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.
nurse
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.
witness
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.
T
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.
T
76
A ______ may not give informed consent. Specific guidelines regarding consent for minors vary among the states.
minor
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.
T
78
The _________ and ______ should also be assessed in the preoperative phase.
client’s mobility and ability to function
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.
T
80
When data cannot be collected directly, the perioperative nurse uses other data sources such as the _________.
nursing admission assessment
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 _______.
anesthesia; surgery
82
A brief or “mini” _______ provides valuable baseline data for evaluating the client’s mental status and alertness after surgery.
mental status examination
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.
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.
Current health status
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.
Allergies
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.
Medications
87
Previous surgical experiences may influence the client’s physical and psychologic responses to surgery or may reveal unexpected responses to anesthesia.
Previous surgeries
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.
Mental Status
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.
Understanding of the surgical procedure and anesthesia
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.
Smoking
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.
Obstructive sleep apnea (OSA)
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.
Alcohol and other mind-altering substances
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.
Coping
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.
Social resources
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.
Cultural and spiritual considerations
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
Complete blood count (CBC)
97
Rationale: Determined in case blood transfusion is required during or after surgery
Blood grouping and cross-matching
98
Rationale: To evaluate fluid and electrolyte status
Serum Electrolytes
99
Rationale: High levels may indicate undiagnosed diabetes mellitus
Fasting blood glucose
100
Rationale: To evaluate renal function
Blood urea nitrogen (BUN) and creatinine
101
Rationale: To evaluate liver function
ALT, AST, LDH, and bilirubin
102
Rationale: To evaluate nutritional status
Serum albumin and total protein
103
Rationale: To determine urine composition and possible abnormal components (e.g., protein or glucose) or infection
Urinalysis
104
To evaluate respiratory status and heart size
Chest X-ray
105
Rationale: To identify pre-existing cardiac problems or disease
Electrocardiogram (ECG) (all clients over 40 years of age and clients with pre-existing cardiac conditions)
106
Rationale: To identify if the client is pregnant
Pregnancy test (all female clients of childbearing age)
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
All of the above
108
The overall goal in the preoperative period is to ensure that the client is ______ and _______ prepared for surgery.
mentally and physically
109
T/F: Planning should involve the client, the family, and significant others.
T
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.
t
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.
Preoperative teaching
112
T/F: Effective preoperative teaching also facilitates the client’s successful and early return to work and other activities of daily living (ADLs).
T
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.
Information, including what will happen to the client, when, and what the client will experience, such as expected sensations and discomfort.
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.
All of the above
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.
Psychosocial support to reduce anxiety
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.
The roles of the client and support people in preoperative preparation, the surgical procedure, and during the postoperative phase.
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.
Skills training
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.
outpatient surgery
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.
Both T
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.
All of the above
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.
T
122
Adequate hydration and nutrition promote healing. Nurses need to identify and record any signs of malnutrition or fluid imbalance.
Preparation of Nutrition and Balance
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.
T
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.
“NPO after midnight”
125
The consumption of clear liquids (no alcohol) up to ________ before surgery
2 hours
126
The consumption of breast milk up to ________ before surgery; infant formula may be ingested up to ________ before surgery
4 hours; 6 hours
127
A light meal may be ingested up to ______ before the procedure
6 hours
128
A heavier meal (fried or fatty foods) may be eaten up to ________ before surgery.
8 hours
129
_______ before surgery are no longer routine, but ________ may be ordered if bowel surgery is planned.
Enemas; cleansing enemas
130
The ________ help prevent postoperative constipation and contamination of the surgical area (during surgery) by feces.
enemas
131
After surgery involving the intestines, peristalsis often does not return for ________.
24 to 48 hours
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.
indwelling Foley catheter
133
T/F: If the client does not have a catheter, it is not important to empty the bladder prior to receiving preoperative medications.
T - it is important
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.
T
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.
circulation
136
Intraoperatively the client will be required to wear a ________. It contains the client’s hair and any microorganisms on the hair and scalp.
surgical cap
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.
T
138
The ______ or_______ may order routinely taken medications to be held the day of surgery.
anesthetist or anesthesiologist
139
________ such as midazolam (Versed) may be administered IV prior to surgery (Adams, Holland, & Urban, 2020) to reduce anxiety and ease anesthetic induction.
Benzodiazepines
140
___________ such as morphine provide clients sedation and reduce the required amount of anesthetic.
Opioid analgesics
141
__________ such as atropine, scopolamine, and glycopyrrolate (Robinul) reduce oral and pulmonary secretions and prevent laryngospasm.
Anticholinergics
142
__________such as droperidol (Inapsine) are administered parenterally to prevent nausea and vomiting; reduce anxiety, and relax muscles
Dopamine blockers
143
________ antihistamines such as cimetidine (Tagamet) and ranitidine (Zantac) reduce gastric fluid volume and gastric acidity.
Histamine-receptor
144
Neurolept analgesic agents such as Innovar induce general calmness and sleepiness.
Neurolept analgesic
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.
sedative
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.
Both T
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.
tape
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.
T
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.
Jehovah's Witness
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).
Special orders
151
T/F: In most agencies, skin preparation is carried out during the intraoperative phase.
T
152
The _______ is cleansed with an antimicrobial to remove soil and reduce the resident micro- bial count to subpathogenic levels.
surgical site
153
Surgical clients are at risk of losing _______; therefore, temperature management is an important aspect of peri-operative client safety and comfort.
body heat
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
All of the above except inactivity after the surgery
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.
All of the above except fluid imbalance
156
T/F: It is important for the client’s temperature to be assessed during the entire perioperative experience to prevent unintended hypothermia.
T
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.
forced-air warming system
158
Postoperatively, it is important to monitor temperature every ________.
hour
159
The first step requires ________. The frequency and scope of the verification process depends on the type and complexity of the procedure.
preoperative verification
160
The Joint Commission established the Universal Protocol for Preventing_______, _______, and _______ Surgery in 2004.
Wrong Site, Wrong Procedure, and Wrong Person
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
all of the above except after surgery
162
The second step involve:
marking of the operative site
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.
T
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.
“time-out"
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.
vital signs
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.
Antiemboli (elastic) stockings
167
These stockings are frequently applied to surgical clients to prevent the potential postoperative problem of________.
venous thromboembolism (VTE)
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
1st T 2nd T 3rd F - Elastic stockings come in small, medium, and large sizes
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.
sequential compression device (SCD)
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.
T
171
An anesthesiologist or a ________ administer anesthetic agents.
certified registered nurse anesthetist (CRNA)
172
__________ is the loss of all sensation and consciousness. Under it, protective reflexes such as cough and gag reflexes are lost.
General anesthesia
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.
awareness
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.
T
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.
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.
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.
Regional anesthesia
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.
Topical (surface) anesthesia
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.
Conscious sedation
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 ________.
presurgical care unit (PSCU)
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
All of the above
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.
All of the above
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
all of the above except potential for grieving
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.
none of the above
184
Intraoperative interventions are carried out by the:
circulating nurse, the scrub person, and the registered nurse's first assistant.
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).
circulating nurse
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.
scrub person
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.
registered nurse first assistant (RNFA)
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.
circulating nurse and the scrub person
189
________ involves cleaning the surgical site, removing hair only if necessary, and applying an antimicrobial agent
Surgical skin preparation
190
Should the surgery personnel perform skin preparation near the time of surgery?
Yes
191
T/F: Hair removal with a razor is not recommended.
T
192
T/F: The NURSE is responsible for minimizing the client’s risk of perioperative complications related to positioning.
F - entire operating room team
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).
All of the above
194
Positioning is performed BEFORE anesthesia is induced and before surgical draping of the client.
F - after
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.
Straps
