Preview Extract
Chapter 26
1. A nurse is currently conducting a surgical hand scrub in preparation to work with a patient.
The patient is most likely located in the:
1. Operating room.
2. Holding area.
3. Same-day surgery waiting room.
4. Postanesthesia care unit.
Answer: Operating room.
Rationale:
The surgical hand scrub is conducted prior to participating in a surgical procedure; therefore,
the patient is most likely in the operating room. A surgical scrub is not typically done to
provide care to a patient in the holding area, the same-day surgery waiting room, or in the
postanesthesia care unit.
2. A patient planning to receive regional anesthesia asks the nurse if he will be able to watch
his total knee replacement. Which of the following is the nurse’s best response to this patient?
1. “No, there will be a screen placed and you will be given a sedative to relax you and help
you to sleep through the procedure.”
2. “If you would like to watch the procedure, you can.”
3. “The surgeon will not like having you watch her work.”
4. “There will be so many people there, you won’t be able to see anything anyway.”
Answer: “No, there will be a screen placed and you will be given a sedative to relax you and
help you to sleep through the procedure.”
Rationale:
If regional anesthesia is being used, the patient will be awake, and therefore a screen is placed
to block the patient’s view. Sedatives or tranquilizers are administered to decrease the
patient’s feelings of anxiety and provide sedation. The other responses do not directly answer
the patient’s question.
3. After the nurse and nurse anesthetist transport a patient to the postanesthesia care unit, a
detailed report about the patient and the surgical procedure is provided to the postanesthesia
care unit nurse. This communication is considered:
1. Handoff communication.
2. Surgical timeout.
3. End-of-shift report.
4. Discharge summary.
Answer: Handoff communication.
Rationale:
Handoff communication describes any pertinent information about the patient and surgical
procedure provided to the postanesthesia care unit nurse. This communication is to be free of
interruptions and includes a systematic process of verification. A surgical timeout is done
before the start of the surgical procedure. The detailed report is neither an end-of-shift report
nor a discharge summary.
4. During a surgical procedure, a nurse assesses the patient’s response to anesthesia and
determines the amount of pain medication to provide. The nurse most likely providing this
care would be the:
1. Certified registered nurse anesthetist.
2. Circulating nurse.
3. Scrub nurse.
4. Registered nurse first assistant.
Answer: Certified registered nurse anesthetist.
Rationale:
The certified registered nurse anesthetist is responsible for preanesthesia preparation,
anesthesia induction and maintenance, and providing care to alleviate pain. The circulating
nurse observes the surgical team from a broad perspective and assists the team to create and
maintain a safe, comfortable environment for surgery. The scrub nurse works directly with
the surgeon within the sterile field and passes instrument, sponges, and other items needed
during the surgical procedure. The registered nurse first assistant collaborates with the
surgeon and performs activities such as handling tissue, providing exposure, using
instruments, and suturing wounds.
5. A registered nurse is assisting the surgeon in conducting an exploratory laparoscopy. The
nurse holds the tissue retractors, biopsies tissue, and sutures the patient at the conclusion of
the case. The nurse most likely to conduct these activities would be the:
1. Registered nurse first assistant.
2. Circulating nurse.
3. Scrub nurse.
4. Certified registered nurse anesthetist.
Answer: Registered nurse first assistant.
Rationale:
The registered nurse first assistant collaborates with the surgeon and performs activities such
as handling tissue, providing exposure, using instruments, and suturing wounds. The
circulating nurse observes the surgical team from a broad perspective and assists the team to
create and maintain a safe, comfortable environment for surgery. The scrub nurse works
directly with the surgeon within the sterile field and passes instruments, sponges, and other
items needed during the surgical procedure. The certified registered nurse anesthetist is an
advanced practice nurse educated to administer anesthesia and provide anesthesia-related
care.
6. The surgical team is assembled and is preparing to conduct a procedure on a patient. The
health care professional responsible for the overall functioning of the surgical team would be
the:
1. Surgeon.
2. Registered nurse first assistant.
3. Circulating nurse.
4. Scrub nurse.
Answer: Surgeon.
Rationale:
The surgeon heads the surgical team and is responsible for making decisions related to the
surgical procedure. The registered nurse first assistant collaborates with the surgeon and
performs activities such as handling tissue, providing exposure, using instruments, and
suturing wounds. The circulating nurse observes the surgical team from a broad perspective
and assists the team to create and maintain a safe, comfortable environment for surgery. The
scrub nurse works directly with the surgeon within the sterile field and passes instrument,
sponges, and other items needed during the surgical procedure.
7. A patient’s blood pressure begins to drop during a surgical procedure. Which of the
following surgical team members would most likely intervene to assist the patient at this
time?
Select all that apply.
1. Surgeon
2. Anesthesiologist
3. Circulating nurse
4. Registered nurse first assistant
5. Certified registered nurse anesthetist
Answer: 1. Surgeon
2. Anesthesiologist
Rationale:
Surgeon. The surgeon is responsible for making decisions about the surgical procedure. The
patient’s blood pressure is dropping, which could indicate blood loss. The surgeon is in the
best position to determine the amount of blood being lost during the procedure.
Anesthesiologist. The anesthesiologist is responsible for estimating and replacing blood and
fluid losses and maintaining the hemodynamic stability of the patient. Together with the
surgeon, the anesthesiologist will make decisions for the patient’s needs at the time.
Circulating nurse. The circulating nurse would not be aware of the amount of blood lost
during the surgical procedure. Registered nurse first assistant. The registered nurse first
assistant would be helping the surgeon with the case, but would not be able to determine the
amount of blood lost during the procedure. Certified registered nurse anesthetist. The
certified registered nurse anesthetist works under the direction of the anesthesiologist and
does not act independently.
8. A patient has just had surgery and is being transported to the postanesthesia care unit. Who
will accompany the nurse when transporting the patient?
1. The nurse anesthetist
2. The surgeon
3. The scrub nurse
4. The circulating nurse
Answer: The nurse anesthetist
Rationale:
Once the surgery is completed, the nurse anesthetist and the nurse will accompany the patient
to the postanesthesia care unit. The surgeon, scrub nurse, and circulating nurse are not
responsible for transporting the patient safely to the postanesthesia care unit.
9. Prior to beginning a surgical procedure on a patient, the surgical team members stop
performing activities and determine that the procedure is being done on the correct patient
and the correct site. These members are practicing a:
1. Surgical timeout.
2. Quality improvement initiative.
3. Handoff communication.
4. Joint Commission patient tracer.
Answer: Surgical time-out.
Rationale:
Surgical timeout is an attempt to prevent wrong-site surgery and is done in response to the
Joint Commission regulation in which all members of the surgical team are to stop
performing activities and ensure that the procedure is being done on the right patient, the
right surgery, the correct side/site, the correct patient position, and any additional
information. The surgical team members are not participating in a quality improvement
initiative, nor are they conducting a Joint Commission patient tracer. Handoff communication
is done between the nurse anesthetist and operating room nurse with the postanesthesia care
unit nurse.
10. Prior to bringing a patient into the operating room, the nurse examines an instrument that
will be used for the surgical procedure. The nurse is working with the instrument in order to:
1. Ensure the patient’s safety when the instrument is used for the procedure.
2. Ensure the correct instrument is reflected in the charges to be made to the patient’s
insurance for the surgical procedure.
3. Be able to efficiently use the instrument when it is required that she do so.
4. Determine if the instrument should be replaced with one that is disposable after use.
Answer: Ensure the patient’s safety when the instrument is used for the procedure.
Rationale:
Perioperative nursing responsibilities include ensuring proper instrument functioning through
inspection. This is to avoid inadvertent patient injury while the instrument is being used for
the surgical procedure. The nurse is not examining the instrument to ensure proper charging
to the patient’s insurance, nor will the nurse be expected to use the instrument during the
procedure. The goal is to ensure proper instrument functioning, not to determine if the
instrument can be replaced with a disposable version of the same instrument.
11. After the anesthesiologist inserts the anesthetic agent into the patient’s spinal column, the
nurse assists the patient into a supine position with the neck flexed. The nurse is doing this to:
1. Help the anesthetic agent reach the appropriate level in the spinal column.
2. Assist the patient with respirations.
3. Ensure the patient’s cardiac function will not be affected by the anesthesia.
4. Better monitor the patient’s blood pressure and pulse.
Answer: Help the anesthetic agent reach the appropriate level in the spinal column.
Rationale:
Spinal anesthesia is the administration of a local anesthetic into the spinal column. Once the
medication is introduced, having the patient assume a supine position with the neck flexed
will ensure that the anesthesia will reach the appropriate level in the spinal column. Having
the patient assume this position does not specifically support respirations or ensure that the
patient’s cardiac function is not affected by the anesthesia. This position is not assumed to
better monitor the patient’s blood pressure and pulse.
12. The scrub nurse is preparing to access a sterilized item; however, the item is missing the
appropriate sterilization tag. Which of the following should the nurse do?
1. Request another item be brought that has the appropriate sterilization tag present.
2. Use the item.
3. Inform the physician that the item does not have the sterilization tag and use the item.
4. Substitute the item with another similar item that has been properly sterilized.
Answer: Request another item be brought that has the appropriate sterilization tag present.
Rationale:
Intra-operative infections do occur, primarily because no sterilization procedure can
completely eliminate all microorganisms. Sterilized items should have the appropriate tag or
marking identifying that sterilization has occurred. The nurse should reduce the patient’s risk
for infection by requesting another item be brought that has the appropriate sterilization tag
present. The nurse should not use the item, nor inform the physician that the sterilization tag
is not present and use the item anyway. The nurse should not substitute the item with another
similar item that has been properly sterilized.
13. A patient tells the nurse that her brother had surgery done on the wrong hand and she
wants to make sure that the surgeon knows that she is having surgery on her left shoulder.
Which of the following should the nurse do to address this patient’s concerns?
1. Mark the site of surgery directly on the patient.
2. Write the site of surgery on the patient’s medical record.
3. Write the words “Left Shoulder” on a piece of paper for the patient to hold.
4. Tell the circulating nurse that the surgery is to be done on the left shoulder.
Answer: Mark the site of surgery directly on the patient.
Rationale:
In some cases when there is a left or right side involved in the procedure, the correct area for
surgery is marked directly on the patient. It is not sufficient for the nurse to write the site of
surgery on the patient’s medical record or write “left shoulder” on a piece of paper for the
patient to hold. Telling the circulating nurse that the surgery is to be done on the left shoulder
is not sufficient.
14. A patient fearful of anesthesia asks the nurse to make sure that she wakes up after surgery
just so she can see her family one more time if she is going to die. Which of the following
should the nurse do to support this patient?
1. Attempt to reduce the patient’s fears and discuss these fears with the surgical team.
2. Explain that everyone who undergoes anesthesia thinks they won’t wake up.
3. Tell the patient that no one is going to let her die.
4. Tell the patient that there is no guarantee that she won’t die during the procedure.
Answer: Attempt to reduce the patient’s fears and discuss these fears with the surgical team.
Rationale:
The patient is fearful that the anesthesia will cause her to die. The nurse should try to reduce
the patient’s fears but also communicate them to the surgical team. The anesthesiologist
might be able to provide medication to help reduce the patient’s anxiety. The nurse should not
minimize the patient’s fears by saying that everyone who undergoes anesthesia thinks they
won’t wake up. The nurse should not promise the patient that she isn’t going to die. The nurse
should also not compound the patient’s fears by saying that there is no guarantee that she
won’t die during the procedure.
15. A patient tells the nurse that she knows that she is having surgery in a teaching hospital,
but she only wants the surgeon and other necessary people in the operating room. She does
not want the surgeon to be teaching medical students while conducting the surgery. Which of
the following should the nurse do to support this patient’s request?
1. Ensure that the consent form identifies this information and communicate the patient’s
request to the surgical team.
2. Explain to the patient that she has no control over who participates in the surgery.
3. Tell the patient that it really doesn’t matter who is in the operating room during the surgery.
4. Remind the patient that she can refuse the surgery at any time.
Answer: Ensure that the consent form identifies this information and communicate the
patient’s request to the surgical team.
Rationale:
Depending upon the organization, surgical consent forms often identify who will be
performing the surgery and if the surgeon will be using the procedure as an opportunity to
teach. The nurse should ensure that the patient’s request be identified on the consent form and
communicate the patient’s request to the surgical team. The nurse should not tell the patient
that she has no control over who participates in the surgery, as this would not be supportive
patient advocacy. Telling the patient that it does not matter who is in the operating room is
dismissive of her concerns. The patient is not refusing to have surgery, so the nurse should
not encourage the patient to do so.
16. A patient who received epidural anesthesia for surgery develops hypotension during the
procedure. The nurse realizes that which of the following will be done to support this patient?
1. Provide normal saline intravenously with medications to stimulate venous return.
2. Increase the amount of anesthesia being provided.
3. Increase pain medication.
4. Prepare to intubate the patient.
Answer: Provide normal saline intravenously with medications to stimulate venous return.
Rationale:
Hypotension can occur during the surgical procedure in patients who receive epidural
anesthesia. Hypotension is avoided with the administration of normal saline intravenously
and with medications that have a strong alpha-adrenergic effect to stimulate venous return.
The patient should not have an increase of anesthesia nor should the patient be provided with
more pain medication. There is nothing to indicate that the patient needs to be intubated.
17. While in the postanesthesia care unit, a patient recovering from spinal surgery tells the
nurse that she cannot feel her right hand and that her right shoulder is painful. The nurse
realizes the patient is exhibiting signs of:
1. Brachial plexus nerve injury.
2. Infiltrated intravenous access site.
3. Thromboembolism in the brachial artery.
4. Residual effects of spinal anesthesia.
Answer: Brachial plexus nerve injury.
Rationale:
One complication due to patient positioning during a surgical procedure is injury to nerves.
The patient’s complaint of reduced sensation of the right hand with right shoulder pain would
indicate an injury to the brachial plexus nerve region. There is no information to support that
the patient has an infiltrated intravenous access site or that the patient has a
thromboembolism in the brachial artery. The patient had spinal surgery and most likely did
not have spinal anesthesia.
18. At the conclusion of a surgical procedure, it has been determined that one sponge is
missing. Which of the following should be done to ensure the sponge has not accidentally
been left inside the patient’s wound?
1. Pass the radiofrequency wand over the patient’s wound to check if the sponge is in the
patient.
2. Ask the circulating nurse to return the removed items back into the operating room and
conduct the sponge count again.
3. Conduct the count again after the patient has been transported to the postanesthesia care
unit.
4. Ask housekeeping personnel to look for the missing sponge while preparing the surgical
suite for the next procedure.
Answer: Pass the radiofrequency wand over the patient’s wound to check if the sponge is in
the patient.
Rationale:
Retaining items from surgeries is a greater issue than is reported. Surgical sponges are
implanted with tags that emit radiofrequencies so that a wand can be used to detect if the
sponge has been accidentally left inside of the patient. No items should be removed from the
operating room until the surgical item count is accurate. The patient should not be transported
to the postanesthesia care unit until all items are accounted for. It is not the housekeeping
staff’s responsibility to look for the missing sponge.
19. Prior to a patient going into the surgical suite, the nurse anesthetist assesses the patient’s
previous experience with anesthesia and answers any questions the patient might have about
the anesthesia plan for the case. The nurse anesthetist is conducting which of the following
patient care activities?
1. Preanesthetic preparation and evaluation
2. Induction
3. Maintenance
4. Peri-anesthetic clinical support
Answer: Preanesthetic preparation and evaluation
Rationale:
The certified registered nurse anesthetist provides patient care in four categories. The first
category is that of preanesthetic preparation and evaluation, which includes assessing the
patient’s previous experience with anesthesia and answering any questions the patient might
have about the anesthesia plan for the case. During induction, the patient is initially provided
anesthesia. Maintenance describes anesthesia being continually provided throughout the
duration of the surgical procedure. In peri-anesthetic clinical support, the nurse anesthetist
would provide fluids or medications to support the patient’s physiological functioning while
the surgical procedure is being conducted.
20. A patient has lost over 1000 ml of blood during a surgical procedure that is estimated to
continue for at least another 2 hours. The nurse anesthetist prepares to administer packed red
blood cells to the patient during the procedure. Which of the following patient care activities
is the nurse anesthetist conducting?
1. Perianesthetic clinical support
2. Maintenance
3. Postanesthesia care
4. Preanesthetic preparation
Answer: Perianesthetic clinical support
Rationale:
The patient needing blood during a surgical procedure is an example of clinical support that
needs to be done while the surgery and anesthesia are also occurring. In maintenance, the
patient is continued to be provided with anesthesia. Postanesthesia care is that provided after
the anesthesia has been stopped. Preanesthetic preparation includes assessing the patient’s
previous experience with anesthesia and determining which type of anesthesia would be the
most appropriate for the patient and the upcoming surgery.
21. The nurse anesthetist stops to see a patient recovering from surgery in the postanesthesia
care unit to make sure the patient is not experiencing any untreated side effects from the
anesthesia. The nurse anesthetist is conducting which of the following aspects of patient care?
1. Postanesthesia care
2. Preanesthesia evaluation
3. Emergence
4. Maintenance
Answer: Postanesthesia care
Rationale:
One category of care that certified registered nurse anesthetists provide is postanesthesia care.
This includes assessing how well the patient is recovering from the effects of anesthesia and
if the patient is experiencing any untreated side effects from the anesthesia agents.
Preanesthesia evaluation is done before the surgical procedure. Emergence occurs when the
anesthesia amount is reduced to bring the patient “out of” anesthesia. In maintenance, the
patient continues to receive a certain level of anesthesia to keep the patient “asleep” during
the surgical procedure.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
