The circulating nurse notes that the anesthetized patient has tensed muscles and irregular respirations. The nurse is aware that the patient has reached stage:

Ill and the patient has depressed reflexes.

IV and the patient will not depend on the anesthesia machine of oxygenations.

Il and the surgical environment should be kept quiet.

and the patient's hearing is amplified.

Answer and Explanation

The Correct Answer is C

A. Stage III and the patient has depressed reflexes. Stage III of anesthesia is the surgical stage, where the patient is under deep anesthesia, and reflexes are typically depressed. However, tensed muscles and irregular respirations may indicate that the patient is still in an earlier stage of anesthesia (stage II).

B. Stage IV and the patient will not depend on the anesthesia machine for oxygenation. Stage IV is the deepest level of anesthesia, where respiratory and cardiovascular functions are severely depressed. It does not match the description of tensed muscles and irregular respirations, which are more characteristic of an earlier stage (stage II).

C. Stage II and the surgical environment should be kept quiet. Stage II of anesthesia is the excitement stage, where patients may exhibit tensed muscles, irregular respirations, and uncoordinated movements. The surgical environment should be kept quiet to minimize stimuli that could cause agitation or further excitement in this stage.

D. Stage I and the patient's hearing is amplified. Stage I is the stage of anesthesia where the patient is still conscious and responsive to stimuli. The description of tensed muscles and irregular respirations does not match this stage. Additionally, the patient’s hearing would not be amplified in stage I, but rather in stage II or as they begin to emerge from anesthesia.

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Correct Answer is B

Explanation

A. Nausea and vomiting. Nausea and vomiting can occur after surgery due to anesthesia and other factors. However, it is more common in patients of all ages who undergo certain types of surgery. Though these groups may be more susceptible, this is not the most specific risk.

B. Delayed healing. Both very young and older adult patients are at higher risk for delayed healing. In the very young, the immune system and cell regeneration processes are still developing, while in older adults, decreased circulation, chronic conditions, and slower cellular regeneration can impair wound healing.

C. Anorexia. Anorexia is not specific to surgical patients. While appetite loss can occur postoperatively, it is not as universally problematic in young or older surgical patients as delayed healing.

D. Hydration issues. Hydration issues can occur in all patients, especially following surgery, but they are particularly critical for the very young (due to smaller body mass and high fluid turnover) and the elderly (due to decreased kidney function and total body water). However, this is not as universally prevalent as delayed healing.

A. Are communications links with personnel outside the room B. Set up initial sterile instruments and supplies C. Advise the team of breaks in sterile technique D. Position lights on step stools

Correct Answer is A

Explanation

A. Are communications links with personnel outside the room. Both the scrub person and the circulating nurse serve as communication links with the personnel outside the operating room. The scrub person may communicate regarding sterile equipment needs, while the circulating nurse communicates about patient status and surgical progress.

B. Set up initial sterile instruments and supplies. This is the responsibility of the scrub person, not the circulating nurse. The scrub person ensures that sterile instruments are ready and that the sterile field is set up properly.

C. Advise the team of breaks in sterile technique. Only the scrub person is typically responsible for maintaining sterile technique and calling attention to any breaches in sterility. The circulating nurse may assist with ensuring the environment is safe, but the scrub person is directly in charge of sterile technique.

D. Position lights on step stools. Positioning the lights is the responsibility of the circulating nurse. The scrub person’s role is more focused on the sterile field and assisting with surgical instruments.

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The circulating nurse notes that the anesthetized patient has tensed muscles and irregular respirations. The nurse is aware that the patient has reached stage:

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Naxlex Comprehensive Predictor Exams

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