Review Intraoperative Phase

Perioperative Nursing > Medical Surgical

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Intraoperative Phase

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Total Questions : 5

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Question 1:

A nurse is preparing a patient for surgery in the supine position. What is the rationale for this position?

A. It allows optimal exposure of the abdominal cavity. B. It prevents injury to the spinal cord and nerves. C. It facilitates drainage of secretions from the mouth and throat. D. It enhances circulation and oxygenation to the brain.

Answer and Explanation

Choice A:

This is incorrect because the supine position does not allow optimal exposure of the abdominal cavity. The supine position is used for surgeries involving the anterior surface of the body, such as cardiac, thoracic, and cranial surgeries. For abdominal surgeries, other positions such as Trendelenburg or lithotomy may be used to improve access and visualization of the abdominal organs.

Choice B:

This is incorrect because the supine position does not prevent injury to the spinal cord and nerves. In fact, the supine position may cause nerve damage or pressure ulcers if the patient's arms, legs, and head are not properly supported and padded. The patient's arms should be abducted less than 90 degrees and the palms should face up to avoid stretching or compressing the brachial plexus and ulnar nerves. The patient's legs should be uncrossed and the heels should be padded to prevent pressure on the peroneal nerve and the skin. The patient's head should rest on a pad or pillow and the neck should be in a neutral position to avoid injury to the cervical spine and nerves.

Choice C:

This is correct because the supine position facilitates drainage of secretions from the mouth and throat. The supine position is commonly used during induction and emergence of anesthesia, which can impair the patient's ability to clear their airway. By lying on their back with their face up, the patient can benefit from gravity-assisted drainage of secretions from the mouth and throat, reducing the risk of aspiration or airway obstruction.

Choice D:

This is incorrect because the supine position does not enhance circulation and oxygenation to the brain. The supine position may actually decrease the functional residual capacity (FRC) of the lungs, which is the amount of air remaining in the lungs after a normal expiration. This can lead to reduced oxygenation and ventilation of the blood. Additionally, the supine position may cause venous congestion in the head and neck, which can impair cerebral perfusion and increase intracranial pressure. To enhance circulation and oxygenation to the brain, other positions such as reverse Trendelenburg or sitting may be used.

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Question 2:

A nurse is reviewing the roles of the intraoperative team members. Which of the following are functions of the circulating nurse? (Select all that apply.).

A. Assisting with surgical procedures. B. Counting instruments and sponges. C. Documenting events and interventions. D. Administering anesthesia and monitoring vital signs. E. Maintaining surgical asepsis and sterile technique.

Answer and Explanation

Choice A:

Assisting with surgical procedures is not a function of the circulating nurse, but of the scrub nurse or the surgical assistant. The circulating nurse is responsible for coordinating the care of the patient in the operating room and ensuring a safe environment.

Choice B:

Counting instruments and sponges is a function of both the scrub nurse and the circulating nurse. They work together to ensure that no foreign objects are left inside the patient or on the sterile field.

Choice C:

Documenting events and interventions is a function of the circulating nurse. The circulating nurse records all relevant information about the patient's condition, the surgical procedure, the anesthesia administration, and any specimens collected.

Choice D:

Administering anesthesia and monitoring vital signs is not a function of the circulating nurse, but of the anesthesia care provider (ACP). The ACP is responsible for assessing the patient's health status, selecting and administering the appropriate anesthetic agent, and monitoring the patient's response to anesthesia.

Choice E:

Maintaining surgical asepsis and sterile technique is a function of both the scrub nurse and the circulating nurse. The scrub nurse maintains a sterile field by wearing sterile attire, handling sterile instruments and supplies, and preventing contamination. The circulating nurse maintains asepsis by monitoring the sterile field, checking for breaks in technique, and obtaining additional items as needed.

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Question 3:

A nurse is caring for a patient who is undergoing surgery with general anesthesia. The patient asks, "What will happen to me when I'm under anesthesia?” How should the nurse respond?

A. "You will be in a state of controlled unconsciousness, pain relief, memory loss and muscle relaxation.” B. "You will be in a state of reduced sensation, awareness and movement in a large area of your body.” C. "You will be in a state of numbness, tingling and loss of feeling in a small area of your skin.” D. "You will be in a state of deep sleep, relaxation and dreaming with minimal awareness of your surroundings.”

Answer and Explanation

Choice A:

This is the correct definition of general anesthesia, which is a state of controlled unconsciousness, pain relief, memory loss and muscle relaxation that is induced by a combination of medications. It is used for surgical procedures where it is safer or more comfortable to be unaware and not feel pain.

Choice B:

This is the definition of regional anesthesia, which is a state of reduced sensation, awareness and movement in a large area of your body such as the lower half or an arm. It is used for surgical procedures that involve a specific region of the body and do not require complete unconsciousness.

Choice C:

This is the definition of local anesthesia, which is a state of numbness, tingling and loss of feeling in a small area of your skin such as a finger or a tooth. It is used for minor surgical procedures that involve only a small part of the body and do not require deep pain relief or unconsciousness.

Choice D:

This is not a correct definition of any type of anesthesia, but rather a description of natural sleep. General anesthesia is different from sleep because it involves a complete loss of awareness and responsiveness to any stimuli, whereas sleep involves periodic changes in brain activity and responsiveness to certain stimuli such as sounds or light. General anesthesia also requires artificial maintenance of vital functions such as breathing and blood pressure, whereas sleep does not.

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Question 4:

A nurse is assisting with positioning a patient on the operating table in the Trendelenburg position. The patient asks, "Why do I have to be in this position?” What should the nurse say?

A. "This position helps to improve your blood pressure and blood flow to your brain.” B. "This position helps to reduce the risk of bleeding and infection in your lower abdomen or pelvis.” C. "This position helps to prevent pressure ulcers and nerve damage in your back and legs.” D. "This position helps to increase the space and visibility in your upper abdomen or chest.”

Answer and Explanation

Choice A:

This is incorrect because the Trendelenburg position does not improve blood pressure or blood flow to the brain. In fact, it may increase intracranial pressure and reduce cerebral perfusion.

Choice B:

This is incorrect because the Trendelenburg position does not reduce the risk of bleeding or infection in the lower abdomen or pelvis. It may increase the risk of aspiration, respiratory compromise, and venous congestion.

Choice C:

This is incorrect because the Trendelenburg position does not prevent pressure ulcers or nerve damage in the back and legs. It may cause nerve injury due to stretching of the brachial plexus and pressure on the peroneal nerve.

Choice D:

This is correct because the Trendelenburg position helps to increase the space and visibility in the upper abdomen or chest by displacing the abdominal organs downward. This may facilitate surgical procedures such as cholecystectomy, hiatal hernia repair, or thoracic surgery.

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Question 5:

A nurse is observing a certified surgical technologist (CST) during surgery. Which of the following are tasks that the CST performs?

A. Preparing the surgical instruments and equipment. B. Providing emotional support and education to the patient. C. Monitoring the patient's vital signs and oxygen saturation. D. Applying sterile drapes and handing instruments to the surgeon.

Answer and Explanation

Choice A:

Preparing the surgical instruments and equipment is one of the tasks that the CST performs, but it is not the only one. According to the Mayo Clinic, surgical technologists also assist during and after surgical procedures by passing tools, holding retractors, cutting suture, applying dressings, and counting materials. Therefore, choice A is incomplete and not the best answer.

Choice B:

Providing emotional support and education to the patient is not a task that the CST performs. This is usually done by the registered nurse (RN) or the anesthesia care provider before the surgery. The CST does not interact with the patient directly, but rather focuses on preparing and maintaining a sterile environment in the operating room. Therefore, choice B is incorrect.

Choice C:

Monitoring the patient's vital signs and oxygen saturation is not a task that the CST performs. This is usually done by the anesthesia care provider or the perioperative nurse during the surgery. The CST does not monitor the patient's condition, but rather assists the surgeon and other members of the surgical team. Therefore, choice C is incorrect.

Choice D:

Applying sterile drapes and handing instruments to the surgeon are both tasks that the CST performs. According to WebMD, these are part of the intraoperative duties of the CST, along with keeping the operating room sterile, assisting in retracting tissues, and suctioning and sponging. Therefore, choice D is correct and covers two of the main tasks that the CST performs.

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Total Questions : 5

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Intraoperative Phase

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