Perioperative Flashcards

In the operating room (OR), the circulating nurse sets up the sterile field. After fifteen minutes, the nurse gets word that the surgeon is working at another hospital, thus the procedure will be delayed by twenty minutes. What would be the best course of action for the nurse?

Answer: Monitor the sterile field while awaiting the surgeon.

Maintaining the sterility of the surgical field is paramount to prevent surgical site infections. If a procedure is delayed, the circulating nurse's primary responsibility is to continuously monitor the sterile field to ensure it remains intact and uncontaminated. Covering the field or tearing it down introduces unnecessary risks of contamination or delays in re-establishing sterility when the surgeon arrives.

Which test result would necessitate the nurse's quick attention for the patient who was supposed to have surgery?

Answer: Potassium 2.4 mEq/L.

A potassium level of 2.4 mEq/L indicates severe hypokalemia, which is a critical electrolyte imbalance. Hypokalemia can lead to life-threatening cardiac dysrhythmias, muscle weakness, and respiratory compromise, especially in the perioperative period. This abnormal finding requires immediate attention and correction before surgery to ensure patient safety.

The patient being cared for by the nurse is experiencing sinus tachycardia following surgery. Which intervention from the list below ought to be carried out by the nurse?

Answer: Manage the client’s anxiety

Sinus tachycardia post-surgery can often be a physiological response to pain, anxiety, hypovolemia, or fever. Among the given options, managing the client's anxiety is a direct and appropriate nursing intervention for sinus tachycardia, as anxiety can significantly elevate heart rate. Addressing anxiety can help reduce sympathetic stimulation and normalize the heart rate.

A disparity in the number of sponges is discovered by the scrub tech and the circulating nurse. Which task ought to be completed by the circulating nurse first?

Answer: Re-count all sponges.

A discrepancy in the sponge count during surgery is a serious safety concern, as it indicates a potential retained surgical item. The immediate priority for the circulating nurse is to re-count all sponges to confirm the discrepancy and rule out a counting error. Only after a confirmed discrepancy should other actions, like notifying the surgeon or completing an occurrence report, be taken.

When a client needs fluids, the nurse gets ready to place a peripheral intravascular catheter. Which antiseptic is best for cleaning the skin before the catheter is inserted?

Answer: Chlorhexadine

Chlorhexidine is the preferred antiseptic for skin preparation before inserting peripheral intravascular catheters. It provides superior and longer-lasting antimicrobial activity compared to alcohol or iodophor, effectively reducing the risk of catheter-related bloodstream infections. Its efficacy and residual activity make it the gold standard for this procedure.

In the early postoperative phase, a client feels confused. Which of the following evaluations is necessary to identify the confusion's cause?

Answer: Airway status

Postoperative confusion can be a sign of various complications, but the most critical and immediate concern is inadequate oxygenation or ventilation, which directly relates to airway status. Hypoxia or hypercapnia due to an obstructed airway or respiratory depression can quickly lead to brain dysfunction and confusion. Therefore, assessing airway status and ensuring adequate oxygenation is the priority to identify the cause of confusion.

Following surgery, your patient's vital signs are within normal ranges and they are semicomatose. Which position would be ideal for this patient, as the nurse?

Answer: Side positioning preferably on the left side

For a semicomatose patient post-surgery, maintaining a patent airway and preventing aspiration are paramount. Side positioning, especially on the left side, helps to prevent the tongue from falling back and obstructing the airway. It also facilitates drainage of oral secretions, significantly reducing the risk of aspiration, making it safer than supine positions for patients with altered consciousness.

The patient, who underwent surgery 24 hours ago, is being observed by the nurse. Which finding calls for action?

Answer: 24-hour urine output of 300 ml

A 24-hour urine output of 300 ml is significantly below the normal minimum of 0.5 mL/kg/hr or approximately 400-500 mL/day for an adult, indicating oliguria. This finding suggests potential kidney dysfunction, hypovolemia, or urinary obstruction, which requires immediate investigation and intervention in a postoperative patient. Other options like mild pain, slightly low BP (if asymptomatic), or a low-grade fever might be expected post-op and are less immediately concerning.

What is a potential postoperative concern regarding a patient who has already resumed a solid diet?

Answer: Failure to pass stool within 48 hours of eating solid foods

After resuming a solid diet post-surgery, the return of normal bowel function is expected. Failure to pass stool within 48 hours of eating solid foods indicates a potential complication such as ileus, constipation, or obstruction. This warrants nursing intervention and further assessment, as prolonged absence of bowel movements can lead to discomfort and more serious issues.

A nurse is creating a post-operative care plan for a patient who is susceptible to pneumonia. Out of the following, which one is not a suitable nursing intervention?

Answer: Repositioning every 3-4 hours

To prevent postoperative pneumonia, frequent repositioning is crucial to promote lung expansion, mobilize secretions, and prevent atelectasis. Repositioning every 3-4 hours is generally insufficient; patients at risk for pneumonia should be repositioned at least every 1-2 hours while awake, and often more frequently. Other interventions listed (incentive spirometry, fluid intake, early ambulation) are appropriate and beneficial.

You are watching your patient using the spirometry incentive. What kind of patient demonstration demonstrates to you that the patient knows how to operate the device correctly?

Answer: The patient inhales slowly on the device and maintains the flow indicator between 600 to 900 level

Correct use of an incentive spirometer involves a slow, deep inhalation to maximize lung expansion and hold the breath for a few seconds. The goal is to keep the flow indicator within the target range (e.g., 600-900 mL/sec) to ensure optimal inspiratory effort and sustained lung inflation. Rapid inhalation or blowing into the device are incorrect techniques that do not achieve the therapeutic effect.