Intraoperative Phase

Total Questions : 10

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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?

Explanation

Choice A reason:

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 reason:

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 reason:

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 reason:

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.)

Explanation

Choice A reason:

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 reason:

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 reason:

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 reason:

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 reason:

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?

Explanation

Choice A reason:

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 reason:

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 reason:

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 reason:

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?

Explanation

Choice A reason:

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 reason:

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 reason:

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 reason:

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?

Explanation

Choice A reason:

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 reason:

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 reason:

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 reason:

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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Question 6:

A nurse is preparing to assist with a surgical procedure that involves electrocautery. Which of the following actions should the nurse take to prevent burns to the patient?

Explanation

Choice A reason:

Placing a grounding pad on the patient's skin near the surgical site is the correct action to prevent burns to the patient during electrocautery. The grounding pad provides a low-current-density pathway for the high-frequency cautery current to return to the electrosurgical unit, thus avoiding injury to other body areas.

Choice B reason:

Applying petroleum jelly to the patient's skin around the surgical site is not a correct action to prevent burns to the patient during electrocautery. Petroleum jelly is flammable and can ignite during electrocautery, causing fire and thermal injury to the patient.

Choice C reason:

Covering the patient's hair with a wet towel is not a correct action to prevent burns to the patient during electrocautery. A wet towel can create a conductive pathway for the cautery current to flow through, resulting in burns or shocks to the patient or the staff.

Choice D reason:

Removing any metal jewelry from the patient is a correct action to prevent burns to the patient during electrocautery, but it is not sufficient by itself. Metal jewelry can cause electrical arcing or heating, leading to skin burns or fire hazards. However, removing metal jewelry alone does not ensure a safe return pathway for the cautery current, which requires a grounding pad as well.


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Question 7:

A nurse is assisting with a surgical procedure that requires a large number of instruments and supplies. Which of the following strategies should the nurse use to facilitate counting and prevent foreign body retention? (Select all that apply.)

Explanation

Choice A reason:

Using a standardized counting method and sequence for each procedure helps to ensure consistency and accuracy in the counting process. It also reduces the risk of confusion or miscommunication among the surgical team members. This is a recommended standard of practice by the Association of Surgical Technologists (AST)

Choice B reason:

Separating sponges into groups of five or ten and counting them as one unit helps to facilitate counting and prevent foreign body retention. It also allows for easier identification of missing sponges in case of an incorrect count. This is another recommended standard of practice by the AST.

Choice C reason:

Keeping instruments and supplies on separate trays according to their function does not necessarily facilitate counting or prevent foreign body retention. It may help to organize the surgical field, but it does not address the issue of counting or documenting the items used during the procedure. Therefore, this is not a correct answer.

Choice D reason:

Using a white board or paper to record the counts and update them as needed helps to facilitate counting and prevent foreign body retention. It provides a visual reference for the surgical team members and allows for easy verification of the counts at any time during the procedure. It also helps to document any discrepancies or changes in the counts. This is another recommended standard of practice by the AST.

Choice E reason:

Discarding any unused items before the final count does not facilitate counting or prevent foreign body retention. It may actually increase the risk of losing track of the items used during the procedure or leaving some items inside the patient. Therefore, this is not a correct answer.


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Question 8:

A nurse is assisting with a surgical procedure that involves suturing a wound. Which of the following statements should the nurse make to the surgeon when handing a suture needle?

Explanation

Choice A reason:

This is incorrect because a curved needle with a cutting edge is used for general closure of skin, subcutaneous tissue, and other tissues that are tough or difficult to penetrate A cutting edge needle has a triangular point that can cause more tissue damage and scarring than a tapered point needle.

Choice B reason:

This is incorrect because a straight needle with a tapered point is used for easily accessible tissues, such as mucous membranes, gastrointestinal tract, or blood vessels A tapered point needle has a round body that gradually tapers to a point, allowing it to pierce through tissues without cutting them.

Choice C reason:

This is correct because a half-circle needle with a reverse cutting edge is used for suturing at sites that have limited space and require precise placement of stitches, such as ophthalmic, plastic, or cardiovascular surgery A reverse cutting edge needle has a triangular point with the cutting edge on the outer convex curvature of the needle, which helps prevent the suture from tearing through the tissue.

Choice D reason:

This is incorrect because an eyed needle with a blunt point is used for suturing tissues that are easy to separate, such as liver, kidney, or spleen A blunt point needle has a round body that ends in a blunt tip, which pushes aside the tissue fibers rather than cutting them An eyed needle has an eye at the end of the needle where the suture thread is inserted, which can cause more drag and tissue trauma than a swaged needle that has the suture attached to the end of the needle.


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Question 9:

A nurse is assisting with a surgical procedure that involves applying a dressing to the wound. Which of the following statements should the nurse make to the patient after the procedure?

Explanation

Choice A reason:

This is incorrect because changing the dressing every day and keeping it dry may not be appropriate for all types of wounds. Some wounds may require more frequent dressing changes or moist wound healing environment to promote healing and prevent infection.

Choice B reason:

This is incorrect because showering with the dressing on may cause the dressing to become wet and contaminated, which can increase the risk of infection and delay healing. The dressing should be changed before and after showering, and the wound should be protected from water as much as possible.

Choice C reason:

This is correct because inspecting the dressing for signs of infection, such as redness, swelling, or drainage, is an important part of wound care. The patient should be taught how to recognize and report these signs to the health care provider as soon as possible. Early detection and treatment of infection can prevent complications and promote healing.

Choice D reason:

This is incorrect because removing the dressing after 24 hours and leaving the wound open to air may not be advisable for some wounds, especially those that are deep, large, or at risk of infection. The wound may need to be covered with an appropriate dressing for a longer period of time to protect it from contamination, maintain moisture balance, and support healing.


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Question 10:

A nurse is assisting with a surgical procedure that involves placing a drain in the wound. Which of the following actions should the nurse take to ensure proper functioning of the drain?

Explanation

Choice A reason:

Compressing the drain reservoir before closing the wound creates a vacuum that helps to suction out the fluid from the wound and prevent infection. This is a common practice for bulb-type drains that apply gentle suction.

Choice B reason:

Securing the drain tubing to the patient's skin with tape is not necessary and may cause skin irritation or damage. The drain tubing can be attached to the patient's clothes with a safety pin or secured near the bandage.

Choice C reason:

Emptying the drain reservoir when it is half full and measuring the output is part of the drain care at home, not during the surgical procedure. The patient or caregiver should empty the drain 2 to 3 times a day (or more), depending on the amount of output, and record it in a chart.

Choice D reason:

Flushing the drain tubing with saline solution every 4 hours is not recommended and may introduce infection or clog the tubing. The tubing should be kept clear by squeezing or "milking”. it occasionally to prevent clots from forming. : Instructions for Surgical Drain Care - Cleveland Clinic : How to Care for Your Surgical Drain at Home - Verywell Health : Surgical Drain Care: Care Instructions | Kaiser Permanente.


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