Deck 5: Intraoperative

Question 1

Which of the following is a true statement about surgical attire that the nurse must don before working in the operating suite?

A)The nurse should put on the scrub suit first, followed by the scrub cap.
B)If the nurse needs to leave the operating suite, they should untie the mask to leave it around the neck before leaving.
C)At the end of the day, the nurse should take their scrub suit home to wash and wear again at their next shift.
D)When moving between procedures, the nurse should put on a different mask before working with the next patient.

Answer 1

When moving between procedures, the nurse should put on a different mask before working with the next patient.

Question 2

Which of the following measures will help to reduce the risk of infection in the operating room?

A)Limiting the number of people allowed in the peripheral corridor, nursing station, and holding room.
B)Wearing masks and gloves at all times when in the surgical suite, hallways, and post-anesthesia care unit.
C)Scrubbing the hands with an antimicrobial soap and donning sterile gloves before performing any operative techniques.
D)Keeping the scrub top tucked in and a long-sleeved closed jacket on during the surgical preparation.

Answer 2

Scrubbing the hands with an antimicrobial soap and donning sterile gloves before performing any operative techniques.

Question 3

Which of the following is a perioperative nurse intervention that is important during the induction phase of anesthesia?

A)Monitoring urinary output
B)Ensuring that suction devices are working properly
C)Positioning the patient on the table
D)Keeping the atmosphere quiet

Answer 3

Keeping the atmosphere quiet

Question 4

Which signs or symptoms might be seen in a patient who has entered an alkalotic state?

A)Convulsions
B)Nausea
C)Headache
D)Disorientation

Question 5

Which of the following might be a cause of a large difference in blood pressure between the arterial pressure on the cardiac monitor and the cuff pressure?

A)The arterial catheter is clotted or positioned incorrectly.
B)The transducer has not been calibrated.
C)The transducer is at the level of the atria.
D)Both A and B

Question 6

What types of signs and symptoms might the nurse see if a patient suddenly develops cardiac tamponade?

A)A loud systolic murmur and chest pain
B)Dyspnea and postural hypotension
C)Blue appearance in the neck and pulsus paradoxus
D)Clammy skin and distended neck veins

Question 7

Which of the following is a true statement regarding asepsis in the surgical environment?

A)The front of the surgical gown, from top to bottom is considered sterile, but not the back.
B)A break in the sterile field renders the associated object contaminated.
C)Tables are sterile at the level of the tabletop and descending to three inches below.
D)All items should be considered sterile unless clearly contaminated.

Question 8

What is the normal level of ammonia in the body for an adult patient?

A)1-12 mg/dl
B)15-110 mg/dl
C)65-280 mg/dl
D)300-450 mg/dl

Question 9

What is the preferred positioning of a patient who is undergoing a hemorrhoidectomy?

A)Lithotomy
B)Lateral recumbent
C)Kraske
D)Both A and C

Question 10

Which of the following is not an indication for performing a C- section?

A)Shoulder dystocia
B)Active herpes infection
C)Previous C-section
D)Breech presentation

Question 11

What types of actions must the perioperative nurse consider when assisting with a flexible bronchoscopy?

A)Limit talking during the procedure.
B)Place the patient in the reverse Trendelenburg position.
C)Obtain copies of chest x-rays to have for easy access during the procedure.
D)Both B and C

Question 12

Which of the following are changes associated with aging that put the elderly patient at higher risk during surgery?

A)Slow infusion of intravenous anesthesia may lead to pulmonary edema.
B)More anesthesia is needed and it wears off more quickly.
C)Decreased cough reflex increases risk of pneumonia.
D)Poor kidney function results in larger amounts of urine output.

Question 13

Which of the following symptoms are characteristic of the overdosage stage of anesthesia?

A)The patient is unconscious with a regular pulse rate.
B)The patient may have uncontrollable movements.
C)The patient experiences feelings of disconnectedness from the body.
D)The patient develops shallow respirations and dilated pupils.

Question 14

Which of the following is considered to be a disadvantage of using intravenous anesthesia?

A)Increased risk of nausea and vomiting
B)Laryngospasm may occur with use
C)Dizziness typically occurs during onset
D)Both A and C

Question 15

Which of the following is a disadvantage of using morphine as an anesthetic during the surgical process?

A)It does not produce amnesia.
B)It may cause nausea and vomiting.
C)It may lead to hallucinations.
D)It should not be used in children.

Question 16

During a heart catheterization procedure, the patient exclaims, "I feel like my heart is pounding!" What is the most appropriate response from the nurse?

A)"Take a deep breath and hold it for five seconds. I'll count for you."
B)"You are probably experiencing anxiety. Tell me more about how you are feeling."
C)"Take a breath and cough. This might make that feeling go away."
D)"I don't usually have patients who get that feeling. How long has it been going on?"

Question 17

Which of the following conditions may be treated through a splenectomy?

A)Multiple myeloma
B)Disseminated intravascular coagulopathy
C)Von Willebrand's disease
D)Autoimmune hemolytic anemia

Question 18

Which of these factors contribute to the development of patient hypothermia during a surgical procedure?

A)Anesthesia use
B)Greater body mass due to obesity
C)Supine positioning
D)Bacterial sepsis

Question 19

Which of the following interventions are important for the nurse to perform to prevent hypothermia in the intraoperative period?

A)Immediately hang intravenous fluids after they have arrived from the pharmacy.
B)Increase the thermostat in the operating room.
C)Check the patient's body temperature once every two hours.
D)Give the patient a warm blanket once he has completed the recovery period.

Question 20

Which of the following manifestations is more likely to be seen in a pediatric surgical patient?

A)Increased concentration of fluids and electrolytes through the kidneys.
B)Larger blood volume per kg of body weight
C)Greater cardiac output due to higher pulse rate
D)Decreased chest wall compliance

Question 21

Which of the following is a duty of the perioperative nurse when handling patient specimens?

A)Labeling the specimen with patient name and the source of the specimen.
B)Removing the specimen from the patient to give to the surgical technician.
C)Transporting the specimen to the laboratory for analysis.
D)Handling patient specimens is beyond the nurse's scope of practice.

Question 22

Which of the following measures must be considered when working with a patient specimen in formaldehyde?

A)Keeping the specimen in enclosed quarters.
B)Wearing gloves at all times when working with the substance.
C)Monitoring formaldehyde exposure once per year.
D)Both A and B

Question 23

At what point during the surgical procedure should the sponge count be performed?

A)When opening the surgical pack at the beginning of the procedure
B)After the skin preparation is complete
C)Before the physician closes the wound
D)Both A and C

Question 24

Which of the following statements is true regarding sharps counts during the operating procedure?

A)Packages of suture should all be opened onto the sterile field for counting.
B)The scrub nurse should document how many needles are contained within a package at the time of counting.
C)Needles should be counted once at the beginning of the procedure and once at the end.
D)A broken needle should be counted as two sharps because of having two sharp ends.

Question 25

Which of the following is an example of a flexible endoscope?

A)Laparoscope
B)Ureteroscope
C)Angioscope
D)Arthroscope

Question 26

The light source on the end of an endoscope radiates heat in such a way as to reduce tissue damage at the tip of the scope. This type of light source is called:

A)Cold light
B)Distal lens
C)Light connection
D)Cold end

Question 27

Which of the following is a true statement regarding trochar and cannula use during a surgical procedure?

A)A trochar and cannula are used to create an opening for the procedure.
B)A reusable trochar must be sharpened on a routine basis.
C)After entry into the body cavity, the trochar is left in place and the cannula is removed.
D)Both A and B

Question 28

During a laser procedure in the operating suite, which of the following precautions are essential for the safety of the entire healthcare team?

A)A sign should be posted at the entry warning others of the use of laser technology inside.
B)Everyone in the room should wear eye protection at all times.
C)The patient's face should be covered with a towel during the procedure to protect from the laser.
D)Both A and B

Question 29

Which statement is a requirement when managing exposure to blood borne pathogens?

A)Nurses should receive training in handling occupational exposure if there is a risk of coming in contact with blood borne pathogens.
B)Food and drink should be kept on a separate table in the operating suite, away from the patient.
C)A contaminated needle should be carefully recapped before placing it in a biohazard container.
D)Employers are required to provide measures for hand hygiene practices.

Question 30

When pouring a substance in a sterile field, which of the following measures are necessary to avoid contamination?

A)Pour the substance quickly to reduce the time spent in the sterile field.
B)Stand three feet away from the container to avoid contaminating the sterile field.
C)Pour the solution into a container on a sterile table or held by another person in sterile attire.
D)Place the used container in a trash receptacle on the other side of the sterile table.

Question 31

The process of putting on sterile gloves by turning the inside of the glove outward and touching only the interior when putting it on is called the:

A)Closed-glove technique
B)Open-glove technique
C)Assisted-glove technique
D)Individual-glove technique

Question 32

Which of the following steps should the nurse perform when removing surgical attire in order to avoid contamination?

A)Before removing gloves, wipe them clean with a sterile towel.
B)Grasp the front of the gown and pull forward to untie it and pull it off.
C)To remove a mask, pull the front of the mask forward from the face and then down.
D)Remove sterile gloves after all other scrub attire has been removed.

Question 33

A patient is on the operating table before the procedure. What should the nurse keep in mind when draping the patient?

A)Open the package, unfold the drape and carry it over to place on the patient.
B)Carry sterile drapes above the head to avoid contact with the floor.
C)Discard a drape that has become contaminated and replace it with a sterile one.
D)Once drapes are on the patient, shift them slightly to ensure they are in the right place.

Question 34

What are the most important goals of proper positioning of the patient during a surgical procedure?

A)Patient comfort
B)Access to the surgical site
C)Patient privacy
D)Success of anesthesia

Question 35

How can the nurse reduce the risk of pressure injuries to a patient during a surgical procedure?

A)Limit the length of the procedure.
B)Perform range of motion exercises on the patient during the procedure.
C)Avoid placing equipment or body weight against the patient for extended periods of time.
D)Turn the patient from side to side every hour.

Question 36

The nurse observes that the patient has developed a small pressure ulcer on the back of their right arm. It appears as a blister that seems to include the superficial layers of skin. What stage of pressure ulcer would this wound be classified as?

A)Stage I
B)Stage II
C)Stage III
D)Stage IV

Question 37

According to the Braden Scale for assessing the risk of pressure sores, which of the following patients would be at highest risk for developing a pressure injury during a surgical procedure?

A)A patient who is alert and responsive and who can walk with assistance.
B)A patient who is responsive to commands and has dry skin.
C)A patient who moves around with assistance and eats ½ of their meals.
D)A patient who can make position changes and who eats three meals a day with snacks.

Question 38

What can the nurse do to prevent injury to a patient's ulnar nerve during surgery?

A)Secure the patient's arms to his sides.
B)Fold the patient's arms across his chest.
C)Raise the patient's arms above his head.
D)Dangle the patient's arms off the table.

Question 39

Which of the following measures can the nurse take to ensure adequate respiratory status and proper ventilation for the patient during the surgical procedure?

A)Place the patient's arms folded across their chest.
B)Ensure that straps across the chest are secure but not overly tight.
C)Place the patient in the lateral recumbent position.
D)Both A and B

Question 40

Which of the following are potential nursing diagnoses related to patient positioning during the surgical procedure?

A)Body image disturbance
B)Impaired gas exchange
C)Alteration in nutrition, less than bodily requirements
D)Alteration in comfort

Question 41

Which of the following is a potential complication associated with positioning the patient in the reverse Trendelenburg position?

A)Shearing of the skin
B)Increased intracranial pressure
C)Decreased movement of the diaphragm
D)Poor venous return

Question 42

What is a potential complication associated with placing the patient in the lithotomy position?

A)Hip dislocation
B)Nasal drainage
C)Decreased movement of the diaphragm
D)Low blood pressure

Question 43

During a surgical procedure, the nurse is unwrapping a set of sterile instruments to use for the surgery and notes a water stain on the outside of the package. What is the next intervention?

A)Continue to unwrap the set and use the instruments as indicated.
B)Open the pack and try to determine which instruments are usable.
C)Stop the procedure and notify infection control about a potential breach in policy.
D)Discard the instrument pack and obtain another; the first set is contaminated.

Question 44

The perioperative nurse is assisting the surgeon during a procedure when the surgeon hands them a set of clamps covered in blood for disposal. What is the nurse's next action?

A)Inspect the clamps to ensure they have not been damaged during the procedure.
B)Place the clamps back on the table with the other surgical instruments.
C)Put the clamps in a bowl containing saline solution to clean before disposal.
D)Both A and C.

Question 45

Which of the following interventions can the nurse provide to manage awareness of the surgical procedure for the patient under anesthesia?

A)Determine if the patient has a history of this occurring in the past.
B)Routinely test patient response during the procedure by lightly touching the skin of the face.
C)Monitor the patient through the Bispectral Index System to indicate changes in status.
D)Both A and C

Question 46

A patient who is suffering from pain due to an ulcer is getting ready to undergo a vagotomy. In what method does this procedure relieve ulcer pain?

A)By removing part of the stomach and intestine
B)By inserting a drain that will release excess stomach acid outside of the body
C)By removing the ulcer and closing the area to allow it to heal
D)By severing the nerves to the stomach that promote acid secretion

Question 47

Which of the following measures does the nurse perform for a patient who is undergoing an appendectomy?

A)Administer antibiotics to reduce infection.
B)Administer an enema before surgery.
C)Insert a nasogastric tube.
D)Both A and C

Question 48

The perioperative nurse is planning to administer fluids and electrolytes to a patient who has just undergone surgery for removal of the appendix. What potential complication does this intervention prevent?

A)Paralytic ileus
B)Pelvic abscess
C)Constipation
D)Postoperative pain

Question 49

What is the purpose of the footboard on the operating room table?

A)To provide an extra length of table on which the patient can rest their feet.
B)To serve as a cushion to prevent pressure injuries.
C)To secure the patient's legs to the table.
D)To act as a place for the surgeon to rest their feet when they are tired.

Question 50

Which of the following conditions would most likely require use of a flotation mattress during the procedure?

A)A patient who is having a coronary artery bypass graft
B)A patient who is having a vasectomy
C)A patient who is having a cesarean section
D)A patient who is having eye surgery

Question 51

Which of the following incision types would be used for pancreatic surgery?

A)Inguinal
B)Left lower paramedian
C)Right upper paramedian
D)Horizontal flank

Question 52

The surgeon is making a midline abdominal incision and starts by cutting through the skin and subcutaneous fat. What is the next layer below the subcutaneous fat that he will cut through?

A)Muscle
B)Fascia
C)Dermis
D)Bone

Question 53

For which of the following procedures might a surgeon perform a Pfannenstiel incision?

A)Appendectomy
B)Bowel resection
C)Nephrectomy
D)Hysterectomy

Question 54

The nurse is performing the skin prep before the surgery. Which of the following is most important for the nurse to maintain aseptic technique?

A)Marking the skin in the areas where the prep must be performed.
B)Applying the skin prep solution in a back and forth manner across the incision site.
C)Starting at the site of the incision and working outward toward the border.
D)Performing the skin prep and then going back over the site in case any areas were missed.

Question 55

Which of the following solutions are used to control both gram-positive and gram-negative bacteria as part of the surgical skin prep?

A)Ethylene alcohol
B)Chlorhexidine gluconate
C)Hydrogen peroxide
D)Both A and B

Question 56

Which of the following is necessary when performing a circumferential skin preparation on a patient's arm?

A)Prop the limb up onto a table in order to reach all sides.
B)Use an assistant who is in sterile clothing to hold the arm while another nurse performs the prep.
C)Cleanse one side of the arm and allow it to dry; then return and cleanse the other side.
D)Start at the top of the arm while cleaning, holding with one hand and moving down the arm.

Question 57

What important points must the nurse remember when performing a surgical skin prep on a patient before the procedure?

A)Avoid allowing the prep solution to collect underneath the patient in large amounts.
B)Perform the scrub for one full minute.
C)Prepare the area by applying the skin prep to extend six inches from where the incision will be.
D)Both A and B.

Question 58

What is the outer border for a skin prep performed on the breast area?

A)Across the chest at the level of the clavicle
B)Two inches below the level of the breast tissue
C)Upper portion of the arm, down to the elbow
D)Above the neck, extending up to the chin

Question 59

Which of the following surgical areas is considered dirty and should be cleaned last when preparing a patient for surgery?

A)Eyes
B)Genitalia
C)Popliteal region
D)Feet

Question 60

Which of the following patients would have contraindications for having a laparoscopic cholecystectomy?

A)An obese patient
B)A patient who cannot tolerate an open cholecystectomy
C)A patient with gall stones in the common bile duct
D)Both A and B

Question 61

Which of the following is not an acceptable practice when managing a Jackson-Pratt drain?

A)Pinning the drain in an upward position so that it rests above the patient's wound.
B)Fully collapsing the drain so that it will draw fluid out of the wound.
C)Milking the drain tubing to clear particles that are clogging the opening.
D)Emptying the drain when it becomes half full.

Question 62

During a surgical procedure, a patient begins bleeding profusely. The surgeon tells the nurse to administer a blood transfusion. What solution is most appropriate to hang with blood?

A)D10W
B)D5LR
C)0.9% NS
D)Ringer's lactate

Question 63

After giving a dose of an antibiotic, the nurse notices the patient is developing a rash and their blood pressure is dropping. What is the most likely reason for this reaction?

A)The patient is in pain.
B)The patient is allergic to the medication.
C)The patient has awareness while under anesthesia.
D)Both A and C.

Question 64

A physician has ordered Valium for a patient who is extremely anxious in the time surrounding the surgical procedure. In which of the following situations should this drug be avoided?

A)In a patient with a history of diabetes mellitus
B)In a patient with a respiratory rate of 24/minute
C)In a patient with a history of narrow-angle glaucoma
D)In a patient with a heart rate of 86 bpm

Question 65

What types of nursing interventions should the nurse perform for the patient who develops hypovolemia during the surgical procedure?

A)Add NaCl to the patient's intravenous solution.
B)Obtain an order and administer a dose of furosemide.
C)Insert a central venous pressure line to avoid overloading the circulatory system while replacing fluids.
D)Both A and C

Question 66

What symptoms might a nurse encounter in a patient who develops hyperkalemia during a surgical procedure?

A)ECG changes and decreased urine output
B)Restlessness and agitation
C)Depressed respirations and fever
D)Rapid breathing and rigid muscles

Question 67

The perioperative nurse is preparing to open a sterile instrument pack before a procedure. While carrying the closed pack over to the table, they accidentally drop it on the floor. What is their next action in order to maintain asepsis for the procedure?

A)Discard the closed pack; it is contaminated.
B)Pick it up and set it aside in case some of the instruments can still be used.
C)Return the pack to the storage area and retrieve another one.
D)Pick it up, open it, and use it anyway.

Question 68

When preparing a table for instruments, the nurse spreads a sterile drape over the table and begins placing sterile instruments on top. What is considered the sterile area in this situation?

A)The table top and the instruments
B)The table top and two inches extending down the sides, and the instruments
C)The table top, the length of the drape down the sides, and the instruments
D)The instruments only

Question 69

In what order should the nurse open a package of sterile instruments?

A)Top flap opens toward the nurse, side flaps; inside flap opens away from the nurse.
B)Top flap opens away from the nurse, side flaps; inside flap opens toward the nurse.
C)Top flap opens away from the nurse, inside flap, side flaps.
D)Top flap opens toward the nurse, inside flap, side flaps.

Question 70

The surgeon is preparing to close the skin at the end of the procedure and the nurse retrieves needles to use. Which of the following needle types would most likely be used for skin closure?

A)Taper point needle
B)Spatula side cutting needle
C)Inverted lancet
D)Reverse cutting needle

Question 71

When assisting the anesthesiologist with an intubation, which of the following is essential when applying cricoid pressure to the patient's neck?

A)Use the palm of the hand to exert downward pressure on the cartilage.
B)Apply cricoid pressure just prior to tube placement.
C)Do not release cricoid pressure until the tube is in place and secured.
D)Applying cricoid pressure is out of the nurse's scope of practice.

Question 72

Which of the following situations may require more anesthesia to produce the necessary effects?

A)A patient who is very anxious
B)A patient who has anorexia
C)A patient who has gone into shock
D)Both A and B

Question 73

Which of the following nursing interventions are appropriate when caring for a patient under conscious sedation?

A)Providing continuous respiratory support through bag-mask ventilation.
B)Assisting with intubation procedures by applying cricoid pressure.
C)Monitoring the patient and providing supplemental oxygen if necessary.
D)Frequently stimulating the patient to ensure they do not fall asleep during the procedure.

Question 74

Which of the following processes will help to prevent an allergic reaction to latex during the surgical procedure?

A)Taking a full history to determine patient risk factors.
B)Providing latex-free surgical supplies for any patient who has an allergy.
C)Administering a histamine blocker prophylactically.
D)Both A and B

Question 75

Which of the following must the nurse remember when administering oxytocin to a patient during a cesarean section?

A)Oxytocin is administered after the birth of the baby but before the placenta.
B)Oxytocin may cause decreased urine output.
C)Oxytocin will cause an immediate increase in bleeding, followed by a reduction in bleeding.
D)Oxytocin may have side effects that cause constipation and abdominal pain.

Question 76

Which of the following is an example of a hemostatic agent?

A)Oxidized cellulose
B)Cystografin
C)Heparin
D)Cefazolin

Question 77

Which of the following effects would the nurse expect to see in a patient who has been given pentothal for anesthesia?

A)Drowsiness
B)Euphoria
C)Flaccid paralysis
D)Agitation

Question 78

Which of the following actions should the nurse consider for the patient who has just been extubated at the end of the surgical procedure?

A)Monitoring urine output and potential blood loss.
B)Providing respiratory support through bag-mask ventilation.
C)Staying with the patient for safety if they awaken in a combative state.
D)Teaching the patient about postoperative wound care.

Question 79

What effect does temperature control have on the patient's cardiac and respiratory systems during a surgical procedure?

A)The hypothermic patient may begin to shiver, causing increased respiratory effort.
B)The method of heat regulation is depressed, causing increased oxygen consumption.
C)The blood vessels dilate, caused a disrupted acid-base balance.
D)Both B and C

Question 80

A central venous pressure catheter directly measures the pressure of which portion of the heart?

A)Right atrium
B)Right ventricle
C)Left atrium
D)Left ventricle