CHECK FOR UNDERSTANDING (60 minutes) You will answer and rationalize this by yourself.

This will be
recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the
correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 60 minutes
for this activity:

Case Study: Read and examine the case thoroughly.

Patient Profile: T.M., a 76-year-old retired police officer, is admitted to the OR for an inguinal hernia
repair. He has a history of severe chronic obstructive pulmonary disease (COPD) and heart failure.
Therefore, the anesthesia care provider (ACP) has decided to administer spinal anesthesia. The
circulating nurse has verified the baseline data (vital signs, height, weight, age; allergies; level of
consciousness; NPO status; and comfort level). A signed informed consent is on the chart. T.M. has no
allergies.

Discussion Questions:

1. Priority Decision: What is the priority nursing actions that should be taken when T.M. arrives in the
OR?

Answer: Ensure that enough help is available to transfer the patient from the stretcher to the or table.
Position the patient carefully to prevent injury. Apply safety straps. Place electrocardiogram (ecg) leads,
blood pressure (bp) cuff, and pulse oximetry. Check the iv to verify insertion and patency. Ensure that
the grounding pad is placed correctly. Complete the patient safety checklist implement the universal
protocol; take a surgical timeout with the surgical team members to verify patient name, birth date, and
operative procedure and location and to compare the hispital id number onthe patient id band withthe
chard. Aseptic technique must be maintained by all surgical team members. A fire risk assessment may
also be completed.

2. What specific precautions should be taken when positioning T.M. for surgery?

Answer: The patient position should allow for operative site accessibility. Place in correct
musculoskeletal alignment. Be sure that no undue pressure is occurring to bony prominences, nerves,
earlobes, and eyes. Be sure that there can be adequate thoracic wall movement. Prevent any pressure
or occlusion of veins and arteries. Secure the patient's extremities and provide adequate padding.
Respect patient modesty. Respect the patient's specific aches and pains or deformities.

3. What complications of spinal anesthesia should T.M. be monitored for during surgery?

Answer: T.M should be monitored for hypotension, bradycardia, nausea and vomiting, respiratory
difficulties, and apnea.

4. T.M. is 76 years old. What gerontologic considerations should be taken?

Answer: Monitor the effect of anesthetic agents and adjuncts closely. Ensure clear communication and
verify patient understanding. Closely monitor the patient's skin, especially where tape, electrodes,and
pads have been applied. Position the ol= der patient carefully with close attention to patient alignment
and joint support. Consider using warming devices and monitor closely if these are used. Assess the
postoperative recovery from the anesthetic agents before the patient is transferred out of the
postanesthesia care unit(pacu).

5. Priority Decision: Based on the data presented, what are the priority nursing diagnoses?

Answer:

--Risk For Infection

--Risk For Impaired Skin Integrity
--Risk For Injury
--Risk For Hypothermia

Multiple Choice

1. Nurse Jay is preparing to change a client’s dressing. The statement that best explains the basis of
surgical asepsis that the nurse will perform in this procedure is:

a. Keep the area free from microorganisms

b. Protect self from microorganisms in the wound
c. Confine the microorganisms to the surgical site
d. Keep the number of opportunistic microorganisms to a minimum

ANSWER: A
RATIO: 1. Surgical asepsis means that the defined area contains no microorganisms. 2. This would apply
to personal protective equipment and medical asepsis. 3. Same as answer 2. 4. This would apply to
medical asepsis

2. Function of a circulating nurse is:

a. Assists the scrub nurse and surgeon
b. Draping the client with sterile drapes
c. Wear sterile gloves, gowns, caps
d. Handling sterile instruments and supplies

ANSWER: A
RATIO:

3. Which among the following are not members of the sterile team in the operating room? Select that all
apply:
1. Surgeon
2. Anesthesiologist
3. Radiation technician
4. Scrub nurse
5. Circulating nurse

a. 1, 2, 3
b. 2, 3
c. 2, 3, 5
d. 3, 4, 5

ANSWER:
RATIO:

4. What is the responsibility of the nurse regarding informed consent?

a. To explain the surgical options
b. To describe the operative procedure to be done
b. To explain the operative risks
d. To witness a patient’s signature

ANSWER:
RATIO:

5. Which of the following is the primary responsibility of the nurse before surgical operation?
a. Taking the vital signs
b. Explaining the procedure
c. Obtaining the permit
d. Checking the lab works

ANSWER: A
RATIO: The primary responsibility of the nurse is to take the vital signs before any surgery. The actions in
answers B, C, and D are the responsibility of the doctor.

SITUATION: Injection of a local agent into the subarachnoid space produces spinal block. Epidural block
occurs when the local agent is injected into the epidural space. Spinal and epidural blocks are used
mainly for lower extremity and lower abdominal surgery. Both motor and sensory function is blocked.

6. Mr. Alejandro is scheduled for a prostatectomy and the anesthesiologist plans to use a spinal
(subarachnoid) block during surgery. In the operating room, the nurse positions the client according to
the anesthesiologist's instructions. Why does the client require special positioning for this type of
anesthesia?
a. To prevent confusion
b. To prevent seizures
c. To prevent cerebrospinal fluid (CSF) leakage
d. To prevent cardiac arrhythmias
ANSWER: C
RATIO:

7. What is the most important postoperative instruction nurse Nikki must give to Mrs. Serrano who has
just returned from the operating room after receiving a subarachnoid block?
a. "Avoid drinking liquids until the gag reflex returns."
b. "Avoid eating milk products for 24 hours."
c. "Notify a nurse if you experience blood in your urine."
d. "Remain supine for the time specified by the physician."

ANSWER: D
RATIO: The nurse should instruct the client to remain supine for the time specified by the physician.
Local anesthetics used in a subarachnoid block don't alter the gag reflex. No interactions between
local anesthetics and food occur. Local anesthetics don't cause hematuria.

8. The common anesthesia used for appendectomy is?

a. Spinal
b. General
c. Caudal
d. Hypnosis

ANSWER:
RATIO:

9. The client returns from surgery with a blood pressure of 90/50, pulse 132, and respirations 30.
Which action by Nurse Jo should receive priority?
a. Continue to monitor the vital signs
b. Contact the physician
c. Ask the client how he feels
d. Ask the nursing assistant to continue the post-op care

ANSWER:
RATIO:

10. An additive given to potentiate and prolong the effects of regional anesthesia is:
a. Lidocaine
b. Epinephrine
c. Digoxin
d. Lanoxin

ANSWER:
RATIO: