SINGSON, KRISTINE DONDE C.

BSN 3-A6
Medical Surgical Nursing 1 – Lecture
Session #2: Intraoperative Nursing Care
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: Nurse should ensure the enough help to transfer the patient from the stretcher to the OR
table. Position the patient properly/ carefully to prevent injury. Apply safety straps. Check the vital
signs, check the IV to verify insertion and patency and complete the patient safety checklists.

2. What specific precautions should be taken when positioning T.M. for surgery?
Answer: The patient should allow for the operative site accessibility. Place in correct musculoskeletal
alignment. Be sure that no undue pressure is occurring to bony prominences, nerves, earlobes and
eyes. Prevent all pressure or occlusion of veins and arteries. Secure the patient’s extremities and
provide adequate padding and we should respect all the patient’s modesty   

3. What complications of spinal anesthesia should T.M. be monitored for during surgery?
Answer: T.M. should be monitored for respiratory difficulties, apnea, nausea and vomiting, especially
the vital signs,

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 older patient carefully with close attention to
patient alignment and joint support. Also 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: Based on the data above, the priority nursing diagnoses are, Risk for infection, risk for injury,
and 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: The basis of surgical asepsis is the elimination of all microorganisms and keeping the area free
from infection causing microbes.

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: Circulating nurse also specialize in the surgical field, but their focus is on creating and
maintaining a sterile working environment. They assist all surgical staff present, including scrub
nurses, and surgeons, and are alslo involved in the assessment of patients before the operation.

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: C
RATIO: The anesthesiologist and circulating nurse are not members of sterile surgical team. The
surgeon, radiation technician and scrub nurse directly come in contact with the sterile field they
comprise the sterile surgical team.

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
c. To explain the operative risks
d. To witness a patient’s signature
ANSWER: D.
RATIO: The nurse is responsible and accountable for the verification of and witnessing that the patient
or the legal significant others has signed the consent document in their presence.

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 doctors.

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: The client requires special positioning to prevent cerebrospinal Fluid (CSF) leakage. The
bending, lifting, stretching, and twisting should be avoided.

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 specified by the Physician. Local
anesthetics used in a subarachnoid block don’t alter the gag reflex.

8. The common anesthesia used for appendectomy is?

a. Spinal
b. General
c. Caudal
d. Hypnosis
ANSWER: B
RATIO: Appendectomy is the surgical removal of the appendicitis. The surgery can often also be done
using laparoscopic or open appendectomy. General anesthesia is common anesthesia being used.

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: B
RATIO: The vital signs are abnormal and should be reported immediately to the Physician. Choices
A,C, and D are incorrect.

10. An additive given to potentiate and prolong the effects of

regional anesthesia is:

a. Lidocaine
b. Epinephrine
c. Digoxin
d. Lanoxin
ANSWER: B
RATIO: Epinephrine has been used as an addictive to local anesthetics for a very long period.