Roles
Complications/ Interventions
Safety/ Prevention
Anesthesia
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100
What is the primary responsibility of the circulating nurse during a surgical procedure?
- A. Performing the surgical hand scrub and setting up sterile tables
- B. Administering anesthesia and monitoring the patient’s vital signs
- C. Continually assessing the patient for signs of injury, managing the OR environment, and ensuring the safety and proper identification of the patient
- D. Suturing and handling tissues during the operation
Correct Answer: C. Continually assessing the patient for signs of injury, managing the OR environment, and ensuring the safety and proper identification of the patient
100
During surgery, a patient develops hives, itching, and angioedema. Which adverse reaction is most likely occurring?
- A. Hypothermia
- B. Anaphylaxis
- C. Malignant hyperthermia
- D. Compartment syndrome
- Correct Answer: B. Anaphylaxis
Rationale: Hives, itching, and angioedema are signs of anaphylaxis, a severe allergic reaction that requires immediate intervention.
100
Q5: What critical safety measure must the surgical team take before beginning any surgical procedure to ensure the correct surgery is performed on the correct patient and at the correct site?
- A. Conducting a “Time-Out” to verify patient identity, surgical procedure, and surgical site
- B. Performing a final count of all instruments and sponges
- C. Administering preoperative antibiotics
- D. Applying sterile drapes to the surgical site
- Correct Answer: A. Conducting a “Time-Out” to verify patient identity, surgical procedure, and surgical site
Rationale: The “Time-Out” is a critical safety measure performed before the start of any surgical procedure to verify the patient’s identity, the planned procedure, and the correct surgical site, thereby preventing mistakes in surgery.
100
Which medication used during general anesthesia is specifically monitored for respiratory depression?
- A. Vecuronium
- B. Fentanyl
- C. Succinylcholine
- D. Midazolam
- Correct Answer: B. Fentanyl
Rationale: Fentanyl, an opioid used during general anesthesia, can cause significant respiratory depression and must be carefully monitored.
100
Which actions will the nurse include in the surgical time-out procedure before surgery (select
all that apply)?
a. Check for placement of IV lines.
b. Have the surgeon identify the patient.
c. Have the patient state name and date of birth.
d. Verify the patient identification band number.
e. Ask the patient to state the surgical procedure.
f. Confirm the hospital chart identification number
ANS: C, D, E, F
These actions are included in surgical time out. IV line placement and identification of the
patient by the surgeon are not included in the surgical time-out procedure
200
Which action best describes the role of the certified registered nurse anesthetist (CRNA) on
the surgical care team?
a. Performs the same responsibilities as the anesthesiologist.
b. Releases or discharges patients from the postanesthesia care area.
c. Administers intraoperative anesthetics ordered by the anesthesiologist.
d. Manages a patient’s airway under the direct supervision of the anesthesiologist
ANS: B
A nurse anesthetist is a registered nurse who has graduated from an accredited nurse
anesthesia program (minimally a master’s degree program) and successfully completed a
national certification examination to become a CRNA. The CRNA scope of practice includes,
but is not limited to, the following:
1. Performing and documenting a preanesthetic assessment and evaluation
2. Developing and implementing a plan for delivering anesthesia
3. Selecting and initiating the planned anesthetic technique
4. Selecting, obtaining, and administering the anesthesia, adjuvant drugs, and fluids
5. Selecting, applying, and inserting appropriate noninvasive and invasive monitoring
devices
6. Managing a patient’s airway and pulmonary status
7. Managing emergence and recovery from anesthesia
8. Releasing or discharging patients from a postanesthesia care area
200
Which intraoperative complication is characterized by a rapid rise in body temperature and severe muscle contractions, often triggered by certain anesthetic agents?
- A. Anaphylaxis
- B. Hypothermia
- C. Malignant hyperthermia
- D. Hypoxia
- Correct Answer: C. Malignant hyperthermia
Rationale: Malignant hyperthermia is a severe reaction to certain anesthetic agents, characterized by a rapid increase in body temperature and severe muscle contractions, and requires immediate intervention to prevent life-threatening complications.
200
What attire is required in the restricted zone of the surgical environment?
- A. Street clothes and caps
- B. Scrub clothes, shoe covers, caps, and masks
- C. Scrub clothes and masks only
- D. Street clothes and masks
- Correct Answer: B. Scrub clothes, shoe covers, caps, and masks
Rationale: In the restricted zone, full surgical attire, including scrub clothes, shoe covers, caps, and masks, is required to maintain sterility and prevent infection.
200
What is a common complication following spinal anesthesia that can be relieved by lying flat?
- A. Hypotension
- B. Positional headache
- C. Respiratory depression
- D. Nausea and vomiting
- Correct Answer: B. Positional headache
Rationale: A common complication of spinal anesthesia is a positional headache, which often improves when the patient lies flat.
200
A patient in surgery receives a neuromuscular blocking agent as an adjunct to general
anesthesia. While in the postanesthesia care unit (PACU), what assessment finding is most
important for the nurse to report?
a. Laryngospasm
b. Complaint of nausea
c. Weak chest wall movement
d. Patient unable to recall the correct date
ANS: C
The most serious adverse effect of the neuromuscular blocking agents is weakness of the
respiratory muscles, which can lead to postoperative hypoxemia. Nausea and confusion are
possible adverse effects of these drugs, but they are not as great of concern as respiratory
depression. Because these medications decrease muscle contraction, laryngospasm is not a
concern.
300
During a surgical procedure, which of the following tasks is performed by the scrub person?
- A. Administering anesthesia and managing patient’s vital signs
- B. Counting all needles, sponges, and instruments to ensure they are all accounted for and not retained as a foreign body inside the patient
- C. Verifying the surgical site and ensuring second verification of surgical site and fire safety
- D. Providing emotional support during the induction of general anesthesia
- Correct Answer: B. Counting all needles, sponges, and instruments to ensure they are all accounted for and not retained as a foreign body inside the patient
Rationale: The scrub person is responsible for setting up the surgical instruments, maintaining the sterile field, and ensuring all surgical instruments, sponges, and needles are accounted for before, during, and after the procedure to prevent any items from being left inside the patient.
300
What is the primary treatment for malignant hyperthermia once diagnosed?
- A. Administration of succinylcholine
- B. Immediate cessation of anesthesia and administration of Dantrolene
- C. Rapid cooling with ice packs
- D. Increasing the dosage of anesthetic agents
- Correct Answer: B. Immediate cessation of anesthesia and administration of Dantrolene
Rationale: Dantrolene is the medication used to treat malignant hyperthermia, along with immediate cessation of triggering anesthetic agents and active cooling measures
300
The nurse educator facilitates student clinical experiences in the surgical suite. Which action,
if performed by a student, would require the nurse educator to intervene?
a. The student wears a mask at the sink area.
b. The student wears street clothes in the unrestricted area.
c. The student wears surgical scrubs in the semirestricted area.
d. The student covers head and facial hair in the semirestricted area
ANS: C
The surgical suite is divided into three distinct areas: unrestricted—staff and others in street
clothes can interact with those in surgical attire; semirestricted—staff must wear surgical attire
and cover all head and facial hair; restricted—includes the operating room, the sink area, and
clean core where masks are required in addition to surgical attire.
300
Why is careful monitoring required when administering spinal anesthesia?
- A. To prevent hypotension
- B. To manage post-operative pain
- C. To observe for signs of complete respiratory paralysis as the anesthesia agent can move up to the diaphragm
- D. To ensure patient comfort during the procedure
- Correct Answer: C. To observe for signs of complete respiratory paralysis as the anesthesia agent can move up to the diaphragm
Rationale: Spinal anesthesia requires careful monitoring because the anesthetic agent can ascend towards the diaphragm, potentially causing respiratory paralysis.
300
Which nursing action should the operating room (OR) nurse manager delegate to the
registered nurse first assistant (RNFA) when caring for a surgical patient?
a. Adjust the doses of administered anesthetics.
b. Make surgical incision and suture incisions as needed.
c. Coordinate transfer of the patient to the operating table.
d. Provide postoperative teaching about coughing to the patient.
ANS: B
The role of the RNFA includes skills such as making and suturing incisions and maintaining
hemostasis. The other actions should be delegated to other staff members such as the
circulating nurse, scrub nurse, or surgical technician. The anesthesia care provider should
adjust the doses of anesthetics for patients, not the RNFA.
400
Which of the following is a critical role of the anesthesiologist during surgery?
- A. Performing the surgical hand scrub and setting up the sterile field
- B. Assessing the patient prior to surgery, administering anesthesia, intubating the patient, and continuously monitoring the patient’s condition throughout the surgery
- C. Handling tissues, suturing, and providing exposure to the operative field
- D. Managing the OR environment and positioning the patient safely
Correct Answer: B. Assessing the patient prior to surgery, administering anesthesia, intubating the patient, and continuously monitoring the patient’s condition throughout the surgery
400
Which intervention is most effective in preventing perioperative hypothermia?
- A. Administering IV fluids at room temperature
- B. Adjusting the environmental temperature of the operating room and using warmed IV and irrigation fluids
- C. Increasing the room ventilation
- D. Keeping the patient covered with a cotton blanket
- Correct Answer: B. Adjusting the environmental temperature of the operating room and using warmed IV and irrigation fluids
Rationale: Adjusting the operating room temperature and using warmed IV and irrigation fluids are key strategies to prevent unintentional hypothermia during surgery.
400
Which part of a sterile gown is considered sterile during surgery?
- A. The back of the gown
- B. The front of the gown from chest to the level of the sterile field and sleeves from 2 inches above the elbow to the cuff
- C. The entire gown
- D. Only the cuffs of the sleeves
- Correct Answer: B. The front of the gown from chest to the level of the sterile field and sleeves from 2 inches above the elbow to the cuff
Rationale: The sterile areas of a gown include the front from chest to the level of the sterile field and the sleeves from 2 inches above the elbow to the cuff.
400
Q7: Which type of peripheral nerve block is most appropriate for providing anesthesia to the leg?
- A. Brachial plexus block
- B. Femoral nerve block
- C. Paravertebral anesthesia
- D. Transsacral (caudal) block
- Correct Answer: B. Femoral nerve block
Rationale: The femoral nerve block is specifically used to provide anesthesia to the nerves supplying the leg.
400
A patient scheduled to undergo total knee replacement surgery under general anesthesia asks
the nurse, “Will the doctor put me to sleep with a mask over my face?” Which response by the
nurse is most appropriate?
a. “A drug may be given to you through your IV line first. I will check with the
anesthesia care provider.”
b. “Only your surgeon can tell you for sure what method of anesthesia will be used.
Should I ask your surgeon?”
c. “General anesthesia is now given by injecting medication into your veins, so you
will not need a mask over your face.”
d. “Masks are not used anymore for anesthesia. A tube will be inserted into your
throat to deliver a gas that will put you to sleep.”
ANS: A
Routine general anesthesia is usually induced by the IV route with a hypnotic, anxiolytic, or
dissociative agent. However, general anesthesia may be induced by IV or by inhalation. The
nurse should consult with the anesthesia care provider to determine the method selected for
this patient. The anesthesia care provider will select the method of anesthesia, not the surgeon.
Inhalation agents may be given through an endotracheal tube or a laryngeal mask airway.
500
Which action most effectively demonstrates that a new staff member understands the role of
scrub nurse?
a. Documents all patient care accurately
b. Labels all specimens to send to the lab
c. Keeps both hands above the operating table level
d. Takes the patient to the postanesthesia recovery area
ANS: C
The scrub nurse role includes maintaining asepsis in the operating field. The other actions
would be performed by the circulating nurse.
500
What intraoperative intervention can help reduce the risk of compartment syndrome related to patient positioning?
- A. Administering muscle relaxants
- B. Using padded braces for support and ensuring no nerve compression
- C. Keeping the patient in a sitting position
- D. Providing continuous IV fluids
- Correct Answer: B. Using padded braces for support and ensuring no nerve compression
Rationale: Proper positioning with padded braces and avoiding nerve compression can help prevent the postoperative complication of compartment syndrome.
500
What is the recommendation regarding the routine administration of hyperoxia to reduce surgical site infections?
- A. It is recommended to always use hyperoxia
- B. It is not recommended to routinely administer high levels of oxygen
- C. It is recommended only for high-risk surgeries
- D. It is recommended for all surgeries under general anesthesia
- Correct Answer: B. It is not recommended to routinely administer high levels of oxygen
Rationale: Routine administration of hyperoxia (high levels of oxygen) is not recommended to reduce surgical site infections, as it has not been shown to be effective.
500
A patient received inhalation anesthesia during surgery. Postoperatively the nurse should
monitor the patient for which complication?
a. Tachypnea
b. Myoclonus
c. Hypertension
d. Laryngospasm
ANS: D
Possible complications of inhalation anesthetics include coughing, laryngospasm, and
increased secretions. Hypertension and tachypnea are not associated with general anesthetics.
Myoclonus may occur with nonbarbiturate hypnotics but not with the inhalation agents
500
Which action best describes how the scrub nurse maintains aseptic technique during surgery?
a. Uses waterproof shoe covers
b. Wears personal protective equipment
c. Insists that all operating room (OR) staff perform a surgical scrub
d. Changes gloves after touching the upper arm of the surgeon’s gown
ANS: D
The sleeves of a sterile surgical gown are considered sterile only to 2 inches above the elbows,
so touching the surgeon’s upper arm would contaminate the nurse’s gloves. Shoe covers are
not sterile. Personal protective equipment is designed to protect caregivers, not the patient,
and is not part of aseptic technique. Staff members such as the circulating nurse do not have to
perform a surgical scrub before entering the OR.