Perioperative Nursing

  1. What are the four patient-centered domains in perioperative nursing?
    • 1. Safety 
    • 2. Physiologic responses
    • 3. Behavioral responses
    • 4. Health Systems
  2. What are these terminologies:

    1. -centesis
    2. -ectomy
    3. -otomy
    4. -ostomy
    • 1. surgical puncture
    • 2. surgical removal
    • 3. surgical incision
    • 4. creating a hole
  3. What are these terminologies:
    1. -opsy
    2. -oscopy
    3. -pexy
    4. -plasty
    5. -rraphy
    • 1. looking at
    • 2. viewing of, normally with a scope
    • 3. to fix or secure
    • 4. to modify or reshape
    • 5. to strengthen, usually with a suture
  4. What are the three phases of perioperative nursing
    • 1. Preoperativ
    • 2. Intraoperative
    • 3. Postoperative
  5. T or F: you need a durable power of attorney for mentally disabled patients, but not for dementia patients
    False: need for both
  6. List what you are assessing for during preoperative in each body system:

    1. Neuro
    2. Liver
    3. Respiratory
    4. Renal
    5. Endocrine
    • 1. Neuro: assess ability to answer questions, hearing or vision problems
    • 2. Liver: LF clotting problems, fat metabolism, glucose homeostasis
    • 3. Respiratory: Infections? Asthma?
    • 4. Renal: Incontinence or lyte imbalances
    • 5. Endocrine: DM or thyroid control
  7. What are preoperative assessments you should consider with obese patients?
    • Increased ventilation needed
    • Cardiac problems
    • Sleep apnea
    • HTN, DM
    • poor healing, atelectasis
    • PNA post-opo
  8. How can antihypertensives influence intraoerative phase?
    • Interact with anesthetics, cause bradycardia
    • hypotension and impared circulation with beta blockers (Metroprolol)
  9. How can Metropolol influence the intraoperative phase?
    hypotension and impared circulation with beta blockers
  10. This drug type can reduce cardiac contractility and impair conduction during anesthesia

  11. This drug type can increase effects of anesthesia, prolong emergence
    Antidepressants (sertraline)
  12. T or F: Gluconeogenesis will need to be tightly monitored unless patient isn't DM
    False: always
  13. Garic, feverfew, ginger, ginseng, vitamin E, and ginko can effet intraoperative phase by:

  14. Valerian, St. John's Wort, and Kava may effect intraoperative phase by:

  15. Vitamin E and Licorice may effect intraoperative phase by:

  16. One of the Preoperative checklist is to start what size gauge IV?
    18 gauge
  17. What are the 4 common preoperative medications and their actions?
    • 1. Famotidine - decrease stomach acid and helps with post-op nausea
    • 2. Metoclopramide  - antiemetic
    • 3. Midazolam - antianxiety
    • 4. Abx (Cefazolin may be given as prophylaxis)
  18. T or F: The circulating RN must keep sterile precautions at all times
  19. This role in the OR is a sterile team member, preps the instrument table, passes instruments to surgeon
    Scrub Nurse
  20. This team member in the OR assist anesthesia care provider by appying monitor and asssting with spinal block
    They apply SCD and patient positioning
    Circulating Nurse
  21. This type of anesthesia is used for significant muscle relaxation when patient is going in for long procedure and/or in an awkward position
  22. What are the four stages of anesthesia?
    • 1. Induction
    • 2. Excitement
    • 3. Surgical Anesthesia or Maintenance
    • 4. Emergence
  23. State the stage of General Anesthesia:
    Resp. and HR may become irregular, uncontrolled movements, vomit, dilated pupils

  24. Which stage is this:
    Muscle relaxes, vomiting stops, respiratory depression occurs, eye movement stops

    D. Maintenance (surgical anesthesia)
  25. what are the maintenance drugs  used during a Monitored Anesthesia Care (MAC) or conscious sedation? What do they do?
    • 1. Propofol (Diprivan) - slows activity of brain, used to help relax for surgery
    • 2. Midazolam (Versed) - a benzo used as a sedative as part of balanced anesthesia
  26. Lidocaine and Marcaine (w/ or w/out epinephrine) may be used to help administer what kind of anesthesia?
  27. What is the most common post-op complication of spinals and epidurals?
  28. What are 2 risks for regional anesthetics?
    • 1. nerve damage
    • 2. Infection after cath placement
  29. T or F: Urinary retention is a risk for both spinals and epidurals
  30. ___ to ___ minutes is typical recovery time for post op
    30-60 minutes
  31. During post-op eval, BP should be within __a__ mm pre-op level.
    Temp should be within __b__ degrees C of preop.
    • a. 20
    • b. 1 degrees C
  32. List the things patient must show to be discharged home from post-op
    • 1. Fully orientated
    • 2. Able to ambulate again (normal sensation)
    • 3. Voiding
    • 4. Drinking fluids w/out nausea
    • 5. Can manage pain, understand teaching, and has transport and care for first 24hours
  33. Which statement made by a client scheduled for an exploratory laparotomy indicates to the nurse the client needs more information?

  34. The client in the preoperative holding area is wearing an amulet. What is the most appropriate intervention for the nurse?

  35. The nurse is obtaining consent for surgical procedure. Which client requires a valid co-signature?


    A narcotic pain med can cloud the client’s judgment of the procedure, in an emergency it can be dangerous to wait for the drug to wear off.  A 16 year old can sign for her infant.
  36. #1 Upon entering the patient's room, you plan to provide support and information in order to decrease T.A.'s anxiety. Which statement most accurately identifies why decreasing T.A.'s anxiety is a priority at this point?

  37. The nurse is assessing a client 2 hours postoperative open cholecystectomy.  The clients vital signs are  T= 98.8, P = 114, R= 18, BP = 168/92.  Which intervention should the nurse implement first?


    Acute pain will cause a physiological response of elevating the BP and pulse.  VS does not need to be rechecked.  Pain control should alleviate the elevated BP.  Positioning on the operative site will increase pain.
  38. The nurse is administering morphine intravenous push to a client with acute lower back pain. Which interventions should the nurse implement?  Select all that apply.

    a. Obtain the medication from the client’s medication drawer.
    b. Rule out neurological deficits.
    c. Administer the morphine slowly over 5 minutes.
    d. Ask the client to identify his place of birth.
    e. Check the MAR against the client’s identification band.
    b, c, e

    The nurse should rule out complications/deficits before masking sympatientoms with a narcotic.  Morphine is administered slowly IVP, and the nurse should check ID. Morphine comes from the controlled area in the Pyxis, and the birthplace would only be a secondary identifier IF the nurse can verify accuracy.
  39. The nurse is administering medications to clients on a surgical unit. Which medication should the nurse administer first?


    The first dose of antibiotic is the priority.  The nurse should investigate a different pain med for a level of 3.  the other meds can be given within the accepatiented time range of 30 minutes before and after the scheduled time.
Card Set
Perioperative Nursing
MS Exam 1 Lecture