1. The nurse has administered a preoperative medication to the patient going to surgery. Which action will
the nurse take next?
a. Notify the operating suite that the medication has been given.
b. Instruct the patient to call for help to go to the restroom.
c. Waste any unused medication according to policy.
d. Ask the patient to sign the consent for surgery.
ANS: B
Once a preoperative medication has been administered, instruct the patient to call for help when getting out of
bed to prevent falls. For patient safety, explain the purpose of a preoperative medication and its effects.
Notifying the operating suite that the medication has been given may be part of a facilities procedure but is not
the best next step. It is important to have the patient sign consents before the patient has received medication
that may make him/her drowsy. Wasting unused medication according to policy is important but is not the best
next step.
2. The nurse has completed a preoperative assessment for a patient going to surgery and gathers assessment
data. Which will be the most important next step for the nurse to take?
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a. Notify the operating suite that the patient has a latex allergy.
b. Document that the patient had a bath at home this morning.
c. Administer the ordered preoperative intravenous antibiotic.
d. Ask the nursing assistive personnel to obtain vital signs.
ANS: A
The most important step is notifying the operating suite of the patient’s latex allergy. Many products that
contain latex are used in the operating suite and the postanesthesia care unit (PACU). When preparing for a
patient with this allergy, special considerations are required from preparation of the room to the types of tubes,
gloves, drapes, and instruments utilized. Obtaining vital signs, documenting, and administering medications
are all part of the process and should be done—with the latex allergy in mind. However, making sure that the
patient has a safe environment is the first step.
3. The nurse is preparing a patient for a surgical procedure on the right great toe. Which action will be
mostimportant to include in this patient’s preparation?
a. Place the patient in a clean surgical gown.
b. Ask the patient to remove all hairpins and cosmetics.
c. Ascertain that the surgical site has been correctly marked.
d. Determine where the family will be located during the procedure.
ANS: C
Because errors have occurred in the past with patients undergoing the wrong surgery on the wrong site, the
universal protocol guidelines have been implemented and are used with all invasive procedures. Part of this
protocol includes marking the operative site with indelible ink. Knowing where the family is during a
procedure, placing the patient in a clean gown, and asking the patient to remove all hairpins and cosmetics are
important but are not most important in this list of items.
4. The circulating nurse is caring for a patient intraoperatively. Which primary role of the circulating nurse
will be implemented?
a. Suturing the surgical incision in the OR suite
b. Managing patient care activities in the OR suite
c. Assisting with applying sterile drapes in the OR suite
Handing sterile instruments and supplies to the surgeon in the OR
d. suite
ANS: B
The circulating nurse is an RN who remains unscrubbed and uses the nursing process in the management of
patient care activities in the OR suite. The circulating nurse also manages patient positioning, antimicrobial
skin preparation, medications, implants, placement and function of intermittent pneumatic compression (IPC)
devices, specimens, warming devices and surgical counts of instruments, and dressings. The RN first assistant
collaborates with the surgeon by handling and cutting tissue, using instruments and medical devices, providing
exposure of the surgical area and hemostasis, and suturing. The scrub nurse, who can be a registered nurse, a
licensed practical nurse, or a surgical technologist, maintains the sterile field, assists with applying the sterile
drapes, and hands sterile instruments and supplies to the surgeon.
5. The nurse is caring for a patient in the preoperative holding area of an ambulatory surgery center. Which
nursing action will be most appropriate for this area?
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