Intraoperative Phase

Every question here, with the answer

1. During an operation, a perioperative nurse notices that there is doubt about whether an instrument package remained sterile. No one else appears to have seen the possible contamination. What is the nurse’s best action?

   1. Ask the surgeon after closure whether the item should be considered contaminated.
   2. Speak up and take appropriate action to address possible contamination.
   3. Continue the procedure because the sterile field has not visibly changed.
   4. Wait until the end of the procedure and document the concern.

   Answer: Speak up and take appropriate action to address possible contamination.

   The correct action reflects surgical conscience: when sterility is in doubt, the nurse speaks up and acts to prevent patient harm. Ignoring the concern, delaying action, or waiting until after the procedure fails to maintain sterile technique and may increase the risk of SSI.

2. The RN circulator is preparing for an intraoperative case. Which actions are responsibilities of the RN circulator? Select all that apply.

   1. Ensure an accurate surgical count to help prevent retained surgical items.
   2. Label medications and fluids on the sterile field.
   3. Monitor the sterile field to prevent contamination.
   4. Coordinate communication among surgical team members.
   5. Administer anesthesia and monitor vital signs during surgery.

   Answer: Ensure an accurate surgical count to help prevent retained surgical items., Monitor the sterile field to prevent contamination., Coordinate communication among surgical team members.

   The RN circulator coordinates communication, monitors the sterile field, and ensures an accurate surgical count. Labeling medications and fluids on the sterile field is listed for the scrub person, while administering anesthesia and monitoring vital signs are responsibilities of the anesthesia provider.

3. A surgical team confirms the patient, procedure, and site only before the first incision. Which response by the perioperative nurse best supports the National Patient Safety Goals described in this section?

   1. Ask the surgeon to confirm the site privately before the case begins.
   2. Accept this practice because confirmation before incision is the required time-out.
   3. Document that the team completed the time-out after the incision is made.
   4. Remind the team that confirmation should occur before induction, before incision, and before the patient leaves the OR.

   Answer: Remind the team that confirmation should occur before induction, before incision, and before the patient leaves the OR.

   The section describes confirmation at three points: before induction of anesthesia, before incision, and before the patient leaves the OR. Limiting verification to only one point, doing it privately, or documenting it after the fact does not follow the described safety process.

4. A nurse is reviewing surgical attire and zones with a new perioperative staff member. Which statements are accurate? Select all that apply.

   1. The restricted zone requires at least surgical attire plus head covering and mask.
   2. Shoe covers are not required if the shoes are worn only in the surgical suite.
   3. Street clothing is allowed in the unrestricted zone.
   4. Personnel in the semirestricted zone are clothed in surgical attire.
   5. Scrubbed personnel may wear rings as long as sterile gloves cover them.

   Answer: The restricted zone requires at least surgical attire plus head covering and mask., Shoe covers are not required if the shoes are worn only in the surgical suite., Street clothing is allowed in the unrestricted zone., Personnel in the semirestricted zone are clothed in surgical attire.

   The unrestricted, semirestricted, and restricted zones each have specific attire expectations, and shoes worn only in the surgical suite do not require shoe covers. Scrubbed personnel must not wear rings, watches, bracelets, or necklaces that can fall outside sterile scrubbed attire.

5. The team is preparing for a procedure using a laser. Which situation should the nurse recognize as creating the greatest fire concern based on the fire triangle?

   1. The scrub person organizes instruments on the sterile field.
   2. The anesthesia provider discusses postoperative pain management orders.
   3. A laser is used near surgical drapes while oxygen is present.
   4. A patient is transported through the unrestricted zone in street clothing.

   Answer: A laser is used near surgical drapes while oxygen is present.

   A fire requires fuel, an oxidizer, and an ignition source; surgical drapes, oxygen, and a laser represent those three elements. The other options do not combine the elements of the fire triangle described in the section.

6. During a procedure using electrosurgical equipment, surgical smoke is visible. Which actions or understandings are appropriate for the perioperative nurse? Select all that apply.

   1. Ignore the smoke because patient exposure is short-term and relatively low-risk.
   2. Use an effective smoke evacuation system.
   3. Use smoke plume management techniques such as smoke shields or suction devices.
   4. Turn off ventilation to prevent movement of smoke through the room.
   5. Recognize that daily exposure of surgical personnel to surgical smoke can cause multiple health problems.

   Answer: Use an effective smoke evacuation system., Use smoke plume management techniques such as smoke shields or suction devices., Recognize that daily exposure of surgical personnel to surgical smoke can cause multiple health problems.

   The section emphasizes smoke evacuation systems and smoke plume management techniques to protect patients and personnel. Although patient exposure is described as short-term and relatively low-risk, daily exposure for surgical personnel can cause multiple health problems, so ignoring smoke is inappropriate; turning off ventilation is not supported by the section.