CNOR Managing Emergency Situations 4 — Questions and Answers
Question 1: A patient receiving a blood transfusion intraoperatively develops hypotension, hemoglobinuria, and back pain. The nurse should FIRST:
- Slow the transfusion rate and continue monitoring
- Stop the transfusion and maintain IV access with normal saline (Correct answer)
- Administer diphenhydramine and continue the transfusion
- Document the reaction and notify the blood bank after the case
Correct answer: Stop the transfusion and maintain IV access with normal saline
These signs indicate an acute hemolytic transfusion reaction; stopping the transfusion immediately while maintaining IV access is the critical first step.
Question 2: During a spine procedure in prone position, the patient develops a sudden drop in oxygen saturation and absent breath sounds on the left. The nurse anticipates:
- Pneumothorax requiring chest tube insertion (Correct answer)
- Endobronchial intubation requiring tube repositioning
- Allergic reaction requiring epinephrine
- Pulmonary embolism requiring anticoagulation
Correct answer: Pneumothorax requiring chest tube insertion
Sudden unilateral absent breath sounds with desaturation in a prone patient suggests tension pneumothorax, which requires immediate decompression.
Question 3: Which action is MOST important when a power outage occurs in the OR during an active surgical procedure?
- Immediately evacuate all OR personnel
- Switch critical equipment to emergency battery backup and notify engineering (Correct answer)
- Cancel remaining cases for the day
- Restart all equipment to restore normal function
Correct answer: Switch critical equipment to emergency battery backup and notify engineering
Switching life-support and critical equipment to emergency power and notifying facilities engineering ensures patient safety while restoring power.
Question 4: A patient experiences laryngospasm during emergence from anesthesia. The FIRST nursing action is to:
- Assist the anesthesia provider with jaw thrust and positive pressure ventilation (Correct answer)
- Prepare succinylcholine for immediate administration
- Administer 100% oxygen via non-rebreather mask
- Place the patient in high-Fowler's position
Correct answer: Assist the anesthesia provider with jaw thrust and positive pressure ventilation
Laryngospasm is an airway emergency; the first response is supporting the anesthesia provider with jaw thrust and positive pressure ventilation to break the spasm.
Question 5: Which intraoperative finding is the EARLIEST reliable indicator of malignant hyperthermia?
- Mottled skin and cyanosis
- Rising end-tidal CO2 (EtCO2) (Correct answer)
- Elevated body temperature
- Ventricular fibrillation on ECG
Correct answer: Rising end-tidal CO2 (EtCO2)
Rising EtCO2 is the earliest and most sensitive sign of MH because accelerated cellular metabolism produces CO2 before temperature rises significantly.
Question 6: In a 'can't intubate, can't oxygenate' (CICO) airway emergency, the DEFINITIVE rescue intervention is:
- Repeated laryngoscopy attempts with a different blade
- Cricothyrotomy (Correct answer)
- Nasopharyngeal airway insertion
- Bag-valve-mask ventilation with two providers
Correct answer: Cricothyrotomy
Cricothyrotomy is the definitive surgical airway rescue procedure when all other airway management attempts have failed in a CICO emergency.
Question 7: A patient develops intraoperative anaphylaxis to latex. After administering epinephrine, which intervention addresses the UNDERLYING trigger?
- Switching to non-latex gloves and removing all latex from the field (Correct answer)
- Administering a second dose of epinephrine prophylactically
- Applying a tourniquet to slow allergen absorption
- Increasing anesthetic depth to suppress the response
Correct answer: Switching to non-latex gloves and removing all latex from the field
Removing all latex products from the surgical field eliminates ongoing allergen exposure, which is essential to prevent continued or escalating anaphylaxis.
CNOR Managing Emergency Situations 4
A patient receiving a blood transfusion intraoperatively develops hypotension, hemoglobinuria, and back pain.
The nurse should FIRST: