MSNCB Perioperative Nursing 3 — Questions and Answers
Question 1: Which positioning complication is most associated with the lithotomy position during surgery?
- Brachial plexus injury
- Compartment syndrome of the lower extremities (Correct answer)
- Pressure ulcer on the occiput
- Air embolism
Correct answer: Compartment syndrome of the lower extremities
Prolonged lithotomy position can impair lower extremity perfusion, leading to compartment syndrome, especially in lengthy procedures.
Question 2: The circulating nurse notices the surgical drape has become wet near the incision site. What is the priority action?
- Place a waterproof pad over the wet area and continue
- Notify the surgeon and prepare to change the drape to maintain sterility (Correct answer)
- Document the finding and monitor for signs of infection postoperatively
- Apply a sterile towel over the wet drape
Correct answer: Notify the surgeon and prepare to change the drape to maintain sterility
A wet drape is considered contaminated because moisture enables microorganism migration (strike-through contamination), requiring drape replacement.
Question 3: A patient's core temperature drops to 35.2°C intraoperatively. Which intervention is most appropriate?
- Increase the OR ambient temperature and apply a forced-air warming blanket (Correct answer)
- Administer a bolus of warm IV fluid only
- Cover the patient with standard cotton blankets
- Notify the surgeon but continue the procedure without intervention
Correct answer: Increase the OR ambient temperature and apply a forced-air warming blanket
Active warming with forced-air warming blankets and increasing OR temperature are first-line interventions for intraoperative hypothermia.
Question 4: Which parameter most directly reflects adequate tissue oxygenation in a PACU patient?
- Blood pressure within normal range
- Pulse oximetry SpO2 ≥ 95% (Correct answer)
- Urine output of 0.3 mL/kg/hr
- Skin color pink without cyanosis
Correct answer: Pulse oximetry SpO2 ≥ 95%
Pulse oximetry SpO2 ≥ 95% is the direct quantitative measure used to assess adequate arterial oxygen saturation in PACU patients.
Question 5: When performing a surgical hand scrub, which area requires the most attention to ensure adequate antisepsis?
- The dorsal surface of the hands
- The subungual area (under the fingernails) (Correct answer)
- The forearms up to the elbows
- The wrist crease
Correct answer: The subungual area (under the fingernails)
The subungual area harbors the highest concentration of microorganisms and requires thorough cleaning during the surgical hand scrub.
Question 6: A patient arriving in the PACU after general anesthesia begins to exhibit muscle rigidity, high fever, and hemodynamic instability. Which condition should the nurse suspect?
- Neuroleptic malignant syndrome
- Malignant hyperthermia (Correct answer)
- Septic shock
- Thyroid storm
Correct answer: Malignant hyperthermia
Malignant hyperthermia is a life-threatening hypermetabolic crisis triggered by inhaled anesthetic agents or succinylcholine, presenting with muscle rigidity and hyperthermia.
Question 7: Which documentation element is most critical when completing the intraoperative nursing record?
- Names of all OR personnel who observed the procedure
- Surgical count results with nurse signatures at each count (Correct answer)
- Patient's preoperative vital signs from the floor
- Estimated duration of future dressing changes
Correct answer: Surgical count results with nurse signatures at each count
Accurate documentation of surgical count results with nurse signatures is a legal requirement and key patient safety record.
MSNCB Perioperative Nursing 3
Which positioning complication is most associated with the lithotomy position during surgery?