MSNCB Perioperative Nursing 5 — Questions and Answers
Question 1: A scrub nurse accidentally contaminates a glove during surgery. What is the correct immediate response?
- Wipe the glove with a sterile gauze and continue
- Request a glove change and re-establish sterility before continuing (Correct answer)
- Apply a sterile drape over the contaminated hand
- Notify the surgeon and wait for their instruction
Correct answer: Request a glove change and re-establish sterility before continuing
Any break in sterile technique requires immediate correction by changing the contaminated glove to prevent introducing microorganisms to the surgical field.
Question 2: Which laboratory result would most likely require postponement of an elective surgical procedure?
- Hemoglobin of 11.5 g/dL
- INR of 3.8 (Correct answer)
- Serum creatinine of 1.1 mg/dL
- Platelet count of 175,000/μL
Correct answer: INR of 3.8
An INR of 3.8 indicates excessive anticoagulation, significantly increasing intraoperative hemorrhage risk and requiring correction before elective surgery.
Question 3: During the surgical time-out, the team discovers the consent form lists the left knee but the surgical site is marked on the right knee. What should happen?
- Proceed with the right knee as the site marking takes precedence
- Halt the procedure and reconcile the discrepancy with the patient and surgeon before proceeding (Correct answer)
- Correct the consent form in the OR and proceed with surgery
- Proceed with the left knee as documented in the consent
Correct answer: Halt the procedure and reconcile the discrepancy with the patient and surgeon before proceeding
Any discrepancy identified during the time-out must be resolved before surgery begins to prevent wrong-site surgery.
Question 4: A patient returns to the surgical unit from PACU with a urinary catheter. Which postoperative assessment finding requires the most urgent action?
- Urine output of 40 mL over the past hour
- Urine output of 15 mL over the past two hours (Correct answer)
- Amber-colored urine with no sediment
- Urine output of 60 mL in the first postoperative hour
Correct answer: Urine output of 15 mL over the past two hours
Urine output less than 0.5 mL/kg/hr (approximately 30 mL/hr for average adult) over two hours indicates oliguria and possible acute kidney injury requiring urgent intervention.
Question 5: Which statement best describes the primary role of the circulating nurse during a surgical procedure?
- Maintaining the sterile field and passing instruments to the surgeon
- Managing the unsterile environment, coordinating care, and advocating for patient safety (Correct answer)
- Assisting the anesthesiologist with airway management
- Documenting the surgeon's intraoperative findings
Correct answer: Managing the unsterile environment, coordinating care, and advocating for patient safety
The circulating nurse works outside the sterile field to manage the OR environment, coordinate the team, document care, and serve as the patient's advocate.
Question 6: When applying electrosurgical unit (ESU) grounding pad to a patient, which site is most appropriate?
- Over a bony prominence such as the hip
- Over well-vascularized muscle mass close to the operative site (Correct answer)
- On the patient's back regardless of the surgical site
- Over a site with a tattoo for better conductivity
Correct answer: Over well-vascularized muscle mass close to the operative site
The ESU grounding pad should be placed on a well-vascularized, fleshy area close to the operative site to ensure even current distribution and prevent burns.
Question 7: A postoperative patient reports sudden onset of chest pain and shortness of breath on the first day after hip replacement surgery. Which complication should the nurse suspect first?
- Postoperative pneumonia
- Pulmonary embolism (Correct answer)
- Myocardial infarction
- Pleural effusion
Correct answer: Pulmonary embolism
Sudden chest pain and dyspnea in a postoperative orthopedic patient are classic signs of pulmonary embolism, a life-threatening complication of DVT.
MSNCB Perioperative Nursing 5
A scrub nurse accidentally contaminates a glove during surgery.
What is the correct immediate response?