Perioperative Nursing Flashcards

A patient is scheduled for elective laparoscopic cholecystectomy at a Saudi hospital. She has been NPO (nil per os) since midnight. The anesthesiologist approves clear fluids up to 2 hours before surgery per current Saudi guidelines. At 06:00 for a 10:00 surgery, the nurse should:

Answer: Offer the patient water or clear apple juice up to 250 mL since it is still 4 hours before surgery

Current enhanced recovery after surgery (ERAS) and anesthesia guidelines — adopted in Saudi MOH hospitals — permit clear fluids up to 2 hours before surgery (solids NPO for 6–8 hours). At 06:00 for a 10:00 surgery, the patient has 4 hours remaining, so offering up to 250 mL of clear fluid is appropriate and reduces preoperative thirst and insulin resistance. Strict midnight NPO for clear fluids is outdated practice.

During an intraoperative procedure, the scrub nurse is responsible for:

Answer: Passing sterile instruments directly to the surgeon while maintaining the sterile field

The scrub nurse (sterile nurse) works within the sterile field, passing instruments and supplies directly to the surgeon and first assistant. The circulating nurse (non-sterile) documents fluids, retrieves supplies, and positions the patient. Anesthetic agents are administered only by the anesthesiologist or nurse anesthetist. The scrub nurse's primary responsibility is maintaining sterility and instrument integrity throughout the procedure.

A patient in the Post-Anesthesia Care Unit (PACU) of a Saudi hospital has a Glasgow Coma Scale (GCS) score of 15, SpO2 of 98% on room air, pain score of 2/10, and stable vital signs 30 minutes after arriving from the OR. Using the Aldrete Scoring System, what is the MOST appropriate next action?

Answer: Prepare the patient for transfer to the surgical ward

The Aldrete Score assesses activity, respiration, circulation, consciousness, and SpO2 — a score of 9–10/10 indicates PACU discharge readiness. This patient has a GCS of 15 (full consciousness), SpO2 98% on room air, mild pain, and stable vitals, indicating a high Aldrete score. Transfer to the surgical ward is appropriate. Unnecessary PACU prolongation consumes critical resources in Saudi hospitals applying ERAS protocols.

Before a patient undergoes surgery under general anesthesia at a Saudi hospital, the preoperative nurse must verify the surgical safety checklist (WHO Surgical Safety Checklist). Which of the following is verified during the 'Sign In' phase (before anesthesia induction)?

Answer: Patient identity, consent, site marking, allergy status, and airway/aspiration risk

The WHO Surgical Safety Checklist has three phases: Sign In (before anesthesia) confirms patient identity, informed consent, surgical site marking, known allergies, and anesthesia/aspiration risk assessment. 'Time Out' (before incision) confirms team introductions, antibiotics, and anticipated critical events. 'Sign Out' (before leaving OR) covers instrument/sponge counts and specimen labeling. Antibiotic timing is confirmed at Time Out.

A postoperative patient in a Saudi hospital's PACU develops laryngospasm 15 minutes after extubation. Which is the nurse's PRIORITY intervention?

Answer: Apply jaw thrust, administer 100% oxygen via tight-fitting mask, and call the anesthesiologist immediately

Laryngospasm is a life-threatening closure of the vocal cords causing airway obstruction. The immediate priorities are: apply a jaw thrust to open the airway, provide 100% oxygen with positive pressure via a tightly fitting mask, and immediately summon the anesthesiologist. Vigorous suctioning can worsen laryngospasm by stimulating the larynx. Opioids are contraindicated as they depress respiration. Supine positioning without airway management does not address the obstruction.

A nurse is preparing a surgical site for an orthopedic procedure on the right knee. According to Saudi MOH Infection Prevention Standards and WHO surgical site infection guidelines, which antiseptic agent is PREFERRED for skin preparation of an intact surgical site?

Answer: Chlorhexidine gluconate in alcohol (CHG-alcohol)

Chlorhexidine gluconate in alcohol (CHG-alcohol) is the preferred surgical skin antiseptic per WHO SSI prevention guidelines and Saudi MOH standards because it offers both immediate bactericidal action (from alcohol) and prolonged residual activity (from CHG). Aqueous povidone-iodine is a second choice if CHG-alcohol is contraindicated. Alcohol alone has no residual effect, and hydrogen peroxide is not appropriate for intact skin prep.