Which activities are the circulating nurse's responsibilities in the operating room? Show
1. Monitor the position of the client, prepare the surgical site, and ensure the client's safety. 1. Monitor the position of the client, prepare the surgical site, and ensure the client's safety. Rationale: The circulating nurse has many responsibilities in the OR, including coordinating the activities in the OR, keeping the OR clean, ensuring the safety of the client and maintaining the humidity, lighting and safety of the equipment. Why it's not the rest: Option 2 and 4 are the roles of an anesthesiologist or nurse anesthetist. Option 3 is the role of the scrub nurse or technician. The circulating nurse observes the surgical scrub technician remove a sponge from the edge of the sterile field with a clamp and place the sponge and clamp in a designated area. Which action should the nurse implement? 1. Place the sponge back where it was. 3. Do nothing because this is the correct procedure. Rationale: The technician followed the correct procedure. Sponges are counted to maintain client safety, so all sponges must be kept together to repeat the count before the incision site is to be sutured. The sponge must not be removed, not used, and placed in a designated area to be counted later. Why it's not the rest: Items which are on the edge of the sterile field are considered contaminated and should be removed from the field. The technician is not wasting supplies, and is following principles of asepsis. Taking a contaminated sponge out of the room would cause a discrepancy in the sponge count. The circulating nurse and the scrub technician find a discrepancy in the sponge count. Which action should the circulating nurse take first? 1. Notify the client's surgeon. 4. Recount all sponges. Rationale: A recount of the sponges may lead to the discovery of the cause of the presumed error. Usually it is just a miscount or a result of a sponge being placed in a location other than the sterile field, such as the floor or a lower shelf. Why it's not the rest: When discrepancies occur in the count, it is usually a simple mistake discovered with a recount. The surgeon will be notified if the count is wrong after a recount. If an error is found to have been made, an occurrence report will be completed, but it is not a first intervention. Contacting the surgical manager occurs when a correct count is not maintained, and is not a first intervention. Which violation of surgical asepsis would require immediate intervention by the circulating nurse? 1. Surgical supplies
were cleaned and sterilized prior to the case. 4. The scrub nurse setting up the sterile field is wearing artificial nails. Rationale: According to the Centers for Disease Control (CDC), the Association of Operating Room Nurses (AORN), and the Association for Practitioners in Infection Control (APIC), artificial nails harbor microorganisms, which increase the risk of infection. Why it's not the rest: All other answers are appropriate activities and precautions to be taken following principles of surgical asepsis. The nurse identifies the nursing diagnosis "risk for injury related to positioning" for the client in the operating room. Which nursing intervention should the nurse implement? 1. Avoid using the cautery unit which does not have a biomedical tag on it. 2. Carefully pad the client's elbows before covering the client with a blanket. Rationale: Padding the elbows decreases pressure so nerve damage and pressure ulcers are prevented; this addresses the nursing diagnosis etiology. Why it's not the rest: Option 1 would prevent an electrical injury. Option 3 would decrease hypothermia. Option 4 would help prevent interactions between anesthesia and routine medications. The circulating nurse is positioning clients for surgery. Which client has the greatest potential for nerve damage? 1. The
16-year-old client in the dorsal recumbent position having an appendectomy. 2. The 68-year-old client in the Trendelenburg position having a cholecystectomy. Rationale: The client's age, along with positioning with increased weight and pressure on the shoulders, put this client at a higher risk. Why it's not the rest: The other positions do not put the clients at risk for nerve damage. Which situation demonstrates the circulating nurse acting as the client's advocate? 1. Plays the client's favorite audio book during surgery. 3. Keeps the operating room door closed at all times. Rationale: This would keep the client's dignity by maintaining privacy. With this action, the nurse is speaking for the client while the client cannot speak as a result of anesthesia; this is an example of client advocacy. Why it's not the rest: The client is not awake during surgery, so laying a favorite audio book is not client advocacy. Keeping the family informed is a nice thing to do, but is not client advocacy. Clients should be referred to by their last name, rather than first, unless the client requests the staff to use his or her first name; this is not an example of client advocacy. The circulating nurse is planning the care for an intraoperative client. Which statement is the expected outcome? 1. The client has no injuries from the OR
equipment. 1. The client has no injuries from the OR equipment. Rationale: This expected outcome addresses the safety of the client while in the OR. Why it's not the rest: Option 2 is an example of an expected outcome in the postoperative period. The anesthesiologist or the nurse anesthetist would monitor the client's vital signs during surgery, as well as how the client recovers from anesthesia. Which nursing intervention has the highest priority when preparing the client for a surgical procedure? 1. Pad the client's elbows and knees. 2. Apply soft restraint straps to the extremities. Rationale: This action would prevent the client from falling off the table, which is the highest priority. Why it's not the rest: Padding prevents nerve damage from positioning. Preparing the incision site is not a higher priority than preventing the patient from falling. The temperature of the room does not have a higher priority than safety. The nursing manager is making assignments for the OR. Which case should the manager assign to the inexperienced nurse? 1. The client having open-heart surgery. 2. The client having a biopsy of the breast. Rationale: The case of a client having a biopsy of the breast would be a good case for an inexperienced nurse because it is simple. Why it's not the rest: Open-heart surgery is complex, and the care of the client should be assigned to an experienced nurse with special training. Laser eye surgery requires the nurse in the OR to have additional training to operate the equipment. Additional training to be in the OR would be required for the laparoscopic because special care to prevent infection is needed in orthopedic cases. The circulating nurse assesses tachycardia and hypotension in the client. Which intervention should the nurse implement? 1. Prepare ice packs and mix dantrolene sodium. 1. Prepare ice packs and mix dantrolene sodium. Rationale: Unexplained tachycardia, hypotension, and elevated temperature are signs of malignant hyperthermia, which is treated with ice packs and dantrolene sodium. Why it's not the rest: A defibrillator would be needed if the client were in ventricular tachycardia, or ventricular fibrillation. A PTT and heparin would not be appropriate for malignant hyperthermia. A finger stick would be appropriate for the client if they had diabetes. The nurse is planning the care of the surgical client having a procedural sedation. Which intervention has the highest priority? 1. Assess the
client's respiratory status. 1. Assess the client's respiratory status. Rationale: Assessing the respiratory rate, rhythm, and depth is the most important action. Why it's not the rest: The nurse needs to monitor all systems, but monitoring the urine output would not be priority over monitoring breathing. Monitoring the client's ECG is appropriate, but it is not the priority. The client needs to be relaxed, not focused, but this is not priority over respiratory status. What is involved with being a circulating nurse and a scrubbed in personnel?Shared Duties
Both scrub nurses and circulating nurses are responsible for keeping the operating room running smoothly. Each is responsible for patient care; the circulating nurse takes care of the patient before the operation and the scrub nurse monitors the health of the patient during the operation.
Which nursing intervention has the highest priority when preparing the client for surgical intervention?Nursing Responsibilities
Safety is the highest priority.
Which activities are the circulating nurse's responsibility in the operating room?Responsibilities include ensuring that surgical asepsis is adhered to during the surgical procedure, keeping track and conducting an inventory of supplies and equipment used during and after the surgical procedure, or calling for a time-out.
Which priority intervention should the nurse in the preoperative waiting area implement?The key nursing intervention during the preoperative period is patient and family education. Take every opportunity during the patient assessment and preparation for surgery, to provide information that will increase the patient's familiarity with the procedure, which will decrease anxiety.
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Which violation of surgical asepsis would require immediate intervention by the circulating nurse?
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