OMSB_OEN Practice Questions

To calculate the flow rate in drops per minute (gtt/min), use the formula:

Flow rate (gtt/min) = (Total volume (ml) × Drop factor (gtt/ml)) / Time (minutes)

Given:

Total volume = 500 ml

Drop factor = 15 gtt/ml

Time = 4 hours (240 minutes)

Flow rate (gtt/min) = (500 ml × 15 gtt/ml) / 240 minutes = 7500 gtt / 240 minutes = 31.25 gtt/min

Rounded to the nearest whole number, the flow rate is 32 drops/minute.

Role of Circulating Nurse: The circulating nurse manages the overall environment of the operating

room, ensuring safety and coordination among the surgical team. They are responsible for

maintaining patient safety, including correct positioning.

Prioritizing Safety:

Risk for anxiety: While relevant, managing anxiety is typically addressed preoperatively and

postoperatively, not the immediate intraoperative period.

Risk for bleeding: While bleeding is a concern, it is primarily monitored and managed by the surgical

team.

Risk for injury related to positioning: During surgery, improper positioning can lead to nerve damage,

pressure sores, and musculoskeletal injuries. The circulating nurse must ensure that the patient is

correctly positioned to avoid these injuries.

Risk for infection: Preventing infection is crucial, but the sterile field and surgical techniques

primarily address this risk.

Conclusion: The highest priority for the circulating nurse is to ensure the patient is correctly

positioned to prevent any injury related to positioning, as this is a direct and immediate

responsibility during the surgical procedure.

Reference: Surgical nursing textbooks, NCLEX-RN review guides, AORN (Association of periOperative

Registered Nurses) guidelines.

According to Freud's theory of psychosexual development, the stage affected in a newborn is the oral

stage.

Oral Stage: This stage occurs from birth to about 18 months of age, where the infant's pleasure

centers on the mouth through activities like sucking and biting.

Anal Stage: This stage follows the oral stage, from 18 months to 3 years, focusing on bowel and

bladder control.

Phallic Stage: This occurs from 3 to 6 years, focusing on the genitals and the differences between

males and females.

Latent Stage: This stage occurs from 6 years to puberty, characterized by dormant sexual feelings and

a focus on social and intellectual skills.

Reference:

Freud, S. (1905). Three Essays on the Theory of Sexuality.

National Institutes of Health (NIH): Child Development Theories

Chlorpromazine is an antipsychotic medication that can cause extrapyramidal symptoms (EPS), such

as muscle spasms and tremors. Benztropine is an anticholinergic medication often prescribed to

manage these side effects.

If a client on chlorpromazine develops muscle spasms and tremors, it indicates EPS, and

administering Benztropine would help alleviate these symptoms. The other options, such as severe

agitation, sore throat, or suicidal thoughts, are not directly related to the need for Benztropine.

Reference:

Stahl,

S. M. (2013). Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical

Applications. Cambridge University Press.

Cushing Syndrome Symptoms:

Cushing syndrome is characterized by high levels of cortisol which can lead to brittle bones

(osteoporosis), easy bruising, and muscle weakness.

Best Nursing Actions:

Review Calcium Level: Important but not the immediate priority to prevent fractures.

Orthopedic Clinic Visit: Necessary for follow-up but not the immediate action.

High Protein Diet: Important for muscle strength but secondary to immediate safety.

Protective Environment: Preventing falls and injuries is the best immediate action to avoid further

fractures and bruising. Ensuring the patient’s environment is safe and free from hazards is essential.

Reference:

Mayo Clinic guidelines on Cushing Syndrome

American Association of Clinical Endocrinologists (AACE)

Post-Tonsillectomy Care:

After a tonsillectomy, the focus is on minimizing discomfort, preventing bleeding, and promoting

healing.

Food and Drink Recommendations:

Citrus Juice and Carbonated Beverages: These can irritate the throat and should be avoided.

Fruits Cut into Pieces: Solid foods can be difficult to swallow and may cause discomfort.

Crushed Ice: Helps to soothe the throat, reduce swelling, and provide hydration without causing

irritation.

Reference:

American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

Mayo Clinic guidelines on tonsillectomy aftercare

A perforated appendix is a medical emergency requiring immediate surgical intervention to prevent

complications such as peritonitis and sepsis. Therefore, an appendectomy in this context is classified

as an emergent procedure. Emergent surgeries are those that need to be performed without delay to

preserve the patient's life or health.

Reference:

Smeltzer,

S. C., Bare,

B. G., Hinkle,

J. L., & Cheever,

K. H. (2010). Brunner & Suddarth's Textbook of

Medical-Surgical Nursing. Lippincott Williams & Wilkins.

When assessing the health of a family, considering their genetic predispositions to certain conditions

falls under the category of bio-cultural factors. These factors include genetic traits, physical

characteristics, and biological variations that can influence health. In this case, the nurse's awareness

of the genetic predisposition of Asian individuals to cardiovascular diseases helps in understanding

the family's health risks.

Reference:

Spector,

R. E. (2017). Cultural Diversity in Health and Illness. Pearson.

Handling Medication Refusal:

When a patient refuses medication, the nurse must assess the reason and ensure the patient's safety

and adherence to treatment plans.

Best Actions:

Report to the Physician: Ensures the healthcare provider is aware and can make necessary

adjustments or provide alternatives.

Crushing Medication and Mixing: Bisacodyl tablets should not be crushed as it can alter the drug's

effectiveness and increase side effects.

Informing about Dosing: Not helpful if the patient is already refusing.

Ice Chips: Not relevant to enhancing medication compliance.

Reference:

American Nurses Association (ANA) on patient medication administration

Pharmacology guidelines on Bisacodyl administration

The situation describes a breach of confidentiality, which occurs when private patient information is

accessed or disclosed without proper authorization.

Negligence: This refers to the failure to provide the standard of care that a reasonably prudent

person would provide in a similar situation, but it doesn't specifically address unauthorized access to

patient information.

Malpractice: This is a type of negligence by a professional, which results in harm to the patient, and

usually involves direct patient care rather than record-keeping issues.

Breach of Privacy: This involves the inappropriate disclosure of private information. In this case,

using someone else's account does not directly disclose patient information to unauthorized parties.

Breach of Confidentiality: This specifically addresses the unauthorized access or use of patient

information, which is exactly what happened when another nurse used the first nurse's account to

enter notes.

Reference:

Health Insurance Portability and Accountability Act (HIPAA) Guidelines

American Nurses Association (ANA): Code of Ethics for Nurses with Interpretive Statements