A nurse is assisting a physician who is performing a circumcision ...

[rmenurse]

A nurse is assisting a physician who is performing a circumcision on a newborn. The physician asks the nurse to prepare lidocaine and epinephrine for injection to provide anesthesia. What will the nurse do?
 
  a. Ask the provider why an injectable anes-thetic is being used for this procedure.
  b. Draw up the medication as ordered and prepare the infant for the procedure.
  c. Make sure that seizure precautions are in place.
  d. Question the use of the epinephrine for this procedure.

Question 2

A nurse is caring for a patient after hip replacement surgery. The patient has been receiving iron replacement therapy for 2 days. The nurse notes that the patient's stools appear black. The patient is pale and complains of feeling tired.
 
  The patient's heart rate is 98 beats per minute, respirations are 20 breaths per minute, and the blood pressure is 100/50 mm Hg. The nurse will contact the provider to: a. report possible gastrointestinal hemorr-hage.
  b. request a hemoglobin and hematocrit (H&H).
  c. request an order for a stool guaiac.
  d. suggest giving a hypertonic fluid bolus.

[lin77x]

Answer to Question 1

D
The physician is preparing to use infiltration anesthesia by injecting the local anesthetic directly into the immediate area of surgery. Epinephrine can be used in some cases but should never be used in areas supplied by end arteries, such as the penis, toes, fingers, nose, or ears, because re-striction of blood flow in these areas can result in gangrene. Injectable agents are appropriate for this procedure. The nurse should not draw up the medication as requested, because the combina-tion of agents can harm the patient. Seizure precautions are not necessary.

Answer to Question 2

B
This patient is showing signs of iron deficiency anemia, as manifested by tachycardia and pallor. Because this patient's blood pressure is low, the anemia probably has occurred secondary to blood loss, a common occurrence with hip replacement surgery. The first response should be to obtain an H&H to assess the anemia. GI hemorrhage is not a concern in this patient; black stools are an expected effect of oral iron administration. A stool guaiac is not indicated. If the patient has blood loss that is causing hypotension, an isotonic fluid bolus and packed red blood cells (PRBCs) are indicated to treat this.

[rmenurse]

Excellent

[zacnyjessica]

Thanks for the timely response, appreciate it