**CNOR Flash Cards set 3 **
What ASA class might a person with mild systemic disease such as smoking or pregnancy receive? A: ASA I B: ASA II C: ASA III D: ASA IV E: ASA V F: ASA VI
B: ASA II
Which of the following statements is TRUE regarding chemical indicators? A: Chemical indicators can be used in place of biological indicators. B: Chemical indicators do not establish the sterility of an item. C: Chemical indicators consist of endospores that can measure the killing power of the sterilization process. D: These are 5 different classes of Chemical indicators.
B: Chemical indicators do not establish the sterility of an item. Chemical indicators should be used in conjunction with biological indicators and are not intended to replace biological indicators. Only a biological indicator indicator consists of resistant endospores can measure the microbial killing power of the sterilization process. The Association for the Advancement of Medical Instrumentation has defined 6 classes of chemical indicators, according to the type of process measurement they perform.
Double the distance from radiation source (IE: X-ray machine or C-arm) does what to the dose? A: Distance has no effect on radiation doses with medical equipment. B: Is equal to 1/4 of the intensity. C: Increases the dose. D: Is equal to 1/2 of the intensity.
B: Is equal to 1/4 of the intensity
The most powerful form of communication is: A: Humor B: Touch C: Empathy D: Active listening
B: Touch Touch is considered the most powerful form of communication. Comfort touch, such as holding a hand, is especially important for vulnerable patients who are experiencing severe illness. Other forms of nonverbal body language such as active listening, eye contact, pleasant facial expression, and empathy can be very comfortable to the distressed patient as well.
What condition would your patient be experiencing if their PH is less than 7.35 with HCo3 less than 22? A: Respiratory Acidosis B: Respiratory Alkalosis C: Metabolic Acidosis D: Metabolic Alkalosis
C: Metabolic Acidosis
Your patient is undergoing abdominal surgery when he suddenly begins to bleed heavily. His heart rate increases and his blood pressure starts to drop. What type of fluids should you prepare to administer for fluid resuscitation of this patient? A: Ringer's solution. B: Normal saline with potassium added. C: Dextrose in water. D: NaCl 0.45%
A: Ringer's solution. You should prepare to resuscitate the patient using a crystalloid such as Ringer's solution. Colloids such as albumin and hetastarch (Hespan, Hextend) may also be used. These solutions are administered IV for fluid replacement and plasma volume expansion. They are not the sole replacement for blood loss and must be used with caution. They are blood volume expanders, adding volume to the vascular space. Normal saline with added potassium, dextrose in water, and NaCl are not blood volume expanders this not appropriate for use in this situation.
Ozone gas sterilization is used for all types of surgical devices EXCEPT: A: Sealed glass ampules. B: Heat- and moisture-sensitive items. C: Metal instruments. D: Instruments with rigid lumens.
A: Sealed glass ampules. Ozone gas sterilization provides an alternative to EO gas sterilization of many heat- and moisture-sensitive items. The FDA has cleared ozone sterilization for use on plastic, metal, and instruments with rigid lumen; it sterilizes by oxidation, a process that destroys organic and inorganic matter. It penetrates the membrane of cells, causing them to explode. Ozone sterilization destroys natural rubber, such as latex, natural fibers, and some plastics. It cannot be used to sterilize sealed glass ampules or implants and flexible endoscopes (at this time).
All of the following are ways in which microsurgical instruments should be cared for after cleaning EXCEPT: A: Sharpen microsurgical instruments. B: Check microsurgical instruments for burrs and nicks. C: Demagnetize microsurgical instruments. D: Check microsurgical forceps to ensure they align.
A: Sharpen microsurgical instruments. After cleaning, inspect microsurgical instruments under a magnifying glass or microscope to check alignment and detect burrs on tips and nicks on cutting edges. The exact alignment of teeth on fine tooth forceps is an absolute necessity. Microscopic teeth are very easily bent. Demagnetize instruments by passing them back through a magnetic field. Sharpening and repair should be done by reputable instrument companies.
Patient stretchers transportation for the preoperative holding room to the OR involves all of the following actions EXCEPT: A: Ensure slow and smooth travel B: Attach the IV pole to the stretcher near the patient's head. C: Make sure the staff member is at the patient's head D: Push from the head end so the patient's feet go first
B: Attach the IV pole to the stretcher near the patient's head. The IV pole should be placed at the foot of the stretcher for safety, away from the patient's head. Transporting a patient's involves the patient going feet first with the staff member pushing the stretcher at the patient's head, and the travel should be slow and smooth. Quick movements through corridors and around corners can cause dizziness and nausea, especially if the patient has been medicated. The staff member at the head end can observe the patient for respiratory distress and/or vomiting.
Microbial communities that are tightly attached to surfaces and cannot be easily removed are known as: A: Endospores B: Biofilms C: Colonies D: Bioburden
B: Biofilms Biofilm forms when one or more species of bacteria, fungi, and other microorganisms adhere in layers to moistened surfaces, such as biological tissue, implanted metals, and plastics. They slimy matrix that binds the microorganisms together creates a barrier against antibacterial treatment that results in a persistent disease state (chronic infections). Plaque can break off and attach elsewhere, causing a separate biofilm colony. Bacteria within biofilms are up to 1,000 times more resistant to antimicrobials than are the same bacteria in suspension. Endospores are forms of bacterial classes only, which are generated when living conditions are not favorable. They form protective capsules that encircle the bacterial (spore), making them particularly resistant to disinfection and sterilization. Bioburden is defined as the degree of microbial load on an item before sterilization.
What preoperative lab tests are routinely ordered for a patient undergoing general anesthesia if a transfusion is anticipated? A: Blood urea nitrogen and blood chemistry. B: Blood type and crossmatch. C: Blood chemistry and complete blood count. D: Complete blood count and Prothrombin tine/PTT.
B: Blood type and crossmatch. If a transfusion is anticipated, the patient's blood is typed and crossmatched. Many patients prefer to have their own blood drawn and stored for autotransfusion. Patients should be advised that blood banks charge an additional fee to store and preserve autologous blood for personal use. Routine lab testing for any surgical procedure that involves general anesthesia include complete blood count, blood chemistry profile, prothrombin, hematocrit, blood glucose, and urinalysis. However, if the patient is likely to receive a transfusion, blood type and crossmatch MUST be drawn and in the patient's chart.
What condition would your patient be experiencing if their PH is greater than 7.45 and C02 less than 35? A: Respiratory Acidosis B: Respiratory Alkalosis C: Metabolic Acidosis D: Metabolic Alkalosis
B: Respiratory Alkalosis
When allograft products are implanted, documentation must be made available to what regulatory body? A: Occupational Safety and Health Administration B: The Joint Commission C: Center for Medicare and Medicaid Services D: Food and Drug Administration
B: The Joint Commission An allograft is human tissue, obtained from on genetically dissimilar person (i.e.: unmatched donor) that is grafted to another person. The Joint Commission requires that documentation of implanted allografts products be kept readily available at all time.
Your diabetic patient is scheduled to have a below the knee amputation of the right leg. The patient states "I'm really going to miss having two legs." What nursing diagnosis might be appropriate in this situation? A: Fear B: Anxiety C: Anticipatory grieving D: ineffective coping.
C: Anticipatory grieving Patients who know that they are going to lose a body part will suffer anticipatory grieving as they come to terms with losing a part of themselves. While this patient probably is dealing with some fear and anxiety, his coping is effective. By allowing the patient to express feelings of grief, you support him.
Electricity Standards and practices are recommended by: A: Joint Commission of Health Care Organizations (JACO) B: The manufacture of the medical product C: Association for the Advancement of Medical Instrumentation (AAMI) D: Underwriter Laboratories (UL)
C: Association for the Advancement of Medical Instrumentation (AAMI)
The following nursing diagnosis is common in the preoperative phase: A: Body image disturbance B: Altered nutrition: more than bodily requirement C: Knowledge deficit D: Sleep disturbance: less than body requirements.
C: Knowledge deficit Most people have some level of knowledge deficit prior to surgery, which is why preoperative teaching is so vital. Body image disturbance may occur after surgery if the body is altered is some ways (i.e.: amputation). Anxiety and fears are also common, and should be addressed.
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At what level is Formaldehyde is a mutagen and carcinogen and PEL A: 2 ppm B: 20 mm Hg C: < 5 ppm D: Equals 1 ppm
D: Equals 1 ppm
What condition would your patient be experiencing if their PH is greater than 7.45 and HCo3 greater than 26? A: Respiratory Acidosis B: Respiratory Alkalosis C: Metabolic Acidosis D: Metabolic Alkalosis
D: Metabolic Alkalosis
You should never communicate in a way that depersonalizes a patient. All of the following are examples of inappropriate ways to refer to a patient EXCEPT: A: "Helen Jones, Dr. Smith's lap gallbladder patient." B: "Dr. Smith's gallbladder patient." C: "The gallbladder patient in OR 4." D: "The gallbladder patient I need help to move."
A: "Helen Jones, Dr. Smith's lap gallbladder patient." Although routine procedures care for and teachings have been established, each patient deserves personalized care in the face of a disruptive life experience. You should not become insensitive to patients because of depersonalized procedures and routines or your own prejudices. The patient must not be treated as inanimate or anonymous, or categorized by a disease or surgical procedure. The patient is a living, feeling person, not "DR. Smith's gallbladder patient.", "The gallbladder patient in OR 4.", or "The gallbladder patient I need help to move." Jargon such as this is depersonalizing, demoralizing, offensive, and unacceptable. The goal of preoperative care is to combine efficiency with caring.
A patient with a nonunion wrist fracture is scheduled for an open reduction internal fixation with bone bank allograft chips. What is the recommended time that sterilized bone can be stored in a bone bank for use in surgical procedures such as this? A: 1 year B: 3 months C: 6 months D: Indefinitely
A: 1 year........................................................................................................................... Bone may be preserved and stored in a bone bank until needed. Bone used for allografts must be clean and sterile, and bone should never be used until negative results if culture and serology are received (hepatitis B and HIV). A 1-year expirations date is recommended for bone that is placed in a heat-sealed, peel-apart package in appropriate storage conditions.
You are providing preoperative teaching to a mother of a 2-month old infant who is scheduled for surgery. The mother is breastfeeding the patient. You instruct her that the last feeding must be given no later than: A: 4 hours preoperatively B: 1 hour preoperatively C: 2 hours preoperatively D: 3 hours preoperatively
A: 4 hours preoperatively For infants, the appropriate NPO interval is: Clear liquids up to 2 hours preoperatively; Breast milk up to 4 hours preoperatively; and Cow's milk/solids up to 6 hour preoperatively.
The timing of preoperative medications administration for children is extremely important. What is the recommended time frame? A: 45-60 minutes before surgery B: 30-45 minutes before surgery C: 60-75 minutes before surgery D: 15-30 minutes before surgery
A: 45-60 minutes before surgery To be effective, drugs should be given at least 45 to 60 minutes before surgical procedure. This results in a calm, but an awake child.
When arriving in the surgical department for the day, the initial hand cleansing should be with a brush scrub. To avoid abrading skin and releasing microorganisms from hair follicles, do not scrub for longer than how many minutes? A: 5 minutes B: 7 minutes C: 2 minutes D: 4 minutes
A: 5 minutes A vigorous 2- to 5-minute scrub with s reliable antimicrobial agent is effective. Prolonged scrubbing (more than 5 minutes) with a brush raises resident microbes from deep dermal layer sand is therefore, counterproductive.
During Mr. H's total hip surgery, the surgeon decided to "cement" implants into place using methyl methacrylate. After the cementing had been completed, the anesthesia care provider noticed that Mr. H's pulse oximeter levels dropped dramatically. Over the next half hour, the patient's condition plummeted. The surgeon completed the surgery, Mr. H was moved into a supine position, and consultations with anesthesiologists and a cardiovascular surgeon determined Mr. H suffered a pulmonary embolus. What is the name of this syndrome? A: Bone cement implantation syndrome B: Methyl methacrylate syndrome C: Cement replacement syndrome D: Exothermic cement reaction
A: Bone cement implantation syndrome Bone cement implantation syndrome (BCIS) can occur if a tiny fragment of cement enters the venous system and embolized to the lungs. This is a never event, but it does occur; BCIS involves hypotension, pulmonary embolus, and cardiac arrest. Factors in the development of the syndrome include emboli (fat, cement, or blood clot) form pressurizing cement, and enhancement of anesthesia gasses, which may cause cardiac depression and hypotension.
All of the following statements are true related to chemical solutions EXCEPT: A: Chemically sterilized items can be held in long term sterile storage B: It is not absorbed by rubber or plastics C: It is noncorrosive D: It penetrates into crevices and is readily rinsed from items
A: Chemically sterilized items can be held in long term sterile storage Items that are chemically sterilized must be processed for immediate use and not held in long-term storage. Liquid chemical agents registered as sterilants by the Environmental Protection Agency provide an alternative method for sterilizing minimally invasive heat-sensitive items if a gas or plasma sterilizer is not available or the aeration period makes ethylene oxide (OE) sterilization impractical. The solution has a low surface tension and therefore penetrates into crevices and easily is rinsed from items. It is not absorbed by rubber or plastic and is noncorrosive, non-staining, and safe for instruments that can be immersed in a chemical solution.
You have prepared the sterile back table and the Mayo stand. You receive word that surgery will be delayed due to an unanticipated emergency. You should: A: Cover the table and stand with sterile drapes and leave them in their current position. B: Leave the table and stand uncovered but move them out of the way. C: Cover the table and stand with sterile drapes and move them out of the way. D: Leave the sterile field in its current position and monitor continuously to maintain sterility.
A: Cover the table and stand with sterile drapes and leave them in their current position. The Association of Perioperative Registered Nurses (AORN) has had a long-standing recommendation that, once created, the sterile field should not be left unattended until the procedure has been completed. This recommendation has not changes. If there is an unanticipated delay or during periods of increased activity, such as when the patient is brought into the t room, the sterile field that will not be immediately used may be covered with a sterile drape. Sterile field should cover in a manner that does not allow the portion of the cover that falls below the sterile field to come above the sterile field.
Hypotension is common in the first 24 hours after a severe burn for which of the following reasons? A: Fluid shifts from the intravascular space to the interstitial tissue. B: Blisters contain fluid form on the skin. C: Fluid shifts from the interstitial tissues to the intravascular space. D: The patient who is badly burned may be unable to drink enough fluids to keep up with fluid loss.
A: Fluid shifts from the intravascular space to the interstitial tissue. In the first 24 hours after a severe burn, fluid is pulled from the blood vessels to the tissues, resulting in massive edema and hypotension. Electrolytes and protein are also lost through these changes in capillary permeability, causing intravascular volume to shift to interstitial tissues. Therefore, fluid and electrolyte balance must be restored as quickly as possible. A crystalloid solution of Ringer's lactate is initially infused because its isotonic state helps to treat the hypotension by expanding the volume of the fluid in the veins, (Intravascular space). A colloid-containing fluid, such as fresh frozen plasma (FFP), and other nutrients may be infused after the first 24 hours.
Symptoms of neurogenic shock resulting from spinal anesthesia may include all of the flowing EXCEPT: A: Hyperventilations B: Cool and clammy skin C: Tachycardia D: Hypotension
A: Hyperventilations In a patient who has had a spinal cord injury, loss of vasomotor tone in peripheral blood vessel (capillaries) leads to sudden vasodilation and pooling of blood. The body will compensate by increasing the heart rate. The risk of congestive heart failure and pulmonary embolism is increased due to increased peripheral resistance and the inability of the heart to compensate (despite increased cardiac output). Signs and symptoms include hypotension, tachycardia, and signs of poor perfusion; including cyanosis or pallor, cool skin, and diaphoresis. Fever is not seen in patients with neurogenic shock.
What are the three types of reactions reaction to latex? A: Irritant contact dermatitis, Hypersensitivity (t-cells, delayed action), and Hypersensitivity Immunoglobulin (immediate). B: IGG, IG, and IGM C: T-Lymphocyte, B- Lymphocyte, and cell-mediated immunity reactions D: Passive, immunized, or active immunity.
A: Irritant contact dermatitis, Hypersensitivity (t-cells, delayed action), and Hypersensitivity Immunoglobulin (immediate)
Your patient is having a skin lesion removed from her face. You explain to the patient that their surgeon will incise around the lesion orientated to the: A: Langer's line. B: Laugh lines. C: Wrinkles. D: Frown lines.
A: Langer's line. If a surgeon has a choice about where and in what direction to place an incision, he or she will often cut in the direction of the natural lines of the skin (Langer's lines). Incisions are more cosmetic if natural cleavage lines are followed when planning the surgical incision. Incisions made parallel to the body's natural lines may heal better and produce less scarring than those that cut across.
When comparing fluoroscopy to flat plate radiologic imaging; fluoroscopy produces: A: More scattered radiation than flat plate radiographs B: No discernible difference in radiation doses. C: At 2 meters distance no shielding is needed for OR personal. D: Is equal to ½ the intensity.
A: More scattered radiation than flat plate radiographs
Mrs. H arrives for preadmission testing and teaching. She is scheduled for a total hip replacement. When you note her posture, her dowager's hump suggests which of the following? A: Mrs. H probably has osteoporosis and poor bone quality. B: Mrs. H probably has diabetes and uncontrolled blood sugar. C: Mrs. H probably has heart disease and high blood pressure. D: Mrs. H probably has chronic obstructive pulmonary disease (COPD) and diminished lung capacity.
A: Mrs. H probably has osteoporosis and poor bone quality. A dowager's hump (kyphosis) indicates osteoporosis or osteoarthritis. If so, her poor bone quality may require cementing in the total hip stem. The preoperative nurse should notify the circulating nurse and scrub nurse so they can gather bone cement and supplies in case they surgeon decides to cement the total hip implants.
Another nurse is handling off care of a patient to you. How can you BEST convey that you are listening to the person giving the report? A: Nod appropriately and make eye contact with the speaker. B: Interrupt frequently to ask pertinent questions. C: Examine your nails while the person is speaking. D: Write down everything the person says.
A: Nod appropriately and make eye contact with the speaker. Active listening is a form of communication and is essential component of effective communication. By making eye contact and nodding appropriately, you show that you are hearing and understanding what is being said. Interrupting frequently, examining your nails, and indiscriminately writing down everything is said is poor communication habits.
You have identified your patients and reviewing his chart. As you ready to take the OR he says, "I forgot to tell them I'm allergic to eggs." Your communication should include all of the following EXCEPT: A: Notify the operating room manager because this allergy was not discovered and communicated through normal channels. B: Notify anesthetist so they consider this allergy wen given medications. C: Notify the surgeon so he has complete knowledge of patient allergies. D: Have the preoperative nurse add it to the patient's electronic medical record (EMR) so all appropriate staff (the floor nurses, pharmacy and food services, ETC) get the notice.
A: Notify the operating room manager because this allergy was not discovered and communicated through normal channels. This patient's electronic medical record (EMR) should have the egg allergy added so all support departments such as pharmacy and food services will know of this allergy. The anesthesia care provider and surgeon need to know and adjust their plan of care accordingly to protect the patient from a potential allergic reaction. Thorough communications can overcome the timing of when the patient informed the staff of his allergy.
Risk for electrical and thermal burns includes: A: O2 rich environments, jewelry, metal objects B: Elderly and obese patients C: Long duration cases D: Patient's with other allergies like latex or penicillin
A: O2 rich environments, jewelry, metal objects and solution storage.
Berry & Kohn's Operating Room Technique lists "Eight P's of Operating Room and Sterile Field Setup and Management." Of the "Eight P's" which of the following describes the importance of an OR environment that is not cluttered? A: Perfect picture. B: Proper placement. C: Place it once. D: Position of function.
A: Perfect picture. Perfect picture pertains to the room appearing neat and tidy, with a clear path for the crash cart, a closed door, and appropriate temperature/humidity. Items within and around the sterile field should not be at risk for causing harm or becoming damaged. The environment should not be cluttered. The other choices do not describe a neat and tidy OR environment. Proper placement refers to the need for equipment (suction canisters, tourniquets, the ESU, etc.) to be stationary and not moved during the procedure. Place it once refers to equipment ( OT bed, dispersive electrode) being in the correct place for the procedure. Position of function refers to putting equipment such as C-arm, laser, or microscope in the best place for function.
Methods of instrument disinfection include all of the following EXCEPT: A: Pre-rinsing with an enzymatic cleaner. B: Processing by flush-through machinery. C: Soaking by total immersion. D: Manual wiping with a chemical impregnated cloth.
A: Pre-rinsing with an enzymatic cleaner. Pre-rinsing or pre-soaking an instrument in an enzymatic solution DECONTAMINATES it by preventing blood and debris from drying or softening and removing already dried blood and debris; this decontamination process aids in making further processing (disinfection or sterilization) more efficient. The other methods are all methods of disinfection used depend on the desired level of disinfection (low, intermediate, or high).
The circulating nurse must go to the head of the room to plug in the surgeon's headlight, which is behind him. What is the best way to accomplish this? A: Reaching below the sterile drapes of the tables, she moves the sterile table closer to the sterile field and walk around the periphery of the sterile field. B: Being watchful of sterile field, she walks up and plugs in the headlight C: reaching over the sterile drapes of the table, she moves the sterile table closer to the sterile field and walks around the periphery of the sterile field. D: Staying at least 1 foot away from the sterile table and the drape patient, she walks between the plug in the headlight.
A: Reaching below the sterile drapes of the tables, she moves the sterile table closer to the sterile field and walk around the periphery of the sterile field. Circulating (unsterile) personnel should not walk between two sterile areas (tables) even when watching and even if staying at least a foot away. She should always reach below a sterile field (not over), carefully moving the sterile table toward the sterile field in this manner, then walk around the periphery to the head of the room to plug in the headlight.
What condition would your patient be experiencing if their PH is less than 7.35 and Co2 Greater than 45? A: Respiratory Acidosis B: Respiratory Alkalosis C: Metabolic Acidosis D: Metabolic Alkalosis
A: Respiratory Acidosis
Mr. H is scheduled for a right total hip replacement. He has implants in his left hip already. He will be in the lateral position with his right hip up. Where will you place the patient return electrode (inactive dispersive electrode, or IDE)? A: Right upper flank. B: Right lower leg. C: Left inner thigh. D: Left flank under his torso.
A: Right upper flank. The patient return electrode or inactive dispersive electrode (IDE) should be placed over a clean, dry muscle area, and should cover as large an area of the patient's skin as possible. Thus, the right upper flank is the appropriate placement of the IDE in this scenario. A patient return electrode should not be placed over or near metal implant. The IDE current could be diverted to the implant and generate excessive heat. Also, since the area that overlies the implant is a former surgical site, the scar tissue there will not disperse the current appropriately.
What are five methods of instrument sterilization? A: Steam, dry heat, ethylene oxide (EO) gas, hydrogen peroxide plasma/vapor, and microwave. B: Quaternary ammonium, hydrogen peroxide plasma/vapor, ozone gas, iodophor, steam. C: Steam, hydrogen peroxide plasma/vapor, microwave, quaternary ammonium, and sodium hypochlorite. D: Steam, sodium hypochlorite, iodophor, aqueous aldehyde, and isopropyl alcohol.
A: Steam, dry heat, ethylene oxide (EO) gas, hydrogen peroxide plasma/vapor, microwave. Methods of instrument sterilization include steam (moist heat sterilization), dry heat, ethylene oxide (EO) gas, hydrogen peroxide plasma/vapor, and microwave. Steam and dry heat are categorized as thermal sterilization. EO gas and hydrogen peroxide plasma by microwave is nonionizing radiation sterilization. The other choices listed are types of disinfectants.
What is the difference between sterilization and high-level disinfection? A: Sterilization kills all microorganisms, including endospores, while high-level disinfection kills microorganisms. B: Sterilization kills bacteria, virus, and prions, while high-level disinfection kills bacteria. C: Sterilization kills microorganisms, including endospores, while high-level disinfection kills prions. D: Sterilization kills all microorganisms, including prions, (endospores), while high-level disinfection kills microorganisms.
A: Sterilization kills all microorganisms, including endospores, while high-level disinfection kills most microorganisms. Sterilization involves killing all pathogens and nonpathogenic microorganisms, including endospores. High-level disinfections is a process that destroys all microorganisms except for high number of bacteria endospores. Prions are not microorganisms (not a living plant, animal, or virus), but protein particles which can become infectious when they mutate and are passed to others through direct tissue contact, etc. It takes a special type of process to destroy prions, involving steam sterilization (of a surgical instrument used) for at least one hour at 132 degrees Celsius (270 degrees Fahrenheit) after soaking in bleach at room temperature for 1 hour.
Surgical complications and poor surgical outcomes are often related to all of the following factors EXCEPT: A: Surgical checklists. B: Staffing issues. C: Emergencies. D: Multiple surgeons.
A: Surgical checklists. Factors that contribute to adverse patient outcomes (wrong site, wrong patient, wrong procedure) include emergencies, multiple surgeons, or procedures, staffing issues, morbid obesity, physical deformity, unusual equipment in OR, unmarked/unverified patients, no checklist, no assessment, distractions among staff, and organizational errors. The use of surgical checklists, however, can significantly reduce adverse events.
Only people involved with caring for an individual have the right to view HIPPA protected information. All of the following individuals have the right EXCEPT: A: The patient's priest or minister. B: The patient's nursing home caregiver. C: Health care personnel caring for the patient. D: Family members who care for the patient.
A: The patient's priest or minister. HIPPA provides for confidentiality of patient health data. The release or disclosure of the protected health information (PHI) requires patient authorization. Individuals caring for the patient (Family members, health care workers, and designated health support individual, and nursing home care givers) have the right to view the patient's records per HIPAA regulations. The patient's minster or priest may not view those records unless the patient provides authorization via consent for the minister to do so.
To prevent errors, handoff communications upon arrival at the post-anesthesia care unit (PACU) should include telling the PACU nurse which of the following medications? A: The seven rights of administering medication B: The five rights of administering medication C: The six rights of administering medication D: The eight rights of administering medication
A: The seven rights of administering medication The "seven rights" of medication administration include right patient, right drug, right dose, right reason, right time, right route, and right documentation. These rights help prevent medication errors and should be communicated during handoff report when discussing the administration of medications.
All of the following are common microorganisms in an OR environment EXCEPT: A: Tuberculosis B: Staphylococci C: Escherichia coli D: Pseudomonas
A: Tuberculosis Infections can be caused by one microorganism or a combination of them. Each type of microorganism has a specific set of characteristics that promotes survival and proliferation. The five main types of microorganisms are bacteria, viruses, prions, fungi, and protozoa. Knowing specific needs for microbial life aids in the prevention of infection. Tuberculosis, although a well-known bacterial disease, is not a common pathogenic microorganism found in the OR setting.
A patient is in the post-anesthesia care unit says to you, "I'm feeling so sick." How would you respond to elicit more information for the patient? A: "You'll feel better soon. It is likely the anesthesia that is making you feel that way." B: "Can you tell me more about how you are feeling?" C: "What do you think is wrong?" D: "I'll get you some pain medication right away."
B: "Can you tell me more about how you are feeling?" Asking the patient to tell you how they are feeling invite the patient to be more specific and provide information. Offering pain medication would not be the appropriate as the patient did not state they were in having pain, only that they felt sick. The patient looks to you to provide answers, so asking the patient what they think is wrong may lessen the confidence in you. Telling the patient that they will feel better soon may make them feel that you are not interested in how they are feeling.
The bacterial activity of alcohol sharply drops when it falls below what concentration? A: 45% B: 50% C: 55% D: 60%
B: 50% Alcohol is volatile; it will act only as only as it is in solution. Alcohol becomes ineffective as soon as it evaporates, and it loses its microbicidal activity in concentrations below 50%. Most antimicrobial alcohol hand wash solution contains a minimum of 60% alcohol.
Possible complications related to patient placement in the lateral kidney position include: A: Tissue ischemia to the sacrum B: Compromise of pulmonary function in the dependent lung. C: Extreme abduction of the hips. D: Pressure injury to the breast/chest.
B: Compromise of pulmonary function in the dependent lung. The lateral kidney position is used for procedures in the kidney and ureter and is not well tolerated. In this position, the skin and underlying tissues can be damaged by excessive pressure during flexion of the OR bed. Respiratory and cardiovascular changes are possible, as well as venous compromise of the lower extremities as blood tends to pool in the lower arms and legs. The spine is stressed in a laterally flexed position, and it can cause strain on the vertebral structures as well. Pressure to the breast /chest, hip abduction and sacral tissue ischemia will not occur, as the patient is positioned laterally with the knees together and therefore those parts of the body will not be affected.
"Time Out" protocol involves a "hard stop", eye contact between the surgeon and circulating nurse, verbal agreement of all staff in the room, and is done before incision. It involves 7 "corrects." What are they? A: Correct position, Correct site, Correct procedure, Correct surgeon, Correct equipment, Correct implants and Correct images (as applicable). B: Correct patient, Correct procedure, Correct site, Correct position, Correct equipment, Correct implants, and Correct images (if applicable). C: Correct patient, Correct allergy information, Correct site, Correct procedure, Correct equipment, Correct implants, and Correct images (if applicable). D: Correct patient, Correct surgeon, Correct site, Correct procedure, Correct equipment, Correct implants, and Correct images (if applicable).
B: Correct patient, Correct procedure, Correct site, Correct position, Correct equipment, Correct implants, and Correct images (if applicable). Before making an incision, the entire team pauses for a "time out" as the surgical site listed on consent is read aloud and verified with the site0marking on the patient. The entire team confirms that this is the correct information for the patient and that any images (scans or x-rays) reflecting the same body part are displayed in the correct orientation. The availability of the correct implants or special equipment is confirmed. This process should be documented in the patient's record by the circulating nurse. The correct surgeon should already have been verified in the pre-op holding area. Correct allergy information should be discussed if it applies to anesthesia or intraoperative drugs, but it's not one of the 7 "corrects".
During a very long operative procedure, you, as the circulating nurse, talk to the patient's wife hourly. As the surgery is being completed, you call the wife to update her. She thanks you for the update and your kindness to her during the long wait. The Perioperative Patient Focused Model is divided into 4 domains and focuses on patient outcomes. What domain applies to the scenario described above? A: D 4- Health system in which perioperative care is delivered. B: D 3- Patient's and designated support person's behavioral responses to operative and other invasive procedures. C: D 2- Patient's physiologic response to operative and other invasive procedures. D: D 1-Patient safety.
B: D 3- Patient's and designated support person's behavioral responses to operative and other invasive procedures. In this scenario, Domain 3 (D3) applies. Families or significant others often find waiting to be stressful. Hourly updates from the circulating nurse can allay their fears and worries. The patient's wife was appreciative of the update and kindness of the circulating nurse. The other domains are not pertinent in this scenario.
What is the advantage of a bipolar verses monopolar electrosurgery? A: It generates relatively high output voltage. B: Energy current flows between the tips of the bipolar forceps, not through the patient's body. C: Energy current flows through the patient's body. D: It creates a high-frequency plasma field.
B: Energy current flows between the tips of the bipolar forceps, not through the patient's body. Bipolar electrosurgery does not require a Bovie pad (inactive dispersive electrode) because the energy current does not flow through the patient's body as in monopolar electrosurgery. The current is instead directed from the generator to a special Bovie forceps with one active and one inactive tip. The current flows from the generator to the active tip and returns to the generator through the inactive tip. Output voltage is relatively low. This provides extremely precise control of the coagulated area. Bipolar electrosurgery is safe for patients with pacemakers and internal defibrillators (since the electrical current is not passing through the body, causing potential disruption in such devices).
All of the following are included in the implementation phase of the nursing process EXCEPT: A: Discontinue any intervention that is ineffective B: Establish and prioritize a working set of interventions C: Activate the interventions in a systematic order of priority D: Share the plan with the perioperative team for continuity of care
B: Establish and prioritize a working set of interventions Establishing and prioritizing a working set of interventions would be done in the planning phase of the nursing process. The nursing process is a systematic approach to nursing practice using problem-solving techniques and involves a six-step process that provides a foundation for assessing the patient. The steps include assessment, diagnosis, outcome identification, planning, implementation and evaluation. During implementation, the preoperative nurse shares the plan with the team, activates the interventions, discontinues any interventions that are ineffective, and documents the implementation of the interventions and their effectiveness.
Using a Bag valve mask (BVM) to provide oxygen, it is important to so all the following EXCEPT: A: Cover the nose and mouth with the mask, ensuring that the mask fits snugly against the face. B: Give 15 chest compressions after 2 breaths. C: Watch for bilateral rise and fall of the chest to ascertain that air is entering the lungs. D: Squeeze the bag to its full volume with the hand that is not holding the mask.
B: Give 15 chest compressions after 2 breaths. The mask should fit firmly over the nose and mouth without extending past the chin or covering the eyes. Ventilations are assessed by seeing bilateral chest rise and fall and feeling air escape during the patient's exhalation. Typically, you will secure the mask with one hand and squeeze the bag completely with the other. For adult patients, the ratio of compressions to ventilations (breaths) is 30 to 2.
An ophthalmic complication called toxic anterior segment syndrome (TASS) is caused by what? A: Cataract fragments left behind during cataract extraction B: Improperly cleaned and processed eye instruments C: Improper treatment of a corneal abrasion D: Corneal damage from improper use of local anesthetic optic drops
B: Improperly cleaned and processed eye instruments Eye instruments that are improperly cleaned and processed can subject the patient to toxic anterior segment syndrome (TASS). An inflammatory response in the anterior chamber of the eye causes permanent damage to intraocular tissue and predisposes the patient to secondary glaucoma. Eye instruments should be cleaned separately from other instruments.
Environmental hazards in the OR can be classified as physical, chemical ad biologic. What is an example of a biological hazard? A: Back injury B: Infectious waste C: Irradiation D: Toxic fumes from gasses
B: Infectious waste Injuries in the OR can caused by faulty equipment, using equipment improperly, exposing oneself or others to toxic or irritating agents, or coming into contact with harmful agents. A biological hazard refers to a biological substance that poses a threat to the health of patients and personal. Example of infectious wastes, the patient (as a host for, or source of pathogenic microorganisms), cuts or needle stick injuries, surgical plume, and latex sensitivity. Back injury and irradiation are examples of physical hazards, while toxic fumes from gasses would be a chemical hazard.
Our patient's chart lists St. John's Wort as a daily herbal medication. What significant information should you know about St. John's Wort, and what members of the perioperative staff should you notify? A: It caused bleeding and slow wound healing and collagen repair; notify all perioperative staff members. Including the anesthesia care provider and surgeon. B: It prolongs sedation and interferes with metabolism of some medications such as calcium channel blockers, warfarin (Coumadin, Jantoven), and some antibiotics; notify all perioperative staff members, including the anesthesia care provider and surgeon. C: It causes cardiovascular instability, palpitations, high blood pressure, and seizures; notify anesthesia care provider. D: It can cause hypokalemia and dysrhythmia, high blood pressure, and edema; notify the anesthesia care provider and surgeon.
B: It prolongs sedation and interferes with metabolism of some medications such as calcium channel blockers, warfarin (Coumadin, Jantoven), and some antibiotics; notify all perioperative staff members, including the anesthesia care provider and surgeon. Herbal supplements and their side effects can have negative interactions with other medications, and can cause serious compilations such as bleeding. For this reason, patients are advised to report all herbal supplements prior to a surgical procedures. All perioperative staff including the anesthesia care provider and the surgeon should be reminded that the patient is on herbal supplements.
Documentation of surgical positioning includes which of the following? A: Preoperative ,limitations in patient's range of motion; skin assessment before and after surgical procedure; patient position including use of special positioning equipment; staff involved in positioning including name, role and title. B: Skin assessment before and after surgical procedure; patient position including use of special positioning equipment; and staff involved in positioning including name, role and title. C: Preoperative limitations in patient's range of motion, patient position including use of special positioning including name, role and title and postoperative skin assessment. D: Skin assessment before and after surgical procedure; type and location of equipment used in positioning; and staff involved in positioning including name, role and title.
B: Skin assessment before and after surgical procedure; patient position including use of special positioning equipment; and staff involved in positioning including name, role and title.
Criteria for defining a superficial incisional surgical site infection, (SSI) include all of the following EXCEPT: A: Purulent drainage from the incision B: Stitch abscess C: Pain/tenderness D: Localized swelling and redness
B: Stitch abscess With superficial incisional SSI, the infection occurs within 30 days of surgical procedure, and involves only skin or subcutaneous tissue of the incision, with at least one of the following (unless the wound culture is negative): purulent drainage, swelling, redness or heat, surgeon deliberately open the incision, a diagnosis by the surgeon, and specific microorganisms isolated from an aseptically obtained culture of fluid or tissue. A stich abscess with minimal inflammation and discharge is not criteria for a superficial SSI.
You are providing preoperative teaching to a patient undergoing an uvulopalatopharyngoplasty (UPPP). Your teaching regarding his airway should include all the following information EXCEPT: A: A call light and a message board will be provided so that the patient may communicate with staff. B: The patient's solid food supper order postoperative day is predetermined. C: The head of the bed will be elevated to decrease postoperative swelling. D: Oxygen will be provided by a mask to the face, or over the tracheal stoma if trach is preformed until swelling subsides.
B: The patient's solid food supper order postoperative day is predetermined. The surgery is performed to increase the size of the pharyngeal airway (for severe sleep apnea sand intractable snoring not relieved by non-surgical treatment). Airway obstruction is a major concern with this type of surgery, and many patients will have a tracheostomy, sometimes preformed initially. Communication is a huge concern to these patients.
All of the following statements are true regarding planning for transfer of information EXCEPT: A: The structure used to present the transfer of care information should be developed by a multidisciplinary team. B: Transfer of care information is rarely a cause of adverse events. C: Using a multidisciplinary team ensures that all of the patient's needs will be met. D: All members of the multidisciplinary team should be involved in the planning process.
B: Transfer of care information is rarely a cause of adverse events. Transfer of care information and communication is a FREQUENT cause of adverse events in the hospital setting. Some barriers to effective communication include rapid turnover in team members, personal who are rushed for time, withholding of information, pecking order, laziness, fatigue, distractions, and complacency. A multidisciplinary team is needed to plan and design a through transfer of care documentation that will include all aspects of patient care.
Standard precautions protect health care workers from contact with blood and body fluids of all patients. When they consider all blood and body fluids as infectious, health care workers will take all of the following precautions EXCEPT: A: Wash hands or use antiseptic gel appropriately B: Treat a specific communicable disease with appropriate isolation C: Clean/disinfect the OR environment D: Wear appropriate protective gear
B: Treat a specific communicable disease with appropriate isolation Standard precautions as established by the CDC and enforced by OSHA treat all body fluids as infectious, therefore protecting patients, perioperative staff, and surgeons from potential infections. Standard precautions include wearing appropriate protective gear, washing hands or using antiseptic gel appropriately, and cleaning/disinfecting the OR environment. Isolation precautions are more specific to each known communicable disease. Standard precautions provide safety in ALL situations.
Virchow's Triad refers to what? A: Venous stasis, vessel wall damage, and normal coagulability. B: Venous stasis, vessel wall damage, and hypercoagulability. C: Venous patency, intact vessel wall, and hypercoagulability. D: Venous patency, vessel wall damage, and hypercoagulability.
B: Venous stasis, vessel wall damage, and hypercoagulability. These three risk factors are the primary cause of deep vein thrombosis (DVT) in the lower extremities and can be used to predict increased risk. Age, obesity, immobility, and a history of thromboembolic or other cardiovascular disease are predisposing factors. Preoperative prophylactic interventions, including anticoagulants, compression devices, or antiembolic stockings, can reduce the risk of postoperative pulmonary embolism, which is a life-threatening complication of DVT.
Health care workers exposed to Glutaraldehyde may experience all of the following symptoms EXCEPT: A: Dermatitis or itchy, irritated skin. B: Viral conjunctivitis C: Mucous membranes irritation D: Pulmonary or asthma symptoms.
B: Viral conjunctivitis Glutaraldehyde, a chemical agent, used to sterilize heat-sensitive items, emits fumes from the liquid from that may be irritating to the eyes, nose and throat. Acute or chronic exposure can result in skin irritation or dermatitis, mucus membrane irritation (eyes, nose, or mouth), or pulmonary symptoms. Epistaxis, allergenic contact dermatitis, asthma, and rhinitis also have been reported in health care workers exposed to Glutaraldehyde. Viral conjunctivitis (pink eye) would not be the result if Glutaraldehyde exposure but rather is most commonly caused by the adenovirus.
What ASA class might a person with severe systemic disease such as 2 comorbidities? A: ASA I B: ASA II C: ASA III D: ASA IV E: ASA V F: ASA VI
C: ASA III
A trauma patient suffers massive blood loss and develops disseminated intravascular coagulation (DIC). What is the treatment for DIC? A: Fresh frozen plasma, whole blood units, and platelets B: Blood thinners, packed red blood cells, and fresh frozen plasma. C: Blood, fresh frozen plasma, and blood thinners. D: Fresh frozen plasma, platelets, and blood thinners.
C: Blood, fresh frozen plasma, and blood thinners. Disseminated intravascular coagulation (DIC) is a complex derangement of clotting factors. It occurs when the normal clotting mechanisms do not function, and an overactive cycle of clots formation and simultaneous clot breakdown occurs, leading to consumption of platelets and coagulation factors and release fibrin degradation products that act as potent anticoagulants. DIC can follow hemorrhage, thrombi, emboli, infection, or reactions to incomplete blood transfusions. Hemorrhage recurs, and multiple organ failure can begin. Treatment involves blood, plasma, and dextran via IV administration. Blood thinners (heparin, warfarin) and replacement of clotting factors, of given early, may prevent hemorrhage.
Why do surgeons prefer to use carbon dioxide (CO2) to create a pneumoperitoneum for laparoscopic abdominal surgery? A: CO2 supports combustion. B: CO2 contributes to normothermia for the patient. C: CO2 is a normal metabolic end product. D: There is no risk of gas embolism when CO2 is used.
C: CO2 is a normal metabolic end product. Carbon dioxide (CO2) gas insufflation is preferred by most surgeons preforming laparoscopic procedures because it has a high diffusion coefficient and is a normal metabolic end product, rapidly clearing from the body. Carbon dioxide (CO2) is highly soluble in the blood and tissues and does not support combustion. The risk of gas embolism is lowest with CO2. As a negative side effect, carbon dioxide (CO2) contributes to the risk of hypothermia for the patient.
Symptoms of hyponatremia might include all of these EXCEPT: A: Diaphoresis B: Convulsions C: Decreased urine specific gravity D: Pulmonary edema
C: Decreased urine specific gravity In hyponatremia, urine specific gravity may be elevated, not decreased. Hypernatremia may also cause the symptoms of elevated body temperature, diaphoresis (sweating), restlessness and pulmonary edema. In addition, the patient with hyponatremia might be irritable and may seize (convulsions).
A trauma patient has suffered massive blood loss and has had multiple blood transfusions. The surgeon notices symptoms of disseminated intravascular coagulation (DIC). What are those symptoms? A: Thrombophlebitis, air embolism, and abnormal clotting. B: Hemorrhage, bruising, and deep vein thrombosis. C: Hemorrhage, oozing from puncture sites, and ischemia of vital organs. D: Hemorrhage, air embolism, and deep vein thrombosis.
C: Hemorrhage, oozing from puncture sites, and ischemia of vital organs. Disseminated intravascular coagulation (DIC) is a life-threatening syndrome that can follow hemorrhage, thrombi, emboli, infection, or allergic reaction to an incompatible blood transfusion. It is a complex derangement of clotting factors, and normal clotting mechanisms fail to function. A repetitive, overactive cycle of clot formation (coagulopathy) and simultaneous clot breakdown (fibrinolysis) instead occurs. Hemorrhage, oozing from puncture sites (and prolonged bleeding), and petechial are obvious symptoms of DIC, while micro embolisms in blood vessels interfere with blood supply to body tissue including vital organs, producing ischemia. Treatment begins with control of the primary condition. Blood, plasma, and dextran can be administered IV. Heparin and clotting factors may prevent hemorrhage if given early.
What is the difference between a gravity displacement sterilizer and prevacuum sterilizer? A: In a gravity displacement sterilizer, steam enters the chamber at the side and slowly pushes the air out the other side through a discharge outlet. The prevacuum sterilizer removes air by a vacuum before filling the chamber with steam. B: In a gravity displacement sterilizer, steam enters the chamber at the bottom and slowly pushes the air out the up and out through a discharge outlet. The prevacuum sterilizer removes air by a vacuum before filling the chamber with steam. C: In a gravity displacement sterilizer, steam enters the chamber at the top and slowly pushes the air down and out through a discharge outlet. The prevacuum sterilizer removes air by a vacuum before filling the chamber with steam. D: In a gravity displacement sterilizer, steam enters the chamber at the top and slowly pushes the air down out through a discharge outlet. The prevacuum sterilizer removes air by using an air hose and pushes steam into the chamber.
C: In a gravity displacement sterilizer, steam enters the chamber at the top and slowly pushes the air down and out through a discharge outlet. The prevacuum sterilizer removes air by a vacuum before filling the chamber with steam. Both are types of steam sterilizers, designed to use steam under pressure to sterilizer items, and are often referred to as autoclaves to distinguish them from sterilizers that use other agents. With gravity displacement, steam enters the chamber at the back, near the top, and slowly pushes the air down wards, forcing it out through a discharge outlet at the bottom front. The air passes through a filter screen to a waste line. With the prevacuum method, air is almost completely evacuated from the chamber before sterilizing steam is admitted. The desired vacuum is achieved by means of a pump and a steam injector system.
The perioperative nurses role to a patient with a pacemaker involves all the following EXCEPT: A: Verifying the type of pacemaker. In the case of a defibrillator function has been deactivated by a sales representative, who plans to return when the patient is in post-anesthesia care to check pacemaker function. B: If monopolar electrosurgery is planned, do not place the return electrode over the pacemaker. C: Interrogate the pacemaker using a pacemaker wand. D: Communicate with post-anesthesia care unit staff the patient has a pacemaker, Follow manufacture's guidelines and facility policy.
C: Interrogate the pacemaker using a pacemaker wand. The perioperative nurse must pay attention to the patient as a physical being, as well as to the devices used in care. When dealing with a patient who has a pacemaker, the perioperative nurse must not interrogate the pacemaker because he or she is not trained to do so; it is outside the scope of nursing practice. The patient typically receives a pacemaker interrogation after the initial pacemaker implantation, not during the intraoperative phase. The nurse should verify the type of pacemaker and follow necessary precautions depending on the type of device; know what to do if electrosurgery is to be performed (placing a return electrode directly other the pacemaker in monopolar electrosurgery could cause the current to be diverted or not anesthesia care unit staff that the patient has a pacemaker. The nurse must always follow manufacturer's guidelines and facility policy.
Steam sterilization loads should be documented, and records kept in central supply. Documentation for non-implants items including all of the following EXCEPT: A: Load numbers and contents of load. B: Parameters (exposure time, temperature), operator's name and results of monitors. C: Last sterilizer maintenance. D: Identification of autoclave (type) and cycle.
C: Last sterilizer maintenance. Documentation of steam cycles include Identification of autoclave, sterilizer type, and cycle, load numbers, list of contents, results of monitoring, and operator's name. While the last sterilizer maintenance record is kept, it is not included in steam cycle documentation.
An employee exposed to ethylene oxide may require all the following first-aid measures EXCEPT: A: CPR if cardiac or respiratory failure occurs. B: Administer oxygen. C: Lying down to cool off. D: Apply ointment to blisters and cover with nonstick bandage.
C: Lying down to cool off. Lying down to cool off would not help with EO gas exposure. Ethylene oxide is a vesicant when in contact with skin and mucous membranes. Overexposure causes nasal and throat irritation, and can result in nausea, vomiting, dizziness, difficulty breathing, and peripheral paralysis. If exposes, first aid measures include (depending on severity of exposure) administration of oxygen, applying an ointment to any blisters caused by direct contact and covering with nonstick gauze bandages, and may even require CPR if cardiac or respiratory failure occurs.
Manual cleaning would be recommended for all the following EXCEPT: A: Lensed instruments B: Power equipment C: OR floors D: Delicate instruments
C: OR floors The purpose of manual cleaning is to remove residual blood and debris before terminal sterilization or high-level disinfection. It is recommended for delicate and sharp instruments and devices such as microsurgical and ophthalmic instruments, lensed equipment, power equipment, and other instruments that cannot tolerate an automated cleaning process. OR suites, including the OR floors, should be terminally disinfected between patients, as well as the end of the day's schedule.
Patient classified as morbidly obese they have a body mass index (BMI) that exceeds 25 to greater than 30 kg/m2 or weight more than 100 lbs. over their recommended weight. Morbid obesity predisposed an individual to several conditions which make surgical procedures more difficult and include all off the following EXCEPT: A: Inefficient respiratory muscles which reduce ventilation capability. B: A compromised airway which makes intubation more difficult C: Pressure ulcers D: Increased demand on the heart
C: Pressure ulcers Respiratory issues of morbidly obese individuals include a short, thick neck (mobility of the cervical spine to hyperextend the neck for intubation may be limited), which compromise the airway and makes intubation more difficult. Also, ineffective respiratory muscles, poor lung/chest wall compliance, and increased intra-abdominal pressure in the supine position reduce ventilation capacity. Circulatory issues include the risk of myocardial hypertrophy and congestive heart failure due to increased demand on the heart, pulmonary function abnormalities, and risk of compressing the inferior vena cava in certain positions.
All the following are indications for preforming a Cesarean section EXCEPT: A: Breech presentation. B: Active herpes infection. C: Previous Cesarean section. D: Disproportion between the mother's pelvis and the fetal head.
C: Previous Cesarean section. A Cesarean or C-section is a method of delivery by abdominal and uterine incisions. A C-section is preformed when safe vaginal delivery is questioned or immediate delivery is critical because the well-being of the mother or fetus is threatened. A previous Cesarean section alone, without other risk factors, is no longer an indication for a repeat C-section. Women may attempt vaginal birth after a C-section (VBAC) or may elect to schedule a planned Cesarean birth. Indications for Cesarean delivery include hemorrhage, placenta previa, placenta abruption, invasive placenta, toxemia, fetal malpresentation (breech), CPD (cephalopelvic disproportion), chorioamnionitis, genital herpes in the mother within 6 weeks of delivery, fetal distress, or prolapsed umbilical cord.
During an irrigation and debridement case, the surgeon asks for #1 monofilament nonabsorbable suture... What suture choices should you offer? A: Silk and Fiberwire B: Vicryl and Monocryl C: Prolene and Ethilon D: Vicryl and Prolene
C: Prolene and Ethilon Surgical sutures are classified as absorbable and nonabsorbable. Absorbable sutures are made from collagen from mammal or synthetic polymer. Absorbable sutures will absorb and disappear, thus not requiring removal. Nonabsorbable sutures are made from synthetic or natural material, which body enzymes cannot digest. Sub classifications of sutures involve monofilament (single strand) vs. multifilament (more than one strand braided or twisted together. Examples of monofilament nonabsorbable sutures include Prolene and Ethilon.
What are three methods of surgical instrument/equipment sterilization? A: Steam, pasteurization, hydrogen peroxide. B: Formaldehyde, hydrogen peroxide plasma, and ethyl alcohol. C: Steam, ethylene oxide, and hydrogen peroxide plasma D: Steam, quaternary ammonium, and ozone gas.
C: Steam, ethylene oxide, and hydrogen peroxide plasma Sterilization methods include steam, dry heat, ethylene oxide, hydrogen peroxide plasm, low-temperature gas plasma (STERRD), and ozone gas. Chemical agents for high-level disinfection include ethyl or isopropyl alcohol, chlorine compounds, formaldehyde, glutaraldehyde, iodophor, phenolic compounds, quaternary ammonium compounds, and hydrogen peroxide. Physical disinfectants include pasteurization and ultraviolet (UV) irradiation.
Safety precautions for laser usage in to the OR include all of the following EXCEPT: A: A smoke evacuator must be used. B: Nonflammable endotracheal tubes must be used. C: Sterile nitrile gloves must be worn by the surgeon and OR staff. D: All dry material in the OR near the operative field must be dampened with saline or water.
C: Sterile nitrile gloves must be worn by the surgeon and OR staff. Safety measures for laser usages include nonflammable endotracheal tubes, smoke evacuator, laser signs on OR doors, laser safety googles for staff and patient, and dampened sponges to place around the surgical site. In addition, a large amount of water and an appropriate fire extinguisher should be present in the OR.
Your elderly patient has ectropion which is to be repaired surgically. This means: A: The eyelid margin is inverted. B: Infection of the eyelid follicle is present. C: The eyelid is everted to expose conjunctival surface. D: Drooping of the upper eyelid is present.
C: The eyelid is everted to expose conjunctival surface. Ectropion occurs when the tissue that supports the upper or lower eyelid begins to weaken, resulting in a lid that droops out and away from the eye globe, exposing conjunctival surface. The problem in his condition is that more of the eye globe is exposed, and tears are unable to drain properly. Entropion occurs when the lid margin is inverted, causing the eyelashes to abrade the cornea. A stye is an infection of an eyelash follicle. Drooping of the upper eyelid is called ptosis.
You, the circulator, together with the scrub nurse, are preparing the OR for a pediatric patient aged 13 months who weighs 22 pounds (10 KG). At what temperature should the operating room be for this patient? A: 85 o Fahrenheit (29.4 o Celsius) B: 68 o Fahrenheit (20 o Celsius) C: 70 o Fahrenheit (21 o Celsius) D: 73 o Fahrenheit (22.8 o Celsius)
D: 73 o Fahrenheit (22.8o Celsius) Neonates, infants, and children are kept warm during a surgical procedure to minimize heat loss and to prevent hypothermia. Body temperature tends to decrease in the OR because of cooling from air conditioning and open body cavities. The rooms should be warmed to 73 o Fahrenheit (22.8o Celsius) or slightly warmer before the pediatric patient is taken to the OR room. A warmed blanket should be positioned on the OR bed as an undercover to prevent conduction of the child's body heat into the cooler mattress. A second warm blanket should be placed over or around the child to prevent heat radiation into the room air.
Which of the following statements explains the difference between a spinal block and an epidural block? A: A spinal block medication is injected into the cerebrospinal fluid, and an epidural block involves medication being injected under the pia mater. B: A spinal block medication is injected under the pia mater, and an epidural block involves medication being injected into the epidural space. C: A spinal block medication is injected outside the subarachnoid space, and an epidural injection involves medication being injected under the epidural space. D: A spinal block medication is injected into the subarachnoid space, and an epidural block involves medication being injected into the epidural space.
D: A spinal block medication is injected into the subarachnoid space, and an epidural block involves medication being injected into the epidural space. The pia mater (innermost layer) is too deep for either spinal or epidural injection. Spinal injection into the cerebrospinal fluid in the subarachnoid space of the meninges is correct. The epidural space lies between the dura mater, the outermost sheath covering the spinal cord and the appropriate area for epidural injection.
Which of the following terms refer to the actual or potential amount of microbes found on an instrument? A: Pathogen burden B: Microbial count C: Article contamination D: Bioburden
D: Bioburden Bioburden refers to the degree of microbial load (contamination with microorganisms and organic debris) on an item before sterilization. Items must be decontaminated, then sterilized or disinfected to reduce the bioburden of any given item. Sterilization success can be judged by the amount of bioburden that remains on an instrument after decontamination.
Preparation for bilateral breast biopsies should include 2 setups. Why? A: Breast masses are treated as if infectious until proven not infected. B: Breast masses are treated as if benign until proven malignant. C: Breast masses are treated as if benign until proven infectious. D: Breast masses are treated as if cancerous until proven benign.
D: Breast masses are treated as if cancerous until proven benign. Preoperatively, the surgeon discusses with the patient the possible findings and treatment options. The patient may agree to an immediate definitive surgical procedure such as a mastectomy or lumpectomy. If warranted by the biopsy and frozen section results. Two separated prepping, draping, and instrument sets are necessary to avoid cross-contamination of cancerous (malignant) cells of the breast specimen with fresh prepared reconstructive site. The team should change gown and gloves as well.
What are 2 example of antibiotics started preoperatively for surgical prophylaxis? A: Amoxicillin (Amoxil) and vancomycin (Vancocin) B: Clindamycin (Cleocin, ClindaMax) and ceftriaxone (Rocephin) C: Vancomycin (Vancocin) and cephalexin (Keflex) D: Ceftriaxone (Rocephin) and cephalexin (Keflex)
D: Ceftriaxone (Rocephin) and cephalexin (Keflex) A prophylactic antibiotic is given preoperatively (30 minutes to one hour before the surgical incision) and continued for 24 hours postoperatively. It is effective as a supplement to host defense mechanism in selected patients and is commonly used for procedures associated with brief exposure to possible infections (evidence indicated that antibiotics can reduce infection). Cephalosporins (including cephalexin and ceftriaxone) are a category of broad-spectrum antibiotics commonly used for surgical prophylaxis. Vancomycin (Vancocin) is commonly to treat C. diff and endocarditis. Clindamycin (Cleocin, ClindaMax) treats protozoa, toxoplasmosis, osteomyelitis, intraabdominal sepsis, malaria, and toxic shock. Amoxicillin (Amoxil) treats many different types of infection caused by bacteria, such as tonsillitis, bronchitis, pneumonia, gonorrhea, and infections of the ear, nose throat, skin or urinary tract.
What types of sponges used in surgery are primarily used on delicate tissue, have a radiopaque element, and have a thread attached? A: Kitners B: Raytec sponges C: Lap pads D: Cottonoids
D: Cottonoids Cottonoids are small square or rectangular sponges made of compressed rayon or cotton; they are very absorbent and resemble a strip of felt. They have a radiopaque element and a thread attached so they can be located in the wound. They are moistened with Ringer's lactate or a topical hemostatic agent, such as thrombin, for used on delicate structures (EG: nerve, brain, spinal cord). They are pressed out flat after moistening and before handing them to the surgeon. Lap pads (laparotomy tapes) are used for retaining the viscera and keeping them moist and warm. Raytec (gauze) sponges are used during blunt dissection. Kitner sponges are small, firm, cylindrical rolls of heavy, tightly wound cotton dental tape that are held in a Kelly clamp for use during blunt dissection. All of these types of sponges are radiopaque.
Malignant hyperthermia (MH) is triggered by exposure to which of the following? A: Antimetabolic drugs B: Anticholinergic drugs C: Anabolic steroids D: Halogenated anesthesia agents
D: Halogenated anesthesia agents Both halogenated anesthesia agents and depolarizing muscle relaxants may cause malignant hyperthermia (MH) in susceptible individuals. The most common triggering agent are volatile anesthetic gasses or the depolarizing muscle relaxants (IE: suxamethonium) used primary in general anesthesia. MH is a potentially fatal complication of inhalant anesthesia, characterized by uncontrolled acceleration of muscle metabolism accompanied by tremendous oxygen consumption and the products of heat and carbon dioxide.
The most commonly used surgical instruments are: A: Forceps B: Retractors. C: Surgical scissors. D: Hemostats
D: Hemostats Hemostats are the most commonly used surgical instrument and are used primarily to clamp blood vessels during surgical procedures. They have a crushing action. Hemostats have either straight or curved slender jaws that taper to a fine point. The serrations are longitudinal or horizontal inside the jaws. Forceps, surgical scissors, and retractors are also frequently used instruments and come in many variations, depending on their intended purposes.
Your postoperative patient is shivering, complains of dizziness, and has impaired speech. What is the likely cause? A: Anoxia B: Malignant hyperthermia C: Excessive blood loss (hypovolemia) D: Hypothermia
D: Hypothermia Shivering, impaired speech, cyanosis, muscle rigidity, dizziness, a weak pulse, falling blood pressure, and dysthymias seen in the post-anesthesia care unit (PACU) are all signs of hypothermia caused by an inability to generate body heat. Anesthesia inhibits the body's ability to generate heat. Anoxia would present as cyanosis, confusion, and dizziness, but not shivering. Excessive blood loss (hypovolemia) would present as dry mucous membranes and skin, hypotension, decreased urine output, and deep, rapid respirations. Malignant hyperthermia would show as tachycardia, fever and muscle rigidity.
You are providing Pre-OP teaching to a young teenage girl who is about to have a central venous catheter (CVC) placed for chemotherapy. She tells you she is worried that her friends will notice the catheter under her clothing. Choose the BEST response: A: "No one will notice. Don't worry about it." B: "You should be more worried about your cancer than the catheter." C: "You should not be so worried about what other kids will think." D: I understand that you are worried about others seeing the catheter. Let's talk about dressing strategies you can use to hide the catheter."
D: I understand that you are worried about others seeing the catheter. Let's talk about dressing strategies you can use to hide the catheter." To meet the patient's needs, you should be sensitive to her feelings and concerns about the illness. The correct response shows that you have heard and understand the patient's concern and offer constructive feedback. The other responses downplay the patient's concern and may be viewed as uncaring or condescending.
Your 21 year old patient has just undergone a partial splenectomy to stage his recently diagnosed Hodgkin's disease. He is still semi-conscious in the PACU. His parents are at the bedside and ask you what was found during the patient's surgery. How should you BEST respond? A: "You will need to talk to the surgeon if you have any questions." B: "My nursing supervisor can tell you, but I'm not allowed." C: "He has stage 4 cancer, and it's very serious." D: I'm sorry, but because your son is legally an adult, I must have his permission to give you any information about his diagnosis."
D: I'm sorry, but because your son is legally an adult, I must have his permission to give you any information about his diagnosis." Patient confidentiality and privacy is a right to all patients. This patient is legally an adult and therefore you must have his permission before divulging any personal information, even to his parents.
Which of the following is a category 1 (critical) surgical item (Spaulding classification)? A: Arterial blood pressure cable B: Ambu bag (bag valve mask) C: Bronchoscope D: Internal defibrillator
D: Internal defibrillator An internal defibrillator is an example of a category 1 (critical) surgical item, as it is implanted in the chest, and therefore need to be sterile. Bronchoscopes and Ambu bags are examples of semi-critical items, which are use with intact skin and mucous membranes and are treated with high-level disinfection. They may be sterilized if needed. An arterial blood pressure cable is an example of a noncritical item used in contact with intact skin, and can be intermediate- or low level disinfected.
Identify the shortest acting anesthesia of the choices listed: A: Halothane (Fluothane) B: Ketamine (Ketalar) C: Thiopental (Pentothal) D: Methohexital (Brevital)
D: Methohexital (Brevital) Methohexital (Brevital) is used for rapid inductions and is a brief anesthesia. It is the shortest-acting anesthesia of the choices listed. Halothane is used for slow, smooth induction; it is rarely used. Ketamine and thiopental are both short-acting anesthetics, used when muscle relaxations is not needed.
Spaulding Classification of items used on patient involves 3 classes. Class 3 involves noncritical items/equipment. Low and intermediate disinfection are adequate for this class. What are two items that fit into class 3? A: Bronchoscopes and OR furniture. B: OR furniture and sigmoidoscopies. C: Sterile set of colon instruments and blood pressure cuffs. D: OR furniture and blood pressure cuffs.
D: OR furniture and blood pressure cuffs. Noncritical items are used in contact only with intact skin and therefore only need low-level disinfection. OR furniture and blood pressure cuffs fit into class 3. Health care workers must understand appropriate ways to use and terminally clean equipment and supplies to prevent cross-contamination and protect their patients and themselves. Sigmoidoscopies and bronchoscopes fit into category 2 (semi-critical items) because they come into contact with mucous membranes and therefore required high-level disinfection of sterilization. Sterile sets of instruments are critical item-class 1- and MUST be sterile.
Preoperative communications which treats the patient with consideration including all of the following EXCEPT: A: Understanding information about tests and treatments. B: Using a kind tone of voice. C: Provision of privacy and dignity. D: Frequent family updates and taking the patient's picture at family request.
D: Patients perceived the nurse as caring, knowledgeable, protective, and efficient. Preoperative communications should involve treating the patient with consideration. Patient responds favorable to the provision of privacy and dignity, accurate and understandable information about test and treatments, and overall friendliness including using a kind tone of voice. The nurse should provide frequent family updates during the surgical procedure, but because of HIPAA and confidentiality policies, staff should not be taking any patient picture, even at the family's request.
The World Health Organization (WHO) Universal Protocol has been included in the Comprehensive Checklist advocated by the Association of Perioperative Registered Nurses (AORN). What are the preoperative components of this checklist? A: Procedure consents, history and physical including labs and x-ray test results, site marking, and sterilization indicators. B: Procedure consents, history and physical including labs and x-ray test results, anticipated blood loss, and site marking. C: Patient identify, procedure consents, difficult airway assessment, history and physical including lab and x-ray test results. D: Procedure consents, history and physical including labs and x-ray test results, and site marking.
D: Procedure consents, history and physical including labs and x-ray test results, and site marking. These details are critically important to give quality care to your patient and should be checked in the holding area, prior to entering the OR. Also check for pre-anesthesia assessment, blood products, and any special equipment, devices, or implants. Patient identity must be included every time. Airway assessment, anticipated blood loss, and sterilization indicators are intraoperative components.
What is a common coping mechanism sometimes seen in children preoperatively. A: Denial B: Regression C: Identification D: Regression
D: Regression To meet a patient's needs, the health care team should be sensitive to the patient's feelings about the illness. A patient's reactions influence his or her behaviors and the staff behavioral responses. An understanding of the patient's basic methods of coping in helpful to the caregiver in developing the plan of care. When in a scary or threatening situation, such as facing surgery, a child may cope by regressing (reverting to a more primitive state of being), acting like he did at a younger age. The other options are also coping mechanisms but children tend to regress more frequently than they display denial (refusing to accept), or identification (acting as the hero) when faced with surgery.
What are three infectious agents that could be used in a bioterrorism attack? A: Shigella, Ebola, clostridium perfringens B: Botulism, smallpox, Moraxella catarrhalis C: Ebola, anthrax, listeria monocytogenes D: Ricin toxin, shigella, botulism
D: Ricin toxin, shigella, botulism Heath care workers should have a basic familiarity with microorganisms associated with bioterrorism. Bioterrorism agents could include ricin toxin, shigella, botulism, anthrax, Ebola, brucellosis, cholera, glanders, Lassa fever, melioidosis, psittacosis, smallpox, typhus, tularemia, etc. These infectious agents could be used to cause large numbers of people to become infectious and possible die.
During anesthesia induction, the circulator nurse should stay close to the patient and assist in his care. All these nonverbal signals showing caring and consideration EXCEPT: A: Make eye contact and smile B: A gentle touch C: Listen to what the patient says D: Turn up the music
D: Turn up the music The patient may be aware of conversation and sounds, even if he or she appears to be asleep. Sedation does not imply exclusion. Time is of the essence to keep anesthesia and procedure times to a minimum, and it is a protective factor to provide as little disturbance to physiologic homeostatic as possible. Loud music is not conductive or appropriate in the OR environment. The patient's welfare and individual needs to take priority over all other activities before and during the induction of anesthesia. Human beings react through their senses. Positive, nonverbal signs such as making eye contact, paying attention to the patient's needs and comfort, smiling, listening to the patient, staying close, and gentle touch to convey caring and kindness. In addition, remember to appear poised, confident and professional at all times when with your patient.