Periop 101 Final Exam
Based on the knowledge gained about the special assessment needs, identify the needs of the surgeries listed below: 1. ostomy placement 2. positioning requirements 3. platelet counts 4. metabolism imbalance a. gastro surgery b. thyroid/parathyroid surgery c. hepatobiliary surgery d. gyn surgery
1. a, 2. d, 3. c, 4. b
Many national organizations are focusing on ways to improve pt care. Match the organization with their associated safety activity. A. Centers for Medicare and Medicaid services (CMS) B. Institute of medicine IOM c. The Joint Commision d. WHO 1. HIPPA 2. National patient safety goals 3. Safe surgery saves lives 4. To err is human: Building a safer health system
A. 1, b. 4, c. 2, d. 3
As directed by their surgeon, pt's should bathe or shower before surgery with soap or antimicrobial in order to a. Reduce the skin's microbial count B. Soften hair shafts for preoperative removal c. Lessen the effectiveness of the surgical skin prep d. None of the above
A
EMI can be harmful to the pt with an implantable electronic device. What does EMI mean? a. Electromagnetic interference b. Equated monthly installment c. Electromagnetic induction
A
Pt is scheduled for reconstruction of her external ear following a dog bite injury. Which skin prep is indicated for use? a. Aqueous iodophor (betadine) b. CHG c. CHG-alcohol d. Iodophor-alcohol
A
The pat's privacy is guaranteed under the HIPPA. What other resource should the nurse review before sharing a pt's healthcare information? a. The facility's policy and procedure b. Department protocol c. Physician's notes d. None of the above
A
What is the perioperative RN's responsibility regarding informed consent? a. Ensure that the consent is correct, signed and witnessed b. Obtain verbal consent if there is no written consent c. Provide the pt a list of alternative treatments to the proposed surgery d. Review the procedure and expected outcome with the pt
A
What physiological effect is most likely to result from positioning a pt in the Otho to my position? a. Hip dislocation b. Venous pooling in the legs C. Damage to brachial nerve d. Severe hypertension
A
Which of the following observations are critical when doing skin antisepsis on a peds pt? a. Take measure to prevent loss of body heat b. Small bodies require smaller amounts of antimicrobial agents c. Children are not sensitive to chemical agents d. The whole body must be prepped irrespective of the operative site
A
one of the physiological effects of the trendelenburg position is a. Decreased diaphragmatic movement b. Even distribution of lung ventilation c. Increased cardiac output d. Venous pooling in the lower legs
A
perioperative nursing care documentation must include a description of the pt care delivered and the pt response to that care a. True b. False
A
An area of painful skin that is abraded blistered or has shallow craters would be classified as which stage ulcer? a. I b. II c. III D. IV
B
If a highly contaminated area is part of the surgical procedure, the area with lower bacterial count should be a. Confined and contained b. Prepped first c. Prepped last d. Prepped with gentle friction
B
What is an important consideration r/t transferring a pt who has received general anesthesia from the OR bed today gurney for transport to PACU? a. One staff member should routinely be available for pt transfers b. Transfer with a minimum of 4 staff members in attendance c. Pre medicate the pt to make them less anxious during transport d. Wait until the pt it's fully awake and able to transfer himself
B
A neighbor calls the preoperative area and asks the perioperative RN "how is my friend? I missed her at church and I heard she was in the hospital." What is the RN's appropriate response? a. Here's her daughter's number; she can give you more info b. She's doing well but I cannot give you any more info c. The pt has requested that we share her info only with family d. We are getting her ready for surgery so you can talk with her in a few hours
C
According to the universal protocol for preventing wrong site, wrong procedure and wrong person surgery, what is an acceptable method to identify a pt? a. Their room number b. Pt's name by reviewing consent c. Ask pt to state name and date of birth d. Pt's armband for MRN and social
C
Antimicrobial agents used for the surgical skin prep need to be fast acting with a broad spectrum in order to be effective against a wide range of microorganisms. What other properties are necessary for an effective skin prep agent? a. Low log reduction capability and non irritating b. Persistent and toxic c. High log reduction and non toxic d. Persistent and non irritating a. 1 and 2 b. 2 and 3 c. 3 and 4 d. 1 and 4
C
Positioning the patient has critical safety implications. What must the RN circulator and periop team do to ensure that the pt does not suffer an injury or permanent damage? a. Use positioning devices that are sized for all pt types b. Positions the geriatric pt according to the preference card c. Repositions extremities when possible during long surgeries d. Places arms on a non padded arm boards to reduce pt profile
C
What is included in the Universal Protocol for preventing wrong site, wrong procedure and wrong person surgery? a. Briefing and time out B. preoperative verification and handover report c. Preoperative verification, surgical site marking and time out d. Surgical site marking and time out
C
What type of human factor error occurs when a perioperative rn is trying to juggle several tasks at once? a. Device user error b. Knowledge based c. Situational d. Skill based
C
When performing surgical skin prep, the anitseptic agent should be applied for the length of the time designated by the A. AORN guideline b. Available evidence based research c. Manufacturer's instructions for use (IFU) d. Recommendations from facility's infection control
C
Which of the following is not a goal of the surgical prep? a. Removal of soil and transient microbes b. Reduction of resident microbes below a pathogenic level c. The promotion of rapid rebound growth of microorganisms d. All options are correct
C
Which of the following should be avoided during hair removal? a. Use of clippers b. Clipping of hair against the grain of hair growth c. Nicking or cutting the skin d. Removal of loose hair from prepped area
C
63 yr old female pt who has just had a total knee. The RN circulator and anesthesia provider transport her to the PACU. Which of the following is included in the hand off communication to the PACU RN? A. Estimated blood loss b. Urine output c. Pt's family/support group info d. All of the above
D
CHG is recommended for a. The auditory canal b. The scalp c. Vaginal preps d. Topical application
D
In planning and provision for safer pt care r/t the prevention of positioning injury, the RN should a. Depend on the pt's natural defense mechanisms to indicate the need for positioning alterations b. Rely on the surgeon and anesthesia assessments to guide positioning c. Use a consistent method of procedure specific positioning for each pt d. Use additional precautions as appropriate based on unique pt considerations
D
Individuals within the periop team play the biggest role in fostering and maintaining safety. Identify the element that is not the responsibility of the individual staff member a. Know the facility's emergency outage plan b. Monitor area for safety hazards c. Identify and report safety hazards D. Updating safety policies and procedure
D
What is the best way to conduct a time out? a. Perform it in the pre procedure area if all team members are present b. Perform when the pt enters the room so he can participate c. The circulating RN leads the time out and documents it on the count board with in the OR for all to agree d. It occurs after the pt is prepped and draped, and involves the entire team
D
Which characteristic promotes a culture of safety within a health care organization? a. Commitment to safety as the first priority in providing care b. Ongoing education of staff members about pt safety c. Trust among healthcare team members d. All of the above
D
Which of the following must be noted during the preoperative nurse's assessment? a. Financial and insurance info b. Length of illness and physical therapy arrangements c. Detailed religious beliefs and expectations of the surgical outcome d. Family of personal reactions to anesthesia
D
Which statement correctly describes recommendations for preoperative pt skin antisepsis? a. In determining the area to be prepped, expose the smallest area possible to protect the pt's privacy b. Prep dirty areas before clean areas c. Remove hair with a razor d. The prep should start at the site of the incision and move outwards
D
It is important to discuss the pt's spiritual needs during the pre-op assessment. What elements of different faiths should the periop nurse be aware of in the event of a pt's intraoperative death? a. Islamic beliefs include that one designated person should wash the body of the deceased b. The team should prepare for an organ donation for the deceased of any religious belief c. The RN circulator should immediately contact a local mortuary d. Cremation is preferred by memebers of the Jewish faith
a
Periop teaching encompasses the 3 elements of info, psychological support, and skills training. What most accurately describes the level of skills training? a. Information describing elements of postoperative recovery b. Coping mechanisms provided for fear and anxiety c. The explanation of the periop process d. Description of intraoperative pt care activities
a
The endotracheal tube or laryngeal mask airway is removed a. when the pt is able to maintain their airway b. when the pt is fully awake c. after in IV injection of sugammadex d. one the narcotic reversal agent is administered
a
The pathology lab and blood bank are usually situated in which of the following areas? a. unrestricted b. semi restricted c. restricted d. fully restricted
a
The preoperative interview is the final assessment of the pt. This nurse-pt interaction enables the nurse to a. identify any additional pt care needs prior to surgery b. determine the length of the procedure and needed supplies c. introduce the pt to the surgical team d. provide info necessary for d/c
a
The ultimate responsibility for obtaining informed consent resides with the a. surgeon b. risk manager c. pt's guardian d. preoperative nurse
a
What are the principle elements required for an infection to occur? a. A method of transmission, a source or reservoir, a susceptible host b. A susceptible host, middle age pt, skin integrity c. A susceptible organism, a warm, moist environment, a method of transmission d. Limited air flow in the OR, a source or reservoir, compromised sterile technique
a
What are the types of transmission based precautions? a. contact, droplet, airborne b. direct contact, enteric, standard c. indirect contact, direct contact, standard contact d. MRSA, VRE, C Diff
a
What is the first step in reprocessing surgical instruments after they have been used in a procedure? a. Cleaning b. Decotamination c. Disinfection d. Transport to the sterilizer
a
What legal standard does the professional nurse need to meet when providing care? a) Reasonably prudent care b) certification standard c) Reasonably responsible standard d) There is no legal standard
a
Which of the following practices violates a pt's ethical right to self-determination or removes his or her ability to make informed choices? a. Automatically suspending an intraoperative DNR decision b. Including family in the education process c. Performing emergency surgery without informed consent d. Providing info about the scientific evidence for planned care
a
Who is responsible for ensuring that the daily operations of the surgical suite meet accrediting and regulatory agency requirements? a. Administrative support staff b. Biomedical staff c. Environmental support staff d. Surgical team
a
factors that may affect postoperative pain are: select all that apply a. The surgical site b. The nature and intended purpose of the surgery c. The pt's fears regarding anesthesia or surgery d. The level of anxiety of the pt's family members
a, b, c
Vaccine preventable disease against which health care providers should be immunized include: (select all that apply) a. hep B b. seasonal flu c. tuberculosis d. varicella
a, b, d
PACU nurses hold which 2 advanced certs? (select all that apply) a. PALS b. wound care cert c. ACLS d. certified emergency nurse
a, c
Proper OR attire for restricted areas includes: (select all that apply) a. head covering in a shower cap or hood style b. shoe covers required for all team members c. 2 piece scrub suit with top tucked into the pants and secured at the waist d. warm up jacket snapped with cuffs down to wrists
a, c, d
Select the appropriate Spaulding Classification System category for each item listed: a. Blood pressure cuff b. Laryngoscope blade c. Ortho implants 1. critical 2. non- critical 3. semi critical
a. 2, b. 3, c. 1 or BP non crit, blade semi, implants critical
Match the designated surgical area with the correct surgical zone: a. preoperative pt care area b. work area for processing instruments c. individual OR suite with sterile supplies opened 1. restricted 2. semi restricted 3. unrestricted
a. 3, b. 2, c. 1
Match the anesthesia term to it's definition: a. general b. regional c. monitored anesthesia care (MAC) d. moderate sedation e. local 1. administration of anesthetic agents by an anesthesiologist, CRNA, or specially trained perioperative RN 2. an injection of local anesthetics near nerve fibers to cause reversible loss of sensation over an area of the body 3. anesthesia provider monitory and sedation of the pt 4. drug induced, reversible state of unconsciousness 5. infiltration or topical administration of agents to anesthetize a body part
a. 4, b. 2, c. 3, d. 1, e. 5
4 ways to ensure professional practice r/t the AORN practice include: maintaining competency, the use of EBP, certification and a. mentoring student nurses b. pursuit of lifelong learning c. achieving a minimum of an associate's degree d. achievement of an advanced practice nurse degree
b
A 65 yr old pt is in the pre op holding area. The pt's pre op lab test results show several critical values. Which of the following actions should the circulating nurse complete first? a. ask the lab to draw confirmatory lab tests b. inform the anesthesia provider of the lab values c. notify the charge nurse of your findings d. proceed with the schedule case
b
A preoperative nursing assessment should be conducted by a preoperative RN at what point? a. prior to d/c b. before the surgery c. in the surgeon's office d. before the surgical consent is signed
b
According to AORN recommended practices, the shelf life of a sterile package kept in storage is: a. time related b. event related c. content related d. sterilization related
b
An integrator is a multiparameter indicator designed to measure which of the following parameters? a. pressure, steam, temp b. temp, time, presence of steam c pressure and sterility
b
Biological monitoring a. Is utilized to document the sterility of an item b. Indicates that the intended physical conditions in the sterilizer were met c. Can be read immediately after the sterilization cycle is complete d. Should never be used in IUSS
b
Decontamination of instruments should begin after the completion of all invasive porcedures to prevent the formation of biofilm. Which of the following statements is correct? a. Decontamination of instruments occurs at the time of use of the instruments b. Decontamination begins when instruments are treated with an approved chemical application or covered with a moistened towel c. Decontamination of lumened instruments begins with flushing the lumen with sterile saline d. Instruments with multiple parts are not disassembled if they were not used during the surgery
b
During a handover report to the PACU RN, the perioperative RN may use a communication method identified by the acronym "SBAR". What does SBAR stand for? a. Safety, Background, Actions, Recovery expectations b. Situation, Background, Assessment, Recommendation
b
In which surgical wound category should a total abdominal hysterectomy be classified a. clean b. clean contaminated c. contaminated d. dirty
b
Per the Pt Care Partnership, the AHA believes the pt has the right to the following: a. info, unless the surgeon deems it unnecessary or detrimental to the pt b. to give informed consent for their treatment c. to have a loved one in the OR during the surgery d. a video showing and explaining the upcoming surgery
b
The most consistent early indicator of a malignant hyperthermia crisis is a. a change in the ECG b. an increase in end tidal CO2 c. hyperkalemia d. lactic acidosis
b
The phrase "At least one individual failed to do what a similarly situated, reasonable and prudent professional would have done under similar circumstances" is the definition of a. abandonment b. negligence c. unethical behavior d. malpractice
b
The relative humidity in the OR suite should be maintained within a range of a. 20-30% b. 20-60% c. 30-70% d. 40-50%
b
The ventilation system in the restricted area of the OR should have an air exchange rate of at least _________ air exchanges per hour a. 5 b. 20 c. 10 c. 15
b
What are the preoperative nurse's responsibilities for the informed consent process? a. acts as a surgeon's agent to educate the pt about risks and benefits of surgery b. confirming that the pt is fully informed during the pre op interview c. discusses what the surgeon has told the pt and answers pt questions about the plan for surgery d. discuss the proposed intervention and the risks involved with the pt and the pt has signed the consent
b
When transporting a pt who is on contact precautions, the transporter a. Always wears PPE b. Wears PPE for a restless or intubated pt c. Wears PPE if they are uncertain if they will need to touch the pt d. Wears PPE only when touching the bedrails
b
Which assessment finding is common among elderly pts? a. An increase in oxygen saturation b. Decrease in vision including color and depth perception c. Increased perception of pain d. An easy adjustment to a change in their environment
b
immediate-use steam sterilization can be used a. for implants b. in urgent situations c. under no circumstances d. for all items
b
Why is it important to assess the use of herbal supplements or recreational drugs before surgery? (select all that apply) a. herbal preparations can decrease the toxicity of other drugs administered during anesthesia b. herbal preparations can affect bleeding times c. herbal preparations can interfere with drug metabolism d. recreational drug use can result in withdrawal symptoms e. recreational drug users may require higher doses of anesthetic medications
b, c, d, e
A 40 yr old male pt is awake and alert in the PACU after a right shoulder surgery. What is the best measure to assess the pt's pain? a. Disucss the pt's pain with the anesthesiologist b. Observe facial expressions c. Ask the pt to rate pain from 1-10 d. Monitor vital sign changes
c
A _______ does not permit a person to excuse an error but rather to admit and rectify one readily. a. adherence to ascetic technique b. practice of professional c. surgical conscience d. just culture
c
A hand over communication report is given by the anesthesia professional and a. surgical resident b. medical student c. OR nurse d. inpatient nurse
c
A surgical mask should cover both mouth, nose and should be a. Allowed to hang around the neck between procedures b. Changed after 2 hours of use c. Removed and discarded after every case d. Tied snugly with strings crossed
c
After transferring a male pt into the Phase I PACU, the perioperative RN could reasonably expect the PACU RN to FIRST a. Administere med to the pt for nausea and vomiting b. Ask the pt if he has any pain c. Assess the pt's airway and respirations d. Care for this pt and 2 other pts as assigned
c
An RN who attends continuing nursing education and has verified skills, knowledge, and attitudes about perioperative nursing is demonstrating accountability in his/her: a) Certification requirements for professional achievement in perioperative nursing b) Collaboration among team members c) Professional growth and maintenance of competency d) Verification of nursing knowledge
c
An example of a standardized format for hand off communications is the SBAR. This acronym represents: a. Situation, background, application, responsiveness b. Site marking, background, application, readiness c. Situation, background, assessment, recommendation
c
The Perianesthesia nurse has ASPAN to guide their practice. What does ASPAN stand for? a. American Sterilization of PeriAnesthesia Nurses b. Association of Specialized PeriAnesthesia Nursing c. American Society of PeriAnesthesia Nurses d. Association of Surgical Post Anesthesia Nursing
c
What are the 3 main factors to consider when assessing the pt for allergies? a. heredity, age, prior reaction b. prior reaction, diet, age c. prior reaction, heredity, type of reaction d. type of reaction, weight, heredity
c
When is it appropriate for the periop nurse to release cricoid pressure? a. as the anesthesia provider starts to intubate the pt b. one the trachea is occluded c. when the ET tube cuff is inflated d. when the ET tube stylet is removed
c
Which is the best method for preventing blood borne pathogen exposure? a. Allowing for proper air exchange to occur between cases b. Inspecting all sharps to ensure they are intact after use c. Using PPE and handwashing d. Wearing non sterile gloves at all times when in the surgical suite
c
Which of the following best illustrates the purpose of perioperative pt and family education? a. To reduce the pt's anxiety b. To increase pt and family adherence to the plan of care c. To increase the pt's and fam's satisfaction with the quality of care d. To support legal, ethical, and regulatory mandates
c
Which of the following is a disease that is transmitted via the airborne route? a. C Diff b. Flu c. Measles d. Shingles, localized
c
Which of the following is not an example of an ethical dilemma that period nurses may encounter? a. DNR order for a surgical pt b. family disagreement regarding possible organ donation c. family disagreement about a BKA on an 18 yr old who has already given consent d. human experimentation
c
Witnessing a signature to an informed consent assures that: a. the pt understands the reason for the surgical procedure b. the surgeon has explained the risks, benefits, and alternatives to the planned procedure c. signature is authentic, pt is competent and consent was done voluntarily d. the surgical procedure lists all steps on the consent correctly
c
a professional practice model includes personal accountability and ethical decision making. Which of the following is not part of personal accountability? a) Responsibility to self, patients, and peers b) Make decisions and accept consequences when necessary c) Accept performance input from direct and upper level management only d) Maintain professional engagement
c
truth telling and the process of reaching informed consent underlie the principle of: a. respect b. empathy c. self determination d. communication
c
A 43 yr old female scheduled for a lap choly, the periop RN should provide preop education to her and her family, incuding a. Detailed info about the surgical procedure, including risks and benefits b. Obtaining informed consent from her and suspending any DNR orders c. Verification of financial records d. Wound care and pain management
d
A 47 yr old male is admitted to the Pre-op area for an inguinal hernia repair. What does the nurse include in the intake assessment? a. Pain b. Cognitive ability of the pt c. Cultural considerations d. All of the above
d
Documentation should be accurate, concise, and complete, providing information for future reference in addition to a. Ensuring the quality of pt care b. Serving as evidence in a court of law c. Reconstructing the pt's healthcare experience d. All of the above
d
During the preoperative interview, the RN should ask the pt about use of any herbal preparations and/or botanicals. Why is this a critical component of the assessment? a. These products can affect bleeding times b. An alteration of medication metabolism can ensue c. Anesthetic toxicity can occur d. All of the above
d
Every member of the healthcare team has a role to play in cost containment. Which of the following is an example of how the perioperative RN can participate in cost containment in the OR? a) Ask the surgeon to use a less expensive implant b) Begin cleaning the OR for the next case before the patient leaves the room c) Open all supplies listed on preference card, including "available" supplies d) Verify with surgeon before opening suture
d
If a pt is scheduled for surgery and general anesthesia eats a cheeseburger, according to the American Society of Anesthesiologists, how long should they wait before having anesthesia for surgical procedure? a. 2 hours b. 4 hours c. 6 hours d. 8 hours
d
In relation to transcultural needs of the pt, it is important to include __________ needs in the nursing assessment. a. medical b. ADLs c. pharmacological d. spiritual
d
Regulatory agencies require documentation for equipment and staff education. Which of the following are types of records that the healthcare facility is required to maintain? a. Sterilization logs b. Equipment maintenance records c. Chemical sterilant records d. All of the above
d
What is the best method for keeping instruments clean on the sterile field? a. Soak instruments in a basin of normal saline b. Wipe instruments with a sponge moistened with sterile water c. Spray instruments with an enzymatic detergent d. Wipe instruments with a sponge moistened with sterile water and flush lumens with sterile water
d
What would be the MOST important information for a nurse in Preadmission Testing (PAT) to collect on an insulin dependent diabetic patient? a. How long the patient has been diabetic b. If there is someone to deive them home c. The last time the patient ate or drank d. The type of insulin that patient takes
d
Which of the following are true about AORN's guidelines for Preoperative practice? a. they are based on what doctors do in ideal situations b. they can replace your department and institution's policies c. they contain information that must be followed as mandatory practice d. they may be fulfilled to varying degrees in the different situations
d
Which of the following statements is TRUE concerning use of the AORN Guidelines for Perioperative Practice? a) Both medical and nursing licensing boards require health care institutions to comply with the AORN guidelines b) The AORN Guidelines legally supersede departmental and institutional policies c) The AORN Guidelines reflect scientific evidence of how nurses actually practice in perioperative settings d) Work setting and situation variations may determine the extent to which AORN Guidelines can be applied
d
You are circulating on a lap appendectomy. Upon entering the abdomen, the surgeon encounters purulent inflammation and asks for a culture. What is the wound class for this case? a. Class I: Clean b. Class II: Clean contaminated c. Class III: Contaminated d. Class IV: Dirty infected
d
During the preoperative interview, the perioperative nurse should ask pt's about their use of a. alcohol b. herbal preparations c. recreational drugs d. tobacco products e. all of the above
e
