MV RNFA 2

Which statement best reflects the appropriate purpose of a surgical drain?

Drains can prevent the development of deep wound infections.

True or False: It is permissible to scrub without removing rings.

False

Fingers under the right ribs cause pain with Cholecystitis

How do you assess for Murphys sign?

CO2 via veress needle seeing at 15mm HG maintaining pneumoperitoneum

The process of insufflation includes?

Which of the following is true about the Braden scale? The lower the score, the greater the risk of developing a pressure ulcer.

The most common and natural position used for operative procedures is: supine

Clean Contaminated

Wound class for laparoscopic Sigmoid or colectomy is?

A few steps in the abdominal skin prep procedure are given below. Identify the correct order of the steps. a. Preoperative cleansing b. Preoperative hair removal c. Exposing the area to be prepped d. scrubbing and blotting e. apply antiseptic agent

A, B, C, E, D

Direct hernia

Hernia that is Medial to the inferior epigastric artery

Indirect hernia

Hernia that is lateral to the inferior epigastric artery

Pressure against the skin above ____mm hg interferes with tissue perfusion

32

The horizontal mattress is _____.

An everting stitch

hyperparathyroidism

An increase in normal value of calcium could indicate what condition?

An expansive tendinous sheet that projects from a muscle is called _____.

Aponeurosis

statement regarding risk factors for developing vascular disease is true

Arteriosclerosis is a natural part of the aging process.

In order: Inspection Auscultation Palpation Percussion

Assessment of the abdomen includes?

Cellulitis

Bacterial infection involving the inner layers of the skin.It usually affects the dermis and the subcutaneous fat?

Identify the activities that may be handled by the environmental services personnel. *Select all that apply* a. Preliminary room preparation b. Damp dusting/mopping c. End-of-procedure cleaning d. Terminal cleaning

C & D

Vascular access in pediatric patients may be established intraoperatively for short-term (weeks) or long-term (months, years) use

Central venous line

Chapter 05 - Anesthesia

Chapter 05 - Anesthesia

accidental division of vein intimal injury of vein over destention of vein avulsion injury

Concerns when harvesting vein?

Uterosacral ligament

Connects the sacrum to the uterus?

What is the appropriate action if the doctor is delayed after the room and instruments have been opened?

Cover the instruments with a sterile drape and have the scrub nurse continually visually observe the room for breaches in sterility

Olfactory- Smell

Cranial Nerve I

a polyester suture

Ethibon

Polyester fibers include _____.

Ethibond

Which of the following is a complex stitch?

Figure of eight

round ligament

Following a tubular structure to the side wall during a hysterectomy help identify it as the ?

Infundibulum

Funnel shaped portion of the uterus?

Kocher oblique incision

Incision which is made on an angle extending rom the midline laterally. Running just underneath the lower ribs?

Respiratory tract Eyes Skin

Methylmethacrylate is an irritant to?

Perioperative Nursing Data Set

PNDS

Fluid Replacement Carry O2 to tissue and organs

Purpose of PRBC administration?

Reticulum

Strength layer of the dermis is the?

Cervix

The Ureter passes more closely to the uterus at this level?

Hesselbachs Triangle

The region between the rectus abdominus muscle, the inguinal ligament and medial to the inferior epigastric artery.

The most common congenital cyst found in the neck is

Thyroglossal duct cysts

Perpendicular

To prevent beveled edges, the scalpel blade should be held____________ to the skin?

which surgical approach reduces the morbidity and mortality in removal of an acoustic tumor

Translabyrinthine approach

Nissen Fundoplication

Treatment for GERD?

Why would extracorporeal sutures be used? They can be tied outside the body and inserted through a trocar.

Which of the following practices supports laser safety? Using nonreflective instruments near the site

When microlaryngoscopy is performed to remove polyps or nodules from the vocal cords, what important postoperative instruction must the nurse give the patient during discharge teaching?

a. Complete voice rest is important

Which classification of hemostatic methods involves pressure or the use of ligating clips? a. Chemical b. Mechanical c. Thermal

b. Mechanical

The science of plastic and reconstructive surgery, which means to mold or create form and shape, improves appearance and body image through an understanding of:

b. the anatomy and biology of tissue

Ethics is an attempt to define right and wrong based upon ____.

beliefs

The pterion

c. is part of the temporal bone.

Visceral

peritoneum which lines the abdominopelvic organs is called the ?

The surface tissue effect of the CO2 laser serves as the laser of choice for:

plastic surgery or dermatologic removal of tattoos

Individual smoke evacuation units with a 0.1 micrometer filter include. 1. LEV 2. ULPA 3. HEPA 4. N95 a. 1 and 2 b. 2 and 3 c. 1, 2, and 3 d. 1, 2, and 4

B.

Choose the correct statements about incise drapes: *select all that apply* a. Are a type of fenestrated sheet. b. Are available with or without adhesive backing. c. Are made of plastic and impermeable material. d. May be used in ear or eye cases. e. May be impregnated with iodophor.

B, C, & E

Perioperative personnel should use hand hygiene and don clean scrub attire and head coverings when: 1. Entering the OR or an invasive procedure room for any reason. 2. when assisting with surgery. 3. when stocking rooms in the restricted zone. 4. when opening sterile supplies a. 1 and 3 b. 1, 2, and 3 c. 1, 3, and 4 d. 1, 2, 3, and 4

a. 1 and 3

At what point in the healing process do most wound disruptions occur? a. Beginning of proliferative phase- (Phase 2) 2-10 days b. End of proliferative phase- (Phase 2) 10-22 days c. Beginning of maturation phase (Phase 3) 21 days to 6 weeks d. End of maturation phase- (Phase 3) 6 weeks to 2 years

a. Beginning of proliferative phase- (Phase 2) 2-10 days

John, who has been a full-time perioperative RN for 2 years, has completed the coursework and clinical components to become an RN First Assist (RNFA). John also wishes to become certified. Which of the three certifications listed below is specific to the RNFA role? a. CRNFA b. CNOR c. CRNA

a. CRNFA

Potential sources of fuel for surgical fires include: a. Draping b. Fiber optic cables c. Lasers d. Nitrous oxide.

a. Draping

In a fire, the ESU would be considered what part of the Fire Triad? a. Ignition b. Oxygen c. Fuel d. Fire

a. Ignition

A direct inguinal hernia is located _____.

a. Inside Hesselbach's triangle

Monopolar electrosurgery requires the use of which device? a. Return electrode b. Foot pedal c. Two-pronged forceps d. Bipolar

a. Return electrode

Within a steam sterilizer, at a temperature of 100° C (212° F), the water condensation and the steam are the same temperature. This scientific phenomenon is called ________ and will ________.

a. Steam saturation; not kill microorganisms

Which position is used most for abdominal procedures and vascular surgeries? a. Supine b. Prone c. Lateral d. Kraske e. Trendelenburg

a. Supine. The supine position is the most natural position for the body at rest and is used for most abdominal procedures, head and neck procedures, and vascular surgery.

In the following illustration, the arrow points to the:

a. left vagus nerve.

The closed gloving technique is used: a. only when the hands have never passed through the gown cuffs. b. when re-gloving without assistance during the procedure. c. to assist a surgeon in donning sterile attire. d. as a method for correcting glove contamination.

a. only when the hands have never passed through the gown cuffs.

Randomized studies show that ______________________ gloving is associated with increased microbial contamination of glove cuffs. For this reason, ____________________ gloving should be performed whenever possible when donning the initial pair of gloves. a. open assisted, closed assisted b. closed assisted, open assisted

a. open assisted, closed assisted

Which region of the patient's abdomen is traditionally used to established pneumoperitoneum for laparoscopic surgery? a. periumbilical b. supraumbilical c. subumbilical d. umbilical

a. periumbilical

Iodophors with added detergents are referred to as "________" and those without added detergents are referred to as "________." a. scrubs; paints b. paints; scrubs c. gels; film forming d. scrubs; gels

a. scrubs; paints

The right coronary artery typically

a. supplies both the AV and SA nodes.

As a perioperative nurse thinking about a course of action, a good question to ask oneself is "What data did I use to reach this decision/course of action?" This is an example of the following component of critical thinking: a. using evidence b. being credible c. being introspective d. using sound judgment

a. using evidence

Two anesthetic gases that are included in the balanced inhalation mix during general anesthesia are:

air and oxygen.

The risk of an accident increases exponentially with each hour after the ____ consecutive hour of work. a. 8th b. 9th c. 10th d. 11th

b. 9th

Using which of the following currents can produce higher voltage than that of the pure cut mode? a. Coagulation b. Blended c. Cutting d. Vaporization

b. Blended

In addition to hyponatremia, which of the following conditions can be a result of improper fluid management? a. Hypertension b. Hypervolemia c. Hypotension d. Hyperkalemia

b. Hypervolemia

A violation of professional duty to act with reasonable care and good faith is a. Tort b. Malpractice c. Libel d. Abandonment

b. Malpractice

Identifying high-risk factors in the health care environment before an adverse event occurs is called a. Root cause analysis b. Proactive risk assessment c. Risk aversion d. Risk tolerance

b. Proactive risk assessment

The use of a pneumatic tourniquet during extremity surgery: a. is a noncontroversial practice b. Requires effective communication and collaboration between nurses, anesthesia personnel, and the surgeon. c. Is safe for all patients as long as tourniquet time does not exceed 30 min. d. All of the above.

b. Requires effective communication and collaboration between nurses, anesthesia personnel, and the surgeon.

An integrator is a multi-parameter indicator designed to measure which of the following parameters? a. Pressure, steam, and temperature. b. Temperature, time, and presence of team. c. Pressure and sterility.

b. Temperature, time, and presence of team.

What is the adverse reaction to penicillin when topically administered? a. Nausea b. Tissue damage c. Fever d. Chills

b. Tissue damage

Per the Patients The Patient Care Partnership, the American Hospital Association believes the patient has a right to the following: a. Information, unless the surgeon deems it unnecessary or detrimental to the patient. 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. To give informed consent for their treatment.

Identify which light source would be used in a surgery where bright light is required. a. Metal halide light source b. Xenon light source

b. Xenon light source

According to the Joint Commission, what is a "time out?" a. an opportunity for all OR staff to take a break b. a review of all important data relating to the procedure c. a time to review patient data- right patient, right procedure. d. a time to make sure all equipment is operating correctly

b. a review of all important data relating to the procedure

Destructive behavior toward self or others is a sign of: a. anxiety b. depression c. poor coping mechanisms d. type A behavior

c. poor coping mechanisms

Identify the dura fold that separates the right and left cerebral hemispheres.

c. Falx cerebelli

Which is *NOT* a local anesthetic drug used for regional anesthesia? a. Bupivicaine b. Lidocaine c. Fentanyl d. Tetracaine

c. Fentanyl

Which is the most serious physical hazard nurses face in the perioperative setting? a. Needle stick b. Exposure to radiation c. Fire d. Electrical shock

c. Fire

Which drug is used to reverse valium and midazolam? a. Neostigmine b. Pancuronium c. Flumazenil d. Succinylcholine

c. Flumazenil

Select the alternative or complementary therapy that would be appropriate to integrate into the plan of care in the perioperative setting.

c. Guided imagery before and during anesthesia induction

The transverse colon meets the ascending colon at what point?

c. Hepatic flexure

Select the suture material below that is a synthetic absorbable suture: a. Surgical cotton b. Surgical silk c. Polyglycolic acid d. Linen

c. Polyglycolic acid

When do spinal headaches usually occur? a. after 40 years of age b. During anesthesia c. Postoperatively d. before surgery

c. Postoperatively

Truth telling and the process of reaching informed consent underlie the principle of: a. respect b. empathy c. self-determination d. communication

c. self-determination

When there is a break in sterile technique, the minimum corrective actions should be: a. removing the entire tray and contaminated instruments from the OR. b. having team members change any potentially contaminated gloves. c. making any additional corrective actions that may required subject to thoughtful assessment. d. All of the above

d. All of the above

Identify the needle that is also known as a pop-off needle. a. Single-armed b. Double armed eyeless needle c. Permanently swaged needle d. Controlled release needle e. French needle

d. Controlled release needle

Sterile gowns and drapes are regulated as surgical devices. Federal law requires that if a gown or drape failes, the event must be reported to which US agency? a. CDC b. Agency for Health Care Research and Quality(AHRQ) c. National Institutes of Health (NIH) d. FDA

d. FDA

What method can be used to improve the prevention of health care-associated infections? a. Environmental cleaning b. Safe injections practices c. Process monitoring d. Policies and procedures

d. Policies and procedures

When documenting the placement of a surgical drain, which of the following components should be included? a. Date for expiration noted on the packaging. b. Manufacturer's name c. Serial number d. Where the drain was placed on the patient.

d. Where the drain was placed on the patient.

Which of these is considered to be a part of the environment of care? a. buildings b. equipment c. personnel d. all of the above

d. all of the above

Small Wire Sutures are:

23G, 24G, 25G

ligaments

A needle that is classified as reverse cutting is used primarily on?

Which medications are administered as an irrigation solution? *Select all that apply* a. Hyskon b. Sulfonamides c. Decadron d. Liquaemin e. Radial artery solution

A, B, & D

Identify the common ignition and fuel sources found in the surgical suite. *Select all that apply* a. Coagulators b. Cables c. Patient's hair d. Drills e. Nitrous oxide f. Oxygen

A, B, C & D

Biopsies that require specialized methods of preparation and preservation to preserve cells include: *select all that apply* a. bone marrow b. muscle c. nerve d. testicular e. tendon

A, B, C, & D

Select the systemic factors that affect wound healing. *Select all that apply* a. Age of the patient b. Sex of the patient c. Preoperative stress d. Medications

A, C, & D

Blood loss

Abnormally low range of HGB may indicate?

Identify the surgeries that may require the use of a tourniquet *Select all that apply.* a. Endoscopy b. Carpal tunnel release c. Morton's neuroma d. Ulnar nerve transposition e. Shoulder arthroscopy

B, C, & D

Compromised blood supply

Blanching is a sign of?

Cystic Artery Cystic Duct Common Hepatic Duct

Calot's Triangle consists of what landmarks?

Definitive information about the extent and location of ischemic heart disease can be obtained from which of the following tests

Cardiac catherization

Which structure supports the uterus and contains the uterine artery and vein

Cardinal ligaments

Chapter 03 - Workplace Issues and Staff Safety

Chapter 03 - Workplace Issues and Staff Safety

associated pancreatitis due to a common bile duct stone

Common cause for an increased amylase level?

Optic- vision

Cranial Nerve II

Pt with chronic, severe angina who cannot be revacularized with either coronary bypass surgery or PCI may be appropriate candidates for laser transmyocardial revascularization (TMR). Channels are created in the left ventricular wall with laser energy. What relevant interventions must accompany this procedure?

Employ laser safety precautions

Which of the following men has the greatest risk for developing prostate cancer? Ted, a 45-year-old of Jamaican descent

Freeda Lubowicz is scheduled for an endoscopic nephrectomy to treat her renal cancer. What surgical position should the nurse anticipate when planning Freeda's care? Supine

Age-related skin changes include a thinning epidermis and decreased subcutaneous fat and elasticity. What special consideration should the first assistant provide to avoid skin injuries?

Gently lift, not slide, the patient to and from the OR bed.

15 per hour

How many air exchanges do you need in each OR?

When a thyroglossal duct cyst is present in an adult, it exists as a pretracheal cystic pouch attached to what structure

Hyoid

Ureters

It is important to make an early identification and to avoid which of the following structures during TAH?

intima media adventitia

Layers of an artery?

pulmonary disease size of uterus

Limitations on contraindications for performing LAVH/RAVH would be?

The most common pediatric premedication given in the U.S. is:

Midazolam

Which suture material is more likely to come untied?

Monofilament

Dementia

Most common cognitive impairment for patients over 70?

Inflammatory proliferative remodeling (maturation)

Name the Phases of wound healing

Ampulla of vater

Pancreatic duct and the common bile duct enter the duodenum at?

Chapter 2

Patient Safety and Risk Management

Which of the following absorbable suture has the best tensile strength

Polydioxanone

Colostomy

Postoperatively what would you expect the patient to have following a sigmoid colectomy with Hartman's?

Primary divisions of a nerve are known as

Rami

Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained foreign objects (RFOs). What new and evolving risk reduction strategy could prevent RFOs and frustrating, time-consuming miscount adventures at the end of these procedures?

Replacing or tagging sponges and laparotomy instruments with RFID chips

Hyperresonance

Sound which occurs because of over inflation of the lung(as in emphysema or pneumothorax)?

When tying, what kind of knot do you want?

Square knot

If you noticed a partial-thickness loss of dermis presenting as a shallow, open ulcer with a red-pink wound bed without slough, how would you stage the wound?

Stage II

Nursing diagnosis

Statements about actual health problems or clinical conditions?

The nerve supply for the female pelvis comes from the autonomic nerves that enter the pelvis through the

Superior hypogastric plexus

In general, the needle that causes the least amount of tissue trauma is _____.

Taper

The cerebellar tentorium supports which structures of the cerebral hemispheres

Temporal lobe

stapler designed to close the end of a hollow organ

Terminal End (TA stapler)

Allens Test

Test during assessment used to determine arterial blood flow to the hands?

What one factor describes the high incidence of musculoskeletal disorders among surgical technologists and perioperative nurses

The cumulative effect of repeated patient handling events.

Hepatopancreatic Sphincter and enter the duodenum at the ampulla of vater

The pancreatic duct and the common bile duct join at?

How long can an operating room remain open and not used and still be considered sterile?

There is no specified amount of time that a room can remain open and not used and still be considered sterile.

Artificial nails harbor organisms and prevent effective hand antisepsis, therefore, should not be worn in the OR.

True

Draping is the procedure of coming the patient and surrounding areas with a sterile barrier to create a sterile field. True or False

True

True or False: Occupational safety concerns are a factor in nurses leaving the profession.

True

True or false: Do not use an ESU in an oxygen-enriched environment, such as the trachea.

True

True or false: Negligence is a form of malpractice.

True.

When placing rolled sheets and towels as a uterine displacing wedge or chest roll, these positioning devices should be placed:

Underneath the patient and over the mattress and overlay

If a staff person receives a needlestick injury, what is the first corrective action?

Wash wound with soap and water; flush mucous membranes.

The number one patient safety issue identified in a survey of peri-operative nurses is preventing:

Wrong site/procedure/patient surgery

All of the following may be associated with a "heart block" except:

a. section of the superior part of the thoracic sympathetic trunk.

Cirrhosis of the liver is associated with all of the following except:

a. softening of the liver.

Anaerobic organism (E-coli, Clostridium Tetani)

abscesses, infected tissue and foul odor which are able to sustain itself without O2?

A mosquito is classified as a __________. a. Cutting instrument b. Clamp c. Grasper d. Retractor

b. Clamp

Suture can be used for more than repairing tissue.

ligate, suture, and close tissue.

when cathing a female patient the periop nurse must locate the urethra.

mons pubis, labia majora, labia minora, clitoris, urethra, vaginal opening.

Gram stain designation is based on the:

physical and chemical properties of the cell wall

Criminal negligence is _____.

reckless disregard for the safety of another.

_____ is the most frequently acquired nosocomial infection.

urinary tract infection

F) Polymerized Caprolactam (multifilament)

• Synthetic • Brand Name - Vetafil or Supramid • Advantages: Good tensile strength; inexpensive • Disadvantages o Poor knot security o Moderate tissue reaction • Uses: Skin closure for large and small animals

Identify all the times that sharps should be counted. *Select all that apply* a. Prior to the start of the procedure b. When sharps are added to the field c. Before closure of a cavity d. At skin closure or end of the procedure. e. Before wound closure begins. f. All of the above

f. All of the above

What are some "KEY" safety issues to address during the use of surgical equipment?

*Communication* (with MDs, manufacturer's rep, team members) *Awareness of complications*, possible responses, resources to address complications.

What are some of the components of professionalism that affect clinical practice?

*Components such as practicing according to evidenced- based guidelines, standards, and clinical policies* form the intellectual foundation for practice. Clinical experience augments the didactic aspect of practice and creates a more robust level of professionalism.

How does skin antisepsis relate to infection-prevention, patient safety, and optimal clinical outcomes?

*Prepping agents are designed to reduce the risk* of developing a SSI by reducing skin flora and dirt. Prepping also reduces the number of microorganisms that can be transferred to areas within the surgical site, the sterile drapes, and the instruments. *An important aspect of 'safe surgery' is the prevention of complications*, such as SSI; safety also exists when the RN applies prep agents that do not produce an allergic reaction. *Reducing the risk of infection* and enhancing safety contribute to optimal patient outcomes.

What are some "KEY" issues connecting surgical draping and patient outcomes?

*Prevention of SSI; protection of the integumentary system;* freedom from lint and toxic ingredients; resistant to tears (and possible entry of microorganisms)

For the greatest concentration of antibiotic prophylaxis, the infusion should end within ___ hours of incision?

1

Match each description with the most appropriate form of accountability. 1. Collaboration on surgical procedures 2. Commitment to nursing 3. Overall performance 4. Commitment to patients a. Maintaining current knowledge and providing and a safe environment b. Becoming certified c. Ensuring availability of all necessary equipment, instruments, and supplies based on the patient's preoperative assessment d. Self-evaluating, seeking peer evaluations.

1-C, 2-B, 3-D, & 4-A

The tensile strength of lactic & glycolic acid polymers is sufficient for approximation of tissues for _____ weeks.

2-3

Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below:

32 mm Hg

Identify the correct statements about volatile liquids and agents. *Select all that apply* a. Vapors of the volatile gases are hazardous. b. Volatile agents may be found in aerosol spray. c. Volatile liquids spread quickly. d. Alcohol is the only volatile liquid used in the OR.

A & B

Basic surgical furniture found in the restricted area includes: *select all that apply* a. ring stand b. sterilizers c. scrub tanks d. kick bucket e. crash carts

A & D

Rovsing's sign (sign of appendicitis)

A maneuver of applying pressure over the left iliac fossa deeply in and directed toward the right side to illicit pain in the appendicular region is called?

Albert Janson, a 325-pound patient, is scheduled for a 6-hour abdominal surgery. The surgical assistant is concerned about the risk for pressure injury because of the weight of the patient's body pressing against the surface of the OR bed for a long surgery. Which of these other factors may also produce pressure?

A self-retaining retractor post clamped to the OR bed rail and tightened against the patient's side

Identify facts that are true about prions. *Select all that apply* a. Prions are not bacteria or viruses but rather malformed proteins. b. Creutzfeldt-Jakob Disease (CJD) is a degenerative neurologic disease that appears to be caused by prions. c. Prions appear to be resistant to most forms of sterilization used in health care settings. d. Prions appear to have a marked vulnerability towards moist heat.

A, B, & C

The benefits of a standardized count procedure include which of the following? *select all that apply* a. Assists in achieving accuracy during the count procedure. b. Assists in conducting efficient counts c. Human errors studies have shown that many errors result from deviation. d. Provides a bonding situation among perioperative team members.

A, B, & C

To prevent central line associated blood stream infection, follow proper insertion practices such as: *Select all that apply.* a. Perform hand hygiene before insertion. b. Adhere to aseptic technique c. Always use the femoral site for adult patients. d. Perform skin antisepsis with >0.5% chlorhexidine with alcohol.

A, B, & D

For a professional nurse, personal accountability means: *Select all that apply* a. willingness to take responsibility for one's actions. b. being dependable in all situations. c. making the best decisions with the input available. d. willingness to bear consequences for one's actions. e. willingness to take blame for others.

A, B, C, & D

Alternate pathway burns can occur because of improper placement of the dispersive electrode. The dispersive electrode SHOULD NOT be applied on which of the following: *select all that apply* a. Hairy skin surfaces b. Burn tissue c. Tattoo sites d. Well-perfused muscle e. Areas proximal to tourniquet application f. Bony prominences

A, B, C, & F

Which items below are included in a psychosocial assessment? *select all that apply* a. coping styles b. cultural beliefs and practices c. expectations of perioperative care d. sensory impairment e. spiritual or religious beliefs f. understanding of the surgical procedure

A, B, C, E, & F

Perioperative nursing documentation of the skin prep procedure should include which of the following components? *select all that apply* a. Antiseptic agent used b. Areas prepped c. Hair removal if performed d. Name of person holding the limb if applicable e. Name of the person performing the prep f. Placement of blotting towels g. Preoperative assessment of them skin at the operative site

A, B, C, E, & G

Before beginning a surgical hand antisepsis/hand scrub, the perioperative RN should perform hand hygiene. Hand hygiene including which of the following: *Select all that apply* a. Don a mask b. Dry hands and arms using a sterile towel c. Remove jewelry from hands and wrists d. Rub hands together, covering all surfaces of hands and fingers for at least 15 seconds.

A, C, & D

During the medication administration phase of the medication use process, nursing assessment, should include which of the following factors? *Select all that apply* a. Current medications, including herbal b. Immunization status c. Medication allergies d. Patient weight in pounds and kilograms

A, C, & D

Identify the instruments that can be used in laparoscopic surgery. *Select all that apply* a. Babcocks forceps b. Mosquitoes forceps c. Needle holder forceps d. Dissector forceps

A, C, & D

Identify the symptoms that indicate a patient is experiencing an MH episode. *Select all that apply.* a. Sudden rise in temperature b. Sudden relaxation of muscles c. Increase in ETCO2 d. Increased O2 demand

A, C, & D

Indirect fire hazards and risks specific to the OR include: *Select all that apply* a. anesthetic complication risks. b. gas emboli risks. c. postoperative infections. d. postoperative surgical complications.

A, C, & D

What indicators should be checked when you assess the skin condition of a patient? *select all that apply* a. Color b. Texture c. Turgor d. Thickness e. Water content

A, C, & D, the skin should be checked for color, temperature, sensation, turgor, thickness, and subcutaneous tissue.

Packaging systems should: *Select all that apply.* a. permit sterilization to take place. b. maintain sterility for a limited period of time. c. be structured to provide for aseptic delivery of the contents onto the sterile field. d. be compatible with the sterilization process. e. be used according to the manufacturer's written instructions.

A, C, D, & E

Which factors contributed to the creation of a specialized care unit for the surgical patient? a. Use of anesthetic gases b. Use of alcohol-based prep solutions c. Advancement of surgical procedures d. Use of specialized equipment e. Introduction of PACU standards.

A, C, D, & E

Identify the correct statements about an active electrode. *select all that apply* a. The active electrode should be connected to a stress-resistant receptacle of the ESU. b. The tip of the active electrode should never be cleaned during a procedure. c. When not in use, the electrode should be stored in a safety holster. d. Using an electrolyte solution may render the electrode less effective. e. When performing electrosurgery above the xiphoid process, administer the lowest practical level of oxygen to the patient.

A, C, D, & E.

In the following view of the right leg, match the correct nerve to the identified letter.

A. common peroneal nerve B. superficial peroneal nerve C. sural nerve D. deep peroneal nerve

Tissue reaction characteristics that need considered when choosing suture include

Absorption

Femoral and popliteal nerve or artery

Acute movement to the hip in lithotomy position can cause damage to what?

faster recovery shorter length stay less adhesions

Advantages of LAVH/Robotic AVH are?

Which of the following pose a fire risk during a laser treatment?

All of the above pose a fire risk

Select the positioning devices and accessories commonly used for bariatric surgery.

All of the options are correct

While a sudden drop in the SpO2 level may result from systemic hypoxia, blood flow to the distal extremity may be inadequate because of:

All of these options may decrease SpO2 level.

If a surgical patient complained of dyspnea and was hypoxia within the first 36 hours postop, you would suspect _____.

Atelectasis

The goals of the periop nursing interventions are to deliver optimal patient care ______________________. *select all that apply* a. conveniently b. effectively c. efficiently d. safely e. skillfully

B, C, D, &E. The goal of the periop nurse is to deliver optimal pt care as safely, skillfully, efficiently, and effectively as possible.

Lower Leg, Arms

Brachial Pressure Index is used to measure the ratio of the blood pressure in the ___________ to the blood pressure in the ________?

Urinary bladder

By opening the anterior leaf of the broad ligament, what structure can be dissected from the lower uterus and cervix?

A percutaneous method of instituting femoral vein-femoral artery cardiopulmonary bypass (CPB) can be used for minimally invasive (or conventional open) procedures and in emergency situations where the environment is not conducive to traditional CPB methods. Select the areas where percutaneous CPB would be indicated

Cardiac catheterization unit and intensive care unit

Posteriorly:Sternocleidomastoid Inferiorly: omohyoideus Superiorly: stylohyoideus

Carotid Triangle landmarks?

In examining a male pt you place your finger in his superficial inguinal ring and ask him to cough. You then feel a sudden, impulse medial to your finger. You conclude that your pt most likely has:

Direct inguinal hernia

Acute Hemorrhage Fibrinolysis

Disseminated intravascular coagulation syndrome causes?

Palm up, To protect ulnar nerve

During lateral positioning what position is the lower arm in and why?

Laparoscopic Cholecystectomy

For what procedure do you identify calot's triangle?

A typical hernia mass is composed of: covering tissues, peritoneal sac, and any contained viscera.

Hernias always occur in: the abdominal area.

45 degree

In recovery after head surgery, the patients head should be at what angle?

Nitrates

In reviewing the lab results of a routine urinalysis, an increase in what value is an indication of a UTI?

What is the advantage of a running stitch?

It's faster

The occurrence of perioperative mortality in geriatric surgical patients is influenced by several evidence-based factors. Select the patient most at risk for perioperative mortality.

Janice, age 70, scheduled for an emergency bowel resection with an ASA class IV

Credentialing and granting of practice privileges is a _____ process

Legal

Umbilical hernias occur in adults as a result of a defect in the

Linea alba

Local anesthetic medications, such as lidocaine hydrochloride, have more than one indication for use as an anesthetic. Which three anesthesia modalities use local anesthesia?

Local, spinal, MAC

Identify the pathogenic organism

Most important step in treating an infection is to first?

The immature blood-brain barrier and decreased protein binding in infants increase their sensitivity to which group of drugs?

Opioids and hypnotics

Morbidity and mortality may be greater with penetrating trauma because identification of injuries may be more difficult when injuries are less obvious. In the case of an adult victim with a low-velocity, low-caliber gunshot wound, at far range, of the anterior left quadrant of the lower abdomen, what is the MOI and description of the possible injuries?

Penetrating; small entrance wound, puncture of the anterior wall of the sigmoid colon, no disruption of vessels, and bullet not found in pelvis

Loose cartilage or a meniscus tear

Popping in the knee can indicate?

highly allergic to latex and the anesthesia provider plans to give prophylactic medications before anesthesia. What medications might be administered to Linda in the preoperative holding area?

Prednisone and a beta-agonist inhaler

Sterile surgical drapes are used to create the sterile field, protecting the patient from endogenous and exogenous sources of contamination. Of the characteristics listed, which are essential to maintaining the sterile field?

Provide barrier protection from microorganisms, fluid, and particulate matter

Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained foreign objects (RFOs). What new and evolving risk reduction strategy could prevent RFOs and frustrating, time-consuming miscount adventures at the end of these procedures?

Replacing or tagging sponges and laparotomy instruments with radiofrequency identification (RFID) chips

1

Research has shown that administering antibiotics within ______ hour(s) of surgery can decrease surgical site infections

Prone

Respiratory system is most vulnerable in what position?

What kind of needle would be used on the skin

Reverse Cutting

Head and neck

Reverse Trendelenburg position is used for procedures of the?

Common hepatic duct

Right and left Hepatic ducts join to form the?

You examine a pt after an automobile accident that resulted in a posterior dislocation of the hip joint. Which nerve are you most concerned might have been injured by such an accident?

Sciatic

three anesthetic agents that promote fast induction, rapid emergence, and minimal side effects and have been credited as a significant factor in this trend

Sevoflurane, propofol, desflurane

Which of the following is a true statement about the use of liquids?

Skin prepping solutions can cause chemical burns.

If you noticed a full-thickness loss, with exposed tendon and slough on some parts of the wound, how would you stage the wound?

Stage IV

Providing preoperative teaching and comfort measures to decrease anxiety

The RNFA can have a direct effect on the stress response by?

Cardiac Output

The amount of blood ejected by the left ventricle per minute is a product of heart rate times the stroke volume and is known as ?

Best suture for vasectomy

The base material for synthetic absorbable sutures is a combination of lactic acid and glycolic acid polymers (Vicryl, Dexon, and Polysorb). The molecular structure of these products has a tensile strength sufficient for approximation of tissues for 2 to 3 weeks

extension

The desired position of the wrist of an assistant is slight?

Which of the following best describes the location of the kidneys? Within the retroperitoneal space alongside the psoas muscle

The male scrotum contains two cavities, each lined with smooth glistening tissue called the: tunica vaginalis.

S. Aureus, Staphylococcus, Enterococcus, Pseudomonas

The most common organisms isolated from SSI's

3 weeks

The proliferative stage of wound healing can last up to ?

Fundus

The upper dome like portion of the uterus is referred has the?

Minimum of 3 inches, maximum of 6 inches

Tourniquet should overlap by how much?

Blisters

What can form when skin is stretched when tape is applied?

T-Tube

What kind of drain is used for bile duct exploration?

Fingers

When at all possible the RNFA uses _________ to provide exposure?

What is an indication for total hip replacement?

a. Arthritis

Lifting without assistance is an example of which kind of hazard? a. Ergonomic stressor b. Overwork stressor c. Occupational stressor d. Physical hazard

a. Ergonomic stressor

Which blood test determines adequate immunization to a vaccine-preventable illness? a. Titer b. Antigen c. Antibody d. Serum

a. Titer

what incision is used for lumbar laminectomy

a. midline direcly over the appropriate lumbar spine

When preparing a sterile field, the first thing that team members should do is: a. perform a surgical hand scrub. b. don sterile gloves c. don sterile gown d. don clean (nonsterile) gloves

a. perform a surgical hand scrub.

Credentialing of AHPs (allied health professionals) is influenced by? Select all that apply.

a. state regulations b. scope of practice c. institutional policy d. medical bylaws e. regulatory compliance

What term represents a fibrous band between serous membranes that can cause obstructions and subsequent surgical emergencies?

adhesion

Endoscopic instruments are designed to perform the intervention at the target tissue site through the tubular endoscope. The endoscopic instrument is considered:

an extension of the surgeon's hand.

Larger Sutures are:

anything from 1+

Small Sutures are:

anything with a 0 in the size

The average estimated number of surgical fires every year in the United States is: a. 20 to 30 b. 200 to 240 c. 700 to 1000 d. 2000 to 2500 e. 2500 to 2700

b. 200 to 240

Humidity in the operating room should be maintained at or below: a. 55% b. 60% c. 70% d. 75%

b. 60%

The table is flexed 90 degrees for the _________ position, which is a version of the __________ position. a. lateral, prone b. Jack-knife (Kraske), prone c. Trendelenburg, supine d. Jack-knife (Kraske), supine

b. Jack-knife (Kraske), prone

Opposition to the flow of current is called what? a. Voltage b. Resistance c. Grounding d. Bony prominence

b. Resistance

Who determines the design of the operating room? a. OSHA b. architects and planners c. the circulating nurse d. the chief of surgery

b. architects and planners

Communicating your needs and feelings clearly is an example of _______________ communication. a. aggressive b. assertive c. passive d. postponing

b. assertive

Which electrode tip has a greater surface area and is excellent for coagulation and fulguration? a. flat b. ball c. needle d. loop

b. ball

Laparoscopic instruments with small, blunt tips are used for: a. cutting tissue b. dissecting tissue c. grasping tissue d. moving tissue from one place to other

b. dissecting tissue

the most likely reason for avascular necrosis in an 80 year old woman following a hip fracture is that the

b. fracture split the neck of the femur longitudinally

Perioperative registered nurses and scrub personnel have primary control over which component of the fire triangle during operating or invasive procedure? a. oxidizing sources b. fuel sources c. ignition sources d. a and b e. a and c

b. fuel sources

Teamwork in the OR includes: a. understanding who is in charge b. maintaining an awareness of individual capabilities and responsibility c. keeping track of who has made mistakes d. offering to take over another's duties

b. maintaining an awareness of individual capabilities and responsibility

Chemotherapeutic agents may pose a hazard to patients and personnel because they are: 1. Carcinogenic 2. Eugenic 3. Mutagenic 4. Teratogenic a. 1 & 2 b. 2 & 3 c. 1, 3, & 4 d. 1, 2, 3, & 4

c. 1, 3, & 4

In addition to maintaining negative pressure in the operating room, how many minimum total air exchanges should occur each hour? a. 5 b. 10 c. 15 d. 20

c. 15

Fulgeration is achieved with mode on the generator? a. Cutting b. Blended c. Coagulation d. Vaporization

c. Coagulation

Complete the following statement: The bacterium ________________, which colonizes the nose and throat of asymptomatic carriers can cause SSIs as well as severe systemic infections including myocarditis and pneumonia. a. Pseudomonas aeruginosa b. Staphylococcus epidermis c. Staphylococcus aureus d. Clostridium dificile

c. Staphylococcus aureus

Select the name of the procedure that the patient in the picture is positioned for

c. Stereotactic brain biopsy

________ can also be used in spray form. a. Plasma-lyte pH 7.4 b. Microfibrillar collagen c. Topical thrombin d. Liquaemin (Heparin)

c. Topical thrombin

Identify the nutritional component that supports collagen formation and increases capillary formation. a. Vitamin A b. Vitamin B c. Vitamin C d. Zinc e. Protein

c. Vitamin C

The thoracic cavity is an airtight compartment. The lateral walls are formed by 12 pairs of ribs. Each hemithorax contains 11 external intercostal muscles and 11 internal intercostal muscles. What accompanies each intercostal muscle?

c. an artery, vein, and nerve

The front of a sterile gown should be considered sterile: a. after donning sterile gloves b. before the procedure starts c. from the chest level to the sterile field d. until the end of the procedure.

c. from the chest level to the sterile field

Complete sterilization in EO dependent on four primary variables: proper time, humidity, temperature, and: a. proper packaging b. aeration. c. gas concentration d. pressure

c. gas concentration

Written policies governing traffic patterns are maintained: a. by human resources b. by the circulating nurse c. in an accessible spot in the perioperative area. d. by the medical staff.

c. in an accessible spot in the perioperative area.

Charting by exception is a time saver and ________________. a. is easy even if you don't understand what is expected of a nurse. b. does not require assessment skills. c. is based on the premise that the patient manifests normal response to most interventions. d. does not require documentation during the shift or notes on changes in the patient's progress.

c. is based on the premise that the patient manifests normal response to most interventions.

which of the following associations is incorrect

c. left border of the heart-mainly left atrium

The argon laser is most useful in the specialty of: a. orthopedics b. urology c. ophthalmology d. dermatology

c. ophthalmology

recommended long-term pain management in the elderly includes

c. opoid analgesics (low potential for addiction)

Postop apnea in infants and neonates is a recognized risk until they reach: a. 44 weeks post conceptual age. b. 6 weeks post conceptual age. c. 2 months post conceptual age. d. 60 weeks post conceptual age.

d. 60 weeks post conceptual age.

Which of the following is incorrect pertaining to the gall bladder?

d. During cholecystectomy surgeons typically ligate the left hepatic artery

Which of the following is incorrect pertaining to the hamstrings?

d. One of them is partially innervated by the common fibular division of the sciatic nerve.

Of the three salivary glands, which one is the largest?

d. Parotid

Fluid and electrolytes play a key role in _____; I:maintaining homeostasis II:transporting oxygen III:blood clotting IV:maintaining temperature

i, ii, iii, iv

What are complications of spinal anesthesia? i. Slow inconspicuous hypotension ii. Rapid hypotension iii. Reduced venous return iv. Peripheral pooling

ii, iii, iv

Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however:

it can only be used for the initial gloving.

The primary use for suture is essentially to:

ligate, suture, and close tissue.

Latex allergy reaction is best prevented by:

limiting exposure to latex.

The design of the physical space within an OR attempts to minimize horizontal surfaces by placing cabinets flush with the wall. This prevents dust settling on multiple surfaces and decreases the areas that have to be monitored and cleaned. Another concern with horizontal surfaces is that is turbulence from staff movement and activity plus door movement, when it opens and closes, can:

mobilizing resting dust from these surfaces.

B) Cutting needles (traumatic)

o Cutting has triangular tip, sharp edges o Used for tough tissue such as skin o Reverse/inverted cutting often used for suturing tendons and ligaments

1. Tissue Glue Uses

o Declaws to glue the toe closed o Incisions that have small gaps o Gluing glue to glue fentanyl patches down at the 4 corners o Minor cuts o Breed Standards - glue ears down to have appropriate shape etc for show dogs o Tube placements = nasal esophageal tubes for patients who are not eating. o Nasal oxygen tubes o Turtle shell fractures o Glue eyes shut on deceased patients for owners

Types of Suture Material

o Peel package o Cassette (spool)

The strength layer of the skin is the _____.

reticulum

Which statement about surgical dressings is true?

surgical dressings cushion and protect the wound from trauma and gross contamination and absorb drainage

Silk is categorized as non-absorbable because it _____.

takes several years to absorb

Proper positioning of the arm and hands on the OR bed armboards is importamt to avoid pressure on the elbow and prevent which type of injury?

ulnar nerve injury

While Fowler's position offers the best respiratory excursion for the patient, the patient is at higher rick for _________ because of dependent pooling in the hips and legs.

venous thromboembolism (VTE)

F) Poliglecaprone

• Brand name = Monocryl • Synthetic • Monofilament • Absorbed more quickly than PDS

B) Swaged Needles

• Eyeless needle • Suture pre-attached to needle • Less trauma (hole created in tissue smaller) • Expensive • Single use

Suture Needles

• No universal standards for size and shape • Literally hundreds of different needles • Generally identified by 4 characteristics: 1. Type of attachment 2. Shape of Needle Body 3. Point of Needle/Cross Section 4. Size

A) Eyed Needles

• Reusable with almost any suture material • Straight or curved • Any point type or cross section • Disadvantage - suture must be threaded through eye; creates bulk that must pass through tissue (creates hole larger than suture material) • Round, square or French eye • Not used on easily damaged tissues (bowel, blood vessels)

An integrator is a multiparameter indicator designed to measure:

temperature, time, and presence of steam.

____ is an integrated system developed by hospitals for the prevention and control of areas of potential liability.

risk management

What are some actual and potential risks to patient safety?

*A major risk is the failure to "speak up" or 'question' when the RN notices* (is aware) of certain 'cues': actual risks may be the appearance of premature ventricular contractions (PVCs) or a sudden drop in blood pressure; potential risks may be a family history of malignant hyperthermia or allergies to (eg latex, silk dressing tape).

What are some 'KEY' issues to address during the management of health care information?

*Accuracy in documentation is essential:* questions about the precise name of the procedure or the accurate location of a specimen must be answered by the surgeon and documented property. *Documentation must be complete*; the RN must be competent in the use of EHR menus, shortcuts, and other EHR-specific elements; down-time forms must be readily available.

What do we consider crucial about specimen management?

*Most errors in specimen management occur in the period before the specimen(s) arrives to the laboratory; thus the perioperative nurse plays a crucial role in the determination of an accurate diagnosis.

What are some "KEY" issues that can affect effective patient/family education?

*Not all patient questions have an answer*; not all concerns have an easy resolution. *If a patient's scheduled surgery needs to be cancelled due to an emergency* taking precedence, the RN can help the 'scheduled' patient (and family) to accept the decision by explaining that were the scheduled patient having an emergency, then his/her surgery would take precedence. It is important for the 'cancelled' party to accept the decision. However, they need not be 'happy' about it and the RN can assure the cancelled party that patients have a right to feel the way they wish, but they do need to accept the reason for the cancellation. *These types of situations require the RN to exercise knowledge, judgment, and experience;* new RNs are encouraged to discuss possible scenarios - and possible responses - with their preceptor & mentor.

How is clinical reasoning specifically employed during patient and family education?

*Nurses employ non-technical skills* (eg, communication, situational awareness, collaboration) to educate patients & families. *Not all patient needs are logical or rational*; RNs recognize that psycho-social factors play a key role and should be elicited as part of the assessment.

How does clinical reasoning relate to professionalism?

*Professional behaviors and practices*- such as seeking new learning opportunities, engaging in ethical actions, and employing clinical guidelines- employ clinical reasoning skills can assist the clinician to determine and mange patient problems and promote positive outcomes.

What are some 'KEY' issues affecting patient outcomes relative to surgical instrumentation?

*Proper cleaning, sterilization, maintenance, storage, and use* of instruments. *Vascular clamps should be checked: teeth aligned, proper closure of jaws, appropriate clam for blood vessel type.

How is clinical reasoning employed to help patient safety?

*RNs can use critical thinking skills to identify issues relevant to clinical reasoning,* and initiate actions (eg, request an additional "count") to reduce the possibility of error (eg, RSI).

How is clinical reasoning specifically employed during sterilization and disinfection actives?

*Reusable instruments, supplies, and devices must be cleaned and sterilized* in a manner that does not injure the item and the material of which it is made. For example, some items cannot withstand the high temperatures associated with steam sterilization and require other sterilization methods such as gas plasma. *Employ practices that maintain sterility, avoid contamination,* promote good cleaning within the OR environment, reinforce proper surgical technique, and improve hand hygiene.

What are some 'KEY' issues affecting specimen management and patient outcomes?

*Staff knowledge of guidelines, standards, and related principles. Ongoing staff education related to sterile technique. Potential for injury* from microorganisms encountered during the perioperative period to patients and OR staff.

The recommended length of time for inflation of an upper extremity tourniquet on a patient under 50 years old is_______while the recommended pressure is _____.

1 hour; 250-300 mmHg continuous tourniquet pressure less than 1 hour on the upper extremity and less than 2 hours on the thigh. Tourniquet pressure should not exceed the recommended maximum cuff pressure limits of 300 to 350 mm Hg for the thigh and 250 to 300 mm Hg for the arm and the lower leg.

Match the stapler/skin closure product with its appropriate application. 1. Skin stapler 2. Linear stapler 3. Intraluminal circular stapler 4. Ligating and dividing stapler 5. Skin Clips 6. Skin Closure strips a. Used to approximate skin edges b. Used to secure stockinet or towels to the skin. c. Used to ligate and divide omental vessels or soft tubular structures. d. Used for intraluminal anastomosis of a tubular hollow organ, usually GI tract. e. Used to approximate the edges of superficial lacerations or as a primary closure. f. Used throughout the alimentary tract and in thoracic procedures.

1-A, 2-F, 3-D, 4-C, 5-B, 6-E

Several types infections may be acquired in the perioperative setting. Match the definition with the acronym. 1. surgical site infections 2. multidrug-resistant organisms 3. central line-associated blood stream infections 4. catheter-associated urinary tract infection a. CAUTIs b. SSIs c. CLABSIs d. methicillin-drug resistant organisms e. MDROs

1-B, 2-E, 3-C, 4-A

Match the surgical methods with the appropriate definition. 1. Incisional biopsy 2. Needle aspiration 3. Excisional biopsy a. Fine gauge needle and syringe used to aspirate the sample. b. Entire section of the tissue sent for examination. c. Small portion of tissue sent for examination.

1-C, 2-A, 3-B

Match the suture with its appropriate application. 1. Plain catgut (Type A) 2. Chromic catgut (Type C) 3. Polydioxanone sutures (PDS) 4. Polyglyconate sutures (Maxon) 5. Polyglactin 910 sutures (Vicryl) 6. Polyglycolic acid sutures (Dexon) a. Infected tissues and slow-healing tissue and ligation of larger vessels, biliary, urinary tracts and muscle and fascia closure. b. Ophthalmic procedures and when absorption is desired. c. Ligation of small vessels and to suture subcutaneous fat tissue under tension while healing. d. Peritoneal, fascial, and subcutaneous closure. e. Soft tissue except cardiovascular, neural, and ophthalmic tissues. f. Abdominal and thoracic closure, subcutaneous tissue, and colorectal surgery.

1-C, 2-A, 3-F, 4-E, 5-B, 6-D

Match the theory below with the given description. 1. Protein receptor theory 2. Meyer-Overton theory 3. Endogenous Endorphins Theory a. Anesthetic work through opiate-like substances that suppresses various pain pathways. b. The potency of the anesthetic depends upon its lipid solubility. c. The response to anesthesia depends on the occupation of a critical number of receptor sites.

1-C, 2-B, 3-A

Match the Topical Hemostatic Method with the appropriate Method of Action. 1. Passive 2. Flowables 3. Fibrin Sealants 4. Active a. Enhanced clotting b. Mechanically obstruct flow of blood c. Provide a barrier d. Increase amount of fibrinogen at site

1-C, 2-B, 3-D, 4-A

Match the following: 1. Volatile liquid 2. Combustible skin agent 3. Flammable skin agent 4. Combustible rating a. A skin antiseptic that has a flash point of lower than 100 degrees F or 37.8 C. b. An established rating used with skin antiseptic solutions that can be found. c. A liquid that evaporates quickly. d. A skin antiseptic agent that will burn with a flash point of higher than 100 degrees F () 37.8 C.

1-C, 2-D, 3-A, 4-B

Match the type of evidence with the appropriate medicolegal implications. 1. Fabric and clothing 2. Hair and fibers 3. Broken fingernails 4. Debris 5. Foreign objects a. Excessive handling may alter the specimen. b. May connect the victim or suspected perpetrator with the crime scene. c. Bacterial/fungal growth increases when evidence is stored in closed plastic. d. Striations are unique to each person; can determine sex, race, and blood type. e. May be transferred between the victim and suspected perpetrator or victim and the crime scene.

1-C, 2-E, 3-D, 4-B, 5-A

Match the wound class with the wound class description. 1. Class 1 - Clean 2. Class 2 - Clean- Contaminated 3. Class 3 - Contaminated 4. Class 4 - Dirty a. There are fresh, open, accidental wounds b. Existing infection with purulence c. The respiratory tract is entered under controlled conditions. d. Wounds are clean non-traumatic wounds.

1-D, 2- C, 3-A, 4-B

Match the 3 types of transmission based precautions with the correct examples of precautions that should be implemented for them. 1. Contact 2. Droplet 3. Airborne a. Donning PPE and patient placement b. Donning PPE and wearing a surgical mask with a respirator N95 or higher c. Using barriers to cover infectious lesions and wearing an N95 respirator mask. d. Donning PPE and environmental cleaning.

1-D, 2-A, 3-B

Match the type of drape with the surgery it is typically used for. 1. Laparotomy 2. Extremity 3. Perineal 4. Aperture a. Carpal tunnel surgery b. Vaginal hysterectomy. c. Tympanoplasty d. Umbilical hernia repair

1-D, 2-A, 3-B, 4-C

Match the phase or unit or age group with the correct nurse-to-patient ratio. 1. Extended Care Unit 2. Patients younger than age 8 3. Upon admission 4. Patient recovering in the CCU a. 1:2 b. 2:1 c. 1:1 d. 1:3/5

1-D, 2-A, 3-C, 4-B

Match type of budget with its description. 1. Capital Budget 2. Operating Budget 3. Direct expenses 4. Indirect expenses a. Includes the products and services directly related to patient care b. Covers both revenue and expenses that are associated with patient care c. Expenses incurred in support of patient care. d. A plan for acquisition of equipment or buildings.

1-D, 2-B, 3-A, 4-C

Match the type of budget with its description. 1. Gross revenue 2. Fixed expensed 3. Net revenue 4. Variable costs a. Costs directly related to patient volume b. Medical records and administration c. Gross revenue minus expenses d. All monies received by the facility for goods and services

1-D, 2-B, 3-C, 4-A

Match the basic categories of surgical instrument with their uses. 1. Graspers 2. Retractors 3. Cutting instruments 4. Clamps a. To incise, cut, dissect, or separate tissue. b. To hold, join, or compress parts together. c. To provide exposure of the operative site. d. To handle tissues and dressings.

1-D, 2-C, 3-A, 4-B

Match the critical thinking components with their descriptions. 1. Introspection 2. Logic 3. Credibility 4. Relevant criteria 5. Knowledge 6. Judgment 7. Evidence a. based on understanding and skill b. has bearing upon the situation c. based on reason, evidence, logic, and good sense d. self-reflection e. Reasoning f. data

1-D, 2-E, 3 NOT USED, 4-B, 5-A, 6-C, 7-F

Match the following: 1. Human immunodeficiency virus 2. Acquired immunodeficiency syndrome 3. Creutzfeldt-Jakob disease 4. Methicillin-resistant Staphylococcus aureus 5. Vancomycin-resistant Enterococci a. A rare but progressive, fatal disease caused by prions. b. One of the hardest bacteria and most difficult to treat. It has been cultured from dried clinical materials and found on gloves and surfaces. c. Usually spread by the hand of caregivers or patients and contaminated equipment or environmental surfaces. d. Only survives in blood and body fluids that contain WBC's. Fragile and easily destroyed outside the body. e. A state of immune dysfunction that results as the HIV infection progresses.

1-D, 2-E, 3-A, 4-B, 5-C

Match the implant with the type of surgery in which it is used. 1. Teflon and Darcon patches 2. Stapedectomy prostheses 3. Synthetic mesh 4. Ventriculoartial shunts 5. Scleral buckles/bands a. Ears, Nose, and Throat (ENT) b. General Surgery c. Neurosurgery d. Ophthalmic surgery e. Cardiac/vascular surgery

1-E, 2-A, 3-B, 4-C, & 5-D

Match the type of drape with its appropriate use in the surgical suite. 1. Perineal sheet 2. Medium sheet 3. Towel 4. Laparotomy sheet 5. Extremity sheet a. Used as added protection above or below the surgical area or when a fenestrated sheet cannot be used. b. Used when draping an extremity to permit the extremity to remain a part of the sterile field. c. Used to cover the surgical site on the abdomen and back. d. Used to outline the surgical site e. Used to create a sterile field with the patient in lithotomy position.

1-E, 2-A, 3-D, 4-C, 5- B

Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below:

32 mm Hg.

Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below:

32 mm Hg.

Match the object with the appropriate guideline. 1. Formalin 2. Cultures 3. Smears 4. Stones and calculi 5. Amputated limbs 6. Biohazard a. Made on a glass slide from tissue or body fluid. Sprayed with a fixant and then handled. b. Should be sent to the pathology laboratory immediately, because the air and warmth of the OR can affect the bacteria and cell count. c. Usually wrapped in an impervious bag or wrapper. d. If the outside of the container becomes contaminated with blood or body fluids, the container must be wiped before transportation. e. Very toxic if inhalfed or splashed on mucous membranes of the eyes, the face, or skin of the hands. f. Placed in a dry container and sent to pathology laboratory for gross and chemical analysis.

1-E, 2-B, 3-A, 4-F, 5-C, 6-D

Match the needle point with its appropriate description. 1. Conventional cutting point 2. Reverse cutting point 3. Side cutting point 4. Trocar Point 5. Taper Point 6. Taper cut 7. Blunt point a. These needles do not penetrate underlying tissues, but rather split tissue layers; used for ophthalmic surgery. b. Used on organs, as they are less apt to puncture the vessels within organs; used for dissection of friable tissue. c. Curved needles with cutting edges on the outer curvature d. Has cutting edges at the point only e. Cutting edge on the inside curvature, creating a very small path that heals quickly. f. Pushes the tissue aside when passing through. g. Used to punch through tough tissues.

1-E, 2-C, 3-A, 4-G, 5-F, 6-D, 7-B

Number the sequence of steps for positioning a patient in lithotomy position.

1: Stirrups are checked before use to ensure they are securely fastened to the side rails of the OR bed. 2: With the patient supine, the legs are raised simultaneously and abducted to expose the perineal region. 3: The legs are placed in stirrups to maintain this position. 4: The thighs are elevated to the appropriate degree for the planned procedure. 5: The sacral area is padded with a gel or foam pad. 6: The leg section of the OR bed is removed and the leg section platform is lowered.

Based on your understanding you have gained about pressure ulcers, match the stage with the correct descriptions. 1. Stage 1 2. Stage 2 3. Stage 3 4. Stage 4 a. Most resolve easily with no discomfort. b. Partial skin loss involving the epidermis. c. Deep craters without undermining adjacent tissue. d. Full thickness skis loss with extensive destruction.

1:A, 2:B, 3:C, & 4:B.

Match each staff member with the appropriate responsibility: 1. Scrub person 2. RN circulator 3. Housekeeping 4. Nurse anesthetist a. Administered anesthesia to the patient. b. Monitors aseptic technique. c. Creates and maintains a safe environment. d. Cleans the furniture at the end of the OR day.

1:B 2:C 3:D 4:A

Based on the knowledge you have gained about sanitation procedures, match activities with the procedure. 1. Preprocedure 2. During Procedure 3. Post Procedure 4. Terminal cleaning a. the OR floor should be cleaned as needed for each procedure. b. Clean all horizontal surfaces. c. clean spills of contaminated debris d. clean entire surgical suite.

1:B, 2:C, 3:A, 4:D

Match the age groups with their ability for learning and understanding. 1. birth to 1 month 2. 1 to 12 months 3. 1 to 3 years 4. 3 to 6 years a. the baby will smile, babble, and gurgle. b. the baby is able to understand and respond to simple commands. c. the child is able to interpret terms literally. d. the child is able to express only through crying.

1:D, 2:A, 3:B, 4:C

Match the types of surgery with their assessment needs. 1. Gastrointestinal surgery 2. Hepatobiliary 3. Parathyroid 4. Orthopedic 5. Neck a. A review of electrolyte balance is done. b. There is a higher rick for skin breakdown c. There may be limited motion and neurovascular changes. d. The surgery may be long e. Lab studies may indicate nutritional deficiencies

1:E, 2:A, 3:B, 4:C, 5:D

Identify the general guidelines for transporting frozen sections. *select all that apply* a. Before passing very small specimens, such as needle biopsies, off the sterile field, they can be placed on a section of dampened non-adherent wound dressing. b. A counted surgical sponge may be used for transportation of the specimen. c. Once in the laboratory, the tissue is frozen and thinly sliced into sections to be examined under a microscope by the pathologist. d. A fixed, permanent section is done to reaffirm the preliminary findings. e. The specimen is identified by the surgeon before being passed off the surgical field to the RN circulator. f. The specimen is placed into an appropriate-sized receptacle that contains a preservative fluid (usually 10% formalin)

A, C, D, & E

Identify the information that should be included when documenting the patient's position. *Select all that apply.* a. Position the sand bags b. Persons bringing the positioning devices c. Placement of patient's arms d. Position of the padding applied e. Position of the pillows

A, C, D, & E

Identify the complications that are possible while passing a needle holder to a surgeon during surgery. *Select all that apply* a. Passing the needle holder to the surgeon may compromise the sterile field if the surgeon is injured. b. The surgeon may not identify the instrument if it is not held properly. c. The needle may drop if the needle holder is not passed properly. d. The sterile field may be compromised due to knotting of the suture.

A & C

Judy is a patient about to under surgery. She was given anesthesia a few minutes ago and is beginning to feel its effects. What stage and phase of anesthesia is she in? *Select all that apply* a. Stage 1- Induction b. Stage 3- Maintenance c. Phase 1- Initial Administration d. Phase 2- Maintenance

A & C

PACU nurses hold which 2 advanced certifications? *Select all that apply.* a. PALS b. Wound Care Certified (WCC) c. ACLS d. Certified Emergency Nurse

A & C

Proper handling of an explant removed because of an apparent defect or failure includes: *select all that apply* a. completing a risk management report. b. decontamination and sterilization before transport to the pathology lab. c. documentation of the serial number in the MR and on the pathology requisition. d. placing the explant in a container with formalin for transport to the pathology lab.

A & C

Select the correct statements about spray bottles. *Select all that apply.* a. Spray bottles can aerosolize potentially infectious materials. b. Spray bottles are occasionally used to apply disinfectant. c. Spray bottles are not used to apply disinfectant. d. Spray bottles are an easy way to clean the environment.

A & C

Select the factors that are responsible for slower healing and post-surgical complications. *Select all that apply.* a. Diabetes b. Rhinitis c. Obesity d. Ear wax

A & C

The identification number on a pneumatic tourniquet is used: *Select all that apply* a. for the documentation of tourniquet maintenance b. for the hospital inventory purposes. c. for tracking any problems that occur. d. by the infection preventionist to track down an infection outbreak.

A & C

Which of the following are natural absorbable suture materials? *Select all that apply* a. Chromic catgut b. Polyglactin 910 c. Collagen d. Polyglyconate

A & C

Which of the following are reasons to avoid using radiopaque sponges for postoperative dressings? *select all that apply* a. Possible invalidation of subsequent sponge counts if the patient were returned to the OR with intact dressings. b. Radiopaque sponges are not as absorbent. c. Radiopaque sponges may appear as a foreign body on postoperative x-rays. d. Radiopaque sponges are more costly than non-radiopaque sponges

A & C

Which of the following practices are NOT examples of the recommendation that "A sterile field should be maintained and monitored constantly." *Select all that apply* a. A sterile field that as been set up for more than 1 hours before the procedure begins should be broken down and a new set up prepared. b. If a delay occurs after a sterile field is set up, it may be covered with sterile drapes until the delay is resolved. c. If a delay occurs after a sterile field is set up, the personnel may leave the room as long as the room as been secured. d. The sterile field should be prepared as close as possible to the time of use.

A & C

General guidelines for tourniquet inflation times have been identified as: *Select all that apply* a. 1 hour for upper extremities. b. up to 2.5 hours for lower extremities c. 1.5 hours for upper extremities d. 1.5 to 2.0 hours for lower extremities.

A & D

The standards of nursing practice require that documentation is based on which of the following: *Select all that apply* a. the patient's condition or need. b. current and past health status. c. evaluation of the patient's response. d. the relationship of the condition or need to the proposed intervention.

A & D

What actions can the RN circulator take to assist the scrub personnel during gowning? *Select all that apply.* a. Touch only the times, Velcro, or snaps to secure the back of the gown at the neck and the waist. b. Don the sterile gloves before fastening the gown to prevent contamination from the gown flaps c. Grasp the tie 4-6 inches from the tag and pull d. Adjust the gown by grasping the bottom edge and pulling down to eliminate any blousing.

A & D

When a Bier block is used during a procedure, the perioperative nurse should: a. Check the calibration of the tourniquet before applying it. b. Deflate the tourniquet quickly c. Inflate the distal cuff first. d. Monitor the length of time the tourniquet is inflated.

A & D

Which actions can the scrub person take to help prevent incidental thermal burns? a. Inspect laparoscopic instrumentation for excessive wear or obvious breaks and replace when necessary. b. Clean all instruments with sterile water. c. Watch the surgery carefully. d. Replace instruments that have damaged insulation.

A & D

Which actions can the scrub person take to help prevent incidental thermal burns? a. Inspect laparoscopic instrumentation for excessive wear or obvious breaks and replace when necessary. b. Clean all instruments with sterile water. c. Watch the surgery carefully. d. Replace instruments that have damaged insulation.

A & D

Which of the following are true about AORN's Guidelines for Perioperative Practice? *Select all that apply* a. They are based on what nurses 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 different situations

A & D

Which of the following statements reflects the findings from a research study of more than 11,00- nurses conducted in 2007 related to the importance of certification? *Select all that apply* a. Enhances feelings of personal accomplishment. b. is not related to professional growth. c. is being recognized with monetary incentives. d. validates specialized knowledge.

A & D

The term local exhaust ventilation (LEV) is used to describe the process of evacuation of smoke from the surgical site. Which of the following are considered LEV? *select all that apply* a. Central suction system with an in line filter. b. HEPA filter c. High filtration surgical mask d. N95 respirator e. Smoke evacuator unit

A & E

Skin preparation of the surgical site is intended to reduce the risk of postoperative SSI by which of the following: *Select all that apply* a. removing soil and transient microorganisms from the skin. b. reducing the resident microbial count to subpathogenic levels in a short period with the least amount if tissue irritation. c. evaporating the skin prep solution rapidly so it cools the skin and kills microbes d. inhibiting rapid , rebound growth of microorganisms

A, B, & D

The following measures should be considered when placing a patient in the lateral position: *select all that apply* a. The upper leg is straight and supported with pillows between the legs. b. Lower arm in same plane as OR bed mattress; forearm and wrist in neutral position; palm up. c. Safety strap is applied at chest level. d. The patient's dependent ear should be assessed to ensure that it is not folded.

A, B, & D

The goals of performing interim cleaning of the OR/procedure room performed at the end of each surgical procedure include the following: *Select all that apply* a. It renders the environment safe for the patient following in that room to prevent cross-contamination. b. It breaks the cycle of contamination from the patient to the environment and from the environment to OR personnel and then to subsequent patients. c. After each surgical procedure if there are no additional surgeries in that room, interim cleaning is not necessary. d. It is the patient's right to have a clean and safe environment.

A, B, & D

The perioperative nurse should use the directive interview technique over a nondirective interview technique when the information her or she needs: *Select all that apply* a. consists of predetermined questions b. consists of questions in a predetermined order. c. is to assess the patients emotional reactions and concerns d. is to document the patient's health history e. requires observation of the patient's nonverbal behavior. f. require the patient to respond in an open, informal manner.

A, B, & D

The sterile area on the sterile attire are: *Select all that apply* a. The sleeves from 2 inches above the elbow to the cuff. b. The surgical gloves c. The back of the gown from the table level. d. The front of the gown from the table level to 2 inches below the neck.

A, B, & D

What interventions can the perioperative nurse perform to protect elderly patients? *select all that apply* a. Employ DVT prophylactic devices. b. Position the patient for effective air exchange. c. Slide the patient onto the OR bed without use of assistive devices. d. Use warming devices to maintain normothermia.

A, B, & D

When working with electrical equipment, the perioperative RN should adhere to which of the following guidelines? *Select all that apply.* a. Wipe up liquid spillage as soon as possible. b. Do not use an open flame when electrical equipment is in use. c. Tightly wrap up electrical cords. d. Ensure that all electrical devices to be used in a medical treatment facility are checked and cleared by biomedical. e. Ensure that the electrical devices are checked by a trained electrician before use.

A, B, & D

Which activities should the transport person complete before transferring a patient? *Select all that apply* a. Identify the patient and the surgical procedure. b. Verbally confirm that the preoperative orders have been completed. c. Identify the surgeon. d. Reconcile any medications the patient may have been taking preoperatively.

A, B, & D

Which of the following are mandatory components of documentation of the prepping procedure on the perioperative patient record? *select all that apply* a. the area of the body prepped. b. The development of any reaction c. the properties of prepping agents. d. The name (or initials) of the person(s) performing the prep.

A, B, & D

Identify the true statements about patient verification and marking the surgical site. *Select all that apply* a. Asking the patient to state the planned procedure is a valid procedure identifier. b. The patient's room is a valid patient identifier. c. The site marking should be visible after prepping and draping. d. The site should be marked by visually showing the site to the patient or verbal confirmation. e. Confirming the consents given for the procedure is a valid procedure identifier.

A, C, D, & E

After the preoperative assessment has been conducted on a patient, the perioperative nurse should document: *Select all that apply.* a. cuts and abrasions b. preoperative hair removal, if ordered. c. skin condition d. financial arrangements e. the patient's verbal consents for preoperative orders.

A, B, C, & E

Based on your understanding of the application of the PNDS to positioning of the patient, identify the potential nursing diagnosis. *select all that apply* a. Risk for impaired skin integrity b. Impaired skin integrity c. Risk for perioperative positioning injury. d. Disturbed sensory perception e. Impaired physical mobility.

A, B, C, & E

Identify the true statements about documenting requirements. *Select all that apply.* a. You may be required to write out the physician's verbal orders for medications administered and have the physician sign the order. b. Hypersensitivity reactions should be documented. c. The manufacturer of implants should be documented. d. The manufacturer of the Foley catheter should be documented. e. Rationale for counts not performed should documented.

A, B, C, & E

Identify the true statements about the SDS (Safety Data Sheets) *Select all that apply* a. OSHA requires the development and use of SDS in each facility. b. The SDS describes only hazardous physical liquids. c. The SDS provides post exposure information and actions. d. Employers should ensure that employees know where SDS are located. e. The SDS provides guidelines for handling and using the agents. f. The SDS provide guidelines for disinfecting surgical sites.

A, C, D, & E

Jake Brown is scheduled for a complex surgical procedure. He and his immediate family are asking for more information. Which of the following form part of Jake's ongoing education needs as a patient? *Select all that apply* a. The medications to be given and the time intervals at which they are to be given. b. Details about how the surgery will be carried out. c. Details about the life support machines that may be required in case there are complications. d. A list of foods that might be harmful if eaten during the time the patient is on medications. e. Counseling on modified diets.

A, C, D, & E

Perioperative personnel precautions for the spread of airborne infections include: *Select all that apply* a. taking the surgical patient from the airborne infection isolation room to surgery and then directly back after surgery. b. placing the patient in the room at least 3 feet away from the other patients. c. wearing PPE. d. using an airborne infection isolation room. e. wearing a surgical mask- N95 or higher.

A, C, D, & E

When using chemical products, the perioperative nurse should: *Select all that apply.* a. Use skin prep solutions according to manufacturer's recommendations. b. Never remove the skin prep solutions. c. Ensure the prep solution does not pool on the drapes. d. Apply blotting towels before performing skin prep. e. Allow skin prep solutions to dry before draping.

A, C, D, & E

Match the Human factor with its Description. a. Skill based behavior b. Knowledge based performance errors c. Attention and situational factors. 1. This type of error arises when a nurse misinterprets a situation or incorrectly applies a rule. Mistakes include errors in perception judgment, inference, and interpretation. 2. This type of error generally occurs when our attention is diverted and we fail to monitor the actions we are performing. 3. These types of factors significantly contribute to medical errors: distraction, fatigue, and/or sleep loss, juggling multiple activities, stress, boredom, frustration, anxiety, and anger.

A-2, B-1, C-3

Identify which of the following the perioperative RN should bear in mind when using an ESU on a patient with a pacemaker. *select all that apply* a. The distance between the active electrode and the dispersive electrode should be as short as possible. b. Both electrodes should be as far from the pacemaker as possible. c. The dispersive electrode should be placed in such a position that the current from the active electrode does not pass through the vicinity of the patient's heart or through the pacemaker. d. The nurse need not consult the patient's cardiologist. e. All ESU cables and cords should be kept away from the pacemaker and its leads. f. Monopolar current is preferred.

A, B, C, & E

In what areas would you most likely find a perianesthesia nurse? *Select all that apply.* a. Extended Care Unit b. PACU c. Preadmission Testing Unit d. Prenatal Care Unit e. Preoperative Holding f. Trauma Rehabilitation Center

A, B, C, & E

When conducting the preoperative assessment on the day of surgery, the nurse should include information on: *Select all that apply* a. Cognitive ability of the caregiver b. Patient's pain assessment c. Psychosocial needs d. Preoperative meal e. Discharge planning

A, B, C, & E

When documenting the use of a pneumatic tourniquet, which items must be included? *Select all that apply* a. Cuff pressure b. Location where the cuff was placed. c. Name of the person who applied the tourniquet d. Name of person who inflated the tourniquet e. Serial number of the unit

A, B, C, & E

Criteria for the select of drapes includes: *select all that apply* a. amount of area around the incision site to be included. b. amount of fluid exposure expected. c. furniture and equipment to be draped d. size of the incision e. type of procedure being performed

A, B, C, & E.

Identify which statements about dispersive electrodes are true. *select all that apply* a. Should not be used on bony prominences. b. Alternate pathway burns can occur because of improper placement. c. After repositioning, should be rechecked for skin adherence. d. May be inappropriate for patients weighting less than 25 lbs. e. Condition of the skin should be documented after removing the electrode. f. Can be reused.

A, B, C, & E.

Methods of producing hemostasis include which of the following? *Select all that apply* a. Administering blood. b. Applying pressure c. Using electrocautery d. Irrigating with large amounts of sterile saline e. Using an antiseptic solution containing alcohol f. Using topical hemostatic agents

A, B, C, & F

Sponge and instrument counts are performed according to facility policy and procedure. Generally, the times during a surgical procedure that sponges are counted are: *Select all that apply* a. At skin closure. b. At the time of permanent relief of the scrub person or RN circulator. c. Before the procedure begins. d. When the new sponges are added to the sterile field. e. When would closure begins. f. When either the scrub person or the RN circulator has completed gowning.

A, B, C, D, & E

The elements required to create a culture of safety include: *Select all that apply* a. sense of trust among team members. b. a sincere commitment to affirming safety as the first priority. c. development and support of a proactive approach rather than a reactive, blaming approach. d. development of a reporting mechanism for grievances and complaints. e. dissemination of receipt of information to all levels of staff.

A, B, C, E

Select the seven rights of medication administration: a. Right dose b. Right indication c. Right time d. Right response e. Right patient f. Right route g. Right medication h. Right documentation

A, B, C, E, F, G, H Right dose, indication, time, patient, route, medications, and documentation.

The patient, the surgeon, and the scrub person all interact with the circulator in the management of specimens and each have a special roles. Match the role to the appropriate team member. a. Patient b. Surgeon c. Scrub person d. Circulator 1. Communicates identifying characteristics to the scrub person and to the circulator. 2. Concerned with diagnosis, speed of diagnosis, psychosocial concerns. 3. Sensitive to the scrub person's needs and to actions that facilitate accurate specimen management. 4. Ensure accurate identification of the specimen by having a sterile marking pen to write location and type of tissue.

A-2, B-1. C-4, D-3

Identify the functions of the components of listed below. a. Alarm b. Nasogastric tube c. Two-way disposable filter 1. To prevent contamination of the operational cavity 2. To indicate the level of CO2. 3. To decompress the stomach

A-2, B-3, C-1

Match the functions of the components below: a. Alarms b. Nasogastric Tube c. Two-way disposable filter 1. To prevent contamination of the operational cavity 2. To indicate the level of CO2. 3. To decompress the stomach.

A-2, B-3, C-1

Identify the functions of the instruments listed below. a. Clamps b. Retractors c. Graspers 1. To hold back tissue layers 2. To hold tissue 3. To control bleeding

A-3, B-1, C-2

Identify the correct statements about tourniquet use. *Select all that apply* a. Never injury and paralysis can result from prolonged use of the tourniquet. b. Keep fluids, such as skin prep solutions and irrigation, from pooling under the cuff. c. Nursing documentation for pneumatic tourniquet use should include time of applying the cuff. d. Only the cuff should be cleaned after the tourniquet has been used. e. The Bier Block technique involves an IV injection of a local anesthetic agent into the vein of a tourniquet-occluded extremity. f. Nursing documentation for pneumatic tourniquet use should include serial number and model of the specific tourniquet.

A, B, E, & F

Identify the correct statements about various ESUs. *select all that apply* a. In bipolar electrosurgery, both the active and return electrode functions are performed at the site of surgery. b. AEC is a Monopolar for of electrosurgery. c. When using AEC, the venous pressure exceeds argon gas pressure in the circulating system, creating a risk for emboli. d. Bipolar electrosurgery should not be used for brain or neurosurgery. e. Laparoscopic electrosurgery has the potential to cause capacitive- coupling injuries. f. AEC provides a secondary source of gas that can result in a rapid rise in the intra-abdominal pressure.

A, B, E, & F.

Benefits of evidence- based practice include which of the following? *Select all that apply* a. The professional perioperative nurse can base his or her practice on evidence. b. Promotes decision-making based on the opinions of individual health care providers. c. Provides point-of-care clinicians with tools that can assist in improving patient care. d. The evidence collected is rated for quality and strength.

A, C, & D

During the preop interview, why should the preop nurse ask patients about their use of herbal preparations, alcohol, tobacco products, and recreational drugs? *select all that apply* a. herbal supplements may affect the metabolism of drugs administered. b. patients who use alcohol heavily are unable to tolerate general anesthesia c. recreational drug use mat affect the choice of preop sedation. d. smoking may affect circulatory and respiratory system assessment results.

A, C, & D

Identify the features of disposable instrument sets. *Select all that apply* a. Come preassembled and sterile b. Have many moving and detachable parts whose mechanisms may not always be reliable c. Are self-contained and lightweight d. Are supplied with pre-sterilized staples and disposable cartridges, which are usually color-coded by size.

A, C, & D

Identify the instruments that can be used in laparoscopic surgery. *Select all that apply* a. Babcocks forceps b. Mosquitos forceps c. Needle holder forceps d. Dissector forceps

A, C, & D

Identify the tasks that should be completed while setting up the camera before surgery. *Select all that apply.* a. Inspect the camera head for smudges or debris. b. Clean the camera head using sterile water. c. Plug the camera into the CCU and turn on the unit. d. Complete white balancing of the camera.

A, C, & D

Identify the tasks that should be completed while setting up the camera before surgery. *select all that apply* a. Inspect the camera head for smudges or debris. b. Clean the camera head using sterile water. c. Plug the camera into the CCU and turn on the unit. d. Complete white balancing of the camera.

A, C, & D

In Phase 2, patient education becomes a critical task. What aspects of post-discharge life should the nurse be teaching the patient? a. How to empty drainage fluid b. When they can return to work c. Coughing and deep-breathing exercises d. How to take the prescribed medications

A, C, & D

Individual staff members play the biggest role in maintaining a safe OR environment. Staff members are required to: *Select all that apply* a. Monitor, identify, and report safety hazards. b. Set appropriate electrical and fire safety procedures. c. Understand and comply with the emergency power outage plan. d. Practice sound, basic and OR specific electrical and fire safety.

A, C, & D

Mechanical issues and problems that can cause skin injury include: a. Placing heavy objects on the patient. b. Placing an ESU hand piece on the patient. c. Dragging the patient's body across the sheets. d. Improperly applying sequential compression stockings. e. Allowing prep solution to pool under the patient. f. Failing to remove prep solution from skin postoperatively.

A, C, & D

Patient and family education is a combined process involving: *Select all that apply* a. influencing behavior. b. determining patient competency. c. producing changes in knowledge. d. producing change in attitudes and skills.

A, C, & D

Risk for errors at the procurement phase of the medication process can be reduced by making proactive decisions about: *Select all that apply* a. unit-of-use (single use) versus multi-dose containers. b. Brand identification c. Shelf life d. General supply chain, which includes medication availability, delivery, and protection during transit.

A, C, & D

Some of the ways by which professional nurses can protect themselves from legal action include maintaining: *Select all that apply* a. Documentation of performance appraisals b. Documentation of administrative competency c. Documentation of continuing education d. Knowledge of the state of nurse practice act

A, C, & D

The perioperative RN prepares the medications and solutions after receiving orders from: a. Anesthesiologist b. First assistants c. Surgeons d. Advanced practice RN's.

A, C, & D

What are the most common roles of the perioperative nurse? *Select all that apply* a. Preparing medications and solutions per the physician's preference card. b. Administering medications IV c. Preparing and labeling medications and solutions. d. Taking only minimal verbal orders for medication administration.

A, C, & D

When a count discrepancy occurs, facility policy and procedure should be followed. General guidelines include: *Select all that apply.* a. The RN begins a search of the area immediately surrounding the sterile field. b. The RN circulator calls for an anteroposterior and lateral x-ray as soon as the discrepancy is identified. c. The RN informs the surgeon and surgical team as soon as the discrepancy is noted. d. The scrub person visually inspects the immediate sterile field. e. The surgeon continues to close the wound f. If the count is not resolved, it is noted in the EMR.

A, C, & D

When documenting, the perioperative nurse should: *Select all that apply* a. document in a timely manner. b. used medical diagnosis. c. use nursing diagnoses based on sound judgment. d. use patient statements to verify the nurse's findings e. document patient statements as facts.

A, C, & D

Which of the following patient factors should be considered in the perioperative assessment (related to positioning)? *select all that apply* a. Age b. Ethnicity c. Nutritional Status d. Preexisting conditions e. Gender

A, C, & D

Which pathology specimens require fresh preparation and the use of a sterile container? *select all that apply* a. Breast tissue for hormonal assay b. Bullets c. CSF d. Semen for infertility studies e. Undergarments

A, C, & D

Which pathology specimens require fresh preparation in a sterile container? *select all that apply* a. Cerebral Spinal Fluid b. Undergarments c. Semen for fertility studies d. Breast tissue for hormonal assay e. Bullets

A, C, & D

Which precautions should be taken for a patient who has an implantable electronic device (IED)? *select all that apply* a. All team members should be informed about the IED. b. Insist that the surgeon use bipolar instead of Monopolar current. c. There should be continuous EKG monitoring. d. The active and dispersive electrodes should be located as close together as possible.

A, C, & D

Why is it important for perioperative nurses to have a basic understanding of business principles? *Select all that apply.* a. To enable them to plan safe and effective care that is also cost-effective b. To eliminate the focus on competitive pricing c. To facility competition for patient volume d. To mange and allocate resources wisely e. To reduce the focus on productivity and efficiency

A, C, & D

Based on the knowledge you have gained about the prone position, identify the correct statements about the position. *select all that apply* a. Face positioner is used to place head in neutral position. b. Padding is placed under the stomach. c. Ensure the breasts, abdomen, and genitals are free from torsion or pressure. d. The patient is positioned after the administration of anesthesia. e. Improper positioning can result in pressure on the Superior Vena Cava.

A, C, & D.

Identify the correct draping considerations. *select all that apply* a. Drape from the sterile area to an unsterile area by draping the nearest first. b. Start draping from the periphery to the operating site. c. Ensure that surgical drapes are applied after prepping solutions have dried. d. After a drape is placed, it can be moved if necessary. e. When draping the opposite side, the scrubbed person should walk around the OR bed to drape.

A, C, & E

Identify the pathogens that can be commonly found in the OR environment. a. Escherichia coli b. Shingella boydii c. Methicillin-resistant Staphlococcus aureus d. Wuchereia boncrofti e. Serratia marcescens

A, C, & E

Which medications can be used as topical applications? a. Hydrocortisone b. Hypaque c. Epinephrine d. Vasopressin e. Papaverine

A, C, & E

A fluid imbalance may occur rapidly due to fluid loss as a result of: *Select all that apply.* a. fluid restrictions b. accurate measurement of irrigation fluids. c. wound drainage. d. nasogastric tubes e. inadequate fluid replacement

A, C, D, & E

Basic fire safety guidelines include the following: *Select all that apply* a. Apply an extinguishing agent even after the flames are out. b. Evacuate ambulatory patients last. c. At a safe area, regroup and account for all patients and personnel. d. Have an evacuation plan posted in the surgical suite, and review it frequently. e. Hold routine fire drills or mock scenarios involving all members of the surgical team. f. Move patients vertically

A, C, D, & E

According to research, certain risk factors can predispose some patients to postoperative nausea and vomiting (PONV). Review the list below and select the patient with the greatest risk of developing PONV. Joyce Myers, 43 years old, a nonsmoker who states she has to take Dramamine every time she flies or rides in a car for long trips and who is scheduled for an abdominal hysterectomy under general anesthesia

Aspiration is a potential complication that may present in the postanesthesia care unit. Review the list below and select the response that best describes the symptoms that could present when aspiration has occurred. Tachypnea, hypoxemia, hypotension, bradycardia

Administration of anesthesia requires specialized equipment to provide a safe environment for the patient. Which of the following data may be monitored during surgery? *Select all that apply.* a. Blood pressure b. Temperature c. ECG d. CBC e. Pulse Oximetry f. FLuid volume status

All EXCEPT D

The goal of patient and family education is to: *Select all that apply* a. provide information to the patient. b. improve knowledge c. achieve long lasting changes in behavior. d. make patient aware of their reliance on medical personnel e. take ownership of the patient's care. f. improve the patient's outcome.

All EXCEPT D

During admission of a patient to Phase 1 of postanesthesia care, the perianesthesia nurse is responsible for: *Select all that apply* a. assessing the patient's level of consciousness b. assessing the patient's pain level c. assessing the patient's x-rays. d. maintaining a patent airway. e. monitoring blood pressure, heart rate, and oxygen

All except C

ESUs are high-risk equipment with potential complications, including: a) Patient injuries b) Fires c) Electromagnetic interference with other equipment d) Electromagnetic interference with internal devices

All of the above

ESUs are high-risk equipment with potential complications, including: a) Patient injuries b) Fires c) Electromagnetic interference with other equipment d) Electromagnetic interference with internal devices

All of the above

What non-antimicrobial strategies are important to decrease the risk of postoperative infection?

All of the above

Identify the additional assessment that should be made by the perioperative nurse before an endoscopic surgery. *Select all that apply* a. History of thermal burns b. History of DVT c. Consent for open surgery d. History of anaphylactic reactions e. History of previous incisions f. Types of instruments used in surgery

B, C, & E

Identify the additional assessments that should be made by the perioperative nurse before an endoscopic surgery. *Select all that apply* a. History of thermal burns b. History of deep vein thrombosis c. Consent for open surgery. d. History of anaphylactic reactions e. History of previous incisions f. Types of instruments used in surgery

B, C, & E

the correct branch of the Left main coronary artery

Circumflex coronary artery

prolonged bleeding time

Ibuprofen can cause?

The new general surgery fellow placed the three trocar ports for the laparoscopic appendectomy. She was focused on the concept of exact geometric triangulation of the three port accesses, to avoid the concept of sword fighting after inserting her instruments. She knew she had to proceed with caution and determination since this hospital was not able to provide the protected blade trocars she was used to using at the university medical center. The procedure was completed without incident; however, on postoperative day 1, the patient demonstrated signs and symptoms of sepsis. What might have been the unusual occurrence that could have resulted in patient sepsis?

Inadvertent trocar puncture through the bowel on insertion

Select the guideline that complements the design of the culture of safety model.

Incorporate safe practices into your daily work when handling sharps.

Peri-operative hypothermia is an important issue for all anesthetized patients because of all of the following EXCEPT:

Increases risk of renal failure

What best describes hyperbaric oxygenation as a management therapy for a chronic wound? SELECT ALL THAT APPLY

Increases the ability of the blood to carry oxygen to the tissues Restores cells and kills bacteria that thrive without oxygen

Clair Townsend arrived at the endoscopy center 2 days before her scheduled interventional bronchoscopy to receive an injection of a photosensitive intravenous dye that the pulmonologist explained would highlight the dysplastic tissues of her bronchi that were precancerous. He scheduled her for an ablative procedure called photodynamic therapy (PDT), where the highlighted tissues would be affected by the laser light that is color-specific for uptake of the dye. Select the laser that would be appropriate to use on this patient during a PDT bronchoscopy.

KTP laser using a Nd:YAG beam passed through a fiber delivery system

Identify the primary substance that composes a layer of the epidermis, is responsible for hardening nails and hair, and protects the body from fluid loss and invasion by pathogens.

Keratin

At a regional MH testing center Davis Washington is undergoing a muscle biopsy for suspected genetic predisposition to malignant hyperthermia. The anesthesia provider will provide light intravenous (IV) sedation while the surgeon infiltrates the biopsy site with a local anesthetic. This will facilitate Davis' tolerance of the procedure and minimize his risk for an MH episode. What is the current correct name for this anesthesia modality?

Monitored anesthesia care (MAC)

numbness and tingling of the hands, feet or lips, muscle cramps muscle spasms seizures facial twitching muscle weakness light headedness slow heartbeat(bradycardia)

Signs of hypocalcemia?

Sally Hargraves is a 72 yo pt with multicentric carcinoma in situ (CIS) of the vulva, without evidence of leukoplakia and pruritus. She has a history of prior papillomavirus infection. Select the most appropriate surgical option...

Simple vulvectomy

Lung Capacity Lung Volume Flow rates

Pulmonary function tests measure what?

Percutaneous injuries represent a significant hazard to perioperative nursing personnel. Which type of percutaneous injury is the most prevalent? Injuries from hollow-bore needles

Rhonda Batson is a surgical technologist who sustained a needlestick injury during a procedure on a patient who has hepatitis C. What is the sequence of postexposure testing that Rhonda will follow? Testing at 6 weeks, 3 months, 6 months, and 1 year

Trauma to the chest area is the primary cause of death in approximately 25% of trauma victims. Involvement of the heart, great vessels, lungs, and diaphragm, attributable to penetrating or blunt injury, can provide multiple unexpected findings when the chest is opened. Because of the nature of the potential findings and expected surgical intervention, what would be an appropriate preparatory action?

Set up the autotransfusion system and resuscitation equipment.

Which two similar hernia repair approaches reestablish the integrity of the transversalis fascia and simultaneously reestablish and strengthen the posterior inguinal floor by sewing the transversalis fascia to the Poupart ligament?

The McVay or the Cooper ligament repair

Percussion

The act of striking one object against another to produce a sound of resonance or dullness is known as?

Review the list of patients below and select the one who is at greatest risk for cholelithiasis. Tiesha Jansen, a 39-year-old female with type 2 diabetes who weighs 260 pounds

Wei-Ann Chinn has been admitted with acute pancreatitis secondary to cholecystitis. Which lab value supports her diagnosis? Serum amylase of 160 units/dL

Which of the following is an important statement regarding the prevention of degenerative orthopedic conditions

Weight-bearing activities and joint movement prevent cartilage from becoming thin or damaged

Which of the following determines the selection of the suture? Type of approximation required

When selecting suture for a cataract procedure, which size suture is the perioperative nurse likely to pull for the surgical technologist? 7-0

Which of the following statements about the anatomy of the liver is true? The hepatic artery maintains the arterial supply while venous blood from the stomach, pancreas, intestines, and spleen travels to the liver via the portal vein and its branches.

Where are Kupffer cells found? In the hepatic sinusoids

At the internal and external carotids

Where is the bifurcation of the common carotid artery?

Which of the criteria below are appropriate when determining whether an incisional surgical site infection (SSI) is superficial or deep? SELECT ALL THAT APPLY.

Where the purulent drainage comes from, superficial or deep

best describes a key component of the culture of safety in regards to blood exposure.

a goal of the culture of safety is to reduce the risk of blood exposure and sharps injuries to staff

Pediatric, geriatric, and physiologically compromised patients have impaired thermal regulatory mechanisms that place them at risk for hypothermia. The OR bed should be prepared before patient arrival by placing:

a patient-sized forced air-warming blanket on top of the OR bed surface

The sterile areas of the gown include: 1. front from two inches below the neck to waist or table level. 2. gloves and gown sleeve to inches above the elbow. 3. sides from axillae to waist or table level. 4. back of a wrap around gown. a. 1 & 2 b. 1 & 3 c. 1, 2, & 3 d. 1, 2, 3, & 4

a. 1 & 2

During an electrical power outage, the perioperative RN should ne aware that the back up generator should be activated within ______________. a. 10 seconds b. 15 seconds c. 20 seconds d. 25 seconds

a. 10 seconds

A familiarity with basic neurologic assessment tools gives the nurse the ability to perform a standardized neurologic exam that can be used preoperatively to establish a baseline assessment and postoperatively to establish a return to baseline or assess postoperative neurologic stability. The Glasgow Coma Scale (GCS) is commonly used to assess patients with brain injury using three indicators of cerebral function: eye opening, verbal communication, and motor response to verbal and noxious stimuli. Within the scoring range for the GCS, the best possible score is _____ and the worst possible score is ______.

a. 15, 3

The NIOSH reports that more than ____________ U.S. health care workers may be exposed to blood or bodily fluids through percutaneous injuries, contact with mucous membranes or exposure to abraded skin each year. a. 8 million b. 800,000 c. 6 million d. 600,000

a. 8 million

Who would be the best preceptor to assign to an advanced beginner nurse who enters the perioperative nursing? a. A competent nurse b. An expert nurse c. Another advanced beginner nurse

a. A competent nurse

What biting instrument is used for cutting through tissue or bone? a. A roungeur b. A rasp c. An osteotome d. A curette

a. A roungeur

One's cultural background can influence attempts to resolve conflict. Which of the following may be a useful resolution technique? a. Acknowledging culture b. Analyzing culture c. Circumventing culture d. Ignoring culture

a. Acknowledging culture

Components of the electrosurgical circuit include: a. Active electrode, dispersive electrode, and generator. b. Dispersive electrode, fiber, and generator. c. Active electrode, dispersive electrode, generator, and scratch pad. d. Dispersive electrode, fiber, generator, and key.

a. Active electrode, dispersive electrode, and generator.

Which statement below is best to use when confirming a procedure with a patient? a. Please tell me what procedure Dr. Price is going to perform. b. I understand you are going to come in for a TURP. c. You are having a right TKA with a spinal. d. Your procedure is a LVRS with MIS.

a. Please tell me what procedure Dr. Price is going to perform.

A hospital disinfectant has passes the potency test for activity against the given 3 microorganisms. a. Pseudomonas aeruginosa, Staphyloccus aureus, and Salmonella cholerae. b. Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus. c. Pseudomonas aeruginosa, Clostridiu, and Sterptococci. d. Pseudomonas aeruginosa, Sterptococci, and Salmonella.

a. Pseudomonas aeruginosa, Staphyloccus aureus, and Salmonella cholerae.

When transferring a patient to the surgical suite, the staff member should never ___________. a. Push the gurney head first down the hallway. b. identify the patient. c. verify that preoperative orders have been followed. d. gain assistance to transfer the patient from the bed to the gurney.

a. Push the gurney head first down the hallway.

Which of the following is *not* a reason to avoid using radiopaque sponges for postoperative dressings? a. Radiopaque sponges are not as absorbent. b. Possible invalidation of subsequent sponge counts if the patient were returned to the OR with intact dressings. c. Radiopaque sponges may appear as foreign bodies on post op x-rays.

a. Radiopaque sponges are not as absorbent. Counts

Dispersement or grounding pads are also called by which name? a. Return electrode b. Impedence pad c. Monopolar d. Resistance pad

a. Return electrode

Which of the following observations are critical when doing skin antisepsis on pediatric patients? a. Take measures to prevent loss of body heat. b. The relatively small bodies of peds patients 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. Take measures to prevent loss of body heat.

Identify the correct steps for opening a sterile package. a. The RN opens the wrapper flap farthest away from them. Open each of the side flaps next. The nearest wrapper flap should be opened last. b. The RN opens each of the side flaps first, then opens the wrapper flap farthest from them next. The nearest wrapper flap should be opened last. c. The RN opens the nearest wrapper flap first, then opens each of the side flaps next. The RN opens the wrapper flap farthest away from them last.

a. The RN opens the wrapper flap farthest away from them. Open each of the side flaps next. The nearest wrapper flap should be opened last.

Herbal, orthomolecular, individual biologic therapies and special dietary treatments are encompassed in biologically based therapies. Which of the biologically based therapies listed below are classified as therapeutic nutrition?

a. The diets of Drs. Atkins, Pritikin, and Weil

Surgical tissue banking is: a. The retrieval, processing, preserving, and storing of selected human tissue for later transplantation back into the patient or into another patient. b. The retrieval and storing of selected human tissue for later transplantation into another patient. c. The preserving and storing of selected human tissue for later transplantation into the patient or into another patient. d. The retrieval, preserving, and storing of human tissue for later transplantation back into the patient.

a. The retrieval, processing, preserving, and storing of selected human tissue for later transplantation back into the patient or into another patient.

___________ are worn to protect against ethylene oxide exposure. a. Thick, heavy-duty gloves b. Utility gloves c. Non-sterile gloves d. Sterile gloves

a. Thick heavy-duty gloves

What is the rationale for wearing gloves when handling or transporting surgical specimens? a. To avoid exposure to bio hazardous substances b. To avoid imprints on the specimen. c. To prevent contamination of the specimen d. To prevent misdiagnosis

a. To avoid exposure to bio hazardous substances

tui nyugen 32 year old hysteroscopy patient. What patient safety info relevant to hysteroscopy should be given to the receiving relief nurse before break?

a. a review of the amount of hyskon infused and fluid received back b. a reminder to monitor for discrepancies over 500ml

Lois grew up in Wisconsin at 500 feet above sea level. She is now living in Denver, Colorado, at an altitude of 5280 feet. She recalls a favorite chocolate cake recipe from her childhood and phones her mother for the recipe. She meticulously follows the recipe. The cake neither rises nor tastes like anything she remembers. Has she used critical thinking? a. absolutely not b. probably not c. probably yes d. absolutely yes

a. absolutely not- Although it is rare to be able to say anything related to critical thinking is absolutely so, we do know that carefully following a recipe is not critical thinking. In this case, we known she was not thinking critically because she had been, she would've adjusted the recipe to accommodate the fact that she was at an altitude 4,700 feet higher than where the original recipe was successful.

Most of the energy emitted by a medical laser is: a. absorbed by the tissue b. scattered within the tissue c. reflected off the tissue d. transmitted through the tissue

a. absorbed by the tissue

It is challenging to diffuse a disruptive situation, particularly if you are the target. It may be helpful to try to find some truth to what is being said and to a. agree with the angry person. b. be passive. c. disagree with the angry person. d. stand your ground.

a. agree with the angry person.

The goal of the use of premedication with anxiolytics is to: a. allay anxiety b. hasten induction c. placate parents d. sedate the child

a. allay anxiety

replantation is an attempt to reattach a completely amputated digit or other body part. good candidates for replantation are those with the following amputations

a. almost any body part of a child

Written policies and procedures should be reviewed: a. annually b. quarterly c. bimonthly d. only at orientation

a. annually

The environment of care is defined as: a. any setting in which patients receive treatment. b. the semi-restricted and restricted areas. c. the sterile operating suite. d. the holding area, operating room, and recovery room.

a. any setting in which patients receive treatment.

Which of the following associations pertaining to the dural venous sinuses is incorrect?

a. arachnoid granulations—calcifications of arachnoid mater within the sinuses associated with arteriosclerosis

Discharge planning begins during the a. assessment phase b. planning phase c. implementation phase d. evaluation phase

a. assessment phase

blunt force to the larnyz can result in fracture and impose immediate airway obstruction

a. assist the anesthesia provider with securing the airway while applying cricoid pressure

A surgical hand scrub should be performed a. before donning sterile gowns and gloves for surgical and other invasive procedures. b. whenever you need to enter the OR. c. in the OR or invasive procedure area. d. before opening a sterile instrument pack.

a. before donning sterile gowns and gloves for surgical and other invasive procedures.

An individual's critical thinking abilities are demonstrated within a specific clinical setting. The clinical setting reflects a culture that is affected by: a. beliefs, attitudes and values b. duty, competence, and respect c. knowledge, experience, and diversity d. synergy, team cohesion, and communication.

a. beliefs, attitudes and values

Which type of fire extinguisher is most appropriate to extinguish a fire on a patient? a. carbon dioxide extinguisher b. ammonium phosphate or other dry powder extinguisher c. water mist extinguisher d. foam extinguisher e. a or c

a. carbon dioxide extinguisher

A technique NOT to use when interviewing the preoperative patient is to: a. carefully avoid acknowledging the patient's feelings of anger or fear. b. be aware of body language. c. repeat the patient's statements d. introduce yourself to family members.

a. carefully avoid acknowledging the patient's feelings of anger or fear.

Sterile drapes should: a. not be subjected to rapid movement. b. be placed on the patient before entry into the OR. c. be draped over the OR door to create a sterile barrier d. never be placed on OR equipment.

a. not be subjected to rapid movement.

Terminal cleaning must be done: a. once during each 24 hour period. b. twice during a 24- hour period c. once in a week-long period d. twice in a week-long period

a. once during each 24 hour period.

A stapedotomy is removal of the stapes superstructure and creation of a fenestra (opening) in the fixed stapes footplate for treatment of abnormal bone growth around the footplate that results in its immobility. A prosthesis is placed to restore ossicular continuity and alleviate conductive hearing loss. The patient scheduled for a stapedotomy will probably have a surgical diagnosis of:

a. otosclerosis.

To assess the patient for "pitting edema," depress the skin: a. over the shin for 5 seconds and then release b. over the neck veins for 5 seconds then release c. over the shin for 15 seconds then release d. over the axilla for 5 seconds then release

a. over the shin for 5 seconds and then release

The perioperative nurse provides care to each patient undergoing a surgical intervention in a manner that preserves and protects: a. patient autonomy, dignity, and human rights. b. patient thoughts and feelings. c. health maintenance and wellness. d. the practice of nursing

a. patient autonomy, dignity, and human rights.

Carlos Gracia is a 12-year-old boy scheduled for a laparoscopic hernia repair. During the preoperative assessment and interview, the perioperative nurse notes that Carlos has mild myotonia congenita. Carlos' mother states that she is worried about the anesthesia because her husband's brother died many years ago when he became very feverish during surgery and they could not cool him. The perioperative nurse's appropriate risk reduction strategy in this situation would be to:

a. perform a careful assessment of family history to identify risk for developing malignant hyperthermia (MH).

Which region of the patient's abdomen is traditionally used to establish pneumoperitoneum for laparoscopic surgery? a. periumbilical b. supraumbilical c. subumbilical d. umbilical

a. periumbilical

Hang hygiene is the best method to: a. prevent transmission of infections b. increase compliance with standard precautions c. develop immunity against transmissible infections d. improve patient satisfaction

a. prevent transmission of infections

Galvin and Curley suggested specific interventions for use with pediatric patients, including: a. protecting areas of skin to skin contact b. sheepskin under all bony prominences c. towels to prevent pooling of solutions d. use of rolled towels/diapers for positioning

a. protecting areas of skin to skin contact

Steven Morganstein, a 51-year-old male with hepatobiliary disease, is scheduled for surgery. The perioperative nurse, during the preoperative assessment, questions and examines the patient for signs and symptoms of jaundice, petechiae, and lethargy and:

a. reviews his chart for bleeding and coagulation times and the platelet count

A sterile open procedure setup: a. should not be transported from one sterile operating room to another. b. may be transported from one sterile operating room to another c. may be transported from one sterile operating room to another if the patient has not yet entered either room. d. should be unwrapped in the clean supply room and moved to a sterile OR suite.

a. should not be transported from one sterile operating room to another.

The lungs should be auscultated with the patient: a. sitting with legs dangling over the side of the exam table b. sitting with the legs up on the exam table. c. supine with legs dangling over the side of the exam table d. supine with the knees bent and the feet on the exam table.

a. sitting with legs dangling over the side of the exam table

Always clean wounds with ___________. a. sterile water b. iodine c. alcohol d. chlorhexidine gluconate

a. sterile water

Which of the following is a common design for a perioperative area? a. the core design b. the hotel design c. the group or pod arrangement d. the school house design

a. the core design

which of the following is not typically visable in a PA chest radiograph

a. the interventricular septum

which of the following is incorrect pertaining to the pancreas

a. the superior mesenteric artery lies anterior to its neck.

The proper method of wearing a surgical mask is: a. tied closely to the face, to prevent venting of respiratory contaminants around the sides. b. tied loosely around the face, to facilitate ease of breathing. c. with ties crossed around the back of the head. d. none of the above.

a. tied closely to the face, to prevent venting of respiratory contaminants around the sides.

The primary reason for documenting sharp, sponge, and instrument count is: a. to prevent injury to the patient from a retained foreign object. b. to maintain an inventory for the sterile processing department. c. to provide an accurate item charge for the patient. d. to track instruments that might be needed for the next procedure.

a. to prevent injury to the patient from a retained foreign object.

The movement of patients from an unrestricted area to a semi-restricted or restricted area is usually done via a: a. transition zone b. central corridor c. peripheral corridor. d. central admissions desk.

a. transition zone

In the following illustration, the arrow traverses the:

a. transverse pericardial sinus

Counts are routinely made at specific times and in a particular sequence. a. true b. false

a. true

In areas used for the processing of soiled equipment, the flow of equipment should be: a. unidirectional b. bidirectional c. toward a central supply processing area d. it does not matter once the equipment has left the restricted area

a. unidirectional

The pathology laboratory and blood bank are usually situated in which of the following areas? a. Unrestricted b. Semi-restricted c. Restricted d. Fully restricted

a. unrestricted. Depending on the layout other unrestricted areas include PACU, periop, waiting room, lab, blood bank, and pathology.

what statements regarding vascular clamps are true? select all that apply

a. vascular clamps are designed to partiall occlude blood flow. b. vascular clamps are designed to totally occlude blood flow. c. all vascular clamps are designed to hold vessels securely without trauma.

The administrative support staff should help ensure that the care delivered within the surgical environment results in positive outcomes for the surgical patient. a. True b. False

a.True

Both sterilization and disinfection describe the elimination of microbial contamination and the achievement of a state suitable for patient care in select situations. However, disinfection differs from sterilization in that the process for disinfection uses:

agents to disinfect and eliminate most, if not all, pathogenic microbes

The nurse and the scrub person determine that the sponge count is incorrect as the peritoneum is being closed. What is the first step that the nurse should take? Inform the surgeon the count is incorrect, and conduct a recount.

Third spacing can interrupt the homeostasis of the body. Which of the following is an example of third spacing? Ascites related to liver failure

Which of the following reflects the basic values for health care practice?

all of these

You examine a comatose pt in the ER. His wife relates that her husband was struck accidentally in his "temple" by a baseball. After an initial period of unconsciousness, he seemed to be okay but later became drowsy and comatose. You suspect that the patient is suffering from:

an extradural (epidural) hematoma caused by a laceration of a branch of the middle meningeal artery

Select a prevention strategy that is a best practice for preventing STFs from spills on wet floors.

Transport liquids in covered containers with lids in place.

Dantrolene (Skeletal Muscle Relaxant) Cooling pt. with ice & cold IV solution Diuretics

Treatment of MH?

Oculocardiac reflex (OCR) is an intraoperative emergency that can occur during eye surgery. Select the definition of the response and contributing factor(s)

Trigeminal-vagal response caused by pressure on the globe or retrobulbar block

Sparks and fires may occur from open suture packets containing alcohol in the vicinity of a ESU.

True

True or False The three components of the fire triangle are oxidizing source, ignition, and fuel source.

True

True or False: A recent innovation that has allowed more specific placement of endotracheal tubes in pediatric patients is the microcuff endotracheal tube.

True

True or False: Because the process of chemical disinfection destroys blood, tissue, and mucous, there is no need to decontaminate used surgical instruments before chemical disinfection.

True

True or False: It is important for perioperative nurses to evaluate their practice within the context of professional standards and to maintain current knowledge in nursing practice.

True

True or False: Pop culture can create fears in children, specifically a fear of not bring all the way asleep during surgery and feeling pain.

True

True or False: Skin prep solutions should be allowed to dry before the patient is draped to reduce the risk associated with vapor ignition.

True

True or False: The Privacy Rule, a federal law, gives individuals rights over their health information and sets rules and limits on who can look at and receive an individual's health information.

True

True or False: The circulator may assist the scrub person by reaching inside the gown and pulling the inside seam to bring the gown over the scrub person's shoulders.

True

True or False: The prevent exposure to some plume, the room suction nose nozzle inlet should be kept within two inches of the surgical site to capture airborne contaminates.

True

True or False: The thee most common contributing factors to a musculoskeletal injury are static posture, repetitive motion, and moving patients.

True

True or False: When documenting, always include your assessment of the situation, the actions you took, and the patient's response to them.

True

True or False: When performing a surgical hand scrub, it is acceptable to use an alcohol-based antiseptic solution if it exhibits persistent, cumulative antimicrobial activity that meets FDA standards.

True

True or false: If a staff member receives a shock when plugging in a piece of equipment, the equipment should be sent to biomedical maintenance for evaluation/repair.

True

True or false: It is the responsibility of the perioperative RN to raise questions to the perioperative team if any dosage of anticoagulants appears to be not within recommended guidelines.

True

True or false: One goal of the Joint Commission National Patient Safety Goals is use at least two unique patient identifiers to identify patients.

True

True or false: Percutaneous injuries are often self inflicted.

True

True or false: The linens used in the surgical suite should be flame retardant.

True

True or false: The use of a brush for surgical hand scrubs is not necessary.

True

True or false: Transcribing is the point in the medication use process that involves anything related to the act of recording or transferring an order by someone other than the prescriber for order processing.

True

True or False: A basic requirement for a safe workplace is complying with all federal, state, and local health and safety laws.

True.

True or False: AORN and OSHA are working together to prevent exposure to blood-borne diseases, reduce ergonomic injuries and prevent exposure to smoke plume.

True.

Fibroids Cancer Abnormal bleeding endometriosis

Valid indications for a hysterectomy are?

Because herbal products are so readily available and have such widespread media attention, many people think that they can safely self-medicate. Why should the public be aware and educated about dietary supplements and potential harmful effects

Unknown substances may be present in these products.

Surgical assistants should be familiar with all basic anesthetic monitors and normal ranges of physiologic parameters in order to:

anticipate patient and anesthesia provider needs in terms of patient status and potential emergencies, and safely use the equipment when they monitor a patient under local anesthesia.

While tucking the arms at the sides of the patient in supine position offers comfort, safety, and easy access to the patient by the scrubbed team, improper positioning and securing of the arms can result in significant injury. Injury can be avoided by tucking the draw sheet ___________ the arm and under the ____________.

around; body

Which of the following social media practices are important for the professional nurse to follow? *Select all that apply* a. Acknowledge that anything you post on the internet is there forever. b. Do not speak on behalf of your employer unless you have been authorized to do so. c. Facebook mixes your personal and professional lives and requires careful attention. d. Ignore any breaches in confidentiality or privacy. e. Online contact with patients is okay with their permission.

A, B, & C

Based on the understanding you have gained about the Guideline on documentation, identify the correct statements. *select all that apply* a. After positioning, the periop nurse should evaluate the patient's body alignment and tissue integrity. b. The documentation should include location of padding devices. c. The documentations should not include the names of the persons positioning the patient. d. Postop outcome evaluation is an integral part of documentation.

A, B, & D

CN III Occulomotor CN IV Trochlear CN VI Abducens

assessment of the extraocular movements during a neurological exam, tests which cranial nerve(s)?

In the following picture, match which nerves innervate which parts of the anatomy.

auxillary = deltoid musculocutaneous = ? (not deltoid) median = arm to fingers radial = arm to fingers ulnar = arm to fingers

Match each type of wound when its appropriate example. 1. Clean wounds 2. Clean contaminated wounds 3. Contaminated wounds 4. Dirty wounds a. A colon resection b. Open or fresh traumatic wound c. Ruptured appendix d. Thyroidectomy

1-D, 2-A, 3-B, 4-C

Which surgical position adversely affects the diaphragmatic movement? *select all that apply* a. Trendelenburg b. Prone position c. Sitting or semi-sitting position d. Lateral position

A, B, & D

1. Type of Suture Attachment

A) Eyed Needles B) Swaged Needles

Which of the following agents are antimicrobial agents? *select all that apply* a. Chlorhexidine gluconate (CHG) b. Providone iodine (an iodophor) c. Alcohol d. Phenylephrine

A, B, & C

In creating a sterile field, which of the following are recommended by AORN? *Select all that apply* a. Cuff the drapes over your gloved hand to prevent contamination. b. Handle drapes as needed to get the best coverage. c. Place drapes in sequence from the surgical site to peripheral areas. d. Place drapes on the patient and any furniture and equipment that will be in the sterile field. e. When placing drapes do not lean across unsterile areas. f. After placing the drape on the patient, reposition as needed to provide coverage.

A, C, D, & E

Which of the following factors increase the patient's risk for skin injury? a. Use of the wrong type of linen. b. Unusual positions or positioning devices c. Use of electrical equipment d. Use of chemical agents e. Prolonged length of surgery f. Reduced tissue perfusion

B, C, D, E, & F

Identify the "five rights" of surgical specimens. *select all that apply* a. Right medication b. Right patient c. Right specimen d. Right date and time of collection e. Right procedure f. Right laboratory test g. Right surgeon

B, C, D, F, & G

In Phase 1 of PACU, the patient is assessed for: *Select all that apply* a. Home care b. Blood pressure c. O2 saturation d. Suicide e. LOC f. Degree of pain

B, C, E & F

The perioperative nurse's role in preparing and administering medications includes: *Select all that apply* a. Administering all medications ordered by the surgeon b. Assessing the patient's medication allergies and use of herbal or dietary supplements. c. verifying the administration of the correct medication, dose, and route. d. Writing down and reading back the surgeon's oral orders before preparing medication.

B, C, & D

Identify the true statements about abbreviations. a. Abbreviations are to be used by physicians only b. Abbreviations can lead to medical errors. c. Abbreviations are difficult to read. d. Abbreviations might be wrongly interpreted.

B, C, D

As a new perioperative nurse, you are assigned to work with a preceptor in general surgery. Rather than "show you and tell you" how to do things, this preceptor often asks you questions. She explains to you that she wants to help you discover the connections and relationships between perioperative patient care activities. Your preceptor is helping you build which component of critical thinking? a. Communication b. Context c. Relevant criteria d. Questioning

c. Relevant criteria

Question text Morris Bettelman, an 86-year-old retired plumber, states that he has suffered from a groin hernia all of his adult life; he states, "as far back as I can remember." Sometimes he has to push the bulge back into his abdominal muscle and then he is fine until he has a coughing spell. This morning the bulge was large and tender when he woke up and he could not reduce it. As the pain increased, he felt weak and nauseous. His daughter took him to the emergency department. Morris was diagnosed with a strangulated incarcerated hernia and scheduled for emergency surgery. If the contents of Morris' hernia sac become compromised, with strangulation of the bowel, the probable label on his surgical specimen will be:

c. necrotic bowel.

What areas does the physician cover in the initial pre-surgical assessment in the office? a. type of anesthesia, the procedure, and analgesia b. patient history including medications, and insurance coverage. c. an overview of the surgical procedure, risks of surgery and recovery process. d. vital signs, cardiovascular status, and surgical procedure.

c. an overview of the surgical procedure, risks of surgery and recovery process.

Cold clammy skin may be a sign of: a. inadequate rooms heating b. poor circulation c. anxiety d. a febrile illness

c. anxiety

WHen conducting a perioperative assessment of a hearing impaired patient, it may be helpful to: a. have the patient face forward toward the light to facilitate lip reading. b. shout at the patient c. ask in short, direct questions d. let the surgeon conduct the assessment

c. ask in short, direct questions

The skin can ________ be sterilized. a. always b. easily c. never d. none of the above

c. never

What is similar in patient teaching about postoperative care for both endovascular aortic aneurysm repair and abdominal aortic aneurysm resection?

c. no lifting of more than 5 lb for 6 weeks

A fire risk assessment should be performed: a. only before procedures involving electrocautery, an ESU, or a laser. b. only if requested by the surgeon or first assistant c. before all operative procedures d. only before surgical procedures above the xiphoid process and in the nasopharynx e. only of the patient requires more than 30% of supplemental oxygen

c. before all operative procedures

Damp dusting of the OR as part of the preliminary room preparation should be done: a. in the morning the day of surgery b. the night before the scheduled surgery. c. before bringing in any surgical supplies. d. after the surgery.

c. before bringing in any surgical supplies.

Appropriate positioning of the patient for the procedure ensures: a. the patient will be able to communicate with the team. b. the patient will not be able to pull off the surgical drape. c. optimal exposure to the surgical site. d. opportunity for observation of the procedure.

c. optimal exposure to the surgical site.

Use of the hands and fingertips on the patient's skin to distinguish temperature variations, hard and soft, rough and smooth, and stillness and vibration is called: a. auscultation b. percussion c. palpation d. inspection

c. palpation

select the statement that most correctly matches a risk factor for adhesions with an appropriate preventitive strategy

c. patients with endometriosis may be best served with a laparoscopic approach

The person who develops the patient's plan of care is the: a. surgeon, using the physcian's pick list. b. circulating nurse, consulting HIPPA c. pre-admission nurse, using the PNDS d. preoperative nurse, using the PNDS

c. pre-admission nurse, using the PNDS

If a natural absorbable suture starts to dry during a procedure: a. use a new suture b. soak the suture in sterile chemicals c. quickly immerse the suture in sterile water or normal saline solution. d. drench the suture in sterile peroxide.

c. quickly immerse the suture in sterile water or normal saline solution.

The hepatorenal recess (Morison pouch):

c. receives infected fluids draining from the omental bursa in the supine position

A preoperative patient's do-not-resuscitate order is: a. irrevocable and unchangeable once established. b. not intended to be upheld in the perioperative environment. c. reconsidered to ensure that the risks and benefits of anesthesia and surgery are discussed before surgery. d. not reinstated until the patient leaves the perioperative environment.

c. reconsidered to ensure that the risks and benefits of anesthesia and surgery are discussed before surgery.

The primary purpose of documentation is to: a. be prepared in case a court case is filed. b. make sure everything is written down. c. record the chronological order of events during the nursing care of a patient. d. relate any conversations and discussion with the patient and family in detail.

c. record the chronological order of events during the nursing care of a patient.

Fears that are common to virtually all children include all of the following EXCEPT: a. loss of control b. pain c. recovery d. separation anxiety

c. recovery

Posterior pituitary hormonal agents are administered by ___________. a. saline irrigation solution b. topical application c. regional injection d. immersion method

c. regional injection

Perioperative hand hygiene includes all of the following *except*: a. removing bracelets and watches before washing hands or beginning a surgical hand scrub. b. removing chipped nail polish before entering the perioperative area. c. removing the visible soil on the hands and arms with an alcohol-based antiseptic hand rub that meets US FDA standards for antimicrobial activity. d. using a disposable nail cleaner to clean under the nails. e. removing rings before entering the perioperative area.

c. removing the visible soil on the hands and arms with an alcohol-based antiseptic hand rub that meets US FDA standards for antimicrobial activity.

The concept of a standard of care related to documentation: a. is not determined by hospital policy or AORN standards. b. requires the nurse's care to be perfect. c. requires the nurse to document and act as a reasonably qualified nurse would in a similar situation. d. set in law and never changes.

c. requires the nurse to document and act as a reasonably qualified nurse would in a similar situation.

_____________ stockings are used to prevent deep vein thrombosis during surgical procedure. a. Symmetrical compression. b. Spatial compression c. Sequential compression d. Secondary compression

c. sequential compression

A scrubbed perioperative RN observes a fire start on a patient in the OR. After alerting the team, the nurse should immediately: a. obtain and operate the nearest fire extinguisher by using the PASS technique. b. pat the flames with a drape. c. smother the fire with a towel or pour nonflammable liquid on the fire. d. lift the patient and transport him/her out of the room. e. turn off oxygen source

c. smother the fire with a towel or pour nonflammable liquid on the fire.

Which of the three elements required for an infection to occur is related to inanimate environmental surfaces? a. method of transmission b. susceptible host c. source or reservoir

c. source or reservoir

During anesthesia induction the perioperative nurse should: a. complete documentation b. get ready for the surgeon to make the first incision c. stand by the patient to offer comfort or assistance as needed d. inform the patient that they are getting sleepy

c. stand by the patient to offer comfort or assistance as needed

Which of the following will the perioperative nurse be sure to have when setting up for a mediastinoscopy?

c. suture and needle holders

The "time-out" communication that must occur immediately before an intended procedure in a health care facility is mandated by a. the Centers for Disease Control b. the Food and Drug Administration c. the Joint Commission d. Medicare

c. the Joint Commission

Where should the scrubbed person hold onto his or her gown when lifting it up to don it? a. the sterile exterior of the gown b. the inside seams at armpits c. the inside of the gown, just below the neckband d. at the waist

c. the inside of the gown, just below the neckband

This tissue contains fat cells.

c. yellow marrow

The point of forceps should be facing __________ while passing it to the surgeon. a. Upward b. Downward c. Forward d. Backward

b. Downward

The thermal effects of the ESU and which of the following are used to cut and coagulate the tissue? a. Pedal b. Electrode c. Pad d. Doctor

b. Electrode

What is the appropriate action if the doctor is delayed after the room and instruments have been opened?

Do not cover open supplies and have the scrub nurse continually visually observe the room for breaches in sterility.

Collagen suture is absorbed by _____.

Enzyme digestion

True or False: Same-level slips, trips, and falls are a leading cause of workplace injury.

True

Greater Curvature of the stomach

Where are the splenic vessels/short epigastircs cut ?

The recent survey of AORN members found that perioperative RN's TOP TWO patient safety concerns were a. falls and surgical fires b. Wrong site/ wrong procedure/ wrong patient errors and retained surgical items. c. Specimen management errors and documentation errors. d. Pressure injuries and protecting patients' property.

b. Wrong site/ wrong procedure/ wrong patient errors and retained surgical items.

What does not need to be counted on a surgical field

cautery pencil

____ is a term that refers to permission being given for an action.

consent

A minimally invasive video-assisted thyroidectomy (MIVAT) procedure relies on Miccoli instruments added to the standard thyroid or neck dissection setup, a 30-degree endoscope, and an ultrasonic (harmonic) scalpel with scissors to ligate and divide the vessels. An important risk reduction strategy for any minimally invasive procedure would be

consider and plan for the possibility of conversion to open thyroidectomy

A 60-year-old man had surgery 6 days ago for a ruptured diverticula. What was the wound classification at the time of his emergency surgery?

contaminated wound, classification 3

Based on your knowledge of Maslow's Hierarchy of Needs, rate the patient needs given below in decreasing order of their importance. 1. the patient believes that he or she can confide feelings to the periop nurse. 2. the patient's religious beliefs are being considered during decisions about perioperative practices. 3. the patient is well-fed and warm. 4. the patient is confident in his or her prospects of recovery from surgery. a. 3>4>1>2 b. 3>1>2>4 c. 1>4>3>2 d. 3>1>4>2

d. 3>1>4>2

Place the events in the defense process in the proper sequence. 1. Seal the wound against infection 2. Regenerate the natural epidermal covering 3. Repair deeper tissue damage 4. Clean up pathogens and debris in the wound. 5. Stop the blood loss (hemostasis) a. 1-2-3-4-5 b. 2-3-4-5-1 c-4-5-1-2-3 d. 5-4-1-2-3

d. 5-4-1-2-3

When evaluating appropriate materials for gowns, gloves, and drapes, perioperative personnel should consider a. the length of the procedure and anticipated volumes of blood loss, fluid loss, and irrigation fluid used. b. the barrier performance of the product. c. whether electrosurgical cautery will be performed. d. A & B

d. A & B

Surgical gloves should be changed a. immediately after your gloves come in contact with methly methacrylate, because it can rapidly break down latex. b. between patients, but only if the patient is suspected to have an infection or if the gloves are visibly contaminated. c. if they become loose on the hands from exposure to fluids or fat. d. A & C

d. A & C

A perioperative nurse is assessing patients for DVT risk factors prior to lower limb surgeries. Based on the following descriptions, which patient *DOES NOT* have risk factor(s) for DVT? a. A 35-year-old patient on prolonged bed rest. b. A 70-year-old smoker with no history of significant medical problems. c. An obese 45-year-old who is otherwise healthy d. A 20-year-old non-smoking athlete with a left anterior cruciate ligament tear.

d. A 20-year-old non-smoking athlete with a left anterior cruciate ligament tear.

Oxidizing sources in the operating room include: a. Oxygen b. Nitrous oxide c. Carbon dioxide d. A and B e. A, B, & C

d. A and B

Which is *NOT* a protocol for treatment during an MH crisis? a. Stopping all triggering agents b. Continue with safe agents c. Hyperventilate with 100% O2 d. Administer serum potassium

d. Administer serum potassium

How does the perioperative nurse determine what constitutes proper isolation precautions for a particular patient? a. Follow the physician's orders b. Consider the infection source and transmission qualities of the organism c. Collaborate with the infection control nurse d. All of the above

d. All of the above

Recommendations for draping include: a. handling sterile drapes as little as possible. b. cuffing the drape material over gloved hands. c. holding the drapes in a controlled manner. d. All of the above

d. All of the above

The OSHA's Blood borne Pathogen standard requires ________ to prevent infectious diseases. a. Following standard precautions b. Wearing PPE c. Place used sharps in puncture-proof containers d. All of the above

d. All of the above

Which of the following is a potential reservoir for infection transmission in the perioperative setting? a. Ventilator humidifier b. OR table c. Safety Strap d. All of the above

d. All of the above

Who is responsible for continuity of care in the surgical patient? a. Preoperative nurse b. Perioperative nurse c. Postoperative nurse d. All of the above

d. All of the above

Why will the perioperative nurse ensure availability of hemodynamic monitoring equipment and supplies for the patient having thoracic surgery?

d. All of the above are true.

Select the positioning devices and accessories commonly used for bariatric surgery. Select one: a. Air-filled, roller, or slider transfer device b. Upper body ramp c. Elevated padded armboards d. All of the options are correct

d. All of the options are correct

Identify the risk for an elderly patient with an insufflation system flow rate of 16 mm Hg. a. gastroesophageal reflux. b. hypercarbia. c. postoperative nerve damage and shoulder pain. d. All of the options are correct.

d. All of the options are correct.

Even small perforations in surgical gloves increase risk of exposure to bloodborne pathogens and potentially infectious materials. When wearing surgical gloves, it is appropriate to do all of the following *except*: a. double glove during surgical and other invasive procedures. b. change gloves when contamination or perforation is suspected, even if you are not sure it happened. c. change gloves every 45 minutes during surgical and other invasive procedures d. use a performance indicator system in which the inner pair of gloves is colored to make perforations easier to see.

c. change gloves every 45 minutes during surgical and other invasive procedures

Four core principles of perioperative risk reduction are: a. readiness, response, rationality, root cause analysis. b. perception, prevention, process and policy. c. competence, communication, compassion, charting. d. training, treatment, testing, teamwork.

c. competence, communication, compassion, charting.

Draping the patient involves: a. covering the patient with a sterile barrier. b. covering the patient and the surrounding areas with a sterile barrier. c. covering the patient and the surrounding areas with sterile materials to create and maintain a barrier between non-sterile and sterile areas. d. covering the patient, the surrounding areas, and the instruments with a sterile barrier.

c. covering the patient and the surrounding areas with sterile materials to create and maintain a barrier between non-sterile and sterile areas.

Any tissue of fluid removed from the body is documented and identified. Some of the items included in the documentation accompanying specimens are: a. site, locations, and type of dressings, and loss of fluid. b. type of specimen, date, and time of collection, and hypersensitive reactions. c. date and time of collection, site, and surgeon's name and contact information.

c. date and time of collection, site, and surgeon's name and contact information.

By establishing preoperative evaluation clinics for outpatients, hospitals have: a. increased laboratory use b. increased surgical cancellation rates c. decreased length of stay for surgical patients d. improved patient outcomes

c. decreased length of stay for surgical patients

Which stitch do you have to backhand? a. Figure of eight b. Vertical mattress c. Horizontal mattress d. Any stitch with a buried knot

b, c

As defined in health care literature, a safety culture is an environment that a. focuses on issues such as medication errors and wrong-site surgery. b. applies primarily to large surgical facilities like hospitals and urban medical centers. c. encourages reporting, ends blame, involves senior leadership, and focuses on systems. d. maintains strict asepsis in the areas classed as restricted.

c. encourages reporting, ends blame, involves senior leadership, and focuses on systems.

Data about alcohol intake and recreational drug use are: a. not necessary b. not reliable c. essential d. best obtained in the presence of family members

c. essential

what mechanisms do chest catheters and drainage systems use to remove fluid and air from the pleural cavity

c. expiratory pressure and gravity

When using argon- enhanced coagulation (AEC), there is a risk of __________. a. electrosurgical injury b. carbon dioxide purge c. gas emboli d. decreased insufflator pressure

c. gas emboli- the argon gas pressure exceeds venous pressure in the circulating system, so there is a risk of gas embolism when the active electrode is placed in direct contact with tissue.

When a scrub person assists another team member with gowning and gloving, he or she does all of the following *except*: a. protect gloved hands by forming a cuff of the neck and shoulder area. b. release the gown when the team member's hands are in the sleeves. c. handle the glove on the inside only. d. always offer the right glove first.

c. handle the glove on the inside only.

 The renal artery and vein enter and exit the kidney on the medial side of the organ through a concave area known as the:

c. hilum.

during a lap chole, the scrub person inspects the integrity of the insulation along the shaft. what nursing outcome is expected. the patient will be free from:

c. impaired skin integrity

Per the Spaulding Classifications System, critical items include instruments or objects that are: a. in contact with mucous b. in contact with the patient's unbroken skin. c. introduced into the human body. d. out of the sterile field.

c. introduced into the human body.

During his evaluation, Juan Perez, who has just completed his first year in the OR, was asked to complete a self-evaluation. In his self-evalution, critical thinking is one of the major areas of appraisal. Juan was asked to identify his strengths and areas he needs to strengthen in the coming year. Such self-reflection is a component of critical thinking termed: a. credibility b. self-assessment c. introspection d. realistic goal setting

c. introspection

After completion of the steam sterilization cycle, wrapped, sterilized items should be: a. placed on metal table until cooled. b. used immediately c. left untouched to cool for 30-60 minutes. d. left untouched to cool for 15 to 30 minutes.

c. left untouched to cool for 30-60 minutes.

Marissa Walton is a 6-year-old girl with full-thickness burns involving both lower legs, circumferentially, excluding her feet, over less than 2% of her body surface area (BSA) and partial-thickness burns over less than 15% of her BSA, after her clothes caught fire during a camping trip when she stepped into the campfire. Based on the American Burn Association and the "Rule of Nines" classifications, Marissa's burns would be classified as ______________ with a burn surface area percentage of approximately ______________.

c. minor 9%

A successful lawsuit that an RN could be involved in: a. does not require patient injury b. only requires a nurse-patient relationship. c. must show duty, breach, causation, and damages. d. considered whether the patient has filed previous lawsuit.

c. must show duty, breach, causation, and damages.

An experienced anesthesia provider administered MAC to a 29-year-old female undergoing local scar revision surgery for an old abdominal incision. She titrated midazolam and propofol to dull the patient's level of consciousness. She was alerted by the dropping SpO2 reading and the patient's loss of chest movement. The patient did not respond to a head tilt-chin lift maneuver. The anesthesia provider's next response to this event is to:

alert the surgeon and ventilate the patient's lungs with a self-inflating bag/valve/mask.

Match the agents listed with their action in the perioperative setting. a. Antibiotics b. Anticoagulants c. Hemostatic agents d. Cardiac agents e. Anti-inflammatory agents 1. Delays the coagulation of blood. 2. Test patency and integrity of a graft. 3. Reduce possible post-operative edema 4. Controlling infection 5. Assist in blood clotting

a-4, b-1, c-5, d-2, e-3

John Dewey defined "reflected thinking" as: "Active, persistent, and careful consideration of a belief or supposed form of knowledge in the light of the grounds which support it and the further conclusions to which it tends." The last part of that definition: "and the further conclusions to which it tends" refers to which of the following: a. What matters are the reasons we have for believing/accepting something. b. It matters that we identify the implications of our beliefs or acceptance of the received knowledge. c. We should not memorize the product of others' thinking. d. We all tend to make snap judgments based on the situation at hand.

b. It matters that we identify the implications of our beliefs or acceptance of the received knowledge.

Identify which types of clamps are used to control bleeding in muscle tissue. a. Crile clamps b. Kelly clamps c. Mosquito clamps d. Occluding clamps

b. Kelly clamps

Identify one characteristic difference between laparoscopic instruments and those used in open procedures. a. All laparoscopic scissors are "take-apart." b. Laparoscopic instruments have long, thin shafts to accommodate trocar cannulas. c. One cannot dissect tissue with laparoscopic instruments. d. All laparoscopic instruments are disposable.

b. Laparoscopic instruments have long, thin shafts to accommodate trocar cannulas.

Identify one characteristic difference between laparoscopic instruments and those used in open procedures? a. All laparoscopic scissors are "take-apart" b. Laparoscopic instruments have long, thin shafts to accommodate trocar cannulas. c. One cannot dissect tissue with laparoscopic instruments. d. All laparoscopic instruments are disposable.

b. Laparoscopic instruments have long, thin shafts to accommodate trocar cannulas.

Grounding pads should be placed over which of the following? a. Bony prominences b. Large muscle masses c. Scars d. Implants

b. Large muscle masses

What gloving technique method is recommended for the initial gowning and gloving during an operative or other invasive procedure? a. Close assisted gloving method. b. Open assisted gloving method when close assisted gloving is not possible or practical. c. Closed gloving as long as the cuffs are not compromised. d. Open gloving method

a. Close assisted gloving method.

Select the proper removal of drapes. a. Last suture placed- incision site dressed- removal of drapes- removal of instruments- disposable material disposed of. b. Last suture placed- incision site dressed- removal of instruments- removal of drapes- disposable material disposed of. c. Last suture placed- incision site dressed- disposable material disposed of-removal of instruments- removal of drapes. d. Last suture placed- incision site dressed-removal of instruments- disposable material disposed of- removal of drapes.

b. Last suture placed- incision site dressed- removal of instruments- removal of drapes- disposable material disposed of.

One strategy for handling verbal abuse is: a. Avoid eye contact b. Listening carefully and attentively c. Responding with aggressive behavior d. Occupational safety concerns are a factor in nurses leaving the profession.

b. Listening carefully and attentively

Which of the following practices is recommended when transferring a patient from the OR bed to a gurney? a. Apply a safety strap around the patients hips once the patient is centered on the gurney. b. Lock the wheels of the gurney and the OR bed before beginning the transfer. c. One person may transfer a patient who is alert and able to cooperate. d. Remove the sheet covering the patient before asking the patient to move laterally.

b. Lock the wheels of the gurney and the OR bed before beginning the transfer.

_____________ hemostasis is achieved by occluding severed vessels until platelet formation occurs. a. Thermal b. Mechanical c. Chemical

b. Mechanical

The brainstem is located in the posterior fossa and forms the floor of the fourth ventricle. It is the site of many ascending and descending fiber tracts that allow for communication among the structures of the brain and between the brain and spinal cord. The brainstem consists of what three structures?

b. Midbrain, pons, and medulla oblongata

Which agency sets health care standards for blood-borne pathogens, hazardous communication, personal protective equipment, and hazardous material? a. CDC b. OSHA c. FDA d. EPA

b. OSHA

Which phase of the nursing process begins with a discussion and planning with the patient and his or her family? a. Clinical documentation b. Perioperative assessment c. Implementation d. Outcome identification

b. Perioperative assessment

What is an important safety consideration when using a light source? a. Leave the light cord on the sterile field at all times. b. Place the light source in standby mode whenever it is not in use. c. Coil the light cord tightly to keep its fibers in shape. d. Replace the light cords only when more than 50% of the fibers are broken.

b. Place the light source in standby mode whenever it is not in use.

Barrier material that contains lint and is worn in the surgical suite has the potential to cause: a. sneezing by perioperative personnel. b. Post-operative wound complications c. the material to appear dirty d. Dust

b. Post-operative wound complications

What does AORN's Guideline for Preoperative Patient Skin Antisepsis recommend for prepping areas with high microbial counts? a. Prep them first b. Prep them last. c. Prep them during the procedure. d. Prep them whenever necessary.

b. Prep them last.

To accommodate near and distant focus, the lens changes shape and focus by relaxation and tightening of the zonular fibers. What physiologic change of the normal aging process is typically corrected with bifocals?

b. Presbyopia

Baby Boy Doe is a newborn found outside of the emergency department (ED). He is hypothermic and has several deep lacerations across his back, abdomen, and legs that will require surgical repair. He is transferred to the surgical bay of the ED and prepared for anesthesia induction. What risk reduction strategies are appropriate during the preanesthetic phase to achieve and maintain normothermia?

b. Provide a radiant heat lamp during placement of monitoring lines and induction

Colles' (wrist) fracture is a dorsally angulated fracture of the distal end of the radius. Most of these fractures can be managed successfully with closed reduction and immobilization, but external fixation is especially useful in the case of a comminuted intra-articular fracture. Internal fixation with Kirschner wires (K wires) is indicated when the distal end of the radius is severely comminuted and displaced. Select the nursing considerations for a patient with a Colles' fracture fixation.

b. Provide soft tissue instruments in OR and casting supplies available outside OR.

The 3-teniae coli converge at what point?

b. The cecum at the base of the appendix

Substituting a cryo-preserved cadaveric vein or an in situ or reversed vein graft from the patient for an arterial bypass graft is an option for patients who have healthy, easily accessed saphenous veins. How does an in situ vein graft differ from a reversed vein graft?

b. The in situ method leaves the vein in its position and the valves are removed.

Curved Mayo scissors are used for which of the following? a. To cut delicate tissue b. To cut heavy tissue c. To hold suture material d. To grasp tissue

b. To cut heavy tissue

Local anesthesia, or monitored anesthesia care (MAC), is used for most ophthalmic surgery. The local anesthetic regimen, administered by the operative surgeon, is typically a combination of anesthesia delivery methods, or routes. Select the anesthetic plan that is administered by the surgeon before the start of surgery.

b. Topical anesthetic eye drops, subconjunctival infiltration, and retrobulbar block

What is the most consistent indicator of MH during surgical intervention? a. Tachycardia b. Unexplained increased in ETCO2 c. Elevated temperature d. Sustained muscle contraction

b. Unexplained increased in ETCO2

Choose the extremity and nerve most frequently affected by pneumatic tourniquet-induced nerve damage. a. Lower limb, peroneal nerve. b. Upper limb, radial nerve. c. Upper limb, median nerve. d. Upper limb, ulnar nerve.

b. Upper limb, radial nerve.

After the surgical hand scrub, the scrub person should keep the fingers pointed in which direction to allow water to drip off away from the attire? a. Downwards b. Upwards c. Straight d. Curled towards the palm

b. Upwards

Which methods are most effective for cleaning floors in the OR? a. Damp mop with two-mop system b. Wet vacuum or damp mop c. Microfiber mop d. Dry vacuum

b. Wet vacuum or damp mop

The culture of a clinical setting, such as perioperative setting, is: a. unimportant to the patient care that is delivered. b. affected by patient and staff beliefs, staff attitudes, and individual and collective values. c. irrelevant to patient outcomes d. totally determined by the people within an OR at any given time, including the patient.

b. affected by patient and staff beliefs, staff attitudes, and individual and collective values.

During the preoperative nursing assessment in the ambulatory surgery receiving unit, the nurse notices bruises and abrasions in various stages of healing on her patient's abdomen, arms, and breasts. In a quiet and respectful manner the nurse said, "The staff at our facility are concerned about your safety. We know that many things can happen in our lives that affect our mental and physical health." This technique is an appropriate method of establishing a sense of __________ with the patient while conveying caring and concern.

b. normalizing

When one or both gloves must be changed without assistance, which one of the following methods listed below should be used? a. double gloving b. open-glove technique c. barehanded gloving d. closed-glove technique

b. open-glove technique

Placing the ESU dispersice electrode over which of these choices can cause severe tissue burns? a. Scars b. Muscle c. Thigh d. Buttocks

a. Scars

Silk loses up to 20% in tensile strength when wet.

a. True

In perioperative practice setting the operating room is usually considered: a. a restricted area b. an unrestricted area c. for staff only area d. a semi-restricted area

a. a restricted area

When a team member other than the scrub nurse contaminates a glove during the surgical procedure, the scrub nurse re-gloves the team member using which one of the following methods? a. assisted gloving b. reverse gloving c. protected gloving d. open gloving

a. assisted gloving

Which of the following activities is NOT correct when inspecting a rigid sterilization container? a. check external locks, latch filters, tamper evident devices, and valves to ensure that the seal is intact. b. place the container on the sterile field and lift the lid up and away from you. c. inspect the lid's filter to be sure it is not moist, broken, ripped, or torn. d. after a scrubbed team member has lifted the inner basket out of the rigid container, check the inside surface of the container for signs of damage, contamination, or debris.

b. place the container on the sterile field and lift the lid up and away from you.

A plain radiograph of a patient following a knife wound to the left side of his neck showed elevation of the left hemidiaphragm, narrowing of the left intercostals spaces, and displacement of the trachea to the left. You suspect:

b. pneumothorax due to knife penetration of the cervical pleura.

To decrease risk of contamination, AORN recommends that a sterile field be a. prepared in the room adjacent to where it will be used b. prepared as close as possible to the start time of the procedure c. prepared no more than 60 minutes before the start time of the procedure. d. covered and left for up to 2 hours of a procedure is unexpectedly delayed.

b. prepared as close as possible to the start time of the procedure

Patients and personnel must be evacuated because of an OR fire. The proper order of steps to take is: a. alarm, confine/contain, rescue, evacuate b. rescue, alarm, confine/contain, evacuate c. rescue, evacuate, alarm, confine/contain d. confine/contain, alarm, rescue, evacuate e. alarm, rescue, evacuate, confine/contain

b. rescue, alarm, confine/contain, evacuate (RACE)

Sterile gowns should be selected based on: a. color of the gown b. size and sleeve length c. a tight fit d. a loose fit

b. size and sleeve length

Question text When setting up for a gastrectomy, the scrub person will ensure that appropriate instruments are available to clamp and ligate the:

b. splenic vessels.

A directive interview is: a. open-ended and unstructured. b. structured with predetermined questions. c. used to determine personality traits. d. an observation of the patient's nonverbal behavior.

b. structured with predetermined questions.

In the anthropological sense, prescribed ways of behaving to prevent actual or possible harm to self and others are called: a. myths b. taboos c. cultures d. philosophies

b. taboos

Perioperative nursing had its beginnings in: a. WW1 b. the Crimean War c. the Korean War d. the Spanish-American War

b. the Crimean War

The surgical hand scrub controls resident microorganisms by: a. the mechanical action of scrubbing b. the chemical action of microbial agents used. c. the temperature of the water combined with the chemical action. d. none of the above

b. the chemical action of microbial agents used.

When opening a sterile package, the LAST flap to be opened should be: a. the flap to your left b. the flap closest to you c. the flap to your right d. the flap farthest to from you

b. the flap closest to you

Which areas of a surgical gown are considered sterile? a. the front, from the chest to the level of the surgical field. b. the front, from the chest level of the surgical field. c. the neck and shoulders d. the axillary area.

b. the front, from the chest level of the surgical field.

When performing a surgical scrub with an antimicrobial agent, how far up the arm must an individual scrub? a. up to the armpit b. two inches above the elbow c. to the elbow d. four inches above the wrist

b. two inches above the elbow

Wearing artificial or acrylic nails in the surgical setting is: a. permitted if they are in good repair. b. unacceptable because they may harbor microorganisms. c. permitted if polish is less than 4 days old d. unacceptable for aesthetic reasons

b. unacceptable because they may harbor microorganisms.

Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone, which leads to a reduced absorption of calcium and phosphorus. This malabsorptive condition is due to a deficiency of ______________ that can be treated by __________________.

b. vitamin D; dietary supplements and exposure to sunlight

The carbon dioxide laser wavelength is strongly absorbed by: a. protein b. water c. melanin d. hemoglobin

b. water

Susie Reynolds, a 9-year-old softball player, has arrived in the OR for emergency repair of superficial facial and deep arm lacerations when she ran into the chain link fence during practice after school. It is discovered that Susie has diabetes and has an insulin pump that should remain connected during the short procedure. The best option for energy-generated hemostasis is:

bipolar electrosurgery.

The instrument tips in laparoscopic instruments are designed to produce the same tissue effects as a traditional instrument used for open surgery. Because of the process challenges of the laparoscopic approach, it is time-consuming to insert and withdraw instruments repeatedly during the procedure. Instrument manufacturers have attempted to make their products efficient by combining functions. An appropriate combined function for a laparoscopic instrument would be:

blunt dissection with the smooth, rounded edge of the closed endoscopic scissors.

On extubation, Daniel presented with coughing, wheezing, dyspnea, use of accessory muscles, and tachypnea. Daniel is presenting with _______ probably caused by _______.

bronchospasm; aspiration

The light transmission through an endoscope is achieved by way of

bundles of fiberoptic glass rods

The age group for the toddler is __________. a. Birth to 1 month b. 1 to 12 months c. 1 to 3 years d. 3 to 6 years

c. 1 to 3 years

Which of the following fire safety practices should be implemented when a laser is used during surgery? 1. keep wet towels on the sterile field. 2. place moist sterile towels, sponges, and drapes around the surgical site. 3. Use standard ET tubes for upper airway involving laser. 4. allow fumes from flammable solutions to dissipate before activating the laser. a. 1 and 2 b. 1, 2, and 3 c. 1, 2, and 4 d. 1 and 4 e. 3 and 4

c. 1, 2, and 4

A clinically proficient nursing colleague is helping a novice nurse to prepare for a 75 y.o. patient scheduled for a cataract surgery. The patient's history and physical examination include a history of coronary artery disease, pacemaker insertion 3 years earlier, and a history of occasional chest discomfort. The patient's blood pressure, heart rate, and temperature are WNL, his weight is 140# or 63.5kg. Medication is one "baby" aspirin daily. In planning the care for the patient, which of the following might the proficient nurse emphasize in discussions with the novice nurse? 1. Having the crash cart readily available. 2. Ensuring availability of 2 units PRBCs 3. Applying a pulse ox finger cot 4. Applying EKG leads 5. Starting an IV line a. 2, 3, 4, 5 b. 1, 2, 3, 4 c. 1, 3, 4, 5 d. All of the above.

c. 1, 3, 4, 5

A child in which of the following age groups can be described as "likes to socialize and can interpret terms"? a. 1 to 12 months b. 1 to 3 years c. 3 to 6 years d. 6 to 12 years

c. 3 to 6 years

Identify the correct order of tasks to complete in an assessment. 1. Ask questions to determine the patient's knowledge of the procedure. 2. Determine, from the patient's responses, the patient's knowledge. 3. Collate information from the patient's previous medical records. a. 1, 2, 3 b. 3, 2, 1 c. 3, 1, 2 d. 2, 1, 3

c. 3, 1, 2

Noise pollution in the perioperative workplace can interfere with critical activities. The Environmental Protection Agency recommends that noise level should not exceed: a. 10 megahertz b. 25 decibels c. 45 decibels d. 100 megahertz

c. 45 decibels

Select the true statement about antimetabolite drugs and their indications for use.

c. 5-Fluorouracil and mitomycin can both be administered topically to dissolve scars and pterygia.

When passing sharps during a procedure, the best way to protect yourself is by using ___________. a. Extra care b. Assistive devices c. A neutral zone d. A knife handle

c. A neutral zone

What is incisional biopsy? a. A fine gauge needle and syringe are used to aspirate the sample. b. An entire section of tissue is sent for examination. c. A small portion of tissue is incised and sent for examination. d. A small portion of the fluid is drawn and sent for examination.

c. A small portion of tissue is incised and sent for examination.

Two junior level students are assigned to a clinical rotation in your area and you have built a good rapport with each. They are both concurrently enrolled in a US History class to fulfill their humanities requirement. Each has completed the first paper on the American Revolution. Heather's paper is a careful list of almost every key event and battle that occurred in the war and concludes that because of all these events, America achieved its independence from Britain. Amy's paper has almost no specific dates and places but addresses other topics, such as the advantage of the insurgency against traditional war tactics and the importance of the French-British enmity to influence France to support the Americans. Both have expressed interest in becoming perioperative nurses. Based solely on these data, which is likely to develop into the "better" nurse? a. Either one- they both have qualities that make good perioperative nurses. b. Heather because she is stronger in meticulous detail. c. Amy because she is stronger at the interrelationships of evidence and their influence on the total picture. d. Neither

c. Amy because she is stronger at the interrelationships of evidence and their influence on the total picture. Amy demonstrates the ability to think critically. Heather has demonstrated memorization and repeating what she has learned elsewhere that the Americas prevailed rather than analyzing how the events led to that conclusion. Ability to think critically is not limited to nursing or any other one discipline.

What structure traverses the opening indicated by the arrow in the following figure?

c. Aorta

Michael is circulating today in neuro. He has pulled instruments and supplies for an anterior cervical decompression and fusion on patient John O'Malley following Dr. Cortez's preference card exactly. IF the is thinking critically which of the following steps should Michael take to ensure that his scrub person has everything that is needed for Mr. O'Malley's procedure? a. Nothing more is needed. If the preference card precisely, they should be ready. b. Use the time out pause to ask what else Dr. Cortez needs. c. Assess the patient and his medical record for any additional patient needs. d. Both B & C

c. Assess the patient and his medical record for any additional patient needs.

Michael is circulating today in neuro. He has pulled instruments and supplies for an anterior cervical decompression and fusion on patient John O'Malley following Dr. Cortez's preference card exactly. If he is thinking critically which of the following steps should Michael take to ensure that his scrub person has everything that is needed for Mr. O' Malley's procedure? a. Nothing more is needed. If he followed the preference card precisely, they should be ready. b. Use the time out pause to ask what else Dr. Cortez needs. c. Assess the patient and his medical record for any additional patient needs. d. Both B & C

c. Assess the patient and his medical record for any additional patient needs.

Tuberculocidals are a special class of disinfectants. In order to be labeled "tuberculocidal," products need to have demonstrated potency against: a. Pseudomonas b. Staphylococcus c. Mycobacteria d. Salmonella

c. Mycobacteria

Select the *FALSE* statement about pneumatic tourniquet safety. a. Wider, contoured cuffs are generally safer than narrow cuffs because they require less pressure to achieve a near bloodless field. b. Increased tourniquet time increases the risk of postoperative complications. c. Narrow cuffs are generally safer than wide, contoured cuffs because they require less pressure to achieve a near bloodless field. d. Increased cuff pressure increases the risk of postoperative complications.

c. Narrow cuffs are generally safer than wide, contoured cuffs because they require less pressure to achieve a near bloodless field.

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 prep area.

c. Nicking or cutting the skin.

Where the scrub person's sterile gown be opened? a. As far away from the instrument tray as possible. b. In the back corner of the instrument table. c. On a separate Mayo stand d. On top of the gloves for the scrub person.

c. On a separate Mayo stand

Defining nursing goals and interventions strategies is a part of which phase of the nursing process? a. Assessment b. Nursing diagnosis c. Outcome identification d. Planning

c. Outcome identification

Name two identifying factors in establishing patient identity: a. patient name and address b. patient name and DOB c. Patient name and surgeon name d. Procedure and name of surgeon

c. Patient name and surgeon name

A precise way of looking at general anesthesia is to divide it into 3 phases: a. Phase 1: initial administration, Phase 2: maintenance, Phase 3: excitement. b. Phase 1: initial administration, Phase 2: maintenance, Phase 3: emergence c. Phase 1: induction, Phase 2: maintenance, Phase 3: Emergence d. Phase 1: induction, Phase 2: intrasurgery, Phase 3: Excitement

c. Phase 1: induction, Phase 2: maintenance, Phase 3: Emergence

During which phase of wound healing does contraction occur? a. Epitheliazation b. Inflammation c. Proliferation d. Remodeling

c. Proliferation

Choose the FALSE statement about fire risks in the operating room. a. Patients with their heads draped are at increased risk of fire because of supplemental oxygen can accumulate under drapes. b. Substances that would not ignite in room or medical air can do so in an oxygen-enriched environment, which may occur in the operating room. c. Evaporated gases from flammable prep solutions can ignite, especially if they are allowed to accumulate under drapes. d. Bowel surgeries are associated with the highest risk of surgical fires. e. A piece of equipment that is smoking unexpectedly represents an immediate fire risk.

d. Bowel surgeries are associated with the highest risk of surgical fires.

Specific malignant conditions that may require splenectomy include all EXCEPT _____.

d. Carcinoma of left kidney

A healthcare laser system that presents significant skin and fire hazards if used improperly is classified. a. Class 1 laser b. Class 2 laser c. Class 3 laser d. Class 4 laser

d. Class 4 laser

The Perioperative Nursing Data Set is an example of how critical thinking supports positive patient outcomes. Why is this so? a. The PNDS provides a recipe for the clinician to follow. b. Use of the PNDS assists comprehensive charting via electronic medical record. c. The PNDS has been tested in clinical settings by nurse, physicians, and technologists. d. Components of the PNDS necessitate application of the components of critical thinking and reflect a process for identifying interventions.

d. Components of the PNDS necessitate application of the components of critical thinking and reflect a process for identifying interventions.

Physiologic effects of exsanguination and pneumatic tourniquet inflation during surgery typically include all of the following *EXCEPT*: a. Increase in Central Venous Pressure b. Increased heart rate c. Increased core body temperature d. Decreased core body temperature

d. Decreased core body temperature

Which of the following is correct regarding the disposable of contents from reusable suction systems? a. Done by emptying into a hopper b. Done by following the physician's preference c. Reusable containers should never be purchased. d. Done according to federal, state, and local regulations.

d. Done according to federal, state, and local regulations.

Because skin is a major source of contaminiation in the surgical environment, which of the following statements is true? a. Hand hygiene is only necessary before providing care to a patient. b. Hand hygiene should be considered effective only if you are using an antimicrobial solution. c. Hand lotion with petroleum as an ingredient are acceptable to use with gloves. d. Health care personnel who have cuts on their hands should not provide direct patient care.

d. Health care personnel who have cuts on their hands should not provide direct patient care.

Choose the correct phase to complete this sentence. Critical thinking: a. Enjoys a commonly accepted definition. b. Is based on firm belief and scientific truth. c. Is a concrete concept developed by the nursing profession. d. Is an abstract concept that has been developing since Socrates' time.

d. Is an abstract concept that has been developing since Socrates' time.

What action is NOT effective for minimizing transmission of TB in the OT when caring for a patient with active TB? a. Perform surgery in an airborne infection isolation room or use a portable HEPA filter to achieve negative pressure during the procedure. b. Schedule the surgery as the last case of the day. c. Have filters available for the anesthesiologist to place on the patients airway. d. Leave the OR immediately after intubation and extubation.

d. Leave the OR immediately after intubation and extubation.

What therapy is guided by the principle that dysfunction of one part of the body often affects secondarily the function of other discrete, possibly indirectly connected body parts?

d. Manual healing methods

Which of the following is true in handling hemostatic agents such as collagen or gelatin sponges? a. Should be moistened prior to use. b. Should not be left in the wound, since they are not absorbable. c. Are highly perishable and should be refrigerated prior to use. d. Must not be injected or allowed to enter large vessels, as extensive intravascular clotting may occur.

d. Must not be injected or allowed to enter large vessels, as extensive intravascular clotting may occur.

Wilber Johnson, an 84-year-old retired musician of Jamaican descent, was seen by his family practice physician for urinary problems. His physician performed a digital rectal exam (DRE), which was abnormal, ordered a PSA, and referred him to a urologist. Wilber's PSA was 12 ng/ml. His transrectal prostatic biopsy was positive. The biopsy specimen determined a Gleason score of 10 and his AUA score was D2. Based on this clinical diagnostic information, what is the best surgical treatment plan for Wilber?

d. No surgery. Wilber is not a candidate for surgery

Trocar needle points are used for which type of tissue? a. Aponeurosis, biliary tract, dura b. Dissection of friable tissue. c. Ligaments, nasal and oral cavities. d. Penetration of tough tissues.

d. Penetration of tough tissues.

A variety of implantable devices are used in aesthetic and reconstructive plastic surgery procedures. Tracking of these devices is critical to patient safety. Institutions must report any incident of death or serious injury relating to the use of a medical device. What regulatory agency, commission, or act mandates this process when medical devices fail or cause injury?

d. Safe Medical Device Act

while not as prevalent as arthoplasty of the shoulder, knee or hip, total elbow replacement is indicated for patients with traumatic lesions or excessive bone loss from rheumatic or degenerative arthritis. It may be used with or without pmma depending on the quality of the

d. Side plates, screws, and circumferential wires

Which of the following is a correct application of the AORN Guidelines for Perioperative Practice for use of appropriate eyewear during laser use? a. Personnel should not use protective eyewear in common. b. Protective eyewear is required only for certain types of lasers. c. Regular corrective lenses, including contact lenses, are sufficient for most types of lasers. d. The eyewear should be matched to the type of laser, optical density, and wavelength.

d. The eyewear should be matched to the type of laser, optical density, and wavelength.

Which professionals are *NOT* qualified to provide anesthesia care to the patient? a. Anesthesia b. Certified registered nurse anesthestists (CRNA's) c. Perioperative nurses d. The operating surgeon

d. The operating surgeon

Which of the following is true about the use of abbreviations in perioperative documentation? a. There are only three possible words that could present problems in the clinical setting. b. They are easy to interpret when writing orders. c. They are not part of the Joint Commission and AORN safety goals. d. They can put patient at risk for medication errors.

d. They can put patient at risk for medication errors.

Chose the FALSE statement about perioperative fire prevention and management plans: a. They should be developed by a multidisciplinary group of key stakeholders. b. They should describe key content and frequency of fire safety education activities. c. They should specify policies and procedures for fire prevention and response. d. They generally are not needed unless required by a health care facility's insurance policy. e. They should specify team member roles and responsibilities during fire prevention and response.

d. They generally are not needed unless required by a health care facility's insurance policy.

Denise Michaelson had a scar revision of her knee performed along with her bilateral mastectomy with saline implants and ear piercing procedures. The knee scar, before revision, was an 8-cm linear, thin scar that extended obliquely across the anterior portion of her knee. The tension of the scar tissue met resistance when she would bend her knee. The surgeon opted to remove the scar with a procedure to break up the linear scar and rearrange the tissue direction to form a natural line. The proper name of this tissue transfer scar revision is the:

d. Z-plasty.

In the OR, the role of the scrub person may be filled by: a. the circulating nurse b. The RNFA c. a CNA d. a ST or CST

d. a ST or CST

According to WHO and JCO, the following information should be included in a preoperative checklist: a. signed consent form b. patient identification c. marked surgical site d. all of the above

d. all of the above

Assessment data are collected: a. preoperatively b. intra-operatively c. postoperatively d. all of the above

d. all of the above

Assessment data may be collected from: a. the patient b. the patient's family members c. other health care providers d. all of the above

d. all of the above

Calling a "time out" before beginning the procedure allows for opportunity to confirm a. the nature of the procedure. b. the name of the patient. c. the correct patient position. d. all of the above

d. all of the above

Competency statements: a. direct a nurses activity in the perioperative arena. b. provide a basic model to eval the quality of nursing practice. c. ascertain a level of skills and abilities necessary to fulfill the professional role. d. all of the above.

d. all of the above

Nurses have the responsibility to: a. identify safety hazards and unsafe behaviors. b. take action to eliminate safety hazards c. report safety issues through appropriate channels d. all of the above

d. all of the above

Policies and procedures should be established for the movement of: a. equipment b. visitors c. patients d. all of the above

d. all of the above

Sterile fields may be covered with a sterile drape a. during periods of increased activity in the OR. b. when there is an unanticipated delay in the start of the surgical or invasive procedure. c. to shorten exposure time to environmental contaminates. d. all of the above

d. all of the above

Surgical sites should be marked preoperatively a. when the site involves limbs. b. when the surgery involves bilateral organs c. when the surgery involves multiple structures or levels. d. all of the above

d. all of the above

The patient's identity should be verified: a. verbally (whenever possible) b. by checking the patient's chart c. by checking the patient's identification bracelet or wristband d. all of the above

d. all of the above

When preparing an adult for flexible bronchoscopy, what patient considerations must the nurse keep in mind?

d. all of the above

Which of the following is a routine part of preventing cross-contamination? a. restricting personnel movement b. closing doors c. minimizing talking d. all of the above

d. all of the above

In the first few minutes of PACU care, assessment should be made of the patient's postoperative: a. vitals, cardiac status, and LOC. b. pain management, skin integrity, and experience of nausea. c. allergies, sensitivities, and lucidity d. all of the above at the least.

d. all of the above at the least.

In the semi restricted area of the OR: a. traffic is limited to authorized personnel and patients. b. there are areas where instruments may be stored or processed. c. is where peripheral support areas are maintained. d. all of the above conditions apply.

d. all of the above conditions apply.

During gowning, the circulating nurse can assist the scrub person by: a. pulling the bottom edge of the front of the gown to eliminate blousing. b. helping to get the creases out of the gown's sleeves by pulling the shoulders up. c. reaching inside the gown and pulling the inside seam. d. all of the above.

d. all of the above.

Effective methods for preventing SSIs include: a. effective environmental cleaning procedures. b. performance of sterile technique c. use of surgical attire and other barriers d. all of the above.

d. all of the above.

When entering the OR or procedure area, non-scrubbed members of the perioperative team should wear: a. head covering and clean, low-linting two piece pantsuit, one-piece coverall, or scrub dress. b. a clean or single-use long-sleeved scrub jacket that is buttoned or snapped closed and fully covers the torso, arms, and wrists. c. shoe coverings, if spills or splashes are likely to occur. d. all of the above.

d. all of the above.

Who is responsible for monitoring the movement of soiled equipment in the perioperative area? a. the circulating nurse b. the surgical technician c. the recovery room discharge nurse d. all staff members

d. all staff members

Surgical conscience demands the recognition of improper practices observed during surgery by: a. the surgeon b. the anesthesiologist. c. the perioperative nurse. d. any member of the health care team.

d. any member of the health care team.

A history of noncompliance with previous instructions for self-care may be indicative of: a. denial of illness b. a perception that recommended therapeutic regimens are ineffective c. a lack of understanding of the seriousness of the patient's health problems. d. any of the above

d. any of the above

Best practice dictate that perioperative personnel should wear a clean surgical mask secured in a manner to prevent venting: a. only if indicated by the surgeon to do so. b. with surgery and other invasive procedures. c. when open sterile supplies are present. d. both b and c

d. both b and c

What patient position is used for reduction mammoplasty?

d. both modified fowlers and supine

Prolonged high dosages of steroids preoperatively delay _____________. a. hemoglobin formation b. bile production c. insulin production d. collagen formation

d. collagen formation

Risk factors that contribute to postoperative infection include all below *except*: a. age b. nutritional status. c. length or type of surgery d. ethnicity e. surgical technique

d. ethnicity

Following an argument with his wife in which a man backed through a glass storm door resulting in deep laceration of his buttocks, he is having great difficulty walking. To better understand the nature of his disability, you ask him to stand on one foot. By doing so, you are doing all of the following except:

d. evaluating the function of the gluteus maximus.

Which of the following *best* describes sterile technique. Sterile technique is: a. applied when stocking supplies in the surgical suite. b. carried out by non-scrubbed personnel by maintaining a distance of at least 6 inches from the sterile field. c. employed during terminal cleaning to ensure a sterile environment. d. implemented during surgical procedures to prevent microbial contamination.

d. implemented during surgical procedures to prevent microbial contamination.

a number of screening tools have been developed for comprehensive geriatric assessment (CGA)

d. indentifying at-risk individuals

upon palpating the anterior abdominal wall of a patient you notice an intense reflexive muscular contraction in the abdominal muscles which is not correct>

d. it is best observed when the patient is perfectly supine.

A desired outcome of critical thinking is clinical competence. Experience in perioperative patient care is essential to developing both perioperative-specific critical thinking skills and perioperative nursing competence. Which basic component of critical thinking is enhanced and developed with clinical experience. a. ethical reasoning b. communication c. context d. knowledge

d. knowledge

Upon arrival at a medical facility for surgery, considerable anxiety may be experienced by patients who: a. do not have enough information about their surgical procedure. b. have had prior surgeries c. do not have serious illness d. meet any or all of the criteria above.

d. meet any or all of the criteria above.

Which of these is reactive and does not cause resistance to the flow of electricity? a. Prep b. Extremities c. Holster d. Metal

d. metal

The CDC's Classification of Surgical Wounds system is intended to ____________________. a. categorize surgical wounds based on coexisting diseases and according to origin, diagnosis, and treatment. b. elaborate on the CDC's principles of universal precautions by establishing guidelines for treating infections should they occur. c. suggest emergency criteria for dealing with infections inside the procedure room. d. monitor postoperative infections and suggest steps to take to reduce these infections.

d. monitor postoperative infections and suggest steps to take to reduce these infections.

Fast-tracking a patient is possible because: a. health insurance companies support quick discharge of patients. b. patients are motivated to be out of the hospital. c. available medicines and postoperative care directions make home care more effective than it has been in the past. d. new advances in anesthetics allow patients to be awake and stabilized in less time.

d. new advances in anesthetics allow patients to be awake and stabilized in less time.

Which practice is *NOT* recommended to prevent fires during surgeries at high-risk sites? a. use ignition source to enter gas-distended bowel b. pack the back of the throat with radiopaque sponges prior to a tonsillectomy. c. stop supplemental oxygen or nitrous oxide for one minute before using ignition sources. d. place an adhesive incise drape between the surgical site and the oxygen source. e. inflate the ET tube with tinted solutions prior to tracheotomy.

d. place an adhesive incise drape between the surgical site and the oxygen source.

an exapmple of an indicaiton for liver transplantation would be

d. primary hepatic cancer

By which route are antibiotics most commonly administered by the perioperative nurse during the intraoperative phase? a. Intramuscular b. Intravenous c. Irrigation solution d. Subcutaneous

c. Irrigation solution

this tissue is concerned with the formation of red blood cells

c. red marrow

clean and uninfected surgically incised without much loss of cells and tissue edges of wound are approximated by surgical sutures

characteristics first intention wound healing

A needletype frequently used in microsurgery is

cutting taper

Perioperative support staff does NOT include: a. building-service personnel b. scheduling staff c. BMET's d. CFA's

d. CFA's

A perioperative nurse is performing a preoperative assessment of a patient scheduled for total knee arthoplasty. Which of the following is *NOT* a primary contraindication for pneumatic tourniquet use? a. Significant vascular disease, including recent bypass, history of deep vein thrombosis, or impaired peripheral circulation. b. Sickle cell anemia and other forms of hemoglobinopathy. c. History of pain or weakness in the bones or muscles of the extremities. d. History of Ulcerative colitis.

d. History of Ulcerative colitis.

The use of peracetic acid on surgical items requires the following consideration: a. Items can be stored for future use. b. Items must be aerated. c. Items must be isolated for 7 days. d. Items must be immersible.

d. Items must be immersible.

The use of which monitor is most important during the inhalation induction of a child? a. BP cuff b. Capnography c. EKG leads d. Pulse oximeter

d. Pulse oximeter

Which of the following practices is recommended to reduce the patient's risk for intraoperative skin injury? a. Drag the patient's body across sheets when moving patient. b. Leave blotting towels in place after the skin prep is completed. c. Place the hose of the patient warmer under the patients blanket, avoiding contact with the skin. d. Remove skin antiseptic before dressings are applied.

d. Remove skin antiseptic before dressings are applied.

What type of drainage is placed in the common bile duct after a CBDE is performed?

d. T-tube

While passing scissors, which of their parts should be visible to the surgeon? a. Ratchet b. Joint c. Shanks d. Tip

d. Tip

Which term BEST describes a civil wrong that unfairly causes suffering for someone else and results in lefal liability? a. Negligence b. Respondeat superior c. Borrows servant d. Tort

d. Tort

A cross section of the mid-shaft of the femur would appear _____.

d. Triangular

Idenitfy which category of ophthalmic agent is used to maintain tissue separation in ophthalmic procedures? a. Topical anesthetic agents (eg. tetracaine hydrochloride) b. Miotic agents (pilocarpine) c. Glucocorticoid agents (betamethasone sodium phosphate) d. Viscoelastic agents (sodium hyaluronate)

d. Viscoelastic agents (sodium hyaluronate)

Volts are the measurement of the force that pushes electrons through the circuit. What is this force called? a. Resistance b. Impedence c. Grounding d. Voltage

d. Voltage

Clinical nurse progression from Novice to Expert necessarily requires enhancement of critical thinking skills. The development and refinement of critical thinking skills is affected by: a. clinical narratives, simulation, and questioning b. partnering with proficient nurses c. the nurse's level of knowledge and experience d. all of the above

d. all of the above

Fire blankets should NOT be used un the operating room because they: a. are made of wool, which can catch fire in an oxygen-enriched environment. b. can cause wound contamination or move instruments at the surgical site, c. can trap fire next to or under a patient. d. all of the above e. b and c

d. all of the above

When gathering information about medications that the patient is taking, it is important to include: a. physician prescribed medications b. OTC medications and vitamins c. herbal medications that the patient may be taking. d. all of the above

d. all of the above

Which of the following statements is true? a. blood pressure remains constant with age. b. body temperature increases with age. c. heart rate increases with age d. lung capacity decreases with increasing age.

d. lung capacity decreases with increasing age.

Which of the following is incorrect pertaining to the pattern of referred pain typically associated with angina pectoris?

d. may be felt in left fingers

The part of the femur that is most susceptible to fracture in conjunction with osteoporosis is:

d. neck

The process of digestion of pathogens by neutrophils and macrophages is known as ______________. a. epitheliazation b. hemostasis c. edema formation d. phagocytosis e. proliferation

d. phagocytosis

The importance of patient and family education is reflected by which of the following phrases? *Select all that apply* a. Improvement in the nurse-patient relationship b. Improvement in quality of care. c. Increase in patient satisfaction d. Increase in patient compliance. e. Ethical and legal mandates for patient education. f. All of the above

f. All of the above

Surgical site infections (SSIs) account for 14% to 16% of all hospital-acquired infections. The surgical team is responsible for understanding the factors that contribute to SSIs and preventive measures. Which of the following is a true statement about preparation of the patient?

the patient should bathe or shower the night before surgery with chlorhexidine gluconate (CHG)

Non-union can be caused when bone graft isn't used to fill a bony deficit at the fracture site

true

What are some ways we think about the risk of patient infection and ways to prevent?

*Employ practices that maintain sterility and asepsis,* avoid contamination; promote good cleaning within the OR environment; reinforce proper surgical technique; wear proper surgical attire; limit OR traffic; and improve hand hygiene. *Collaborate with colleagues* (surgical and medical) to implement practices that reduce infection, strengthen the clinical culture to review and improve infection-prevention practices, and educate clinicians in an interprofessional manner.

What are some actual and potential risks to patients receiving medications and solutions intraoperatively?

*Failure of the RN circulator and scrub person* to identify and confirm the medications, dose, route, ect, when transferred to the sterile field. *The medication must be visually confirmed* by both the circulator to the scrub.

How is clinical reasoning specifically employed during the safe use of surgical energy?

*Identifying which energy(s) to use* and how to use; possible risks (burns) and side effects (electrical plume); actions to prevent or correct complications.

How is clinical reasoning employed during (skin) prepping?

*identifying risks (eg, preexisiting infection) & opportunities* (eg, possibility of an additional incision site) enables the RN to develop contingency plans should a more extensive area of prep or use of different prepping agents be needed.

A 76-year-old male patient has been approved as a candidate for hyperbaric oxygenation as a management therapy for his chronic sacral wound. He responded well to his surgical debridement and the nurse is planning to explain the next course of therapy. He will describe to him how hyperbaric oxygenation.

*increases the ability of the blood to carry oxygen to the tissues *restores cells and kills bacteria that thrive without oxygen

Match the type of healing with its appropriate features. 1. Primary union (first intention) 2. Granulation (second intention) 3. Delayed primary closure (third intention) a. Wound kept open to monitor infection, gauze packing, closed on day 3-5 b. Minimal tissue loss, wound margins approximated c. Significant tissue loss, wound remains open

1-B, 2-C, 3-A

Match the surgical specimens with the appropriate features. 1. Cytology 2. Forensic specimens 3. Gross examination a. Used as evidence in a court of law to help reconstruct events of an accident, civil or criminal complaint, or crime. b. Explants c. Specimens may be obtained through washings.

1-C, 2-A, 3-B

Which of the concepts below are appropriate for the care of forceps during a procedure? *Select all that apply* a. cleaning the tips of blood or tissue frequently. b. handing them of the sterile field to the circulating RN if the surgeon says that they are not working properly. c. organizing them on the back table by nesting them. d. standing them upright along the sides of the instrument tray so that handles are easily grasped when needed.

A & B

Patient-related factors that can contribute to hypothermia include: *Select all that apply.* a. Low birth weight infants b. Diabetes c. CHF d. Male gender

A & C

3. Point of Needle/Cross Section:

A) Non-Cutting B) Cutting

Identify the potential complications related to laparoscopic surgery. *Select all that apply* a. Pneumonia b. Hypoxemia c. Hypercarbia d. Cardiac dysrhythmia e. Hypocarbia f. CO2 embolism

B, C, D, & F

While hypothermia was historically credited as a therapeutic modality benefitting all surgery because it decreases metabolism and reduces oxygen demand, inadvertent hypothermia is now recognized as impacting many critical physiologic functions and patient outcomes. Which of the following impairments can contribute to surgical site infections?

Impaired wound healing

Select the positioning device and accessory commonly used for neurosurgical procedures.

Mayfield head positioner

Select the correct guidelines for preserving, transferring, and transporting specimens. *select all that apply* a. Save all the tissue removed from the patient, even if it appears to be of no value. b. Do not use large crushing instruments on specimens. c. Use a forceps to remove very small specimens from instrumentation. d. Place the specimen in a basin until it can be passed off the field. e. Always hand a specimen off on a counted or radiopaque surgical sponge. f. Store only one specimen per container.

A, B, D, & F

Shelf life is related to: *Select all that apply* a. Exposure to external events b.Methods of sterilization c. Type of packaging material used. d. Number of personnel who may have handled the package e. Time from initial sterilization.

A, C, & D

The purpose of performing a surgical hand scrub include: *Select all that apply* a. To accomplish personal hygiene b. To kill microorganisms c. To reduce the resident microbial count to a minimum d. To inhibit rapid rebound growth of microorganisms e. To remove soil, debris, and transient microorganisms

C, D, & E

Indirect Hernia

Peritoneal sac containing intestines protrudes through the internal inguinal ring and passes down the inguinal canal outside of Hesselbachs triangle indicates what?

A medication that is used for PONV and has the potential to prolong the QT interval

Droperidol

eyes fingers breasts perineum

During positioning the patient, it is important to remember that areas of pressure vulnerability include?

Vasoconstriction

During the inflammatory phase of wound healing, the vascular response is?

Which list of medications best reflects medications indicated for latex sensitivity therapeutic management?

Epinephrine, prednisone, and a beta-agonist inhaler

the correct term to describe the inward turning of one or both eyes

Esotropia

healing process

Excessive bleeding obscures visualization and interferes with the?

A hard bristle surgical hand brush should be used during a surgical scrub.

False

Retention sutures are a type of primary suture line.

False

True or False: "Cooked-on" dirt is considered to be sterile dirt and hence ignored during the decontamination process.

False

True or False: In an ambulatory care setting, unmedicated patients may walk to and from the OR alone and unaided.

False

True or False: Managing pain in toddlers requires specific questioning, highlighting the surgical incision location.

False

True or False: One way to prevent exposure to blood borne pathogen exposure from percutaneous injury includes hand to hand passing of sharp instruments, suture needles, and other sharp devices.

False

True or False: Terminal cleaning of the OR/procedure room is performed at the end of each surgical procedure in order to render the environment safe for the patient following in that room and to prevent cross-contamination.

False

True or False: The scrub person may use the closed-gloved method to change one or both gloves if they become contaminated.

False

True or False: Vehicles transporting patients are not considered to be contaminated and hence do not need to be cleaned during end-of-procedure cleaning.

False

True or false: When documenting a dressing, the name of the person applying the dressing should be noted.

False

True or False: Sterile technique is defined as "comprises methods that are designed to exclude all microbes."

False: The use of specific actions and activities to prevent contamination and maintain sterility of identified areas during operative or other invasive procedures.

When working with electrical equipment, the perioperative RN must: * Select all that apply* a. ensure that the active electrocautery is switched on before starting the procedures. b. ensure that warming therapy devices are used at appropriate settings. c. ensure that users are educated in the safe use of all electrical equipment. d. never place the hose of a patient warmer directly under the patient's blankets. e. ensure that laser electrodes are discharged after each use.

B, C, & D

Which factors determine the likelihood of transmission and persistence of muti-drug resistant organisms? *Select all that apply.* a. Decreased antimicrobial use b. Effectiveness of prevention methods c. Numbers of colonized patients d. Vulnerability of the patients

B, C, & D

Which of the following handle medications and solutions in the operating suite? *Select all that apply* a. The nursing assistant b. The perioperative nurse c. The anesthesia provider d. The scrub person

B, C, & D

Which of the following statements reflect the importance of certification? *Select all that apply* a. Certification is mandatory b. Certification relates to a sense of personal accomplishment c. Certification helps to validate specialized knowledge d. Certification relates to professional growth.

B, C, & D

Factors that may affect an adult patient's ability to learn include: *Select all that apply* a. age b. attitude c. emotional state d. intellectual ability e. physical ability f. socio-economic status

B, C, D, & E

Foot drop

What condition is caused by damage to the common peroneal nerve?

Aspirin

What inhibits platelet aggregation?

When facial nerve is tapped in front of tragus, the facial muscles on the same side the face will contract momentarily. (typically a twitch of the nose or lips. Sign of hypocalcemia

What is Chvostek sign?

Releasing a clamp briefly, cinching down the stitch and then securely reclamping

What is Flashing?

Throw two ties the same direction and then one in the opposite direction.

What is surgeons knot?

vasoconstriction platelet aggregation and formation phagocytosis

What takes place in the Inflammatory phase of wound healing?

prolonged bleeding time

What would be your immediate concern on preop assessment for a patient receiving salicylate therapy for over a year?

avoid leaning on the patient

When holding retractors to aid in exposure it is essential for the RNFA to?

Which of the following is a correct gas hose, color-code pair? Air: yellow

Which of the following anesthetic agents was used in the early history of anesthesia and remains in common use today? N2O

Recurrent laryngeal

Post thyroidectomy, Damage to what nerve would account for hoarseness?

The arcuate line is the point where the _____.

Posterior rectus sheath ends below the umbilicus

When beginning a stitch with a curved needle, the hand begins in a _____ position.

Prone

Prevent cardiac Tamponade

Purpose of chest tube in the pericardium?

Cinch the stitch down securely on the pedicle and enable you to place a second stitch or free tie on the pedicle.

Purpose of flashing is?

Which of the following choices reflects the appropriate order of four of the steps in preparing for the surgical hand scrub procedure?

Remove jewelry, contain hair, don fresh mask and eye protection, wash hands and forearms.

the appropriate order of four of the steps in preparing for the surgical hand scrub procedure

Remove jewelry, contain hair, don fresh mask and eye protection, wash hands and forearms.

True or False: Reduced tissue perfusion can contribute to intraoperative skin injuries.

True

True or False: Removing equipment that hasn't passed a recent safety inspection is a strategy for electrical safety.

True

A number of screening tools have been developed to accurately establish biologic age. One tool, the Comprehensive Geriatric Assessment (CGA), is a multidimensional evaluation that scrutinizes medications, functional ability, co-morbid conditions, cognitive ability, mental function, nutritional status, and socioenvironmental factors. In geriatric medical studies, the CGA has been valuable in providing a metric for describing healthy aging and _____.

identifying at-risk individuals.

What condition is created from the cumulative effect of the multiple drugs that the elderly patient will receive during the perioperative phase?

increased chance for adverse reactions and consequential results

A patient recently operated on for a ruptured appendix had a temperature of 103 degrees F and returned to the OR for a debridement and washout of purulent drainage from his wound on postoperative day 3. what was the wound classification at the time of his debridement and washout surgery?

infected wound, classification 4

Surgical team members have control of many of the factors that have been shown to contribute to SSIs. Which statement below reflects a best practice for surgical scrub/surgical hand asepsis?

keep nails short and do not wear artificial nails or nail wraps

Identify the primary substance that composes a layer of the epidermis, is responsible for hardening nails and hair, and protects the body from fluid loss and invasion by pathogens?

keratin

Latex allergy reaction is best prevented by

limiting exposure to latex

An example of an indication for liver transplantation would be

primary hepatic cancer

The right to perform certain activities within an institution is a _____.

privilege

The external ear canal lining

reduces bacterial levels in the outer ear

If a sterile glove becomes contaminated during the procedure, the best practice for corrective action is:

reglove with open-glove or assistive glove technique.

Choice of needle _____.

relates to the type and location of tissue

A perioperative nurse returns back to work in a busy OR tomorrow after a 3-week vacation. She is certain she will be assigned to scrub in cardiac surgery in the morning. Select the infection prevention measures she must accomplish before she returns to the OR.

remove her artificial nail tips and cut her nails to 1/4 inch past her finger tips

Edward Lewis is scheduled for a transthoracis esophagectomy with lymph node dissection for cancer of the esophagus. Which incisional approach is indicated for this procedure?

right posterior lateral thoracotomy and midline abdomiial incision

An advantage of monofilament suture is _____.

smooth passage through tissue

another name for the left colic flexure is

splenic flexure

Access to the substernal compartment is typically facilitated by:

using long instruments through a regular thyroid incision.

Brandon O'Neill, a 13-year-old, has just been admitted through the emergency department. He has been vomiting for several days and has a temperature of 103° F (39.4° C) and rebound tenderness of the abdomen. The surgeon schedules him for an appendectomy, and perforation is suspected. What kind of incision would you anticipate? McBurney

Which of the following is a difference between the laparotomy and laparoscopic approaches to GI surgery? Intra-abdominal pressure should be at 10 to 12 mm Hg.

Qualities of suture that effect selection are: a. Absorption rate b. Tensile strength c. Ease of handling d. Tissue reactivity

a, b, c, d

Identify the category in which tracheostomy is classified. a. Class 1- clean wound b. Class 2- Clean contaminated wound c. Class 3- Contaminated wounds d. Class 4- Dirty or infected wounds

b. Class 2- Clean contaminated wound

When addressing the patient during the preoperative interview, the nurse should: a. use the patient's first name b. use the patient's title and last name c. ask permission before using the patient's first name d. wait for the patient to say how he/she wishes to be addressed.

c. ask permission before using the patient's first name

What device should be used while carrying out an extremity prep? a. cuff b. tape c. assistive prop d. clip

c. assistive prop

The top four health and safety concerns for nurses include the chronic effects of stress, fear of a back injury, the possibility of contracting a deadly disease, and a. chemical hazards b. laser burns or injuries c. being physically assaulted d. fires in the operating room.

c. being physically assaulted

Complete sterilization in ethylene oxide is dependent on four primary variables: proper time, gas concentration temperature, and: a. proper packaging. b. aeration. c. chamber humidity. d. pressure.

c. chamber humidity.

Resident organisms: *Select all that apply* a. live on the skin's surface b. are easy to remove c. live in hair follicles and sweat glands d. are acquired by direct contact

c. live in hair follicles and sweat glands

Which of the following involves applying physical pressure to the wound to stop the blood flow. *select all that apply* a. chemical method b. thermal method c. mechanical method d. Both a and c.

c. mechanical method

Based on AORN RPs, procedure-related requirements for surgical gowns, gloves, and drapes are differentiated by: a. a pleasing color b. the way the material smells c. their resistance to blood and other body fluids d. the cost of the product in the facility.

c. their resistance to blood and other body fluids

A surgical mask should be worn at all the following times *except*: a. during the lumbar puncture b. during insertion of a central venous catheter (CVC) c. when placing a peripheral venous catheter. d. in the presence of opened packs of sterile supplies.

c. when placing a peripheral venous catheter.

A basic anesthesia monitoring device that is used during general anesthesia to confirm successful endotracheal tube placement and determine the presence of gas exchange is the:

capnometer/end-tidal CO2 monitor to identify expired CO2 in the breathing circuit.

Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral, and __________ nerve, which can result in injury from __________.

common peroneal; full leg sequential compression wraps

A 62-year-old man had surgery 6 days ago for a ruptured diverticula. He is back in the OR for a debridement and washout. The patient's fever has subsided, and the drainage is clear. The surgeon will schedule the patient to return to the OR in 3 days for?

delayed primary sutured closure

Jacob is a 62-year-old man who had surgery 6 days ago for a ruptured diverticulum. He is back in the OR for a debridement and washout. Jacob's fever has subsided and the drainage is clear. The surgeon will continue with wet to dry dressings and schedules Jacob to return to the OR in 3 days for:

delayed primary sutured closure.

If evacuated because of a fire, health care personnel should go: a. to the front doors of the building b. outside the building c. behind at least two sets of fire doors. d. to the nearest stairwell e. to the nearest safe location where they can resume caring for patients

e. to the nearest safe location where they can resume caring for patients

The ideal suture material is one that has handling characteristics such as:

ease of tying

Morbidity and mortality may be greater with penetrating trauma because identification of injuries may be more difficult when injuries are less obvious. In the case of an adult victim with a low-velocity, low-caliber gunshot wound, at far range, of the anterior left quadrant of the lower abdomen, what is the MOI and description of the possible injuries

enetrating; small entrance wound, puncture of the anterior wall of the sigmoid colon, no disruption of vessels, and bullet not found in pelvis

The design of laparoscopic instruments aims to provide a clamping, cutting, dissecting, electrocoagulating, suturing, or stapling instrument on the tip of a shaft that is long or short enough to reach the target tissue. The hand control on the surgeon's end of the instrument is engineered to provide

ergonomic comfort and control

Identify the information to be assessed by the perianesthesia nurse. *Select all that apply* a. Caregiver's ability to understand instructions. b. Patient's level of alertness c. Pain assessment d. Previous anesthetic history e. Comfort assessment f. All of the above

f. All of the above

Which scenario falls under the definition of a sentinel event, but would not be subject to review by the Joint Commission? a. A surgical sponge is retained inside a patient during abdominal surgery. b. A surgeon fuses the wrong spinal vertebrae. c. A drape catches fire during an operative procedure, but no one is harmed. d. A device is found to be defective during surgery, but the patient is not harmed.

d. A device is found to be defective during surgery, but the patient is not harmed.

When two scrubbed team members need to change position during an operative or other invasive procedure, they should do so by passing each other a. back to back b. front to front (face to face) c. back to front d. A or B

d. A or B

Which organization has regulations and/or guidelines applicable to the perioperative area? a. Joint Commission for the Accreditation of Healthcare Organizations b. The Occupational Safety and Health Administration c. The CDC d. All of the above

d. All of the above

Neuropathologic conditions requiring surgical intervention can be found in any age group. What are the most common problems requiring neurosurgical procedures in infants and children?

d. All of the options are correct.

What special consideration should be made when assessing a geriatric trauma patient before surgery?

d. All of the options can negatively impact the geriatric patient's perioperative experience

During IV regional anesthesia (Bier Block), the tourniquet should be deflated slowly to prevent which of the following from entering the circulation? a. Bacteria b. Lymphatic fluids c. Thrombus d. Bolus of anesthetic

d. Bolus of anesthetic

Sutures fall in the following categories: a. Monofilament and multifilament b. Absorbable and nonabsorbable c. Short and long d. Both A & B

d. Both A & B

The circulating nurse's role is to: a. conduct the instrument, sponge, and sharp counts with the scrub nurse. b. remain at the patient's side to reassure the patient. c. gather positioning equipment. d. begin entering data on the periop record.

d. begin entering data on the periop record

The three overriding principles of operating room fire safety are: a. awareness, communication, teamwork. b. oxidizing source, heat source, fuel source c. inspect, check, respond d. prevent, extinguish, evacuate e. source, extinguish, safety

d. prevent, extinguish, evacuate

If an airway fire occurs, perioperative team members should be prepared to help the anesthesia professional do which of the following: a. disconnect and remove the anesthesia circuit and turn off the flow of oxygen. b. remove the ET from the airway, including any burned fragments. c. pour saline or water into the airway. d. examine and re-establish the airway. e. assess the surgical field for secondary fire. f. all of the above

f. all of the above

Plastic incise drapes: a. may increase moisture and bacterial growth under the drape. b. are recommended for use only for certain procedures c. are NOT recommended for use d. All of the above e. A and C only

e. A and C only

When unexpected events occur that have, or could have, compromised patient safety, a systematic investigatory process takes place. Significant information is gained through this meticulous exploration. The primary motive for carrying out a root cause analysis is to:

find out what needs to take place to prevent a recurrence of the event.

David Reese, a 14-year-old patient with marked scoliosis, is in prone position with gel rolls, gel pads, and pillows for a spinal fusion. Before the skin prep is begun, the surgical assistant should check the positioning for pressure areas of the:

genitals, eyes, and all areas that are in contact with the OR bed or accessories.

The safest practice for passing sharps and instruments during the procedure is to

give verbal notification when passing a sharp

Denise Michaelson, a 46-year-old woman with an early-stage second primary cancer in her left breast, has elected to have a bilateral mastectomy with saline implants. She has requested that the surgeon also revise a small unsightly scar on her right knee and pierce her ears. While Denise's breast tumor could be treated with an excisional biopsy, she has decided to have a mastectomy of both breasts, which is considered an appropriate preemptive (preventative) surgery for a woman of her age with two primary cancers of the breast. The saline implant insertion surgery is considered a _______________ procedure, the scar revision is considered a ___________ procedure, and the ear piercing is considered a _______________ procedure.

d. reconstructive, cosmetic and cosmetic

An experienced perioperative nurse was precepting a new perioperative nurse in the circulating role. She watched and coached as the new purse prepared to perform the skin prep on a patient for closure of a colostomy. The new nurse had never had the opportunity to prep a patient with an exisiting colostomy and was concerned about the potential of her actions contributing to an SSI. After the successful prep and the onset of the procedure, the experienced nurse and the new nurse had an opportunity to discuss SSIs in this patient population and preventive measures. What combinations of topics should they have discussed?

sterile technique during skin prep procedure and protection from cross-contamination

Who is responsible for checking diagnostic tests, such as X-rays and CT scans, to confirm the proper area or side before an incision is made?

surgeon

A veteran perioperative nurse remembers a time when all suture needles had eyes, and she even had her own needle rack. She hand-threaded all sutures according to the surgeon's preference. The newer sutures were originally called "atraumatic" sutures because they did not double back through a needle eye and cause tissue trauma during pulling or suturing through the tissue. Today, we call this manufacturing process of connecting the suture thread to the needle:

swaged

Ketamine is a short-acting induction and IV or IM maintenance agent. Patients are able to maintain their airways. It is a suitable agent to use with small children and burn patients. The concern with this agent is that in large doses it may cause:

hallucinations and respiratory depression.

Sponge, instrument, and sharp counts are a crucial perioperative intervention used to prevent retention of foreign bodies in the wound. To conduct a count properly the scrub person generally performs the count with _____.

the circulator.

A 48-year-old tetraplegic with a chronic sacral wound is scheduled for another would debridement. What is the purpose of doing a wound debridement on a chronic wound?

the debridement will remove dead tissue that could support infection

Before the patient leaves the OR for transport to the postanesthesia care unit (PACU) or intensive care unit (ICU), the circulating nurse empties the closed drain reservoir. What important information must the circulating nurse document and communicate about the drain to the PACU or ICU nurse during hand-off report?

the location and type of drain, description and amount of drainage

Minimizing risk factors and administering antiemetics are important preventive actions against postoperative nausea and vomiting. Antiemetics are designed to interact with the four main neurotransmitters that affect postoperative nausea and vomiting. These four neurotransmitters are:

histamine, acetylcholine, serotonin, and dopamine.

1-5 days

how long is the inflammatory phase of wound healing ?

Emma, a frail 92-year-old, was positioned in lithotomy for a 90-minute rectal procedure under spinal anesthesia block (SAB). At the end of the procedure, when the surgical assistant and surgeon gently removed her legs from position and placed her in supine position, she experienced a common side effect of spinal anesthesia, ____________.

hypotensive episode

Cosmetic elective plastic surgery, on healthy patients, is based on the expectations that healthy healing and ideal cosmesis will be achieved. On which phase or phases of healing is considerable emphasis placed during the procedure?

inflammatory phase

he final step, after decontamination and before sterilization, is the prep, pack, and wrap process. The sterile processing technologist has taken the laparotomy set from the washer/decontaminator to prepare for sterilization. Select the most appropriate order that the instrument set must travel before reaching the steam sterilizer

inspect, inventory against list, assemble, place integrators, wrap and tape

The challenge of suturing intra-abdominally is not as great as the process needed to tie and tighten the surgical knot. The knot-tying process can be achieved within or outside of the abdominal compartment. One technique uses laparoscopic grasping forceps and a laparoscopic needle holder only, and another uses the same instruments plus two obturator sleeves to push, slide, and tighten the knot into place. When sutures are tied and knotted during an open procedure, the surgeon may tie the knot with gloved fingers, called a one- or two-handed tie, or wrap the suture around the tip of a needle holder and grasp the other end of the suture to pull it through the wrapped coils; this is called an instrument tie. The intracorporeal suture technique uses the suture-tying process analogous to the:

instrument tie

A stitch that is tied and cut before placing another stitch is called _____.

interrupted

Whenever regional anesthesia is used, resuscitative equipment and drugs must be immediately available and the patient monitored for any substantial change in vital signs or untoward reactions. An example of an untoward reaction or risk with regional anesthesia is:

intravascular injection of the anesthetic agent.

The lateral kidney position allows approach to the retro-peritoneal area of the flank. To render the kidney region readily accessible, the _________________ is raised, and the bed flexed so that the area between the twelfth rib and the iliac crest is elevated. Compression of the ________________ can occur when the flank is raised too high.

kidney bridge; vena cava

The lateral kidney position allows approach to the retroperitoneal area of the flank. To render the kidney region readily accessible, the _______________ is raised, and the bed flexed so that the area between the twelfth rib and the iliac crest is elevated. Compression of the ____________ can occur when the flank is raised too high.

kidney bridge; vena cava

The lateral kidney position allows approach to the retroperitoneal area of the flank. To render the kidney region readily accessible, the _______________ is raised, and the bed flexed so that the area between the twelfth rib and the iliac crest is elevated. Compression of the ____________ can occur when the flank is raised too high.

kidney bridge; vena cava

The mitral valve is anchored to the

left ventricular wall

If you noticed muscle stiffness, dark blood in the operative field, tachycardia and increased body temperature, what might you suspect?

malignant hypertension

Lisa,, a 29 yo woman, is in the ED with a ruptured appendix. Before the ED nurse and surgical resident transported Lisa to the OR the nurse called to inform them that Lisa is 27 wks preg. What special considerations must he surgical team and anesthesia provider address with this new info?

pt may need rapid induction of general anesthesia, a spinal anesthesia`

Hydrotherapy for wound care was traditionally accomplished in an immersion bath whirlpool system. Because immersion in a tank is not practical from an intraoperative perspective, the hydrotherapy method most frequently used in the OR is?

pulsatile lavage

Two monitoring devices that are commonly used to determine ventilatory status are required by some insurance providers as reflective of high-quality care and by anesthesia provider professional organizations as a recommended standard of care. These two devices are:

pulse oximetry and capnography

A patient undergoing a laparoscopic Nissen fundoplication procedure will be positioned in both high and low lithotomy during the procedure. After the patient is re-positioned into lo lithotomy, the perioperative nurse should:

reassess the patient for body alignment, tissue integrity, and pressure areas.

TURP syndrome is often seen during the intraoperative period. Signs and symptoms exhibited by patients include

restlessness, apprehension, irritability, confusion, nausea, slow pulse rate, seizures, dysrhythmias, and rising blood pressure may be suggestive of TURP syndrome,

Pt with hepatobiliary disease, The perioperative nurse, during the preoperative assessment, questions and examines the patient for signs and symptoms of jaundice, petechiae, and lethargy and:

review chart for bleeding and coagulation times and the platelet count.

A patient was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled vaginal-assisted laparoscopic hysterectomy. She demonstrated and verbalized that she understood all of the tenets of the procedure, risks, expected outcome, complications, and procedural process. Before she signed the consent form, she informed the surgeon that she did not want any medical students or surgical residents performing any parts of the procedure other than assisting and did not want any photographs of her body taken. The surgeon agreed, and she crossed out those portions of the form and initialed them before she signed. The patient was exercising her:

right to informed consent.

There are many factors that influence surgical wound healing. Some are helpful, and some are beyond the scope of the surgical team. Select the response below that reflects a factor with high influence over wound healing and is within the control of the surgical team.

selection of wound closure materials, dressings and drains

cool, clammy skin confusion decreased or no urine output general weakness pallor rapid breathing sweating, moist skin

signs of hypovolemic shock

The instillation of a local anesthetic into the subarachnoid space is termed:

spinal anesthesia.

The perioperative nurse preparing for a procedure where STSGs will be taken to cover several large burn areas will need to have available:

sterile mineral oil, tongue blades, and a mesher dermatome

Miriam Glass is a 78-year-old female scheduled for compression nail insertion of a left fractured hip. She was positioned for a spinal injection to induce spinal anesthesia. During the process, the anesthesia provider inadvertently inserted the spinal needle into the subarachnoid space, not noticing the error until the entire syringe of lidocaine was emptied into the patient. Miriam immediately experienced rapid onset of hypotension, bradycardia, and apnea. Miriam's unintentional condition is called ______________ and now must be managed with _____________.

total spinal anesthesia; general endotracheal anesthesia

A 24-year-old female sought the consult of a plastic surgeon to repair a large 2-year-old surgical scar on her right leg that was healed but remained darkly pigmented, uneven, and raised. The plastic surgeon reviewed the operative report from the patient's prior surgery, which revealed an uneventful procedure, wound classification 1, closure with uninterrupted 4-0 nylon, and no drain. The underlying cause of the uneven healing was probably due to?

unknown interruption in the normal healing process during proliferative and remodeling phases

Samantha sought the consult of a plastic surgeon to repair a large 2-year-old surgical scar on her right leg that was healed but remained darkly pigmented, uneven, and raised. The plastic surgeon reviewed the operative report from Samantha's prior surgery, which revealed an uneventful procedure, wound classification I, closure with uninterrupted 4-0 nylon, and no drain. The underlying cause of the uneven healing was probably due to:

unknown interruption in the normal healing process during proliferative and remodeling phases.

While Fowler's position offers the best respiratory excursion for the patient, the patient is at higher risk for _______ because of dependent pooling in the hips and legs.

venous thromboembolism (VTE)

The OR is a danger-prone area for both patients and staff. Providing a safe environment of care for the patient involves identifying, mitigating, and managing the hazards inherent in surgical care. Choose the answer below that completes the blanks in this sentence: The risk of the surgical hazard of _________________ can be mitigated through _______________________.

wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists

Miriam Glass is a 78-year-old female scheduled for compression nail insertion of a left fractured hip. She was positioned for a spinal injection to induce spinal anesthesia. During the process, the anesthesia provider inadvertently inserted the spinal needle into the subarachnoid space, not noticing the error until the entire syringe of lidocaine was emptied into the patient. Miriam immediately experienced rapid onset of hypotension, bradycardia, and apnea. Miriam's unintentional condition is called _______ and now must be managed with ________.

total spinal anesthesia; general endotracheal anesthesia

Direct complications of a knot coming untied are: a. Evisceration b. Dehiscence c. Loss of assisting opportunities d. Infection

A and B

Identify the class of medications that can increase the risk or severity of a reaction to contrast media

Beta Blockers

Cosmetic elective plastic surgery on healthy patients is based on the expectations that healthy healing and ideal cosmesis will be achieved. Which phase or phases of healing is considerable emphasis placed during the procedure?

Inflammatory phase

Which statement best explains the mechanism of action of general anesthetic agents?

Inhibition of synaptic transmission of nerve impulses

t is important for the RNFA to be aware of this ESU safety hazard when assisting with endoscopic surgery. Choose the correct answer from the following.

Insulation failure

Weighing sponges is a valuable tool for meticulous calculation of blood and fluid loss when conducted correctly and used in appropriate circumstances. Select the response that correctly reflects the best practice in weighing sponges.

Keep a running total blood loss calculated from available sponges during procedure

12-17

Normal HGB

During a hypermetabolic MH crisis, the patient will eventually assume a state of metabolic acidosis. What is the desired drug used to reverse this trend?

Sodium bicarbonate

An older surgeon explains his justification for this suture choice to the new perioperative nurse in the scrub role. He prefers to suture his intestinal anastomosis with a suture that has multiple filaments braided together because it ties well and holds the knot, which tightens when the thread absorbs the tissue fluids. He also needs a strand that is easy to see and only needs to retain its tensile strength for about 1 year, at which time the intestinal junction will be healed, even though this suture is considered nonabsorbable. He will ask the nurse for a 24-inch 4-0:

Sofsilk

Supraspinatus Infraspinatus teres minor Subscapularis

The Muscles that compose the Rotator cuff?

Ethical

Used to refer to reasons for decision about how one ought to act.

Careful counting (according to established policy), situational awareness, and conscientious and meticulous attention to the field are believed to prevent miscounts and lost items. A recent patient safety statement about preventing retained foreign objects recommends which of these practices?

Verbal handoff must include count status at time of relief.

Cardiovascular instability can occur in the postanesthesia care unit due to the depressive nature of many of the anesthetic agents used in the OR. Which is the most common cardiovascular complication that the nurse is likely to encounter when caring for patients in the immediate postoperative period? Tachycardia

Which of the following patients has the greatest risk for postoperative hypothermia? Alexandra Frazier, a 26-year-old patient who has just undergone a tumescent liposuction procedure to her abdomen and thighs, breast reduction, and rhinoplasty under general endotracheal anesthesia

How does a direct inguinal hernia differ from an indirect inguinal hernia? Direct hernias occur within the Hesselbach triangle.

Which of the patients listed below is at risk for developing an acquired umbilical hernia? Korine Oglesby, a 30-year-old female who is 50 pounds overweight

In the following illustration, the arrows points to a line that represents the:

b. separation between the superior mediastinum and the inferior mediastinum

Who is responsible for marking the surgical site? a. the anesthesiologist b. the patient c. the preoperative nurse d. the surgeon

d. the surgeon

Indicate the risk level of a patient with a Braden scale score is 11.

high

Malignant hyperthermia (MH) is a rare, multifaceted syndrome with an increased incidence in individuals with central core diseases such as:

muscular dystrophy and congenital myopathies

D) Polyglactin 910 (multifilament)

• Synthetic material • Coated and non-coated (coated means decreased capillary action) • Brand Example - Vicryl (dyed form is purple) • Advantages o Easy to handle o Minimal tissue reaction o Good knot security o Stable in contaminated wound • Uses o Intestinal tissue, uterus, tying of vessels o Muscle, thin fascia, fat

D) Polyester (multifilament)

• Synthetic material • Manufacturer = Ethicon • Advantages: One of the strongest non-metallic sutures • Disadvantages o Most tissue reaction of synthetic suture materials o Poor knot security • Uses o Cruciate ligament surgery o Some large animal surgeries

C) Polyglycolic Acid (multifilament)

• Synthetic material • May dissolve more quickly in presence of urine • Brand Example - Dexon • Advantages o Less tissue reaction compared to gut o Tolerated in clean and infected wounds • Disadvantages o Can drag the tissue o Can cut friable tissue o Initially poorer knot security than gut (requires more throws in each knot)

Wire Suture Sizes

• Unit of measure for size of wire sutures is gauge (like with needle sizes) • The higher the gauge, the thinner the wire

E) Polydioxanone (Monofilament)

• aka PDS • Synthetic material • Purple in colour • Advantages o Minimal tissue reaction o Good tensile strength • Uses o Slow healing tissue o Contaminated wounds

Early on, during the preliminary sponge count on closure of a repair of a ruptured abdominal aortic aneurysm, the circulating nurse was unable to account for 2 lap sponges. He had meticulously maintained accountability for all sponges and instruments discarded from the sterile field and bagged each sponge carefully. He immediately turned and addressed the entire team in a clear voice. Select the appropriate communication that the circulating nurse must employ during this count discrepancy.

"We have a count discrepancy. We started with 70 sponges and find only 68. We are missing 2 lap sponges. Everyone, please check your areas.

rectus abdominis muscle

Abdominal wall structure that is encased by the anterior and posterior rectus sheath?

The suture creating the greatest tissue reaction is _____.

Absorbable

Lasers, dependent on their wavelength, can produce absorption, reflection, transmission, and scatter. The effect of scatter does not have any therapeutic benefit at this time and can be destructive to both staff and instruments. Select a safety measure that would prevent inadvertent scatter of laser energy during a surgical procedure.

Advance the laser fiber at least 1 cm beyond the tip of the endoscope within operator's view.

The perioperative nurse is best situated to foster collegiality and collaboration among the variety of disciplines functioning in the perioperative setting because: nurses are more accountable to their patients and use best practices

Advanced practice nurses include which of the following? Nurse practitioners and clinical nurse specialists

distal

After application of a cast, pulses _________ to the immobilization device should be monitored

Seek medical attention if: bleeding from the incision wound dehiscence fever pain, edema, erythema, warmth , purulent drainage, foul odor from incision, abdominal distention, nausea, vomiting, and separation of wound edges

After care instructions for hernia surgery

Select the positioning devices and accessories commonly used for bariatric surgery. Select one: a. Air-filled, roller, or slider transfer device b. Upper body ramp c. Elevated padded armboards d. All of the options are correct

All of the options are correct

You examine a comatose pt in the ER. His wife relates that her husband was struck accidentally in his "temple" by a baseball. After an initial period of unconsciousness He seemed to be okay but later became drowsy and comatose. You suspect that the pt is suffering from:

An extradural (epidural) hematoma caused by a laceration of a branch of the middle meningeal artery

Tran Do is scheduled for an open splenectomy. What action can the surgical team take to prevent infection and enhance wound healing for Tran Do? Minimize pressure from retractors and other instruments.

Annette Bachle is a 30-year-old patient who developed a nonhealing wound after a cesarean section. She has had large amounts of exudate, so alginate rope has been used as wound packing. Annette now presents to the OR for a wound debridement under anesthesia. What does the nurse need to consider in preparing for Annette's case? Alginate dries easily, so the nurse should have normal saline available to irrigate the wound prior to removing the alginate rope.

While antibiotics have been credited with saving lives, misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs). Select the antibiotic application that has evident to support it as a best practice and not, potentially, a misuse of antibiotics.

Antibiotics given intravenously within 1 hour of the incision for every procedure with an incision or entered body system.

When opening the instruments for a vaginal hysterectomy, the scrub person notices that the instrument case contains water. What should the scrub person do? Return the instrument set for reprocessing and obtain a new set.

As a general rule, a patient's hair is best left at the surgical site. If hair removal is necessary, which statement reflects current best practice? If hair removal is necessary, clippers should be used and the hair removal performed as close as possible to the time of surgery.

Pamela is a 62 yo woman with a 4 year history of Graves' disease that has not responded to medical therapy. She is scheduled for a subtotal thyroidectomy. What condition, a complication of Graves' disease is her probable indication for subtotal thyroidectomy?

Autoimmune hypothyroidism

Proper care and handling of surgical specimens is imperative for correct diagnosis, treatment, and prognosis planning of the patient. Select the response that best reflects correct specimen care and handling

Avoid placing specimens for frozen section in formalin.

the circulating nurse received the trauma call from the emergency department (ED) and called sterile supply to assemble the instruments for an abdominal trauma case with possible aortic rupture. When the cart arrived, she saw the vascular set; however , the most important set was missing. What important instrument set was needed for this procedure besides the vascular set?

Basic laparotomy set

Sponge counts should be performed at the time of permanent relief of either the scrub person or circulating nurse, and

Before the procedure, before closure of each body cavity, before wound closure, at skin closure or end of procedure

The pediatric patient is at risk for imbalanced fluid volume related to invasive surgery and accompanying blood loss. Select the outcome indicator that would best reflect that the goal of maintained fluid balance was attained.

Blood pressure within acceptable range

What type of needle is most often used on friable tissue?

Blunt point

An 86-year-old male was admitted to the intensive care unit (ICU) 3 weeks ago for heart failure and intractable atrial fibrillation. He has had diarrhea for 4 days that has cultured C. difficile. The transmission-based precautions sign on the door to his room alerts the staff to employ which practice precaution?

Both standard precautions and contact precautions

A patient presents to the ER as a victim of violence and is transferred directly to the OR. Assessment reveals a laceration to the neck that involves the lower trachea. Which other structure can be involved in with this type of injury?

Brachiocephalic artery

Luci Edwards has undergone a bilateral bunionectomy under regional anesthesia. The nurse is demonstrating crutch walking to Luci. In what phase of postoperative care does this activity occur? Phase II

Brady Martin was admitted to the postanesthesia care unit (PACU) 20 minutes ago after a hemicolectomy. He began snoring loudly and his oxygen saturation began to fall. The nurse gently shook his shoulder and reminded him to take deep breaths. Brady did not respond to her and continued to snore. What action should the nurse take next? Use a jaw thrust to open the airway.

Which of the following are the most desirable initial actions after assessing laryngospasm in an awake patient? Removing the irritating stimulus, providing reassurance, and positive-pressure ventilation

Bronchospasm is a serious postanesthesia complication that may be caused by: aspiration, pharyngeal suctioning, or histamine release.

In addition to the surgon, which surgical team members wear sterile gowns and gloves during the procedure? *select all that apply* a. Anesthesia Care Provider b. Circulation nurse c. Scrub person d. Surgical assistant

C & D

The AORN Surgical Wound Classification Decision Tree is helpful in determining: *Select all that apply* a. if closed drainage is necessary b. if a major break in technique will affect the wound class. c. What constitutes an old injury d. Which wound class a surgery should be assigned.

C & D

What are the complications associated with laparoscopic surgery? *Select all that apply* a. Umbilical hernia b. Post surgical pneumonia c. Wound infections d. CO2 embolism

C & D

High-pressure insufflation rates can cause increased intra-abdominal pressure that can result in life-threatening sequelae

CO2 gas embolism

Patients with chronic venous insufficiency (CVI) are not typically treated surgically as often as patients with arterial disease because:

CVI is not life-threatening or limb-threatening

Round ligaments

Can stretch during pregnancy and cause pain

Which of the following could be classified as an intrinsic factor influencing pressure ulcer development? Preexisting comorbidity

Carmine Grimaldi, a 70-year-old patient with spinal stenosis, has just undergone a 9-hour procedure in the prone position on the Wilson laminectomy frame. Mr. Grimaldi is 5 feet, 10 inches and weighs 140 pounds. The perioperative nurse notes an intact, red, nonblanching area the size of a quarter on his chest when the team moves him to the transport vehicle at the conclusion of the procedure. What stage of pressure injury is Carmine likely to have sustained? Stage I

Chapter 04 - Infection Prevention and Control

Chapter 04 - Infection Prevention and Control

Chapter 06 - Positioning the Patient for Surgery

Chapter 06 - Positioning the Patient for Surgery

Chapter 07 - Sutures, Needles, and Instruments

Chapter 07 - Sutures, Needles, and Instruments

Chapter 10 - Postoperative Patient Care and Pain Management

Chapter 10 - Postoperative Patient Care and Pain Management

Chapter 11 - Gastrointestinal Surgery

Chapter 11 - Gastrointestinal Surgery

Chapter 12 - Surgery of the Liver, Biliary Tract, Pancreas, and Spleen

Chapter 12 - Surgery of the Liver, Biliary Tract, Pancreas, and Spleen

Chapter 13 hernia repair

Chapter 13 hernia repair

Chapter 14 - Gynecologic and Obstetric Surgery

Chapter 14 - Gynecologic and Obstetric Surgery

Chapter 15 - Genitourinary Surgery

Chapter 15 - Genitourinary Surgery

What is the difference between a suture and a ligature? Suture refers to all materials used to sew severed body tissue together; a ligature is a strand of suture used to tie off blood vessels or isolate a mass of tissue.

Characteristics of the ideal suture are: minimal inflammation and maximum strength.

Jaundice Abdominal pain in right upper quadrant Fever

Charcot's Triad

Preexisting pulmonary disease increases the risk of perioperative pulmonary complications. Which condition presents the most significant risk factor?

Chronic obstructive pulmonary disease (COPD)

Ryan has an indirect hernia that is characterized by a small neck, thin walls, and close attachment to the cord structures. Marc has a hernia with a short wide neck, and a thick-walled sac. Based on this description. Ryan has a(an)_________ hernia and Marc has a(n)___________ hernia

Congenital; acquired

Broad ligament

Connects the sides of the uterus to the lateral walls and floor of the pelvis and helps maintain uterine position?

Jacob, a 62-year-old man, had surgery 6 days ago for a ruptured diverticulum. What was the wound classification at the time of his emergency surgery?

Contaminated wound, classification III

Josh, a 28 yo firefighter, sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire. What surgical treatments may josh need before he is discharged from the burn center to home?

Debridement, allograft placement during initial healing, and later split-thickness skin grafting

Matilda, a 55 yo woman with uterine cancer, is scheduled for an open panhysterectomy. She is positioned in low lithotomy with her legs symmetrically arranged in padded cradle stirrups. After the incision is made and primary dissection accomplished she will be positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area. Matilda is @ risk for compromise and injury reated to prolonged Trendelenburg tilt, which promotes _____________

Decreased pulmonary compliane and functional residual capacity

Chromium salt coating on suture _____.

Delays absorption of gut

The diagnostic test that is performed to differentiate between acute and chronic thrombosis

Digital subtraction angiography

Which of the following best describes general anesthesia? A reversible unconscious state characterized by amnesia, analgesia, and depression of reflexes

During intubation, cricoid pressure is sometimes given with the thumb and index finger of one hand. This procedure: should be continued until the endotracheal tube placement has been confirmed and the cuff has been inflated.

Which of the following describes the most likely patient having a hernia repair? A 58-year-old male with a right-sided inguinal hernia

Edward Yener comes to the emergency department (ED) with a swollen enlarged testicle. The ED physician suspects a hernia. With what type of hernia is Edward likely to be diagnosed? Indirect inguinal hernia

Sharon has been diagosed with severe GERD without the dysplastic changes of Barretts' esophagus. Her GERD is unresponsive to proton pump inhibitors and histamine blockers. She also has a history of endometriosis with multiple surgeries for ablation of endometrial implants on her small bowel and adhesiolysis. her surgeon is hesitant to pursue an open or laparoscopic Nissen

Endoluminal plication of the ower esophageal segment

the surgeon makes an incision through which of the following to access the cremaster muscle, inguinal canal, and cord structures

External oblique muscle

True of False: The NIOSH requires employers to provide a work environment free of hazards that are likely to cause serious physical harm to employees.

False

True or False: A 2010 Cochrane review established that parent-present induction was obligatory for patients with preoperative apprehension.

False

True or False: AORN Guidelines for Perioperative Practice can replace departmental and institutional policies.

False

Fimbria

Finger-like projections at the open end of the uterine tubes are referred to as the?

Unexplained ventricular dysrhythmias tachycardia PVC's followed by: increased endtidal CO2 tachypnea cyanosis skin mottling unstable B/P

First signs of Malignant Hyperthermia(MH)?

The perioperative nurse visited Mr. Jennings in the ICU the next day and noticed abrasions on his elbows. Mr. Jennings told her that the ICU nurses had difficulty pulling him back up in bed every time he slid down toward the bottom and he was not able to be much help in moving himself. This skin injury was probably the result of which physical force

Friction from his elbows rubbing over the sheets when slid up in bed

The perioperative nurse visited Mr. Jennings in the ICU the next day and noticed abrasions on his elbows. Mr. Jennings told her that the ICU nurses had difficulty pulling him back up in bed every time he slid down toward the bottom and he was not able to be much help in moving himself. This skin injury was probably the result of which physical force?

Friction from his elbows rubbing over the sheets when slid up in bed

With injury to the brain, swelling may occur quickly, requiring aggressive decisions to manage increasing intracranial pressure (ICP). What is an appropriate diuretic medication to give and what nursing actions would be indicated for an older adult patient with traumatic brain injury, increased ICP, and a history of congestive heart failure (CHF)

Furosemide (Lasix) 20-80 mg IV; monitor for hypotension and note extent of diuresis

The potential for intraoperative awareness (IOA) can exist for patients in all modes of anesthesia. Select the anesthesia modality that presents the least likely opportunity for IOA.

General endotracheal anesthesia

The brain and red blood cells relay almost exclusively on a steady supply of _____ to function.

Glucose

Qualities of an effective packaging material must include several key characteristics. Select the three most important qualities.

Good steam penetration and removal, good microbial barrier, aseptic presentation.

Which of the following lists the correct order of the proper steps in the removal of soiled sterile attire when breaking scrub?

Gown, gloves, mask

Which of the following is not contained within the anterior mediastinum

Great Vessels

Which anesthetic agent could not be given if an IV-only anesthesia plan was employed?

Halothane

Cardinal ligament

Helps support the uterine angle and located at the base of the broad ligament?

Protamine

Heparin antagonist, used to reverse heparin anticoagulation?

Thrombocytopenia

Heparin cannot be used if a patient suffers from?

Common Bile duct

Hepatic duct joins the cystic duct to form what?

Collagen suture is absorbed by _

Hydrolysis

A frail and thin 91-pound, 83-year-old woman is scheduled for a right pneumonectomy for non-small cell lung cancer. She will be positioned in left lateral position for her procedure. Based on the perioperative nurse's preoperative assessment, identify three position-related nursing diagnoses for this procedure and four relevant nursing interventions. Select from the options to fill in the blanks.

Hypothermia; impaired skin integrity; falls; remain at patient's side during induction; use under- and over-body forced air warming blanket; use at least four people to assist with lift and transfer; pad all bony prominences with foam or gel pads.

Increased Potassium

If a patient is taking diuretics, how can that affect the potassium?

Which of the following is an indication for damage control surgery

Indications for the potential need for damage control surgery include hemodynamic instability, hemorrhagic shock, coagulopathy, hypotension, tachycardia, tachypnea, inaccessible major anatomic injury, concomitant major injury, and altered mental status

Rebecca, a 2-year-old scheduled for bilateral myringotomy with tube placement, was calm and giggling as her mother stood by her side stroking her cheek. OR policy permitted parents to be present during the initial administration of anesthetic. The anesthesia provider explained her actions, and what Rebecca would experience, to the mother as she gently placed the mask over Rebecca's nose and mouth and turned on the flow of sevoflurane and oxygen. Rebecca calmly slid into unconsciousness. The anesthesia provider told the mother that Rebecca would soon begin to squirm and possibly thrash around a bit restlessly, but it is a normal effect and Rebecca would soon be in a quiet sleep. What phase of anesthesia is Rebecca in and what stage is she about to enter?

Induction and stage 2

Which position modification should the perioperative nurse anticipate during a thyroidectomy? Reverse Trendelenburg

Injury to the brachial plexus can be avoided by: properly tucking the arms at the patient's sides.

the final step, after decontamination and before sterilization, is the prep, pack, and wrap process. The sterile processing technologist has taken the laparotomy set from the washer/decontaminator to prepare for sterilization. Select the most appropriate order that the instrument set must travel before reaching the steam sterilizer.

Inspect, inventory against list, assemble, place integrators, wrap and tape

Interactive Study Questions - Chapter 08

Interactive Study Questions - Chapter 08

Interactive Study Questions - Chapter 09

Interactive Study Questions - Chapter 09

The linea alba is _____.

Interlaced aponeuroses of the anterolateral muscles of the abdomen

You examine a young boy in the ER who is bleeding from his penis after an accident. This blood is derived primarily from a branch of which of the following arteries?

Internal pudendal

Which of the following stitch is considered to be among the strongest and most secure.

Interrupted

a physical barrier used in the prevention of adhesions that can take up to 2 weeks to absorb

Interseed

Creutzfeldt-Jakob disease

Is a human Prion disease that is a fatal neurodegenerative disease of the CNS?

In the past, MH mortality ranged up to 80%, but the immediate infusion of dantrolene (Dantrium) and proper treatment have reduced the death rate to about 7%. What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis?

It is a skeletal muscle relaxant.

Which of the following is a true statement about surgical dressings? Primary dressings are placed directly over or in the wound.

Jacob Sutzkever is a 62-year-old patient who underwent an emergency colon resection for a ruptured diverticulum 1 week ago. Due to fecal spillage, the surgeon created a colostomy and planned to perform a delayed primary closure within 3 days of the procedure. On the third postoperative day, Mr. Sutzkever developed a fever of 103° F (39.4° C) and purulent drainage from the wound. He is scheduled for a wound debridement and washout. The surgeon anticipates bringing Mr. Sutzkever back to the OR every 3 days for debridement with wet-to-dry dressing changes in between. Review the list below and select the best dressing choice in light of Mr. Sutzkever's situation. Moist fine-mesh gauze, 4 × 4s, ABD pads, Montgomery straps

Identify the primary substance that composes a layer of the epidermis, is responsible for hardening nails and hair, and protects the body from fluid loss and invasion by pathogens

Keratin

The Joint Commission (TJC) is an example of an agency that has set forth regulations that affect perioperative nurses. Which statement best describes the work of TJC? Sets standards related to structure, process, and outcomes of healthcare

Key features of the Universal Protocol include: performing a preoperative verification process, marking the operative site, and conducting a time-out immediately before starting the procedure.

the statement that reflects a true special consideration for skin preparation before facial surgery.

Leave the eyebrows and eyelashes intact to preserve facial appearance and expression.

35% of the refractive power of the eye is credited to which part of the eye

Lens

All surgical patients present with the risk for hypothermia from a variety of factors inherent in the surgical experience. Hypothermia has been shown to be a factor that may place the surgical patient at risk for infection and delayed healing. Select the intervention that is an engineered control factor to protect the patient from hypothermia

Maintaining the ambient room temperature and limiting patient exposure is the first line of defense in protecting the patient from hypothermia. Temperatures in ORs should be maintained at 68° F (20° C) to 73° F (23° C).

Which of the following is an anesthetic-related factor that contributes to patient hypothermia? Vasodilation from inhalation agents that enhances heat transfer from the core to the periphery

Malignant hyperthermia can be a life-threatening event. Which of the following represents a true statement about malignant hyperthermia? It is a multifactorial disease and genetically transmitted as an autosomal dominant trait.

inhalation agents

Malignant hyperthermia is brought on by?

Gayle Saluki has been diagnosed with several large leiomyomas and is scheduled for an abdominal hysterectomy. When reviewing her chart prior to surgery, which of the following lab values associated with her condition might the nurse see? Decreased Hg

Matilde Gunderson is a 55-year-old who is diagnosed with uterine cancer and is scheduled for a panhysterectomy. Which organs will be removed in this procedure? The uterus, cervix, both fallopian tubes, and both ovaries

device commonly used for positioning the head during neurosurgical procedures

Mayfield head positioner

The hands of health care providers

Multiple antibiotic resistant organisms are most often transmitted by?

Miotics and mydriatics produce opposite effects on the pupil of the eye. Select the most appropriate statement about miotic and mydriatic drugs

Mydriatic drugs, such as phenylephrine, dilate the pupil.

Key issues affecting clinical reasoning for anesthesia.

NPO status, allergies, weight, metal implants, previous surgeries, skin integrity, significant labs and imaging results, contact lenses or eye glasses, hearing aides or other prostheses, informed consent documentation, and presence of family or significant other.

rectus abdominus muscle inguinal ligament medial to inferior epigastric artery

Name the landmarks of Hesselbachs triangle

Intima Media Adventitia

Name the layers of an artery

Pericardial tamponade includes which of the following signs or symptoms

Narrow pulse pressure

Which of the following may be a consequence of high-dose or full-body radiation?

Nausea, vomiting, and diarrhea

Morris, an 86 yo retired plumber, states that he has suffered from a groin hernia all of his adult life. Sometimes he has to psh the bulge back into his abdominal muscle and then he is fine until he has a coughing spell. This morning the bulge was large and tender when he woke up and he could not reduce it. As the pain increased, he felt weak and nauseous. His daughter took him to the emergency department. Morris was diagnosed with a strangulated incarcerated hernia and scheduled for emergency surgery. If the contents of Morris' hernia sac become compromised, with strangulation of the bowel, the probable label on his surgical specimen will be:

Necrotic bowel

Phrenic nerve

Nerve that passes between the lungs and the heart to the diaphragm? Is very important for breathing

Left and Right recurrent laryngeal Nerve Parathyroid

Nerves to be aware of when removing the thyroid?

Methylene Blue

Never to be given in Neurosurgery because it produces an inflammatory reaction in CNS tissue

Which inhalational anesthetic agent(s) has the fastest onset of induction, emergence, and recovery?

Nitrous oxide and halothane

Multiple studies have found that intraoperative awareness (IOA) occurs in 0.1% to 0.2% of patients undergoing general anesthesia. These studies also determined that even under seemingly adequate general anesthesia, implicit memory may be retained along with the ability to process auditory stimuli subconsciously. Based on these studies, it was determined that anesthesia techniques that rely solely on receptor-based drugs are a risk factor for IOA. Which classification of drugs should be avoided for patients at risk for IOA?

Nitrous oxide, benzodiazepines, and opioids

Yes or No: Would a task checklist be a for of "active" thinking in John Dewey's definition?

No, a task checklist is not a form of active thinking, it is the product of others' thinking.

Dr. Wheeler prefers the argon beam coagulator for dissection in his liver procedures because the liver bleeds easily and traditional monopolar electrosurgery often causes more bleeding than it stops. What is the application characteristic of the argon beam coagulator that enhances liver tissue hemostasis?

Noncontact tissue coagulation with reduced risk of rebleeding

0.8-1.1

Normal INR

3.5-5.0

Normal K+

11-13.5 seconds

Normal PT

25-35 seconds

Normal PTT

5,000-10,000

Normal WBC's

6.0-8.0

Normal serum Total Protein

Reprocessing (flashing) instruments in the OR is high risk because:

OR personnel not properly trained to reprocess instruments

During preoperative preparation of a GI surgery patient and family, what potential knowledge deficits will require the perioperative nurse's focus (as opposed to the surgeon's informed consent role)? How having the proposed procedure will affect the patient and family postoperatively

Of all of the usual nursing diagnoses applicable to patients having major abdominal surgery, a patient undergoing an ileostomy is at greater risk than patients having other laparotomies for: Disturbed Body Image related to intestinal diversion.

Right and left Recurrent laryngeal nerves parathyroid nerve

On a thyroidectomy, which nerve is at risk?

Internal Carotid Artery

On which artery is the the last clamp to be removed when performing a Carotid Endarterectomy?

Clean Contaminated wound

Operative wounds in which the respiratory, alimentary, or GI tract is entered under controlled conditions?

A female patient with end-stage pancreatic cancer was admitted from hospice for a celiac plexus block to treat intractable pain. She had a Whipple procedure 18 months earlier and enjoyed a good quality of life until 3 weeks ago. She wanted to be able to complete "getting her things in order" and saying good-bye to her friends and family while enjoying her last days pain-free. The patient insisted that her Do Not Resuscitate (DNR) status NOT be rescinded. She was conscious and competent and knew what was best for herself. The patient was taking full advantage of what provision for her care?

PSDA and advance directives

Preventing surgical fires is a top priority for all OR personnel and members of the surgical team should perform all of the following duties EXCEPT:

Perform a weekly fire risk assessment

Which of the following best describes evidence-based medicine? The use of theory-derived, research-driven information to make decisions about the care delivered to individuals or groups

Performance improvement program participation is important to the perioperative nurse because: involvement can strengthen the nurse's commitment to meeting standards and enhance program effectiveness.

Michael has suffered from subsacral pain and swelling for 2 weeks and finally was referred to a colorectal surgeon for care. He is currently in the ambulatory surgical center OR bed positioned in the jackknife position. The surgical assistant has gently but firmly tape his buttocks laterally to the rails of the OR bed to promote exposure to the surgical site. What procedure is Michael prepared to undergo, based on his symptoms and the surgical preparation?

Pilonidal cystectomy

An important anatomic landmark in thyroid surgery is known as

Poles

The process of bladder evacuation is initiated by: nerve cells from the sacral division of the autonomic nervous system.

Polk Thayer has recently been diagnosed with prostate cancer and underwent a metastatic workup. His surgeon told him that he has a Gleason score of 6. Which of the following statements best defines Polk's score? His cancer is mildly aggressive.

legs should be slightly flexed @ the hips and knees with pillow between knees and ankles. Padding for the greater trochanter, independent femur and head of fibula on dependent lower extremity

Position of legs when patient is placed in lateral position?

On postoperative day 2, a patient developed edema, redness, and purulent exudate that appeared to be isolated to the subcutaneous plane above the sternum. What important criteria must be met to conclusively define this as surgical site infection (SSI)?

Positive diagnosis of the SSI by the surgeon or attending physician

CBC blood chemistry pap smear CT MRI U/S ECG Chest Xray colposcopy UA Blood type D&C

Possible diagnostic studies indicated for a hysterectomy ?

avoid heavy lifting/driving for 7-10 days avoid intercourse, douching, tampons until seen by dr call DR if redness, swelling at the incision site

Post op considerations for LAVH

What is the major difference between a diagnostic endoscope and an operative endoscope? Diagnostic scopes have no channels; operative scopes are channeled.

Preoperative preparation of the patient having a procedure requiring pneumoperitoneum should include: telling the patient that shoulder pain may occur postoperatively.

the semi-invasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function

Radionuclide imaging

reperitonealization

Reapproximating the bladder flap peritoneum to the posterior cul-de-sac peritoneum is referred to as?

Proper specimen management techniques prevent errors and include all of the following EXCEPT:

Receiving specimens from the surgical field then affixing patient label to each

21 days to months

Remodeling(maturation) phase of wound healing can take how long?

A vena cava filter (Greenfield filter) maintains a patent vena cava but prevents pulmonary emboli (PE) by trapping the emboli at the apex of the device. This procedure may be performed in the OR, radiology suite, or ICU for critical patients

Right jugular and right femoral

ectopy dysrhythmias conduction abnormalities altered sensitivity to digitalis muscle weakness gastric distention paralytic ileum urinary retention

Signs and symptoms of Hypokalemia?

One source of catgut is _____.

Small intestines of sheep

The Centers for Disease Control and Prevention (CDC) has identified pathogens that could pose a threat to national and world security and safety through bioterrorism. Select the four most probable agents that could be used to cause mass transmission, mortality, panic, and social disruption.

Smallpox, plague, botulism, tularemia

Precautions apply to blood, all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood, mucous membranes, and nonintact skin.

Standard

Surgical site infections (SSIs) are most often caused by gram-positive cocci and may arise from the patient's own endogenous sources. The most typical causative microorganism cultured from SSIs is:

Staphylococcus aureus.

The bariatric unit was experiencing an alarming rate of postoperative wound dehiscence and evisceration on postoperative day 1, as the patients began to ambulate independently. Select the response below that reflects significant surgical team influence on wound healing.

Sterile technique, wound closure materials, hemostasis methods

As the pediatric cardiac team prepared to cannulate for a coarctation repair, their neonate patient presented with a sudden dysrhythmia, ectopy, and failure to respond to digitalis. Point-of-care serum electrolyte measurements revealed low potassium, sodium, and magnesium levels. On anesthesia induction, only 35 minutes earlier, these values were at normal levels and the patient status was secure. The electrolyte levels were treated to normal and the patient was cannulated and placed on cardiopulmonary bypass. As the procedure continued the team pondered the cause to prevent a recurrence. What possible event could have caused, or contributed to, this loss of electrolytes?

Sterile water from back table switched with heparinized saline

The original equipment manufacturer (OEM) instructions that came with the new rigid endoscope system did not recommend a particular sterilization modality; however, high temperatures and ultrasonic cleaning were discouraged and the facility recently removed the ethylene oxide sterilizers from the sterile processing department. The perioperative nurses and surgical technologists in the minimally invasive surgery (MIS) service collaborated on developing a processing procedure for their new equipment. What modality is their best option?

Sterilize the entire set in the low-temperature plasma sterilization system.

Horizontal mattress

Stitches that are placed horizontal to the wound are called?

Describe the internal inguinal ring

Structures that traverse the inguinal canal enter it from the abdomen by the internal ring, a natural opening in the transversalis fascia

Psychology

Study of mental processes and human behavior?

What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp

Subgaleal space

Platysma Muscle

Superficial muscle that overlaps the sternocleidomastoid?

The concept of surgical asepsis is directed at: practices that restrict microorganisms in the environment.

Surgical site infections are usually caused by: the patient's own flora

If you noticed a purple localized area of discolored intact skin with a blood-filled blister, how would you stage the wound?

Suspected deep tissue injury

There are several risk factors associated with dehiscence. Which of the following can be controlled by the RNFA

Sutures placed too close together

When closing a wound, you need to make sure that there is appropriate tension on the suture line. Take into consideration the potential for _____.

Swelling

The physiologic effects resulting from the inhalation of gaseous anesthetic agents and intravenous infusion of anesthetic drugs inhibit several areas of the central nervous system (CNS). The processes by which they occur are explained by several proposed theories. Which of the options describes a plausible anesthetic mechanism of action?

Synaptic transmission of nerve impulses in the CNS is inhibited

In several studies, it was determined that the risk of contamination and subsequent infection to the wearer can be reduced by wearing two pairs of sterile surgical gloves, as opposed to wearing one pair. Select the correct statement that refers to double gloving in terms of a best practice.

The AORN publication titled Recommended Practices for Prevention of Transmissible Infections in the Perioperative Practice Setting recommends the double-glove procedure during invasive procedures.

collaboration

The RNFA works in __________with the surgeon and health care team members to achieve optimal patient outcomes.

Adnexa are defined as the: ovaries, fallopian tubes, and supporting tissues.

The blood supply to the female pelvis is primarily derived from the: internal iliac branches of the common iliac.

Samuel, a 48-year-old tetraplegic with a chronic sacral wound, is scheduled for another wound debridement. What is the purpose of doing a wound debridement on a chronic wound?

The debridement will remove dead tissue that could support infection.

elbows

The height of the operating room table should reach the level of the?

Mesovarium

The mesentery of the ovary and ovarian ligament is called the ?

he blood is oxygenated in the lungs and returns to the left atrium through the pulmonary veins. Where does the blood flow after leaving the left atrium

Through the mitral valve into the left ventricle

The perioperative nurse must be prepared for which additional procedure when head and neck surgery is performed?

Tracheostomy

Debora Bellanger is an 8-year-old scheduled for a tonsillectomy and adenoidectomy. Considering the surgical site, where is the safest place for the nurse to place the dispersive electrode pad? On Debora's thigh

Traditionally, normal saline is used for irrigation because it is isotonic with human tissue cells. What other quality of normal saline can cause possible concern when using monopolar electrosurgery? It is a conductive fluid that transfers heat and electrical current in adjacent tissue.

Which of the following sulci is of particular anatomic importance during surgery?

Two sulci of particular anatomic importance during surgery are: (1) the lateral sulcus, or sylvian fissure, which divides the temporal lobe from the frontal and parietal lobes, and (2) the central sulcus, or fissure of Rolando, which separates the frontal from the parietal lobe

Therapeutic communication

Type of communication that utilizes both verbal and non verbal methods of retrieving information that will address both the patient health care and personal needs?

Clean Wound

Uninfected operative wounds in which no inflammation is encountered and the respiratory, alimentary and gI tracts are not entered?

OSHA requires all healthcare organizations protect their workers from exposure. The exposure control plan must include which of the following

Universal Precautions, engineering and work-practice controls, personal protective equipment and housekeeping, hepatitis B vaccination, postexposure evaluation and follow-up, communication of hazards to employees and training, recordkeeping, and procedures to evaluate exposure incidents.

A variety of assessment tools exist to assist the perianesthesia nurse in evaluating a patient's pain. What is the most reliable indicator of pain that the nurse should consider? The patient's self-report of pain

Virginia Grier is a 33-year-old patient who underwent a D & C and laparoscopic tubal ligation. She was transitioned from phase I recovery to phase II, where she has been for 3 hours. She has expressed a desire to go home, but her surgeon has written an order that states, "Patient must void before discharge." Virginia states she is unable to void. What should the phase II nurse do next? Assist Virginia to the bathroom, run the water, and apply warm water to her perineum to stimulate urination.

The use of Universal Precautions has become widespread and mandated by the Occupational Safety and Health Administration. Which of the following is a part of Universal Precautions? Employees must receive training in handling hazardous materials.

Viruses transmitted through blood and some blood products are a major concern in operating rooms because of the risk of direct percutaneous exposure to blood. Bloodborne viruses include: hepatitis B and C viruses.

Which complications have been reported in association with patients undergoing spinal surgery in the prone position as a result of decrease venous return from the head?

Vision Loss

Which complications have been reported in association with patients undergoing spinal surgery in the prone position as a result of decrease venous return from the head?

Vision loss

Flagyl Ampicillin Gentamicin

What antibiotics are known as "triple antibiotics"

Cystic Artery Cystic Duct

What are clipped and cut when doing a Laparoscopic Cholecystectomy?

Recurrent Laryngeal nerves parathyroid glands

What are the most important anatomical structures to identify and protect while dissecting out the thyroid?

Common Peroneal Nerve Distal fibula

What are you protecting by placing padding at the lateral aspect to the bottom knee and ankle?

Herbs

What can alter clotting mechanisms besides over the counter medication?

Fibroblasts

What cells are responsible for the synthesis and secretion of collagen and elastin?

venous air embolism

What complication does the RNFA need to plan for with a patient having a posterior fossa craniotomy in sitting position?

CN VIII- Vestibulocochlear

What cranial nerve relates to the assessment of hearing and balance?

lateral and medial epigatrics

When placing a trocar in the abdomen laterally what structure do you want to avoid?

Intraoperative arteriograms

When preparing for an emergency femoral embolectomy the RNFA should anticipate the need for?

What is the least common route of chemical exposure in the OR? Ingestion

Which of the following statements regarding the use of the hepatitis B virus (HBV) vaccine is true? Once immunity is established via a hepatitis B antibody titer, booster doses are not required.

Pearl Koenig has just learned of her diagnosis of stage II cervical cancer. Which of the statements made by Pearl indicates that she understands her diagnosis? "The cancer has not spread beyond my vagina."

Which of the following women has the highest risk for ovarian cancer? Geeta Ramaswamy, a 45-year-old 2-year breast cancer survivor

The most frequently reported locations of pressure sores are the sacrum and the: heels

Winston Williams is scheduled for a hemorrhoidectomy. While gathering supplies for the lithotomy, the nurse chooses wider ankle straps rather than thinner ones for Mr. Williams. What physical principle is the nurse applying to reduce pressure to the area and hence prevent pressure injury? Intensity of pressure is inversely proportional to the size of the surface area being compressed.

To protect the forearms, hands, and clothing from contacting bacteria on the outside of the used gown and gloves, members of the scrubbed surgical team should use the following procedure to remove soiled gowns and gloves. first 3 steps

Wipe gloves clean, untie side gown closure, grasp gown at one shoulder seam

Contaminated wounds

Wounds that are open, fresh, accidental wounds, such as penetrating trauma, open fractures or operations with major breaks in aseptic technique

Dirty or Infected wounds

Wounds that include old physically induced wounds with retained devitalized tissue and wounds that involve and existing clinical infection or perforated viscera?

True statements regarding instrument tying are all EXCEPT _____.

You have as much tactile sensation/feedback as two handed tying

Denise had a scar revision of her knee performed along with her bilateral mastectomy with saline implants and ear piercing procedures. The knee scar, before revision, was an 8cm linear, thin scar that extended obliquely across the anterior portion of her knee. The tension of the scar tissue met resistance when she would bend her knee. The surgeon opted to remove the scar with a procedure to break up the linear scar and rearrange the tissue direction to form a natural line. The proper name of this tissue transfer scar revision is the :

Z-plasty

Select the diagnostic and interventional radiology procedure that is not classified as a vascular procedure.

a. Percutaneous nephrolithotomy

A type of tissue in the extremities that is highly susceptible to ischemia is: a. Skeletal muscle b. Nerves c. Bone d. Skin

a. Skeletal muscle

Which stitch do you have to backhand? a. Figure of eight b. Vertical mattress c. Horizontal mattress d. Any stitch with a buried knot

b, c

To reduce the possibility of an injury or burn, which of the following most accurately describes where the perioperative RN should place the dispersive electrode? a. As far from the operative site as feasible. b. Directly on the operative site. c. As close to the operative site as feasible. d. Anywhere it will be easy to access.

c. As close to the operative site as feasible. - should be placed over a large, well perfused muscle mass, which will permit uniform contact.

During a laminectomy what is the preferred form of hemostasis?

c. Cottonoid strips or patties

Which statement best describes the path for bipolar surgical current? a. Current leaves the generator, is applied to tissue using a pencil device, is collected in the dispersive pad, and returns to the generator. b. Current leaves the generator, is applied to tissue using a pencil device, and returns to the generator. c. Current leaves the generator, is applied to tissue using a two-poled instrument, and returns to the generator.

c. Current leaves the generator, is applied to tissue using a two-poled instrument, and returns to the generator.

Electrosurgical generators can produce 3 different current modes. The first 2 are cut, Fulgeration and what is the third? a. Vaporize b. Coagulation c. Desiccation d. Blend

c. Desiccation

Hypothermia in the neonate can create a cascade of events leading to hypoxia. Which of the following is the accurate sequence of events? a. Anaerobic metabolism, decreased oxygen consumption, pulmonary vasoconstriction. b. Anaerobic metabolism, pulmonary vasoconstriction, respiratory acidosis. c. Peripheral vasoconstriction, increased oxygen demand, and respiratory acidosis d. Peripheral vasodilation, increased oxygen consumption, respiratory alkalosis

c. Peripheral vasoconstriction, increased oxygen demand, and respiratory acidosis

Which type of dressing is used to prevent drying of the wound and increase the proliferation of epithelial cells? a. Gauze b. Pressure c. Rigid support d. Occlusive

d. Occlusive

Match the surgery with its appropriate example. 1. monofilament nylon 2. Coated multifilament nylon 3. Uncoated polyester fiber 4. Coated polyester fiber 5. Polybustester 6. Polyethylene 7. Polypropylene a. Novafil b. Eithilon and Dermalon c. Mersilene and Dacron d. Ticron, Eithibond, Teflon, Polydek, and Tevdek. e. Dermalene f. Prolene and Surgilene g. Surgilon

1-B, 2-G, 3-C, 4-D, 5-A, 6-E, 7-F

Self determination or autonomy

A philosophical basis for informed consent in health care?

Mannitol

An osmotic diuretic that has an effect on renal vascular resistance is?

8.8-10

Normal Calcium

Eschar buildup on the active electrode ESU tip impedes the desired current flow and can tear tissue, causing rebleeding and serve as a foreign body if deposited in the wound. Appropriate methods to remove debris from the tip include: a) Scraping the non-coated ESU tip carefully with the scalpel b) Soaking the coated ESU tip in sterile water c) Wiping with moist sponge to clean non-stick coated ESU tips d) Abrasive electrode cleaning pad to remove eschar from non-coated electrodes e) Electrode tips should not be cleaned. They should always be replaced if there is a buildup of eschar.

(c and d)

What are some 'KEY' issues related to professionalism?

*Although the formal components of professionalism are known and respected by perioperative nurses,* experienced clinicians are also alert to clinical 'exceptions' necessitating creative thinking and clinical reasoning to address a patient's unique needs. The student should discuss possible situations with the preceptor. An example- performing surgery is a non-sterile location. It's against the rules (ie, guidelines) but if a patient arrests postop in a nursing unit or ICU and the patient's status is so unstable as to preclude transporting the patient to a sterile OR environment, surgery may have to be performed in the unit. Clinical reasoning, critical thinking and clinical judgment will all be needed to achieve a positive outcome.

What are some other key issues affecting hemostasis and patient outcomes?

*Available resources* - suture, liga-clips, staples; hemostats; gauze sponges; pledgets; electrocautery; other.

How is clinical reasoning specifically related to surgical instrumentation?

*Careful planning, preparation, selection, and use of instruments* promotes efficient, effective and safe surgery.

What are some "KEY" issues during the management of health care information?

*Communication must be clear, active, & conscise.* Questions, imprecuse directions, conflicting information, and too much ambiguity must be corrected. *Situational Awareness refers to assessing one's surroundings and identifying risks* and an increased potential for error. Patients with excessive bleeding who require the use of a large number of sponges, may be at risk for retention of bloody sponges. By maintaining track of the sponges inside & outside the patient, the RN exerts independent thinking and plays a key role in reducing risk.

How is clinical reasoning specifically employed during hemostasis?

*Determine the clinical situation*- Bleeding from artery or vein? Muscle? Is blood pumping or oozing? Is the color bright red or darker red? *How do team members know?*- Directly visible? Adequate lighting? Suction working? Level of experience (RN, MD, Tech)?

What are some of the ways to think about hemostasis during a patient's surgery?

*Determine the risks for bleeding*- history of anticoagulants; bleeding disorder; the kind of tissue being repaired; anatomic anomalies. *Determine the surgeon's preferences for hemostasis*- eg tissue type, suture.

What are some potential dangers in the use of surgical equipment?

*Different types of energy can affect devices* in ways that can injure internal programming or components; misuse of equipment.

How is clinical reasoning specifically employed during surgical draping?

*Differentiating what the goals* are for draping and what is acceptable technique. *Asking yourself what opportunities exist* to be creative without departing from guidelines?

How does the education of a patient and/or family member relate to optimal clinical outcomes?

*Education provides a sense of commitment and engagement*; patients (and family) can become more active participants in their care and play a role in their success.

What are some 'KEY' factors affecting scrubbing, gowning, and gloving?

*Gowning and gloving (open and closed) quickly and properly requires practice* and in some cases assistance (eg, during a crucial moment in surgery), it may be helpful- and faster- to re-glove a (sterile) team member who would otherwise self-glove. *A 'key' factor as a team member is to assist other team members* to perform their clinical duties by assisting others with gowning, gloving and scrubbing.

What are some "KEY" issues affecting specimen management and patient outcomes?

*Identifying, checking (and rechecking), documenting and transferring specimens as requested and according to established guidelines, policies, and procedures. *Seeking clarification of any confusing or unclear information related to specimen(s)*- from any team member handling the specimen, with final confirmation by the surgeon.

How is clinical reasoning specifically employed to maintain sterile technique?

*Increasing one's knowledge about sterility* expands available options to maintain sterility, *Interacting with colleagues to ensure compliance* with accepted sterile guidelines can improve the professional culture and benefit both patients and staff.

How is clinical reasoning specifically employed during administration of medication and solutions?

*Intraoperative verbal orders for medications, doses, routes, and times, must be clarified before the medication is given.* Have the medication available and check with the anesthesia provider if surgeon is unable to talk. The surgeon must approve the medications. *The verbal order must be signed off by the surgeon before the patient leaves the OR;* have the form/electronic record ready for the MD's signature when the surgeon "breaks scrub." Having the paperwork ready when the surgeon is ready is often a successful strategy for surgeon compliance with required facility practices (policies).

How is clinical reasoning employed during the safe use of surgical equipment?

*Knowledge of the implanted device and its use*, possible causes of injury or malfunctions related to the device, contingency plans for restoring function.

What is the association between scrubbing, gowning, and gloving and patient safety?

*Maintaining a sterile environment*- and minimizing the risk of infection- is an important safety activity. *Reducing delays in surgery* by, for example, promptly replacing contaminated gowns or gloves and promptly scrubbing ( and setting up the sterile field) *When tying up all sterile team members, tie the waist portion first* while the sterile person is putting on gloves. When the waist is tied, the gown is less likely to slip off the shoulders and the neck can be tied more easily after the person is gloved.

How is clinical reasoning specifically employed during specimen management?

*Many factors go into safe and accurate specimen management*- not the least of which are the ability to anticipate possible problems and risks for error (eg, laterally, multiple specimens from different areas) and the skill to engage in active, precise communication and documentation.

How is clinical reasoning employed during scrubbing, gowning, and gloving?

*Monitoring the sterile field;* anticipating breaks, knowledge of surgical procedure. *Being aware of surgical activities.* For example, when a sterile member moves to a position that may contaminate one's gown, then changing the gown may be indicated.

What are some 'KEY' issues affecting sterilization and disinfection?

*Standard Precautions should be applied to all items*- whether sterile or contaminated- that have been in contact with patients. *In order to properly clean, disinfect, and decontaminate an item in preparation for sterilization, it is helpful to reduce bioburden on instruments and other items introperatively by using a moist sponge to remove blood and other material accumulated. There also is less risk of foreign bodies being retained within the surgical field. *Collaborate with colleagues* (eg, sterile processing) to implement practices that reduce infection, strengthen the clinical culture to review and improve infection-prevention and sterilization practices, and educate clinicians and technologists in an interprofessional manner.

How does surgical draping relate to sterile technique, infection prevention, and other patient related factors?

*Sterile drapes serve as a barrier to microorganisms, fluids, and particulate matter*- all of which can contribute to increased risk for SSI. *Sterile drapes provide (some) privacy, (some) warmth, and (some) protection* against injury to the patient's skin.

What is the association between sterile technique and positive patient issues?

*Sterile technique is associated with lower rates of SSI.* *Breaks in sterile technique further increase the risk to patients* with pre-existing infection or immunosuppression.

How is clinical reasoning employed during the management of health care information?

*The RN is aware of the information that must be documented* (eg, positioning, procedure performed, names of clinicians involved in the surgery). *The RN may have knowledge of other information that may not be mandatory to document,* but may be important to forward to receiving caregivers (eg, experiences of friends or family members, unhappiness with insurance coverage); the RN must decide.

What are some of the ways we relate the patient's care to the documentation of that care?

*The legal truism that "If it wasn't documented, it wasn't done" applies both to hand-written and electronic health records; the RN must become adapt at using both documentation formats. *The novice perioperative student should undergo an extensive and thorough orientation* to the use of the facility's electronic health record and rely on the preceptor's help.

What are some "KEY" issues affecting efficient and effective prepping outcomes?

*The prompt initiation of the prep enables surgery* to start on time (or even early); the RN ensures the Universal Precaution requirements, counts, & other required practices have been completed. *The RN taking the initiative to begin a prep after required practices* are completed reflects the nurse's value to patient care. Communication with the surgeon and anesthesia provider would be important components of the interdependent practice displayed by the nurse.

How is clinical reasoning employed during infection prevention?

*Use standard precautions* for all perioperative patients; *Use appropriate precautions* (eg contact, airborne, droplet) with patients as indicated. *Follow blood-borne pathogen standards* in presence of blood and other infectious materials.

Which of the criteria below are appropriate when determining whether an incisional SSI is superficial or deep?

*Where the purulent drainage comes from, superficial or deep *Where the positive wound culture comes from, superficial or deep *Whether the wound dehisces and/or is deliberately opened by a surgeon *The diagnosis by the surgeon or attending physician

In post discharge home care of the postoperative patient, which statements reflect best practice by the patient?

*clean the wound daily with soap and water *change dressings as instructed by your nurse or physician *Take showers; do not swim or put your wound under water *keep your physician visit as planned

A 70-year-old male patient was fitted with a negative-pressure wound therapy system (NPWT), also called vacuum-assisted closure, after his most recent surgical wound debridement. This device works by?

*creating mechanical tension on the tissues and pulling wound edges together *causing macro-deformation and wound contraction

Infection control and prevention surveillance was underway in the cardiac ICU because of an alarming prevalence of sternal wound infections. The infection preventionist and perioperative clinical nurse specialist reviewed the criteria in order to define the SSI and develop strategies for further investigation and prevention. The infectious signs and symptoms arose on postoperative day 2 with edema, redness and purulent exudates that appeared to be isolated to the subcutaneous plane above the sternum. What two important criteria must be met to conclusively define this SSI?

*positive wound cultures obtained from the deepest accessible source of wound drainage *Positive diagnosis of the SSI by the surgeon or attending physician

12-15 mmHG

In a laparoscopic procedure, the peritoneal cavity is insufflated with CO2 to an intraoperative pressure of ?

Match the surgical specimen with its appropriate description. 1. Biopsy 2. Frozen section 3. Culture 4. Routine specimen 5. Cytology a. Tissue is surgically removed for diagnostic purposes. b. Used for identification of the function and orgin of cells in the specimen (malignancy may be suspected) c. Specimen is obtained from and incisional or excisional biopsy or by aspiration. d. Done when identification of pathogens is needed e. Done when immediate analysis of a specimen is required.

1-A, 2-E, 3-D, 4-C, 5-B

What are some "KEY" safety issues to address during the use of surgical energy?

1. *Energy related injuries can occur* to the patient or to a device within the patient (eg, pacemaker); complex, electronic devices require expert repair. 2. *For electrical energy, the most appropriate- and safe- form of energy dispersal* should be selected before the incision (eg, when using multiple energy sources requiring multiple dispersive electrodes)

What are some potential dangers in the use of surgical energy?

1. *Patient injuries* related to burns within or adjacent to the surgical site. 2. *Injuries may also occur at a distance* when electrical energy cannot be safely dispersed from the body; other energies (i.e. Argon) can also cause harm.

Match each class of surgical wound with the appropriate example. 1. Class 1 2. Class 2 3. Class 3 4. Class 4 a. Gastrectomy b. Compound fracture c. Perforated viscera d. Hernia surgery

1- d, 2-a, 3-b, 4-c

Match the types of sponges with their purpose. 1. Round, small sponges used to promote hemostasis during tonsillectomy procedures. 2. Used for packing or walling off viscera and for absorbing fluid in large areas. 3. Used to absorb fluid and blood during cranial procedures and around the spinal cord in place of coarse gauze sponges. 4. Used in all surgical procedures to absorb blood and other fluids. Material contains x-ray detectable filaments. 5. Used to absorb blood/fluid in very small areas or to dissect delicate tissue. a. Dissector sponges b. X-ray detectable 4 x 4 (Raytec) c. Neuro-patties or cottonoids d. Lapartomy sponges e. Tonsil sponges

1-A, 2-D, 3-C, 4-B, 5-A

Match the indicator type with its description. 1. Class 1 2. Class 2 3. Class 3 4. Class 4 5. Class 5 6. Class 6 a. Integrating- Reacts to all critical parameters over a specified range of sterilization cycles; performance has been correlated to the performance of the stated test organism under the labeled conditions of use. b. Emulating- Reacts to all the critical parameters of a specific cycle. c. Reacts to two or more of the critical parameters of sterilization d. Bowie-Dick- detects air leaks, ineffective air removal, and presence of non-condensable gases; used in dynamic air-removal sterilizers. e. Demonstrates that the package has been exposed to the sterilization process to distinguish between processed and unprocessed packages. f. Process indicator that reacts to a single parameter of the sterilization process.

1-E, 2-D, 3-F, 4-C, 5-A, 6-B

Match the suture characteristics with the appropriate definitions. 1. Memory 2. Coeffiecent of friction 3. Capillarity 4. Pliability 5. Knot tensile strength 6. Elasticity a. The ability to glide through tissue and retain a knot. b. The ability to regain original form and length after being stretched c. The ability to bend easily d. The force, measured in pounds, that the suture strand can withstand before it breaks when knotted. e. The ability to soak up fluid along a strand f. The capacity to take back former shape after being tied.

1-F, 2-A, 3-E, 4-C, 5-D, 6-B

Match the suture with its appropriate description. 1. Surgical silk 2. Virgin silk 3. Dermal silk 4. Surgical cotton 5. Linen 6. Steel a. Used in orthopedics, may also be used in the presence of infection. b. Tensile strength is inferior to other non-absorbables; used for GI surgery c. Composed of natural fibers; used for ophthalmic surgery. d. Strands are encased in a gelatin or protein substance; used for skin sutures. e. Weakest of non-absorbable material choices, gains strength when wet. f. Gives good support during early ambulation and promotes rapid healing, used to close fascia when no infection is present.

1-F, 2-C, 3-D, 4-E, 5-B, 6-A

Match the pathological test with the appropriate preparation. 1. Bacteriology 2. Cell count 3. Donor tissue 4. Calculi 5. Muscle 6. Projectile from crime scene 7. Clothing of crime or accident victim a. Dry in a sterile container b. Dry in a porous paper c. Fresh or added solution of the pathologist's choice d. Fresh in sterile container, extended in a special clamp e. Fresh in a sterile container f. Aerobic and anaerobic on a culture swab in a sterile tube g. Placed in a nonmetallic container; DO NOT MARK TO ID

1-F, 2-E, 3-C, 4-A, 5-D, 6-G, 7-B

Match the procedure with the appropriate features. 1. Incisional Biopsy 2. Excisional biopsy 3. Needle biopsy 4. Bone marrow biopsy 5. Muscle biopsy 6. Culture 7. Slide a. Requires specialized forceps that are applied to the tissue before it is removed and keeps the tissue stretched during processing. b. Pap Smear c. Requires specialized needles that can puncture, directly or with a twisting motion. d. Performed to determine the exact organism and which treatment it will be sensitive to once identified. e. A core of tissue is removed for diagnosis. f. A portion of the tumor removed. g. Whole tumor removed.

1-F, 2-G, 3-E, 4-C, 5-A, 6-D, 7-B.

Match the terms with their definition. 1. Surgical conscience 2. Sterile 3. Sterile technique a. The use of specific actions and activities to prevent contamination and maintain sterility b. Allows for no compromise in the principles of sterile technique c. The absence of all living microorganisms

1-b, 2-c, 3-a

Match the decontamination device with its description. 1. Ultrasonic cleaner 2. Washer decontaminator/ disinfector. 3. Washer/sterilizer a. Process instruments through several cycles. Instruments are not considered prepared for subsequent use. b. Allows hands-free processing. Renders instruments safe for handling. c. Removes the fine debris through cavitation.

1-c, 2-b, 3-a

What are the two main categories of Suture material?

1. Absorbable 2. Non-Absorbable

Other Methods of Closing Incisions?

1. Tissue Glue 2. Staples

Match the uses of the equipment with their correct piece of furniture. 1. mayo stand 2. back table 3. ring stand 4. suction stand 5. sterilizer a. holds irrigation fluid b. used to render surgical instruments or equipment sterile for use. c. may be used to hold basins of water d. holds pans of sterile instruments, supplies, and prepared solutions. e. holds frequently used instruments.

1: E, 2:D, 3:C, 4:A, 5:B

How long should the patient be monitored after deflation of the pneumatic tourniquet?

15 minutes

To safely transfer and position patients in a manner that prevents shearing, personnel should use a mechanical lifting device for a supine-to-supine transfer of a patient weighing more than:

157 lbs

Based on your knowledge of assessment of cardiovascular, respiratory, and renal status, match the indicators listed below with the system they are used to assess. 1. Cardiovascular system 2. Respiratory system 3. Renal system a. Intake and output of urine b. Complaints of edema, fatigue, and orthopnea. c. Tidal volume

1: B, 2: C, 3:A

The tensile strength of lactic & glycolic acid polymers is sufficient for approximation of tissues for

2-3wks

Match the type of drain to the description. 1. Penrose Drain 2. Jackson-Pratt 3. Foley Catheter a. Used to drain fluid or blood after abdominal, urologic, thoracic, and head and neck procedures. b. Primarily used for urinary drainage, but can also be used as a gastrostomy tube or to drain the gall bladder following a cholecystectomy. c. Usually placed in a "stab" wound that is made adjacent to the main incision or may be placed near an intestinal anastomosis.

2-A, 3-B, 1-C

Which of the following assessment factors are important to include when screening patients for potential risks of MH? *Select all that apply.* a. Family history of problems related to anesthesia. b. Patient's previous experience with anesthesia c. Patient's use of herbal and vitamin supplements. d. Patient's use of OTC medications

A & B

Larger Wire Sutures are:

22G, 21G, 20G

New synthetic polymers such as PDS provide wound support up to _____ months

3

What is determined to be the appropriate time for a surgical hand scrub, depending on the manufactures written directions?

3-5 minutes

Vaccine-preventable diseases against which health care providers should be immunized include: a. hepatitis B b. seasonal influenza c. tuberculosis d.varicella 1. B & C 2. A & D 3. A, B, & D 4. A, B, C, & D

3. A, B, & D

With the production of more steam in the sterilizer chamber, the pressure increases as well. The steam should contain little or no entrapped liquid water. Steam quality is the term that describes the amount of water mixed with the steam. The constitution of high-quality steam would be measured by:

<3% of the mixture is liquid water.

All of the following are true of the mediastinum except:

?b. it contains the lungs

Sampson artery (Artery under the round ligament)

Artery which is insignificant and is dissected during hysterectomies?

Which of the following statements are applicable when prepping a contaminated area such as a colostomy? *select all that apply* a. Cover the stoma with sterile gauze/sponge dipped in prepping agent. b. Prep the abdomen before prepping the stoma. c. Never prep the stoma, just the skin. d. Prep the contaminated area first.

A & B

Which items of attire should be worn where supplies are stored? *select all that apply* a. Scrub suit b. Head cover c. Shoe covers d. Surgical mask

A & B. Everyone who enters the semi-restricted area of the OR must don attire that is intended for use within these areas which includes body cover and head cover.

Aperture drapes: *select all that apply* a. permit visualization of skin tones and landmarks. b. are used to "wall off" a contaminated area, such as a stoma, from the other clean areas. c. conform to body contours. d. may be used to cover equipment such as a tourniquet or a microscope.

A & C

Documentation of the perioperative nursing care should be include, but not be limited to: a. Type of positioning devices use. b. Name of the operating surgeon. c. Names of persons positioning the patient. d. Preoperative outcome evaluation.

A & C

Identify some methods used to maintain a sterile camera head. *Select all that apply* a. Put the camera head in a sterile pouch. b. Gas-sterilize the camera head. c. Cold soak the camera head in glutamate for 20 minutes. d. Wipe the camera head and cord with alcohol and carefully arrange it on the sterile field.

A & B

Risks to patients and staff members associated with laser use include: *Select all that apply* a. eye injury b. fire hazard c. inhalation of laser plume d. radiation hazards

A & B

When using the ESU generator, the perioperative nurse should remember to: *select all that apply* a. Never use the ESU in presence of alcohol-based antimicrobial prep agents until the agents are dry and vapors have dissipated. b. Never allow fluids to be poured on the generator. c. Encase the foot switch in an insulated safety holster.

A & B

Which medications are used as moderate sedation? *Select all that apply* a. Morphine sulfate b. Midazolam c. 2-chloroprocaine d. Mepivacaine

A & B

Identify some methods used to maintain a sterile camera head. *Select all that apply* a. Put the camera head in a sterile pouch b. Gas-sterilized the camera head. c. Cold soak the camera head in glutamate for 20 min. d. Wipe the camera head and cord with alcohol and carefully arrange it on the sterile field.

A & B

Characteristics of a "no-touch" technique to reduce sharps injuries during an operation include: no two people touching the same contaminated sharp at the same time.

A Metzenbaum is an example of a: cutting instrument.

Focused assessment with sonography in trauma (FAST) may assist with diagnosis in difficult situations. What group of scans is performed and what do they identify?

A chest, pelvic, and four abdominal scans; collections of fluid and free air

Which of the following are recommended guidelines for preserving a bullet collected as forensic evidence? *select all that apply* a. Do not drop the bullet into a metal basin or bowl b. Rinse the bullet with saline or water if requested by local authorities. c. Handle as little as possible d. Remove the specimen with hard steel forceps e. Wrap the bullet in cotton or tissue paper and mark the specimen.

A, B, & C

Which pieces of equipment are used in a laparoscopic surgery? *Select all that apply* a. CO2 insufflators b. ESU c. Smoke evacuators d. Fiber-optic head light e. Traction apparatus

A, B, & C

Broad ligament

A double fold of peritoneum extending from the uterus laterally, downward and posteriorly forms this ligament?

Which statement regarding level III and level IV trauma centers best describes the difference between the two types of centers

A level III trauma center provides advanced cardiac life support (ACLS), surgery, stabilization, and transfer, while a level IV only provides ACLS services before immediate transfer to a higher level center

Which GI surgical procedure typically requires two stages done approximately 48 hours apart? Loop colostomy

A major difference between gastroscopy and colonoscopy is: the patient's position for the procedure.

A pulse oximeter provides an early warning of hypoxia by: indicating oxygen saturation through the use of two light-emitting diodes alternately transmitted through blood and tissue to measure light absorption.

A normal SpO2 for a young healthy patient on room air is: 95% to 100%.

A patient classified as an ASA-P3 could be expected to need which of the following perioperative nurse interventions? Preoperative teaching with increased emphasis on the importance of early postoperative ambulation to prevent postoperative complications

A patient who will be sedated to a state that allows him/her to tolerate unpleasant procedures while maintaining adequate cardiorespiratory function: may be monitored by a perioperative nurse who has completed a competency-based program for conscious sedation.

Poor state of nurtition

A patient with malignancy, chronic infection, chronic GI disease may be in a?

The portion of the GI tract that lies partly in the abdomen and partly in the pelvis is called the: sigmoid colon.

A primary purpose of the small intestine is to: absorb essential nutrients at 95% efficiency.

Which pieces of equipment are used in laparoscopic surgery? *Select all that apply* a. CO2 insufflators b. Electrosurgical unit c. Smoke evacuators d. Fiber optic headlight e. Traction apparatus

A, B, & C

How long can Methicillin-resistant Staphylococcus epidermidis and VRE survive on fabrics and plastics.

Longer than 90 days

Albert Janson, a 325-pound patient, is scheduled for a 6-hour abdominal surgery. The surgical assistant is concerned about the risk for pressure injury because of the weight of the patient's body pressing against the surface of the OR bed for a long surgery. Which of these other factors may also produce pressure?

A self-retaining retractor post clamped to the OR bed rail and tightened against the patient's side

A 325-pound male is scheduled for a 6-hour abdominal surgery. While assessing the patient in the preoperative holding area, the perioperative nurse is concerned about the risk for pressure injury because of the weight of the patient's body pressing against the surface of the operating room bed for a long surgery. Which of these other factors may also produce pressure?

A self-retianing retractor post clamped to the OR bed rail and tightened against the patient's side.

As the patient emerged from the propofol, she stated that her mouth, lips, and tongue were numb and prickly feeling and she had a metallic taste. The anesthesia provider suspected that the patient had ________ and responded by _________.

A toxic overdose of local anesthetic; monitoring and increasing the flow rate of IV saline

Identify the factors that should be assessed to decide the best time for teaching the patient. *Select all that apply* a. Doubts about how the procedure will affect the patient's image. b. Anxiety about the level of pain caused due to the procedure. c. The patient's knowledge level and intellectual ability. d. Details about postoperative plan of care. e. Details about alternative plans of treatment.

A, B, & C

Identify which of the following statements are correct about sterile technique. *Select all that apply* a. Scrubbed personnel should wear caps, masks, and sterile gowns and gloves. b. Scrubbed personnel should perform hand hygiene. c. Scrubbed personnel should inspect gloves for integrity after donning. d. Scrubbed personnel can handle the sterile drapes as frequently as possible.

A, B, & C

Many factors affect the amount of postoperative pain the patient will experience. Factors that may affect the amount of pain are: *Select all that apply* a. the surgical site. b. the nature and intended purpose of the surgery. c. the patient's fears regarding anesthesia or surgery. d. the level of anxiety of the patient's family members.

A, B, & C

Professionalism in nursing means: *Select all that apply* a. showing personal accountability in understanding the Nurse Practice Act b. maintaining a current knowledge base. c. participating in professional organizations d. practicing without any errors.

A, B, & C

The purpose of the National Patient Safety Goals is to: *Select all that apply* a. Promote specific improvements in patient safety. b. Highlight problematic areas in health care. c. Describe evidence and expert-based system-wide solutions to the problems. d. Create a monitoring mechanism for health organizations and personnel.

A, B, & C

When using the forum for public commenting on clinical guidelines and offering a suggested change in the comment field, it is very important that you: *Select all that apply* a. suggest alternate phrasing b. cite evidence to support your change c. provide rationale for your suggestion d. call the consult line to clarify the content with the guidelines

A, B, & C

Which intraoperative factors should be considered during perioperative assessment (related to positioning)? *select all that apply* a. Type of anesthesia delivered b. Duration of surgery c. Position required d. Type of draping used

A, B, & C

Which of the following are desired characteristics of antimicrobial agents? *select all that apply* a. Broad spectrum b. High log reduction capability c. Effective for long periods of time. d. High toxicity e. Low toxicity

A, B, & C

Which of the following are desirable characteristics of antimicrobial agents? *select all that apply* a. Broad spectrum b. High log reduction capability c. Persistent d. Slow action

A, B, & C.

Accurate preoperative documentation of the patient admission is an integral part of the nursing process. This includes: *Select all that apply* a. patient identification b. preoperative orders c. discharge referral d. patient assessment

A, B, & D

An individualized patient care plan that was initiated during the preoperative phase includes: *Select all that apply* a. cultural or religious preferences b. emotional considerations c. financial considerations d. psychosocial considerations

A, B, & D

During end of procedure cleaning: *Select all that apply.* a. all kick buckets, hampers, and similar, receptacles must be inspected and disinfected as needed. b. transport vehicles are to be considered contaminated after patient contact. c. the OR bed should not be moved while the floor is being mopped. d. all horizontal surfaces of tables and equipment, including the anesthesia machine, should be wiped down with a lint-free cloth moistened with a hospital-approved disinfectant.

A, B, & D

Factors that affect the amount of pain include: *Select all that apply* a. the site of the surgery b. the nature and intended purpose of the surgery c. the patient's age, sex, and weight. d. the level of anxiety or fear that the patient has about the procedure.

A, B, & D

Identify the correct statements about time out. *Select all that apply* a. The procedure should not begin until the missing patient information is completed and agreed upon. b. Time out documentation should include agreement on procedure. c. Time out can occur before the patient is prepped and draped. d. Time out should take place in the room where the procedure is to be performed.

A, B, & D

Identify the correct statements about volatile liquids and agents. *Select all that apply* a. Agents such as ether, acetone, and alcohol are volatile agents. b. Volatile agents are highly susceptible to ignition. c. Vapors of volatile gases are benign. d. Volatile agents may be found in aerosol sprays.

A, B, & D

Identify the three basic guidelines to be followed while handling powered instruments. *Select all that apply* a. Always have the safety turned on while passing the instrument to surgeon b. Always use the instrument with the drill guard in place. c. Always soak the instruments before cleaning. d. Always have irrigation ready during the surgeon e. Clean the cords of powered instruments with a moistened sponge.

A, B, & D

Radiation exposure safety controls include the following: *Select all that apply* a. Nonessential personnel should leave the room. b. Pregnant health care workers should avoid or limit exposure. c. Perioperative nurses should all be trained to operate x-ray machines. d. Lead protective aprons, gloves, and thyroid collars should be worn.

A, B, & D

Select the options open to the scrub person who needs to change gloves during a surgical procedure. *Select all that apply.* a. Remove both gown and gloves b. Have another team member assist in re-gloving c. Use the closed glove technique d. Use the open glove technique

A, B, & D

AORN recommends that the following factors be considered when selecting drape products: *select all that apply* a. Amount of irrigation fluid. b. Anticipated blood loss c. Duration of procedure d. Potential for linting e. Surgeon preference

A, B, C, & E

Identify the factors that are considered while selecting surgical drapes. *select all that apply* a. Type of procedure to be performed. b. Amount of area around the incision to be included c. Age of the patient d. Furniture and equipment to be draped.

A, B, & D.

The Occupational Safety and Health Administration (OSHA) recommends that smoke evacuation systems be used to reduce the amount of smoke in the air. Measures that reduce smoke inhalation include: *select all that apply* a. Using a wall suction with an in-line filter. b. Using a smoke evacuator. c. Opening the doors of the OR. d. Using high filtration surgical masks. e. Using a HEPA filter.

A, B, & D.

Identify the preoperative orders that should be recorded. *Select all that apply.* a. NPO orders b. Skin preparation orders c. DNR orders d. Patient's mental state of alertness e. Medication orders

A, B, & E

Identify the statements that are true about an ESU. (Electrosurgical Unit) *select all that apply* a. Electrosurgery is used to cut tissue. b. ESUs are a high radio-frequency electrical current. c. The active electrode is also referred to as a "grounding pad." d. Bipolar current is most frequently used for electrosurgery. e. The dispersive electrode is also referred to as the "grounding pad."

A, B, & E.

Identify the correct statements related to lasers. *Select all that apply* a. Use only non-reflective or ebonized instruments near the tissue interaction site. b. Evacuate all surgical smoke. c. Use ignition- resistant drapes during laser procedures. d. Use a laser- resistant endotracheal tube with a cuff that is inflated with saline and methylene blue dye when using a laser near the aerodigestive tract. e. Prescription eyewear is acceptable in rooms where lasers are in use.

A, B, C, & D

Identify the facts that are true regarding peracetic acid sterilization. *Select all that apply.* a. It is a liquid chemical sterilization method. b. It uses low temperatures. c. It is equal in efficiency to steam and ethylene oxide sterilization. d. It requires the use of a special unit designed for this type sterilization. e. It can be used for surgical items.

A, B, C, & D

Identify the guidelines for creating and maintaining a sterile field. *select all that apply* a. use only sterile drapes b. inspect drapes for integrity c. keep drapes in control d. handle drapes as little as possible; do not flip, fan, or shake drapes.

A, B, C, & D

Select the intraoperative factors that negatively affect wound healing. *Select all that apply* a. a surgical complication b. Failure to eliminate dead space when closing the incision. c. Implantation to orthopedic hardware d. Surgical incisions in an area of high mobility. e. Surgical incision in highly vascular areas. f. Use of x-ray during the procedure

A, B, C, & D

The IOM recommendations are applicable to ______________. *Select all that apply* a. health care organizations b. health care professions c. medical device manufacturers d. the FDA e. AORN

A, B, C, & D

The OSHA Bloodborne Pathogen standard requires health care personnel to wear the following when splashes, spray, spatter, or droplets of blood or other potentially infectious materials can be reasonably anticipated. *Select all that apply* a. masks b. shoe coverings c. eye protection devices d. gloves e. paper gown

A, B, C, & D

The use of the PNDS helps a perioperative nurse to: a. plan the nursing interventions. b. assess and develop the nursing diagnosis. c. assess and evaluate the patient's status. d. evaluate responses to positioning. e. determine medical diagnosis.

A, B, C, & D

Identify the correct measures to reduce personnel exposure to specimen fixatives. *Select all that apply* a. Wear a protective mask to avoid inhaling fumes. b. Avoid splashing while pouring. c. Never pour a volatile liquid under a flow hood. d. Use absorbent material and then triple-rinse with water any area where accidental formalin spillage occurs. e. Avoid skin contact by wearing gloves when pouring.

A, B, D, & E

Identify the situations where a decision would be based on ethical grounds. *Select all that apply* a. Using new technology at your facility b. implementing or suspending the DNR orders on a patient c. After the patient gives consent for surgery, refusing to proceed until all involved personnel discuss the situation d. Participating in human experiments that are conducted at your facility e. Strongly supporting organ donation even though the family disagrees.

A, B, D, & E

Identify ways to enhance one's professional practice. *Select all that apply* a. Documentation of orientation program b. Documentation of clinical competency c. Documentation of employee performance evaluations d. Knowledge of the nursing practice in your state. e. Documentation of continuing education activities. f. Revision of all departmental policies and procedures.

A, B, D, & E

Key business metrics over which you can have control to affect the "bottom line" are: *Select all that apply* a. Length of procedure b. On-time starts c. Physician satisfaction d. Turn over time e. Volume of procedures

A, B, D, & E

Many medical errors occur due to the three types of human errors. Which of the following statements are true? *Select all that apply* a. A nurse programming a new ESU incorrectly is committing a skill-based error. b. A nurse misinterpreting test results is committing a knowledge-based error. c. Juggling multiple activities is a knowledge based error. d. A nurse failing to provide indicated prophylactics is committing a knowledge-based error. e. Lack of physical stamina due to occupational musculoskeletal injuries is a situational factor.

A, B, D, & E

When medication is administered from the sterile field, it is removed from an original container by the RN circulator and presented to the scrub person. It should be immediately and clearly labeled with: *Select all that apply* a. concentration and amount. b. date prepared c. expiration date when used within 24 hours d. expiration time if less than 24 hours e. initials of the RN preparing the medication.

A, B, D, & E

Which elements must be proved for a negligence claim to be successful? *Select all that apply* a. Damages: Actual injury to the patient b. Breach of Duty: Care provided was not within the standard of care. c. Reasonableness: A nurse in the same circumstances would have done the same thing. d. Duty: A nurse-patient relationship exists e. Causation: What the nurse did or did not do resulted in injury.

A, B, D, & E

Which of the following actions should be included in the perioperative nursing care of the patient with a suspected latex allergy? *Select all that apply* a. Assess the patient's cross-sensitivities and previous reactions to latex. b. Indicate latex precautions on door signs for every room that the patient occupies. c. Schedule the patient as the last procedure of the day if possible. d. Use latex free supplies for IVs, hair coverings, and dressing material. e. Verify that the surgeon is aware of the allergy.

A, B, D, & E

Nursing documentation for pneumatic tourniquet use includes: *Select all that apply* a. identification number and model of the specific tourniquet. b. location of the cuff. c. name of company that manufactured the cuff. d. skin and tissue integrity under the cuff before the use of the pneumatic tourniquet. e. skin temperature. f. time of inflation and deflation.

A, B, D, & F

When transferring medication and solutions to the sterile field the perioperative nurse should adhere to which of the following recommendations? *Select all that apply.* a. Avoid removing stoppers from vials. b. Discard unused, opened irrigation or IV solutions at the end of the procedure. c. Dispense medications and fluids to the sterile field as soon as possible after opening the case. d. Dispense the entire contents of the container slowly. e. Replace caps on unopened medication to maintain sterility. f. Use a sterile transfer device.

A, B, D, & F

The four elements required to create a culture of safety are: *Select all that apply* a. a sincere commitment to affirming safety as the first priority. b. development and support of a proactive approach and not a reactive blaming approach. c. emphasis on patient safety over worker safety. d. dissemination and verification of the receipt of information to all levels of staff and management. e. a sense of trust among team members.

A, B, D, E

Non-research parts of evidence ratings include the following: *Select all that apply* a. summaries of the evidence b. organizational experience c. consensus on appraisal scores d. community standards e. clinician experience and expert opinion f. consumer preferences

A, B, D, E, & F

Identify the correct safety measures about handling positioning devices. *Select all that apply* a. The positioning device should be of the correct size for the patient. b. Extremities once positioned should not be rearranged. c. Gel pads should be used to relieve pressure. d. Sensitive genital areas should be placed in normal anatomical position. e. Patient's arms must be supported by the arms of the surgical bed. f. The patient should be properly secured to the bed.

A, C, D, & F

According to the AORN Guideline for Safe Use of Energy-Generating Devices, which of the following are recommended components of documentation when using an ESU? *select all that apply* a. ESU brand name b. Name of the person applying the dispersive pad. c. Patient's skin condition after removing dispersive pad. d. Patient's skin condition before applying the dispersive pad. e. Serial number or biomedical number of the ESU. f. Use of a safety holster.

A, C, D, E, & F.

Based on the knowledge that you have gained about the 3 surgical zones, identify the statements that are true to these zones. *select all that apply* a. "racetrack" is a floor plan design b. The blood bank is a part of the semi-restricted zone. c. There is unidirectional traffic in the semi-restricted zone. d. the humidity in the restricted zone should remain below 50% at all times. e. Temperature in the restricted zone can be maintained at 70F. f. Air in the surgical suite is cleaned by passing through HEPA filters.

A, C, E & F

Select the correct procedural steps from the given options. *Select all that apply* a. Grasp the sterile towel near the opened corner and lift it up, taking care not to drip water on the gown. b. Stay close to the table c. Keep the towel away from the non-sterile scrub attire by bending forward slightly, keeping hands and elbows up and away from the waist. d. Let the opened towel unfold half of its length e. Use one half of the towel for one hand and arm, and the other half for the other hand and arm. f. Discard the towel without dropping the hands

A, C, E & F

What phases of the nursing process does the periop nurse practice during the preop phase of the surgical experience? *select all that apply* a. Assessment b. Evaluation c. Identification of desired outcome d. Implementation e. Nursing Diagnosis f. Planning

A, C, E, &F.

Identify the factors you would take into consideration before determining what anesthetic to use for a particular patient. *Select all that apply* a. Age of the patient b. Sex of the patient c. Physiological status of the patient d. Surgeon's preference

A, C< & D

AORN's Guidelines for Perioperative Practice provides: *Select all that apply.* a. information on administrative topics. b. mandatory regulations that must be followed. c. rationale for following the AORN Guidelines instead of regulatory standards. d. information that can be used to develop institution-specific policies e. scientific evidence for clinical practice

A, D, & E

Based on the knowledge you have gained about the lithotomy position, identify the statements that correctly describe the lithotomy position. * select all that apply* a. Nerve damage can occur to the femoral nerve. b. Lithotomy position should never be used for perineal procedures. c. The patient's buttocks should extend over the break od the table to prevent strain on the sacrum. d. Dislocation of the hips can occur if the legs are not raised simultaneously. e. Injury can occur to the fingers if they are left too close to the break of the table.

A, D, & E

Based on the knowledge that you have gained about the effects on the integumentary systems, identify the statements that are true. *select all that apply* a. Shearing accompanied by pressure, can result in a decubitus ulcer. b. Shearing can denude the epidermis. c. The prolonged exposure to skin prep solution chemicals under pressure can increase the likelihood of atopic dermatitis. d. Elderly patients at risk from shearing. e. Friction can also lead to the formation of pressure ulcers. f. Patients with arthritis are more prone to musculoskeletal stress.

A,D,E, &F

Identify which graspers should be used for the tasks listed. a. Allis clamps b. Kocher clamps c. Babcock clamps 1. To grab fascia, bones and uterine broad ligaments 2. To grasp fascia, cysts, and knee cartilage. 3. To grasp delicate bowel tissue.

A-2, B-1, C-3

Match the definition with the type of precautions listed. a. Contact precautions b. Transmission-based precautions c. Standard precautions 1. are the foundation for preventing transmission of infectious diseases in all patients across all health care settings. 2. apply to inanimate environmental sources. 3. should be used when health care providers are providing care to patients who are known or are suspected to be infected or colonized with microorganisms that are transmitted by direct contact or indirect contact. 4. are designed to be used with patients that are known or suspected to be infected or colonized with highly transmissible or epidemiologically important pathogens for which additional precautions are needed to prevent transmission in the practice setting.

A-3, B-4, C-1

Match each Term with the appropriate definition. a. disinfection b. decontamination c. sterilization d. high-level disinfection 1. The use of physical or chemical means to remove, inactivate, or destroy blood borne or other pathogens on a surface or item. 2. The process of destroying all microorganisms on a substance by exposure to physical and chemical agents; the complete elimination of all forms of microorganisms. 3. A process that destroys all microorganisms (vegetative forms of bacteria, all fungi, all viruses) with the exception of high numbers of bacterial spores. 4. A chemical or physical process of destroying all pathogenic microorganisms, except spores, on inanimate objects.

A-4, B-1, C-2, D-3

Match the special assessment needs with the type of instrument. a. To shape and cut bone b. To cut skull bones in cranial surgery c. To smooth rough bone surfaces in orthopedic surgery d. To scrape away soft tissue. 1. Rasps 2. Curettes 3. Trephines 4. Osteotomes

A-4, B-3, C-1, D-2

Data collection is part of which phase in the nursing process? a. Assessment b. Implementation c. Nursing Diagnosis d. Planning

A. Assessment

Based on the knowledge you have gained about the special assessment needs, identify the needs of the surgeries listed below. a. Ostomy placement b. Positioning requirements c. Platelet counts d. Metabolism imbalance 1. Gastrointestinal surgery 2. Thyroid/parathyroid surgery 3. Hepatobiliary surgery 4. Gynecologic surgery

A:1, B:4, C:3, D:2

Based on the knowledge you have gained, identify the position that causes each complication. a. Venous pooling in lower extremities and hypotension related to the position and the affect of anesthesia. b. Cyanosis and increased vascular load from the lower extremities to the heart and respiratory embarrassment due to decreased lung volume. c. Decrease in brainstem perfusion and decreased cardiac return. 1. Reverse Trendelenburg 2. Trendelenburg 3. Sitting/ Semi- sitting

A:3, B:2, C:1

Match each Surgical Position with its correct Physiologic Effect. a. Supine b. Trendelenburg c. Reverse Trendelenburg d. Lithotomy e. Sitting or Semi-sitting f. Prone g. Lateral Recumbent 1. Elevated blood pressure 2. Pooling of blood in the dependent limb. 3. Hypotension related to the position. 4. Increase in cardiac output. 5. Decreased cardiac return. 6. Compression of the diaphragm. 7. Potential femoral, obturator, and perineal nerve damage.

A:4, B:1, C:5, D:7, E:3, F:6, G:2

Based on your knowledge of special assessment needs, identify the needs for the types of surgery listed below. a. May be concerned with body image. b. Congenital anomalies c. Neurovascular changes d. Length of procedure 1. Orthopedic surgery 2. Vascular surgery 3. Ophthalmic surgery 4. Plastic/reconstructive surgery

A:4, B:3, C:1, D:2

A key feature of the Perioperative Patient-Focused Model is the emphasis on: outcome-driven care.

AORN's Standards of Clinical Nursing Practice: set forth the expectations of the professional role within which the nurse practices.

The linea alba is extends from ______to _________.

Above the xyphoid process to the pubis

Marie Ferrenti is scheduled for a cystocele and rectocele repair in 3 days and has come to your facility for a tour and to complete her preoperative workup. When providing patient education to Marie, which of the following points do you want to emphasize? "It's important to avoid bearing down when you're having a bowel movement after your surgery."

Adrienne Roederick is scheduled for an elective cesarean section to deliver her quadruplets. How many sponge counts can the surgical technologist and registered nurse assigned to her case expect to perform? Three

External rotation and abduction

After a total hip arthroplasty with postero-lateral approach, the patients leg should be maintained in ?

The perioperative nurse should plan to remain close to the elderly patient during induction because

Airway anatomy changes in the elderly

Hermalinda Guzman is scheduled to have a vaginal hysterectomy under general anesthesia. Which position should the circulating nurse prepare for? Lithotomy position with arms on armboards

Albert Jennings is a 325-pound patient who has just undergone a UPPP procedure. During his transfer from the OR bed to the transport vehicle to the operating bed, his skin and underlying tissue are at risk for injury because of friction and what other physical force? Shear

An endoscope is a diagnostic or therapeutic instrument that enters the body through a: Select one: a. natural orifice. b. small incision into a body compartment. c. externalized sinus tract. d. All of the options are correct.

All of the options are correct.

Identify the risk for an elderly patient with an insufflation system flow rate of 16 mm Hg.

All of the options are correct.

Lateral, lateral chest, and lateral kidney positions all place pressure on structures of the dependent side: ears, shoulder, ribs, hips, greater femoral head, knees, and ankles. The potential for injury to the patient is significant, based on these pressure areas. Which resultant injury or harm could be related to these lateral positions?

All of the options are correct.

Lateral, lateral chest, and lateral kidney positions all place pressure on structures of the dependent side: ears, shoulder, ribs, hips, greater femoral head, knees, and ankles. The potential for injury to the patient is significant, based on these pressure areas. Which resultant injury or harm could be related to these lateral positions? Select one: a. Diminished lung capacity of dependent lung b. Brachial plexus injury c. Venous pooling shifts toward dependent side with DVT in lower extremities d. All of the options are correct.

All of the options are correct.

The surgical hand scrub is designed to render the hands, nails, and arms:

All of the options are correct.

Electrophysiology

An non-Invasive procedure used to diagnose atrial and ventricular arrhytmias

Dr. Wheeler's patient, a 72-year-old man with a single early-stage liver tumor, has an implanted automatic internal defibrillator that the anesthesia provider has decided not to disarm for the procedure. What energy-generated dissection device should Dr. Wheeler use to replace the argon beam coagulator?

An ultrasonic dissector

_______________ should be the primary decision makers for what equipment and supplies are purchased and stocked in the difficult airway management cart.

Anesthesia personnel

The anesthesia department at Evergreen Medical Center has a total staff of 102 persons. These employees serve in many roles as care providers, technical assistants, materials management, clinical engineers, and clerical staff. Select the list of direct-care anesthesia providers.

Anesthesia provider, AA, CRNA

A neutral zone is a predetermined location on the surgical field where sharps are placed for retrieval by the surgeon. Which of the following is a best practice for the use of the neutral zone?

Announce the transfer of each sharp before placing it in the neutral zone.

Flat neurosurgical patties are flat sponges composed of soft compressed cotton or rayon with an embedded radiopaque element and string attached. They are often used in neurosurgical procedures. While used for hemostasis and exposure, what other use would be important in surgery?

Application of topical steroids

A 47-year-old man was admitted to the emergency department (ED) with respiratory symptoms, facial and upper body abrasions, burns, and moist lesions after a small package, delivered to his office, exploded and sprayed him dried powder and glass shards. In response to the reported mechanism of injury, the ED team sequestered him in a secluded area away from the rest of the patients. The team believed that this was highly suspicious of a bio-terrorism event. The epidemiologist was called, and the patient was transferred to a negative-pressure isolation room and placed on standard, contact, airborne, and droplet precautions. Based on these actions, which microorganism agents might be suspected to be involved?

Anthrax and smallpox

Bleeding Hx Skin integrity anxiety level continence status contraceptive Hx maternal diethylstilbestrol therapy core body temp sexually transmitted disease his/hx allergies pain/discomfort abdominal girth menstural cycle hormone replacement therapy positional considerations Rh factor status

Assessment of the gynecologic surgery patient includes:

The skin preparation for a vaginal-assisted laparoscopic hysterectomy begins _____ and _____ before and after the procedure.

At the cleanest area first and proceeds to less clean areas (abdomen then vagina/perineum); a skin assessment should be performed

Preema Chapaty is the nurse assigned to care for Fernando Leal during his ureteroscopy and stone retrieval procedure. As part of her preoperative assessment, Preema reviews Fernando's lab results. Which of the lab results listed below is a cause for concern in light of Fernando's proposed procedure? Creatinine 2.0 mg/dL

At the end of Harold Covey's TURP procedure, the surgeon inserted a three-way Foley catheter with 30-mL balloon. Why is this type of catheter used after a TURP? The catheter aids in maintaining hemostasis of the prostatic bed.

In addition to back-up electrical power in the cause of power outage, ORs may plan for outages by: *Select all that apply* a. having a generator in each hospital wing. b. identifying which outlets in the OR are connected to emergency power. c. maintaining battery-operated (flood) lights in each OR. d. routinely checking the operation and availability of back up equipment.

B, C, & D

Professional organizations and societies, as well as individual organizations, can proactively create a culture that supports patient safety through which of the following mechanisms? *Select all that apply* a. Set processes rather than standards. b. Convene and communicate with members about safety. c. Incorporate attention to patient safety into training programs. d. Collaborate across disciplines.

B, C, & D

The IOM report describes the importance of setting standards and expectations for patient safety. The report states that standards can ____________. *Select all that apply* a. help in reviewing the work of the organization. b. set expectations for health professionals. c. establish consistency across individuals and organizations. d. help set expectations of consumers and purchasers.

B, C, & D

The knowledge gained in the informal process of a teaching and learning interaction between a patient and perioperative nurse can be a simple narrative in the nursing notes, but should include the: *Select all that apply.* a. A patient's medical history. b. Content of the interview. c. Assessment data and outcomes of the assessment. d. Referrals to other disciplines.

B, C, & D

What are the overall goals of surgical positioning? *select all that apply* a. Ensure the patient is strapped in to prevent sliding. b. Provide access to monitoring devices and IV lines. c. Provide optimal exposure d. Maintain the patient's airway.

B, C, & D

Based on what you have learned about the 3 surgical phases, identify the nursing processes that are part of the intraoperative phase. *select all that apply* a. data collection b. coordination of interventions c. evaluation of nursing interventions. d. development of plans of care. e. implementation of the plan of care. f. communicate care given.

B, C, & E

Secondary intention

When a tissue defect decreases in size by wound contraction, it is designated as healing by?

Which are the major components of medical video imaging? *Select all that apply* a. Electrosurgical unit b. Fiber-optic light cable c. Verres needle d. Camera control unit

B & D

Which are the major components of medical video imaging? *Select all that apply* a. Electrosurgical unit b. Fiber-optic light cable c. Verres needle d. Camera control unit (CCU)

B & D

Which of the following forensic specimens should be placed in a paper envelope, labeled, and sealed? *select all that apply* a. Gastric contents b. Fingernails c. Pellets d. Carpet remnants e. Knives

B & D

Identify the possible adverse effects of diagnostic imaging agents: a. Chills b. Renal failure c. Hypervolemia d. Vertigo e. Cell sickling

B & E

Identify the statements that are valid for the IV induction of general anesthesia when administering total IV anesthesia. *Select all that apply.* a. Often used with children to avoid the use of a catheter b. Carried out by the action of short-acting during that are continuously infused throughout the surgery. c. Requires the administration of muscle relaxants d. is carried out using drugs such as nitrous oxide and halothane. e. is carried out using drugs such as thiopental and propofol

B & E

AORN guidelines for the time out recommend that all team members verbally verify their agreement on the following: a. The name of the surgeon b. The name of the patient c. The site of the procedure, including right/left distinction d. The procedure to be performed.

B, C, & D

Postoperative nausea and vomiting is often a side effect of the inhalational anesthetic ________ and the analgesic _______.

nitrous oxide; morphine

Based on your knowledge of medications, identify the true statements from those given below. *Select all that apply* a. Papaverine and Ringer's lactate solution can be administered safely. b. Radiographic dyes are a risk to patients allergic to iodine and shellfish. c. Radiographic dyes are instilled directly into an organ or duct with a catheter or tube. d. Miotic agents are used to reduce intraocular pressure.

B, C, & D

Carbon Dioxide is the gas used for abdominal insufflation because it: *Select all that apply* a. is not readily absorbed by the body b. is inexpensive c. suppresses combustion d. is rapidly eliminated from the body.

B, C, & D

Carbon Dioxide is the gas used for abdominal insufflation because it: *Select all that apply* a. is not readily absorbed by the body. b. is inexpensive c. suppressed combustion d. is rapidly eliminated by the body.

B, C, & D

Identify the correct radiation safety controls. *Select all that apply* a. Nonessential personnel should leave the room when radiation is being used. b. Pregnant personnel should limit radiation exposure c. During long radiation procedures, the surgical team should wear lead aprons. d. Film badges may be used for those staff members who have prolonged radiation exposure.

B, C, & D

Identify the correct statements about handling knives. *Select all that apply* a. When passing a knife, it should be carefully held using an assistive device such as a needle. b. When passing a knife, it should be carefully held between the thumb and index finger. c. When passing a knife, it is preferable to use a neutral zone rather than directly passing the knife from hand to hand. d. When passing a knife, the cutting edge of the knife should point away from the surgeon and the perioperative nurse.

B, C, & D

Identify the true statements from those given below. a. When asleep, the patient will not be affected by solutions pooling under the bedding or the body. b. It is safe to extend an incision because routine preps should be large enough to accommodate the incision. c. The risk of inadvertent hypothermia can be prevented by decreasing patient exposure during the prep and before draping. d. Solutions should not be warmed under conditions in which the temperature cannot be controlled.

B, C, & D

Select the areas of the sterile gown that are considered sterile. *Select all that apply.* a. Back of the gown from the nape of the neck to the level of the elbows. b. Gown sleeves from two inches above the elbow to the cuff, circumferentially. c. Front of the gown from the chest to the level of the sterile field d. Sleeve cuff that is covered by the sterile glove.

B & C

Select the correct steps regarding removal of the gown and gloves. *Select all that apply* a. Always remove the gloves before the gown b. Always remove the gown before the gloves c. Pull the gown from the shoulder and pull it downward to turn the sleeves inside out. d. Pull the gown from the sleeves and pull it upward without turning the sleeves inside out.

B & C

The _________ should be sterile during a surgical procedure. *select all that apply* a. biohazard personnel b. first assistant c. anesthesia technician d. surgeon

B & C

What are the cautions and contraindications when using bone wax? *select all that apply* a. Could cause a moveable clot if placed near a vessel. b. Can act as a physical barrier that prevents bone union. c. Is contraindicated when rapid bone regeneration is desired. d. Can react with any metal hardware that is attached to the bone.

B & C

What precautions should a scrub person take during the draping procedure? *select all that apply* a. Never cuff the drapes over a gloved hand. b. Be careful not to contaminate gown when placing drapes. c. Never reach across an unsterile drape area to drape. d. Use perforating towel clips.

B & C

Which of the following actions should the scrub person perform for most specimens after receiving them from the surgeon? *select all that apply* a. Hand it off the field to the RN circulator on a radiopaque sponge. b. Keep it in a sterile basin until it can be passed to the RN circulator. c. Keep it moist with saline. d. Use a sponge to remove a very small specimen from a forceps.

B & C

Which of the following drains allows for passive drainage of fluid from the body? *select all that apply* a. Jackson- Pratt b. Penrose c. T-tube d. Hemovac

B & C

Which of the following statements are true about iodophor paints and iodophor scrubs? *select all that apply* a. A paint has a detergent additive, a scrub does not. b. A scrub has a detergent additive, a paint does not. c. A scrub is followed by a paint in a two-step prep. d. A paint is followed by a scrub in a two-step prep.

B & C

Which powered cutting instruments are used in orthopedic surgery? *Select all that apply* a. Dermatomes b. Tissue shavers c. Bone reamers d. Phacoemulsifiers

B & C

Correct surgical attire for the restricted areas include: *Select all that apply* a. Facility identification on a lanyard b. Head covering that covers all hair. c. Long-sleeved jacket with the sleeves pushed up. d. Scrub top tucked into scrub pants and warm-up jacket. e. A lab coat when leaving the department

B & D

Identify the correct ways to inform and reassure the patient and his or her family about the procedure. *Select all that apply* a. Explain all details about the procedure so that the patient has full knowledge. b. Explain the procedure in general terms. c. Explain the procedure in specific terms. d. Keep the family updated about the progress of the procedure.

B & D

In what ways should the perioperative nurse assist with general anesthesia induction? *Select all that apply.* a. Administer the muscle relaxant reversal agent if needed. b. Apply cricoid pressure of needed during intubation. c. Document anesthetic agents used, dose, route, and time. d. Remain at the patient's side to offer reassurance and promote safety.

B & D

Select the features and benefits of using a French-eye or split-eye needle. *Select all that apply* a. Can be used with any type of suture material. b. Diameter of the needle should match the type of suture used. c. Double wrapping the eye is acceptable d. Easy to thread e. Eye has a variety of shapes.

B & D

Select the statements below that are correct: *Select all that apply* a. During open assisted gloving, the team members gown sleeve is pulled down so that the gown cuff is at fingertip level. b. Closed assisted gloving should be used to glove team members during initial gowning and gloving. c. During open assisted gloving, the gown cuff of the team member being gloved remains at the wrist level. d. Scrubbed team members should wear 2 pairs of surgical gloves.

B & D

Factors that affect the patient's ability to learn include: *Select all that apply* a. hunger b. disability c. fear of dying d. pain e. self-esteem

B, C, D, & E

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

Safety measures to prevent complications or injury caused by the use of a pneumatic tourniquet include the following: *Select all that apply* a. Apply three layers of padding around the extremity at the most proximal point. b. Keep the fluids from pooling under the cuff. c. Only minimal effective pressure should be used to create a bloodless field. d. There should be a complete preoperative patient assessment. e. The cuff should properly on the patient. f. The inflation time should be monitored.

B, C, D, E, & F

Identify the correct statements about fire hazards. *Select all that apply* a. Bag valve masks should be readily available for ventilating patients with oxygen. b. There should be an evacuation plan displayed in every surgical suite. c. There can be increased anesthesia-related complications. d. Mentally competent patients older than age 10 should evacuate themselves. e. Patients should be moved out horizontally. f. The patient's medical records should be saved when possible.

B, C, E, & F

Identify the true statements about electrical safety. *Select all that apply.* a. Tightly wrap electrical cords around equipment to minimize the possibility of someone tripping. b. Back-up electrical power should be supplied to all ORs within 10 seconds. c. Do not use 3:1 wire adapters. d. Do not wipe up spilled liquid as it might hamper the electrical integrity of the equipment. e. Remove electrical cords from outlets by holding the plug, not the cord itself. f. Maintain additional battery-operated flash lights in ORs and holding areas.

B, C, E, & F

To ensure proper handling of surgical specimens, which unique identifers should the perioperative nurse verify before the patient enters the OR? *select all that apply* a. Laboratory test to be performed b. Patient's medical record number c. Patient's medical diagnosis d. Spelling of the patient's name e. Surgeon's name

B, D, & E

Identify the correct safety checks for an ESU. *select all that apply* a. When removing the plug from the outlet, pull the cord. b. The generator should be turned off after use. c. The ESU can be used in the presence of defatting agents. d. The generator and the foot switch should be protected from fluid spills. e. Power settings should be confirmed verbally between the perioperative nurse and the surgeon both before and during the procedure. f. When using multiple ESUs, the dispersive electrodes should not touch each other.

B, D, E, & F.

Based on the knowledge you have gained about the supine position, identify the correct statements. *select all that apply* a. The supine position is used only for breast surgery. b. The patient lies flat on his/her back with arms extended at a less than 90- degree angle on padded arm boards. c. Arm extension should be less than 45 degrees. d. There is an increase in systolic pressure. e. There is a decrease in the diaphragmatic expansion. f. Use a heel- suspension device to redistribute heel pressure.

B, E, & F

Which of the following statements are true about informed consent? *Select all that apply* a. Is not covered in hospital policy. b. Is a physician's duty, and RNs are witnesses to the patient's signature c. Does not expose the nurse to liability if the nurse does not follow hospital policy. d. Does not allow approved substitutes to give consent for patient. e. Must contain the name of the health care facility f. Needs to state the indication for the proposed intervention.

B, E, & F

Based on the knowledge you have gained about the surgical attire, identify the correct statements. *select all that apply* a. All hair, including beards and eyebrows, must be covered by surgical team members during surgical procedures. b. Protective gloves should be worn when removing shoe covers. c. A disposable sterile gown, once worn, can be reused. d. A mask can be reused. e. A pathologist may wear a one piece coverall. f. The mask should never dangle around the neck.

B, E, & F.

Ligament of Treitz

Band of smooth muscle extending from the junction of the duodenum to the left crux of the diaphragm and functions as a suspensory ligament

When prophylactic antibiotics are ordered for a procedure involving a pneumatic tourniquet, they should be infused:

Before the tourniquet cuff is inflated

Which actions should the perioperative nurse take in prepping an extremity when a tourniquet is used? *select all that apply* a. Drape the tourniquet with a cloth towel to keep solution from going under the tourniquet. b. Start prepping at the level of the tourniquet c. Start the prep at the incision site and extend both distally and proximally to include the entire extremity. d. Use an assistive device to support the extremity during the prep. e. Use an impervious drape to protect the tourniquet.

C, D, & E.

Low temperature gas plasma hydrogen peroxide sterilization has which of the following properties? a. Accommodates lumened instruments. b. Exhaust monitoring is required. c. Items can be stored for future use. d. No toxic residue. e. The sterilant is bactericidal, viruicidal, and fungicidal. f. Useful for items that are heat sensitive.

C, D, E & F

Select the details that should be included in the documentation. *select all that apply* a. Color of the surgical tissue implant. b. Name and social security number of the organ donor. c. Serial number of the implant. d. Expiration date e. Size, if applicable f. Type of implanted tissue g. Position of the implant

C, D, E, F, & G

The patient's hair should be covered before entering the ___________? a. Semi-restricted zone b. Unrestricted zone c. Restricted Zone

C. Restricted Zone

The purpose of the surgical hand scrub is to: *Select all that apply* a. remove the normal skin flora. b. sterilize the skin c. suppress growth of microorganisms d. remove soil and debris

C & D

What are the complications associated with laparoscopic surgery? a. Umbilical hernia b. Post surgical pneumonia c. Wound infections d. CO2 embolism

C & D

Which of the following definitions are correct? *Select all that apply* a. Assault means the actual physical act of harm. b. Battery means the threat of physical harm. c. Liable means to bind or to be responsible to or to be under obligation d. Negligence means the failure to exercise care that a prudent person would perform under the same circumstances.

C & D

Which of the following statements are correct? *Select all that apply* a. The closed glove method is used for subsequent gloving. b. The open glove method is used for the initial donning of sterile gown and gloves. c. The open method is used for subsequent gloving. d. The open glove method is used while performing sterile procedures when a gown is not worn.

C & D

Which of the following statements are true about objective data? *select all that apply* a. Data that consists of a patient's own feelings. b. Age, religion. or culture are examples of objective data. c. Data that is the information written in the patient's record and nursing notes. d. History, physical, and la data are examples of objective data.

C & D

Which of the following statements are true in relation to scrubbing for the first procedure of the day? *Select all that apply* a. Clean under your finger nails b. Consider your hands and arms as two dimensional to ensure covering all aspects when washing. c. First, wash your hands under running water with soap. d. Use an approved antimicrobial scrub agent on wet hand arms.

C & D

Aubrey Scheel is scheduled for an inguinal hernia repair. During the preoperative assessment, Aubrey mentions that his hernia is noticeable when he stands and disappears when he lies down. Based on this information, what kind of hernia does Aubrey have? A reducible hernia

Charlie Lerma is in phase II recovery putting on his clothes in preparation for discharge home. Which of the statements below indicates that Charlie understands his discharge instructions? "I should increase the fiber in my diet so I don't become constipated and strain while having a bowel movement."

The surgeon used the ESU in monopolar mode to cut and coagulate through the subcutaneous tissue on opening the abdomen during a bariatric bypass procedure. As the surgeon began to proceed through the muscle and fascia layer, she asked the circulating nurse to increase the cut and coagulation modes on the ESU. What measure could the scrub or surgical assistant person take to enhance energy delivery?

Clean the charred tissue from the active electrode blade.

The surgeon used the ESU in monopolar mode to cut and coagulate through the subcutaneous tissue on opening the abdomen during a bariatric bypass procedure. As the surgeon began to proceed through the muscle and fascia layer, she asked the circulating nurse to increase the cut and coagulation modes on the ESU. What measure could the scrub or surgical assistant person take to enhance energy delivery?

Clean the charred tissue from the active electrode blade.

2. Non- Absorbable

• Not absorbed or digested by tissue • Remain in tissue until removed

Hypoglossal Affects Speech and Swallowing

Cranial Nerve XII

Select the appropriate nursing action that supports hands-free instrument passing and sharps safety

Create a neutral hands-free area between the scrub person and surgeon with a basin or magnetic mat

Select the appropriate nursing action that supports hands-free instrument passing and sharps safety.

Create a neutral hands-free area between the scrub person and surgeon with a basin or magnetic mat.

Occulomotor- eye movement: damage can cause diplopia and the inability to coordinate eye movements

Cranial Nerve III

Trochlear- Eye Movement

Cranial Nerve IV

Glossopharyngeal Sensation, taste, salivation

Cranial Nerve IX

Trigeminal- controls muscles of chewing and provides sensation to the skin of the face

Cranial Nerve V

Abducens- eye movement

Cranial Nerve VI

Facial- Facial expression (bells palsy) Taste on Anterior 2/3 of the tongue

Cranial Nerve VII

Vestibulocochlear Balance and hearing

Cranial Nerve VIII

Vagus Affects Para Sympathetic Nervous System(PNS) Increase or decrease in B/P Recurrent laryngeal nerve is a branch: damage can cause hoarseness

Cranial Nerve X

Spinal Accessory Nerve: turning of head and shoulders, Ipsilateral weakness in the trapezius muscle.

Cranial Nerve XI

Samuel was fitted with a negative-pressure wound therapy system, also called vacuum-assisted closure, after his most recent surgical wound debridement. This device works by (SELECT ALL THAT APPLY):

Creating mechanical tension on the tissues and pulling wound edges together

Although cryosurgery is used primarily for early stage skin cancer, it is also used in the treatment of cancers that can be found in the

Cryosurgery has been used to treat a variety of cancers, including prostate, liver, breast, bone, brain, spinal, lung, and tracheal.

What kind of needle would be used on the skin?

Cutting

To follow the AORN guidelines for positioning the patient, the perioperative nurse should: a. depend on the patient's natural defense mechanisms to indicate the need for positioning alternations. b. rely on the surgeon's and anesthesia professional's assessments to guide positioning. c. use a consistent method of procedure-specific positioning for each patient. d. use additional precautions as appropriate based on unique patient considerations.

D. use additional precautions as appropriate based on unique patient considerations.

The potential for development of a direct inguinal hernia is

When a weakening or a tear in the aponeurosis of the transversus abdominis and the transversalis fascia occurs,

Observing for facial movement

When assisting on a parotidectomy, what is your primary concern as an RNFA?

Which of the following is considered a critical periop nursing diagnosis with the PNDS? a. Impaired tissue integrity b. Pain c. Risk for fluid volume deficit d. Risk for perioperative positioning injury

D. Risk for periop positioning injury

Alfred Eichelberger has a liver abscess secondary to a diverticular abscess. He underwent a percutaneous drainage that was unsuccessful. He is now scheduled for surgical drainage of the abscess. What approach is the surgeon likely to use to drain Alfred's abscess? Transperitoneal

David Linscomb has a diagnosis of cholelithiasis and is scheduled for a cholecystectomy with an intraoperative cholangiogram. What data can be gained from the cholangiogram? Visualization of the gallbladder to determine the number and size of stones

Skeletonization

Dissecting excess tissue from around the uterine vessels for secure clamping is?

Hyperressonance

When percussing, what sound is considered normal for a patient with emphysema?

Excision of the uterus from the superior aspect to the uterine vessels

During LAVH surgery where is the uterus excised from?

liver

During abdominal surgery, too much pressure on the ___________ can cause blood loss or even death?

A nurse gathers data on a patient's past medical history, allergies, and current medications. What phase of the nursing process is being used in these activities? Assessment

During the admission interview, a patient tells the nurse she is afraid she will not wake up after the surgery. A possible nursing diagnosis is: Fear related to unknown outcome of surgery.

According to a 2010 article published in The Journal of the American College of Surgeons and citing data from a 1998 study, where do more that half of needle-stick injuries involving suture needles occur?

During the suturing of fascia or muscle tissue

inspection auscultation palpation percussion

When performing a physical assessment of the abdomen, what is the correct order of the assessment skills?

angled toward the sternum

When placed in the prone position, female breasts should be?

Is it acceptable to enter restricted areas of the OR suite without a mask as long as the individual remains greater than 10 feet away from open sterile items?

False

True or False: Adolescents can hide body jewelry from their parents. This is a face that perioperative nurses need to be aware of, and nurses should therefore question adolescents about body jewelry in front of their parents to ensure full disclosure.

False

True or False: During the assembly process, instruments should be placed in a specifically designed container that restricts the penetration of the sterilizing agent and prevents the trapping of air.

False

True or False: If children see that their parents trust the nurses and doctors, they will have absolutely no fear of surgery.

False

True or False: It is up to the health care organization's administrative body to handle all cultural issues, especially ethical dilemmas.

False

True or false: A surgical mask provides adequate protection when entering the room of a patient who requires airborne precautions.

False

True or false: The perioperative RN is legally responsible for obtaining the patient's informed consent.

False

True or false: When performing closed assisted gloving, you should pull the gown cuffs up over your wrists toward your elbows and then don the gloves.

False

Which of the following is incorrect pertaining to the CSF?

a. It returns to the venous system by passing into the vertebral venous plexuses.

Which of the following is a personal monitoring device for radiation exposure? Film badge

Howard Pearson is an RN who has been experiencing symptoms of redness, dryness, itchiness, and cracking on both hands. He notices that the symptoms seem to be worse on busy days when he changes gloves more frequently. Howard visits a dermatologist and learns his symptoms are related to latex exposure. Based on Howard's symptoms, what type of reaction is he experiencing? Irritant contact dermatitis

Which of the following wound closure suturing methods will require the scrub person to prepare the fewest number of individual sutures? Continuous suture

How are clamps differentiated? By their jaws

Hyperglycemia

Impaired leukocyte function can be a result of?

What impairments can contribute to surgical site infections

Impaired wound healing

Compartment syndrome

Increased pressure in one of the body's compartments that results in insufficient blood supply to tissue, most common in arms or legs

40-50

Normal HCT

An interventional radiology procedure used to open a blocked or narrowed blood vessel as a result of atherosclerosis

Percutaneous transluminal angioplasty

Aerobic organism( Staph, Strep, Pseudomonas)

Organism that needs O2 to survive?

he largest part of the mammary gland rests on the

Pectoralis major muscle and serratus anterior

Traumatic deaths may occur in three phases, or time frames. The first phase occurs immediately after the injury, the second phase within the first 1 to 2 hours after the injury, and the third phase occurs days to weeks after the injury. Approximately 30% of total fatalities from trauma could be prevented with definitive trauma care, including appropriate and aggressive resuscitation with rapid transport to an appropriate facility. Which phase, or timeframe, of potential for trauma death, does this group represent?

Phase II

Jordan Gribbins, a 69yo pipe smoker with a history of cardiac disease and atrial rhythm disturbance, is scheduled for a supratentorial craniotomy and is securely positioned in a semisitting position. The surgical assistant and anesthesia provider have discussed the anesthesia plan and Mr. Gribbin's surgical and anesthesia risks, and agree that he is at risk for venous air embolism (VAE). Sequential compression devices have been placed on both legs. Pulmonary lines have been placed and the surgical assistant has prepared an area for preparation of TEE, if needed. During the procedure, Mr. Gribbins reacted with decreases in arterial pressure and endtital CO2. Precordial "washing machine" sounds emanated from the Doppler. What two action should the surgical assistant anticipate as a possible next response?

Reposition the pt in left lateral decubitus position to entrap air in the right atrium

A 68-year-old, American Society of Anesthesiologists (ASA) physical status (OS)-2 male with early-stage prostatic cancer, was intubated and positioned for a robotic-assisted laparoscopic radical prostatectomy. The initial position for insertion of the trocars was supine with arms tucked and secured within under-mattress sled arm positioners padded with gel. His hands were placed in a natural position with the fingers wrapped around gauze rolls and touching his lateral thighs. The new anesthesia provider, who had never seen a robotic prostatectomy, was concerned about anesthesia implications when the patient would be repositioned into extreme Trendelenburg for the dissection and anastomosis. The circulating nurse assured her that they would implement protective measures and work together to ensure the best patient outcome. Select all of the potentially harmful effects of extreme 45-degree Trendelenburg in a robotic procedure.

Respiratory compromise and ventilation resistance Shearing injury to soft tissues

Pilar Slayton has just undergone a modified radical mastectomy. Her wound was closed in layers, a drain was placed, and staples were used on the skin. Provided there are no untoward events in her postoperative course, what type of wound healing can Pilar expect? Healing by primary intention

Review the statements below and select the statement that is true about the anatomy of the skin. The dermis is the largest portion of the skin.

Contact with infected patients or infectious material places healthcare workers at risk for occupational-acquired infection. Which communicable disease are healthcare workers at risk for acquiring or transmitting?

Seasonal influenza

There are many factors that influence surgical wound healing. Some are helpful and some are beyond the scope of the surgical team. Select the response below that reflects a factor with high influence over wound healing and is within the control of the surgical team.

Selection of wound closure materials, dressings, and drains

A desired anesthesia experience for a child is an anesthetic agent that offers a rapid and smooth induction with good relaxation, followed by rapid emergence. Which of the listed inhalational agents is the best choice for pediatric anesthesia?

Sevoflurane

Many factors have contributed to the evolution and progressive growth of ambulatory surgery. Select the three anesthetic agents that promote fast induction, rapid emergence, and minimal side effects and have been credited as a significant factor in this trend.

Sevoflurane, propofol, desflurane

The hospital epidemiologist was alerted when several cultures had recently revealed suspicious similarities. He was concerned about two unrelated patients with similar abscesses in similar body regions. Susan, a 72-year-old diabetic patient taking immunosuppressive medications for chronic Crohn's disease, had an incision and drainage of a perianal fistula. Shawn, a healthy 22-year-old college student and motocross racer, had an incision and drainage plus excision of a pilonidal cyst. Both patients cultured out a new subtype of S. aureus. Susan's specimen results showed a significant colony growth of S. aureus plus differential growth of coagulase-negative S. epidermidis, while Shawn's specimen was a high colony growth coagulase-positive, similar subtype of S. aureus. The epidemiologist charged his department to be alert for this S. aureus subtype and cross-check for trends. He was most concerned about one of these patients in particular and pulled up the medical record for review. Which patient may be at higher risk with the more virulent strain and why?

Shawn because he has a high microbial load that is coagulase positive

Which of the following medications is a specific depolarizing muscle relaxant than can produce generalized fasciculations?

Succinylcholine

study comparing tep and tapp techniques.

b. mesh infection rate was low with both techniques d. there was no apparent difference in teh rate of hernia recurrence

Wound tissue healing is enhanced by the use of stapling instruments that mechanically apply internal staples for ligation and division, resection, and anastomoses. What feature of the mechanical process reduces tissue manipulation, edema, and inflammation?

The non-crushing B shape of the staples allows nutrients to pass through.

Surgical site infections (SSIs) account for 14% to 16% of all hospital-acquired infections. Surgical assistants are responsible for understanding the factors that contribute to SSIs and preventive measures. Which of the following is a true statement about preparation of the patient?

The patient should be required to bathe or shower the night before surgery.

The perioperative nurse puts on scrubs in preparation for the first procedure of the day. She dons her bouffant hat and warm-up jacket and heads into the lounge where she meets the charge nurse. The charge nurse asks the perioperative nurse to please tuck in her hair before she leaves the lounge. The nurse retorts, "Why? This is okay. There are just a few strands showing. The doctors wear those skull caps all the time and their hair hangs out!" Is the perioperative nurse basing her belief that this is okay on her *personal inference* or *on evidence*?

The nurse is using personal inference. Evidence shows that hair acts as a filter when left uncovered and collects bacteria un proportion to its length, curliness, and oiliness. Shedding from hair has been shown to affect surgical wound infections.

The transplant team received the liver from the procurement team moments after it arrived by medical air lift

The patient should have been held in preoperative holding until the liver was split and the second segment placed back into the coole

The order of tissues from the surface of the abdomen to the abdominal cavity is: skin, subcutaneous tissue, muscle, fascia, peritoneum.

The small intestine: consists of the duodenum, jejunum, and ileum.

absorbable

The suture used to ligate a uterine artery is always a _______________ suture?

Uterine tubes ovaries uterine ligaments

The term "adnexa" refers to the?

The primary purpose of the surgical hand scrub is: to reduce the number of microorganisms on the nails, hands, and arms.

The term asepsis means the absence of infectious organisms.

During ventriculoperitoneal shunt placement,

The unit is soaked in NS & antibiotic solution, never lubricated.

Which glove lubricant, used to facilitate easy donning, is considered a best practice?

The use of powder as a glove lubricant is not recommended

Internal iliacs

The uterine arteries branch from the?

Head Shoulders Elbows Back Sacrum Coccyx Heels

There is increased risk of pressure to what areas in the supine position?

Monofilament

What type of suture is used in vascular procedures?

Exposure to blood-borne pathogens occurs during all phases of the perioperative process. Observing safety precautions during all phases of surgery, from setup to cleanup, reduces the number of injuries and exposures for all OR personnel. For the prevention of sharps injuries in the pre-procedure and post-procedure phases, which safe handling practices reflect appropriate nursing actions?

Use standardized sterile field setups throughout the surgical service department. Transport reusable sharps in a safe, closed container to the decontamination cleanup area. Do not place hands or fingers into a container to dispose of a device. Inspect the sharps container for overfilling before discarding disposable sharps in it.

Observing safety precautions during all phases of surgery, from setup to cleanup, reduces the number of injuries and exposures for all OR personnel. For the prevention of sharps injuries during the perioperative phase, which risk reduction strategy reflects appropriate nursing action

Use standardized sterile field setups throughout the surgical services department.

Pin prick to pinky (3rd,4th,5th fingers affected with ulnar nerve injury)

Used to diagnose injury to ulnar nerve

Describe the best practice for aseptic removal of sterile gloves after removal of the sterile gown at the end of the procedure. Select the best practice to protect the wearer from cross-contamination.

Using the gloved fingers of one hand to secure the everted cuff, remove the glove, turning it inside out. Discard appropriately. Using the ungloved hand, grasp the fold of the everted cuff of the other glove and remove the glove, inverting the glove as it is removed. Discard in biohazard trash. Remove mask by the ties and discard. Wash hands.

Recommendations for preventing retained surgical items include all of the following EXCEPT:

Utilizing a multidisciplinary team to resolve incorrect counts

skin periosteum bone

What type of tissue is a cutting needle used on?

Select the appropriate order for administering blood and blood products.

Verify informed consent for blood, verify patient identification and blood type and unit numbers against blood tag and requisition slip with second licensed person, sign slips

Which of the following associations is incorrect pertaining to the blood supply of the brain

Vertebral arteries --- supplies the occipital lobe

Increased ICP

What will recovery be watching for in a patient that just had head surgery?

titanium rods

When CO2 laser is being used to vaporize intra-abdominal adhesions, inadvertent beam contact with the underlying tissue can be avoided by using?

eggs

What allergy does anesthesia need to be aware of if using Diprovan?

What work-related injury or illness is responsible for the most lost work time, need for protracted medical care, and permanent disability among healthcare workers? Musculoskeletal disorders

What component of a successful slips, trips, and falls prevention initiative has the most impact on reducing the incidence of slips, trips, and falls in the healthcare environment? Providing education to healthcare workers about the importance of preventing slips, trips, and falls

the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system

What does CVP reflect?

Clinical sign of hypocalcemia

What does Chvostek sign indicate?

Cephalosporins

What group of antibiotics poses the greatest potential for cross-sensitivity?

Collagen is produced wound tensile strength increases granulation tissue forms, Healing is evident with sub tissue being replaced by soft skin and connective tissue

What happens during the Proliferative stage of wound healing?

Checking for gallbladder/liver pain

What is Murphys sign an assessment for?

Fundus of the stomach is wrapped 360 degrees around the base of the esophagus or the lower esophageal sphincter

What is a Nissen Fundoplication?

Pancreatitis

What is associated with common bile duct stone?

Hernia reoccurance

What is indicative of firm, tender, globular, irreducible swelling in the groin or abdomen?

respiratory system

What is most vulnerable when the patient is prone position?

Circle of Willis

What is the blood supply to the brain and surrounding structures?

Superior Thyroid Artery

What is the most inferior of the 3 anterior branches of the carotid arteries?

Good Surgical Technique

What is the number one non-pharmacologic way to prevent a post-op infection?

Granny knot

What kind of knot does not ensure that tissue will be held together and vessels remain closed is the ?

Dull sound

What kind of sound would be produced by percussing over the liver?

Suprascapular nerve

What nerve originates in the brachial plexus and can cause shoulder , chest and arm pain if damaged?

Collagen fibers reorganize and tighten to reduce scar tensile strength increases

What occurs during the Remodeling(maturation) phase of wound healing?

Group B strep

What organism causes rapidly progressive erythema and tenderness to develop in wound edges early in the post-op course?

Allen Stirrups

What piece of equipment helps with supporting the legs while in lithotomy position giving access to the perineal and rectal area?

Trendelenberg

What position is the patient placed in, in order to gain increased exposure to the uterus?

Ureters

What structure do you need to be aware of while doing a hysterectomy?

Urinary bladder

What structure lies anterior to the uterus and cervix?

The cornea of the uterine tubes

What structure mark the end of the fundus and the beginning of the corpus?

Any tissue that is easy to penetrate: peritoneum fat muscle most fascia bowel dura vessels

What the of tissue is a Taper needle used on?

Indwelling Catheter

What type of catheter is used when performing a prostatectomy?

Pfannenstiel Incision

Which incision would be chosen for a TAH for its superior cosmetic results?

Common facial nerve

Which nerve is usually ligated when dissecting for a carotid endarterectomy?

Which of the following is true about sharps? Sharps should be handled with a "hands-free" approach.

Which of the following abbreviations is acceptable to use in perioperative documentation? IV Not IU, MS or MSO4

When a laser is used, there are three predictable absorptive reactions that occur and result in tissue alteration. Review the list below and select the correct set of reactions. Photochemical, photothermal, photoacoustic

Which of the following accurately describes the modes used for electrosurgery in the OR? Monopolar and bipolar

Why must facilities have policies and procedures in place to meet requirements of the Health Insurance Portability and Accountability Act (HIPAA)? To protect the privacy and confidentiality of the patient's health information

Which of the following represents a sentinel event that would be reported to The Joint Commission? Retained sponge

Which of the following diagnoses would be an indication for laparoscopic splenectomy? Hemolytic jaundice

Which of the following statements about pancreaticoduodenectomy is true? Pancreaticoduodenectomy is the removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the lower half of the common bile duct.

What action describes the inflammatory phase of wound healing? Leukocytes fight bacteria by phagocytosis.

Which of the procedures below would be classified as a Class II wound? Laparoscopic appendectomy for uncomplicated appendicitis

Direct Hernia

Which type of Hernia occurs inside Hesselbachs Triangle

absorbable

Which type of suture creates the greatest tissue reaction?

Serratus anterior nerve thoracodorsal nerve

While doing an axillary dissection be aware of?

To prevent rectus diastasis

Why do some surgeons choose to approximate the rectus abdominus muscles?

To create enough space to prevent compression of vessels and nerves in the brachial plexus

Why is an axillary roll used during lateral positioning?

They are contaminated with vaginal flora

Why would instruments be isolated from the sterile field during a hysterectomy?

Which type of staplers are used in the alimentary tract and in thoracic procedures? a. Linear staplers b. Intraluminal circular staplers c. Skin staplers d. Ligating and dividing staplers

a. Linear staplers

The OR is a danger-prone area for both patients and staff. Providing a safe environment of care for the patient involves identifying, mitigating, and managing the hazards inherent in surgical care. Choose the answer below that completes the blanks in this sentence: The risk of the surgical hazard of ______ can be mitigated through _______.

Wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists

Direct complications of a knot coming untied are: a. Evisceration b. Dehiscence c. Loss of assisting opportunities d. Infection

a and b

Which of the following medications is typically administered intravenously? a. Morphine sulfate b. Tetracaine c. Renografin d. Glycine 1.5%

a. Morphine sulfate

Personnel radiation monitoring is an important part of radiation exposure safety. Select the statement that best describes the proper placement of the personal radiation dosimeter.

a. On the trunk under the apron and at the collar level outside the apron

Choose the *FALSE* statement regarding intravenous regional anesthesia (Bier's block). a. After a procedure is over, the perioperative nurse should leave the cuff fully inflated for at least 60 minutes. b. Intermittently deflating and re-inflating the cuff for several cycles after the procedure is over may help minimize peak blood concentration of the local anesthetic and reduce the risk of a systemic toxic reaction. c. Central nervous system abnormalities are usually the earliest warning signs of a systemic toxic reaction during intravenous regional anesthesia. d. Before applying a pneumatic tourniquet, nurses should screen patients for sensitivities to local anesthetics and communicate with the anesthesia professional to confirm the plan for intravenous regional anesthesia.

a. After a procedure is over, the perioperative nurse should leave the cuff fully inflated for at least 60 minutes.

Nurses who think critically are constantly aware of context, culture, and environment. Which of the following statements is true about these critical thinking components? a. All three apply to the clinical setting, the health care system, and the patient, are affected by values and beliefs. b. These are completely unrelated components to be treated separately. c. They reflect unexamined values and beliefs of staff members and patients. d. None of the above are true.

a. All three apply to the clinical setting, the health care system, and the patient, are affected by values and beliefs.

Which method is used to prevent aspiration during endotracheal intubation? a. Applying cricoid pressure b. Inserting a nasal/oral airway c. Laryngoscopy d. Invasive techniques

a. Applying cricoid pressure

Which is an example of cultural competency in the perioperative setting? a. Assisting a patient who needs to wear a head covering for religious reasons. b. Practicing your second language with a bilingual patient. c. Working primarily with patients from one's own background. d. Explaining to patients why their beliefs about health are incorrect.

a. Assisting a patient who needs to wear a head covering for religious reasons.

Trina Gasterson, a 7-year-old girl recovering from a successful kidney transplant, is visited by her perioperative nurse on her day of discharge. While they conversed, Trina's mother opened a bottle of herbal supplement tablets from a local nutrition and dietary supplement store, whose label the nurse recognized

a. Astragalus, licorice, and echinacea

A broad range of implant materials are used in plastic and reconstructive surgery. Select the implant that represents a biologic composition of a surgical implan

a. Autologous human tissue

How can health care providers BEST protect themselves from contracting pertussis? a. Being vaccinated b. Using proper cough etiquette c. Following respiratory hygiene practices d. Following airborne precautions

a. Being vaccinated

______________ current leaves the generator, is applied to tissue using a two-poled instrument, and returns to the generator. a. Bipolar b. Monopolar

a. Bipolar- the current flows between the tips of the two-poled instrument and back to the generator.

Fiberoptic transmission is not possible for the beam produced by the: a. CO2 laser b. Nd:YAG laser c. Ho:YAG laser d. argon laser

a. CO2 laser

What is the best way to be sure the family members/support persons are well cared for? a. Call them in the surgery waiting room to inform them of the patient's progress b. Give them the patient's room number and ask them to remain there. c. Show them where the cafeteria is. d. Tell them the precise time the patient will be out of surgery.

a. Call them in the surgery waiting room to inform them of the patient's progress

Which of the following physiological effects is most likely to result from positioning a patient in the lithotomy position? a. Circulatory and respiratory compromise due to pressure on the abdomen. b. Circulatory pooling in the lower legs. c. Decreased brainstem perfusion. d. Pressure on the brachial nerves.

a. Circulatory and respiratory compromise due to pressure on the abdomen.

Which of the following factors make geriatric patients more sensitive to injury and cold? a. Decrease in subcutaneous fat. b. Decrease in lung capacity. c. Bilirubin and hemoglobin shift. d. Decreased range of medication absorption.

a. Decrease in subcutaneous fat.

Select the statements that best reflect the benefits of laser surgery for the surgical services department. SELECT ALL THAT APPLY. a. Decreases postoperative scarring that could lead to stenosis. b. Reduces operative and anesthesia time. c. Sterilizes tissue from the heat generated at the laser-tissue impact site. d. Allows a shift to more ambulatory surgery procedures.

a. Decreases postoperative scarring that could lead to stenosis. c. Sterilizes tissue from the heat generated at the laser-tissue impact site. d. Allows a shift to more ambulatory surgery procedures.

Which of the following statements about ethylene oxide (EO) sterilization is true? a. EO exposure is potentially carcinogenic and mutagenic to personnel and patients. b. It cannot be used for heat-sensitive items. c. It is effective against prions. d. Items processed by EO sterilization may be used immediately.

a. EO exposure is potentially carcinogenic and mutagenic to personnel and patients.

Which type of anesthesia involves an injection into the space between the ligamentum flavum and the dura? a. Epidural anesthesia b. General anesthesia c. Spinal anesthesia d. Bier block

a. Epidural anesthesia

The single most important factor in preventing the spread of infection is: a. Hand hygiene b. cleaning all horizontal surfaces c. patient's hygiene d. none of the above

a. Hand hygiene

What is the primary strategy for reducing hospital-associated infections? a. Hand hygiene b. Environmental controls c. Standard precautions d. Wearing PPE

a. Hand hygiene

Select the dressing that would be used if the goal were hydration of tissue. a. Hydrogel b. Gauze c. Biologic d. Occlusive

a. Hydrogel

What major artery supplies the descending colon?

a. Inferior mesenteric

Most glove- related skin reactions are of this type: a. Irritant contact dermatitis b. immediate Type 1 hypersensitivity. c. delayed type 4 hypersensitivity d. delayed allergic contact dermatitis.

a. Irritant contact dermatitis

Camilla Armstrong, a 59-year-old woman with multiple prior cardiac procedures for congenital cardiac anomalies at birth, is scheduled for an open approach coronary artery bypass graft. During the preoperative interview and assessment, the perioperative nurse reviewed Camilla's hematologic tests, including a detailed coagulation profile to uncover possible hemorrhagic disorders. During the assessment the nurse learned of Camilla's many varied co-morbid conditions, including prior vascular procedures, fibromyalgia, diabetes, and eczema. The nurse noted one of Camilla's many nursing diagnoses as: Risk for Bleeding related to surgical incision(s), tissue dissection, altered coagulation function, and inadvertent hypothermia. As a result of this diagnosis, the nurse implemented measures to have blood available, measure and report blood loss, assist with the use of the autotransfusion system per protocol, and have topical hemostatic agents available. The patient will be free from excessive bleeding as evidenced by (select all that apply):

a. chest tube drainage less than 100 mL/hr.

Patients in which of the following age groups have the greatest blood volume per unit of body weight? a. children b. elderly adults c. middle adults d. young adults

a. children

Disassembly, cool-water rinse, enzymatic wash, and use of appropriate detergent are principles used in: a. decontamination b. steam sterilization c. high-level disinfection d. gas plasma sterilization

a. decontamination

Both ears provide stereophonic hearing that gives us very specific hearing capabilities. Binaural hearing makes it possible for:

a. determination of the source location of sounds

A designation of "4-0" on a suture package indicates the suture material's: a. diameter b. elasticity c. pliability d. strength

a. diameter

When an Nd:YAG laser beam is passed through a KTP crystal, the interaction between the laser light and the crystal lattice: a. doubles the frequency of the laser energy b. halves the frequency of the laser energy c. doubles the wavelength of the laser energy. d. doubles the amplitude of the laser energy.

a. doubles the frequency of the laser energy

Choose the INCORRECT statement. Proper sterile technique: a. eliminates all microorganisms in the OR. b. is key responsibility of perioperative personnel c. helps prevent health care-associated infections in patients and medical professionals. d. includes wearing gowns, gloves, and surgical masks whose barrier performance is appropriate for the specific procedure being performed.

a. eliminates all microorganisms in the OR.

Transient microorganisms live in the ________ layer of the skin. a. epidermal b. dermal c. fatty (adipose) d. all of the above

a. epidermal

Marla, the perioperative nurse circulating for a skin contracture release of the ear on a 5-year-old boy, transfers 0.25% bupivacaine via syringe to the scrub person's sterile back table. The scrub person, Jake, questions why she is not giving him bupivacaine with epinephrine, since there may be bleeding expected at the incision site. Marla's reply to Jake is based on the fact that:

a. epinephrine is contraindicated in areas with limited vascularity, such as the ears

The adrenal glands lie retroperitoneally beneath the diaphragm, capping the medial aspects of the superior pole of each kidney. The adrenal medulla secretes ______________ while the adrenal cortex secretes ____________ and ____________.

a. epinephrine; steroids and hormones

The anterolateral abdominal wall consists of an arrangement of muscles, fascial layers, and muscular aponeuroses lined interiorly by peritoneum and exteriorly by skin. The key landmark of the _____________ designates the roof of the inguinal canal and the key landmark of the __________ designates the floor of the inguinal canal.

a. external oblique aponeurosis; transversalis aponeurosis and fascia

Areas of a sterile gown that should be considered sterile include the: a. front of the gown from the chest level to the sterile field. b. back of the gown c. neckline, shoulders, and axillary regions. d. entire sleeves of the gown.

a. front of the gown from the chest level to the sterile field.

Fuel sources in the operating room include: a. gauze sponges b. floor glue c. ceiling tile d. scrubs e. surgical instruments

a. gauze sponges

While the pancreas' function is carbohydrate metabolism with the production of insulin and digestive enzymes, the spleen's function is primarily ___________ with the production of _______________.

a. immunologic; leukocytes

An intramuscular injection into the buttocks is most safely done:

a. into the superolateral quadrant.

Matthew Ryan, a 9-year-old boy, is admitted to the emergency department for a sledding accident, when he lost control of his sled and crashed into a tree. He is pale and in pain; his abdomen is tender and firm to palpation. The CT scan suggests rupture of the spleen with internal bleeding. Matthew's scheduled surgery will most probably be a/an:

a. laparoscopic splenic resection with sutured mesh overlay

The flash point of flammable materials is _____________, while the flash point of combustible materials is ________________. a. less than 100 degrees F, greater than 100 degrees F. b. Greater than 100 degrees F, less than 100 degrees F. c. Equal to 100 degrees F, greater than 100 degrees F. d. less than 120 degrees F, greater than 120 degrees F. e. Greater than 120 degrees F, less than 120 degrees F.

a. less than 100 degrees F, greater than 100 degrees F.

Symptoms of toxicity of anesthetics include: SELECT ALL THAT APPLY.

a. metallic taste c. tinnitus d. numbness of tongue

Under the res ipsa loquitor rule, health care providers being sued for malpractice a. must prove that they were not negligent and that the injury occurred for other reasons. b. supplant the facility as master when working as independent contractors. c. are not liable if they acted within the legitimate scope of their authority. d. are presumed innocent until prove otherwise.

a. must prove that they were not negligent and that the injury occurred for other reasons.

Surgical site infection (SSI) is a dreaded complication of surgery. Knowledge of both risk factors and effective interventions is important for preparing the patient for surgery and preventing infection. Which of the following discussion topics might be especially important between an advanced beginner and the preceptor? 1. Susceptibility to infection (pt history of immunosuppression, type 2 DM, hepatic disorders, renal failure, alcoholism.) 2. Immune status (expected range of WBC within normal limits 3-30 days after surgery) 3. Clinical factors (proposed length of procedure, wound class, prophylactic antibiotic infusion) 4. Situational factors (exposure to community-acquired infectious agents, lack of immunizations, limited personal hygiene, chronic diseases)' a. 1, 2, 3 b. 1, 3, 4 c. 1, 2, 4 d. All of the above

b. 1, 3, 4 not 2 because it refers to a postoperative measurement

Check the statements below that are correctly pertain to a sterile field: 1. Sterile fields should be prepared where they are used but can be moved if appropriately draped. 2. The sterile field should be prepared for only 1 patient at time. 3. Only sterile items should come in contact with the sterile field. 4. Two patients may occupy the OR or procedure room at the same time as long as all OR personnel are wearing appropriate attire. a. 1 and 3 b. 2 and 3 c. 2 and 4 d. 3 and 4

b. 2 and 3

A perioperative nurse experienced in general, orthopedic, and neurosurgery has started a preceptorship in the CV service. What aspects of the CV service should be especially emphasized by the nurse's preceptor? 1. Electrosurgical safety, preoperative medication history. 2. Location of vascular implants and devices. 3. Advanced cardiovascular anatomy and physiology, surgeon preferences. 4. Common cardiovascular procedures, possible complications and related potential safety risks. a. 1, 3, 4 b. 2, 3, 4 c. 1, 2, 4 d. all of the above

b. 2, 3, 4

Which surgical patient is MOST likely to develop a hospital-associated infection? a. 30 y.o., healthy patient undergoing knee arthroscopy b. 4 y.o. patient with leukemia undergoing port placement. c. 75 y.o. patient with asthma undergoing bladder cystoscopy d. 64 y.o. patient with diabetes undergoing craniotomy

b. 4 y.o. patient with leukemia undergoing port placement.

When does the body's reaction to the suture material start? a. Days after the suture insertion b. At the time of insertion c. Months after the suture insertion d. Weeks after the suture insertion

b. At the time of insertion

How does the perioperative nurse test the patient's level of understanding? a. By checking to see whether the patient feels knowledgeable enough to sign the consent. b. By asking questions about the procedure and evaluating the answer. c. By offering reassurance. d. By returning at another time to test recall.

b. By asking questions about the procedure and evaluating the answer.

The most frequent location for a cerebral aneurysm is the ______.

b. Cerebral arterial circle

If the surgeon continuously asks for higher power settings, what is the first action that the perioperative nurse should take? a. Get another ESU unit immediately. b. Check the circuitry for possible disruption. c. Switch to a bipolar generator and electrode. d. Change the active electrode and dispersive electrode.

b. Check the circuitry for possible disruption.

Which agents are effective in removing resident microorganisms? a. Mechanical agents b. Chemical agents c. Biochemical agents d. Hydrostatic agents

b. Chemical agents- resident microorganisms require chemical methods to eliminate them and prevent regrowth for a period of time.

In which surgical wound category should a total abdominal hysterectomy be classified? a. Clean b. Clean contaminated c. Contaminated d. Dirty

b. Clean contaminated

This orthopedic diagnosis is a complex deformity that is diagnosed prenatally through ultrasound or at birth. It may occur unilaterally or bilaterally and may be idiopathic or one in a combination of other syndromes with associated anomalies. The general characteristic for all cases includes inversion of the foot such that the anterior foot is located in the typical position of the posterior foot; often there is a deep crease in the midfoot. Select the orthopedic diagnosis.

b. Clubfoot

Droplet precautions include all of the following *except*: a. Donning PPE b. Consulting with the risk manager c. Placing a mask on the patient during transport. d. Placing the patient in a single-patient room. e. Using an isolation room for the patient.

b. Consulting with the risk manager

Select the true statement about application and operation of the pneumatic tourniquet.

b. Cuffs should overlap a minimum of 3 inches and a maximum of 6 inches; excess overlap can pinch skinfolds. A tourniquet cuff that is too short can loosen after inflation.

The acid base effects of pneumatic tourniquet deflation following a period of inflation are characterized by: a. Elevated PaCO2 with respiratory acidosis and metabolic acidosis. b. Elevated PaCO2 with respiratory acidosis and metabolic acidosis. c. Decreased PaCO2 with respiratory alkalosis and metabolic acidosis. d. Decreased PaCO2 with respiratory alkalosis and metabolic alkalosis.

b. Elevated PaCO2 with respiratory acidosis and metabolic acidosis.

Which of the following is important in maintaining the separation of clean and dirty equipment? a. Moveable equipment from outside the operating room is only wiped down after the procedure. b. Equipment areas should be clearly marked as either clean or contaminated. c. Dirty equipment is transported alongside clean equipment. d. Movement of dirty equipment usually flows in a circular pattern.

b. Equipment areas should be clearly marked as either clean or contaminated.

At what age can a child benefit from the following activities: investigate, lay a hand on, come into contact with, and check out medical supplies? a. Eight b. Four c. Seven d. Three

b. Four

Which bloodborne pathogen is vaccine preventable? a. HIV b. Hepatitis B c. Hepatitis C d. None of the above

b. Hepatitis B

What is the most frequently cite root cause of sentinel events? a. Effective communication b. Ineffective communication c. Medical staff errors d. Nursing errors

b. Ineffective communication

The capacity of a suture to regain its former shape after being reformed is known as ____________. a. elasticity b. memory c. knot tensile strength d. capillarity

b. memory

Marvin Townsend is a 29-year-old man with paraplegia caused by spinal cord injury from a diving accident 4 years ago. He is transported into the trauma ED after being hit by a car as he was crossing the street in his wheelchair. He has a possible rupture of his liver and is scheduled for surgery. The perioperative nurse, on response to the trauma call, meets him in the ED to conduct a preoperative assessment and prepare for his procedure. Marvin tells the nurse that he is latex-sensitive because he was told that as a spinal cord injured person he should always be considered latex-allergic. An appropriate risk reduction strategy for Marvin's latex sensitivity/allergy would be to:

b. alert the OR and postoperative recovery areas of his latex allergy, check the setup for latex-containing items, and replace those items with non-latex alternatives

Patient confidentiality is NOT breeched when the: a. preoperative nurse tells the family that the patient is overweight. b. circulating nurse reminds the PACU nurse that the patient has Alzheimer's c. pre-admission nurse asks the CNA over lunch if Mrs. Smith's extreme anxiety delayed her procedure. d. surgeon interviews the pre-operative patient in the presence of strangers without asking the patient.

b. circulating nurse reminds the PACU nurse that the patient has Alzheimer's

Movement routes of soiled equipment should be a. the reverse of those of clean equipment b. clearly marked c. include a central holding area d. concurrently located with the clean supply room.

b. clearly marked

Obtaining informed consent is a two-step process of: a. weighing the benefits and burdens of treatment options. b. communicating information and documenting the decision. c. determining patient competency and authenticity of the signature. d. communicating the plan of care and reaching a decision.

b. communicating information and documenting the decision.

Adolescents tend to have varied reactions to surgery, including all of the following EXCEPT: a. anger b. cowardice c. depression d. willfulness

b. cowardice

When preparing for pars plana vitrectomy in the posterior segment, the perioperative nurse must be aware that a combined scleral buckling procedure may be necessary. Other important information the perioperative nurse should know before preparing the OR for the procedure includes the location of the ocular problem, the surgeon's plan to address the problem, and the instrumentation and biomedical equipment and devices to be used. Technologic advances in ophthalmic surgery require that perioperative nurses be familiar with complex biomedical equipment. A best practice, stated below, relevant to the safe use of complex equipment would be:

b. demonstrate competence with equipment and check each piece carefully before the patient arrives in the OR.

Laparoscopic instruments with small, blunt tips are used for ____________. a. cutting tissue b. dissecting tissue c. grasping tissue d. moving tissue from one place to another.

b. dissecting tissue

Maintaining the sterile field does NOT include: a. scrubbing hands and forearms for at least two to five minutes. b. donning a surgical gown selected from the sterile instrument table. c. double-gloving and wearing masks. d. holding the hands above the elbows after the scrub.

b. donning a surgical gown selected from the sterile instrument table.

IN the course of the preoperative assessment, the perioperative nurse should: a. obtain informed consent from the patient b. ensure that a signed informed consent is in the patient's chart. c. explain the risks and alternatives of the planned procedure. d. all of the above for this information.

b. ensure that a signed informed consent is in the patient's chart.

The __________ assists the surgeon is suturing, ligating, and other tasks required during the procedure. a. scrub person b. first assistant c. anesthesia assistant d. RN circulator

b. first assistant

Chlorhexidine gluconate (CHG) is a antimicrobial skin prepping agent used : a. above the neck b. for topical skin application only below the neck. c. for vaginal or mucous membrane preps. d. in the brain or meninges.

b. for topical skin application only below the neck.

When taking off the gown at the end of the case, the gloves' cuffs usually turn down as the sleeves pass off the arms. The wearer removes the gloves using which of the techniques listed below? a. pull off by fingers of each gloves. b. glove-to-glove then skin-to-skin c. open-glove technique. d. Scrubbed person's choice if gloves are not too dirty.

b. glove-to-glove then skin-to-skin

Accurate information about a patient's care, treatment services, current condition, and any recent or anticipated changes as the care of the patient is transferred from one health care provider to another is a. aggressive communication. b. hand-off communication c. time-out communication d. none of the above.

b. hand-off communication

Risk management: a. is intended to place blame on individuals responsible for adverse effects. b. helps identify root causes of events and prevent their re-occurrence. c. helps identify risks to prevent adverse events before they occur. d. b and c

b. helps identify root causes of events and prevent their re-occurrence.

Immediate-use steam sterilization can be used: a. for implants b. in an urgent situations c. under no circumstances d. for all items

b. in an urgent situations

The superior mesenteric artery:_____

b. is accompanied by the superior mesenteric vein on its right.

Marla Moriarity, a 32-year-old recently unemployed and uninsured college professor, is diagnosed with an early ectopic pregnancy. Her obstetrician has given her the option of surgical or medical therapy. She is well-informed about the details of each medical and surgical option, but her primary concern about her condition is that her decision will be based upon her strong cultural belief system that will not sanction the destruction of the fetus. Marla's treatment decision will most likely be:

b. laparoscopic injection of methotrexate to the extrauterine gestational sac.

The information given by a patient during the assessment interview: a. is always assumed to be correct b. may not always be correct and should be checked against another source if there is any question about its accuracy. c. should always be checked against another source. d. must be accepted; there is no other source for this information.

b. may not always be correct and should be checked against another source if there is any question about its accuracy.

Michael has pulled a case following Dr. Cortez's preference card exactly. If he is thinking critically, what should he do to be sure the scrub person has what is needed for Mr. O'Malleys procedure? a. Nothing- if he followed the card precisely, they should be set until they open. b. Use the time out pause to ask what else Dr. Cortez needs. c. Assess the patient and record for indicated actions. d. Both B and C

c. Assess the patient and record for indicated actions. Meticulously following a procedure card is like meticulously following a checklist or recipe without thinking critically. While the "time out" is a time for critical reflection, it is not the time to gather anticipated data needed. Michael should assess the patient and his history to relate those data to his own knowledge of the anticipated procedure in order to individualize the patient's care.

What precaution should be taken when microfibrillar collagen is used as a hemostatic agent intraoperatively? a. Antibiotics must be administered concurrently because of increased risk of wound infection. b. Moisten or wet agent to achieve hemostasis. c. Avoid using it with an autologous blood salvage unit. d. Protamine sulfate should be available as a reversal agent.

c. Avoid using it with an autologous blood salvage unit.

NOT appearing on the pre-admission nurse's questionnaire is the patient's" a. History of allergies b. limitation in movement c. BP and HR d. surgeon's name

c. BP and HR

Sponges counts are done for the following reasons *EXCEPT*: a. To account for sponges used on the surgical field. b. To prevent injury to a patient by a retained foreign body. c. Because state laws require specific count procedures.

c. Because state laws require specific count procedures.

In which type of electrosurgery is the current confined to the tissue between the poles of the instrument? a. Monopolar b. Laser c. Bipolar d. Electrode

c. Bipolar

In most health care facilities, who is reponsible for accounting for all sponges, needles, sharps, and instruments before an operative procedure begins and before and incision is closed? a. The RN circulator b. The scrub person c. Both are responsible d. Neither are responsible

c. Both are responsible

An abdominal perineal resection, or APR, for a patient at high risk for colon cancer without anal/rectal involvement (e.g., familial adenopolyposis [FAP]) can be accomplished through an open laparotomy or laparoscopic-assisted ileoanal pull-through approach, per surgeon preference and appropriate patient selection. Which of these statements about approaches for APR is correct?

c. Both procedures require only an abdominal skin incision(s) as the rectal segment is removed and anastomosed intraluminally

A percutaneous method of instituting femoral vein-femoral artery CPB can be used for minimally invasive (or conventional open) procedures and in emergency situations where the environment is not conducive to traditional CPB methods. Select all the areas where percutaneous CPB would be indicated.

c. Cardiac catheterization unit and intensive care unit

Atraumatic forceps are most often used in ____________. a. Abdominal surgery b. Plastic surgery c. Cardiovascular surgery d. Endoscopic procedures

c. Cardiovascular surgery

These types of sponges provide blunt dissection as they absorb fluids: a. Neuro-patties b. Laparotomy sponges c. Cherry dissectors d. Radiopaque sponges

c. Cherry dissectors

Identify the category in which acute appendicitis or choleystitis is classified. a. Class 1- Clean wounds b. Class 2- Clean contaminated wounds c. Class 3- Contaminated wounds d. Class 4- Dirty or infected wounds

c. Class 3- Contaminated wounds

Conflict may be effectively managed when both parties have some of their needs met in a "win/win" strategy. Which of the following best describes a "win/win" strategy? a. Accommodation b. Avoidance c. Collaboration d. Compromise

c. Collaboration

_____________ recommend prompt cleanup of items stained with blood, tissue, or body fluids. a. Manufacturer guidelines b. Local, state, and federal regulations. c. Confine and contain principles. d. Hospital specification.

c. Confine and contain principles.

Which of the following is included in the AORN "Recommened Practices for Traffic Patterns in the Perioperative Setting"? a. Educating staff about wound classifications b. Limiting the number and type of procedures performed. c. Developing policies and procedures for traffic patterns for patients, personnel, and supplies. d. Standards for redesigning the practice settings.

c. Developing policies and procedures for traffic patterns for patients, personnel, and supplies.

When is the closed glove technique used? a During a surgical procedure. b. During insertion of an IV cut down c. During the initial donning of sterile gown and gloves only. d. When changing one or both gloves.

c. During the initial donning of sterile gown and gloves only.

_______________ is the information, or data, on which a conclusion might be based. a. Logic b. Knowledge c. Evidence d. Judgment

c. Evidence

Which of the following statements is correct regarding hair removal from a surgical patient? a. Hair should be removed from the surgical site before any surgical procedure. b. Hair should be removed from the surgical site by using clippers or razors. c. Hair should be removed from the surgical site only when the hair is so thick that it will interfere with the procedure. d. All of the above.

c. Hair should be removed from the surgical site only when the hair is so thick that it will interfere with the procedure.

One of the most effective ways to prevent disease transmission and control infections in health care settings is: a. Cough etiquette b. Effective cleaning of health care surfaces c. Hand hygiene d. Use of PPE

c. Hand hygiene

Which of the following is *NOT* a common physiologic effect of pneumatic tourniquet deflation following a period of inflation during surgery? a. Hypotension b. Decreased heart rate c. Increased core body temperature d. Decreased core body temperature

c. Increased core body temperature

Which of the following is incorrect for the cricoid cartilage?

c. It is an attachment of the vocal ligaments

In rare instances, which premedication is given IM to highly uncooperative or combative children? a. Clonidine b. Diazepam c. Ketamine d. Midazolam

c. Ketamine

Jordan Gribbins, a 69-year-old pipe smoker with a history of cardiac disease and atrial rhythm disturbance, is scheduled for a supratentorial craniotomy and is securely positioned in a semisitting position. The perioperative nurse and anesthesia provider have discussed the anesthesia plan and Mr. Gribbin's surgical and anesthesia risks, and agree that he is at risk for venous air embolism (VAE). Sequential compression devices have been placed on both legs. Pulmonary lines have been placed and the nurse has prepared an area for preparation of TEE (transesophageal electrocardiography), if needed. During the procedure, Mr. Gribbins reacted with decreases in arterial pressure and end-tidal CO2. Precordial "washing machine" sounds emanated from the Doppler. What should the perioperative nurse anticipate as a possible next response?

c. Reposition the patient in left lateral decubitus position to entrap air in the right atrium.

Critical thinking is required to deliver safe patient care. Why is this statement true? a. Anyone can be taught to safely perform the scrub role for a surgical procedure. b. Safe care is assured by carefully following checklists. c. Safe care requires teamwork and care tailored to the individual patient. d. Safe care is legally required

c. Safe care requires teamwork and care tailored to the individual patient.

Identify the marginal boundaries of the breasts

c. Second to sixth rib and horizontally from the lateral edge of sternum to anterior axillary line

The Joint Commission defines a(n) ____________________ as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. a. Adverse event b. Near miss c. Sentinel event d. None of the above

c. Sentinel event

What response is the result of tissue layers moving on each other? a. Pressure ulcers b. Maceration c. Shearing d. Friction

c. Shearing

Which of the following skin closure products involve the use of liquid polymers? a. Skin clips b. Skin closure dressings c. Skin adhesives d. Skin closure strips

c. Skin adhesives

____________ needles are in continuity with the suture material. a. French eyed b. Eyed c. Swaged d. All of the above

c. Swaged

What action below is the best course when a hair is found in an instrument try on the back table? a. Using a sterile clamp, the scrub person should remove the hair and pass it off to the RN circulator. b. The scrub person should pass off the entire instrument tray and request another. c. The entire sterile field should be broken down and a sterile field reestablished. d. The scrub person should pass off the instrument tray and change gown and gloves.

c. The entire sterile field should be broken down and a sterile field reestablished.

Which of the following "AORN Position Statement on Correct Site Surgery" statements is true? a. Family members should not be involved in identifying the correct site. b. The surgical site should be marked with a washable marker. c. The staff member should verbally verify the correct site with each member of the surgical team. d. Wrong site surgery is most common in ophthalmologic procedures.

c. The staff member should verbally verify the correct site with each member of the surgical team.

Acoustic neuromas arise from the Schwann cells of the vestibular portion of the eighth cranial nerve and are benign tumors. What is the postauricular incisional approach that offers the best chance of saving the integrity of the facial nerve?

c. Translabyrinthine

Many gynecologic conditions and diseases cause chronic pelvic pain. Both surgical and nonsurgical therapies include invasive manipulations. Select the least invasive treatment option for chronic pelvic pain that is recommended by the Agency for Healthcare Research and Quality (AHRQ).

c. Trigger point injections and acupuncture

Which of the following practices should be used to implement The Joint Commission's Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery? a. Asking the patient to mark the correct surgical site with an "X". b. Asking the patient to verify the expected procedure in writing. c. Using a time-out procedure before beginning the procedure d. using three unique patient identifiers.

c. Using a time-out procedure before beginning the procedure

When using the posterolateral incisional approach, which muscles are retracted anteriorly to expose the femoral fracture site

c. Vastus lateralis and vastus intermedius

Which of the following terms is TRUE for the health care provider treating a patient who requires contact isolation? a. Wear an isolation gown, gloves, N95 respirator b. Wear isolation gown, gloves, and mask c. Wear an isolation gown and gloves for all patient contact d. Wear an isolation gown and gloves only of contact with body fluids is expected

c. Wear an isolation gown and gloves for all patient contact

The proper device for the disposal of blades, needles, stapling devices, pins, and cautery tips should be: a. a kick bucket b. proper bags c. a sharps disposable d. impervious biohazard waste receptacles.

c. a sharps disposable

When donning a surgical gown, it is permissible to a. stand next to the instrument table. b. grasp the outside back of the gown with your scrubbed hands. c. accept help from an unscrubbed perioperative team member, so long as the helper touches only the inside of the gown. d. don the surgical gloves first, and then the gown.

c. accept help from an unscrubbed perioperative team member, so long as the helper touches only the inside of the gown.

Which of the following procedures for isolation technique, also known as bowel technique or contamination technique, is NOT recommended? a. when practicing, single setup, segregate all instruments, towels, and other items (e.g. Mayo stand, basin) that have contacted the bowel lumen to a designated area. b. begin isolation technique when the gastrointestinal tract is transected, and end it when anastomosis is complete. c. after announcing the change to clean closure, ensure that the entire scrubbed team leaves the sterile field and changes into sterile gown and gloves at the same time. d. a health care facility should develop and follow standardized procedures for bowel isolation technique to reduce errors and improve efficiency among perioperative team members.

c. after announcing the change to clean closure, ensure that the entire scrubbed team leaves the sterile field and changes into sterile gown and gloves at the same time.

open with large tissue defect, at time infected having extensive loss of cells and tissues the wound is not approximated by surgical sutures but is left open

characteristics of 2nd intention wound healing

delayed primary closure occurs when two granulated surfaces are approximated. The traumatic surgical wound is debrided and purposely left open to heal by second intention for approximately 4-6 days

characteristics of 3rd intention wound healing

The child inhales the favorite flavor while drifting off to sleep. This complementary therapy falls within the category of:

clinical aromatherapy

Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral, and __________nerve, which can result in injury from _________.

common peroneal; full leg pneumatic compression sleeves

he external ear, which includes the auricle (or pinna) and external auditory canal, is composed of cartilage covered with skin. The primary function of the auricle is to

concentrate and conduct incoming sound waves into the external auditory canal.

While assisting during a surgery, a team member observes that an instrument in a set is clamped shut. The rest of the instruments in the set are unclamped, as expected. The chemical sterilization indicators have changed as expected. The team member has already passed other insturments in the pack to the surgeon. To take corrective action, the team member should: a. unclamp the instrument b. use a sterile sponge or towel to pick up the clamped instrument and set it aside, then continue using the rest of the pack. c. set the instrument and the rest of the pack aside, and discuss the event with the team when the procedure is over. d. remove the entire set and any other instruments the set may have come in contact with; change gloves; and notify the team right away, so that additional corrective steps can be taken if needed.

d. remove the entire set and any other instruments the set may have come in contact with; change gloves; and notify the team right away, so that additional corrective steps can be taken if needed.

All of the following statements apply when drying hands and arms *except* a. bend over slightly from the waist. b. begin drying with the hand and move up the arm. c. dry thoroughly to avoid skin irritation. d. roll the towel before discarding into the appropriate container.

d. roll the towel before discarding into the appropriate container.

Communication can best be defined by: a. active listening, eye contact, and touching. b. asking questions, seeking answers, and speaking rapidly. c. non-verbal gestures, facial expressions, or tone of voice. d. sharing of information between individuals or groups.

d. sharing of information between individuals or groups.

The nominal hazard zone for laser use is the: a. area outside the maximum permissible exposure. b. area within 3 feet of the surgical field. c. distance from laser delivery device to the target tissue. d. space where direct, scattered, or reflected laser radiation exceeds maximal permissible exposure.

d. space where direct, scattered, or reflected laser radiation exceeds maximal permissible exposure.

The transition zone in which an individual enters an unrestricted area wearing street clothes and exits into a semi-restricted area wearing surgical attire is usually the: a. the recovery b. anesthesia work room c. clean supply room d. staff locker room

d. staff locker room

Effective forms of perioperative documentation related to patient education combine: a. patient data, outcomes, and nursing interventions. b. nursing diagnosis, patient outcomes, and evaluation. c. a narrative note with referrals. d. teaching protocols, objectives, and outcomes.

d. teaching protocols, objectives, and outcomes.

In the perioperative environment, the message must come across to patients arriving for surgery that: a. the patient should dispense with any preconceptions about surgery. b. the surgical team has all the patient's information it will need. c. all equipment, staff and supplies are ready and waiting in the OR. d. the patient is at the center of all we do.

d. the patient is at the center of all we do.

In the OR, on the draped back table, only: a. the table front and surface are sterile. b. the area from two inches below the table surface and up is sterile c. the circulating nurse counts and positions instruments on the surface. d. the surface is considered sterile.

d. the surface is considered sterile.

All of the following are appropriate practices to manage oxidation sources in the OR *EXCEPT*: a. administer the lowest concentration of oxygen needed to maintain adequate oxygen saturation. b. use a laryngeal mask or ET tube if the patient needs more than 30% supplemental oxygen. c. ensure that there are no leaks in the anesthesia circuit. d. turn the warmer blower off when using a warming blanket with an attached head drape. e. prevent oxygen from accumulating under drapes.

d. turn the warmer blower off when using a warming blanket with an attached head drape.

During laparoscopic surgery, perioperative RNs can reduce the chances of capacitive-coupling injuries by: a. using a combination of insulated and non-insulated instruments. b. using a coagulation waveform and a high setting. c. using metal and plastic cannulas together. d. using the lowest power settings and the low voltage cutting waveform.

d. using the lowest power settings and the low voltage cutting waveform.

Health care facilities should have ________________ for disruptive behavior. a. high tolerance b. limited empathy c. no understanding d. zero tolerance

d. zero tolerance

Terminal cleaning and disinfection of the operating room should be done

daily when the areas are being used

a possible benefit to the paramedian incision

decreased risk for hernia

A 49-year-old female long-distance runner with dysfunctional uterine bleeding was scheduled for a hysteroscopy. During the procedure, sterile saline was used to expand the intrauterine compartment and enhance visualization. The infiltration to the uterus and fluid collected as drainage from the uterus was monitored. The first assistant was concerned that approximately 500 ml of fluid was unaccounted for. The motive for this surveillance was to:

determine the potential for intravascular uptake of fluid or third spacing.

Which statement best reflects the appropriate purpose of a surgical drain?

drains can prevent the development of deep wound infections

Identify the best practices to be followed when performing environmental sanitation. *Select all that apply.* a. When cleaning spills of blood or any other potentially infectious material, use gloves and any other PPE that is appropriate to the task. b. Visibly soiled operating room equipment, furniture, and floors should be cleaned with a hospital-grade germicide. c. Infectious waste should be segregated from noninfectious waste in the general waste stream. d. Color coded or labeled bags should be used to facilitate separation of the various wastes. e. All of the above

e. All of the above

Identify the true statements about patients' rights: *Select all that apply.* a. The patient must be fully informed about the procedure before given consent. b. The patient must give consent to the treatment in the absence of coercion. c. The patient has the right to withdraw consent at any point in the procedure. d. The patient must be mentally competent in order to give consent to the procedure. e. All of the above

e. All of the above

Select the correct statements about inspecting hands and arms before scrubbing. *Select all that apply* a. The skin on the hands and forearms should be inspected for cuts and abrasions. b. The skin must be free of open lesions or cracks c. The fingernails should be short, clean, and healthy d. The cuticles should also be clean and in good condition. e. All of the above

e. All of the above

Which of the following pose a fire risk during a laser treatment? a. Pooled prep solution b. Increased oxygen concentrations of the air c. Standard endotracheal tubes d. None of the above, if standard precautions are taken e. All of the above pose a fire risk

e. All of the above pose a fire risk

Which PPE should a perioperative nurse wear to care for a patient who requires droplet precautions? a. Isolation gown, gloves, and isolation mask. b. Isolation gown, gloves, and N95 respirator. c. Isolation gown and gloves only d. Surgical gown, gloves and surgical mask e. Either A or D

e. Either A or D

Which of the following is incorrect pertaining to the umbilicus?

e. The umbilicus is in the L1 dermatome.

Examples of ignition sources include: a. electro cautery units and active electrosurgical electrodes b. fiber optic light cords c. lasers d. A and C e. a, b, & c

e. a, b, & c

Appropriate surgical attire for the scrub person includes: *Select all that apply* a. headgear that covers all hair. b. protective eyewear c. a face mask d. shoes that provide protection e. all of the above

e. all of the above

Identify the ways in which a perioperative nurse can improve professionally based ion the various sources of information. *Select all that apply* a. Attending continuing education conferences. b. Reading perioperative journals c. Visiting the AORN website d. Attending AORN chapter meetings e. all of the above

e. all of the above

Perioperative nurses can enhance their professionalism by: *Select all that apply* a. learning from perioperative textbooks. b. participating in their facility's continuing education activities. c. using ARON's online resources d. attending AORN chapter meetings. e. all of the above

e. all of the above

Professional nurses seek to support and encourage their peers by: *Select all that apply.* a. mentoring b. role modeling c. providing periodic feedback on clinical performance. d. precepting e. all of the above

e. all of the above

A sterile includes which of the following? a. the site surrounding an incision or tissue perforation. b. the site where an instrument has been introduced into a body orifice that has been prepared for a surgical or other invasive procedure. c. working areas, furniture and equipment covered with sterile drapes and drape accessories d. personnel in sterile attire. e. all of the above.

e. all of the above.

Which of the following is not correct pertaining to the cavernous sinus?

e. contains the mandibular division of the trigeminal nerve

which of the following associations is correct

e. pancreatic cancer-rarely metastasizes

Immunizations and testing for health care workers should include all of the following *except*: a. hepatitis B b. immunity to measles, mumps, and rubella. c. tetanus toxoid d. seasonal influenza e. shingles

e. shingles

Marrisa is a 6 yo girl with full-thickness burns involving both lower legs, circumferentially, excluding her feet, over less than 2% of her body surface area (BSA) and partial thickness burns over less than 15% of her BSA, after her clothes caught fire during a camping trip when she stepped into the campfire. Based on the american burn association and the rule of 9s classifications, Marissa's burns would be classified as _____________ with a burn surface area percentage of approximately _______________

minor; 9%

Hypotension is a blood pressure reading that is 20% less than the patient's normal baseline pressure. Hypovolemia is the most common cause of postoperative hypotension; however, hypotension may also be caused by cardiac dysfunctions. Which of the following cardiac conditions will present with hypotension?

myocardial infarction, myocardial tamponade, and pulmonary embolism

Characteristics to Consider:

o Monofilament - single thread/Multifilament - several threads braided together o Tensile strength (How hard can the material be tugged before it breaks? Want good tensile strength) o Absorbable - Suturing inner layer/Non-absorbable - Suturing skin or outer layer o Capillary vs Non-capillary (Capillarity: how well the material will support the movement of fluid along that material - High capillarity in infection = more likely to harbor or keep that infection along the wick and in the wound. So if suturing wound, they choose suture material that has less capillarity. o We would choose something that's high in capillarity because of its other characteristics. We don't want capillarity, but its characteristics will be beneficial) o Stimulate minimal tissue reaction o Knot security (How secure will the knots stay

Type is chosen based on:

o Preference of the veterinarian o Mechanical properties o Biologic interactions

A) Non-cutting (atraumatic)

o Round cross section, tapered point o Don't cut tissue, spread it around needle o Used for soft tissue - abdominal organs, fat and muscle

What does the Package contain?

o Sizes o Brand Names o Mono or Multifilament o Absorbable/Non absorbable o Shape of suture needle and whether or not it's taper or sharp o Type of needle o Colour of material (some is dyed and some is not. To differentiate between suture material during surgery. Visibility against tissue.) o Length of material

Which of the following statements reflects the location of the arcuate line

one third of the distance between the umbilicus and the symphysis pubis

Matthew, a 9 yo boy, is admitted to the emergency department for a sledding accident, when he lost control of his sled and crashed into a tree. He is pale and in pain; his abdomen is tender and firm to palpation. The CT scan suggests rupture of the spleen with internal bleeding. Matthew's scheduled surgery will most probably be a(n)

open total splenectomy

While tucking the arms at the sides of the patient in supine position offers comfort, safety, and easy access to the patient by the scrubbed team, improper positioning and securing of the arms can result in significant injury. Injury can be avoided by tucking the draw sheet _____ the arm and under the ______.

over; body

While tucking the arms at the sides of the patient in supine position offers comfort, safety, and easy access to the patient by the scrubbed team, improper positioning and securing of the arms can result in significant injury. Injury can be avoided by tucking the draw sheet _____ the arm and under the ______.

over; body

A patient was transferred to the postanesthesia care unit (PACU) by the anesthesia provider and perioperative nurse. A hand-off report was given, using situation, background, assessment, recommendation (SBAR) format, to the accepting PACU nurse. The first element of information that should be presented in the hand-off report is:

patient identification and procedure performed.

A swab of a fluid collection from an edematous, red, and separating postoperative wound is sent to the microbiology lab for culture, sensitivity, and Gram stain. The surgeon expects that the result will show a gram-positive coccus. This Gram stain designation is based on the:

physical and chemical properties of the cell wall.

The ideal suture material is one that has handling characteristics such as

pliability

Reverse trendelenburg with table tilted to the left.

positioning for a Lap chole?

Somatosensory evoked potential (SEP) monitoring assesses neuromuscular transmission pathways during procedures where ischemia may occur because of surgical manipulation, resulting in sensory and motor function. This surveillance is most often employed in:

posterior spinal fusion.

As defined by the American College of Surgeons (ACS), the surgical assistant may provide aid in all of the following functions that help the surgeon carry out a safe operation with optimal results for the patient, EXCEPT _____.

postoperative evaluations

Central Venous Pressure (CVP)

pressure of the blood in the thoracic vena cava near the right atrium of the heart?

The perioperative nurse practitioner received a call from a patient 2 days after she was discharged to home. The patient related that her drains were not working or drawing in fluid, and she had red, hot-to-touch skin and swelling around the left drain exit site. She also noted some yellowish fluid seeping around the drainage tube that smelled bad. What indications convinced the nurse practitioner that the patient followed her postoperative teaching?

the patient communicated the appropriate descriptive information about her incision

Franklin hardy with mulitple moles skin lesions

the perioperative nurse recognized his signs and symptoms of bupivicaine and lidocaine toxicity and began immediate treatment with airway support.

True statements regarding blunt needles include all EXCEPT _____.

they are only used on liver tissue

E) Nylon (monofilament or multifilament)

• Synthetic • Advantages o Minimal tissue reaction; inexpensive o Non-capillary (monofilament) • Disadvantages o Poor knot security o Requires 5-6 knots to secure • Uses: Skin sutures

Suture Sizes

• Refers to the diameter of the material • Smaller suture sizes expressed in "0" sizes • The more zeros (i.e. the higher the number in front of the zero) the smaller the suture material • For example, 2-0 is larger than 6-0 • Suture sizes greater than 0 are expressed as numbers • The larger the number, the larger the diameter of the suture material • For example, #4 is larger than #2 material

2. Shape of Needle Body

• Straight or curved • Straight driven through tissue by hand • Curved require needle drivers • Most common - straight, half curved, ½ circle, 3/8 circle

G) Polypropylene (monofilament)

• Brand name - Prolene • Advantages o Good strength o Greater knot security than all other monofilament synthetic materials o Minimal tissue reaction • Disadvantages: Slippery to handle • Uses: Skin sutures, thick fascia, tendons

Tissue Glue Brand, Dye, Amount, Applicator Tips, Storage, & Precautions

• Brand: Vetbond • Dyed: Blue (for visibility purposes) • Amount to use: too high volume doesn't give good adherence. 1 drop is enough (sparingly) • Applicator tips: plastic tips or needle tips to help guide the small drop of glue where to go for better precision. • Storage: Fridge prolongs the life of the glue. Let it come to room temp before using. • Precautions: Be careful where it goes. Don't get it on yourself. Too much all at once = glob together and crack.

1. Absorbable

• Digested by the body • Does not require removal • Used when sutures must be buried (i.e. within a body cavity) • Animal and synthetic sources • Absorption is sped up in the following scenarios: o Highly vascularized tissue o Infected wounds o Acidic pepsin secretion from the stomach

When Would A VT Suture?

• Following dental extractions • Small uncomplicated lacerations • DVM didn't suture skin up and they get called away for emergency, we can suture the skin incision • Following Necropsy • Stay Sutures: • IV catheters will be sutured in ferrets because they dig. • Indwelling Urinary Catheters may be sutured to make sure it stays in.

4. Size

• Generally, the lower the number the larger the needle • e.g. # 0, 1, 2 are large needles; 18, 19 are small/fine needles

C) Stainless Steel Wire (monofilament or multifilament)

• Highest tensile strength of all suture material • Advantages o Greatest knot security of all materials o No inflammatory reaction of tissue • Disadvantages o Tendency to cut tissue o Can cause tissue necrosis o Cannot withstand repeated bending without breaking • Uses o Orthopedic surgery o Orthodontic surgery

B) Cotton (multifilament)

• Natural material • Example: umbilical tape • Advantages o Reasonable cost o Easy to sterilize o Less tissue reaction than silk • Disadvantages o Supports bacterial growth o Difficult to handle when wet - sticks to sx gloves • Uses: Prolapsed rectum, vagina, uterus (used for purse string sutures)

A) Silk (multifilament)

• Natural material • Not commonly used • Coated to decrease capillary action • Advantages o Inexpensive o Readily available o Retains tensile strength • Disadvantages o Supports bacterial growth o More tissue inflammation than other sutures • Uses: Ophthalmic, cardiovascular and gastrointestinal surgeries and for vessel ligation

B) Collagen (multifilament)

• Natural material • Produced from bovine flexor tendon • Same absorption as surgical gut • Prematurely absorbed and causes tissue reaction • Expensive • Used almost exclusively in ophthalmic surgery

A) Surgical Gut (multifilament)

• Natural material • Produced from sheep or hog intestine • Plain or chromic • Chromic gut treated to prolong absorption time, increase tensile strength, and decrease tissue reaction • Plain gut - absorbed in 3-5 days (generally not used due to rapid absorption and tissue reaction) • Chromic gut - absorbed in 10-15 days • Advantages o Elastic, easy to handle, will not shrink and strangulate tissues o Inexpensive • Disadvantages o Causes inflammatory tissue reactions o Harbors bacterial growth o Absorbs water & swells (loosens surgical knots