OR Practice Questions
Since its organization and establishment as a professional nursing association in the early 1950s, the Association of periOperative Registered Nurses (AORN) continues its endeavor to: a.promote guidelines influencing patient safety. b.create professional operating room (OR) nursing care delivery models. c.interpret healthcare statistics critical to perioperative nursing care. d.ensure risk reduction strategies are the foundation of perioperative education.
Answer: A AORN provides an array of standards, recommended practices (RPs), guidelines, publications, videos, and tool kits that specifically address patient safety from the perioperative team's point of view.
During a perioperative assessment, the O.R. nurse notices a red rash under the Ace bandage on the patient's wrist, and around his IV insertion site, which delivers normal saline solution. The patient complains the area is itchy and the nurse hears him wheezing. Identify the most likely problem: a. Possible latex allergy b. Bronchitis c. Hypersensitivity to IV solution d. Psychological fear of surgery
Answer: A Ace bandages and IV tubing contain latex to make them stretchy. Symptoms of latex allergies are redness, rash, and asthmatic reactions on contact. Notify the surgeon and anesthetist immediately. Bronchitis is unlikely because the patient's History and Physical showed no respiratory disease. Since wheezing began after IV insertion, its most likely cause is an allergic reaction. Normal saline solution rarely causes any type of negative reaction. Fear of surgery is common, but usually presents as anxiety.
To prevent potential chemical or thermal burns from occurring after skin antisepsis, the circulating nurse would... a.Use disposable towels to avoid pooling b.Prohibit use of alcohol-based skin cleaners c.Wipe excess cleaning solution from surgical site d.Heat cleaning solutions to decrease drying time
Answer: A Alcohol based skin cleaners are effective prepping solutions and, although flammable, do not need to be prohibited. Prep solutions are supposed to be allowed to dry to obtain optimal effectiveness. Wiping prep solutions off are counter-productive. Heating skin prep solutions may alter the chemical properties and equilibrium of the solution causing burns. However, using disposable towels to absorb run-off of solutions helps with eliminating excess solution and decreasing the potential for chemical and thermal burns.
The systematic and ongoing collection of data used to make judgements and predictions about a patient's response to illness is known as: a.Assessment b.Diagnosis c.Planning Evaluation
Answer: A Assessment is the collection of data about a patient to determine the appropriate nursing diagnosis and expected outcomes. Nursing diagnosis is a statement derived from the nursing assessment data that provides the framework for nursing interventions that enable the patient to attain specific desired outcomes. Planning or the plan of care is the result of a systematic process of identifying expected patient outcomes and determining how to achieve them through a list of interventions that may be used. Evaluation is the act of determining expected outcomes identified in the planning process. Outcome criteria indicate an expected, measurable change in the patient's health status.
After your 56 year old female patient is induced under general anesthesia for her abdominal hysterectomy you assist anesthesia personnel in padding the elbows and placing a pillow under the lower extremities allowing the heals to float. Padding the elbows protects the ______ nerve. a. Ulnar b. Brachial c. Radial d. Popliteal
Answer: A The ulnar nerve runs on the inside of the elbow. This is also protected by positioning the patient's hands palms up or thumbs up instead of palms down.
When placing the dispersive electrode on the patient, the perioperative nurse should not place it: a. Over Scar Tissue b. Near The Incision Site c. Over Muscle Mass d. Near An Active Electrode
Answer: A When a perioperative nurse is placing a dispersive electrode on a patient, he or she should take care to avoid scar tissue; it is optimally placed on the muscle to ensure good skin contact. A dispersive electrode should be placed near the operative site as it delivers the current from the generator to the active electrode at the operative site.
The surgeon's preference card calls for 0.1ml Epinephrine for every 20ml of 0.5% Ropivicaine. You have a 30ml vial of Ropivicaine. How much Epinephrine would you draw up? a.0.15 b.0.5 ml c.1ml d.1.5ml
Answer: A While you could just draw up 20ml of Ropivicaine and 0.1ml of Epinephrine, each vial is single use. To avoid waste, it is better to dispense the entire vial of Ropivicaine onto the field and calculate the correct dosage of Epinephrine.
How often should the OR be terminally cleaned, regardless of whether or not it was used? a.Each day after every 24-hour period b.There is no need to terminally clean and unused OR c.At the end of each 8-hour shift First thing in the morning and again at the end of the day
Answer: A §Terminal cleaning is defined as a thorough cleaning of all surfaces. This includes disinfecting all horizontal and vertical surfaces such as walls, kick buckets, equipment, chairs, doors, cabinets, etc. as well as disassembling the OR table and re-assembling it when dry. Terminal cleaning also involves disinfecting ancillary areas like scrub sinks and sub-sterile areas. Floors are also often cleaning by wet-vac as well. Whether a room has been used or not, it needs to be terminally cleaned every day.
Which of the following are essential aspects of the patient's preoperative checklist for surgery? § a.Patient identification, operative consent, and allergies b.Patient address and telephone number, chest x-ray results, and urine output c.Patient insurance information, personal effects, and laboratory results d.Both A and B
Answer: A Patient identification, operative consent and allergies are all essential components of the patient's preoperative checklist for surgery. The patient's identification typically involves their name, date of birth and hospital number. The nurse must verify that the right patient is receiving the right surgery and that they have consented to it. Allergy information is important for patient safety.
Which of the following represents a sentinel event that would be reported to The Joint Commission? a.Retained sponge b.Malignant hyperthermia c.Cardiac arrest during hip replacement d.Formalin spill of 10 mL
Answer: A TJC designated unexpected occurrences involving death or risk of serious physical or psychologic injuries as "sentinel events." Examples of sentinel events in the OR include care errors related to anesthesia; caused by medical equipment; caused by medication error; result in infection, fires, and transfusion reactions; are operative or postoperative complications; or give rise to unintended retained surgical items (RSIs) or wrong site/patient/procedure surgery.
The Perioperative Patient Focused Model presents key components of nursing influence that guide patient care. Select the statement that best describes the dynamic relationship within the model. a.The patient experience and nursing presence are in continuous interaction. b.Structure, process, and outcome are the foundation domains of the model. c.The perioperative nurse is the central dynamic core of the model. d.The interrelated nursing process rings bind the patient to the model.
Answer: A The Perioperative Patient Focused Model consists of domains or areas of nursing concern: nursing diagnoses, nursing interventions, and patient outcomes. These domains are in continuous interaction with the health system that encircles the focus of perioperative nursing practice—the patient.
The most common and natural position used for operative procedures is: a.supine. b.lateral. c.prone. d.Fowlers.
Answer: A The supine (dorsal recumbent) position is most common. The patient lies with the back flat on the OR bed. Supine is the most natural position of the body at rest and is the position in which the patient usually undergoes anesthesia.
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. a.Venous thromboembolism (VTE) b.Compartment syndrome c.Sacral syndrome d.Restless leg syndrome
Answer: A This position poses significant circulatory compromises and risks. Blood pooling occurs in the lower torso and legs, which in turn causes significant orthostatic hypotension and diminished perfusion to the brain. Venous return from the lower extremities also lessens, and such hindrance increases the threat of venous thrombosis.
All anesthetized surgical patients are at risk for unplanned hypothermia. Select the most effective preventative intervention (Select all that apply). a.Forced air warming b.Prewarming prior to incision c.Heated cotton blankets d.Ambient room air above 98.6° F (37° C)
Answer: A & B Numerous clinical trials have demonstrated that intraoperative forced air warming (FAW) is an effective intervention for preventing perioperative hypothermia.
Maintaining normothermia during surgery reduces the patient's risk of... (Select all that apply). a.Pressure Ulcers b.Infection c.Pneumonia d.Bleeding
Answer: A, B, D Patients undergoing surgery have a decreased risk of surgical site infection if they are not allowed to become hypothermic during the perioperative period. Vasoconstriction-induced tissue hypoxia may decrease the strength of the healing wound independently of its ability to reduce resistance to infection. Increased surgical bleeding and pressure ulcers have also been complications attributed to hypothermia due its vasoconstrictive effects.
The agent least likely to be responsible for anaphylaxis during surgery is: a.Isosulfan blue b.Anesthetic agents c.Latex d.Antibiotics
Answer: B Anesthetic agents, such as halothane and isoflurane, rarely cause anaphylactic reactions. Most anaphylaxis relates to antibiotics (penicillin, cephalosporins, sulfonamides) or latex. Isosulfan blue 1% (a blue dye) results in severe allergic reactions or anaphylaxis in up to 3% of those receiving the dye, commonly used for sentinel node biopsies. Typically, with IgE-mediated response (anaphylactic shock), an antigen triggers release of substances, such as histamine and prostaglandins, which affect the skin, cardiopulmonary, and GI systems. Each time the person has contact with the antigen, more antibodies form in response, so allergic reactions worsen with each contact.
When prepping the patient's skin for surgery, you should take the following precautions except? a.Make sure prep does not pool under the patient b.Make sure to avoid the incision site c.Make sure patient has no allergies to solution Make sure prep is completely dry prior to draping
Answer: B Before surgery , antimicrobial solutions are used to clean an area of the skin somewhat larger than that required for the incision. Because pooled solutions can cause chemical burns, the nurse must be sure no fluids have pooled under the patient and that the preoperative assessment include questions about allergies or sensitivities to prep solutions. All other parts of the patient's body should be covered with sterile drapes.
Your patient is having a C-Section. What would be the minimum number of overall counts you would expect to perform before the patient leaves the operating room? a.3 b.4 c.5 d.6
Answer: B Counts should be conducted prior to procedure start, after closure of every cavity and upon closure of skin. During a C-Section, you conduct a preliminary count, count upon closure of the uterus, count upon closure of the abdomen and a final skin count. The "count out for safety" and extra sponge count conducted by the GYN service is a UVA specific practice and is not a recommended guideline from AORN.
Pathogens can live on environmental surfaces for days, weeks, and even months, causing risk of transmission to patients; however, if health care providers use gloves, this reduces the risk of HAI transmission. a.True b.False
Answer: B Health care providers touch environmental surfaces and patients often, and even with the use of gloves, personnel can transfer pathogens from surface to surface and then to patients, increasing patients' risk of HAIs. Health care providers are also at risk for acquiring potentially pathogenic organisms from the patient care environment and transferring these pathogens to themselves, their homes, and their communities. Routine cleaning and disinfecting of the patient's environment has been shown to reduce the level and frequency of contamination and the risk of HAIs.
Which of the following surgical complications is unlikely to be related to improper positioning? a. Joint Dislocation b. Hypoglycemia c. Peripheral Nerve Damage d. Hypoventilation
Answer: B Improper positioning during surgery can compromise the respiratory system, the musculoskeletal system, and the neuromuscular system. Common positions include the dorsal recumbent position, with the patient flat on the back; the Trendelenburg position, where the head and body are lowered; the lithotomy position, where the feet are in stirrups and the Sims or lateral position, where the patient lies on the non-operative side. Because these positions may be maintained for long periods of time, it is possible to sustain injuries from compression of arteries, nerves, or bony prominences and the hyperextension of joints. Hypoglycemia is a complication of diabetes and not associated with surgery and anesthesia.
How do institutional standards of care, such as policies and procedures, differ from national standards, such as AORN's Standards of Perioperative Nursing Practice? a.They are written by nurses. b.They are written specifically to address responsibilities and circumstances. c.They are collaborative and collective agreement statements. d.They are rarely based on research.
Answer: B Institutional standards apply to the system or facility that develops them and can be directive about specific actions in specific circumstances; national standards provide generalized authoritative statements that can be implemented in all settings.
Informed consent is both a requirement and a patient right. The perioperative nurse's responsibility in terms of informed consent is to: a.Obtain verbal consent when the written consent is unavailable. b.Ensure that the consent is in the medical record, correct and signed. c.Withhold preoperative medication until the consent is completed. d.Review the procedure and expected outcome with the patient.
Answer: B On the patient's arrival in the OR, both the circulating nurse and anesthesia provider are responsible for verifying that documentation of the consent is in the chart, is correct and properly signed before the administration of anesthesia.
Hair removal is recommended for all surgical patients to reduce the risk for infection. a.True b.False
Answer: B Preoperative hair removal by any means is associated with increased SSI rates. According to World Health Organization guidelines hair should not be removed unless it interferes with the surgical procedure. If hair removal is required, the evidence supports the use of clippers, which cut the hair close to the patient's skin, for all sites.
Which position is associated with complications of increased intraocular pressure, corneal abrasions and retinal artery occlusion? a.Lithotomy b.Prone c.Supine d.Lateral Recumbent
Answer: B Prone and lateral positions both carry an increased risk for intraocular pressure; however, corneal abrasions, retinal artery occlusion or retinal detachment are most commonly complications resulting from improper or extended prone positioning.
Which complication or characteristic is not a risk factor for deep vein thrombosis (DVT)? a.Stroke b.Ovarian Cysts c.Varicose Veins d.Diabetes
Answer: B Risk factors for deep vein thrombosis (DVT) include age older than 50, a history of varicose veins, myocardial infarction, atrial fibrillation, cancer, ischemic stroke, previous DVT, diabetes, obesity, paralysis, and inhibitor deficiency state. A history of ovarian cysts does not increase the risk of DVT.
An injury to the patient when the skin remains stable while the tissue beneath is lifted is caused by: a. Friction b. Shearing c. Pressure d. None of the above
Answer: B Shearing results when a layer of skin remains stable while another layer beneath it is disrupted. This can occur, for example, if a patient repeatedly slides down or is improperly pulled up to a sitting position. Friction results when the skin moves or rubs across coarse surfaces, such as bed linen. Pressure injuries can result from prolonged pressure over bony prominences.
Choose the best method for confirming the exact surgical site with the patient during the perioperative assessment: a.Ask the patient to point to the surgical site, and then mark the area with a sticky note b.Ask the patient to show you where the surgery site will be, and then check if the surgeon marked it with a permanent marker c.If the patient cannot verbalize the surgical site, confirm the site with a family member or guardian, then mark the site with adhesive tape d.Check the surgical permit to confirm the proposed surgical site, then affirm correct marking
Answer: B Standard procedure is for the nurse to ask the patient, parent, or guardian to clearly point out the surgery site, and ensure the surgeon marked the same position with a permanent marker. Sticky notes and adhesive tape dislodge easily when wet with sweat, blood, and irrigation fluids. One legal requirement of the preoperative assessment is confirming that the surgical permit agrees with the patient's description of the location and type of surgical procedure. If the permit differs from the patient's description of the proposed procedure, the nurse contacts the surgeon, and confirms the proper procedure and site with both the surgeon and patient, parent, or guardian.
Your diabetic patient has a score of 10 on the Braden Scale. Her surgery will require her to be in lithotomy position for several hours. Because of her score you choose to implement these actions during the procedure except: a.Use padding to disperse potential pressure points b.Place sequential compression devices on patient's lower extremities c.Check that heels are properly seated in the lithotomy boots d.Ensure patient skin free from resting on any cords, intravenous lines or tubing
Answer: B The Braden Scale is used for Predicting Pressure Sore Risk. It consists of six categories: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Each category is rated on a scale of 1 to 4, excluding the 'friction and shear' category which is rated on a 1-3 scale. This combines for a possible total of 23 points, with a higher score meaning a lower risk of developing a pressure ulcer and vice versa. A score of 23 means there is no risk for developing a pressure ulcer while the lowest possible score of 6 points represents the severest risk for developing a pressure ulcer. While the nurse may choose to implement all of these interventions, the score on the Braden Scale has no bearing on whether SCDs should be used.
Before accepting an item to the sterile field, the scrub person is responsible for checking the: a. Color of the indicator tape b. Chemical indicator or integrator inside the package c. Wrapper for stains or wetness d. Expiration date
Answer: B The circulating nurse is a registered nurse who is responsible for the safety and health of the patient in the operating room by continuously monitoring the activities and equipment in the operating room, including the color of the indicator tape, the wrappers for stains or wetness, and expiration dates. The scrub nurse is responsible for maintaining sterile tables for instruments, the instruments themselves, and anticipating what the surgeons will need during surgery. This includes responsibility for the chemical indicator or integrator inside the packaging. The scrub nurse is also responsible for counting needles, sponges, and instruments before and after the operation to be sure they have not been left inside the patient.
Before the first procedure of the day, the perioperative nurse should do which of the following? a.Damp dust furniture, equipment, and lights with hospital-grade, high-level disinfectant registered with the environmental protection agency (EPA) b.Damp dust furniture, equipment, and lights with EPA-registered, hospital-grade disinfectant c.Damp dust furniture, equipment, and lights with EPA-registered, hospital-grade chlorhexidine gluconate D. Damp dust furniture, equipment, and lights with EPA-registered, hospital-grade alcohol
Answer: B The perioperative nurse should damp dust all environmental surfaces furniture with an EPA-registered hospital-grade disinfectant. High-level disinfectants are used to disinfect devices and instruments, not environmental surfaces. Chlorhexidine gluconate and alcohol are most commonly used as skin prep solutions.
A Metzenbaum is an example of a: a.grasping instrument. b.cutting instrument. c.retracting instrument. d.clamping instrument.
Answer: B A basic instrument set usually includes a curved Mayo scissors for dissection of heavy tissues, a Metzenbaum scissors for dissection of delicate tissues, and a straight scissors for cutting suture.
A patient was positioned, prepped, and draped following general endotracheal anesthesia induction. The team assembled to perform the time-out as described in the WHO surgical checklist. Successful employment of the time-out can only be ensured when: A.the time-out is initiated by the surgeon. B.the entire team stops and focuses active attention together. C.perioperative services has a physician champion and surgeon buy-in. D.someone simultaneously checks the patient ID band.
Answer: B All members of the team must introduce themselves by name and role and participate in sharing critical elements of care. The team includes the surgeon, anesthesia provider, and nursing staff, plus any allied or ancillary care providers contributing to the procedure when the time-out is performed.
Which of the following practices supports laser safety? a.Keeping oxygen concentrations between 31% and 45% b.Using nonreflective instruments near the site c.Keeping oxygen concentrations between 16% and 20% d.Using reflective instruments near the site
Answer: B Because laser systems are capable of concentrating high amounts of energy within very small areas, they present hazards. Safe and appropriate use of lasers is the responsibility of the entire healthcare team. Use nonreflective instruments in or near the laser-tissue impact site to decrease accidental reflection of the laser beam. Cover larger instruments, such as retractors, with wet sponges or towels to protect against reflection.
Which of the following local anesthetic agents is long-acting and may be used for epidural, spinal, or local infiltration? a.Lidocaine b.Bupivacaine c.Tetracaine d.Chloroprocaine
Answer: B Bupivacaine may be used for epidural, spinal, or local infiltration. It is long-acting, provides good relaxation, and can constrict blood vessels to reduce bleeding.
With the traditional surgical wound classification system, a surgical wound that enters into a colonized area of the body, such as the respiratory or urinary tract, is classified as: a. Class I b. Class II c. Class III d. Class IV
Answer: B Class II: Clean-contaminated wounds (risk < 10%) enter into colonized parts of the body, such as the respiratory or urinary tract.Class I: Clean wounds (risk < 2%) do not enter an area of the body that is usually colonized by normal flora.Class III: Contaminated wounds (risk 20%) have obvious inflammation but no purulent discharge. They may involve spillage of the gastrointestinal tract, penetrating wounds (< 4 hours), and/or substantial break in aseptic technique. Class IV: Dirty-infected wounds (risk 40%) show obvious inflammation and purulent discharge. There may be perforation of viscera prior to surgery and/or penetrating wounds (> 4 hours).
What is the major difference between a diagnostic endoscope and an operative endoscope? a.Diagnostic endoscopes are channeled; operative scopes are not. b.Diagnostic scopes have no channels; operative scopes are channeled. c.There is no difference in the scopes. d.Laser fibers are inserted into diagnostic scopes but not into operating scopes.
Answer: B Endoscopes are diagnostic or operative. Diagnostic scopes are for observation only and have no operating channels. The system is sealed at both ends. A diagnostic scope can be used; however, when multiple access sites are planned for the introduction of other instrumentation to perform a surgical procedure. Operative scopes are channeled to irrigate, suction, insert, and connect accessory instrumentation.
Which of the following best describes general anesthesia? a.A reversible loss of sensation in a specific region or area of the body characterized by blockage of nerve fibers to induce amnesia and analgesia. b.A reversible unconscious state characterized by amnesia, analgesia, and depression of reflexes. c.A reversible semiconscious state characterized by amnesia and analgesia. d.A reversible loss of sensation in a specific region or area of the body characterized by blockage of a nerve pathway from the spinal cord to induce amnesia and analgesia.
Answer: B General anesthesia is a reversible, unconscious state characterized by amnesia (sleep, hypnosis, or basal narcosis), analgesia (freedom from pain), depression of reflexes, muscle relaxation, and homeostasis or specific manipulation of physiologic systems and functions.
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? a.Place all sharps that will be used during surgery in the neutral zone before the start of the procedure b.Announce the transfer of each sharp before placing it in the neutral zone. c.When a sterile basin is designated as the neutral zone, have the scrub person hold the basin. d.Use the neutral zone for non-sharp instruments when it is the most convenient location.
Answer: B Guidelines for the best use of the neutral zone include the following: only one sharp at a time should be placed in the zone; if a sterile basin is used, it should be placed on the field and not held by the scrub person; transfers should be announced before a sharp is placed in the zone; the neutral zone should be dedicated to sharps only.
A patient, Mrs. Anna Jones, has arrived in the holding area. You are the circulator on duty. You should identify the patient by: a.Reading the name and age on the patient's identification bracelet and chart/consent. b.Asking the patient to give her name and one other identifier, such as birthdate, and compare this information to the patient's identification bracelet and chart/consent. c.Asking the patient, "Are you Anna Jones?" and comparing the answer to her identification bracelet and chart d.Reading the patient's name off the paper label at the end of the patient's bed, and comparing it to the patient's identification bracelet and chart
Answer: B In the holding area, the nurse should introduce him/herself. The patient should be addressed as Mr., Mrs., or Ms. - not by the first name. It is appropriate to ask the patient to state or spell his or her name. The patient should be asked his or her full name and date of birth. These, including the identification number, should be compared to the patient's identification (ID) bracelet and medical record/consent. Do not attempt identification by stating their name in your question, as this may lead to misidentification (i.e., "Are you Anna Jones?"). Reading a label off the bed is not sufficient. A person's age isn't an identifier.
Which blood type is appropriate for emergency untyped/uncrossmatched transfusion? a.A- b.O- c.O+ d.B-
Answer: B People with type O- blood are often called universal donors because they can give blood to any other blood group. People with type AB+ blood are called universal recipients because they can receive blood from any other blood group.
Why must facilities have policies and procedures in place to meet requirements of the Health Insurance Portability and Accountability Act (HIPAA)? a.To protect patients from unauthorized surgical procedures while under anesthesia b.To protect the privacy and confidentiality of the patient's health information c.To bar healthcare industry representatives from the OR d.To ensure a source of payment to cover the cost of a surgical procedure
Answer: B Protection of privacy is an integral patient right. The federal HIPAA was enacted in 1996 and had several objectives including a patient's right to privacy and confidentiality. There are limitations on use and disclosure of patient information.
A 325-pound male patient is undergoing a 6-hour abdominal procedure. While asleep and intubated, the surgeon requests the patient to be placed in lithotomy position for a sigmoidoscopy before the open portion of the procedure. The patient is positioned with a lift sheet, sliding him down toward the foot of the OR bed. After the sigmoidoscopy, the perioperative nurse has the team roll the patient to his side for a skin assessment of his back before he is placed in the supine position. What injury is the perioperative nurse concerned that she might see? a.Side-to-side striations from the lifting sheet b.A shearing force injury from sliding c.Incontinence from inadequate bowel prep d.Skin creases from the lifting sheets
Answer: B Shear is the folding of underlying tissue when the skeletal structure moves while the skin remains stationary. A parallel force creates shear, unlike the perpendicular force created by pressure. As gravity pulls the skeleton down, any stretching, folding, and tearing of the underlying tissues, as they slide with the skeleton, can occlude vascular perfusion, which can lead to tissue ischemia.
When using bipolar delivery of electrical current, the nurse should remember that..... a.The dispersive electrode should be placed after positioning of the patient is complete b.The dispersive electrode is not needed because one side of the forceps returns current to the generator c.The dispersive electrode is needed to return the current to the generator d.The dispersive electrode should be placed as close to the surgical site as possible to reduce tissue damage
Answer: B The current is directed from the generator to a special forceps with one active tip and one inactive tip. The current flows to the active tip and returns through the inactive tip. There is no need for a grounding pad.
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? a.Administer naloxone (Narcan) to reverse the effects of the narcotics causing his somnolence. b.Use a jaw thrust to open the airway. c.Increase the oxygen rate to reverse his hypoxia. d.Position him on his left side.
Answer: B The first priority in the care of the PACU patient is to establish a patent airway. A common cause of airway obstruction is the tongue, which is relaxed because of anesthetic agents, muscle relaxants, and opioids used during surgery. The patient may present with snoring, little or no air movement on lung auscultation, retraction of intercostal muscles, asynchronous movements of the chest and abdomen, and a decreased oxygen saturation level. Nursing actions may be simple, such as stimulating the patient to take deep breaths, positioning the patient on the side, or providing supplemental oxygen. If the patient is still unresponsive, the nurse may need to open the airway with a chin tilt or jaw thrust.
Wound dressings containing silver are especially useful for: a.Large wounds where additional absorbency is required b.Wounds at risk for infection c.Wounds that require additional support during and after healing d.None of the above
Answer: B Wound dressings that contain silver (19%-23%) are especially useful for wounds that are at risk for infection, such as rectal, vaginal, ureteral, and nasal wounds. Large wounds, where additional absorbency is required would require application of an absorbent pad after the gauze layer is placed. Special closing techniques are used for wounds that require additional support during healing.
Irregular breathing, increased muscle tone, and involuntary motor activity describe which of the following stages of anesthesia, according to Guedel's schema? a.Relaxation b.Danger c.Excitement Surgical anesthesia
Answer: C According to Guedel's stages of anesthesia, stage I is the relaxation stage, when the patient first becomes unconscious; stage II, is the excitement stage, when the patient may become very restless , but this stage is rarely seen because patients are quickly brought to stage III,the stage of surgical anesthesia. Stage IV is when respiratory arrest occurs, and death ensues.
When conducting a "Pause for a Cause," the following team members must be involved except: a.Surgeon b.Circulating Nurse c.Anesthesiologist/CRNA d.Scrub Nurse/Technician
Answer: C According to UVA Policy, the circulator verifies the implant verbally and visually with the surgeon and the scrub person. In cases where a scrub person is not indicated, the verification will be completed by the circulating nurse and the surgeon.
A key feature of the Perioperative Patient-Focused Model is the emphasis on: A.patient-centric care. B.nursing research. C.outcome-driven care. D.nursing care activities in the perioperative arena.
Answer: C All perioperative care is patient-centric with emphasis on a proactive outcome-driven approach. Through each patient interaction and creation of a customized care plan, the perioperative nurse identifies risks and designs interventions toward the prevention of undesirable outcomes (such as injury from positioning, or inadvertent hypothermia). Outcome-based decision making is driven by evidenced-based principles.
Percutaneous injuries (PIs) represent a significant hazard to perioperative nursing personnel. Which type of percutaneous injury is the most prevalent? A.Injuries from sharp instruments B.Injuries from hollow-bore needles C.Injuries from suture needles D.Injuries from scalpel blades
Answer: C Although injuries from hollow-bore needles constitute the most common PIs in the healthcare field overall, the pattern of injuries inside the OR is somewhat different. Suture needle injuries (SNIs) are considered the predominant cause of PIs in the surgical setting. They account for as many as 77% of PIs (AORN, 2017) and are a primary cause of occupational exposure to BBPs among OR professionals.
Which of the following actions best describes an element of the perioperative nursing assessment? a.Scanning the surgical schedule for the day before morning report b.Reading the pick/preference list attached to the case cart c.Reviewing the patient medical record d.Studying an on-line tutorial about the intended surgical procedure
Answer: C Assessment is the collection and analysis of relevant health data about the patient. Sources of data may be a preoperative interview with the patient and the patient's family; review of the planned surgical or invasive procedure; review of the patient's medical record; examination of the results of diagnostic tests; and consultation with the surgeon and anesthesia provider, unit nurses, or other personnel.
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: a.Establish cause and trends based on who was involved. b.Determine precisely what happened and why. c.Find out what needs to take place to prevent a recurrence of the event. d.Uncover factors that contributed to the environment and the event.
Answer: C Root cause analysis is a systematized process to identify variations in performance that cause, or could cause, a sentinel event. The analysis phase of root cause analysis progresses from "why" questions to "what can be done to prevent this" questions that flow and ultimately result in an action plan. Root cause analysis concentrates on systems and processes, not individuals.
Where are the sources of radiation exposure in an operating room setting? a.Ionizing sources (e.g. ultrasound machines) and non-ionizing sources (e.g. MRI scanners). b.Non-attenuated fluorescent lights and portable x-ray machines without lead guards. c.Non-ionizing sources (e.g. lasers) and ionizing sources (e.g. X-ray machines and C-arms). d.Ionizing sources (e.g. ultrasound machines) and non-ionizing sources (e.g. Lasers).
Answer: C Sources of radiation exposure in the OR include ionizing sources, such as portable radiography (X-ray) machines and portable fluoroscopy units (C-arm), and nonionizing sources, such as lasers.
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 5'10" and weighs 140 lb. 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? a.Stage II b.Stage IV c.Stage I d.Stage III
Answer: C Stage I pressure injury is defined as intact skin with nonblanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer, or cooler as compared to adjacent tissue.
During a bilateral lower extremity debridement and skin graft the surgeon requests that the drapes be repositioned farther apart to achieve better surgical access. According to the AORN standards the scrub nurse's most appropriate response is: a.Re-drape the patient with a new laparotomy drape b.Move the drapes to best accommodate the surgeon's access c.Tell the surgeon that the drapes should not be repositioned d.Use sterile towels to cover the edges of the original drape
Answer: C The answer is to tell the surgeon that he drapes should not be re-positioned. You can't remove the old drapes and re-drape while the patient is open. You can't move the drapes around once placed (according to standards).
A patient scheduled for a C-section is placed in the supine position with the right side elevated to: a.Displace the uterus and increase aortocaval pressure to enhance fetal oxygenation b.Assist in placement of the Foley catheter c.Displace the uterus and prevent aortocaval compression, which could compromise fetal oxygenation d.Minimize the risk of an amniotic fluid embolism
Answer: C The pregnant patient should be positioned at a higher angle or in the left-lateral tilt position to avoid aortocaval compression.
In an operating room department, which area is most likely to be unrestricted? a. Scrub sinks b. Instrument processing area c. Patient preoperative area d. Clean storage supply area
Answer: C To lessen the chances of postoperative infection, surgical units are classically divided into three sections: unrestricted zone, semi-restricted zone, and restricted zone. In the unrestricted zone, personnel may wear street clothes; in the semi-restricted zone, personnel must wear scrub clothes and caps, and in the restricted zone, personnel must wear scrub clothes, including shoe covers, caps and masks. Operating rooms are normally in the restricted zone but the scrub sinks, instrument processing area and clean storage supply area are usually located in the semi-restricted zone. However, scrub sinks may also be considered restricted depending on it's location. The patient reception area is commonly an unrestricted zone.
Irrigation for Kidney Transplants is prepared with 5mg of Amphotericin B. The vial contains 50mg of Amphotericin B in powder form. It is reconstituted by injecting10 mL of Sterile Water. How much Amphotericin B should be drawn up and dispensed. a.0.1ml b.0.5ml c.1ml d.5ml
Answer: C What is Amphotericin? An antifungal medication used to treat serious, life-threatening fungal infections. It is not for use in treating a minor fungal infection such as yeast infections of the mouth, esophagus, or vagina.
When an incorrect surgical count occurs, the search for the missing item begins with the: a. Kick Bucket b. Trash c. Incision site d. Floor
Answer: C When an incorrect count of the equipment occurs at the end of a surgical procedure, the search process begins with the incision site and then extends to other areas, including kick buckets, trash and the floor.
Your patient is scheduled to have a liver resection. His previous surgical history indicates that he has a right hip replacement and an automatic internal defibrillator (AICD) in his left anterior chest. He also has scarring over his left flank from a previous bicycle accident. Where would be the most appropriate site to place a dispersive electrode to minimize the risk of electrical burns or discharging the AICD? a.Right Calf b.Left Calf c.Right Upper arm d.Left Upper Arm
Answer: C When considering dispersive pad placement, it is important to know the electrical pathway. Electrical current passing through metal may cause build up of heat and burn tissue. A dispersive pad on the right calf will have electrical current passing from the incision site through the right hip. A dispersive pad on the left upper arm will have electrical current passing from the incision site through the AICD. Electrical current does not travel well through bone, scar or adipose tissue. Therefore the dispersive pad on the left calf would not be as effective as the placing it on the right upper arm which is also closer to the incision site.
Proper handling of specimens is crucial for patient safety. What is the most serious negative outcome that could occur as a result of the loss, mislabeling or mishandling of a surgical specimen? a.The medical facility could be sued for negligence. b.The patient might be unsatisfied with the treatment received. c.The patient condition could be misdiagnosed. d.The medical facility's reputation could be damaged.
Answer: C A mislabeled specimen may result in misdiagnosis and consequently inappropriate treatment of the patient. Communication errors pose significant risks to patients in the misidentification of a surgical specimen before its arrival in the pathology laboratory.
The two solutions approved for use near the eye and ear are povidone-iodine and _________. a.Alcohol & Povidone-Iodine (Duraprep) b.Hexachlorophene (Phisoderm) c.Chloroxylenol (Techni-care) d.Chlorhexidine gluconate (Hibiclens)
Answer: C All prep solutions other than povidone-iodine and chloroxylenol (also known as parachoroxylenol or PCMX) can cause corneal and nerve damage. They also can cause deafness if the solution reaches the middle ear.
Which of the following actions best describes an element of the perioperative nursing assessment? A.Scanning the surgical schedule for the day before morning report B.Reading the pick/preference list attached to the case cart C.Reviewing the patient medical record D.Studying an on-line tutorial about the intended surgical procedure
Answer: C Assessment is the collection and analysis of relevant health data about the patient. Sources of data may be a preoperative interview with the patient and the patient's family; review of the planned surgical or invasive procedure; review of the patient's medical record; examination of the results of diagnostic tests; and consultation with the surgeon and anesthesia provider, unit nurses, or other personnel.
Why do most surgeons prefer to use carbon dioxide (CO2) to create a pneumoperitoneum for laparoscopic abdominal surgery? a.CO2 supports combustion b.CO2 has no risk for causing gas embolism c.CO2 is a normal metabolic end product d.CO2 contributes to normothermia for the patient
Answer: C Carbon dioxide (CO2) gas insufflation is preferred by most surgeons performing laparoscopic procedures because it has a high diffusion coefficient and is a normal metabolic end product, rapidly cleared from the body. CO2 is highly soluble in blood and tissues and does not support combustion. The risk of gas embolism is lowest with CO2. As a negative side effect, CO2 contributes to the risk of hypothermia for the patient.
How are clamps differentiated? a.By their rings b.By their shanks c.By their jaws d.By their cutting ability
Answer: C Clamps are instruments specifically designed for holding tissue or other materials, and most have an easily recognizable design. They have finger rings, for ease of holding; shanks, whose length is appropriate to the wound depth; ratchets on the shanks near the rings, which allow for the distal tip to be locked on the tissue or object grasped; a joint, which joins the two halves of the instrument and allows opening and closing of the instrument. Clamps also have a jaw, which is the working portion of the instrument and defines its use.
A new graduate perioperative nurse was consistently verbally criticized and teased by her preceptor. The ensuing stress caused her to make mistakes and contributed to lost time from work. She was experiencing: a.Unlawful discrimination b.Physical violence c.Horizontal violence d.Psychological demise
Answer: C Horizontal (or lateral) violence occurs when nurses inflict psychologic injury on one another. While patients are the main perpetrators of physical violence, staff members are the main perpetrators of psychological violence.
A patient has been admitted to the post-surgical unit after having a gastroduodenostomy. The patient has had a total urine output of 36cc in the last four hours. What is the nurse's next intervention? a.Notify the nursing assistant that the patient needs help with sitting up in bed. b.Consult the chart to determine if the patient had any urine output during the surgical procedure. c.Contact the physician to report the output and determine further orders. d.Do nothing; this is not an abnormal output for this type of surgery.
Answer: C If a patient has a total urine output of 36cc in the last four hours, the nurse should contact the physician to report the output and determine further orders. Following surgery, a patient should have a minimum urine output of 30 cc per hour. Changes in patient status, such as decreased urinary output, should be communicated to the physician to ensure that there is not another, underlying problem that could cause patient deterioration.
When opening the instruments for a vaginal hysterectomy, the scrub person notices that the instrument case contains water. What should the scrub person do? a.Dry the instruments with a sterile towel and use them; the water is sterile. b.Consult with the surgeon about whether it is safe to use the instruments. c.Return the instrument set for reprocessing and obtain a new set. d.Use the instruments because the indicator strip indicates sterility.
Answer: C Items of doubtful sterility must be considered unsterile. Examples include sterile items found in unsterile work areas, sterilized packages wrapped in pervious materials that have become wet, sterilized items without an integrator or other internal chemical indicator, or packages in which integrity has been compromised.
Which of the following stages of wound healing entails the regeneration of epithelial cells and the synthesis of collagen? a.Maturation stage b.Remodeling stage c.Proliferation stage Inflammatory stage
Answer: C One of the primary jobs of the nurse is assessment of wound healing, which occurs in three stages. The inflammatory stage (1-4 days) is the initial stage; during this stage a clot forms and the wound becomes red and swollen. The second stage is called the proliferative stage (5-20 days) in which epithelial cells are regenerated, collagen is produced and granulation tissue is formed. The maturation stage (21 days to months or years), also known as the remodeling stage, is the final stage in which the strength of the wound increases and scar tissue forms.
Which of the following conditions normally occurs during phase two of anesthetic induction? a.Hypotension b.Vasoconstriction c.Thrashing movements d.Cessation of breathing
Answer: C Phase two of anesthesia induction is referred to as the excitement or delirium stage. Stage two starts at loss of consciousness, start of regular breathing, and loss of eye reflexes. During the excitement phase patients may start thrashing.
Surgical aseptic techniques are designed to: a.remove all microbes from the skin. b.sterilize equipment. c.restrict microorganisms in the environment and on equipment. d.eliminate infectious agents that can be inhaled.
Answer: C Practices that restrict microorganisms in the environment and on equipment and supplies and that prevent normal body flora from contaminating the surgical wound are termed aseptic techniques. The goal of each aseptic practice is to optimize primary wound healing, prevent surgical infection, and minimize the length of recovery from surgery. For perioperative practitioners, surgical aseptic principles and practices are the foundation for infection control efforts in the perioperative arena.
Waste anesthetic gases are small amounts of gases that may leak either from the patient's anesthetic breathing circuit in the air while anesthesia is being administered or from exhalation of the patient during recovery. Both mechanisms of exposure create risks for OR personnel. What is an effect if short-term exposure for the healthcare worker? a.Spontaneous abortion b.Infertility c.Lethargy and fatigue d.Cancer
Answer: C Short-term exposure causes lethargy and fatigue. Long-term exposure may be linked to spontaneous abortion, congenital abnormalities, infertility, premature births, cancer, and renal and hepatic disease. Today, perioperative staff members are exposed to trace amounts of waste anesthetic gas, and although this exposure cannot be eliminated, it can be controlled.
All of the pathogenic organisms listed below are commonly associated with surgical site infections except: a.staphylococcus aureus b.enterococcus spp. c.streptococcus pneumoniae staphylococcus epidermidis
Answer: C Surgical site infections are most commonly caused by staphylococcus aureus, enterococcus spp., and staphylococcus epidermidis. Streptococcus pneumoniae is a common cause of pneumonia.
The safest option for drapes during a laser procedure are? a. Clear, adhesive drapes b. Standard Surgical Drapes c. Moistened woven materials such as towels d. Moistened surgical drapes
Answer: C The area around the site should be draped with moist towels or sponges to decrease the potential for fire. Since standard surgical drapes are resistant to penetration of fluids they will not stay moist and protect the site.
Mrs. H is a 42-year-old obese, diabetic, smoker with end-stage renal disease. Which of her co-morbidities is not a contributing factor to her risk for developing a surgical site infection (SSI)? a.Diabetes b.Smoking c.Obesity d.Renal Disease
Answer: D A number of risk factors are known to increase the risk for SSIs, including obesity, advanced age, diabetes mellitus, malnutrition, steroid use, prolonged preoperative stay, infection at a remote site, duration of surgery, surgery technique, presence of drains, inappropriate use of antimicrobial prophylaxis, perioperative temperature, and poor postoperative glycemic control. While Renal Disease may be a common co-morbidity for patients who are obese, smoke or have diabetes, this does not necessarily increase a patient's risk for infection.
When considering teaching an adolescent about ostomy self care it is important to realize that they may have concerns relating to their: a. Impact on career b. Financial issues c. Independence d. Body Image
Answer: D Adolescence is a prime time for self-esteem development and an ostomy can be considered a crisis for a young adult. They are dealing with their developing sexuality and they may feel an ostomy may hinder their acceptance.
Positive-pressure air handling systems with unidirectional flow of non-recirculated air from the ceiling to the floor are designed to: a.Create mild air turbulence to prevent dust from settling on surfaces. b.Redirect and absorb anesthetic gases. c.Augment the oxygen-enriched environment with dust-free air. d.Flow clean air over the patient and prevent corridor air intake.
Answer: D Air pressure in the operating room (OR) should be greater than that in the surrounding corridor. This is called positive-pressure in relation to corridors and adjacent areas. This positive-pressure helps maintain the unidirectional airflow in the room and minimizes the amount of corridor air (less clean area) entering the OR (more clean area).
If a biological indicator (BI) shows a positive growth , which of the following steps is necessary? a. The sterilizer should be taken out of service b. Any items processed in the load should be recalled c. The BI should be reported to the Manager or Charge Nurse d. All of the above are true
Answer: D Biological Indicators (BI) are bacterial spores of Geobacillusstearothermophilus. TheBI is exposed to the sterilization process and then incubated under defined growth conditions to determine whether any spores survived the process.Bacterial spores are chosen for a specific sterilization process based on their known resistance to that process. If a biological indicator (BI) shows positive growth, the sterilizer should be taken out of service until the cause of the contamination (e.g. bacterial, viral, fungal) is determined and a subsequent BI test is negative. Any items that were processed in the load should be recalled and re-sterilized. It is essential to report a positive BI to the supervisor
The following medication is contraindicated for treatment of malignant hyperthermia: a.Dantrolene sodium b.Regular insulin in 50% glucose solution. c.Calcium chloride d.Calcium channel blocker
Answer: D Calcium channel blockers are contraindicated as treatment for malignant hyperthermia as they may result in severe hyperkalemia and myocardial depression. The primary treatment is 8 to 10 mg/kg of dantrolene sodium with repeat doses of 2.5 mg/kg up to 4 times. Other treatments include insulin in 50% glucose solution (0.15 units/kg of regular insulin in 1 mL/kg of glucose or 10 mg of regular insulin in 50 mL of glucose) and/or calcium chloride for treatment of hyperkalemia. Lidocaine or amiodarone may be indicated for cardiac arrhythmias.
Desflurane is contraindicated for induction for infants and children because of: a.Increased risk of anesthesia-related hepatitis b.Decreased cerebral metabolism c.Decreased cardiac output d.Upper airway complications
Answer: D Desflurane is used for induction and maintenance of anesthesia in adults but is contraindicated for induction in infants and children because of upper airway complications (coughing, apnea, laryngospasm), although it can be used for maintenance. Halothane is associated with many adverse effects, so other anesthetic agents are often used. Halothane effects include increased risk of anesthesia-related hepatitis in those with liver dysfunction and 50% reduction in BP and cardiac output. Cerebral blood flow and ICP are moderately increased, but cerebral metabolism is decreased and autoregulation is impaired.
Critical components of universal precaution practice standards of the Occupational Safety and Health Administration include which of the following? a. Use of personal protective barriers b. Proper hand washing c. Precautions in handling sharps d. All of the above
Answer: D Standard precautions were designed by the Occupational Safety and Health Administration (OSHA) to protect patients and employees of health care facilities (or anyone) who come in contact with bodily fluids (e.g. blood, saliva, vomit, feces). They mandate that protective barriers are used (e.g. gloves, eye coverings, gowns, aprons, masks); proper hand washing is performed before and after handling a patient, using soap and water, but also alcohol-based hand sanitizer; and the proper disposal of needles and other items that come in contact with patients in designated containers.
You are preparing for a Femoral-Popliteal Bypass procedure. The preference card states that heparinized saline is needed. You need to have 2,000 units heparin in 200ml of Injectable 0.9% NaCl. Your heparin vial is 10,000 units/20ml. How much heparin do you draw up? a.1ml b.2ml c.3ml d.4ml
Answer: D What is heparin used for? §Heparin is an anticoagulant (blood thinner) that prevents the formation of blood clots. What is the antidote or antagonist for heparin? §Protamine
Which of the procedures below would be classified as a Class II wound? a.Mitral valve replacement b.Debridement of an infected open tibial fracture c.Breast biopsy for breast cancer d.Laparoscopic appendectomy for uncomplicated appendicitis
Answer: D Clean contaminated wounds are considered Class II wounds. These wounds are those in which the respiratory, alimentary, or genitourinary tract is entered under controlled conditions. There is no sign of infection and no break in surgical aseptic technique. Examples of clean contaminated wounds are nonperforated appendectomy, hysterectomy, and thoracotomy.
Which of the following best describes evidence-based practice? a.A method of organizing patient data that guides decision making and ensures positive outcomes. b.Evaluation of nursing interventions to guide future care and determine usefulness. c.A type of planning used in clinical pathways to decrease recovery time and control costs. d.The use of theory-derived, research-driven information to make decisions about the care delivered to individuals or groups.
Answer: D EBP allows the perioperative nurse to base care decisions on the best available research rather than "traditional" practices, beliefs, or opinions. In the practice of EBP, only the strongest types of research are used to shape recommendations.
Ms. 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 Ms. Slayton expect? a.Healing by granulation b.Healing by tertiary intention c.Healing by beneficial inflammation d.Healing by primary intention
Answer: D Healing through primary intention occurs when wounds are created aseptically, with a minimum of tissue destruction and postoperative tissue reaction. Wounds closed with sutures, staples, tape, or surgical adhesive applied as soon after the time of injury as possible fall into this category. When wounds are created under sterile conditions, healing is optimized and begins almost immediately.
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? a.Two circulators must conduct the count. b.Call for a "pause for a cause" when ready for closing count. c.Keep all used sponges on the sterile field for final count d.Verbal handoff must include count status at time of relief.
Answer: D In situations in which personnel may be relieved on a temporary basis, the verbal hand-off should include a discussion about counted items. In all situations it is imperative that two individuals be involved in the count—one counting and the other witnessing that the count is correct. Rushing at the end of a surgical procedure can result in incorrect or incomplete
Injury while being intubated is most likely in the patient who has: a.Dentures b.A tongue stud c.Cracked lips All of the above
Answer: D Intubation is used to maintain the airway in patients who are having trouble breathing. Dentures and a tongue stud could cause injury to the patient during intubation as they could become dislodged. Cracked lips could be further injured through manipulation.
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? a.Exposure to waste anesthetic gases b.Exposure to bloodborne pathogens c.Radiation exposure d.Musculoskeletal disorders
Answer: D Perioperative staff routinely faces a wide array of occupational hazards that place them at risk for work-related musculoskeletal injuries. Ergonomic tools for safe patient movement and handling help the nurse determine whether assistive equipment should be used, what type of equipment would best support the task, and how many caregivers are needed to perform the task safely.
When applying sterile drapes to create the sterile field on the patient, which of the following principles is the most important? a.The circulating nurse should monitor the scrub person's gowned arms when reaching over the sterile parts of the patient. b.Drape the patient starting at the periphery and proceed towards the incision site. c.Gently shake and fan out the drapes to open up the folds before approaching the patient. d.Drape the patient starting with the incision area and proceeding to the periphery.
Answer: D The draping procedure should begin at the area of the intended incision and proceed outward to the periphery. Always drape from a sterile area to an unsterile area by draping the near side first. Never reach across an unsterile area to drape. When draping the opposite side of the OR bed, go around the bed to drape.
A frail 76-year-old diabetic woman is scheduled for major surgery. She is vulnerable and at high risk for harm because of several factors related to her preexisting conditions and overall health status. As part of developing a plan to guide her care, the nurse uses standardized descriptive terms. This step of the nursing process is called: A.nursing diagnosis. B.nursing assessment. C.nursing outcome. D.nursing intervention.
Correct Answer: A Nursing diagnosis is the process of identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care.
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? A.Altered drug uptake B.Impaired wound healing C.Increased patient discomfort D.Cardiac rhythm disturbances
Correct Answer: B Vasoconstriction from hypothermia can interfere with skin perfusion and delay wound healing processes. Unintentional hypothermia can cause patient discomfort, untoward cardiac events, adrenergic stimulation, impaired platelet function, altered drug metabolism, delayed emergence from anesthesia, and impaired wound healing.
Which of the following may be a consequence of high-dose or full-body radiation? A.Contrast media reaction B.Perioral numbness and tingling C.Nausea, vomiting, and diarrhea D.Wheezing, dyspnea, and tachycardia
Correct Answer: C Acute exposure to ionizing radiation can result in dermatitis and reddening of the skin (erythema) at the point of exposure, while large, full-body exposures can lead to radiation poisoning, symptoms of which may include nausea, vomiting, diarrhea, weakness, and death.
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. A.Label consecutive specimens in alphabetical order for laboratory efficiency. B.Send all specimens to the laboratory together as one pickup, including frozen sections. C.Avoid placing specimens for frozen section in formalin. D.Neutralize formalin/formaldehyde spills with glycerin sulfate and call the hazmat team
Correct Answer: C Specimens for frozen section should be sent fresh (e.g., without fixatives [formalin/formaldehyde]). Specimens for frozen section usually are placed on Telfa or into a dry specimen container. They are never placed in saline solution or formalin, nor are they ever transported on a counted sponge. They should be sent immediately to the laboratory. Formalin, a combination of methanol, water, and formaldehyde, is frequently used to preserve specimens if they are not taken to the laboratory immediately.
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: A.70% or greater. B.55% or greater C.<3% of the mixture is liquid water. D.<1% of the mixture is liquid water.
Correct Answer: C Steam entering the sterilizer chamber should contain little or no trapped liquid water. The term steam quality describes the amount of steam vapor and liquid water in the mixture. A steam quality of 100% indicates that no liquid water is present in the steam. A steam quality of 97% or greater.
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: A.Staphylococcus epidermidis. B.Streptococcus pyogenes. C.Staphylococcus aureus. D.Enterococcus.
Correct Answer: C The organisms most commonly found in postoperative SSIs include staphylococcal, enterococcal, pseudomonal, and streptococcal species. S. aureus is the most frequently identified organism.
The mechanism of lethality (microbial death) with steam sterilization is achieved with this event. a.Time, temperature, and steam pressure b.Reduced and limited mitosis within the bioburden c.Saturated vaporization of the microbial cytoplasm d.Denaturation and coagulation of enzyme proteins
Correct Answer: D Microorganisms are believed to be destroyed by moist heat through a process of denaturation and coagulation of the enzyme-protein system when steam sterilized. This fact is based on the theory that all chemical reactions, including coagulation of proteins, are catalyzed by the presence of water.
Perioperative nurses should be familiar with all basic anesthetic monitors and normal ranges of physiologic parameters in order to: A.relieve the anesthesia provider for short periods of time during long procedures with stable patients. B.be familiar with the setup, operation and leak testing of the anesthesia machine. C.safely monitor a patient under MAC. D.be familiar with the principles and practices of anesthesia and the perioperative functions of the anesthesia provider.
Correct Answer: D As integral members of the patient care team in operative and other invasive procedure settings, perioperative nurses need to be familiar with the principles and practices of anesthesia and the perioperative functions of the anesthesia provider.
Which of the following substances is a trigger for Malignant Hyperthermia (MH): a. Rocuronium b. Succinylcholine c. Vecuronium d. Propofol
Correct: B Inhaled anesthetics other than Nitrous Oxide and depolarizing paralytics trigger MH. Halothane is an inhaled anesthetic. Vecuronium (Norcuron) is a non-depolarizing paralytic unlike Suxamethonium (Succinylcholine), which is associated with triggering MH. Propofol (Diprivan) is a drug used for its sedative and amnesia effects and is not associated with triggering MH.
¡A nurse is encouraging a post-operative patient to cough and to take deep breaths. This nursing action is due to the understanding by the nurse that retaining of pulmonary secretions can lead to A. Pneumonia B. Carbon dioxide retention D. Pulmonary edema E. Edema
¡Answer: A ¡Explanation: Coughing and deep breathing exercises help to prevent post- operative complication: pneumonia. In pneumonia, there is inflammation of lung tissue which produces cough, crackles and dyspnea. The other above-mentioned situations would not arise because of retaining pulmonary secretions.
