Review 3 Mod 2

अब Quizwiz के साथ अपने होमवर्क और परीक्षाओं को एस करें!

Which of the following is not a result of Computer Integration?

Automatically provides critical update to industry standards

For a steriliant to be legally marketed in the USA the FDA requires that each sterilant

Be rigorously tested against a broad range of microorganisms

Suspected medical device-related deaths are reported by device manufacturers and hospitals to the

FDA

When packaging instruments only materials approved by _________ are used.

FDA

Which of the following organizations ensures the safety of drugs, food, and cosmetics

FDA

Which of the following statements about endoscopes is true?

Not all endoscopes can be processed in an automatic endoscope reprocessor

Which of the following is not a feature of an instrument tracking system?

Product updates and recall information

Placing warm sterilized package on a cool surface will cause

condensate to form

Three of the main phases of a terminal steam sterilizer cycle are

conditioning, exposure and exhaust

The central nervous system is the body's

control center

Which of the following provide a detailed list of tray contents

count sheets

A group of employees from different departments within the healthcare facility that work together to solve operating problems is called

cross-functional team

Factors that can cause strilant contact failure with the instrument are

crowded loads, clogged drain strainer

Bacteria require _________ to live and grow

different conditions

When instruments are assembled for testing, it should be

disassembled prior to sterilization

Central Service technicians who do not think they are being treated appropriately by their employer should

discuss the situation with their supervisor

Pathogens are _________ bacteria

disease causing

The weakest part of the steam sterilizer is the

door

Another name for super-heated steam is ____________

dry steam

Computerized tracking systems are fast but manual tracking systems are more effective for tracking.

false

Connective tissue of the body includes the skin

false

Decentralization of Central Service in now a growing trend

false

Endoscope channel should be cleaned and then left moist for storage.

false

Equipment shortages can be caused if CS technicians fail to perform soiled pickup rounds.

false

Facing paper to paper is the recommended arrangement for peel pouches in the sterilizer

false

Flexible endoscopes that fail a leak test may be used until the break impacts the scope's function.

false

Gauze squares are the wicking material of choice for instrument sets

false

High-foaming detergents are required for mechanical washers

false

Hydrogen Peroxide has the same inherent penetration capabilities as EtO

false

Hydrogen peroxide gas plasma is compatible with powders and paper

false

Hydrogen peroxide sterilizer works better when cellulose wrappers are used.

false

Immediate Use Steam Sterilization (IUSS) should be used only when there is no time to process items using the wrapped method

false

Immediate use steam sterilization (IUSS) is the process to sterilize trays for future use.

false

Implants are highly recommended to be sterilized with IUSS method

false

In mechanical washers, all items should be washed on the same cycle.

false

When water and cleaning solutions penetrates the interior of PSI's causing damage, this is called:

fluid invasion

The main theory of standard precautions is to treat all human blood and body fluids as

infectious

Demineralized (treated) water should be used to thoroughly rinse all traces of disinfectant from an endoscope

true

EtO cannot be used in sterilizing liquid because the water can become toxic

true

When a technician cannot see what is in a sink or basin they should

use a sponge forceps to grasp items

Endometrium is the lining of the

uterus

Yellow test material is used for scissors

4 inches or less

Surgical removal of the leg below the knee is abreviated

BKA

Which of the following is not part of stock rotation in Central Service Department?

.FIFO .event related .expiration date .all the answers are part of stock rotation

Which of the following is an example of communication?

.Spoken Word .Written word .Non-verbal expression .all of the above

Immediate Use Steam Sterilization documentation should include

.The name of the patient for which the items were sterilized .sterilizer number and cycle .name of the instrument strilized .all of the above

Which of the following is NOT a requirement of OSHA blood-borne pathogen standard?

.Use engineering controls to prevent biohazard exposures .Observe standard precautions .Provide hepatitis B vaccine to employees at no cost .all answers are correct

Which of the following is not recommended when loading a steam sterilizer?

.basin set should be placed facing up .there should be visible space between trays .solid containers should be placed so air can get out .all are correct

High level disinfectants may be deactivated by

.organic matter .time .dilution .all answers are true

Which of the following is not necessary when storing items on shelves?

.package integrity .expiration date .seams and filters to be sure they are intact .all answers are necessary

The OSHA PEL for Hydrogen peroxide is __________ ppm

1

OSHA requires a monitoring ppm of H202 sterilizers at

1 ppm

The minimum requird SAL for sterilants is

10-6

Sterile items should be stored following these measurements except

12-15 from ceiling

What is 270 degrees expressed in celcius

132 c

Muslin is a broad term for plain-weave cotton having approximately __________ threads per square inch

140

When examining through the lens of the rigid or semi-rigid endoscope with the paper, this paper should be held approximately __________ inches from the distal tip.

3

The relative humidity of Central Service prep and pack area should be

30% to 60%

The standard temperature where EtO turns to gas is _________ degrees F.

51.3

Proper coil size for sterilizing air hoses should be ______ to _______ inches

9-12

Tests for sterilization that uses bacteria spores

BI

Which of the following is a professional organization that writes guidelines for the operating room?

AORN

The most accepted means for providing quality assurance for H202 sterilizers is

BI

Regulatory guidelines include the regulations of which of the following:

CDC

Treating a fractured bone without a surgical incision is abreviated

CR

Chemical Indicators are class 2 devices and regulated by

FDA

Medwatch program is a federal reporting program of device related problems controlled by

FDA

Transport of biohazardous items are regulated by

DOT

Which of the following is NOT true about Laser finished intruments?

Durable protective finish cannot be chipped or scratched

Which of the following has been the primary sterilant of choice for items that cannot withstand steam since the 1960's

EtO

Which of the following basic listening tactics is most useful?

Ignore any non-verbal communication sent by the speaker

Which of the following statements is correct?

Informal workgroups develop an informal communication system called the grapevine

To minimize the spread of microorganisms

Items should be contained in an enclosed cart

Which of the following is not a reason for tracking supplies, equipment and instruments?

Meeting Centers for Disease Control and OSHA requirements

The study of microorganisms is

Microbiology

Ethylene oxide is

More toxic than hydrogen peroxide gas plasma

Which of the following material is approved for use with H202 sterilizer?

Non-cellulose items

Aerobic bacteria always require

O2

Fluid Resistant gowns used in the decontamination area to protect technicians from splashes and spills are enforced by

OSHA

Healthcare facilities are required by the ___________ to provide adequate ventilation systems, personal protective equipment and safe work operating procedures.

OSHA

Which of the following tracking methods provides real-time information?

Radio frequency identification tags

The process of monitoring requires the "4 R's". What is the meaning of the "4R's"

Run, read, record, retain

The probability of a viable microorganism being present on a product unit after sterilization is known as

SAL

Which of the following is NOT reusable packaging material.

Spunbond Polyolefin

the meaning of SAL is

Sterility Assurance Level

Which of the following is NOT true of positive air?

The door opens air flows in

The amount of EtO that remains inside a material after they are sterilized is the

The residue

Which of the following is not a characteristic of powered surgical instruments (PSIs)

They look easy to clean

No toxic sterilant residuals should be left on packaging devices after sterilization process is completed.

To avoid safety risks to patients

The 8 hour TWA is the

Total allowable worker exposure during an 8-hour period

Which of the following is NOT required for sharps safety?

Wash all disposable sharps before discarding them

Asepsis means

absence of microorganisms that cause disease

Gram stain and _______ stain are used to identify bacteria shape

acid fast

The level of expposure to a harmful substance when an employer must take required precautions to protect the worker.

action level

The EPA is responsible for regulating

air quality

the process by which ETO destroys microorganisms is

alkylation

The reason and advantage to centralize management of the sterile processing is to

allow for maximization of people and services

The circular opening of the eye controls

amount of light

Wet contact time is the

amount of time an item must remain wet with a disinfectant to achieve disinfection

Endoscopes are often processed in a mechanical unit called

an automatic endoscope reprocessor

Ergonomic injuries

are a risk factor for persons who perform repetitive or physical work

Which of the following is inflammation of the joint?

arthritis

Visual exam of a joint is termed

arthroscopy

Joint viewing requires

arthroscopy instruments

Activities that prevent infection is the basics of

aseptic technique

When setting personal goals, they should be

attainable then build on those successes

Which of the following is the most important factor necessary for teamwork

attitude

The microrganism of choice to test items sterilized by EtO method is

bacillus athrophaeus

Cell is the

basic unit of a living organism

Loaner instruments should

be decontaminated before use

the process of passivation during instrument manufacture

build a protective chromium oxide layer on the instrument's surface

Aeration is required for items sterilized

by ETO method

Detergents for cleaning most surgical instruments are

neutral

The process of changing work or working conditions to reduce physical stress is

called ergonomic

The consequences of a non-sterile item being used during surgery

can be life threatening

Tungsten carbide jaw needle holders ______ ______

can be repaired

Healthy people

can harbor or transmit bacteria

Point of use preparation of instruments

can prevent instruments from damage

Which of the following is NOT an acceptable sterilization packaging material?

canvas

The Spaulding classification system is used

categorize patient care items based on the degree of risk of infection

used to remove cement

cebatome

The _____________ is located in the floor of the sterilizer

chamber drain

Which of the following provide a written record of sterilizer cycle activities?

charts and printouts

The first step to inspect the insulation of a laparoscopic instrument is to

check the collar at the distal tip

Sterilization packaging is classified by the FDA as a ___________ packaging.

class 2

The US Food and Drug Administration classifies sterilization packaging as a _____ ________ Medical Device

class II

Semi-restricted traffic control dress code requirement applies to

clean assembly area

Before an item can be placed in a liquid chemical sterile processing system they must be

cleaned

What is the first step in the sterilization process?

cleaning

Which of the following is the removal of all visible and non-visible soil

cleaning

used to visualize the entire large intestine

colonoscope

The ability to use information gained from words or body language to interact with others

communication

This process allows a person to understand someone else's needs.

communication

A group of organs is collectively called

system

How frequently should a sterilizer's strainer be removed and cleaned?

daily

Damaged light fibers of an endoscope shows _____________ areas.

dark

Negative air flow is an engineering control in the __________ area.

decontamination

The _______ process is the most critical step in processing loaner instrumentation

decontamination

Which of the following areas receive soiled instruments?

decontamination

used to repair and reconstruct teeth

dental drill

used to harvest skin grafts and reshape skin surfaces

dermatome/dermabraider

Test strips to check MEC of glutaraldehyde and OPA are required

each time the chemicals are used

Which of the following means surgical removal

ectomyw

Arthroscopy shavers are

electric powered

AERs are better used in reprocessing

endoscopes

Which of the following is not considered one of the three occupational hazards?

ergonomic

Behavior relating to what is right and wrong relative to the standard of professional conduct are called

ethical behavior

The reprocessing of prion contaminated instruments requires

extended reprocessing protocols

A single monitoring product is capable of providing all the information necessary to ensure effective sterilization

false

Aeration is required for items sterilized in gas plasma processes

false

All Central Service departments perform the same basic services

false

All endoscopes can be processed in an AER

false

All flexible endoscopes have internal channels

false

All sonic cleaners have a decontamination cycle?

false

At least, 20 minutes is the time recommended for hand washing.

false

At this time tracking systems are unable to track worker productivity information

false

Biohazard label signs are normally red and pink

false

Both the AORN and the Joint Commission recommend that only Central Service Technicians operate immediate use steam sterilizers.

false

Canvas has been approved by FDA as one of the best sterilization packaging materials.

false

Canvas is considered the best material of choice for packaging

false

Cleaning brushes clean better when they are larger than the lumens

false

Communication skills involve only verbal and written?

false

Computer supply chain management systems are used to monitor facility assets

false

Instrument sets and other required instrumentation needed for all scheduled procedures for an entire day are usually pulled early morning for morning procedures and early afternoon for afternoon procedures.

false

It's optional to put on PPE in the decontamination area according to OSHA.

false

Items contaminated with prions can be sterilized with immediate use steam sterilizers.

false

Jewelry should not be worn in the Central Service Department because it can cause reaction to the instruments

false

Leak testing should be performed on each flexible endoscope on an annual basis.

false

Loaner instrument trays that are received sterile from other facilities do not need to be decontaminated and re-sterilized before use.

false

Loaner instruments cause less space challenges

false

Mask is the PPE to put on first.

false

Medical Terminology provides the sterile processing technician with understanding of French and Latin.

false

Mirror finish and matte finish are the same

false

OSHA and EPA are in charge of Med-watch programs.

false

On the job relationships do not change when one team member has been promoted.

false

Once a tracking system is implemented, there is generally no need to update system information.

false

PPE is not required when cleaning items for immediate use steam sterilization (IUSS)

false

Patient census information used in Central service is obtained from the electronic health record.

false

Prep and pack areas of Central Service receive soiled instruments.

false

Resources found on line have already been determined to be valid before they were posted.

false

Reusable textile packaging requires less labor than disposable packaging

false

Rigid container filter retention plates should be manually cleaned and attached to the lid for mechanical cleaning

false

Steam flush pressure pulse steilizers are a type of gravity sterilizers

false

Temperature in a sterile storage area should be 55 degrees F to 60 degrees F

false

Textile packaging requires less labor than disposable packaging

false

The key to working safely is keeping the work area organized

false

The muscular system gives the body shape and support.

false

The temperature for the prep & pack area is 60-65 degrees F.

false

The three power sources of PSIs are steam, electric, and pneumatic

false

There are no problems when chemicals are mixed for high-level dinfection?

false

Transporting soiled items is acceptable if placed with clean and sterile items.

false

Used items on patient floors must be kept at the patients' bedside for pickup

false

Using latex tubing to protect delicate instrumentation is the process of choice for items to be steam sterilized

false

When combining loads, hard goods should be placed on the top shelves to allow for more efficient removal of the condensate.

false

When speaking one should be influenced by the listener's emotions.

false

When sterilizing items at the point of use a short cleaning procedure is accepted due to the urgent need for the instruments.

false

When water is seen on the outside of a pack after sterilization, the pack is considered safe to use if all other packs in the load are dry.

false

While the outside of all instruments must be dry before sterilization it is important to ensure all lumens are kept moist for sterilization

false

Wood products should be sterilied in an extended steam cycle

false

the biggest advantage to battery-powered surgical instruments is that they can be immersed for cleaning

false

Lipase enzymes are used to breakdown _________ tissue on instruments.

fatty

Leak testing happens _______ in decontamination when processing endoscopes

first

The product rotation used in the storage area of sterile processing is

first in, first out

All rigid sterilization containers have tamper-evident seals

true

Coaching is an example of

formal communication

Open Reduction Internal Fixation relates to

fractured bone

Cholecystectomy is the removal of the

gallbladder

The ___________ is designed to maintain a tight seal that prevents steam from escaping the chamber of the sterilizer

gasket

allows for visual inspection of the upper digestive tract

gastroscope

Which of the following characteristics of Staphylococcus bacterium is not true?

gram negative

Which sterilizer removes air from the chamber by steam forcing the cooler air in the chamber through the drain?

gravity

Which of the following is considered the single most important factor in reducing infections?

hand hygiene

During pasteurization ____________ is used.

heated water

What is the terminology for half as a prefix

hemi

Which of the following hepatitis diseases is transmitted by blood?

hep B

A procedure to repair a muscle layer that is allowing all part of an organ to project through an opening is known as

herniorrhaphy

Which of the following is a ball and socket joint?

hip

Below refers to an anatomy or level that is termed

hypo

Low blood sugar is termed

hypoglycemia

The process by which instruments are steam sterilized for immediate use is called

immediate use steam sterilization

Contaminated items are normally returned to the decontamination area

in a closed cart

The best way to transport items that have been processed using immediate use steam sterilization at the point use is

in a rigid container designed for immediate use steam sterilization

Electronic testing of laparoscopic insulation should be done

in the clean assembly area prior to set assembly

Under Spaulding Classification critical items are those

introduced directly into the bloodstream

Hydrogen peroxide is a popular low temperature sterilization method because of

its short sterilization cycle

the interior chamber of the sterilizer are heated by steam in the ___________ of the sterilizer

jacket

The most common reason for steam sterilization failure is

lack of steam contact with the instrument

The removal of part of the lamina is termed

laminectomy

Which of the following steps happens first when processing fllexible endoscopes?

leak testing

Which of the following is reommended for powered surgical instruments?

mechanical cleaning process

For a Central Service technician to understanding what is asked when a request is made for a surgical procedure requires

medical terminology

used in ear surgery and for driving very small wires through bone

micro dril

Healthcare regulations and standards provide consistency of departmental performance by outlining

minimal levels of quality and safety

where there is a difference between state and local regulations, the

most stringent regulations apply

Point of Use computing

moves computers into Central Service work areas

Secondary containers of chemicals

must be labeled with a copy of the original manufacturer's label or a generic label that identifies hazard warnings

Due to event related sterility stock rotation is __________ for effetive inventory.

necessary

infections that occur in the course of being treated in a healthcare facility is

nosocomial infection

Peel pouches should be placed ____________ for sterilization

on edge, paper to plastic

The movement of products from soiled areas to clean processing areas is termed _______ ____ ______ of materials

one way flow

Craniotomy is

opening made into the skull

Visual examination is termed

oscopy

The instrument used to cut bone is known as

osteotome

Which of the following instruments does not require an index card for testing?

osteotome

H202 (gas plasma) kills microorganisms by a process called

oxidation

Some plastics including formulation of spun-bunded polyolefin are intended for use solely in these sterilization processes.

ozone and hydrogen peroxide

When arranging paper/plastic pouches in the sterilizer, the pouches should be arranged

paper to plastic

The decontamination area should have 10 air exchanges

per hour

An instrument used to remove tissue around the bone

periosteal elevator

Which of the following is considered intermediate -to-low level disinfectants?

phenolics

Which of the following identifies the supplies and instruments needed for a specific doctor and procedure

pick list

When loading a steam sterilizer, basins should be

placed on edge

Which of the following is not part of end of procedure point of use guidelines?

placing instruments in the ultrasonic cleaner

When placing curved clamp in a peel pack, the tips should always face the _____ ______ of the pack.

plastic side

A molecular reaction that creates an uncontrolled release of energy is called

polymerization

Which of the following is done at the point of use?

pre-cleaning

Bacteria are larger than viruses

true

The word element that comes before the root is

prefix

Root word element is the ____________ of a word.

primary meaning

Which of the following is abnormal form of proteins?

prions

Laparoscopic instruments insulations are tested

prior to assembly

Knowing what is expected and consistently meeting those expectations is part of

professional behavior

Items to be disinfected or sterilized at the point of use must be

properly cleaned per Manufacturer's Instructions for Use

Using a ____________ is the best way to clean a suction's lumen

properly sized brush

Which of the following is not fungi?

protozoa

Count Sheets

provide a detailed list of tray contents

AAMI (Association for the Advancement of medical instrumentation) provides

recommendation regarding sterilization practices

Which of the following is not a function of the muscular system

regulates oxygen and carbon dioxide

Binary Fission is a method of

reproduction

Which of the following does not come apart for cleaning?

robotic instruments

used to perform specific cutting actions such as reciprocating or oscillating

saw

Cellulose materials cannot be processed within ozone sterilizers

true

High-level disinfection are necessary for items categorized as

semi critical items

Surgery to straighten up the nose is termed

septoplasty

Surgical repair of the nose is termed

septorhinoplasty

Dressing forceps have

serrations

Which of the following PPE is removed first?

shoe covers

Soiled instrument found in a tray in prep and pack

should be sent back to decontamination for cleaning with the entire tray

Implantable devices

should not be sterilized by IUSS unless there is a tracking system in place to track the item to a patient

How does the technician inspect air hoses of powerred surgical devices?

should use air pressure

The endoscope that would be dispensed for a procedure that requires visualization of the lower part of the large intestine would be a

sigmoidoscope

Which of the following move only when we want them to move.

skeletal muscles

Which of the following is not a component of risk management?

staff management

To check that a laparoscopic instrument insulation is intact first

start from the collar at the distal tip

The terminal low temperature sterilization methods usedi n healthcare settings include all the following except

steam

Which of the following is NOT the responsibility of the Joint Commission

sterilization methods

used in open heart surgery

sternal saw

Beneath the skin is termed

subcutaneous

Word elements include all the following except

supplement

Bacteria that develops into spores

survive in adverse conditions

One of the most frequent causes of a clogged drain screen is

tape

The common cause of sterilizer drains being clooged is

tape

Information regarding cleaning processes for endoscopes should be provided by

the instrument manufacturer

Information about a device's compatibility with a specific sterilization process should be obtained from

the manufacturer

the higher the bioburden on an object

the more difficult it will be to sterilize

When placing instruments in a peel pack, the curved tips should always face the

the plastic side

The area in central service where instruments are checked for cleaniness and function

the prep and pack

Immediate Use Steam Sterilizaion is

the process by which instruments are sterilized for immediate use

Safety Data Sheets are provided by the

the product manufacturer

Hysterectomy is a procedure related to

the reproductive system

The coolst place in the steam sterilizer is the

thermostatic trap

The portion of the steam sterilizer that measures steam temperature and automatically controls the flow of air and condensate from the sterilizer chamber is the ___________

thermostatic trap

The U.S. or State DOT guidelines should be followed when transporting soiled instruments

to an offsite facility for processing

The purpose of using a decontamination battery or hose when cleaning powered surgical instruments is

to keep fluid from entering the unit

Items should be brushed below the surface of water

to prevent aerosols

Which of the following should be used to thoroughly rinse (remove) all traces of disinfectant from an endoscope's channels?

treated water

A primary reason that batteries do not hold charge relates to steam damage of the battery cells

true

A technician teaching others increases their own understanding of the standards

true

After sterilization the load contents may take two hours or more to cool.

true

After use, loaner instrumentation must be decontaminated before it is shipped out.

true

All chemicals used to sterilize low temperature items have some form of toxicity.

true

All mechanical cleaning equipment provides consistent process

true

All personnel entering central service department storage area should wear attire that meets facility requirements

true

All rigid containers have tamper evident seals

true

EtO is useful because it can reach and sterilize areas that other chemicals cannot. Because of this, long aeration periods are necessary before items can be used or handled.

true

Everyone entering the CS Department has to comply with departmental dress code.

true

High-level disfection done at the point of use requires logging

true

Hydrogen peroxide allows faster instrument turnaround time than EtO

true

In addtion to providing financial and operational management, information technology and systems are used to help ensure patient safety

true

Inadequate exposure time at the correct elevated temperature is a reason for sterilization failure?

true

Information Technology is often the cornerstone of initiative to transform healthcare

true

Information about chemical or hazardous substances must be available to all employees

true

Items with a standard steam sterilization cycle recommended by the manufacturer can be damaged if run in an extended cycle.

true

Lack of uderstanding of medical terminology may compromise patient care

true

Loaner instruments can cause receiving challenges

true

Low temperature sterilization requires physical, chemical, and biological monitoring

true

Microbes are useful to breakdown sewage

true

Most Central Service Departments employ some sort of automated information management system

true

Nitrogen can be used for pneumatic power

true

Packs that are improperly packaged or loaded on the sterilizer cart frequently become wet packs.

true

Personal Protective Equipment minimizes bloodborne pathogens and contaminants

true

Personal development improves employabilty skills

true

Planning and reviewing goals will identify activities to help meet those goals

true

Point of use instrument preparation helps prolong the life of instruments.

true

Prevention of cross contamination is one of the goals of point-of-use preparation.

true

Professional development provides the information and experience needed for career progress.

true

Relative humidity is a required cycle parameter for ozone and ethylene oxide

true

Return loaner items should be cleaned and decontaminated

true

Risk management programs are designed to prevent accidents and injury

true

Standards and regulations help set minimal levels of quality and safety.

true

Steam sterilization cycles are faster than gas plama sterilization

true

The first goal of ceating an instrument pack is making a pack that meets user needs

true

The most frequent cause for sterilization failure is lack of steam contact.

true

The proper handling of instruments is the responsibility of everyone who comes in contact with the instruments

true

The steam sterilization process can be affected by the design of the medical device being sterilized.

true

There are no special cleaning requirements for items contaminated with pseudomonas.

true

Time weighted average (TWA) is the amount of a substance a person can be exposed to over an eight-hour day.

true

Tracking Systems can help manage preventive maintenance schedules

true

Tracking individual instruments is important to help ensure specific instruments are kept with a specific set

true

Gold handle instruments are called

tungsten carbide

Which of the following is the surgery of the ear that reconstructs the eardrum so sound waves can be sent to the middle ear

tympanoplasty

Which of the following mechanical washers uses cavitation for cleaning instruments?

ultrasonic washers

Central Service technicians need to understand the anatomy of a steam sterilizer to

understand how the sterilizer operates

When placing hinged instruments in an instrument tray

unlock the handles and open the instruments

Which of the following microorganisms have no means of movement of their own

viruses

Impingement is the spray force action used by

washer decontaminator

The door is considered the ________ part of the sterilizer.

weakest

Which of the following is an open-endedn question?

what problems do you most encounter on the job?


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