Procedures I Final

Femoral hernias occur more frequently in which group of individuals? a. Postoperative obese patients b. Newborns c. Weight lifters d. Females

Females

Select the structure of the trachea that is a landmark during bronchoscopy. a. Cartilaginous ring b. Cricoid cartilage c. Carina d. Right main bronchus

Carina

The surgical microscope is often used to provide illumination and magnification for complex procedures to the ear, laryngeal surgery, or reconstructive free flap procedures following neck surgery. A common eyepiece magnification for an otologic microscope is 12.5, and the usual objective (lens) is ______- mm focal length (f). A _______- mm lens is used for laryngeal surgery. a. 250 or 300; 400 b. 400; 150 c. 150; 400 d. 400; 250 or 300

250 or 300; 400

Fibrocystic changes in the breast describe many different breast changes. These changes affect almost all women at some time in their lives. Nipple discharge is more commonly associated with benign lesions than with cancer; however, discharge is usually significant only if it is spontaneous, persistent, and: a. chronic. b. unilateral. c. bloody. d. All of the options are significant.

All of the options are significant.

Although each potential kidney transplant recipient is judged individually as a candidate, which condition from the list below would most likely eliminate a patient as a candidate for kidney transplant? a. Systemic disease b. Cardiovascular disease c. Post-treatment cancer in remission d. Active cancer

Active cancer

Several types of diagnostic imaging studies visualize structures by producing serial sections through different anatomic planes, highlighting specific structures or tissue densities. Examples of these imaging diagnostics would be: a. complementary CT scan with MRI. b. MRI scan. c. CT scan. d. All of the options

All of the options

The mesh-plug open hernia repair technique is indicated for which type(s) of hernias? a. Femoral hernias b. Indirect inguinal hernias c. Direct inguinal hernias d. All of the options are correct

All of the options are correct

Open common bile duct (CBD) exploration may be indicated in some cases where: a. the patient has undergone prior biliary surgery. b. a positive cholangiogram shows a CBD obstruction during an open cholecystectomy. c. laparoscopy technology is not available. d. All of the options are correct.

All of the options are correct.

Jennifer Peoples is a 41-year-old woman with suspected primary adenocarcinoma of the thyroid; she is scheduled for total thyroidectomy surgery. How can the scrub person, Joni, a new surgical technologist, participate in using risk reduction strategies in the scrub role? a. Pay meticulous attention to sterile technique. b. Provide efficient and expedient hemostatic devices and materials as needed. c. Maintain sterility of the instruments until the patient leaves the room in the case of need for emergency tracheostomy. d. All of the options reflect appropriate scrub role risk reduction techniques.

All of the options reflect appropriate scrub role risk reduction techniques.

Oral malignancies can be linked to specific carcinogens, the most important one being tobacco. Benign or malignant lesions of the tongue, floor of the mouth, alveolar ridge, buccal mucosa, or tonsillar area are excised depending on the extensiveness of disease, involvement of surrounding vessels and nerves, and candidacy for surgery. Benign or small malignant tumors of the oral cavity may be excised without a neck dissection. What indicator would prompt the surgeon to perform a neck dissection for benign or small malignant tumors? a. Evidence of disease in the upper lymphatic chain b. Suspicious metastatic disease c. Presence of diagnosed malignancy d. All of the options would be indications for neck dissection

All of the options would be indications for neck dissection

Thyroid surgery is considered surgery of the head and neck. There is a high risk for surgical fires because of the proximity of all three components of the fire triangle. Select the statement that best reflects an appropriate nursing action to prevent a surgical fire. a. Include the fire risk score during the time-out briefing. b. Prevent prep solution from pooling under the patient's head, neck, and shoulders. c. Permit the prep solution to dry before draping. d. All the options are risk reduction considerations.

All the options are risk reduction considerations.

The liver, pancreas, and spleen share many similarities. Select the statement about these organs that is true. a. All three are solid organs and very vascular. b. All three are metabolic organs. c. All three organs have terminal attachments to the duodenum. d. All of the options are false.

All three are solid organs and very vascular.

A breast biopsy, performed after the patient has received a local anesthetic, will require adjunct sedation and monitoring equipment. What relevant considerations should the surgical team member note during the preoperative assessment? a. Skin assessment b. Allergies c. ASA physiologic status d. Risks for injury

Allergies

A kidney transplant entails transplantation of a living-related or cadaveric donor kidney into the recipient's iliac fossa. It is performed in an effort to restore renal function and maintain life in a patient who has end-stage renal disease. Select the statement that best reflects the ideal living-related donor candidate. a. An identical twin or spouse, young, ABO and Rh factor compatibility b. An identical twin or parent, good health, and large right kidney c. An identical twin or sibling, no family history of diabetes, Rh factor compatibility d. An identical twin or sibling or parent, ABO and HLA compatibility, good health

An identical twin or sibling or parent, ABO and HLA compatibility, good health

Breast screening guidelines are developed and published by the American Cancer Society (ACS) for asymptomatic women of various age and risk groups. Select the statement that best reflects the ACS guidelines for women at high risk for breast cancer. a. Biannual mammography with two views of each breast and clinical breast exam b. An individualized screening plan c. Biannual clinical breast exam, mammography, and bimonthly breast self-exam d. Annual mammography, ultrasonography, and MRI with CT

An individualized screening plan

Edward Lewis is scheduled for a transthoracic esophagectomy with lymph node dissection for cancer of the esophagus. Which incisional approach is indicated for this procedure? a. Left thoracoabdominal incision b. Right posterior lateral thoracotomy and midline abdominal incision c. Three-incision (three-hole) approach with cervical, right thoracotomy, and midline laparotomy incisions d. Any of the three above incisions may be used per surgeon preference or tumor location.

Any of the three above incisions may be used per surgeon preference or tumor location.

Select the diagnosis/procedure option that pairs the correct surgical diagnosis with the surgical/endoscopic procedure for diseases of the esophagus: a. Barrett's dysplasia of the distal esophagus/endoscopic mucosal resection (EMR) b. Gastroesophageal reflux disease (GERD)/photodynamic therapy (PDT) c. Zenker's diverticulum/Ivor Lewis esophagectomy d. Esophageal varices/Heller myotomy

Barrett's dysplasia of the distal esophagus/endoscopic mucosal resection (EMR)

An example of perineal glands that secrete mucus is: a. Skene's glands. b. Bartholin's glands. c. perineal glands. d. labial glands.

Bartholin's glands.

Of the open hernia procedures listed below, which classic hernia procedure is considered, by some surgeons, to not be anatomically correct because the superior transversalis fascia is sutured to the inguinal ligament instead of to the inferior portion of the transversalis fascia or the Cooper ligament? a. Shouldice repair b. Bassini repair c. McVay repair d. Cooper repair

Bassini Repair

Which of the diagnostic modalities listed below does not employ the use of ionizing radiation? a. Audiogram b. Magnetic resonance imaging (MRI) c. Computed tomography (CT) d. Both audiogram and magnetic resonance imaging (MRI)

Both audiogram and magnetic resonance imaging (MRI)

The Caldwell-Luc procedure is a radical antrostomy used to establish a large opening into the wall of the inferior meatus leading to the sinuses. Where is this large incisional approach made? a. Proximal to the maxillary artery b. Antrum wall on the affected sinus side c. Canine fossa of the upper jaw d. Intranasally on the affected sinus side

Canine fossa of the upper jaw

Carly Shelmire is a 5-year-old girl with a history of weight loss and stomach upset and pain after eating; she is also small for her age. Her pediatrician suspects celiac disease. Carly has arrived at the pediatric endoscopy unit for a procedure that is less invasive and will also have the benefit of spending the next few hours in the mall across from the hospital with her mom until the procedure is over. What is Carly's scheduled procedure? a. GI manometry b. Small bowel enteroscopy c. Capsule endoscopy d. Stretta procedure

Capsule endoscopy

Exposure of intra-abdominal anatomy is crucial to safe surgery and employs varied instruments, applications of highly technical energy sources, patient manipulations, light, and imaging. What is unique to the laparoscopic approach that promotes exposure? a. Self-retaining retractors b. Automatic rod-lens fiberscope c. Carbon dioxide pneumoperitoneum d. Endoscopic fan blades

Carbon dioxide pneumoperitoneum.

Ann Contreras has consulted a noted colorectal surgeon after experiencing episodes of rectal bleeding over the last 2 weeks. She had a screening colonoscopy 5 years ago with several adenomatous polyps and mild diverticular disease. She presents to the endoscopy suite after a successful bowel prep and NPO since midnight. The GI endoscopist is confident that she will find tumor growth in the rectum and decides to employ further diagnostic applications to determine potential for metastasis. Which of the following endoscopic procedures best describes Ann's procedure? a. Endoscopic retrograde cholangiopancreatoscopy (ERCP) b. Rectal manometry with dilatation c. Flexible sigmoidoscopy d. Colonoscopy with endoscopic ultrasound (EUS)

Colonoscopy with endoscopic ultrasound (EUS)

When microlaryngoscopy is performed to remove polyps or nodules from the vocal cords, what important postoperative instruction must be provided to the patient during preparation for discharge? a. Complete voice rest is important. b. Coughing and deep-breathing exercises should be performed. c. Clearing the throat to remove secretions is advised. d. The patient should use a humidifier.

Complete voice rest is important.

Select the congenital anomaly that best reflects indications for fetal surgery. a. Imperforate anus b. Tracheoesophageal fistula c. Congenital diaphragmatic hernia d. Nonobstructive uropathy

Congenital diaphragmatic hernia

Margie Donaldson's examination has revealed a family history of endometrial cancer. She has never been pregnant and has been taking hormone replacement therapy for 4 years. Her physician has scheduled her for a surgical procedure to obtain visual and pathologic information and provide treatment as indicated. Margie was sure that she would have to have a D&C (dilatation and curettage). Margie's surgery, on the operative schedule, would most probably be written as: a. D&C with endocervical biopsies. b. hysteroscopy with endometrial ablation. c. D&C with endometrial biopsies, frozen section, possible LAVH. d. D&E with endometrial washings, frozen section, total abdominal hysterectomy.

D&C with endometrial biopsies, frozen section, possible LAVH.

Two patients are scheduled to have a gastrojejunostomy for obstruction. How will perioperative planning differ for a patient weighing 280 lb as compared to that for a 150-lb patient? a. The ligament of Treitz will not need to be identified in a lighter person. b. Forced air-warming devices are more important for a lighter patient. c. The anastomosis will require sutures rather than staples for the heavier patient. d. Deaver retractors will replace Richardson retractors with the heavier patient.

Deaver retractors will replace Richardson retractors with the heavier patient.

While direct and indirect hernias both protrude into the inguinal canal and represent tears in the transversalis fascia, which one of the two occurs within the Hesselbach triangle? a. Direct inguinal hernia b. Indirect inguinal hernia c. Both options occur within the triangle d. Neither option occurs within Hesselbach's triangle

Direct inguinal hernia

In the past, radical procedures, which involved removal of the affected breast and all axillary and thoracic lymph nodes, were used to treat breast cancer. These procedures did not significantly lower mortality. What factor(s) may have contributed to mortality after these procedures? a. Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection. b. Early pathology techniques for frozen section and histology microexamination could not define margins. c. Breast cancer was believed to spread by direct extension from its initial site in the breast to adjacent lymph nodes. d. Tumor size was not usually correlated with involvement of lymph nodes and cancer spread.

Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection.

Hypothyroidism results from undersecretion of thyroid hormone. The most common cause of primary hypothyroidism is chronic autoimmune thyroiditis (Hashimoto's disease). Select the set of symptoms that is most commonly associated with hypothyroidism. a. Dry skin, edema, constipation, and depression b. Irritability, mood changes, visual disturbances, and diarrhea c. Heat intolerance, anorexia, hair loss, and menstrual irregularity d. Bradycardia, hypotension, hypoxia, and poor concentration

Dry skin, edema, constipation, and depression

Breast cancer is usually staged to measure the extent of the disease and to design a specific treatment plan, using the TNM (T = tumor; N = node; M = metastasis) classification system. Apply the description of a stage 0 carcinoma in situ to the appropriate disease description listed below. a. Lobular carcinoma in situ (LCIS) has abnormal cells lining the lobule and often becomes invasive. b. Ductal carcinoma in situ (DCIS) is defined as abnormal cells lining the ductal system and is not invasive. c. Lobular carcinoma in situ (LCIS) has abnormal cells infiltrating the lobule and often does not become invasive. d. Ductal carcinoma in situ (DCIS) has abnormal cells lining the ductal system and is often invasive.

Ductal carcinoma in situ (DCIS) has abnormal cells lining the ductal system and is often invasive.

Sharon Close has been diagnosed with severe gastroesophageal reflux disease (GERD) without the dysplastic changes of Barrett's esophagus. Her GERD is unresponsive to proton pump inhibitors and histamine blockers. She also has a history of endometriosis with multiple surgeries for ablation of endometrial implants on her small bowel and adhesiolysis. Her surgeon is hesitant to pursue an open or a laparoscopic Nissen surgical approach. What procedure might her surgeon consider in lieu of a Nissen? a. Thoracoabdominal partial esophagectomy b. Endoscopic mucosal resection c. Endoluminal plication of the lower esophageal segment d. Heller's myotomy

Endoluminal plication of the lower esophageal segment

Specific positioning considerations for bariatric patients require particular attention to protecting these patients from inherent risks related to their size and weight. Of considerable concern is the risk of injury to staff. Protective measures to protect both patient and staff include those below. Which measure reflects the most safety protection for both patient and staff? a. Review back safety precautions and awareness during preincision briefing. b. Ensure that the OR bed can accommodate the patient's weight and girth. c. Employ at least three safety straps over the patient's largest girth. d. Overlap the viscoelastic gel mattress top with three lifting sheets.

Ensure that the OR bed can accommodate the patient's weight and girth.

The cricoid cartilage is a complete cartilaginous ring that resembles a signet ring; it rests beneath the thyroid cartilage and supports the airway. What membrane, attached to the midline of the upper thyroid cartilage, protects the larynx during swallowing? a. False vocal cords b. True vocal cords c. Arytenoids d. Epiglottis

Epiglottis

From the list below, select the statement that is true about fallopian tube cancer. a. Fallopian tube cancer metastasizes to the ovaries and cervix. b. Fallopian tube cancer is fast-growing in women with genital herpes. c. Fallopian tube cancer is very rare, with an incidence of less than 1%. d. Fallopian tube cancer is seen primarily as a metastasis from the small intestine.

Fallopian tube cancer is very rare, with an incidence of less than 1%.

In transurethral resection of the prostate gland (TURP), the surgeon passes a resectoscope into the bladder through the urethra and resects successive pieces of tissue from around the bladder neck and the lobes of the prostate gland, leaving the capsule intact. TURP is traditionally indicated for patients with benign obstructive disease of the prostate. A TURP would be indicated for a patient with malignant prostatic disease under which of the following conditions? a. For palliative relief of obstruction for end-stage disease b. For symptom relief of obstruction before initiating other treatments c. For specimen retrieval for diagnostic cancer staging d. For men who cannot tolerate, or who are not candidates for, high-intensity focused ultrasound

For symptom relief of obstruction before initiating other treatments

The recipient liver OR is arranged for a major laparotomy and vascular procedure with customized instruments, supplies, and sutures according to the transplant surgeon's preference. In addition to the general patient care accessories, equipment, and supplies needed for any large surgery, also included are intraoperative laboratory testing and an autotransfusion system. Describe the boundaries of the surgical skin prep for the patient about to receive a liver transplant. a. From neck to midthigh; midaxillary line to midaxillary line b. From nipple line to pubis; bedline to bedline c. From the neck to midthigh; bedline to bedline d. From nipple line to midthigh; midaxillary line on the patient's left side, and bedline on the right

From the neck to midthigh; bedline to bedline

The mammary glands are affected by physiologic changes throughout a woman's life span. Select the option that best reflects the life cycle events that impact the anatomy and physiology of the breasts. a. Growth and development, menstruation, and menopause b. Menstruation, pregnancy, and lactation c. Hormone development, pregnancy, and menopause d. Growth and development, menstruation, and pregnancy and lactation

Growth and development, menstruation, and pregnancy and lactation

Anatomic exposure is promoted and supported by proper body alignment in collaboration with safe and secure surgical positioning. The optimal presentation of the thyroid and surrounding structures of the neck can be achieved with the patient in supine or beach-chair position. Select the positioning considerations that enhance visualization and access to important structures. a. 30-degree Trendelenburg's tilt of the OR bed, shoulder roll, and arms tucked snuggly at sides b. Hyperflexion of the neck, shoulder roll, and arms tucked loosely at sides with palms facing up c. Hyperextension of the neck, shoulder roll, and 30-degree reverse Trendelenburg's tilt of the OR bed d. Headrest, arms abducted at 90 degrees on armboards, and axillary roll

Hyperextension of the neck, shoulder roll, and 30-degree reverse Trendelenburg's tilt of the OR bed

TURP syndrome is a state of severe hyponatremia, caused by systemic absorption of irrigating fluid during the procedure. Select the sign/symptom that the anesthesia provider would report in a patient experiencing TURP syndrome. a. Hypertension b. Hyperthermia c. Hypernatremia d. Hypokalemia

Hypertension

Myringotomy is often accompanied by the aspiration of fluid under pressure in the tympanum, and the subsequent placement of small, hollow, pressure equalization tubes. It is indicated for acute otitis media (AOM) in the presence of an exudate that has not responded to antibiotic therapy. If left untreated, what is the main concern for a child with chronic otitis media? a. Impaired language development b. Encephalitis c. Hearing loss d. Impaired language development and hearing loss

Impaired language development and hearing loss

During a laparoscopic colectomy, the scrub person carefully placed the endoscopic electrosurgery instruments on the Mayo stand after inspecting the integrity of the insulation along the shaft. This practice is designed to meet the expectation for the following outcome: The patient will be free from: a. fluid and electrolyte imbalance. b. thermal burns and adhesions. c. impaired tissue integrity. d. thermal burns and adhesions, and impaired tissue integrity.

Impaired tissue integrity.

Hernia-entrapped viscera, typically loops of small intestine, will result in intestinal obstruction with resulting pain, vomiting, and distention. What is the appropriate descriptive diagnosis of this condition? a. Nonreducible hernia b. Incarcerated hernia c. Torsion of the hernia sac d. Gangrenous bowel

Incarcerated hernia

Select the most common hernia that occurs in both males and females and name the side on which it would most likely occur. a. Direct femoral hernia on the left b. Indirect inguinal hernia on the right c. Indirect femoral hernia on the left d. Direct inguinal hernia on the right

Indirect inguinal hernia on the right

Identify the triad of anatomic sites of abdominal wall weakness with a potential for hernias. a. Groin, ventral line, umbilicus b. Inguinal rings, femoral canal, incision c. Inguinal canal, femoral rings, umbilicus d. Ventral line, aponeurosis, inguinal canal

Inguinal canal, femoral rings, umbilicus

Select the triad of the boundaries of the Hesselbach triangle. a. Inguinal ligament, rectus abdominis muscle, deep epigastric vessels b. Rectus abdominis muscle, Cooper ligament, aponeurosis c. Scarpa's fascia, deep epigastric vessels, external oblique muscle d. Inguinal ligament, inguinal canal, Cooper ligament

Inguinal ligament, rectus abdominis muscle, deep epigastric vessels

Functional endoscopic sinus surgery (FESS) provides a more physiologic type of drainage by reducing trauma to normal tissues. FESS involves the endoscopic resection of inflammatory and anatomic defects of the sinuses. Select all of the appropriate indications listed below for FESS. a. Inhibited mucociliary clearance b. Impaired nasal ventilation c. Mucocele d. Sinus infections

Inhibited mucociliary clearance Impaired nasal ventilation Mucocele Sinus infections

What is the purpose of using an intravenous injection of a radiopaque contrast dye during select imaging diagnostic studies? a. There is enhanced uptake of radiation in areas of suspicion. b. It provides visual enhancement of anatomic structures. c. It minimizes ionizing radiation scatter to noninvolved anatomic structures. d. Contrast dye leaves a locator marker for impending surgery.

It provides visual enhancement of anatomic structures.

Which statement about the McBurney incision is most correct? a. It is an oblique inguinal incision in the left lower quadrant. b. It is the incision of choice to repair a direct inguinal hernia. c. It is an oblique inguinal incision in the right lower quadrant. d. The direction is more transverse than oblique.

Its an oblique inguinal incision in the right lower quadrant.

Ramona Guerne has been admitted through the emergency department for severe abdominal pain, distended abdomen, and fever. The surgery service has been consulted and has scheduled her for exploratory surgery. Ramona has undergone two abdominal surgeries in the past for "female problems" and states that she has a tendency to form keloids. A small bowel obstruction is suspected. Postoperative ileus is a common complication of open abdominal surgery. Select the procedure that is least likely to promote postoperative ileus formation in this patient. a. Long (4-hour) laparoscopic procedure, with incidental peritonitis b. Open small bowel resection with postoperative signs of pancreatitis c. Laparoscopic lysis of adhesions with release of bowel torsion d. Laparoscopic-assisted hemicolectomy with mild peritoneal inflammation

Laparoscopic lysis of adhesions with release of bowel torsion

The supraglottis, glottis, and the subglottis represent three portions of which structure of the throat? a. Epiglottis b. Tongue c. Larynx d. Pharynx

Larynx

Laryngoscopy is direct visual examination of the interior of the larynx by means of a rigid, lighted speculum known as a laryngoscope to obtain a specimen of tissue or secretions for pathologic examination. What action should the surgical technologist take in preparing for the conclusion of the procedure? a. Maintain instrument setup until the patient leaves the OR. b. Determine fire risk score. c. Place O2 tank, nasal cannula, and bag/valve/mask on the transport vehicle. d. Assist anesthesia provider with anesthesia emergence and transfer to the PACU.

Maintain instrument setup until the patient leaves the OR.

A chain of three small articulated bones extends across the middle ear cavity and conducts vibrations from the tympanic membrane across the middle ear into the oval window and the fluid-filled inner ear. What are the names of those three small articulating bones? a. Ossicles, incus, and crura b. Stapes, capitulum, and stirrup c. Malleus, incus, and stapes d. Anvil, head, and hammer

Malleus, incus, and stapes

A study was conducted that compared laparoscopic and open-mesh methods of inguinal hernia repair and also compared TEP and TAPP techniques for cost and patient outcome effectiveness. Some of the factors measured included patient's return to prior activities, persisting pain and numbness, infection, length of operation time, and complications. The researchers discovered several compelling findings and many differences between the two approaches. Select two statements that reflect true findings from the study. a. TEP and TAPP techniques were of similar cost to the patient. b. Mesh infection rate was low with both techniques. c. There was no significant difference in complication rates. d. There was no apparent difference in the rate of hernia recurrence. e. Return to work and activity was similar for the two techniques. f. TEPP and open-mesh techniques shared equal costs to the patient.

Mesh infection rate was low with both techniques. There was no apparent difference in the rate of hernia recurrence.

Patients scheduled for otologic surgery may have undergone evaluation of their hearing through audiograms to determine whether they have which of these diagnoses? Select all answers that apply. a. Normal hearing b. Sensorineural hearing loss c. Conductive hearing loss d. Mixed loss of hearing from combination of conductive and sensorineural

Normal hearing Sensorineural hearing loss Conductive hearing loss Mixed loss of hearing from combination of conductive and sensorineural

Many breast cancer patients subscribe to various complementary and integrative therapies to provide relief from anxiety, depression, pain, and chemotherapy and radiation therapy related complications and side effects. Quality of life issues become important in providing comfort and life balance. In addition to their oncology physicians and other health care providers, patients may also receive therapeutic assistance for their cancer care from which of the following? a. Pharmacists b. Nutritionists and dietitians c. Wound ostomy care nurses d. Genetic counselors

Nutritionists and dietitians

What classification of drugs are GYN/obstetric-related medications that require monitoring of blood pressure, assessment for continued bleeding, and monitoring of fundal response to the drug? a. Oxytocics b. Tocolytics c. Antimetabolites d. Cytotoxics

Oxytocics

Select the statement that most correctly matches a risk factor for adhesions with an appropriate preventive strategy. a. Multiple surgeries may be managed with the use of sequential compression devices. b. Glove powder adhesions can be prevented with cellulose mist. c. Patients with endometriosis may be best served with a laparoscopic approach. d. Fibrous bands within the peritoneum can be treated with sterile talcum powder.

Patients with endometriosis may be best served with a laparoscopic approach.

Ova travel through the fallopian tubes toward the uterus by which type of action? a. Peristalsis b. Gravity c. Brownian motion d. Intra-abdominal pressure

Peristalsis

Select the option that pairs the correct surgical diagnosis with the surgical/endoscopic procedure for diseases of the abdomen. a. Peritoneal cancer/hyperthermic intraperitoneal chemotherapy b. Ascites/hyperthermic intraperitoneal antibiotic therapy c. Adhesions/lysis of adhesions d. Peritoneal cancer/hyperthermic intraperitoneal chemotherapy and adhesions/lysis of adhesions

Peritoneal cancer/hyperthermic intraperitoneal chemotherapy and adhesions/lysis of adhesions

The general risks associated with gastrointestinal surgery parallel those risks associated with most abdominal procedures. Select a complication that is the most typical risk associated with surgery of the large bowel. a. Colitis b. Peritonitis c. Paralytic ileostomy d. Intestinal obstruction

Peritonitis.

Michael Mason has suffered from subsacral pain and swelling for 2 weeks and finally was referred to a colorectal surgeon for care. He is currently in the ambulatory surgical center OR bed positioned in the jackknife position. The perioperative nurse has gently but firmly taped his buttocks laterally to the rails of the OR bed to promote exposure to the surgical site. What procedure is Michael prepared to undergo, based on his symptoms and the surgical preparation? a. Internal hemorrhoidectomy b. External hemorrhoidectomy c. Removal of rectal foreign body d. Pilonidal cystectomy

Pilonidal cystectomy

During the skin preparation for a gynecologic procedure that requires both an abdominal and a vaginal prep, the circulator must ensure that cross-contamination does not occur. Select two principles of aseptic technique that support cross-contamination prevention. a. Tuck sterile towels under the patient's buttocks and both sides of the abdomen. b. Insert the urinary catheter to drainage before beginning the prep. c. Prep the abdomen before beginning the vaginal prep. d. Use two separate prep trays (one for the abdomen, one for the vagina).

Prep the abdomen before beginning the vaginal prep. Use two separate prep trays (one for the abdomen, one for the vagina).

The PSA test is a serum lab test for prostate-specific antigen. If the test value is elevated, the patient is at risk for carcinoma of the prostate; a PSA value greater than 10 ng/ml is highly suggestive of prostatic carcinoma. Tissue from a transrectal prostate biopsy provides the cellular information to confirm the diagnosis. The American Urological Association (AUA) prostate cancer staging tool essentially provides what important information about the tissue specimen? a. Prostate cancer stages of severity b. Indications for selecting appropriate intervention c. Prognosis and potential for recovery d. All of the options define the AUA score system.

Prostate cancer stages of severity

Postoperative hoarseness, obstructed airway, or paralysis of the vocal cords is a serious complication of thyroid surgery. During surgery, care is taken to identify and protect which nerve? a. Superior branch of the vagus nerve b. Intrinsic cricothyroid nerve c. Recurrent tracheoesophageal nerve d. Recurrent laryngeal nerve

Recurrent laryngeal nerve

An orthotopic neobladder is surgically created as a bladder substitute after a cystectomy, prostatectomy, or hysterectomy is performed for bladder cancer. Bladder substitution relies on meticulous dissection with preservation of the urinary sphincter and neurovascular bundles, as well as a watertight urethral anastomosis. Also termed the "Le Bag continent diversion," what segments of the bowel and/or small intestine are used in this technique to create the neobladder? a. Segment of sigmoid colon b. Right colon and ileum c. Proximal right colon segment with cecum d. Transverse colon

Right colon and ileum

As the surgeon prepared to clamp and transect the bowel during a small bowel resection for tumor, the scrub person transferred instruments from the Mayo stand to the back table and prepared the sterile field for bowel isolation technique. The rationale for this application involves a. Risk for Infection b. Risk for Metastasis c. Risk for Tissue injury d. Risk for Infection

Risk for infection.

Identify the marginal boundaries of the breasts. a. Second to fifth rib horizontally, lateral edge of sternum to mid-clavicular line b. Second to sixth rib horizontally, mid-sternum to mid-clavicular line c. Second to sixth rib horizontally, lateral edge of sternum to anterior axillary line d. Second to fifth rib horizontally, lateral edge of sternum to mid-axillary line

Second to sixth rib horizontally, lateral edge of sternum to anterior axillary line

Sally Hargraves is a 72-year-old patient with multicentric carcinoma in situ (CIS) of the vulva, without evidence of leukoplakia and pruritus. She has a history of prior papillomavirus infection. Select the most appropriate surgical option. a. Radical vulvectomy with inguinal lymph node dissection b. Skinning vulvectomy c. CO2 laser surface ablation of the vulvar lesions d. Simple vulvectomy

Simple vulvectomy

Which action best reflects the movement of urine from the renal pelvis to the bladder? a. Normal intra-abdominal positive pressure promotes renal drainage. b. Slight distention of the renal pelvis initiates a wave of peristaltic contractions. c. Distention of the proximal ureter facilitates gravity drainage through signaling channels. d. Urine is propelled into the bladder when adrenal hormones bind with ureteral receptor sites.

Slight distention of the renal pelvis initiates a wave of peristaltic contractions.

When setting up for a gastrectomy, the scrub person will ensure that appropriate instruments are available to clamp and ligate the: a. branches of the peritoneal artery. b. splenic vessels. c. popliteal artery. d. Treitz arterial stump.

Splenic vessels.

Sarah Pergines, an 82-year-old woman, was referred to the breast surgery service by her gerontologist because of a large inflammatory mass in her left breast. Sarah stated that the lump has existed for several years and she believed it was just part of old age. The surgeon examined Sarah and found tumor nodules growing into the skin of the breast, with breast swelling and redness. Diagnostic imaging results described a tumor that had grown into the chest wall and may have spread to axillary lymph nodes and to other lymph nodes behind the breastbone and below the collarbone. Based on this description, what is Sarah Pergines' probable cancer stage? a. Stage IIa b. Stage IIIc c. Stage IIIb d. Stage IV

Stage IIIc

Talia Mendelson, a 27-year-old patient who had a lumpectomy for early-onset breast cancer, arrived at the ambulatory surgery center for infusion port insertion. She is scheduled to begin adjuvant chemotherapy next week. The catheter component of Talia's port system is inserted into what structure(s)? a. Left mammary or subclavian vein b. Right atrium by way of the jugular vein c. Subclavian or jugular vein d. Inferior vena cava

Subclavian or jugular vein

Charles Wilkins had a laparoscopic hernia repair with good results and an uneventful recovery. Weeks later, as he reviewed his hospital bill, he noted that he had been charged for a very expensive preperitoneal distention balloon, polypropylene mesh, an endomechanical stapler, and three endosurgical trocars. What hernia repair technique was probably performed on Charles? a. TAPP repair b. Laparoscopic Bassini repair c. TEP repair d. Mesh-plug insertion repair

TEP repair

Which two similar hernia repair approaches reestablish the integrity of the transversalis fascia and simultaneously reestablish and strengthen the posterior inguinal floor by sewing the transversalis fascia to the Poupart ligament? a. The Shouldice and the McVay ligament repair b. The Bassini and the Shouldice repair c. The McVay and the Cooper ligament repair d. The Shouldice and the Cooper ligament repair

The McVay and the Cooper ligament repair

The transabdominal preperitoneal patch (TAPP) hernia repair and the totally extraperitoneal patch (TEP) repair differ in the manner in which access is gained to the preperitoneal space. Which of the two provides access to the preperitoneal space without entering the peritoneum? a. The TEP technique b. The TAPP technique c. Both techniques require access into the peritoneal compartment d. Neither technique enters the peritoneal compartment

The TEP technique

Select the statement that best reflects the functional components of the gastrointestinal (GI) tract. a. The GI tract is a continuous pathway from mouth to rectum. b. Peristaltic waveforms produce agitation, which digests large food particles. c. The alimentary canal extends from the mouth to the anus. d. The microscopic ecosystem of the GI tract is an unbalanced colony of germs.

The alimentary canal extends from the mouth to the anus.

Select the statement that best describes fine needle aspiration of a suspicious breast mass. a. The aspirate fluid is cytologically examined. b. The aspirate fluid is histologically examined by frozen section. c. The aspirate fluid is microscopically examined immediately by the procedural physician. d. If the aspirate fluid is positive, the excisional biopsy can be done immediately.

The aspirate fluid is cytologically examined.

The goal of breast cancer surgery is removal of the mass with a margin of normal tissue and a good cosmetic result. The choice of procedure depends on the size and site of the mass, the characteristics of the cells, the stage of the disease, and the patient's choice. Select the statement that best reflects the difference between minimally invasive excisional breast biopsy with stereotactic image-guided location and removal of tissue. a. The stereotactic biopsy produces a specimen for cytologic study, while the excisional biopsy produces a histologic specimen. b. The excisional biopsy is performed under direct visualization, while the stereotactic approach is image-guided. c. The excisional approach requires drain placement, while stereotactic biopsy rarely requires a drain. d. Stereotactic biopsy is recommended for lesions in the areola, high in the axilla, or chest wall while excisional biopsy is not appropriate for these areas.

The excisional biopsy is performed under direct visualization, while the stereotactic approach is image-guided.

An abdominal perineal resection, or APR, for a patient at high risk for colon cancer without anal/rectal involvement (e.g., familial adenopolyposis [FAP]) can be accomplished through an open laparotomy or laparoscopic-assisted ileoanal pull-through approach, per surgeon preference and appropriate patient selection. Which of these statements about approaches for APR is correct? a. Both open and laparoscopic approaches require an abdominal skin incision(s) and perineal incision(s). b. Neither approach requires two or more skin incisions. c. Both procedures require only an abdominal skin incision(s) as the rectal segment is removed and anastomosed intraluminally. d. The laparoscopic-assisted approach only has an abdominal skin incision(s).

The laparoscopic-assisted approach only has an abdominal skin incision(s).

What technologic characteristic of robotic surgery provides a superior indication for robotic-assisted laparoscopic cholecystectomy? a. The surgeon controls two instruments plus a camera while an assistant suctions and retracts. b. Bladeless robotic trocars minimize entry injury and inadvertent hemorrhage. c. The magnified three-dimensional picture may reduce bile duct injuries during dissection. d. Robotic stapler and suture devices promote intracorporeal anastomotic techniques.

The magnified three-dimensional picture may reduce bile duct injuries during dissection.

Patients having genitourinary surgery are at risk for impaired urinary elimination. Select the statement that best reflects a desired outcome for an adult patient. a. The patient will be able to urinate before the bladder exceeds 350 ml of fullness. b. The patient will regain his or her normal pattern of urinary elimination. c. The patient will excrete 50 ml of urine per hour. d. All of the options are desired outcomes.

The patient will regain his or her normal pattern of urinary elimination.

Select the statement about the prostate that best reflects its location, size, and weight. a. The prostate sits adjacent to the urethra, is 2 to 4 cm in depth, and weighs about 25 g. b. The prostate sits below the urethra, is 2 to 3 cm in depth, and weighs 25 to 30 g. c. The prostate sits below the bladder, is 2 cm in depth, and weighs about 25 to 40 g. d. The prostate sits below the base of the bladder, is 4 cm at the base, and weighs 20 to 30 g.

The prostate sits below the base of the bladder, is 4 cm at the base, and weighs 20 to 30 g.

Jan Stuyvesant, a surgical technologist, was the scrub person during a robotic-assisted laparoscopic cholecystectomy. She locked the robotic endoscissor into the adaptor on the robotic arm and positioned the tip end into the trocar port in order for the surgeon to dissect the cystic duct and artery, while the surgical assistant placed the clips on the cystic duct and artery. As she reached across the sterile field to insert the cholangiocatheter through the port, the anesthesia provider accidentally made contact with the distal end of the catheter as he stood up to reach the monitor controls. The contaminated end of the catheter touched the endoscopic clip applier, the endoscissor connector that the surgeon was using, the glove of the assistant, and Jan's gown sleeve. The surgeon ordered everyone to change their gown and gloves and covered the port area with a sterile towel. What was the rationale for the surgeon to continue to dissect and not change his attire? a. The tip of the dissector that was in the patient's abdomen was not contaminated. b. The surgeon planned to remove the dissector after he finished dissecting and then dispose it. c. The surgeon's gown was not touched, just the dissector connection to the robotic arm. d. The surgeon was not in contact with the sterile field because he worked from the robotic console.

The surgeon was not in contact with the sterile field because he worked from the robotic console.

Joanne Grizwald, a 24-year-old woman with type 1 diabetes who is in end-stage kidney failure, is scheduled for a combined kidney-pancreas transplant. She is relatively healthy and at normal weight for her height in spite of her disease process. Her bleeding time and coagulation parameters are within normal limits. The circulating nurse has set up the autotransfusion system, verified Joanne's blood type, and crossmatched blood availability. The scrub person, while organizing the sterile back table, identified several instruments that she will not need. She organizes those instruments on the most distant part of the back table. What instruments is the scrub person unlikely to need during this procedure? a. Based on Joanne's coagulation status, excess bleeding is not expected to be an issue. b. Hemostasis will be achieved by the use of microfibrillar collagen agents that do not leave electrosurgical eschar (burned tissue) on the bleeding surfaces, thereby reducing the chance of infection. c.Any excess bleeding will be removed and returned to the patient through the autotransfusion system. d. The transplant procedure is an open approach and laparoscopic instruments (the insulated electrosurgical-adapted scissors, graspers, and the endoscopic suction tips) are not needed.

The transplant procedure is an open approach and laparoscopic instruments (the insulated electrosurgical-adapted scissors, graspers, and the endoscopic suction tips) are not needed.

What is the mechanism by which the parathyroid glands maintain calcium homeostasis? a. They secrete parathyroid hormone (PTH), which promotes calcium storage in the intestines. b. They produce a hormone that, with calcitonin, takes calcium from the bones and promotes calcium absorption by the intestines. c. They stimulate the pituitary to produce PTH and calcitonin, which elevates serum calcium levels. d. They secrete hormones that stimulate the production of calcium in the bones and small intestines when serum calcium levels fall below 4.5 mg/dl.

They produce a hormone that, with calcitonin, takes calcium from the bones and promotes calcium absorption by the intestines.

Pamela Morris is a 62-year-old woman with a 4-year history of Graves' disease that has not responded to medical therapy. She is scheduled for a subtotal thyroidectomy. What condition, a complication of Graves' disease, is her probable indication for a subtotal thyroidectomy? a. Tracheal obstruction b. Diffuse unilateral enlargement of a lobe c. Hyperthyroidism with cricothyroid compression d. Autoimmune hypothyroidism

Tracheal obstruction

Benign or small malignant tumors of the oral cavity may be excised without a neck dissection, though in the presence of diagnosed or highly suspicious metastatic disease, a selective neck dissection may be performed in an effort to control a cancerous growth in the upper jugular lymphatic chain of the neck. Typically, endotracheal anesthesia is used and a pharyngeal pack of moist gauze may be inserted in the mouth. The perioperative team must be prepared for which additional procedure when head and neck surgery is performed? a. Tracheostomy b. Microscopic free flap graft c. Laryngoscopy d. Difficult airway protocol

Tracheostomy

Acoustic neuromas arise from the Schwann cells of the vestibular portion of the eighth cranial nerve and are benign tumors. What is the postauricular incisional approach that offers the best chance of saving the integrity of the facial nerve? a. Transaural b. Supraaural c. Translabyrinthine d. Intravestibular

Translabyrinthine

A wide variety of ureteral and urethral drains, stents, and other catheters are designed and used for specific urologic procedures. A commonly used catheter is described by its tip. What catheter type is described as open-ended tip, whistle tip, cone tip, and olive tip? a. Irrigation catheter b. Urethral catheter c. Ureteral catheter d. Pigtail catheter

Ureteral catheter

Ductal ectasia is a benign breast disorder that is difficult to distinguish from cancer, primarily because it presents with: a. bilateral tenderness, mottled skin patterns of the breast, and fullness. b. bilateral multicentric nodules and nipple discharge. c. mottled skin patterns of the breast and edema. d. a hard and irregular mass, nipple discharge, and enlarged axillary nodes.

a hard and irregular mass, nipple discharge, and enlarged axillary nodes.

The pyramidal lobe of the thyroid is described as: a. a small lobe often involved in 30% of cases of thyroid dysfunction. b. a protrusion of an immature thyroglossal duct cyst overgrowth. c. a thin upward protrusion of thyroid tissue from the isthmus. d. a vestige of an embryonic thyroid cyst.

a thin upward protrusion of thyroid tissue from the isthmus.

The nasal turbinates increase the turbulence of the airflow through the nose to humidify the air. The turbinates also serve another function to the accessory sinuses by: a. filtering inspired air and preventing sinusitis. b. acting as drainage passageways. c. giving resonance to the voice. d. trapping particle matter before it reaches the nasopharynx.

acting as drainage passageways.

The surgical team gently abducted Matilda's arms into position on padded armboards at less than 90 degrees with palms facing up. Extra padding was placed under her elbows and an armboard strap was secured over her forearm. The armboards were locked into place to prevent inadvertent abduction. This important maneuver is designed as a risk reduction strategy to prevent: a. axillary tension. b. brachial plexus injury. c. celiac plexus injury. d. elbow torsion with displacement.

brachial plexus injury

Miranda Cox returned to her gynecologist's office for a second Pap smear when her routine exam showed dysplastic cells in her cervical cytology test. Miranda has a family history of cervical cancer and had laser ablation within the last 2 years for vulvar condylomata. She can expect her gynecologist to perform another Pap smear and: a. colposcopy with endocervical biopsy. b. hysteroscopy with cervical biopsy and frozen section. c. colposcopy with cervical skinning procedure performed using a local anesthetic. d. second-look vaginal exam with cervical Pap smear.

colposcopy with endocervical biopsy.

During otolaryngologic procedures using local anesthetic, the perioperative team plans the environment of care as a quiet, warm, and functional domain of healing and comfort. An important consideration with most otolaryngologic patients identifies their specific _________ needs. a. communication b. anxiety c. airway d. pain

communication

The external ear, which includes the auricle (or pinna) and external auditory canal, is composed of cartilage covered with skin. The primary function of the auricle is to: a. gather and direct sound waves toward the inner ear. b. concentrate and conduct incoming sound waves into the external auditory canal. c. collect and amplify incoming sound waves by facilitating tympanic membrane vibration. d. facilitate air conduction of sound waves.

concentrate and conduct incoming sound waves into the external auditory canal.

Ryan has an indirect hernia that is characterized by a small neck, thin walls, and close attachment to the cord structures. Marc has a hernia with a short, wide neck, and a thick-walled sac. Based on this description, Ryan has a(n) ____________ hernia and Marc has a(n) __________ hernia. a. acquired; congenital b. reducible; nonreducible c. congenital; acquired d. pantaloon; sacular

congenital; acquired

A minimally invasive video-assisted thyroidectomy (MIVAT) procedure relies on Miccoli instruments added to the standard thyroid or neck dissection setup, a 30-degree endoscope, and an ultrasonic (harmonic) scalpel with scissors to ligate and divide the vessels. An important risk reduction strategy for any minimally invasive procedure would be (select all that apply from the options below): a. note the amount of CO2 volume in connected tank and tanks available. b. consider and plan for the possibility of conversion to open thyroidectomy. c. position and drape the patient as for thyroidectomy. d. use fire-resistant light cords, endoscopes, light sources, and cable connections

consider and plan for the possibility of conversion to open thyroidectomy. position and drape the patient as for thyroidectomy.

The primary function of the three thyroid hormones is to regulate: a. energy metabolism. b. body growth and development. c. calcium storage in the bones. d. the decrease in blood calcium levels.

energy metabolism

Matilda Gunderson, a 55-year-old woman with uterine cancer, is scheduled for an open panhysterectomy. She is positioned in low lithotomy with her legs symmetrically arranged in padded cradle stirrups. After the incision is made and primary dissection accomplished, she will be positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area. Matilda is at risk for compromise and injury related to prolonged Trendelenburg tilt, which promotes: a. decreased pulmonary compliance and functional residual capacity. b. increased popliteal congestion and peripheral vascular collapse. c. shearing force injury from sliding toward the head of the OR bed. d. avascular ischemic changes to the lower leg and feet from gravitational devascularization.

decreased pulmonary compliance and functional residual capacity.

Both ears provide stereophonic hearing that gives us very specific hearing capabilities. Binaural hearing makes it possible for: a. determination of the source location of sounds. b. enhanced voice recognition. c. amplification and resolution of sound properties. d. recognition of more than one sound at a time.

determination of the source location of sounds.

Marla Moriarity, a 32-year-old recently unemployed and uninsured college professor, is diagnosed with an early ectopic pregnancy. Her obstetrician has given her the option of surgical or medical therapy. She is well-informed about the details of each medical and surgical option, but her primary concern about her condition is that her decision will be based upon her strong cultural belief system that will not sanction the destruction of the fetus. Marla's treatment decision will most likely be: a. the medical therapy of IM methotrexate for 5 to 7 days. b. laparoscopic injection of methotrexate to the extrauterine gestational sac. c. emergency laparotomy for a ruptured ectopic pregnancy. d. salpingectomy.

emergency laparotomy for a ruptured ectopic pregnancy.

The adrenal glands lie retroperitoneally beneath the diaphragm, capping the medial aspects of the superior pole of each kidney. The adrenal medulla secretes ______________ while the adrenal cortex secretes ____________ and ____________. a. epinephrine; steroids and hormones b. steroids; adrenaline and hormones c. epinephrine; pituitary-stimulating hormone and adrenaline d. pituitary hormones; cortisol and norepinephrine

epinephrine; steroids and hormones

The nasal cavity is associated with the ear by way of the ____________, and communicates with the conjunctiva through the __________________. Select the options that are appropriate to complete the sentence. a. torus tubarius; canaliculi b. eustachian tube; nasolacrimal duct c. nasopharynx; medial caruncle d. middle ear; lacrimal sac

eustachian tube; nasolacrimal duct

The anterolateral abdominal wall consists of an arrangement of muscles, fascial layers, and muscular aponeuroses lined interiorly by peritoneum and exteriorly by skin. The key landmark of the _____________ designates the roof of the inguinal canal and the key landmark of the __________ designates the floor of the inguinal canal. a. external oblique aponeurosis; transversalis aponeurosis and fascia b. lateral rectus abdominis; transversalis aponeurosis and fascia c. external oblique aponeurosis; Poupart ligament d. transversalis aponeurosis and fascia; Cooper ligament aponeurosis

external oblique aponeurosis; transversalis aponeurosis and fascia

An example of a potential risk associated with pneumoperitoneum would be: a. tachycardia caused by peritoneal irritation from the CO2. b. CO2 absorption into the peritoneal capillaries, causing decreased oxygen saturation. c. bradycardia from CO2 pressure lower than 15 mm Hg. d. gas embolus into an exposed blood vessel during the procedure.

gas embolus into an exposed blood vessel during the procedure.

The functional units of the liver are the lobules. The functional cells of the liver are the ______________ and they manufacture _______________. a. Kupffer cells; phagocytes b. sinusoid cells; lymphocytes c. hepatocytes; bile d. portal triad cells; ductal epithelium

hepatocytes; bile

An example of a common postoperative complication related to inguinal hernia surgery is: a. delayed return to activity. b. delayed healing. c. postoperative adhesions. d. hernia recurrence.

hernia recurrence.

High-intensity focused ultrasound (HIFU) is a noninvasive technique used in the treatment of prostate cancer. HIFU is a targeted therapy that is highly focused into a small area without causing collateral tissue damage. Aside from primary therapy, HIFU can be used as salvage therapy, primarily after radiation. HIFU can be performed as an outpatient procedure, often with an epidural anesthetic. The HIFU-directed energy modality is best described as: a. high-temperature nonionizing thermal energy. b. cavitation of the prostate cell cytoplasm by the implosion of microscopic bubbles. c. mechanical shearing force of ultrasonic waves. d. radiofrequency coagulation of prostatic cell nuclei.

high-temperature nonionizing thermal energy.

The renal artery and vein enter and exit the kidney on the medial side of the organ through a concave area known as the: a. calyces. b. pedicle. c. hilum. d. renal pelvis.

hilum.

When laryngoscopy, bronchoscopy, and esophagoscopy are performed in a single session on a patient, the procedure is termed triple endoscopy or panendoscopy. The purpose of triple endoscopy is usually diagnostic. A critical role of the surgical technologist in the scrub role during this complex diagnostic procedure is that of: a. documenting the serial numbers of the scopes in the perioperative record. b. identifying, containing, and labeling all specimens accurately. c. carefully handling and reprocessing the endoscopes. d. assisting the anesthesia provider with maintaining the airway.

identifying, containing, and labeling all specimens accurately.

While the pancreas' function is carbohydrate metabolism with the production of insulin and digestive enzymes, the spleen's function is primarily ___________ with the production of _______________. a. immunologic; leukocytes b. metabolic; granulocytes c. anabolic; plasma cells d. as a blood reservoir; phagocytes

immunologic; leukocytes

Contributing factors to hernia formation include age, gender, previous surgery, obesity, nutritional status, and pulmonary and cardiac disease. The formation of the hernia at a site of weakness is due to any number of conditions that cause: a. impaired healing and defective collagen formation. b. thinning and stretching of muscle fibers. c. increased pressure within the abdomen. d. loss of tissue elasticity.

increased pressure within the abdomen.

During endoscopic sinus surgery, patient eye protection includes: a. taping the eyelids closed. b. placing moist gauze over the eyelids. c. instilling eye lubricant into both eyes. d. All of the options apply

instilling eye lubricant into both eyes.

A group of United Kingdom (UK) researchers undertook an analysis of several research studies comparing the outcomes of laparoscopic versus open incisional hernia repair of patients who had prior laparotomies. They examined surgical time, duration of hospital stay, perioperative complications, postoperative surgical site pain, and recurrence rates in 183 patients whose incisional hernias were repaired by the open approach and 183 repaired by the laparoscopic approach. Based on the results of this study, an appropriate risk reduction strategy for patients with incisional hernias would be to repair incisional hernias: a. laparoscopically. b. through an open approach. c. using either open or laparoscopic approaches for equally good patient outcomes. d. with the open approach to decrease surgical time.

laparoscopically.

Women of high socioeconomic status and higher education also have a high incidence of breast cancer, most likely due to: a. high-fat diet. b. lifestyle-related genetic mutations. c. later age at first birth. d. better compliance with regular screening.

later age at first birth.

The Whipple procedure is the removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the ____________ as a surgical treatment for____________. a. left lobe of the liver; metastatic hepatocytoma b. distal segment of the spleen; pancreatic metastasis c. inferior margin of the ligament of Treitz; pancreatic cancer d. lower half of the common bile duct; pancreatic cancer

lower half of the common bile duct; pancreatic cancer

The palatine and lingual tonsils are situated in the oropharynx, while the adenoids are located in the nasopharynx. Both adenoids and tonsils consist of: a. lymphoid tissue. b. glandular tissue. c. vascular tissue. d. mucosal tissue.

lymphoid tissue.

Lasers assist in vaporization of scar tissue, granulomas, and cholesteatomas without damaging surrounding tissue and may be used for select otolaryngologic procedures. Lasers can be secured to the operating microscope and laser energy delivered to the tissue by means of a: a. fiberoptic probe. b. beam separator. c. micromanipulator. d. flexible micro laser fiber.

micromanipulator.

A patient having a subtotal thyroidectomy for tracheal or esophageal obstruction is best served by a surgical team that recognizes and is prepared for patients who are at risk for difficult intubation. An example of a postoperative patient care management plan is: a. monitor the patient closely for airway difficulty. b. prevent coughing. c. support the neck during movement. d. prevent postoperative nausea and vomiting.

monitor the patient closely for airway difficulty.

During urologic surgery, large quantities of irrigating fluids are infused intraoperatively. Which of the following is appropriate? a. monitoring and recording the volume of IV and irrigating fluids instilled. b. maintaining a closed urinary drainage system. c. providing the patient with information on preventing recurrent urinary tract infections. d. monitoring blood loss and volume replacement.

monitoring and recording the volume of IV and irrigating fluids instilled.

When catheterizing the female patient, the urethra must be located. The correct order of the external organs of the vulva listed anterior to posterior is: a. mons pubis, labia majora, labia minora, urethra, clitoris, vaginal opening. b. labia majora, labia minora, clitoris, urethra, vaginal opening, mons pubis. c. mons pubis, labia majora, labia minora, clitoris, urethra, vaginal opening. d. labia majora, labia minora, urethra, mons pubis, clitoris, vaginal opening.

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

A nasal polypectomy is the removal of polyps from the nasal cavity. Nasal polyps are benign, grapelike clusters of mucous membrane and connective tissue. When the polyps become large, they obstruct the free passage of air, make breathing difficult, and cause a change in speech quality. Nasal polypectomies are typically performed endoscopically with the use of microdebriders, which remove the polyps by their mechanism of _______________ the polyp and suctioning the tissue. a. ultrasonic cavitating b. morcellating c. radiofrequency ablating d. laser vaporizing

morcellating

Audible facial nerve monitors (nerve integrity monitor systems) are used intraoperatively during procedures in which the facial nerve is at risk for injury. The purpose of this monitoring technique is to assist in the early identification of the nerve, to increase the possibility of its preservation by minimizing trauma, and to assess its integrity after dissection. Communication with the anesthesia provider is essential because: a. the electrodes are often in proximity to the anesthetic airway. b. manipulation of the anesthetic airway during the procedure can misplace the electrodes. c. muscle relaxants, paralyzing agents, and some local anesthetics must be avoided. d. the anesthesia provider is responsible for the facial nerve monitoring.

muscle relaxants, paralyzing agents, and some local anesthetics must be avoided.

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

necrotic bowel

Matthew Ryan, a 9-year-old boy, is admitted to the emergency department for a sledding accident, when he lost control of his sled and crashed into a tree. He is pale and in pain; his abdomen is tender and firm to palpation. The CT scan suggests rupture of the spleen with internal bleeding. Matthew's scheduled surgery will most probably be a(n): a. laparoscopic splenic resection with sutured mesh overlay. b. open splenic lobectomy with vascular ligation. c. open total splenectomy. d. open splenic repair with sutured anastomosis and argon plasma coagulation vessel sealing.

open total splenectomy.

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

otosclerosis.

The biliary system (also called the biliary tree) drains bile from the gallbladder to the ampulla of Vater. The primary function of the gallbladder is to: a. manufacture bile. b. convert bile salts into bile enzymes. c. store and concentrate bile. d. contract to secrete bile into the hepatic duct.

store and concentrate bile.

Tympanoplasty is the surgical repair of the tympanic membrane and the tympanum and the reconstruction of the ossicular chain. Conductive hearing loss is caused by an obstruction in the external canal or middle ear, which impedes the passage of sound waves to the inner ear. A common cause of conductive hearing loss would be: a. acute otitis media. b. fluid invasion of the ear canal. c. perforation of the tympanic membrane. d. a healed myringotomy.

perforation of the tympanic membrane.

What composes the lining of a herniated abdominal sac? a. Fascia b. Peritoneum c. Muscularis d. Rectus abdominis muscle

peritoneum

The nose is divided into the prominent external portion and the internal portion known as the nasal cavity. The primary purpose of the nose is to: a. facilitate the sense of smell. b. warm inspired air. c. moisturize inspired air. d. prepare inspired air for the lungs.

prepare inspired air for the lungs.

A power drill and assorted rotating burrs are essential for middle ear surgery and some sinus procedures. A selection of burrs including assorted sizes of round cutting burrs and diamond polishing burrs should be available. During drill and power saw use, the scrub person keeps irrigation solution on the sterile field to: a. keep the drill bit or burr cool and prevent breaking. b. prevent clogging of the burr and contamination of the area with bone dust. c. prevent aerosolized bone dust particles, because they are an occupational hazard. d. avoid using a wire brush.

prevent clogging of the burr and contamination of the area with bone dust.

Open parathyroidectomy is currently being replaced with less invasive and more targeted techniques; however, the amount of parathyroid tissue that should be removed remains controversial and relates to whether single or multiple glands are involved. A portion of a gland must remain to: a. prevent hypocalcemia and its complications. b. serve as a marker for later surgery should the gland fail to produce PTH. c. regenerate into normal parathyroid tissue. d. maintain the patient in a state of hypercalcemia to compensate for the lost glands.

prevent hypocalcemia and its complications.

An example of an indication for liver transplantation would be: a. end-stage liver disease resulting from advanced hepatic cancer with metastasis. b. acute fulminant biliary disease of unknown origin. c. infection caused by untreated cystic anomalies. d. primary hepatic cancer.

primary hepatic cancer.

Thyroid storm can occur in patients whose hyperthyroidism is partially controlled or untreated. Thyrotoxic crisis can be precipitated by a stressful event, such as surgery. An example of an action(s) the circulator and surgical technologist can take to reduce the risk of thyroid storm is: a. administer potassium iodide before transfer to the OR. b. provide a quiet, calm atmosphere and help the patient relax. c. provide comfort measures, including a cooling blanket. d. provide a quiet, calm atmosphere and help the patient relax, and provide comfort measures, including a cooling blanket.

provide a quiet, calm atmosphere and help the patient relax, and provide comfort measures, including a cooling blanket.

The external ear canal lining is protected and lubricated with cerumen (earwax), which traps foreign material and: a. liquefies foreign matter in the ear canal. b. lubricates the external ear. c. maintains the acidic pH in the ear canal. d. reduces bacterial levels in the outer ear.

reduces bacterial levels in the outer ear.

The internal thoracic lymph nodes, which drain the inner half of the breast, can also be a channel for the: a. secretion of estrogen. b. spread of metastasis. c. drainage of the outer half of the breast. d. spread of infections.

spread of metastasis.

Total thyroidectomy is the removal of both lobes of the thyroid and all thyroid tissue present. Total thyroidectomy is the desired surgical treatment for patients with: a. hyperthyroidism with more than two episodes of thyroid storm. b. thyroid cancer. c. autoimmune inflammatory thyroid dysfunction. d. hypothyroidism unresponsive to antithyroid medications.

thyroid cancer.

Substernal or intrathoracic thyroidectomy is indicated for extensions of goiters that are encroaching into the substernal or intrathoracic regions, causing tracheal or esophageal obstruction. Access to the substernal compartment is typically facilitated by: a. splitting the sternum. b. using a right mini-thoracotomy approach. c. using long instruments through a regular thyroid incision. d. using a mediastinoscopy approach.

using long instruments through a regular thyroid incision.

The donor liver OR is prepared for an open laparotomy procedure with basic laparotomy and vascular instruments and accessories. A second sterile instrument table is set up to receive and prepare the procured liver. Select the additional instruments and accessories needed on the donor organ preparation table. a. vascular instruments, silk sutures and ties, sterile ice, flushing solution, and slush machine. b. flushing solution, ice chest, sterile ice, powered sternal saw, and long Kocher clamps. c. culture tubes, Wisconsin University forceps, Deaver retractors, and slush machine. d. toothed forceps, vessel loops, two sterile plastic draw-string bags, and flushing solution.

vascular instruments, silk sutures and ties, sterile ice, flushing solution, and slush machine.

Depending on their location, hernias are classified as direct inguinal, indirect inguinal, femoral, umbilical, incisional, or epigastric. Hernias in any of these groups are either reducible or nonreducible. The characteristic "reducible" hernia can best be described as a hernia: a. that does not require surgical repair. b. that is an emergent diagnosis. c. with visceral contents that can be returned to the abdomen. d. with a narrow sac neck that is closed with adhesions.

with visceral contents that can be returned to the abdomen.