Practice Exams CST for Class 2

A patient has arrived in the operating room for a bilateral mastectomy. She is crying inconsolably. The surgical technologist can best console her by saying which of the following? A. "I am sure we will be able to remove all of the cancer." B. "Everything will be fine." C. "Your surgeon is the best in the hospital." D. "We are going to give you the best care possible."

"We are going to give you the best care possible."

Which of the following blades fits a #4 handle?

#20

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

. d. All of the options are correct. << With the advent of endoscopic, percutaneous, and laparoscopic techniques (Figure 3-21), open exploration of the common bile duct is rarely performed. When these newer methods are not available, when they are not possible because of prior surgery, or when an open procedure is otherwise necessary, open common bile duct exploration is performed.

A physician prescribed 50 milligrams of Demerol. The Demerol is supplied in 100 mg/mL. How many mL of Demerol should be given?

0.5 mL > 100:1 = 50:x or 100 mg = 50 mg x is the unknown amount of solution needed, set up the proportion1mL x mL > 100 x x = 50 x 1 Multiply the means and the extremes > 100x = 50 Solve for x by dividing both sides by 100 so x stands alone on one side > x= 50/100 or 0.5 mL

A Marshall-Marchetti-Krantz (MMK) requires which of the following skin preparations? 1. abdominal 2. vaginal 3. rectal 4. extremity

1 and 2 only > An abdominal prep is required because manual manipulation on the abdomen is needed to ensure suture placement. > A vaginal prep is needed to elevate the base of the bladder.

Which of the following is MOST likely to be in place while transferring a patient from the operating room table to the stretcher? 1. IV tubing 2. Fogarty catheter 3. EKG wires 4. Foley catheter

1 and 4 only

Which of the following describes events that would require filing an incident report? 1. medication error 2. bullying 3. cardiac or respiratory arrest 4. equipment failure prior to surgery

1, 2, and 3 only

List in order the sequence of induction for general anesthesia: 1. leads placed on the patient 2. induction agent is given through an IV 3. patient is prompted to breathe 100% oxygen 4. patient is intubated 5. anesthetic gas agent is selected and applied

1,3,2,4 and 5

A surgeon is preparing to close the abdomen of an average weight patient. Which of the following closing supplies should the surgical technologist have ready for closing the fascial layer? A. 2-0 suture and toothed tissue forceps B. 7-0 Vicryl and toothed tissue forceps C. 0 retention sutures and toothed tissue forceps D. staples and Adson with teeth

2-0 suture and toothed tissue forceps

During the application of arch bars, the surgeon will MOST likely use which of the following between the teeth and around the bar? A. 0-1 Dexon B. 5-0 to 6-0 Vicryl C. 25- or 26-gauge stainless steel wire D. 35- or 40-gauge stainless steel wire

25- or 26-gauge stainless steel wire

Which of the following should be the MINIMUM exposure time in a flash sterilizer for unwrapped instruments? A. 1 minute B. 3 minutes C. 5 minutes D. 7 minutes

3 minutes

Which of the following is the correct order, from the outermost to the innermost layer, of the tissues that compose the wall of the stomach and small intestine? 1. submucosa 2. muscularis 3. serosa 4. mucosa

3, 2, 1, 4

When transferring an unconscious, post-operative adult patient from the operating room table to a bed, what is the minimum number of people required for safe transfer?

4

How much 0.25% bupivacaine (Marcaine) should be mixed with 1 mL of 1.0% lidocaine (Xylocaine) to make the solution equal strengths of both medications?

4.0 mL

When inflating a 5-cc balloon on a Foley catheter, which of the following would be the MOST appropriate choice? A. 3-5 mL of sterile water B. 3-5 mL of normal saline C. 8-10 mL of sterile water D. 8-10 mL of normal saline

8-10 mL of sterile water > For a 5-cc Foley catheter balloon, 8-10 mL of sterile water would be needed to compensate for the water that remains in the catheter lumen between the syringe port and the balloon.

Which of the following is used to cross-clamp the intestine during a bowel resection? A. Allen B. Lahey C. Heaney D. Duval

Allen

Which of the following instruments is used to grasp the base of the hemorrhoid during a hemorrhoidectomy? A Allis B. Pennington C. Kocher D. mosquito

Allis

A surgical technologist has selected the sutures for a procedure based on the surgeon's preference card. The surgeon states he would like additional sutures and his preference card is outdated. Which of the following is the surgical technologist's BEST course of action?

Ask the surgeon if he would like to have his preference card updated and proceed accordingly

Which of the following spore-forming microorganisms are used as biological monitors for checking steam sterilization effectiveness for a load of instruments in a rigid container?

Bacillus stearothermophilus

Which of the following spore-forming microorganisms are used as biological monitors for checking steam sterilization effectiveness for a load of instruments in a rigid container? A. Bacillus stearothermophilus B. Bacillus atrophaeus C. Mycobacterium tuberculosis D. Streptococcus pyogenes

Bacillus stearothermophilus

A surgical technologist enters the OR after scrubbing and notices spots of blood on the OR lights. Which of the following actions is the MOST appropriate? A. Ignore the spots because they are small. B. Tell the circulator to obtain replacements and wait at the scrub sink. C. Ask the circulator to clean the spot and then proceed. D. Break scrub to clean the lights and help open a new sterile field.

Break scrub to clean the lights and help open a new sterile field.

During a procedure, a surgical technologist touches an unsterile item with a sterile glove. Which of the following should be done? A. Change the glove at once. B. Break scrub and rescrub. C. Wait until closing to change the glove. D. Ask the surgeon what to do.

Change the glove at once.

Which of the following is a sign of cardiac arrest?

Cyanosis- With lack of circulation (which provides oxygen to tissues) in cardiac arrest, the patient will look blue (cyanotic)

Which of the following retractors is used for a C-section?

De Lee

A surgical technologist sees a neighbor being admitted. How should the surgical technologist respond?

Do not acknowledge the neighbor unless greeted first.

Which of the following staplers should be used for end-to-end intestinal resection? A. EEA B. skin C. LDS D. purse string

EEA

Which of the following is used to remove clots and tissue from the bladder during transurethral resections (TURPs)? A. lithotrite B. asepto syringe C. Ellik evacuator D. Fogarty catheter

Ellik evacuator

When applying a pneumatic tourniquet preoperatively, which of the following items is used to force blood from an extremity?

Esmarch bandage

Which of the following catheters is MOST commonly used to perform an embolectomy?

Fogarty- inserted past the clot, then inflated to remove the clot

During an abdominoperineal resection, which of the following stapling devices should the surgical technologist have available to form an anal pouch from the ileum?

GIA

Which of the following is a surgical instrument designed for retracting? A. Potts B. Penfield C. Lowman D. Gelpi

Gelpi

In order to remove a portion of the kidney, the surgeon must enter which of the following? A. synovial membrane B. Gerota's fascia C. Hesselbach's triangle D. suprapleural membrane

Gerota's fascia > Gerota's fascia is also known as renal fascia. It encloses the suprarenal glands and separates them from the kidney.

Which of the following retractors may be used during an open cholecystectomy?

Harrington

A surgical technologist is preparing the incision site for the dressing following a TAH. The patient has developed a hematoma at the incision site. The surgeon has left the room. Which of the following actions should the surgical technologist take? A. Place a pressure dressing. B. Cover with Dermabond. C. Steri-Strip the incision. D. Have the surgeon return.

Have the surgeon return > The surgeon would need to see the incision site and evaluate the extent of the hematoma. Some hematomas require evacuation to prevent infection; others reabsorb and require no further action

A surgical technologist is preparing the incision site for the dressing following a TAH. The patient has developed a hematoma at the incision site. The surgeon has left the room. Which of the following actions should the surgical technologist take?

Have the surgeon return- The surgeon would need to see the incision site and evaluate the extent of the hematoma. Some hematomas require evacuation to prevent infection; others reabsorb and require no further action.

During a herniorrhaphy, the abdominal area that is bound by the rectus abdominis muscle, the inguinal ligament, and the inferior epigastric vessels is the

Hesselbach triangle

Which of the following pathological conditions may be caused by an excessive production of cerebrospinal fluid in the brain? A. hydrocephalus B. encephalocele C. cranial bifida D. craniosynostosis

Hydrocephalus

Which of the following is a contrast media? A Marcaine B. Hypaque C. Depo-Medrol D. Lymphazurin

Hypaque

Which of the following wound classes is assigned to a bowel case in which the resident perforated during the procedure? A. I B. II C. III D. IV

III

Place the following phases of wound healing by first intention in correct order from first to last: I. proliferation II. remodeling III. inflammatory

III, I, II

Which of the following scissors is MOST likely found in a basic hysterectomy set-up? A. Potts-Smith B. Stevens C. Jorgenson D. Iris

Jorgenson > Jorgenson scissors are heavy and curved dissecting scissors used in OB/GYN surgery.

Once the spinous process is exposed during a laminectomy, the next instrument needed for the removal of the lamina is a A. Kerrison rongeur. B. pituitary rongeur. C. Penfield dissector. D. periosteal elevator.

Kerri son rongeur

Which of the following instruments should be included in the set-up for a laminectomy? A. Hohmann B. Mayfield C. Kerrison D. Bennett

Kerrison

Which of the following rongeurs is used to expand the antrostomy in a Caldwell-Luc procedure?

Kerrison

Which of the following is used to stabilize a fractured finger? A. Rush rods B. Hagie pins C. Knowles pins D. Kirschner wires

Kirschner wires > Kirschner wires are used in hand and finger fractures.

Which of the following instruments has teeth? A. Kocher B. Mixter C. Babcock D. Mosquito

Kocher

The surgeon is performing a suprapubic prostatectomy. Control of bleeding is a major consideration. Which of the following clamps should the surgical technologist hand to the surgeon to aid in hemostasis? A. Long Right Angle Clamp B. Wertheim-Cullen Clamp C. Rochester Carmalt Clamp D. Jacobson Micro Mosquito Clamp

Long right angle clamp

Which of the following solutions is used to identify diseased areas for a cold conization of the cervix? A. Lugol's B. fluorescein C. methylene blue D. Isovue

Lugol's > Lugol's is a strong iodine solution used to identify neoplasms of the cervix in gynecological surgery.

Which of the following is a specimen container used in a flexible or rigid bronchoscopy? A. Ellik B. chest bottle C. Lukens D. suction canister

Lukens

Which of the following is MOST likely to be used to stabilize a cervical fracture? A. Kirschner wire B. Hoffman device C. Steinmann pins D. Mayfield clamp

Mayfield clamp > If the patient has a cervical fracture or dislocation, the cervical spine is held in alignment by a Mayfield clamp.

Which of the following instruments is found in a basic laparotomy set-up?

Mayo scissors

During dissection of the cystic duct in an open cholecystectomy, which of the following instruments is necessary? A. Ochsner forceps B. Jennings retractor C. Mixter clamp D. O'Sullivan-O'Connor retractor

Mixter clamp > A Mixter (right angle) clamp is necessary for an open cholecystectomy.

While preparing a sterile field, a surgical technologist secures the Bovie holster to the Mayo stand. The surgeon insists on keeping the Bovie by him toward the head of the patient. Which of the following would be the BEST course of action? A. Move Bovie holster up by head of patient. B. Do not move the Bovie holster. C. Tell the circulator to document the surgeon's response. D. Remove the Bovie from the field.

Move Bovie holster up by head of patient.

Sterile supplies and instruments for a case have been opened in OR 1. A surgical technologist was just informed that the case has been moved to OR 2 and the next case in OR 1 is scheduled in two hours. Which of the following is the BEST course of action?

New sterile supplies and instruments should be obtained for OR 2 and the setup in OR 1 should be disposed of.

During an open repair of an indirect hernia, which of the following drains should a surgical technologist have available to pass the surgeon once the spermatic cord has been dissected? A. Malecot B. T-tube C. Jackson-Pratt D. Penrose

Penrose > A small Penrose drain is used to retract the spermatic vessels and vas deferens (spermatic cord). A surgical technologist should moisten the drain before passing it to the surgeon.

A patient's dentures are removed in the operating room. Which of the following is the proper procedure for the care of the dentures? A. Return them to the patient's unit and leave them at the nurses' station. B. Place them in a labeled denture cup and keep them with the patient's chart. C. Wrap them in a paper towel and give them to the anesthesiologist. D. Ask the circulator to return them to the patient's room.

Place them in a labeled denture cup and keep them with the patient's chart. > Using this method, the dentures will be returned to the correct patient because they will be sent to the PACU.

Which of the following instruments is NOT used in otorhinolaryngology surgery? A. Sexton B. Baron C. Frazier D. Poole

Poole

Which of the following instruments may be used to extend the arteriotomy during carotid endarterectomy?

Potts- Smith

Which of the following is a monofilament suture? A. silk B. cotton C. Ethibond D. Prolene

Prolene

Which of the following statements regarding surgical scrubbing is NOT true? - Two accepted methods of surgical scrubbing are the timed method and the counted brush-stroke method. - A vigorous 5-minute scrub with a reliable agent may be as effective as a 10-minute scrub done with less mechanical action. - Prolonging a scrub beyond the standard scrub length is effective in decreasing microbe counts. - When gloves are removed at the end of a surgical procedure, the hands are contaminated and should be immediately washed.

Prolonging a scrub beyond the standard scrub length is effective in decreasing microbe counts.

Which of the following statements regarding surgical scrubbing is NOT true? A. Two accepted methods of surgical scrubbing are the timed method and the counted brush-stroke method. B. A vigorous 5-minute scrub with a reliable agent may be as effective as a 10-minute scrub done with less mechanical action. C. Prolonging a scrub beyond the standard scrub length is effective in decreasing microbe counts. D. When gloves are removed at the end of a surgical procedure, the hands are contaminated and should be immediately washed.

Prolonging a scrub beyond the standard scrub length is effective in decreasing microbe counts.

A surgical technologist has been asked to serve as a preceptor to a new employee in the operating room. If the surgeon becomes irritated or anxious because of the new employee's lack of experience, which of the following actions should be taken?

Quietly coach the new employee in the background

Which of the following instruments is used for a common bile duct exploration? A. Fogarty clamp B. Randall forceps C. Pennington clamp D. Forester ring forceps

Randall forceps > These are for retrieving stones from the gallbladder and duct

Which of the following techniques is NOT acceptable for draping the patient? A. Hold the drapes high until directly over the patient. B. Protect the gloved hands by cuffing the drapes. C. Readjust the drapes as necessary after placement. D. Place the drapes on a dry area.

Readjust the drapes as necessary after placement > Drapes are never readjusted because it may cause contamination.

After gowning and gloving, a surgeon activates the DuraPrep applicator and proceeds to prep the patient for surgery. Which of the following is the BEST action to take at this time?

Regown and reglove the surgeon.

A laparotomy drape has been placed on a patient, and unprepped skin on the operative site is exposed. Which of the following is the BEST next step? A. Apply drapes over unprepped skin. B. Reposition the drapes closer together. C. Remove drapes and re-prep. D. Cover with an adhesive drape.

Remove drapes and re-prep.

Following a surgical procedure, which of the following is the BEST sequence of actions for a surgical technologist to take? A. Remove sterile drapes, remove gown and gloves, and don a pair of unsterile gloves to aid in the care of the postoperative patient. B. Remove gown and gloves, don a pair of unsterile gloves to remove drapes from the patient, and remove instruments and supplies from the back table. C. Remove gown and gloves, don a pair of sterile gloves to remove drapes from patient, and remove gloves and don a pain of unsterile gloves to clean the back table. D. Remove sterile drapes, remove gown and gloves, and don a pair of sterile gloves to clean back table.

Remove sterile drapes, remove gown and gloves, and don a pair of unsterile gloves to aid in the care of the postoperative patient

Following a surgical procedure, which of the following is the BEST sequence of actions for a surgical technologist to take? A. Remove sterile drapes, remove gown and gloves, and don a pair of unsterile gloves to aid in the care of the postoperative patient. B. Remove gown and gloves, don a pair of unsterile gloves to remove drapes from the patient, and remove instruments and supplies from the back table. C. Remove gown and gloves, don a pair of sterile gloves to remove drapes from patient, and remove gloves and don a pair of unsterile gloves to clean the back table. D. Remove sterile drapes, remove gown and gloves, and don a pair of sterile gloves to clean back table.

Remove sterile drapes, remove gown and gloves, and don a pair of unsterile gloves to aid in the care of the postoperative patient. > PPE (personal protective equipment) will protect surgical personnel from coming in contact with body fluids on the drapes. After the drapes are removed, the surgical technologist can safely remove the gown and gloves to aid in the care of the postoperative patient.Note: The surgical technologist may be required to remain sterile until the patient leaves the room in some circumstances.

A surgical technologist counts only 9 sponges in a pack on the initial count. After recounting the sponges, it is confirmed that there are only 9 sponges in the pack. Which of the following is the appropriate course of action?

Remove the current package from the surgical field, but not the operating room; document the problem; open a new package; recount

After gowning and gloving, a surgeon activates the DuraPrep applicator and proceeds to prep the patient for surgery. Which of the following is the BEST action to take at this time?

Renown and reglove the surgeon

An RN has just asked a surgical technologist to complete a task that is within the surgical technologist's scope of practice, but the surgical technologist does not feel comfortable completing the task independently. Which of the following is the surgical technologist's BEST course of action? A. Ensure that the RN has documented that the task was delegated to the surgical technologist. B. Request that the RN provides the appropriate level of supervision during the task to ensure safety. C. Confirm that the initial orientation asked about the surgical technologist's competency for the task. D. Obtain verbal instructions for completing the task from the RN before she leaves the room.

Request that the RN provides the appropriate level of supervision during the task to ensure safety.

Which of the following is the MOST common straight catheter used prior to laparoscopic gynecological surgery in the OR? A. Foley B. Pezzer C. Malecot D. Robinson

Robinson > The Robinson is a straight catheter used to drain the bladder.

Which of the following may be needed during an emergency splenectomy that may not be required during a routine splenectomy? A. CUSA B. Sarot clamp C. vascular sets D. ligating clip appliers

Sarot clamp

For a splenectomy procedure, which of the following clamps could be used? A. Allen B. Doyen C. Duval D. Satinsky

Satinsky

Which of the following instruments may be used to clamp the aorta?

Satinsky

When performing a dilation and curettage, which of the following instruments is used to grasp the cervix? A. Sims B. Auvard C. Schroeder D. Bozeman

Schroeder > Schroeder is a tenaculum with a single tooth used to grasp the cervix.

Which of the following retractors should the surgical technologist have available to provide exposure to the patellar tendon while harvesting the graft for an ACL repair? A. Senn B. Richardson C. Hayes D. Fukuda

Senn

Which of the following is MOST commonly used for wound closure in the presence of infection?

Stainless steel- recommended for use in infected areas because it is non-absorbable with indefinite tensile strength

Which of the following pathogens would MOST likely cause a post-operative SSI? A. Staphylococcus aureus B. Enterococcus spp. C. Streptococcus spp. D. Escherichia coli

Staphylococcus aureus > Staphylococcus aureus has been identified as the pathogen associated with 20% of SSIs.

A patient undergoing a blood transfusion is having a hemolytic reaction. Which of the following actions should the healthcare providers take FIRST? A. Administer dantrolene. B. Stop the transfusion. C. Monitor urine output. D. Send blood sample to blood bank.

Stop the transfusion

Which of the following is classified as a clean-contaminated wound (Class II)? A. suprapubic prostatectomy B. incision and drainage of abscessed foot C. coronary artery bypass graft (CABG) D. gunshot wound

Suprapubic prostatectomy

A surgical technologist just opened an instrument set that is wet inside after undergoing steam sterilization. Which of the following is the MOST likely reason for the condensate in the package and how can it be corrected? A. There are not enough instruments in the tray to allow for revaporization of the condensate. The number of instruments in the tray should be increased and the tray should be reprocessed. B. The instrument set contained absorbant towels, which soaked up the moisture and prevented efficient drying. The tray should be reprocessed without any towels. C. The absorbent towels were wrapped too tightly around the instrument tray, so they retained moisture. The tray should be reprocessed with loosely wrapped new towels. D. Condensate has built up on the steam lines. The surgical technologist should clean the steam lines and reprocess the instrument tray.

The absorbent towels were wrapped too tightly around the instrument tray, so they retained moisture. The tray should be reprocessed with loosely wrapped new towels.

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

The alimentary canal extends from the mouth to the anus. <<The GI tract, or alimentary canal, is a continuous tubelike structure that extends the entire length of the trunk. The tract includes the mouth; pharynx; esophagus; stomach; small intestine, consisting of the duodenum, jejunum, and ileum; and large intestine, which consists of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anus.

Which of the following situations would present a problem when preparing instruments for sterilization using a paper-plastic peel pack?

The instruments within the paper-plastic peel pack have been held together with tape to avoid shifting.

Which of the following situations would present a problem when preparing instruments for sterilization using a paper-plastic peel pack? A. The open end of the paper-plastic peel pack has been sealed with tape. B. The instruments within the paper-plastic peel pack have been held together with tape to avoid shifting. C. The instruments should be placed in the paper-plastic peel pack with the rings at the end that was sealed by the manufacturer. D. A felt-tip marker was used to label the plastic on the paper-plastic peel pack prior to sterilization.

The instruments within the paper-plastic peel pack have been held together with tape to avoid shifting.

Why is the right kidney typically several centimeters lower than the left kidney?

The liver rests superior and anterior to the right kidney.

Which of the following procedures for obtaining an informed consent form is appropriate? A. The patient is asked to sign the consent form after the surgeon has explained the procedure. B. The surgical technologist in the circulator role is ultimately responsible for obtaining the signed consent form. C. The patient is asked to read the entire consent form after signing it. D. The consent form is witnessed by one member of the patient's family.

The patient is asked to sign the consent form after the surgeon has explained the procedure.

A 15-year-old girl with anemia will be undergoing an exploratory procedure and a blood transfusion will be necessary. The parents are Jehovah's Witnesses and will not consent to a blood transfusion, but the patient states that she wants the transfusion. The operating room staff reports this to the nurse manager. Which of the following is the BEST course of action now?

The physician or nurse manager should contact the hospital's administration to request that legal counsel becomes involved

A cardiac arrest occurs during a procedure, and the surgeon is resuscitating the patient. What is the responsibility of the surgical technologist in the scrub role during this time?

The surgical technologist in the scrub role should remain sterile and maintain the sterile field unless otherwise directed by the surgeon.

If a patient is undergoing a mastectomy immediately followed by a reconstruction, how many surgical setups should be obtained?

Two; the reconstruction will immediately follow the mastectomy, but a second set of instruments should be used to prevent seeding.

Which of the following examples illustrates UNSAFE technique for disposing of contaminated sharps? A. Used suture needles and scalpel blades are removed from the needle counter and individually placed in the biohazard sharps container. B. Used suture needles and scalpel blades remain in the needle counter and the closed needle counter is placed in the biohazard sharps container. C. The biohazard sharps container is located as close as possible to the area in which the items were used. D. Disposable surgical blades are removed from knife handles with a needle holder or other instrument.

Used suture needles and scalpel blades are removed from the needle counter and individually placed in the biohazard sharps container. > At the close of surgery, it is dangerous to handle each contaminated sharp again. The needle counter is disposable and should be closed and placed in the biohazard sharps container.

Which of the following is a preferred retractor for a groin incision?

Weitlaner

Which of the following surgical procedures may be used to remove a carcinoma from the head of the pancreas? A. Heller B. Whipple C. Bankart D. Billroth I

Whipple

A surgeon's preference card indicates the surgeon wears a size L gown and double-gloves with a size 7 inner glove and size 6-1/2 outer glove, and the first assistant wears a size XL gown and double-gloves with a size 7-1/2 inner glove and size 7 outer glove. The first assistant arrives prior to the surgeon. Which of the following is the proper order to place the sterile attire on the back table? A. L gown, 7 glove, 6-1/2 glove, XL gown, 7-1/2 glove, 7 glove B. XL gown, 7-1/2 glove, 7 glove, L gown, 7 glove, 6-1/2 glove C. XL gown, 7 glove, 7-1/2 glove, towel, L gown, 6-1/2 glove, 7 glove D. L gown, 6-1/2 glove, 7 glove, towel, XL gown, 7 glove, 6-1/2 glove

XL gown, 7-1/2 glove, 7 glove, L gown, 7 glove, 6-1/2 glove

Which of the following is a fenestrated drape? A. a drape with an opening that allows exposure of the operative site B. a split drape that has two tails C. a drape used to cover the operating table, instrument table, and body regions D. an incise drape that is self-adhering

a drape with an opening that allows exposure of the operative site > A fenestrated drape allows exposure of the operative skin.

A lumbar meningocele involves removal of

a fluid-filled sac.

Which of the following patients is MOST likely to acquire a nosocomial infection? A. a healthy female patient who is 45 years of age B. a female patient in labor and delivery C. a healthy male patient who is 45 years of age D. a male patient who has diabetes

a male patient who has diabetes

During a laminectomy, disk material is removed with

a pituitary rongeur.

The number of Staphylococcus aureus micro-organisms carried by the surgical technologist can be drastically reduced by

a thorough surgical scrub

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 ?6?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

a. 250 or 300; 400 <<Several kinds of surgical microscopes with different attachments are available for otologic and laryngologic surgery. A common eyepiece magnification for an otologic microscope is ?6?12.5, and the usual objective (lens) is 250- or 300-mm focal length (f). A 400-mm lens is used for laryngeal surgery. The total magnification is determined by multiplying the magnification of the eyepiece times that of the microscope body times that of the objective. The type of head and objective selected is based on the surgeon's preference. Microscopes equipped with a variable distance feature allow the surgeon to adjust the focal length from 200 to 400 mm without changing the lens objective.

If cervical spine precautions were not implemented before arrival at the hospital, the emergency department team initiates them before performing any other procedures on the patient. A trauma team member can stabilize the head and neck, if necessary, until a cervical collar is placed. What event needs to take place before the team removes the cervical collar and continues care? Answers: a. A cervical radiograph is obtained to rule out injury to the neck. b. A halo traction apparatus is applied. c. A myelogram of the cervical spinal canal is obtained to rule out injury to the spinal cord. d. A CT scan with contrast of the upper body is obtained to rule out vascular involvement.

a. A cervical radiograph is obtained to rule out injury to the neck. << Once placed, the team does not remove the collar until a cervical radiograph clears the neck of injury.

Among the treatment options for tricuspid valve disease are suture annuloplasty, ring annuloplasty, and valve replacement with either a biologic or a mechanical prosthesis. Like the mitral valve, the tricuspid annulus is saddle-shaped and techniques to repair the valve should consider this anatomic configuration for optimal repair. Patients with significant tricuspid stenosis, regurgitation, or failed tricuspid (suture or ring) annuloplasty may require insertion of a prosthetic biologic or mechanical valve. Because there are no specific tricuspid prosthetic valves available, what type of prosthetic graft would be created or implanted? a. A mitral prosthesis b. An annuloplasty with a felt-pledgetted suture c. An annuloplasty ring d. A tricuspid annular permanent dilator

a. A mitral prosthesis <<There are no specific tricuspid prosthetic valves; rather, a mitral prosthesis would be implanted.

Complete heart block and bradydysrhythmias are the most common indications for pacemaker implantation. A permanent pacemaker (pulse generator and electrodes) initiates atrial or ventricular contraction, or both. What therapy might be used for acute forms of heart block and dysrhythmias that occasionally occur during and after cardiac surgery? Answers: a. A temporary pacemaker b. Epicardial cardioversion c. Transvenous endocardial stimulation d. Resynchronization therapy

a. A temporary pacemaker <<A temporary pacemaker may be used for acute forms of heart block and dysrhythmias that occasionally occur during and after cardiac surgery. The transvenous or the epicardial approach may be used to place the electrodes. Cardiac resynchronization therapy (CRT), dual-site pacing, employs leads placed on the right atrium and the right ventricle.

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? Answers: a. Active cancer b. Post-treatment cancer in remission c. Cardiovascular disease d. Systemic disease

a. Active cancer << Each potential recipient is judged individually in regard to kidney transplantation. Most persons younger than 55 years are acceptable; older patients are less tolerant of postoperative complications. The following are contraindications for renal transplantation: systemic disease that precludes major surgery, oxalosis (a metabolic disorder), a positive HLA cytotoxic antibody screen, untreatable cardiovascular disease, active cancer, and noncompliance.

Personal comfort or security items should be permitted to accompany children to the OR who are in which developmental age? a. All of options are correct. b. Toddler to early childhood c. Infancy to 1 year d. Adolescence

a. All of options are correct. << Allow personal items into the OR for comfort/security in all developmental age groups.

The temporary substitution of a pump oxygenator for the heart and lungs allows the surgeon to stop the heart and perform cardiac procedures under direct vision in a relatively dry, motionless field. It also allows the surgeon to manipulate the heart without the risk of producing ventricular fibrillation and reduced cardiac output that jeopardize perfusion to the myocardial, peripheral, and cerebral tissues. In traditional cardiopulmonary bypass (CPB), systemic venous return to the heart flows by gravity drainage through cannulae placed in the superior and inferior venae cavae or through a single two-stage cannula in the right atrium into tubing connected to the bypass machine. Blood is oxygenated, filtered, warmed or cooled, and pumped back into the systemic circulation through a cannula placed in the: a. All of the arteries could be used for return flow. b. ascending aorta. c. femoral artery. d. axillary artery.

a. All of the arteries could be used for return flow. <<In traditional cardiopulmonary bypass (CPB) circuits, systemic venous return to the heart flows by gravity drainage through cannulae placed in the superior and inferior venae cavae (Figure 16-36) or through a single two-stage cannula in the right atrium (Figure 16-37) into tubing connected to the bypass machine. Blood is oxygenated, filtered, warmed or cooled, and pumped back into the systemic circulation through a cannula placed in the ascending aorta or occasionally in the femoral artery (Figure 16-38) or the axillary artery.

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. All of the options b. complementary CT scan with MRI. c. CT scan. d. MRI scan.

a. All of the options <<CT scans are radiographic studies that visualize structures by producing serial sections, many times clinically referred to as "cuts," through planes of the head and neck. Magnetic resonance imaging (MRI) is an imaging modality using powerful magnetic and radiofrequency waves to reproduce cross-sectional images of the human body without exposing the patient to ionizing radiation. CT imaging provides visualization of bone, soft tissue, and adjacent intracranial and extracranial pathologic conditions. CT is the study of choice to assess intratemporal bone pathologic conditions and to evaluate the paranasal sinuses and adjacent structures. It is also used in the assessment of the oral cavity and neck. On an MRI scan, fat and fluid produce high-intensity signals, which appear as bright areas, whereas bone and air emit weak signals and appear as darkened areas on the scan. MRI is often used with CT imaging in a complementary fashion when evaluating lesions in and around bone for a variety of head and neck conditions including tumors in the oral cavity, external auditory canal, middle ear, and mastoid.

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. Allergies b. ASA physiologic status c. Risks for injury d. Skin assessment

a. Allergies <<Patient allergies should be reviewed to avoid allergic or toxic reactions to local anesthetics. When adjunct sedation is also scheduled, monitoring equipment(e.g., electrocardiogram [ECG], pulse oximeter, blood pressure apparatus) should also be readied

Cycloplegic drugs produce a similar effect on the pupil as mydriatic drugs, with one difference. From the options below, select the most appropriate statement about the effects of cycloplegics Answers: a. Anticholinergics dilate the pupil and inhibit focusing. b. Cycloplegics and mydriatics have similar effects on the pupil; however, cycloplegics preserve the patient's ability to refract light and focus. c. Homatropine hydrobromide (Isopto Homatropine) sustains the longest and most potent duration of dilation. d. Epinephrine is added to balanced salt solution (BSS) to constrict sclera vessels and the pupil.

a. Anticholinergics dilate the pupil and inhibit focusing. <<Cycloplegics are anticholinergics that dilate the pupil and inhibit focusing. Examples include the following: Tropicamide 0.5%, 1% (Mydriacyl): cycloplegic (paralysis of accommodation, inhibits focusing), dilates the pupil, anticholinergic, used for examination of fundus or refraction; Atropine 1%, anticholinergic, dilates the pupil, inhibits focusing, potent and long duration (7-14 days); Cyclopentolate 0.5%, 1%, and 2% (Cyclogyl), anticholinergic, dilates the pupil, inhibits focusing; Scopolamine hydrobromide 0.25% (Isopto Hyoscine), anticholinergic, dilates the pupil, inhibits focusing; Homatropine hydrobromide 2%, and 5% (Isopto Homatropine), anticholinergic, dilates the pupil, inhibits focusing; Epinephrine (1:1000) preservative free (PF), dilates the pupil, added to bottles of balanced salt solution for irrigation to maintain pupil dilation during cataract or vitrectomy procedure.

Polymethyl methacrylate (PMMA, or bone cement) is an acrylic, cement-like substance composed of a liquid methyl methacrylate monomer and a powder methyl methacrylate-styrene co-polymer. What element is added to the powder component to make the finished product radiopaque? Answers: a. Barium b. Granular allograft bone c. Polycrylate sodium d. Radiografinpaque

a. Barium <<The powder component is 10% barium sulfate, U.S. Pharmacopoeia (USP), which provides radiopacity to the finished product. The liquid monomer is highly flammable, and the OR should be properly ventilated. Caution should be exercised during mixing of the two components to prevent excessive exposure of OR personnel to the vapors of the monomer.This exposure can cause irritation of the respiratory tract and eyes.

Autotransfusion can present a vital asset in trauma care, when considering the high blood loss associated with many traumatic injuries. This process provides immediate volume replacement, decreases the amount of bank blood used, and reduces the possibility of transfusion reactions or risk of transfusion with bloodborne pathogens. What are the contraindications to using autotransfusion as a blood replacement source? a. Blood contaminated with food, bowel contents, or antibiotic irrigation b. Clean, hemodiluted blood c. Pooled blood from a ruptured aortic aneurysm d. Blood and fluids squeezed out of sterile bloody sponges

a. Blood contaminated with food, bowel contents, or antibiotic irrigation << The blood collected in the salvage unit must be free from contamination. If the abdomen is contaminated with free food particles or colonic perforation is present, the blood cannot be used. Similarly, once antibiotic irrigation is initiated, the blood salvage unit is not used. During autologous blood salvage the surgical technologist squeezes out additional blood and fluid from saturated sponges before discarding them from the surgical field.

Blunt trauma injuries may not fully reveal the degree or depth of injury. What noninvasive diagnostic test is critical to diagnosis in potential traumatic brain injury? a. CT scan of the head b. Skull radiograph c. Pupil reflex and response to light d. Neurovascular arteriography

a. CT scan of the head <<Depending on the MOI, such as a fall, CT scans of the head and abdomen may be performed. A CT scan of the brain may reveal an injury incompatible with life. Because injuries in blunt trauma are very difficult to diagnose, the CT scan is frequently done before patient transfer to the OR.

Patients with chronic venous insufficiency (CVI) are not typically treated surgically as often as patients with arterial disease because: a.CVI is not life-threatening or limb-threatening. b.venous surgery contributes to thromboembolism. c.All of the options are correct. d.surgical interventions for venous valves have not been refined.

a. CVI is not life-threatening or limb-threatening. <<Patients with chronic venous insufficiency (CVI) have not been treated surgically as often as patients with arterial disease for several reasons, one of which is that CVI is generally not a life-threatening or limb-threatening condition.

During the preoperative assessment for a patient scheduled for nasal surgery using a local anesthetic that includes epinephrine, what important consideration, relevant to epinephrine use, should be explored? a. Cardiac status b. Renal clearance c. Coagulopathy d. Anxiety

a. Cardiac status <<Cardiac status should be noted because many surgeons use epinephrine as an additive to the local anesthetic to achieve vasoconstriction and minimize blood loss. The epinephrine effect may contribute to cardiac dysrhythmias and an increased potential for cardiac arrest.

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

a. Carina <<The posterior surface of the trachea is flattened rather than round because the cartilaginous rings are incomplete. The carina is a ridge on the inside of the bifurcation of the trachea. It is a landmark during bronchoscopy and separates the upper end of the right main branches from the upper end of the left main branches of the bronchi.

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. Colonoscopy with endoscopic ultrasound (EUS) b. Flexible sigmoidoscopy c. Endoscopic retrograde cholangiopancreatoscopy (ERCP) d. Rectal manometry with dilatation

a. Colonoscopy with endoscopic ultrasound (EUS) <<Colonoscopy is endoscopic examination of the colon from the rectum to the ileocecal valve. The bowel wall is inspected for abnormalities such as bleeding, polyps, inflammation, ulceration, or tumors during both insertion and withdrawal of the colonoscope. EUS combines endoscopy and ultrasound, using sound waves to generate an image of the histologic layers of the esophageal, gastric, and intestinal walls. The frequencies used, higher than those used in traditional ultrasound, provide high-level accuracy of depth of mucosal invasion. EUS is of critical importance in staging GI malignancies and determining surgical options and potential for therapeutic resection.

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.

a. Complete voice rest is important. << Voice rest may be used for minor surgery of the larynx, especially for the removal of polyps or nodules on the vocal cords. The patient is cautioned to observe complete voice rest or to whisper postoperatively. The patient should be provided with a pencil and paper or erasable slate to aid in communication. The patient's restriction on speaking should be noted on the nursing plan of care and on the front of the chart

During an endoscopic thoracic sympathectomy for hyperhidrosis, what action by the anesthesia provider ensures exposure and minimizes damage to the lung? a. Deflates the lung on recommendation of the surgeon during dissection and resection. b. Decreases ventilatory pressure to decrease lung expansion during dissection. c. Positions the patient in the anterolateral position with an expandable axillary roll. d. Decreases positive end-expiratory pressure until resection is complete.

a. Deflates the lung on recommendation of the surgeon during dissection and resection. << The anesthesia care provider deflates the patient's lung as directed by the surgeon.Endoscopic thoracic sympathectomy (ETS) is a thoracoscopic intervention used to surgically treat hyperhidrosis. The surgeon needs an unobstructed view from either side, because the procedure is performed bilaterally.

Open reduction and internal fixation (ORIF) is a method of providing exposure of the fracture site and using pins, wire, screws, a plate and screw combination, rods, or nails to correct the fracture. Surgeons use open reduction and internal fixation when they are unable to reduce a fracture by closed methods and skeletal traction is not indicated. What would be an advantage for an open rather than a closed fracture reduction technique? Answers: a. Direct observation and verification of fracture alignment b. Improved bone union outcomes c. Ability to rule out comminuted or compound fractures without imaging d. Decreased opportunity for surgical site infection

a. Direct observation and verification of fracture alignment <<The advantage of ORIF is that anatomic alignment of the fracture can usually be obtained and verified through direct observation. Fractures that are comminuted or difficult to reduce can be more effectively treated using this technique. The incidence of infection and nonunion, however, is increased when the wound is opened.

A child's comprehension of, and responses to, the environment are based on his or her developmental age. The works of Drs. Jean Piaget and Erik Erikson provide excellent guidelines for assessing the pediatric patient's developmental level in order to use appropriate interventions. The infant develops the belief that the world can be counted on to meet basic needs through the trust vs. mistrust concept based on the stages of psychosocial and emotional needs. This theoretical framework of stages was described by ______________, while the stages based on changes in cognition and ability to think were described by _____________. a. Dr. Erick Erikson; Dr. Jean Piaget b. Dr. Geoffery Barns; Dr. Jules Junger c. This statement is a combined consensus of both of their theories. d. Neither theory is represented by this statement.

a. Dr. Erick Erikson; Dr. Jean Piaget <<Dr. Jean Piaget described the stages by changes in cognition and the ability to think, and Dr. Erik Erikson based the stages on psychosocial and emotional needs. For example, according to Erikson, infancy to 1 year: trust vs. mistrust; infant develops belief that world can be counted on to meet basic needs. According to Piaget, infancy to 2 years: Who to trust? Identifies strangers at 7 to 8 months of age.

Identify the dural fold that separates the right and left cerebral hemispheres. a. Falx cerebri b. Falx cerebelli c. Tentorium cerebri d. Tentorium cerebelli

a. Falx cerebri <<The dura mater is a tough, shiny, fibrous membrane that is close to the inner surface of the skull and folds to separate the cranial cavity into compartments. The largest fold is the falx cerebri—an arch-shaped, vertically placed, midline structure separating the right and left cerebral hemispheres.

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

a. Inguinal ligament, rectus abdominis muscle, deep epigastric vessels <<The boundaries of the Hesselbach triangle are deep epigastric vessels laterally, inguinal ligament inferiorly, and rectus abdominis muscle medially.

Triangulation is a term used to describe the method used to provide instrument access to the anatomy during abdominal surgery. It is uniquely associated with which surgical incision? a. Laparoscopic port incisions b. Thoracoabdominal incision c. Mid-epigastric transverse incision d. Left paramedian incision

a. Laparoscopic port incisions <<Traditional laparoscopic port placement, via triangulation, is the fundamental concept of laparoscopic surgery. It places the instruments on planes where they meet to effectively support dissection with adequate visualization and identification of anatomy and pathology. Incorrectly placed ports can cause "sword-fighting" instruments and indirect access to the operative anatomy

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. Malleus, incus, and stapes b. Anvil, head, and hammer c. Stapes, capitulum, and stirrup d. Ossicles, incus, and crura

a. Malleus, incus, and stapes << The malleus (hammer) consists of a head, neck, handle, and short process. The handle and short process are attached to the undersurface of the eardrum, and the head articulates with the body of the incus in the upper segment of the middle ear called the epitympanum or "attic." The incus (anvil) consists of a body and long and short processes (see Figure10-2). The distal end of the long process of the incus is called the lenticular process and articulates with the capitulum (head) of the stapes, which is the third, innermost bone. The stapes (stirrup) consists of a head, neck, anterior and posterior crura, and a mobile footplate that is secured to the oval window by an annular ligament. The movable joints between these ossicles contribute to a lever system that amplifies the received sound and transmits and converts vibrations from ambient air to the fluid of the inner ear.

One of the most popular lasers used in plastic and reconstructive surgery is attracted to the water in the skin cells and ablates the cells at a predetermined depth. Collagen material beneath the skin surface is also heated, resulting in smoother and slightly tighter skin. Several lasers are attracted to areas of darker pigmentation. This treatment has virtually replaced dermabrasion, because of its consistency in terms of depth of penetration and also because this technique is less dependent on user technique or skill. Select the laser modality that would be the best option for ablation or removal of a pigmented red tattoo. Answers: a. Nd:YAG laser b. Erbium:YAG laser c. CO2 laser d. Excimer laser

a. Nd:YAG laser <<The Nd:YAG laser is suited to ablate or remove benign pigmented lesions and red tattoos.Common uses for lasers in plastic surgery include exfoliation, treatment of vascular malformations, removal of hair and tattoos, and tightening of collagen fibers in aging skin.Candela dye, diode, and Q-Switch lasers are suited for pigmented benign lesions, tattoos, and hemangiomas.

The kidneys are highly vascular organs. Approximately how much of the entire circulating blood volume do the kidneys process at any one time? a. One fifth b. One third c. 1 ml per kg body weight d. 30 ml per hour

a. One fifth << The kidneys are highly vascular organs that process approximately one fifth of the entire volume of blood at any one time.

Improvements in instrumentation and the development of equipment in smaller sizes have resulted in the evolution of minimally invasive surgery (MIS) from that of a rapidly growing field to one of routine practice in the pediatric surgical arena. The advantages of MIS for the pediatric population include which true statement? a. Pediatric patients having MIS procedures have less prevalence of adhesion formation. b. There is less risk for injury or complications with pneumoperitoneum insufflation. c. MIS procedures on children do not require the use of thromboembolic devices. d. There is less possibility for abdominal injury from Foley catheter decompression.

a. Pediatric patients having MIS procedures have less prevalence of adhesion formation <<Advantages of minimally invasive surgery include diminished postoperative pain, improved cosmetic results, decreased prevalence of adhesion formation, and accelerated recovery periods and shorter hospital stays. Despite the technical congruence with adult MIS procedures, the pediatric populations undergoing these procedures have specific needs. Anesthesia providers must consider the size and age of the patient because of the risk of physiologic compromise related to insufflation. Likewise, steps are taken intraoperatively to decrease the likelihood of intra-abdominal injury, such as insertion of an appropriate size Foley catheter to decompress the bladder or application of thromboembolic hose or sleeves to prevent deep vein thrombosis.

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 and adhesions/lysis of adhesions b. Adhesions/lysis of adhesions c. Ascites/hyperthermic intraperitoneal antibiotic therapy d. Peritoneal cancer/hyperthermic intraperitoneal chemotherapy

a. Peritoneal cancer/hyperthermic intraperitoneal chemotherapy and adhesions/lysis of adhesions <<Cancer of the peritoneum can be treated with topical application of selected chemotherapeutic agents instilled into the abdomen after induction of anesthesia. Lysis of adhesions is a surgical procedure that employs sharp tissue dissection to cut and release 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. Peritonitis b. Colitis c. Intestinal obstruction d. Paralytic ileostomy

a. Peritonitis <<The risks for injury or failure to achieve the intended outcome are equally present in GI surgery as in any surgical or invasive procedure. The surgical and anesthesia experience challenges the immune system and poses many risks of introducing endogenous and exogenous microorganisms

A trauma patient is rushed to the OR after a primary survey is completed in the emergency department. He is a 36-year-old male with multiple penetrating gunshot and knife wounds to the abdomen. He is bleeding profusely. What appropriate actions are critical in the rapid preparation for this procedure? a. Prep the patient from the suprasternal notch to the mid-thigh. b. Set up the autotransfusion system. c. Place the aortic cross-clamp on the Mayo stand. d. Open a silo-bag closure system on the sterile field.

a. Prep the patient from the suprasternal notch to the mid-thigh. << The circulator should prep the patient from the suprasternal notch to the midthigh. This allows for rapid access to the chest to clamp the aorta should massive hemorrhage control be indicated; it also allows for exposure of the femoral arteries for potential cannulation and access to the thigh for harvesting a saphenous vein.

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. Recurrent laryngeal nerve b. Intrinsic cricothyroid nerve c. Recurrent tracheoesophageal nerve d. Superior branch of the vagus nerve

a. Recurrent laryngeal nerve <<The recurrent laryngeal nerve, a branch of the vagus nerve, innervates the intrinsic muscles of the larynx. During surgery, care is taken to identify and protect this nerve. Immediate hoarseness occurs if the nerve is divided on one side. If the recurrent nerve is injured bilaterally, acute paralysis of both vocal cords may obstruct the airway and require emergency tracheotomy. Injury to the external branch of the superior laryngeal nerve, which innervates the cricothyroid muscle, results in difficulty shouting or singing high notes.

During Shelbie Wilson's valve repair, the surgeon realized that the torn leaflet was too damaged to be repaired and Shelbie would be better served with a bioprosthetic replacement valve. The circulator selected the implant from its secure storage area and transferred it in its storage solution to the sterile back table. What is the appropriate risk reduction strategy the surgical technologist needs to perform to prepare the bioprosthetic valve for implantation? a. Rinse according to the biovalve manufacturer's instructions. b. Rinse the biovalve in glutaraldehyde. c. Rinse the biovalve in 5 baths of sterile saline. d. Rinse the biovalve in sterile albumin.

a. Rinse according to the biovalve manufacturer's instructions. <<Both the amount of rinsing solution in each rinsing basin and the time for each rinse (total of three rinsing baths) should be followed according to each manufacturer's instructions. Safety considerations include storing prosthetic materials in a clean, protected environment and using them according to manufacturers' instructions.

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

a. Second to sixth rib horizontally, lateral edge of sternum to anterior axillary line <<The breasts extend from the second to the sixth rib horizontally and from the lateral edge of the sternum to the anterior axillary line.

Thoracotomy can be performed with the patient in one of three common positions: lateral, semilateral, and supine. While the supine position is used for the median sternotomy approach, which of the lateral positions is used for an anterolateral approach? a. Semilateral b. Prone c. Lateral d. Lateral decubitus

a. Semilateral <<The type of position used in thoracic surgery is determined by the operative procedure planned. Thoracotomy can be performed with the patient in one of three common positions: (1) lateral for the posterolateral approach, (2) semilateral for the anterolateral approach, and (3) supine for the median sternotomy approach.

Identify the venous structure that prevents blood backflow. a.Semilunar intimal folds b.Coarctation segments c.Venules d.Pressure receptors

a. Semilunar intimal folds <<Another difference between arteries and veins is the presence of semilunar intimal folds, or valves, in veins that prevent backflow.

Which of the following diagnostic procedures involves placement of fiducials (frameless system) on the patient's head preoperatively for creation of a virtual image in three dimensions and can be used intraoperatively with a synchronized hand piece for precise targeting of intracranial lesions? a. Stereotactic MRI or CT scan b. Wada's test c. Digital subtraction angiography d. Electroencephalography

a. Stereotactic MRI or CT scan <<Placement of a stereotactic head frame (frame-based system) or fiducials (frameless system) before receiving a computed tomography scan or magnetic resonance image produces information that is registered into a computer. The goal of stereotactic surgery is to target a point or volume in space precisely by means of a predefined minimally invasive trajectory. The frameless system allows the neurosurgeon to see beyond the actual operative field by using an optical tracking device. This handheld device depicts in three planes on a computer screen where the surgeon is working in the brain relative to deeper structures beyond view. Digital subtraction angiography allows for examination of selected arterial circulation by injection of contrast media.Electroencephalography records the brain's continuous electrical activity by means of electrodes placed on the scalp or intraoperatively on the brain. Wada's test can be used before brain surgery to lateralize language, memory, and the dominant hemisphere.

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. Subclavian or jugular vein b. Inferior vena cava c. Left mammary or subclavian vein d. Right atrium by way of the jugular vein

a. Subclavian or jugular vein <<A breast cancer patient who needs further medical treatment may opt to have an implanted venous access port placed under the skin in either the chest, the abdomen, or the upper arm.The port has a soft, pliable plastic catheter that is threaded into the subclavian vein or right atrium by way of the subclavian or internal jugular vein under x-ray guidance.

What is the ideal position for bronchoscopy? a. Supine with a shoulder roll b. Supine c. Left semilateral d. Semi-Fowler with neck extended

a. Supine with a shoulder roll << Bronchoscopy is performed in the supine position with a shoulder roll.

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. TEP repair b. Laparoscopic Bassini repair c. Mesh-plug insertion repair d. TAPP repair

a. TEP repair <<The totally extraperitoneal patch (TEP) laparoscopic hernia repair technique was used on Charles. Access to the posterior rectus sheath is gained by trocar insertion in the periumbilical region. A balloon dissector is placed on the anterior surface of the posterior rectus sheath and inflated, thereby creating an optical cavity. The proximal peritoneal sac is closed with loop ligature to prevent pneumoperitoneum from occurring. A piece of polypropylene mesh is inserted; unfolded to cover the direct, indirect, and femoral spaces and rest over the cord structures; and carefully secured with a tacking stapler.

What mouth structure is considered the boundary between the buccal cavity and the lingual cavity? a. Teeth b. Floor of the mouth c. Soft palate d. Hard palate

a. Teeth <<The portion of the mouth outside the teeth is the buccal cavity, and that on the inner side of the teeth is the lingual cavity. The hard palate forms the upper boundary of the oral cavity. The hard palate is formed by the maxilla and palatine bones. The mandible and floor of the mouth form the lower boundary of the oral cavity.

How does the lacrimal gland differ from the lacrimal sac? a. The lacrimal gland secretes tears that are drained by the lacrimal sac and duct system. b. The lacrimal gland produces hormones that stimulate the lacrimal sac to secrete tears. c. The lacrimal sac stores and concentrates the tears secreted by the lacrimal gland. d. The lacrimal gland and lacrimal sac are the same structure.

a. The lacrimal gland secretes tears that are drained by the lacrimal sac and duct system. <<The lacrimal apparatus effectively functions like a sink, with a faucet (main and accessory lacrimal glands) and drain (lacrimal puncta, canaliculi, sac, and nasolacrimal duct). The lacrimal gland produces tears and secretes them through a series of ducts onto the anterior ocular surface, thereby keeping the cornea moist and washing away any debris. The tears then flow inward to the puncta, from which they are conducted by the canaliculi to the lacrimal sac and finally pass into the nasolacrimal duct (see Figure 9-2).

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

a. The magnified three-dimensional picture may reduce bile duct injuries during dissection << Robotic surgery enables surgeons to perform more advanced and complex procedures. The view of the ductal anatomy is subjectively superior with robotic surgery because of the magnified three-dimensional picture, which may reduce bile duct injuries.

Vascular surgery patients are at risk for impaired skin integrity and ineffective tissue perfusion related to surgical positioning, presence of vascular disease, and vascular clamping. Positioning of the patient undergoing vascular surgery is of particular importance because of restricted circulation distal to the area of arterial obstruction and a generalized state of poor circulation. An appropriate protective intervention is reflected in which true statement about patient positioning for vascular surgery? a.The patient's vulnerable neurovascular bundles should be protected from compression. b.There should be warmed sterile saline compresses provided to bony prominences to increase vascular perfusion. c.The weight of instruments on top of the patient should be equally distributed to prevent pressure injuries. d.The patient should be positioned on a radiopaque pressure-reducing mattress on the OR bed.

a. The patient's vulnerable neurovascular bundles should be protected from compression. <<Protect vulnerable neurovascular bundles from compression. Position the patient on a pressure-reducing mattress on the OR bed that is radiolucent (x-ray compatible). Keep OR bed sheets dry and wrinkle-free. Pad all bony prominences. Maintain body alignment.

What is the mechanism by which the parathyroid glands maintain calcium homeostasis? Answers: a. They produce a hormone that, with calcitonin, takes calcium from the bones and promotes calcium absorption by the intestines. b. They secrete parathyroid hormone (PTH), which promotes calcium storage in the intestines. c. 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. d. They stimulate the pituitary to produce PTH and calcitonin, which elevates serum calcium levels.

a. They produce a hormone that, with calcitonin, takes calcium from the bones and promotes calcium absorption by the intestines. <<The parathyroid glands secrete parathyroid hormone (PTH), an antagonist to calcitonin. Both PTH and calcitonin work together to maintain calcium homeostasis by increasing calcium removal from storage in bone and increasing absorption of calcium by the intestines.

The blood is oxygenated in the lungs and returns to the left atrium through the pulmonary veins. Where does the blood flow after leaving the left atrium? a. Through the mitral valve into the left ventricle b. Through the tricuspid valve into the left ventricle c. Through the aorta into the systemic circulation d. Through the aortic valve into the left ventricle

a. Through the mitral valve into the left ventricle <<The blood is oxygenated in the lungs and returns to the left atrium through the pulmonary veins. From the left atrium, it flows through the mitral valve into the left ventricle, where it is ejected through the aortic valve into the aorta and the systemic circulation

In the pulmonary circulatory system, blood is pumped from the right ventricle (RV) through the pulmonary valve into the main pulmonary artery (PA). The PA divides into the right and left pulmonary arteries, which further subdivide into the arterioles and capillaries of the lungs. Where does the blood from the lungs flow next? a. Through the pulmonary veins to the left atrium b. Through the pulmonary artery to the left atrium c. Into the alveoli d. Into the capillary beds

a. Through the pulmonary veins to the left atrium <<External respiration occurs in the capillary beds and the alveoli, where carbon dioxide is exchanged for oxygen. Freshly oxygenated blood from the lungs flows through the pulmonary veins into the left atrium.

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. Hyperthyroidism with cricothyroid compression c. Diffuse unilateral enlargement of a lobe d. Autoimmune hypothyroidism

a. Tracheal obstruction <<Graves' disease, the most common cause of hyperthyroidism, is associated with diffuse, bilateral enlargement of the thyroid gland. Surgery is not the first response for Graves' disease, but is reserved for those patients who fail medical therapy (antithyroid drugs and radioactive iodine) or have a contraindication to medical therapy. Surgery is performed to relieve tracheal obstruction.

Oculocardiac reflex (OCR) is an intraoperative emergency that can occur during eye surgery. It is characterized by bradycardia that can lead to asystole, hypotension, and a wide range of other dysrhythmias attributable to negative inotropic and conduction effects. Select the definition of the response and contributing factor(s). a. Trigeminal-vagal response caused by pressure on the globe or retrobulbar block b. Increased intracranial pressure response to traction on extraocular muscles c. Adrenergic response to effect of retrobulbar block on the pituitary d. Lidocaine toxicity caused by intravascular uptake of retrobulbar anesthetic

a. Trigeminal-vagal response caused by pressure on the globe or retrobulbar block <<The most common symptom of OCR is sinus bradycardia, which can lead to asystole. The patient may become hypotensive and may experience a trigeminal-vagal response caused by pressure on the globe, traction on extraocular muscles, or retrobulbar block. The incidence of reported OCR ranges from 32% to 90%; in as many as 1 in 2200 strabismus surgeries, transient cardiac arrest may ensue

Pleurodesis is undertaken as a treatment for malignant pleural effusion and for unresolved spontaneous pneumothorax. The endpoint goal of a pleurodesis is to: a. cause adherence of the pleural layers. b. prevent accumulation of pleuritic secretions. c. bond the parietal pleura to the lung. d. achieve permanent pneumothorax.

a. cause adherence of the pleural layers. << A variety of chemical agents are used to cause adherence of the pleural layers. Adherence of the pleural layers is thought to prevent the accumulation of pleural fluid in the case of pleural effusion and to prevent subsequent pneumothoraces.

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

a. communication << Patients undergoing otolaryngologic procedures may have special communication needs that must be considered in planning effective care. The perioperative team should determine the best way to communicate with patients who have hearing deficits or impaired vocalization. Information given to the patient should be reinforced as needed throughout the perioperative experience. The OR environment must be quiet. Intraoperative noises, such as those from suction, electrosurgical units (ESUs), and other equipment, should be explained to the locally anesthetized patient before they are generated. This will help avoid startling the patient and adversely affecting the success of the surgery. Patients receiving local anesthetics need to remain still during the procedure, so providing for comfort measures becomes especially important. The room temperature should be regulated at a comfortable setting, and the patient should be adequately covered to maintain normal body temperature.

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. congenital; acquired b. pantaloon; sacular c. acquired; congenital d. reducible; nonreducible

a. congenital; acquired <<Indirect hernias may be either congenital, representing a persistence of the processus vaginalis, or acquired. In a congenital hernia, the hernia sac has a small neck, is thin-walled, and is closely bound to the cord structures. In an acquired indirect hernia, the neck is wide and the sac is both short and thick-walled. When both direct and indirect hernias are present, the defect is called a pantaloon hernia after the French word for "pants," which this situation suggests.

When preparing for pars plana vitrectomy in the posterior segment, the perioperative nurse must be aware that a combined scleral buckling procedure may be necessary. Other important information the perioperative team should know before preparing the OR for the procedure includes the location of the ocular problem, the surgeon's plan to address the problem, and the instrumentation and biomedical equipment and devices to be used. Technologic advances in ophthalmic surgery require that perioperative teams be familiar with complex biomedical equipment. A best practice, stated below, relevant to the safe use of complex equipment would be: a. demonstrate competence with equipment and check each piece carefully before the patient arrives in the OR. b. schedule the manufacturer's representative to be present to provide technical support. c. determine the presence and appropriate date (not expired) of the biomedical monitoring label. d. schedule the biomedical clinical engineer to check all equipment before each procedure.

a. demonstrate competence with equipment and check each piece carefully before the patient arrives in the OR. <<Technologic advances in ophthalmic surgery require that perioperative nurses be competent to prepare and check each piece carefully before the patient arrives in the OR.

The head of the pancreas is fixed to the: a. duodenum. b. spleen. c. stomach. d. biliary tree

a. duodenum << The pancreas (see Figure 3-3) is a fixed structure lying transversely behind the stomach in the upper abdomen. The head of the pancreas is fixed to the curve of the duodenum.

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.emergency laparotomy for a ruptured ectopic pregnancy. b.laparoscopic injection of methotrexate to the extrauterine gestational sac. c.salpingectomy. d.the medical therapy of IM methotrexate for 5 to 7 days.

a. emergency laparotomy for a ruptured ectopic pregnancy. <<Ectopic pregnancy, a devastating complication that affects up to 2% of all pregnancies, may be treated medically with methotrexate or surgically through salpingostomy, segmental resection, fimbrial expression, and salpingectomy. Methotrexate destroys rapidly dividing cells and is often administered in conjunction with the surgical procedure to destroy any residual trophoblastic cells that might remain. Laparoscopic and/or ultrasound-guided application of methotrexate to the extrauterine gestational sac may also be used as an alternative therapy. The more cost-effective medical treatment for ectopic pregnancy is considered a front-line therapy in many major medical centers. Ruptured ectopic pregnancy is considered a surgical emergency and is associated with severe abdominal pain, tachycardia, and hypotension.

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. eustachian tube; nasolacrimal duct b. nasopharynx; medial caruncle c. middle ear; lacrimal sac d. torus tubarius; canaliculi

a. eustachian tube; nasolacrimal duct <<The nasal cavity is also associated with each ear, sharing the torus tubarius (opening of the eustachian tube in the nasopharynx) with the paranasal sinuses (frontal, maxillary, ethmoidal, sphenoidal) through their respective orifices (meatus). The nasal cavity also communicates with the conjunctivae through the nasolacrimal duct.

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

a. hernia recurrence <<A successful herniorrhaphy is measured by the percentage of recurrence, the number of complications, the total costs, and the ability to return to normal activities of daily living.

This retractor is used to elevate the sternal border to expose the: a. internal mammary artery. b. anterolateral coronary arteries. c. aortic arch. d. superior vena cava and right atrium.

a. internal mammary artery. << The IMA retractor is used to elevate the sternal border for exposure of the internal mammary artery.

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. using either open or laparoscopic approaches for equally good patient outcomes. c. with the open approach to decrease surgical time. d. through an open approach.

a. laparoscopically. <<Response Feedback: Open repair was associated with significantly higher complication rates and longer hospital stays, as well as longer surgical times than laparoscopic repair. There was no statistical difference in surgical site pain or recurrence rates. The researchers concluded that laparoscopic repair of incisional hernias is a safe, feasible, and effective alternative to open repair techniques.

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. lower half of the common bile duct; pancreatic cancer b. inferior margin of the ligament of Treitz; pancreatic cancer c. left lobe of the liver; metastatic hepatocytoma d. distal segment of the spleen; pancreatic metastasis

a. lower half of the common bile duct; pancreatic cancer << Pancreaticoduodenectomy (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 lower half of the common bile duct, with reestablishment of continuity of the biliary, pancreatic, and GI tract systems.

Marissa Walton is a 6-year-old girl with full-thickness burns involving both lower legs, circumferentially, excluding her feet, over less than 2% of her body surface area (BSA) and partial-thickness burns over less than 15% of her BSA, after her clothes caught fire during a camping trip when she stepped into the campfire. Based on the American Burn Association and the "Rule of Nines" classifications, Marissa's burns would be classified as ______________ with a burn surface area percentage of approximately ______________. a. minor; 9% b. major; 18% c. minor; 17% d. moderate; 17%

a. minor; 9% <<The percentage of body surface area (BSA) system of the American Burn Association uses the following burn classification: Minor burns: Full-thickness burns over less than 2% of BSA; partial-thickness burns over less than 15% of BSA. Both of Marissa's lower legs were burned circumferentially, giving her a score of approximately 9% for the sum of both lower legs. Moderate burns: Full-thickness burns over 2% to 10% of BSA; partial-thickness burns over less than 15% to 25% of BSA. Major burns: Full-thickness burns over 10% or more of BSA; partial-thickness burns over 25% or more of BSA, including any burns to face, head, hands, feet, or perineum; inhalation and electrical burns; or burns complicated by trauma or other disease processes.

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, clitoris, urethra, vaginal opening. b. labia majora, labia minora, clitoris, urethra, vaginal opening, mons pubis. c. labia majora, labia minora, urethra, mons pubis, clitoris, vaginal opening. d. mons pubis, labia majora, labia minora, urethra, clitoris, vaginal opening.

a. mons pubis, labia majora, labia minora, clitoris, urethra, vaginal opening. <<The external organs, referred to collectively as the vulva, include the mons pubis, the labia majora and labia minora, the clitoris, the vestibular glands, the vaginal vestibule, the vaginal opening, and the urethral opening (Figure 5-3).

When coverage for a defect cannot be achieved through skin grafting, plastic surgeons rely on other techniques to replace tissue. After mastectomy, reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap is one of several options for nonsynthetic prosthetic reconstruction. Another descriptive term for the TRAM flap is the: a. pedicle-based flap. b. mastopexy. c. rotated tunneled flap. d. free flap.

a. pedicle-based flap <<The transverse rectus abdominis myocutaneous (TRAM) flap for postmastectomy breast reconstruction is the most common pedicle-based flap used for breast reconstruction. The rectus muscle is the broad, wide abdominal muscle that extends from under the ribs to the pubis, and either one or both sides of the muscle may be used for reconstruction. The blood supply (superior epigastric artery and vein) is carried within the muscle pedicle. The muscle along with its pedicle is severed at its most distal origins and pulled through a subcutaneous tunnel to the chest to form a breast. Although this procedure has the added benefit of an abdominoplasty, if there is inadequate abdominal tissue the patient may require a small mammary prosthesis.

Vertebroplasty and kyphoplasty are used for the treatment of vertebral compression fractures attributable to osteoporosis or pathologic conditions. Bone cement is injected into the vertebral body to decrease back pain and prevent further vertebral body height loss. Equipment includes C-arm, radiolucent OR bed, and x-ray vests for staff as well as bone biopsy needles, vertebroplasty system, and cement injection system. An important consideration relevant to this interventional radiology-assisted procedure would be: a. position patient in prone body alignment with padding to prevent skin and nerve injury. b. organize and have casting supplies available outside of the room. c. abduct both arms less than 90 degrees on attached armboards. d. shield the patient with a lead apron, covering from thyroid to reproductive organs.

a. position patient in prone body alignment with padding to prevent skin and nerve injury. <<Positioning of the patient requires careful vigilance to prevent skin breakdown and nerve damage. After the administration of anesthetic, the patient is positioned prone with hyperextension of the vertebral compression fracture on the radiolucent OR bed. Full body shielding would interfere with radiolucency of the operative site. These procedures do not require postprocedure casting. Armboards would interfere with movement of the C-arm image intensifier.

The refractive apparatus of the eye directs (refracts) the light rays to strike the: a. retina. b. lateral geniculate body. c. optic nerve. d. vitreous body.

a. retina <<Light rays from an object pass through the system of refractory devices—the cornea, aqueous humor, lens, and vitreous body—and are refracted (bent) so that the rays strike the retina.

A major function of the colon is to

absorb water

Once a surgical technologist dons a gown, the cuffs on the gown are considered unsterile because they are

absorbant and collect moisture.

On the way into the operating room, a terminally ill patient tells the nurse, "No matter what happens, it will be okay." Which of the Five Stages of Grief is the patient MOST likely in? A. denial B. bargaining C. depression D. acceptance

acceptance > In the acceptance stage, the patient has had enough time to work through the other stages and is no longer depressed or angry. He or she has reached a state of resolution.

Which of the following is reshaped during a total hip arthroplasty?

acetabulum

Which of the following solutions can be used to disinfect endoscopic instruments? A.iodophors B ethyl alcohol 70% C. phenolic compounds D. activated glutaraldehyde

activated glutaraldehyde

A sterile item used with an electrosurgical unit is the

active electrode. > An active electrode (pencil) is sterile because it is used on the operative field, directly on the patient.

Which of the following is applied as a nonadherent dressing?

adaptic

Which of the following wounds is MOST likely in the inflammatory phase of wound healing? A. a Bankart repair, one week post-procedure B. a laparotomy incision with a cicatrix C. an open reduction internal fixation (ORIF) of a finger, two weeks post-procedure D. an abdominal incision, 20 minutes post-closure

an abdominal incision, 20 minutes post-closure > The inflammatory phase is the first phase of wound healing and begins within minutes of injury and lasts for 3 to 5 days.

Which of the following characterizes bacteria of the genus Clostridium? A. aerobic B. anaerobic C. Gram-negative D. non-spore-forming

anaerobic

Which of the following is the BEST placement area for the electrosurgical grounding pad for a patient in the lithotomy position? A. upper arm B. lower back C. anterior thigh D. posterior shoulder

anterior thigh

What is the function of silver sulfadiazine (Silvadene)?

antimicrobial > Silver sulfadiazine is an antimicrobial typically used in topical form for burn treatment.

During which of the following surgeries is a Meckel's diverticulum typically discovered?

appendectomy > During an appendectomy, the bowel is examined, which can lead to the discovery of a Meckel's diverticulum.

In comparison to oral Fahrenheit temperatures, rectal Fahrenheit temperatures are A. exactly the same. B. approximately 1 degree lower. C. approximately 1 degree higher. D. approximately 2 degrees higher.

approximately 1 degree higher

Between each surgical procedure, decontamination of walls involves washing

areas that have been splashed with blood or debris.

A trauma patient from a motor vehicle accident is on the way to the operating room. Which of the following injuries is MOST likely related to airbag deployment? A. liver or spleen lacerations B. femur fracture C. arm fractures D. bruising of the heart muscle

arm fractures

Which of the following parts of the body are prepped for an ORIF of the olecranon process?

arm, fingers to shoulder

Which of the following retractors is used during a femoro-femoral bypass?

army-navy

When performing a right hemicolectomy, the surgeon will MOST likely remove portions of which of the following?

ascending and transverse colon

For a patient recovering from general anesthesia, which of the following complications of vomiting is considered the MOST dangerous? A. dehiscence B. aspiration C. dehydration D. evisceration

aspiration

Which of the following is the MOST important consideration when cutting suture? A. avoiding the knot B. using sharp scissors C. opening the scissors wide when cutting D. tagging the end of suture to be cut with a hemostat

avoiding the knot > Care must be taken to avoid cutting the knot. The ends must be short to reduce the amount of foreign material, but the suture ends must be long enough so that the knot does not untie.

Microsurgery, a fundamental tool in reconstructive plastic surgery, allows an almost unlimited choice of reconstructive methods, replacement of lost tissue with similar components, and optimal selection of donor sites with minimal morbidity. Reconstructive microsurgical procedures include replantation of amputated body parts, repair of facial nerves, repair of lacerated nerves and blood vessels, treatment of extensive trauma to extremities and hands, reconstruction following removal of extensive cancers, and female to male transsexual reassignment. Today's surgeons skilled in microsurgery can successfully anastomose the ends of a vessel or nerve measuring less than: a. 1.5 mm. b. 1 mm. c. 2 mm. d. 0.5 mm.

b. 1 mm. <<Today's surgeons who are skilled in microsurgery can successfully anastomose the ends of a vessel or nerve measuring less than 1 mm in diameter. The surgeon's use of an operating microscope or loupes for microsurgical procedures depends on the procedure to be performed, condition of the tissue, and personal preference.

A cataract is defined as any opacification of the lens. Cataracts may be congenital, posttraumatic, or induced by medications, but are most commonly the result of age-related changes. Which of the following statements about cataracts best describes its presentation or etiology (cause)? a. Cataracts are an early sign of type 1 diabetes. b. A cataract can be compared to a window that is frosted or yellowed. c. Cataracts can be classified as brittle or pliable, based on collagen matrix fibers in the capsule. d. The cloudiness is caused by clumping of lipoproteins in the lens capsule.

b. A cataract can be compared to a window that is frosted or yellowed. <<When the lens becomes cloudy through the aging process, vision becomes blurred. A cataract can be compared to a window that is frosted or yellowed. The lens is made mostly of water and protein; over time, some of the protein may clump together, leading to clouding of the lens (cataract). Cataract removal is warranted when there is interference with everyday activities such as driving, reading, and watching television

Which statement regarding level III and level IV trauma centers best describes the difference between the two types of centers? Answers: a. A level III trauma center determines severity of injury and provides ACLS support before transfer to a level IV center, while a level IV provides all comprehensive services. b. A level III trauma center provides advanced cardiac life support (ACLS), surgery, stabilization, and transfer, while a level IV only provides ACLS services before immediate transfer to a higher level center. c. A level III trauma center immediately transfers to a higher level center, while a level IV does not accept trauma patients. d. A level III trauma center provides all types of trauma services but is located in a rural setting, while a level IV provides post-hospital convalescent care for trauma patients.

b. A level III trauma center provides advanced cardiac life support (ACLS), surgery, stabilization, and transfer, while a level IV only provides ACLS services before immediate transfer to a higher level center. << A level III facility provides prompt evaluation, resuscitation, emergency surgery, and stabilization, as needed, before transfer to a higher-level facility. A level IV trauma center has the ability to provide advanced trauma life support before patient transfer. These facilities may be located in rural areas with limited access and may be a clinic or a hospital.

Any misalignment of the eyes is called strabismus. The goal for treatment of strabismus is to straighten the eyes so that binocular vision functions appropriately. Surgery may be recommended to change the alignment of the eyes relative to each other by: a. strengthening the eye muscles b. All of the options are correct. c. weakening the eye muscles d. repositioning the eye muscles

b. All of the options are correct <<Surgery may be recommended to change the alignment of the eyes relative to each other by strengthening, weakening, or repositioning the eye muscles.

An orchiopexy is the surgical placement and fixation of the testicle in a normal anatomic position in the scrotal sac. If the testis fails to descend into the scrotum during gestation, it is considered undescended. Which statement regarding indications for orchiopexy is true? a. The testis is strangulated by contraction of the cremaster muscle. b. All testes that are undescended after 1 year require surgical placement in the scrotum. c. The normal path of the testis becomes obstructed. d. Retractile testes require surgical or hormonal treatment.

b. All testes that are undescended after 1 year require surgical placement in the scrotum <<All testes undescended after 1 year require surgical placement in the scrotum for optimum maturation. Retractile testes require no surgical or hormonal treatment. Laparoscopic exploration may also be used to determine position, existence, or size of a "hidden" testis.

Children classified in the early childhood phase or who are preschool age begin to imagine and explore. Their thinking is dominated by perceptions and, often, distorted reasoning. They are magical thinkers. What would be an appropriate intervention for preschool age children? a. Allow them to play with a saline-filled syringe to decrease their fear of injections. b. Allow them to play with their own mask and place on their stuffed bunny's face. c. Tell them a scary story during anesthesia induction. d. Draw faces on inflated latex gloves and give each glove a name of a surgical team member.

b. Allow them to play with their own mask and place on their stuffed bunny's face. <<For the preschool, early childhood patient, use stories during induction. They like colorful Band-Aids. Allow the child to handle unfamiliar objects to decrease stress (e.g., mask, pulse oximeter probe). Allow personal item into OR for comfort/security.

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 clinical breast exam, mammography, and bimonthly breast self-exam b. An individualized screening plan c. Annual mammography, ultrasonography, and MRI with CT d. Biannual mammography with two views of each breast and clinical breast exam

b. An individualized screening plan <<The American Cancer Society Breast Cancer Screening Guidelines for Asymptomatic Women (see Table 8-4) recommends breast self-examination (BSE) monthly and clinical breast examination (CBE) every 3 years for women ages 20 to 39. For women 40 and older, the guidelines recommend BSE monthly, CBE annually, and screening mammography (two views of each breast) annually. Asymptomatic women who are identified to be at higher risk need to have an individualized screening plan that may differ from these guidelines.

While not as prevalent as arthroplasty of the shoulder, knee, or hip, total elbow replacement is indicated for patients with traumatic lesions or excessive bone loss from rheumatic or degenerative arthritis, resulting in elbow instability and pain or bilateral elbow ankylosis. The prosthesis may be used with or without PMMA, depending on the quality of the diseased bone and the design of the implant. If PMMA is not used, what replacement product, element, or substance is used? Answers: a. Synthetic bone putty b. Autologous bone graft c. Side plates, screws, and circumferential wires d. Hemostatic gel sponge with thrombin

b. Autologous bone graft << If PMMA is not employed, bone grafting with local bone that has been resected may be used to help seat the ulnar component snugly and achieve adequate bony contact against the porous coating of the metal ulnar component. The design of implants and methods of fixation for postoperative stability have presented challenges that have been overcome in arthroplasty of other joints but remain a challenge in elbow arthroplasty. Postoperative stability of the elbow implant depends largely on the soft tissues surrounding the joint. Patients with degenerative arthritis generally have better results from elbow arthroplasty than those undergoing this procedure after injury to the elbow joint.

A broad range of implant materials are used in plastic and reconstructive surgery. Select the implant that represents a biologic composition of a surgical implant. a. Medical-grade sterile silicone b. Autologous human tissue c. Polypropylene d. Gold

b. Autologous human tissue <<The range of materials available for implantation and augmentation in the specialty of plastic and reconstructive surgery has benefited from ongoing research. Biologic materials (autogenous grafts) are preferred when available. Autologous human tissue successfully utilized includes fat, solid dermis, and collagen. Human cadavers are used as a source for acellular collagen (AlloDerm).

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

b. Both audiogram and magnetic resonance imaging (MRI) <<Magnetic resonance imaging (MRI) is an imaging modality using powerful magnetic and radiofrequency waves to reproduce cross-sectional images of the human body without exposing the patient to ionizing radiation. CT scans are radiographic studies that visualize structures by producing serial sections, many times clinically referred to as "cuts," through planes of the head and neck. Two types of audiometric testing, pure tone and speech audiometry, are performed on patients with suspected hearing loss.

Identify the correct path of the cardiac conduction system. a. Neither from the area where the superior vena cava meets the right atrium to the atrioventricular junction close to the tricuspid valve to the right side of the interventricular system into a network of fibers by way of the right and left bundle branches, and from the SA node to the AV node to the bundle of His to the Purkinje system b. Both from the area where the superior vena cava meets the right atrium to the atrioventricular junction close to the tricuspid valve to the right side of the interventricular system into a network of fibers by way of the right and left bundle branches, and from the SA node to the AV node to the bundle of His to the Purkinje system c. From the area where the superior vena cava meets the right atrium to the atrioventricular junction close to the tricuspid valve to the right side of the interventricular system into a network of fibers by way of the right and left bundle branches d. From the SA node to the AV node to the bundle of His to the Purkinje system

b. Both from the area where the superior vena cava meets the right atrium to the atrioventricular junction close to the tricuspid valve to the right side of the interventricular system into a network of fibers by way of the right and left bundle branches, and from the SA node to the AV node to the bundle of His to the Purkinje system <<The conduction system process of excitation and contraction originates in the sinoatrial (SA) node, located in the area where the superior vena cava (SVC) meets the right atrium. The impulse spreads to the atria through intermodal pathways and travels to the AV junction (which contains the AV node) located medial to the entrance of the coronary sinus in the right atrium, close to the tricuspid valve. From the AV junction, the impulse spreads to the bundle of His, which extends down the right side of the interventricular septum. The bundle of His divides into the right and left bundle branches, which terminate in a network of fibers called the Purkinje system. Purkinje fibers are spread throughout the inner surface of both ventricles and the papillary muscles, which when stimulated produce contraction of the heart muscle.

Which of the following involves establishment of high standards, professional conduct, legal rights, and protection of the profession's integrity? a. Recommended Standards of Practice b. Code of Ethics c. Guidelines d. Position Statements

b. Code of Ethics <<The code of ethics focuses on protecting the patient but expands to protect professional standards and the profession's integrity.

Thoracic aortic aneurysmectomy is excision of an aneurysmal portion of the ascending aorta, aortic arch, or descending thoracic aorta and replacement with a prosthetic graft, valve-graft conduit, or intra-aortic prosthesis. Aneurysms may be caused by atherosclerosis, trauma, infection, or cystic medial degeneration. What presenting conditions will indicate that surgical intervention is necessary? a. Combined saccular and fusiform morphology without dissection b. Compromised circulation or danger of rupture c. Spindle-shaped morphology d. Circumferential involvement

b. Compromised circulation or danger of rupture <<Surgical intervention becomes necessary when presenting symptoms indicate a compromised circulation or danger of rupture; generally, medical management with hypotensive agents to reduce stress on the vessel is the preferred initial treatment until surgical repair can be performed.

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

b. Congenital diaphragmatic hernia <<Conditions treated by fetal surgery include congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, bronchopulmonary sequestration, obstructive uropathy, sacrococcygeal teratomas (Figure 5-63), twin-to-twin transfusion syndrome, thoracic lesions, twin reversed arterial perfusion syndrome, monochorionic twins, discordant twins, and myelomeningocele (Figure 5-64). Fetal surgery may be accomplished by way of laparotomy and hysterotomy or, in some instances, with endoscopic techniques.

Assessing blood flow through diseased vessels by palpation is often difficult. Assessment of the patient's hemodynamic status during surgery can be further complicated by spasm of the vessel walls, the cool environment of the OR, and alterations in blood pressure caused by hemorrhage. Vascular monitoring during carotid endarterectomy (CEA) is critical to determine the quality of cerebral perfusion. What vascular monitoring device is employed during CEA and what important surgical need is determined by its results? Answers: a.Doppler, need for embolectomy b.Electroencephalogram (EEG), need for a shunt c.Laser flow cytometry, need for increased IV fluids d.Electromyogram (EMG), need for muscle relaxants

b. Electroencephalogram (EEG), need for a shunt <<An EEG accurately determines reduced cerebral perfusion during a CEA. This enables the surgeon to decide whether to use a temporary shunt in the carotid artery or if the patient can tolerate clamping.

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. Endoluminal plication of the lower esophageal segment c. Heller's myotomy d. Endoscopic mucosal resection

b. Endoluminal plication of the lower esophageal segment. << plication is an antireflux procedure that can be performed endoscopically in an endoscopy procedure room using moderate sedation or a general anesthetic. One example is the EndoCinch (Bard Medical) technique that dilates the lumen of the esophagus before passing the EndoCinch device through an EGD scope. The device is a sewing capsule that pinches or pleats mucosal folds and anchors them in place with suture. Several plications are placed in a circumferential or staggered vertical pattern. Another device is the Wilson-Cook sewing system (Wilson-Cook Medical). It is a submucosal plication device that suctions a small fold of tissue into the lumen of the scope accessory, and then plicates, sutures, and knots the tissue pleat

During an open femoropopliteal bypass with graft, an incision is made into the femoral artery with a #11 knife blade and extended with a Potts angulated scissors. What is the proper name of this surgical approach? Answers: a.Popliteal arteriostomy b.Femoral arteriotomy c.Medial vasculotomy d.Potts arterial punch cut

b. Femoral arteriotomy <<An incision is made into the femoral artery with a #11 knife blade and extended with a Potts angulated scissors. An incision is made into the popliteal artery as explained for femoral arteriotomy. Femoropopliteal bypass is the restoration of blood flow to the leg with a graft bypassing the occluded section of the femoral artery. A saphenous vein or a straight synthetic graft can be used as bypass material.

The toddler uses symbols and engages in creative play. Toddlers are beginning to develop free will and control over their bodies. Which of the interventions below is age-appropriate for toddlers? a. Make up a story about their personal comfort item as you give it to their parent to keep. b. Give only simple choices and involve them in actions when possible. c. Sing songs from your own childhood that the child may be able to learn. d. Ask them about their concerns and offer information to decrease their fears.

b. Give only simple choices and involve them in actions when possible. <<Toddlers are very egocentric. They develop free will and increasing control of their body and feel regret and sorrow for inappropriate behavior. Give only simple choices; involve child in actions when possible; use distractions; sing songs the child may recognize. Allow personal item into OR for comfort/security.

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. Hyperextension of the neck, shoulder roll, and 30-degree reverse Trendelenburg's tilt of the OR bed c. Headrest, arms abducted at 90 degrees on armboards, and axillary roll d. Hyperflexion of the neck, shoulder roll, and arms tucked loosely at sides with palms facing up

b. Hyperextension of the neck, shoulder roll, and 30-degree reverse Trendelenburg's tilt of the OR bed <<Proper patient positioning on the OR bed is crucial for optimal exposure of the thyroid gland. The patient is positioned supine. Some surgeons prefer a beach-chair position or a wedge under the back. Hyperextension of the neck is required for maximal exposure. A headrest provides proper support, keeps the head straight, and prevents aggravation of prior neck problems. Alternatively, a shoulder roll may be used. The arms are tucked at the side, the elbows are padded to protect the ulnar nerve, the palms face inward, and the wrist is maintained in a neutral position. Reduction of venous congestion can be accomplished by a 30-degree reverse Trendelenburg's tilt of the OR bed.

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 inguinal hernia on the right b. Indirect inguinal hernia on the right c. Indirect femoral hernia on the left d. Direct femoral hernia on the left

b. Indirect inguinal hernia on the right <<Although hernias occur most often in males, the most common hernia in both males and females is the indirect inguinal hernia. Hernias occur more commonly on the right side than on the left.

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

b. It provides visual enhancement of anatomic structures. <<Intravenous (IV) injection of iodine contrast agents produces visual enhancement of some anatomic structures and pathologic tissues, including highly vascularized tumors.

Select the appropriate procedure performed for a patient with Fuchs' dystrophy, edema after cataract surgery, or keratoconus (abnormal steepening) of the cornea. a. Laser epithelial keratomileusis b. Keratoplasty c. Laser-assisted in-situ keratomileusis d. Keratorefraction

b. Keratoplasty <<A corneal transplantation (keratoplasty) is performed when the patient's cornea is thickened or opacified by disease and degeneration. Corneal transparency may be impaired as a result of scars, infection (bacterial, fungal, or viral), thermal or chemical burns, Fuchs' dystrophy, edema after cataract surgery, or keratoconus (abnormal steepening).

Karen Masterson, circulator, is preparing the OR for a vascular procedure where heparin will be used. She has obtained the heparin from the medication dispensing system and is preparing to mix the heparin in IV saline according to the dosage on the surgeon's preference/pick list. The scrub person, Judy Rothman, a surgical technologist, is preparing the sterile back table. What expected and appropriate risk reduction strategies related to the use of heparin would both Karen and Judy perform? a.Verify the drug and labels with three qualified individuals including the surgeon. b.Label syringe, medicine cup, and IV saline bag with the drug name, dosage, strength, date, and expiration date. c.Be aware of sound-alike cautions by not placing the heparin vial next to Hespan. d.Comply with the 7 rights of medication storage and documentation.

b. Label syringe, medicine cup, and IV saline bag with the drug name, dosage, strength, date, and expiration date. <<Heparin sodium is considered a high-alert drug, so designated by The Joint Commission and the Institute for Safe Medication Practices (ISMP) because it may cause life-threatening or permanent harm to the patient if administered incorrectly. Sound-alike caution: Hespan. Institutions should identify and at a minimum annually review look-alike/sound-alike drugs to prevent errors involving the interchange of such drugs. Labeling requirements: Any medication container, such as a syringe, medicine cup, or basin, containing heparin or a heparin solution must be labeled on or off the sterile field. The following risk reduction strategies are included: ensure concurrent verification, both verbally and visually, between the perioperative nurse and scrub person of all medications introduced to the sterile field, including medication name, strength, dose, and expiration date. Labels should be verified by two qualified individuals if the person preparing the medication is not the person administering it; this may be the case during relief of OR personnel.

The circulator should verify with the patient that all of the preoperative prescribed skin preparation regimens ordered by the surgeon have been performed. All body jewelry that pierces the skin should be removed before the skin prep. Select the statement that reflects a true special consideration for skin preparation before facial surgery. a. Isolate rashes, open sores, cuts, or lesions in the prep site with a sterile, clear adhesive patch. b. Leave the eyebrows and eyelashes intact to preserve facial appearance and expression. c. Use chlorhexidine gluconate (CHG) around the ears and eyes. d. Prep the skin graft and donor sites together with the same prep set and drape immediately.

b. Leave the eyebrows and eyelashes intact to preserve facial appearance and expression. <<Response Feedback: The eyebrows and eyelashes, in particular, are left intact to preserve facial appearance and expression. The use of CHG should be avoided around the ears and eyes. When prepping for a skin graft procedure, separate skin prep setups are needed for the graft and donor sites.Inspect for any rashes, bruises, open sores, cuts, or other skin conditions.

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. Determine fire risk score. b. Maintain instrument setup until the patient leaves the OR. 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.

b. Maintain instrument setup until the patient leaves the OR. << Laryngoscopy instrumentation should remain set up in the OR until the patient is transferred because the equipment may be needed if the patient experiences laryngospasm postoperatively.

Which of the following is the tissue most often responsible for spinal nerve root compression in patients with herniated intervertebral disks? a. Annulus fibrosis b. Nucleus pulposus c. Spinous process d. Posterior longitudinal ligament

b. Nucleus pulposus <<The nucleus pulposus protrudes beyond the perimeter of the disk space into the epidural space, resulting in nerve root compression and radiculopathy. The annulus fibrosis is made of rings of fibers and disk rupture occurs with radial fissuring of the annulus. The posterior longitudinal ligament runs vertically posterior to the vertebral body and anterior to the intervetebral foramen and assists in maintaining disks in place. The bony spinous process extends posteriorly and can be palpated in most people.

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. Wound ostomy care nurses b. Nutritionists and dietitians c. Pharmacists d. Genetic counselors

b. Nutritionists and dietitians <<Breast cancer patients are increasingly seeking and using complementary and alternative medicine (CAM) and integrative therapies to enhance their surgical and medical treatment (see Table 8-5). Besides using products such as green tea, vitamins E and C, and flaxseed, breast cancer patients are incorporating massage therapy and meditation and enlisting the help of dietitians and nutritionists as they battle breast cancer.

The term hammer toe is most often used to describe an abnormal flexion posture of the proximal interphalangeal joint of one of the four lesser toes. A bunion (hallux valgus) is a soft tissue or bony mass at the medial side of the first metatarsal head. Both of these deformity conditions of the feet share similar surgical positions, instrumentation for fixation, and recovery plans. Which of the following considerations is also shared by both procedures? a. Perform skin preparation of the same toes. b. Position patient supine and apply ankle tourniquet. c. Provide epinephrine for injection into the toes to decrease bleeding. d. None of these options are relevant to both procedures.

b. Position patient supine and apply ankle tourniquet. <<The goals of surgery are correction of the deformity (cosmesis), resection of the abnormal bony components (reconstruction), and restoration of normal or near-normal range of motion (function). The anesthesia provider administers a general or regional anesthetic, and an ankle tourniquet is applied. The foot and leg are prepped and then draped using a sterile stockinette. A soft tissue set, a small bone set, Kirschner wires, a power wire driver, and a microsagittal saw are required. The foot is prepped and draped. The toes are end organs and epinephrine should be used with caution.

Which part of paired spinal nerves is responsible for sensory functions? a. Pyramidal tracts b. Posterior root c. Dermatomes d. Anterior root

b. Posterior root <<The posterior, or sensory, root contains cell bodies that lie in the spinal ganglia located in the intervertebral foramina, the opening through which the nerves exit from the spinal canal and emerge from the cord. The normal segmental sensory distribution is valuable in the anatomic localization of sensory disorders. The anterior, or motor, root contains cell bodies that lie in the anterior horn of the spinal gray matter. Dermatomes are bands of skin innervated by a sensory root of a single spinal nerve. The pyramidal tracts are laterally placed long pathways within the central gray matter of the spinal cord that carry impulses down from the cerebral cortex to the motor neurons of the cord.

Baby Boy Doe is a newborn found outside of the emergency department (ED). He is hypothermic and has several deep lacerations across his back, abdomen, and legs that will require surgical repair. He is transferred to the surgical bay of the ED and prepared for anesthesia induction. What risk reduction strategies are appropriate during the preanesthetic phase to achieve and maintain normothermia? a. Adjust room temperature to 23?0? to 24?0? C (73.4?0? to 75.2?0? F). b. Provide a radiant heat lamp during placement of monitoring lines and induction. c. Wrap lower extremities in elastic bandages and encase in a plastic bag for newborns. d. Keep child exposed as much as possible to benefit from the heat lamp.

b. Provide a radiant heat lamp during placement of monitoring lines and induction <<Adjust room temperature approximately 1 hour before arrival of the child: 26?? to 27?0? C (78.8?0? to 80.6?0? F) for infants and newborns; 23?0? to 24?0? C (73.4?0? to 75.2?0? F) for older children. Provide radiant heat lamp for use during placement of monitoring lines, induction of anesthesia, positioning, skin prep, and draping. Keep child covered as much as possible. Consider wrapping lower extremities in soft gauze or stockinette and encasing in plastic bag for newborns and infants.

Which of the following are applied along the skin edges for mechanical hemostasis during opening of the scalp for craniotomy? a. Bone wax b. Raney clips c. Topical thrombin d. Methylmethacrylate

b. Raney clips <<Application of disposable scalp (Raney) clips limits bleeding by applying pressure to the scalp edges. They remain in place until closure. The clips are a mechanical method of hemostasis.

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 Infection c. Risk for Tissue injury d. Risk for Metastasis

b. Risk for Infection <<Bowel technique, also referred to as contamination or isolation technique, prevents cross-contamination of the wound or abdomen with bowel organisms. Initiate practices required for creating and maintaining a sterile field. Protect the patient from cross-contamination—employ bowel/GI technique as appropriate

Which of the 12 cranial nerves is involved in Bell's palsy and may be damaged during parotidectomy procedures? a. Twelfth (XII) b. Seventh (VII) c. Third (III) d. Fifth (V)

b. Seventh (VII) <<Response Feedback: The seventh (VII) cranial nerve is the facial nerve and supplies the musculature of the face and the sensation of taste for the anterior two-thirds of the tongue. It originates in the brainstem, passes through the skull with the eighth nerve by way of the internal acoustic meatus, continues along the facial canal, and exits just posterior to the parotid gland. The nerve may be damaged by surgical procedures in the vicinity of the parotid gland. Bell's palsy, a facial lower motor neuron paralysis, can affect the seventh nerve. The third (III) cranial nerve is the oculomotor nerve and is a motor nerve that innervates the muscles of the eye. The fifth (V) cranial nerve is the trigeminal nerve, which is a mixed nerve with sensory supply to the forehead, eyes, face, jaw, teeth, and other facial structures and innervates the muscles of mastication. The twelfth (XII) cranial nerve is the hypoglossal nerve and innervates the musculature of the tongue.

Which action best reflects the movement of urine from the renal pelvis to the bladder? a. Urine is propelled into the bladder when adrenal hormones bind with ureteral receptor sites. 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. Normal intra-abdominal positive pressure promotes renal drainage.

b. Slight distention of the renal pelvis initiates a wave of peristaltic contractions. << As urine accumulates in the renal pelvis, slight distention initiates a wave of muscular contractions. This peristaltic activity continues down the ureter, propelling urine into the bladder.

Which of the following personal character traits pertains to one's pledge to recognize and admit mistakes so that corrective action can be taken immediately? a. Respect for the team b. Surgical conscience c. Organizational skills d. Good manual dexterity

b. Surgical conscience <<Beside education in critical technical skills, the surgical technologists needs to have good communication with and respect for the entire surgical team. This produces the necessary environment to safely admit one's own mistakes and provides the ability for corrective action.

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. Neither technique enters the peritoneal compartment b. The TEP technique c. Both techniques require access into the peritoneal compartment d. The TAPP technique

b. The TEP technique <<Response Feedback: TEP provides access to the preperitoneal space without entering the peritoneal cavity. The TAPP uses intraperitoneal trocars and the creation of a peritoneal flap over the posterior inguinal region.

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

b. The aspirate fluid is cytologically examined. <<Once a mass is identified, the physician has multiple techniques to establish a diagnosis. Cytologic examination of the aspirate can assist in microscopic evaluation of the mass. During a fine needle aspiration biopsy (FNAB), the physician anesthetizes a small area of the breast with lidocaine. A 22- or 25-gauge needle attached to a 20-ml syringe is inserted into the mass, and a small amount of the contents is aspirated.

The nerves of the lungs are a part of the autonomic nervous system. What structures are constricted and relaxed by their influence? a. The bronchi and bronchioles b. The bronchi and the blood vessels c. The pulmonary artery and vein d. The alveoli and the pulmonary vein

b. The bronchi and the blood vessels << The nerves of the lungs are a part of the autonomic nervous system. They regulate constriction and relaxation of the bronchi and the blood vessels within the lungs.

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.

b. The excisional biopsy is performed under direct visualization, while the stereotactic approach is image-guided. <<In an excisional biopsy, the entire tumor mass is excised along with a small margin of normal tissue for examination. Digital stereotactic imaging and use of minimally invasive instruments to locate and remove tissue allow for simultaneous biopsy and removal of mammographic densities. Masses located near the patient's areola, high in the axilla, or near the chest wall are not appropriate for this technique. The benefits to the patient include small incisions for cosmetic results, decreased disfigurement, shortened time between detection and diagnosis, and elimination of the need for more involved surgical intervention.

Substituting a cryo-preserved cadaveric vein or an in situ or reversed vein graft from the patient for an arterial bypass graft is an option for patients who have healthy, easily accessed saphenous veins. How does an in situ vein graft differ from a reversed vein graft? a.Valvulotomes are used to remove the valves in both methods. b.The in situ method leaves the vein in its position and the valves are removed. c.Arteriovenous fistulas are a common complication with the reversed vein graft method. d.With the in situ method, the vein segment is resected, reversed, and anastomosed into position.

b. The in situ method leaves the vein in its position and the valves are removed. <<Two methods of grafting veins are the in situ graft and the reversed vein graft. The in situ method leaves the vein in its place, side branches are ligated to prevent arteriovenous fistulas, and the valves that would impede arterial flow are disrupted with instruments specifically designed to cut valves, called valvulotomes. Autogenous vein grafting for infrainguinal bypass is considered the criterion standard. Reoperation is more frequent with the in situ method because of missed valves and residual arteriovenous fistulas. Reversal of a vein graft is performed per the surgeon's preference or when it must be harvested from the contralateral limb.

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. The laparoscopic-assisted approach only has an abdominal skin incision(s). c. Neither approach requires two or more skin incisions. d. Both procedures require only an abdominal skin incision(s) as the rectal segment is removed and anastomosed intraluminally.

b. The laparoscopic-assisted approach only has an abdominal skin incision(s). <<The laparoscopic-assisted ileoanal pull-through procedure for total colectomy creates a rectal anastomosis in which the distal ileal segment is anastomosed to the rectal segment. Intraluminal staples are inserted through the rectum to connect the rectum to the created J pouch. The only skin incisions are the trocar port sites.

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. All of the options are desired outcomes. d. The patient will excrete 50 ml of urine per hour.

b. The patient will regain his or her normal pattern of urinary elimination. << The patient outcome related to the risk for urinary retention could be stated as follows: The patient will demonstrate or regain a normal pattern of urinary elimination. Normal urinary output for an adult is 0.5 to 1 ml/kg body weight/hour. Full bladder capacity is 350 to 700 ml.

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 surgeon's gown was not touched, just the dissector connection to the robotic arm. b. The surgeon was not in contact with the sterile field because he worked from the robotic console. c. The tip of the dissector that was in the patient's abdomen was not contaminated. d. The surgeon planned to remove the dissector after he finished dissecting and then dispose it.

b. The surgeon was not in contact with the sterile field because he worked from the robotic console. << The surgeon manages the robotic system from a console away from the operative field. With current robotic systems, the surgeon sits at an operative console with three-dimensional imaging and handheld controls. Movement of the controls follows the movement of the instrument's tip. Robotic arms function just like a surgeon's hands.

The thoracic outlet is a junction bound anteriorly by the manubrium, anterolaterally by the first ribs, and posteriorly by the first thoracic vertebrae and posterior angles of the first ribs of the space. The great vessels of the head, neck, and arm pass through this space. What syndrome is caused by the compression of these structures? a. Brachial plexus palsy b. Thoracic outlet syndrome c. Vertebral tipping syndrome d. Thoracic plexus compression

b. Thoracic outlet syndrome <<Compression of these structures causes thoracic outlet syndrome.

Which of the following groups created a patient safety campaign titled "Safe Surgery Saves Lives" which utilized a surgical safety checklist to aid in the time-out process? a. Agency for Healthcare Research & Quality (AHRQ) b. World Health Organization (WHO) c. Council on Surgical and Perioperative Safety (CSPS) d. American College of Surgeons (ACS)

b. World Health Organization (WHO) <<WHO designed a campaign titled" Safe Surgery Saves Lives", which includes a Surgical Safety Checklist to be used by all operating room teams to aid in the time-out process.

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

b. a thin upward protrusion of thyroid tissue from the isthmus. <<The pyramidal lobe, a long, thin projection of thyroid tissue protruding cephalad from the isthmus, is found in about 30% of patients at surgery; it is the vestige of the embryonic thyroglossal duct and migrates from the foramen cecum at the base of the tongue. If the migratory tract fails to degenerate, a fistula or cyst may be present.

Osteoporosis is one of the most common and serious of bone diseases and is responsible for more than 2 million fractures a year. Osteoporosis-related fractures most commonly occur in the hip, spine, and wrist, but any bone can be affected. The excessive reduction of total bone mass in osteoporosis is due to the loss of: a. estrogen and testosterone. b. calcified matrix and collagenous fibers. c. calcium or vitamin D. d. exercise and weight-bearing physical activity.

b. calcified matrix and collagenous fibers. <<Osteoporosis is characterized by excessive loss of calcified matrix, bone mineral, and collagenous fibers, causing a reduction of total bone mass. Decreasing levels of estrogen and testosterone in the older adult results in reduced new bone growth and maintenance of existing bone. Inadequate intake of calcium or vitamin D; lack of weight-bearing activities, exercise, and physical activity; smoking; and caffeine intake are other contributing factors. Osteoporotic bone is porous, brittle, and fragile, fracturing easily under stress. This results in susceptibility to spontaneous fractures and pathologic curvature of the spine.

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.hysteroscopy with cervical biopsy and frozen section. b.colposcopy with endocervical biopsy. c.second-look vaginal exam with cervical Pap smear. d.colposcopy with cervical skinning procedure performed using a local anesthetic.

b. colposcopy with endocervical biopsy. <<A colposcopy, with colpomicroscopy, is often performed in the physician's office. This examination is indicated for the patient with an abnormal Papanicolaou (Pap) smear suggestive of dysplasia. It identifies cellular abnormalities that may involve the vulva, vagina, or cervix and helps identify areas of dysplasia and carcinoma in situ. Endocervical curette samples may be obtained during the colposcopic procedure to rule out invasive carcinoma or to detect early adenocarcinoma.

Sally Andres and her orientee have returned from an airway fire simulation exercise with the otorhinolaryngologic surgeon, fellow, and anesthesia provider. They were amazed at the statistics for OR fires and the threat of serious injury to the patient and team. Patients undergoing otorhinolaryngologic procedures are at greater risk for fire injury because of the proximity of the surgical field to high concentrations of oxygen. The team discussed a plan to change their practices. An example of a risk reduction strategy that involves collaboration of the entire surgical team during otorhinolaryngologic surgery would be: a. placing ESU active electrodes in a secure holster. b. conducting regularly scheduled team simulations that rehearse an airway fire protocol. c. identifying the fire risk score during the preincision time-out. d. maintaining the laser on standby until needed.

b. conducting regularly scheduled team simulations that rehearse an airway fire protocol. <<Specific recommendations that members of the surgical team caring for otorhinolaryngologic patients must consider include awareness of fire risk factors. The perioperative nurse and scrub person should collaborate before procedures to plan for fire risk and ensure that sterile saline is available on the surgical field, the holster is used for the active ESU electrode, and the volumes of music, conversation, and ambient room noise are reasonable so that the audio from the ESU or laser can be heard. A careful review of the facility protocol for handling fire in the OR, including verification of the location of fire pull alarms, extinguishers, and evacuation routes, is essential and should not be minimized.

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.shearing force injury from sliding toward the head of the OR bed. b.decreased pulmonary compliance and functional residual capacity. c.increased popliteal congestion and peripheral vascular collapse. d.avascular ischemic changes to the lower leg and feet from gravitational devascularization.

b. decreased pulmonary compliance and functional residual capacity. <<Patients placed in Trendelenburg position for prolonged gynecologic procedures are at increased cardiovascular risk because of decreased pulmonary compliance and functional residual capacity (FRC).

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

b. energy metabolism <<The thyroid gland produces three hormones: thyroxine (T4) and triiodothyronine (T3) (together known as the thyroid hormones [THs]) and calcitonin. T3 and T4 cannot be synthesized without iodine. Calcitonin increases calcium storage in the bone and decreases blood calcium levels. The primary function of thyroid hormones is to regulate energy metabolism, but they also play an important role in growth and development. Thyroid-stimulating hormone (TSH) is synthesized by the anterior pituitary, and stimulates the production and release of thyroid hormones and the uptake of iodine.

It is important to recognize that the difference between pediatric care and adult care is not just a size issue. Major areas of distinction are the airway and pulmonary status, cardiovascular status, temperature regulation, metabolism, fluid management, and psychologic development. The most significant consideration when caring for pediatric patients that is not of concern when caring for adults is: a. congenital birth anomalies and conditions are the most frequent surgical diagnoses. b. from birth onward, the child is in a continual state of development and physiologic change. c. a proportionally large head, short neck, and large tongue influence anesthesia care. d. thorough knowledge of the differences between children and adults is integral to the provision of nursing care.

b. from birth onward, the child is in a continual state of development and physiologic change <<From birth onward, the body and organs exist in a continual state of development, and multiple physiologic changes occur with age. A thorough knowledge of these differences is integral to the provision of nursing care for the pediatric patient in the OR.

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

b. gas embolus into an exposed blood vessel during the procedure. << CO2 is the gas of choice for pneumoperitoneum. The perioperative nurse should set the insufflation unit to a maximum pressure of 15 mm Hg. Pressure higher than 15 mm Hg may result in bradycardia or a change in blood pressure, or may force a gas embolus into an exposed blood vessel during the operative procedure.

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

b. hepatocytes; bile << Response Feedback: Lobules are the functional units of the liver. Each lobule contains a portal triad that consists of a hepatic duct, a hepatic portal vein branch, and a branch of the hepatic artery, nerves, and lymphatics. The hepatic cords consist of numerous columns of hepatocytes—the functional cells of the liver. The hepatic sinusoids are the blood channels that communicate among the columns of hepatocytes. The sinusoids have a thin epithelial lining composed primarily of Kupffer cells—phagocytic cells that engulf bacteria and toxins. Bile is manufactured by the hepatocytes.

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

b. later age at first birth <<Breast cancer incidence is greater in women of higher education and socioeconomic background. This relationship is possibly related to lifestyle differences, such as age at first birth. Other risk factors for breast cancer include alcohol consumption (the equivalent of two drinks per day may increase risk by 21%). Women of Jewish Ashkenazic (eastern European) heritage also have higher incidences ofBRCA1 and BRCA2 genetic mutations.

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. intestinal obstruction. b. necrotic bowel. c. compromised bowel. d. strangulated bowel.

b. necrotic bowel. <<In a strangulated hernia, the blood supply of the trapped sac contents becomes compromised and eventually the sac contents necrose. When bowel is strangulated in such a hernia, resection of necrotic bowel, in addition to repair of the hernia defect, becomes necessary. This is a surgical emergency.

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. moisturize inspired air. b. prepare inspired air for the lungs. c. facilitate the sense of smell. d. warm inspired air.

b. prepare inspired air for the lungs <<The chief purpose of the nose is to prepare air for use in the lungs.

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. regenerate into normal parathyroid tissue. b. prevent hypocalcemia and its complications. c. maintain the patient in a state of hypercalcemia to compensate for the lost glands. d. serve as a marker for later surgery should the gland fail to produce PTH.

b. prevent hypocalcemia and its complications. <<Although it is quickly being replaced with the focused approach to parathyroidectomy, in the classic open approach, with the thyroid gland visible, bilateral neck exploration of the "normal" locations of the four parathyroid glands is conducted. A portion of a gland must remain to prevent hypocalcemia and its complications. The amount of remaining parathyroid tissue can then be adjusted to regulate PTH to the desired level.

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

b. primary hepatic cancer. << Liver transplantation is indicated for patients with primary hepatic cancer, chronic hepatocellular disease, chronic cholestatic disease, metabolic liver disease, acute fulminant liver disease, and inborn errors of metabolism. When malignancies are the cause of end-stage liver disease, the right upper quadrant may be radiated intraoperatively—after hepatectomy and before transplantation

Paget's disease is a disorder affecting older adults. The bones are weak and poorly constructed. It is characterized by the proliferation of osteoclasts and compensatory increased osteoblastic activity. This degenerative process results in: Answers: a. replacement of cancellous bone with cortical bone. b. rapid, disorganized bone remodeling. c. immature bone cells with air spaces. d. weak and non supported bone matrix.

b. rapid, disorganized bone remodeling <<Paget's disease is characterized by proliferation of osteoclasts and compensatory increased osteoblastic activity, resulting in rapid, disorganized bone remodeling

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. spread of infections. d. drainage of the outer half of the breast.

b. spread of metastasis. <<Lymph drainage generally follows the course of the vessels. Lymphatics drain into two main areas represented by the axillary nodes and the internal thoracic chain of nodes (see Figure 8-3). The internal thoracic nodes are few, but are responsible for most lymph drainage from the inner half of the breast. Thus the lymph system can also be a channel for the spread of malignant disease from the breast to associated areas of the chest wall or to the axilla.

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. convert bile salts into bile enzymes. b. store and concentrate bile. c. manufacture bile. d. contract to secrete bile into the hepatic duct.

b. store and concentrate bile. << The gallbladder, which lies in a sulcus on the undersurface of the right lobe of the liver, terminates in the cystic duct (Figure 3-3). This ductal system provides a channel for the flow of bile to the gallbladder, where it becomes highly concentrated during storage. The liver produces about 600 to 1000 ml of bile each day. The gallbladder's average storage capacity is 40 to 70 ml. As the musculature of the gallbladder contracts, bile is forced into the cystic duct and through the common duct. As the sphincter of Oddi in the ampulla of Vater relaxes, bile is released, flowing into the duodenum to aid in digestion by emulsification of fats.

The science of plastic and reconstructive surgery, which means to mold or create form and shape, improves appearance and body image through an understanding of: a. form and function. b. the anatomy and biology of tissue. c. body image. d. body geometry.

b. the anatomy and biology of tissue. << Plastic and reconstructive surgery is based on a thorough understanding of the anatomy and biology of tissue. Derived from the Greek word plastikos, which means to mold or give form, plastic surgery is a medical specialty that restores or gives shape to the body.

Skin grafting provides an effective way to cover a wound if vascularity is adequate, infection is absent, and hemostasis is achieved. Skin from the donor site is detached from its blood supply and placed in the recipient site. The best description of a successful skin graft outcome is: a. capillary refill returns within 24 hours. b. the recipient site develops a new blood supply from the base of the wound. c. the skin is a good color match. d. a split-thickness graft is able to regenerate in an area of full-thickness loss.

b. the recipient site develops a new blood supply from the base of the wound. <<Skin from the donor site is detached from its blood supply and placed in the recipient site, where it develops a new blood supply from the base of the wound. Color match, contour, and durability of the graft are all considerations in selection of an appropriate donor area. Color, temperature, signs of infection, blanching of the skin, excessive pain and discomfort, edema, vasoconstriction, and venous congestion should be noted and any change reported to the surgeon.

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. hypothyroidism unresponsive to antithyroid medications. b. thyroid cancer. c. autoimmune inflammatory thyroid dysfunction. d. hyperthyroidism with more than two episodes of thyroid storm.

b. thyroid cancer. <<For patients with cancer of the thyroid, total thyroidectomy is the desired surgical treatment followed by iodine-131 remnant ablation. Preventing thyroid cancer recurrence does not depend on surgical approach, but on complete surgical excision of the tumor.

Varicose veins are enlarged and distended veins that are visible and palpable beneath the skin. Secondary varicose veins are believed to be a result of insufficiency of the deep venous system. The primary objective of varicose vein surgery, for the patient with secondary disease, is to prevent: a.vasculitis, pitting edema, and sclerosed vein clusters. b.ulceration, edema, pain, and fatigue. c.thromboemboli, claudication, and unsightly blue clusters of veins. d.venospasm, phlebitis, and vascular sacculations.

b. ulceration, edema, pain, and fatigue. <<Response Feedback: The objective of surgical intervention is to remove the diseased veins, thus preventing ulceration, secondary edema, pain, and fatigue in the extremity. Disease may prevent the normal functioning of these valves, resulting in distention; as the vein wall weakens and dilates, venous pressure increases and the valves become incompetent. Dilation of the saphenous vein produces venous stasis, which may be followed by secondary complications, such as stasis ulcers.

Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone, which leads to a reduced absorption of calcium and phosphorus. This malabsorptive condition is due to a deficiency of ______________ that can be treated by __________________. a. calcium; nutritional diet and mineral supplements b. vitamin D; dietary supplements and exposure to sunlight c. soy protein; weight-bearing exercise and sunlight d. phosphorus; nutraceuticals and exposure to therapeutic radiation

b. vitamin D; dietary supplements and exposure to sunlight <<Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone as a result of vitamin D deficiency, which leads to a reduced absorption of calcium and phosphorus. Risk factors for development of osteomalacia include malabsorption problems, vitamin D and calcium deficiencies, chronic renal failure, and inadequate exposure to sunlight. Medical treatment includes dietary supplements and exposure to sunlight.

Which of the following procedures is used for removal of an embolus? A. endarterectomy B. balloon catheterization C. aneurysmectomy D. fasciotomy

balloon catheterization > Balloon catheterization is a common method using a Fogarty catheter to remove an embolus. This procedure is called an embolectomy.

If a routine surgical procedure was performed without consent, the surgeon committed

battery > Battery is unlawful touching of another without consent, justification, or excuse.

Which of the following instruments is used for placement of cottonoid strips during a craniotomy? A. bayonet forceps B. Russian forceps C. Kelly clamp D. angled DeBakey clamp

bayonet forceps > Bayonet forceps are used as the primary forceps for neurosurgical procedures, and are used to place cottonoids and Gelfoam for hemostasis.

Which of the following items may be used in positioning a patient for a total hip arthroplasty? A. fracture table B. Wilson frame C. Andrews frame D. bean bag

bean bag

Which of the following items should be used to transport a patient in traction? A. bed B. stretcher C. wheelchair D. fracture table

bed > The patient should be placed in a bed postoperatively because the traction device is often attached to the frame of the bed.

After a lung resection is performed, which of the following BEST describes the placement of the collection unit once it is hooked up to the drainage tubing? A. at the same level as the insertion tube B. below the level of the insertion tube C. above the level of the insertion tube D. at the level of the patient's feet

below the level of the insertion tube

Which of the following surgical procedures can induce menopause?

bilateral oophorectmy

A patient entering the operating room for a laparoscopic cholecystectomy looks jaundiced. Which of the following is the BEST explanation for this? A. pancreatitis B. biliary obstruction C. cholecystitis D. gastroschisis

biliary obstruction > Biliary obstruction causes increased serum levels of bilirubin, resulting in toxicity and a jaundiced appearance.

When preparing endoscopic cameras for ethylene oxide sterilization, which of the following monitoring processes would be utilized to ensure all parameters of sterilization were met?

biological indicator

Which of the following verifies that autoclave sterilization has occurred? A. chemical indicator B. Julian date C. heat-sensitive tape D. biological indicator

biological indicator

During a C-section, a surgical technologist passes the surgeon a pair of Metzenbaum scissors and Russian forceps. Which of the following anatomical parts is dissected off the uterus and gently retracted prior to uterine incision?

bladder

During a C-section, a surgical technologist passes the surgeon a pair of Metzenbaum scissors and Russian forceps. Which of the following anatomical parts is dissected off the uterus and gently retracted prior to uterine incision? A. ovaries B. bladder C. peritoneum D. broad ligament

bladder

It is important that the patient void before pelvic surgery to prevent

bladder injury

A Stamey needle is used for which of the following types of surgery? A. hysterectomy B. prostatectomy C. bladder suspension D. anterior colporrhaphy

bladder suspension > The Stamey needle is used ONLY in the Stamey procedure to treat incontinence. This is a type of bladder suspension procedure.

The primary purpose of a local anesthetic is to

block peripheral nerve receptors.

What color is a nitrous oxide tank?

blue

A liver laceration is identified during an emergency exploratory laparotomy. A surgical technologist will prepare suture attached to which of the following types of needles?

blunt

Which of the following surgical needles is MOST appropriately used in a liver resection? A. cutting B. taper C. blunt D. trocar

blunt > A blunt needle does not puncture the tissue, and it is the least traumatic needle for organs such as the liver.

During an anterior cervical fusion, a bone graft is taken in order to fuse the vertebral A. body. B. disk. C. spinous process. D. transverse process.

body

Which of the following may be used for a cerebral aneurysm? A. dura hook B. nerve hook C. brain spoon D. rake retractor

brain spoon > The brain spoon is used for a cerebral aneurysm. It should always be dipped in saline before being handed to the surgeon

The diagnostic procedure that examines the interior of the respiratory structures is A. bronchoscopy. B. culdoscopy. C. esophagoscopy. D. mediastinoscopy.

bronchoscopy

A pad-like sac or cavity that prevents friction within a joint is known as a

bursa- a pad-like sac or cavity found in connective tissues, usually in the vicinity of joints

How many phases of patient care constitute surgical case management? Answers: a. 4 b. 5 c. 3 d. 2

c. 3 <<This three-phase involvement - preoperative, intraoperative and postoperative - is called surgical case management.

What is the minimum number of Continuing Education (CE) credits required for a 4-year CST recertification cycle? a. 30 b. 40 c. 60 d. 50

c. 60 <<In order to maintain current certification, a surgical technologist must acquire 60 Continuing Education credits in a four year certification cycle or sit for re-examination through the National Board of Surgical Technologists and Surgical Assistants (NBSTSA).

Focused assessment with sonography in trauma (FAST) may assist with diagnosis in difficult situations. What group of scans is performed and what do they identify? a. A full body scan; midline shifts b. A chest, abdominal, and cervical spine scans; hemorrhage c. A chest, pelvic, and four abdominal scans; collections of fluid and free air d. A full body CT, MRI, and PET scans; life-threatening and secondary injuries

c. A chest, pelvic, and four abdominal scans; collections of fluid and free air << FAST is a portable, noninvasive scan that can be used to determine the presence of free fluid in the chest or abdomen. The typical FAST scan consists of chest, pelvic, and four abdominal scans. The chest scan examines right and left chest views and can determine the presence of pericardial fluid. The upper right abdominal scan evaluates the hepatorenal area, the first area that shows the presence of air. The left upper scan examines the splenorenal area. The left and right paracolic gutters are also scanned. The pelvic scan assesses for free fluid near the bladder.

Direct visualization of the mucosa of the trachea, the main bronchi and their openings, and most of the segmental bronchi may also include the removal of material for microscopic study, and is an integral part of the examination of patients with pulmonary symptoms such as persistent cough or wheezing, hemoptysis, obstruction, and abnormal roentgenographic changes. What diagnostic modality has been described? a. Rigid bronchoscopy b. Standard bronchoscopy c. All bronchoscopic approaches apply d. Flexible bronchoscopy

c. All bronchoscopic approaches apply << Standard bronchoscopy is the direct visualization of the mucosa of the trachea, the main bronchi and their openings, and most of the segmental bronchi. It also includes removal of material for microscopic study if necessary. Bronchoscopy is an integral part of the examination of patients with pulmonary symptoms such as persistent cough or wheezing, hemoptysis, obstruction, and abnormal roentgenographic changes. Flexible bronchoscopy on an adult patient may be completed after induction of local anesthesia or monitored anesthesia care; a child usually receives a general anesthetic. Patients undergoing rigid bronchoscopy should be paralyzed and ventilation continued to minimize trauma.

An aneurysm of the left ventricle (LV) can develop after a severe myocardial infarction. The affected area of the myocardium is replaced by thin scar tissue that can rupture. The LV undergoes remodeling when the scar stretches as a result of the left ventricular pressure and forms an aneurysm. Left ventricular aneurysmectomy (LVA) is the excision of an aneurysmal portion of the left ventricle. LVA is a form of left ventricular reconstruction undertaken to optimize cardiac function. Select the appropriate actions in preparation for LVA surgery. a. Have Teflon felt pledgets, woven Dacron patches, and cardiovascular sutures available. b. Prepare for the procedure in the same manner as typical open-heart surgery. c. All of the options are appropriate for LVA. d. Place the patient in supine position.

c. All of the options are appropriate for LVA. <<The patient is placed in the supine position. The setup is the same as that described for open-heart surgery, with the addition of synthetic patch material, Teflon felt pledgets, and 0, 3-0, and 4-0 cardiovascular sutures. Occasionally, Teflon felt strips are required to bolster the suture lines. Patch closure of the ventriculotomy (endoaneurysmorrhaphy) is performed more often than the traditional excision, plication, and oversewing of the ventricular tissue. Patch closure better preserves the geometry of the left ventricle. A circular cuff of scar tissue is left, through which a purse-string suture with felt pledgets is placed through the rim of the scar. A patch of woven Dacron is sewn to the rim with interrupted sutures. A second (internal) patch of pericardium may be placed for hemostasis.

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. unilateral. b. bloody. c. All of the options are significant. d. chronic.

c. All of the options are significant. <<Discharge is usually significant only if it is spontaneous and persistent. Chronic unilateral nipple discharge, especially if bloody, should prompt an investigation for occult carcinoma

Select the statement that best describes the comparative difference between open aortic aneurysm repair and endovascular aneurysm (EVAR) repair. a.In EVAR, self-expanding or balloon-expandable stents are used rather than sutures. b.The open aneurysm surgery approach has a major abdominal incision and increased patient morbidity. c.All the options are correct. d.In EVAR, the prosthetic endograft or stent-graft is introduced into the aneurysm through a surgically exposed femoral artery.

c. All the options are correct. <<Endovascular aneurysm repair (EVAR) differs from open surgical repair in that the surgeon introduces the prosthetic endograft or stent-graft into the aneurysm through a surgically exposed femoral artery and fixes it in place to the nonaneurysmal infrarenal neck and iliac arteries with self-expanding or balloon-expandable stents rather than sutures. A major abdominal incision is thus avoided, and patient morbidity related to the procedure is much reduced.

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

c. All three are solid organs and very vascular. << All three organs are solid (not hollow or collapsible) organs. A pathologic condition in the liver, biliary tract, pancreas, or spleen often requires surgical intervention. These organs are highly vascular and control many metabolic and immune functions of the body.

Disturbances of the conduction system affect the rate, rhythm, and effectiveness of the contracting heart. Surgical techniques have been developed to treat a variety of supraventricular dysrhythmias and both ischemic and nonischemic ventricular tachydysrhythmias. Preprocedural electrophysiologic mapping of the patient's conduction pathways identifies and locates aberrant pathways, or ectopic foci. A catheter is inserted percutaneously into the femoral vein or artery and threaded retrograde to the right or left atrium and ventricle. Various areas of the heart are tested in an attempt to reproduce the dysrhythmia; then the area of the heart where the rhythm disturbance originates is ablated. What directed energy source is employed to produce this selective ablation effect? a. Cryotherapy b. Ultrasonic energy c. All three energy sources can produce the desired ablative effect. d. Radiofrequency energy

c. All three energy sources can produce the desired ablative effect. <<Currently, the focus is on the selective ablation (with cryotherapy, ultrasonic energy, or radiofrequency [RF] energy sources) of tissues surrounding, for example, the pulmonary veins to reestablish normal conduction pathways

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. Right posterior lateral thoracotomy and midline abdominal incision b. Left thoracoabdominal incision c. Any of the three above incisions may be used per surgeon preference or tumor location. d. Three-incision (three-hole) approach with cervical, right thoracotomy, and midline laparotomy incisions

c. Any of the three above incisions may be used per surgeon preference or tumor location <<Transthoracic esophagectomy is indicated for disease of the middle third of the esophagus and high-grade dysplasia in Barrett's esophagus, permitting complete lymph node dissection under direct vision and combines a left-sided thoracoabdominal incision or separate right posterior lateral thoracotomy and midline abdominal incision. The latter describes the traditional Ivor Lewis approach. Another variation, sometimes called the "three-hole esophagectomy," combines an approach for proximal tumors. The single-incision thoracoabdominal incision provides the best exposure for low gastroesophageal junction tumors and is indicated for patients with cardiac and pulmonary disease.

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. Cooper repair c. Bassini repair d. McVay repair

c. Bassini repair <<The Bassini repair procedure was introduced in 1887 and was formerly the standard of repair. In this procedure the conjoined tendon and the shelving edge of the inguinal ligament are sutured together up to the internal ring. The major difference with this repair is that the superior transversalis fascia is sutured to the inguinal ligament with no attempt made to approximate it to the inferior portion of the transversalis fascia or the Cooper ligament. Critics of this procedure claim that it is not anatomically correct because layers that normally are not integrated (transversalis fascia and inguinal ligament) now are approximated.

Why is the change in sound made by a passing train's whistle similar to the reason the pitch rises quickly in systole and drops quickly in early diastole when measuring arterial sounds? a.Both involve the science of plethysmography. b.Both are explained by B-mode ultrasonography. c.Both are explained by the Doppler effect. d.Both are explained by the science of atomic behavior in a strong magnetic field such as MRI.

c. Both are explained by the Doppler effect. <<The Doppler effect is the change in the frequency of echo signals that occurs whenever there is a change in the distance between the sources of a sound and the receiving object. The probe, or transducer, is aimed toward the blood vessel at an angle of 45 to 60 degrees. This directs an ultrasound beam that is reflected back to the probe by moving red blood cells (RBCs). The velocity of the flow of cells is converted into an audible signal heard through a speaker. The signal is described as a swishing sound. The sound is called a signal, not a pulse. The Doppler transducer is the most widely used instrument for vascular study. It has the advantages of being readily available, inexpensive, and easy to use.

Which of the following is the minimum exposure method frequently used for evacuation of subdural hematomas, placement of ventriculoperitoneal shunts, or stereotactic brain biopsies? Answers: a. Craniotomy b. Transsphenoidal c. Burr hole d. Craniectomy

c. Burr hole <<A burr hole is the minimum exposure made to gain access to the brain. Burr holes are necessary for many neurosurgical procedures and can be used to access the intracerebral ventricles for the placement of a ventricular catheter (VP shunt) to drain obstructed cerebrospinal fluid. Craniectomy is the permanent removal of a section of the cranium using burrs and rongeurs to enlarge one or more burr holes. Craniectomy is indicated as treatment for craniosynostosis in infants and young children. A craniotomy may be performed to evacuate intracranial hematomas, tumors, or vascular lesions not accessible through a burr hole. The bone plate may be separated from the soft tissues, removed from the skull, and set aside for replacement at the end of the procedure. If intracranial swelling at the end of the procedure is a major concern, the bone plate may be frozen and stored in a sterile container according to hospital protocol to be replaced on the patient at a future date when the reduced intracranial pressure and swelling permits. The transsphenoidal route to the pituitary fossa is a less invasive means of removing pituitary or parasellar tumors than the transcranial approach

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. Intranasally on the affected sinus side b. Proximal to the maxillary artery c. Canine fossa of the upper jaw d. Antrum wall on the affected sinus side

c. Canine fossa of the upper jaw <<The purpose of a radical antrostomy is to establish a large opening into the wall of the inferior meatus, which ensures adequate gravity drainage and aeration. This large opening allows removal of the diseased tissues in the sinuses under direct vision. The Caldwell-Luc approach is also used to access the maxillary artery in cases of extreme epistaxis. The procedure requires an incision into the canine fossa of the upper jaw and exposure of the antrum for the removal of bony diseased portions of the antral wall and the contents of the sinus.

Select the true statement about dacryocystorhinostomy (DCR). a. The passageway is usually restored with the use of ultrasonic lacrimal probes. b. A DCR is performed for chronic or recurrent dacryocystitis, which is also called epiphora. c. DCR establishes a new passageway for tear drainage into the nasal cavity. d. A dacrolithotripsy is attempted if the DCR is unsuccessful.

c. DCR establishes a new passageway for tear drainage into the nasal cavity. <<Dacryocystorhinostomy (DCR) is the establishment of a new tear passageway for drainage directly into the nasal cavity. Dacryocystitis (see Figure 9-27) is an infection in the lacrimal sac, which may result in a localized cellulitis. Chronic or recurrent dacryocystitis in adults may necessitate probing or DCR because of resistant obstruction of the nasolacrimal duct related to infection-associated scarring, dacryolith (calculus in the duct), or trauma. Another indication for DCR surgery may be intolerable epiphora (tearing) resulting from tear duct laceration following medial orbital wall fracture.

Josh Tremain, a 28-year-old firefighter, sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire. What surgical treatments may Josh need before he is discharged from the burn center to home? a. Allograft and xenograft placement as temporary dressings until secondary granulation begins b. Debridement and monitoring of full-thickness skin regeneration c. Debridement, allograft placement during initial healing, and later split-thickness (ST) and full-thickness (FT) skin grafting d. Tangential excision of the burn wound with antibiotic-soaked dressings

c. Debridement, allograft placement during initial healing, and later split-thickness (ST) and full-thickness (FT) skin grafting <<Full-thickness burns may require debridement of necrotic tissue (eschar) before healing can occur by skin regeneration or grafting. An allograft may be used to cover the burned area during the initial healing process. A xenograft may also be used for covering the burned area. An alternative method is tangential excision of the burn wound, which is performed with a knife dermatome. This type of excision usually extends only to the bleeding subcutaneous fat, rather than to fascia. Dressings saturated with the topical antimicrobial agent of choice are applied. Although skin grafting may be done at the time of wound debridement, it is usually performed several days later, particularly in burns that are extensive

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. Both options occur within the triangle b. Indirect inguinal hernia c. Direct inguinal hernia d. Neither option occurs within Hesselbach's triangle

c. Direct inguinal hernia <<Response Feedback: The triangle formed by the deep epigastric vessels laterally, the inguinal ligament inferiorly, and the rectus abdominis muscles medially is referred to as the Hesselbach triangle. Hernias that occur within the Hesselbach triangle are called direct inguinal hernias. Indirect inguinal hernias occur laterally to the deep epigastric vessels. Both direct and indirect hernias represent attenuations or tears in the transversalis fascia. Direct hernias protrude into the inguinal canal but not into the cord, and therefore rarely into the scrotum.

A 26-year-old woman is rushed to the operating room after a primary and secondary survey in the emergency department. She was hit by a small truck as she was riding her bicycle through a busy intersection. She has sustained rib fractures and several fractured transverse vertebral processes. Renal injury is suspected. As the circulator prepares to insert a urinary catheter, she notices blood at the urinary meatus. What should the circulator's next action be? Answers: a. Place a gauze dressing over the perineum after inserting the urinary catheter. b. Insert the catheter and notify the surgeon. c. Discontinue the catheter insertion. d. Insert a latex-free straight catheter to empty the bladder and then remove it.

c. Discontinue the catheter insertion. << In these instances an indwelling urethral catheter should not be inserted. Laceration of the kidney is closely associated with fracture of the ribs and transverse vertebral processes. This injury is detected by the presence of blood at the urinary meatus. Blood at the urinary meatus may indicate a tear in the anterior urethra

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 infiltrating the lobule and often does not become invasive. b. Ductal carcinoma in situ (DCIS) is defined as abnormal cells lining the ductal system and is not invasive. c. Ductal carcinoma in situ (DCIS) has abnormal cells lining the ductal system and is often invasive. d. Lobular carcinoma in situ (LCIS) has abnormal cells lining the lobule and often becomes invasive.

c. Ductal carcinoma in situ (DCIS) has abnormal cells lining the ductal system and is often invasive. <<Stage 0 is carcinoma in situ. Ductal carcinoma in situ (DCIS) is defined as abnormal cells that are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated. Lobular carcinoma in situ (LCIS) is defined as abnormal cells that are in the lining of a lobule. LCIS seldom becomes invasive cancer.

Select the diagnostic test that represents an invasive cardiac study. a. Cardiac function b. Resting MUGA c. Electrophysiology studies d. Exercise MUGA

c. Electrophysiology studies <<The following are invasive diagnostic tests commonly performed for cardiovascular disorders: electrophysiology studies, aortography, arteriography, digital subtraction angiography, cardiac catheterization, ventriculography, endomyocardial biopsy.

Which of the following types of interventional neuroradiologic endovascular procedures is less invasive than traditional surgical clipping of complex (short-necked) or difficult-to-reach intracranial aneurysms? a. Endovascular embolization b. Intraarterial thrombolysis c. Endosaccular coiling d. Balloon angioplasty

c. Endosaccular coiling <<The endovascular approach to the treatment of both ruptured and unruptured cerebral aneurysms is endosaccular occlusion. This is an excellent technique for aneurysms that are complex, have a neck that is too short for clipping, or are difficult to reach via traditional craniotomy. A flexible platinum coil is fed through the transfemoral catheter and is coiled within the body of the aneurysm, conforming to the aneurysm's shape. The coil is then detached from the catheter. Although surgical excision is still the standard treatment for intracranial arteriovenous malformation (AVM), surgical morbidity may be decreased by using endovascular embolization preoperatively in select cases. Intraarterial thrombolysis is used for treatment of acute ischemic stroke patients who have missed the 3-hour window for therapeutic intravenous thrombolysis. Successful balloon angioplasty has not been evaluated in controlled clinical trials for treatment of intracranial stenosis and documented in mostly academic, high-volume centers.

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. True vocal cords b. Arytenoids c. Epiglottis d. False vocal cords

c. Epiglottis <<The epiglottis is a slightly curled, leaf-shaped, elastic, fibrous membrane that is attached in the midline to the upper border of the thyroid cartilage. The epiglottis helps to protect the larynx during swallowing. Contraction of the cricothyroid muscle pulls the thyroid cartilage and the cricoid cartilage to tighten the vocal cords and close the glottis. The arytenoid cartilages, which rest above the signet-ring portion of the cricoid cartilage, support the posterior portion of the true vocal cords.

Review the list below and select the answer that reflects the correct match between the procedure and the disease. a. Small bowel enteroscopy for ulcerative colitis b. Duodenoscopy for gastric reflux disease and hiatal hernia c. Esophagogastroduodenoscopy (EGD) for gastric ulcer disease d. Bariatric surgery for Roux-en-Y for gastritis

c. Esophagogastroduodenoscopy (EGD) for gastric ulcer disease <<Common GI endoscopy procedures used to establish a diagnosis or monitor gastric disease include esophagogastroduodenoscopy (EGD) (also referred to as gastroscopy or upper endoscopy).

From the list below, select the statement that is true about fallopian tube cancer. Answers: a.Fallopian tube cancer is seen primarily as a metastasis from the small intestine. 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 metastasizes to the ovaries and cervix.

c. Fallopian tube cancer is very rare, with an incidence of less than 1%. <<Fallopian tube cancer is very rare, with an incidence of less than 1%. It is seen primarily as a metastasis from ovarian and endometrial cancers. Gynecologic cancers commonly occur in the endometrium, the cervix, the ovaries, or the vagina. Less common sites are the vulva and fallopian tubes. Risk factors associated with the development of these cancers are noted in Table 5-2.

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 men who cannot tolerate, or who are not candidates for, high-intensity focused ultrasound c. For symptom relief of obstruction before initiating other treatments d. For specimen retrieval for diagnostic cancer staging

c. For symptom relief of obstruction before initiating other treatments << TURP is one surgical method of treating benign obstructive enlargement of the prostate gland. If the prostate gland is cancerous, a radical retropubic or radical perineal prostatectomy, in conjunction with open or laparoscopic pelvic lymph node dissection, is usually performed. TURP may also be used in men who cannot have a radical prostatectomy, or to relieve symptoms caused by prostate cancer before other treatments are initiated.

Which chemical hemostatic agent comes in compressed and noncompressed sheets and is often cut into various sizes soaked with topical thrombin and placed on oozing surfaces during neurosurgical procedures? a. Bone wax b. Surgicel c. Gelfoam d. FloSeal

c. Gelfoam <<An absorbable gelatin sponge (Gelfoam) absorbs and holds blood and fluid within its interstices, exerting a physical hemostatic effect. Thrombin is a drug that can be topically applied to bleeding surfaces to achieve hemostasis. Typically, Gelfoam or patties are saturated with thrombin and placed on the oozing surface. Bone wax is a hemostatic material that should be available for all cranial and spinal cord operations. Bone wax may be applied with the surgeon's fingertip or with the tip of an instrument such as a Freer or Penfield elevator. The surgeon firmly rubs or packs the wax into the bleeding surfaces of bone. The granules in a gelatin matrix (FloSeal) form a composite clot that seals a bleeding site. Regenerated cellulose (Surgicel) allows platelets and aggregates of thrombin and particulate blood elements to cling and form a coagulum that can act as a patch.

The liver is essential in the metabolism of carbohydrates, proteins, and fats, generating nutrient stores of which substance that supplies energy sources to the brain and body? a. Serum glucosamine b. Carbohydrate glucose substrate c. Glycogen d. Bile salts

c. Glycogen << The liver is essential in the metabolism of carbohydrates, proteins, and fats. It metabolizes nutrients into stores of glycogen, used for regulation of blood glucose levels and as energy sources for the brain and body functions.

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. Torsion of the hernia sac b. Nonreducible hernia c. Incarcerated hernia d. Gangrenous bowel

c. Incarcerated hernia Patients with incarcerated hernias may have signs of intestinal obstruction, such as vomiting, abdominal pain, and distention. The greatest danger of an incarcerated hernia is that it may become strangulated.

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

c. It is an oblique inguinal incision in the right lower quadrant. <<The McBurney incision is an open appendectomy approach and the appendix is typically in the right lower quadrant of the abdomen.

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. Open small bowel resection with postoperative signs of pancreatitis b. Long (4-hour) laparoscopic procedure, with incidental peritonitis c. Laparoscopic lysis of adhesions with release of bowel torsion d. Laparoscopic-assisted hemicolectomy with mild peritoneal inflammation

c. Laparoscopic lysis of adhesions with release of bowel torsion <<A laparoscopic approach combined with sharp-dissection lysis of adhesions and release of bowel torsion (twisting) does not include a bowel resection and will not cause excessive manipulation of the bowel. This patient may possess risk factors for development of postoperative (paralytic) ileus attributable to two past surgeries, keloid history, and possible bowel obstruction

Facial fractures are classified according to a system developed by Rene Le Fort in the early 1900s. A fracture that starts at the nasal bones, crosses the frontal process of the maxilla and lacrimal bones, and extends through the orbital floor, infraorbital rim, and lateral maxillary sinus wall is known as a: a. Le Fort IV. b. Le Fort I. c. Le Fort II. d. Le Fort III.

c. Le Fort II. <<Le Fort I, or transverse maxillary, fracture—this horizontal fracture includes the nasal floor, septum, and teeth. Le Fort II, or pyramidal maxillary, fracture (unilateral or bilateral)—often involves the nasal cavity, hard palate, and the orbital rim. Le Fort III, or craniofacial dysjunction, fracture—includes fractures of both zygomas and the nose. Like a mandibular fracture, a maxillary fracture also produces malocclusion. In addition, depending on the severity of the fracture, it may produce considerable deformity of the middle of the face, usually perceived as a flattening or smashed-in appearance. Closed reduction with intermaxillary fixation suffices for treatment of Le Fort I and some Le Fort II fractures.

Miotics and mydriatics produce opposite effects on the pupil of the eye. Select the most appropriate statement about miotic and mydriatic drugs. a. Miotic drugs dilate the pupil for posterior chamber access after lens removal. b. Mydriatic drugs are often referred to as cycloplegics. c. Mydriatic drugs, such as phenylephrine, dilate the pupil. d. Miotic drugs are anticholinergic drugs useful in lowering intraocular pressure.

c. Mydriatic drugs, such as phenylephrine, dilate the pupil. <<Mydriatics: Phenylephrine 2.5%, and 10% (Neo-Synephrine, Mydfrin) promotes mydriasis (dilates pupil but permits focusing); used for objective examination of the retina, testing of refraction, easier removal of lens; and used alone or with a cycloplegic. Miotics: (1) Carbachol 0.01% (Miostat) is a potent cholinergic (constricts pupil); used intraocularly during anterior segment surgery; (2) Carbachol 0.75%, 1.5%, 2.25%, and 3% (Isopto Carbachol) is a potent cholinergic (constricts pupil); used topically for lowering intraocular pressure in glaucoma; (3) Acetylcholine chloride 1% (Miochol-E) is a cholinergic that rapidly constricts the pupil; used intraocularly during anterior segment surgery; reconstitute immediately before using; (4) Pilocarpine hydrochloride 1%, and 4%, which is a cholinergic (constricts pupil) used topically for lowering intraocular pressure in glaucoma.

What is a common congenital neural tube closure defect that may present as a fluid-filled sac in the lumbar region and contains neural elements? a. Encephalocele b. Hydrocephalus c. Myelomeningocele d. Chiari malformation

c. Myelomeningocele <<The most common congenital lesion encountered is a lumbar meningocele, or myelomeningocele, a failure of the union of the vertebral arches during fetal development. The fluid-filled, thin-walled sac often contains neural elements. Encephalocele is a neural tube defect that occurs most frequently in the occipital region of the skull. A Chiari malformation is a condition in which there is protrusion of the cerebellar hemispheres and medulla through the foramen magnum, causing hydrocephalus, or excess accumulation of cerebrospinal fluid, resulting in dilation of the intracerebral ventricles.

Which surgical specialist might be asked to assist in providing exposure for the neurosurgeon in a transsphenoidal hypophysectomy (TSH) procedure? a. Neuroradiologist b. Orthopedic surgeon c. Otorhinolaryngologist d. Cardiothoracic surgeon

c. Otorhinolaryngologist <<Otorhinolaryngologic surgeons can be consulted to assist the neurosurgeon with this approach through the sphenoid sinus into the pituitary fossa. Endocrine pituitary disorders (e.g., Cushing's syndrome, acromegaly, malignant exophthalmos, and hypopituitarism resulting from intrasellar tumors), as well as nonpituitary disorders (e.g., advanced metastatic carcinoma of the breast and prostate, diabetic retinopathy, and uncontrollable severe diabetes), have been successfully treated by TSH. Complete extracapsular enucleation of the pituitary in cases of hypophysectomy and possible complete removal of small pituitary tumors, with the remaining normal portion of the gland left intact, can be achieved.

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.Antimetabolites b.Cytotoxics c.Oxytocics d.Tocolytics

c. Oxytocics <<Oxytocics are medications that increase motor activity within the uterus by hormonal stimulation or by direct stimulation on the smooth muscles, usually resulting in uterine contractions. They may be used intraoperatively and postoperatively. The following are some nursing considerations after their administration: monitor blood pressure, assess for continued bleeding, and monitor fundal response to the drug.

Of the three salivary glands, which one is the largest? a. Zygomatic b. Sublingual c. Parotid d. Submandibular

c. Parotid <<The salivary glands consist of three paired glands: the sublingual, the submandibular, and the parotid. The parotid gland, the largest of the salivary glands, lies below the zygomatic arch in front of the mastoid process and behind the ramus of the mandible; it is divided into a superficial portion and a deep portion. The parotid duct (Stensen's duct) pierces the buccal pad of fat and the buccinator muscle, finally opening into the oral cavity opposite the crown of the upper second molar tooth.

Identify the layer of connective tissue that covers all bone. a. Calcium b. Cartilage c. Periosteum d. Fascia

c. Periosteum <<A layer of connective tissue called periosteum covers all bone.

To accommodate near and distant focus, the lens changes shape and focus by relaxation and tightening of the zonular fibers. What physiologic change of the normal aging process is typically corrected with bifocals? a. Astigmatism b. Cataracts c. Presbyopia d. Glaucoma

c. Presbyopia <<The lens changes shape and focus (accommodation) by relaxation and tightening of the zonular fibers. Over time (particularly after age 40), the lens and lens zonules become progressively less elastic, resulting in presbyopia. This loss of accommodative power is typically corrected with reading glasses or bifocals.

Colles' (wrist) fracture is a dorsally angulated fracture of the distal end of the radius. Most of these fractures can be managed successfully with closed reduction and immobilization, but external fixation is especially useful in the case of a comminuted intra-articular fracture. Internal fixation with Kirschner wires (K wires) is indicated when the distal end of the radius is severely comminuted and displaced. Select the correct statement for a patient with a Colles' fracture fixation. a. Position affected wrist and take an AP and lateral film before surgeon's arrival. b. Position in modified semi-Fowler with the hand table and tourniquet at the operative side. c. Provide soft tissue instruments in OR and casting supplies available outside OR. d. Place tourniquet cuff at mid-forearm level and set to systolic blood pressure level.

c. Provide soft tissue instruments in OR and casting supplies available outside OR <<The patient is in the supine position with the arm extended on a hand table. Traction by means of finger traps may be required. A soft tissue set and a small bone set are required, along with a power drill, small elevator, and the external fixation device of choice. Fluoroscopy is necessary.

Lung volume reduction surgery (LVRS) is an alternative surgical treatment for patients with which pulmonary condition? a. Unsuccessful or failed laser surgery for giant lung bulla b. Acute unilateral pulmonary emphysema c. Severe bilateral heterogeneous or homogeneous emphysema d. Chronic pulmonary asthma with oxygen needed to keep saturation at 90%

c. Severe bilateral heterogeneous or homogeneous emphysema << The National Emphysema Treatment Trial (NETT) suggests the following criteria as patient eligibility for LVRS: high-resolution computed tomography evidence of moderate to severe bilateral heterogeneous emphysema or moderate to severe bilateral homogeneous emphysema; no previous laser surgery or LVRS; no giant bulla. LVRS is an alternative surgical treatment for patients with chronic pulmonary emphysema.

The rotator cuff consists of which group of muscles? a. Deltoid, teres major, and teres minor b. Supraspinatus, subscapularis, pectoralis major, and deltoid c. Supraspinatus, infraspinatus, teres minor, and subscapularis d. Latissimus dorsi, deltoid, and teres major

c. Supraspinatus, infraspinatus, teres minor, and subscapularis <<The muscles immediately surrounding the shoulder joint are the supraspinatus, infraspinatus, teres minor, and subscapularis muscles; together they are referred to as the rotator cuff. These muscles stabilize the shoulder joint, whereas the powerful deltoid, pectoralis major, teres major, and latissimus dorsi muscles move the entire arm.

Select the name of the procedure for which this patient is positioned. a. Transsphenoidal hypophysectomy b. Bilateral parietal craniotomy for subdural hematoma c. Supratentorial stereotactic brain biopsy d. Infratentorial craniectomy for acoustic neuroma

c. Supratentorial stereotactic brain biopsy <<This patient is in the sitting position to undergo a supratentorial stereotactic brain biopsy.

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

c. The McVay and the Cooper ligament repair <<Approaches that reestablish the integrity of the transversalis fascia and simultaneously reestablish and strengthen the posterior inguinal floor are favored. A surgical repair in which transversalis fascia is sewn to the Poupart ligament accomplishes this goal. A McVay or Cooper ligament repair approximates transversalis fascia superior to the inferior insertion of the transversalis fascia along the Cooper ligament.

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

c. The prostate sits below the base of the bladder, is 4 cm at the base, and weighs 20 to 30 g <<The prostate gland is a donut-shaped organ composed of fibromuscular and glandular components. It is located at the base of the bladder neck and completely surrounds the urethra. The gland is about 4 cm at the base, is about 2 cm in depth, and normally weighs 20 to 30 g (see Figures 6-5 and 6-7).

Select the true statement about application and operation of the pneumatic tourniquet. a. In a healthy person, inflation time for an arm should not exceed 30 minutes. b. Limb exsanguination is optional, using a sterile sequential compression sleeve. c. The tourniquet cuff should not overlap less than 3 inches or more than 6 inches. d. Pneumatic tourniquets are contraindicated in patients with bleeding tendencies.

c. The tourniquet cuff should not overlap less than 3 inches or more than 6 inches. <<Pneumatic tourniquets are frequently used for procedures involving the extremities.Limb exsanguination is achieved by elevating the limb or by wrapping it, distally to proximally, with an Ace or Esmarch rubber bandage before tourniquet inflation. Preoperative assessment of the patient includes determining contraindications for use, including compartment syndrome, McArdle's disease, hypertension, or other vascular problems. Duration of tourniquet inflation should be kept to a minimum. It is recommended in the average, healthy 50-year-old person to apply continuous tourniquet pressure less than 1 hour on the upper extremity and less than 2 hours on the thigh. Tourniquet pressure should not exceed the recommended maximum cuff pressure limits of 300 to 350 mm Hg for the thigh and 250 to 300 mm Hg for the arm and the lower leg. The interval between inflation and deflation should be 5 minutes for every 30 minutes of tourniquet ischemia to minimize detrimental effects on muscle and nerves. Cuffs should overlap a minimum of 3 inches and a maximum of 6 inches; excess overlap can pinch skinfolds. A tourniquet cuff that is too short can loosen after inflation.

What special consideration should the perioperative team be alert to in order to prevent a negative surgical outcome in bariatric trauma patients? a. Several persons will be needed to position the patient. b. They may have decreased self-esteem and suffer from societal prejudice. c. They are at risk for retained foreign bodies related to the size of the abdominal cavity. d. They may not be able to fit into the CT or MRI scanner.

c. They are at risk for retained foreign bodies related to the size of the abdominal cavity. << Bariatric trauma patients are at increased risk for retention of foreign bodies (soft goods, sponges, instruments) related to the size of the abdominal and other cavities.

What special consideration should be made when assessing a pediatric trauma patient for level of consciousness? a. Stimulate the child gently in case he or she is a victim of shaken baby syndrome. b. Use the Broslow tape. c. Use the modified Glasgow Coma Scale for children. d. Use the universal Glasgow Coma Scale for all ages.

c. Use the modified Glasgow Coma Scale for children. << Special considerations for infants and children who have sustained a trauma is based on use of a modified Glasgow Coma Scale.

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

c. Z-plasty <<Z-plasty is the most widely used method of scar revision. It breaks up linear scars, rearranging them so that the central limb of the Z lies in the same direction as a natural skin line. Scar revision involves the rearranging or reshaping of an existing scar so that the scar is less noticeable. The simplest form of scar revision is excision of an existing scar and simple resuturing of the wound.

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

c. a hard and irregular mass, nipple discharge, and enlarged axillary nodes. <<Ductal ectasia, generally seen in women approaching menopause, is described by a hard, irregular mass or masses with nipple discharge, enlarged axillary nodes, redness, and edema. It is difficult to distinguish from cancer.

The three most common skin cancers are basal cell, squamous cell, and melanoma.Treated early, skin cancers such as squamous cell and basal cell carcinomas may be cured by simple excision and closure (with pathologic diagnosis to ensure disease-free margins).Melanoma is treated much more aggressively because of its high mortality. The A-B-C-Ds of the warning signs for skin cancer stand for: a. acute, borderline, color, dysplastic. b. asymmetry, blanching, cohesion, depth. c. asymmetry, border, color, diameter. d. aplastic, bilateral, chronic, dysplastic.

c. asymmetry, border, color, diameter. << Any unusual skin conditions, especially a change in the size or color of a mole or other darkly pigmented growth or spot, should be suspicious of skin cancer. The mnemonic A-B-C-D stands for the following:A: Asymmetry: One half of the lesion looks different from the other side.B: Border irregularity: Instead of a smooth edge, the border is ragged or irregular.C: Color: The color is usually irregular; may have a number of different hues and colors.D: Diameter: Lesions larger than 6 mm have a greater chance of being a melanoma

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.celiac plexus injury. b.elbow torsion with displacement. c.brachial plexus injury. d.axillary tension.

c. brachial plexus injury. <<Whenever possible the circulator positions the patient's arms on padded armboards with the palms up and fingers extended. Armboards are maintained at less than a 90-degree angle to prevent stretching of the brachial plexus. Care should be taken to protect all patients from integumentary, musculoskeletal, and nerve injury while ensuring adequate circulatory, renal, and respiratory functions.

A set of guidelines for professional advancement and recognition within an institution or department through the use of an AST-established set of performance-based evaluation and advancement criteria is also known as: a. crew management model b. core curriculum c. clinical ladder d. continuum of care

c. clinical ladder <<A clinical ladder is a tool for encouraging surgical technologists to pursue continuing education and competency in their field.

The indications for single-lung transplantation (SLT) include restrictive lung disease, emphysema, pulmonary hypertension, and other nonseptic end-stage pulmonary diseases, while the indications for double-lung transplantation (DLT) include patients with: a. bilateral chronic infection causing end-stage renal failure. b. bilateral early-stage sarcoma without systemic disease. c. cystic fibrosis in end-stage pulmonary failure. d. bilateral disease, recent ex-smoker with a suitable living-related donor.

c. cystic fibrosis in end-stage pulmonary failure. << Double-lung transplantation (DLT) is indicated for patients with cystic fibrosis or patients with a chronic infection in end-stage pulmonary failure. Developments in SLT include donor contribution from living relatives for patients who have chronic disease and a high risk for death while waiting on the donor transplantation list. Contraindications for transplantation include history of carcinoma or sarcoma, significant renal dysfunction, or cigarette smoking within 3 or 4 months.

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

c. determination of the source location of sounds. <<Both ears provide stereophonic hearing that gives us very specific sound localization capabilities. Without binaural hearing, determining where sounds emanate can be difficult; this is a common problem for patients with unilateral or asymmetric hearing loss.

A patient whose neck has been slashed and has a severed lower trachea may also have injury to the: a. aorta. b. bronchial merge. c. esophagus. d. duodenum.

c. esophagus <<The esophagus begins at C6 and passes through the neck posterior to the trachea

Revision arthroplasty may be indicated if the patient's original knee replacement wears out or loosens, or fails as a result of repeated dislocation, infection, or trauma. Total joint revision can be a very demanding and complicated procedure. Attention to detail, anticipation, and preparation are essential. Following the induction of anesthesia, the surgeon performs an exam under anesthesia (EUA) to determine the approach. The most difficult aspect of revision surgery is that there is: a. a significant challenge ahead with postoperative pain management. b. polymethyl methacrylate (PMMA) bone cement that must be drilled out. c. no clear-cut sequence of events. d. considerable scar tissue and edema.

c. no clear-cut sequence of events. <<Although one of the most difficult aspects of revision surgery is that there is no clear-cut sequence of events, it is best, if possible, to approach revision surgery using the same logical sequence for each procedure. This allows all members of the surgical team to anticipate the steps in the procedure and the needs of the patient. Important patient information includes the preoperative x-rays, bone scan, laboratory results (including aspiration results), and physical findings.

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. a healed myringotomy. c. perforation of the tympanic membrane. d. fluid invasion of the ear canal.

c. perforation of the tympanic membrane. <<Tympanoplasty is indicated for conductive hearing losses caused by perforation of the tympanic membrane as a result of trauma or infection; for ossicular discontinuity; for chronic or recurrent otitis media; for progressive hearing loss; and for the inability to safely bathe or participate in water activities as a result of perforation of the tympanic membrane with or without hearing loss. Perforation of the tympanic membrane is the most common ear injury necessitating surgical intervention. It may be attributable to disease of the middle ear or tympanic membrane. Occasionally the tympanic membrane does not heal after myringotomy.

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. avoid using a wire brush. b. prevent aerosolized bone dust particles, because they are an occupational hazard. c. prevent clogging of the burr and contamination of the area with bone dust. d. keep the drill bit or burr cool and prevent breaking.

c. prevent clogging of the burr and contamination of the area with bone dust. <<Bone dust must be prevented from settling in areas such as those in stapedectomy, tympanoplasty, or endolymphatic sac or fenestration surgery. A sterile field continuously flooded with irrigation solution helps to lessen clogging of the burr and washes bone dust from the field. A diamond burr cuts slowly and grinds the bone away rather then tearing into it; it is commonly used around vital structures. Cutting burrs assist in quickly removing bone from areas not close to vital structures. The grooves or teeth of burrs must be clean of bone dust. Bone-cutting burrs tend to clog more easily than coarse-toothed burrs. A sterile wire brush may be used to keep burrs clean intraoperatively.

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. provide comfort measures, including a cooling blanket. b. administer potassium iodide before transfer to the OR. c. provide a quiet, calm atmosphere and help the patient relax, and provide comfort measures, including a cooling blanket. d. provide a quiet, calm atmosphere and help the patient relax.

c. provide a quiet, calm atmosphere and help the patient relax, and provide comfort measures, including a cooling blanket. <<By planning a quiet, calm atmosphere and helping the patient relax, the circulator and surgical technologist can reduce the risk of thyroid storm. Collaborating with the surgical and anesthesia team, they can plan for appropriate interventions to assist in reducing body temperature and heart rate, provide oxygen and intravenous solutions, and administer medications as prescribed in the event thyrotoxic crisis occurs.

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

c. reduces bacterial levels in the outer ear <<The canal lining is protected and lubricated with cerumen, a waxy substance secreted by sebaceous glands in the distal third of the canal. Cerumen helps to trap foreign material, and has a mildly acidic pH that reduces bacterial levels in the outer ear.

Response Feedback: The eyebrows and eyelashes, in particular, are left intact to preserve facial appearance and expression. The use of CHG should be avoided around the ears and eyes. When prepping for a skin graft procedure, separate skin prep setups are needed for the graft and donor sites.Inspect for any rashes, bruises, open sores, cuts, or other skin conditions. a. meticulous accounting of fluid loss and blood replacement. b. pressure dressings. c. repositioning one or more times during surgery. d. patient transfer to an alternating-pressure bed.

c. repositioning one or more times during surgery. << Response Feedback: Whereas a majority of plastic surgical procedures are performed in the supine position, many also take place with the patient prone or lateral. Liposuction and post-bariatric body contouring procedures may also require repositioning one or more times during surgery.

Prevention of which of the following is the MAIN reason for performing surgical sponge, sharps, and instrument counts? a. revenue loss from non-charged items b. accidental disposal in trash or linen c. retained foreign objects in patient d. stock/supply depletion

c. retained foreign objects in patient <<Performing sponge, sharps, and instrument counts with the circulating nurse helps to ensure that all items have been retrieved from the patient.

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. using a mediastinoscopy approach. b. splitting the sternum. c. using long instruments through a regular thyroid incision. d. using a right mini-thoracotomy approach.

c. using long instruments through a regular thyroid incision. <<Extensions of goiters enlarging into the substernal and intrathoracic regions may occur. If they cause tracheal and esophageal obstruction, they are usually excised surgically. Longer instruments are sometimes required. Splitting the sternum is rarely necessary because access to the substernal part of the gland is usually satisfactory through the standard thyroid incision.

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. Presence of diagnosed malignancy b. All of the options would be indications for neck dissection c. Evidence of disease in the upper lymphatic chain d. Suspicious metastatic disease

c. All of the options would be indications for neck dissection <<Response Feedback: 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.

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? Answers: a. All of the options define the AUA score system. b. Indications for selecting appropriate intervention c. Prostate cancer stages of severity d. Prognosis and potential for recovery

c. Prostate cancer stages of severity <<The American Urological Association (AUA) recommends that starting at age 40 the prostate-specific antigen (PSA) test and digital rectal examination (DRE) be offered to men at average risk. Clinical evaluation and an elevated PSA usually indicate the need for a transrectal ultrasound needle biopsy to confirm the diagnosis. When the results of the biopsy are positive for cancer, the AUA score measures the severity of the cancer: stage A = clinically unsuspected disease; stage B = tumor confined to the prostate gland; stage C = tumor localized to the periprostatic area; stage D = metastatic prostate cancer.

The parathyroid gland regulates

calcium > The parathyroid releases parathyroid hormone, which acts to increase calcium levels in the blood.

Where is the gastrocnemius muscle located?

calf

During the intraoperative phase, which of the following activities can be completed by both sterile and non-sterile members of the surgical team? A. caring for the specimen B. maintaining the patient's operative record C. clearing residual blood from the surgical field D. maintaining the sterile field and neutral zone

caring for the specimen

A Javid shunt is used for which of the following procedures? A. carotid endarterectomy B. femoral-popliteal bypass C. abdominal aneurysmectomy D. saphenous vein ligation

carotid endarterectomy > A Javid shunt is utilized only for this procedure due to the small size of the shunt and the incision.

The surgical technologist in the scrub role should remain sterile following which of the following surgical procedures? A. laparoscopic cholecystectomy B. carotid endarterectomy C. total hip arthroplasty D. tympanoplasty

carotid endarterectomy > It is necessary for the surgical technologist in the scrub role to remain sterile after vascular procedures because there is a chance of bleeding complications and the need for immediate re-entrance of the surgical wound in order to control blood flow.

During a transurethral resection of the prostate, bleeding is controlled by

cauterization > Cauterization is the method for controlling bleeding during a TURP.

The vermiform appendix originates from the

cecum

When performing a Shirodkar procedure, on which of the following is attention being focused? A. cervix B. mouth C. stomach D. small intestine

cervix

During a procedure, a surgical technologist notices a hole in his glove. Which of the following should be done next?

change the glove using the open-gloving technique

Which of the following procedures is used to visualize the cystic, hepatic, and common ducts? A. barium enema B. cholangiography C. intravenous pyelography D. upper gastrointestinal series

cholangiography > Cholangiography is a diagnostic x-ray study to identify stones in the biliary tract.

Which of the following procedures requires an opening into the gallbladder to permit drainage and removal of stones?

cholecystostomy

A T-tube drain may be used following

choledochotomy > A T-tube drain is used to irrigate and to demonstrate patency of the common bile duct. A T-tube's unique design fits into the common duct and facilitates drainage outside of the body.

The destruction of organisms in an autoclave is accomplished by the A. division of the nucleus. B. desiccation of the nucleus. C. coagulation of cell protein. D. destruction of the cell membrane.

coagulation of cell protein

When a cholecystectomy is performed, which of the following anatomical structures must be preserved?

common duct

During strabismus surgery, which of the following is the first tissue layer that must be incised? A. iris B. cornea C. sclera D. conjunctiva

conjunctiva > The conjunctiva is the outermost tissue layer of the eye.

When a break in aseptic technique occurs, the surgical technologist in the scrub role should FIRST notify the A. circulator. B. contaminating team member. C. operating room supervisor. D. surgeon.

contaminating team member

Which of the following types of sponges is used directly on the structures of the brain? A. RAY-TEC B. cherry C. Weck-cel D. cottonoid

cottonoid

Which of the following items is used for sponging around the spinal cord? A. cottonoids B. gauze sponges C. peanut dissector D. laparotomy sponges

cottonoids

A perforator is used for which of the following procedures? A. cordotomy B. craniotomy C. laminectomy D. spinal fusion

craniotomy > When performing a craniotomy, a perforator is used to make a burr hole in the skull in order to turn a flap.

For which of the following procedures is Gelfoam MOST commonly used?

craniotomy for subdural hematoma

Anterior and posterior knee stability is influenced by the dynamics of the

cruciate ligaments.

When assisting with the closure of a skin incision and operating the skin stapler, the surgical technologist in the scrub role is placing the staples through which two layers?

cuticular and subcuticular

Which of the following structures are ligated and divided during the cholecystectomy? A. cystic artery and cystic duct B. hepatic artery and hepatic duct C. cystic artery and common bile duct D. hepatic artery and pancreatic duct

cystic artery and cystic duct > It is necessary to ligate and divide the cystic artery and cystic duct because they are the major structures supplying blood to the gall bladder and draining bile from the liver.

As a surgical technologist begins to prep a female patient for Foley catheterization, a bulge in the vaginal wall is noticed. Which of the following would cause this bulge? A. cystocele B. endometriosis C. leiomyoma D. ectopic pregnancy

cystocele > Cystocele is caused by herniation of the bladder into the vaginal wall. In severe cases, surgery is performed to strengthen the vaginal wall.

What statement regarding level I and level II trauma centers best describes the difference between the two types of centers? Answers: a. A level I trauma center is staffed 24 hours/7 days, while a level II has many support services that are open and staffed 8 hours/5 days. b. A level I trauma center has a transplant program, while a level II is only able to complete organ procurements. c. A level I trauma center requires trauma certification and 8 hours of annual trauma education for all staff, while a level II does not. d. A level I trauma center provides care for every type of injury, while a level II lacks some specialized resources.

d. A level I trauma center provides care for every type of injury, while a level II lacks some specialized resources. << Trauma centers (TCs) are classified based on the scope of services and resources that are available. A level I TC is capable of providing total care for every type of injury. A level II TC provides comprehensive care for all injuries but lacks some of the specialized clinicians and resources required for the level I designation. Accepting the designation of level I commits the TC to providing qualified personnel and equipment necessary for rapid diagnosis and treatment on a 24-hour basis.

Professional settings for the surgical technologist can include: a. Hospital suites and ambulatory surgery centers. b. Ambulatory surgery centers and PACU c. Labor and delivery units and for a physician as a private scrub d. All of the above

d. All of the above <<Surgical technologists can work in both hospital surgical suites and ambulatory surgery centers. They can also work in labor and delivery suites within the hospital setting.

Entry level surgical technologists can fill which of the following roles: a. Scrub surgical technologist b. Circulating surgical technologist c. Second assisting surgical technologist d. All of the above

d. All of the above <<The entry level surgical technologist can serve in any of the listed roles. It is always important for surgical technologists to be familiar with their institutional job description and comply with it. Knowing federal and state rules and regulations is also important.

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

d. All of the options are correct <<The mesh-plug technique has been recommended for the treatment of primary and recurrent direct and indirect inguinal hernias. The various hernia types as classified by Gilbert have a corresponding relationship to the use of mesh plugs type I through type VII. Femoral hernias are classified as type VII. Regardless of the hernia type, the mesh-plug technique is performed on an ambulatory basis, through a small incision, often laparoscopically. In femoral hernias, a small- or medium-size plug is secured in position after the sac has been reduced.

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. Maintain sterility of the instruments until the patient leaves the room in the case of need for emergency tracheostomy. b. Provide efficient and expedient hemostatic devices and materials as needed. c. Pay meticulous attention to sterile technique. d. All of the options reflect appropriate scrub role risk reduction techniques.

d. All of the options reflect appropriate scrub role risk reduction techniques. <<Attention to sterile technique is a core team value. Gentle tissue handling reduces the risk of damage to nerves, parathyroid glands, and surrounding structures. Achieving and maintaining hemostasis promotes visibility and reduces postoperative bleeding. The scrub person keeps instruments sterile for those patients who are at risk for postoperative bleeding. This would include patients with large thyroids that necessitated finger dissection and those who were difficult to intubate.

Pneumonectomy is removal of an entire lung, usually to treat malignant neoplasms. What structures are excised or resected in order to remove the entire lung and complete the surgery? a. A section of rib, bronchus, pulmonary artery and vein, and hilar pleura b. The lung, peripheral adhesions, and pulmonary ligament c. Mediastinal lymph nodes, portions of the chest wall or diaphragm, and parietal pleura d. All of these structures may be resected during a pneumonectomy

d. All of these structures may be resected during a pneumonectomy << Other resections are often combined with pneumonectomy, such as resection of mediastinal lymph nodes, resection of portions of the chest wall or diaphragm, and removal of parietal pleura. If a rib is to be excised, bone instruments are required. The surgeon frees any peripheral adhesions to mobilize the lung and divides the pulmonary ligament. The superior pulmonary vein is gently retracted, and the pulmonary artery is dissected. The surgeon clamps and divides the branches of the pulmonary artery and vein of the involved lobe. The inferior pulmonary vein is exposed by incising the hilar pleura and retracting the lung anteriorly. The inferior pulmonary vein is clamped, doubly ligated, and divided. The surgeon divides the bronchus near the tracheal bifurcation. The lung is removed from the chest.

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. Prevent prep solution from pooling under the patient's head, neck, and shoulders. b. Include the fire risk score during the time-out briefing. c. Permit the prep solution to dry before draping. d. All the options are risk reduction considerations.

d. All the options are risk reduction considerations. <<The entire team should note, discuss, and determine the fire risk score during the preincision time-out briefing. The operative area (chin and anterior neck region, lateral surfaces of the neck from the earlobes down to the outer aspects of the shoulder, and upper anterior chest region to the nipples) is prepped with an antimicrobial solution. Appropriate precautions must be taken to prevent pooling of solution under the neck or in the axillary area. Alcohol-based prep solutions around the head and neck area present a risk for surgical fire. They must be used with caution, allowing time for the prep to dry and the fumes to dissipate. Bed sheets that become soaked with a flammable prep solution should be removed from the OR.

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

d. Bartholin's glands. <<Bartholin's glands and ducts are located on each side of the lower end of the vagina. These narrow ducts open into the vaginal orifice on the inner aspects of the labia minora. The glands secrete mucus and can become infected or inflamed.

When the patient arrives in the ED, the trauma team initiates a primary assessment. This is a logical, orderly process of patient assessment for potential life threats. These assessment activities are based on established protocols for advanced trauma life support (ATLS). The mnemonic "ABCDE" is used, representing assessment of the following: Airway, Breathing, Circulation, Disability, and Exposure. The D and E represent what degree of investigation? a. D = musculoskeletal impairments; E = environmental issues b. D = a brief reflex examination; E = extraneous sensory impairments c. D = history of prior impairments; E = events that contributed to the injury d. D = a brief neurologic examination; E = exposure to reveal all life-threatening injuries

d. D = a brief neurologic examination; E = exposure to reveal all life-threatening injuries << The mnemonic "ABCDE" is used, representing assessment of the following: Airway (with cervical spine precautions), Breathing, Circulation, Disability (brief neurologic examination), Exposure (to reveal all life-threatening injuries, including Environmental control [thermoregulation]).

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.D&E with endometrial washings, frozen section, total abdominal hysterectomy. c.hysteroscopy with endometrial ablation. d.D&C with endometrial biopsies, frozen section, possible LAVH.

d. D&C with endometrial biopsies, frozen section, possible LAVH. <<D&C is done either for diagnostic purposes or as a form of therapy for a variety of pelvic conditions, such as abnormal uterine bleeding or primary dysmenorrhea (see Table 5-1). D&C may also be performed when carcinoma of the endometrium is suspected. Indications for LAVH may be absence of genital prolapse, required adnexectomy, history of abdominopelvic surgery, salpingitis or endometriosis, lymphadenectomy, and endometrial cancer.

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. Tumor size was not usually correlated with involvement of lymph nodes and cancer spread. b. Breast cancer was believed to spread by direct extension from its initial site in the breast to adjacent lymph nodes. c. Early pathology techniques for frozen section and histology microexamination could not define margins. d. Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection.

d. Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection. <<Breast cancer may be a systemic condition at the time of diagnosis. Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection. External physical changes, such as dimpling of the skin, can also indicate the presence of a benign or malignant pathologic process. The older the patient, the more likely it is that a mass is malignant. The most common form of breast cancer is infiltrating ductal carcinoma (see Table 8-2). The cause of breast cancer remains unknown. The belief that breast cancer spreads by direct extension from its initial site in the breast to adjacent lymph nodes may not always be correct. This could explain why radical breast surgery of the past, which involved removal of the affected breast and all axillary and thoracic lymph nodes, did not greatly lower mortality. Tumor size can usually be correlated with involvement of lymph nodes. The larger a tumor is, the more likely it is that lymph nodes are involved.

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. Irritability, mood changes, visual disturbances, and diarrhea b. Heat intolerance, anorexia, hair loss, and menstrual irregularity c. Bradycardia, hypotension, hypoxia, and poor concentration d. Dry skin, edema, constipation, and depression

d. Dry skin, edema, constipation, and depression <<Symptoms of hypothyroidism include fatigue, weight gain, cold intolerance, hair dryness or loss, dry skin, depression, hoarse voice, poor concentration, muscle stiffness and pain, edema, bradycardia, constipation, and menstrual irregularity (especially heavy menses; infertility).

What properties enable arteries to compensate for changes in blood pressure and blood volume? Answers: a.Dilatation and absence of valves b.Regeneration and thick muscularis c.Contraction and constriction d.Elasticity and distensibility

d. Elasticity and distensibility <<The properties of elasticity and distensibility enable arteries to compensate for changes in blood pressure and volume. Because of the thicker muscle layer, severed arteries are capable of contracting and constricting enough to stop hemorrhage

What is the term for softening of brain matter or loss of brain tissue, often caused by cerebral infarct, ischemia, or trauma? a. Abscess b. Kernicterus c. Neurocysticercosis d. Encephalomalacia

d. Encephalomalacia <<Encephalomalacia is a condition of softening of brain matter or loss of brain tissue. Cerebral infarct, ischemia, and trauma are common causes. Although less a cause of increased intracranial pressure, encephalomalacia may be observed during craniotomy, noted on diagnostic imaging studies, or as a pathologic finding at autopsy. Brain abscess is defined as an intracerebral collection of pus. Typically, anaerobic bacteria are involved and induce an inflammatory response that encapsulates necrotic brain tissue. Kernicterus, also known as bilirubin encephalopathy, is a rare neurologic condition in neonates. Severe jaundice in the first 1 to 3 weeks of infancy may result in the excess bilirubin moving from the circulatory system and collecting in brain tissue. Neurocysticercosis is a parasitic infection caused by the pork tapeworm Taenia solium in its larval form. It is the most common infestation of the central nervous system and is mainly seen in developing countries.

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. Menstruation, pregnancy, and lactation b. Growth and development, menstruation, and menopause c. Hormone development, pregnancy, and menopause d. Growth and development, menstruation, and pregnancy and lactation

d. Growth and development, menstruation, and pregnancy and lactation <<The mammary glands are affected by three types of physiologic changes: (1) those related to growth and development, (2) those related to the menstrual cycle, and (3) those related to pregnancy and lactation.

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. Hypernatremia b. Hypokalemia c. Hyperthermia d. Hypertension

d. Hypertension << Signs and symptoms such as sudden restlessness, apprehension, irritability, confusion, nausea, slow pulse rate, seizures, dysrhythmias, and rising blood pressure may be suggestive of TURP syndrome. This syndrome results in severe hyponatremia caused by systemic absorption of irrigating fluid used during surgery.

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. Hearing loss b. Impaired language development c. Encephalitis d. Impaired language development and hearing loss

d. Impaired language development and hearing loss <<The majority of children with AOM have spontaneous resolution. Hearing loss is the main concern when fluid is present in the middle ear. If left untreated, hearing loss can affect language development. If the fluid persists more than 8 to 12 weeks and is accompanied by hearing loss, removal of the fluid and placement of ventilating tubes in the eardrum are necessary.

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

d. Larynx <<The larynx can be divided into three portions: supraglottis (or upper portion above the true vocal cords), glottis (level of the true vocal cords), and subglottis (below the true vocal cords). The upper portion of the larynx is continuous with the pharynx above and includes the epiglottis, vallecula, and the laryngeal cartilages.

What is the name for the division of the brain that contains the hippocampus and amygdala, which are responsible for learning and memory and regulate perceptive and expressive aspects of emotional and social behavior? a. Brainstem b. Basal ganglia c. Diencephalon d. Limbic system

d. Limbic system <<The hippocampus is critical for learning and memory. The amygdala regulates the perceptive and expressive aspects of emotional and social behavior. The limbic system consists of large parts of the cortex near the medial wall of the cerebral hemisphere (cingulate and parahippocampal gyri) along with the hippocampus, amygdala, and septum. It is closely and significantly connected with the hypothalamus. The limbic system affects endocrine and autonomic functions of the body, recent memory, emotions, behaviors, and motivational and mood states.

Which of the following histologic classifications of brain tumors is usually benign, circumscribed and slowly growing and arises from arachnoid cells? a. Oligodendroglioma b. Craniopharyngioma c. Astrocytoma d. Meningioma

d. Meningioma <<Response Feedback: Tumors of the meninges (meningiomas) commonly occur in people in the fourth to sixth decades of life. They are usually benign, circumscribed, slow-growing tumors, arising from arachnoid cells with secondary attachment to the dura. They can be very vascular and may adhere to the dural venous sinuses or major arteries, making their complete removal challenging; however, meningiomas often can be totally surgically removed. Astrocytomas are the most common of all primary brain tumors and are believed to originate from neuroglial cells. Craniopharyngiomas account for 2.5% to 4% of intracranial tumors with 50% occurring in childhood and arise from the region of the pituitary stalk. Oligodendrogliomas are believed to represent 5% to 15% of gliomas and originate from neuroglial cells.

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. Fibrous bands within the peritoneum can be treated with sterile talcum powder. d. Patients with endometriosis may be best served with a laparoscopic approach.

d. Patients with endometriosis may be best served with a laparoscopic approach <<Adhesions may also develop as a result of radiation-induced endarteritis, endometriosis, pelvic inflammatory disease (PID), or Crohn's disease. Preventive measures include the following: minimizing tissue trauma and inflammation with meticulous surgical technique and using the laparoscopic approach when indicated

Marissa Walton is transferred to the OR from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia. What important preparation for the procedure will the perioperative team need to perform before Marissa arrives in the OR? a. Procure the allograft skin from the freezer and begin the thaw process. b. Procure a basic plastic instrument set plus a knife dermatome and sterile mineral oil. c. Collaborate with the anesthesia provider to determine fluid replacement requirements. d. Prewarm the OR to above the ambient high temperature for an adult.

d. Prewarm the OR to above the ambient high temperature for an adult. <<Because patients who have sustained burns are vulnerable to hypothermia from the loss of BSA, the perioperative nurse should ensure the temperature and humidity in the OR are increased and exposure is limited only to the areas related to the planned surgical event. Throughout the procedure, the temperature in the OR is constantly monitored to prevent hypothermia

Select the noninvasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function. a. Cardiac catheterization b. Echocardiography c. Cardiac function studies d. Radionuclide imaging

d. Radionuclide imaging <<Radionuclide imaging is employed to illustrate wall motion and blood flow through the heart and to quantify cardiac function. These noninvasive techniques are generally well tolerated by patients, especially when patients may be too unstable to withstand a cardiac catheterization. These techniques may also be used as a complement to catheterization. Cardiac catheterization provides definitive information about the extent and location of ischemic heart disease and is an adjunct to echocardiography for diagnosing valvular heart disease.

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. Transverse colon b. Proximal right colon segment with cecum c. Segment of sigmoid colon d. Right colon and ileum

d. Right colon and ileum << The orthotopic ileocolic neobladder, or Le Bag continent diversion technique, uses the right colon and ileum as an orthotopic bladder replacement. Contraindications include previous radiation therapy, bowel disease (e.g., diverticulosis, Crohn's disease, colitis), and other major medical problems.

Patients with acute arterial insufficiency with occlusion usually present with the onset of the six P's: sudden severe pain, pulselessness, paresthesia, paralysis, pallor, and poikilothermia (coolness) of an extremity. This occlusion can be the result of which condition? a.Atrial tachycardia b.Hypothermia c.Asystole d.Rupture of an unstable atherosclerotic plaque

d. Rupture of an unstable atherosclerotic plaque <<Arterial insufficiency may result from an acute occlusion, as in embolic disease, or from the rupture of an unstable atherosclerotic plaque, causing acute thrombosis of the vessel. Emboli usually arise from the heart as a result of atrial fibrillation but may occasionally result from a myocardial infarction (MI), where a clot forms on the endocardium (the lining of the heart) in an area of muscle damage. Atherosclerotic plaque can also detach from other areas and result in an acute arterial blockage

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. Answers: a.CO2 laser surface ablation of the vulvar lesions b.Skinning vulvectomy c.Radical vulvectomy with inguinal lymph node dissection d.Simple vulvectomy

d. Simple vulvectomy <<Simple vulvectomy is removal of the labia majora and labia minora, possibly (but not preferably) the glans clitoris, and occasionally tissue from the perianal area. A simple vulvectomy is usually performed to treat carcinoma in situ of the vulva when it is multicentric. Occasionally, a vulvectomy is necessary for the treatment of either leukoplakia or intractable pruritus, especially when a skinning procedure is impractical or has failed.

Which of the following is the anatomical bloodless plane that contains loose areolar tissue and permits mobility of the scalp? a. Subarachnoid space b. Galea aponeurotica c. Diploe table d. Subgaleal space

d. Subgaleal space << The subgaleal space contains loose areolar tissue that permits mobility of the scalp. It is in this bloodless plane that the standard craniotomy scalp flap is created. The subcutaneous tissue, which is exceptionally dense, tough, and vascular, is firmly attached to the galea. Most of the blood vessels lie superficial to the galea. The pericranium, or outer periosteum of the skull, separates the galea from the cranium.

Inspiration normally takes place when the intrathoracic pressure is slightly below atmospheric pressure and when a partial vacuum exists between the parietal and visceral pleural (intrathoracic) surfaces. As the muscles of inspiration contract to enlarge the chest cage, what action by the lungs occurs to facilitate air intake? Answers: a. The lungs produce a pressure gradient that suctions air. b. The lungs recoil and expand to draw air into them. c. The alveolar sacs expand when triggered by neural triggers in all 10 lung segments. d. The lungs are passive and follow the diaphragm and chest wall.

d. The lungs are passive and follow the diaphragm and chest wall. << As the muscles of inspiration contract to enlarge the chest cage, the lungs passively follow the diaphragm and chest wall because of decreased intrathoracic pressure. The acts of inspiration and expiration are the result of air moving in and out of the lung, causing pressure to equalize with that of the atmosphere at the end of expiration.

The surgical technologist prepares a sterile treatment set-up for the surgeon to use before the DCR operative procedure is started. Select the statement that describes the justification for this sterile treatment set-up. a. The silastic tubing needs to be cut to size and soaked during the procedure. b. The surgeon will cut and mold the nasal splint to size before the nose becomes edematous. c. The skin markings, with methylene blue, are done on clean skin before the skin prep. d. The nasal cavity is anesthetized with cocaine and a local anesthetic is administered.

d. The nasal cavity is anesthetized with cocaine and a local anesthetic is administered. <<The nasal cavity is anesthetized topically with cocaine just before the DCR. The surgery (see Figure 9-28) is performed after the patient has been administered a local or general anesthetic.

Local anesthesia, or monitored anesthesia care (MAC), is used for most ophthalmic surgery. The local anesthetic regimen, administered by the operative surgeon, is typically a combination of anesthesia delivery methods, or routes. Select the anesthetic plan that is administered by the surgeon before the start of surgery. a. Subconjunctival block and topical anesthetic eye ointment b. Peribulbar infusion into Tenon's capsule and periorbital skin infiltration c. Ganglionic infiltration and periorbital block of the anterior chamber d. Topical anesthetic eye drops, subconjunctival infiltration, and retrobulbar block

d. Topical anesthetic eye drops, subconjunctival infiltration, and retrobulbar block <<The topical method of local anesthesia has gained popularity for cataract extraction procedures. A combination of anesthetic eye drops is instilled into the eye and may be supplemented with infiltration of preservative-free anesthetic into the anterior chamber. Selection of patients for the topical method requires that they can cooperate and follow verbal commands to keep their eyes open and look up or down. The infiltration method involves the surgeon injecting the anesthetic solution beneath the skin, beneath the conjunctiva (subconjunctival), or into Tenon's capsule, depending on the type of surgery. The most common technique for regional anesthesia in eye surgery is a peribulbar block. The anesthetic is injected around the soft tissue of the globe after the needle is directed to the floor (inferior) or roof (superior) of the orbit (see Figure 17-9). Retrobulbar block is injection of anesthetic solution into the base of the eyelids at the level of the orbital margins or behind the eyeball to block the ciliary ganglion and nerves (see Figure 17-10).

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. Urethral catheter b. Irrigation catheter c. Pigtail catheter d. Ureteral catheter

d. Ureteral catheter << The most commonly used ureteral catheters include the open-ended, whistle tip, cone tip, and olive tip. When a retrograde ureterogram is indicated, a cone-tipped ureteral catheter may be helpful in occluding the ureteral orifice to accomplish the x-ray study effectively. A variety of urethral and ureteral catheters are designed for specific procedures. Ureteral catheters are manufactured of polyurethane material and are graduated so that the urologist may determine the exact distance the catheter has been inserted into the ureter.

A wide range of equipment is used in ophthalmic surgery. The perioperative team's knowledge of proper operation should be confirmed through inservice education and training specific to new equipment, plus demonstrated competency. To ensure patient safety and appropriate function and application of surgical devices, which statement best reflects recommended practice when using complex biomedical equipment? a. Follow the policy and procedure of the facility and/or unit, and request biomedical support. b. Follow the explanation and demonstration as originally provided by the preceptor during orientation. c. Request assistance and technical support from the appropriate vendor representative; encourage the vendor to operate the device or equipment, or request biomedical support. d. Use the device according to the manufacturer's directions and test for proper performance before the patient enters the OR.

d. Use the device according to the manufacturer's directions and test for proper performance before the patient enters the OR. <<For safety, all items must be used according to the manufacturer's directions and tested for proper performance before the patient enters the OR.

The vertebral bodies are connected by several cartilaginous joints. What purpose does this connection enable? a. Sustains integrity and spinal support b. Communication between the spinous processes and vertebral bodies c. Vertebral flexion and torsion d. Vertebral flexion, rotation, and extension

d. Vertebral flexion, rotation, and extension <<Vertebrae form the longitudinal axis of the skeleton. The vertebral bodies are connected by several cartilaginous joints that enable the vertebrae to flex, extend, or rotate while being held together. Intervertebral disks and ligaments connect the bodies of adjacent vertebrae. The ligamenta flava bind the laminae of adjacent vertebrae.

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. trapping particle matter before it reaches the nasopharynx. c. giving resonance to the voice. d. acting as drainage passageways.

d. acting as drainage passageways. <<The turbinates act as drainage passages of the accessory sinuses and also increase the turbulence of airflow to humidify the air that is nasally inspired. This area is commonly referred to as thesphenoethmoidal recess and contains the bony shelves known as the superior, middle, and inferior meatus or turbinates (Figure10-6).

Bone grafting using allografts or autografts may be used to fill cavities after removal of large amounts of bone that might result in instability, or to fill bony defects and to promote the union of fractures at the time of open reduction. Banked bone is available in many shapes of cortical and cancellous tissue. The American Association of Tissue Banks (AATB) accredits and periodically inspects bone-banking programs to ensure that specific standards are followed in the retrieval, processing, storage, and distribution of bone grafts. Bone graft that is sealed in a sterile labeled envelope from a tissue transplant company and stored in a vacuum-sealed freezer, monitored with an alarm, would be considered a(n): a. xenograft. b. autograft. c. reengineered human tissue product. d. allograft.

d. allograft. <<Allografts are frozen until use. Vacuum-sealed freezers are monitored with an alarm. When requested for a procedure, the bone allograft is delivered to the field, slightly thawed, cultured, and washed with an antibiotic solution. Allografts are used when bone is not available from the patient because of the lack of sufficient quantity or because a secondary procedure is undesirable for the patient. Records are maintained on both donors and recipients. Like other implants, the recipient's operative record should include the name of the bone bank from which the allograft was received, type of allograft, tissue number, and expiration date if applicable.

The salivary glands produce saliva, which serves to moisten the mouth and initiate: a. enzymatic activity on all ingested food. b. antibacterial activity in the mouth. c. alimentary (GI) tract peristalsis. d. carbohydrate digestion.

d. carbohydrate digestion <<The three paired salivary glands communicate with the mouth and produce saliva, which serves to moisten the mouth and initiate digestion of carbohydrates. The minor salivary glands exist in the submucosa of the cheeks, tongue, palates, and floor of the mouth and in the pharynx, lips, and paranasal sinuses.

The kidneys are highly vascular organs that process approximately one fifth of the entire volume of blood at any one time. a. epinephrine; pituitary-stimulating hormone and adrenaline b. steroids; adrenaline and hormones c. pituitary hormones; cortisol and norepinephrine d. epinephrine; steroids and hormones

d. epinephrine; steroids and hormones << Each adrenal gland has a medulla, which secretes epinephrine (adrenaline), and a cortex, which secretes steroids and hormones. Secretions from the adrenal cortex are influenced by the activity of the pituitary gland.

A long bone fracture in a child can have devastating consequences in terms of the child's skeletal maturity and potential for limb shortening and malformation when the fracture line involves the: a. cancellous bone. b. epiphysis. c. diaphysis. d. epiphyseal plate.

d. epiphyseal plate. <<Long bones consist of a shaft (diaphysis) and two ends (epiphyses). The shaft is composed of compact bone. The epiphyses flare out and consist of cancellous bone. They are covered by cartilage, which provides a cushion and offers protection during weight-bearing and movement. Until skeletal maturity, a line of cartilage called the epiphyseal plate separates the epiphysis from the diaphysis. Fractures in this region in children can be devastating because they often lead to malformation and permanent limb shortening.

Video-assisted thoracic surgery (VATS) is a minimally invasive operative technique that has evolved over the past decade. It uses an endoscopic approach to visualize the thoracic cavity for diagnosis of pleural disease or treatment of pleural and lung conditions. In the adult, the surgeon creates a 2- to 3-cm incision between the ________ intercostal spaces for insertion of the 10- or 12-mm trocar. The trocar sites can also be used for insertion of a ____________. a. sixth and eighth; video camera b. fourth and sixth; robotic EndoWrist grasper c. fifth and seventh; chest tube d. fifth and seventh; zero-degree scope

d. fifth and seventh; zero-degree scope << The surgeon creates a 2- to 3-cm incision between the fifth and seventh intercostal spaces for insertion of the 10- or 12-mm trocar. The zero-degree telescope is inserted to view the site so that the approach can be determined. After the selected procedure, the surgeon inserts a chest tube through one of the surgical puncture sites and secures it to the skin. Trocar sites are closed, and small dressings or adhesive skin tapes are applied.

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. cavitation of the prostate cell cytoplasm by the implosion of microscopic bubbles. b. mechanical shearing force of ultrasonic waves. c. radiofrequency coagulation of prostatic cell nuclei. d. high-temperature nonionizing thermal energy.

d. high-temperature nonionizing thermal energy. <<HIFU is highly focused into a small area, creating intense heat of 80° to 100° C, which is lethal to prostate cancer tissue. HIFU destroys tissue by heat, rather than by cavitation or mechanical shearing. Since ultrasound is nonionizing, there is no collateral tissue damage.For the majority of patients, HIFU is indicated as a curative therapy. The best candidates are clinical/pathologic stages T1c to T3. Because of the limited focal length of HIFU, gland volume cannot be 40 ml or larger. Aside from primary therapy, HIFU can be used as salvage therapy, primarily after radiation. HIFU can also be repeated without any increase in risk or complications.

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. metabolic; granulocytes b. as a blood reservoir; phagocytes c. anabolic; plasma cells d. immunologic; leukocytes

d. immunologic; leukocytes << The spleen has many functions. Among them are defense of the body by phagocytosis of microorganisms, formation of nongranular leukocytes and plasma cells, and phagocytosis of damaged red blood cells. It also acts as a blood reservoir. The pancreas contains groups of cells, called islets, or islands, of Langerhans, that secrete hormones into the blood capillaries instead of into the duct. These hormones are insulin and glucagon, and both are involved in carbohydrate metabolism.

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. loss of tissue elasticity. c. thinning and stretching of muscle fibers. d. increased pressure within the abdomen.

d. increased pressure within the abdomen. <<Response Feedback: Any number of conditions causing increased pressure within the abdomen can contribute to the formation of a hernia. Loss of tissue turgor occurs with aging and from chronic debilitating diseases. Current evidence suggests that adult male inguinal hernias are likely associated with impaired collagen metabolism and weakening of the fibroconnective tissue of the groin. Smoking has also been noted as a contributing factor to hernia formation.

Heparin sodium is an anticoagulant. The basic mechanism of heparin's action is best described as: a.it acts as an enzyme by lysing the fibrin-thrombin matrix. b.it extends the activated partial thromboplastin time (APTT). c.it dissolves and liquefies existing blood clots and thromboemboli. d.it blocks the conversion of prothrombin to thrombin and fibrinogen to fibrin.

d. it blocks the conversion of prothrombin to thrombin and fibrinogen to fibrin. <<Heparin sodium is an anticoagulant that interferes with blood coagulation by blocking conversion of prothrombin to thrombin and fibrinogen to fibrin. It has no effect on a blood clot that has already formed or on ischemic tissue injured as a result of inadequate blood supply caused by a clot. It is used for prophylaxis and/or treatment of vascular thromboembolic disorders, such as venous thrombosis and peripheral arterial embolism, and for prevention of thromboembolus during vascular surgical procedures.

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. vascular tissue. b. mucosal tissue. c. glandular tissue. d. lymphoid tissue.

d. lymphoid tissue. <<The adenoids, or pharyngeal tonsils, are suspended from the roof of the nasopharynx and consist of an accumulation of lymphoid tissue. The tonsils are situated on each side of the oropharynx, lodged in a tonsillar fossa that is attached to folds of membrane-containing muscle. The palatine tonsils (a pair of oval structures) are the only lymphatic organs covered with stratified squamous epithelium. The anterior and posterior tonsillar pillars join to form a triangular fossa, with the posterior lateral aspects of the tongue at its base. The lingual tonsils are lodged in each fossa

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

d. monitoring and recording the volume of IV and irrigating fluids instilled. << Large amounts of irrigating fluids are often used during urologic procedures, which may impact the patient's electrolyte status. Irrigating fluids should be monitored both for fluid infused and for fluid returned. Thorough knowledge of the potential hazards encountered intraoperatively is extremely important and close observation is essential. A sudden change in signs and symptoms may be suggestive of TURP syndrome, a severe hyponatremia caused by systemic absorption of irrigating fluid used during surgery. Minimum amounts of fluids should be given and urine output carefully monitored. Irrigation fluid should be under as little pressure as possible and the bladder emptied before it reaches full capacity to prevent intravesical pressure.

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. All of the options apply. b. ossicular immobility. c. indeterminate hearing loss. d. otosclerosis.

d. otosclerosis <<Otosclerosis is the formation of abnormal bone around the stapes footplate, resulting in immobility of the footplate. Sound waves cannot be transmitted adequately through the oval window and round window to be changed into electrochemical impulses in the cochlea.

Young children are predisposed to parasympathetic hypertonia (increased vagal tone), which can be induced by: a. thermal stimuli such as ambient excessive heat or cold. b. anxiety stimuli such as separation from a parent. c. environmental stimuli such as loud noise or flashes of light. d. painful stimuli such as eye surgery or abdominal retraction.

d. painful stimuli such as eye surgery or abdominal retraction <<Young children are predisposed to parasympathetic hypertonia (increased vagal tone), which can be induced by painful stimuli such as laryngoscopy, intubation, eye surgery, or abdominal retraction.

Which role of the surgical technologist would likely include making hospital rounds, first-assisting, and expanded patient interaction? a. labor and delivery technologist b. circulating surgical technologist c. scrub surgical technologist d. private scrub technologist

d. private scrub technologist <<A surgical technologist who is practicing as a private scrub for a surgeon or group of surgeons can take on expanded duties under their direct supervision. Activities such as making hospital rounds often require additional credentialing to obtain privileges to assume an expanded role. The surgical technologist who acts as an assistant during surgery needs both additional educational preparation for the role and credentialing if they are a private employee of the surgeon.

The scaphoid, also called the navicular, links the proximal row of carpal bones as it: a. attaches its rough surfaces to the ligaments. b. articulates with each metacarpal head. c. articulates proximally with its matching carpal row. d. stabilizes and coordinates the movement of the proximal and distal rows.

d. stabilizes and coordinates the movement of the proximal and distal rows. <<Functionally, the scaphoid links the rows as it stabilizes and coordinates the movement of the proximal and distal rows. The eight carpal bones in the wrist are arranged in two rows. The distal row, proceeding from the radial to the ulnar side, includes the trapezium, trapezoid, capitate, and hamate; the proximal row consists of the scaphoid (also called the navicular), lunate, triquetrum, and pisiform. Each carpal bone consists of several smooth articular surfaces for contact with the adjacent bones, as well as rough surfaces for the attachment of ligaments.

Sutures used in ophthalmic surgery are very fine and range in size from 4-0 to 10-0. Handling and arming these sutures can be a challenge for the surgical technologist with uncorrected presbyopia. Eye sutures should be handled as little as possible to avoid: a. causing the formation of needle burrs. b. reaction and discomfort for the patient. c. losing sutures among the drapes or on the floor. d. weakening and fraying.

d. weakening and fraying. <<Fine eye sutures produce minimum reaction and discomfort for the patient. They should be handled as little as possible to avoid weakening and fraying. Ophthalmic needles also are very delicate and must be handled with extreme care and inspected for evidence of burrs before use.

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. with a narrow sac neck that is closed with adhesions. b. that is an emergent diagnosis. c. that does not require surgical repair. d. with visceral contents that can be returned to the abdomen.

d. with visceral contents that can be returned to the abdomen. <<A reducible hernia is an abdominal hernia whose contents of the hernia sac can be returned to the normal intra-abdominal position and are not trapped in the extra-abdominal sac (incarcerated). The conditions preventing the return of the hernia contents to the abdomen (nonreducible) can result from (1) adhesions between the contents of the sac and the inner lining of the sac, (2) adhesions among the contents of the sac, or (3) narrowing of the neck of the sac.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?

Bacteria can be reduced in the operating room by

damp dusting of surfaces each morning

The MOST common method for decontaminating operating room floors at the end of each case is to

damp mop or wet vacuum with a detergent-disinfectiot solution

Mannitol (Osmitrol) is used in neurosurgical procedures to

decrease intracranial pressure. > Mannitol is used within the operating room to decrease intracranial pressure. It is a medication given by the anesthesia provider.

A scleral buckle procedure repairs

detached retinas > A scleral buckle procedure is used to repair a retinal detachment.

Which of the following terms best describes a formal medical process when death occurs in surgery and the surgeon and anesthesia care provider must verify that death has occurred? A. determination of death B. rigor mortis C. postmortem procedures D. livor mortis

determination of death

Local anesthetics containing epinephrine should NEVER be used in which of the following areas?

digits and penis- Fingers, toes, penis, and tip of nose are all areas of decreased vascular supply.

A surgical technologist is explaining the steps of the ESU circuit to a student. The surgical technologist should explain that the electric current is channeled back to the generator through the

dispersive (inactive) electrode. > The electric current is channeled back to the generator via the dispersive (inactive) electrode or grounding pad.

An Esmarch bandage should be applied to an extremity

distal to proximal

Which of the following positions is used for mastopexy? A. Kraske B. dorsal recumbent C. lateral Sims D. lithotomy

dorsal recumbent

A nasogastric (NG) tube is used to A. dilate the lower esophageal sphincter. B. monitor the pH of stomach contents. C. drain the stomach. D. promote vomiting.

drain the stomach

When evaluating the patient's skin for the preoperative prep, which of the following is considered a contaminated area? A. groin B. toes C. body hair D. draining sinus

draining sinus

The MOST appropriate time to position the Mayo stand is after

draping the patient

What is the desired effect of atropine sulfate when used as a preoperative medication?

drying of secretions > Atropine suppresses salivation and bronchial and gastric secretions; therefore, it has a drying effect.

What advantage do hand-held retractors have over self-retaining retractors?

dynamic adjustability

During surgery, a patient becomes hypotensive. Which of the following medications should be given? A. cephalexin (Keflex) B. propofol (Diprivan) C. epinephrine (Adrenalin) D. furosemide (Lasix)

epinephrine (Adrenalin)

Growth in the length of a long bone occurs at the

epiphyseal plate

Which of the following should be visualized on an x-ray to determine if a long bone is still growing? A. periosteum B. diaphysis C. medullary canal D. epiphyseal plate

epiphyseal plate > The epiphyseal plate, also known as the growth plate, is the center for ossification at each extremity of a long bone.

Which of the following methods of hospital sterilization does not corrode metal and passes through woven materials like steam? A. ionizing radiation B. Steris C. glutaraldehyde D. ethylene oxide

ethylene oxide

Which of the following procedures repairs a ruptured abdominal aortic aneurysm? A. endarterectomy B. debridement with irrigation C. excision with graft placement D. portacaval shunt

excision with graft placement

Which of the following instruments must be readily available for a modified radical mastectomy?

extra #10 blades- The skin is undercut in all directions to the limits of dissection by means of a #10 blade. Knife blades will need to be changed on a regular basis in order to ensure precise dissection

Which of the following is used to oxygenate and circulate blood? A. Doppler ultrasound B. defibrillator C. extracorporeal bypass D. autotransfuser

extracorporeal bypass

When performing a parotidectomy, which of the following nerves is identified and preserved with the use of a nerve stimulator? A. facial nerve B. recurrent laryngeal nerve C. acoustic nerve D. vagus nerve

facial nerve > The facial nerve splits the parotid gland into superficial and deep lobes, and must be identified and retracted to avoid injury during the removal of parotid tissue.

If the VII cranial nerve is severed, which of the following is the result? A. loss of hearing B. loss of vision C. facial paralysis D. impairment of eye muscles

facial paralysis > The VII cranial nerve (facial) is responsible for muscular movement of the face.

Following an abdominal surgery, the surgeon has just closed the peritoneum. Which of the following layers will be sutured next? A. fascia B. muscle C. subcutaneous D. subcuticular

fascia

When utilizing a laparoscopic set-up, potential hazards associated with the equipment include

fiberoptic beam fire

During a craniotomy, which of the following types of bone is entered? A. flat B. round C. long D. short

flat

When donning gloves using the open-gloving technique, the ungloved hand will touch the

folded edge of the cuff of the glove

An inanimate object that harbors and transmits a disease is a A. fomite. B. vector. C. carrier. D. arthropod.

fomite

Which of the following is the opening in the occipital bone through which the spinal cord passes? A. foramen ovale B. foramen magnum C. foramen rotundum D. foramen of Bochdalek

foramen magnum > The foramen magnum is a large opening at the base of the skull for passage of the spinal cord.

When a hernia is strangulated, which of the following instrument sets is added to the general abdominal set-up?

gastrointestinal

A colonoscopy has just concluded, and it is time to reprocess the instruments utilized in the case. Which of the following is the MOST effective method for processing the endoscopes? A. gravity displacement sterilizer B. ethylene oxide C. cobalt-60 radiation D. glutaraldehyde

glutaraldehyde

After completing an operative procedure, the FIRST item a surgical technologist in the scrub role should remove is the

gown

At the conclusion of a surgical case, how would the surgical technologist in the scrub role aid in reducing bioburden on instruments as the first step in the sterilization cycle?

hand cleaning > Hand cleaning is utilized at the point of use to prevent drying of blood, feces, or respiratory secretions, which can harbor embedded microorganisms and prevent penetration of the disinfecting agent.

While being transferred from the stretcher to the operating room bed, the patient expresses fear of not awakening from anesthesia. The surgical technologist should

have the anesthesia care provider address the patient's concerns

The oxygen-carrying capacity of red blood cells is a function of

hemoglobin > Hemoglobin is the iron-containing pigment of red blood cells that carries oxygen from the lungs to the tissues.

Which of the following anticoagulants should be given during a vascular procedure to prevent normal blood clotting? A. heparin sodium B. protamine sulfate C. atropine D. epinephrine

heparin sodium > Heparin sodium is a parenteral anticoagulant that inhibits factor X, interferes with the conversion of prothrombins to thrombin, and prevents conversion of fibrinogen to fibrin.

Traction sutures are used on common duct explorations to A. ligate the duct. B. permanently close the duct. C. hold the duct open. D. seal the stones inside.

hold the duct open

Which of the following is necessary for ethylene oxide sterilization to occur? A. indirect contact B. gravity displacement C. humidity D. steam

humidity

Which of the following is a benign fluid-filled sac that develops in the anterior testis?

hydrocele

Which of the following is NOT a symptom of shock? A. tachycardia B. hypertension C. cold, clammy skin D. increased respirations

hypertension

In which of the following congenital anomalies does the urethra open on the underside of the penis?

hypospadias > Hypospadias refers to the urethra on the underside of the penis

When an anesthetized patient's position is changed from lithotomy to supine, the patient's legs should be lowered slowly to prevent which of the following?

hypotension

Heaney clamps are used MOST frequently for which of the following types of surgery? A. hysterectomy. B. lobectomy. C. cystectomy. D. gastrectomy.

hysterectomy > Heaney clamps are used to clamp the uterine ligaments during a hysterectomy.

Heaney clamps are used MOST frequently for which of the following types of surgery?

hysterectomy. > Heaney clamps are used to clamp the uterine ligaments during a hysterectomy.

When can instrument counts be omitted?

if an emergency procedure must be performed

Care of a surgical specimen includes placing it

in a bag or container with formalin

For steam sterilization, biological indicators should be placed

in the most challenging area of the load

During a craniotomy, removal of the bone flap is followed by

incision of the dura mater. > The dura mater is the first protective membranous layer over the brain and lies immediately beneath the bone (cranium).

A cerclage procedure is performed for which of the following conditions?

incompetent cervix- A cerclage procedure is performed to prevent spontaneous abortion and preterm delivery by placing a purse-string suture around the cervix.

Which of the following is the body's local tissue reaction to injury? A. fever B. infection C. inflammation D. immune reaction

inflammation > Inflammation is a localized reaction and the first step in the healing process.

Which of the following must be done before sterilizing an instrument with a lumen? A. allowing the instrument to dry completely B. ensuring the stylet is still within the lumen C. injecting a small amount of distilled water into the lumen D. wrapping separately in a peel pack pouch and placed in the tray

injecting a small amount of distilled water into the lumen > During the sterilization process, the water within the lumen turns to steam and forces the air out of the lumen. This is important, because the air trapped within lumens can interfere with the sterilization process.

To revascularize the heart muscle of a patient with heart disease, a graft may be anastomosed between which of the following two vessels?

internal mammary artery to affected coronary artery > The internal mammary artery is the preferred vascular conduit to revascularize the myocardium

A three-way Foley catheter is inserted following a transurethral resection of the prostate (TURP) in order to A. irrigate and facilitate hemostasis. B. prevent the patient from getting out of bed. C. keep accurate input and output records. D. keep the perineal area dry.

irrigate and facilitate hemostasis

When using power saws on bone, which of the following actions BEST helps prevent bone damage? A. irrigation B. suction C. illumination D. retraction

irrigation

A specimen obtained for frozen section is generally removed from the sterile field intraoperatively because it

is sent to pathology immediately. > Special preparation and examination of the tissue can determine whether it is malignant, if nodes are involved, and if margins are clear of malignant cells. Sending a frozen section will give the physician an immediate diagnosis and will be able to treat the patient correctly.

During a breast augmentation, the surgeon repeatedly asks the surgical technologist to refill the 10 cc syringe with local anesthetic. Which of the following is the BEST way to keep track of how much is used?

keep note on the field of how much has been used

When performing a urinary bladder catheterization, it is essential to

keep the catheter tip sterile

A patient is complaining of nausea, fever, and severe back pain. The patient was previously diagnosed with hyperparathyroidism. This patient MOST likely suffers from

kidney stones

If unexpected heavy blood loss occurs during an abdominal procedure, a surgical technologist should request additional

lap sponges

Which of the following procedures uses a trocar? A. cystoscopy B. laparoscopy C. proctoscopy D. bronchoscopy

laparoscopy

Which of the following positions is used for a pneumonectomy?

lateral

When exposed to ionizing radiation, staff and patients should wear personal protective equipment containing

lead

In which of the following positions is a patient placed for a right nephrectomy?

left lateral kidney

In which of the following positions is a patient placed for a right nephrectomy? A. left lateral B. right lateral C. left lateral kidney D. right lateral kidney

left lateral kidney > This is the correct side of the body. The flank would be elevated, and the kidney rest would be used.

Which of the following is NOT an acceptable technique when placing a patient in the lithotomy position? A. arms placed on arm boards B. legs placed in stirrups one at a time C. both legs placed in stirrups simultaneously D. hips placed over the lower break of the table

legs placed in stirrups one at a time > Legs should not be placed one at a time due to back, knee, and hip pain; also for pressure injury to skin, nerves, and blood vessels and blood pressure changes.

Which of the following types of anesthetic is injected during a Bier block?

lidocaine (Xylocaine)

The drug MOST commonly used to treat ventricular tachycardia is

lidocaine (xyloxaine)- antiarrhythmic

During a laparoscopic appendectomy, which of the following types of staplers should the surgical technologist have ready on the back table for removing the appendix and ensuring no spillage of bowel content? A. intraluminal B. linear C. skin D. purse-string

linear

Which of the following does NOT result after dipping a bloody RAY-TEC sponge into irrigation solution? A. The solution is tainted. B. Lint is released into the solution. C. The solution is diluted. D. Cellular components are released into the solution.

lint is release into the solution

In which of the following positions should a patient be placed for a low anterior colon resection? A. dorsal recumbent B. prone C. lateral D. lithotomy

lithotomy

Which of the following is the correct position for dilation and curettage? A. Sims B. supine C. Kraske D. lithotomy

lithotomy

Surgery to repair a Colles' fracture is performed on which of the following types of bone?

long

In which of the following procedures will the surgical technologist expect to use cottonoids?

lumbar laminectomy

In metastatic cancer, tumors extend beyond the regional area by which of the following systems?

lymphatic

Surgical loupes are used to

magnify the surgical field. > Surgical loupes are worn like glasses and are less cumbersome than an operating microscope when less magnification is required.

Which of the following INCREASES air contamination in the operating room? A. restricting traffic flow in and out of the room B. damp-dusting with a germicidal solution C. maintaining air pressure lower than in the outside hall D. using pneumatic surgical equipment

maintaining air pressure lower than in the outside hall

A patient presented in the OR without family history related to anesthesia complications. Which of the following complications is of MOST concern related to the lack of family history? A. malignant hyperthermia B. bronchospasm C. cardiac arrest D. transfusion reaction

malignant hyperthermia

A patient undergoing a procedure while under general anesthesia begins to experience muscle rigidity, followed by tachycardia, metabolic and respiratory acidosis, and cardiac dysrhythmias. Which of the following is the patient experiencing?

malignant hyperthermia > Malignant hyperthermia is a rare physiological response to all volatile anesthetic agents and succinylcholine which results in a severe hypermetabolism. Symptoms include extremely high body temperature, tachycardia, tachypnea, and muscle rigidity, as well as metabolic/respiratory acidosis.

Which of the following conditions is triggered by an injection of succinylcholine (Anectine) and causes an unusually high fever?

malignant hyperthermia > Succinylcholine is an anesthetic muscle relaxant that can trigger malignant hyperthermia.

Which of the following conditions is triggered by an injection of succinylcholine (Anectine) and causes an unusually high fever? A. osteomyelitis B. sepsis C. malignant hyperthermia D. appendicitis

malignant hyperthermia > Succinylcholine is an anesthetic muscle relaxant that can trigger malignant hyperthermia.

A device used to measure fluid pressure is known as a A. capnometer. B. manometer. C. spirometer. D. thermometer.

manometer

Which of the following procedures may require a postauricular incision?

mastoidectomy

Which of the following procedures requires an incision in the suprasternal notch? A. mediastinoscopy B. bronchoscopy C. parotidectomy D. pericardectomy

mediastinoscopy

In preparation for a cranial aneurysm, which of the following pieces of equipment would MOST likely be used? A. microscope B. cryoprobe C. Jordan Day drill D. Crutchfield tongs

microscope > A microscope is needed to visualize the aneurysm for clipping.

The tissue that covers bones and provides movement to the skeletal system is

muscle

Which of the following procedures involves the injection of contrast media into the spinal subarachnoid space? A. myelogram B. arteriogram C. lumbar puncture D. pneumography

myelogram

Which of the following is the MOST serious complication of a strangulated hernia? A. shock B. necrosis C. infection D. hemorrhage

necrosis > The blood supply of the trapped sac becomes compromised and the sac contents eventually necrose. It is an emergency condition requiring surgery to release the tissue to prevent ischemia and necrosis.

The safest method for placing a blade on a knife handle is with a

needle holder

If an adult patient refuses a blood transfusion, the surgical staff should

not administer blood to the patient. > This is a legal issue. Other agents can be used to maintain circulatory volume if necessary.

Retention sutures are advantageous when the patient is A. pediatric. B. athletic. C. thin. D. obese.

obese

Which of the following layers are transected when a subcostal flank incision is used for a nephrectomy? A. pre-peritoneal fat B. linea alba C. oblique muscles D. rectus abdominis muscle

oblique muscles > The oblique muscles are located at the flank area on the lateral side of the body covering the kidney.

Which of the following layers are transected when a subcostal flank incision is used for a nephrectomy?

oblique muscles- oblique muscles are located at the flank area on the lateral side of the body covering the kidney

Which of the following conditions should be treated FIRST? a. instructed airway b. closed cerebral injury c. shock due to hemorrhage d. sucking wound to the chest

obstructed airway

Ratcheted instruments should be

opened for washing and sterilizing.

Which of the following is used during a tympanoplasty? A. image intensifier B. hypothermia unit C. operating microscope D. argon laser

operating microscope > A microscope is needed to visualize the tympanic membrane, which begins the middle ear structures.

A postoperative total arthroplasty patient presents to the emergency department with severe throbbing pain, fever, and malaise. Which of the following is the likely diagnosis? A. osteoarthritis B. osteoporosis C. osteomyelitis D. osteomalacia

osteomyelitis > Osteomyelitis is the general name for bacterial infections of bone and bone marrow tissue most commonly caused by Staphylococcus aureus.

Aerobic organisms are BEST characterized as

oxygen-requiring.

Which of the following is the FIRST step in applying the pneumatic tourniquet necessary in creating a bloodless field? A.wrapping the limb sequentially with an Esmarch bandage from distal to proximal B. applying the pneumatic tourniquet to the limb and immediately inflating it C. prepping the limb with ChloraPrep, including the determined location of the tourniquet D. padding the area where the tourniquet is to be wrapped with Webril

padding the area where the tourniquet is to be wrapped with Webril

When two individuals in sterile attire pass one another in the sterile field, they should..

pass back-to-back

A tourniquet is used in which of the following procedures? a. patellectomy b. ORIF hip c. shoulder arthroscopy d. Bankart repair

patellectomy

An effective packaging material used for a Balfour to be steam sterilized

permits penetration by the sterilant.

Removing a cataract by ultrasonic vibration and aspiration is called

phacoemulsification > Phacoemulsification uses ultrasonic vibration and aspiration to remove the nucleus.

The PRIMARY consideration in selecting an appropriate anesthetic agent is the

physiologic condition of the patient. > The patient's specific needs and risk factors for anesthesia must be determined to identify the techniques and medications to use and avoid. Length of the operation is an important aspect to consider. However, the patient's health condition must take precedence.

A patient with multiple trauma injuries requires surgical intervention. The patient has a history of DVT and is currently taking anticoagulants. Which of the following should be done to ensure a clot does not develop?

place a sequential compression device on lower extremities

During an excisional biopsy of sentinel nodes, the surgical technologist should prepare specimens using which of the following methods? A. Place on a RAY-TEC to be handed off to the circulator. B. Separate on Telfa and pass to the circulator. C. Place in separate containers and identify. D. Place in specimen container held by the circulator using a hemostat.

place in separate containers and identify

Instruments that come in contact with the appendiceal stump during an appendectomy should be

placed in a separate basin > The instruments should be placed in a separate basin because they are contaminated by bowel contents from the appendiceal stump.

If an x-ray cassette must be placed directly against the operative site, it must be A. sterilized using hydrogen peroxide plasma. B. put in a sterile pillowcase. C. sterilized using peracetic acid. D. placed in a sterile cassette cover.

placed in a sterile cassette cover

Which of the following is the MOST effective mechanical method of controlling bleeding occurring from needle holes in vessel anastomoses? A. pledget B. suction C. ligature D. clamp

pledget > A pledget is a small square of Teflon sutured over a hole in a vessel; it exerts external pressure over any small needle holes to prevent bleeding and to promote clotting.

Which of the following lies between the lung and the chest wall? A. mediastinum B. peritoneum C. pleura D. pericardium

pleura > The pleura is the external lining of the lungs and inner thoracic cavity.

Which of the following is an absorbable suture? A. silk B. nylon C. polypropylene (Prolene) D. polyglycolic acid (Dexon)

polyglycolic acid (Dexon)

Which of the following may be used when applying a sterile dressing to a skin graft site? A. pressure dressing B. ABD pad C. 4x4s D. Steri-Strips

pressure dressing > A pressure dressing is most often used over a skin graft. Slight pressure on the graft site prevents serous fluid from lifting the skin graft away from the recipient site.

The primary reason padding is used in positioning a patient is to

prevent injury to pressure points

An appendectomy incision closed using suture is considered to be which of the following types of wound closure? A. primary intention B. secondary intention C. tertiary intention D. third intention

primary intention > The closure is considered to be primary intention because the incision is created aseptically, the edges of the wound are accurately approximated, and no dead space is remaining following closure.

Which of the following medications is the anesthesia provider responsible for recording the name, amount, and delivery method during a surgical procedure? A. thrombin B. topically applied epinephrine C. polymyxin B sulfate irrigation D. propofol

propofol

Which of the following anesthetic agents is administered intravenously?

propofol (Diprivan)

A resectoscope is used to resect the

prostate

During a carotid endarterectomy, which of the following is administered to reverse the effects of systemic heparin? A. protamine sulfate B. thrombin C. lidocaine D. atropine

protamine sulfate

Which of the following drugs neutralizes the action of heparin? A. calcium chloride B. protamine sulfate C. lidocaine (Xylocaine) D. neostigmine (Prostigmin)

protamine sulfate > When used in conjunction with heparin, protamine acts to reverse heparin's anticoagulant action.

To help prevent toxicity and vascular events in a patient where polymethylmethacrylate (PMMA) is used, which of the following devices should a surgical technologist have available? A. pulse lavage B. mask C. smoke evacuator D. cement mixer with charcoal filter

pulse lavage > Bone cement implantation syndrome can be reduced by the use of good surgical technique, such as using pulse lavage to clear the medullary canal before the cement and implant are inserted.

The appendiceal stump, when inverted, is held in place by which of the following types of suture? A. mattress B. traction C. interrupted D. purse-string

purse-string

Which of the following procedures treats a congenital obstructed lesion found at the distal end of an infant's stomach?

pyloromyotomy- Infantile pyloric stenosis is relieved by removing the congenital obstructive lesion in the pylorus of the stomach

A form of contrast media used within the body that is visible when exposed to x-ray is A. exogenous. B. radiopaque. C. radiolucent. D. endogenous.

radiopaque

The PRIMARY purpose of chest tubes is to

re-establish negative pressure.

Herniation of the rectum through a weakened posterior vaginal wall is known as

rectocele

Which of the following structures is separated first when a paramedian incision is performed? A. peritoneum B. transverse abdominis C. external oblique D. rectus abdominis

rectus abdominis

A pneumatic tourniquet may be used for extremity surgery to

reduce blood loss.

While speaking to the nurse in the pre-operative area, the patient is crying excessively, pouting, and acting like a child. Which of the following coping mechanisms is MOST likely being displayed?

regression- involves the patient assuming an earlier stage of life. Patients commonly exhibit behaviors such as assuming the fetal position, excessive crying, and pouting

Which of the following should the surgical technologist in the scrub role do during a cardiac emergency? A. open all of the emergency trays B. pull in the crash cart C. remain sterile and keep the table sterile D. record all medication being used

remain sterile and keep the table sterile

At the conclusion of the surgical procedure, the Mayo stand should

remain sterile until the patient leaves the room. > The Mayo stand should be kept sterile until the patient leaves the room in the event there is bleeding or other complications, and sterile instrumentation and supplies are still needed.

Which of the following is done FIRST when performing a myringotomy?

removal of cerumen from the ear canal

A surgical technologist is assigned to a room where the patient happens to be his neighbor. To protect patient confidentiality, the technologist should indicate that he knows the patient and

request to be removed from the room. > For the surgical technologist to indicate that he knows the patient and request to be removed from the room is the proper action to take in this circumstance. The surgical technologist may inform the charge nurse and ask to be moved to another room.

If a Kelly clamp is left in a patient who underwent a cholecystectomy, which of the following legal concepts apply? A. misdemeanor B. res ipsa loquitur C. extension doctrine D. intentional tort

res ipsa loquitur > Res ipsa loquitur means "the thing speaks for itself." This doctrine applies to injuries sustained by the patient while in the operating room.

Which of the following instruments should be included in a transurethral resection of the prostate (TURP) setup? A. lithotrite B. urethrotome C. resectoscope D. Randall

resectoscope > The resectoscope is used to cut and coagulate prostate tissue.

Which of the following positions is used to provide access to the head and neck during a thyroidectomy? A. lateral B. lithotomy C. Kraske D. reverse Trendelenburg

reverse Trendelenburg

Which of the following is a procedure for removing excess skin from the face and neck? A. rhinoplasty B. rhytidectomy C. cheiloplasty D. blepharoplasty

rhytidectomy

A surgeon asks a surgical technologist to place a drop of a mydriatic solution in OD. As a result of this medication, the pupil of the

right eye will dilate.

A surgeon asks a surgical technologist to place a drop of a mydriatic solution in OD. As a result of this medication, the pupil of the

right eye will dilate. > A mydriatic solution will dilate the pupil, and OD is the abbreviation for the right eye.

Hair removed during preparation for cranial surgery should be

saved because it is personal property.

Which of the following structures is behind and below the base of the penis?

scrotum

A surgeon has just completed an incisional biopsy and would like to have an immediate diagnosis. Which of the following is the MOST appropriate next step?

send the specimen to pathology in a dry specimen container so that a frozen section can be completed

Which of the following is an unexpected occurrence that involves physiologic or psychologic injury or death?

sentinel event- A sentinel event is an unexpected occurrence that involves physiologic or psychologic injury or death

Which of the following is the correct skin preparation for a female patient undergoing a right mastectomy with possible axillary dissection? A. shoulder, upper arm and extending down to the elbow, axilla, chest to the table line, and to the left shoulder B. base of the neck, shoulder, scapula, chest to midline, and circumference of upper arm down to the elbow C. entire arm, shoulder, axilla, including the hand D. chin to umbilicus and laterally to the table line

shoulder, upper arm and extending down to the elbow, axilla, chest to the table line, and to the left shoulder > For procedures in the area of the chest and breast, the areas to be prepped include the shoulder, the upper arm and extending down to the elbow, the axilla, and the chest to the table line and to the shoulder opposite from the affected side.

A Balfour is used in which of the following procedures? A. adaptic B. collodion C. steri-strip D. elastoplast

sigmoid resection > A sigmoid resection requires a large abdominal incision and thus a Balfour is appropriate for this procedure because it is a large, self-retaining abdominal retractor.

Immediately before a hemorrhoidectomy, which of the following procedures might be performed on the patient in the operating room? A. cystoscopy B. culdoscopy C. sigmoidoscopy D. laparoscopy

sigmoidoscopy

Wrinkle-free padding is applied to an extremity before application of a tourniquet to avoid

skin injuries. > Wrinkle-free padding is used to protect the skin and equally distribute the pressure from the tourniquet.

On which of the following would an antiseptic be used? A.skin surface B. anesthesia masks C. intravenous tubing D. operating room table

skin surface

When entering the abdominal cavity, which of the following BEST describes the order of contact with the layers of tissue? A. skin, fascia, subcutaneous, peritoneum, muscle B. skin, subcutaneous, muscle, fascia, peritoneum C. skin, fascia, peritoneum, subcutaneous, muscle D. skin, subcutaneous, fascia, muscle, peritoneum

skin, subcutaneous, fascia, muscle, peritoneum

The first pair of cranial nerves is associated with which of the following? A. smell B. sight C. speech D. balance

smell

A potential surgical complication of an inguinal herniorrhaphy is injury to the

spermatic cord. > In both direct and indirect inguinal herniorrhaphy in males, both the spermatic cord and the blood supply to the testes must be protected from injury.

Which of the following is MOST resistant to sterilization processes?

spore

If two basins are wrapped together for sterilizing, they should be packaged with one basin

stacked inside the other and separated by impervious material > Nested basins must be separated by a porous material, such as a towel, to allow the sterilizing agent to permeate and contact all surface areas of the basins.

A patient who is HIV-positive is having an abdominal procedure. Another patient who is HIV-negative is having an orthopedic procedure. During and subsequent to the cases, the surgical technologist should take A. standard precautions for the HIV-positive patient. B. standard precautions for the HIV-negative patient. C. no precautions for either patient. D. standard precautions for both patients.

standard precautions for both patients

Which of the following destroys bacterial spores? A. germicide B. antiseptic C. sterilant D. fungicide

sterilant

What type of incision is typically used for an open cholecystectomy?

subcostal

Which of the following suturing techniques features short lateral stitches that are taken beneath the epithelial layer of skin? A. purse-string B. traction C. mattress D. subcuticular

subcuticular > A subcuticular stitch is a type of continuous stitch placed beneath the epidermis.

To prevent contamination at the end of a surgical procedure, which of the following should be removed LAST by the surgical technologist in the scrub role? A. patient's drapes B. surgical gloves C. surgical gown D. Mayo stand drape

surgical gloves > After the gown has been removed and disposed of in the waste container, the gloves are removed one layer at a time. This allows the wearer to identify whether one or both pairs of gloves were breached by a tear or puncture.

To prevent contamination at the end of a surgical procedure, which of the following should be removed LAST by the surgical technologist in the scrub role?

surgical gloves- After the gown has been removed and disposed of in the waste container, the gloves are removed one layer at a time. This allows the wearer to identify whether one or both pairs of gloves were breached by a tear or puncture.

Which of the following is responsible for the proper care and handling of an intraoperative specimen? A. surgical technologist in the scrub role and anesthetist B. surgical technologist in the scrub role and the circulator C. surgical technologist in the first assistant role and the surgeon D. surgical technologist in the circulator role and anesthetist

surgical technologist in the scrub role and the circulator

Sponges that have been added to the sterile field after a procedure has begun should be counted by the

surgical technologist in the scrub role and the circulator.

During a tympanoplasty, which of the following is the best choice for graft material?

tempoalis fascia

Which of the following types of connective tissue fastens muscle to bone?

tendon

While removing peel pack instruments from the sterilizer, a surgical technologist notices several of the packages have ruptured. Which of the following would MOST likely be the cause of this?

the air was not evacuated from the pouch

Which of the following statements is true regarding surgical correction of a Colles' fracture?

the distal radius is fractured and the periosteum will be closed with absorbable sutures

Scoliosis is MOST commonly found in which of the following curves of the vertebral column? A. cervical B. thoracic C. lumbar D. sacral

thoracic > Scoliosis is a lateral bending of the spine most commonly seen in the thoracic region or thoracic curve. The thoracic curve is formed by the 12 thoracic vertebrae.

Which of the following is associated with secondary intention wound healing? A. delayed suturing B. tissue granulation C. wound dehiscence D. uncomplicated healing

tissue granulation > When wound edges cannot be approximated, the wound is left open to heal by secondary intention, which allows tissue granulation to occur.

A surgeon asks for warm irrigation after a GI tract reanastomosis. Which of the following BEST describes the reason for irrigating at this point in the procedure?

to aid visual inspection for leakage

Which of the following is the primary purpose for changing into operating room attire? A. to standardize uniforms B. to prevent the of spread of microorganisms C. to identify operating room personnel D. to avoid damage to personal attire

to prevent the of spread of microorganisms > Operating room attire provides an effective barrier to prevent the spread of microorganisms to patients and protect OR personnel from blood and body fluids.

A #12 knife blade on a #7 handle is MOST commonly used for what type of surgery?

tonsillectomy

Which of the following is the administration route for thrombin? A. local infiltration B. topical application C. intravenous injection D. intramuscular injection

topical application

The surgical technologist in the scrub role MUST keep track of blood loss as well as

track amount of irrigation used

A resectoscope is used in which of the following prostatic approaches? A. perineal B. suprapubic C. retropubic D. transurethral

transurethral

If the parents of a dependent minor requiring emergency surgery cannot be located, the operative consent form for surgery may be signed by

two consulting physicians

Which of the following operations is performed to correct hearing loss due to defects of the eardrum?

tympanoplasty

Which of the following is a type of herniation that occurs with protrusion of the peritoneal sac and its contents (omentum or abdominal viscera)? A. epigastric B. umbilical C. hypogastric D. femoral

umbilical

A surgeon is performing a procedure to repair damage from a gunshot wound to the chest. Which of the following types of drains should the surgical technologist have available at the end of the procedure?

underwater- used to pull fluid or air from the thoracic cavity after surgery or trauma to the thorax. It is used to restore negative pressure to the thoracic cavity

Hepatitis B is caused by a

virus > Hepatitis B is a generalized inflammation of the liver caused by one of several viral agents.

During a laser laryngoscopy, which of the following supplies must be available? A. wet sponges, towels, and sterile water B. microscope, sterile water, and bronchoscope C. sterile water, thyroid tray, and methylene blue D. tracheotomy tray and tube, bronchoscope, and sterile water

wet sponges, towels, and sterile water

A surgical technologist is preparing a fresh specimen for frozen section to be passed off of the field. How should the specimen be prepared to be passed to the circulator?

wrap it in a Telfa pad