RNFA FINAL PRACTICE
Silk, when buried in tissue, loses its tensile strength after which period of time?
1 year
The Glasgow Coma Scale (GCS) is commonly used to assess patients with brain injury using three indicators of cerebral function: eye opening, verbal communication, and motor response to verbal and noxious stimuli. Within the scoring range for the GCS, the best possible score is _____ and the worst possible score is ______.
15; 3
The tensile strength of lactic & glycolic acid polymers is sufficient for approximation of tissues for _____ weeks.
2-3
New synthetic polymers such as PDS provide wound support up to _____ months.
3
The teniae coli consist of __________longitudinal bands of muscle.
3
Pressure against the skin above ____mm hg interferes with tissue perfusion.
32
Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below:
32 mm Hg
The lifting equation provides a mathematical equation to determine the recommended weight limit (RWL) and lifting index (LI) for selected two-handed manual lifting tasks. Essentially, what is the recommended maximum weight limit for one person in a patient handling task? What is the best option when the weight limit exceeds the recommendation?
35 lb; use assistive lift devices
Select the true statement about antimetabolite drugs and their indications for use.
5-Fluorouracil and mitomycin can both be administered topically to inhibit scars and pterygium excision
The amount of fluid normally held in the parietal space is?
50 ml
The Joint Commission (TJC) suggests that surgical consents be written at what level to meet health literacy needs of all patients?
5th grade
Prostate cancer is the most frequently diagnosed cancer in men and is the leading cause of cancer death in men. Select the triad that best reflects the individual with the highest risk for prostate cancer.
65+ years old, African descent, father had prostate cancer
To help visualize abdominal structures and to enhance safety during laparoscopic procedures, a pneumoperitoneum is created. After Veress needle confirmation, insufflation tubing is connected and the process begun. CO2 gas is used to insufflate the abdominal cavity at an ideal flow rate of ______ to achieve an ideal intra-abdominal pressure of ______.
9 L/min;14 to 16 mm Hg
Postoperative hypothermia is defined as a temperature less than:
96.8
Anesthetic management impacts the success of ophthalmic surgery. Safe ambulatory surgery, especially in certain populations, depends on patient selection, preoperative evaluation, preparation, monitoring, and local anesthesia techniques. Select the patient below that would be an appropriate candidate for general anesthesia, instead of local anesthesia alone.
A 22-year-old healthy female for a tear duct probing
Select the patient that is the most vulnerable and at high risk for hypothermia in the perianesthesia phase based on diagnosis or surgical procedure.
A 3-week-old neonate undergoing surgery for a cardiac anomal
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?
A cervical radiograph is obtained to rule out injury to the neck.
Describe a pantaloon hernia.
A combination direct and indirect hernia
What statement regarding level I and level II trauma centers best describes the difference between the two types of centers?
A level I trauma center provides care for every type of injury, while a level II lacks some specialized resources.
Which statement regarding level III and level IV trauma centers best describes the difference between the two types of centers?
A level III trauma center provides advanced cardiac life support (ACLS), surgery, stabilization, and transfer, while a level IV only provides ACLS services before immediate transfer to a higher level center.
Among the treatment options for tricuspid valve disease are suture annuloplasty, ring annuloplasty, and valve replacement with either a biologic or a mechanical prosthesis. Because there are no specific tricuspid prosthetic valves available, what type of prosthetic graft would be created or implanted?
A mitral prosthesis
Describe the internal inguinal ring.
A natural opening in the transversalis fascia
Which of the following describes a strangulated hernia?
A persistent incarceration with a compromised blood supply
The patient stated that her mouth, lips, and tongue were numb and prickly feeling and she had a metallic taste after receiving local anesthesia for a procedure. The anesthesia provider suspected that the patient had ________ and responded by _________.
A toxic overdose of local anesthetic; monitoring and increasing the flow rate of IV saline
The linea alba is extends from ______to _________.
Above the xyphoid process to the pubis
Tissue reaction characteristics that need considered when choosing suture include:
Absorption
What part of the hip are the hemispherical reamers used on?
Acetabulum
The initial primary assessment by the perianesthesia nurse, on the patient's admission to the PACU, begins with which criterion?
Airway adequacy
The perioperative nurse should plan to remain close to the elderly patient during induction because:
Airway anatomy changes in the elderly
During the preoperative assessment of an adult with a previously corrected congenital heart defect, the perioperative nurse should be aware of anatomic anomalies associated with the original defect, or its subsequent repair, that may alter the current surgical plan for a patient who had prior pediatric cardiac surgery. What is an appropriate nursing response when the assessment reveals the adult patient has undergone prior pediatric cardiac surgery?
Alert the staff to anticipate altered anatomy, special supplies, and potential complications
Mandibular fractures are highly associated with assault as the MOI. The goals of operative intervention are to reduce and immobilize the fracture, prevent infection, and restore facial cosmesis and function. What might be an appropriate nursing action and a nursing outcome statement for a patient with a mandibular fracture caused by assault?
All of the options are appropriate and desirable for this patient.
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?
All testes that are undescended after 1 year require surgical placement in the scrotum
The liver, pancreas, and spleen share many similarities. Select the statement about these organs that is true.
All three are solid organs and very vascular.
What statements regarding vascular clamps are true? Select all that apply.
All vascular clamps are designed to hold vessels securely without trauma
A breast biopsy, performed after the patient has received a local anesthetic, will require adjunct sedation and monitoring equipment. What relevant considerations should the nurse note during the preoperative assessment?
Allergies
The perioperative nurse may not be able to assess the trauma patient until the patient arrives in the OR for surgical intervention. If the patient's condition permits, the perioperative nurse should obtain a brief, precise report from the ED nurse. One component of this report is the AMPLE history. What are the components of the AMPLE mnemonic?
Allergies, Medications, Past medical history, Last meal, Event leading to injury
From the following, choose where the hypothalamus is located.
Along the floor of the third ventricle
As a person ages. there is reduced blood flow to the abdominal viscera, reduced amounts of hydrochloric acid, and delayed gastric emptying. The result of of these physical changes include:
Altered absorption of drugs
A dietary supplement, as defined by the Dietary Supplement Health and Education Act (DSHEA), is a product that contains a number of ingredients that are intended to supplement the individual's diet. What ingredient is considered an appropriate additive to classify a product as a dietary supplement?
Amino acid
You examine a comatose patient in the emergency room. His wife relates that her husband was struck accidentally in his "temple" by a baseball. After an initial period of unconsciousness, he seemed to be okay but later became drowsy and comatose. You suspect that the patient is suffering from:
An Epidural hematoma
A kidney transplant entails transplantation of a living-related or cadaveric donor kidney into the recipient's iliac fossa. It is performed in an effort to restore renal function and maintain life in a patient who has end-stage renal disease. Select the statement that best reflects the ideal living-related donor candidate.
An identical twin or sibling or parent, ABO and HLA compatibility, good health
Surgical and nonsurgical options exist for endometriosis. Select the triad that best reflects nonsurgical and nonhormonal options.
Analgesics, anxiolytics, and acupuncture
The anesthesia department at Evergreen Medical Center has a total staff of 102 persons. These employees serve in many roles as care providers, technical assistants, materials management, clinical engineers, and clerical staff. Select the list of direct-care anesthesia providers.
Anesthesia provider, AA, CRNA
The ovarian artery is a branch of which vessel?
Aorta
Potential development of a direct inguinal hernia results from ___________and __________weakening or tearing.
Aponeurosis of transversus abdominus and transversalis muscle
Samuel Garcia was fitted with a negative-pressure wound therapy system, also called vacuum-assisted closure, after his most recent surgical wound debridement. This device works by:
Applying constant negative controlled pressure Creating mechanical tension on the tissues and pulling wound edges together
What action is considered a best practice when communicating with geriatric patients with cognitive impairments?
Approach the patient from the front and identify yourself
What statement regarding risk factors for developing vascular disease is true?
Arteriosclerosis is a natural part of the aging process.
The diagnostic test that is performed to differentiate between acute and chronic thrombosis is known as:
Ascending venography
Many alternative medical therapies are culturally, ethnically, spiritually, or religiously derived and have a wide range of applications from health promotion to the treatment of illness. Key foundations of several therapies are a focus on universal connectedness (e.g., that all living and nonliving things are joined together; health will be good if one's mind and body are in harmony and balance; disease arises when a person is out of harmony with the universe). Which of the therapies listed below prescribe to this belief system?
Asian medicine
Blunt force to the larynx can result in a fracture and impose immediate airway obstruction. These patients are at risk for a lost airway and may require immediate tracheotomy followed by repair of the fracture when the fracture is unstable or displaced. It is also important to consider that a trauma patient is assumed to have a full stomach; thus these patients are at high risk for aspiration and resultant pneumonia. What is an appropriate nursing action in the event of a lost airway after anesthesia induction and before intubation?
Assist the anesthesia provider with securing the airway while applying cricoid pressure.
Studies show that patients with overactive thyroid conditions have an increased risk of various heart problems. Which of the following has an increased risk of development that can lead to premature death?
Atrial fibrillation
Innervation of the lungs is part of the _______system.
Autonomic
Proper care and handling of surgical specimens is imperative for correct diagnosis, treatment, and prognosis planning of the patient. Select the response that best reflects correct specimen care and handling.
Avoid placing specimens for frozen section in formalin.
Select the diagnosis/procedure option that pairs the correct surgical diagnosis with the surgical/endoscopic procedure for diseases of the esophagus:
Barrett's dysplasia of the distal esophagus/endoscopic mucosal resection (EMR)
An example of perineal glands that secrete mucus is:
Bartholin's glands
Sponge counts should be performed at the time of permanent relief of either the scrub person or circulating nurse, and _____.
Before the procedure, before closure of each body cavity, before wound closure, at skin closure or end of procedure.
Identify the class of medications that can increase the risk or severity of a reaction to contrast media.
Beta Blockers
Which of the following regarding specimen labeling is a regulatory requirement?
Biohazard information
What does the presence of bruit on auscultation of a blood vessel mean?
Blood flow is disrupted.
The pediatric patient is at risk for imbalanced fluid volume related to invasive surgery and accompanying blood loss. Select the outcome indicator that would best reflect that the goal of maintained fluid balance was attained.
Blood pressure within acceptable range
Which hemostatic agent should be available for all cranial and spinal cord operations?
Bone wax
Herbal supplements may have a role in the perioperative setting and are an important consideration for nurses. A mistaken assumption is that botanical dietary supplements are safer than prescribed or over-the-counter drugs. What assumption should the nurse make, during the nursing assessment, when the patient describes the use of dietary supplements and herbal products?
Botanicals may initiate a pharmacologic response and should be considered as a medication.
During a total hip arthroplasty, the instrument used to access the femoral canal is the_____.
Box osteotome
Damage to this area of the brain is often devastating and life-threatening because it can affect movement, senses, consciousness, perception, and cognition. Choose the correct answer from the following.
Brainstem
Sources of radiation exposure in the OR include:
C-arm fluoroscopy
Of the following procedures, which represents the standard of care for patients with left main or three vessel disease?
CABG
High-pressure insufflation rates can cause increased intra-abdominal pressure that can result in life-threatening sequelae. The perioperative nurse reduces the flow rate in collaboration with the surgeon, while monitoring the patient for signs of:
CO2 gas embolism
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?
CT scan of the head
Several types of diagnostic imaging studies visualize structures by producing serial sections through different anatomic planes, highlighting specific structures or tissue densities. Which of the following is contraindicated in pregnancy?
CT scan.
Which of the following is a "triangle" anatomic landmark in surgical removal of the gallbladder, and may be remembered by the 3C's: cystic duct, common hepatic duct and cystic artery?
Calot's
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?
Canine fossa of the upper jaw
Specific malignant conditions that may require splenectomy include all EXCEPT _____.
Carcinoma of left kidney
Definitive information about the extent and location of ischemic heart disease can be obtained from which of the following tests?
Cardiac catherization
A percutaneous method of instituting femoral vein-femoral artery cardiopulmonary bypass (CPB) can be used for minimally invasive (or conventional open) procedures and in emergency situations where the environment is not conducive to traditional CPB methods. Select the areas where percutaneous CPB would be indicated.
Cardiac catheterization unit and intensive care unit
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?
Cardiac status
The incidence of intraoperative awareness (IOA) may increase in high risk patient populations. From the following, choose the group that is considered high risk for IOA.
Cardiac surgery patients
Which structure supports the uterus and contains the uterine artery and vein ?
Cardinal ligaments
Which of the following do not need to be counted and documented?
Cautery pencil ?
Which of the following is the most common non-emergent abdominal surgery in the U.S.?
Cholecystectomy
What term is used to describe inflammation of the gallbladder?
Cholecystitis
During a stapedotomy, it is important to save which of the following nerves that control taste on the anterior 2/3's of the tongue?
Chorda tympani nerve
The production of CSF occurs where?
Choroid plexus of the ventricles
The surgeon used the ESU in monopolar mode to cut and coagulate through the subcutaneous tissue on opening the abdomen during a bariatric bypass procedure. As she began to proceed through the muscle and fascia layer, she asked the circulating nurse to increase the cut and coagulation modes on the ESU. What measure could the scrub person take to enhance energy delivery?
Clean the charred tissue from the active electrode blade
Jacob Sutzkever, a 62-year-old man, had surgery 6 days ago for a ruptured diverticulum. What was the wound classification at the time of his emergency surgery?
Clean/contaminated wound, classification II
This orthopedic diagnosis is a complex deformity that is diagnosed prenatally through ultrasound or at birth. It may occur unilaterally or bilaterally and may be idiopathic or one in a combination of other syndromes with associated anomalies. Select the orthopedic diagnosis.
Clubfoot
Which of the following is an indication for damage control surgery?
Coagulopathy
Which type of fracture is a dorsally angulated fracture of the distal end of the radius?
Colles
Identify the type of fracture that has more than two fragments.
Comminuted
When microlaryngoscopy is performed to remove polyps or nodules from the vocal cords, what important postoperative instruction must the nurse give the patient during discharge teaching?
Complete voice rest is important.
The process of decontamination should initially begin at what point?
Completion of the surgical procedure
Select the congenital anomaly that best reflects indications for fetal surgery.
Congenital diaphragmatic hernia
Sherry Ames is an endoscopy nurse in a busy free-standing ambulatory surgery center. She is an RN with additional documented competency in providing an anesthesia modality to healthy patients having screening colonoscopies, bronchoscopies, and upper GI endoscopies. This modality will allow this patient population to tolerate potentially uncomfortable procedures while maintaining their own airway and be easily aroused from light sleep. Sherry is competent and legally qualified to provide which modality of anesthesia?
Conscious sedation/analgesia
Suction applied directly to neural tissue can be harmful To prevent tissue damage, a ___________should be placed between the neural tissue and the suction tip.
Cottonoid
During a laminectomy what is the preferred method of hemostasis?
Cottonoid strips or patties
What is the appropriate action if the doctor is delayed after the room and instruments have been opened?
Cover the instruments with a sterile drape and have the scrub nurse continually visually observe the room for breaches in sterility
Identify the cranial nerve that is responsible for pupillary reaction.
Cranial III
Select the appropriate nursing action that supports hands-free instrument passing and sharps safety.
Create a neutral hands-free area between the scrub person and surgeon with a basin or magnetic mat.
What structure covers the spermatic cord and contracts to make the testicles ascend in the scrotum?
Cremaster muscle
A patient that presents to the OR with midface fractures should not have NG or nasal intubation performed due to a fracture of this particular structure can result in tube placement in the brain. Identify the structure from the following.
Cribriform plate
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?
D = a brief neurologic examination; E = exposure to reveal all life-threatening injuries
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:
D&C with endometrial biopsies, frozen section, possible LAVH.
Select the true statement about dacryocystorhinostomy (DCR).
DCR establishes a new passageway for tear drainage into the nasal cavity.
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?
Debridement and allograft placement during initial healing
Why will the perioperative nurse ensure availability of hemodynamic monitoring equipment and supplies for the patient having thoracic surgery?
Decreased surface area of the lung for perfusion can be anticipated.
Aubrey Scheel arrived to the preoperative receiving and waiting lounge of the ambulatory surgery center for an elective hernia repair. The RNFA began Aubrey's preoperative nursing assessment. It was a beautiful and warm spring day and Aubrey shared his concern about how he would feel after the procedure. He wanted to know when he would be able to get back to work and resume his place as pitcher on his softball team. He also told the RNFA that he planned to do some yard work today as soon as the anesthesia "wears off." Which one of the following nursing diagnoses is given priority in both preoperative and postoperative education?
Deficient Knowledge related to disease process and convalescence
The death of microorganisms occurs in steam sterilization as a result of which process?
Denaturation and coagulation of enzyme proteins
Which anesthetic agent could not be given if an IV-only anesthesia plan was employed?
Desflurane
During urologic surgery large quantities of irrigating fluids are infused intraoperatively. It is important to avoid the use of distilled water during TURP as this complication may occur, Choose the complication from the following.
Dilutional Hyponatremia
Lateral, lateral chest, and lateral kidney positions all place pressure on structures of the dependent side: ears, shoulder, ribs, hips, greater femoral head, knees, and ankles. The potential for injury to the patient is significant, based on these pressure areas. Which resultant injury or harm could not be related to these lateral positions?
Diminished lung capacity of dependent lung
During a laparoscopic colectomy, the scrub person carefully placed the endoscopic electrosurgery instruments on the Mayo stand after inspecting the integrity of the insulation along the shaft. This practice is designed prevent a unique MIS problem. Choose the correct option from the following.
Direct coupling
Hernias that occur within Hesselbach's triangle are called:
Direct inguinal hernia
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?
Direct observation and verification of fracture alignment
A 26-year-old female 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 perioperative nurse prepares to insert a urinary catheter, she notices blood at the urinary meatus. What should the nurse's next action be?
Discontinue the catheter insertion
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?
Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection
When applying sterile drapes to create the sterile field on the patient, which of the following principles is most important?
Drape the patient starting with the incision area and proceeding to the periphery.
Select from the following a medication that is used for PONV and has the potential to prolong the QT interval
Droperidol
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.
Dry skin, edema, constipation, and depression
What properties enable arteries to compensate for changes in blood pressure and blood volume?
Elasticity and distensibility
Most patients will have undergone diagnostic procedures before arriving in the OR. Radiologic and other diagnostic studies are of great significance to the surgical team for determining a surgical diagnosis and developing a plan for treatment. MRI is the gold standard imaging scan for the diagnosis of tumors, abscesses, tissue/ligamentous injury, and disk herniation. Which of the following diagnostic tests of neurologic activity can be performed before surgery and also concurrently during the procedure?
Electroencephalogram
Select the diagnostic test that represents an invasive cardiac study.
Electrophysiology studies
FESS provides a more functional approach to treat sinus disease. FESS involves the endoscopic resection of inflammatory and anatomic defects of the sinuses while preserving natural function in a surgical procedure that is minimally invasive. From the following, choose an important finding that should be communicated to the surgeon immediately during this procedure.
Encroachment of the orbit
Sharon Close has been diagnosed with severe gastroesophageal reflux disease (GERD) without the dysplastic changes of Barrett's esophagus. Her GERD is unresponsive to proton pump inhibitors and histamine blockers. 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?
Endoluminal plication of the lower esophageal segment
Talia Mendelson, a 27-year-old patient who had a lumpectomy for early-onset breast cancer, is now scheduled for infusion port insertion. Talia is very nervous because during the previous lumpectomy, performed using a local anesthetic, she was not entirely sedated. Talia tells the perioperative nurse that she was uncomfortable and heard everything in the room, but admitted that she did not feel pain. The nurse recognized Talia's anxiety related to the surgical intervention and prepared to implement corrective actions in the OR. What nursing intervention best reflects one that would ensure support or contribute to Talia realizing her expected outcome?
Ensure a quiet and calm environment of care
Specific positioning considerations for bariatric patients require particular attention to protecting these patients from inherent risks related to their size and weight. Protective measures to protect both patient and staff include those below. Which measure reflects the most safety protection for both patient and staff?
Ensure that the OR bed can accommodate the patient's weight and girth.
Waste anesthetic gases are small amounts of gases that may leak either from the patient's anesthetic breathing circuit into the OR air while anesthesia is being administered or from exhalation of the patient during recovery. Both mechanisms of exposure create risks for OR personnel. Select the appropriate risk reduction strategy that protects the environment and perioperative worker from exposure to ambient waste anesthetic gas.
Ensure that the scavenging system is properly connected to the gas outlet.
Select the herbal supplement that may cause potential adverse cardiac effects such as palpations and hypertension.
Ephedra
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?
Epiglottis
Select the correct choice for a polyester suture.
Ethibond
The great saphenous vein branches off of which vessel?
External iliac
In the pediatric population, which is the preferred site for central venous access?
External jugular
When assisting with an open inguinal hernia repair, the surgeon makes an incision through which of the following to access the cremaster muscle, inguinal canal, and cord structures? Choose the correct answer.
External oblique muscle
Identify the dura fold that separates the right and left cerebral hemispheres.
Falx cerebri
Anesthesia providers are concerned about the potential increased risk of instability intraoperatively resulting from inhibition of coagulation. Which herbal supplement, from the list below, would be implicated in a coagulation interaction?
Feverfew
The main pressure points in Fowler position does not include which of the following?
Fibular head
Fluoroscopy time should be limited as much as possible. Which of the following is radiation reduction technique?
Fluoroscopy equipment is required to have an audible alarm after 5 minutes of use
Identify the correct path of the cardiac conduction system.
From the SA node to the AV node to the bundle of His to the Purkinje system
Describe the boundaries of the surgical skin prep for the patient about to receive a liver transplant.
From the neck to midthigh; bedline to bedline
There are 8 bones that form the cranial cavity. Four of the bones are paired and four are singular. Choose the correct list of singular bones from the following:
Frontal, ethmoid, sphenoid, occipital
With injury to the brain, swelling may occur quickly, requiring aggressive decisions to manage increasing intracranial pressure (ICP). What is an appropriate diuretic medication to give and what nursing actions would be indicated for an older adult patient with traumatic brain injury, increased ICP, and a history of congestive heart failure (CHF)?
Furosemide (Lasix) 20-80 mg IV; monitor for hypotension and note extent of diuresis
Which of the following associations is incorrect regarding gallstones?
Gallstones in cystic duct = cholangitis
Velour grafts are impregnated which of the following to ease handling without the need to preclot?
Gelatin
Age-related skin changes include a thinning epidermis and decreased subcutaneous fat and elasticity. What special consideration will the perioperative nurse provide, in terms of additional attention and care, in one of the following nursing actions?
Gently lift, not slide, the patient to and from the OR bed
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?
Glycogen
There are three main vessels of the coronary arterial system. Which of the following is not one of the three?
Great Cardiac Artery
Which of the following is not contained within the anterior mediastinum?
Great Vessels
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.
Growth and development, menstruation, and pregnancy and lactation
The tensile strength of which type of suture should never be tested before handing it to the surgeon?
Gut suture
Open commissurotomy of the mitral valve, which is performed for mitral stenosis, is the separation of fused, adherent leaflets of the mitral valve. The nurse assists in placing the patient in the supine position for a median sternotomy. The setup is the same as that described for open-heart procedures, with mitral valve instruments. Additional supplies needed could include which of the following?
Have valve replacement instruments available
Aortic stenosis promotes a pathologic remodeling of the heart that can lead not only to valvular dysfunction but also which of the following?
Heart failure
Hyperkalemia can result from massive blood transfusion as well as the administration of medications introperatively. Which of the following medications can induce hyperkalemia?
Heparin
During kidney transplant surgery and prior to clamping the renal vessels, which of the following drugs are administered to prevent intravascular clotting and maximize duiresis?
Heparin and Mannitol
Which of the following is a major infectious risk for healthcare workers?
Hepatitis B
For indirect hernia repair, the _____.
Hernia contents are reduced to the abdominal cavity
The most commonly performed procedure in general surgery is which of the following?
Hernia repair
Contrast media-induced nephrotoxicity (CIN) can occur as a result of a physiologic change when a transient increase in blood flow is then followed by a longer period of decreased blood flow to the kidneys, after the administration of contrast media. Which of the following is considered a preventative action against CIN?
Hydration
When a thyroglossal duct cyst is present in an adult, it exists as a pretracheal cystic pouch attached to what structure?
Hyoid
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.
Hypertension
Exophthalmos can be associated with which of the following?
Hyperthyroidism
Transsphenoidal hypophysectomy (TSH) is performed with the patient administered a general endotracheal anesthetic, combined with a local anesthetic. The surgical team places the patient in a semisitting position, with the head against the headrest. A transnasal or a sublabial incision can be used for rapid access to the sella turcica. Select the diad (2) of conditions that would be appropriate indications for TSH.
Hypopituitarism and small pituitary tumors
Linda Martinez, a 61-year-old woman with nontoxic nodular goiter, is scheduled for a subtotal thyroidectomy to relieve esophageal obstruction and rule out a malignant nodule. Select the statement that best describes Linda's thyroid dysfunction and cause.
Hypothyroidism resulting from insufficient hormone production, increasing thyroid tissue proliferation
A rapid rise in thyroid hormone levels is not caused by which of the following?
Idodized table salt use Thyroid hormone medication
Which of the following is not included in the the bony pelvis?
Ileum
Susan Graton is a 52-year-old, 425-pound patient is scheduled for surgery at the bariatric surgery center in 3 days. She has osteoarthritis and had a spinal fusion when she was 13. Susan shared her concern that she would not be able to move herself over to the OR bed and would be embarrassed if the nurses could not lift her. Based on this information, the following nursing diagnosis and three positioning-relevant nursing interventions are suitable for this patient.
Impaired transfer ability; lock OR bed and transport vehicle during transfer; use at least 4 persons to assist with lift and transfer; use OR bed to accommodate patient weight and size.
While hypothermia was historically credited as a therapeutic modality benefitting all surgery because it decreases metabolism and reduces oxygen demand, inadvertent hypothermia is now recognized as impacting many critical physiologic functions and patient outcomes. Which of the following impairments can contribute to surgical site infections?
Impaired wound healing
Select the statement that best describes the comparative difference between open aortic aneurysm repair and endovascular aneurysm (EVAR) repair.
In EVAR, the prosthetic endograft or stent-graft is introduced into the aneurysm through a surgically exposed femoral artery.
What vaccine should healthcare workers receive if they are caring for immunocompromised patients?
Inactivated influenza vaccine.
The new general surgery fellow placed the three trocar ports for the laparoscopic appendectomy. The procedure was completed without incident; however, on postoperative day 1, the patient demonstrated signs and symptoms of sepsis. What might have been the unusual occurrence that could have resulted in patient sepsis?
Inadvertent trocar puncture through the bowel on insertion
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?
Incarcerated hernia
Select the appropriate example of physiologic symptoms of pain.
Increased B/P
Age-related changes cause decreased blood flow to the kidneys with a resultant decrease in nephron function. What condition is created from the cumulative effect of the multiple drugs that the elderly patient will receive during the perioperative phase?
Increased chance for adverse reactions and consequential results
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:
Increased pressure within the abdomen.
The patient with hyperthyroidism most likely has received appropriate drug therapy that has returned thyroid hormone levels and metabolic state to normal; however, the perioperative nurse should assess for any symptoms that relate to accelerated metabolism. Select the set of symptoms that is most commonly associated with hyperthyroidism.
Increased sweating, insomnia, tremor, and muscle weakness
Samuel Garcia has been approved as a candidate for hyperbaric oxygenation (HBO) as a management therapy for his chronic sacral wound. He responded well to his surgical debridement and the nurse is planning to explain how HBO will benefit wound healing by way of:
Increases the capacity of the blood to carry oxygen to the tissues
Jacob Sutzkever had a temperature of 103° F and returned to the OR for a debridement and washout of purulent drainage from his wound on postoperative day 3. What was the wound classification at the time of his debridement and washout surgery?
Infected wound, classification IV
Side effects the patient may encounter as a result of extracoproreal circulation include:
Inflammatory responses
Monica Sorensen, a patient with end-stage pancreatic cancer, was admitted from hospice for a celiac plexus block to treat intractable pain. She had a Whipple procedure 18 months earlier and enjoyed good quality of life until 3 weeks ago. She wanted to be able to complete "getting her things in order" and saying good-bye to her friends and family while enjoying her last days pain-free. Monica insisted that her Do Not Resuscitate (DNR) status NOT be rescinded. She was conscious and competent and knew what was best for herself. Monica was taking full advantage of what provision for her care?
Informed consent
Identify the triad of anatomic sites of abdominal wall weakness with a potential for hernias.
Inguinal canal, femoral rings, umbilicus
Surgical hand scrub products should have which of the following attributes?
Inhibit the regrowth of microorganisms
Which statement best explains the mechanism of action of general anesthetic agents?
Inhibition of synaptic transmission of nerve impulses
Recommended practices for sponge, sharp and instrument counts are requirements/recommendations of:
Institutional policy
Melissa Pepe is a 17-year-old female with cancer of the thyroid secondary to leukemia, which went into remission 7 years earlier. She is very concerned about scarring from the surgery. The nurse discussed Melissa's concerns with the surgical team before the incision was made. Melissa had a minimally invasive thyroidectomy approach, which left a small scar that was closed with a 4-0 nonabsorbable subcuticular suture. In the postoperative phase, the nurse provided Melissa with her postoperative education relative to her incision. Select all the incision care instructions that would be relevant for Melissa.
Instruct her to refrain from prolonged exposure to direct sunlight or tanning salons while the incision is healing.
Two patients are scheduled to have bariatric surgery. How will perioperative planning differ for a patient weighing 280 lb as compared to that for a 450-lb patient?
Instrumentation will need to be longer
It is important for the RNFA to be aware of this ESU safety hazard when assisting with endoscopic surgery. Choose the correct answer from the following.
Insulation failure
An example of an amphiarthrotic joint includes:
Intervertebral joints
Catheters are available in a variety of lengths and shapes, each with a specific advantage. Select the true statement about a pigtail catheter that describes its indications for use.
It can deliver a large amount of contrast medium through its side holes.
Which of the following is correct regarding the trochlear nerve?
It is one of the motor nerves of the eyes
The highest risk of injury per needle use is attributed to the:
Keith needle
Identify the primary substance that composes a layer of the epidermis, is responsible for hardening nails and hair, and protects the body from fluid loss and invasion by pathogens.
Keratin
Which of the following is a physical characteristic of suture material?
Knot strength
Maureen Gilroy, a 39-year-old mother of 5 children, was recently diagnosed with early stage, noninvasive ductal carcinoma in situ. She has decided to have a bilateral preemptive modified radical mastectomy to minimize her risk of metastatic disease. She is calm and confident that she has made the right decision, but is concerned about the length of her recovery. The perioperative nurse recognizes Maureen's concern and assigns her a nursing diagnosis of:
Knowledge Deficit related to unfamiliarity with perioperative routines
Which of the following correctly identifies the phagocytic cells of the liver?
Kupffer cells
Karen Masterson, the perioperative nurse 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, also a perioperative nurse, 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?
Label syringe, medicine cup, and IV saline bag with the drug name, dosage, strength, date, and expiration date.
Which of the following is not a reason to convert a case from laparoscopic to an open abdominal case?
Lack of warmer for insufflation gas
Microlaryngoscopy facilitates improved diagnosis and allows the laryngologist to view, with relative ease, areas that previously were inaccessible or difficult to visualize. What are the two most common indications for microlaryngoscopy?
Laryngeal polyps and nodules
The supraglottis, glottis, and the subglottis represent three portions of which structure of the throat?
Larynx
Which of the following are the sources of radiation exposure in an operating room setting?
Lasers and C-arms
The surfaces of the hemispheres form convolutions called gyri and intervening furrows called sulci, which serve as anatomic landmarks. Which of the following sulci is of particular anatomic importance during surgery?
Lateral sulcus
Indirect hernias occur ___________to the deep epigastric vessels. Choose from the following.
Laterally
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:
Le Fort II
The perioperative nurse 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.
Leave the eyebrows and eyelashes intact to preserve facial appearance and expression.
What major artery supplies the descending colon?
Left colic artery
A positive Kehr's sign is _____.
Left shoulder pain
As the RNFA assisting with a splenectomy, a _____________incision should be anticipated.
Left subcostal incision
35% of the refractive power of the eye is credited to which part of the eye?
Lens
Mohs' surgery is a specialized excision used to treat basal and squamous cell skin cancers. Select the statement about Mohs' surgery that best reflects the process, procedure, and outcome goal.
Lesions are mapped, excised, and examined by frozen section until clear margins are found.
A benefit to the patient undergoing SILS procedure which of the following?
Less postoperative pain
The pelvic floor consists of which muscle groups?
Levator ani and coccygeal muscles
Medullary thyroid cancer
Levator muscle
The most commonly used medication for local anesthesia is __________?
Lidocaine
This hemostatic device offers a rapid and secure method of clamping arteries, veins, nerves, and other small structures. This device remains in the patient, is not counted, and is made of a metal that is compatible with MRI. Select the correct hemostatic device that fits this description.
Ligating clip
Umbilical hernias occur in adults as a result of a defect in the:
Linea alba
Justin, a 4-year-old preschool student, was telling his friend Jacob about his operation. He had a hernia fixed and told Jacob that the nurse put "magic cream on his hand before she stuck the ivy in" and then the doctor "gave him surgery sleep medicine that was like milk in his ivy" and "another doctor put a little needle stick in his back near his butt after he was asleep so he would not hurt when he woke up." Based on Justin's self-report of his surgery experience, what three types of anesthesia, in the correct order to his story, did Justin receive?
Local, general, caudal
A herniated disc most commonly occurs in which section of the vertebral column?
Lumbar
Identify the name of the procedure that is an alternative treatment for patients with chronic pulmonary emphysema.
Lung volume reduction surgery
Which of the following operations require general anesthesia?
MVR
Another name for the Cardinal ligament is?
Mackenrodt's Ligament
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 risk reduction strategy should the perioperative nurse employ in preparing for the conclusion of the procedure?
Maintain instrument setup until the patient leaves the OR.
Of the following, which is not a risk factor for the development of postoperative ventral hernias?
Male gender
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?
Malleus, incus, and stapes
Which of the following structures is responsible for division between left and right chest cavity ?
Mediastinum
When elevations in serum calcitonin are found in the patient's blood work, what diagnosis would you suspect?
Medullary thyroid cancer
The lymphatics of the small bowel and portions of the colon are located in the _________.
Mesentary
The peritoneal fold that connects the appendix to the ileum is known as the ____________.
Mesoappendix
What is the correct rationale for not using methylene blue as a skin marker in the neurosurgical OR?
Methylene blue produces an inflammatory reaction in CNS tissue.
Morgan Fairlawn is a 7-year-old female who fell off of the swing at school and landed on an outstretched arm. She is awake and anxious. Morgan is being prepped for surgery to repair her fractured arm. Which of the following is the most commonly used pediatric premedication administered in U.S.?
Midazolam
The most common pediatric premedication given in the U.S. is:
Midazolam
The brainstem is located in the posterior fossa and forms the floor of the fourth ventricle. It is the site of many ascending and descending fiber tracts that allow for communication among the structures of the brain and between the brain and spinal cord. The brainstem consists of what three structures?
Midbrain, pons, and medulla oblongata
Which of the following supplies blood to the transverse colon?
Middle colic artery
What incision is used for lumbar laminectomy?
Midline directly over the appropriate lumbar spines
Of the following, which is not a symptom of compartment syndrome?
Moderate pain
The nasal septum is lined with blood vessels and mucus-secreting cells. The proper name of this lining is the:
Mucoperichondrium
The colon wall has five distinct layers that include the :
Mucosa
Miotics and mydriatics produce opposite effects on the pupil of the eye. Select the most appropriate statement about miotic and mydriatic drugs.
Mydriatic drugs, such as phenylephrine, dilate the pupil.
Which of the following layers of the uterus contains the lymphatics?
Myometrium
Infants and children with severe gastroesophageal (GE) reflux can have life-threatening complications, including obstructive apnea, aspiration pneumonia, esophagitis, and failure to thrive. What is the name of the procedure, performed open or laparoscopically, that is designed to create a competent antireflux barrier?
Nissen fundoplication
Which inhalational anesthetic agent(s) has the fastest onset of induction, emergence, and recovery?
Nitrous oxide
Uvulopalatopharyngoplasty (UPPP) is performed primarily to relieve obstructive sleep apnea (OSA) and snoring. Select two common indications for UPPP surgery.
O2 saturation below 80%, and apnea index worse than 20
The double layer of fatty peritoneum attached to the greater curve of the stomach is known as the ____________.
Omentum
Personnel radiation monitoring is an important part of radiation exposure safety. Select the statement that best describes the proper placement of the personal radiation dosimeter.
On the trunk under the apron and at the collar level outside the apron
The kidneys are highly vascular organs. Approximately how much of the entire circulating blood volume do the kidneys process at any one time?
One fifth
The immature blood-brain barrier and decreased protein binding in infants increase their sensitivity to which group of drugs?
Opioids and hypnotics
Which of the following is the first major branch of the internal carotid artery?
Opthalmic artery
The most accurate method for routine post operative temperature monitoring is via:
Oral
Femoral neck fractures are more common in women than men for which of the following reasons.
Osteoporosis
Which of the following is not included in the terrible triad?
PCL tear
Which duct joins the common bile duct as it enters the duodenum at the hepatopancreatic or major duodenal papilla?
Pancreatic duct
A hernia that involves both a direct and indirect hernia is known as a :
Pantaloon hernia
There are many factors that influence the behavioral manifestations of pain in the pediatric population. Which of the following is not an influencing factor?
Parental involvement
Which of the following pelvic fascias cover the perineum?
Parietal
Of the three salivary glands, which one is the largest?
Parotid
Administration of cyclogyl should be used in caution with which of the following patient groups?
Patients on tricyclics
The largest part of the mammary gland rests on the _____.
Pectoralis major muscle and serratus anterior
Morbidity and mortality may be greater with penetrating trauma because identification of injuries may be more difficult when injuries are less obvious. In the case of an adult victim with a low-velocity, low-caliber gunshot wound, at far range, of the anterior left quadrant of the lower abdomen, what is the MOI and description of the possible injuries?
Penetrating; small entrance wound, puncture of the anterior wall of the sigmoid colon, no disruption of vessels, and bullet not found in pelvis
An interventional radiology procedure used to open a blocked or narrowed blood vessel as a result of atherosclerosis is a(n):
Percutaneous transluminal angioplasty
Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained foreign objects (RFOs). What new and evolving risk reduction strategy could prevent RFOs and frustrating, time-consuming miscount adventures at the end of these procedures?
Performing radiologic surveillance on all conversion procedures at closure
The cranial meninges are composed of all except _____.
Pericranial mater
Identify the layer of connective tissue that covers all bone.
Periosteum
What composes the lining of a herniated abdominal sac?
Peritoneum
Risk-benefit analysis is weighed differently for elders. Important factors that need to be evaluated are:
Personal motivation
The spleen's function in the defense of the body is achieved by:
Phagocytosis
The innermost membrane of of the brain is known as:
Pia mater
If the injury to the patient is a result of a violent crime, the team must give special attention to preservation of evidence during the course of patient care. When clothing is removed from the patient, why must it be placed and secured in a paper bag rather than a plastic bag?
Plastic bags may trap moisture and allow mold growth, destroying evidence.
A complication of thyroidectomy that included an extended thyroid dissection is which of the following?
Pneumothorax
An important anatomic landmark in thyroid surgery is known as:
Poles
Which of the following absorbable suture has the best tensile strength?
Polydioxanone
The gastric veins drain into the ___________vein.
Portal vein
Changes to the elderly person's skeleton, such as the loss of bone mass, contribute to skeletal instability and make fractures of the hip, rib, distal radius, and vertebrae very common. What special intervention will the perioperative nurse provide, in terms of additional attention and care, in one of the following nursing actions?
Position the patient using appropriate padding and joint protection devices.
Infection control and prevention surveillance was underway in the cardiac intensive care unit because of an alarming prevalence of sternal wound infections. On postoperative day 2, a patient developed edema, redness, and purulent exudate that appeared to be isolated to the subcutaneous plane above the sternum. What important criteria must be met to conclusively define this as surgical site infection (SSI)?
Positive diagnosis of the SSI by the surgeon or attending physician
From the following, choose a disadvantage in the use of a shunt during CEA.
Possible dislodging of debris with insertion
Commonly implicated in SAH, the vessels of the Circle of Willis include:
Posterior communicating artery
After retracting the nerve roots during a laminectomy, this structure is incised before getting to the disc.
Posterior longitudinal ligament
The right and left coronary arteries originate in the corresponding sinuses of Valsava which are located ____________.
Posterior to the cusps of the aortic valve
Linda Gardner is highly allergic to latex and the anesthesia provider plans to give Linda prophylactic medications before anesthesia. What medications might be administered to Linda in the preoperative holding area?
Prednisone and a beta-agonist inhaler
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 nursing actions are critical in the rapid preparation for this procedure?
Prep the patient from the suprasternal notch to the mid-thigh.
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?
Presbyopia
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 technique in tumor removal/cancer procedures is to:
Prevent mechanical metastasis
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 nurse perform before Marissa arrives in the OR?
Prewarm the OR to above the ambient high temperature for an adult.
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?
Prognosis and potential for recovery
Which of the following medications should be avoided if a patient has an allergy to fish?
Protamine
What drug can be used to reverse the effects of heparin ?
Protamine sulfate
Allergic reactions to latex range from skin disease to asthma and anaphylaxis that can result in chronic illness, disability, career loss, hardship, and death. What types of signs and symptoms would be indicative of an allergic contact dermatitis response to contact with natural rubber latex?
Pruritus, edema, erythema, and vesicles that develop 6 to 48 hours after exposure
A patient's vital capacity is influenced by which of the following?
Pulmonary disease
Select the semi-invasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function.
Radionuclide imaging
Primary divisions of a nerve are known as:
Rami
The name of the fascia that separates the anterior rectum from the vagina in females is called the:
Rectovaginal fascia
The mesh-plug open hernia repair technique is indicated for which type(s) of hernias?
Recurrent Indirect inguinal hernias
Inadvertent injury to which of the following nerves can result in vocal cord paralysis?
Recurrent nerve
Which of the following is a complication of patellectomy?
Reduced knee extension
Select the nursing activity that would reduce the impact of an extrinsic factor that could cause a pressure injury to the patient.
Removing all but one layer of linen from the dry polymer elastomer gel mattress surface of the OR bed before patient transfer
Morton White, a 68-year-old, ASA PS-2 male with early-stage prostatic cancer, was intubated and positioned for a robotic-assisted laparoscopic radical prostatectomy. The initial position for insertion of the trocars was supine with arms tucked and secured within under-mattress sled arm positioners padded with gel. His hands were placed in a natural position with the fingers wrapped around gauze rolls and touching his lateral thighs. The new anesthesia provider, who had never seen a robotic prostatectomy, was concerned about anesthesia implications when the patient would be repositioned into extreme Trendelenburg for the dissection and anastomosis. The circulating nurse assured her that they would implement protective measures and work together to ensure the best patient outcome. Select all of the potentially harmful effects of extreme 45-degree Trendelenburg in a robotic procedure.
Respiratory compromise and ventilation resistance, shearing
A bunion (hallux valgus) is a soft tissue or bony mass at the medial side of the first metatarsal head. Which of the following is a goal of this surgery?
Restore normal range of motion
Which of the following is correct regarding chromium salt coating on surgical gut suture?
Results in a low tissue reactivity
A type of suture to help eliminate tension on the primary suture line is known as:
Retention
How is the ilioinguinal nerve protected during inguinal herniorrhaphy?
Retract it back along with the external oblique aponeurosis
Of the following ocular blocks, which carries the highest risk?
Retrobulbar block
What kind of needle would be used on the skin?
Reverse Cutting
Luci Edwards, a patient of Dr. Jordan, has been admitted to the PACU after a bilateral bunionectomy. During the hand-off report from the anesthesia provider and circulating nurse, Luci began to awaken, crying in drowsy garbled speech that she was thirsty and wanted water. What would be the perianesthesia nurse's appropriate response?
Review Luci's intake and output and cardiac status, and increase her intravenous flow rate
Which of the following is the treatment for a patient that has a postoperative empyema?
Rib resection
A vena cava filter (Greenfield filter) maintains a patent vena cava but prevents pulmonary emboli (PE) by trapping the emboli at the apex of the device. This procedure may be performed in the OR, radiology suite, or ICU for critical patients. Select the statement that best describes the appropriate preferred insertion approaches.
Right jugular and right femoral
The RNFA should anticipate the surgeon making an incision in which region to gain access to the pancreas?
Right subcostal
A patient presents to the OR with an injury to the anterior chest from blunt force trauma. The RNFA can expect damage to which of the following?
Right ventricle
Norma Hightower, a 32-year-old thin and pale patient with hypothyroidism, is met by the perioperative nurse for her preoperative assessment. The nurse notes Norma's thin frame and pale, fragile skin. Norma states that she is so cold that she has all of her clothes on under her patient gown. Based on her assessment, the nursing diagnosis that the nurse will not focus interventions on is:
Risk for fluid overload
Describe the inguinal ligament.
Runs from the anterior superior iliac spine to the pubic tubercle
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?
Rupture of an unstable atherosclerotic plaque
A 3-year-old is scheduled for a bronchoscopy to remove a penny. What will the nurse anticipate?
Sanders Venturi system, rigid bronchoscope, general anesthetic
The most commonly fractured carpal bone is the :
Scaphoid
Before reaching the rectus abdominis muscle during surgical exposure, the surgeon must first progress through which of the following?
Scarpa's fascia
Which of the following is not included in the breast's sensory nerve supply?
Second and third branches of the brachial plexus
Identify the marginal boundaries of the breasts.
Second to sixth rib and horizontally from the lateral edge of sternum to anterior axillary line
Identify the venous structure that prevents blood backflow.
Semilunar intimal folds
The standard procedure for staging an axillary lymph node -negative patient is:
Sentinel lymph node biopsy
Select the injury or conditions that reflect probable child abuse or neglect.
Severe diaper rash with the presence of ammonia burns.
Select all the injuries or conditions that reflect probable child abuse or neglect.
Severe injuries inconsistent with the history
Many factors have contributed to the evolution and progressive growth of ambulatory surgery. Select the three anesthetic agents that promote fast induction, rapid emergence, and minimal side effects and have been credited as a significant factor in this trend.
Sevoflurane, propofol, desflurane
Select the statement below that best reflects the effects of hypothermia in the perianesthesia period.
Shivering can increase the need for oxygen by 300% to 400%.
A common dysrythmia seen after surgery is:
Sinus tachycardia
Which of the following regarding PMMA ( bone cement) is not an affect local tissue?
Skin burns due to exothermic reaction
Which of the following is a true statement about the use of liquids in the OR?
Skin prepping solutions can cause chemical burns.
Which action best reflects the movement of urine from the renal pelvis to the bladder?
Slight distention of the renal pelvis initiates a wave of muscular contractions.
One source of catgut is _____.
Small intestines of sheep
The Centers for Disease Control and Prevention (CDC) has identified pathogens that could pose a threat to national and world security and safety through bioterrorism. Select the four most probable agents that could be used to cause mass transmission, mortality, panic, and social disruption.
Smallpox, plague, botulism, tularemia
The transverse colon ends at the _____.
Splenic flexure
The transverse colon meets the descending colon at what point?
Splenic flexure
______________ Precautions apply to blood, all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood, mucous membranes, and nonintact skin.
Standard
The bariatric unit was experiencing an alarming rate of postoperative wound dehiscence and evisceration on postoperative day 1, as the patients began to ambulate independently. Select the response below that reflects significant surgical team influence on wound healing.
Sterile technique, wound closure materials, hemostasis methods
During an emergent total open splenectomy on a patient with blunt force trauma to the abdomen, the circulating nurse and anesthesia provider noticed rust-colored urine in the urinary collection container. They had just hung the third unit of whole blood. What nursing action is the first priority?
Stop the blood transfusion.
What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp?
Subgaleal space
Which nodes in the lymphatic system are responsible for drainage from the mouth, lips, and external nose?
Submandibular
Which of the following anesthetics result in fasiculations for the patient?
Succhinylcholine
Which of the following medications is a specific depolarizing muscle relaxant than can produce generalized fasciculations?
Succinylcholine
The rotator cuff consists of which group of muscles?
Supraspinatus, infraspinatus, teres minor, and subscapularis
Metastases to the spine occur most often in the thoracic spine, followed by the lumbar and cervical areas. Select the statement that best reflects a therapeutic spinal procedure goal for a secondary metastatic tumor.
Surgery is directed toward decompressing and stabilizing the spine.
Which statement about surgical dressings is true?
Surgical dressings cushion and protect the wound from trauma and gross contamination, and absorb drainage
There are several risk factors associated with dehiscence. Which of the following can be controlled by the RNFA?
Sutures placed too close together
The physiologic effects resulting from the inhalation of gaseous anesthetic agents and intravenous infusion of anesthetic drugs inhibit several areas of the central nervous system (CNS). The processes by which they occur are explained by several proposed theories. Which of the options describes a plausible anesthetic mechanism of action?
Synaptic transmission of nerve impulses in the CNS is inhibited.
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?
Systemic disease
What type of drainage is placed in the common bile duct after a CBDE is performed?
T-tube
The stapler designed to close the end of a hollow organ is called the:
TA
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?
TEP repair
What mouth structure is considered the boundary between the buccal cavity and the lingual cavity?
Teeth
The cerebellar tentorium supports which structures of the cerebral hemispheres?
Temporal lobe
Which of the following is not included in the group of tendons that comprise the rotator cuff?
Teres Major
In several studies, it was determined that the risk of contamination and subsequent infection to the wearer can be reduced by wearing two pairs of sterile surgical gloves, as opposed to wearing one pair. Select the correct statement that refers to double gloving in terms of a best practice.
The Centers for Disease Control and Prevention (CDC) endorses double gloving for all surgery and invasive procedures.
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?
The TEP technique
Select the statement that best reflects the functional components of the gastrointestinal (GI) tract.
The alimentary canal extends from the mouth to the anus.
A neurologist is about to perform a lumbar puncture on a patient presenting with altered neuro status due to a possible intracranial mass. Why would this procedure be contraindicated?
The change in ICP from the lumbar puncture can result in brain herniation
Samuel Garcia, a 48-year-old tetraplegic with a chronic sacral wound, is scheduled for another wound debridement. What is the purpose of doing a wound debridement on a chronic wound?
The debridement will remove dead tissue that could support infection.
The phrenic nerve innervates which structure?
The diaphragm
Herbal, orthomolecular, individual biologic therapies and special dietary treatments are encompassed in biologically based therapies. Which of the biologically based therapies listed below are classified as therapeutic nutrition?
The diets of Drs. Atkins, Pritikin, and Weil
What does the lacrimal gland do?
The lacrimal gland secretes tears that are drained by the lacrimal sac and duct system.
What important information must be documented and communicated about a drain to the PACU or ICU nurse during hand-off report?
The location and type of drain
What technologic characteristic of robotic surgery provides a superior indication for robotic-assisted laparoscopic cholecystectomy?
The magnified three-dimensional picture may reduce bile duct injuries during dissection
Progressive relaxation techniques, biofeedback, meditation, and cognitive-behavioral approaches have a well-documented theoretical basis with supporting scientific evidence. What is the theoretical clinical justification for this relationship categorized as mind-body medicine?
The mind has the ability to affect the body
Lisa Torentino, a 29-year-old woman, is in the emergency department (ED) with a ruptured appendix. Before the ED nurse and surgical resident transported Lisa to the OR, the nurse called to inform them that Lisa is 27 weeks' pregnant. What special considerations must the perioperative nurse and anesthesia provider address with this new information?
The patient may need rapid induction of general anesthesia, or spinal anesthesia.
Rigo Vegas, a 24-year-old tennis coach, was scheduled as the first case for a knee arthroscopy. He has a family history of anesthesia and surgery complications. He denied any history of allergies, obstructive sleep apnea, or reflux disease. He admitted to eating a cheese steak and drinking 2 cans of beer the night before at 11:30 PM. On attempt at intubation, it was evident that total muscle relaxation had not been achieved. The circulating nurse gently restrained Rigo's arms as he began to move and gag on the laryngoscope. Rigo vomited undigested stomach contents. Intubation was achieved, and a nasogastric tube was inserted and connected to suction. Rigo experienced respiratory distress on extubation and was transferred to ICU with acute respiratory distress syndrome. Based on his preanesthetic history, aspiration could have been prevented by which measure?
The perioperative nurse applying cricoid pressure during induction through intubation
Select the statement about the prostate that best reflects its location, size, and weight.
The prostate sits below the base of the bladder, is 4 cm at the base, and weighs 20 to 30 g.
Impaired nutritional status is highly prevalent among the elderly; as many as 12% of men and 8% of women in the healthy geriatric population are considered undernourished. During the preoperative assessment and interview, what information will the perioperative nurse review, in addition to a thorough assessment including body mass index and Mini Nutritional Assessment?
The serum albumin level
True statements regarding the arterial supply of the spleen are the following EXCEPT
The splenic artery is a branch of the celiac axis
Jan Stuyvesant, a perioperative nurse, 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?
The surgeon was not in contact with the sterile field because he worked from the robotic console.
During a stapedotomy or stapedectomy procedure, the perioperative nurse manages and controls the environment of care by maintaining a quiet, warm, and comfortable OR. Energy modality devices and monitor alarms are turned down to the lowest audible setting for the team to hear without startling the patient. The English-speaking, nonanxious patient sedated using local or MAC anesthetics is well prepared by the perioperative nurse for sensory and procedural expectations. What event occurs near the conclusion of the procedure that predicts patient outcome?
The surgeon whispers softly in the patient's operative ear to determine return of hearing.
Joanne Grizwald, a 24-year-old woman with type 1 diabetes is in end-stage kidney failure, and is scheduled for a combined kidney-pancreas transplant. The circulating nurse has set up the autotransfusion system, verified Joanne's blood type, and crossmatched blood availability. The scrub person, while organizing the sterile back table, identified several instruments that she will not need. She organizes those instruments on the most distant part of the back table. What instruments is the scrub person unlikely to need during this procedure?
The transplant procedure is an open approach and laparoscopic instruments (the insulated electrosurgical-adapted scissors, graspers, and the endoscopic suction tips) are not needed.
During ventriculoperitoneal shunt placement, _____.
The unit is soaked in NS & antibiotic solution, never lubricated.
Bone grafting can be completed using Allografts or Autografts. The type of graft used is not dependent on which of the following factors?
The weight bearing ability of the bone affected
Which of the following is incorrect pertaining to lung segments?
There are 5 segments on the right and 3 segments on the left
What is the mechanism by which the parathyroid glands maintain calcium homeostasis?
They produce a hormone that, with calcitonin, takes calcium from the bones and promotes calcium absorption by the intestines.
Twelve pairs of cranial nerves arise within the cranial cavity. Although they are part of the peripheral nervous system, from a surgical standpoint they are considered part of the anatomy of the head. Which three pairs of nerves, conveniently considered together because of their motor influence on the eye, are subject to toxic, inflammatory, vascular, and neoplastic lesions?
Third, fourth, and sixth cranial nerves
A minimally invasive technique that may be used to remove parathyroid tumors deep in the mediastinum is known as:
Thoracoscopy
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?
Through the pulmonary veins to the left atrium
The most common congenital cyst found in the neck is:
Thyroglossal duct cysts
The most common endocrine problem in the U.S. is:
Thyroid nodule
All staff members are responsible for patient and staff safety. The principle of ALARA, "As Low As Reasonably Achievable," is a protective measure designed to protect both patients and staff. What are the three principles of ALARA?
Time, distance, and shielding
Pharyngeal obstruction is revealed by a history of sleep-disordered breathing. Mouth breathing, snoring, pauses in breathing, restless sleep, waking at night, and enuresis may be related to obstruction. Pharyngeal obstruction may also be caused by recurrent pharyngitis or tonsillitis. Select the procedures that is designed for the relief of pharyngeal obstruction.
Tonsillectomy
Identify the structure that is important for weight bearing, providing strength to withstand stress placed on the bone.
Trabeculae
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?
Tracheal obstruction
Benign or small malignant tumors of the oral cavity may be excised without a neck dissection, though in the presence of diagnosed or highly suspicious metastatic disease, a selective neck dissection may be performed in an effort to control a cancerous growth in the upper jugular lymphatic chain of the neck. The perioperative nurse must be prepared for which additional procedure when head and neck surgery is performed?
Tracheostomy
Shari Donaldson is scheduled for a thyroidectomy. As the RNFA, it is important that stress the the team the importance of having which tray available for this case?
Tracheotomy tray
Acoustic neuromas arise from the Schwann cells of the vestibular portion of the eighth cranial nerve and are benign tumors. What is the postauricular incisional approach that offers the best chance of saving the integrity of the facial nerve?
Translabyrinthine
Wet floors are a common hazard causing slips, trips, and falls (STFs). Select a prevention strategy that is a best practice for preventing STFs from spills on wet floors.
Transport liquids in covered containers with lids in place.
Skin injuries related to shearing occur most commonly as a result of which of the following positions?
Trendelenburg
The adrenal glands can be identified not only by their location in the body but also their shape. The right side is ________while the left is ____________.
Triangular, crescent
An important landmark during perineal prostatectomy is the:
True prostatic capsule
The first diagnostic test performed in thyroid assessment is:
Ultrasound
A surgical patient that presents with an acoustic neuroma will demonstrate which of the following symptoms?
Unilateral deafness
Because herbal products are so readily available and have such widespread media attention, many people think that they can safely self-medicate. Why should the public be aware and educated about dietary supplements and potential harmful effects?
Unknown substances may be present in these products.
Select the positioning device(s) commonly used for bariatric patients prior to intubation.
Upper body ramp
The absence of distinct teniae serves as a visual landmark for what abdominal structure?
Upper margin of the rectum
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?
Upper midline abdominal and Right thoracotomy
Guidelines from WHO focus on which of the following in the prevention of SSIs?
Use of antibiotics
Depending on the surgical defect, head and neck surgical procedures to remove malignant tumors may also involve reconstructive procedures. The wound may be closed primarily, or local flaps and split-thickness skin grafts or full-thickness skin grafts may be used to restore function as well as cover defects. An important role of the perioperative nurse in the ongoing assessment of graft integrity includes which assessment tool?
Use of intraoperative and postoperative Doppler to detect presence of graft pulse
Observing safety precautions during all phases of surgery, from setup to cleanup, reduces the number of injuries and exposures for all OR personnel. For the prevention of sharps injuries during the perioperative phase, which risk reduction strategy reflects appropriate nursing action?
Use standardized sterile field setups throughout the surgical services department.
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?
Use the device according to the manufacturer's directions and test for proper performance before the patient enters the OR.
Weighing sponges is a valuable tool for meticulous calculation of blood and fluid loss when conducted correctly and used in appropriate circumstances. Select the response that correctly reflects the best practice in weighing sponges. Use the following to calculate loss:
Use the following to calculate loss: 1.0 grams = 1.0 milliliters = 1.0 cc.
What special consideration should be made when assessing a pediatric trauma patient for level of consciousness?
Use the modified Glasgow Coma Scale for children.
Postoperative infection in total hip arthroplasty is _____.
Usually catastrophic
Select the appropriate order for administering blood and blood products. Verify informed consent for blood, separate blood bag from identification slips, sign slips, verify identification numbers and expiration dates with second licensed person, verify patient with blood tag and requisition slips.
Verify informed consent for blood, verify patient identification and blood type and unit numbers against blood tag and requisition slip with second licensed person, sign slips.
The Doppler transducer is the most widely used instrument for vascular study. What statement regarding a Doppler is true?
Water-soluble gel is needed when the Doppler is used on intact skin
Celeste Barney and Amanda Vail, two experienced perioperative nurses, are orienting two new surgical technology students to the orthopedic service for their 6-week clinical rotation. Today they are focusing on how to properly wear, care, and handle lead aprons and protective radiologic apparel. Of the list of orientation content topics, which are considered risk reduction strategies for protection from inadvertent radiation exposure?
Wear lightest apron available that meets shielding requirements.
Frances, a 68-year-old retired art dealer is overweight due to a sedentary lifestyle and has chronic joint pain in both knees and hips. She does not have osteoarthritis per medical history and is not a candidate for surgical intervention. Which of the following is an important statement regarding the prevention of degenerative orthopedic conditions?
Weight-bearing activities and joint movement prevent cartilage from becoming thin or damaged
To protect the forearms, hands, and clothing from contacting bacteria on the outside of the used gown and gloves, members of the scrubbed surgical team should use the following procedure to remove soiled gowns and gloves. Which choice lists the appropriate first 3 steps in the removal of the sterile gown?
Wipe gloves clean, untie side gown closure, grasp gown at one shoulder seam
Cleft lip is usually associated with a notch or cleft of the underlying alveolus and a cleft of the palate. Cleft lip repair is most often performed when the infant is about 3 months of age. Cleft lip is described as:
a deficiency of tissue (skin, muscle, and mucosa) along one or both sides of the upper lip
Select the true statement that best describes a key component of the culture of safety in regards to blood exposure.
a goal of the culture of safety is to reduce the risk of blood exposure and sharps injuries to staff
Ductal ectasia is a benign breast disorder that is difficult to distinguish from cancer, primarily because it presents with:
a hard and irregular mass, nipple discharge, and enlarged axillary nodes.
Which of the following factors might the RNFA recognize as having the potential to produce pressure?
a self-retaining retractor post clamped to the OR bed rail and tightened against the patient's side
The pyramidal lobe of the thyroid is described as:
a thin upward protrusion of thyroid tissue from the isthmus.
Surgical instruments that do not fall under the category of clamps, retractors, or cutting instruments, but are used in most procedures, are typically included within the category of:
accessory and ancillary instruments.
Terminal cleaning and disinfection of the operating room should be done _____.
after each procedure
Women of high socioeconomic status and higher education also have a high incidence of breast cancer, most likely due to:
age at first birth
The final step, after decontamination and before sterilization, is the prep, pack, and wrap process. The sterile processing technologist has taken the laparotomy set from the washer/decontaminator to prepare for sterilization. Select the most appropriate order that the instrument set must travel before reaching the steam sterilizer.
air-dry, inventory, inspect, lubricate, assemble and string instruments, wrap and tape
Marvin Deloitte, a 19-year-old male, received an intravenous peripheral nerve block (PNB/Bier block) for an ORIF of an ankle fracture. The anesthesia provider injected a distal dorsal vein of Marvin's right foot with 2% lidocaine, after placing a single cuffed pneumatic tourniquet circumferentially around Marvin's upper right thigh. The surgeon looked through the OR window to check on anesthesia progress as he scrubbed at the sink outside of the OR. The circulating nurse had the leg elevated and was prepping the ankle. The surgeon noticed that the cuff seemed to be deflating and that the anesthesia provider was turned away from the patient. The circulating nurse also noticed the movement under the protective towel placed over the cuff, and saw the tourniquet tubing fall to the floor. The nurse's first response should be to:
alert the anesthesia provider, reconnect the tubing to cuff and inflate, and send the surgeon for the code cart
Shawna Bolten, a perioperative nurse, relieved the circulating nurse in OR 5 where they were about to begin a circumcision on a 17-year-old patient under general anesthesia. After she received the hand-off report from the circulating nurse, she noticed an empty vial of lidocaine 1% with epinephrine 1:100,000 by the computer. During the hand-off report, the scrub person showed her the medication cup on the sterile field and labeled "lidocaine 1%." The scrub person had drawn up 10 ml in a syringe to hand to the surgeon for a penile block. Shawna's immediate response should be:
alert the team that lidocaine with epinephrine was accidentally placed on the back table
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. 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/an:
allograft
Following a heart attack you tell a patient that he now has a myocardial infarction. You explain this as:
an area of his myocardium that has irreversible damage
The thoracic cavity is an airtight compartment. The lateral walls are formed by 12 pairs of ribs. Each hemithorax contains 11 external intercostal muscles and 11 internal intercostal muscles. What accompanies each intercostal muscle?
an artery, vein, and nerve
Surgically created arteriovenous fistulas are also referred to as a(n) _________ and are indicated for enabling __________.
arteriovenous shunt; hemodialysis
A type of monofilament suture that does not require the user to tie knots is known as:
barbed
The circulating nurse received a call from the emergency department and called sterile supply to assemble the instruments for an abdominal trauma case with possible aortic rupture. When the cart arrived, she saw the vascular set; however, the most important instrument set was missing. What important instrument set was needed for this procedure besides the vascular set?
basic laparotomy set
Abdominal aortic aneurysms (AAAs), which account for most aneurysms, occur primarily in what area?
between the renal arteries and the aortic bifurcation
Susie Reynolds, a 9-year-old softball player, has arrived in the OR for emergency repair of superficial facial and deep arm lacerations when she ran into the chain link fence during practice. The perioperative nurse discovers that Susie has an insulin pump that should remain connected during the short procedure. The RNFA should consider which of the following options for energy-generated hemostasis?
bipolar electrosurgery unit
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:
bloody
The instrument tips in laparoscopic instruments are designed to produce the same tissue effects as a traditional instrument used for open surgery. Because of the process challenges of the laparoscopic approach, it is time-consuming to insert and withdraw instruments repeatedly during the procedure. Instrument manufacturers have attempted to make their products efficient by combining functions. An appropriate combined function for a laparoscopic instrument would be:
blunt dissection with the smooth, rounded edge of the closed endoscopic scissors
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:
brachial plexus injury.
The light transmission through an endoscope is achieved by way of:
bundles of fiberoptic glass rods
Sara Gardiner is the perioperative nurse in the circulating role in OR 2, and is planning for her three neurosurgical procedures for the day. She is explaining the basic processes of the three procedures to the scrub person and double-scrubbed surgical technology student: (1) a VP shunt insertion, (2) a reconstructive craniosynostosis for an infant with severe deformity, and (3) exploration of a severe head injury with increased intracranial pressure (ICP) to evacuate a hematoma and possible brain tissue. To give the brain room to swell in the third procedure, the bone flap may need to be sterile-wrapped and stored, for later replacement. Sara asks the student to name the appropriate surgical approach to the brain for each of the procedures. She expects the correct sequence to be:
burr hole, craniectomy, and craniotomy.
A basic anesthesia monitoring device that is used during general anesthesia to confirm successful endotracheal tube placement and determine the presence of gas exchange is the:
capnometer/end-tidal CO2 monitor to identify expired CO2 in the breathing circuit
The salivary glands produce saliva, which serves to moisten the mouth and initiate:
carbohydrate digestion.
Which of the following structures form the mouth?
cheeks, the hard palate, the mandible, and the tongue
Closed thoracostomy will require:
chest catheters and water-seal drainage
Which of the following documentation requirements is unique to vascular surgery?
clamp application and removed times
During the preoperative assessment and teaching for a patient scheduled for otolaryngologic surgery performed using local anesthetic, the perioperative nurse reviews with the patient normal coping mechanisms that are personally effective and supports and encourages the patient during the surgical intervention. The nurse is preparing the patient to anticipate and self-control physiologic indicators of:
claustrophobia.
Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral, and ______ nerve, which can result in injury from ______.
common peroneal; Direct compression from the stirrup bars
Upon neurological examination, you notice an abnormal pupillary light reflex in a patient's right eye. Which of the following is consistent with this sign?
compression of the oculomotor nerve
The external ear, which includes the auricle (or pinna) and external auditory canal, is composed of cartilage covered with skin. The primary function of the auricle is to:
concentrate and conduct incoming sound waves into the external auditory canal.
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:
conducting regularly scheduled team simulations that rehearse an airway fire protocol.
Malignant hyperthermia (MH) is a rare, multifaceted syndrome with an increased incidence in individuals with central core diseases such as:
congenital myopathies
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.
congenital; acquired
A minimally invasive video-assisted thyroidectomy (MIVAT) procedure relies on Miccoli instruments added to the standard thyroid or neck dissection setup, a 30-degree endoscope, and an ultrasonic (harmonic) scalpel with scissors to ligate and divide the vessels. An important risk reduction strategy for any minimally invasive procedure would be ?
consider and plan for the possibility of conversion to open thyroidectomy.
A reverse cutting needle is preferred for ___________suturing.
cutaneous
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:
decreased pulmonary compliance and functional residual capacity.
From the following, which is a possible benefit to the paramedian incision?
decreased risk for hernia
Jacob Sutzkever is a 62-year-old man who had surgery 6 days ago for a ruptured diverticulum. He is back in the OR for a debridement and washout. Jacob's fever has subsided and the drainage is clear. The surgeon will continue with wet to dry dressings and schedules Jacob to return to the OR in 3 days for:
delayed primary sutured closure
The strength layer of the skin is found in the _____.
dermis
Norma Miller, a 49-year-old long-distance runner with dysfunctional uterine bleeding, was scheduled for a hysteroscopy. During the procedure, sterile saline was used to expand the intrauterine compartment and enhance visualization. The perioperative nurse meticulously monitored fluid use and documented infiltration to the uterus and fluid collected as drainage from the uterus. The perioperative nurse was concerned that approximately 500 ml of fluid was unaccounted for and alerted the surgeon. The nurse's motive for this surveillance was to:
determine the potential for intravasation
Evelyn Pettigrew is a 67-year-old former competitive track athlete with debilitating osteoarthritis; she is scheduled for a laparoscopic-assisted vaginal hysterectomy (LAVH). During the preoperative assessment, Evelyn tells the first assistant that, while she is in excellent health for her age, her hip and leg joints are tender and her movement is limited. The first assistant explains to Evelyn that during the procedure she will be "up in stirrups" but will be handled gently and protected from further discomfort. An appropriate first assisting action, after Evelyn is transferred to the OR bed and before anesthesia induction, is:
discuss nonlithotomy leg positioning options with the surgeon.
When creating a vascular or intestinal anastomosis, the surgeon will typically suture one half of the anastomosis with one half of the suture and the other half of the anastomosis with the other half of the suture. This technique minimizes the drag and wear on the suture material and needle. The correct name for this type of suture and needle is:
double-armed
Denise Corson, a 35-year-old mother of twins, was scheduled for a left breast lumpectomy. This is her third lumpectomy in 6 years for benign fibrocystic disease. Denise shared her concerns with the perioperative nurse about her breast's appearance after three similar surgeries in the same breast. The nurse noticed, on assessment, how much smaller the left breast was in comparison with the right. An appropriate action for the nurse to take in response to Denise's concern would be:
encourage her to discuss her feelings regarding body image and resulting changes.
The primary function of the three thyroid hormones is to regulate:
energy metabolism.
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:
epiphyseal plate.
The design of laparoscopic instruments aims to provide a clamping, cutting, dissecting, electrocoagulating, suturing, or stapling instrument on the tip of a shaft that is long or short enough to reach the target tissue. The hand control on the surgeon's end of the instrument is engineered to provide:
ergonomic comfort and control
The safest practice for passing sharps and instruments during the procedure is to:
establish a neutral zone or separate area to place reusable sharps
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:
estrogen and testosterone.
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.
eustachian tube; nasolacrimal duct
Aubrey Scheel, a 37-year-old physically active male, is getting dressed to return home from the emergency department (ED) after he experienced a large, tender bulge in his scrotum while straining at the toilet. The emergency physician reduced Aubrey's indirect inguinal hernia and referred him to a general surgery practice for elective herniorrhaphy. The ED nurse prepared Aubrey for his discharge. An appropriate nursing intervention by the ED nurse would be to:
explain the signs and symptoms of an incarcerated hernia and appropriate action.
The roof of the inguinal canal consists of the _________________while the __________________makes up the major support for the floor of the inguinal canal.
external oblique aponeurosis; transversalis aponeurosis and fascia
Risk factors for PONV should be assessed preoperatively. Which of the following is a risk factor for PONV?
female gender
The hypogastric plexus innervates the:
female pelvis
The most likely reason for avascular necrosis in an 80-year-old woman following hip fracture is that the:
femoral neck fracture
When unexpected events occur that have, or could have, compromised patient safety, a systematic investigatory process takes place. Significant information is gained through this meticulous exploration. The primary motive for carrying out a root cause analysis is to:
find out what needs to take place to prevent a recurrence of the event.
Positive-pressure air handling systems with unidirectional flow of non-recirculated air from the ceiling to the floor are designed to:
flow clean air over the patient and prevent corridor air intake
Hypothermia is a common side effect of surgery and the perianesthesia setting. The most common and effective method to prevent hypothermia is through the use of:
forced air-warming blankets
The trigone of the bladder:
forms the base of the bladder
The perioperative nurse visited Mr. Jennings in the ICU the next day and noticed abrasions on his elbows. Mr. Jennings told her that the ICU nurses had difficulty pulling him back up in bed every time he slid down toward the bottom and he was not able to be much help in moving himself. This skin injury was probably the result of which physical force?
friction from his elbows rubbing over the sheets when slid up in bed
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:
from birth onward, the child is in a continual state of development and physiologic change
An example of a potential risk associated with pneumoperitoneum would be:
gas embolus into an exposed blood vessel during the procedure.
David Reese, a 14-year-old patient with marked scoliosis, is in prone position with gel rolls, gel pads, and pillows for a spinal fusion. Before the skin prep is begun, the perioperative nurse should check the positioning for pressure areas of the:
genitals, knees, toes, and eyes
Qualities of an effective packaging material must include these key characteristics. Select the correct statement that includes the most important qualities for packaging material.
good sterilant penetration and air removal, microbial barrier, aseptic presentation
Microsurgical techniques have been applied to cranial, spinal, and peripheral nerve operations. Some procedures in which microsurgery is of value are explorations of the posterior fossa, especially for tumors of the fourth ventricle or cerebellopontine angle, and removal of small acoustic neuromas, with resulting preservation of the facial nerve. Each time the surgeon must look away and then back to the surgical field, open wound time and anesthesia time are increased while the surgeon becomes reoriented to the field. A nursing action, in the scrub person role, directed toward assisting the surgeon in efficiency and expediting the microsurgical procedure would be:
hand instruments proficiently, in direction of use, without delay.
An instrument that is used to occlude a vessel is known as:
hemostat
The functional units of the liver are the lobules. The functional cells of the liver are the ______________ which manufactures _______________.
hepatocytes; bile
An example of a common postoperative complication related to inguinal hernia surgery is:
hernia recurrence
The Shouldice repair is utilized in _____________surgery and has a ___________recurrence rate.
hernia, low
The renal artery and vein enter and exit the kidney on the medial side of the organ through a concave area known as the:
hilum
An important area of the brain that is critical for learning and memory is the ___________, while emotion and social behavior are regulated by the ____________.
hippocampus; amygdala
The nursing research and practice committee searched the scientific literature for information on smoke evacuation, as they planned for a unit-wide initiative to use this safety measure on all procedures where smoke or plume is generated. Their main concern is that the surgeons will not be as willing to comply as the staff. Select the safety measure that will be the most critical and most challenging to enforce.
hold the smoke evacuation suction tube close (<1 inch away) to the tissue interaction site to remove as much plume as possible
The OR was trialling a new insufflation system and the vendor representative was out of the room taking a phone call. The perioperative nurse was concerned that the flow rate was well above 14 L/min and the pressure had risen to 16 mm Hg. She alerted the surgeon and reduced the rate and pressure because she feared that the elderly patient was at high risk for:
hypercarbia
Which of the following is not an event that would adversely affect the pulse ox reading?
hypertension
Emma Clements, a frail 92-year-old, was positioned in lithotomy for a 90-minute rectal procedure under spinal anesthesia block (SAB). At the end of the procedure, when the circulating nurse and surgeon gently removed her legs from position and placed her in supine position, she experienced a common side effect of spinal anesthesia, ____________.
hypotensive episode
A number of screening tools have been developed to accurately establish biologic age. One tool, the Comprehensive Geriatric Assessment (CGA), is a multidimensional evaluation that scrutinizes medications, functional ability, co-morbid conditions, cognitive ability, mental function, nutritional status, and socioenvironmental factors. In geriatric medical studies, the CGA has been valuable in providing a metric for describing healthy aging and:
identifying at-risk individuals.
When laryngoscopy, bronchoscopy, and esophagoscopy are performed in a single session on a patient, the procedure is termed triple endoscopy or panendoscopy. The purpose of triple endoscopy is usually diagnostic. A critical role of the perioperative nurse during this complex diagnostic procedure is that of:
identifying, containing, and labeling all specimens accurately.
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 not prompt the surgeon to perform a neck dissection for benign or small malignant tumors?
increased salivation
James Romano, a 68-year-old retired school teacher, presents for surgical intervention of recently diagnosed bladder cancer. He states the cancer is located in the urothelial layer. As the RNFA, you realize this is ___________layer of the bladder.
inner
A saphenous cutdown refers to a skin incision associated with:
insertion of a cannula into the external iliac vein
The intracorporeal suture technique uses the suture-tying process analogous to the:
instrument tie
A stitch that is tied and cut before placing another stitch is called _____.
interrupted
From the following, choose the correct statement regarding closed gloving.
it can only be used for the initial gloving
In the past, MH mortality ranged up to 80%, but the immediate infusion of dantrolene (Dantrium) and proper treatment have reduced the death rate to about 7%. What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis?
it is a skeletal muscle relaxant
The lateral kidney position allows approach to the retroperitoneal area of the flank. To render the kidney region readily accessible, the ______ is raised, and the bed flexed so that the area between the twelfth rib and the iliac crest is elevated. Compression of the _______ can occur when the flank is raised too high.
kidney bridge; vena cava
While assisting in an anterior thigh free flap procedure, the surgeon asks where the perforating vessels arise from. Choose your reply from the following.
lateral circumflex artery
In addition to health care workers in surgery, emergency care, and obstetrics, children with spina bifida and persons needing indwelling catheters seem to have a common risk factor for allergy development to which of the following?
latex
The mitral valve is anchored to the _________________wall.
left ventricular wall
Of the following, which is the point of insertion for the ileopsoas muscle ?
lesser trochanter
Suture can be used for more than repairing tissue. Choose uses of suture from the following.
ligate, suture, and close tissue.
Latex allergy reaction is best prevented by:
limiting exposure to latex
When a patient absorbs an unsafe amount of local anesthetic into the bloodstream, a catastrophic outcome is possible. Treatment for LAST includes the use of which of the following?
lipids
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____________.
lower half of the common bile duct; pancreatic cancer
The palatine and lingual tonsils are situated in the oropharynx, while the adenoids are located in the nasopharynx. Both adenoids and tonsils consist of:
lymphoid tissue.
OR personnel can reduce their exposure to ionizing radiation by:
maintaining the greatest practicable distance from the ionizing source
Select the positioning device commonly used for positioning the head during neurosurgical procedures.
mayfield head positioner
Which of the following is not an advantage to the use of silk suture?
memory
Lasers assist in vaporization of scar tissue, granulomas, and cholesteatomas without damaging surrounding tissue and may be used for select otolaryngologic procedures. Lasers can be secured to the operating microscope and laser energy delivered to the tissue by means of a:
micromanipulator.
Acquired valvular heart disease most commonly affects the ____________valves. Choose the correct answer.
mitral
Much like the adult population, many traditional "open" pediatric surgical procedures are being replaced by minimally invasive surgery (MIS) procedures. Because the field of pediatric MIS is relatively new, surgeons are at an advantage because they are able to combine virtual reality techniques and robotics with the most current technology and instrumentation. Select the procedure not commonly performed via MIS technique on pediatric patients.
mitral valve repair
When catheterizing the female patient the perioperative nurse must locate the urethra. The correct order of the external organs of the vulva listed anterior to posterior is:
mons pubis, labia majora, labia minora, clitoris, urethra, vaginal opening
When catheterizing the female patient, the perioperative nurse must locate the urethra. The correct order of the external organs of the vulva listed anterior to posterior is:
mons pubis, labia majora, labia minora, clitoris, urethra, vaginal opening.
Nasal polypectomies are typically performed endoscopically with the use of microdebriders, which remove the polyps by their mechanism of _______________ the polyp and suctioning the tissue.
morcellating
Hypotension is a blood pressure reading that is 20% less than the patient's normal baseline pressure. Hypovolemia is the most common cause of postoperative hypotension; however, hypotension may also be caused by cardiac dysfunctions. Which of the following cardiac conditions will present with hypotension?
myocardial infarction, myocardial tamponade, and pulmonary embolism
The part of the femur that is most susceptible to fracture in conjunction with osteoporosis is:
neck.
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:
necrotic bowel.
The area between the surgeon and scrub person designated for passing sharps safely is referred to as the:
neutral zone
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. The most difficult aspect of revision surgery is that there is:
no clear-cut sequence of events.
What is similar in patient teaching about postoperative care for both endovascular aortic aneurysm repair and abdominal aortic aneurysm resection?
no lifting of more than 5 lb for 6 weeks
Which of the following statements reflects the location of the arcuate line?
one third of the distance between the umbilicus and the symphysis pubis
Which of the following is a risk factor associated with unplanned hypothermia?
open cavity surgery
Matthew Ryan, a 9-year-old boy, is admitted to the emergency department for a sledding accident, when he lost control of his sled and crashed into a tree. He is pale and in pain; his abdomen is tender and firm to palpation. The CT scan suggests rupture of the spleen with internal bleeding. Matthew's scheduled surgery will most probably be a/an:
open total splenectomy.
A stapedotomy is removal of the stapes superstructure and creation of a fenestra (opening) in the fixed stapes footplate for treatment of abnormal bone growth around the footplate that results in its immobility. The patient scheduled for a stapedotomy will typically not have a surgical diagnosis of:
otosclerosis.
While tucking the arms at the sides of the patient in supine position offers comfort, safety, and easy access to the patient by the scrubbed team, improper positioning and securing of the arms can result in significant injury. Injury can be avoided by tucking the draw sheet _____ the arm and under the ______.
over; body
Young children are predisposed to parasympathetic hypertonia (increased vagal tone), which can be induced by:
painful stimuli such as eye surgery or abdominal retraction.
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:
pedicle-based flap
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:
perforation of the tympanic membrane.
Luanne Williamson, a 39-year-old, 248-lb mother of 4 children, is assisted with transfer from a transport vehicle to the OR bed for laparoscopic cholecystectomy, operative cholangiogram, and possible common bile duct exploration. The perioperative nurse determined that Luanne is at risk for positional injury related to her size and the positional requirements and OR bed manipulations required for this procedure. An appropriate nursing implementation for positioning this patient would be to:
place two safety belts over the thighs and lower legs to prevent the patient from sliding out of position when the surgeon tilts the table for better exposure and access, and place a positioning lift under the lower right side of the chest to elevate the lower rib cage for exposure and access to the viscera in the right upper quadrant of the abdomen.
The ideal suture material is one that has handling characteristics such as:
pliability
The splenic vein drains into the:
portal system
Somatosensory evoked potential (SEP) monitoring is most often employed during which type of surgical procedure?
posterior spinal fusion
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:
prepare inspired air for 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:
prevent hypocalcemia and its complications.
Heparin sodium is an anticoagulant. The basic mechanism of heparin's action is best described as:
prevents the conversion of fibrinogen to fibrin.
An example of an indication for liver transplantation would be:
primary hepatic cancer
An example of antithyroid drugs that would be administered during a thyroid storm crisis would be:
propylthiouracil and methimazole
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 a nursing action(s) to reduce the risk of thyroid storm is:
provide a quiet, calm atmosphere and help the patient relax, and provide comfort measures, including a cooling blanket.
Two monitoring techniques used by anesthesia that have improved morbidity and mortality include:
pulse oximetry and capnography
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:
rapid, disorganized bone remodeling.
The perianesthesia nurse completes a systematic and comprehensive secondary assessment of the patient (e.g., head-to-toe assessment or major body systems' approach). Select the response that best reflects the parameters of a comprehensive respiratory assessment.
rate, rhythm, and breath sounds
Denise Michaelson, a 46-year-old woman with an early-stage second primary cancer in her left breast, has elected to have a bilateral mastectomy with saline implants. She has requested that the surgeon also revise a small unsightly scar on her right knee and pierce her ears. The saline implant insertion surgery is considered a _______________ procedure, the scar revision is considered a ___________ procedure, and the ear piercing is considered a _______________ procedure.
reconstructive, cosmetic and cosmetic
The external ear canal lining is protected and lubricated with cerumen (earwax), which traps foreign material and:
reduces bacterial levels in the outer ear.
If a sterile glove becomes contaminated during the procedure, the best practice for corrective action is:
reglove with assisted gloving technique
A function of nasal turbinates is to:
regulate the temperature of inspired air.
Nancy Gallo returns back to work in a busy OR tomorrow after a 3-week vacation. She is certain she will be assigned to scrub in cardiac surgery in the morning. Select the infection prevention measures she must accomplish before she returns to the OR.
remove nail polish and jewelry and cut her nails to 1/4 inch past her finger tips
During the planning phase of a procedure for liposuction or post-bariatric contouring procedures, the perioperative nurse will assemble and organize supplies and devices because the procedure may require:
repositioning one or more times during surgery.
Ketamine is a short-acting induction and IV or IM maintenance agent. Patients are able to maintain their airways. It is a suitable agent to use with small children and burn patients. The concern with this agent is that in large doses it may cause:
respiratory depression
Steven Morganstein, a 51-year-old male with hepatobiliary disease, is scheduled for surgery. The perioperative nurse, during the preoperative assessment, questions and examines the patient for signs and symptoms of jaundice, petechiae, and lethargy and:
reviews his chart for bleeding and coagulation times and the platelet count.
Upon examination of a patient with a knife wound to the right side of her neck, you observe that the patient has weakness turning her head to the left against resistance and has a drooping right shoulder. Your diagnosis is injury to the:
right spinal accessory nerve.
Sandra Williams was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled vaginal-assisted laparoscopic hysterectomy. She demonstrated and verbalized that she understood all of the tenets of the procedure, risks, expected outcome, complications, and procedural process. Before she signed the consent form, she informed the surgeon that she did not want any medical students or surgical residents performing any parts of the procedure other than assisting and did not want any photographs of her body taken. The surgeon agreed and she crossed out those portions of the form and initialed them before she signed. Sandy was exercising her:
right to informed consent
Of the following choices, which would not not be a consideration for choosing suture?
scrub person preference
The IXth cranial nerve provides which of the following?
sensation to the tonsils
In renal transplantation a kidney with __________ artery(ies) is preferred.
single
Which one of the following signs is not consistent with Horner syndrome?
sinking of the eye (enophthalmos)
During a surgical procedure to excise a malignant thyroid gland, the surgeon asks you why she is not removing the posterior part of the patient's thyroid gland. Your correct response is:
so that the patient does not develop hypocalcemia
The instillation of a local anesthetic into the subarachnoid space is termed:
spinal anesthesia
The scaphoid, also called the navicular, links the proximal row of carpal bones as it:
stabilizes and coordinates the movement of the proximal and distal rows.
Surgical site infections (SSIs) are most often caused by gram-positive cocci and may arise from the patient's own endogenous sources. The most frequently identified microorganism cultured from SSIs is:
staphylococcus aureus
The evening before the procedure was scheduled, the central sterile processing department received two complete sets of an orthopedic spine fusion system that contained titanium-implantable instrumentation, four flexible coated retractor blades, and a sterilized internal paper inventory form. The sterilization instructions provided by the vendor representative recommended steam sterilization for the implants, but stated that the flexible coated blade retractors could not be exposed to temperatures higher than 220° F. The appropriate sterilization option for these instruments and devices would be:
steam sterilization for the implant sets and paper inventory form, hydrogen peroxide gas plasma for the retractors, wrapped separately.
Dermatomes are used for removing split-thickness skin grafts (STSGs) from donor sites. The perioperative nurse preparing for a procedure where STSGs will be taken to cover several large burn areas will need to have available:
sterile mineral oil, tongue blades, and a mesher dermatome.
Laryngospasm is a common but serious complication in the immediate postoperative pediatric tonsillectomy and adenoidectomy patient. What is the ideal immediate and last resort response by the anesthesia provider or perianesthesia nurse in an emerging patient who has been in spasm for over 1 minute, is not responding to positive-pressure ventilation, and is in significant distress?
suctioning, IV succinylcholine administration, and reintubation
The surgical hand scrub is designed to render the hands, nails, and arms:
surgically clean
Which of the following will the perioperative nurse be sure to have when setting up the back table for a mediastinoscopy?
suture and needle holders
The manufacturing process of permanently connecting the suture thread to the needle is known as:
swaged
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:
the anatomy and biology of tissue
Which members of the surgical team can be held liable in litigation for retained foreign bodies?
the entire team
Sara was positioned, prepped, and draped following general endotracheal anesthesia induction. The team assembled around Sara and the sterile field to perform the time-out as described in the WHO surgical checklist. Successful employment of the time-out can only be ensured when:
the entire team stops and focuses attention together
After prepping the face, neck, and upper chest for a radical neck dissection, the protective towels around the prep site were removed. The RNFA applied the head drape and completed draping the patient. During the preincision surgical time-out, the fire risk score was determined to be high. When the surgeon noticed an area on the neck that did not look prepped. She asked for prep solution on a sponge and sponge forceps to complete the prep area, taking care not to moisten the head drape. After handing off the used sponge forceps she asked for the scalpel. What step was omitted in this process?
the new prep area was not given time to dry
Open common bile duct (CBD) exploration may be indicated in some cases where:
the patient has undergone prior biliary surgery.
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:
the recipient site develops a new blood supply from the base of the wound.
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:
thyroid cancer.
Miriam Glass is a 78-year-old female scheduled for compression nail insertion of a left fractured hip. She was positioned for a spinal injection to induce spinal anesthesia. During the process, the anesthesia provider inadvertently inserted the spinal needle into the subarachnoid space, not noticing the error until the entire syringe of lidocaine was emptied into the patient. Miriam immediately experienced rapid onset of hypotension, bradycardia, and apnea. Miriam's unintentional condition is called _______ and now must be managed with ________.
total spinal anesthesia; general endotracheal anesthesia
The gold standard for treating sleep apnea with obstruction is which of the following?
trachostomy
The RNFA instructed the new anesthesia resident in the proper positioning of the arm and hands on the OR bed armboards. The resident was cautioned to avoid pressure on the elbow to prevent:
ulnar nerve injury
OSHA requires all healthcare organizations protect their workers from exposure. The exposure control plan must include which of the following?
universal precautions, PPE, and recordkeeping
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:
using long instruments through a regular thyroid incision.
The ability to maintain thermoregulation is compromised in elders because of changes in the:
vascular system
What type of bleeding is more difficult to control and why?
venous because veins have thinner muscle layer
While Fowler's position offers the best respiratory excursion for the patient, the patient is at higher risk for _______ because of dependent pooling in the hips and legs.
venous thromboembolism (VTE)
The scrub person was precepting a surgical technology student an orthopedic case. The scrub person explained the importance of keeping the instruments free of blood and bioburden during the procedure and demonstrated the best practice and how to:
wipe the instruments with a sponge moistened with sterile water after each use.
