Surgical procedures End of Chapter
True or False Central venous pressure measurements require that a central line be places
True
True or False The edges of all sterile packages are considered nonsterile
True
All of the following are goals of balanced anesthesia except a. maximize the effects of certain drugs b. minimize the side effects of certain drugs c. minimize the likelihood of allergic reactions d. maximize cardiac depression
c. minimize the likelihood of allergic reaction
What can be done to help prevent a deep chested dog from tilting to the side while in dorsal recumbency a. using a v trough b. bracing the chest with sandbags c. tying the forelegs crossed over the chest d. all of the above e. none of the above
d. all of the above
What items should be located in the scrub area/room a. hair clippers b. scrub sink c. autoclave d. table/counter to hold open gown packs e. answers b, c, and d
e. answers b, c, and d
For which of the following is the surgical assistant responsible a. monitoring the patient b. maintaining sterility c. maintaining homeostasis d. all of the above e. both b and c
e. both b and c
Which of the following is true regarding positioned patients of the surgery table a. the particular position of the limbs is insignificant because the patient is anesthetized and cannot feel any pain that might be associated with awkward positioning b. bony prominences should be cushioned to protect against excessive compression c. the patients legs should not be forced into unnatural anatomic alignment d. all of the above e. both b and c
e. both b and c
What are some safe techniques for preventing hypothermia in small animal surgical patients a. circulating warm water pads b. electric heating pads c. snuggle safe discs d. all of the above e. none of the above
e. none of the above
Which of the following statements is true regarding the sterile field a. only scrubbed in personnel need to know what is sterile and nonsterile b. only the circulating nurse needs to keep track of what is sterile and nonsterile c. excessive talking and movement among scrubbed in personnel are acceptable, but not among non scrubbed in personnel d. all of the above e. none of the above
e. none of the above
True or False All procedures should be performed in the surgery room whether they are considered "clean" or "dirty"
False
True or False Anesthesia (as provided by gas anesthetics) provides multimodal analgesia
False
True or False Anticholinergics, such as glycopyrrolate and atropine, increase the heart rate and provide purely beneficial effects for the patient
False
True or False Chlorhexidine scrub or solution can be used as the final, sterile surgical paint
False
True or False For orthopedic surgeries of the extremity, only the side of the limp to be incised needs to be clipped and prepped
False
True or False Going into surgery with an empty stomach is the best way for the surgical nurse to avoid experiencing nausea and hypoglycemia if the procedure is unexpectedly long
False
True or False It is acceptable practice for the circulating nurse to reach over the sterile field if required to assist the surgeon or surgical assistant
False
True or False It is recommended that all nonscrubbed personnel wear long sleeve laboratory coats in the surgery room
False
True or False Jewelry and long fingernails are protected by the sterile gloves worn by the scrubbed in surgical personnel and therefore do not need to be removed (jewelry) or cut (nails)
False
True or False Prophylaxis antibiotic therapy should be administered to all surgical candidates
False
True or False Rubbing or wiping a "bleeder" with a gauze square is the best means of maintaining hemostasis
False
True or False Strikethrough renders surgical drapes "sterile proof" and therefore drapes affected by strike through cannot become contaminated under any circumstance
False
True or False The Gelpi retractor is a handheld retractor that is frequently used in orthopedic surgery
False
True or False The best drape material is 200 thread count linen
False
True or False The surgery room needs to have easy access, so doors should not be placed between surgery rooms and scrub or prep areas
False
True or False When scrubbing the skin of the intended surgical site, suficient friction should be generated to cause hyperemia
False
True or False If unscrubbed personnel enter or touch the sterile field, it is no longer considered sterile
True
True or False Movable equipment (i.e. equipment that is not permanently affixed) in the surgery room should not leave the surgery room
True
True or False Peripheral catheters generally suffice for short term use (1-3 days), and central lines are more appropriate for long term vascular access (>3 days)
True
True or False Surgery rooms should be cleaned daily whether they are used or not
True
True or False The Allis tissue forceps is considered a traumatic type of forceps
True
True or False The Balfour retractor is a self-retaining retractor that is frequently used during abdominal exploratory procedures
True
True or False The air pressure in the surgery room should be greater than that in the rest of the hospital to reduce the influx of bacteria into the surgery room
True
True or False The first spray of the final prep should be directly over the incision site
True
True or False The space above and surrounding an open sterile pack is considered part of the sterile field
True
True or False The surgical nurses scrub top should be tucked into the scrub pants
True
True or False When passing ring handled instruments to the surgeon, the assistant should firmly place the rings into the surgeons palm
True
Which scissors is finer and more lightweight therefore used on delicate tissues? a. Metzenbaum b. Mayo c. Operating D. Suture
a. Metzenbaum
Of the following needle holders, which have scissors included in the jaws? a. Olsen-Hegar b. Mayo-Hegar c. Derf d. Crile-Wood
a. Olsen-Hegar
What information is included in the patients signalment a. age, gender, breed b. "proceed with caution" signals (e.g. will bite) c. previous surgery d. all of the above
a. age, gender, breed
What is the difference between antiseptics and disinfectants a. antiseptics are intended for use on living tissues, and disinfectants are intended for inanimate objects b. antiseptics are intended for use on inanimate objects, and disinfectants are intended for living tissues c. there is no difference, and they are used interchangeably d. antiseptics are used daily, and disinfectants are only used weekly e. disinfectants are sporicidal, bactericidal, and virucidal, wheras antiseptics are only bactericidal and virucidal
a. antiseptics are intended for use on living tissues, and disinfectants are intended for inanimate objects
Which of the following is the correct order of events associated with performing the surgical hand prep and donning the surgical gown and gloves a. confirm the removal of or remove all jewelry, open gown and glove packs, done cap and mask, perform hand prep, dry hands using sterile hand towel, gown, perform closed gloving b. perform hand prep, open gown and glove packs, don cap and mask, don gown and perform open gloving c. perform hand prep, open gown and glove packs, don cap and mask, don gown and gloves d. remove all jewelry, gown and glove, perform hand prep e. none of the above
a. confirm the removal of or remove all jewelry, open gown and glove packs, done cap and mask, perform hand prep, dry hands using sterile hand towel, gown, perform closed gloving
Which reflex significantly diminishes or is absent when the patient enters the surgical plane of anesthesia a. palpebral b. laryngeal c. pedal d. corneal
a. palpebral
Basic cleaning of surgical instrument involves which order of the following steps? a. presoaking, decontaminating, ultrasonic cleaning b. ultrasonic cleaning, rinsing, lubricating c. decontaminating, ultrasonic cleaning, presoaking d. none of the above
a. presoaking, decontaminating, ultrasonic cleaning
Regarding disinfectants, what does "contact time" refer to a. the time required for the disinfectant to be in contact with the microorganisms to achieve its intended effect ( i.e. significantly reduce the number of microorganisms) b. the time of day when the manufacturer can be contacted for assistance c. the time required for a microorganism to develop a resistance to the disinfectant d. the latent phase of microorganisms, giving the disinfectant a "window of opportunity: to kill the microorganisms
a. the time required for the disinfectant to be in contact with the microorganisms to achieve its intended effect ( i.e. significantly reduce the number of microorganisms)
When might a situation of negative pressure exist in the anesthesia system a. when the oxygen source is depleted b. during anesthesia induction c. during recovery from anesthesia d. only during "high flow" anesthesia
a. when the oxygen source is depleted
a 27kg patient would need what size rebreathing bag? a. 1.0 l b. 2.0 l c. 3.0 l d. 4.0 l
b. 2.0 l
To ensure the most accurate blood pressure reading the cuff should be what percentage of the width of the limb a. 25% b. 40% c. 60% d. 75%
b. 40%
Ideally the surgery room is a. at least 12x12 feet in dimension b. a separate room used only for surgery c. adjacent to the scrub sinks d. has no doors for easy communication
b. a separate room used only for surgery
What is the correct order of events used to achieve the level of disinfection required for surgical supplies and instruments a. decontaminate, sanitize, sterilize b. clean, sanitize, sterilize c. sterilize, sanitize, decontaminate d. sterilize, sanitize, clean e. none of the above
b. clean, sanitize, sterilize
When the rebreathing bag is being squeezed to ventilate the patient manually, the pop off valve needs to be a. open and then closed after giving a breath b. closed and then open after giving a breath c. open and remain open after giving a breath d. closed and remain closed after giving a breath
b. closed and then open after giving a breath
How often should the surgery room floor be cleaned a. only as needed b. daily c. morning and evening d. weekly e. it does not matter
b. daily
What position is the patient placed in for abdominal exploratory surgery? a. sternal recumbency b. dorsal recumbency c. right or left lateral recumbency depending on which side of the abdomen needs to be accessed
b. dorsal recumbency
How frequently should physiologic parameters be recorded in the anesthesia log during a surgery? a. every minute b. every 5 minutes c. every 10 minutes. d. whenever the technician has time
b. every 5 minutes
What areas of he scrubbed in personnels gown are part of the sterile field a. back of the gown b. front from chest to the level of sterile field c. cuffs of he sleeves d. all of the above if the gown was autoclaved e. none of the above
b. from the chest to the level of the sterile field
In what room should anal sac surgeries and abscessed wounds be lances and flushed a. in the surgery room b. in the preparation room c. in the scrub room d. in the examination room
b. in the preparation room
When movable equipment is removed from the surgery room a. it should not be brought back into the surgery room b. it should be thoroughly cleaned and disinfected before being returned to the surgery room c. it is considered contaminated and must be sterilized before being returned to the surgery room d. it can be returned directly to the surgery room when it is no longer needed outside the surgery room
b. it should be thoroughly cleaned and disinfected before being returned to the surgery room
What should the surgical nurse don on leaving the surgery suite a. street clothes b. laboratory coat c. shoe covers d. cap and mask e. none of the above
b. laboratory coat
Why should taking the patients temperature be saved for the end of the physical examination (PE) a. it is the least important part of the PE b. most animals dislike having their temperature taken, and it is easier to perform a PE on a cooperative patient; taking the temperature early during the PE may make the patient uncooperative for the rest of the examination c. by the end of the PE, the examiner should have already ascertained whether the patient is febrile, and only then does the temperature need to be taken d. none of the above e. all of the above
b. most animals dislike having their temperature taken, and it is easier to perform a PE on a cooperative patient; taking the temperature early during the PE may make the patient uncooperative for the rest of the examination
Which of the following surgical procedures may create challenges for monitoring the patient owing to patient positioning a. total hip replacement b. perineal urethrostomy c. prostate biopsy d. lateral ear ablation
b. perineal urethrostomy
Which of the following anesthesia monitoring devices is used primarily to measure the percentage of available hemoglobin that is saturated with oxygen a. capnometer b. pulse oximeter c. noninvasive blood pressure monitor d. direct blood pressure monitor
b. pulse oximeter
Which of the following is false regarding the surgical hand preparation? a. the preparation should begin with a quick, general hand and arm wash b. the purpose of the prep is to sterilize the skin on the surgeons hands and arms c. stiff scrub brushes should not be used to scrub the hands and arms d. the product manufacturer determines the recommended length of time the product should be scrubbed on the hands and arms during the surgical hand prep
b. the purpose of the prep is to sterilize he skin on the surgeons hands and arms
The first ground drape placed for four corner draping is on which side of the patient? a. the cranial side b. the side closest to the person draping c. the side closest to the assistant d. the caudal side
b. the side closest to the person draping
Which of the following statements is false regarding the sterile field a. unscrubbed personnel should not walk between two sterile fields b. unscrubbed personnel should never face the sterile field c. all unscrubbed personnel should keep a safe distance from the sterile field d. only sterile items should be in the sterile field e. the sterile field should never be left unattended
b. unscrubbed personnel should never face the sterile field
Why is it important to confirm that the pop off valve is completely open after the anesthesia machine and circuit are checked for leaks? a. it can only reset if it is open b. when the patient is connected to the anesthesia machine with the pop off valve closed, the patient will not be able to exhale c. it is not important; the pop off valve can be open or closed after the system is checked for leaks d. all of the above
b. when the patient is connected to the anesthesia machine with the pop off valve closed, the patient will not be able to exhale
Which instrument would be used to collect large amounts of bone graft material intraoperatively a. Jacob's hand chuck b. Periosteal elevator c. Bone curette d. Biopsy needle
c. Bone curette
Hypotension can be caused by a. increased heart rate b. vasoconstrictive drugs c. cardiac insufficiency d. patient obesity
c. cardiac insufficiency
In the absence of cleaning instructions from the manufacturer, stethoscopes, blood pressure cuffs, and other noncritical items can be cleaned in what manner for use in the surgery room? a. autoclaved b. immersed in high level disinfectants c. cleaned and then disinfected with alcohol d. put through a cycle in a washing machine or dishwasher e. none of the above
c. cleaned and then disinfected with alcohol
Which class of drugs causes muscles ridigity a. local anesthetics b. anticholinergics c. dissociative anesthetics d. antibiotics
c. dissociative anesthetics
Which tactic(s) may stop a cat from purring during thoracic auscultation a. gently squeezing the thorax with one hand while the other holds the stethoscope on the chest wall b. massaging under the cat's chin c. holding the cat near a sink or faucet, with or without the water running d. all of the above e. none of the above
c. holding the cat near a sink or faucet, with or without the water running
Which of the following methods should be used to place a scalpel blade on a scalpel handle a. thumb and index finger of the assistants non dominant hand b. any hemostat with secure ratchets c. needle holder d. allis tissue forceps
c. needle holder
Which valve allows for room air to enter the anesthesia system if negative pressure is detected in the system a. pop off valve b. flowmeter c. negative pressure relief valve d. pressure manometer
c. negative pressure relief valve
The suction tip best used to remove large volumes of fluid is the a. Yankauer b. Adson c. Poole d. Plastic connector
c. poole
Why are refillable soap dispensers not recommended for use in the surgery prep or scrub area a. they always run out just when they are needed b. they take too long to refill if they run out of soap during the hand prep process c. they can harbor bacterial growth d. all of the above e. none of the above
c. they can harbor bacterial growth
The minimum database (MDB) for a young, healthy feline patient having elective surgery would most likely include which of the following diagnostic tests a. cbc, parvovirus test, electrolytes, and blood typing b. cbc, serum chemistry panel, FeLV/FIV test, intestinal parasite test, and urinalysis c. FeLV/FIV test, abdominal radiographs, and ecg d. PCT/TS, estimate of BUN, BG, and ALT e. PCV/TS, thyroid panel, and FeLV/FIV test
d. PCT/TS, estimate of BUN, BG, and ALT
What does managing the instrument table involve a. keeping the instruments organized for quick retrieval b. counting instruments and gauze squares at the beginning and end of the procedure c. loading the needle holders with suture needle d. all of the above e. only a and c
d. all of the above
What is the purpose of premedicating a patient before inducing anesthesia for surgery? a. to provide a smooth transition to anesthesia b. to provide preemptive analgesia c. to facilitate a smooth recovery from anesthesia d. all of the above e. none of the above
d. all of the above
What needs to be done to the patent after the hair clip and before the patient is moved into the surgery suit a. vacuum the clipped hair and clipped area of the skin b. check to see whether the bladder needs expressing c. perform initial skin scrub d. all of the above e. none of the above
d. all of the above
Which of the following contributes to hypothermia in the anesthetized patient a. anesthetic induced muscle relaxation b. the surgical prep using water and alcohol c. administering room temperature IV fluids d. all of the above
d. all of the above
Which of the following is true a. proper surgical attire includes wearing freshly laundered scrub top and pants, head cover, and mask b. each surgical facility should have its own posted surgery dress code c. proper surgical attire decreases the risk of infection associated with surgery d. all of the above e. none of the above
d. all of the above
Which of the following should be performed on the day of the surgery a. thorough physical exam b. review of the patients medical history with the owner c. verbal review of the consent form and obtaining of the owners signed consent for anesthesia and surgery d. all of the above e. none of the above
d. all of the above
Why is it important to review all medications and supplements that a patient is taking before beginning the surgery a. to avoid possible drug interactions b. to know whether other diagnostic tests are indicated c. to make any necessary adjustments to the anesthesia protocol d. all of the above
d. all of the above
Why is it important to use surgical instruments only for their designed purpose? a. to avoid damaging them b. to protect their useful life c. the high quality instruments are expensive and should be handled with care d. all of the above
d. all of the above
What position is the patient placed in on the surgery table for thoracic surgery a. dorsal recumbency b. right lateral recumbency c. left lateral recumbency d. any of the above may be appropriate e. none of the above
d. any of the above may be appropriate
What are the two most important practices used to prevent surgical infections a. aseptic and septic technique b. sterile and septic technique c. septic and antiseptic technique d. aseptic and sterile technique e. sterile and antiseptic technique
d. aseptic and sterile technique
Why are leading questions inappropriate to ask during the history taking a. they make the owner feel compelled to answer a certain way b. they may encourage the owner to answer inaccurately c. they are appropriate and should be asked d. both a and b e. none of the above
d. both a and b
Why is it important for ratchets to remain locked when the jaw is closed? a. the instrument needs to be a reliable mechanism of holding the target tissue (e.g. pedicle) or item (e.g. suture needle) b. if the ratchets do not remain locked, complications (e.g. hemorrhage) could result c.ratchets need to be protected by lock and key so the only the surgeon can unlock them when it is appropriate d. both a and b
d. both a and b
Why should the patients identity be verified before the animal is anesthetized for surgery a. to avoid anesthetizing the wrong patient b. to avoid performing surgery on the wrong patient c. it is not necessary to cross check the patients correct identity because any good technician should be able to distinguish all black cats in the hospital on any given day on the basis of physical appearance alone d. both a and b e. none of the above
d. both a and b
Which monitoring device measures exhaled CO2 levels a. pulse oximeter b. electrocardiograph c. sphygmomanometer d. capnometer
d. capnometer
Of the procedures listed below, which should be scheduled as the first of the day? a. corneal laceration b. splenectomy c. OHE d. knee replacement
d. knee replacement
which of the following statements best describes the difference between direct and indirect (noninvasive) blood pressure monitoring? a. noninvasive blood pressure monitoring is more accurate b. direct monitoring requires placing a catheter with a sensor in an artery, and indirect monitoring requires placing a catheter with a sensor in a vein. c. noninvasive pressure monitors can be placed only by veterinarians d. none of the above
d. none of the above
Which of the following provide multimodal analgesia a. gas anesthetics, morphine, butorphanol, and fentanyl b. nonsteroidal anti inflammatory drugs (NSAIDS), carprofen, and meloxicam c. xylazine and medetomidine d. opioids, NSAIDS, local anesthetic agents, and alpha 2 adrenergic agonists e. none of the above
d. opioids, NSAIDS, local anesthetic agents, and alpha 2 adrenergic agonists
Which part of the anesthesia machine indicates the amount of pressure in the system a. pressure reducing valve b. flowmeter c. carbon dioxide canister d. pressure manometer
d. pressure manometer
A change in which wave of an electrocardiogram is likely when myocardial hypoxia is occurring a. p b. q c. s d. t
d. t
Which of the following is the next step after the patient has been induced with anesthesia and the intended surgical site has been clipped and had initial prep a. the patient is moved to the surgery room, positioned on and secured to the table, then draped, and the surgeon begins surgery by making an incision b. the final prep is applied, and the patient is moved to the surgery room and positioned on and secured to the table. c. the patient is moved to the surgery room, the final prep is performed, and the patient is positioned on and secured to the table d. the patient is moved to the surgery room and is positioned on and secured to the surgery table and the final prep is performed e. none of the above
d. the patient is moved to the surgery room and is positioned on and secured to the surgery table and the final prep is performed
What part of the anesthesia machine converts the liquid anesthetic into a gas anesthetic? a. pressure manometer b. oxygen flowmeter c. pressure-reducing valve d. vaporizer
d. vaporizer
Which of the following affect a disinfectants effectiveness a. amount of protein present in the area b. type of microorganisms present c. concentration of the disinfectant d. both b and c e. all of the above
e. all of the above
Which of the following contributes to hypothermia in the anesthetized patient a. anesthetic induced muscle relaxation b. the surgical prep using water and alcohol c. administering room temperature IV fluids d. breathing cold gases from compressed cylinders e. all of the above
e. all of the above
Which of the following should be assessed during the history taking a. patients attitude and mental status b. patients previous medical problems and treatments c. patient ability to see and hear d. patients gait and body condition e. all of the above
e. all of the above
Why does an orthopedic "clip and prep" of an extremity need to include a circumferential clip around the entire limb a. if the incision goes all the way through the limb and out the other side, the other side will already be prepared for this scenario b. if the surgeon mistakenly incises the wrong side of the limb with the first incision, and if the leg is clipped circumferentially, the mistake is easily corrected c. for patient comfort d. all of the above e. none of the above
e. none of the above
True or False It is accepted practice to scrub a patient initially with a povidone iodine product
true