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What is the leading and most costly occupational health problem in the united states?
- headache
- needlesticks and sharps injury resulting in exposures to transmissible diseases
- overexertion leading to back strains sand sprain
- overwork leading to fatigue Correct Answer-overexertion leading to back strains sand sprain
when should leak testing of a flexible endoscope be performed?
- after manual cleaning and before it is placed into cleaning solution
- after manual cleaning and being placed into cleaning solution and before drying
- at the point of use during precleaning
- before manual cleaning and before it is placed into cleaning Correct Answer-before manual cleaning and before it is placed into cleaning.
an rn circulator hears an anesthesia professional ask an unlicensed assistive person (UAP) to push IV. What should the perioperative rn immediately do?
- help the UAP administer the IV push medication
- notify the charge rn that the UAP is performing a task that is not within his job description
- offer assistance to the anesthesia professional so that the anesthesia professional can administer the medication himself
- tell the UAP to stop and the perioperative rn should administer the medication for the anesthesia professional. Correct Answer-offer assistance to the anesthesia professional so that the anesthesia professional can administer the medication himself
After a vaginal hysterectomy, a healthy 47-yr-old woman is in the postanesthesia care unit. Her body mass index is 22. her arterial blood gas test results are pH 7.52, PaCO2 28, HCO3 24. the patient's condition is
metabolic acidosis metabolic alkalosis respiratory acidosis respiratory alkalosis Correct Answer-respiratory alkalosis
an ambulatory surgery center (ASC) does not have a radiology department at the facility. When surgical count discrepancies occur, what actions should be taken 1st by the perioperative rn?
- arrange for the pt to be x-rayed for the missing item at the closest hospital
- document the results of the surgical count
- follow the ASC's standardized process to locate the missing item
- inform the pt's family or caregiver that the procedure is taking longer than expected due to the missing item Correct Answer-follow the ASC's standardized process to locate the missing item
the perioperative rn should be recognized that the most common complication for a pt with multiple traumatic injuries is
fluid and electrolyte imbalance hemorrhage infection shock Correct Answer-shock
in addition to the pt's identity, which of the following should be confirmed to help decrease the risk for wrong site surgery?
allergies medication history
- after the pt is under anesthesia and positioned on the OR bed and the surgeon is in the OR
- that is long enough so that bladder of the tourniquet overlaps sufficiently on the limb. Correct Answer-that is long enough so that bladder of the tourniquet overlaps sufficiently on the limb.
A pt is on a stretcher in the perioperative ready area. When he arrived at the facility's surgery admission desk that morning, he appeared disheveled and incoherent. Laboratory blood tests indicated a high level of cocaine in his system. The anesthesia professional was at the pt's side discussing the need to postpone the surgery with the surgeon when the pt became belligerent and forcefully grabbed the anesthesia professional's neck. The pt was placed into restraints. In this situation, why were restraints necessary?
- the pt was incoherent
- the pt posed a threat to himself
- the pt posed a threat to the anesthesia professional
- the pt was using illegal drugs before his surgery Correct Answer-the pt posed a threat to the anesthesia professional
a root cause analysis is conducted after it is discovered that a laparotomy sponge was left in a patient's abdomen after a surgical procedure. In response to this event, which of the following actions would be consistent with conducting a root cause analysis?
- apologize and disclose the error to the patient
- identify and analyze each step of the surgical count process that is in place at the facility.
- Identify the involved perioperative learn members and initiate disciplinary actions
- report the event to the designated hospital accreditation organization Correct Answer-identify and analyze each step of the surgical count process that is in place at the facility.
when the retractable magnetic resonance imaging (MRI) scanner is in use in a hybrid OR, the OR is considered to be MRI zone
I
II
III
IV Correct Answer-IV
if a pt experiences a cardiac arrest in a hybrid OR when the magnetic resonance imaging (MRI) scanner is in use, the first action the perioperative rn should do to assist the team is
- begin basic cardiopulmonary resuscitation and retract the MRI scanner back into the holding bay
- call for help, bring in the code cart and resuscitate the pt.
- Remind the team that the MRI scanner is in use and follow the facility protocol
- turn off the MRI scanner by pushing the quench button Correct Answer-begin basic cardiopulmonary resuscitation and retract the MRI scanner back into the holding bay
the role of the health care industry representative includes all of the following except
- opening sterile implants and instructing the surgeon and the assistants how to implant the medical devices
- providing one-on-one instruction for the perioperative team related to the medical device.
- Providing technical support according to the health care organization's policies and local, state, and federal regulations
- teaching in-service programs to the perioperative team related to the medical device Correct Answer-opening sterile implants and instructing the surgeon and the assistants how to implant the medical devices
what should the water temperature be for hand hygiene?
- 60 F (15.6C) or lower
- between 60 F and 100 F (15.6c to 37.8C)
- between 70 F and 80F (21.1C and 26.7C)
- 80F (26.7C) or higher Correct Answer-between 70 F and 80F (21.1C and 26.7C)
if exposure to blood or other potentially infectious materials is anticipated, team members at the sterile field should
- change gloves every 30- 60 minutes
- change gowns and gloves after 60 minutes
- wear two pairs of gloves while draping and remove the top gloves after draping
- wear two pairs of surgical gloves, one over the other Correct Answer-wear two pairs of surgical gloves, one over the other
as the scrub person passes and autologous vein graft to the surgeon, the graft inadvertently drops onto the OR floor. What should the perioperative RN do?
- follow a predetermined process according to the hospital policy related to when an autologous tissue is dropped
- inform the surgeon that according to the collective evidence, a dropped vein graft is considered highly contaminated and should not be replanted
- notify the OR charge RN
- prepare to sterilize the autologous vein graft using a low-temperature sterilization method Correct Answer-follow a predetermined process according to the hospital policy related to when an autologous tissue is dropped
- recent studies have identified that a _________has been linked to an increase in pt care errors and worker injuries (eg, needle-stick injuries, musculoskeletal injuries)?
4 hr shift 8 hr shift 10 hr shift 12 hr shift Correct Answer-12 hr shift
- perioperative team members should maintain short, natural fingernails; fingernail tips should be no longer than
2 mm (0.08") 6mm (0.25") 1.25mm (0.5") 2.5mm (1") Correct Answer-2 mm (0.08")
- a primary concern for an RN preparing a premature infant for surgery is to initiate measure to
- ensure that all supplies are assembled before the pt arrives
- ensure that the anesthesia professional is standing by
- maintain proper body alignment
- prevent loss of body heat Correct Answer-prevent loss of body heat
- a perioperative RN's documentation for postoperative pt, "the pt is free from pain or numbness associated with surgical positioning," is an example of a nursing
assessment diagnosis intervention outcome statement Correct Answer-outcome statement
with what organization must facilities that procure, process, and/or preserve autologous tissue and facilities that store tissue for potential transfer to a different facility register as tissue banks?
- centers for disease control and prevention
- centers for Medicare & Medicaid services
- US Food and Drug Administration
- the Joint Commission Correct Answer-US Food and Drug Administration
Mohs surgery involves excision lesions layer by layer for surgeries involving treatment for
- may be covered by two persons in sterile attire using sterile technique, to ensure there is no contamination of the cover. Correct Answer-may be covered by two persons in sterile attire using sterile technique, to ensure there is no contamination of the cover.
which of the following is an example of a recommended quality improvement activity to monitor and improve the prevention of sharps injuries?
- developing processes to measure rates of percutaneous injuries and near misses
- providing ongoing feedback to perioperative team members about improvement in the prevention of retained items
- purchasing new safety straps secure pt's on the OR bed
- using hand hygiene data to determine whether an individual organization is within benchmark goals Correct Answer-developing processes to measure rates of percutaneous injuries and near misses
- where should the hand washing station be placed in a single-room endoscopy processing area?
- clean work area
- decontamination are
- center of the room
- outside the entrance to the room Correct Answer-decontamination are
- when providing care for a pt who is suspended to be infected or colonized with rubeola or varicella zoster, the perioperative RN should follow what type of precautions in addition to standard precautions?
- airborne precautions
- contact precautions
- droplet precautions = no other precautions are necessary Correct Answer-airborne precautions
the risks for alternate site injuries that can occur due to insulation failure of the endoscopic equipment and/or the phenomenon of capacitive coupling can be decreased by
- irrigating the area with electrolyte solutions
- performing preoperative and postoperative skin assessments
- placing the active electrode in a plastic holder when it is not in use
- using active electrode monitoring Correct Answer-using active electrode monitoring
to decrease the potential for _____ during spinal surgery, the perioperative RN should ensure that the cardiac monitoring leads and neuromuscular monitoring cords are as far as possible from the electrosurgical handpiece cord
- antenna coupling
- capacitive coupling
- direct coupling
- insulation failure Correct Answer-antenna coupling
well-constructed physician order sets should include all of the following except
- a recent review date
- acceptable abbreviations
- trailing zeroes in medication dosages
- standardized names and terms Correct Answer-trailing zeroes in medication dosages
surgical pts at risk for venous thromboembolism include
- all surgical pts
- elderly perioperative pts
- obese pts
- pts taking oral contraceptives Correct Answer-all surgical pts
- ensuring no breaks in sterile technique
- guaranteeing that pathogens do not harm the pt
- minimizing contamination of the surgical wound
- minimizing wound contamination and reducing the pt's risk for surgical site infection Correct Answer-minimizing wound contamination and reducing the pt's risk for surgical site infection
how often should surgical gloves are worn during invasive surgical procedures be changed during the procedure?
- every 60 to 90 minutes
- every 90 to 150 minutes
- surgical gloves only require changing if a known or suspected break-in technique occurs or a tear in the glove is identified
- there is no recommended time for changing gloves Correct Answer-every 90 to 150 minutes
how often should surgical gloves are worn during invasive surgical procedures be changed during the procedure?
- every 60 to 90 minutes
- every 90 to 150 minutes
- surgical gloves only require changing if a known or suspected break-in technique occurs or a tear in the glove is identified.
- There is no recommended time for changing gloves. Correct Answer-
the timing of the administration of a preoperative prophylactic antibiotic ordered for a pt whose plan of care includes the use of a pneumatic tourniquet should be based on the -anesthesia professional orders
- anticipated length of pt's postoperative recovery from planned surgical procedure -average length of time to perform the surgical procedures
- health care organization's policy and procedure. Correct Answer-health care organization's policy and procedure.
the evidence supports performing medication reconciliation during all phases of pt care to
- decrease the amount of medication a pt is required to receive
- educate the pt about medication interactions
- increase medication practices compliance by the pt
- reduce medication errors Correct Answer-reduce medication errors
what laboratory value can assist the perioperative RN determining a surgical pt's nutritional status for effective wound healing?
-albumin -electrolyte panel -hemoglobin -potassium Correct Answer-albumin
what is an effective medium in which to store an avulsed tooth when immediate replantation is not possible?
- Carbonate water
- hydrogen peroxide
- milk
- water Correct Answer-milk
which of the following chemical indicator tests detects air leaks, ineffective air removal, and presence of non-condensable gases in a dynamic air removal steam sterilizer?
- bacillus atrophaeus (biological indicator)
- bowie-dick test (class 2 chemical indicator)
- class 5 ( integrating indicator)
a solution of 2% glutaraldehyde is categorized as which of the following type of disinfectant?
critical level high level intermediate level low level Correct Answer-high level
for what procedures should scrubbed team members double glove (ie, wear one glove over another)?
- all operative and other invasive procedures
- all operative and invasive procedures as identified by an interdisciplinary team of Rns, infection preventions, and surgeons at each health care facility.
- Invasive procedures with the potential for exposure to blood, body fluids, and other potentially infectious materials
- invasive procedures during which powered surgical tools will be used. Correct Answer- Invasive procedures with the potential for exposure to blood, body fluids, and other potentially infectious materials
unauthorized access to a pt's health information is in violation of the ____
- american recovery and reinvestment act of 2009
- budget control act of 2011
- health insurance portability and accountability act of 1996
- safe medical devices act of 1990 Correct Answer-health insurance portability and accountability act of 1996
what type of indicator should be used to monitor sterilizer efficacy?
- biological indicator
- chemical indicator
- class 5 chemical integrating indicator
- physical monitor Correct Answer-biological indicator
during the surgical count before closure of the peritoneum, the scrub person and the RN circulator are unable to locate a laparotomy sponge. What should the surgeon do?
- contact the radiology department scheduler to obtain a stat x-ray for instrument and sponge verification
- inform the charge RN
- methodically explore the wound before closing
- re-open all bagged and discarded sponges and recount them Correct Answer-methodically explore the wound before closing
a principle concept that the perioperative RN should be aware of during the cleaning of instruments is that after an operative or invasive procedure
- all instruments are to be taken to the decontamination area and placed in a non-perforated instrument tray before decontamination to allow all surfaces to be exposed when processed in an automated cleaner.
- All instruments opened for the procedure are to be taken to the decontamination area and placed in a perforated or mesh bottom instrument tray to allow all surfaces to be exposed when processed in an automated cleaner
- all sharp instruments should be placed in a separate paper/peel-pack pouch inside the instrument tray when processed.
- All shar instruments should be placed in a separate tray within a larger tray when processed. Correct Answer-...- all instruments are to be taken to the decontamination area and placed in a non-perforated instrument tray before decontamination to allow all surfaces to be exposed when processed in an automated cleaner.
- electromagnetic interference
- inadvertent device activation
- inadvertent device failure
- monopolar surgery equipment interference. Correct Answer-electromagnetic interference
which of the low-temperature sterilization methods is an alkylating agent that disrupts proteins and DNA and is lethal to microbes?
- ethylene oxide
- low-temperature gas plasma sterilization
- low-temperature hydrogen peroxide vapor sterilization
- steam sterilization. Correct Answer-ethylene oxide
to provide optimal pt care for a pt scheduled fro moderate sedation/analgesia, the RN manager should assign one perioperative RN to circulate and
- a certified RN anesthetist to manage the pt receiving moderate sedation.
- A second RN to manage the pt receiving moderate sedation
- a surgical technologist to scrub
- an anesthesiologist to provide monitored anesthesia care to the pt Correct Answer-A second RN to manage the pt receiving moderate sedation
evidence suggests that the most common causes of sentinel events are communication failure and
- failure to provide a handover communication
- incomplete or missing pt information
- use of abbreviations
- use of acronyms Correct Answer-incomplete or missing pt information
identify the correct protocol for assisted gowning and gloving
- ask the RN circulator to first gown and glove and then assist the incoming team member
- open the gown and gloves on the back table and have the scrub RN gown and glove the incoming team member
- open the sterile gown and gloves on the back table and have the incoming team member gown and glove himself or herself
- using aseptic technique, open the sterile gown and gloves on a separate surface. Correct Answer-open the gown and gloves on the back table and have the scrub RN gown and glove the incoming team member
the sterility of an item is
-dependent on multidisciplinary team decisions
- event-related and dependent on whether the integrity of the item has been maintained
- dependent on hospital protocol and community standards.
- Time-limited, event-related, and dependent on whether the integrity of the item has been maintained Correct Answer-event-related and dependent on whether the integrity of the item has been maintained
if surgical smoke is not evacuated out of the pneumoperitoneum during minimally invasive surgery, the pt is at risk for
- delayed wound healing hypothermia, and deep vein thrombosis due to unrelieved abdominal pressure
- cancer cells spreading into the retroperitoneal space
- infection due to smoke absorption by the white blood cells.
- Absorption and excretion of smoke by-products and carboxyhemoglobinemia. Correct Answer- Absorption and excretion of smoke by-products and carboxyhemoglobinemia.
