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The number one patient safety issue identified in a survey of peri-operative nurses is preventing: - ✔✔Wrong site/procedure/patient surgery Reprocessing (flashing) instruments in the OR is high risk because: - ✔✔OR personnel not properly trained to reprocess instruments To safely transfer and position patients in a manner that prevents shearing, personnel should use a mechanical lifting device for a supine-to-supine transfer of a patient weighing more than: - ✔✔157 lbs _______________ should be the primary decision makers for what equipment and supplies are purchased and stocked in the difficult airway management cart. - ✔✔Anesthesia personnel Proper specimen management techniques prevent errors and include all of the following EXCEPT: - ✔✔Receiving specimens from the surgical field then affixing patient label to each Preventing surgical fires is a top priority for all OR personnel and members of the surgical team should perform all of the following duties EXCEPT: - ✔✔Perform a weekly fire risk assessment Peri-operative hypothermia is an important issue for all anesthetized patients because of all of the following EXCEPT: - ✔✔Increases risk of renal failure Recommendations for preventing retained surgical items include all of the following EXCEPT: - ✔✔Utilizing a multidisciplinary team to resolve incorrect counts Select the appropriate order for administering blood and blood products. - ✔✔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
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. - ✔✔Keep a running total blood loss calculated from available sponges during procedure 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? - ✔✔Replacing or tagging sponges and laparotomy instruments with radiofrequency identification (RFID) chips A female 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 a 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. The patient insisted that her Do Not Resuscitate (DNR) status NOT be rescinded. She was conscious and competent and knew what was best for herself. The patient was taking full advantage of what provision for her care? - ✔✔PSDA and advance directives A patient 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. The patient was exercising her: - ✔✔right to informed consent. Early on, during the preliminary sponge count on closure of a repair of a ruptured abdominal aortic aneurysm, the circulating nurse was unable to account for 2 lap sponges. He had meticulously maintained accountability for all sponges and instruments discarded from the sterile field and bagged each sponge carefully. He immediately turned and addressed the entire team in a clear voice. Select the appropriate communication that the circulating nurse must employ during this count discrepancy. - ✔✔"We have a count discrepancy. We started with 70 sponges and find only 68. We are missing 2 lap sponges. Everyone, please check your areas. The OR is a danger-prone area for both patients and staff. Providing a safe environment of care for the patient involves identifying, mitigating, and managing the hazards inherent in surgical care. Choose the
Transport reusable sharps in a safe, closed container to the decontamination cleanup area. Do not place hands or fingers into a container to dispose of a device. Inspect the sharps container for overfilling before discarding disposable sharps in it. Which list of medications best reflects medications indicated for latex sensitivity therapeutic management? - ✔✔Epinephrine, prednisone, and a beta-agonist inhaler While antibiotics have been credited with saving lives, misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs). Select the antibiotic application that has evident to support it as a best practice and not, potentially, a misuse of antibiotics. - ✔✔Antibiotics given intravenously within 1 hour of the incision for every procedure with an incision or entered body system. With the production of more steam in the sterilizer chamber, the pressure increases as well. The steam should contain little or no entrapped liquid water. Steam quality is the term that describes the amount of water mixed with the steam. The constitution of high-quality steam would be measured by: - ✔✔<3% of the mixture is liquid water. A 47-year-old man was admitted to the emergency department (ED) with respiratory symptoms, facial and upper body abrasions, burns, and moist lesions after a small package, delivered to his office, exploded and sprayed him dried powder and glass shards. In response to the reported mechanism of injury, the ED team sequestered him in a secluded area away from the rest of the patients. The team believed that this was highly suspicious of a bio-terrorism event. The epidemiologist was called, and the patient was transferred to a negative-pressure isolation room and placed on standard, contact, airborne, and droplet precautions. Based on these actions, which microorganism agents might be suspected to be involved? - ✔✔Anthrax and smallpox Qualities of an effective packaging material must include several key characteristics. Select the three most important qualities. - ✔✔Good steam penetration and removal, good microbial barrier, aseptic presentation.
The design of the physical space within an OR attempts to minimize horizontal surfaces by placing cabinets flush with the wall. This prevents dust settling on multiple surfaces and decreases the areas that have to be monitored and cleaned. Another concern with horizontal surfaces is that is turbulence from staff movement and activity plus door movement, when it opens and closes, can: - ✔✔mobilizing resting dust from these surfaces. An 86-year-old male was admitted to the intensive care unit (ICU) 3 weeks ago for heart failure and intractable atrial fibrillation. He has had diarrhea for 4 days that has cultured C. difficile. The transmission-based precautions sign on the door to his room alerts the staff to employ which practice precaution? - ✔✔Both standard precautions and contact precautions Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however: - ✔✔it can only be used for the initial gloving. 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. - ✔✔Inspect, inventory against list, assemble, place integrators, wrap and tape A patient undergoing a laparoscopic Nissen fundoplication procedure will be positioned in both high and low lithotomy during the procedure. After the patient is re-positioned into lo lithotomy, the perioperative nurse should: - ✔✔reassess the patient for body alignment, tissue integrity, and pressure areas. A 68-year-old, American Society of Anesthesiologists (ASA) physical status (OS)-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 pr - ✔✔Respiratory compromise and ventilation resistance Shearing injury to soft tissues
A veteran perioperative nurse remembers a time when all suture needles had eyes, and she even had her own needle rack. She hand-threaded all sutures according to the surgeon's preference. The newer sutures were originally called "atraumatic" sutures because they did not double back through a needle eye and cause tissue trauma during pulling or suturing through the tissue. Today, we call this manufacturing process of connecting the suture thread to the needle: - ✔✔swaged The ideal suture material is one that has handling characteristics such as: - ✔✔ease of tying Careful counting (according to established policy), situational awareness, and conscientious and meticulous attention to the field are believed to prevent miscounts and lost items. A recent patient safety statement about preventing retained foreign objects recommends which of these practices? - ✔✔Verbal handoff must include count status at time of relief. An older surgeon explains his justification for this suture choice to the new perioperative nurse in the scrub role. He prefers to suture his intestinal anastomosis with a suture that has multiple filaments braided together because it ties well and holds the knot, which tightens when the thread absorbs the tissue fluids. He also needs a strand that is easy to see and only needs to retain its tensile strength for about 1 year, at which time the intestinal junction will be healed, even though this suture is considered nonabsorbable. He will ask the nurse for a 24-inch 4-0: - ✔✔Sofsilk Flat neurosurgical patties are flat sponges composed of soft compressed cotton or rayon with an embedded radiopaque element and string attached. They are often used in neurosurgical procedures. While used for hemostasis and exposure, what other use would be important in surgery? - ✔✔Application of topical steroids the circulating nurse received the trauma call from the emergency department (ED) 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 set was missing. What important instrument set was needed for this procedure besides the vascular set? - ✔✔Basic laparotomy set The primary use for suture is essentially to: - ✔✔ligate, suture, and close tissue. Wound tissue healing is enhanced by the use of stapling instruments that mechanically apply internal staples for ligation and division, resection, and anastomoses. What feature of the mechanical process
reduces tissue manipulation, edema, and inflammation? - ✔✔The non-crushing B shape of the staples allows nutrients to pass through. According to a 2010 article published in The Journal of the American College of Surgeons and citing data from a 1998 study, where do more that half of needle-stick injuries involving suture needles occur? - ✔✔During the suturing of fascia or muscle tissue The nerve supply for the female pelvis comes from the autonomic nerves that enter the pelvis through the - ✔✔Superior hypogastric plexus 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 The cerebellar tentorium supports which structures of the cerebral hemispheres - ✔✔Temporal lobe the surgeon makes an incision through which of the following to access the cremaster muscle, inguinal canal, and cord structures - ✔✔External oblique muscle a physical barrier used in the prevention of adhesions that can take up to 2 weeks to absorb - ✔✔Interseed Tissue reaction characteristics that need considered when choosing suture include - ✔✔Absorption The diagnostic test that is performed to differentiate between acute and chronic thrombosis - ✔✔Digital subtraction angiography 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 - ✔✔enetrating; small entrance wound, puncture of the anterior wall of the sigmoid colon, no disruption of vessels, and bullet not found in pelvis
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 the correct term to describe the inward turning of one or both eyes - ✔✔Esotropia The nerve supply for the female pelvis comes from the autonomic nerves that enter the pelvis through the - ✔✔Superior hypogastric plexus which surgical approach reduces the morbidity and mortality in removal of an acoustic tumor - ✔✔Translabyrinthine approach Pt with hepatobiliary disease, The perioperative nurse, during the preoperative assessment, questions and examines the patient for signs and symptoms of jaundice, petechiae, and lethargy and: - ✔✔review chart for bleeding and coagulation times and the platelet count. The external ear canal lining - ✔✔reduces bacterial levels in the outer ear 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. Vascular access in pediatric patients may be established intraoperatively for short-term (weeks) or long- term (months, years) use - ✔✔Central venous line What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp - ✔✔Subgaleal space Pericardial tamponade includes which of the following signs or symptoms - ✔✔Narrow pulse pressure 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 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 Which two similar hernia repair approaches reestablish the integrity of the transversalis fascia and simultaneously reestablish and strengthen the posterior inguinal floor by sewing the transversalis fascia to the Poupart ligament? - ✔✔The McVay or the Cooper ligament repair Identify the class of medications that can increase the risk or severity of a reaction to contrast media - ✔✔Beta Blockers The recommended length of time for inflation of an upper extremity tourniquet on a patient under 50 years old is_______while the recommended pressure is _____. - ✔✔1 hour; 250-300 mmHg continuous tourniquet pressure less than 1 hour on the upper extremity and less than 2 hours on the thigh. Tourniquet pressure should not exceed the recommended maximum cuff pressure limits of 300 to 350 mm Hg for the thigh and 250 to 300 mm Hg for the arm and the lower leg. the 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. 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 he 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.
The mitral valve is anchored to the - ✔✔left ventricular wall 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 correct branch of the Left main coronary artery - ✔✔Circumflex coronary artery When a thyroglossal duct cyst is present in an adult, it exists as a pretracheal cystic pouch attached to what structure - ✔✔Hyoid statement regarding risk factors for developing vascular disease is true - ✔✔Arteriosclerosis is a natural part of the aging process. Which of the following is an indication for damage control surgery - ✔✔Indications for the potential need for damage control surgery include hemodynamic instability, hemorrhagic shock, coagulopathy, hypotension, tachycardia, tachypnea, inaccessible major anatomic injury, concomitant major injury, and altered mental status The most common congenital cyst found in the neck is - ✔✔Thyroglossal duct cysts The potential for development of a direct inguinal hernia is - ✔✔When a weakening or a tear in the aponeurosis of the transversus abdominis and the transversalis fascia occurs, 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 - ✔✔Right jugular and right femoral There are several risk factors associated with dehiscence. Which of the following can be controlled by the RNFA - ✔✔Sutures placed too close together
Access to the substernal compartment is typically facilitated by: - ✔✔using long instruments through a regular thyroid incision. Pressure against the skin above ____mm hg interferes with tissue perfusion - ✔✔ 32 Latex allergy reaction is best prevented by - ✔✔limiting exposure to latex 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 Suture can be used for more than repairing tissue. - ✔✔ligate, suture, and close tissue. Which of the following absorbable suture has the best tensile strength - ✔✔Polydioxanone The light transmission through an endoscope is achieved by way of - ✔✔bundles of fiberoptic glass rods 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 On extubation, Daniel presented with coughing, wheezing, dyspnea, use of accessory muscles, and tachypnea. Daniel is presenting with _______ probably caused by _______. - ✔✔bronchospasm; aspiration 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
