AORN Perioperative Nursing Practice Questions and Answers, Exams of Nursing

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In addition to the surgeon, which surgical team members wear sterile gowns and gloves during the procedure? - ANS-Scrub Person AND Surgical assistant The pathology laboratory and blood bank are usually situated in which of the following areas? - ANS-Unrestricted area What phases of the nursing process does the periopeartive nurse practice during the preoperative phase of the surgical experience? - ANS-Assessment, Identification of desired outcome, Nursing diagnosis, Planning Data collection is part of which phase in the nursing process - ANS-Assessment Which of the following is considered a critical perioperative nursing diagnosis within the PNDS? - ANS-Risk for perioperative positioning injury Competency statements - ANS-Direct a nurse's activity in the perioperative arena; Provide a basic model to evaluate the quality of nursing practice; Ascertain a level of skills and abilities necessary to fulfill the professional role (All of the above) Defining nursing goals and intervention strategies is a part of which phase in the nursing process - ANS-Outcome identification Match each staff member with the appropriate responsibility - ANS-Scrub person- Monitors aseptic technique; RN circulator- Creates and maintains a safe environment; Housekeeping- Cleans the furniture at the end of the OR day; Nurse anesthetist- administers anesthesia to the patient Creating cultures that supports patient safety through which of the following mechanisms? - ANS-Convene and communicate with members about safety; Incorporate attention to patient safety into training programs; Collaborate across disciplines. The IOM report describes the importance of setting standards and expectations for patient safety. Setting standards can_____ - ANS-Set expectations for the health professionals; Establish consistency across individuals and organizations; Help set expectations of consumers and purchases.

Which of the following AORN Position Statement on Correct site of surgery is true? - ANS-The staff member should verbally verify the correct site with each member of the surgical team Maintaining a safe OR environment, staff members are required to - ANS-Monitor, identify, and reports safety hazards; Understand and comply with the emergency power outage plan; Practice sound, basic and OR specific electrical and fire safety. The elements required to create a cultures of safety include - ANS-A sense of trust among team members; A sincere commitment of affirming safety as the first priority; Development and support of a proactive approach rather than a reactive blaming approach; Dissemination of receipt of information to all levels of staff. Which of the following practices should be used ti implement the Joint Commission's Universal Protocol for preventing Wrong Site, Wrong Procedure, Wrong Person Surgery? - ANS-Using a time-out procedure before beginning the procedure The purpose of the National Patient Safety Goals is to - ANS-Promote specific improvements in patient safety; Highlight problematic areas in health care; Describe evidence and expert-based system-wide solutions to the problems AORN's Guidelines for Perioperative Practice provides - ANS-Information on administrative topics; Information that can be used to develop institution-specific policies; Scientific evidence for clinical practices. Which of the following are true about AORN's Guidelines for Perioperative Practice? - ANS-They are based on what nurses do in ideal situations; They may be fulfilled to varying degrees in different situations. Why is it important for perioperative nurses to have a basic understanding of business principles? - ANS-To enable them to plan safe and effective care that is also cost- effective; To facilitate competition for patient volume; To manage and allocate resources wisely Match the type of budget with its description - ANS-Gross revenue- All monies received by the facility for goods and services; Fixed expenses- Medical records and administration; Net revenue- gross revenue minus expenses; Variable costs- Costs directly related to patient volume Which of the following definitions are correct? - ANS-Liable means to bind or to be responsible to or to be under obligation to; Negligence means the failure to exercise care that a prudent person would perform under the same circumstances. Professionalism in nursing means - ANS-Showing personal accountability in understanding the Nurse Practice Act; Maintaining a current knowledge base; Participating in professional organizations.

Which of the following statements is true? - ANS-Lung capacity decreases with increasing age Which of the following factors make geriatric patients more sensitive to injury and cold?

• ANS-Decrease in subcutaneous fat Why is it important to assess the use of herbal supplements or recreational drugs before surgery? - ANS-Herbal preparations can affect bleeding times; Herbal preparations can interfere with drug metabolism; Recreational drug use can result in withdrawal symptoms; Recreational drug users may require higher doses of anesthetic medications. What interventions can the perioperative nurse perform to protect elderly patients? - ANS-Employ DVT prophylactic devices; Position the patient for effective air exchange; Use warming devices to maintain the normothermia A child in which of the following age groups can be described as "likes to socialized and can interpret terms"? - ANS-3 to 6 years The goal of patient and family education is to - ANS-Provide information to the patient; Improve knowledge; Achieve long lasting changes in behavior; Take ownership of the patient's care; Improve the patient's outcome. The importance of patient and family education is reflected by which of the following phrases? - ANS-Improvement in quality of care; Increase in patient satisfaction; Increase in patient compliance; Ethical and legal mandates for patient education Which of the following form part of patient's ongoing education needs as a patient? - ANS-Contact information for questions or concerns after surgery; Counseling on modified diet to be followed after surgery; List of foods that might interfere with prescribed mediation; Medications to be given and time intervals for taking. Factors that affect the patient's ability to learn include - ANS-Disability; Fear of dying; Pain; Self-esteem The perioperative nurse provides care to each patient undergoing a surgical intervention in a manner that preserves and protects - ANS-Patient autonomy, dignity, and human rights

Patient and family education is a combination process involving - ANS-Influencing behavior; Producing changes in knowledge; Producing change in attitudes and skills Factors that may affect an adult patient's ability to learn include - ANS-Age; Attitude; Emotional state; Intellectual ability; Physical ability The perioperative nurse should use the directive interview technique over a nondirective interview technique when the information he or she needs - ANS-Consists of predetermined questions; Consists of questions in a predetermined order; Is to document the patient's health history A preoperative patient's DNR order is - ANS-Reconsidered to ensure that the risks and benefits of anesthesia and surgery are discussed before surgery Obtaining informed consent is a two step process of - ANS-Communicating information and documenting the decision How does the perioperative nurse test the patient's level of understanding? - ANS-By asking questions about the procedure and evaluating the answer A directive interview is - ANS-Structures with predetermined questions Factors that may affect the amount of pain the patient will experience postoperatively are - ANS-The surgical site; The nature and intended purpose of the surgery; the patient's fears regarding anesthesia or surgery Which of the three elements required for an infection to occur is related to inanimate environmental surfaces? - ANS-Source or Reservoir One of the most effective ways to prevent disease transmission and control infections in health care settings is - ANS-Hand Hygiene Match the three types of transmission based precautions with the correct examples of precautions that should be implemented - ANS-Contact- Donning PPE and environmental cleaning; Droplet- Donning PPE and patient placement Airborne- Donning PPE and waring a surgical mask with a respirator level of N95 or higher

Which of the following is correct regarding the disposal of contents from reusable suction systems? - ANS-done according to federal, state, and local regulations Correct statements about spray bottles - ANS-Spray bottles can aerosolize potentially infectious materials; Spray bottles are not used to apply disinfectant The proper device for the disposal of blades, needles, stapling devices, pins, and cautery tips should be - ANS-A sharps disposal container The goals of performing post procedure cleaning of the OR/procedure room include the following - ANS-It renders the environment safe for the patient following in that room to prevent cross contamination; It breaks the cycle of contamination from the patient to the environment and from the environment to OR personnel and then to subsequent patients; It is the patient's right to have a clean and safe environment. Terminal cleaning must be done - ANS-Once during each 24 hour period During post procedure cleaning - ANS-All kick buckets, hampers, and similar receptacles must be inspected and disinfected as needed; Transport vehicles are to be considered contaminated after patient contact; All horizontal surfaces of tables and equipment, including the anesthesia machine, should be wiped down with a lint free cloth moistened with a hospital approved disinfectant. Identify the pathogens that can be commonly found in the OR environement - ANS- Escherichia coli; Methicilin resistant STaph aureus; Serratia marcescens. In which surgical wound category should a total abdominal hysterectomy be classified?

• ANS-Clean contaminated wound Match terms - ANS-Disinfection- A chemical or physical process of destroying all pathogenic microorganisms, except spores, on inanimate objects. Decontamination- The use of physical or chemical means to remove, inactivate, or destroy bloodborne or other pathogens on a surface or item. Sterilization- The process of destroying all microorganisms on a substance by exposure to physical and chemical agents; the complete elimination of all forms of microorganisms. High level disinfection- A process that destroys all microorganisms with the exception of high numbers of bacterial spores. Immediate use steam sterilization can be used - ANS-In urgent situations

A packing system for items undergoing sterilization should - ANS-Permit aseptic delivery of contents to the sterile field Complete sterilization in ethylene oxide is dependent upon four primary variables: proper time, gas concentration, temperature, and - ANS-Chamber humidity Which of the following is true about ethylene oxide sterilization - ANS-EO exposure is potentially carcinogenic and mutagenic to personnel and patients Which of the following is true about the use of peracetic acid on surgical items - ANS- Items must be immersible An integrator is a multiparameter indicator designed to measure which of the following parameters - ANS-Temperature, time, and presence of steam Which of the following are true about low temperature hydrogen peroxide gas plasma sterilization - ANS-Items can be stored for future use; No toxic residue is produced; The sterilant is bactericidal, viruicidal, and fungicidal; It can be used for items that are heat sensitive. Shelf life is related to - ANS-Exposure to external events; Type of packaging material used; Number of personnel who may have handled the package. Match the basic categories of surgical instrument with their uses - ANS-Graspers- To handle tissues and dressings. Retractors- To provide exposure of the operative site. Cutting instruments- To incise, cut, dissect, or separate tissue. Clamps- To hold join, or compress parts together. A mosquito is classified as a - ANS-Clamp When passing sharps during a procedure, the best way to protect yourself and surgeon is by using - ANS-A neutral zone Curved Mayo scissors are used for which of the following? - ANS-To cut heavy tissue What biting instrument is used for cutting tough tissue or bone? - ANS-A Rongeur while passing scissors, which of their parts should be visible to the surgeon? - ANS-Tip Which of the concepts are appropriate for the care of forceps during a procedure? - ANS-Cleaning the tips of blood or tissue frequently.

What action below is the best course to take when a hair is found in an instrument tray on the back table? - ANS-c. The entire sterile field should be broken down and a sterile field reestablished. Which of the following practices are NOT examples of the recommendation that "A sterile field should be maintained and monitored constantly"? - ANS-A sterile field that has been set up for more than 1 hour before the procedures begins should be broken down and a new set up prepared. If a delay occurs after a sterile field is set up, the personnel may leave the room as long as the room as been secured. When transferring medication and solutions to the sterile field the perioperative nurse should - ANS-Avoid removing stoppers from vials. Discard unused, opened irrigation or IV solutions at the end of the procedures. Dispense the entire contents to the container slowly. Use a sterile transfer device. Accurate preoperative documentation of the patient admission is an integral part of the nursing process. This includes - ANS-Patient identification; Preoperative orders; Patient assessment. The primary purpose of documentation is to - ANS-Record the chronological order of events during the nursing are of a patient. When documenting the placement of a surgical drain, which of the following components should be included? - ANS-Where the drain was placed on the patient. Which of the following is true about the use of abbreviations in perioperative documentation? - ANS-They can put patients at risk for medication errors. When documenting, the perioperative nurse should - ANS-Document in a timely manner; Use nursing diagnoses based on sound judgement; Use patient statements to verify the nurse's findings. Which of the following statements are true about informed consent? - ANS-Needs to state the indications for the proposed intervention; Is a physician's duty, and RNs are witnesses to the patient's signature; Must contain the name of the health care facility. When documenting the use of a pneumatic tourniquet, which items must be included? - ANS-Cuff pressure; Location where the cuff was placed; Name of person who applied the tourniquet cuff;

Serial number of the unit The concept of a standard of care related to documentation - ANS-Requires the nurse to document and act as a reasonably qualified nurse would in a similar situation An individualized patient care plan that was initiated during the preoperative phase includes - ANS-A cultural or religious preferences; Emotional considerations; Psychosocial considerations The primary reason for documenting sharp, sponge, and instrument counts is - ANS-to prevent injury to the patient from a retained foreign object Scrubbing Procedures Steps - ANS-1. Inspection of hands and arms

2. Open the gown and place on the table
3. Open the sterile scrub sponge package
4. Wet and later the hands and forearms
5. Clean under the fingernails of both hands with the nail cleaner
6. Scrub fingertips, nails, palm, and wrist to two inches above elbow
7. Repeat the procedure for other hand
8. Rinse hands and arms keeping the fingers pointed upward The purpose of performing a surgical hand scrub include - ANS-To reduce the resident microbial count to a minimum; To inhibit rapid rebound growth of microorganisms; To remove soil, debris, and transient microorganisms After the surgical hand scrub, the scrub person should keep the fingers pointed in which direction to allow water to drip off away from the attire? - ANS-Upwards What actions can the RN circulator take to assist the scrub personnel during gowning? - ANS-Touch only the ties, Velcro, or snaps to secure the back of the gown at the neck and the waist; Adjust the gown by grasping the bottom edge and pulling down to eliminate any blousing. Because skin is a major source of contamination in the surgical environment, which of the following statements is true? - ANS-Health care personnel who have cuts on their hands should not provide direct patient care You have just finished a surgical procedures and are removing your gown and gloves. - ANS-1. Pull the gown downward from the shoulders and off the arms.
9. Fold the contaminated side of the gown to the inside, roll it up, and discard it.
10. Remove and discard the gloves using a glove to glove and skin to skin technique.
11. Wash hands with soap and water.

Prolonged length of surgery When using chemical products, the perioperative nurse should - ANS-Use skin prep solutions according to the manufacturer's recommendations; Ensure the prep solution does not pool on the drapes; Apply blotting towels before performing a skin prep; allow skin prep solutions to dry before draping sponge and instrument counts are performed according to facility policy and procedure. Generally, the times during sx procedure that sponges are counted are: SATA - ANS-a. at skin closure c. before the procedure begins d. when new sponges are added to the field e. when wound closure begins when a count discrepancy occurs, what should be the FIRST action by the RN circulator? - ANS-c. inform the surgical team of the discrepancy Which of the following actions should be included in the perioperative nursing care of a patient with a suspected latex allergy? - ANS-Assess the patient's cross sensitivities and previous reactions to latex; Indicate latex precautions on door signs for every room that the patient occupies; Use latex free supplies for IVs, hair covering, and dressing materials; Verify that the surgeon is aware of the allergy. Which of the following would be an appropriate action for the perioperative nurse when assisting with anesthesia? - ANS-Apply cricoid pressure if needed during intubation Which of the following is NOT included in basic monitoring of the patient for anesthesia?

• ANS-Arterial line Which drug is used to reverse valium and midazolam? - ANS-Flumazenil Which method is used to prevent aspiration during endotracheal intubation? - ANS- Applying cricoid pressure How can the perioperative nurs assist the anesthesia provider with placement of a spinal or epidural block? - ANS-Calm the patient During intravenous regional anesthesia (Bier Block), the tourniquet should be deflated slowly to prevent which of the following from entering the circulation? - ANS-Bolus of anesthetic What is the most consistent indicator of MH during a surgical intervention? - ANS- Unexplained increase in end tidal CO

Depending on state laws and hospital policies, which of the following types of anesthesia can be performed without a professional anesthesia provider? - ANS- Moderate sedation Which assessment factor is important to include when screening patients for potential risk of MH? - ANS-Family history of problems related to anesthesia Match medications - ANS-Antibiotics- controlling infection. Anticoagulants- Delays the coagulation of blood. Hemostatic agents- Assist in blood clotting. Cardiac agents- Test patency and integrity of a graft Anti inflammatory agents- Reduce post operative edema. By which route are antibiotics most commonly administered by the perioperative nurse during the intraoperative phase? - ANS-Irrigation solution The perioperative nurse's role in preparing and administering medications includes - ANS-Assessing the patient's medication allergies and use of herbal or dietary supplements; Verifying the administration of the correct medication, dose, and route; Checking expiration date of medication Identify the true statements from those given - ANS-Radiographic dyes are a risk to patients allergic to iodine and shellfish; Radiographic dyes are instilled directly into an organ or duct with a catheter or tube; Miotic agents are used to reduce intraocular pressure. In addition to hyponatremia, which of the following conditions can be a result of improper fluid management? - ANS-b. Hypervolemia During the medication administration phase of the medication use process, nursing assessment should include which of the following factors? - ANS-Current medications, including herbal; Medication allergies; Patient weight in pounds and kilograms What are the most common roles of the perioperative nurse in preparing medications and solutions? - ANS-Preparing medications and solutions per the physiciansrpeference card; Preparing and labeling medications and solutions; Document and verify by verbally reading back to the provider all verbal orders, per facility policy When medication is administered from the sterile field, it is removed from an original container by the RN circulator and presented to the scrub person. It should be immediately and speedily labeled with - ANS-Concentration and amount;

The inflation time should be monitored When working with electrical equipment, the perioperative nurse must - ANS-Ensure that warming therapy devices are used at appropriate settings; Ensure that users are educated in the safe use of all electrical equipment; Never place the hose of a patient warmer directly under the patient's blankets In addition to back up electrical power in the case of power outage, ORs may plan for outage by - ANS-Identifying which outlets in the OR are connected to emergency power; Maintaining battery operated lights in each OR; Routinely checking the operation and availability of back up equipment Radiation exposure safety controls include - ANS-Nonessential personnel should leave the room; Pregnant health car workers should avoid or limit exposure; Lead protective aprons, gloves, and thyroid collars should be worn Indirect fire hazards and risks specific to the OR include - ANS-Anesthetic complication risks; Postoperative infections; Postoperative surgical complications To follow the AORN guidelines for positioning the patient, the perioperative nurse should - ANS-Use additional precautions as appropriate based on unique patient considerations Which of the following physiological effects is most likely to results from positioning a patient in the lithotomy position? - ANS-Circulatory and respiratory compromise due to pressure on the abdomen The following safety measures should be considered when placing a patient in the lateral position - ANS-The upper leg is straight and supported with pillows between the legs; Lower arm on same plane as OR bed mattress, forearm and wrist in neutral position, palm up; The patient's dependent ear should be assessed to ensure that it is not folded. Documentation of the perioperative nursing care should include, but not be limited to - ANS-Type of positioning devices used; Names of persons positioning the patient Which of the following patient factors should be considered int he perioperative assessment - ANS-Age; Nutritional status; Preexisting conditions

Which intraoperative factors should be considered during periop assessment? - ANS- Type of anesthesia delivered; Duration of the surgery; Position required The table is flexed 90 degrees for the _____ position, which is a variation of the _____ position. - ANS-Jack-knife (Kraske), prone Which surgical position adversely affects the diaphragmatic movement? - ANS- Trendelenburg position; Prone position; Lateral position the use of the PNDS helps a periop nurse to - ANS-Plan the nursing interventions; Assess and develop the nursing diagnoses; Assess and evaluate the patient's status; Evaluate response to positioning What response is the results of tissue layers moving on each other - ANS-Shearing chlorhexidine gluconate CHG is a antimicrobial skin prepping agent used - ANS-For topical skin application only below the neck What agents are effective in removing resident microorganisms - ANS-chemical agents Which of the following are desired characteristics of antimicrobial agents? - ANS-Broad spectrum; High log reduction capacity; Effective for long periods of time Which of the following statements is correct regarding hair removal from a surgical patient? - ANS-Hair should be removed from the surgical site only when the hair is so thick that it will interfere with the procedure What does AORN's guideline for preop patient skin antisepsis recommend for prepping areas with high microbial counts? - ANS-Prep them last Which of the following should be avoided during hair removal - ANS-Nicking or cutting the skin Which of the following observations are critical when doing skin antisepsis on pediatric patients? - ANS-Take measures to prevent the loss of body heat

Surgical tissue banking is - ANS-The retrieval, processing, preserving, and storing of selected human tissue for later transplantation back into the patient or into another patient Which pathology specimens require fresh preparation and the use of a sterile container? - ANS-Breast tissue for hormonal assay; Cerebral spinal fluid; Semen for infertility studies The patient, the surgeon, and the scrub person all interact with the circulator in the management of specimens and each have special roles - ANS-Patient- Concerned with diagnosis, speed of diagnosis, psychosocial concerns. Surgeon- communicates identifying characteristics to the scrub person and to the circulator. Scrub person- Ensure accurate identification of the specimen by having a sterile marking pen to write location and type of tissue. Circulator- Sensitive to the scrub person's needs and to actions that facilitate accurate specimen management Which of the following forensic specimens should be placed in a paper envelope, labeled, and sealed? - ANS-Finger nails; Carpet remnants Songs counts are done for all the following reasons, EXCEPT - ANS-Because state laws require specific count procedures Which of the following are reasons to avoid using radiopaque sponges for postoperative dressings? - ANS-Possible invalidation of subsequent sponge counts if the patient were returned to the OR with intact dressings; Radiopaque sponges may appear as a foreign body on postop x-rays Which classification of hemostatic methods involves pressure or the use of ligating clips? - ANS-Mechanical What precaution should be taken when microfibrillar collagen is used as a hemostatic agent intraoperatively? - ANS-Avoid using it with an autologous blood salvage unit Which of the following drains allows for passive drainage of fluid from the body? - ANS- Penrose; T-tube The benefits of a standardized count procedure include which of the following? - ANS- Assists in achieving accuracy during the count procedure; Assists in conducting efficient counts; Human error studies have shown that many errors results from deviation

Which type of dressing is used to prevent drying of the wound and increase the proliferation of epithelial cells? - ANS-Occlusive Which of the following is true in handling hemostatic agents such as collagen or gelatin sponges? - ANS-Must not be injected or allowed to enter large vessels, as extensive intravascular clotting may occur Match the suture with its appropriate description - ANS-Surgical silk- Gives good support during early ambulation and promotes rapid healing, used to close fascia when on infection is present. Virgin silk- Composed of natural fibers, used for ophthalmic surgery. Dermal silk- Strands are encased in a gelatin or protein substance; used for skin sutures. Surgical cotton- Weakest of the nonabsorbable material choices, gains strength when wet. Linen- Tensile strength is inferior to other nonabsorbables, used for GI surgery. Steel- Used in ortho; may also be used in the presence of infection. Match the suture with its appropriate example - ANS-Monofilament nylon- Ethilon and Dermalon. Coated multifilament nylon- Surgilon. Uncoated polyester fiber- Mersilene and Dacron. Coated polyester fiber- Ticron, Ethibond, Teflon, Polydek, and Tevdek. Polybutester- Novafil. Polyethylene- Dermalene. Polypropylene- Prolene and Surgilene. Match the needle point with its appropriate description - ANS-Conventional cutting point- Cutting edge on the inside curvature, creating a very small path that heals quickly. Reverse cutting point- Curved needles with cutting edges on the outer curvature. Side cutting point- These needles do not penetrate underlying tissues, but rather split tissue layers, used for ophthalmic surgery. Trocar point- Used to punch through tough tissues. Taper point- pushes the tissue aside when passing through. Taper cut- Has cutting edges at the point only. Blunt point- used on organs, as they are less apt to puncture the vessels within organs, used for dissection of friable tissue. A designation of "4-0" on a suture package indicates the suture material's: - ANS-a. diameter Which type of staplers are used in the alimentary tract and in thoracic procedures? - ANS-Linear staples