FLS Module 2 Practice Questions 2026 Study Guide, Exams of Nursing

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FLS Module 2 Practice Questions 2026 Study Guide

“1 I I I I I I I I I I I I I I I I I I I I I I I I al FLS Module 2 Practice Questions 2026 Study Guide Indications for using local anesthesia in laparoscopy CORRECT ANSWER -no conclusive evidence that it will prevent visceral pain but can be helpful for tubal ligations, diagnostic laparoscopies or hernia repairs Types of local anesthesia - GORRECTANSWER Bupivacaine, Ropivacaine, Lidocaine Advantages of epidural anesthesia - SOIRREGHANINGWERE-Decreased post-operative anesthesia and deceased length of postop ileus as well as improved muscle relaxation. What medication can you give to prevent bradyarrhythmias in lap surgery? - CORRECT ANSWER - Prophylactic atropine prevents bradyarrhythmias caused by pneumoperitoneum but causes excessive dry mouth so better to give intea-op rather than pre-op. Can give glycopyrrolate What class of meds are used pre-op for relaxation of patients - GORRECTANSWER Benzos. For relaxation and also to give amnesia. CORRECT ANSWER -H2 blocker or non-particulate antacid sodium citrate to minimize effects of aspiration should it occur. Also any chronic cardiovascular or What meds should patient take prior co surger pulmonary medications What components are important for anesthetizing a patient for laparoscopy CORRECT ANSWER IV induction + GETA and neuromuscular blockade Can you use an LMA for laparoscopy r I I I I I I I I I I I I I I I I I I I I I I I I L a | Does the use of nitrous oxide as an insuffating gas cause bowel distension - SQORRECIVANSSUERE usually not seen (rare) unless patient has a bowel obstruction Common patient positions in surgery GORRECTANSWER Supine, Trendelenburg, Reverse T-burg, Lithotomy, lateral decubitus How should you position the arms in a pelvic laparoscopic surgery - SORRECIANGMWVERArm tucked ro the sides, Ensure hands are not near a break in the table to avoid a hand injury if table is flexed during surgery How should you position the arms in an upper abdominal surgery - (ORRECIANS WERE Arms abducted to 90 degree angle but not greater than 90 to avoid brachial plexus stretch injury What are some key elements to keeping patient safe in a steep reverse Trendelenburg position - GORREGL ANSWER Foot board to keep patient from sliding, safety belt to keep patients knees from buckling Keys to safely positioning a patient in lithotomy position - CORRECT ANSWER Fit the equipment to the patient, not the patient to the equipment. Allen stirups preferable to candy cane stirrups given more movements, In an omentectomy, what level should the knees be placed in the lithotomy position for optimal positioning? - PORRESTMNSWER For open surgery such as omenectomy it's important to make sure the knees are level with the torso to keep the instruments from interfering with the knees GORRECTANGWER «void stretch in brachial plexus, roll in the the axilla on the dependent side, with a an arm board for the contralateral arm. Can use a bean bag but it cannot extend Decubitus position precautions too far anterior or posterior to avoid interference with port placement and manipulation What is the risk to using a vacuum sealed bean bag rather than pillows or blankets for positioning a patient - GORRECTENGWER Higher tisk of pressure injury with the vacuum sealed bag as it is more firm than pillows or blankets bua ee ee ee ee eee ee ee ee ee eee eee eee Ds ce eee ee ee es “1 I I I I I I I I I I I I I I I I I I I I I I I I al Open - inserting trochar thru small incision ‘What gas is used to inflate the abdomen? - GORRECHANSWERI-CO2 What are the physiologic effects of CO2 - GORRECTANSWER cardiac arthythmias, hypotension, bradycardia, hypoxia Why is CO2 the preferred gas for laparoscopy? - GORRECIANSWERY rapidly absorbed, easily elimitenated, suppresses combusion, readily available, inexpensive, rapidly absorbed and easily eliminated. ‘What is the diffusion coefficient of CO2 compared to 02? - GORRECTANSWER! Diffusion coefficient CO2 is 20x that of 02 so it is easily soluble in blood and easily transported to the alveoli for easy elimination. What are the chemical effects of Co2 - CORRECT ANSWER -Rise in arterial and end tital CO2 concentrations with an accompanying drop in serum pH During a procedure, when is the greatest rate of change of the CO2 metabolism in a patien? - SORRECT ANSWERE The first 15 minutes, stabilizing wichin the first hour of surgery regardless of the effects of the pneumoperitoneum. Who will have a higher risk of adverse sequelae of CO2 insufflation - GORREGIANSWEREPaciencs with severe cardiopulmonary disease. Need to monitor end tidal CO2 and cardiac rhythm, particularly in the first 20 minutes. How is CO2 eliminated from the body? - GORRECTANSWER! Through the pulmonary system with increased minute ventilation. Because of pneumoperitoneum r I I I I I I I I I I I I I I I I I I I I I I I I L “1 I I I I I I I I I I I I I I I I I I I I I I I I al What are the physiologic changes of the chest/lungs when pneumoperitoneum is established CORRECT AINSWWERE Decreased functional residual capacity (FRC), Increased peak airway pressure, reduced pulmonary compliance, hypercapnea What are the chemical effects of CO2 on the brain? - GORRECTANSWER! Systemic vascular changes, cerebral autoregulation of blood flow and and vagal responsiveness to T-burg position. What does pneumoperitoneum do to the risk of VTE? - GORRESTANSWER Increases, Mechanism: decrease venous flow and theoretically lead to increased VTE formation What are alternate gases used for pneumoperitoneum - CORRECTANSWERL Nitrous oxide, air, helium, argon (CORRECHANSHIERE sci base disturbance, increased tolerance without general anesthesia, less post-op pain. What are the benefits of using nitrous oxide as the insufflation medium? When is nitrous oxide considered combustible for a laparoscopic insufflation medium? ANSWER when a combustible gas is present in the abdomen such as hydrogen or methane. So, do not use in the case of suspected bowel injury. But it does NOT suppress combustion. Ts nitrous oxide combustible - CORRECT ANSWER -No, it is not flammable itself and can be used with monopolar electrocautery. BUT it does not SUPPRESS combustion like CO2 does. What are benefits of using Argon or Helium as insufflation mediums? - SORRECIANGIVER] They are inert gases and eliminate the tisk of hypercarbia and acidosis. What are the drawbacks of using Argon or Helium as insufflation mediums? - CORRECT ANSWER - Decreased solubility therefore increased risk of gas embolus. Much more expensive and insufflators not readily available. r I I I I I I I I I I I I I I I I I I I I I I I I L a | Describe the mechanism of decreased urine production as it is related to pneumoperitoneum - CORRECT BINSRVERE Increased abdominal pressure —> decreased renal profusion -> decreased filtration rate —> decreased UOP. What is the mechanism of oliguria post-operatively in patients s/p laparoscopy - CORRECT ANSWER -A secondary release of renin and ADH leads to sodium adn free water reabsorption and oliguria. ost-operatively UOP remains low until hormonal mediators resume hemostasis, this can lead to physicians providing too much IVF leading to pulmonary edema, especially in patients with poor cardiac function. Will patients be more likely to be hyperthermic or hypothermic in laparoscopy? - CORRECT ANSWER - Hypothermic GORRECTANSWER)-warmed IVF, Barehugger, warm room temp. Using warm irrigation fluid has not been shown to have any significant effects. How do you prevent hypothermia How common is a gas emoblism? How does it present? - CORRECT ANSWER-< 1% of cases. Sudden cardiovascular collapse due to lack of venous return: Hypotension, tachycardia, JVD, and a "mill wheel murmur.” What do you do when you suspect a gas embolus? - CORRECT ANSWER -Stop insufflation, place patient in T-burg in left lateral decubitus position to prevent gas embolus to get to the right heart system, give fluid bolus co reverse severe hypotension, and place central line to evacuate or break up the embolus in the right heart chamber. How do we minimize risk of transmission of infectious particles from patient to OR staff in laparoscopy - CORRECT ANSWER -Use filters for all suction devices, universal protection (eye protection, gloves, impervious gowns} What is importance to do in a “final look" before removing the camera in laparoscopy? - CORRECT AINSIVERE-Check the surgical bed for hemostasis, perform survey of abdomen to rule out occult injury to remote organs, let out some of the pneumoperitoneum for a “low pressure test.” bua ee ee ee ee eee ee ee ee ee eee eee eee Ds ce eee ee ee es “1 I I I I I I I I I I I I I I I I I I I I I I I I al Trocar injury of abdominal wall vessels, injury to vessels and organs away from operative field, tamponade of What are the most common causes of unrecognized bleeding in laparoscopy? venous bleeding due to pneumoperitoneum. How do you place a suction drain at the time of a laparoscopy? - CORRECT ANSWER -Pull it through a 5- 8 mm trocar site with a grasper or push it through a 10-12 mm port. Normal duration that CO2 remains in the abdomen following laparoscopy - CORRECT ANSWER-3 hours (usually 3,500 ce total, only 200 ce of it usually remain at conclusion of case after closure of sites) What size port sites do not require closure? - CORRECT ANSWER -5 mm GORRECTANSWER! unknown, but probably <5% Incidence of port site hernia needles with an exagerated curve, In obese patients, may need to enlarge the skin incision for adequate What is needed for an open technique for closing port sites? exposure, -abdominally to include the fascia on both How do you close a port site with laparoscopic assistance (i.e. not an open technique)? ANSWER! Sucure is carried through skin incision and exited intre sides of the incision using a NeoClose or Carter Thomason device. A Kieth needle can also be used, incerted, reversed intra-corporeally and driven from insite to out. How do you close the fascia exclusively with laparoscopic instruments (i.e. not using a NeoClose or other GORRECTANSWER suture fascia closed from posterior aspect of abdominal wall. Exposure of fascia is poor with this technique, making it difficult to ensure proper fascial closure. device outside of the body) r I I I I I I I I I I I I I I I I I I I I I I I I L