RNFA FINAL EXAMS AND PRACTICE EXAMS WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED, Exams of Nursing

Download RNFA FINAL EXAMS AND PRACTICE EXAMS WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED and more Exams Nursing in PDF only on Docsity! 1 | P a g e RNFA FINAL EXAMS AND PRACTICE EXAMS WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED RATIONALES ANSWERS 2024 ALREADY GRADED A+ Laryngoscopy is direct visual examination of the interior of the larynx by means of a rigid, lighted speculum known as a laryngoscope to obtain a specimen of tissue or secretions for pathologic examination. What risk reduction strategy should the perioperative nurse employ in preparing for the conclusion of the procedure? Maintain instrument setup until the patient leaves the OR. Marissa Walton is transferred to the OR from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia. What important preparation for the procedure will the perioperative nurse perform before Marissa arrives in the OR? Prewarm the OR to above the ambient high temperature for an adult. FESS provides a more functional approach to treat sinus disease. FESS involves the endoscopic resection of inflammatory and anatomic defects of the sinuses while preserving natural function in a surgical procedure that is minimally invasive. From the following, choose an important finding that should be communicated to the surgeon immediately during this procedure. Encroachment of the orbit Administration of cyclogyl should be used in caution with which of the following patient groups? Patients on tricyclics What drug can be used to reverse the effects of heparin ? Protamine sulfate When assisting with an open inguinal hernia repair, the surgeon makes an incision through which of the following to access the cremaster muscle, inguinal canal, and cord structures? Choose the correct answer. External oblique muscle Identify the type of fracture that has more than two fragments. Comminuted 2 | P a g e Identify the correct path of the cardiac conduction system. From the SA node to the AV node to the bundle of His to the Purkinje system Transsphenoidal hypophysectomy (TSH) is performed with the patient administered a general endotracheal anesthetic, combined with a local anesthetic. The surgical team places the patient in a semisitting position, with the head against the headrest. A transnasal or a sublabial incision can be used for rapid access to the sella turcica. Select the diad (2) of conditions that would be appropriate indications for TSH. Hypopituitarism and small pituitary tumors Describe a pantaloon hernia. A combination direct and indirect hernia In renal transplantation a kidney with __________ artery(ies) is preferred. single With injury to the brain, swelling may occur quickly, requiring aggressive decisions to manage increasing intracranial pressure (ICP). What is an appropriate diuretic medication to give and what nursing actions would be indicated for an older adult patient with traumatic brain injury, increased ICP, and a history of congestive heart failure (CHF)? Furosemide (Lasix) 20-80 mg IV; monitor for hypotension and note extent of diuresis The production of CSF occurs where? Choroid plexus of the ventricles Select the true statement about antimetabolite drugs and their indications for use. 5-Fluorouracil and mitomycin can both be administered topically to inhibit scars and pterygium excision Select the statement that best reflects the functional components of the gastrointestinal (GI) tract. The alimentary canal extends from the mouth to the anus. As the surgeon prepared to clamp and transect the bowel during a small bowel resection for tumor, the scrub person transferred instruments from the Mayo stand to the back table and prepared the sterile field for bowel isolation technique. The rationale for this technique in tumor removal/cancer procedures is to: Prevent mechanical metastasis Heparin sodium is an anticoagulant. The basic mechanism of heparin's action is best described as: prevents the conversion of fibrinogen to fibrin. Which of the following associations is incorrect regarding gallstones? Gallstones in cystic duct = cholangitis 5 | P a g e In the pulmonary circulatory system, blood is pumped from the right ventricle (RV) through the pulmonary valve into the main pulmonary artery (PA). The PA divides into the right and left pulmonary arteries, which further subdivide into the arterioles and capillaries of the lungs. Where does the blood from the lungs flow next? Through the pulmonary veins to the left atrium Of the following ocular blocks, which carries the highest risk? Retrobulbar block An example of an amphiarthrotic joint includes: Intervertebral joints What composes the lining of a herniated abdominal sac? Peritoneum A neurologist is about to perform a lumbar puncture on a patient presenting with altered neuro status due to a possible intracranial mass. Why would this procedure be contraindicated? The change in ICP from the lumbar puncture can result in brain herniation There are many factors that influence the behavioral manifestations of pain in the pediatric population. Which of the following is not an influencing factor? Parental involvement Anesthetic management impacts the success of ophthalmic surgery. Safe ambulatory surgery, especially in certain populations, depends on patient selection, preoperative evaluation, preparation, monitoring, and local anesthesia techniques. Select the patient below that would be an appropriate candidate for general anesthesia, instead of local anesthesia alone. A 22-year-old healthy female for a tear duct probing Thyroid storm can occur in patients whose hyperthyroidism is partially controlled or untreated. Thyrotoxic crisis can be precipitated by a stressful event, such as surgery. An example of a nursing action(s) to reduce the risk of thyroid storm is: provide a quiet, calm atmosphere and help the patient relax, and provide comfort measures, including a cooling blanket. Herbal supplements may have a role in the perioperative setting and are an important consideration for nurses. A mistaken assumption is that botanical dietary supplements are safer than prescribed or over- the-counter drugs. What assumption should the nurse make, during the nursing assessment, when the patient describes the use of dietary supplements and herbal products? Botanicals may initiate a pharmacologic response and should be considered as a medication. When coverage for a defect cannot be achieved through skin grafting, plastic surgeons rely on other techniques to replace tissue. After mastectomy, reconstruction with a transverse rectus abdominis 6 | P a g e myocutaneous (TRAM) flap is one of several options for nonsynthetic prosthetic reconstruction. Another descriptive term for the TRAM flap is the: pedicle-based flap The RNFA should anticipate the surgeon making an incision in which region to gain access to the pancreas? Right subcostal A wide range of equipment is used in ophthalmic surgery. The perioperative team's knowledge of proper operation should be confirmed through inservice education and training specific to new equipment, plus demonstrated competency. To ensure patient safety and appropriate function and application of surgical devices, which statement best reflects recommended practice when using complex biomedical equipment? Use the device according to the manufacturer's directions and test for proper performance before the patient enters the OR. Steven Morganstein, a 51-year-old male with hepatobiliary disease, is scheduled for surgery. The perioperative nurse, during the preoperative assessment, questions and examines the patient for signs and symptoms of jaundice, petechiae, and lethargy and: reviews his chart for bleeding and coagulation times and the platelet count. The absence of distinct teniae serves as a visual landmark for what abdominal structure? Upper margin of the rectum Which of the following operations require general anesthesia? MVR Exophthalmos can be associated with which of the following? Hyperthyroidism When a thyroglossal duct cyst is present in an adult, it exists as a pretracheal cystic pouch attached to what structure? Hyoid What special consideration should be made when assessing a pediatric trauma patient for level of consciousness? Use the modified Glasgow Coma Scale for children. Young children are predisposed to parasympathetic hypertonia (increased vagal tone), which can be induced by: painful stimuli such as eye surgery or abdominal retraction. For indirect hernia repair, the _____. 7 | P a g e Hernia contents are reduced to the abdominal cavity Twelve pairs of cranial nerves arise within the cranial cavity. Although they are part of the peripheral nervous system, from a surgical standpoint they are considered part of the anatomy of the head. Which three pairs of nerves, conveniently considered together because of their motor influence on the eye, are subject to toxic, inflammatory, vascular, and neoplastic lesions? Third, fourth, and sixth cranial nerves An important landmark during perineal prostatectomy is the: True prostatic capsule Select the semi-invasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function. Radionuclide imaging Suction applied directly to neural tissue can be harmful To prevent tissue damage, a ___________should be placed between the neural tissue and the suction tip. Cottonoid Select the statement about the prostate that best reflects its location, size, and weight. The prostate sits below the base of the bladder, is 4 cm at the base, and weighs 20 to 30 g. During ventriculoperitoneal shunt placement, _____. The unit is soaked in NS & antibiotic solution, never lubricated. If cervical spine precautions were not implemented before arrival at the hospital, the emergency department team initiates them before performing any other procedures on the patient. A trauma team member can stabilize the head and neck, if necessary, until a cervical collar is placed. What event needs to take place before the team removes the cervical collar and continues care? A cervical radiograph is obtained to rule out injury to the neck. The pelvic floor consists of which muscle groups? Levator ani and coccygeal muscles Damage to this area of the brain is often devastating and life-threatening because it can affect movement, senses, consciousness, perception, and cognition. Choose the correct answer from the following. Brainstem Commonly implicated in SAH, the vessels of the Circle of Willis include: Posterior communicating artery 10 | P a g e decreased pulmonary compliance and functional residual capacity. Surgeons use open reduction and internal fixation when they are unable to reduce a fracture by closed methods and skeletal traction is not indicated. What would be an advantage for an open rather than a closed fracture reduction technique? Direct observation and verification of fracture alignment The right and left coronary arteries originate in the corresponding sinuses of Valsava which are located ____________. Posterior to the cusps of the aortic valve Which of the following regarding PMMA ( bone cement) is not an affect local tissue? Skin burns due to exothermic reaction During a stapedotomy, it is important to save which of the following nerves that control taste on the anterior 2/3's of the tongue? Chorda tympani nerve Acquired valvular heart disease most commonly affects the ____________valves. Choose the correct answer. mitral Bone grafting can be completed using Allografts or Autografts. The type of graft used is not dependent on which of the following factors? The weight bearing ability of the bone affected A rapid rise in thyroid hormone levels is not caused by which of the following? Idodized table salt use Thyroid hormone medication Several types of diagnostic imaging studies visualize structures by producing serial sections through different anatomic planes, highlighting specific structures or tissue densities. Which of the following is contraindicated in pregnancy? CT scan. The cricoid cartilage is a complete cartilaginous ring that resembles a signet ring; it rests beneath the thyroid cartilage and supports the airway. What membrane, attached to the midline of the upper thyroid cartilage, protects the larynx during swallowing? Epiglottis An example of an indication for liver transplantation would be: primary hepatic cancer The gastric veins drain into the ___________vein. 11 | P a g e Portal vein Which of the following pelvic fascias cover the perineum? Parietal Upon examination of a patient with a knife wound to the right side of her neck, you observe that the patient has weakness turning her head to the left against resistance and has a drooping right shoulder. Your diagnosis is injury to the: right spinal accessory nerve. Following a heart attack you tell a patient that he now has a myocardial infarction. You explain this as: an area of his myocardium that has irreversible damage Substernal or intrathoracic thyroidectomy is indicated for extensions of goiters that are encroaching into the substernal or intrathoracic regions, causing tracheal or esophageal obstruction. Access to the substernal compartment is typically facilitated by: using long instruments through a regular thyroid incision. The hypogastric plexus innervates the: female pelvis Identify the dura fold that separates the right and left cerebral hemispheres. Falx cerebri True statements regarding the arterial supply of the spleen are the following EXCEPT The splenic artery is a branch of the celiac axis What statement regarding level I and level II trauma centers best describes the difference between the two types of centers? A level I trauma center provides care for every type of injury, while a level II lacks some specialized resources. Luanne Williamson, a 39-year-old, 248-lb mother of 4 children, is assisted with transfer from a transport vehicle to the OR bed for laparoscopic cholecystectomy, operative cholangiogram, and possible common bile duct exploration. The perioperative nurse determined that Luanne is at risk for positional injury related to her size and the positional requirements and OR bed manipulations required for this procedure. An appropriate nursing implementation for positioning this patient would be to: place two safety belts over the thighs and lower legs to prevent the patient from sliding out of position when the surgeon tilts the table for better exposure and access, and place a positioning lift under the lower right side of the chest to elevate the lower rib cage for exposure and access to the viscera in the right upper quadrant of the abdomen. Which of the following factors might the RNFA recognize as having the potential to produce pressure? 12 | P a g e a self-retaining retractor post clamped to the OR bed rail and tightened against the patient's side The Joint Commission (TJC) suggests that surgical consents be written at what level to meet health literacy needs of all patients? 5th grade Many factors have contributed to the evolution and progressive growth of ambulatory surgery. Select the three anesthetic agents that promote fast induction, rapid emergence, and minimal side effects and have been credited as a significant factor in this trend. Sevoflurane, propofol, desflurane Which statement best explains the mechanism of action of general anesthetic agents? Inhibition of synaptic transmission of nerve impulses High-pressure insufflation rates can cause increased intra-abdominal pressure that can result in life- threatening sequelae. The perioperative nurse reduces the flow rate in collaboration with the surgeon, while monitoring the patient for signs of: CO2 gas embolism A type of suture to help eliminate tension on the primary suture line is known as: Retention The incidence of intraoperative awareness (IOA) may increase in high risk patient populations. From the following, choose the group that is considered high risk for IOA. Cardiac surgery patients The safest practice for passing sharps and instruments during the procedure is to: establish a neutral zone or separate area to place reusable sharps Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral, and ______ nerve, which can result in injury from ______. common peroneal; Direct compression from the stirrup bars What is the appropriate action if the doctor is delayed after the room and instruments have been opened? Cover the instruments with a sterile drape and have the scrub nurse continually visually observe the room for breaches in sterility Which of the following are the sources of radiation exposure in an operating room setting? Lasers and C-arms Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below: 15 | P a g e reduction strategy that protects the environment and perioperative worker from exposure to ambient waste anesthetic gas. Ensure that the scavenging system is properly connected to the gas outlet. When unexpected events occur that have, or could have, compromised patient safety, a systematic investigatory process takes place. Significant information is gained through this meticulous exploration. The primary motive for carrying out a root cause analysis is to: find out what needs to take place to prevent a recurrence of the event. The most common pediatric premedication given in the U.S. is: Midazolam Surgical hand scrub products should have which of the following attributes? Inhibit the regrowth of microorganisms The bariatric unit was experiencing an alarming rate of postoperative wound dehiscence and evisceration on postoperative day 1, as the patients began to ambulate independently. Select the response below that reflects significant surgical team influence on wound healing. Sterile technique, wound closure materials, hemostasis methods Select from the following a medication that is used for PONV and has the potential to prolong the QT interval Droperidol An instrument that is used to occlude a vessel is known as: hemostat What action is considered a best practice when communicating with geriatric patients with cognitive impairments? Approach the patient from the front and identify yourself Which members of the surgical team can be held liable in litigation for retained foreign bodies? the entire team Sponge counts should be performed at the time of permanent relief of either the scrub person or circulating nurse, and _____. Before the procedure, before closure of each body cavity, before wound closure, at skin closure or end of procedure. The perioperative nurse visited Mr. Jennings in the ICU the next day and noticed abrasions on his elbows. Mr. Jennings told her that the ICU nurses had difficulty pulling him back up in bed every time he slid down toward the bottom and he was not able to be much help in moving himself. This skin injury was probably the result of which physical force? 16 | P a g e friction from his elbows rubbing over the sheets when slid up in bed Select the nursing activity that would reduce the impact of an extrinsic factor that could cause a pressure injury to the patient. Removing all but one layer of linen from the dry polymer elastomer gel mattress surface of the OR bed before patient transfer Guidelines from WHO focus on which of the following in the prevention of SSIs? Use of antibiotics Surgical site infections (SSIs) are most often caused by gram-positive cocci and may arise from the patient's own endogenous sources. The most frequently identified microorganism cultured from SSIs is: staphylococcus aureus If a sterile glove becomes contaminated during the procedure, the best practice for corrective action is: reglove with assisted gloving technique Linda Gardner is highly allergic to latex and the anesthesia provider plans to give Linda prophylactic medications before anesthesia. What medications might be administered to Linda in the preoperative holding area? Prednisone and a beta-agonist inhaler The most accurate method for routine post operative temperature monitoring is via: Oral 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. air-dry, inventory, inspect, lubricate, assemble and string instruments, wrap and tape Qualities of an effective packaging material must include these key characteristics. Select the correct statement that includes the most important qualities for packaging material. good sterilant penetration and air removal, microbial barrier, aseptic presentation Luci Edwards, a patient of Dr. Jordan, has been admitted to the PACU after a bilateral bunionectomy. During the hand-off report from the anesthesia provider and circulating nurse, Luci began to awaken, crying in drowsy garbled speech that she was thirsty and wanted water. What would be the perianesthesia nurse's appropriate response? Review Luci's intake and output and cardiac status, and increase her intravenous flow rate Select the correct choice for a polyester suture. Ethibond 17 | P a g e The initial primary assessment by the perianesthesia nurse, on the patient's admission to the PACU, begins with which criterion? Airway adequacy Emma Clements, a frail 92-year-old, was positioned in lithotomy for a 90-minute rectal procedure under spinal anesthesia block (SAB). At the end of the procedure, when the circulating nurse and surgeon gently removed her legs from position and placed her in supine position, she experienced a common side effect of spinal anesthesia, ____________. hypotensive episode Jacob Sutzkever is a 62-year-old man who had surgery 6 days ago for a ruptured diverticulum. He is back in the OR for a debridement and washout. Jacob's fever has subsided and the drainage is clear. The surgeon will continue with wet to dry dressings and schedules Jacob to return to the OR in 3 days for: delayed primary sutured closure Tissue reaction characteristics that need considered when choosing suture include: Absorption A basic anesthesia monitoring device that is used during general anesthesia to confirm successful endotracheal tube placement and determine the presence of gas exchange is the: capnometer/end-tidal CO2 monitor to identify expired CO2 in the breathing circuit Which of the following do not need to be counted and documented? Cautery pencil ? The highest risk of injury per needle use is attributed to the: Keith needle Positive-pressure air handling systems with unidirectional flow of non-recirculated air from the ceiling to the floor are designed to: flow clean air over the patient and prevent corridor air intake A type of monofilament suture that does not require the user to tie knots is known as: barbed The teniae coli consist of __________longitudinal bands of muscle. 3 Morris Bettelman, an 86-year-old retired plumber, states that he has suffered from a groin hernia all of his adult life; he states, "as far back as I can remember." Sometimes he has to push the bulge back into his abdominal muscle and then he is fine until he has a coughing spell. This morning the bulge was large and tender when he woke up and he could not reduce it. As the pain increased, he felt weak and nauseous. His daughter took him to the emergency department. Morris was diagnosed with a 20 | P a g e There are three main vessels of the coronary arterial system. Which of the following is not one of the three? Great Cardiac Artery A herniated disc most commonly occurs in which section of the vertebral column? Lumbar Of the following, which is not a risk factor for the development of postoperative ventral hernias? Male gender Open common bile duct (CBD) exploration may be indicated in some cases where: the patient has undergone prior biliary surgery. The renal artery and vein enter and exit the kidney on the medial side of the organ through a concave area known as the: hilum The tensile strength of which type of suture should never be tested before handing it to the surgeon? Gut suture The main pressure points in Fowler position does not include which of the following? Fibular head Ductal ectasia is a benign breast disorder that is difficult to distinguish from cancer, primarily because it presents with: a hard and irregular mass, nipple discharge, and enlarged axillary nodes. Specific positioning considerations for bariatric patients require particular attention to protecting these patients from inherent risks related to their size and weight. Protective measures to protect both patient and staff include those below. Which measure reflects the most safety protection for both patient and staff? Ensure that the OR bed can accommodate the patient's weight and girth. From the following, which is a possible benefit to the paramedian incision? decreased risk for hernia The adrenal glands can be identified not only by their location in the body but also their shape. The right side is ________while the left is ____________. Triangular, crescent An example of a potential risk associated with pneumoperitoneum would be: gas embolus into an exposed blood vessel during the procedure. 21 | P a g e Cleft lip is usually associated with a notch or cleft of the underlying alveolus and a cleft of the palate. Cleft lip repair is most often performed when the infant is about 3 months of age. Cleft lip is described as: a deficiency of tissue (skin, muscle, and mucosa) along one or both sides of the upper lip What technologic characteristic of robotic surgery provides a superior indication for robotic-assisted laparoscopic cholecystectomy? The magnified three-dimensional picture may reduce bile duct injuries during dissection Which type of fracture is a dorsally angulated fracture of the distal end of the radius? Colles Osteoporosis is one of the most common and serious of bone diseases and is responsible for more than 2 million fractures a year. Osteoporosis-related fractures most commonly occur in the hip, spine, and wrist, but any bone can be affected. The excessive reduction of total bone mass in osteoporosis is due to the loss of: estrogen and testosterone. The PSA test is a serum lab test for prostate-specific antigen. If the test value is elevated, the patient is at risk for carcinoma of the prostate; a PSA value greater than 10 ng/ml is highly suggestive of prostatic carcinoma. Tissue from a transrectal prostate biopsy provides the cellular information to confirm the diagnosis. The American Urological Association (AUA) prostate cancer staging tool essentially provides what important information about the tissue specimen? Prognosis and potential for recovery 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. Select the statement that best describes the appropriate preferred insertion approaches. Right jugular and right femoral If the injury to the patient is a result of a violent crime, the team must give special attention to preservation of evidence during the course of patient care. When clothing is removed from the patient, why must it be placed and secured in a paper bag rather than a plastic bag? Plastic bags may trap moisture and allow mold growth, destroying evidence. The thoracic cavity is an airtight compartment. The lateral walls are formed by 12 pairs of ribs. Each hemithorax contains 11 external intercostal muscles and 11 internal intercostal muscles. What accompanies each intercostal muscle? an artery, vein, and nerve When catheterizing the female patient, the perioperative nurse must locate the urethra. The correct order of the external organs of the vulva listed anterior to posterior is: 22 | P a g e mons pubis, labia majora, labia minora, clitoris, urethra, vaginal opening. During the preoperative assessment and teaching for a patient scheduled for otolaryngologic surgery performed using local anesthetic, the perioperative nurse reviews with the patient normal coping mechanisms that are personally effective and supports and encourages the patient during the surgical intervention. The nurse is preparing the patient to anticipate and self-control physiologic indicators of: claustrophobia. Which of the following is incorrect pertaining to lung segments? There are 5 segments on the right and 3 segments on the left Among the treatment options for tricuspid valve disease are suture annuloplasty, ring annuloplasty, and valve replacement with either a biologic or a mechanical prosthesis. Because there are no specific tricuspid prosthetic valves available, what type of prosthetic graft would be created or implanted? A mitral prosthesis The surfaces of the hemispheres form convolutions called gyri and intervening furrows called sulci, which serve as anatomic landmarks. Which of the following sulci is of particular anatomic importance during surgery? Lateral sulcus What properties enable arteries to compensate for changes in blood pressure and blood volume? Elasticity and distensibility During a surgical procedure to excise a malignant thyroid gland, the surgeon asks you why she is not removing the posterior part of the patient's thyroid gland. Your correct response is: so that the patient does not develop hypocalcemia Denise Corson, a 35-year-old mother of twins, was scheduled for a left breast lumpectomy. This is her third lumpectomy in 6 years for benign fibrocystic disease. Denise shared her concerns with the perioperative nurse about her breast's appearance after three similar surgeries in the same breast. The nurse noticed, on assessment, how much smaller the left breast was in comparison with the right. An appropriate action for the nurse to take in response to Denise's concern would be: encourage her to discuss her feelings regarding body image and resulting changes. The first diagnostic test performed in thyroid assessment is: Ultrasound Postoperative infection in total hip arthroplasty is _____. Usually catastrophic Risk-benefit analysis is weighed differently for elders. Important factors that need to be evaluated are: Personal motivation 25 | P a g e Bone wax Age-related skin changes include a thinning epidermis and decreased subcutaneous fat and elasticity. What special consideration will the perioperative nurse provide, in terms of additional attention and care, in one of the following nursing actions? Gently lift, not slide, the patient to and from the OR bed The Whipple procedure is the removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, and the ____________ as a surgical treatment for____________. lower half of the common bile duct; pancreatic cancer Identify the triad of anatomic sites of abdominal wall weakness with a potential for hernias. Inguinal canal, femoral rings, umbilicus A complication of thyroidectomy that included an extended thyroid dissection is which of the following? Pneumothorax Sally Andres and her orientee have returned from an airway fire simulation exercise with the otorhinolaryngologic surgeon, fellow, and anesthesia provider. They were amazed at the statistics for OR fires and the threat of serious injury to the patient and team. Patients undergoing otorhinolaryngologic procedures are at greater risk for fire injury because of the proximity of the surgical field to high concentrations of oxygen. The team discussed a plan to change their practices. An example of a risk reduction strategy that involves collaboration of the entire surgical team during otorhinolaryngologic surgery would be: conducting regularly scheduled team simulations that rehearse an airway fire protocol. The nose is divided into the prominent external portion and the internal portion known as the nasal cavity. The primary purpose of the nose is to: prepare inspired air for the lungs Anesthesia providers are concerned about the potential increased risk of instability intraoperatively resulting from inhibition of coagulation. Which herbal supplement, from the list below, would be implicated in a coagulation interaction? Feverfew Lisa Torentino, a 29-year-old woman, is in the emergency department (ED) with a ruptured appendix. Before the ED nurse and surgical resident transported Lisa to the OR, the nurse called to inform them that Lisa is 27 weeks' pregnant. What special considerations must the perioperative nurse and anesthesia provider address with this new information? The patient may need rapid induction of general anesthesia, or spinal anesthesia. During a total hip arthroplasty, the instrument used to access the femoral canal is the_____. 26 | P a g e Box osteotome An example of perineal glands that secrete mucus is: Bartholin's glands What major artery supplies the descending colon? Left colic artery Aubrey Scheel arrived to the preoperative receiving and waiting lounge of the ambulatory surgery center for an elective hernia repair. The RNFA began Aubrey's preoperative nursing assessment. It was a beautiful and warm spring day and Aubrey shared his concern about how he would feel after the procedure. He wanted to know when he would be able to get back to work and resume his place as pitcher on his softball team. He also told the RNFA that he planned to do some yard work today as soon as the anesthesia "wears off." Which one of the following nursing diagnoses is given priority in both preoperative and postoperative education? Deficient Knowledge related to disease process and convalescence The roof of the inguinal canal consists of the _________________while the __________________makes up the major support for the floor of the inguinal canal. external oblique aponeurosis; transversalis aponeurosis and fascia Prostate cancer is the most frequently diagnosed cancer in men and is the leading cause of cancer death in men. Select the triad that best reflects the individual with the highest risk for prostate cancer. 65+ years old, African descent, father had prostate cancer What incision is used for lumbar laminectomy? Midline directly over the appropriate lumbar spines Which action best reflects the movement of urine from the renal pelvis to the bladder? Slight distention of the renal pelvis initiates a wave of muscular contractions. Before reaching the rectus abdominis muscle during surgical exposure, the surgeon must first progress through which of the following? Scarpa's fascia During urologic surgery large quantities of irrigating fluids are infused intraoperatively. It is important to avoid the use of distilled water during TURP as this complication may occur, Choose the complication from the following. Dilutional Hyponatremia Which of the following is not included in the terrible triad? PCL tear 27 | P a g e A chain of three small articulated bones extends across the middle ear cavity and conducts vibrations from the tympanic membrane across the middle ear into the oval window and the fluid-filled inner ear. What are the names of those three small articulating bones? Malleus, incus, and stapes Melissa Pepe is a 17-year-old female with cancer of the thyroid secondary to leukemia, which went into remission 7 years earlier. She is very concerned about scarring from the surgery. The nurse discussed Melissa's concerns with the surgical team before the incision was made. Melissa had a minimally invasive thyroidectomy approach, which left a small scar that was closed with a 4-0 nonabsorbable subcuticular suture. In the postoperative phase, the nurse provided Melissa with her postoperative education relative to her incision. Select all the incision care instructions that would be relevant for Melissa. Instruct her to refrain from prolonged exposure to direct sunlight or tanning salons while the incision is healing. Bone grafting using allografts or autografts may be used to fill cavities after removal of large amounts of bone that might result in instability, or to fill bony defects and to promote the union of fractures at the time of open reduction. Bone graft that is sealed in a sterile labeled envelope from a tissue transplant company and stored in a vacuum-sealed freezer, monitored with an alarm, would be considered a/an: allograft Fluoroscopy time should be limited as much as possible. Which of the following is radiation reduction technique? Fluoroscopy equipment is required to have an audible alarm after 5 minutes of use Mohs' surgery is a specialized excision used to treat basal and squamous cell skin cancers. Select the statement about Mohs' surgery that best reflects the process, procedure, and outcome goal. Lesions are mapped, excised, and examined by frozen section until clear margins are found. Upon neurological examination, you notice an abnormal pupillary light reflex in a patient's right eye. Which of the following is consistent with this sign? compression of the oculomotor nerve During the preoperative assessment of an adult with a previously corrected congenital heart defect, the perioperative nurse should be aware of anatomic anomalies associated with the original defect, or its subsequent repair, that may alter the current surgical plan for a patient who had prior pediatric cardiac surgery. What is an appropriate nursing response when the assessment reveals the adult patient has undergone prior pediatric cardiac surgery? Alert the staff to anticipate altered anatomy, special supplies, and potential complications Shari Donaldson is scheduled for a thyroidectomy. As the RNFA, it is important that stress the the team the importance of having which tray available for this case? Tracheotomy tray 30 | P a g e Distant metastases may have already occurred without adjacent lymph node involvement at the time of its palpable detection An important area of the brain that is critical for learning and memory is the ___________, while emotion and social behavior are regulated by the ____________. hippocampus; amygdala A minimally invasive technique that may be used to remove parathyroid tumors deep in the mediastinum is known as: Thoracoscopy Patients with acute arterial insufficiency with occlusion usually present with the onset of the six P's: sudden severe pain, pulselessness, paresthesia, paralysis, pallor, and poikilothermia (coolness) of an extremity. This occlusion can be the result of which condition? Rupture of an unstable atherosclerotic plaque During an emergent total open splenectomy on a patient with blunt force trauma to the abdomen, the circulating nurse and anesthesia provider noticed rust-colored urine in the urinary collection container. They had just hung the third unit of whole blood. What nursing action is the first priority? Stop the blood transfusion. Abdominal aortic aneurysms (AAAs), which account for most aneurysms, occur primarily in what area? between the renal arteries and the aortic bifurcation The IXth cranial nerve provides which of the following? sensation to the tonsils The mitral valve is anchored to the _________________wall. left ventricular wall Uvulopalatopharyngoplasty (UPPP) is performed primarily to relieve obstructive sleep apnea (OSA) and snoring. Select two common indications for UPPP surgery. O2 saturation below 80%, and apnea index worse than 20 A reverse cutting needle is preferred for ___________suturing. cutaneous The strength layer of the skin is found in the _____. dermis The instrument tips in laparoscopic instruments are designed to produce the same tissue effects as a traditional instrument used for open surgery. Because of the process challenges of the laparoscopic approach, it is time-consuming to insert and withdraw instruments repeatedly during the procedure. 31 | P a g e Instrument manufacturers have attempted to make their products efficient by combining functions. An appropriate combined function for a laparoscopic instrument would be: blunt dissection with the smooth, rounded edge of the closed endoscopic scissors Select the patient that is the most vulnerable and at high risk for hypothermia in the perianesthesia phase based on diagnosis or surgical procedure. A 3-week-old neonate undergoing surgery for a cardiac anomal Which anesthetic agent could not be given if an IV-only anesthesia plan was employed? Desflurane Observing safety precautions during all phases of surgery, from setup to cleanup, reduces the number of injuries and exposures for all OR personnel. For the prevention of sharps injuries during the perioperative phase, which risk reduction strategy reflects appropriate nursing action? Use standardized sterile field setups throughout the surgical services department. The perianesthesia nurse completes a systematic and comprehensive secondary assessment of the patient (e.g., head-to-toe assessment or major body systems' approach). Select the response that best reflects the parameters of a comprehensive respiratory assessment. rate, rhythm, and breath sounds Select the appropriate example of physiologic symptoms of pain. Increased B/P Select all the injuries or conditions that reflect probable child abuse or neglect. Severe injuries inconsistent with the history What vaccine should healthcare workers receive if they are caring for immunocompromised patients? Inactivated influenza vaccine. OSHA requires all healthcare organizations protect their workers from exposure. The exposure control plan must include which of the following? universal precautions, PPE, and recordkeeping Surgical instruments that do not fall under the category of clamps, retractors, or cutting instruments, but are used in most procedures, are typically included within the category of: accessory and ancillary instruments. The lifting equation provides a mathematical equation to determine the recommended weight limit (RWL) and lifting index (LI) for selected two-handed manual lifting tasks. Essentially, what is the recommended maximum weight limit for one person in a patient handling task? What is the best option when the weight limit exceeds the recommendation? 35 lb; use assistive lift devices 32 | P a g e Of the following choices, which would not not be a consideration for choosing suture? scrub person preference It is important to recognize that the difference between pediatric care and adult care is not just a size issue. Major areas of distinction are the airway and pulmonary status, cardiovascular status, temperature regulation, metabolism, fluid management, and psychologic development. The most significant consideration when caring for pediatric patients that is not of concern when caring for adults is: from birth onward, the child is in a continual state of development and physiologic change This hemostatic device offers a rapid and secure method of clamping arteries, veins, nerves, and other small structures. This device remains in the patient, is not counted, and is made of a metal that is compatible with MRI. Select the correct hemostatic device that fits this description. Ligating clip It is important for the RNFA to be aware of this ESU safety hazard when assisting with endoscopic surgery. Choose the correct answer from the following. Insulation failure Latex allergy reaction is best prevented by: limiting exposure to latex When applying sterile drapes to create the sterile field on the patient, which of the following principles is most important? Drape the patient starting with the incision area and proceeding to the periphery. The lateral kidney position allows approach to the retroperitoneal area of the flank. To render the kidney region readily accessible, the ______ is raised, and the bed flexed so that the area between the twelfth rib and the iliac crest is elevated. Compression of the _______ can occur when the flank is raised too high. kidney bridge; vena cava Marvin Deloitte, a 19-year-old male, received an intravenous peripheral nerve block (PNB/Bier block) for an ORIF of an ankle fracture. The anesthesia provider injected a distal dorsal vein of Marvin's right foot with 2% lidocaine, after placing a single cuffed pneumatic tourniquet circumferentially around Marvin's upper right thigh. The surgeon looked through the OR window to check on anesthesia progress as he scrubbed at the sink outside of the OR. The circulating nurse had the leg elevated and was prepping the ankle. The surgeon noticed that the cuff seemed to be deflating and that the anesthesia provider was turned away from the patient. The circulating nurse also noticed the movement under the protective towel placed over the cuff, and saw the tourniquet tubing fall to the floor. The nurse's first response should be to: alert the anesthesia provider, reconnect the tubing to cuff and inflate, and send the surgeon for the code cart 35 | P a g e The Centers for Disease Control and Prevention (CDC) has identified pathogens that could pose a threat to national and world security and safety through bioterrorism. Select the four most probable agents that could be used to cause mass transmission, mortality, panic, and social disruption. Smallpox, plague, botulism, tularemia Monica Sorensen, a 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 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. Monica insisted that her Do Not Resuscitate (DNR) status NOT be rescinded. She was conscious and competent and knew what was best for herself. Monica was taking full advantage of what provision for her care? Informed consent The intracorporeal suture technique uses the suture-tying process analogous to the: instrument tie A stitch that is tied and cut before placing another stitch is called _____. interrupted The physiologic effects resulting from the inhalation of gaseous anesthetic agents and intravenous infusion of anesthetic drugs inhibit several areas of the central nervous system (CNS). The processes by which they occur are explained by several proposed theories. Which of the options describes a plausible anesthetic mechanism of action? Synaptic transmission of nerve impulses in the CNS is inhibited. Ketamine is a short-acting induction and IV or IM maintenance agent. Patients are able to maintain their airways. It is a suitable agent to use with small children and burn patients. The concern with this agent is that in large doses it may cause: respiratory depression Laryngospasm is a common but serious complication in the immediate postoperative pediatric tonsillectomy and adenoidectomy patient. What is the ideal immediate and last resort response by the anesthesia provider or perianesthesia nurse in an emerging patient who has been in spasm for over 1 minute, is not responding to positive-pressure ventilation, and is in significant distress? suctioning, IV succinylcholine administration, and reintubation Lateral, lateral chest, and lateral kidney positions all place pressure on structures of the dependent side: ears, shoulder, ribs, hips, greater femoral head, knees, and ankles. The potential for injury to the patient is significant, based on these pressure areas. Which resultant injury or harm could not be related to these lateral positions? Diminished lung capacity of dependent lung Select the statement below that best reflects the effects of hypothermia in the perianesthesia period. 36 | P a g e Shivering can increase the need for oxygen by 300% to 400%. Which of the following statements reflects the location of the arcuate line? one third of the distance between the umbilicus and the symphysis pubis Samuel Garcia has been approved as a candidate for hyperbaric oxygenation (HBO) as a management therapy for his chronic sacral wound. He responded well to his surgical debridement and the nurse is planning to explain how HBO will benefit wound healing by way of: Increases the capacity of the blood to carry oxygen to the tissues Susie Reynolds, a 9-year-old softball player, has arrived in the OR for emergency repair of superficial facial and deep arm lacerations when she ran into the chain link fence during practice. The perioperative nurse discovers that Susie has an insulin pump that should remain connected during the short procedure. The RNFA should consider which of the following options for energy-generated hemostasis? bipolar electrosurgery unit The new general surgery fellow placed the three trocar ports for the laparoscopic appendectomy. The procedure was completed without incident; however, on postoperative day 1, the patient demonstrated signs and symptoms of sepsis. What might have been the unusual occurrence that could have resulted in patient sepsis? Inadvertent trocar puncture through the bowel on insertion Which of the following absorbable suture has the best tensile strength? Polydioxanone When creating a vascular or intestinal anastomosis, the surgeon will typically suture one half of the anastomosis with one half of the suture and the other half of the anastomosis with the other half of the suture. This technique minimizes the drag and wear on the suture material and needle. The correct name for this type of suture and needle is: double-armed The surgical hand scrub is designed to render the hands, nails, and arms: surgically clean Select the appropriate nursing action that supports hands-free instrument passing and sharps safety. Create a neutral hands-free area between the scrub person and surgeon with a basin or magnetic mat. The death of microorganisms occurs in steam sterilization as a result of which process? Denaturation and coagulation of enzyme proteins Paget's disease is a disorder affecting older adults. The bones are weak and poorly constructed. It is characterized by the proliferation of osteoclasts and compensatory increased osteoblastic activity. This degenerative process results in: 37 | P a g e rapid, disorganized bone remodeling. Karen Masterson, the perioperative nurse circulator, is preparing the OR for a vascular procedure where heparin will be used. She has obtained the heparin from the medication dispensing system and is preparing to mix the heparin in IV saline according to the dosage on the surgeon's preference/pick list. The scrub person, Judy Rothman, also a perioperative nurse, is preparing the sterile back table. What expected and appropriate risk reduction strategies related to the use of heparin would both Karen and Judy perform? Label syringe, medicine cup, and IV saline bag with the drug name, dosage, strength, date, and expiration date. An orchiopexy is the surgical placement and fixation of the testicle in a normal anatomic position in the scrotal sac. If the testis fails to descend into the scrotum during gestation, it is considered undescended. Which statement regarding indications for orchiopexy is true? All testes that are undescended after 1 year require surgical placement in the scrotum A saphenous cutdown refers to a skin incision associated with: insertion of a cannula into the external iliac vein Of the following, which is the point of insertion for the ileopsoas muscle ? lesser trochanter Aortic stenosis promotes a pathologic remodeling of the heart that can lead not only to valvular dysfunction but also which of the following? Heart failure Microlaryngoscopy facilitates improved diagnosis and allows the laryngologist to view, with relative ease, areas that previously were inaccessible or difficult to visualize. What are the two most common indications for microlaryngoscopy? Laryngeal polyps and nodules Although each potential kidney transplant recipient is judged individually as a candidate, which condition from the list below would most likely eliminate a patient as a candidate for kidney transplant? Systemic disease A dietary supplement, as defined by the Dietary Supplement Health and Education Act (DSHEA), is a product that contains a number of ingredients that are intended to supplement the individual's diet. What ingredient is considered an appropriate additive to classify a product as a dietary supplement? Amino acid What type of bleeding is more difficult to control and why? venous because veins have thinner muscle layer Which of the following layers of the uterus contains the lymphatics? 40 | P a g e This orthopedic diagnosis is a complex deformity that is diagnosed prenatally through ultrasound or at birth. It may occur unilaterally or bilaterally and may be idiopathic or one in a combination of other syndromes with associated anomalies. Select the orthopedic diagnosis. Clubfoot Two patients are scheduled to have bariatric surgery. How will perioperative planning differ for a patient weighing 280 lb as compared to that for a 450-lb patient? Instrumentation will need to be longer The splenic vein drains into the: portal system Select the statement that best describes the comparative difference between open aortic aneurysm repair and endovascular aneurysm (EVAR) repair. In EVAR, the prosthetic endograft or stent-graft is introduced into the aneurysm through a surgically exposed femoral artery. When catheterizing the female patient the perioperative nurse must locate the urethra. The correct order of the external organs of the vulva listed anterior to posterior is: mons pubis, labia majora, labia minora, clitoris, urethra, vaginal opening The nasal septum is lined with blood vessels and mucus-secreting cells. The proper name of this lining is the: Mucoperichondrium During the planning phase of a procedure for liposuction or post-bariatric contouring procedures, the perioperative nurse will assemble and organize supplies and devices because the procedure may require: repositioning one or more times during surgery. You examine a comatose patient in the emergency room. His wife relates that her husband was struck accidentally in his "temple" by a baseball. After an initial period of unconsciousness, he seemed to be okay but later became drowsy and comatose. You suspect that the patient is suffering from: An Epidural hematoma During a laparoscopic colectomy, the scrub person carefully placed the endoscopic electrosurgery instruments on the Mayo stand after inspecting the integrity of the insulation along the shaft. This practice is designed prevent a unique MIS problem. Choose the correct option from the following. Direct coupling The most common endocrine problem in the U.S. is: Thyroid nodule 41 | P a g e Revision arthroplasty may be indicated if the patient's original knee replacement wears out or loosens, or fails as a result of repeated dislocation, infection, or trauma. Total joint revision can be a very demanding and complicated procedure. Attention to detail, anticipation, and preparation are essential. The most difficult aspect of revision surgery is that there is: no clear-cut sequence of events. James Romano, a 68-year-old retired school teacher, presents for surgical intervention of recently diagnosed bladder cancer. He states the cancer is located in the urothelial layer. As the RNFA, you realize this is ___________layer of the bladder. inner The great saphenous vein branches off of which vessel? External iliac The primary function of the three thyroid hormones is to regulate: energy metabolism. Closed thoracostomy will require: chest catheters and water-seal drainage The patient with hyperthyroidism most likely has received appropriate drug therapy that has returned thyroid hormone levels and metabolic state to normal; however, the perioperative nurse should assess for any symptoms that relate to accelerated metabolism. Select the set of symptoms that is most commonly associated with hyperthyroidism. Increased sweating, insomnia, tremor, and muscle weakness Josh Tremain, a 28-year-old firefighter, sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire. What surgical treatments may Josh need before he is discharged from the burn center to home? Debridement and allograft placement during initial healing Specific malignant conditions that may require splenectomy include all EXCEPT _____. Carcinoma of left kidney Most patients will have undergone diagnostic procedures before arriving in the OR. Radiologic and other diagnostic studies are of great significance to the surgical team for determining a surgical diagnosis and developing a plan for treatment. MRI is the gold standard imaging scan for the diagnosis of tumors, abscesses, tissue/ligamentous injury, and disk herniation. Which of the following diagnostic tests of neurologic activity can be performed before surgery and also concurrently during the procedure? Electroencephalogram The amount of fluid normally held in the parietal space is? 50 ml 42 | P a g e The most likely reason for avascular necrosis in an 80-year-old woman following hip fracture is that the: femoral neck fracture Celeste Barney and Amanda Vail, two experienced perioperative nurses, are orienting two new surgical technology students to the orthopedic service for their 6-week clinical rotation. Today they are focusing on how to properly wear, care, and handle lead aprons and protective radiologic apparel. Of the list of orientation content topics, which are considered risk reduction strategies for protection from inadvertent radiation exposure? Wear lightest apron available that meets shielding requirements. The palatine and lingual tonsils are situated in the oropharynx, while the adenoids are located in the nasopharynx. Both adenoids and tonsils consist of: lymphoid tissue. Which of the following is a risk factor associated with unplanned hypothermia? open cavity surgery Joanne Grizwald, a 24-year-old woman with type 1 diabetes is in end-stage kidney failure, and is scheduled for a combined kidney-pancreas transplant. The circulating nurse has set up the autotransfusion system, verified Joanne's blood type, and crossmatched blood availability. The scrub person, while organizing the sterile back table, identified several instruments that she will not need. She organizes those instruments on the most distant part of the back table. What instruments is the scrub person unlikely to need during this procedure? The transplant procedure is an open approach and laparoscopic instruments (the insulated electrosurgical-adapted scissors, graspers, and the endoscopic suction tips) are not needed. The transverse colon ends at the _____. Splenic flexure Morgan Fairlawn is a 7-year-old female who fell off of the swing at school and landed on an outstretched arm. She is awake and anxious. Morgan is being prepped for surgery to repair her fractured arm. Which of the following is the most commonly used pediatric premedication administered in U.S.? Midazolam Select the injury or conditions that reflect probable child abuse or neglect. Severe diaper rash with the presence of ammonia burns. The gold standard for treating sleep apnea with obstruction is which of the following? trachostomy 45 | P a g e The peritoneal fold that connects the appendix to the ileum is known as the ____________. Mesoappendix Why will the perioperative nurse ensure availability of hemodynamic monitoring equipment and supplies for the patient having thoracic surgery? Decreased surface area of the lung for perfusion can be anticipated. Contrast media-induced nephrotoxicity (CIN) can occur as a result of a physiologic change when a transient increase in blood flow is then followed by a longer period of decreased blood flow to the kidneys, after the administration of contrast media. Which of the following is considered a preventative action against CIN? Hydration Dermatomes are used for removing split-thickness skin grafts (STSGs) from donor sites. 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. Matthew Ryan, a 9-year-old boy, is admitted to the emergency department for a sledding accident, when he lost control of his sled and crashed into a tree. He is pale and in pain; his abdomen is tender and firm to palpation. The CT scan suggests rupture of the spleen with internal bleeding. Matthew's scheduled surgery will most probably be a/an: open total splenectomy. The pediatric patient is at risk for imbalanced fluid volume related to invasive surgery and accompanying blood loss. Select the outcome indicator that would best reflect that the goal of maintained fluid balance was attained. Blood pressure within acceptable range Tympanoplasty is the surgical repair of the tympanic membrane and the tympanum and the reconstruction of the ossicular chain. Conductive hearing loss is caused by an obstruction in the external canal or middle ear, which impedes the passage of sound waves to the inner ear. A common cause of conductive hearing loss would be: perforation of the tympanic membrane. Benign or small malignant tumors of the oral cavity may be excised without a neck dissection, though in the presence of diagnosed or highly suspicious metastatic disease, a selective neck dissection may be performed in an effort to control a cancerous growth in the upper jugular lymphatic chain of the neck. The perioperative nurse must be prepared for which additional procedure when head and neck surgery is performed? Tracheostomy 46 | P a g e Many alternative medical therapies are culturally, ethnically, spiritually, or religiously derived and have a wide range of applications from health promotion to the treatment of illness. Key foundations of several therapies are a focus on universal connectedness (e.g., that all living and nonliving things are joined together; health will be good if one's mind and body are in harmony and balance; disease arises when a person is out of harmony with the universe). Which of the therapies listed below prescribe to this belief system? Asian medicine The nasal cavity is associated with the ear by way of the ____________, and communicates with the conjunctiva through the __________________. Select the options that are appropriate to complete the sentence. eustachian tube; nasolacrimal duct Oral malignancies can be linked to specific carcinogens, the most important one being tobacco. Benign or malignant lesions of the tongue, floor of the mouth, alveolar ridge, buccal mucosa, or tonsillar area are excised depending on the extensiveness of disease, involvement of surrounding vessels and nerves, and candidacy for surgery. Benign or small malignant tumors of the oral cavity may be excised without a neck dissection. What indicator would not prompt the surgeon to perform a neck dissection for benign or small malignant tumors? increased salivation Evelyn Pettigrew is a 67-year-old former competitive track athlete with debilitating osteoarthritis; she is scheduled for a laparoscopic-assisted vaginal hysterectomy (LAVH). During the preoperative assessment, Evelyn tells the first assistant that, while she is in excellent health for her age, her hip and leg joints are tender and her movement is limited. The first assistant explains to Evelyn that during the procedure she will be "up in stirrups" but will be handled gently and protected from further discomfort. An appropriate first assisting action, after Evelyn is transferred to the OR bed and before anesthesia induction, is: discuss nonlithotomy leg positioning options with the surgeon. The transabdominal preperitoneal patch (TAPP) hernia repair and the totally extraperitoneal patch (TEP) repair differ in the manner in which access is gained to the preperitoneal space. Which of the two provides access to the preperitoneal space without entering the peritoneum? The TEP technique What does the lacrimal gland do? The lacrimal gland secretes tears that are drained by the lacrimal sac and duct system. Frances, a 68-year-old retired art dealer is overweight due to a sedentary lifestyle and has chronic joint pain in both knees and hips. She does not have osteoarthritis per medical history and is not a candidate for surgical intervention. 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 47 | P a g e There are 8 bones that form the cranial cavity. Four of the bones are paired and four are singular. Choose the correct list of singular bones from the following: Frontal, ethmoid, sphenoid, occipital Which nodes in the lymphatic system are responsible for drainage from the mouth, lips, and external nose? Submandibular Describe the inguinal ligament. Runs from the anterior superior iliac spine to the pubic tubercle The pyramidal lobe of the thyroid is described as: a thin upward protrusion of thyroid tissue from the isthmus. A kidney transplant entails transplantation of a living-related or cadaveric donor kidney into the recipient's iliac fossa. It is performed in an effort to restore renal function and maintain life in a patient who has end-stage renal disease. Select the statement that best reflects the ideal living-related donor candidate. An identical twin or sibling or parent, ABO and HLA compatibility, good health Personnel radiation monitoring is an important part of radiation exposure safety. Select the statement that best describes the proper placement of the personal radiation dosimeter. On the trunk under the apron and at the collar level outside the apron The supraglottis, glottis, and the subglottis represent three portions of which structure of the throat? Larynx During a stapedotomy or stapedectomy procedure, the perioperative nurse manages and controls the environment of care by maintaining a quiet, warm, and comfortable OR. Energy modality devices and monitor alarms are turned down to the lowest audible setting for the team to hear without startling the patient. The English-speaking, nonanxious patient sedated using local or MAC anesthetics is well prepared by the perioperative nurse for sensory and procedural expectations. What event occurs near the conclusion of the procedure that predicts patient outcome? The surgeon whispers softly in the patient's operative ear to determine return of hearing. The lymphatics of the small bowel and portions of the colon are located in the _________. Mesentary Inadvertent injury to which of the following nerves can result in vocal cord paralysis? Recurrent nerve Which of the following will the perioperative nurse be sure to have when setting up the back table for a mediastinoscopy? 50 | P a g e will the perioperative nurse provide, in terms of additional attention and care, in one of the following nursing actions? Position the patient using appropriate padding and joint protection devices. What type of drainage is placed in the common bile duct after a CBDE is performed? T-tube An interventional radiology procedure used to open a blocked or narrowed blood vessel as a result of atherosclerosis is a(n): Percutaneous transluminal angioplasty Hernias that occur within Hesselbach's triangle are called: Direct inguinal hernia Select the diagnostic test that represents an invasive cardiac study. Electrophysiology studies Identify the marginal boundaries of the breasts. Second to sixth rib and horizontally from the lateral edge of sternum to anterior axillary line What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp? Subgaleal space The diagnostic test that is performed to differentiate between acute and chronic thrombosis is known as: Ascending venography In several studies, it was determined that the risk of contamination and subsequent infection to the wearer can be reduced by wearing two pairs of sterile surgical gloves, as opposed to wearing one pair. Select the correct statement that refers to double gloving in terms of a best practice. The Centers for Disease Control and Prevention (CDC) endorses double gloving for all surgery and invasive procedures. In the past, MH mortality ranged up to 80%, but the immediate infusion of dantrolene (Dantrium) and proper treatment have reduced the death rate to about 7%. What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis? it is a skeletal muscle relaxant To protect the forearms, hands, and clothing from contacting bacteria on the outside of the used gown and gloves, members of the scrubbed surgical team should use the following procedure to remove soiled gowns and gloves. Which choice lists the appropriate first 3 steps in the removal of the sterile gown? 51 | P a g e Wipe gloves clean, untie side gown closure, grasp gown at one shoulder seam Malignant hyperthermia (MH) is a rare, multifaceted syndrome with an increased incidence in individuals with central core diseases such as: congenital myopathies Somatosensory evoked potential (SEP) monitoring is most often employed during which type of surgical procedure? posterior spinal fusion One source of catgut is _____. Small intestines of sheep Jacob Sutzkever, a 62-year-old man, had surgery 6 days ago for a ruptured diverticulum. What was the wound classification at the time of his emergency surgery? Clean/contaminated wound, classification II What kind of needle would be used on the skin? Reverse Cutting Umbilical hernias occur in adults as a result of a defect in the: Linea alba The ideal suture material is one that has handling characteristics such as: pliability The name of the fascia that separates the anterior rectum from the vagina in females is called the: Rectovaginal fascia The manufacturing process of permanently connecting the suture thread to the needle is known as: swaged Terminal cleaning and disinfection of the operating room should be done _____. after each procedure Identify the primary substance that composes a layer of the epidermis, is responsible for hardening nails and hair, and protects the body from fluid loss and invasion by pathogens. Keratin Sandra Williams 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 52 | P a g e 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. Sandy was exercising her: right to informed consent Allergic reactions to latex range from skin disease to asthma and anaphylaxis that can result in chronic illness, disability, career loss, hardship, and death. What types of signs and symptoms would be indicative of an allergic contact dermatitis response to contact with natural rubber latex? Pruritus, edema, erythema, and vesicles that develop 6 to 48 hours after exposure Postoperative hypothermia is defined as a temperature less than: 96.8 Sources of radiation exposure in the OR include: C-arm fluoroscopy While hypothermia was historically credited as a therapeutic modality benefitting all surgery because it decreases metabolism and reduces oxygen demand, inadvertent hypothermia is now recognized as impacting many critical physiologic functions and patient outcomes. Which of the following impairments can contribute to surgical site infections? Impaired wound healing What important information must be documented and communicated about a drain to the PACU or ICU nurse during hand-off report? The location and type of drain Which of the following is a physical characteristic of suture material? Knot strength Susan Graton is a 52-year-old, 425-pound patient is scheduled for surgery at the bariatric surgery center in 3 days. She has osteoarthritis and had a spinal fusion when she was 13. Susan shared her concern that she would not be able to move herself over to the OR bed and would be embarrassed if the nurses could not lift her. Based on this information, the following nursing diagnosis and three positioning-relevant nursing interventions are suitable for this patient. Impaired transfer ability; lock OR bed and transport vehicle during transfer; use at least 4 persons to assist with lift and transfer; use OR bed to accommodate patient weight and size. Recommended practices for sponge, sharp and instrument counts are requirements/recommendations of: Institutional policy The circulating nurse received a call from the emergency department and called sterile supply to assemble the instruments for an abdominal trauma case with possible aortic rupture. When the cart 55 | P a g e memory The surgeon used the ESU in monopolar mode to cut and coagulate through the subcutaneous tissue on opening the abdomen during a bariatric bypass procedure. As she began to proceed through the muscle and fascia layer, she asked the circulating nurse to increase the cut and coagulation modes on the ESU. What measure could the scrub person take to enhance energy delivery? Clean the charred tissue from the active electrode blade Hypotension is a blood pressure reading that is 20% less than the patient's normal baseline pressure. Hypovolemia is the most common cause of postoperative hypotension; however, hypotension may also be caused by cardiac dysfunctions. Which of the following cardiac conditions will present with hypotension? myocardial infarction, myocardial tamponade, and pulmonary embolism The nursing research and practice committee searched the scientific literature for information on smoke evacuation, as they planned for a unit-wide initiative to use this safety measure on all procedures where smoke or plume is generated. Their main concern is that the surgeons will not be as willing to comply as the staff. Select the safety measure that will be the most critical and most challenging to enforce. hold the smoke evacuation suction tube close (<1 inch away) to the tissue interaction site to remove as much plume as possible Select the positioning device(s) commonly used for bariatric patients prior to intubation. Upper body ramp Samuel Garcia, a 48-year-old tetraplegic with a chronic sacral wound, is scheduled for another wound debridement. What is the purpose of doing a wound debridement on a chronic wound? The debridement will remove dead tissue that could support infection. Justin, a 4-year-old preschool student, was telling his friend Jacob about his operation. He had a hernia fixed and told Jacob that the nurse put "magic cream on his hand before she stuck the ivy in" and then the doctor "gave him surgery sleep medicine that was like milk in his ivy" and "another doctor put a little needle stick in his back near his butt after he was asleep so he would not hurt when he woke up." Based on Justin's self-report of his surgery experience, what three types of anesthesia, in the correct order to his story, did Justin receive? Local, general, caudal Rigo Vegas, a 24-year-old tennis coach, was scheduled as the first case for a knee arthroscopy. He has a family history of anesthesia and surgery complications. He denied any history of allergies, obstructive sleep apnea, or reflux disease. He admitted to eating a cheese steak and drinking 2 cans of beer the night before at 11:30 PM. On attempt at intubation, it was evident that total muscle relaxation had not been achieved. The circulating nurse gently restrained Rigo's arms as he began to move and gag on the laryngoscope. Rigo vomited undigested stomach contents. Intubation was achieved, and a nasogastric tube was inserted and connected to suction. Rigo experienced respiratory distress on extubation and 56 | P a g e was transferred to ICU with acute respiratory distress syndrome. Based on his preanesthetic history, aspiration could have been prevented by which measure? The perioperative nurse applying cricoid pressure during induction through intubation Sara was positioned, prepped, and draped following general endotracheal anesthesia induction. The team assembled around Sara and the sterile field to perform the time-out as described in the WHO surgical checklist. Successful employment of the time-out can only be ensured when: the entire team stops and focuses attention together Jacob Sutzkever had a temperature of 103° F and returned to the OR for a debridement and washout of purulent drainage from his wound on postoperative day 3. What was the wound classification at the time of his debridement and washout surgery? Infected wound, classification IV Wet floors are a common hazard causing slips, trips, and falls (STFs). Select a prevention strategy that is a best practice for preventing STFs from spills on wet floors. Transport liquids in covered containers with lids in place. The process of decontamination should initially begin at what point? Completion of the surgical procedure Side effects the patient may encounter as a result of extracoproreal circulation include: Inflammatory responses After retracting the nerve roots during a laminectomy, this structure is incised before getting to the disc. Posterior longitudinal ligament Of the following, which is not a symptom of compartment syndrome? Moderate pain Fibrocystic changes in the breast describe many different breast changes. These changes affect almost all women at some time in their lives. Nipple discharge is more commonly associated with benign lesions than with cancer; however, discharge is usually significant only if it is spontaneous, persistent, and: bloody Jan Stuyvesant, a perioperative nurse, was the scrub person during a robotic-assisted laparoscopic cholecystectomy. She locked the robotic endoscissor into the adaptor on the robotic arm and positioned the tip end into the trocar port in order for the surgeon to dissect the cystic duct and artery, while the surgical assistant placed the clips on the cystic duct and artery. As she reached across the sterile field to insert the cholangiocatheter through the port, the anesthesia provider accidentally made contact with the distal end of the catheter as he stood up to reach the monitor controls. The contaminated end of the catheter touched the endoscopic clip applier, the endoscissor connector that the surgeon was using, 57 | P a g e the glove of the assistant, and Jan's gown sleeve. The surgeon ordered everyone to change their gown and gloves and covered the port area with a sterile towel. What was the rationale for the surgeon to co The surgeon was not in contact with the sterile field because he worked from the robotic console. The ability to maintain thermoregulation is compromised in elders because of changes in the: vascular system Because herbal products are so readily available and have such widespread media attention, many people think that they can safely self-medicate. Why should the public be aware and educated about dietary supplements and potential harmful effects? Unknown substances may be present in these products. Talia Mendelson, a 27-year-old patient who had a lumpectomy for early-onset breast cancer, is now scheduled for infusion port insertion. Talia is very nervous because during the previous lumpectomy, performed using a local anesthetic, she was not entirely sedated. Talia tells the perioperative nurse that she was uncomfortable and heard everything in the room, but admitted that she did not feel pain. The nurse recognized Talia's anxiety related to the surgical intervention and prepared to implement corrective actions in the OR. What nursing intervention best reflects one that would ensure support or contribute to Talia realizing her expected outcome? Ensure a quiet and calm environment of care A 26-year-old female is rushed to the operating room after a primary and secondary survey in the emergency department. She was hit by a small truck as she was riding her bicycle through a busy intersection. She has sustained rib fractures and several fractured transverse vertebral processes. Renal injury is suspected. As the perioperative nurse prepares to insert a urinary catheter, she notices blood at the urinary meatus. What should the nurse's next action be? Discontinue the catheter insertion Open parathyroidectomy is currently being replaced with less invasive and more targeted techniques; however, the amount of parathyroid tissue that should be removed remains controversial and relates to whether single or multiple glands are involved. A portion of a gland must remain to: prevent hypocalcemia and its complications. Which of the following supplies blood to the transverse colon? Middle colic artery Which of the following structures form the mouth? cheeks, the hard palate, the mandible, and the tongue The salivary glands produce saliva, which serves to moisten the mouth and initiate: carbohydrate digestion. 60 | P a g e Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained surgical items (RSI). What risk reduction strategy could prevent RSI? Replacing or tagging sponges and laparotomy instruments with RFID chips. The surgical hand scrub is designed to render the hands, nails, and arms Surgically Clean The RNFA instructed the new anesthesia resident in the proper positioning of the arm and hands on the OR bed armboards. The resident was cautioned to avoid pressure on the elbow to prevent: Ulnar Nerve Injury A type of suture to help eliminate tension on the primary suture line is known as: Retention Suture Identify the primary substance found in the epidermis that protects the body from fluid loss and invasion by pathogens. Keratin When a patient absorbs an unsafe amount of local anesthetic into the bloodstream, a catastrophic outcome is possible. Treatment for LAST includes the use of which of the following? Lipids When buried in tissue, silk loses its tensile strength after what period of time? 1 Year Guidelines from WHO focus on which of the following in the prevention of surgical site infections? Use of Prophylactic Antibiotics To help visualize abdominal structures and to enhance safety during laparoscopic procedures, a pneumoperitoneum is created. After Veress needle confirmation, insufflation tubing is connected and the process begun. CO2 gas is used to insufflate the abdominal cavity at an ideal flow rate of ______ to achieve an ideal intra-abdominal pressure of ______. 9 L/min;14 to 16 mm Hg Due to the BMI of the patient, the case you are participating in was converted to open laparotomy. Your surgeon is uncertain as to which self retaining retractor is available within the facility. From the following, which is an appropriate suggestion? Bookwalter The safest and most commonly used method of sterilization is which of the following? Steam Sterilization Has been identified to reduce SSIs and affect surgical outcomes? 61 | P a g e Antibiotics given IV within 1 hour of the incision for every procedure with an incision or entered body system. When applying sterile drapes to create the sterile field on the patient, which of the following principles is most important. Drape the patient starting with the incision area and proceeding to the periphery. To prevent sharps injury, which of the following is a risk reduction strategy to be used by the sterile team members? Passing sharp items using neutral/hands-free techniques instead of passing hand to hand. The most commonly used medication for local anesthesia is __________? Lidocaine The OR was trialling a new insufflation system and the vendor representative was out of the room taking a phone call. The perioperative nurse was concerned that the flow rate was well above 14 L/min and the pressure had risen to 16 mm Hg. She alerted the surgeon and reduced the rate and pressure because she feared that the elderly patient was at high risk for: Hypercarbia Your patient had an episode of vomiting during anesthesia induction and was effectively suctioned by anesthesia. Upon extubation, the patient presented with coughing, wheezing, dyspnea, use of accessory muscles, and tachypnea. What is this patient most likely experiencing? Bronchospasm High-pressure insufflation rates can cause overpressurization of the intra-abdominal cavity. This overpressurization can lead to which of the following? Hypercarbia Laryngospasm is a serious complication often seen in the PACU setting. What is the ideal immediate and last resort response by the anesthesia provider or perianesthesia nurse in an emerging patient who has been in spasm for over 1 minute? suctioning, IV succinylcholine administration, and reintubation Which of the following is not a characteristic of silk suture? Memory The first case of the day is scheduled as a knee arthroscopy for an otherwise healthy 24 year old patient. Upon pre assessment, the patient admits to a family history of anesthesia and surgical complications. Patient also states last oral intake consisted of eating a cheese steak and drinking 2 cans of beer the night before at 11:30 PM. The patient subsequently vomited when intubation was performed and experienced respiratory distress upon extubation. What measure could have been taken by the team to prevent aspiration based on the patient's history? 62 | P a g e The perioperative nurse applying cricoid pressure during induction through intubation The instillation of a local anesthetic into the subarachnoid space is termed: Spinal Anesthesia What is the appropriate action if the doctor is delayed after the room and instruments have been opened? Cover the instruments with a sterile drape and have the scrub nurse continually visually observe the room for breaches in sterility. Select the positioning device commonly used for positioning the head during procedures such as craniotomies. Mayfield Head Positioners Hypotension is a blood pressure reading that is 20% less than the patient's normal baseline pressure. Hypovolemia is the most common cause of postoperative hypotension; however, hypotension may also be caused by cardiac dysfunctions. Which of the following cardiac conditions will present with hypotension? myocardial infarction, myocardial tamponade, and pulmonary embolism The ideal suture material is one that has handling characteristics such as: Pliability Which of the following patient modifiable factors can contribute to surgical site infections? Alcoholism Which anesthetic agent could not be given if an IV-only anesthesia plan was employed? Desflurane A type of monofilament suture that does not require the user to tie knots is known as: Barbed Which statement about surgical dressings is true? Surgical dressings cushion and protect the wound from trauma and gross contamination, and absorb drainage. A common dysrythmia seen after surgery is: Sinus Tachycardia The type of wound closure that occurs when approximation of the wound edges does not occur for 3 or more days after a surgical procedure. Third Intention 65 | P a g e Audible facial nerve monitors (NIMS) are used intraoperatively during procedures in which the facial nerve is at risk for injury. Why is communication with the anesthesia provider important when assisting in procedures involve the facial nerve? muscle relaxants, paralyzing agents, and some local anesthetics must be avoided. A portion of a parathyroid gland must remain for which of the following reasons? prevent hypocalcemia and its complications. There are several risk factors associated with dehiscence. Which of the following can be controlled by the RNFA? Sutures placed too close together The major arterial blood supply to the descending colon is provided by which of the following? Left Colic Artery Josh Tremain, a 28-year-old firefighter, sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire. What surgical treatments may Josh need? Debridement and monitoring of full-thickness skin regeneration Marissa Walton is transferred to the OR from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia. What important preparation for the procedure should be performed before Marissa arrives in the OR? Prewarm the OR to above the ambient high temperature for an adult. The colon wall has five distinct layers that include which of the following ? Mucosa Before reaching the rectus abdominis muscle during surgical exposure, the surgeon must first progress through which of the following? Preperitoneal fat Identify the triad of anatomic sites of abdominal wall weakness with a potential for hernias. Inguinal canal, femoral rings, umbilicus What technologic characteristic of robotic surgery provides a superior indication for robotic-assisted laparoscopic cholecystectomy? The magnified three-dimensional picture may reduce bile duct injuries during dissection. Which of the following supplies blood to the transverse colon? Middle colic artery Which of the following is a "triangle" anatomic landmark in surgical removal of the gallbladder, and may be remembered by the 3C's: cystic duct, common hepatic duct and cystic artery? 66 | P a g e Calots Describe the internal inguinal ring A natural opening in the transversalis fascia The primary function of the gallbladder is to: store and concentrate bile Umbilical hernias occur in adults as a result of a defect in the Linea Alba Potential development of a direct inguinal hernia results from weakness or tearing of both the ___________and __________. Aponeurosis of transversus abdominus and transversalis fascia Which structure supports the uterus and contains the uterine artery and vein ? Cardinal Ligaments An orchiopexy is the surgical placement and fixation of the testicle in a normal anatomic position in the scrotal sac. If the testis fails to descend into the scrotum during gestation, it is considered undescended. Which statement regarding indications for orchiopexy is true? All testes that are undescended after 1 year require surgical placement in the scrotum. Chose the correct statement regarding the trigone of the bladder forms the base of the bladder Damage to this area of the brain is often devastating and life-threatening because it can affect movement, senses, consciousness, perception, and cognition. Choose the correct answer from the following. Brainstem What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp? Subgaleal space The brainstem consists of what three structures? Midbrain, pons, and medulla oblongata The IXth cranial nerve provides which of the following? taste to posterior 1/3 of tongue Suction applied directly to neural tissue can be harmful To prevent tissue damage, a ___________ should be placed between the neural tissue and the suction tip. 67 | P a g e Cottonnoid Changes to the elderly person's skeleton can present challenges to the intraoperative team. In terms of additional attention and care, what intervention can the intraoperative team provide? Position the patient using appropriate padding and joint protection devices. An important aspect to bone healing that is preserved through intramedullary reaming is which of the following? Maintenance of fracture hematoma Which of the following is a complication of patellectomy? Reduced knee extension Which of the following is not included in the terrible triad? PCL Tear The rotator cuff consists of which group of muscles? Supraspinatus, infraspinatus, teres minor, and subscapularis Which of the following regarding PMMA ( bone cement) is not an affect local tissue? Skin burns due to exothermic reaction Infants and children with severe gastroesophageal (GE) reflux can have life-threatening complications, including obstructive apnea, aspiration pneumonia, esophagitis, and failure to thrive. What is the name of the procedure, performed open or laparoscopically, that is designed to create a competent antireflux barrier? Nissen fundoplication Your 12-year-old patient is scheduled for a laparoscopic hernia repair. During the preoperative assessment, the RNFA notes mild myotonia congenita. Themmother states that she is worried about anesthesia because her husband's brother died many years ago when he became very feverish during surgery and they could not cool him. The RNFA's appropriate risk reduction strategy in this situation would be to: perform a careful assessment of family history to identify risk for developing malignant hyperthermia (MH) A patient presents to the OR with an injury to the anterior chest from blunt force trauma. The RNFA can expect damage to which of the following areas? Right Ventricle Which of the following is a contraindication to using autotransfusion as a blood replacement source? Blood contaminated with food, bowel contents, or antibiotic irrigation 70 | P a g e A benefit to the patient undergoing SILS procedure which of the following? Less postoperative pain The incision used specifically for an open appendectomy is known as: McBurney The patient is placed in what position for open cholecystectomy? Supine From the following, which is a possible benefit to the paramedian incision? decreased risk for hernia Which of the following is the most common non-emergent abdominal surgery in the U.S.? Cholecystectomy Closed thoracostomy will require which of the following? chest catheters and water-seal drainage Fibrous bands of tissue found between abdominal structures that are not normally connected are known as: Adhesions The mesh-plug open hernia repair technique is indicated for which type(s) of hernias? Recurrent Indirect inguinal hernias During robotic hysterectomy, the patient is placed in steep trendelenburg position. Which of the following is complication that can result from extended surgical time when the patient is in steep trendelenburg? increased intracranial pressure The pelvic floor consists of which muscle groups? Levator ani and coccygeal muscles The ovarian artery is a branch of which vessel? Aorta The innermost membrane of of the brain is known as: Pia Mater Pressure against which cranial nerve accounts for pupillary dilation when temporal lobe herniation is present? Cranial Nerve III 71 | P a g e Identify the dura fold that separates the right and left cerebral hemispheres. Falx cerebri The trigeminal nerve provides motor innervation to which muscle group? Muscle of mastication Primary divisions of a nerve are known as: Rami Surgeons use open reduction and internal fixation (ORIF) when they are unable to reduce a fracture using closed reduction and skeletal traction is not indicated. What would be an advantage for an open rather than a closed reduction technique? Direct observation and verification of fracture alignment During a total hip arthroplasty, the instrument used to access the femoral canal is the_____. Box osteotome The use of polymethyl methacrylate (PMMA, or bone cement) can result in adverse patient reactions. Which of the following is considered an adverse patient reaction? Transient hypotension The connective tissue that covers all bone and supplies nutrients is known as___________. Periosteum An example of an amphiarthrotic joint includes: ntervertebral joints The toddler uses symbols and engages in creative play. Toddlers are beginning to develop free will and control over their bodies. Which of the interventions below is age-appropriate for toddlers? Give only simple choices and involve them in actions when possible. The immature blood-brain barrier and decreased protein binding in infants increase their sensitivity to which group of drugs? Opioids and hypnotics Once cervical spine precautions are implemented and a cervical collar is applied, what event needs to take place before the team removes the cervical collar and continues care? A cervical radiograph is obtained to rule out injury to the neck Your patient is unresponsive to treatment methods used to reduce layrngospasm. Anesthesia is notified and administers which of the following medications succinylcholine 72 | P a g e The Glasgow Coma Scale (GCS) is commonly used to assess patients with brain injury using three indicators of cerebral function: eye opening, verbal communication, and motor response to verbal and noxious stimuli. Within the scoring range for the GCS, the best possible score is _____ and the worst possible score is ______. 15:3 A 36 year old trauma patient is rushed to the OR with multiple penetrating gunshot and knife wounds to the abdomen. He is bleeding profusely. What appropriate action is critical in the rapid preparation of this patient for surgery? Prep the patient from the suprasternal notch to the mid-thigh. he RNFA should be prepared to assist with the ______________surgical procedure if a patient needs surgical intervention for the treatment of atrial fibrillation. Maze Physicians must consider which of the following options when determining the best treatment option for breast cancer surgery. Size of Tumor There are ___________main coronary arteries which originate in the ______________. 2, sinuses of Valsalva Of the nerves that are associated with the thyroid gland, which one can be affected by compression resulting from an enlarged left atrium? Left recurrent laryngeal nerve Another name for the left colic flexure is _____. splenic flexure The ligament that connects the laminae of the spine is known as: Ligamentum Flavum Of the following, which is not included in the 5 P's of compartment syndrome? Pulses Hesselbach triangle describes the location of the hernia. Which of the following structures compromise the medial border of the triangle? Lateral edge of the rectus abdominus muscle Nipple discharge is more commonly associated with benign breast lesions than with cancer; however, discharge is usually significant only if it is spontaneous, persistent, and: Bloody 75 | P a g e The production of CSF occurs where? Choroid plexus of the ventricles Commonly implicated in SAH, the vessels of the Circle of Willis include: Posterior communicating artery Which of the following is true regarding CSF in the brain? The fluid does not play a significant role in supplying nutrition to the structures it bathes Of the following, which is not a symptom of compartment syndrome? Moderate Pain Replantation is an attempt to reattach a completely amputated digit or other body part. Good candidates for replantation are those with the following amputations: almost any body part of a child. Bone graft that is sealed in a sterile labeled envelope from a tissue transplant company and stored in a vacuum-sealed freezer and monitored with an alarm would be considered a/an: Allograft A herniated disc most commonly occurs in which section of the vertebral column? Lumbar After retracting the nerve roots during a laminectomy, this structure is incised before getting to the disc. Posterior longitudinal ligament Femoral neck fractures are more common in women than men for which of the following reasons? Osteoporosis Which of the following is the instrument of choice in removing a foreign body from an infant or child's airway? Rigid Bronchoscope The most significant consideration when caring for pediatric patients that is not of concern when caring for adults is: from birth onward, the child is in a continual state of development and physiologic change. Which of the following is an indication for damage control surgery? Coagulopathy A 26-year-old female is rushed to the operating room after being hit by a small truck as she was riding her bicycle through a busy intersection. She has sustained rib fractures and several fractured transverse 76 | P a g e vertebral processes. Renal injury is suspected. As the perioperative nurse prepares to insert a urinary catheter, she notices blood at the urinary meatus. What should the nurse's next action be? Discontinue the catheter insertion Select the injury or condition that reflect probable child abuse or neglect. Severe diaper rash with the presence of ammonia burns. Matthew Ryan, a 9-year-old boy, is admitted to the emergency department for a sledding accident, when he lost control of his sled and crashed into a tree. He is pale and in pain; his abdomen is tender and firm to palpation. The CT scan suggests rupture of the spleen with internal bleeding. Matthew's scheduled surgery will be a/an: open total splenectomy. Which of the following is a routine part of preventing cross-contamination? restricting personnel movement, closing doors, minimizing talking Discharge planning begins during the _____________. Assessment Phase Creating a pneumoperitoneum can cause problems with patients who 1. Have respiratory disease 2. Have sickle cell disease 3. Have cataracts 4. Have glaucoma 5. Are morbidly obese Not 1 and 2 Cold, clammy skin may be a sign of: Anxiety Key points for implementing safe practices include obtaining medications for only one patient at a time, avoiding distractions and interruptions when preparing medications, preparing the medication as close as possible to the time of administration, using safe injection practices Badges worn by pregnant personnel should be worn at waist level and read every: a month General anesthesia with intubation is generally recommended for laparoscopic procedures because of the 1. Need to use muscle relaxant to allow for abdominal insufflation 2. Need to control and increase ventilation to compensate for hypocarbia and respiratory acidosis resulting from absorption of CO2 3. Exaggerated patient positions that can be very uncomfortable for the patient 4. Potential for patient movement, coughing, or bucking that can increase intra-abdominal pressure. 1, 2, 3, and 4 After an MH crisis, the patient should be observed in an ICU setting for: not 1-2 hours 77 | P a g e One of the two strongest layers in tissue closure includes the: Fascia Absorbable sutures, when compared to non-absorbable sutures have this characteristic. Less Tensile Strength The surgeon requests insufflation of the abdominal cavity to be done at high flow rate since he has other cases to complete. A complication that can occur as a result of rapid high pressure is: Hypotension The "Gold Standard" for open hernia repair is called the Lichenstein Repair When a scrub person assists another team member with gowning and gloving, he or she does all of the following except: handle the glove on the inside only Direct current is the source of power for: battery-operated instruments Which of the following disinfectants is required for general disinfection of non-critical items? low-level disinfectant In the lateral position, preventive measures include: pillows between the knees and feet and padding under the dependent ankle and knee Fire blankets should NOT be used in the operating room because they are made of wool, which can catch fire in an oxygen-enriched environment, can cause wound contamination or move instruments at the surgical site, can trap fire next to or under a patient Which of the following procedures for isolation technique, also known as bowel technique or contamination technique, is NOT recommended? a health care facility should develop and follow standardized procedures for bowel isolation technique to reduce errors and improve efficiency among perioperative team members For minors who work with radiation, the annual dose limit is: 10% of adult dose limits The humidity levels of the OR should range between _____% and ______%. 30-70 The RNFA can anticipate this type of case being scheduled for a patient with a history of a malignant tumor in the distal transverse colon. Choose the correct procedure. 80 | P a g e A power drill and assorted rotating burrs are essential for middle ear surgery and some sinus procedures. During drill and power saw use, the scrub person keeps irrigation solution on the sterile field to: prevent clogging of the burr and contamination of the area with bone dust. During a surgical procedure to excise a malignant thyroid gland, the surgeon asks you why she is not removing the posterior part of the patient's thyroid gland. Your correct response is: so that the patient does not develop hypocalcemia Select the set of symptoms that is most commonly associated with hypothyroidism. Dry skin, edema, constipation, and depression Postoperative hoarseness, obstructed airway, or paralysis of the vocal cords is a serious complication of thyroid surgery. During surgery, care is taken to identify and protect which nerve? Recurrent laryngeal nerve The mediastinal surface of the lungs contains a structure known as _____________in which the nerves, vessels, bronchus, and lymphatics enter and leave the lung. Hilum A minimally invasive technique that may be used to remove parathyroid tumors deep in the mediastinum is known as: Thoracoscopy Describe the internal inguinal ring. A natural opening in the transversalis fascia An example of a potential risk associated with pneumoperitoneum would be: c. gas embolus into an exposed blood vessel during the procedure. The head of the pancreas is fixed to which structure? Duodenum Exposure of intra-abdominal anatomy is crucial to safe surgery and employs varied instruments, applications of highly technical energy sources, patient manipulations, light, and imaging. What is unique to the laparoscopic approach that promotes exposure? Carbon dioxide pneumoperitoneum A pantaloon hernia can be best described as which of the following? A combination of direct and indirect hernia Of the following, which is the point of insertion for the iliopsoas muscle ? lesser trochanter 81 | P a g e The common bile duct drains into the _____. duodenum Specific positioning considerations for bariatric patients require particular attention to protecting these patients from inherent risks related to their size and weight. Protective measures to protect both patient and staff include those below. Which measure reflects the most safety protection for both patient and staff? Ensure that the OR bed can accommodate the patient's weight and girth. From the following, chose a physical barrier used in the prevention of adhesions that can take up to 2 weeks to absorb and is indicated for most open procedures. Interceed During kidney transplant surgery and prior to clamping the renal vessels, which of the following drugs are administered to prevent intravascular clotting and maximize duiresis? Heparin and Mannitol Of the following, which is not a risk factor for the development of postoperative ventral hernias? Male gender Choose the correct flow of bile from the gallbladder. Cystic duct, common duct, ampulla of Vater, duodenum The renal artery and vein enter and exit the kidney on the medial side of the organ through a concave area known as hilum Which of the following best describes the boundaries of the surgical skin prep for the patient about to receive a liver transplant? From the neck to midthigh; bedline to bedline