RNFA FINAL PRACTICE EXAM Questions 2024/2025 A+ (100% verified)., Exams of Nursing

Download RNFA FINAL PRACTICE EXAM Questions 2024/2025 A+ (100% verified). and more Exams Nursing in PDF only on Docsity! RNFA FINAL PRACTICE EXAM Questions 2024/2025 A+ (100% verified). The process of decontamination should initially begin at what point? - Answer - Completion of the surgical procedure Side effects the patient may encounter as a result of extracoproreal circulation include: - Answer - Inflammatory responses After retracting the nerve roots during a laminectomy, this structure is incised before getting to the disc. - Answer - Posterior longitudinal ligament Of the following, which is not a symptom of compartment syndrome? - Answer - 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: - Answer - 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, 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 - Answer - 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: - Answer - 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? - Answer - 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? - Answer - 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? - Answer - 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: - Answer - prevent hypocalcemia and its complications. Which of the following supplies blood to the transverse colon? - Answer - Middle colic artery Which of the following structures form the mouth? - Answer - cheeks, the hard palate, the mandible, and the tongue The salivary glands produce saliva, which serves to moisten the mouth and initiate: - Answer - carbohydrate digestion. Potential development of a direct inguinal hernia results from and weakening or tearing. - Answer - Aponeurosis of transversus abdominus and transversalis muscle When the patient arrives in the ED, the trauma team initiates a primary assessment. This is a logical, orderly process of patient assessment for potential life threats. These assessment activities are based on established protocols for advanced trauma life support (ATLS). The mnemonic "ABCDE" is used, representing assessment of the following: Airway, Breathing, Circulation, Disability, and Exposure. The D and E represent what degree of investigation? - Answer - D = a brief neurologic examination; E = exposure to reveal all life-threatening injuries What structure covers the spermatic cord and contracts to make the testicles ascend in the scrotum? - Answer - Cremaster muscle Which of the following is not included in the group of tendons that comprise the rotator cuff? - Answer - Teres Major Which of the following associations is incorrect regarding gallstones? - Answer - Gallstones in cystic duct = cholangitis The ovarian artery is a branch of which vessel? - Answer - Aorta The double layer of fatty peritoneum attached to the greater curve of the stomach is known as the . - Answer - Omentum There are several risk factors associated with dehiscence. Which of the following can be controlled by the RNFA? - Answer - Sutures placed too close together Skin grafting provides an effective way to cover a wound if vascularity is adequate, infection is absent, and hemostasis is achieved. Skin from the donor site is detached from its blood supply and placed in the recipient site. The best description of a successful skin graft outcome is: - Answer - the recipient site develops a new blood supply from the base of the wound. Which of the following is the first major branch of the internal carotid artery? - Answer - Opthalmic artery As a person ages. there is reduced blood flow to the abdominal viscera, reduced amounts of hydrochloric acid, and delayed gastric emptying. The result of of these physical changes include: - Answer - Altered absorption of drugs From the following, choose where the hypothalamus is located. - Answer - Along the floor of the third ventricle Select the true statement about dacryocystorhinostomy (DCR). - Answer - DCR establishes a new passageway for tear drainage into the nasal cavity. A minimally invasive video-assisted thyroidectomy (MIVAT) procedure relies on Miccoli instruments added to the standard thyroid or neck dissection setup, a 30-degree endoscope, and an ultrasonic (harmonic) scalpel with scissors to ligate and divide the vessels. An important risk reduction strategy for any minimally invasive procedure would be ? - Answer - consider and plan for the possibility of conversion to open thyroidectomy. When laryngoscopy, bronchoscopy, and esophagoscopy are performed in a single session on a patient, the procedure is termed triple endoscopy or panendoscopy. The purpose of triple endoscopy is usually diagnostic. A critical role of the perioperative nurse during this complex diagnostic procedure is that of: - Answer - identifying, containing, and labeling all specimens accurately. Which of the following is not a reason to convert a case from laparoscopic to an open abdominal case? - Answer - Lack of warmer for insufflation gas The liver is essential in the metabolism of carbohydrates, proteins, and fats, generating nutrient stores of which substance that supplies energy sources to the brain and body? - Answer - Glycogen The kidneys are highly vascular organs. Approximately how much of the entire circulating blood volume do the kidneys process at any one time? - Answer - One fifth Metastases to the spine occur most often in the thoracic spine, followed by the lumbar and cervical areas. Select the statement that best reflects a therapeutic spinal procedure goal for a secondary metastatic tumor. - Answer - Surgery is directed toward decompressing and stabilizing the spine. The scaphoid, also called the navicular, links the proximal row of carpal bones as it: - Answer - stabilizes and coordinates the movement of the proximal and distal rows. Identify the name of the procedure that is an alternative treatment for patients with chronic pulmonary emphysema. - Answer - Lung volume reduction surgery Pamela Morris is a 62-year-old woman with a 4-year history of Graves' disease that has not responded to medical therapy. She is scheduled for a subtotal thyroidectomy. What condition, a complication of Graves' disease, is her probable indication for a subtotal thyroidectomy? - Answer - Tracheal obstruction The most common congenital cyst found in the neck is: - Answer - Thyroglossal duct cysts A stapedotomy is removal of the stapes superstructure and creation of a fenestra (opening) in the fixed stapes footplate for treatment of abnormal bone growth around the footplate that results in its immobility. The patient scheduled for a stapedotomy will typically not have a surgical diagnosis of: - Answer - otosclerosis. Which structure supports the uterus and contains the uterine artery and vein ? - Answer - Cardinal ligaments A positive Kehr's sign is . - Answer - Left shoulder pain Miotics and mydriatics produce opposite effects on the pupil of the eye. Select the most appropriate statement about miotic and mydriatic drugs. - Answer - Mydriatic drugs, such as phenylephrine, dilate the pupil. 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? - Answer - Through the pulmonary veins to the left atrium Of the following ocular blocks, which carries the highest risk? - Answer - Retrobulbar block An example of an amphiarthrotic joint includes: - Answer - Intervertebral joints What composes the lining of a herniated abdominal sac? - Answer - 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? - Answer - 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? - Answer - 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. - Answer - 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: - Answer - 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? - Answer - 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 myocutaneous (TRAM) flap is one of several options for nonsynthetic prosthetic reconstruction. Another descriptive term for the TRAM flap is the: - Answer - pedicle-based flap The RNFA should anticipate the surgeon making an incision in which region to gain access to the pancreas? - Answer - 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? - Answer - 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: - Answer - reviews his chart for bleeding and coagulation times and the platelet count. Which of the following is a complication of patellectomy? - Answer - Reduced knee extension The part of the femur that is most susceptible to fracture in conjunction with osteoporosis is: - Answer - neck. A patient that presents to the OR with midface fractures should not have NG or nasal intubation performed due to a fracture of this particular structure can result in tube placement in the brain. Identify the structure from the following. - Answer - Cribriform plate What is the correct rationale for not using methylene blue as a skin marker in the neurosurgical OR? - Answer - Methylene blue produces an inflammatory reaction in CNS tissue. The rotator cuff consists of which group of muscles? - Answer - Supraspinatus, infraspinatus, teres minor, and subscapularis Which of the following correctly identifies the phagocytic cells of the liver? - Answer - Kupffer cells Depending on the surgical defect, head and neck surgical procedures to remove malignant tumors may also involve reconstructive procedures. The wound may be closed primarily, or local flaps and split- thickness skin grafts or full-thickness skin grafts may be used to restore function as well as cover defects. An important role of the perioperative nurse in the ongoing assessment of graft integrity includes which assessment tool? - Answer - Use of intraoperative and postoperative Doppler to detect presence of graft pulse Impaired nutritional status is highly prevalent among the elderly; as many as 12% of men and 8% of women in the healthy geriatric population are considered undernourished. During the preoperative assessment and interview, what information will the perioperative nurse review, in addition to a thorough assessment including body mass index and Mini Nutritional Assessment? - Answer - The serum albumin level Identify the class of medications that can increase the risk or severity of a reaction to contrast media. - Answer - Beta Blockers Matilda Gunderson, a 55-year-old woman with uterine cancer, is scheduled for an open panhysterectomy. She is positioned in low lithotomy with her legs symmetrically arranged in padded cradle stirrups. After the incision is made and primary dissection accomplished, she will be positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area. Matilda is at risk for compromise and injury related to prolonged Trendelenburg tilt, which promotes: - Answer - 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? - Answer - Direct observation and verification of fracture alignment The right and left coronary arteries originate in the corresponding sinuses of Valsava which are located . - Answer - Posterior to the cusps of the aortic valve Which of the following regarding PMMA ( bone cement) is not an affect local tissue? - Answer - 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? - Answer - Chorda tympani nerve Acquired valvular heart disease most commonly affects the valves. Choose the correct answer. - 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? - Answer - The weight bearing ability of the bone affected A rapid rise in thyroid hormone levels is not caused by which of the following? - Answer - 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? - Answer - 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? - Answer - Epiglottis An example of an indication for liver transplantation would be: - Answer - primary hepatic cancer The gastric veins drain into the vein. - Answer - Portal vein Which of the following pelvic fascias cover the perineum? - Answer - 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: - Answer - right spinal accessory nerve. Following a heart attack you tell a patient that he now has a myocardial infarction. You explain this as: - Answer - 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: - Answer - using long instruments through a regular thyroid incision. The hypogastric plexus innervates the: - Answer - female pelvis Identify the dura fold that separates the right and left cerebral hemispheres. - Answer - Falx cerebri True statements regarding the arterial supply of the spleen are the following EXCEPT - Answer - 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? - Answer - 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: - Answer - 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? - Answer - 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? - Answer - 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. - Answer - Sevoflurane, propofol, desflurane Which statement best explains the mechanism of action of general anesthetic agents? - Answer - 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: - Answer - CO2 gas embolism A type of suture to help eliminate tension on the primary suture line is known as: - Answer - 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. - Answer - Cardiac surgery patients The safest practice for passing sharps and instruments during the procedure is to: - Answer - establish a neutral zone or separate area to place reusable sharps Waste anesthetic gases are small amounts of gases that may leak either from the patient's anesthetic breathing circuit into the OR air while anesthesia is being administered or from exhalation of the patient during recovery. Both mechanisms of exposure create risks for OR personnel. Select the appropriate risk reduction strategy that protects the environment and perioperative worker from exposure to ambient waste anesthetic gas. - Answer - 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: - Answer - 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: - Answer - Midazolam Surgical hand scrub products should have which of the following attributes? - Answer - 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. - Answer - 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 - Answer - Droperidol An instrument that is used to occlude a vessel is known as: - Answer - hemostat What action is considered a best practice when communicating with geriatric patients with cognitive impairments? - Answer - 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? - Answer - the entire team Sponge counts should be performed at the time of permanent relief of either the scrub person or circulating nurse, and . - Answer - 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? - Answer - 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. - Answer - 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? - Answer - 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: - Answer - staphylococcus aureus If a sterile glove becomes contaminated during the procedure, the best practice for corrective action is: - Answer - 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? - Answer - Prednisone and a beta-agonist inhaler The most accurate method for routine post operative temperature monitoring is via: - Answer - 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. - Answer - 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. - Answer - 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? - Answer - Review Luci's intake and output and cardiac status, and increase her intravenous flow rate Select the correct choice for a polyester suture. - Answer - Ethibond The initial primary assessment by the perianesthesia nurse, on the patient's admission to the PACU, begins with which criterion? - Answer - 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, . - Answer - 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: - Answer - delayed primary sutured closure Tissue reaction characteristics that need considered when choosing suture include: - Answer - 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: - Answer - 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? - Answer - Cautery pencil ? The highest risk of injury per needle use is attributed to the: - Answer - Keith needle Positive-pressure air handling systems with unidirectional flow of non-recirculated air from the ceiling to the floor are designed to: - Answer - 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: - Answer - barbed The teniae coli consist of___________longitudinal bands of muscle. - Answer - 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 strangulated incarcerated hernia and scheduled for emergency surgery. If the contents of Morris' hernia sac become compromised, with strangulation of the bowel, the probable label on his surgical specimen will be: - Answer - necrotic bowel. Indirect hernias occur to the deep epigastric vessels. Choose from the following. - Answer - Laterally Which of the following is not contained within the anterior mediastinum? - Answer - Great Vessels A function of nasal turbinates is to: - Answer - regulate the temperature of inspired air. The transverse colon meets the descending colon at what point? - Answer - Splenic flexure 35% of the refractive power of the eye is credited to which part of the eye? - Answer - Lens A bunion (hallux valgus) is a soft tissue or bony mass at the medial side of the first metatarsal head. Which of the following is a goal of this surgery? - Answer - Restore normal range of motion An example of a potential risk associated with pneumoperitoneum would be: - Answer - gas embolus into an exposed blood vessel during the procedure. 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: - Answer - 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? - Answer - 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? - Answer - 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: - Answer - 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? - Answer - 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. - Answer - 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? - Answer - 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? - Answer - 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: - Answer - 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: - Answer - claustrophobia. Which of the following is incorrect pertaining to lung segments? - Answer - 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? - Answer - 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? - Answer - Lateral sulcus What properties enable arteries to compensate for changes in blood pressure and blood volume? - Answer - 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: - Answer - 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: - Answer - encourage her to discuss her feelings regarding body image and resulting changes. The first diagnostic test performed in thyroid assessment is: - Answer - Ultrasound Postoperative infection in total hip arthroplasty is . - Answer - Usually catastrophic Risk-benefit analysis is weighed differently for elders. Important factors that need to be evaluated are: - Answer - Personal motivation Hyperkalemia can result from massive blood transfusion as well as the administration of medications introperatively. Which of the following medications can induce hyperkalemia? - Answer - Heparin Another name for the Cardinal ligament is? - Answer - Mackenrodt's Ligament Hypothyroidism results from undersecretion of thyroid hormone. The most common cause of primary hypothyroidism is chronic autoimmune thyroiditis (Hashimoto's disease). Select the set of symptoms that is most commonly associated with hypothyroidism. - Answer - Dry skin, edema, constipation, and depression Surgically created arteriovenous fistulas are also referred to as a(n) and are indicated for enabling . - Answer - arteriovenous shunt; hemodialysis A long bone fracture in a child can have devastating consequences in terms of the child's skeletal maturity and potential for limb shortening and malformation when the fracture line involves the: - Answer - epiphyseal plate. The science of plastic and reconstructive surgery, which means to mold or create form and shape, improves appearance and body image through an understanding of: - Answer - the anatomy and biology of tissue Age-related changes cause decreased blood flow to the kidneys with a resultant decrease in nephron function. What condition is created from the cumulative effect of the multiple drugs that the elderly patient will receive during the perioperative phase? - Answer - Increased chance for adverse reactions and consequential results The mesh-plug open hernia repair technique is indicated for which type(s) of hernias? - Answer - Recurrent Indirect inguinal hernias Which of the following is an indication for damage control surgery? - Answer - Coagulopathy The Shouldice repair is utilized in surgery and has a recurrence rate. - Answer - hernia, low Identify the venous structure that prevents blood backflow. - Answer - Semilunar intimal folds Microsurgical techniques have been applied to cranial, spinal, and peripheral nerve operations. Some procedures in which microsurgery is of value are explorations of the posterior fossa, especially for tumors of the fourth ventricle or cerebellopontine angle, and removal of small acoustic neuromas, with resulting preservation of the facial nerve. Each time the surgeon must look away and then back to the surgical field, open wound time and anesthesia time are increased while the surgeon becomes reoriented to the field. A nursing action, in the scrub person role, directed toward assisting the surgeon in efficiency and expediting the microsurgical procedure would be: - Answer - hand instruments proficiently, in direction of use, without delay. Blunt force to the larynx can result in a fracture and impose immediate airway obstruction. These patients are at risk for a lost airway and may require immediate tracheotomy followed by repair of the fracture when the fracture is unstable or displaced. It is also important to consider that a trauma patient is assumed to have a full stomach; thus these patients are at high risk for aspiration and resultant pneumonia. What is an appropriate nursing action in the event of a lost airway after anesthesia induction and before intubation? - Answer - Assist the anesthesia provider with securing the airway while applying cricoid pressure. Which one of the following signs is not consistent with Horner syndrome? - Answer - sinking of the eye (enophthalmos) Which action best reflects the movement of urine from the renal pelvis to the bladder? - Answer - 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? - Answer - 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. - Answer - Dilutional Hyponatremia Which of the following is not included in the terrible triad? - Answer - PCL tear 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? - Answer - 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. - Answer - 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: - Answer - allograft Fluoroscopy time should be limited as much as possible. Which of the following is radiation reduction technique? - Answer - 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. - Answer - 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? - Answer - 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? - Answer - 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? - Answer - Tracheotomy tray From the following, choose a disadvantage in the use of a shunt during CEA. - Answer - Possible dislodging of debris with insertion The phrenic nerve innervates which structure? - Answer - The diaphragm 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? - Answer - Right ventricle The colon wall has five distinct layers that include the : - Answer - Mucosa When elevations in serum calcitonin are found in the patient's blood work, what diagnosis would you suspect? - Answer - Medullary thyroid cancer Medullary thyroid cancer - Answer - Levator muscle While assisting in an anterior thigh free flap procedure, the surgeon asks where the perforating vessels arise from. Choose your reply from the following. - Answer - lateral circumflex artery An example of antithyroid drugs that would be administered during a thyroid storm crisis would be: - Answer - propylthiouracil and methimazole The cerebellar tentorium supports which structures of the cerebral hemispheres? - Answer - Temporal lobe Studies show that patients with overactive thyroid conditions have an increased risk of various heart problems. Which of the following has an increased risk of development that can lead to premature death? - Answer - Atrial fibrillation The Doppler transducer is the most widely used instrument for vascular study. What statement regarding a Doppler is true? - Answer - Water-soluble gel is needed when the Doppler is used on intact skin 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? - Answer - Heparin and Mannitol Margie Donaldson's examination has revealed a family history of endometrial cancer. She has never been pregnant and has been taking hormone replacement therapy for 4 years. Her physician has scheduled her for a surgical procedure to obtain visual and pathologic information and provide treatment as indicated. Margie was sure that she would have to have a D&C (dilatation and curettage). Margie's surgery, on the operative schedule, would most probably be written as: - Answer - D&C with endometrial biopsies, frozen section, possible LAVH. A hernia that involves both a direct and indirect hernia is known as a : - Answer - Pantaloon hernia Norma Hightower, a 32-year-old thin and pale patient with hypothyroidism, is met by the perioperative nurse for her preoperative assessment. The nurse notes Norma's thin frame and pale, fragile skin. Norma states that she is so cold that she has all of her clothes on under her patient gown. Based on her assessment, the nursing diagnosis that the nurse will not focus interventions on is: - Answer - Risk for fluid overload The perioperative nurse should plan to remain close to the elderly patient during induction because: - Answer - Airway anatomy changes in the elderly The brainstem is located in the posterior fossa and forms the floor of the fourth ventricle. It is the site of many ascending and descending fiber tracts that allow for communication among the structures of the brain and between the brain and spinal cord. The brainstem consists of what three structures? - Answer - Midbrain, pons, and medulla oblongata A breast biopsy, performed after the patient has received a local anesthetic, will require adjunct sedation and monitoring equipment. What relevant considerations should the nurse note during the preoperative assessment? - Answer - Allergies Aubrey Scheel, a 37-year-old physically active male, is getting dressed to return home from the emergency department (ED) after he experienced a large, tender bulge in his scrotum while straining at the toilet. The emergency physician reduced Aubrey's indirect inguinal hernia and referred him to a general surgery practice for elective herniorrhaphy. The ED nurse prepared Aubrey for his discharge. An appropriate nursing intervention by the ED nurse would be to: - Answer - explain the signs and symptoms of an incarcerated hernia and appropriate action. 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? - Answer - Calot's In the past, radical procedures which involved removal of the affected breast and all axillary and thoracic lymph nodes, were used to treat breast cancer. These procedures did not significantly lower mortality. What factor(s) may have contributed to mortality after these procedures? - Answer - 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 . - Answer - hippocampus; amygdala A minimally invasive technique that may be used to remove parathyroid tumors deep in the mediastinum is known as: - Answer - Thoracoscopy 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. - Answer - 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: - Answer - alert the anesthesia provider, reconnect the tubing to cuff and inflate, and send the surgeon for the code cart Morton White, a 68-year-old, ASA PS-2 male with early-stage prostatic cancer, was intubated and positioned for a robotic-assisted laparoscopic radical prostatectomy. The initial position for insertion of the trocars was supine with arms tucked and secured within under-mattress sled arm positioners padded with gel. His hands were placed in a natural position with the fingers wrapped around gauze rolls and touching his lateral thighs. The new anesthesia provider, who had never seen a robotic prostatectomy, was concerned about anesthesia implications when the patient would be repositioned into extreme Trendelenburg for the dissection and anastomosis. The circulating nurse assured her that they would implement protective measures and work together to ensure the best patient outcome. Select all of the potentially harmful effects of extreme 45-degree Trendelenburg in a robotic procedure. - Answer - Respiratory compromise and ventilation resistance, shearing 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? - Answer - lipids Norma Miller, a 49-year-old long-distance runner with dysfunctional uterine bleeding, was scheduled for a hysteroscopy. During the procedure, sterile saline was used to expand the intrauterine compartment and enhance visualization. The perioperative nurse meticulously monitored fluid use and documented infiltration to the uterus and fluid collected as drainage from the uterus. The perioperative nurse was concerned that approximately 500 ml of fluid was unaccounted for and alerted the surgeon. The nurse's motive for this surveillance was to: - Answer - determine the potential for intravasation The stapler designed to close the end of a hollow organ is called the: - Answer - TA The tensile strength of lactic & glycolic acid polymers is sufficient for approximation of tissues for weeks. - Answer - 2-3 Pressure against the skin above_____mm hg interferes with tissue perfusion. - Answer - 32 Which of the following regarding specimen labeling is a regulatory requirement? - Answer - Biohazard information While tucking the arms at the sides of the patient in supine position offers comfort, safety, and easy access to the patient by the scrubbed team, improper positioning and securing of the arms can result in significant injury. Injury can be avoided by tucking the draw sheet the arm and under the . - Answer - over; body Which of the following medications is a specific depolarizing muscle relaxant than can produce generalized fasciculations? - Answer - Succinylcholine The design of laparoscopic instruments aims to provide a clamping, cutting, dissecting, electrocoagulating, suturing, or stapling instrument on the tip of a shaft that is long or short enough to reach the target tissue. The hand control on the surgeon's end of the instrument is engineered to provide: - Answer - ergonomic comfort and control From the following, choose the correct statement regarding closed gloving. - Answer - it can only be used for the initial gloving The instillation of a local anesthetic into the subarachnoid space is termed: - Answer - spinal anesthesia A common dysrythmia seen after surgery is: - Answer - Sinus tachycardia Which statement about surgical dressings is true? - Answer - Surgical dressings cushion and protect the wound from trauma and gross contamination, and absorb drainage 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 . - Answer - 9 L/min;14 to 16 mm Hg Risk factors for PONV should be assessed preoperatively. Which of the following is a risk factor for PONV? - Answer - female gender Which inhalational anesthetic agent(s) has the fastest onset of induction, emergence, and recovery? - Answer - Nitrous oxide The area between the surgeon and scrub person designated for passing sharps safely is referred to as the: - Answer - neutral zone The scrub person was precepting a surgical technology student an orthopedic case. The scrub person explained the importance of keeping the instruments free of blood and bioburden during the procedure and demonstrated the best practice and how to: - Answer - wipe the instruments with a sponge moistened with sterile water after each use. 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. - Answer - 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? - Answer - Informed consent The intracorporeal suture technique uses the suture-tying process analogous to the: - Answer - instrument tie A stitch that is tied and cut before placing another stitch is called . - Answer - 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? - Answer - 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: - Answer - 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? - Answer - 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? - Answer - Diminished lung capacity of dependent lung Select the statement below that best reflects the effects of hypothermia in the perianesthesia period. - Answer - Shivering can increase the need for oxygen by 300% to 400%. Which of the following statements reflects the location of the arcuate line? - Answer - one third of the distance between the umbilicus and the symphysis pubis The perioperative nurse should verify with the patient that all of the preoperative prescribed skin preparation regimens ordered by the surgeon have been performed. All body jewelry that pierces the skin should be removed before the skin prep. Select the statement that reflects a true special consideration for skin preparation before facial surgery. - Answer - Leave the eyebrows and eyelashes intact to preserve facial appearance and expression. Select the congenital anomaly that best reflects indications for fetal surgery. - Answer - Congenital diaphragmatic hernia A benefit to the patient undergoing SILS procedure which of the following? - Answer - Less postoperative pain The functional units of the liver are the lobules. The functional cells of the liver are the which manufactures . - Answer - hepatocytes; bile The most commonly fractured carpal bone is the : - Answer - Scaphoid Which of the following is not included in the breast's sensory nerve supply? - Answer - Second and third branches of the brachial plexus What is similar in patient teaching about postoperative care for both endovascular aortic aneurysm repair and abdominal aortic aneurysm resection? - Answer - no lifting of more than 5 lb for 6 weeks Progressive relaxation techniques, biofeedback, meditation, and cognitive-behavioral approaches have a well-documented theoretical basis with supporting scientific evidence. What is the theoretical clinical justification for this relationship categorized as mind-body medicine? - Answer - The mind has the ability to affect the body What does the presence of bruit on auscultation of a blood vessel mean? - Answer - Blood flow is disrupted. Mandibular fractures are highly associated with assault as the MOI. The goals of operative intervention are to reduce and immobilize the fracture, prevent infection, and restore facial cosmesis and function. What might be an appropriate nursing action and a nursing outcome statement for a patient with a mandibular fracture caused by assault? - Answer - All of the options are appropriate and desirable for this patient. A trauma patient is rushed to the OR after a primary survey is completed in the emergency department. He is a 36-year-old male with multiple penetrating gunshot and knife wounds to the abdomen. He is bleeding profusely. What appropriate nursing actions are critical in the rapid preparation for this procedure? - Answer - Prep the patient from the suprasternal notch to the mid-thigh. Women of high socioeconomic status and higher education also have a high incidence of breast cancer, most likely due to: - Answer - age at first birth A 3-year-old is scheduled for a bronchoscopy to remove a penny. What will the nurse anticipate? - Answer - Sanders Venturi system, rigid bronchoscope, general anesthetic Which of the following medications should be avoided if a patient has an allergy to fish? - Answer - Protamine Femoral neck fractures are more common in women than men for which of the following reasons. - Answer - Osteoporosis Charles Wilkins had a laparoscopic hernia repair with good results and an uneventful recovery. Weeks later, as he reviewed his hospital bill, he noted that he had been charged for a very expensive preperitoneal distention balloon, polypropylene mesh, an endomechanical stapler, and three endosurgical trocars. What hernia repair technique was probably performed on Charles? - Answer - TEP repair Describe the internal inguinal ring. - Answer - A natural opening in the transversalis fascia 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. - Answer - 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? - Answer - Instrumentation will need to be longer The splenic vein drains into the: - Answer - portal system Select the statement that best describes the comparative difference between open aortic aneurysm repair and endovascular aneurysm (EVAR) repair. - Answer - 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: - Answer - 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: - Answer - 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: - Answer - 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: - Answer - 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. - Answer - Direct coupling The most common endocrine problem in the U.S. is: - Answer - Thyroid nodule 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: - Answer - 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. - Answer - inner The great saphenous vein branches off of which vessel? - Answer - External iliac The primary function of the three thyroid hormones is to regulate: - Answer - energy metabolism. Closed thoracostomy will require: - Answer - 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. - Answer - 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? - Answer - Debridement and allograft placement during initial healing Specific malignant conditions that may require splenectomy include all EXCEPT . - Answer - 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? - Answer - Electroencephalogram The amount of fluid normally held in the parietal space is? - Answer - 50 ml (ACLS), surgery, stabilization, and transfer, while a level IV only provides ACLS services before immediate transfer to a higher level center. Surgical and nonsurgical options exist for endometriosis. Select the triad that best reflects nonsurgical and nonhormonal options. - Answer - Analgesics, anxiolytics, and acupuncture All staff members are responsible for patient and staff safety. The principle of ALARA, "As Low As Reasonably Achievable," is a protective measure designed to protect both patients and staff. What are the three principles of ALARA? - Answer - Time, distance, and shielding Identify the structure that is important for weight bearing, providing strength to withstand stress placed on the bone. - Answer - Trabeculae The perioperative nurse may not be able to assess the trauma patient until the patient arrives in the OR for surgical intervention. If the patient's condition permits, the perioperative nurse should obtain a brief, precise report from the ED nurse. One component of this report is the AMPLE history. What are the components of the AMPLE mnemonic? - Answer - Allergies, Medications, Past medical history, Last meal, Event leading to injury The peritoneal fold that connects the appendix to the ileum is known as the . - Answer - Mesoappendix Why will the perioperative nurse ensure availability of hemodynamic monitoring equipment and supplies for the patient having thoracic surgery? - Answer - 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? - Answer - 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: - Answer - 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: - Answer - 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. - Answer - 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: - Answer - 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? - Answer - Tracheostomy 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? - Answer - 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. - Answer - 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? - Answer - 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: - Answer - 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? - Answer - The TEP technique What does the lacrimal gland do? - Answer - 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? - Answer - Weight-bearing activities and joint movement prevent cartilage from becoming thin or damaged 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: - Answer - Frontal, ethmoid, sphenoid, occipital Which nodes in the lymphatic system are responsible for drainage from the mouth, lips, and external nose? - Answer - Submandibular Describe the inguinal ligament. - Answer - Runs from the anterior superior iliac spine to the pubic tubercle The pyramidal lobe of the thyroid is described as: - Answer - 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. - Answer - 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. - Answer - 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? - Answer - 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? - Answer - 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 . - Answer - Mesentary Inadvertent injury to which of the following nerves can result in vocal cord paralysis? - Answer - Recurrent nerve What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp? - Answer - Subgaleal space The diagnostic test that is performed to differentiate between acute and chronic thrombosis is known as: - Answer - 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. - Answer - 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? - Answer - 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? - Answer - 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: - Answer - congenital myopathies Somatosensory evoked potential (SEP) monitoring is most often employed during which type of surgical procedure? - Answer - posterior spinal fusion One source of catgut is . - Answer - 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? - Answer - Clean/contaminated wound, classification II What kind of needle would be used on the skin? - Answer - Reverse Cutting Umbilical hernias occur in adults as a result of a defect in the: - Answer - Linea alba The ideal suture material is one that has handling characteristics such as: - Answer - pliability The name of the fascia that separates the anterior rectum from the vagina in females is called the: - Answer - Rectovaginal fascia The manufacturing process of permanently connecting the suture thread to the needle is known as: - Answer - swaged Terminal cleaning and disinfection of the operating room should be done . - Answer - 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. - Answer - 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 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: - Answer - 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? - Answer - Pruritus, edema, erythema, and vesicles that develop 6 to 48 hours after exposure Postoperative hypothermia is defined as a temperature less than: - Answer - 96.8 Sources of radiation exposure in the OR include: - Answer - 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? - Answer - Impaired wound healing What important information must be documented and communicated about a drain to the PACU or ICU nurse during hand-off report? - Answer - The location and type of drain Which of the following is a physical characteristic of suture material? - Answer - 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. - Answer - 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: - Answer - 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 arrived, she saw the vascular set; however, the most important instrument set was missing. What important instrument set was needed for this procedure besides the vascular set? - Answer - basic laparotomy set Which of the following anesthetics result in fasiculations for the patient? - Answer - Succhinylcholine The light transmission through an endoscope is achieved by way of: - Answer - bundles of fiberoptic glass rods Miriam Glass is a 78-year-old female scheduled for compression nail insertion of a left fractured hip. She was positioned for a spinal injection to induce spinal anesthesia. During the process, the anesthesia provider inadvertently inserted the spinal needle into the subarachnoid space, not noticing the error until the entire syringe of lidocaine was emptied into the patient. Miriam immediately experienced rapid onset of hypotension, bradycardia, and apnea. Miriam's unintentional condition is called and now must be managed with . - Answer - total spinal anesthesia; general endotracheal anesthesia Weighing sponges is a valuable tool for meticulous calculation of blood and fluid loss when conducted correctly and used in appropriate circumstances. Select the response that correctly reflects the best practice in weighing sponges. Use the following to calculate loss: - Answer - Use the following to calculate loss: 1.0 grams = 1.0 milliliters = 1.0 cc. Two monitoring techniques used by anesthesia that have improved morbidity and mortality include: - Answer - pulse oximetry and capnography Precautions apply to blood, all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood, mucous membranes, and nonintact skin. - Answer - Standard 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: - Answer - hypercarbia The linea alba is extends from to . - Answer - Above the xyphoid process to the pubis Select the true statement that best describes a key component of the culture of safety in regards to blood exposure. - Answer - a goal of the culture of safety is to reduce the risk of blood exposure and sharps injuries to staff Nancy Gallo returns back to work in a busy OR tomorrow after a 3-week vacation. She is certain she will be assigned to scrub in cardiac surgery in the morning. Select the infection prevention measures she must accomplish before she returns to the OR. - Answer - remove nail polish and jewelry and cut her nails to 1/4 inch past her finger tips