RNFA Study Guide 2024 with Complete Solutions, Exams of Community Health

Download RNFA Study Guide 2024 with Complete Solutions and more Exams Community Health in PDF only on Docsity! RNFA Study Guide 2024 with Complete Solutions Describe the minimal level of education required for an advanced practice nurse. - ANSWER-A Master's degree is required for advanced practice nursing. What is the nursing model created by the Association of periOperative Registererd Nurses (AORN) featuring domains that are in continuous interaction with the health system and encircling the focus of perioperative nursing practice—the patient? - ANSWER-The AORN model is referred to as the Perioperative Patient-Focused Model. Define the phase of the nursing process characterized by preparation for what will or may happen and determining the priorities for care. - ANSWER-The planning phase is characterized by preparation for what will or may happen and determining the priorities for care. Institutional standards are usually directive about specific actions in specific circumstances within a facility or system. What type of standards typically provide generalized authoritative statements that can be implemented in all settings? - ANSWER-National standards provide generalized authoritative statements that can be implemented in all settings. Define the phase of the nursing process characterized by performing the nursing care activities and interventions that were planned, and responding with critical thinking and orderly action. - ANSWER-The implementation phase is characterized by performing the nursing care activities and interventions that were planned, and responding with critical thinking and orderly action. Define the phase of the nursing process that focuses on identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care. - ANSWER-The nursing diagnosis phase focuses on identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care. What is the expanded perioperative role characterized by handling and cutting tissue, using instruments and medical devices, providing exposure and hemostasis, and suturing, all as components of assisting-at-surgery behaviors? - ANSWER-The registered nurse first assistant (RNFA) is an example of an expanded perioperative nursing role. The AORN publication, Standards of Perioperative Nursing, is an example of what kind of standard? - ANSWER-The AORN Standards are an example of process-based standards. What is the specialty nursing language that provides a uniform and systematic method to collect and document the basic elements of perioperative nursing care? - ANSWER- Perioperative Nursing Data Set (PNDS) is the name of the specialty nursing language that provides a uniform and systematic method to collect and document the basic elements of perioperative nursing care. Define the phase of the nursing process typically associated with describing the desired or favorable patient condition that can be achieved through nursing interventions. - ANSWER-The outcome identification phase describes the desired or favorable patient condition that can be achieved through nursing interventions. What is the act of transferring the authority for a selected nursing task or tasks in a selected situation(s) to a competent person? - ANSWER-Delegation is the act of transferring the authority for a selected nursing task or tasks in a selected situation(s) to a competent person. What standards are based on and describe the application of the nursing process in perioperative nursing? - ANSWER-Standards of care are based on and describe the application of the nursing process in perioperative nursing. They include the collection and analysis of data, identification of expected outcomes, planning and implementation of care, and evaluation of outcomes. What is the initiative that encompasses improvements in quality and effectiveness, based on ethical and economic perspectives? - ANSWER-Performance improvement is the initiative that encompasses improvements in quality and effectiveness, based on ethical and economic perspectives. What are some examples of emerging roles in the OR? - ANSWER-Emerging roles include care coordinator, family liaison, robotics coordinator, and informatics specialist. Define the phase of the nursing process that focuses on the patient's progress in attaining identified outcomes. - ANSWER-The evaluation phase focuses on the patient's progress in attaining identified outcomes. What certification is available to perioperative nurses that demonstrates proficiency in support of quality patient care and sets a standard of commitment to the profession of OR nursing? - ANSWER-Certified Nurse, Operating Room (CNOR) is the certification for perioperative nursing. List the types of advanced practice nurses who may practice in the perioperative environment. - ANSWER-Nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), and clinical nurse specialists (CNSs) are examples of nurses who may practice in the advanced role in the perioperative environment. identification number, specific origin of the specimen, and laterality (e.g., Jane Doe, 100001, right breast biopsy). What actions should you take in the event of an incorrect sponge, sharp, or instrument count? - ANSWER-In the event of an incorrect count, you should notify the surgeon of the unresolved count. Search for the missing item, including the surgical wound, field, floor, linen, and trash. Ask all personnel to direct their immediate attention to locating the missing item. If the item is not found, an X-ray film may be taken and read by the radiologist or surgeon as specified in institutional policy. What is the process that is characterized by performing a preoperative verification process, marking the operative site, and conducting a ''time-out'' immediately before starting the procedure? - ANSWER-The Universal Protocol is characterized by performing a preoperative verification process, marking the operative site, and conducting a ''time-out'' immediately before starting the procedure. Define the term extracellular fluid. - ANSWER-Extracellular fluids (ECFs) are those fluids in compartments outside the cells of the body, including plasma, intravascular fluids, fluids in the gastrointestinal (GI) tract, and cerebrospinal fluid (CSF). ECFs comprise 30% of the body's fluid. Define the term "never events." - ANSWER-Never events are events resulting in unsafe patient outcomes that are no longer considered reimbursable under the Centers for Medicare & Medicaid Services (e.g., wrong-site surgery). What is the difference between blood typing and blood crossmatching? - ANSWER- Blood typing refers to the test to determine the ABO and Rh blood type. Crossmatching refers to testing the compatibility of the recipient's serum and the donor's red blood cells. Describe the Occupational Safety and Health Administration (OSHA) exposure control plan. - ANSWER-The OSHA exposure control plan is designed to provide guidelines to control risks and protect workers from sharps injury and bloodborne pathogens. What is the sequence of steps to take after a needlestick or occupational contact/exposure? - ANSWER-1. Wash the area, or in the case of a splash exposure, flood the area with water. 2. Report the injury. 3. Identify the source patient. 4. Report to employee health/ED as recommended per facility policy. 5. Get tested for HIV, HBV, and HCV. 6. Get postexposure prophylaxis. 7. Document the exposure. 8. Obtain an immediate evaluation and assessment. 9. Initiate a postexposure treatment plan to include follow-up, education, and counseling. Healthcare workers are routinely exposed to communicable diseases. What vaccinations are recommended by OSHA and the CDC for healthcare workers who provide direct care? - ANSWER-Recommendations include: HBV, influenza (annually), and Tdap (tetanus, diphtheria, acellular pertussis). Define waste anesthetic gases (WAGs). - ANSWER-WAGs 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. What is the benefit of using an algorithm (such the ones in AORNs Safe Patient Handling Tool Kit)? - ANSWER-An algorithm is a set of rules for solving a problem in a finite number of steps. In the case of the toolkit, it provides a research-based framework for standardization of tasks. List some common workplace controls used to minimize workplace violence. - ANSWER-Identification of high-risk patients; staff training; adequate staffing; implementation of effective processes for reporting suspicious behavior, harassment, or threats; and supervision of the movement of psychiatric patients in the facility. List some common environmental controls used to minimize workplace violence. - ANSWER-Controlled access doors, metal detectors, alarm systems, panic buttons, noise devices, cell phones, and adequate interior and exterior lighting. What information is contained in AORNs Safe Patient Handling Tool Kit? - ANSWER- The tool kit incorporates seven ergonomic tools, or algorithms, to guide workplace safety in the perioperative setting. What information may be located in safety data sheets (SDS)? - ANSWER-A typical SDS includes information such as hazardous ingredients, health hazards, limits to which a worker may be exposed, routes of entry, precautions and safety equipment, first aid procedures, clean-up procedures, and safe handling precautions. Describe the three types of reaction to latex. - ANSWER-Individuals can experience three reactions to latex. 1. Irritant contact dermatitis is the most common reaction, characterized by dry, reddened, itchy, or cracked hands. Irritant contact dermatitis is not a true allergic reaction. 2. Allergic contact dermatitis is a delayed localized allergy caused by chemicals used to manufacture rubber products. Allergic contact dermatitis is a delayed reaction, usually appearing 6 to 48 hours after exposure. Symptoms are similar to those from irritant contact dermatitis, except that the reaction may extend beyond the actual point of contact. 3. True latex allergy is a hypersensitivity reaction that involves systemic antibody formation in reaction to proteins in products made from natural rubber latex. What flu vaccine should healthcare workers receive if they are caring for immunocompromised patients? - ANSWER-The inactivated influenza vaccine is the preferred vaccine for workers who come into direct contact with this group of patients. Nurses working in the operating room (OR) have sharp device injuries at double the rate of other specialties. What is the most common cause of percutaneous injury (PI) in the perioperative setting? - ANSWER-Suture needle injuries are the most common cause of PI in the surgical setting. What are the three main routes of exposure to toxic chemicals for perioperative staff? - ANSWER-Exposure to chemicals occurs through several routes. The three main routes of exposure to toxic chemicals are inhalation, skin contact, and exposure through mucous membranes and ingestion. When should Standard Precautions be used? - ANSWER-Standard Precautions apply to all patients receiving care, regardless of diagnosis or presumed infection status. Standard Precautions apply to (1) blood; (2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood; (3) mucous membranes; and (4) nonintact skin. What are the sources of radiation exposure in the OR? - ANSWER-Sources of radiation exposure in the OR include: (1) ionizing sources such as portable radiography machines and portable fluoroscopy units, and (2) nonionizing sources such as lasers. The use of personal protective equipment is effective against transmission of pathogens in the OR. What are the two most effective practices? - ANSWER-For prevention of infection among OR nurses, two practices are particularly useful: double-gloving and the use of eye protection. According to the American Nurses Association (ANAs) Handle with Care campaign, when should an assistive device be used in lifting a patient? - ANSWER-Any time manual lifting will put the caregiver at risk, an assistive device should be used. Describe a strategy for reducing risk of allergic reaction to latex. - ANSWER-A best practice for minimizing the risk of latex allergy development in nonallergic patients, and the risk of reaction in sensitive or allergic patients, is the use of powder-free gloves that have low levels of protein and chemical allergens. What are the risks of exposure to WAGs? - ANSWER-Short-term exposure to WAGs causes lethargy and fatigue, and long-term exposure may be linked to spontaneous abortion, congenital abnormalities, infertility, premature births, cancer, and renal and hepatic disease. What are the most common preventable factors that cause slips, trips, and falls (STF)? - ANSWER-Wet floors, uneven floor surfaces, obstructed pathways, inadequate lighting, and improper footwear. Define the neutral zone. - ANSWER-The neutral zone is a location on the surgical field where sharps are placed in a predesignated sterile basin or tray, from which the surgeon or assistant can retrieve them. It eliminates hand-to-hand passing of sharps. How does the Spaulding classification define semi-critical items? - ANSWER-Those items that contact nonintact skin and mucous membranes, but do not ordinarily penetrate the blood barrier are considered semi-critical under the Spaulding system. When are liquid peracetic acid sterilant systems used? - ANSWER-Liquid peracetic acid systems are used for devices that are heat sensitive, can be immersed, and have been validated by the device manufacturer for use in these systems. They are suitable for devices that cannot be sterilized with terminal sterilization methods. Which organism is most frequently implicated in surgical site infections? - ANSWER- Staphylococcus aureus is most frequently implicated in surgical site infections. What is the retrovirus that attacks the immune system by destroying T-helper lymphocytes? - ANSWER-Human immunodeficiency virus (HIV) is the retrovirus that attacks the immune system. What non-spore-forming, nonmotile, aerobic bacillus is responsible for tuberculosis? - ANSWER-Mycobacterium tuberculosis is responsible for tuberculosis. Define the term bioburden. - ANSWER-Bioburden is the amount of microbial load and organic debris on an item before sterilization. List the sequence for surgical incision draping. - ANSWER-Draping begins at the area of the intended incision and proceeds outward to the periphery. Always drape from a sterile area to an unsterile area by draping the near side first. What are the human body's three lines of defense against infection? - ANSWER-The three lines of defense against infection are: (1) external barriers, such as the skin and mucous membranes; (2) the inflammatory response, which prevents an invading pathogen from reproducing and possibly involving other tissue; and (3) the immune response, which is triggered after the inflammatory response. List the categories of microbial resistance. - ANSWER-Microbial resistance can be divided into three categories: (1) presence of a naturally resistant strain of an organism before any drugs are administered, (2) acquisition of a drug-resistant strain from an external source, and (3) drug resistance from treatment-related causes. Define the purpose for Gram staining. - ANSWER-Gram staining is a procedure for staining bacteria that is the first step in classifying and differentiating them into two large groups (gram-positive and gram-negative) based on the chemical and physical properties of their cell walls. What gram-positive organisms are responsible for necrotizing fasciitis? - ANSWER- Group A streptococci are responsible for necrotizing fasciitis. List agents identified by the Centers for Disease Control and Prevention (CDC) that could pose a threat to national and world security and safety through bioterrorism. - ANSWER-The CDC has identified anthrax, smallpox, plague, botulism, and tularemia as bioterrorism threats. Which heat-resistant, spore-forming microorganism is used to test steam sterilizer effectiveness? - ANSWER-Geobacillus stearothermophilus is used for steam sterilizers. List the sequence for surgical skin preps. - ANSWER-Surgical skin preps are conducted in the following manner: Prepare (''prep'') the cleanest area first and then move to the less clean areas (clean to dirty). What are the time and temperature parameters for gravity displacement steam sterilizers? - ANSWER-Recommended time and temperature settings for gravity displacement sterilizers are: 121-123° C (250-254° F) for 15-30 minutes, or 132-135° C (270-275° F) for 10-25 minutes. Define the term airborne transmission. - ANSWER-Airborne transmission occurs by dissemination of an infectious agent by evaporated droplets or dust particles suspended in the air that can be inhaled or deposited on a host. What are the methods of air removal used by sterilizer units? - ANSWER-Gravity displacement and dynamic air removal are methods of air evacuation from a sterilization chamber. What is the primary mode of transmission implicated in methicillin-resistant Staphylococcus aureus (MRSA) infections? - ANSWER-The primary mode of transmission for MRSA is via direct contact from the hands of healthcare personnel. What is the human prion disease that is a fatal neurodegenerative disease of the central nervous system? - ANSWER-Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disease of the central nervous system. What is the transmission route for Hepatitis C virus? - ANSWER-Hepatitis C virus is transmitted via direct exposure to blood or other infectious materials. Describe standard precautions - ANSWER-hand hygiene; personal protective equipment (PPE; gloves, gowns, mouth/nose/eye protection); respiratory hygiene/cough etiquette; patient placement; patient-care equipment and instruments/devices; care of the environment; textiles and laundry; worker safety What gram-positive anaerobe proliferates and causes symptoms of diarrhea, colitis, toxic megacolon, dehydration, and colonic perforation? - ANSWER-Clostridium difficile causes symptoms of diarrhea, colitis, toxic megacolon, dehydration, and colonic perforation. What is the recommended temperature in the operating room (OR) to control bacterial growth? - ANSWER-The recommended temperature to control bacterial growth is 68° F (20° C) to 73° F (23° C). What pathologic organism often seen in critical care and burn units? - ANSWER- Pseudomonas aeruginosa is often found in critical care and burn units. What is the recommended steam quality that is necessary to achieve sterilization? - ANSWER-A steam quality of 97% or greater is necessary for sterilization. Define the term sterilization. - ANSWER-Sterilization is the complete elimination or destruction of all forms of microbial life. How does the Spaulding classification define critical items? - ANSWER-Those items that enter sterile tissue or the vascular system are considered critical under the Spaulding system. How does the Spaulding classification define noncritical items? - ANSWER-Those items that come into contact only with intact skin are considered noncritical under the Spaulding system. What is ethylene oxide (EO)? - ANSWER-EO is an alkylating agent used to sterilize heat-labile and moisture-sensitive items. List the types of steam sterilizers used in the OR. - ANSWER-Gravity displacement, pre-vacuum, and immediate use (flash) sterilizers are all examples of steam sterilizers used in the OR. What gram-positive organism is typically responsible for surgical site infections, bacterial endocarditis, septicemia, and urinary tract infections (UTIs)? - ANSWER- Enterococcus is the gram-positive organism responsible for many healthcare- associated infections such as surgical site infections, bacterial endocarditis, septicemia, and UTIs. Describe Stage II anesthesia. - ANSWER-Stage II spans from loss of consciousness to the onset of regular breathing and loss of the eyelid reflex. What depolarizing muscle relaxant is used in the OR? - ANSWER-Succinylcholine (Anectine) is the only depolarizing agent used in the OR. List examples of direct care providers for anesthesia services. - ANSWER-Direct care providers include: anesthesiologist, certified registered nurse anesthetist (CRNA) working alone or in collaboration with or under the direction of an anesthesiologist or a physician, and anesthesiologist's assistant (AA) working under the direct supervision of an anesthesiologist. List examples of long-acting nondepolarizing muscle relaxants. - ANSWER- Tubocurarine, metocurine, pancuronium, pipecuronium, and doxacurium are long-acting nondepolarizing medications. Define the term local anesthesia. - ANSWER-Local anesthesia is the administration of an anesthetic agent to one part of the body by local infiltration or topical application, usually administered by the surgeon. Define the ASA P4 status. - ANSWER-An ASA P4 status is defined as a patient with a severe systemic disease that is a constant threat to life. Define the term intrinsic factors. - ANSWER-Intrinsic factors are the health and the body structure of the patient. List the forces that contribute to injury of the skin and underlying tissue during positioning. - ANSWER-Pressure, shear, friction, moisture, heat, cold, and negativity contribute to positioning injury. What characteristics are thought to increase the likelihood of acquired position-related neuropathies? - ANSWER-Diabetes, peripheral vascular disease, electrolyte imbalance, vitamin B12 deficiency, alcoholism, smoking, malnutrition, advanced age, previous nerve injury, arthritis, obesity, and thin body habitus. List the characteristics of Stage I pressure ulcer. - ANSWER-Stage I is characterized by intact skin with nonblanchable redness of a localized area, usually over a bony prominence. Define the term pressure. - ANSWER-Pressure is the force placed on underlying tissue. Describe the semi-Fowler position. - ANSWER-In semi-Fowler, the patient is supine with the upper body flexed at approximately 45 degrees and the leg section is lowered. Describe the correct procedure for tucking a patient's arms during supine positioning. - ANSWER-To tuck the patient's arms: wrap the draw sheet smoothly around the arm, extending to above the elbow, and then tuck the draw sheet under the patient's body instead of under the mattress. List examples of devices commonly used during prone positioning. - ANSWER-The Wilson frame and the Jackson spinal surgery bed are often used during prone positioning. Define the term shear. - ANSWER-Shear is the folding of underlying tissue when the skeletal structure moves while the skin remains stationary. Describe the supine position. - ANSWER-In the supine position, the patient lies with the back flat on the operating room (OR) bed with their arms tucked at the side or placed on armboards. What peripheral nerve is at risk during lithotomy positioning? - ANSWER-The common peroneal nerve is at increased risk for injury during lithotomy positioning. Describe the Trendelenburg position. - ANSWER-In the Trendelenburg position, the patient is supine with the upper torso lowered and the feet raised. List the characteristics of Stage III pressure ulcer. - ANSWER-Stage III is characterized by full-thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle is not exposed. Define the term friction. - ANSWER-Friction is the force of two surfaces rubbing against one another. Describe the lithotomy position. - ANSWER-In the lithotomy position, the patient is supine with the legs raised and abducted, usually in stirrups. Describe the Fowler position. - ANSWER-In the Fowler position, the patient is supine with the upper body flexed at approximately 90 degrees and the leg section is lowered. What risks are commonly associated with Fowler position? - ANSWER-Venous thromboembolism (VTE) and air embolism are risks associated with the Fowler position. List the characteristics of Stage IV pressure ulcer. - ANSWER-Stage IV is characterized by full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. List the characteristics of deep tissue injury. - ANSWER-Deep tissue injury is characterized by a purple or maroon localized area of discolored intact skin or a blood- filled blister. Define the term pressure ulcer. - ANSWER-A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, that results from pressure or pressure in combination with shear and/or friction. Describe the lateral position. - ANSWER-In the lateral position, the patient lies on his or her nonoperative side. List the characteristics of Stage II pressure ulcer. - ANSWER-Stage II is characterized by partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed without slough. What is the capillary pressure threshold that, when exceeded, is associated with tissue trauma? - ANSWER-The threshold for capillary pressure is 32 mm Hg. Describe the prone position. - ANSWER-In the prone position, the patient lies on his or her abdomen. What nerve complex easily damaged by extending the arms more than 90 degrees during positioning? - ANSWER-The brachial plexus can be injured by positioning the arms more than 90 degrees. Describe the reverse Trendelenburg position. - ANSWER-In the reverse Trendelenburg position, the patient is supine with the upper torso elevated and the feet down. Define the term extrinsic factors. - ANSWER-Extrinsic factors are the physical forces and conditions to which the patient is subjected during surgery. List examples of nonabsorbable sutures. - ANSWER-Silk, nylon, polyester fiber, polypropylene, and stainless steel wire are examples of nonabsorbable sutures. Describe how sutures are measured. - ANSWER-Suture size is measured in millimeters, and expressed in USP sizes with zeroes. The smaller the cross-sectional diameter, the more zeroes; sizes range from #7, the largest, to 11-0, the smallest. List the different types of endomechanical staplers used for internal stapling. - ANSWER-Ligating and dividing staplers (LDSs), gastrointestinal anastomosis (GIA) staplers, thoracoabdominal (TA) staplers, end-to-end anastomosis (EEA) staplers, laparoscopic hernia mesh staplers, open hernia mesh staplers, and endo-GIA devices are used internally. Define the secondary suture line. - ANSWER-The secondary suture line is composed of those sutures that supplement the primary suture line. Define the term continuous suture. - ANSWER-A continuous suture consists of a series of stitches, of which only the first and last are tied. Define the term retention suture. - ANSWER-Retention sutures are placed at a distance from the primary suture line to provide a secondary suture line, relieve undue strain, and help obliterate dead space. Define the term ligature. - ANSWER-A ligature is a strand of suture material used to tie off (seal) blood vessels for the prevention of minor bleeding, or to isolate a mass of tissue for excision (cut out). Describe the "no touch" sharps technique. - ANSWER-Sharps are placed in a predesignated basin, tray collection device, or safe ''neutral'' zone on the field, from List the types of lasers commonly used in the perioperative setting. - ANSWER-Lasers used in the perioperative setting include the CO2, erbium:YAG, holmium:YAG, Nd:YAG, KTP, argon, tunable dye, diode, and excimer lasers. Differentiate between fiberoptic endoscopes and videoscopes. - ANSWER-Fiberoptic endoscopes have an eyepiece with a lens for visualization; the image is carried through the endoscope via a bundle of tiny glass fibers. Videoscopes have, at their distal end, a video chip that provides an image that is directly viewed on a monitor; a videoscope does not have an eyepiece for direct viewing, the eyepiece is replaced with an endoscopic video camera. Define the term endoscope. - ANSWER-An endoscope is a tube inserted into a natural body orifice or through a small incision to access internal organs or structures. List the risks of overpressurization during pneumoperitoneum. - ANSWER- Overpressurization can cause hypercarbia, gastric regurgitation and aspiration, decreased respiratory effort, decreased cardiac output, and phrenic nerve irritation or damage. Describe examples of flexible endoscopes. - ANSWER-Flexible endoscopes include: angioscopes, bronchoscopes, choledochoscopes, colonoscopes, cystonephroscopes, hysteroscopes, mediastinoscopes, ureteroscopes, and ureteropyeloscopes. Describe examples of rigid endoscopes. - ANSWER-Rigid endoscopes include: cystoscopes, laparoscopes, sinuscopes, arthroscopes, bronchoscopes, laryngoscopes, and hysteroscopes. Describe the purpose of white-balancing. - ANSWER-White-balancing adjusts the camera to all other optical components (endocoupler, light cable, laparoscope) to enable the camera to reference white so that it can identify all primary colors properly. Define capacitative coupling. - ANSWER-Capacitative coupling occurs when energy is transferred through intact insulation on the laparoscopic instrument shaft to nearby conductive materials. List the advantages of high-speed ultrasonic device surgery. - ANSWER-Advantages of high-speed ultrasonic surgery include: no surgical plume or odor, minimal aerosolization, reduced damage to adjacent tissue, retention of tactile feedback, no nerve or muscle stimulation, no stray electrical or laser energy, and precise cutting and control. Describe the energy path in a monopolar system - ANSWER-In a monopolar system, electrical energy flows from the generator through an active electrode to the patient to a dispersive electrode (pad) or patient return electrode (PRE) to the generator, completing the circuit. List the four components of a flexible endoscope. - ANSWER-A flexible endoscope is composed of the following: control body, insertion tube, bending section at distal tip, light-guide connector unit. List the advantages of robotic surgery. - ANSWER-Robotic surgery typically minimizes fatigue associated with holding and moving the scope, returns scope control to the physician, accommodates quick scope movements through a computerized memory, shortens the procedure time by minimizing scope positioning time, provides a steady image that enhances video quality, ensures consistent scope positioning and movement, and frees the surgeon's hands to perform other tasks. What term is used to describe knot tying inside of the body during laparoscopic procedures? - ANSWER-Knot tying inside of the body is known as intracorporeal suturing. List the three characteristics that differentiate laser light from ordinary light. - ANSWER- Laser light differs from ordinary light because it is monochromatic, collimated, and coherent. Describe the risk of insulation failure. - ANSWER-Electrical energy can escape at the point of the defect and burn untargeted tissue during insulation failure. List the benefits of argon-enhanced electrosurgery. - ANSWER-Benefits of argon- enhanced electrosurgery include: rapid coagulation, reduced blood loss, reduced risk of rebleeding, noncontact tissue coagulation, reduced depth of penetration by electrical energy, and less adjacent tissue damage. Describe the benefits of laser surgery. - ANSWER-Benefits of laser surgery include: reduced operative and anesthesia time, a shift to more ambulatory surgery procedures, more use of local anesthetics instead of general anesthetics, quicker recovery and return to daily activities. List the disadvantages of single-use laparoscopic instruments. - ANSWER- Disadvantages of single-use instrumentation include the need for increased storage space, budgetary implications, and environmental concerns related to disposal of biohazardous waste. List the four components of a rigid endoscope. - ANSWER-Rigid endoscopes are composed of an eyepiece, body, shaft, and distal end. Describe the advantages of minimally invasive surgery. - ANSWER-Advantages of minimally invasive surgery include: ambulatory or short hospital stay, short postoperative recuperation, reduced postoperative pain, and earlier return to normal lifestyle. Describe the key elements of laser safety. - ANSWER-Laser safety includes the use of eye protection, controlled access, fire safety, smoke (plume) evacuation, skin/tissue protection, and electrical safety. Name the nerve that is responsible for postoperative shoulder pain if irritated during laparoscopic procedures. - ANSWER-The phrenic nerve may be injured or irritated during laparoscopy. List the advantages of single-use laparoscopic instruments. - ANSWER-Single-use instruments are associated with sharpness, reliability, guaranteed sterility, safety, no reprocessing, and no repair costs. List the advantages of laser surgery. - ANSWER-The advantages of laser surgery are: seals small blood vessels, lymphatics, and nerve endings; sterilizes tissue; decreases postoperative stenosis; reduces tissue damage; reduces operative and anesthesia time; allows a shift to more ambulatory surgery procedures; allows more use of local anesthetics instead of general anesthetics; and provides quicker recovery and return to daily activities. List the five major components of a laser. - ANSWER-The laser components are the: (1) laser head, (2) excitation source, (3) ancillary components, (4) control panel, and (5) delivery system. Differentiate between operative and diagnostic endoscopes. - ANSWER-Diagnostic endoscopes are for observation only and have no operating channels. The system is sealed at both ends. Operative endoscopes are channeled to irrigate, suction, insert, and connect accessory instrumentation. Define direct coupling. - ANSWER-Direct coupling occurs when the active electrode accidentally touches a noninsulated metal instrument, allowing the electrical energy to flow from one to the other (metal-to-metal sparking). List the indications for cryosurgery. - ANSWER-Indications for cryosurgery include: skin tumors, liver tumors, prostatic cancer, and cervical dysplasia. Describe the acceptable range of intra-abdominal pressure to maintain during procedures requiring pneumoperitoneum. - ANSWER-The acceptable range for pneumoperitoneum is 14 to 16 mm Hg. Describe the energy path in a bipolar system. - ANSWER-In a bipolar system, energy flows from one tine (or prong or blade) of the bipolar instrument to the other tine as it passes through the tissue located between these tines. Energy returns directly through the instrument to the generator to complete the circuit, eliminating flow of current through the patient. What type of wound healing occurs when the wound is allowed to heal from the inside toward the outer surface? - ANSWER-Secondary intention occurs when the wound is allowed to heal from the inside toward the outer surface. List the three phases of wound healing. - ANSWER-The three phases of wound healing are: (1) inflammatory, (2) proliferative, and (3) remodeling. A breast biopsy is an example of what class of wounds? - ANSWER-A breast biopsy is an example of a class I Clean Wound. Define the term dermis. - ANSWER-The dermis is the layer beneath the skin that provides strength and structure and is composed of collagen. What type of wound healing occurs when the wound is closed with sutures, staples, or tape applied as soon after the time of injury as possible? - ANSWER-Primary intention occurs when the wound is closed with sutures, staples, or tape applied as soon after the time of injury as possible. Define the term chronic wound. - ANSWER-A chronic wound is one caused by an underlying pathophysiologic condition over time. Define the term debridement. - ANSWER-Debridement is the act of removing dead and devitalized tissue from a wound. Define the term keloid. - ANSWER-Keloids are dense, unsightly connective tissue or excessive scar formation that is often removed surgically. Describe the time periods associated with each phase of wound healing. - ANSWER- The proliferative phase begins within hours of the injury. The remodeling phase begins after approximately 2 to 4 weeks, depending on the size and nature of the wound and may last 1 year or longer. Contraction begins approximately 5 days after the wound onset and peaks at 2 weeks, gradually shrinking the entire wound. List the surgical techniques that maximize wound healing. - ANSWER-Techniques to maximize healing include: adequate hemostasis, precise cutting and suturing techniques, efficient use of time to minimize wound exposure to air, elimination of dead spaces, and minimal pressure from retractors and other instruments. Define the term superficial surgical site infection (SSI) - ANSWER-A superficial SSI is one involving only the skin and subcutaneous tissue of the incision and at least one of the following: purulent drainage from the superficial incision, organisms isolated from a culture from the superficial incision, or signs and symptoms of infection. What are the defining characteristics of an organ/space SSI? - ANSWER-Purulent drainage from a drain that is placed through a stab wound into the organ/space; organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space; an abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiologic examination; and diagnosis of an organ/space SSI by a surgeon or attending physician. Define the term adhesions. - ANSWER-Adhesions are described as the adherence of serous membranes to one another, causing fibrous tissue to form. A peri-rectal abscess is an example of what class of wounds? - ANSWER-A peri-rectal abscess is an example of a class IV Dirty or Infected Wound. Define the term deep incisional surgical site infection (SSI). - ANSWER-A deep incisional SSI is one involving deep soft tissues (e.g., fascial and muscle layers) of the incision and at least one of the following: purulent drainage from the deep tissue, incision spontaneously dehisces or is deliberately opened by a surgeon, abscess or other evidence of infection involving the deep incision, and diagnosis of a deep incisional SSI by a surgeon or attending physician. Describe laryngospasm. - ANSWER-During laryngospasm, the muscles of the larynx contract and partially or completely obstruct the airway. What factors contribute to postoperative tachycardia? - ANSWER-Postoperative tachycardia is often caused by pain, hypoxemia, hypovolemia, increased temperature, and anxiety. Define postoperative hypertension. - ANSWER-Postoperative hypertension is defined by a 20% to 30% increase above baseline blood pressure measurement. Define hypotension and the factors that contribute to it. - ANSWER-Hypotension is a blood pressure reading that is 20% less than the baseline or preoperative blood pressure measurement. Hypotension may be caused by cardiac dysfunction or by medications (including anesthetic agents). Describe the difference between phase I and phase II of postanesthesia care. - ANSWER-Phase I activities focus on primary assessment, breathing and circulation, and facilitating the patient to a level of physiologic stability. Phase II PACU prepares the patient for discharge. What is fast-tracking? - ANSWER-Fast-tracking is a process in which the patient bypasses the PACU phase I and is admitted directly to phase II. Define and describe bronchospasm. - ANSWER-Bronchospasm is a lower airway obstruction caused by spasms of the bronchial tubes. The patient presents with wheezing, dyspnea, use of accessory muscles, and tachypnea. List the risk factors for postoperative nausea and vomiting (PONV). - ANSWER-Risk factors for PONV include: Female gender, nonsmoker, history of PONV or motion sickness, use of volatile anesthetics, use of nitrous oxide, postoperative use of opioids, duration of surgery, and type of surgery. Describe measures taken to prevent deep vein thromboembolism (DVT) or pulmonary embolus. - ANSWER-Measures to prevent DVT or pulmonary embolus include administration of prophylactic heparin, aspirin, dextran, or warfarin; and application of intermittent pneumatic compression device (IPCD) or graduated compression stockings. What factors contribute to postoperative bradycardia? - ANSWER-Contributing factors for postoperative bradycardia include hypoxemia, hypothermia, high spinal anesthesia, vagal stimulation, and some medications. What is assessed during the primary assessment on admission to the postanesthesia care unit (PACU)? - ANSWER-The primary assessment focuses on the ABCs (airway, breathing, and circulation). List two drug classes often used in combination to treat postoperative pain. - ANSWER- Medications commonly used to treat postoperative pain include nonsteroidal antiinflammatory drugs (NSAIDs) and opiates. What factors are assessed during the PACU respiratory assessment? - ANSWER- Respiratory assessment comprises rate, rhythm, auscultation of breath sounds for ventilatory adequacy, and the oxygen saturation level. Describe the clinical signs of hypotension. - ANSWER-Hypotension is characterized by rapid, thready pulse; disorientation; restlessness; oliguria; and cold, pale skin. List the possible consequences of untreated postoperative pain. - ANSWER-Untreated pain may be associated with decreased thoracic movement, increased splinting, reduced lung compliance and volume, decreased mobility, increased risk of thromboembolism, exaggerated catecholamine response, increased risk for myocardial ischemia, impaired immune system, and delayed return of bowel and gastric function List examples of objective factors that can be used to evaluate pain. - ANSWER- Objective factors used to evaluate pain include protective guarding behavior, moaning, crying, whimpering, restlessness, irritability, diaphoresis, dilated pupils, facial expression of pain, and changes in vital signs (blood pressure, respiratory rate, or pulse). List the risk factors for hypothermia. - ANSWER-Risk factors for hypothermia include: Female gender, age (very young or very old), length and type of surgical procedure, cachexia, significant fluid shift, use of cold irrigants, ambient room temperature, burns, and neuraxial anesthesia. What factors are considered for the PACU neurologic assessment? - ANSWER-The nurse will consider the following: Has the patient reacted (awakened from anesthesia)? What component of a successful slips, trips, and falls prevention initiative has the most impact on reducing the incidence of slips, trips, and falls in the healthcare environment? - ANSWER-Providing education to healthcare workers about the importance of preventing slips, trips, and falls Which of the following statements regarding the use of the hepatitis B virus (HBV) vaccine is true? - ANSWER-Once immunity is established via a hepatitis B antibody titer, booster doses are not required. Which of the following is a personal monitoring device for radiation exposure? - ANSWER-Film badge Percutaneous injuries represent a significant hazard to perioperative nursing personnel. Which type of percutaneous injury is the most prevalent? - ANSWER-Injuries from hollow-bore needles What is the least common route of chemical exposure in the OR? - ANSWER-Ingestion Rhonda Batson is a surgical technologist who sustained a needlestick injury during a procedure on a patient who has hepatitis C. What is the sequence of postexposure testing that Rhonda will follow? - ANSWER-Testing at 6 weeks, 3 months, 6 months, and 1 year The concept of surgical asepsis is directed at: - ANSWER-practices that restrict microorganisms in the environment. Viruses transmitted through blood and some blood products are a major concern in operating rooms because of the risk of direct percutaneous exposure to blood. Bloodborne viruses include: - ANSWER-hepatitis B and C viruses. As a general rule, a patient's hair is best left at the surgical site. If hair removal is necessary, which statement reflects current best practice? - ANSWER-If hair removal is necessary, clippers should be used and the hair removal performed as close as possible to the time of surgery. The primary purpose of the surgical hand scrub is: - ANSWER-to reduce the number of microorganisms on the nails, hands, and arms. Surgical site infections are usually caused by: - ANSWER-the patient's own flora. The term asepsis means - ANSWER-the absence of infectious organisms. Which of the following represents a break in sterile technique? - ANSWER-Using the closed-gloving technique to replace a torn glove during a surgical procedure The use of Universal Precautions has become widespread and mandated by the Occupational Safety and Health Administration. Which of the following is a part of Universal Precautions? - ANSWER-Employees must receive training in handling hazardous materials. When opening the instruments for a vaginal hysterectomy, the scrub person notices that the instrument case contains water. What should the scrub person do? - ANSWER- Return the instrument set for reprocessing and obtain a new set. A patient classified as an ASA-P3 could be expected to need which of the following perioperative nurse interventions? - ANSWER-Preoperative teaching with increased emphasis on the importance of early postoperative ambulation to prevent postoperative complications Malignant hyperthermia can be a life-threatening event. Which of the following represents a true statement about malignant hyperthermia? - ANSWER-It is a multifactorial disease and genetically transmitted as an autosomal dominant trait. During intubation, cricoid pressure is sometimes given with the thumb and index finger of one hand. This procedure: - ANSWER-should be continued until the endotracheal tube placement has been confirmed and the cuff has been inflated. Which of the following is an anesthetic-related factor that contributes to patient hypothermia? - ANSWER-Vasodilation from inhalation agents that enhances heat transfer from the core to the periphery Which of the following is a correct gas hose, color-code pair? - ANSWER-Air: yellow A patient who will be sedated to a state that allows him/her to tolerate unpleasant procedures while maintaining adequate cardiorespiratory function: - ANSWER-may be monitored by a perioperative nurse who has completed a competency-based program for conscious sedation. Which of the following best describes general anesthesia? - ANSWER-A reversible unconscious state characterized by amnesia, analgesia, and depression of reflexes A pulse oximeter provides an early warning of hypoxia by: - ANSWER-indicating oxygen saturation through the use of two light-emitting diodes alternately transmitted through blood and tissue to measure light absorption. A normal SpO2 for a young healthy patient on room air is: - ANSWER-95% to 100%. Which of the following anesthetic agents was used in the early history of anesthesia and remains in common use today? - ANSWER-N2O Which position modification should the perioperative nurse anticipate during a thyroidectomy? - ANSWER-Reverse Trendelenburg Winston Williams is scheduled for a hemorrhoidectomy. While gathering supplies for the lithotomy, the nurse chooses wider ankle straps rather than thinner ones for Mr. Williams. What physical principle is the nurse applying to reduce pressure to the area and hence prevent pressure injury? - ANSWER-Intensity of pressure is inversely proportional to the size of the surface area being compressed. Hermalinda Guzman is scheduled to have a vaginal hysterectomy under general anesthesia. Which position should the circulating nurse prepare for? - ANSWER- Lithotomy position with arms on armboards Albert Jennings is a 325-pound patient who has just undergone a UPPP procedure. During his transfer from the OR bed to the transport vehicle to the operating bed, his skin and underlying tissue are at risk for injury because of friction and what other physical force? - ANSWER-Shear The most common and natural position used for operative procedures is: - ANSWER- supine. The most frequently reported locations of pressure sores are the sacrum and the: - ANSWER-heels. Carmine Grimaldi, a 70-year-old patient with spinal stenosis, has just undergone a 9- hour procedure in the prone position on the Wilson laminectomy frame. Mr. Grimaldi is 5 feet, 10 inches and weighs 140 pounds. The perioperative nurse notes an intact, red, nonblanching area the size of a quarter on his chest when the team moves him to the transport vehicle at the conclusion of the procedure. What stage of pressure injury is Carmine likely to have sustained? - ANSWER-Stage I Which of the following is true about the Braden scale? - ANSWER-The lower the score, the greater the risk of developing a pressure ulcer. Injury to the brachial plexus can be avoided by: - ANSWER-properly tucking the arms at the patient's sides. Which of the following could be classified as an intrinsic factor influencing pressure ulcer development? - ANSWER-Preexisting comorbidity Which of the following represents the correct sequence for a closing count? - ANSWER- Surgical site → immediate surrounding area → Mayo stand → back table → items discarded from the field Jacob Sutzkever is a 62-year-old patient who underwent an emergency colon resection for a ruptured diverticulum 1 week ago. Due to fecal spillage, the surgeon created a colostomy and planned to perform a delayed primary closure within 3 days of the procedure. On the third postoperative day, Mr. Sutzkever developed a fever of 103° F (39.4° C) and purulent drainage from the wound. He is scheduled for a wound debridement and washout. The surgeon anticipates bringing Mr. Sutzkever back to the OR every 3 days for debridement with wet-to-dry dressing changes in between. Review the list below and select the best dressing choice in light of Mr. Sutzkever's situation. - ANSWER-Moist fine-mesh gauze, 4 × 4s, ABD pads, Montgomery straps Brady Martin was admitted to the postanesthesia care unit (PACU) 20 minutes ago after a hemicolectomy. He began snoring loudly and his oxygen saturation began to fall. The nurse gently shook his shoulder and reminded him to take deep breaths. Brady did not respond to her and continued to snore. What action should the nurse take next? - ANSWER-Use a jaw thrust to open the airway. Virginia Grier is a 33-year-old patient who underwent a D & C and laparoscopic tubal ligation. She was transitioned from phase I recovery to phase II, where she has been for 3 hours. She has expressed a desire to go home, but her surgeon has written an order that states, "Patient must void before discharge." Virginia states she is unable to void. What should the phase II nurse do next? - ANSWER-Assist Virginia to the bathroom, run the water, and apply warm water to her perineum to stimulate urination. Cardiovascular instability can occur in the postanesthesia care unit due to the depressive nature of many of the anesthetic agents used in the OR. Which is the most common cardiovascular complication that the nurse is likely to encounter when caring for patients in the immediate postoperative period? - ANSWER-Tachycardia Luci Edwards has undergone a bilateral bunionectomy under regional anesthesia. The nurse is demonstrating crutch walking to Luci. In what phase of postoperative care does this activity occur? - ANSWER-Phase II Aspiration is a potential complication that may present in the postanesthesia care unit. Review the list below and select the response that best describes the symptoms that could present when aspiration has occurred. - ANSWER-Tachypnea, hypoxemia, hypotension, bradycardia Which of the following are the most desirable initial actions after assessing laryngospasm in an awake patient? - ANSWER-Removing the irritating stimulus, providing reassurance, and positive-pressure ventilation Which of the following patients has the greatest risk for postoperative hypothermia? - ANSWER-Alexandra Frazier, a 26-year-old patient who has just undergone a tumescent liposuction procedure to her abdomen and thighs, breast reduction, and rhinoplasty under general endotracheal anesthesia According to research, certain risk factors can predispose some patients to postoperative nausea and vomiting (PONV). Review the list below and select the patient with the greatest risk of developing PONV. - ANSWER-Joyce Myers, 43 years old, a nonsmoker who states she has to take Dramamine every time she flies or rides in a car for long trips and who is scheduled for an abdominal hysterectomy under general anesthesia A variety of assessment tools exist to assist the perianesthesia nurse in evaluating a patient's pain. What is the most reliable indicator of pain that the nurse should consider? - ANSWER-The patient's self-report of pain Bronchospasm is a serious postanesthesia complication that may be caused by: - ANSWER-aspiration, pharyngeal suctioning, or histamine release. Of all of the usual nursing diagnoses applicable to patients having major abdominal surgery, a patient undergoing an ileostomy is at greater risk than patients having other laparotomies for: - ANSWER-Disturbed Body Image related to intestinal diversion. Which of the following is a difference between the laparotomy and laparoscopic approaches to GI surgery? - ANSWER-Intra-abdominal pressure should be at 10 to 12 mm Hg. Brandon O'Neill, a 13-year-old, has just been admitted through the emergency department. He has been vomiting for several days and has a temperature of 103° F (39.4° C) and rebound tenderness of the abdomen. The surgeon schedules him for an appendectomy, and perforation is suspected. What kind of incision would you anticipate? - ANSWER-McBurney A primary purpose of the small intestine is to: - ANSWER-absorb essential nutrients at 95% efficiency. Which GI surgical procedure typically requires two stages done approximately 48 hours apart? - ANSWER-Loop colostomy The portion of the GI tract that lies partly in the abdomen and partly in the pelvis is called the: - ANSWER-sigmoid colon. The order of tissues from the surface of the abdomen to the abdominal cavity is: - ANSWER-skin, subcutaneous tissue, muscle, fascia, peritoneum. The small intestine: - ANSWER-consists of the duodenum, jejunum, and ileum. A major difference between gastroscopy and colonoscopy is: - ANSWER-the patient's position for the procedure. During preoperative preparation of a GI surgery patient and family, what potential knowledge deficits will require the perioperative nurse's focus (as opposed to the surgeon's informed consent role)? - ANSWER-How having the proposed procedure will affect the patient and family postoperatively Review the list of patients below and select the one who is at greatest risk for cholelithiasis. - ANSWER-Tiesha Jansen, a 39-year-old female with type 2 diabetes who weighs 260 pounds Which of the following diagnoses would be an indication for laparoscopic splenectomy? - ANSWER-Hemolytic jaundice David Linscomb has a diagnosis of cholelithiasis and is scheduled for a cholecystectomy with an intraoperative cholangiogram. What data can be gained from the cholangiogram? - ANSWER-Visualization of the gallbladder to determine the number and size of stones Alfred Eichelberger has a liver abscess secondary to a diverticular abscess. He underwent a percutaneous drainage that was unsuccessful. He is now scheduled for surgical drainage of the abscess. What approach is the surgeon likely to use to drain Alfred's abscess? - ANSWER-Transperitoneal Where are Kupffer cells found? - ANSWER-In the hepatic sinusoids Which of the following statements about pancreaticoduodenectomy is true? - ANSWER- Pancreaticoduodenectomy 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 lower half of the common bile duct. Wei-Ann Chinn has been admitted with acute pancreatitis secondary to cholecystitis. Which lab value supports her diagnosis? - ANSWER-Serum amylase of 160 units/dL Which of the following statements about the anatomy of the liver is true? - ANSWER- The hepatic artery maintains the arterial supply while venous blood from the stomach, pancreas, intestines, and spleen travels to the liver via the portal vein and its branches. Which of the following statements describing sliding hernias is correct? - ANSWER- Sliding hernias involve the bladder in direct hernias. The structure requiring repair in direct, indirect, and femoral hernias is the: - ANSWER- posterior inguinal floor. How does a direct inguinal hernia differ from an indirect inguinal hernia? - ANSWER- Direct hernias occur within the Hesselbach triangle. Robert Nisbet is the perioperative nurse assigned to provide care for Ramona Hollingsworth, a 30-year-old patient who is scheduled for a total thyroidectomy to treat her thyroid cancer. Which of the following points should Robert ensure he includes when providing patient education to Ramona? - ANSWER-Report any numbness or tingling around the lips, twitching of extremities, or spasms. Both parathyroid and thyroid glands are important to: - ANSWER-maintenance of calcium homeostasis. The parathyroid glands can be challenging to isolate during surgery. Which of the statements listed below best describes one of the possible locations of the parathyroid glands? - ANSWER-Near the posterior portion of the superior pole of the thyroid Craig Anderson is scheduled for a subtotal thyroidectomy. Which structures will remain after his procedure? - ANSWER-One lobe of the thyroid, the posterior capsule, and some adjacent thyroid tissue Shay Cummings is a 13-year-old male who is scheduled for excision of his thyroglossal duct cyst. Which instrument set(s) should the team assigned to his care plan on using? - ANSWER-Neck tray, plastic tray A positive Chvostek sign is an indication of: - ANSWER-hypocalcemia. Circulation to the thyroid is supplied by: - ANSWER-two arteries and three pairs of veins. Which of the following medications is used preoperatively in patients with hyperthyroidism to prevent thyroid storm? - ANSWER-Potassium iodine Juan Rocamontes is scheduled to undergo a subtotal thyroidectomy. As part of the informed consent process, his surgeon is explaining the possible risks and complications that could occur during the surgery. Which structure is he likely to discuss at length with Juan as one that, if damaged, could have serious consequences? - ANSWER-Recurrent laryngeal nerve Pamela Desherlia has been diagnosed with hyperthyroidism. Review the list below and select the set of symptoms that is most commonly associated with hyperthyroidism. - ANSWER-Vision changes, heat intolerance, insomnia, diarrhea Which of the facts listed below is true regarding the sentinel node? - ANSWER-It can be located with a radiocolloid and a Geiger counter. Which hormone is responsible for promoting growth of the lobular structure of the breast? - ANSWER-Progesterone What is the mammary tissue that extends laterally on the pectoralis major toward the axilla called? - ANSWER-The tail of Spence Which of the following patients has the greatest risk of developing lymphedema after a mastectomy? - ANSWER-Wilma, a 57-year-old with stage IIa ductal carcinoma who is 75 pounds overweight, has hypertension, and will undergo chemotherapy Janelle has just finished reviewing discharge instructions for Maryanne, a 42-year-old patient who will be undergoing a modified radical mastectomy. As a best practice, Janelle has requested a teach-back from Maryanne to evaluate her understanding of the instructions. Which of the statements below indicates that Maryanne has a good comprehension of her postoperative course? - ANSWER-"I should carry my purse on the opposite side of my surgery." Which of the types of invasive breast cancer listed below has the highest incidence of occurrence? - ANSWER-Ductal carcinoma Miriam Gilbert is a 48-year-old who is in perimenopause. While showering a week ago, she discovered a hard, irregular mass in her right breast. She has some enlarged lymph nodes in her axilla and notes some redness over the mass. When she saw her family physician, he told her that her symptoms were consistent with a benign breast disorder that typically occurs in women her age. Based on Miriam's presentation, which of the following is a possible diagnosis for her condition? - ANSWER-Ductal ectasia Review the list below and select the patient who has the highest increased risk for breast cancer. - ANSWER-Virginia, a 65-year-old who has never had a child Trabeculectomy is a surgical procedure that is performed to treat what condition? - ANSWER-Glaucoma Vanessa Marshall is a 31-year-old who was diagnosed with type 1 diabetes at age 5. On a recent visit to her ophthalmologist, she was diagnosed with a small macular hole. What visual changes might Vanessa experience as a result of this condition? - ANSWER-Blurriness and distortion of straight lines when reading What is the anatomic structure that is referred to as the "blind spot"? - ANSWER-Optic disc Norma Wooten is a 57-year-old who has begun to perceive that she has lost some visual acuity. She is noticing that sunlight seems very bright, and is seeing halos around lights. With what ocular condition are Norma's symptoms commonly associated? - ANSWER-Cataracts Chad Davis is a 4-year-old who has developed dacryocystitis as a complication of a sinus mucocele. Review the list below and select the symptom that most often occurs with dacryocystitis. - ANSWER-Epiphora Tropicamide (Mydriacyl) is a topical medication often used in ophthalmic surgery. What type of medication is tropicamide? - ANSWER-Cycloplegic Wallace Merkins is scheduled for a left eye cataract extraction. Which statement made by Wallace indicates a need for additional patient education regarding home care after cataract surgery? - ANSWER-"I should avoid raising my arms above my head." What is the most common type of retinal detachment? - ANSWER-Rhegmatogenous Which of the following statements is true about toxic anterior segment syndrome (TASS)? - ANSWER-It is a sterile postoperative inflammatory reaction. The refractive apparatus of the eye consists of: - ANSWER-cornea, aqueous humor, lens, and vitreous body. The nasal system is composed of the following three structures: - ANSWER-nasal cartilage, ethmoid perpendicular plate, and vomer bone. Deviations of the nasal septum involving cartilage and bony parts may block the middle turbinate on that side, resulting in obstruction of the sinus opening. The main objective of a septoplasty is to: - ANSWER-establish an adequate partition between the left and right nasal cavities, providing a clear airway through the internal and external cavities of the nose. Dawn Calvert is a 35-year-old who has chronic sinusitis. Her otorhinolaryngologist has recommended she undergo functional endoscopic sinus surgery (FESS). What is the main objective of FESS? - ANSWER-To reestablish sinus drainage flow Ramesh Patel is a 30-year-old male who is scheduled for an endoscopic nasal polypectomy. Ramesh has never had surgery before, and he is very engaged in the patient education process and has repeated instructions back to his nurse so he is sure he understands what to expect after his procedure. Which of the following statements made by Ramesh should be clarified? - ANSWER-"After the surgery, I should blow my nose frequently to clear any blood or clots." Geneva Meisser is present at her husband Eugene's side as you are providing patient education for his hemilaryngectomy procedure. Which statement made by Geneva indicates a good understanding of Eugene's voice quality after surgery? - ANSWER-"Eugene's permanent voice will be hoarse but understandable." Wayne Timmons is a 63-year-old patient who is scheduled for a partial glossectomy and radical neck dissection to treat his tongue cancer. Which of the following findings would be considered to be a normal consequence of his procedure? - ANSWER-Shoulder drop Jordan Ebensberger has a left temporal lobe tumor. What pre- and postoperative assessments are appropriate for Jordan? - ANSWER-Presence and degree of aphasia Lorenzo Knowles is scheduled for a rotational flap to cover an ischial ulcer. Which of the statements below provides the best description of a rotational flap? - ANSWER-The flap is semicircular and rotates along an axis. The success of replantation surgery is often tied to the manner in which the severed body part is maintained prior to surgery. Review the list below and select the answer that represents best practice for preserving severed body parts. - ANSWER-Wrap the amputated body part in saline-soaked gauze, place it in an occlusive bag, and immerse the bag in ice water. Skin cancers are diagnosed in more than 1 million people each year in the United States. Which of the following is true about melanoma? - ANSWER-It rarely metastasizes. Lieshen Voss has just undergone an abdominoplasty. What should the nurse take care to do when transferring Lieshen from the OR bed to the transport bed? - ANSWER- Keep Lieshen's shoulders elevated and knees flexed. Mary Banda is providing discharge instructions for Phillip Duncan, a 33-year-old who has undergone a split-thickness skin graft. What is Mary's best response when Phillip asks her how long it will take for the donor site to heal? - ANSWER-14 days Faye Tibbs is scheduled for liposuction of her abdomen, hips, and thighs. When providing discharge teaching, the nurse discusses the compression garment that she will place on Faye at the end of the procedure and reviews important facts about the garment that Faye will need to know. Which of the following statements made by Faye indicates a need for clarification regarding her compression garment? - ANSWER-"I only need to wear the garment 3 hours a day and can leave it off while sleeping." Which of the following patient's circumstances is descriptive of a full-thickness burn? - ANSWER-Louis, who has a thigh burn involving the epidermis, dermis, and subcutaneous tissue Rachel Boyle is interested in having laser skin resurfacing. Which of the following lasers is typically used for skin resurfacing? - ANSWER-CO2 Which of the following symptoms is commonly associated with macromastia? - ANSWER-Intertrigo Ruby Combs was in a motor vehicle accident in which she sustained multiple injuries, including a pneumothorax and liver laceration. The emergency department physician inserted a chest tube and stabilized her for the OR. When she arrives in the OR, what indicator does the nurse use to assess proper functioning of Ruby's chest tube? - ANSWER-Fluctuation of drainage in the chest tube with respirations The greatest amount of air that can be expired after maximum inspiration is called: - ANSWER-vital capacity. Dominic Jablonski is considering lung volume reduction surgery as a treatment for his emphysema. What physiologic process occurs in the lung as a result of emphysema? - ANSWER-The air spaces distal to the terminal bronchioles become weak and enlarged. Closed thoracostomy will require: - ANSWER-chest catheters and water-seal drainage. Which surgical position is commonly used for endoscopic thoracic sympathectomy? - ANSWER-Supine Chemical pleurodesis is undertaken as a treatment for malignant pleural effusion and unresolved spontaneous pneumothorax. Review the list below and select the agent that is used for chemical pleurodesis. - ANSWER-Doxycycline hyclate The pulmonary arteries: - ANSWER-carry blood to the pulmonary parenchyma. Jordyn Criswell is a 3-year-old who is scheduled for a bronchoscopy to remove a penny. What should the nurse assigned to Jordyn's care anticipate? - ANSWER-Sanders Venturi system, rigid bronchoscope, general anesthetic Bill Monroe is the nurse assigned to care for Eric Arias, who just underwent a left thoracotomy and has a left pleural chest tube connected to suction. On assessment, Eric notes the water level on the suction chamber is 10 cm and the surgeon's order is suction at 20 cm. How should Eric handle this discrepancy? - ANSWER-Add sterile water to the suction chamber to the appropriate level. Which statement regarding dissecting aneurysms is true? - ANSWER-They are caused by a tear in the inner layer or layers of the vessels with escaping blood between the layers of the vessel wall. Pedal pulses should be marked before the beginning of vascular procedures. What is the rationale for doing this preoperatively? - ANSWER-It enables the nurse to easily located the pulses during the procedure if the surgeon requests a check of them. Kem Ng is scheduled for a vena cava filter and is repeating his discharge instructions to the nurse before going into the OR. Which of the following statements made by Kem about his postoperative anticoagulant therapy indicates a need for additional teaching and clarification? - ANSWER-"It's important for me to take my medicine with food, so I will continue to have my banana every morning for breakfast with my cereal when I take my medicine." Doppler scanning is used as a diagnostic test. Which of the following explains the purpose of Doppler studies? - ANSWER-Measure the velocity of the flow of cells What does the presence of bruit on auscultation of a blood vessel mean? - ANSWER- Blood flow is disrupted. Many risk factors have been identified for developing atherosclerosis. Review the list below and select the answer that is descriptive of a relative risk factor. - ANSWER- Hypertriglyceridemia The purpose of an arteriovenous shunt is to: - ANSWER-provide an access for hemodialysis. Which vessel layer is represented by the tunica adventitia? - ANSWER-Outer layer Which of the following is the diagnostic method of choice for venous insufficiency? - ANSWER-Duplex ultrasonography What type of bleeding is more difficult to control and why? - ANSWER-Venous because veins' tunica media is thinner than that of arteries Which approach is commonly used to place pacemaker electrodes? - ANSWER- Transvenous The main coronary arteries are situated in the: - ANSWER-epicardium. Dr. Duncan, the anesthesia provider during a coronary artery bypass graft (CABG) procedure, asks the perioperative nurse to assist him in making an Isuprel drip to treat the patient. What clinical effects will the team observe after the Isuprel is administered? - ANSWER-Increased heart rate, decreased blood pressure What medication will Dr. Duncan administer at the end of the CABG procedure to promote hemostasis? - ANSWER-Protamine sulfate Where is the mitral valve located? - ANSWER-Between the left atrium and left ventricle Shelbie Wilson is scheduled for a valve repair using direct suturing of torn leaflets. What is the technical name for this procedure? - ANSWER-Valvuloplasty What type of surgical approach should the perioperative nurse anticipate for Shelbie Wilson's procedure? - ANSWER-Parasternotomy or left anterior small right thoracotomy Which coronary artery is accessible on the posterior surface of the heart? - ANSWER- The circumflex branch of the left coronary artery Which of the trauma patients described below has the greatest risk for developing hypothermia? - ANSWER-Shirley, 57 years old and homeless, who was hit by a car and has a blood alcohol level of 0.20% On occasion the perioperative nurse will complete the secondary assessment of a trauma patient. Which statement below accurately describes the sequence of the secondary assessment? - ANSWER-Begin at the head, move to the neck, chest, abdomen, and pelvis; check all extremities; and visually and tactilely assess the back. The correct relationship between blunt and penetrating trauma is: - ANSWER-morbidity and mortality are greater with blunt trauma than penetrating trauma. Which of the following trauma centers is capable of providing any type of care on a 24- hour basis? - ANSWER-Level I center Contrast agents may be classified as negative or positive. Review the list below and select the answer that best describes a positive contrast agent. - ANSWER-Barium Which of the following patients has the greatest risk for a contrast media reaction? - ANSWER-Paul, a 40-year-old patient with asthma and sickle cell disease The technique used to obtain venous or arterial access for the passage of catheters is known as the: - ANSWER-Seldinger technique. Contrast media-induced nephrotoxicity (CIN) is a possible complication of contrast media administration in the IR setting. Review the list below and select the answer that best reflects the physiologic change that is responsible for CIN. - ANSWER-Transient increase in blood flow followed by a longer period of decreased blood flow to the kidneys Stewart Corbin is scheduled to undergo an emergency aortogram. The radiologist has a concern with Stewart's clotting mechanism. Which type of contrast medium will the radiology nurse have available to minimize the risk of inhibiting platelet aggregation and limiting the clotting cascade? - ANSWER-Iso-osmolality contrast medium Which of the following statements is true about contrast medium? - ANSWER-Contrast medium is not metabolized. Hilario Gomez is a 45-year-old patient who is scheduled for a myelogram to evaluate his low back pain. During a preprocedure phone call, the IR nurse obtained a medication history. After learning that Hilario takes metformin to treat his type 2 diabetes, the nurse advised him to discontinue the metformin before the myelogram and not to resume taking it for 48 hours after the procedure. Why did the nurse recommend this action? - ANSWER-To minimize the chance of lactic acidosis when combining metformin with contrast media Radiation protection is based on three key principles: time, distance, and shielding. Considering the principle of distance, how far away should nonessential personnel stand from the beam when fluoroscopy is being used? - ANSWER-Six feet Which of the herbal supplements listed below may be implicated in cardiac interactions? - ANSWER-Licorice Which of the herbal supplements listed below may be implicated in coagulation interactions? - ANSWER-Ginkgo An example of a practice within the alternative medical system is: - ANSWER- homeopathic therapy. Music therapy has been shown to significantly decrease patient anxiety in the perioperative setting. To maximize this potential, the preoperative nurse will select music based on: - ANSWER-a tempo of 60 to 72 beats/min. Charlene Burke is a 30-year-old patient who underwent a bilateral thigh liposuction procedure 24 hours ago. During her postoperative phone call follow-up, Charlene asks the nurse if it is safe for her to take goldenseal to help her reduce her swelling from the retained tumescent agent. She admits she has never used herbal supplements and is curious to see if a natural remedy will help her recover faster. After discussing the use of herbal supplements with the nurse, which statement made by Charlene indicates understanding of the information provided? - ANSWER-"I understand that herbs are not classified as drugs and are not regulated by the FDA [U.S. Food and Drug Administration], so it's important to fully research each one." In which of the major categories of integrative health therapies can the practice of chiropractic be placed? - ANSWER-Manipulative and body-based methods Which of the herbal supplements listed below may be implicated in sedative interactions? - ANSWER-Valerian Hypnosis allows patients to share the responsibility for their healing process. Which of the following is also true about hypnosis? - ANSWER-It may help with relaxation and anxiety and engage the patient in self-healing. Energy therapies are based on the principle that: - ANSWER-the human biofield is part of the universal field and is dynamic, open, complex, and pandimensional.