Surgical Instruments and Techniques, Exams of General Surgery

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Updated CNOR Subject Area 3 Questions (Plus

Instruments, Suture, and Wound

Classifications) Comprehensive Review 100%

Pass | Graded A+

David Mungai [Date] [Course title]

Updated CNOR Subject Area 3 Questions

(Plus Instruments, Suture, and Wound

Classifications) Comprehensive Review

100% Pass | Graded A+

CCI Subject 3 Flashcards - Answer>> non-alcoholic iodine/iodophors (if not allergic to iodine) - Answer>> skin antiseptic of choice for the genitals incident (occurrence) report - Answer>> - serves as an internal document for risk management

• should objectively, completely, and accurately describe the even without interpretation or opinion by the person(s) completing the form
• considered facility work documents used to improve processes, NOT to attach blame to an individual
• should NEVER be documented in the patient's record 1 hour - Answer>> antibiotic should be administered within ___ before skin incision 24 hours - Answer>> antibiotic therapy is discontinued within ___ after clean and clean-contaminated cases patient name, patient ID number, origin of specimen, laterality - Answer>> 4 minimum requirements for labeling intraoperative specimens c - Answer>> A DNR order is revoked/suspended during the immediate perioperative period via a) automatic suspension of the order b) the surgeon

Needlestick Safety and Prevention Act (2000) - Answer>> mandates that employers provide safety-engineered devices in the health care setting to prevent sharps injuries (OSHA) dependent iliac crest - Answer>> For patients placed in the lateral position with the OR bed flexed and the kidney rest device elevated, the correct placement of the kidney rest is underneath the patient's ___. bookwalter, weitlander, cerebellar, gelpi, balfour, goligher, iron intern - Answer>> 7 examples of self-retaining retractors self-retaining - Answer>> Bookwalter, weitlander, cerebellar, gelpi, balfour, goligher, and iron intern are all examples of ___ retractors. standard precations - Answer>> implementation of PPE, work practices, and engineering controls that are utilized to minimize exposure to potentially infectious agents is known as ___ standard precautions - Answer>> the foundation of all infection prevention practices is the use of ___ collagen hemostatic - Answer>> Intraoperative autologous blood salvage devices should not be used in conjunction with ___ agents, which may not wash out of the salvaged blood. lethargy and fatigue - Answer>> short-term exposure to waste anesthesia gas may cause ___ and ___ infertility, miscarriage, or cancer - Answer>> long-term exposure to waste anesthesia gas can cause ___, ___, or ___

sodium - Answer>> During TURP, the patient's bladder is distended with a large amount of fluid. If the patient absorbs excess fluid systemically, a decrease in ___ may occur. fluid volume shift - Answer>> A combination of LR, lidocaine, and epi is routinely injected in fatty areas prior to liposuction in order to decrease ___. administrative - Answer>> ___ controls include developing and educating staff about an ergonomically safe environment engineering - Answer>> examples of ___ controls:

• having appropriate assistive, patient-handling equipment available
• limiting the weight of instrument trays to 25 pounds or less
• providing adequate lighting ulnar nerve - Answer>> Which structure is most commonly injured when a patient's arms are placed palm-side down during positioning? brachial plexus - Answer>> Which structure can be injured if a patient's arms are positioned out over 90 degrees? SSI - Answer>> most common cause of delayed wound healing subgaleal - Answer>> The ___ space contains adipose tissue and allows for ease in mobility of the scalp. It is in this bloodless place that the standard craniotomy scalp flap is created. McBurney - Answer>> ___ incision is made in the RLQ of the abdomen and is primarily used for an open appendectomy.

• confer a high risk for infection if they are contaminated with any microorganism
• objects that enter sterile tissue or the vascular system must be sterile because any microbial contamination could transmit disease
• surgical instruments, cardiac and urinary catheters, implants, ultrasound probes used in sterile body cavities, etc. vagotomy - Answer>> procedure performed to reduce gastric acid secretions by interrupting parasympathetic innervation rinsed with sterile saline - Answer>> Surgical gut suture comes in a package moistened with alcohol. If it is removed from the package and allowed to dry out, it should be ___ before use. flumazenil (Romazicon) - Answer>> - benzo antagonist
• has a shorter half-life than most benzos
• contraindicated in patients with long-term use of benzos for life- threatening conditions
• nurse should monitor for signs of re-sedation, as the duration of action may be shorter than benzos freeze, cryo, subcutaneous pocket - Answer>> 3 ways to preserve autologous cranial bone flap Hank's BSS, milk, water (if only option) - Answer>> 3 ways to preserve avulsed tooth cryo - Answer>> way to preserve autologous parathyroid tissue normal saline, cryo - Answer>> 2 ways to preserve autologous skin

in NS or LR and then refrigerated - Answer>> how to preserve autologous veins remove both gloves and re-glove using an assisted gloving technique - Answer>> What should be done in regard to gloving if a glove is punctured? ankle - Answer>> When supine, should a pillow be place under the patient's ankle or heel? penrose, t-tube - Answer>> 2 types of open, or gravity, drains used to evacuate surgical wounds esmark - Answer>> soft rubber bandage that is used to expel venous blood from a limb (exsanguinate) that has had its arterial supply cut off by a tourniquet exsanguinate - Answer>> - to expel venous blood from a limb that has had its arterial supply cut off by a tourniquet by using an esmark or by elevation of the limb alone

• necessary to enable some types of delicate reconstructive surgery where bleeding would obscure the working area after - Answer>> Should exsanguination occur before or after tourniquet cuff inflation? double-armed - Answer>> vascular anastomoses are usually sewn with ___ sutures to allow for the suture line to run circumferentially and join at one point padding - Answer>> adequate and wrinkle-free ___ material should be placed underneath the pneumatic tourniquet cuff to decrease skin complications and maintain skin integrity

kocher - Answer>> - traumatic, toothed clamp

• used for grasping dense, tough tissue with its large teeth allis - Answer>> - clamp that is similar to babcock
• has teeth
• can be used to grasp intestine mayo - Answer>> - heavy scissors available in multiple varieties
• straight scissors are used for cutting suture ("suture scissors")
• curved scissors are used for cutting heavy tissue (i.e., fascia). metzenbaum - Answer>> lighter scissors used for cutting delicate tissue (i.e., heart) and for blunt dissection iris - Answer>> - scissors that are used for fine dissection and cutting fine suture
• originally for ophthalmic procedures, but now serves multipurpose role tissue - Answer>> non-toothed forceps used for fine handling of tissue and traction during dissection adson - Answer>> forceps that are toothed at the tip and used for handling dense tissue, such as in skin closures debakey - Answer>> forceps that are used for atraumatic tissue grasping during dissection deaver - Answer>> retractor used to hold back the abdominal wall army-navy - Answer>> retractor used to gain exposure of skin layers

weitlander - Answer>> self-retaining retractor used for exposing deep or smaller surgical sites richardson - Answer>> retractor used to hold back deep tissue structures bookwalter - Answer>> self-retaining retractor than is anchored to the operating table malleable - Answer>> - retractor that can be bent and customized

• also used to protect intestines during abdominal closure rake - Answer>> hand-held retractor with sharp teeth used to hold back surface structures yankauer - Answer>> suction used primarily for surface suction and some intra-abdominal suction poole - Answer>> suction used to remove large amounts of fluid from the surgical field, as well as intra-abdominal suction frazier - Answer>> - suction used primarily in ENT surgeries and neurosurgery
• usually angled 10 - Answer>> blade used for making large skin incisions (i.e., laparotomy) 11 - Answer>> blade used for making precise or sharply angled incisions

conventional cutting - Answer>> ideal needle type for skin closure taper-point - Answer>> preferred needle type for easily penetrated tissues (dura, peritoneum, abdominal viscera) reverse cutting - Answer>> - preferred needle type for suturing of subcutaneous tissue

• used for suturing tendons, ligaments, and fascia synthetic absorbable sutures (PDS, monocryl, Maxon) - Answer>> best type of suture choice for a fascial closure monofilament (non-braided) - Answer>> Which is better for skin closure? Monofilament (non-braided) or multifilament (braided)? multifilament (braided) - Answer>> Which has greater risk for infection? Monofilament (non-braided) or multifilament (braided)? vicryl - Answer>> braided, absorbable suture used for internal anastomosis wound classifications - Answer>> clean - Answer>> Which wound classification?:
• elective C-section with no pre-rupture of membranes or trial of labor
• exploratory laparotomy/laparoscopy without bowel involvement
• hernia repair
• thyroidectomy
• eye surgery
• skin

• vascular/cardiovascular procedures clean-contaminated - Answer>> ___ wounds are those in which the respiratory, alimentary (GI), or genitourinary tract is entered under controlled conditions clean-contaminated - Answer>> Which wound classification?:
• GI procedures that are controlled and have no significant spillage
• GYN
• GU
• ENT/ear contaminated - Answer>> Which wound classification?:
• non-sterile debris in field
• cholecystectomy with bile spillage or acute inflammation
• appendectomy for inflamed appendicitis
• open, fresh (<4 hours) accidental wounds from a clean source contaminated - Answer>> Which wound classification?:
• acute, non-purulent inflammation
• spillage of bile
• infarcted/necrotic bowel or other tissue
• unplanned entrance into GI/GU/respiratory tract
• major break in sterile technique clean-contaminated - Answer>> Which wound classification?:
• hysterectomy
• lobectomy
• laryngectomy
• small bowel resection

conduction - Answer>> putting a warming blanket on the patient helps prevent ___ heat loss conduction - Answer>> ___ heat loss occurs when a patient is placed on a cold operating bed and body heat is transferred to the surface of the cold bed radiation - Answer>> ___ heat loss occurs when heat transfers from the body surface to the room atmosphere radiation - Answer>> turning up the room temperature combats ___ heat loss convection - Answer>> ___ heat loss involves air currents passing over the skin convection - Answer>> keeping the patient covered and protected from air currents combats ___ heat loss evaporation - Answer>> ___ heat loss occurs when skin becomes wet evaporation - Answer>> avoiding excessive draping of the patient combats ___ heat loss hemostat - Answer>> most commonly used surgical instrument fresh or in saline - Answer>> Breast tissue should be sent to the lab in which of two ways? hearing - Answer>> the last sense a patient loses when going under general anesthesia

bradycardia - Answer>> ___ is common in PACU in adult patients and may be due to hypoxemia, hypothermia, and certain medications analgesia/induction, excitement/delirium, surgical anesthesia/operative, medullary depression/danger/overdose - Answer>> 4 stages/levels of anesthesia analgesia/induction - Answer>> Which of the 4 stages/levels of anesthesia?:

• disorientation
• can be initiated in pre-op where patient is given medication and may begin to feel its effects but has not yet become unconscious
• sedated but conversational
• breathing is slow and regular excitement/delirium - Answer>> Which of the 4 stages/levels of anesthesia?:
• uncontrolled movements
• hyperactivity
• irregular respiration
• HTN, tachycardia
• N/V
• airway reflexes remain intact and are often hypersensitive to stimulation
• airway manipulation should be avoided in this stage
• higher risk of laryngospasm surgical anesthesia/operative - Answer>> Which of the 4 stages/levels of anesthesia?:

first incision, surgical wound is closed - Answer>> airborne particle contamination increases significantly before ___ and after

direct person-to-person contact (OR staff) - Answer>> most common source of transmission of pathological microorganisms in the OR Sellick's maneuver - Answer>> - aka cricoid pressure

• applying pressure to the cricoid cartilage to occlude the esophagus and immobilize the trachea
• prevents regurgitation and aspiration of stomach contents 6 - Answer>> Sellick's maneuver (cricoid pressure): exerting pressure with one or two fingers to compress the cricoid cartilage against the body of the ___th cervical vertebrae to occlude the esophagus Durant - Answer>> ___ position or maneuver is performed in the event an air embolus enters the patient's right atrium during a surgical procedure. It involves immediately repositioning the patient into left lateral position and tilting the bed into steep Trendelenburg to cause the air embolus to move from the right ventricular outflow tract. The anesthesia provider can then aspirate the trapped air bubble via a central venous catheter placed into the right atrium. air embolus, right atrium; left lateral, Trendelenburg, air embolus, right ventricular; central venous catheter, right atrium - Answer>> Durant position or maneuver is performed in the event a(n) ___ enters the patient's ___ during a surgical procedure. It involves immediately repositioning the patient into ___ position and tilting the bed into steep ___ to cause the ___ to move from the ___ outflow tract. The anesthesia provider can

then aspirate the trapped air bubble via a(n) ___ placed into the ___. alkalosis - Answer>> A patient with ___ (acidosis or alkalosis?) might exhibit seizures, convulsions, tremors, twitching of the muscles, confusion, and CNS excitement 3, 6 - Answer>> tourniquet cuff should overlap by at least ___ inches but no more than ___ inches one hour - Answer>> tourniquet should not be inflated for over ___ on an upper extremity hour and a half - Answer>> tourniquet should not be inflated for over ___ on a lower extremity everting - Answer>> everting or inverting suture?:

• used in multiple levels of skin closure
• used when suturing solid organs inverting - Answer>> everting or inverting suture?:
• used to close hollow internal organs, such as the intestines or the stomach
• also used in some ocular techniques, as well as when suturing trachea, bronchus, or ureters cleaning - Answer>> ___ means getting rid of visible soil, dust, blood, and debris disinfection - Answer>> ___ means killing most pathogenic and microorganisms (except spores) by chemical and physical means