202

Question 1

A female patient with end-stage pancreatic cancer was admitted from hospice for a celiac plexus block to treat intractable pain. 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. The patient insisted that her Do Not Resuscitate (DNR) status NOT be rescinded. She was conscious and competent and knew what was best for herself. The patient was taking full advantage of what provision for her care?
1. Informed consent
2. PSDA
3. Advance directives
4. PSDA and advance directives

Answer 1

PSDA and advance directives

Question 2

An obese, malnourished patient who presents for surgery is at higher risk for:
1. MH
2. Postoperative hypothermia
3. Postoperative hyperkalemia
4. Wound infection

Answer 2

Wound infection

Question 3

A patient 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 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. The patient was exercising her:
1. Understanding and rights under the Patient Self-Determination Act (PSDA).
2. Autonomy to protect herself from negligence and malpractice.
3. hope that everyone would honor the Health Insurance Portability and Accountability Act (HIPAA).
4. right to informed consent.

Answer 3

right to informed consent.

Question 4

Which nonprofit organization improves patient care through applied research into effectiveness and safety of devices, drugs, procedures, and processes?
1. Emergency Care Research Institute (ECRI)
2. The Joint Commission (TJC)
3. National Institute for Occupational Safety and Health (NIOSH)
4. Consumers Advancing Patient Safety (CAPS)

Answer 4

Emergency Care Research Institute (ECRI)

Question 5

Proper care and handling of surgical specimens is imperative for correct diagnosis, treatment, and prognosis planning of the patient. Select the response that best reflects correct specimen care and handling.
1. Avoid placing specimens for frozen section in formalin.
2. Neutralize formalin/formaldehyde spills with glycerin sulfate, and call the hazmat team.
3. Send all specimens to the laboratory together as one pickup, including frozen sections.
4. Label consecutive specimens in alphabetical order for laboratory efficiency.

Answer 5

Avoid placing specimens for frozen in formalin

Question 6

If a Kelly clamp is left in a patient who underwent a cholecystectomy, which of the following legal charges can be filed?
1. Primum non nocere
2. Res ipsa loquitur
3. Foreseeability
4. Intentional tort

Answer 6

res ipsa loquitur

Question 7

A patient was positioned, prepped, and draped following general endotracheal anesthesia induction. The team assembled to perform the time-out as described in the WHO surgical checklist. Successful employment of the time-out can only be ensured when:
1. perioperative services have a physician champion and surgeon buy-in.
2. each member of the team has an equal role and voice.
3. the time-out is initiated by the surgeon.
4. the checklist is committed to memory by all team members.

Answer 7

each member of the team has an equal role and voice.

Question 8

A specimen obtained for frozen section is generally removed from the sterile field intraoperatively because it:
1. Needs to be labeled by the circulator
2. Is sent to pathology immediately
3. Will contaminate the sterile field
4. Needs to be placed in formalin solution

Answer 8

is sent to pathology immediately

Question 9

Which of the following are the MOST important consideration when preventing wound infection in the surgical patient?
1. Pathogen transmittal
2. Portal of entry into the susceptible host
3. Anesthetic options for the patient’s operative process
4. Invasion of the susceptible host

Answer 9

1, 2, and 4 only

Question 10

If a routine surgical procedure was performed without consent, what action would be committed?
1. Assault
2. Battery
3. Malpractice
4. Liability

Answer 10

Battery

Question 11

Which of the following organisms normally found on skin can cause wound infections?
1. Bacillus botulinum
2. Staphylococcus aureus
3. Diplococcus pneumoniae
4. Candida albicans

Answer 11

staphylococcus aureus

Question 12

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:
1. establish cause and trends based on who was involved.
2. find out what needs to take place to prevent a recurrence of the event.
3. uncover factors that contributed to the environment and the event.
4. determine precisely what happened and why.

Answer 12

find out what needs to take place to prevent a recurrence of the event.

Question 13

Governmental and professional agencies and organizations, whether voluntary or involuntary, have a significant influence on patient safety policies in the healthcare setting. Select the agency or organization statement that presents a true reflection of its focus or purpose.
1. Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics
2. World Health Organization (WHO): United Nations (UN)–based and supported authority on health throughout most of the world
3. The Joint Commission (TJC): Nonvoluntary bureau that tests healthcare institutions against evidence-based elements of performance
4. American Society of Anesthesiologists (ASA): Professional organization of anesthesia providers and technologists

Answer 13

Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics

Question 14

Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained surgical items (RSIs). What new and evolving risk reduction strategy could prevent RSIs and frustrating, time-consuming miscount adventures at the end of these procedures?
1. Performing radiologic surveillance on all conversion procedures at closure
2. Creating precounted laparotomy sets with only the few necessary instruments
3. Counting all instruments including a laparotomy set before the laparoscopy
4. Replacing or tagging sponges and laparotomy instruments with radiofrequency identification (RFID) chips

Answer 14

Replacing or tagging sponges and laparotomy instruments with radiofrequency identification (RFID) chips

Question 15

What type of biopsy is performed during a flexible endoscopic procedure?
1. Incisional biopsy
2. Needle biopsy
3. Brush biopsy
4. Fine-needle aspiration

Answer 15

Brush biopsy

Question 16

Informed consent is both a requirement and a patient right. The perioperative nurse’s responsibility in terms of informed consent is to:
1. answer questions related to risks and benefits.
2. ensure the consent is completed properly to prevent legal liability.
3. obtain the informed consent.
4. report to the physician any doubts or concerns regarding the patients understanding.

Answer 16

report to the physician any doubts or concerns regarding the patients understanding.

Question 17

Proper handling of specimens is crucial for patient safety. What is the most serious negative outcome that could occur as a result of the loss, mislabeling or mishandling of a surgical specimen?
1. The patient’s condition could be misdiagnosed.
2. The medical facility could be sued for negligence.
3. The medical facility’s reputation could be damaged.
4. The patient might be unsatisfied with the treatment received.

Answer 17

The patient condition could be misdiagnosed.

Question 18

Which of the following situations requires informed consent from the patient/family?
1. Emergent surgery
2. Starting an IV
3. Discharge to home
4. Organ procurement

Answer 18

Organ procurement

Question 19

The Joint Commission (TJC) designates sentinel events as unexpected occurrences involving death or risk of serious physical or psychologic injury. In 2003, TJC mandated the Universal Protocol to address perioperative sentinel events. This protocol includes:
1. improving the safety of using medications.
2. reporting critical results of tests in a timely manner.
3. performing a preprocedure verification process.
4. establishing alarm system safety as a priority

Answer 19

performing a preprocedure verification process.

Question 20

Fires and explosions in the perioperative setting require three components, described as the “fire triangle.” The element of the triangle the perioperative nurse has the most control over is:
1. static electricity.
2. the oxidizer.
3. the ignition sources.
4. the fuel.

Answer 20

the fuel.

Question 21

Surgical patients are at risk for development of pressure injuries due to extrinsic factors such as length of surgery and intrinsic factors such as co-morbidities and age. The most important factor in prevention of such pressure injuries is:
1. use of sheets or blankets to position patients.
2. completion of a preoperative risk assessment and skin assessment.
3. reviewing the guidelines for patient positioning in surgery.
4. use of a transfer sheet to decrease friction.

Answer 21

completion of a preoperative risk assessment and skin assessment.

Question 22

Which of the following procedures for obtaining an informed consent form is appropriate?
1. The patient is asked to sign the consent form after the surgeon has explained the procedure
2. The SFA is ultimately responsible for obtaining the signed consent form
3. The patient is asked to read the entire consent form after signing it
4. The consent form is witnessed by one member of the patient’s family

Answer 22

The patient is asked to sign the consent form after the surgeon has explained the procedure.

Question 23

The OR is a danger-prone area for both patients and staff. Providing a safe environment of care for the patient involves identifying, mitigating, and managing the hazards inherent in surgical care. Choose the answer below that completes the blanks in this sentence: the risk of the surgical hazard of _________________ can be mitigated through _______________________.
1. surgical airway fire; fire extinguishers in every OR
2. surgical site infection; flash sterilization
3. electrical and thermal burns; alcohol-free prep solution
4. wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists

Answer 23

Wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists

Question 24

Which of the following are reasons for keeping the OR at a relative humidity level of between 50-55%?
1. Reduced risk of infection
2. Lower levels of patient discomfort
3. Minimization of static electricity
4. Depressed waste anesthesia gas

Answer 24

1 & 3

Question 25

Using Standard Precautions, which of the following is proper procedure when handling contaminated items?
1. Removing scalpel blades by hand
2. Disposing suctioned body fluids into a drain connected to a sanitary sewer
3. Placing sharps in an emesis basin for disposal into a biohazard trash bag
4. Discarding used needles by hand

Answer 25

disposing suctioned body fluids into a drain connected to a sanitary sewer

Question 26

While antibiotics have been credited with saving lives, misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs). Select the antibiotic application that has evidence to support it as a best practice and not, potentially, a misuse of antibiotics.
1. Vancomycin paste applied to cut edges of the sternum in cardiac surgery.
2. Bacitracin ointment on a clean subcuticular sutured incision as part of the dressing.
3. Antibiotics should be administered 1 hour prior to surgical incision, within 2 hours for vancomycin or fluorquinolones for every procedure with an incision or entered body system.
4. Tobramycin and methylmethacrylate bead implants into deep orthopedic incisions at risk for osteomyelitis.

Answer 26

Antibiotics should be administered 1 hour prior to surgical incision, within 2 hours for vancomycin or fluorquinolones for every procedure with an incision or entered body system.

Question 27

The evening before the procedure was scheduled, the central sterile processing department received two complete sets of an orthopedic spine fusion system that contained titanium-implantable instrumentation, four flexible coated retractor blades, and an unsterilized internal paper inventory form. The sterilization instructions provided by the vendor representative recommended steam sterilization for the implants, but stated that the flexible coated blade retractors could not be exposed to temperatures higher than 220° F. The appropriate sterilization option for these instruments and devices would be:
1. steam sterilization for the implant sets, hydrogen peroxide gas plasma for the retractors and paper inventory form, wrapped separately.
2. steam sterilization for the implant sets and paper inventory form, hydrogen peroxide gas plasma for the retractors, wrapped separately.
3. hydrogen peroxide gas plasma sterilization for everything.
4. steam sterilization for everything with a shortened dry time

Answer 27

steam sterilization for the implant sets and paper inventory form, hydrogen peroxide gas plasma for the retractors, wrapped separately.

Question 28

The mechanism of lethality (microbial death) with steam sterilization is achieved with this event:
1. saturated vaporization of the microbial cytoplasm.
2. denaturation and coagulation of enzyme proteins.
3. time, temperature, and steam pressure.
4. reduced and limited mitosis within the bioburden.

Answer 28

Denaturation and coagulation of enzyme proteins

Question 29

Staphylococcus aureus would most likely be transmitted by:
1. Urine
2. Feces
3. Nose and mouth
4. Sex organs

Answer 29

nose and mouth

Question 30

Within a steam sterilizer, at a temperature of 100° C (212° F), the water condensation and the steam are the same temperature. This scientific phenomenon is called ___________________ and will __________________.
1. saturated steam; kill microbes at 106
2. steam distribution; promote microbial kill
3. . steam saturation; not kill microorganisms
4. sterilization; kill all microorganisms to 106

Answer 30

Steam saturation; not kill microorganisms

Question 31

The accumulation of dust, debris, and other microbial contaminants is a potential source of SSIs. Guidance for cleaning processes in the perioperative area states that perioperative staff should:
1. remove trash before the patient leaves the room.
2. use enhanced cleaning procedures in the presence of multidrug-resistant organisms.
3. clean walls after every patient.
4. use alcohol to disinfect large environmental surfaces.

Answer 31

use enhanced cleaning procedures in the presence of multidrug-resistant organisms.

Question 32

Which of the following are procaryotic?
1. Molds
2. Protozoa
3. Bacteria
4. Plants

Answer 32

Bacteria

Question 33

Both sterilization and disinfection describe the elimination of microbial contamination and the achievement of a state suitable for patient care in select situations. However, disinfection differs from sterilization in that the process for disinfection uses:
1. agents to disinfect and eliminate most, if not all, pathogenic microbes.
2. semi critical medical devices used for ambulatory procedures.
3. contact precautions as well as universal precautions.
4. hospital-grade disinfectant/sterilants.

Answer 33

agents to disinfect and eliminate most, if not all, pathogenic microbes.

Question 34

A common pathogen typically associated with decubitus ulcers is Staphyloccous:
1. Proteus
2. Epidermidis
3. Pyogenes
4. Aureus

Answer 34

aureus

Question 35

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.
1. Air-dry, inventory, inspect, lubricate, assemble and string instruments, wrap and tape
2. Inspect, unlock locked clamps, string instruments, inventory, replace missing items, wrap
3. Inspect, unlock locked clamps, count and string instruments, place indicators, wrap and tape
4. Inspect, inventory against list, assemble, place integrators, wrap and tape

Answer 35

Inspect, inventory against list, assemble, place integrators, wrap and tape

Question 36

The gram stain differentiates:
1. Viruses
2. Bacteria
3. Helminths
4. Prions

Answer 36

Bacteria

Question 37

Which of the following microorganisms is responsible for causing postoperative wound edge erythema and rebound tenderness?
1. S. aureus
2. Clostridium
3. Group B streptococci
4. S. epidermis

Answer 37

Group B streptococci

Question 38

Phagocytosis by the WBCs is an example of the body’s:
1. First line of defense
2. Second line of defense
3. Third line of defense
4. Fourth line of defense

Answer 38

Second line of defense

Question 39

A chemical disinfecting agent used in the OR for cleaning furniture and floors which is bactericidal, fungicidal, and tuberculocidal is a/an:
1. An antiseptic
2. A disinfectant
3. A detergent
4. Ultraviolet irradiation

Answer 39

A disinfectant

Question 40

A 55-year-old woman undergoes laparotomy for small bowel obstruction. During lysis of adhesions, an enterotomy is made in the obstructed, but viable, bowel, and a large amount of fecal-looking bowel contents are spilled into the abdomen. The incision would now be considered what kind of wound?
1. Clean contaminated
2. Secondary
3. Contaminated
4. Clean

Answer 40

Contaminated

Question 41

Clostridium perfringens is associated with which clinical condition?
1. Gas gangrene
2. Toxic shock syndrome
3. Botulism
4. Anthrax

Answer 41

Gas Gangrene

Question 42

Herpes simplex is commonly called:
1. Cold score
2. Shingles
3. Smallpox
4. Chicken pox

Answer 42

cold sores

Question 43

The Centers for Disease Control and Prevention (CDC) have 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.
1. Smallpox, monkeypox, avian influenza, anthrax
2. Anthrax, tuberculosis, Clostridium difficile, tularemia
3. Smallpox, plague, botulism, tularemia
4. Anthrax, H1N1 influenza, botulism, smallpox

Answer 43

Smallpox, plague, botulism, tularemia

Question 44

With the production of more steam in the sterilizer chamber, the pressure increases as well. The steam should contain little or no entrapped liquid water. Steam quality is the term that describes the amount of water mixed with the steam. The constitution of high-quality steam would be measured by:
1. 70% or greater.
2. less than 3% of the mixture is liquid water.
3. 55% or greater.
4. less than 1% of the mixture is liquid water.

Answer 44

<3% of the mixture is liquid water.

Question 45

An integrator is a multiparameter indicator designed to measure:
1. time and pressure.
2. sterility and pressure.
3. temperature, time, and presence of steam.
4. pressure, steam, and temperature.

Answer 45

temp, time, presence of steam

Question 46

Which of the following techniques demonstrate a proven benefit in the prevention of postoperative wound infections?

1. Administering appropriate antibiotics within 1 hour of incision time
2. Maintaining suitable antibiotic coverage fro 48-72 hours postoperatively
3. Irrigating the wound with normal saline
4. Irrigating the wound with sterile water

Answer 46

1 & 3

Question 47

A swab of a fluid collection from an edematous, red, and suppurative postoperative wound is sent to the microbiology lab for culture, sensitivity, and Gram stain. The surgeon expects that the result will show a gram-positive coccus. This Gram stain designation is based on the:
1. ability to cause plasma to coagulate and form a microscopic clot.
2. physical and chemical properties of the cell wall.
3. formation of aerobic clustered spheres.
4. appearance of a thicker and brownish-colored cell wall.

Answer 47

physical and chemical properties of the cell wall.

Question 48

Qualities of an effective packaging material must include several key characteristics. Select the three most important qualities.
1. Stackable in sterilizer/storage shelf, comparable cost, low toxicity
2. Good steam penetration and removal, good microbial barrier, resists tearing
3. Aseptic presentation, event-related sterility indicators, writable surface
4. Cost, good microbial barrier, lint-free writable surface

Answer 48

Good steam penetration and removal, good microbial barrier, aseptic presentation.

Question 49

Which of the following are the MOST important considerations when preventing wound infection in the surgical patient?

1. Pathogen transmittal
2. Portal of entry into the susceptible host
3. Anesthetic options for the patient’s operative process
4. invasion of the susceptible host

Answer 49

1,2,4

Question 50

Sterilization prepares instruments to be used within, and on, sterile tissues. It kills vegetative microorganisms and endospores within a probability of 106. The process of decontamination prepares instruments to be:
1. clean at a high level of disinfection.
2. Used on nonsterile ear, nose, and throat (ENT) procedures.
3. free of bioburden.
4. handled without PPEs.

Answer 50

Free of bio burden

Question 51

The most appropriate devices to prevent skin pressure ulcers and deep tissue injury in the OR are:

Answer 51

Gel pads

Question 52

A 92-year-old frail female nursing home patient was admitted for dehydration, anemia, and respiratory symptoms. She has type 2 diabetes and low albumin levels, is underweight, and continues to smoke cigarettes. The patient is on complete bed rest in a hospital bed with an alternating pressure mattress overlay. She is not able to turn herself in bed and must be assisted to change position. Based on this description of the patient, which factor classification dominates her vulnerability and risk for injury?

Answer 52

Intrinsic factors

Question 53

A 325-lb male is undergoing a 6-hour abdominal surgery. While asleep and intubated, the surgeon requests the patient to be placed in lithotomy position for a sigmoidoscopy before the open procedure. The team of five nonscrubbed persons lifts the patient with the lift sheet, slides the patient down toward the foot of the OR bed, and places him into position. After the sigmoidoscopy, the perioperative nurse has the team roll the patient to his side for a skin assessment of his back before he is repositioned supine. What injury is the perioperative nurse concerned that she might see?

Answer 53

A shearing force injury to the tissue from having been slid into position

Question 54

A “foot drop” results from insufficiency of the extensor muscles in the foot, and may be caused by lumbar disc herniation (damage to a nerve root in the lumbar spine), or damage to/compression of the __________ nerve as it courses superficial to the fibular head.

Answer 54

peroneal

Question 55

Moving the arms away from the body is called _______________.

Answer 55

abduction

Question 56

In which of the following circumstances could the patient sustain an injury to the pudendal nerves?

Answer 56

Positioned on the fracture table

Question 57

Which position would be used for a patient in hypovolemic shock?

Answer 57

modified Trendelenburg

Question 58

The force of integumentary injuries that results from the skin remaining stationary while the underlying tissues shift is known as:

Answer 58

Shearing

Question 59

When moving a patient from lithotomy position:

Answer 59

Lower legs together slowly and simultaneously

Question 60

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 60

around; patient’s body

Question 61

Ulnar nerve damage could result from:

Answer 61

Placement of an elbow on unpadded table

Question 62

Select the positioning devices and accessories commonly used for bariatric surgery.

Answer 62

Air-filled, roller, or slider transfer device

Question 63

A 325-lb male is scheduled for a 6-hour abdominal surgery. While assessing the patient in the preoperative holding area, the perioperative nurse is concerned about the risk for pressure injury because of the weight of the patient’s body pressing against the surface of the operating room (OR) bed for a long surgery. Which of these other factors may also produce pressure?

Answer 63

a self-retaining retractor post clamped to the OR bed rail and tightened against the patient’s side

Question 64

A frail and thin 91-lb, 83-year-old woman is scheduled for a right pneumonectomy for non-small cell lung cancer. She will be positioned in left lateral position for her procedure. Based on the perioperative nurse’s preoperative assessment, identify three position-related nursing diagnoses for this procedure.

Answer 64

Risk for Perioperative Hypothermia; Risk for Impaired Skin integrity; Risk for Falls

Question 65

Which of the following is a potential physiological response when lowering a patient’s legs from the lithotomy position?

Answer 65

Hypotension

Question 66

Stirrups that are inadequately padded or improperly placed can cause pressure on the:

Answer 66

Peroneal nerve

Question 67

Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral, and _____________ nerves, which can result in injury from ______________.

Answer 67

common peroneal; full leg pneumatic compression sleeves

Question 68

The surgical team may begin positioning the patient only after the ________ gives his or her permission.

Answer 68

anesthesia care provider

Question 69

All of the following are requirements of the Kraske position EXCEPT:

Answer 69

Arms are tucked in at sides

Question 70

In positioning for laminectomy, rolls or bolsters are placed:

Answer 70

Longitudinally to support the chest from axilla to hip

Question 71

The correct arm placement when positioning a patient supine with arms extended on armboards is:

Answer 71

armboards extended <90* with palms facing up

Question 72

The proper placement of the legs for a patient in the lateral position is:

Answer 72

Lower leg flexed, upper leg straight

Question 73

The lithotomy position requires each of the following EXCEPT:

Answer 73

each leg is raised slowly and gently as it is grasped by the toes

Question 74

Select three basic criteria requirements that an OR bed mattress must meet.

Answer 74

Nonallergic, pressure-reduction capabilities, radiolucent

Question 75

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 75

kidney bridge; vena cava

Question 76

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 be related to these lateral positions?

Answer 76

Decreased blood return to the right side of the heart

Question 77

A 14-year-old patient with marked scoliosis is in prone position with gel bolster rolls, gel pads, and pillows for a spinal fusion. Before the skin prep is begun, the perioperative nurse should check the positioning for pressure areas on the:

Answer 77

genitals, breasts, toes, eyes, and all areas in contact with the OR bed or accessories.

Question 78

Why is the table straightened before closing a kidney incision?

Answer 78

to create better approximation of tissues

Question 79

The use of a footboard for the patient in the reverse Trendelenburg position may prevent the patient from sliding downward, which can cause ______________.

Answer 79

Shearing injury

Question 80

Select the positioning device and accessory commonly used for neurosurgical procedures.

Answer 80

Mayfield Head Positioner

Question 81

While basic positioning prevention strategies apply to all robotic-assisted procedures, in steep Trendelenburg with severe head-down position, strategies to prevent the patient from slipping toward the head of the OR bed must be considered. These strategies include:

Answer 81

use of beanbag positioning systems.

Question 82

In the lateral chest position, a sandbag or padding is placed under the chest at the axillary level to:

Answer 82

Prevent pressure on lower arm

Question 83

During lateral positioning a:

Answer 83

pillow is placed between the legs

Question 84

Recent studies on the relevance of the Braden pressure ulcer risk scale in the perioperative and critical care setting are inconclusive. In which perioperative setting would the Braden scale be most predictive as a baseline metric?

Answer 84

preoperative

Question 85

A safety strap should be placed __________________ between the patient and the strap.

Answer 85

on top of a blanket or sheet with three finger’s space

Question 86

Putting a patient into Trendelenberg position has effect of:

Answer 86

Increasing blood flow to the brain

Question 87

While Fowler’s position offers the best respiratory excursion for the patient, the patient is at higher risk for ____________________ because of dependent pooling in the hips and legs.

Answer 87

venous thromboembolism (VTE)

Question 88

The ________ position, or foot-down position, is used when the surgeon requires unobstructed access to the upper abdominal cavity and lower esophagus.

Answer 88

reverse trendelenburg

Question 89

The challenge of suturing intra-abdominally is not as great as the process needed to tie and tighten the surgical knot. The knot-tying process can be achieved within or outside of the abdominal compartment. The intracorporeal suture technique uses the suture-tying process analogous to the:
1. stapled ligature.
2. instrument tie.
3. one-handed tie.
4. two-handed tie.

Answer 89

instrument tie

Question 90

Direct coupling during the use of monopolar electrosurgery is caused by __________ and is usually within the control of the ______.
1. metal-to-metal sparking; the surgeon
2. active burns; the surgeon
3. metal to tissue; the scrub person
4. metal-to-metal sparking; the scrub person

Answer 90

metal-to-metal sparking; the surgeon

Question 91

A 72-year-old man with a single early-stage liver tumor has an implanted automatic internal defibrillator that the anesthesia provider has decided not to disarm for the procedure. What energy-generated dissection device should the doctor use to replace the argon beam coagulator?
1. An ultrasonic dissector
2. A monopolar suction-irrigator
3. A monopolar hydrodissector
4. A CO2 laser with articulating arm and handpiece

Answer 91

An ultrasonic dissector

Question 92

Which of the following statements about laparoscopic surgery is true?

1. The abdomen is always prepared and draped for potential laparotomy
2. Due to the minimally invasive nature of laparoscopy, preoperative evaluation of patients is less critical than for laparotomy
3. Routine use of orogastric tubes and urinary catheters is unnecessary during advanced laparoscopic procedures
4. Spinal anesthesia is sufficient for most advanced laparoscopic procedures

Answer 92

The abdomen is always prepared and draped for potential laparotomy

Question 93

Which of the following lasers is used to vaporize a portion of the residual lens capsule after cataract surgery?

1. Nd:YAG
2. Argon
3. Excimer
4. CO2

Answer 93

Nd:YAG

Question 94

Which of the following degrees of endoscope is MOST commonly used during a laparoscopic cholecystectomy?

1. 30
2. 45
3. 70
4. 120

Answer 94

30

Question 95

A 9-year-old female softball player has arrived in the OR for emergency repair of superficial facial and deep arm lacerations when she ran into the chain link fence during practice after school. The perioperative nurse discovers that the patient has diabetes and has an insulin pump that should remain connected during the short procedure. The best option for energy-generated hemostasis is:
1. battery-generated eye electrosonic cautery.
2. hemoelectrocoagulated plasma capacitor.
3. monopolar electrosurgery.
4. Bipolar electrosurgery.

Answer 95

bipolar electrosurgery.

Question 96

The light transmission through a fiberoptic endoscope is achieved by way of:
1. a chain of small connected micro light bulbs.
2. bundles of glass rods.
3. electrified silicon cables.
4. a charge-coupled device chip in the tip of the scope.

Answer 96

bundles of glass rods.

Question 97

During surgery, the intra-abdominal pressure monitor sounds. The SFA should first:
1. Discontinue insufflation
2. Reduce the flow rate
3. Close the trocar valve
4. Check for kinks in the insufflation tubing

Answer 97

Check for kinks in the insufflation tubing

Question 98

The OR was trialing 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 17 mm Hg. She alerted the surgeon and reduced the rate and pressure because she feared that the elderly patient was at high risk for:
1. hypocarbia.
2. hypercarbia.
3. gastroesophageal reflux.
4. postoperative nerve damage and shoulder pain.

Answer 98

hypercarbia

Question 99

Which of the following types of laser is used in retinal surgery?

1. Nd:YAG
2. Excimer
3. Argon
4. CO2

Answer 99

Argon

Question 100

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 ___________.
1. 10 L/min; 10 to 12 mm Hg
2. 9 L/min; 14 to 16 mm Hg
3. less than 9 L/min; 10 to 12 mm Hg
4. 14 to 16 L/min; 9 mm Hg

Answer 100

9 L/min; 14 to 16 mm Hg

Question 101

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:
1. deep vein thrombosis (DVT).
2. hypoxia.
3. CO2 gas embolism.
4. hemostasis.

Answer 101

CO2 gas embolism.

Question 102

Which of the following are safety factors to consider when using electrosurgery units (ESU)?

1. All active electrodes should be stored in a an insulated holster
2. All jewelry should be removed to prevent risk of potential burns to the patient
3. Any malfunctioning ESU should be serviced before and after each case
4. Dispersive electrodes should not be located in proximity to internal implants

Answer 102

1, 2, and 4

Question 103

In which endoscopic knot-tying technique is the knot tied outside the abdomen and slid down the trocar to be secured with a knot pusher?
1. Extracorporeal
2. Pretied endoligature
3. Ski needle technique
4. Suture-introducing technique

Answer 103

Extracorporeal

Question 104

Which of the following are the most common lasers used in gynecological surgery?

1. Ruby and CO2
2. Nd:YAG and Argon
3. Argon and ruby
4. CO2 and Nd:YAG

Answer 104

CO2 and Nd:YAG

Question 105

When should the SFA check overall integrity of laparoscopic instruments to ensure insulation failure does not occur?
1. Before usage
2. Weekly
3. Monthly
4. After usage

Answer 105

Before usage

Question 106

Endoscopic instruments are designed to perform the intervention at the target tissue site through the tubular endoscope. The endoscopic instrument is considered:
1. much less accurate than a surgeon’s hand.
2. an extension of the surgeon’s hand.
3. a means to perform hands-free surgery.
4. an extended instrument with a working head.

Answer 106

an extension of the surgeon’s hand.

Question 107

The acronym LASER stands for:
1. Lower amplification by stimulated emission of radiation
2. Light acceleration by stimulated emission of radiation
3. Light amplification by stimulated emission of radiation
4. Lower altitude by stimulated emission of radiation

Answer 107

Light amplification by stimulated emission of radiation

Question 108

Disadvantages of laparoscopy when compared with laparotomy include all of the following except which?
1. Difficulty controlling severe bleeding
2. Poorer visualization of the operative field
3. Greater difficulty placing sutures
4. Loss of tactile sensation

Answer 108

Poorer visualization of the operative field

Question 109

The surgeon prefers the argon beam coagulator for dissection in his liver procedures, because the liver bleeds easily, and traditional monopolar electrosurgery often causes more bleeding than it stops. What is the application characteristic of the argon beam coagulator that enhances liver tissue hemostasis?
1. Use of argon gas markedly reduces the risk of overpressurization.
2. Argon gas provides noncontact tissue coagulation with reduced risk of rebleeding.
3. Argon gas results in decreased chance of combustion, formation of surgical smoke, and burned tissue.
4. Argon gas is heavier than air, inert, and noncombustible and does not tear tissue.

Answer 109

Argon gas provides noncontact tissue coagulation with reduced risk of rebleeding.

Question 110

Which of the following is needed to complete the circuit on an ESU when using a monopolar electrode tip?

1. Bipolar forceps
2. Insulated electrode
3. Active electrode
4. Dispersive pad

Answer 110

Dispersive pad

Question 111

The viewing system for robotic surgery includes which components?
1. Touch screen, endoscope, and robotic arm
2. Endoscope, camera, and surgeon hand controls
3. Touch screen, endoscope, and camera
4. Endoscope, camera, and graspers

Answer 111

Touch screen, endoscope, and camera

Question 112

The instrument tips in laparoscopic instruments are designed to produce the same tissue effects as a traditional instrument used for open surgery. Because of the process challenges of the laparoscopic approach, it is time-consuming to insert and withdraw instruments repeatedly during the procedure. Instrument manufacturers have attempted to make their products efficient by combining functions. An appropriate combined function for a laparoscopic instrument would be:
1. electrosurgery conduction through the tips of a Babcock grasper.
2. suction and irrigation combined with an argon beam coagulation handpiece.
3. scissors that cut, blunt dissect, and coagulate tissue.
4. ultrasound capability in suturing forceps.

Answer 112

scissors that cut, blunt dissect, and coagulate tissue.

Question 113

An endoscope is a diagnostic or therapeutic instrument that enters the body through:
1. a natural orifice.
2. an internalized sinus tract.
3. a straight catheter via a paraumbilical incision.
4. a large incision into a body compartment.

Answer 113

a natural orifice.

Question 114

A neonate has burns over 45% of his body from a scalding incident. He was prepared for surgical fasciotomy for ensuing compartment syndrome of his legs and trunk. In planning for the use of electrosurgery, the perioperative nurse’s assessment revealed a limited surface area for the dispersive electrode, and the appropriate choice was made to use the:
1. adhesive pad wrapped circumferentially around the arm.
2. battery-operated eye cautery and silver nitrate sticks.
3. large capacitive coupling pad under the neonate.
4. dispersive pad cut in half to the upper unburned back.

Answer 114

large capacitive coupling pad under the neonate.

Question 115

Which of the following lasers does not require an aiming beam?
1. CO2
2. Holmium
3. Argon
4. Nd:YAG

Answer 115

Argon

Question 116

Lasers, dependent on their wavelength, can produce absorption, reflection, transmission, and scatter. The effect of laser wavelength scatter does not have any therapeutic benefit at this time and can be destructive to both staff and instruments. Select a safety measure that would prevent inadvertent scatter or heating of the endoscope channel from laser energy during a surgical procedure.
1. Cover the laser fiber with medical-grade tubing along its entire length.
2. Ebonize the surface of laser mirrors that are used in laparoscopic cholecystectomies.
3. Surround the surface drapes and endoscope trocar with moist sterile towels and cover the glass windows.
4. Advance the laser fiber at least 1 cm beyond the tip of the endoscope within operator’s view.

Answer 116

Advance the laser fiber at least 1 cm beyond the tip of the endoscope within operator’s view.

Question 117

To prevent inadvertent thermal injury during laparoscopic electrosurgical coagulation, the SFA should use:
1. A blend-cut waveform, set on high power
2. A coagulation waveform, set on low power, low voltage
3. A cutting waveform, set on high power, high voltage, in short bursts
4. A cutting waveform set on low power, low voltage

Answer 117

A cutting waveform set on low power, low voltage

Question 118

Which technique of peritoneal entry poses the least risk of injury to intra-abdominal contents?
1. Direct trocar entry
2. Veress needle insertion
3. Open Hasson technique
4. Optical trocar

Answer 118

Open Hasson Technique

Question 119

Which of the following conditions is MOST common when insulation failure occurs in laparoscopic surgery?
1. Hypothermia
2. Wound infection
3. Tissue injury
4. Adhesions

Answer 119

Tissue Injury

Question 120

The new general surgery fellow placed the three trocar ports for the laparoscopic appendectomy. She was focused on the concept of exact geometric triangulation of the three port accesses, to avoid the concept of sword fighting after inserting her instruments. She knew she had to proceed with caution and determination since this hospital was not able to provide the protected blade trocars she was used to using at the university medical center. The procedure was completed without incident; however, on postoperative day 1, the patient demonstrated signs and symptoms of sepsis. What might have been the unusual occurrence that could have resulted in patient sepsis?
1. Significant break in sterile technique
2. Recent H1N1 outbreak on the surgery unit at the hospital
3. Unrecognized appendiceal rupture
4. Inadvertent trocar puncture through the bowel on insertion

Answer 120

Inadvertent trocar puncture through the bowel on insertion

Question 121

The CO2 laser beam is absorbed by:
1. Bone
2. Hemoglobin
3. Water
4. Oxygen

Answer 121

Water

Question 122

One of the main uses for an excimer laser is:
1. GYN surgery
2. Orthopedic surgery
3. LASIK surgery
4. Neurosurgery

Answer 122

LASIK surgery

Question 122

A neutral plasma coagulator is an energy source that produces pure plasma to provide coagulation. Why is patient risk reduced with this directed energy source?
1. The coagulation results in minimal tissue eschar.
2. The plasma is formed from activated carbon dioxide, an inert gas.
3. No electrical current passes through the patient.
4. The plasma approximates tissue with a low heat welding process.

Answer 122

No electrical current passes through the patient.

Question 123

The primary purpose of a robotic device designed to hold and maneuver a laparoscope is to:
1. Eliminate tremor associated with operating endoscope
2. Replace the surgeon
3. Decrease set-up time for an endoscope
4. Reduce the incidence of fogging

Answer 123

Eliminate tremor associated with operating endoscope

Question 124

Delirium is described as an extreme disturbance of arousal, attention, orientation, perception, affect, and intellectual function accompanied by fear and agitation. What is the most common cause of postoperative agitation?
1. Hypoxemia
2. Preoperative anxiety
3. Organic brain disease
4. Excessive blood loss

Answer 124

Hypoxemia

Question 125

Your patient who is scheduled for outpatient hernia repair took furosemide (Lasix) the morning of surgery. The patient might be at rick for:
1. Hypertension
2. Fluid volume deficit
3. Hypotension
4. MH

Answer 125

Fluid volume deficit

Question 126

A 12-year-old developmentally delayed male scheduled for dental rehabilitation became agitated on admission to the preoperative holding unit. In spite of sedation and the calming attention of the nurses and his parents, he was screaming and rapidly turning his head from side-to-side. He vomited and choked twice before he fell into a light but restless sleep. During the short procedure, the anesthesia provider was aware of rigidity and difficulty with ventilation in the patient’s chest, yet his oxygen saturation was between 96% and 100% throughout the procedure. On extubation, he presented with coughing, wheezing, dyspnea, use of accessory muscles, and tachypnea. The patient is presenting with ____________ probably caused by ____________.
1. bronchospasm; aspiration
2. laryngospasm; traumatic intubation
3. hypoxia; laryngospasm
4. aspiration; vomiting

Answer 126

bronchospasm; aspiration

Question 127

The surgical procedure where the spinal nerve roots are cut or burned to relieve intractable pain is called:
1. Kypoplasty
2. Cordotomy
3. Rhizotomy
4. Anterior cervical fusion

Answer 127

Rhizotomy

Question 128

An opioid-naïve patient, one who has not used short-acting opioids in the last 60 days, resedated on admission to the PACU and received which opioid antagonist to reverse the respiratory depression?
1. Romazicon
2. Pavulon
3. Naloxone
4. Ropivicaine

Answer 128

Naloxone

Question 129

Your patient is undergoing a T&A, which of the following lab tests would you expect the surgeon to assess in the patient?

1. Prothrombin time
2. Serum bilirubin
3. BUN
4. Erythrocyte sedimentation rate

Answer 129

Prothrombin time

Question 130

Select the patient who is the most vulnerable and at high risk for hypothermia in the perianesthesia phase based on diagnosis or surgical procedure.

1. A 62-year-old patient who recently lost 80 lb after a gastric sleeve and is scheduled for a cataract extraction.
2. A 3-year-old child with otitis media having bilateral myringotomy with tube placement.
3. A 3-week-old neonate undergoing surgery for a cardiac anomaly.
4. A 26-year-old patient undergoing escharotomy (fasciectomy) of an ankle with second- and third-degree burns.

Answer 130

A 3-week-old neonate undergoing surgery for a cardiac anomaly.

Question 131

Patient is undergoing a repair of a tibial plateau fracture. Which of the following items on the patient’s history most likely to impede healing?

1. BMI 28kg/m
2. Drinking 1 beer a day
3. Peripheral arterial disease
4. Family history of diabetes

Answer 131

Peripheral arterial disease

Question 132

Perfusion or oxygen saturation of the blood is measured by ______________.
1. ADLs
2. arterial blood gases
3. pulse oximeter
4. Glasgow Coma Scale

Answer 132

pulse oximeter

Question 133

Evidence indicates that early analgesia reduces postoperative problems. Recent studies endorse the multimodal approach to both preemptive (preventative) and postoperative analgesia customized to patient needs based on meticulous preoperative assessment. A 72-year-old physically active woman was seen in the preoperative admission center in preparation for her total knee replacement surgery on Thursday. She has not had any opioid medications in her lifetime that she can remember. She has inflammatory bowel and gastric disease and was told she cannot take ibuprofen in any form. Select a multimodal analgesic treatment plan that would best serve the patient’s perianesthesia experience.
1. Intraoperative: Preincision—regional block, IV opioids during the procedure. Postoperative: PCA with opioids and nonsteroidal anti-inflammatory drugs (NSAIDs)
2. Intraoperative: Spinal anesthesia with femoral nerve block. Postoperative: Systemic analgesia with COX-2–selective inhibitors, IV PCA with strong opioids
3. Intraoperative: Spinal anesthesia with femoral nerve block. Postoperative: Systemic analgesia with COX-2–selective inhibitors, IV PCA with strong opioids (titrated to effect), and IM meperidine
4. Intraoperative: Preincision—IV opioids, local lidocaine injection into the incision site before skin closure. Postoperative: Patient-controlled analgesia (PCA) with opioids and nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer 133

Intraoperative: Spinal anesthesia with femoral nerve block. Postoperative: Systemic analgesia with COX-2–selective inhibitors, IV PCA with strong opioids

Question 134

Unfortunately, patients who are managed with opioids as part of their analgesic program can have adverse events related to the medication. What are two of the most serious opioid-related adverse events?
1. Pruritis followed by anaphylaxis
2. Unintended advancing sedation and respiratory depression
3. Urticaria followed by anaphylaxis
4. Respiratory depression and alveolar collapse

Answer 134

Unintended advancing sedation and respiratory depression

Question 135

What type of pain is felt at a distant site from a disease process?
1. Referred
2. Chronic
3. Rebound
4. Motion

Answer 135

Referred

Question 136

Malignant __________ (MH) is a rare condition that results in an extremely high core body temperature, cardiac dysrhythmia, tachypnea (increased respiratory rate), hypoxia, and hypercarbia

Answer 136

hyperthermia

Question 137

Select the statement below that best reflects the effects of hypothermia in the perianesthesia period.

1. Hypothermia shortens the period of elimination of muscle relaxants.
2. Hypothermia has often been shown to cause life-threatening morbidities.
3. Hypothermia increases platelet activity and decreases fibrinolysis.
4. Shivering can increase the need for oxygen by 300% to 400%.

Answer 137

Shivering can increase the need for oxygen by 300% to 400%.

Question 138

Pulmonary ____________ is blockage of a pulmonary vessel by air, a blood clot, or other substance (e.g., fragments of atherosclerotic plaque).
1. clotting
2. dehydration
3. irritation
4. embolism

Answer 138

embolism

Question 139

A large percentage of adults experience lower back pain at some point in their lives. It can be associated with job-related disability and missed workdays. The majority of lower back pain can be mechanical. An example of a mechanical cause of lower back pain is:
1. Hairline fracture
2. Sciatica
3. Ruptured ligament
4. Dislocated bone

Answer 139

Sciatica

Question 140

A 33-year-old female, who had a dilation and curettage (D&C) with laparoscopic tubal ligation and has been in phase II recovery for 3 hours, collapsed while sitting on the toilet. The perianesthesia nurse had recently finished giving the patient her discharge instructions and helped her dress. The patient was assessed for loss of consciousness and airway patency. What action should the phase II nurse take next?
1. Transfer the patient back to phase I PACU and begin airway interventions.
2. Determine if the patient has resedated and is a candidate for a dose of naloxone.
3. Initiate a cardiac arrest call and get the code cart; prepare to intubate.
4. Begin airway interventions; revert to phase I criteria.

Answer 140

Begin airway interventions; revert to phase I criteria.

Question 141

Select the most reliable indicator of pain.

1. The patient’s self-report of pain
2. A proxy pain rating by someone who knows the patient well
3. Facial grimacing and crying
4. Physiologic indicators, such as elevated vital signs

Answer 141

The patient’s self-report of pain

Question 142

A variety of approaches and modalities can be used to treat the physical and emotional aspects of pain. Which of the following is not an alternative method of pain management?

1. Meditation
2. Biofeedback
3. Transcutaneous electrical nerve stimulation
4. Electroconvulsive shock

Answer 142

Electroconvulsive shock

Question 143

A healthy 18-year-old was admitted to the PACU spontaneously breathing through his endotracheal tube. Shortly after the perianesthesia nurse extubated the patient, he stopped breathing and his color changed to pale, dusky-beige. What is the most ideal action that should occur immediately?
1. Administer oxygen 5 L/min by nasal cannula.
2. Administer oxygen 5 L/min by bag-valve-mask.
3. Reintubate and manually ventilate with bag-valve-mask at 4 L/min oxygen.
4. Perform head tilt–chin lift with gentle stimulation.

Answer 143

Perform head tilt–chin lift with gentle stimulation.

Question 144

Hypotension is a blood pressure reading that is 20% less than the patient’s normal baseline pressure. Hypovolemia is the most common cause of hypotension; however, hypotension may also be caused by cardiac dysfunctions. Which triad of cardiac conditions will present with hypotension?
1. Cardiac ischemia, subaortic stenosis, and pericarditis
2. Congestive heart failure, valvular dysfunction, and tachypnea
3. Myocardial infarction, myocardial tamponade, and pulmonary embolism
4. Certain anesthetic agents and cardiac stimulants, conduction defects, and endocarditis

Answer 144

Myocardial infarction, myocardial tamponade, and pulmonary embolism

Question 145

______________ is necessary to determine the need for further action, such as transfusion.
1. Surgical procedure performed
2. Type of anesthesia administered
3. Patient age
4. Estimated blood loss

Answer 145

Estimated blood loss

Question 146

What conditions can mask abdominal pain?

Steroids
Diabetes
Paraplegia
All of the above

Answer 146

Steroids

Question 147

Postoperative nausea and vomiting (PONV) is a problem that affects approximately 30% of PACU patients. Patients with four or more risk factors have a higher incidence of PONV. Select the option that best reflects relevant risk factors for PONV.
1. Predisposition to malignant hyperthermia, night sweats, motion sickness, male gender
2. Latex sensitivity, male gender, use of halogenated gas induction
3. Reaction to nitrous oxide, atopy, postmenopausal, use of volatile anesthetics
4. Nonsmoker, female gender, postoperative opioids, use of nitrous oxide

Answer 147

Nonsmoker, female gender, postoperative opioids, use of nitrous oxide

Question 148

Although _______ is expected in the postsurgical phase, not all patients respond to pain in the same way.
1. mental status
2. level of consciousness
3. neurological function
4. pain

Answer 148

pain