Anesthesia, Aseptic Technique, Documentation & Electrosurgery

Question 1

A precise way of looking at general anesthesia is to divide it into which 3 phases?

Answer 1

Phase I: Induction
Phase II: Maintenance
Phase III: Emergence

Question 2

Which drug is used to reverse valium and midazolam?

Answer 2

Flumazenil

Question 3

Which professionals are not qualified to administer general anesthesia to the patient?

Answer 3

Operating Room Surgeons

Question 4

Which method is used to prevent aspiration during endotracheal intubation?

Answer 4

Applying cricoid pressure

Question 5

When do spinal headaches usually occur?

Answer 5

Postoperatively

Question 6

Which type of anesthesia involves an injection into the space between the ligamentum flavum and the dura?

Answer 6

Epidural anesthesia

Question 7

During intravenous regional anesthesia (Bier Block), the tourniquet should be deflated slowly to prevent __________ from entering the circulation.

Answer 7

A bolus of local anesthetic

Question 8

What is the most consistent indicator of malignant hyperthermia?

Answer 8

An increase in end-tidal CO2

Question 9

Which of the following is the drug of choice for the treatment of malignant hyperthermia?

Answer 9

Dantrolene

Question 10

Which is not a protocol for treatment during an MH crisis?

1) Stop all triggering agents
2) Continue with safe agents
3) Hyperventilate with 100% oxygen
4) Administer serum potassium

Answer 10

4) Administer serum potassium

Question 11

Which is not a local anesthetic drug used for regional anesthesia?

1) Bupivacaine
2) Lidocaine
3) Fentanyl
4) Tetracaine

Answer 11

3) Fentanyl

Question 12

What levels does the Physical Status Classification developed by the ASA contain?

Answer 12

P1 to P6

Question 13

Plastic incise drapes _____________.

A. may increase moisture and bacterial growth under the drape.
B. are recommended for use only for certain procedures.
C. are NOT recommended for use.
D. all of the above.
E. A and C only

Answer 13

E. A and C only

Question 14

Check the statements below that correctly pertain to a sterile field:

a. Sterile fields should be prepared where they are used, but can be moved if appropriately draped.
b. The sterile field should be prepared for only one patient at a time.
c. Only sterile items should come in contact with the sterile field.
d. Two patients may occupy the OR or procedure room at the same time as long as all OR personnel are wearing appropriate attire.

1) a, c
2) b, c
3) b, d
4) c, d

Answer 14

2) b, c

Question 15

Perioperative personnel should use hand hygiene, don clean scrub attire and head coverings when:

a. Entering the OR or an invasive procedure room for any reason
b. When assisting with surgery
c. When stocking rooms in the restricted zone
d. When opening sterile supplies

1) a, c
2) a, b, c
3) a, c, d
4) a, b, c, d

Answer 15

1) a, c

Question 16

Recommendations for draping include:

1) handling sterile drapes as little as possible.
2) cuffing the drape material over the gloved hands.
3) holding the drapes in a controlled manner.
4) all of the above.

Answer 16

4) all of the above.

Question 17

What areas of the sterile gown are considered sterile?

a. The back of the gown from the nape of the neck to the level of the elbows.
b. Gown sleeves from two inches above the elbow to the cuff, circumferentially.
c. The front of the gown from the chest to the level of the sterile field.
d. The part of the sleeve cuff that is covered by the sterile glove.

1) a, d
2) b, c
3) a, c, d
4) b, c, d

Answer 17

2) b, c

Question 18

Select the statements below that are correct:

a. During open assisted gloving, the team member’s gown sleeve is pulled down so that the gown cuff is at fingertip level.
b. Closed assisted gloving should be used to glove team members during initial gowning and gloving.
c. During closed assisted gloving, the gown cuff of the team member being gloved remains at the wrist level.
d. Scrubbed team members should wear two pairs of surgical gloves.

1) b, d
2) b, c, d
3) a, b, c
4) a, b, c, d

Answer 18

1) b, d

Question 19

Define the following Terms:

1) Surgical Conscience
2) Sterile
3) Sterile Technique
4) Aseptic
5) Aseptic Practices

Answer 19

1) Surgical Conscience - Allows for no compromise in the principles of sterile technique.
2) Sterile - The absence of all living organisms
3) Sterile Technique - The use of specific actions and activities to prevent contamination and maintain sterility.
4) Aseptic - The absence of all pathogenic microorganisms.
5) Aseptic Practices - Patterns of behavior and processes that are implemented to prevent microbial contamination.

Question 20

Accurate preoperative documentation of the patient admission includes:

1) Patient identification
2) Preoperative orders
3) Discharge referral
4) Patient assessment

Answer 20

1) Patient identification
2) Preoperative orders
4) Patient assessment

Question 21

A fluid imbalance may occur rapidly due to fluid loss as a result of:

1) fluid restrictions
2) fluids given during surgery
3) wound drainage
4) N/G tubes
5) inadequate fluid replacement

Answer 21

1) fluid restrictions
3) wound drainage
4) N/G tubes
5) inadequate fluid replacement

Question 22

A successful lawsuit:

1) does not require patient injury
2) only requires a nurse-patient relationship
3) must show duty, breach, causation, and damages
4) considers whether the patient has filed previous lawsuits

Answer 22

3) must show duty, breach, causation, and damages

Question 23

Abbreviations:

1) Are easily interpreted when writing orders
2) Can easily put patient at risk for medication errors
3) Are not part of The Joint Commission and AORN safety goals
4) Have only three possible words that could present problems in the clinical setting

Answer 23

2) Can easily put patient at risk for medication errors

Question 24

The care you provide the patient is demonstrated by your documentation; the primary purpose of documentation is to ______________.

Answer 24

Record the chronological order of events during the nursing care of a patient.

Question 25

The standard of care:

1) Is not determined by hospital policy or AORN standards
2) Requires your care to be perfect
3) Requires you to document and act as a reasonably qualified nurse would in a similar situation
4) Never changes

Answer 25

3) Requires you to document and act as a reasonably qualified nurse would in a similar situation

Question 26

When documenting:

1) Use a medical diagnosis
2) Use nursing diagnoses based on sound judgment
3) Do not use patient statements
4) Use patient statements written as a fact

Answer 26

2) Use nursing diagnoses based on sound judgment

Question 27

Charting by exception is a time saver and _____________________.

1) is easy even if you don’t understand what is expected of a nurse
2) does not require assessment skills
3) is based on the premise that the patient manifests normal response to most interventions
4) does not require documentation during the shift or notes on changes in patient’s progress

Answer 27

3) is based on the premise that the patient manifests normal response to most interventions

Question 28

Informed consent:

1) is not covered in hospital policy
2) is a physician’s duty and RN’s are witnesses to patient’s signature
3) does not expose you to liability if you don’t follow hospital policy
4) does not have approved substitutes to give consent for patient

Answer 28

2) is a physician’s duty and RN’s are witnesses to patient’s signature

Question 29

An individualized patient care plan that was initiated during the preoperative phase includes:

1) cultural or religious preferences
2) emotional consideration
3) financial considerations
4) psychosocial considerations

Answer 29

1) cultural or religious preferences
2) emotional consideration
4) psychosocial considerations

Question 30

After the preoperative assessment has been conducted on a patient, the perioperative nurse should document:

1) cuts and abrasions
2) preoperative hair removal, if ordered
3) skin condition
4) financial arrangements
5) patient’s verbal consents for pre-op orders

Answer 30

1) cuts and abrasions
2) preoperative hair removal, if ordered
3) skin condition
5) patient’s verbal consents for pre-op orders

Question 31

The primary reason for documenting sharp, sponge, and instrument counts is:

1) To prevent injury to the patient from a retained foreign object
2) To maintain an inventory for the operating room
3) To provide an accurate item charge for the patient
4) To make sure there are appropriate numbers of instruments for the next procedure

Answer 31

1) To prevent injury to the patient from a retained foreign object

Question 32

By using a high radio frequency electrical current, surgeons routinely use electrosurgery to _________ the tissue.

Answer 32

Cut and Coagulate

Question 33

The parts of the electrosurgical circuit are?

Answer 33

The generator, the active electrode, and dispersive electrode

Question 34

To reduce the possibility of an injury or burn, the perioperative nurse should place the dispersive electrode __________________.

Answer 34

As close to the operative site as feasible.

Question 35

The ____________ current leaves the generator, is applied to tissue using a two-poled instrument, and returns to the generator.

Answer 35

Bipolar

Question 36

If the surgeon continuously asks for higher power settings, what is the first action that the perioperative nurse should take?

Answer 36

Check the circuitry for possible disruption

Question 37

When using the ESU generator, the perioperative nurse should remember to:

1) Never use the ESU in presence of alcohol-based antimicrobial prep agents until the agents are dry and vapors have dissipated.
2) Never allow fluids to be poured on the generator.
3) Encase the footswitch in a insulated safety holster.

Answer 37

1) Never use the ESU in presence of alcohol-based antimicrobial prep agents until the agents are dry and vapors have dissipated.
2) Never allow fluids to be poured on the generator.

Question 38

Alternate pathway burns can occur because of improper placement of the dispersive electrode. The dispersive electrode should not be applied on:

1) Hairy skin surfaces
2) Burn tissue
3) Tattoo sites
4) Well-perfused muscle

Answer 38

1) Hairy skin surfaces
2) Burn tissue
3) Tattoo sites

Question 39

During minimally invasive surgery, how can a perioperative nurse reduce the chances of capacitive coupling injuries?

Answer 39

By using the lowest power setting and the low-voltage cutting waveform.

Question 40

When using argon-enhanced coagulation (AEC), there is a risk of ___________.

Answer 40

Gas emboli

Question 41

Which precautions should be taken for a patient who has an implantable cardioverter/defibrillator (IED)?

1) A defibrillator should be readily available.
2) Insist that the surgeon use bipolar current instead of monopolar current
3) There should be continuous EKG monitoring.
4) The IED is deactivated before the ESU is used.

Answer 41

1) A defibrillator should be readily available.
3) There should be continuous EKG monitoring.
4) The IED is deactivated before the ESU is used.

Question 42

The capture device (eg, wand, nonflammable suction tip) of the smoke evacuation system should be positioned as close as possible, and no greater than ______from the source of the smoke.

Answer 42

2.0 inches

Question 43

Personnel should wear the following type of respiratory protection during procedures that generate surgical smoke as secondary protection against residual plume that has escaped capture by LEV:

a. fit-tested surgical N95 filtering face piece respirator
b. ULPA filter
c. high-filtration surgical mask
d. HEPA filter

1. a, b
2. a, c
3. b, c
4. b, d

Answer 43

2. a, c

Question 44

Accepted measures to reduce the dangers of smoke inhalation include:

1) Using a wall suction with in-line filter
2) Using a smoke evacuator
3) Opening the doors of OR
4) Using high filtration surgical masks
5) HEPA filter

Answer 44

1) Using a wall suction with in-line filter
2) Using a smoke evacuator
4) Using high filtration surgical masks

Question 45

Based on your knowledge gained about ESUs and their usage, identify the statements that are true about an ESU.

A. Electrosurgery is used to cut tissue.
B. ESUs use a high radio frequency electrical current.
C. The active electrode is also referred to as “grounding pad”.
D. Bipolar current is most frequently used for electrosurgery.
E. The ESU must be inspected before use to ensure electrical integrity of the generator.
F. The dispersive electrode is also referred to as the “grounding pad.”

Answer 45

statements that are true about an ESU.

A. Electrosurgery is used to cut tissue.
B. ESUs use a high radio frequency electrical current
E. The ESU must be inspected before use to ensure electrical integrity of the generator.
F. The dispersive electrode is also referred to as the “grounding pad.”

Question 46

Based on your knowledge gained about the safety checks for ESUs, identify the correct safety check.

1) When removing the plug from the outlet, pull the cord.
2) The generator should be turned off after use.
3) The ESU can be used in the presence of defatting agents.
4) The generator and the foot switch should be protected from fluid spills.
5) Power settings should be confirmed verbally between the perioperative nurse and the surgeon both before and during the procedure.
6) When using multiple ESUs, the dispersive electrodes should not touch each other.

Answer 46

2) The generator should be turned off after use.
4) The generator and the foot switch should be protected from fluid spills.
5) Power settings should be confirmed verbally between the perioperative nurse and the surgeon both before and during the procedure.
6) When using multiple ESUs, the dispersive electrodes should not touch each other.

Question 47

Based on your knowledge gained about the active electrode, identify the correct statements.

A. The active electrode should be connected into a stress-resistant receptacle of the ESU.
B. The tip of the active electrode should never be cleaned during a procedure.
C. When not in use, the electrode should be stored in a safety holster.
D. Using an electrolyte solution may render the electrode less effective.
E. Administer the lowest practical level of oxygen to the patient.

Answer 47

A. The active electrode should be connected into a stress-resistant receptacle of the ESU.
C. When not in use, the electrode should be stored in a safety holster.
D. Using an electrolyte solution may render the electrode less effective.
E. Administer the lowest practical level of oxygen to the patient.

Question 48

Based on the understanding you have gained about dispersive electrodes, identify the statements true about dispersive electrodes.

A. Should not be used on bony prominence’s.
B. Alternate pathway burns can occur because of improper placement.
C. After repositioning, should be rechecked for skin adherence.
D. May be inappropriate for patients weighing less than 25 pounds.
E. Condition of the skin should be documented after removing the electrode.
F. Can be reused.

Answer 48

A. Should not be used on bony prominence’s.
B. Alternate pathway burns can occur because of improper placement.
C. After repositioning, should be rechecked for skin adherence.
E. Condition of the skin should be documented after removing the electrode.

Question 49

Based on your understanding gained about various types of ESUs, identify the correct statements.

A. In bipolar electrosurgery, both the active electrode and return electrode functions are performed at the site of surgery.
B. AEC is a monopolar form of electrosurgery.
C. When using AEC, the venous pressure exceeds argon gas pressure in the circulating system, creating a risk of emboli.
D. Bipolar electrosurgery should not be used for surgery on brain or nerve tissue.
E. Laparoscopic electrosurgery has the potential of capacitive coupling injuries.
F. AEC provides a secondary source of gas that can result in a rapid rise in the patient’s intra-abdominal pressure.

Answer 49

A. In bipolar electrosurgery, both the active electrode and return electrode functions are performed at the site of surgery.
B. AEC is a monopolar form of electrosurgery.
E. Laparoscopic electrosurgery has the potential of capacitive coupling injuries.
F. AEC provides a secondary source of gas that can result in a rapid rise in the patient’s intra-abdominal pressure.

Question 50

Based on your understanding gained about precautions when using an ESU, identify which of the following the perioperative nurse should bear in mind when using an ESU on a patient with a pacemaker.

1) The distance between the active electrode and the dispersive electrode should be as short as possible.
2) Both electrodes should be as far from the pacemaker as possible.
3) The dispersive electrode should be placed in such a position that the current from the active electrode does not pass through the vicinity of the patient’s heart or through the pacemaker.
4) The nurse need not consult the patient’s cardiologist.
5) All ESU cables and cords should be kept away from the pacemaker and its leads.
6) Monopolar current is preferred.

Answer 50

1) The distance between the active electrode and the dispersive electrode should be as short as possible.
2) Both electrodes should be as far from the pacemaker as possible.
3) The dispersive electrode should be placed in such a position that the current from the active electrode does not pass through the vicinity of the patient’s heart or through the pacemaker.
5) All ESU cables and cords should be kept away from the pacemaker and its leads.

Question 51

What is the primary means of protection for health care personnel in regards to occupational exposure to airborne contaminants generated by electrosurgery?

Answer 51

LEV aka Local Exhaust Ventilation

Question 52

Individual smoke evacuation units with a 0.1 micron filter include:

1. LEV
2. ULPA
3. HEPA
4. N95

a. 1,2
b. 2,3
c. 1,2,3
d. 1,2,4

Answer 52

b. 2,3

Question 53

What are the 8 factors that influence choice of Anesthetic?

Answer 53

1) Patient/surgeon preference
2) Surgical procedure
3) Physiological status
4) Age
5) Post-op recovery time
6) Length of surgery
7) Position of patient
8) Patient’s previous experiences with anesthesia

Question 54

Briefly describe the 3 following theories of Anesthesia:

1) Protein Receptor Theory
2) Meyer-Overton Theory
3) Endogenous Endorphin Theory

Answer 54

1) Protein Receptor Theory - Response to anesthesia depends on the occupation of a critical number of receptor sites.
2) Meyer-Overton Theory - The potency of the Anesthetic depends upon it’s lipid solubility.
3) Endogenous Endorphin Theory - Anesthetics work through opiate-like substances which suppress various pain pathways.

Question 55

What are the 4 advantages LMAs have over ET Tubes?

Answer 55

1) Faster recovery
2) Greater Comfort
3) Convenience - easier to use
4) Cheaper

Question 56

What are the 3 types of Regional Anesthesias?

Answer 56

1) Spinal
2) Epidural
3) Intravenous Regional (Bier Block)

Question 57

When should surgical gloves changed?

Answer 57

1) after each patient procedure
2) when suspected or actual contamination occurs;
3) after touching surgical helmet system hoods and visors (used frequently in orthopedic procedures);
4) after adjusting optic eyepieces on the operative microscope;
5) after direct contact with methyl methacrylate ( a cement used in total joint procedures);
6) when gloves begin to swell, expand, and become loose on the hands (latex gloves are subject to hydration – the absorption of water molecules which results in increased permeability and porosity);
7) when a visible defect or perforation is noted or when a suspected or actual perforation occurs; and
8) every 90 to 150 minutes (perforation rates have been shown to increase significantly after 150 minutes).

Question 58

Documentation in the patient’s record includes which 4 related elements about the patient?

Answer 58

1) current and past health status
2) nursing diagnoses and interventions
3) expected patient outcomes
4) evaluation of the patient’s response.

Question 59

The standards of nursing practice require that documentation is based on which 2 things?

Answer 59

1) the patient’s condition or need

2) the relationship of the condition or need to the proposed intervention

Question 60

Unless the procedure is designated as an emergency situation, a “properly executed informed consent” must include which 9 things?

Answer 60

1) Name of the health care facility providing the surgery or invasive procedure
2) Name of the surgery/intervention
3) Indications for the proposed surgery/intervention
4) Name of health care provider performing the intervention
5) Risks and benefits
6) Signature of the patient or the patient’s representative
7) Date and time the patient or patient’s representative signed the informed consent document
8) Date and time and signature of the witness for signing the informed consent document
9) Signature of the responsible health care provider who discussed the informed consent document with the patient or the patient’s legal representative.

Question 61

Which 7 components should preoperative documentation include?

Answer 61

1) Patient identification
2) Patient assessment
3) Patient history
4) Verification of surgical procedure
5) Informed consent
6) Preoperative orders
7) Plan of care

Question 62

What are the five Absolute Contraindications to having Laparoscopic Abdominal Surgery?

Answer 62

1) Advanced generalized peritonitis
2) Massive abdominal distention with evidence of bowel obstruction
3) Irreducible hernia
4) Coagulopathy
5) Patient’s inability to tolerate formal laparotomy