Chapter 10: Equipment focus

Question 1

Chose the false statement about perioperative fire prevention and management plans.
A. They should be developed by multidisciplinary group of stake holders.
B. They should describe key content and frequency of fire safety education activities.
C. They should specify policies and procedures for fire prevention and response.
D. They generally are not needed unless required by a health care facility insurance policy.
E. They should specify team members roles and responsibilities during fire prevention and response.

Answer 1

D. They generally are not needed unless required by a health care facility insurance policy.

Question 2

The three overriding principals of operating room fire safety are
a. Awareness, communication,team work.
B. Oxidizing source, heat source, fuel source.
C. Inspect, check, respond
D. Prevent, extinguish, evacuate
E. Source, extinguish, safety.

Answer 2

D. Prevent, extinguish, evacuate

Question 3

Examples of ignition sources include
A. Electrocautery units and active electrosurgical electrodes.
B. Fiber-optic light cords
C. Lasers
D. A and C
E. A, B, and C

Answer 3

E. A, B, and C (Electrocautery units and electrosurgical electrodes, fiber optic light cords, and lasers.)

Question 4

A fire assessment should be preformed
A. Only before procedures involving electrocautery, an electrosurgical unit or a laser.
B. Only if requested by the surgeon or first assist.
C. Before ALL operative procedures.
D. Only before surgical procedures above the xiphoid process and in the nasopharynx
E. Only if the patient requires more than 30% supplemental oxygen.

Answer 4

C. Before ALL operative procedures

Question 5

Oxidizing sources in the OR include
A. Oxygen (can include lung tissue itself as this can create an oxygen enriched environment.)
B. Nitrous oxide
C. Carbon dioxide (Non-flammable)- good choice for endoscopic
D. A and B
E. A, B, and C.

Answer 5

D. A and B- Oxygen and nitrous oxide.

Question 6

Periop RN and scrub personnel have primary control over which component of the fire triangle during an operating or other invasive procedure.
A. Oxidizing sources
B. Fuel sources (includes flammable skin preps, drapes, sponges, patient hair)
C. Ignition sources.
D. A and B
E A and C

Answer 6

B. Fuel sources (includes flammable skin preps, drapes, sponges, patient hair)

Question 7

Choose the FALSE statement about fire risks in the operating Room (Greatest is Airway)
A. Pt with heads drapes are at increased risk of fire because supplemental oxygen can accumulate under drapes.
B Substances that would not ignite in room or medical air can do so in an O2 rich environment, which may occur in the OR.
C. Evaporated gases from flammable prep solutions can ignite.
D. Bowel surgeries are associated with the highest risk of surgical fires.
E. A piece of equipment that is smoking unexpectedly represents an immediate fire risk.

Answer 7

D. Bowel surgeries are associated with the highest risk of surgical fires. (are a high risk due to methane and hydrogen gas byproducts, but greatest risk is airway or procedures above the xiphoid process especially when the supplemental O2 is in use. Should use a scalpel when entering the bowel when distended with gas)

Question 8

Which of the following fire safety practices should be implemented when a laser is used during surgery?
A. Keep wet towels and saline on the sterile field.
B. Place moist sterile towels, sponges, and drapes around the surgical site.
C. Use standard ET tubes for upper airway procedures involving laser
D. Allow fumes from flammable solutions to dissipate before activating the laser.
E. A and B only
F. A, B, and C only
G. A, B and D only

Answer 8

G. A, B and D only (Keep wet towels and saline on the sterile field, place moist sterile towels and sponges, and drapes around surgical site and allow fumes from flammable sources to dissipate before activating the laser.

Question 9

Which type of fire extinguisher is most appropriate to extinguish a fire on or in a patient.
A. Carbon dioxide extinguisher.
B. Ammonium phosphate or other dry powder extinguisher.
C. water mist
D. Foam
E. A or C

Answer 9

E. A or C ( Carbon dioxide and water mist.)

Question 10

A scrubbed Peri-op RN observes a fire start on a patient in the OR. After alerting the team the nurse should immediately.
A. Obtain and operate the nearest fire extinguisher by using the PASS technique.
B. Pat the flames with the drape.
C. Smother the fire with a towel or pour nonflammable liquid on the fire.
D. Lift the Pt and transport them out of the room
E. Turn off the O2 source.

Answer 10

C. Smother the fire with a towel or pour nonflammable liquid on the fire.

Question 11

The nominal hazard zone is the
A. Distance from the laser delivery device to the target tissue.
B. Space where direct or reflected laser radiation exceeds the applicable maximum permissible exposure.
C. Area outside the maximum permissible exposure area.
D. Surgical field.

Answer 11

B. Space where direct or reflected laser radiation exceeds the applicable maximum permissible exposure

Question 12

All of the following are appropriate practices to manage oxidation sources in the OR EXCEPT:
A. administer the lowest concentration of O2 needed to maintain adequate O2 sats
B. Use a laryngeal mask or ET tube if the patient needs more than 30% supplemental oxygen
C. Ensure that there are no leaks in the anesthesia circuit.
D. Turn the warmer blower off when using a warming blanket with an attached head drape
E. Prevent oxygen from accumulating under the drapes

Answer 12

D. Turn the warmer blower off when using a warming blanket with an attached head drape

Question 13

If there is a laser sign on the OR door you may:
A. Enter the room if you ask the laser operator
B. Enter the room if eyewear is not available on the door
C. Don the glasses and enter
D. Don the laser eyewear and assess that they match the wavelength on the sign and reaffirm with the laser operator

Answer 13

D. Don the laser eyewear and assess that they match the wavelength on the sign and reaffirm with the laser operator

Question 14

The main hazards of surgical smoke are
A. Visibility
B. Viability of particulate matter
C. toxic odor and inability to capture
D. toxic gases, particulate matter, and viable contaminants

Answer 14

D. toxic gases, particulate matter, and viable contaminants

Question 15

When an energy source such as a laser is in open delivery use the placement of dry towels will help prevent the drape from catching fire
A. True
B. False

Answer 15

B. False, the towels need to be moist.

Question 16

During laser procedures the patient’s eyes should be covered with moist pads or a method approved by the laser safety officer
A. True (may be laser glasses)
B. False

Answer 16

A. True (may be laser glasses)

Question 17

Which of the following staff members can activate the laser foot pedal?

1. The surgeon
2. The scrub person
3. The circulating nurse
4. The anesthesiologist

A. 1
B. 2
C. 1 and 3
D 2 and 3

Answer 17

A. 1

Question 18

The three fundamental principles of radiation safety are:
A. regulations, protocols, and consistency
B. Measure, protect, and report
C. Aprons, dosimeters, and leaded walls
D. Time, distance, and shielding

Answer 18

D. Time, distance, and shielding

Question 19

Lead shielding should be used?
A. Whenever possible to attenuate radiation
B. If a patient or staff person requests it
C. Only at the discretion of the surgeon
D. If an ionizing radiation dose to a patient is expected to exceed 20 rem

Answer 19

A. Whenever possible to attenuate radiation

Question 20

A 0.25mm lead apron will reduce scattered x-rays by approximately?
A 15%
B. 25%
C. 50%
D. 95%

Answer 20

D. 95%

Question 21

All of the statements about the proper use of dosimeters in the workplace are TRUE except:
A. When one dosimeter is used, all personnel should wear it at the same place on the body.
B. Badges should be exchanged for assessment and replaced at pre-determined intervals
C. Badges should not be taken home at the end of the workday
D. The best place to leave a badge when not in use in on the apron

Answer 21

D. The best place to leave a badge when not in use in on the apron

Should be treated as an individual record of radiation exposure and not shared. If using one badge should be worn on the same place of the body by all personnel

Question 22

If a health care worker who works with radiation becomes pregnant, she should:
A. Stop working with any form of radiation
B. Promptly inform the radiation safety officer
C. Wear a badge at waist level outside her apron
D. Switch from a lead apron to a lead-free alternative for comfort

Answer 22

B. Promptly inform the radiation safety officer

Question 23

The most serious long-term effect of ionizing radiation exposure is:
A. Blindness
B. Osteoporosis
C. Cancer
D. Skin injuries

Answer 23

C. Cancer

Question 24

To minimize patient’s risk of adverse effects from radiation exposure, peri-op nurses should do all of the following except:
A. Keep extraneous body parts out of the primary radiation beam
B. Place lead shielding between the radiation source and the patient
C. Leave the room when x-ray films are being taken
D. Check medical records before radiographic procedures to ensure patients do not have substantial amounts of residual radioactive material in their bodies

Answer 24

C. Leave the room when x-ray films are being taken

Question 25

A peri-op nurse is assessing patients for DVT risk factors prior to lower limb surgeries. Based on the following descriptions, which patient DOES NOT have risk factors for DVT’s?
A. A 35 year old patient on prolonged bed rest
B. A 70 year old smoker with history of significant medical problems
C. An obese 45 year old who is otherwise healthy
D. A 20 year old non-smoking athlete with a left anterior cruciate ligament tear

Answer 25

D. A 20 year old non-smoking athlete with a left anterior cruciate ligament tear

Question 26

Select the FALSE statement about pneumatic tourniquet safety.
A. Wider, contoured cuffs are generally sager than narrow cuffs because they require less pressure to achieve a near bloodless field
B. Increased tourniquet time increases the risk of postoperative complications
C. Narrow cuffs are generally safer than wide, contoured cuffs because they require less pressure to achieve a near bloodless field.
D. Increased cuff pressure increased the risk of postoperative complications

Answer 26

C. Narrow cuffs are generally safer than wide, contoured cuffs because they require less pressure to achieve a near bloodless field.

Question 27

Which of the following is not a common physiologic effect of pneumatic tourniquet deflation following a period of inflation during surgery?
A. Hypotension
B. Decreased heart rate
C. Increased core body temperature
D. Decreased core body temperature

Answer 27

C. Increased core body temperature

Question 28

The use of a pneumatic tourniquet during extremity surgery:
A. Is a non-controversial practice
B. Requires effective communication and collaboration between nurses, anesthesia personnel, and the surgeon
C. Is safe for all patients as long as tourniquet time does not exceed 30 min
D. all of the above

Answer 28

B. Requires effective communication and collaboration between nurses, anesthesia personnel, and the surgeon

Question 29

A peri-op RN is performing a preoperative assessment of a patient scheduled for a total knee arthroplasty. Which of the following is NOT a primary contraindication for pneumatic tourniquet use?
A. Significant vascular disease, including recent bypass, history of DVT, or impaired peripheral circulation
B. Sickle cell anemia and other forms of hemoglobinopathy
C. History of pain or weakness in the bones or muscles of the extremities
D. History of Ulcerative colitis

Answer 29

D. History of Ulcerative colitis

Question 30

A type of tissue in the extremities that is highly susceptible to ischemia is
A. Skeletal muscles
B. Nerves
C. Bones
D. Skin
E. All of the above

Answer 30

A. Skeletal muscles

Question 31

Volatile and combustible liquids are a danger to YOU as a perioperative nurse. Discuss how you reduce personal exposure to specimen fixatives (formalin) while in the OR.

Answer 31

Avoid splashing while pouring, wear gloves, if contact occurs thoroughly wash with water. Wear a mask and goggles. Flush eyes thoroughly if contact occurs. Use absorbent material and triple rinse with water where a spill occurs.

Question 32

Operating rooms must have their electrical power supplied by an isolated power line. An isolated power line prevents unintentional grounding of persons in contact with a live electrical cable or current. Faulty grounding can result in a burn, cardiac fibrillation, or shock to the patient or user. Discuss the immediate actions a perioperative nurse should take when there are line isolation issues.

Answer 32

Electrical shocks - remove the plug from the outlet if safe, or shut off the electrical supply at the circuit breaker then remove the plug
If monitor alarm sounds - unplug the last piece of equipment in the room that was plugged in. If alarm continues, unplug unnecessary pieces of equipment in the room until alarm stop. Notify facility management the alarm was going off and sent equipment to biomed for maintenance and repair.