Chapter 12: Perioperative Safey Patient Focus/Retained Items/Counts

Question 1

What are the most common items retained in patients during surgical or invasive procedures?
A. Surgical sponges
B. Needles
C. Instruments
D. Guide wires

Answer 1

A. Surgical sponges

Question 2

Which items should be included in the surgical count?
A. Radiopaque soft goods
B. Sharps
C. Misc items
D. All of the above.

Answer 2

D. All of the above.

Radiopaque soft goods, sharps, and Misc items

Question 3

Retained surgical items are reported most commonly in which location?
A. Intestine
B. Bladder
C. Abdomen and pelvis
D. Thorax

Answer 3

C. Abdomen and pelvis

Question 4

What is the most common consequence reported to occur as a result of RSIs?
A. Readmission or increased length of hospital stay
B. Re-operation
C. Physical or emotional harm
D. Death

Answer 4

B. Re-operation

Question 5

All of the following risk factors have been significantly associated with RSIs, EXCEPT:
A. Incorrect counts
B. More than one surgical team
C. Short procedures
D. High body mass index

Answer 5

C. Short procedures

Question 6

Which of the following actions is NOT a primary responsibility of the scrub person in preventing RSIs?
A. Maintain an organized sterile field
B. Record the count
C. Consult with the surgeon about whether any supplies will be needed before the closing count
D. Count surgical items in a manner that allows the RN circulator to see the items being counted

Answer 6

B. Record the count

Question 7

The surgeon and first assistant can implement actions to prevent RSI events, including
A. documenting the results of the final count in the medical record
B. initiating a time out in the OR
C. participating in site marking in the preoperative area
D. performing a methodical wound exploration immediately before closing the wound.

Answer 7

D. performing a methodical wound exploration immediately before closing the wound

Question 8

AORN recommendations for anesthesia professionals practices to prevent RSI events include all of the following EXCEPT:
A. planning anesthetic milestone actions that do not pressure the surgical team to compromise count policies.
B. implementing measures to decrease the incidence of a patient experiencing perioperative hypothermia
C. communicating with the perioperative team when throat packs, bite blocks, or other devices are inserted in the oropharynx
D. verifying that devices are removed from the oropharynx

Answer 8

B. implementing measures to decrease the incidence of a patient experiencing perioperative hypothermia

Question 9

Distractions that can increase the risk for error during manual counts include:
A. excessive conversations
B. Pagers
C. loud Music
D. All of the above.

Answer 9

D. all of the above.

Excessive conversations, pagers, and loud music

Question 10

Efforts should be made to create a ______ zone while conducting the surgical count.
A. Neutral
B. No interruption
C. hazard free

Answer 10

B. No interruption

Question 11

Critical phases of an operative or other invasive procedure when a count should not be conducted include:
A. Specimen care and handling
B. Time-Out procedure
C. Wound Closure
E. All of the above
F. A, B, and C only.

Answer 11

F. A, B, and C only

Specimen care and handling, time-Out procedure, wound Closure

Question 12

How many individuals should concurrently view the items being counted?
A. 1
B. 2
C. 3
D. 4

Answer 12

B. 2

Question 13

The RN circulator should record the soft goods and sharps count:
A. Immediately after each type of item is counted
B. On the count board visible to all team members
C. In agreement with the scrub person
D. All of the above
E. A and B only.

Answer 13

D. All of the above

Immediately after each type of item is counted, on the count board visible to all team members, and in agreement with the scrub person

Question 14

Which of the following statements are TRUE:
A. Non-radiopaque items are recommended for use in the surgical wound.
B. Radiopaque sponges should not be used for pre-operative skin antiseptics.
C. Radiopaque sponges should be used as postoperative wound dressings
D. Non-radiopaque gauze dressing materials should be opened onto the sterile field at the beginning of the procedure.

Answer 14

B. Radiopaque sponges should not be used for pre-operative skin antiseptics.

Question 15

Which of the following is a TRUE statement? Radiopaque soft goods should be _________
A. completely separated and viewed concurrently by two individuals
B. counted to the number that the items is packaged in
C. positioned so the entire item is inside the wound
D. All of the above
E. Only A and B.

Answer 15

E. Only A and B.

completely separated and viewed concurrently by two individuals and counted to the number that the items is packaged in

Question 16

Sharps containers should be \_\_\_\_\_?
A. puncture resistant
B. Leak proof
C. labeled in accordance with the blood borne pathogens standard.
D. All of the above.

Answer 16

D. All of the above.

Puncture resistant, leak proof, and labeled in accordance with the blood borne pathogens standard.

Question 17

If an unretrieved device fragment is left in the surgical wound, the patient should be informed of ?
A. location and type of the device fragment
B. Risks and benefits of leaving the fragment in place
C. types of future procedures that should be avoided because the device fragment is retained
D. All of the above

Answer 17

D. All of the above

location and type of the device fragment, risks and benefits of leaving the fragment in place and types of future procedures that should be avoided because the device fragment is retained

Question 18

If a count discrepancy occurs, which of the following statements is TRUE:
A. The RN circulator should inform the team, call for assistance, and receive verbal acknowledgement from the surgeon.
B. The scrub person should organize the sterile field, search the sterile field, and recount with the RN circulator.
C. The surgeon and the first assist should continue to close the wound until notified that the item has been found
D. All of the above.
E. A and B only.

Answer 18

E. A and B only

The RN circulator should inform the team, call for assistance, and receive verbal acknowledgement from the surgeon and the scrub person should organize the sterile field, search the sterile field, and recount with the RN circulator.

Question 19

What strategy has been identified to prevent or reduce the number of RSI events?
A. Each discipline should work independently to develop policies related to their role in the count process
B. Standardized processes for counting and reconciling count discrepancies should be developed.
C. Surgeons should preform a methodical wound exploration before wound closure.
D. All of the above
E. B and C only.

Answer 19

E. B and C only

Standardized processes for counting and reconciling count discrepancies should be developed and surgeons should preform a methodical wound exploration before wound closure.

Question 20

Describe/elaborate on the 3 steps to preoperative verification:

1. Identifying the patient/confirming the patient and procedure
2. Marking the site
3. Time Out

Answer 20

1. Identifying the patient/confirming the patient and procedure - use two patient identifiers
2. Marking the site - marker that is visible after skin is prepped and draped
3. Time Out - occurs immediately before surgery or procedure

Question 21

Describe appropriate counting procedures for the surgical team during a surgical procedure.

Answer 21

It is a standardized approach, in same sequence each time in a logical progression

Question 22

Who can initiate a count?

Answer 22

Any of the surgical team members

Question 23

During a surgical procedure the team member who opens and enters sterile items into the surgical field should also be responsible for what actions?

Answer 23

Count with the scrub person, add counted items to the count documentation, inform RN circulator about what was added

Question 24

How should the surgical team handle counted items?

Answer 24

They should remain in the OR room during the procedure, nothing leaves

Question 25

The staff member who comes to transport a patient from the preop area to the OR should do what before transporting the patient?

Answer 25

Identify the patient and surgical site, position and procedure. Visually or verbally verify that the preoperative orders and procedures have been completed. Reconcile any meds

Question 26

List the reasons why personnel in charge of transferring a patient on a gurney should push the patient feet first.

Answer 26

Patients prefer to see where they are going. As the “driver” you can see the entire patient and protect patient’s head from inadvertent injury. Some patients have motion sickness when pushed facing backwards.

Question 27

In the OR, the patient has a heightened risk for skin injury due to:

Answer 27

Unusual positions or positioning devices - make sure you have the correct size, pad bony prominences and relieve pressure, conduct ROM, protect sensitive areas (breasts, eyes, ears, genitals)

Use of electrical equipment - ensure active electrocautery and laser electrodes are handles and stored appropriately

Prolonged length of surgery

Reduced tissue perfusion

The use of chemical agents - ensure it does not pool on patient or drapes, insert blotting towels and remove them after prep