Chapter 23: Perioperative Environment Flashcards
The first point in the medication-use process where the perioperative registered nurse can participate in is: A. Procuring B. Prescribing C. Dispensing D. Administering
A. Procuring
A patient safety strategy that reduces the opportunities for medication errors is:
A. Obtaining all medications from a single vendor
B. Storing chemicals, solutions, and medications in the same room
C. Arranging products in alphabetical order
D. Tracing the origin and insertion of all tubes and catheters
D. Tracing the origin and insertion of all tubes and catheters
In 1920, an organization that developed a standard curriculum of OR techniques was: A. AMA B. AORN C. Bellevue Hospital D. The National League of Nursing E. The Nightingale Society
D. The National League of Nursing
A patient safety strategy that reduces the opportunities for medication errors is:
A. Obtaining all medications from a single vendor
B. Storing chemicals, solutions, and medications in the same room
C. Arranging products in alphabetical order
D. Tracing the origin and insertion of all tubes and catheters
D. Tracing the origin and insertion of all tubes and catheters
Medications listed on preference cards are not considered to be standing orders unless they have been reviewed and signed by the prescriber.
A. True
B. False
A. True
When a perioperative registered nurse receives a verbal order, the first action would be to:
A. Copy the order onto a white board
B. Confirm by reading back the order to the prescriber
C. Enter the order in an electronic order system
D. Update the preference card
B. Confirm by reading back the order to the prescriber
In an environment of care, perioperative RN’s should:
A. Always follow the instructions of surgeons
B. Maintain the patient as the focus of all team activities
C. Minimize communication in order to work efficiently
D. Never deviate from protocol, even if an error may result
E. Strive for a culture of efficiency rather than safety
B. Maintain the patient as the focus of all team activities
Pharmacists should become involved in medication safety:
A. From the beginning when the safety plan is being created
B. When facilities design new forms
C. During the medication reconciliation process
D. In all of the above situations
D. In all of the above situations
Which of the following statements describe an important value of the medication reconciliation process?
A. The patient is the sole source of information
B. The patient’s list of medications can help identify underlying patient conditions
C. The patient’s literacy level is documented during discharge teaching
D. The patient’s weight in kilograms is obtained for medication calculations
B. The patient’s list of medications can help identify underlying patient conditions
Perioperative RN’s primarily use checklists to ensure that:
A. Lawsuits from the patient and their family are avoided
B. New nurses perform their work as expected
C. Surgical supplies are not wasted before or after surgery
D. Staff begin shifts on schedule and relieve one another as needed
E. The plan of care is implemented correctly before, during, and after surgery
E. The plan of care is implemented correctly before, during, and after surgery
Which one of the following is an important component of the nursing medication plan?
A. The plan begins when health care providers bring the patient into the room
B. The plan assists health care providers with planning for pre-procedural antibiotic administration
C. The plan directs health care providers how to order home care
D. The plan directs health care providers how to obtain all medications for all patients at one time in the medication room
B. The plan assists health care providers with planning for pre-procedural antibiotic administration
Key points for implementing safe practices include:
A. Obtaining medications for only one patient at a time
B. Avoiding distractions and interruptions when preparing medications
C. Preparing the medication as close as possible to the time of administration
D. Using safe injection practices
E. All of the above practices
E. All of the above practices
Obtaining medications for only one patient at a time, avoiding distractions and interruptions when preparing medications, preparing the medication as close as possible to the time of administration, and using safe injection practices.
Points at which the perioperative RN should verify the medication product include:
A. At the point when the medication is being retrieved using the original order
B. At the point when the RN circulator is ready to pass the medication to the scrub person
C. At the point when each product is being placed on the sterile field
D. All of the above situations
D. All of the above situations
At the point when the medication is being retrieved using the original order, at the point when the RN circulator is ready to pass the medication to the scrub person and at the point when each product is being placed on the sterile field
The pre-incision TIME OUT should be performed by which member(s) of the perioperative team?
A. All perioperative team members
B. All perioperative team members except anesthesia professionals
C. Perioperative RN’s
D. Scrub nurses only
E. Surgeons only
A. All perioperative team members
Safe injection practices:
A. Are only applicable when medications are given intravenously
B. Are only applicable to local anesthetics
C. Include using one syringe per injection
D. Require that all health care workers receive the hepatitis B vaccination series
C. Include using one syringe per injection
After the patient undergoes cataract surgery, the unused portion of any eye drops should be:
A. Saved for the next procedure
B. Sent home with the patient
C. Sent home with the patient after being sent to the pharmacy for proper labeling
D. Returned to the stock room
C. Sent home with the patient after being sent to the pharmacy for proper labeling
Unused solutions should be:
A. Poured down the drain with two witnesses
B. Returned to pharmacy for relabeling for the next procedure
C. Secured in a manner to prevent municipal water contamination
D. Retained for risk management personnel because unused solutions at the end of a procedure indicates that an error has occurred
C. Secured in a manner to prevent municipal water contamination
This perioperative RN prepares the OR, helps with anesthesia induction if requested, and works outside the sterile field to ensure the perioperative team has everything it needs:
A. PACU nurse
B. pre-admission nurse
C. RN circulator
D. Registered nurse first assistant (RNFA)
E. Scrub person
C. RN circulator
When updating the patient’s support person during surgery, a nurse should:
A. Call the surgeon away from the operation, but only if the support person demands it
B. Discuss a projected time frame for completion of the surgery
C. Discuss the patient’s expected prognosis
D. Provide details of the surgery and describe any problems
E. Tell the patient that she is not allowed to talk to the support person
B. Discuss a projected time frame for completion of the surgery
Advanced practice nurses in the perioperative setting may do all of the following except which one?
A. Direct patient care
B. Help implement improvements in healthcare systems
C. Perform surgery in an emergency without a surgeon being present
D. Serve as first assistant during surgery
E. Teach self-care to patients and their support team
C. Perform surgery in an emergency without a surgeon being present
Wrong site surgical errors:
A. almost never happen
B. Are the sole responsibility of the surgeon to prevent
C. Are usually due to incorrect information provided by the patient
D. Can result from failure to perform the TIME OUT before surgery
E. Should be concealed from the patient as much as possible
D. Can result from failure to perform the TIME OUT before surgery
Approximately what percentage of serious medical errors are thought to be associated with miscommunication during patient hand-offs? A. < 1% B. 10% C. 50% D. 80% E. 100%
D. 80%
Which of these activities is NOT performed in the perioperative area?
A. Information is confirmed from the patient’s history
B. The circulating RN and scrub nurse count instruments, sponges, needles, and other sharps
C. The patient’s name, DOB, procedure, and procedure site are confirmed
D. The anesthesia plan is confirmed, and consent for anesthesia is obtained
E. The surgical site is confirmed and marked
B. The circulating RN and scrub nurse count instruments, sponges, needles, and other sharps
The postoperative period is defined as which of the following?
A. Admission to the PACU to transfer to a patient care unit
B. Admission to the PACU to patient’s death
C. Closure of the incision to admission to the PACU
D. Discharge from the hospital to patient’s return home
E. Leaving the OR to admission to the PACU
A. Admission to the PACU to transfer to a patient care unit
Fast tracking patients from the OR to the PACU phase II due to rapid-onset, fast-emergence general anesthetics may require the increased use of which drugs? A. Amphetamines B. Anticoagulants C. Anti-emetic and pain control drugs D. Antihypertensives E. Sedatives
C. Anti-emetic and pain control drugs
The body's most important barrier to infection is: A. Saliva B. Skin C. Keratin D. Tears E. Vitamin C
B. Skin
Which activity is NOT recommended to reduce the risk of surgical infections?
A. Administer prophylactic antibiotics as directed
B. Keep the OR doors closed during the operative procedure
C. Minimize movement and talking during the operative procedure
D. Perform a TIME OUT before beginning the procedure
E. Perform a thorough skin prep and hand scrub
D. Perform a TIME OUT before beginning the procedure
The primary responsibility of scrub nurses is to:
A. Help anesthesia professionals anesthetize patients
B. Perform the skin prep
C. Perform a thorough hand scrub before surgery
D. Provide needed instruments to the surgeon and first assistant during the surgical procedure
E. Scrub dirty/used surgery instruments before they are sterilized
D. Provide needed instruments to the surgeon and first assistant during the surgical procedure
Which of the following is a role of a registered nurse first assistant (RNFA)?
A. Assist with the surgical procedure
B. Clean up the OR after surgery
C. Concurrently perform the duties of a scrub nurse
D. Perform the skin prep
E. Practice at the direction of a RN circulator
A. Assist with the surgical procedure
Which of the following phases of anesthesia recovery is best described by the following description?
The patient is more alert and functional and no longer requires intensive nursing care. The focus is on preparing the patient for self-care, care by support persons, or care in an extended-care environment.
A. Phase I
B. Phase II
C. Phase III
D. Phase IV
E. Not possible to state based on this information
B. Phase II
An instrument falls below the level of the back table during an operative procedure. Only the circulating RN sees this happen. The nurse should:
A. Try to catch the instrument before it touches the floor
B. Discard and replace the instrument with a sterile one
C. Pick up the instrument and return it to the table
D. Follow the 5 second rule (Ok if not on floor for more than 5 seconds)
E. Inspect for visible particulate matter and use if clean
B. Discard and replace the instrument with a sterile one
Which statements concerning the surgical suite zones are true? SELECT ALL THAT APPLY
A. Equipment and sterile supply storage are restricted
B. Operating rooms are restricted
C. Sterile processing is semi-restricted
D. The pre-op holding area is unrestricted
B. Operating rooms are restricted
C. Sterile processing is semi-restricted
D. The pre-op holding area is unrestricted
In preparing for regulatory survey, your quality consultant questions you about the restricted zone in your OR suite. The following statements would be correct in reference to the RESTRICTED ZONE (SELECT ALL THAT APPLY):
A. Air flow in the OR rooms should be cleaned by a HEPA filter
B. Air is kept at negative pressure with a minimum of 25 air exchanged per hour
C. Masks are required when open sterile supplies are present
D. Relative humidity is maintained between 60-75% to prevent static electricity
E. Temperature is maintained between 68-75 degrees Fahrenheit
A. Air flow in the OR rooms should be cleaned by a HEPA filter
C. Masks are required when open sterile supplies are present
E. Temperature is maintained between 68-75 degrees Fahrenheit
The patient outcomes identified in the Perioperative Patient Focused Model are derived from three domains:
A. Preoperative assessment data, nursing diagnoses, and physiological responses
B. safety, physiological responses, and behavioral responses
C. safety, preoperative assessment data, and physiological responses
B. safety, physiological responses, and behavioral responses
Describe the differences in perioperative RN roles of a scrub person, circulating nurse, and an RNFA.
Scrub person = establishes and maintains sterile field, assists surgeon with instruments during surgery
Circulating nurse = functions outside of the sterile field, patient’s advocates in all 3 phases of peri-op
RNFA = works under surgeon, has knowledge of surgical physiology and tissue handling, requires additional school
What is the purpose of a standardized nursing language such as PNDS?
PNDS consistently represent the nursing process to maintain patient safety, infection control and manage supplies. It’s a standardized language that all nurses can understand.
List the appropriate attire for each of the following zones:
- The Unrestricted Zone
- The Semi-restricted Zone
- The Restricted Zone
- unrestricted - street clothes are permitted
- semi-restricted - surgical attire consisting of head and body covering is required, all head and facial hair covered
- restricted - surgical attire, cover all head and facial hair, masks if open sterile supplies or sterile team members present
Discuss the requirements for storage and movement dirty, clean, and sterile supplies within the operating room.
Always go from sterile to clean to dirty, you separate sterile and dirty supplies so they don’t get contaminated
