final test Flashcards
What is the first step of instrument processing?
Cleaning
What type of monitor is an external strip or tape?
Chemical
Select one principle of surgical draping
Handle the drapes as little as possible.
Also, drape from the incision outward to the periphery; do not adjust
drapes after they have been positioned at the sterile field; and only the
top surface of a sterile drape.
Which of the following is NOT done when assembling an instrument tray?
Instruments are damp when placed in a container or wrapped.
Which of the following should be used for instrument cleaning at the point-of-use?
Sterile water
Which statement about cleaning and decontamination of contaminated surgical instruments and equipment is FALSE?
All instruments should be submerged in a hot water solution.
You are scrubbed in at the sterile field for an umbilical hernia repair and will
be using cloth towels to square off the incision area. It is best to secure the
towels with
a non-perforating clamp.
Which of the following describes bioburden?
The amount of microbial contaminationhon an instrument surface.
What type of sterile surgical drape would you expect to use for a
laparoscopic-assisted vaginal hysterectomy?
Leggings
Which chemical sterilization method uses a toxic substance that requires aeration?
Ethvlene oxide
What type of drape would you expect to use on an umbilical hernia repair?
laparotomy drape
As a scrubbed team member, how can you protect your gloved hands when
passing a sterile abdominal drape to the anesthesia professional who will
clip the drape to an IV pole?
Cuff the interior portion of the sterile drape over your sterile glove.
Instrument assembly stipulates that
instruments need to be dry when assembled.
You are observing while the anesthesia professional inserts a central venous
catheter into the patient’s right subclavian vein. After the preoperative skin
antisepsis has been applied to the neck area, what sterile drapes are
recommended for use in this procedure?
Use a full-body sterile drape to cover the patient.
Which of the following items is typically a part of the sterile field and requires
a sterile drape cover?
Instrument table
When the IFU for a surgical device, sterilizer, or packaging system conflict, follow the
IFU
device manufacturer’s
What type of sterile surgical drape would you expect to use for a cholecystectomy?
Abdominal drape
Which area is considered a sterile area of a surgical gown?
Front of the gown
When are sterile drapes placed on the patient for surgery?
After preoperative skin antisepsis has been performed at the surgical site
How often should surgical gloves be changed during surgery?
Every 90-150 minutes
After an abdominal surgery is completed, who typically is tasked with removing
the surgical drapes that are over the patient?
Scrubbed team member
How should a surgical hand rub be applied?
Apply solution according to the manufacturer’s instructions for use.
Which type of alloy finish on an instrument eliminates glare and is often used
during laser surgery?
Ebony
What is an example of a glove perforation indicator system?
The inner glove is a different color from the outer glove.
Which is the preferred sterile solution to use on the sterile field to remove debris
from instruments?
Water
Which is NOT an endoscope classification?
Semi-flexible
When assisting a team member to gown and glove, you releasing the gown and stepping away at what point
once the team members arms are in the gown.
Which is a description of the Kocher clamp?
Toothed tip to hold tough tissue
The four major categories of instruments are
cutters, clamps, retractors, other.
The weight of an instrument tray should not exceed
25 pounds
Which of the following should be worn on the hands during surgical hand antisepsis
nothing- no jewelry
It is important to know what an instrument looks like and what it is called
for the count process.
to save OR time.
to understand what is being said.
✔️All of the above
When removing a gown and gloves at the completion of a surgical procedure, do the following action FIRST:
With gloved hands, pull the gown away from your body breaking the ties, roll it into a bundle, and touching only the outside of the gown.
An ergonomic consideration for instrument use would include the ___________________
of the instrument.
Weight
This is a characteristic of robotic instruments and is defined as an instrument
with a specific number of uses.
Reposable
If your sterile glove becomes contaminated during a surgery, what action should you take FIRST?
Ask a non-scrubbed team member to remove the contaminated glove.
For initial gloving, and after you have donned a sterile gown, you should glove without assistance using what technique.
closed gloving
When scrubbing for a surgical procedure in which there is a high risk for exposure to blood, body fluids, and irrigation fluids, it is recommended to wear a gown with the highest level of liquid barrier protection, which is classified as an
ANSI/AAMI Level 4
_________________ is a systematic inquiry used to generate new knowledge.
Research
Which of the following is an example of a direct expense in the perioperative
department?
Wages of fulltime employee who uses a timecard to track working hours
You and another team member just finished a complex procedure. The patient
you cared for had bed bug bites and you hear your team member make snide
comments about the patient in the cafeteria. You notice people who are not
health care providers listening to the conversation.
What type of behavior has your colleague exhibited?
Breach of privacy
Which of the following is NOT a key element of ERAS®, Enhanced Recovery After Surgery?
Opioid-only pain relief
Which organization writes the Standards of Perioperative Nursing?
The Association of periOperative Registered Nurses
Which term means “the duty to do no harm?”
Nonmaleficence
____________ is a structured language used by perioperative RNs
to document nursing care.
PNDS
Which organization determines the scope of practice for RNs in each state?
State board of nursing
Which documents does a facility create based on governmental regulations,
accrediting agency regulations, and AORN Guidelines?
Policies and procedures
What is the correct definition for respondeat superior?
An employer’s responsibility for the RN when the RN acts within the scope of nursing practice
Which of the following is an example of assault and battery?
Not obtaining an informed consent from the patient before surgery
Which of the following would be an appropriate action for the perioperative nurse when assisting with anesthesia?
Apply cricoid pressure if needed during intubation.
Which of the following is NOT included in basic monitoring of the patient for
anesthesia?
Arterial line
The Nursing Alliance for Quality Care (NAQC) emphasizes patient-centered care that includes patient engagement. Which of the following is one of the nine assumptions of patient engagement?
Nurses must form an active partnership with their patient, the patient’s support system, and the patient’s care providers.
Which drug is used to reverse valium and midazolam?
Flumazenil
The focused assessment collects data for a specific health issue and is continuous throughout all nurse-patient interactions. Which element would the nurse assess for the integumentary system?
Turgor
How can the perioperative nurse assist the anesthesia provider with placement
of a spinal or epidural block?
Calm the patient
Which of the following contains the elements of economic stability and built environment?
Social determinants of health
What is the most consistent indicator of malignant hyperthermia during a
surgical intervention?
Increased end-tidal CO2
Anxiety and stress cause unpleasant physiological reactions in patients before surgery. What can patients do to lessen their preoperative anxiety?
Listen to music
Practice aromatherapy
Perform meditation
What are signs the patient is experiencing local anesthetic systemic toxicity?
Ringing in the ears
Dizziness
Tingling sensation around the lips
✔️All of the above
Which of the following drugs is NOT an anticoagulant?
tylenol
When should anticoagulants be discontinued prior to surgery?
48hrs
Which assessment factor is important to include when screening patients for
potential risk of malignant hyperthermia?
Family history of problems related to anesthesia
Virtually every body system is affected by Cannabis. Tetrahydrocannabinol (THC) is metabolized through the liver. Which of the following is NOT a route of elimination?
sweat
What complication can arise with tourniquet deflation at the end of a Bier Block
procedure?
Bolus of anesthetic
What is an important element when assessing your patient’s pain?
Always using the same scale with the same patient
The RN caring for the patient receiving moderate sedation/analgesia should
be competent in the use of emergency resuscitation procedures.
Hallways leading to the OR and the sterile processing areas are designated as ___ areas of the perioperative environment.
semi-restricted
Which method is used to prevent aspiration during endotracheal intubation?
Applying cricoid pressure
A goal of patient- and family-centered care is to
improve the patient’s knowledge regarding their care.
For patient- and family-centered care to succeed, which of the following
must occur?
Active patient engagement in the education process
Identify a goal of ERAS®.
Reduce the patient’s stress response
the airflow in the or has a ____ pressure relationship to the adjacent OR hallway.
positive
_______________ are the conditions where people are born, where they
grow up, where they work, and where they live.
Social determinants of health
Which of the following areas in a perioperative environment is considered a restricted area?
operating room
Which team member establishes the sterile field and passes instruments to the surgeon?
scrub person
What is the primary medication to treat a patient experiencing a malignant hyperthermia (MH) crisis?
dantrolene sodium
Which of the following is NOT a fire prevention practice during surgery?
Verify the patient’s position during the time out.
What is one way the RN circulator can support a family member in the
waiting room during their loved one’s surgical procedure?
Phone call to the family member.
Which of the following are considered ignition sources that may cause a fire to ignite during surgery?
Electrosurgery and laser
What is an example of health equity?
Providing low-cost health services for those living in low income housing.
What is a DOH resource that can enhance population health outcomes?
Public safety
Which of the following is recognized as a primary means to prevent healthcare associated infections?
Perform hand hygiene
What is a hallmark of an accountable care organization?
Decrease in errors
Teach-back is a particularly valuable tool for perioperative nurses when providing
perioperative discharge instructions.
What is one hallmark of patient-centered care?
Physical comfort and emotional well-being are priorities.
what is the process if a patient airway ignites in fire
The correct response is to immediately remove the endotracheal tube and any segments of the burned tube that remain in the airway.
Discontinue the flow of breathing gases to the patient, do not lower them.
Completing an occurrence report and gathering all supplies and equipment involved in the fire should occur after the fire is extinguished and patient care is completed. For more information, review the duties of the perioperative team during a fire.
Which of the following is TRUE regarding general skin antiseptic application?
Prep in a back and forth motion when using a CHG-based antiseptic.
Which of the following is NOT a patient risk factor for SSI?
Patient’s knowledge of the condition
An anesthesia professional states, “This patient is experiencing local anesthetic systemic toxicity.
The perioperative RN should be prepared to assist with the administration of
20% lipid emulsion therapy.
What is the prep time of an alcohol-based CHG product on dry skin?
30 seconds
Hair that is removed from the head for a cranial procedure:
is the property of the patient.
What should be documented after the surgical prep?
Person(s) performing the prep
Skin antiseptic product used
Skin condition at the surgical site
✔️All of the above
what are the 7 key goals of patient positioning?
- Provide optimal exposure to the surgical site.
- Maintain proper body alignment.
- Support circulatory and respiratory functions.
- Protect neuromuscular and skin integrity.
- Allow for access to intravenous (IV) sites and monitoring equipment.
- Maintain the patient’s comfort and privacy.
- Secure the patient to avoid shifting or movement during surgery.
Who is responsible for positioning the patient?
entire surgical team
What is a goal of surgical skin antisepsis?
To reduce the risk of the patient developing an SSI
Which position is a modification of the prone position?
jack knife
In the supine position, a wedge-shaped positioning device is placed under the right lumbar region for a pregnant patient undergoing a non-obstetric surgery to help prevent
hypotension
Which measure helps decrease the risk of fire caused by skin antiseptics?
Prevent flammable skin antiseptics from pooling or soaking into linens or the patient’s hair.
To position a patient who is obese in the supine position, you should
use padded arm guards to contain the arms at the sides.
When the patient is in the supine position with the arms at the sides, where should you tuck the draw sheet?
Under the patient
Approximately, how many inches above the patient’s knees should the safety strap be applied in the supine position?
2 inches
Which statement is TRUE concerning iodine skin antiseptics?
lodine is found in thyroid hormones, amino acids, and other body substances.
_____ occurs when layers of material, such as extra sheets or blankets,
are placed over the OR mattress or padding.
negativity (decreased perfusion)
Which of the following is a pressure injury risk assessment tool designed for surgical patients?
Munro Pressure Ulcer Risk Assessment Scale
Which measure should be included as part of an extremity prep?
Cover the distal edge of the tourniquet with a impervious drape to prevent patient injury.
Patient’s arms should be placed on arm board with palms ___ to reduce pressure on the ulnar nerve.
palms up (think the anatomical man)
Raising the patient’s legs into the lithotomy position shifts blood from the legs into the central circulation and
increases cardiac output and venous return.
Which of the following describes the mode of transmission in the chain
of infection?
A microbe’s route from the portal of exit
Drug diversion is a result of a facility’s _______
lack of narcotic security measures
When the patient is in the supine position with the arms at the sides, where should you tuck the draw sheet?
under the mattress
Which of the following outlines sharps safety for the health care provider?
Bloodborne Pathogen Standard
Your patient is scheduled to have a bronchoscopy in the OR. The patient has a
diagnosis of influenza and has been placed on droplet precautions.
What type of respiratory precautions should the RN take during the procedure?
Wear a fit-tested N95 respirator
when is turnover cleaning conducted
in between surgical cases
When caring for a patient on airborne precautions, in what location is
the respirator removed?
Outside of the AllR
This action is considered to be the single most important action that can prevent the spread of infection
Hand hygiene
Which of the following is included in OSHA’s Bloodborne Pathogens Standard?
Use PPE for any anticipated blood or body fluid exposure.
In the perioperative setting, this surface is always considered contaminated.
floor
Why is an employee screened for certain diseases that have an associated vaccination?
The diseases are preventable.
In the morning, before the start of the first procedure of the day, what should be done to remove dust and debris?
Damp dusting
Which of the following is NOT an emergency warning sign of SARS-CoV-2?
Sore throat
What is the term to describe the amount of time designated by the manufacturer that a cleaning agent must remain wet on the surface to achieve disinfection?
contact time
What is the common term for the directions provided by a manufacturer on how to accurately use their product?
IFU
Which level of the Hierarchy of Controls addresses changing the way people work?
Administrative controls
Terminal cleaning is performed after an environmental contamination event such as flooding due to a natural disaster or building maintenance issue. Which of the following additional measures is taken when there is a pest infestation?
Containing biological waste
Removing food waste
Cleaning common eating areas
Your patient has an airborne transmissible disease. Following this patient’s surgical procedure, your OR would need to reduce the airborne particle contaminants by remaining unoccupied for a specific period of time without an aerosolizing source.
Which of the following is considered to be an airborne transmissible disease?
tuberculosis
____ is the removal of pathogenic and other microorganisms
from surfaces by using chemical or physical means
disinfection
Which of the following is the best method to use to complete turnover cleaning?
a standardized method
Which type of endoscope allows the surgeon to perform surgery by placing instruments into the channels of the endoscope?
Operative
what type of endoscope allows the surgeon to perform surgery by placing instruments into the channels of the endoscope.
OPERATIVE ENDOSCOPES
Endoscopes may be flexible, semi-rigid, or rigid. Diagnostic endoscopes are for visualization only and do NOT have operating channels
What action should the RN circulator take to decrease the risk for injury from a heated fiberoptic light cable?
Place the light source in stand-by mode when it is not being used.
During surgery, the scrub person notices a defect in the insulation coating of one of the instruments. What should they do?
Ask the RN circulator to obtain a replacement instrument.
What type of instrument does the surgeon use for laparoscopic surgery to create one or more orifices in a patient’s body to access the operative site?
trocar
What is the purpose of filling the peritoneal cavity with carbon dioxide gas before performing a laparoscopy?
To create a working space and help visualize the surgical site
Insufflation of gas during endoscopic surgery increases intra-abdominal pressure, and open blood vessels may allow the gas to enter the circulatory system. This places a patient at risk for a ____
gas embolism
Which law mandates that a hospital must report all incidents resulting from
defective equipment or user error that contribute to a patient’s death or serious
injury?
Safe Medical Device Act of 1990
During surgery, the scrub person can remove gross soil and decrease the formation of biofilm on an endoscope by wiping the outside of the instrument and flushing the channels with ___
sterile water
Protective eyewear worn during laser surgery
must be specific to the laser, its wavelength, and its optical density.
Which type of irrigation fluid is typically used for endoscopic procedures using monopolar electrosurgery?
Nonelectrolyte fluids
After source elimination and substitution, what is the next highest level of control
to decrease patients’ and team members’ exposure to surgical smoke?
Surgical smoke evacuation
Which component of a robotic surgery system is a part of the sterile field?
patient cart
Where should the dispersive pad for the electrosurgical unit be placed
on the patient?
Close to the surgical site over a large well-perfused muscle
Which of the following practices may increase the risk for fire during
surgery?
The electrosurgical pencil is lying on the drapes close to the surgeon’s hand.
Which of the following is an example of ionizing radiation therapy?
X-ray
Which of the following is an example of non-ionizing radiation therapy?
Laser
Occupational exposure to radiation can be reduced by following
the principles of time,
distance, and shielding.
What resource should be available to the surgical team when questions arise on
how to safely use surgical equipment?
The manufacturer’s instructions for use
A patient who is experiencing severe pain, a lack of sensation, edema,
vascular compromise, and restricted movement in the extremity after
the use of a pneumatic tourniquet is most likely exhibiting the clinical
manifestations of
compartment syndrome.
A “no-fly zone” in a hybrid OR designates an area ____
in which imaging equipment can be used safelyluring surgery.
During surgery, the surgeon verbally orders a medication they want to administer to the patient at the sterile field.
What should the perioperative RN do FIRST to decrease the risk of a communication error?
Read back the order
Which US law guarantees the privacy of individuals receiving health care services and the confidentiality of their health information?
HIPPA
Which statement about standing orders/preprinted orders is TRUE?
Surgeons should review their standing orders/preprinted orders for accuracy.
What is recommended if a correction is required on a paper health care record?
Follow your facility’s policies for corrections.
A benefit of including the Perioperative Nursing Data Set in a perioperative documentation format is that it ____
describes patient care using standardized and unambiguous terms
A patient’s neighbor calls into the OR while surgery is in process and asks,
“How is my friend? Will she be okay?”
What is the BEST response?
“I cannot give you any information.
Lawsuits may be derived from failure to
follow standards of care.
assess and monitor the patient.
document accurately.
All of the above
Documentation can be used to
align service with reimbursgment.
Management of potential loss of patient care data should be part of:
EHR downtime protocols.
Which of the following is NOT a risk reduction strategy?
Limiting documentation to a major episode in the patient’s care
An organization with a culture of safety
changes care delivery as a result of an error.
AORN advocates for patient and worker safety through the Guidelines for Perioperative Practice and
position statements.
tool kits.
Mission, Vision, and Values statements.
All of the above.
The 2010 Future of Nursing report outlined four key messages. Which of the statements below is NOT one of them?
Data collection is necessary and adequate.
The Surgical Safety Checklist was an initiative of
WHO
Surgical site marking is a regulatory requirement. Which of the following statements about surgical site marking is TRUE?
The patient should be identified prior to site marking.
Organizational elements of a culture of safety include
consistent and safe delivery of services.
In November 1999, the Institute of Medicine (IOM), now the National Academy of Medicine (NAMI), published the landmark report To Err is Human: Building a Safer Health System” and reported
To prevent errors, a safer system needs to be designed.
When an error occurs, the system needs to be examined.
Standardization of process
All of the above.
Which of the following is NOT a skill-based behavior error?
The nurse fails to respond to a device alarm.
_____ is a situational factor error.
A lack of attention
Which of the following publishes regulatory requirements to which facilities and health care workers must adhere?
Centers for Medicare & Medicaid Services
Topical thrombin should never ____
be injected intravascularly.
What is the principal enzyme in hemostasis and catalyst to convert fibrinogen to fibrin in the coagulation cascade?
thrombin
Traditional methods of surgical hemostasis include mechanical methods thermal-based energy sources, and
chemical agents (ie, pharmaceuticals).
Using suture to close a wound is a ____
method to achieve surgical hemostasis.
mechanical
Which medication reverses heparin
protamine
Who should conduct a surgical count with an unlicensed scrub person?
RN circulator
The perioperative RN should anticipate using what type of drain for a trauma patient whose surgery includes treatment of multiple rib fractures?
Chest tubes/chest drainage system
Surgical sponges differ from dressing sponges in that surgical sponges are
radiopaque.
Thrombin is considered a/an ____ agent because it biologically participates in the coagulation cascade.
active
During the closing count, a lap sponge is missing.
What action should the RN circulator take FIRST?
Notify the team the lap sponge is missing.
Which type of drain allows for a free flow of fluids from the wound using gravity only?
penrose drain
Which sterile team member typically administers medication to the patient at or near the incision site during the surgical procedure?
surgeon
A perioperative RN is preparing a heparin flush. Before administration of the medication, the RN should double-check the medication dosage with any of the following team members EXCEPT an
unlicensed team member.
A medication that is accepted onto the sterile field and is not in its original container should be labeled, at a minimum, with the medication name, date, and time accepted, and the
strength and dilution, if diluent is used.
When epinephrine is added to a local anesthetic, its actions include
prolonging the rate of absorption of the local anesthetic.
A medication used in vascular surgery to prevent blood clot formation is
heparin
The last opportunity to detect a medication error to prevent potential harm to the patient occurs prior to
administering medication.
After receiving a verbal order, “I need xylocaine 1% for the local injection” from the surgeon who is scrubbed at the sterile field, the RN circulator should first
read back the order
Which IV medication is indicated for use to decrease intracranial pressure?
mannitol
An RN circulator who dispensed an antibiotic irrigation solution to the scrub
RN at the sterile field should keep the empty medication vials and delivery devices in the OR until the
procedure has completed
Your patient is scheduled for a bariatric gastric bypass procedure, has a body mass index (BMI) of 55, and is Type I diabetic. What ASA classification should you anticipate for your patient?
ASA 3
You are the RN assigned to circulate on an organ recovery procedure on a patient who is determined to be brain dead. What ASA should you anticipate for your patient?
ASA 6
The hand-off process between the intraoperative team and the PACURN requires attention to the post-surgical patient’s condition.
Which of the following elements is NOT correct when considering the hand-off?
Employ the read-back method to confirm patient information.
the ____ is a postanesthesia scoring system to establish postoperative discharge criteria
Aldrete scale
During which phase of care does the perianesthesia nurse focus on preparing the patient for care at home?
phase II
The purpose of the ASA Physical Status Classification System is
to evaluate the surgical risk to the patient.
The initial assessment of the patient entering Phase I consists of the following EXCEPT for
pain
Depending on ___ the patient may bypass Phase I and be transferred directly to Phase II care.
the type of anesthesia the patient received during surgery, their level of pain, and their vital signs,
The ASPAN standards have delineated levels of care for postanesthesia care.
According to the standards, what is the most important staffing consideration in all perianesthesia departments?
patient acuity
Initial PACU placement may include either Phase I or Phase II. Which of the following is one of the determining factors for unit placement for the patient directlv out of surgery?
comorbid conditions
Which of the following is a negative consequence of a specimen error?
potential litigation
When transferring the specimen off of the sterile field, the scrub person should
confirm with the RN circulator that the container is large enough for the specimen.
It is necessary for specimen containers to be
leak-proof.
puncture resistant.
large enough to contain the specimen and preservative.
all of the above
What patient harm may occur due to a specimen management error?
extended length of stay
How are bullets handled during a procedure?
Grasped with a metal instrument with protective rubber shods and placed in a non-metal basin
Why would a patient’s medical device be removed?
Discomfort
Manufacturer recall
Infection
All the above
What is the appropriate procedure for returning an implant to the manufacturer?
Follow the manufacturer’s instructions
If the facility policy and procedure does not describe steps for handling an infectious specimen, who would you call?
Pathology department
To decrease the possibility of specimen compromise, the scrub person should
cover and label the specimen.
An incomplete, inaccurate, or delayed diagnosis can have devastating consequences for the patient. What is a negative outcome of specimen mismanagement that can have a direct impact on any member of the surgical team?
Exposure to blood and other potentially infectious materials
Which of the following features is common to delayed primary closure?
The wound is cleaned, debrided, and packed for eventual skin approximation.
Wound healing is influenced by numerous intrinsic and extrinsic factors.
Which of the following could place stress on a fresh postoperative wound?
Vomiting, coughing, edema
Which is an example of a biologic wound debridement?
Sterile maggot application
What is the main reason for the use of negative pressure wound therapy?
To reduce edematous bacterial load and initiate wound contracture and healing
What is a disadvantage of a drain?
It provides an entry for pathogenic microorganisms.
Which of the following options describes a Class II surgical wound?
The respiratory, gastrointestinal tract, or genitourinary tract is entered under controlled S circumstances.
A stitch that is separate and tied independently of other stitches is called a(an)
interrupted stitch.
In addition to sutures, the skin can be closed by using ___
staples.
adhesive.
wound strips.
all of the above.
Which of the following materials are used in the composition of non absorbable sutures?
Cotton
Metal
Linen
All of the above
Coefficient of friction is an element of which suture material characteristic?
handling
