SURGICAL PATIENT MANAGMENT TEST BANK

Question 1

Which of the following procedures for obtaining an informed consent form is appropriate?

The patient is asked to sign the consent form after the surgeon has explained the procedure

The SFA is ultimately responsible for obtaining the signed consent form

The patient is asked to read the entire consent form after signing it

The consent form is witnessed by one member of the patient’s family

Answer 1

The patient is asked to sign the consent form after the surgeon has explained the procedure

Question 2

Which of the following are reasons for keeping the OR at a relative humidity level of between 50-55%?

Reduced risk of infection
Lower levels of patient discomfort
Minimization of static electricity
Depressed waste anesthesia gas

1 and 3

1 and 4

2 and 3

2 and 4

Answer 2

1 and 3

Question 3

An obese, malnourished patient who presents for surgery is at higher risk for:

MH

Postoperative hypothermia

Postoperative hyperkalemia

Wound infection

Answer 3

wound infection

Question 4

Which of the following organisms normally found on skin can cause wound infections?

Bacillus botulinum

Staphylococcus aureus

Diplococcus pneumoniae

Candida albicans

Answer 4

Staphylococcus aureus

Question 5

Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained surgical items (RSIs). What new and evolving risk reduction strategy could prevent RSIs and frustrating, time-consuming miscount adventures at the end of these procedures?
a. Performing radiologic surveillance on all conversion procedures at closure
b. Creating precounted laparotomy sets with only the few necessary instruments
c. Counting all instruments including a laparotomy set before the laparoscopy
d. Replacing or tagging sponges and laparotomy instruments with radiofrequency identification (RFID) chips

Answer 5

Replacing or tagging sponges and laparotomy instruments with radiofrequency identification (RFID) chips

Question 6

A patient was positioned, prepped, and draped following general endotracheal anesthesia induction. The team assembled to perform the time-out as described in the WHO surgical checklist. Successful employment of the time-out can only be ensured when:
a. perioperative services have a physician champion and surgeon buy-in.
b. the checklist is committed to memory by all team members.
c. the time-out is initiated by the surgeon.
d. each member of the team has an equal role and voice.

Answer 6

each member of the team has an equal role and voice

Question 7

A patient was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled vaginal-assisted laparoscopic hysterectomy. She demonstrated and verbalized that she understood the procedure, risks, expected outcome, complications, and procedural process. Before she signed the consent form, she informed the surgeon that she did not want any medical students or surgical residents performing any parts of the procedure other than assisting and did not want any photographs of her body taken. The surgeon agreed, and she crossed out those portions of the form and initialed them before she signed. The patient was exercising her:
a. autonomy to protect herself from negligence and malpractice.
b. hope that everyone would honor the Health Insurance Portability and Accountability Act (HIPAA).
c. understanding and rights under the Patient Self-Determination Act (PSDA).
d. right to informed consent.

Answer 7

right to informed consent

Question 8

The Joint Commission (TJC) designates sentinel events as unexpected occurrences involving death or risk of serious physical or psychologic injury. In 2003, TJC mandated the Universal Protocol to address perioperative sentinel events. This protocol includes:
a. improving the safety of using medications.
b. reporting critical results of tests in a timely manner.
c. performing a preprocedure verification process.
d. establishing alarm system safety as a priority.

Answer 8

performing a preprocedure verification process.

Question 9

Governmental and professional agencies and organizations, whether voluntary or involuntary, have a significant influence on patient safety policies in the healthcare setting. Select the agency or organization statement that presents a true reflection of its focus or purpose.
a. Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics
b. World Health Organization (WHO): United Nations (UN)–based and supported authority on health throughout most of the world
c. The Joint Commission (TJC): Nonvoluntary bureau that tests healthcare institutions against evidence-based elements of performance
d. American Society of Anesthesiologists (ASA): Professional organization of anesthesia providers and technologists

Answer 9

American Society of Anesthesiologists (ASA): Professional organization of anesthesia providers and technologists

Question 10

When unexpected events occur that have, or could have, compromised patient safety, a systematic investigatory process takes place. Significant information is gained through this meticulous exploration. The primary motive for carrying out a root cause analysis is to:
a. establish cause and trends based on who was involved.
b. find out what needs to take place to prevent a recurrence of the event.
c. determine precisely what happened and why.
d. uncover factors that contributed to the environment and the event.

Answer 10

find out what needs to take place to preven a recurrence of the event

Question 11

Proper handling of specimens is crucial for patient safety. What is the most serious negative outcome that could occur as a result of the loss, mislabeling or mishandling of a surgical specimen?
a. The patient might be unsatisfied with the treatment received.
b. The medical facility’s reputation could be damaged.
c. The medical facility could be sued for negligence.
d. The patient’s condition could be misdiagnosed.

Answer 11

The patient’s condition could be misdiagnosed.

Question 12

Fires and explosions in the perioperative setting require three components, described as the “fire triangle.” The element of the triangle the perioperative nurse has the most control over is:
a. the fuel.
b. the ignition sources.
c. the oxidizer.
d. static electricity.

Answer 12

the fuel

Question 13

If a routine surgical procedure was performed without consent, what action would be committed?

Assault

Battery

Malpractice

Liability

Answer 13

battery

Question 14

Informed consent is both a requirement and a patient right. The perioperative nurse’s responsibility in terms of informed consent is to:
a. report to the physician any doubts or concerns regarding the patients understanding.
b. obtain the informed consent.
c. ensure the consent is completed properly to prevent legal liability.
d. answer questions related to risks and benefits.

Answer 14

report to the physician any doubts or concerns regarding the patients understanding.

Question 15

Which of the following situations requires informed consent from the patient/family?
a. Organ procurement
b. Starting an IV
c. Discharge to home
d. Emergent surgery

Answer 15

Organ procurement

Question 16

The OR is a danger-prone area for both patients and staff. Providing a safe environment of care for the patient involves identifying, mitigating, and managing the hazards inherent in surgical care. Choose the answer below that completes the blanks in this sentence: the risk of the surgical hazard of _________________ can be mitigated through _______________________.
a. wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists
b. electrical and thermal burns; alcohol-free prep solution
c. surgical site infection; flash sterilization
d. surgical airway fire; fire extinguishers in every OR

Answer 16

wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists

Question 17

Proper care and handling of surgical specimens is imperative for correct diagnosis, treatment, and prognosis planning of the patient. Select the response that best reflects correct specimen care and handling.
a. Neutralize formalin/formaldehyde spills with glycerin sulfate, and call the hazmat team.
b. Label consecutive specimens in alphabetical order for laboratory efficiency.
c. Send all specimens to the laboratory together as one pickup, including frozen sections.
d. Avoid placing specimens for frozen section in formalin.

Answer 17

Avoid placing specimens for frozen section in formalin.

Question 18

What type of biopsy is performed during a flexible endoscopic procedure?

Incisional biopsy

Needle biopsy

Brush biopsy

Fine-needle aspiration

Answer 18

brush biopsy

Question 19

If a Kelly clamp is left in a patient who underwent a cholecystectomy, which of the following legal charges can be filed?

Answer 19

The thing speaks for itself

“res ipsa loquitor”

Question 20

A female patient with end-stage pancreatic cancer was admitted from hospice for a celiac plexus block to treat intractable pain. She wanted to be able to complete “getting her things in order” and saying good-bye to her friends and family while enjoying her last days pain-free. The patient insisted that her Do Not Resuscitate (DNR) status NOT be rescinded. She was conscious and competent and knew what was best for herself. The patient was taking full advantage of what provision for her care?

Answer 20

PSDA and advance directives

Question 21

A specimen obtained for frozen section is generally removed from the sterile field intraoperatively because it:

Answer 21

should go to the lab immediately

Question 22

Surgical patients are at risk for development of pressure injuries due to extrinsic factors such as length of surgery and intrinsic factors such as co-morbidities and age. The most important factor in prevention of such pressure injuries is:

Answer 22

Pre-op assessment and skin evaluation

Question 23

Which of the following are the MOST important consideration when preventing wound infection in the surgical patient?

Pathogen transmittal
Portal of entry into the susceptible host
Anesthetic options for the patient’s operative process
Invasion of the susceptible host

Answer 23

pathogen transmittal , portal of entry into the susceptible host, invasion of the susceptible host

Question 24

Which nonprofit organization improves patient care through applied research into effectiveness and safety of devices, drugs, procedures, and processes?

Answer 24

ECRI

Question 25

Which of the following are procaryotic?

Molds

Protozoa

Bacteria

Plants

Answer 25

bacteria

Question 26

Sterilization prepares instruments to be used within, and on, sterile tissues. It kills vegetative microorganisms and endospores within a probability of 106. The process of decontamination prepares instruments to be:
a. free of bioburden.
b. clean at a high level of disinfection.
c. handled without PPEs.
d. Used on nonsterile ear, nose, and throat (ENT) procedures.

Answer 26

free of bioburden

Question 27

Herpes simplex is commonly called:

Cold score

Shingles

Smallpox

Chicken pox

Answer 27

cold sore

Question 28

Qualities of an effective packaging material must include several key characteristics. Select the three most important qualities.
a. Good steam penetration and removal, good microbial barrier, resists tearing
b. Stackable in sterilizer/storage shelf, comparable cost, low toxicity
c. Cost, good microbial barrier, lint-free writable surface
d. Aseptic presentation, event-related sterility indicators, writable surface

Answer 28

Good steam penetration and removal, good microbial barrier, resists tearing

Question 29

Both sterilization and disinfection describe the elimination of microbial contamination and the achievement of a state suitable for patient care in select situations. However, disinfection differs from sterilization in that the process for disinfection uses:
a. hospital-grade disinfectant/sterilants.
b. contact precautions as well as universal precautions.
c. semi critical medical devices used for ambulatory procedures.
d. agents to disinfect and eliminate most, if not all, pathogenic microbes.

Answer 29

hospital grade disinfectant/sterilants

Question 30

The accumulation of dust, debris, and other microbial contaminants is a potential source of SSIs. Guidance for cleaning processes in the perioperative area states that perioperative staff should:
a. remove trash before the patient leaves the room.
b. use enhanced cleaning procedures in the presence of multidrug-resistant organisms.
c. use alcohol to disinfect large environmental surfaces.
d. clean walls after every patient.

Answer 30

use enhanced cleaning procedures in the presence of multidrug-resistant organisms.

Question 31

An integrator is a multiparameter indicator designed to measure:
a. time and pressure.
b. sterility and pressure.
c. temperature, time, and presence of steam.
d. pressure, steam, and temperature.

Answer 31

temperature, time, and presence of steam.

Question 32

A 55-year-old woman undergoes laparotomy for small bowel obstruction. During lysis of adhesions, an enterotomy is made in the obstructed, but viable, bowel, and a large amount of fecal-looking bowel contents are spilled into the abdomen. The incision would now be considered what kind of wound?

Clean contaminated

Secondary

Contaminated

Clean

Answer 32

contaminated

Question 33

Clostridium perfringens is associated with which clinical condition?

Gas gangrene

Toxic shock syndrome

Botulism

Anthrax

Answer 33

gas gangrene

Question 34

The Centers for Disease Control and Prevention (CDC) have identified pathogens that could pose a threat to national and world security and safety through bioterrorism. Select the four most probable agents that could be used to cause mass transmission, mortality, panic, and social disruption.
a. Smallpox, monkeypox, avian influenza, anthrax
b. Smallpox, plague, botulism, tularemia
c. Anthrax, tuberculosis, Clostridium difficile, tularemia
d. Anthrax, H1N1 influenza, botulism, smallpox

Answer 34

Smallpox, plague, botulism, tularemia

Question 35

The evening before the procedure was scheduled, the central sterile processing department received two complete sets of an orthopedic spine fusion system that contained titanium-implantable instrumentation, four flexible coated retractor blades, and an unsterilized internal paper inventory form. The sterilization instructions provided by the vendor representative recommended steam sterilization for the implants, but stated that the flexible coated blade retractors could not be exposed to temperatures higher than 220° F. The appropriate sterilization option for these instruments and devices would be:
a. hydrogen peroxide gas plasma sterilization for everything.
b. steam sterilization for the implant sets, hydrogen peroxide gas plasma for the retractors and paper inventory form, wrapped separately.
c. steam sterilization for the implant sets and paper inventory form, hydrogen peroxide gas plasma for the retractors, wrapped separately.
d. steam sterilization for everything with a shortened dry time.

Answer 35

hydrogen peroxide gas plasma sterilization for everything.

Question 36

While antibiotics have been credited with saving lives, misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs). Select the antibiotic application that has evidence to support it as a best practice and not, potentially, a misuse of antibiotics.
a. Tobramycin and methylmethacrylate bead implants into deep orthopedic incisions at risk for osteomyelitis.
b. Antibiotics should be administered 1 hour prior to surgical incision, within 2 hours for vancomycin or fluorquinolones for every procedure with an incision or entered body system.
c. Vancomycin paste applied to cut edges of the sternum in cardiac surgery.
d. Bacitracin ointment on a clean subcuticular sutured incision as part of the dressing.

Answer 36

Antibiotics should be administered 1 hour prior to surgical incision, within 2 hours for vancomycin or fluorquinolones for every procedure with an incision or entered body system.

Question 37

Which of the following microorganisms is responsible for causing postoperative wound edge erythema and rebound tenderness?

S. aureus

Clostridium

Group B streptococci

S. epidermis

Answer 37

Group B streptococci

Question 38

The final step, after decontamination and before sterilization, is the prep, pack, and wrap process. The sterile processing technologist has taken the laparotomy set from the washer/decontaminator to prepare for sterilization. Select the most appropriate order that the instrument set must travel before reaching the steam sterilizer.
a. Inspect, unlock locked clamps, count and string instruments, place indicators, wrap and tape
b. Inspect, unlock locked clamps, string instruments, inventory, replace missing items, wrap
c. Inspect, inventory against list, assemble, place integrators, wrap and tape
d. Air-dry, inventory, inspect, lubricate, assemble and string instruments, wrap and tape

Answer 38

Inspect, inventory against list, assemble, place integrators, wrap and tape

Question 39

Which of the following techniques demonstrate a proven benefit in the prevention of postoperative wound infections?

Administering appropriate antibiotics within 1 hour of incision time
Maintaining suitable antibiotic coverage fro 48-72 hours postoperatively
Irrigating the wound with normal saline
Irrigating the wound with sterile water

1 and 3

1 and 4

2 and 3

2 and 4

Answer 39

1 and 3

Question 40

Phagocytosis by the WBCs is an example of the body’s:

First line of defense

Second line of defense

Third line of defense

Fourth line of defense

Answer 40

second line of defense

Question 41

A chemical disinfecting agent used in the OR for cleaning furniture and floors which is bactericidal, fungicidal, and tuberculocidal is a/an:

An antiseptic

A disinfectant

A detergent

Ultraviolet irradiation

Answer 41

a disinfectant

Question 42

Staphylococcus aureus would most likely be transmitted by:

Urine

Feces

Nose and mouth

Sex organs

Question 43

A common pathogen typically associated with decubitus ulcers is Staphyloccous:

Proteus

Epidermidis

Pyogenes

Aureus

Answer 43

Aureus

Question 44

With the production of more steam in the sterilizer chamber, the pressure increases as well. The steam should contain little or no entrapped liquid water. Steam quality is the term that describes the amount of water mixed with the steam. The constitution of high-quality steam would be measured by:
a. 55% or greater.
b. 70% or greater.
c. less than 1% of the mixture is liquid water.
d. less than 3% of the mixture is liquid water.

Answer 44

less than 3% of the mixture is liquid water.

Question 45

The mechanism of lethality (microbial death) with steam sterilization is achieved with this event:
a. denaturation and coagulation of enzyme proteins.
b. saturated vaporization of the microbial cytoplasm.
c. time, temperature, and steam pressure.
d. reduced and limited mitosis within the bioburden.

Answer 45

denaturation and coagulation of enzyme proteins.

Question 46

Within a steam sterilizer, at a temperature of 100° C (212° F), the water condensation and the steam are the same temperature. This scientific phenomenon is called ___________________ and will __________________.
a. saturated steam; kill microbes at 106
b. steam distribution; promote microbial kill
c. sterilization; kill all microorganisms to 106
d. steam saturation; not kill microorganisms

Answer 46

steam saturation; not kill microorganisms

Question 47

The gram stain differentiates:

Viruses

Bacteria

Helminths

Prions

Answer 47

bacteria

Question 48

A swab of a fluid collection from an edematous, red, and suppurative postoperative wound is sent to the microbiology lab for culture, sensitivity, and Gram stain. The surgeon expects that the result will show a gram-positive coccus. This Gram stain designation is based on the:
a. physical and chemical properties of the cell wall.
b. ability to cause plasma to coagulate and form a microscopic clot.
c. formation of aerobic clustered spheres.
d. appearance of a thicker and brownish-colored cell wall.

Answer 48

physical and chemical properties of the cell wall.

Question 49

Which of the following are the MOST important considerations when preventing wound infection in the surgical patient?

Pathogen transmittal
Portal of entry into the susceptible host
Anesthetic options for the patient’s operative process
invasion of the susceptible host

1, 2, and 3

1, 2, and 4

1, 3, and 4

2, 3, and 4

Answer 49

1, 2 and 4

Question 50

Using Standard Precautions, which of the following is proper procedure when handling contaminated items?

Removing scalpel blades by hand

Disposing suctioned body fluids into a drain connected to a sanitary sewer

Placing sharps in an emesis basin for disposal into a biohazard trash bag

Discarding used needles by hand

Answer 50

Disposing suctioned body fluids into a drain connected to a sanitary sewer

Question 51

Which of the following is a potential physiological response when lowering a patient’s legs from the lithotomy position?

Hypotension

Hypertension

Bradycardia

Tachypnea

Answer 51

hypotension

Question 52

All of the following are requirements of the Kraske position EXCEPT:

Patient is prone with hips over the break of the table

A pillow is placed under lower legs and ankles

A padded knee strap is applied two inches above knees

Arms are tucked in at sides

Answer 52

arms are tucked at sides

Question 53

A 14-year-old patient with marked scoliosis is in prone position with gel bolster rolls, gel pads, and pillows for a spinal fusion. Before the skin prep is begun, the perioperative nurse should check the positioning for pressure areas on the:
a. forehead, toes, and knees.
b. genitals, breasts, toes, eyes, and all areas in contact with the OR bed or accessories.
c. genitals, knees, toes, and eyes.
d. breasts, forehead, and knees.

Answer 53

genitals, breasts, toes, eyes, and all areas in contact with the OR bed or accessories.

Question 54

Why is the table straightened before closing a kidney incision?

To facilitate easier respirations

To create better approximation of tissues

To facilitate better circulation

To prevent nerve damage

Answer 54

To create better approximation of tissues

Question 55

The use of a footboard for the patient in the reverse Trendelenburg position may prevent the patient from sliding downward, which can cause ______________.
a. shearing injury
b. vascular shift
c. hypotension
d. compartmental syndrome

Answer 55

shearing injury

Question 56

In positioning for laminectomy, rolls or bolsters are placed:

Horizontally, one under the chest and one under the thighs

Longitudinally to support the chest from axilla to hip

Longitudinally to support the chest from sternum to hip

Below the knees

Answer 56

Longitudinally to support the chest from axilla to hip

Question 57

Recent studies on the relevance of the Braden pressure ulcer risk scale in the perioperative and critical care setting are inconclusive. In which perioperative setting would the Braden scale be most predictive as a baseline metric?
a. Postoperative
b. Preoperative
c. Ambulatory
d. Intraoperative

Answer 57

Preoperative ?

Question 58

The ________ position, or foot-down position, is used when the surgeon requires unobstructed access to the upper abdominal cavity and lower esophagus.
a. Trendelenburg
b. Fowler’s
c. reverse Trendelenburg
d. semi-Fowler’s

Answer 58

reverse Trendelenburg

Question 59

While tucking the arms at the sides of the patient in supine position offers comfort, safety, and easy access to the patient by the scrubbed team, improper positioning, and securing of the arms can result in significant injury. Injury can be avoided by tucking the draw sheet ________ the arm and under the _________.
a. under; mattress
b. around; OR bed rail
c. around; patient’s body
d. over; mattress

Answer 59

around; patient’s body

Question 60

In which of the following circumstances could the patient sustain an injury to the pudendal nerves?

Positioned on the fracture table

Placed in lateral chest position

Placed in lithotomy position

Positioned on the urological table

Answer 60

Positioned on the fracture table

Question 61

The lithotomy position requires each of the following EXCEPT:

Patient’s buttocks rest along the break between the body and leg sections of the OR table

Stirrups are at equal height on both sides of the OR table

Stirrups are at the appropriate height for the length of the patient’s legs to maintain symmetry

Each leg is raised slowly and gently as it is grasped by the toes

Answer 61

Each leg is raised slowly and gently as it is grasped by the toes

Question 62

Moving the arms away from the body is called _______________.
a. adduction
b. abduction
c. hyperflexion
d. hyperextension

Answer 62

abduction

Question 63

Which position would be used for a patient in hypovolemic shock?

Modified Trendelenburg

Reverse Trendelenburg

Supine

Dorsal recumbent

Answer 63

Modified Trendelenburg

Question 64

While basic positioning prevention strategies apply to all robotic-assisted procedures, in steep Trendelenburg with severe head-down position, strategies to prevent the patient from slipping toward the head of the OR bed must be considered. These strategies include:
a. use of beanbag positioning systems.
b. tucking the patient’s arms in anatomic alliance.
c. avoidance of dorsal extension.
d. use of protectors on the elbows and under the arms.

Answer 64

use of beanbag positioning systems.

Question 65

A 92-year-old frail female nursing home patient was admitted for dehydration, anemia, and respiratory symptoms. She has type 2 diabetes and low albumin levels, is underweight, and continues to smoke cigarettes. The patient is on complete bed rest in a hospital bed with an alternating pressure mattress overlay. She is not able to turn herself in bed and must be assisted to change position. Based on this description of the patient, which factor classification dominates her vulnerability and risk for injury?
a. Intrinsic factors
b. Bed rest precaution factors
c. Extrinsic factors
d. Shearing force factors

Answer 65

Intrinsic factors

Question 66

The surgical team may begin positioning the patient only after the ________ gives his or her permission.
a. perioperative nurse
b. surgical technologist
c. surgeon
d. anesthesia care provider

Answer 66

anesthesia care provider

Question 67

Select the positioning device and accessory commonly used for neurosurgical procedures.
a. Crutchfield cranial tongs
b. Cushing head stabilizer
c. Cavitron ultrasonic surgical aspirator (CUSA) head positioner
d. Mayfield head positioner

Answer 67

Mayfield head positioner

Question 68

The correct arm placement when positioning a patient supine with arms extended on armboards is:

Armboards extended > 90° with palms facing up

Armboards extended < 90º with palms facing down

Armboards extended > 90º with palms facing down

Armboards extended < 90º with palms facing up

Answer 68

Armboards extended < 90º with palms facing up

Question 69

Putting a patient into Trendelenberg position has effect of:

Decreasing blood flow to the brain

Decreasing blood flow to the coronary arteries

Increasing blood flow to the brain

Increasing blood flow to the coronary arteries

Answer 69

Increasing blood flow to the brain

Question 70

The force of integumentary injuries that results from the skin remaining stationary while the underlying tissues shift is known as:

Pressure

Shearing

Friction

Maceration

Answer 70

Shearing

Question 71

During lateral positioning a:

Pillow is placed between the legs

Sandbags is placed between the knees

Rolled towel is placed under the bottom leg

Sheet is folded flat between the legs

Answer 71

Pillow is placed between the legs

Question 72

Ulnar nerve damage could result from:

Improper placement of the legs in stirrups

External rotation of the shoulder

Hyperextension of the neck

Placement of an elbow on unpadded table

Answer 72

Placement of an elbow on unpadded table

Question 73

Select the positioning devices and accessories commonly used for bariatric surgery.
a. Air-filled, roller, or slider transfer device
b. Abduction pillow
c. Elevated padded heel supports with footboard
d. Lower body ramp

Answer 73

Air-filled, roller, or slider transfer device

Question 74

The proper placement of the legs for a patient in the lateral position is:

Both legs straight

Both legs flexed

Lower leg flexed, upper leg straight

Lower leg straight, upper leg flexed

Answer 74

Lower leg flexed, upper leg straight

Question 75

While Fowler’s position offers the best respiratory excursion for the patient, the patient is at higher risk for ____________________ because of dependent pooling in the hips and legs.
a. diminished tidal volume
b. sacral ischemia
c. compartment syndrome
d. venous thromboembolism (VTE)

Answer 75

venous thromboembolism (VTE)

Question 76

Stirrups that are inadequately padded or improperly placed can cause pressure on the:

Sciatic nerve

Peroneal nerve

Ulnar nerve

Gluteal nerve

Answer 76

Peroneal nerve

Question 77

Select three basic criteria requirements that an OR bed mattress must meet.
a. Electrically conductive, latex-free, black
b. Nonflammable, compatible with warming/cooling devices, black
c. Nonallergenic, pressure-reduction capabilities, radiolucent
d. Fluid resistant, bactericidal, pressure-reduction capabilities

Answer 77

Nonallergenic, pressure-reduction capabilities, radiolucent

Question 78

A frail and thin 91-lb, 83-year-old woman is scheduled for a right pneumonectomy for non–small cell lung cancer. She will be positioned in left lateral position for her procedure. Based on the perioperative nurse’s preoperative assessment, identify three position-related nursing diagnoses for this procedure.
a. Risk for Perioperative Hypothermia, Risk for Impaired Skin Integrity; Impaired Comfort
b. Risk for Perioperative Hypothermia; Risk for Impaired Skin integrity; Risk for Falls
c. Risk for Impaired Skin Integrity; Risk for Falls; Impaired Comfort
d. Risk for Falls; Impaired Comfort; Impaired Physical Mobility

Answer 78

Risk for Perioperative Hypothermia; Risk for Impaired Skin integrity; Risk for Falls

Question 79

The lateral kidney position allows approach to the retroperitoneal area of the flank. To render the kidney region readily accessible, the _______________ is raised, and the bed flexed so that the area between the twelfth rib and the iliac crest is elevated. Compression of the ____________ can occur when the flank is raised too high.
a. head; vena cava
b. kidney bridge; renal artery
c. foot; dependent ureter
d. kidney bridge; vena cava

Answer 79

kidney bridge; vena cava

Question 80

Lateral, lateral chest, and lateral kidney positions all place pressure on structures of the dependent side: ears, shoulder, ribs, hips, greater femoral head, knees, and ankles. The potential for injury to the patient is significant, based on these pressure areas. Which resultant injury or harm could be related to these lateral positions?
a. Diminished lung capacity of nondependent lung
b. Decreased blood return to the right side of the heart
c. Scalene node rupture
d. Celiac plexus injury

Answer 80

Decreased blood return to the right side of the heart ?

Question 81

A 325-lb male is scheduled for a 6-hour abdominal surgery. While assessing the patient in the preoperative holding area, the perioperative nurse is concerned about the risk for pressure injury because of the weight of the patient’s body pressing against the surface of the operating room (OR) bed for a long surgery. Which of these other factors may also produce pressure?
a. Full-leg sequential compression wraps on both legs throughout the entire surgery.
b. A self-retaining retractor post clamped to the OR bed rail and tightened against the patient’s side.
c. A Deaver retractor and two right angle clamps placed on the patient’s thighs when draped.
d. The scrub person leaning with his or her forearm on the Mayo stand.

Answer 81

A self-retaining retractor post clamped to the OR bed rail and tightened against the patient’s side.

Question 82

The most appropriate devices to prevent skin pressure ulcers and deep tissue injury in the OR are:

Sand bags

Gel pads

Towels

Sheets

Answer 82

Gel pads

Question 83

A “foot drop” results from insufficiency of the extensor muscles in the foot, and may be caused by lumbar disc herniation (damage to a nerve root in the lumbar spine), or damage to/compression of the __________ nerve as it courses superficial to the fibular head.

Peroneal

Pudendal

Posterior tibial

Phrenic

Answer 83

Peroneal

Question 84

A 325-lb male is undergoing a 6-hour abdominal surgery. While asleep and intubated, the surgeon requests the patient to be placed in lithotomy position for a sigmoidoscopy before the open procedure. The team of five nonscrubbed persons lifts the patient with the lift sheet, slides the patient down toward the foot of the OR bed, and places him into position. After the sigmoidoscopy, the perioperative nurse has the team roll the patient to his side for a skin assessment of his back before he is repositioned supine. What injury is the perioperative nurse concerned that she might see?
a. Side-to-side striations across his back and buttocks from the lifting sheet
b. A peripheral nerve injury related to lithotomy position
c. A shearing force injury to the tissue from having been slid into position
d. Pressure alopecia

Answer 84

A shearing force injury to the tissue from having been slid into position

Question 85

When moving a patient from lithotomy position:

Lower legs together quickly

Lower legs together slowly

Lower each leg separately and slowly

Lower each leg separately and quickly

Answer 85

Lower legs together slowly

Question 86

A safety strap should be placed __________________ between the patient and the strap.
a. directly on the patient’s skin with two finger’s space
b. directly on the patient’s skin with three finger’s space
c. on top of a blanket or sheet with three finger’s space
d. on top of the blanket or sheet with four finger’s space

Answer 86

on top of a blanket or sheet with three finger’s space

Question 87

Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral, and _____________ nerves, which can result in injury from ______________.
a. iliopsoas; hyperabduction and contact with candy cane stirrup pole
b. patellar; deep tissue injury from contact pressure with underside of Mayo stand
c. common peroneal; full leg pneumatic compression sleeves
d. tibial; hyperextension

Answer 87

iliopsoas; hyperabduction and contact with candy cane stirrup pole

Question 88

In the lateral chest position, a sandbag or padding is placed under the chest at the axillary level to:

Aids in position atability

Prevents pressure on the lower arm

Promote proper body alignment

Add warmth for the patient

Answer 88

Prevents pressure on the lower arm

Question 89

Clean Operations

Answer 89

Endogenous contamination is minimal;
wound should not become infected

Nontraumatic, uninfected, no inflammation. No break in aseptic technique

Question 90

Clean-Contaminated Operations

Answer 90

Bacterial contamination may have
occurred from endogenous sources

Respiratory, alimentary, or GU tract entered without significant spillage

Question 91

Contaminated Operations

Answer 91

Contamination has occurred

Gross spillage from GI; urine or bile is infected. Fresh, traumatic open wounds; acute, non-purulent inflammation present

Question 92

Dirty and Infected Operations

Answer 92

Infection, devitalized tissue, or microbial contamination is present

Old traumatic wound. Wound is infected; viscera may be perforated

Question 93

An observable, pressure-related alteration of intact skin. It looks like reactive hyperemia but is non-blanchable.

Answer 93

Stage I pressure ulcer:

Question 94

A partial thickness skin-loss involving the epidermis and may include the dermis. This ulcer is superficial and appear as an abrasion, blister, or shallow crater.

Answer 94

Stage II pressure ulcer

Question 95

A full thickness lesion, involving damage or necrosis or subcutaneous tissue that may extend down to, but not through, the underlying fascia. It presents as a deep crater, with or without undermining of adjacent tissue.

Answer 95

Stage III pressure ulcer: