CPSS Midterm Exam 57 Questions with Verified Answers
Useful for allergens and TB testing - CORRECT ANSWER Intradermal
Useful for medication
... [Show More] delivery like insulin or enoxaparin - CORRECT ANSWER Subcutaneous
Useful for higher volume meds and some vaccines - CORRECT ANSWER Intramuscular
a patient with a history of anaphylactic allergy to eggs is a contraindication for what vaccines? - CORRECT ANSWER influenza and yellow fever
slow absorption rate which is effective to diagnose delayed type hypersensitivity (reactions dont develop until 24-48 hours) - CORRECT ANSWER Intradermal
where does optimal absorption for subcutaneous occur? - CORRECT ANSWER lower abdomen, anterior/posterior thigh, upper buttocks, lateral back and lateral upper extremities
fastest absorption
route= deltoid, ventrogluteal, and vastis ateralis - CORRECT ANSWER IM
What is the angle for intradermal injection? - CORRECT ANSWER 15 degrees
what is the angle for subcutaneous injection? - CORRECT ANSWER 45 degree angle
What is the angle for IM injection? - CORRECT ANSWER 90 degree
easier to mold to an extremity, absorbs underlying wound drainage making it desirable splinting material for trauma/post op - CORRECT ANSWER Plaster
popular because of strength, flexibility, light weight, ease of application, fully water resistant once hardened, much smaller exothermic reaction - CORRECT ANSWER fiberglass
for fractures, a ___ replaces a ____ after acute swelling subsides - CORRECT ANSWER cast;splint
pain out of proportion indicates what - CORRECT ANSWER compartment syndrome
Tx for compartment syndrome - CORRECT ANSWER bivalving a cast (split cast down both sides to relieve pressure)
Name some complications of casts - CORRECT ANSWER compartment syndrome, cast dermatitis, pressure sores, nerve injuries, DVT
when casting an injured extremity the immobilization should include what? - CORRECT ANSWER the joints proximal and distal to the injured area
Long term issues related to immobilization - CORRECT ANSWER frozen shoulder
used for hand, distal radius, and distal forearm fractures - CORRECT ANSWER short arm cast
used for fractures of the 4th and 5th phalanges and metacarpals - CORRECT ANSWER short arm gutter splint
used for initial stabilization of humerus fracture - CORRECT ANSWER upper arm sugar tong
if patient is given a sling, how many times should they remove is a day to perform elbow/shoulder ROM? - CORRECT ANSWER 3-4 times
After casting a patient you should instruct them to return to check it in how many days? - CORRECT ANSWER 3-7 days
For cast or splint immobilization of lower leg and ankle, the ankle must be strictly maintained at ___ degrees of ___ to avoid causing an equine gait that results from improper immobilization in a plantar-flexed position - CORRECT ANSWER 90 degrees of flexion
What is the main advantage of a splint? - CORRECT ANSWER it allows for soft tissue swelling during acute phase of injury
material of choice for majority of cast and splint applications, espcially for weight bearing - CORRECT ANSWER fiberglass
should be the minimal number of precautions used when handling ALL patients regardless of their diagnosis or presumed infection status - CORRECT ANSWER standard precautions
What secretions are covered and not covered with standard precautions? - CORRECT ANSWER Blood, semen, vaginal secretions, CSF, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid
Feces, nasal secretions, sputum, sweat, tears, urine, and vomit DO NOT APPLY unless they contain visible blood!!!
What should be worn to avoid potential exposure to infectious agents transmitted by the airborne route? - CORRECT ANSWER N95 masks or higher respirators
skin tension lines; Linear clefts in the skin that indicate the direction of orientation of the underlying collagen fibers - CORRECT ANSWER langer lines
Why do we care about langer lines? - CORRECT ANSWER if the skin if disrupted parallel to long axis of fibers, wound would reapproximate; if wound crosses long axis fibers perpendicular they are disrupted in a manner that causes them to gape open
What should you do for foreign bodies in wounds? - CORRECT ANSWER Foreign bodies may remain a source of repeated infections if not thoroughly removed through irrigation, exploration and extraction or debridement of devitalized and contaminated tissue
wounds less than __ to ___ hours old are considered clean and eligible for primary closure with sutures - CORRECT ANSWER 6-8 hours
All layers are closed, best chance for minimal scarring, usually performed for clean and clean-contaminated wounds - CORRECT ANSWER primary intention
deep layers are closed, superficial are left open to granulate on their own from inside out
-often leaves a wide scar and requires frequent wound care
-prolonged process
-reasons for use include excessive tissue loss and infection - CORRECT ANSWER secondary intention
superficial layers are left open until reassessment on day 4 or 5 after initial closure - CORRECT ANSWER tertiary closure
why do we let something heal in a tertiary way? - CORRECT ANSWER because its extremely contaminated
Suture size for
Scalp
eyelid
foot - CORRECT ANSWER SCALP → 5/0 AND 4/0
EYELID → 6/0 AND 7/0
FOOT → 4/0 AND 3/0
Some wounds can be closed within ___ ____ if the anatomic location is highly vascular (face, neck, scalp) - CORRECT ANSWER 24 hours
When should we consider abx? - CORRECT ANSWER Wounds that are more than 12 hours old at initial presentation, especially on the hands
Human or animal bites (including those caused by patients teeth)
Crush wounds
Heavily contaminated wounds
Wounds involving relatively avascular areas, such as cartilage of ear
Wounds involving joint spaces, tendon or bone
Severe paronychia and felons
Wounds in patients with hx of valvular heart disease
Wounds in immunocompromised patients
Where should you use absorbable sutures? - CORRECT ANSWER mucosal areas such as the oral cavity and tongue
used for deeper wounds (scalp), eliminates dead space - CORRECT ANSWER vertical mattress
useful when there is a flap of tissue or when tension of stitch is to be predominantly on one side - CORRECT ANSWER horizontal mattress
used to close surgical incision or very clean wound - CORRECT ANSWER subcuticular
why do use hair nets, foot covers, etc? - CORRECT ANSWER Complete sterilization of skin is not achievable; therefore utilization of appropriate barriers worn by providers and the use of cleansing agents on patients are essential for preventing infection
why do we scrub even though we wear gloves? - CORRECT ANSWER Help minimize the number of microbes present in the OR and therefore prevent infection
What are the two methods of surgical scrubbing? - CORRECT ANSWER 1. timed or anatomic scrub
- 3-5 minutes; scrub with timers
2. counted or numbered scrub
-allotted number of strokes for each body part
-30 strokes for fingernails
-20 strokes needed for each surface of the fingers, hands, wrists, arms, and elbows
What is sterile and what is not? - CORRECT ANSWER The sterile field consists of the draped patient, scrubbed personnel, and the sterile surgical instruments
If sterility of any person or item is in question → consider it contaminated and remove from sterile field promptly
Gowns are considered sterile in front from shoulder to waist level; sleeves are considered sterile to 2 inches above the elbow
Sterile property, including hands, instruments and the table are considered sterile above table or waist-height only
Non-sterile personnel must remain at least 12 inches away from sterile field
Remain facing sterile field when moving within or around the sterile field to avoid accidental contamination
What is the MC reason to do a lumbar puncture? - CORRECT ANSWER Bacterial meningitis
What else can lumbar punctures diagnose? - CORRECT ANSWER Meningitis, SAH, CNS TB, neurosyphilis, unusual viral infections, guillain-barre, MS, etc
Contraindications to LP - CORRECT ANSWER Patients with signs/symptoms of increased intracranial pressure, esp. Suspected intracranial mass lesions, should have a CT scan before LP
Coagulopathies & thrombocytopenia (hemophilia, leukemia, liver dz, anticoag therapy), local infections over site of LP, surface abnormalities, critical illness or medical instability
AE and risks of LP - CORRECT ANSWER Postdural puncture headache (PDPH) is bilateral, generally occipital and has a throbbing or pressure quality
Back discomfort, infection, nerve damage, herniation into foramen magnum where LP was performed, bleeding, intraspinal epidermoid tumors
How long can a tourniquet safely stay on? - CORRECT ANSWER no longer than 2 minutes
how long should you hold pressure on a wound post venipuncture? - CORRECT ANSWER Pressure should be applied for at least 3-4 minutes, until bleeding stops, or 5+ minutes if patient has been taking anticoagulants
how long do we leave IVs in to reduce risk of infection? - CORRECT ANSWER 72-96 hours
Contraindications to IV - CORRECT ANSWER Extremities with
Significant burns, edema or injury
Cellulitis or significant infection
Impaired circulation (mastectomy, axillary lymph node dissection, lymphedema, clot, PVD, venous insufficiency)
Indwelling fistula
Insertion should not be performed distal to prior failed IV cath insertion attempts
Insertion should be avoided distal to any area of preexisting phlebitis
what is the most effective treatment for the postdural headache? - CORRECT ANSWER epidural blood patch [Show Less]