____ is an integrated system developed by hospitals for the prevention and control of areas of potential liability. - ANSWER-risk management
The right
... [Show More] to perform certain activities within an institution is a _____. - ANSWER-privilege
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: - ANSWER-find out what needs to take place to prevent a recurrence of the event.
As defined by the American College of Surgeons (ACS), the surgical assistant may provide aid in all of the following functions that help the surgeon carry out a safe operation with optimal results for the patient, EXCEPT _____. - ANSWER-postoperative evaluations
____ is a term that refers to permission being given for an action. - ANSWER-consent
Criminal negligence is _____. - ANSWER-reckless disregard for the safety of another.
Who is responsible for checking diagnostic tests, such as X-rays and CT scans, to confirm the proper area or side before an incision is made? - ANSWER-surgeon
Credentialing of AHPs (allied health professionals) is influenced by? Select all that apply. - ANSWER-a. state regulations
b. scope of practice
c. institutional policy
d. medical bylaws
e. regulatory compliance
Which of the following reflects the basic values for health care practice? - ANSWER-all of these
Ethics is an attempt to define right and wrong based upon ____. - ANSWER-beliefs
Credentialing and granting of practice privileges is a _____ process - ANSWER-Legal
Morbidity and mortality may be greater with penetrating trauma because identification of injuries may be more difficult when injuries are less obvious. In the case of an adult victim with a low-velocity, low-caliber gunshot wound, at far range, of the anterior left quadrant of the lower abdomen, what is the MOI and description of the possible injuries? - ANSWER-Penetrating; small entrance wound, puncture of the anterior wall of the sigmoid colon, no disruption of vessels, and bullet not found in pelvis
The occurrence of perioperative mortality in geriatric surgical patients is influenced by several evidence-based factors. Select the patient most at risk for perioperative mortality. - ANSWER-Janice, age 70, scheduled for an emergency bowel resection with an ASA class IV
Fluid and electrolytes play a key role in _____;
I:maintaining homeostasis
II:transporting oxygen
III:blood clotting
IV:maintaining temperature - ANSWER-i, ii, iii, iv
Age-related skin changes include a thinning epidermis and decreased subcutaneous fat and elasticity. What special consideration should the first assistant provide to avoid skin injuries? - ANSWER-Gently lift, not slide, the patient to and from the OR bed.
The immature blood-brain barrier and decreased protein binding in infants increase their sensitivity to which group of drugs? - ANSWER-Opioids and hypnotics
For the greatest concentration of antibiotic prophylaxis, the infusion should end within ___ hours of incision? - ANSWER-1
A number of screening tools have been developed to accurately establish biologic age. One tool, the Comprehensive Geriatric Assessment (CGA), is a multidimensional evaluation that scrutinizes medications, functional ability, co-morbid conditions, cognitive ability, mental function, nutritional status, and socioenvironmental factors. In geriatric medical studies, the CGA has been valuable in providing a metric for describing healthy aging and _____. - ANSWER-identifying at-risk individuals.
Traumatic deaths may occur in three phases, or time frames. The first phase occurs immediately after the injury, the second phase within the first 1 to 2 hours after the injury, and the third phase occurs days to weeks after the injury. Approximately 30% of total fatalities from trauma could be prevented with definitive trauma care, including appropriate and aggressive resuscitation with rapid transport to an appropriate facility. Which phase, or timeframe, of potential for trauma death, does this group represent? - ANSWER-Phase II
Preexisting pulmonary disease increases the risk of perioperative pulmonary complications. Which condition presents the most significant risk factor? - ANSWER-Chronic obstructive pulmonary disease (COPD)
_____ is the most frequently acquired nosocomial infection. - ANSWER-urinary tract infection
What non-antimicrobial strategies are important to decrease the risk of postoperative infection? - ANSWER-All of the above
A 49-year-old female long-distance runner with dysfunctional uterine bleeding was scheduled for a hysteroscopy. During the procedure, sterile saline was used to expand the intrauterine compartment and enhance visualization. The infiltration to the uterus and fluid collected as drainage from the uterus was monitored. The first assistant was concerned that approximately 500 ml of fluid was unaccounted for. The motive for this surveillance was to: - ANSWER-determine the potential for intravascular uptake of fluid or third spacing.
The brain and red blood cells relay almost exclusively on a steady supply of _____ to function. - ANSWER-Glucose
As the pediatric cardiac team prepared to cannulate for a coarctation repair, their neonate patient presented with a sudden dysrhythmia, ectopy, and failure to respond to digitalis. Point-of-care serum electrolyte measurements revealed low potassium, sodium, and magnesium levels. On anesthesia induction, only 35 minutes earlier, these values were at normal levels and the patient status was secure. The electrolyte levels were treated to normal and the patient was cannulated and placed on cardiopulmonary bypass. As the procedure continued the team pondered the cause to prevent a recurrence. What possible event could have caused, or contributed to, this loss of electrolytes? - ANSWER-Sterile water from back table switched with heparinized saline
Focused assessment with sonography in trauma (FAST) may assist with diagnosis in difficult situations. What group of scans is performed and what do they identify? - ANSWER-A chest, pelvic, and four abdominal scans; collections of fluid and free air
What is the appropriate action if the doctor is delayed after the room and instruments have been opened? - ANSWER-Do not cover open supplies and have the scrub nurse continually visually observe the room for breaches in sterility.
A hard bristle surgical hand brush should be used during a surgical scrub. - ANSWER-False
There are many factors that influence surgical wound healing. Some are helpful and some are beyond the scope of the surgical team. Select the response below that reflects a factor with high influence over wound healing and is within the control of the surgical team. - ANSWER-Selection of wound closure materials, dressings, and drains
Jacob, a 62-year-old man, had surgery 6 days ago for a ruptured diverticulum. What was the wound classification at the time of his emergency surgery? - ANSWER-Contaminated wound, classification III
Identify the primary substance that composes a layer of the epidermis, is responsible for hardening nails and hair, and protects the body from fluid loss and invasion by pathogens. - ANSWER-Keratin
The bariatric unit was experiencing an alarming rate of postoperative wound dehiscence and evisceration on postoperative day 1, as the patients began to ambulate independently. Select the response below that reflects significant surgical team influence on wound healing. - ANSWER-Sterile technique, wound closure materials, hemostasis methods
Which of the following lists the correct order of the proper steps in the removal of soiled sterile attire when breaking scrub? - ANSWER-Gown, gloves, mask
Artificial nails harbor organisms and prevent effective hand antisepsis, therefore, should not be worn in the OR. - ANSWER-True
If a sterile glove becomes contaminated during the procedure, the best practice for corrective action is: - ANSWER-reglove with open-glove or assistive glove technique.
In several studies, it was determined that the risk of contamination and subsequent infection to the wearer can be reduced by wearing two pairs of sterile surgical gloves, as opposed to wearing one pair. Select the correct statement that refers to double gloving in terms of a best practice. - ANSWER-The AORN publication titled Recommended Practices for Prevention of Transmissible Infections in the Perioperative Practice Setting recommends the double-glove procedure during invasive procedures.
Jacob is a 62-year-old man who had surgery 6 days ago for a ruptured diverticulum. He is back in the OR for a debridement and washout. Jacob's fever has subsided and the drainage is clear. The surgeon will continue with wet to dry dressings and schedules Jacob to return to the OR in 3 days for: - ANSWER-delayed primary sutured closure.
If you noticed a partial-thickness loss of dermis presenting as a shallow, open ulcer with a red-pink wound bed without slough, how would you stage the wound? - ANSWER-Stage II
Which of the criteria below are appropriate when determining whether an incisional surgical site infection (SSI) is superficial or deep? SELECT ALL THAT APPLY. - ANSWER-Where the purulent drainage comes from, superficial or deep
Samuel was fitted with a negative-pressure wound therapy system, also called vacuum-assisted closure, after his most recent surgical wound debridement. This device works by (SELECT ALL THAT APPLY): - ANSWER-Creating mechanical tension on the tissues and pulling wound edges together
How long can Methicillin-resistant Staphylococcus epidermidis and VRE survive on fabrics and plastics. - ANSWER-Longer than 90 days
Samantha sought the consult of a plastic surgeon to repair a large 2-year-old surgical scar on her right leg that was healed but remained darkly pigmented, uneven, and raised. The plastic surgeon reviewed the operative report from Samantha's prior surgery, which revealed an uneventful procedure, wound classification I, closure with uninterrupted 4-0 nylon, and no drain. The underlying cause of the uneven healing was probably due to: - ANSWER-unknown interruption in the normal healing process during proliferative and remodeling phases.
Is it acceptable to enter restricted areas of the OR suite without a mask as long as the individual remains greater than 10 feet away from open sterile items? - ANSWER-False
Describe the best practice for aseptic removal of sterile gloves after removal of the sterile gown at the end of the procedure. Select the best practice to protect the wearer from cross-contamination. - ANSWER-Using the gloved fingers of one hand to secure the everted cuff, remove the glove, turning it inside out. Discard appropriately. Using the ungloved hand, grasp the fold of the everted cuff of the other glove and remove the glove, inverting the glove as it is removed. Discard in biohazard trash. Remove mask by the ties and discard. Wash hands.
If you noticed a full-thickness loss, with exposed tendon and slough on some parts of the wound, how would you stage the wound? - ANSWER-Stage IV
The skin preparation for a vaginal-assisted laparoscopic hysterectomy begins _____ and _____ before and after the procedure. - ANSWER-At the cleanest area first and proceeds to less clean areas (abdomen then vagina/perineum); a skin assessment should be performed
How long can an operating room remain open and not used and still be considered sterile? - ANSWER-There is no specified amount of time that a room can remain open and not used and still be considered sterile.
Which statement best reflects the appropriate purpose of a surgical drain? - ANSWER-Drains can prevent the development of deep wound infections.
Cosmetic elective plastic surgery on healthy patients is based on the expectations that healthy healing and ideal cosmesis will be achieved. Which phase or phases of healing is considerable emphasis placed during the procedure? - ANSWER-Inflammatory phase
Surgical site infections (SSIs) are most often caused by gram-positive cocci and may arise from the patient's own endogenous sources. The most typical causative microorganism cultured from SSIs is: - ANSWER-Staphylococcus aureus.
What is determined to be the appropriate time for a surgical hand scrub, depending on the manufactures written directions? - ANSWER-3-5 minutes
Sterile surgical drapes are used to create the sterile field, protecting the patient from endogenous and exogenous sources of contamination. Of the characteristics listed, which are essential to maintaining the sterile field? - ANSWER-Provide barrier protection from microorganisms, fluid, and particulate matter
The surgical hand scrub is designed to render the hands, nails, and arms: - ANSWER-All of the options are correct.
Which of the following choices reflects the appropriate order of four of the steps in preparing for the surgical hand scrub procedure? - ANSWER-Remove jewelry, contain hair, don fresh mask and eye protection, wash hands and forearms.
Samuel, a 48-year-old tetraplegic with a chronic sacral wound, is scheduled for another wound debridement. What is the purpose of doing a wound debridement on a chronic wound? - ANSWER-The debridement will remove dead tissue that could support infection.
Surgical site infections (SSIs) account for 14% to 16% of all hospital-acquired infections. Surgical assistants are responsible for understanding the factors that contribute to SSIs and preventive measures. Which of the following is a true statement about preparation of the patient? - ANSWER-The patient should be required to bathe or shower the night before surgery.
The instillation of a local anesthetic into the subarachnoid space is termed: - ANSWER-spinal anesthesia.
If you noticed muscle stiffness, dark blood in the operative field, tachycardia and increased body temperature, what might you suspect? - ANSWER-malignant hypertension
An experienced anesthesia provider administered MAC to a 29-year-old female undergoing local scar revision surgery for an old abdominal incision. She titrated midazolam and propofol to dull the patient's level of consciousness. She was alerted by the dropping SpO2 reading and the patient's loss of chest movement. The patient did not respond to a head tilt-chin lift maneuver. The anesthesia provider's next response to this event is to: - ANSWER-alert the surgeon and ventilate the patient's lungs with a self-inflating bag/valve/mask.
Which of the following is a true statement about the use of liquids? - ANSWER-Skin prepping solutions can cause chemical burns.
Surgical assistants should be familiar with all basic anesthetic monitors and normal ranges of physiologic parameters in order to: - ANSWER-anticipate patient and anesthesia provider needs in terms of patient status and potential emergencies, and safely use the equipment when they monitor a patient under local anesthesia.
Pediatric, geriatric, and physiologically compromised patients have impaired thermal regulatory mechanisms that place them at risk for hypothermia. The OR bed should be prepared before patient arrival by placing: - ANSWER-a patient-sized forced air-warming blanket on top of the OR bed surface
A desired anesthesia experience for a child is an anesthetic agent that offers a rapid and smooth induction with good relaxation, followed by rapid emergence. Which of the listed inhalational agents is the best choice for pediatric anesthesia? - ANSWER-Sevoflurane
Which inhalational anesthetic agent(s) has the fastest onset of induction, emergence, and recovery? - ANSWER-Nitrous oxide and halothane
At a regional MH testing center Davis Washington is undergoing a muscle biopsy for suspected genetic predisposition to malignant hyperthermia. The anesthesia provider will provide light intravenous (IV) sedation while the surgeon infiltrates the biopsy site with a local anesthetic. This will facilitate Davis' tolerance of the procedure and minimize his risk for an MH episode. What is the current correct name for this anesthesia modality? - ANSWER-Monitored anesthesia care (MAC)
Minimizing risk factors and administering antiemetics are important preventive actions against postoperative nausea and vomiting. Antiemetics are designed to interact with the four main neurotransmitters that affect postoperative nausea and vomiting. These four neurotransmitters are: - ANSWER-histamine, acetylcholine, serotonin, and dopamine.
Postoperative nausea and vomiting is often a side effect of the inhalational anesthetic ________ and the analgesic _______. - ANSWER-nitrous oxide; morphine
While a sudden drop in the SpO2 level may result from systemic hypoxia, blood flow to the distal extremity may be inadequate because of: - ANSWER-All of these options may decrease SpO2 level.
Ketamine is a short-acting induction and IV or IM maintenance agent. Patients are able to maintain their airways. It is a suitable agent to use with small children and burn patients. The concern with this agent is that in large doses it may cause: - ANSWER-hallucinations and respiratory depression.
Whenever regional anesthesia is used, resuscitative equipment and drugs must be immediately available and the patient monitored for any substantial change in vital signs or untoward reactions. An example of an untoward reaction or risk with regional anesthesia is: - ANSWER-intravascular injection of the anesthetic agent.
Emma, a frail 92-year-old, was positioned in lithotomy for a 90-minute rectal procedure under spinal anesthesia block (SAB). At the end of the procedure, when the surgical assistant and surgeon gently removed her legs from position and placed her in supine position, she experienced a common side effect of spinal anesthesia, ____________. - ANSWER-hypotensive episode
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 _______. - ANSWER-Wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists
The potential for intraoperative awareness (IOA) can exist for patients in all modes of anesthesia. Select the anesthesia modality that presents the least likely opportunity for IOA. - ANSWER-General endotracheal anesthesia
Sponge, instrument, and sharp counts are a crucial perioperative intervention used to prevent retention of foreign bodies in the wound. To conduct a count properly the scrub person generally performs the count with _____. - ANSWER-the circulator.
Local anesthetic medications, such as lidocaine hydrochloride, have more than one indication for use as an anesthetic. Which three anesthesia modalities use local anesthesia? - ANSWER-Local, spinal, MAC
During a hypermetabolic MH crisis, the patient will eventually assume a state of metabolic acidosis. What is the desired drug used to reverse this trend? - ANSWER-Sodium bicarbonate
Which anesthetic agent could not be given if an IV-only anesthesia plan was employed? - ANSWER-Halothane
Rebecca, a 2-year-old scheduled for bilateral myringotomy with tube placement, was calm and giggling as her mother stood by her side stroking her cheek. OR policy permitted parents to be present during the initial administration of anesthetic. The anesthesia provider explained her actions, and what Rebecca would experience, to the mother as she gently placed the mask over Rebecca's nose and mouth and turned on the flow of sevoflurane and oxygen. Rebecca calmly slid into unconsciousness. The anesthesia provider told the mother that Rebecca would soon begin to squirm and possibly thrash around a bit restlessly, but it is a normal effect and Rebecca would soon be in a quiet sleep. What phase of anesthesia is Rebecca in and what stage is she about to enter? - ANSWER-Induction and stage 2
A basic anesthesia monitoring device that is used during general anesthesia to confirm successful endotracheal tube placement and determine the presence of gas exchange is the: - ANSWER-capnometer/end-tidal CO2 monitor to identify expired CO2 in the breathing circuit.
Somatosensory evoked potential (SEP) monitoring assesses neuromuscular transmission pathways during procedures where ischemia may occur because of surgical manipulation, resulting in sensory and motor function. This surveillance is most often employed in: - ANSWER-posterior spinal fusion.
Latex allergy reaction is best prevented by: - ANSWER-limiting exposure to latex.
Many factors have contributed to the evolution and progressive growth of ambulatory surgery. Select the three anesthetic agents that promote fast induction, rapid emergence, and minimal side effects and have been credited as a significant factor in this trend. - ANSWER-Sevoflurane, propofol, desflurane
Miriam Glass is a 78-year-old female scheduled for compression nail insertion of a left fractured hip. She was positioned for a spinal injection to induce spinal anesthesia. During the process, the anesthesia provider inadvertently inserted the spinal needle into the subarachnoid space, not noticing the error until the entire syringe of lidocaine was emptied into the patient. Miriam immediately experienced rapid onset of hypotension, bradycardia, and apnea. Miriam's unintentional condition is called ______________ and now must be managed with _____________. - ANSWER-total spinal anesthesia; general endotracheal anesthesia
While hypothermia was historically credited as a therapeutic modality benefitting all surgery because it decreases metabolism and reduces oxygen demand, inadvertent hypothermia is now recognized as impacting many critical physiologic functions and patient outcomes. Which of the following impairments can contribute to surgical site infections? - ANSWER-Impaired wound healing
In the past, MH mortality ranged up to 80%, but the immediate infusion of dantrolene (Dantrium) and proper treatment have reduced the death rate to about 7%. What is dantrolene's mechanism of action that reverses the hypermetabolic state and crisis? - ANSWER-It is a skeletal muscle relaxant.
Multiple studies have found that intraoperative awareness (IOA) occurs in 0.1% to 0.2% of patients undergoing general anesthesia. These studies also determined that even under seemingly adequate general anesthesia, implicit memory may be retained along with the ability to process auditory stimuli subconsciously. Based on these studies, it was determined that anesthesia techniques that rely solely on receptor-based drugs are a risk factor for IOA. Which classification of drugs should be avoided for patients at risk for IOA? - ANSWER-Nitrous oxide, benzodiazepines, and opioids
The pediatric patient is at risk for imbalanced fluid volume related to invasive surgery and accompanying blood loss. Select the outcome indicator that would best reflect that the goal of maintained fluid balance was attained. - ANSWER-Blood pressure within acceptable range
Trauma to the chest area is the primary cause of death in approximately 25% of trauma victims. Involvement of the heart, great vessels, lungs, and diaphragm, attributable to penetrating or blunt injury, can provide multiple unexpected findings when the chest is opened. Because of the nature of the potential findings and expected surgical intervention, what would be an appropriate preparatory action? - ANSWER-Set up the autotransfusion system and resuscitation equipment.
If a surgical patient complained of dyspnea and was hypoxia within the first 36 hours postop, you would suspect _____. - ANSWER-Atelectasis
A swab of a fluid collection from an edematous, red, and separating 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: - ANSWER-physical and chemical properties of the cell wall.
Identify the primary substance that composes a layer of the epidermis, is responsible for hardening nails and hair, and protects the body from fluid loss and invasion by pathogens - ANSWER-Keratin
The hospital epidemiologist was alerted when several cultures had recently revealed suspicious similarities. He was concerned about two unrelated patients with similar abscesses in similar body regions. Susan, a 72-year-old diabetic patient taking immunosuppressive medications for chronic Crohn's disease, had an incision and drainage of a perianal fistula. Shawn, a healthy 22-year-old college student and motocross racer, had an incision and drainage plus excision of a pilonidal cyst. Both patients cultured out a new subtype of S. aureus. Susan's specimen results showed a significant colony growth of S. aureus plus differential growth of coagulase-negative S. epidermidis, while Shawn's specimen was a high colony growth coagulase-positive, similar subtype of S. aureus. The epidemiologist charged his department to be alert for this S. aureus subtype and cross-check for trends. He was most concerned about one of these patients in particular and pulled up the medical record for review. Which patient may be at higher risk with the more virulent strain and why? - ANSWER-Shawn because he has a high microbial load that is coagulase positive
An integrator is a multiparameter indicator designed to measure: - ANSWER-temperature, time, and presence of steam.
If you noticed a purple localized area of discolored intact skin with a blood-filled blister, how would you stage the wound? - ANSWER-Suspected deep tissue injury
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: - ANSWER-agents to disinfect and eliminate most, if not all, pathogenic microbes
Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however: - ANSWER-it can only be used for the initial gloving.
What best describes hyperbaric oxygenation as a management therapy for a chronic wound? SELECT ALL THAT APPLY - ANSWER-Increases the ability of the blood to carry oxygen to the tissues
Restores cells and kills bacteria that thrive without oxygen
As the patient emerged from the propofol, she stated that her mouth, lips, and tongue were numb and prickly feeling and she had a metallic taste. The anesthesia provider suspected that the patient had ________ and responded by _________. - ANSWER-A toxic overdose of local anesthetic; monitoring and increasing the flow rate of IV saline
What are complications of spinal anesthesia?
i. Slow inconspicuous hypotension
ii. Rapid hypotension
iii. Reduced venous return
iv. Peripheral pooling - ANSWER-ii, iii, iv
Which statement best explains the mechanism of action of general anesthetic agents? - ANSWER-Inhibition of synaptic transmission of nerve impulses
The physiologic effects resulting from the inhalation of gaseous anesthetic agents and intravenous infusion of anesthetic drugs inhibit several areas of the central nervous system (CNS). The processes by which they occur are explained by several proposed theories. Which of the options describes a plausible anesthetic mechanism of action? - ANSWER-Synaptic transmission of nerve impulses in the CNS is inhibited
Which of the following medications is a specific depolarizing muscle relaxant than can produce generalized fasciculations? - ANSWER-Succinylcholine
Malignant hyperthermia (MH) is a rare, multifaceted syndrome with an increased incidence in individuals with central core diseases such as: - ANSWER-muscular dystrophy and congenital myopathies
Two anesthetic gases that are included in the balanced inhalation mix during general anesthesia are: - ANSWER-air and oxygen.
Two monitoring devices that are commonly used to determine ventilatory status are required by some insurance providers as reflective of high-quality care and by anesthesia provider professional organizations as a recommended standard of care. These two devices are: - ANSWER-pulse oximetry and capnography
Symptoms of toxicity of anesthetics include: SELECT ALL THAT APPLY. - ANSWER-a. metallic taste
c. tinnitus
d. numbness of tongue
Choice of needle _____. - ANSWER-relates to the type and location of tissue
True statements regarding instrument tying are all EXCEPT _____. - ANSWER-You have as much tactile sensation/feedback as two handed tying
A stitch that is tied and cut before placing another stitch is called _____. - ANSWER-interrupted
Qualities of suture that effect selection are:
a. Absorption rate
b. Tensile strength
c. Ease of handling
d. Tissue reactivity - ANSWER-a, b, c, d
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. - ANSWER-kidney bridge; vena cava
Proper positioning of the arm and hands on the OR bed armboards is importamt to avoid pressure on the elbow and prevent which type of injury? - ANSWER-ulnar nerve injury
Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral, and
__________ nerve, which can result in injury from __________. - ANSWER-common peroneal; full leg sequential compression wraps
The challenge of suturing intra-abdominally is not as great as the process needed to tie and tighten the surgical knot. The knot-tying process can be
achieved within or outside of the abdominal compartment. One technique uses laparoscopic grasping forceps and a laparoscopic needle holder only,
and another uses the same instruments plus two obturator sleeves to push, slide, and tighten the knot into place. When sutures are tied and knotted
during an open procedure, the surgeon may tie the knot with gloved fingers, called a one- or two-handed tie, or wrap the suture around the tip of a
needle holder and grasp the other end of the suture to pull it through the wrapped coils; this is called an instrument tie. The intracorporeal suture
technique uses the suture-tying process analogous to the: - ANSWER-instrument tie
Select the statements that best reflect the benefits of laser surgery for the surgical services department. SELECT ALL THAT APPLY.
a. Decreases postoperative scarring that could lead to stenosis.
b. Reduces operative and anesthesia time.
c. Sterilizes tissue from the heat generated at the laser-tissue impact site.
d. Allows a shift to more ambulatory surgery procedures. - ANSWER-a. Decreases postoperative scarring that could lead to stenosis.
c. Sterilizes tissue from the heat generated at the laser-tissue impact site.
d. Allows a shift to more ambulatory surgery procedures.
What kind of needle would be used on the skin? - ANSWER-Cutting
Select the positioning device and accessory commonly used for neurosurgical procedures. - ANSWER-Mayfield head positioner
Dr. Wheeler's patient, a 72-year-old man with a single early-stage liver tumor, has an implanted automatic internal defibrillator that the anesthesia
provider has decided not to disarm for the procedure. What energy-generated dissection device should Dr. Wheeler use to replace the argon beam
coagulator? - ANSWER-An ultrasonic dissector
An advantage of monofilament suture is _____. - ANSWER-smooth passage through tissue
Which complications have been reported in association with patients undergoing spinal surgery in the prone position as a result of decrease venous
return from the head? - ANSWER-Vision loss
Which of the following is a complex stitch? - ANSWER-Figure of eight
Indicate the risk level of a patient with a Braden scale score is 11. - ANSWER-high
Number the sequence of steps for positioning a patient in lithotomy position. - ANSWER-1: Stirrups are checked before use to ensure they are securely fastened to the side rails of the OR bed.
2: With the patient supine, the legs are raised simultaneously and abducted to expose the perineal region.
3: The legs are placed in stirrups to maintain this position.
4: The thighs are elevated to the appropriate degree for the planned procedure.
5: The sacral area is padded with a gel or foam pad.
6: The leg section of the OR bed is removed and the leg section platform is lowered.
Albert Janson, a 325-pound patient, is scheduled for a 6-hour abdominal surgery. The surgical assistant is concerned about the risk for pressure
injury because of the weight of the patient's body pressing against the surface of the OR bed for a long surgery. Which of these other factors may
also produce pressure? - ANSWER-A self-retaining retractor post clamped to the OR bed rail and tightened against the patient's side
What is the advantage of a running stitch? - ANSWER-It's faster
David Reese, a 14-year-old patient with marked scoliosis, is in prone position with gel rolls, gel pads, and pillows for a spinal fusion. Before the skin
prep is begun, the surgical assistant should check the positioning for pressure areas of the: - ANSWER-genitals, eyes, and all areas that are in contact with the OR bed or accessories.
Sutures fall in the following categories:
a. Monofilament and multifilament
b. Absorbable and nonabsorbable
c. Short and long
d. Both A & B - ANSWER-d. Both A & B
Identify the risk for an elderly patient with an insufflation system flow rate of 16 mm Hg.
a. gastroesophageal reflux.
b. hypercarbia.
c. postoperative nerve damage and shoulder pain.
d. All of the options are correct. - ANSWER-d. All of the options are correct.
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 ______. - ANSWER-over; body
Eschar buildup on the active electrode ESU tip impedes the desired current flow and can tear tissue, causing rebleeding and serve as a foreign body
if deposited in the wound. Appropriate methods to remove debris from the tip include:
a) Scraping the non-coated ESU tip carefully with the scalpel
b) Soaking the coated ESU tip in sterile water
c) Wiping with moist sponge to clean non-stick coated ESU tips
d) Abrasive electrode cleaning pad to remove eschar from non-coated electrodes
e) Electrode tips should not be cleaned. They should always be replaced if there is a buildup of eschar. - ANSWER-(c and d)
One source of catgut is _____. - ANSWER-Small intestines of sheep
Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to
below: - ANSWER-32 mm Hg.
Endoscopic instruments are designed to perform the intervention at the target tissue site through the tubular endoscope. The endoscopic instrument
is considered: - ANSWER-an extension of the surgeon's hand.
In general, the needle that causes the least amount of tissue trauma is _____. - ANSWER-Taper
Silk loses up to 20% in tensile strength when wet. - ANSWER-a. True
Which of the following pose a fire risk during a laser treatment?
a. Pooled prep solution
b. Increased oxygen concentrations of the air
c. Standard endotracheal tubes
d. None of the above, if standard precautions are taken
e. All of the above pose a fire risk - ANSWER-e. All of the above pose a fire risk
Select the positioning devices and accessories commonly used for bariatric surgery.
Select one:
a. Air-filled, roller, or slider transfer device
b. Upper body ramp
c. Elevated padded armboards
d. All of the options are correct - ANSWER-d. All of the options are correct
ESUs are high-risk equipment with potential complications, including:
a) Patient injuries
b) Fires
c) Electromagnetic interference with other equipment
d) Electromagnetic interference with internal devices - ANSWER-All of the above
Clair Townsend arrived at the endoscopy center 2 days before her scheduled interventional bronchoscopy to receive an injection of a photosensitive
intravenous dye that the pulmonologist explained would highlight the dysplastic tissues of her bronchi that were precancerous. He scheduled her for
an ablative procedure called photodynamic therapy (PDT), where the highlighted tissues would be affected by the laser light that is color-specific for
uptake of the dye. Select the laser that would be appropriate to use on this patient during a PDT bronchoscopy. - ANSWER-KTP laser using a Nd:YAG beam passed through a fiber delivery system [Show Less]