Select from the following a medication that is used for PONV and has the potential to prolong the QT interval
a) droperidol
b) dolasteran
c)
... [Show More] prochlorperazine
d) scopolamine patch -✔✔ A) droperidol
Allergic reactions to latex range from skin disease to asthma and anaphylaxis that can result in chronic illness, disability, career loss, hardship and death. What types of signs and symptoms would be indicative of an allergic contact dermatitis response to contact with natural rubber latex -✔✔ Pruritus, edema, erythema, and vesicles that develop 6 to 48 hours after exposure
The strength layer of the skin is found in the -✔✔ Dermis
Two monitoring techniques used by anesthesia that have improved morbidity and mortality include: -✔✔ Pulse ox and capnography
Jacob Sutzkever 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. Jacobs 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: -✔✔ Delayed primary sutured closure
Which of the following is not an advantage to the use of silk suture -✔✔ Memory
The stapler designed to close the end of a hollow organ is called -✔✔ EEA
Which anesthetic agent could not be given if an IV-only anesthesia plan was employed -✔✔ Desflurane
The process of decontamination should initially begin at what point? -✔✔ Completion of the surgical procedure
Which statement about surgical dressings is true
A) surgical dressing maintain tension on the suture line to prevent dehiscence
B) surgical dressings cushion and protect the wound from trauma and gross contamination and absorb drainage
C) surgical dressings protect surrounding drapes, linen and clothing from contamination
D) surgical dressings cover the wound to maintain moisture to promote granulation -✔✔ B) surgical dressings cushion and protect the wound from trauma and gross contamination and absorb drainage
Risk factors for PONV should be assessed preoperatively. Which of the following is a risk factor for PONV. -✔✔ Female gender
Guidelines from the WHO focus on which of the following in the prevention of SSI's? -✔✔ Use of antibiotics
The death of microorganisms occurs in stream sterilization as a result of which process? -✔✔ Denaturation and coagulation of enzyme proteins
Laparoscopic procedures that emerge toy convert to open procedures place the patient at risk for unintentional retained foreign objects (RFO). What new and evolving risk reduction strategy could prevent RFO's and frustrating, time consuming miscount adventures at the end of these procedures? -✔✔ Replacing or tagging sponges and laparotomy instruments with RFID chips
The name of the fascia that separates the anterior rectum from the vagina in females is called the: -✔✔ Rectovaginal fascia
The area between the surgeon and the scrub person designed for passing sharps safely is referred to as the: -✔✔ Neutral zone
The new general surgery fellow placed the three rep at ports for the laparoscopic appendectomy. The procedure was completed without incident; however, on postoperative day 1, the patient demonstrated signs and symptoms of sepsis. What might have been the unusual occurrence that could have resulted in patient sepsis. -✔✔ Inadvertent trocar puncture through the bowel on insertion.
The patient stated that her mouth, lips, and tongue were numb and prickly feeling and she had a metallic taste after receiving local anesthesia for a procedure. The anesthesia provider suspected that the patient had————and responded by———-. -✔✔ A toxic overdose of local anesthetic; monitoring and increasing the flow rate of IV saline
Which of the following medications is a specific depolarizinf muscle relaxant than can produce generalized fasciculations? -✔✔ Succinylcholine
Sara was positioned, prepped and draped following general endotracheal anesthesia induction. The team assembled around Sara and the sterile field to perform the time out as described in the WHO surgical checklist. Successful employment of the time out can only be ensured when: -✔✔ The entire team stops and focuses attention together.
Which member of the surgical team can be held liable in litigation for retained foreign bodies -✔✔ The entire team
Which statement best explains the mechanism of action of general anesthetic agents? -✔✔ Inhibition of synaptic transmission of nerve impulses
Sherry Ames is an endoscopy nurse in a busy free standing ambulatory surgery center. She is an RN with additional documented competency in providing an anesthesia modality to healthy patients having screening colonoscopies, bronchoscopies and upper GI endoscopes. This modality will allow this patient population. To tolerate potentially uncomfortable-procedures while maintains their own airway and be easily aroused from light sleep. Sherry is competent and legally qualified to provide which modality of anesthesia? -✔✔ Conscious sedation/analgesia
Jacob Sutzkever, 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? -✔✔ Contaminated wound, classification III (counted wrong per NIFA grade. Look at page 250 on 16th Ed.) only other answer would be infected wound classification IV
The incidence of intraoperative awareness (IOA) may increase in high risk patient populations. From the following, choose the group that is considered high risk for IOA -✔✔ Cardiac surgery patients
The RNFA instructed the new anesthesia resident in the proper positioning of the arm and hand on the OR bed arm boards. The resident was cautioned to avoid pressure on the elbow to prevent: -✔✔ Ulnar nerve injury
Surgical site infections (SSI) are most often caused by gram-positive cocci and may arise from the patients own endogenous sources. The most frequently identified microorganisms cultured from SSIs is: -✔✔ Staphylococcus aureus
Select the statement below that best reflects the effects of hypothermia in the perianesthesia period. -✔✔ Shivering can increase the need for oxygen by 300% to 400%
Select the appropriate order for administering blood and blood products. Verify informed consent for blood, separate blood bag from identification slips, sign slips, verify identification numbers and expiration dates with second licensed person, verify patient with blood tag and requisition slips. -✔✔ Verify informed consent for blood, verify patient identification and blood type and unit number against blood tag and requisition slip with second licensed person, sign slips.
Hypotension is a blood pressure reading that is 20% less than the patients normal baseline pressure. Hypovolemia is the most common cause of postoperative hypotension; however, hypotension may also be caused by cardiac dysfunctions. Which of the following cardiac conditions will present with hypotension? -✔✔ Myocardial infarction, myocardial tamponade and pulmonary embolism.
The Joint Commission suggests that surgical consent be written at what level to meet health literacy needs of all patients? -✔✔ 5th grade level
The physiologic effects resulting from the inhalation is gaseous anesthetic agents and intravenous infusions of anesthetic drugs inhibit several areas of the central nervous system. The process by which they occur are explained by several proposed theories. Which of the options describes a plausible anesthetic mechanism of action? -✔✔ Synaptic transmission of nerve impulse in the CNS is inhibited.
Which of the following is corrected regarding chromium salt coating on surgical gut suture? -✔✔ ***??Speeds the absorption of the suture in the tissue??*** says pg 177 in 16th ed
While the 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. -✔✔ Venous thromboembolism (VTE)
Select the appropriate nursing action that supports hands free instrument passing and sharps safety. -✔✔ Create a neutral hands free area between the scrub person and surgeon with a basin or magnetic mat.
The circulating nurse received a phone call from the emergency department and called sterile supply to assemble the instrument for an abdominal trauma case with possible aortic rupture. When the cart arrived, she saw the vascular set; however the most important instrument set was missing. What important set was needed for this procedure besides the vascular set? -✔✔ Basic laparotomy set
Which of the following absorbable suture has the best tensile strength? -✔✔ Polydioxanone
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. Miriams unintentional condition is called ———— and now must be managed with—————-. -✔✔ Cardiogenic shock; ACLS protocol
Which of the following do not need to be counted and documented. -✔✔ Vascular inserts pg 199 16th Ed
Infection control and prevention surveillance was underway in the cardiac intensive care unit because of an alarming prevalence of sternal wound infections. On postop day 2, a patient develop d edema, redness and purulent exudate that appeared to be isolated to the subcutaneous plane above the sternum. What important criteria must be met to conclusively define this is a surgical site infection (SSI) -✔✔ Positive diagnosis of the SSI by the surgeon or attending physician
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. -✔✔ Air dry, inventory, inspect, lubricate, assemble and string instruments, wrap and tape????
Pg 72 16th Ed.
Many factors have contributed to the evolution and progressive growth of ambulatory surgery. Select three anesthetic agents that promote fast induction, rapid emergence and minimal side effects and have been credited as a significant factor in this trend. -✔✔ Sevoflurane, propofol, desflurane
Surgical instruments that do not fall under the category of clamps, retractors, or cutting instruments, but are used in most procedures are typically included within the category of: -✔✔ Accessory and ancillary instruments
The light transmission through an endoscope is achieved by way of: -✔✔ Bundles of fiber optic glass rods
—————— Precautions apply to blood, all body fluid, secretions and excretions (except sweat) regardless of whether they contain visible blood, mucous membranes and not intact skin. -✔✔ Standard
The OR was trialing a new insufflation system and the vendor representative was out of the room taking a phone call. The perioperative nurse was concerned that the flow rate was well above 14L/min and the pressure had risen to 16 mmHg. She alerted the surgeon and reduced the rate and pressure because she feared that the elderly patient was at high risk for: -✔✔ Hypercarbia
A type of monofilament suture that does not require the user to the knots is known as -✔✔ Barbed
A common dysrhythmia seen after surgery is: -✔✔ Sinus tachycardia
Select all the injuries or conditions that reflect probable child abuse or neglect -✔✔ Severe injuries inconsistent with the history
When applying the sterile drapes to create the sterile field on the patient, which of the following principles is most important? -✔✔ Drape the patient starting with the incision area and proceeding to the periphery.
Marvin Deloitte, a 19 year-old male, received in intravenous peripheral nerve block (PNB/Bier block) for an ORIF of about ankle fracture. The anesthesia provider injected a a distal dorsal vein of Marvin's right foot with 2% lidocaine, after placing a single cuffed pneumatic tourniquet circumferentially around Marvins upper thigh. The surgeon looked through the OR window to check on anesthesia progress as he scrubbed at the sink outside of the OR. The circulating nurse had the leg elevated and was prepping the ankle. The surgeon noticed that the cuff seemed to be deflating and that the anesthesia provider was turned away from the patient. The circulating nurse also noticed the movement under the protective towel placed over the cuff, and saw the tourniquet tubing fall to the floor. The nurses first response should be: - ✔✔Alert the anesthesia provider, reconnect thw tubing to cuff and inflate, and send the surgeon for the code cart
The perioperative nurse visited Mr. Jennings in the ICU the next day and noticed abrasions on the elbow. Mr. Jennings told her that the ICU nurses had difficulty pulling him back up in bed every time he slid down toward the bottom and he was not able to be much help in moving himself. The skin injury was probably the result of which physical force - ✔✔A friction from the elbows rubbing over the sheets when slid up in the bed.
Malignant hyperthermia (MH) is a rare, multifaceted syndrome with an increased incidence in individuals with central core diseases such as: - ✔✔Congenital myopathies
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 is begun, the perioperative nurse should check the positioning for pressure areas of the: - ✔✔Genitals, knees, toes, and eyes
A reverse cutting needle is preferred for _________________ suturing. - ✔✔Cutaneous
The installation of a local anesthetic into the subarachnoid space is termed: - ✔✔Spinal anesthesia
Susie Reynolds, a 9 year old softball player, has arrived in the OR for emergency repair of superficial facial and deep arm lacerations when she ran into the chain link fence during practice. The perioperative nurse discovers that Susie has an insulin pump that should remain connected during the short procedure. The RNFA should consider which of the following options for energy generated hemostasis? - ✔✔Bipolar electrosurgery unit
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 not be related to these lateral positions? - ✔✔********look at pg 174 in 15th Ed and 173-174 in 16th Ed. ********
Which of the following regarding specimen labeling is a regulatory requirement? - ✔✔Biohazard information pg 32 15th Ed pg 27 16th Ed.
Which of the following is a major infectious risk for healthcare workers? - ✔✔Hepatitis B
The ideal suture material is one that has handling characteristics such as: - ✔✔Pliability
The perianesthesia nurse completes a systematic and comprehensive secondary assessment of the patient (e. g. Head to toe assessment or major body systems approach). Select the response that best reflects the parameters of a comprehensive respiratory assessment. - ✔✔Rate, rhythm and breath sounds
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 concerns with this agent is that in large doses it may cause: - ✔✔Respiratory depression
Tissue reaction characteristics that need considered when choosing suture include: - ✔✔Absorption
Sandra Williams was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled vaginal assisted laparoscopic hysterectomy. She demonstrates and verbalized that she understood al of the tenets of 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. Sandy was exercising her: - ✔✔Right to informed consent
What vaccine should healthcare workers receive if they are caring for immunocompromised patients? - ✔✔Inactivated influenza vaccine
Sponge counts should be performed at the time of permanent relief of either the scrub person or the circulating nurse, and __________________ - ✔✔Pg 25 16th Ed
In several studies, it was determined that the risk of contamination and subsequent infection to the wearer can be reduced by wearing two pair of sterile surgical gloves, as opposed to wearing one pair. Select the correct statement that refers to double gloving in terms of best practice. - ✔✔The cdc, the American college of surgeons and the American academy of orthopedic surgeons support double gloving during invasive surgical procedures.
Pg 95 16 th Ed. Pg. 113 15th Ed.
Suture can be used for more than repairing tissue. Choose uses of suture from the following. - ✔✔Ligate, suture and close tissue
New synthetic polymer such as PDS provide wound support up to ______ months - ✔✔3
What kind of needle would be used on the skin? - ✔✔Reverse cutting
The highest risk of injury per needle use is attributed to the: - ✔✔Keith needle
Which of the following statements reflect the location of the arcuate line? - ✔✔One third of the distance between the umbilicus and the symphysis pubis
The intracorporeal suture technique uses the suture tying process analogous to the - ✔✔Instrument tie
A stitch that is tied and cut before placing another stitch is called: - ✔✔Interrupted
The surgical hand scrub is designed to render the hands, nails and arms - ✔✔Surgical clean
If a sterile glove becomes contaminated during the procedure, the best practice odor corrective action is: - ✔✔Reglove with assisted gloving technique
Jacob Sutzkever had a temperature of 103 degree f and returned to the OR for the debridement and washout of purple my drainage from his wound on postoperative day 3. What was wound classification at the time of his debridement and washout surgery? - ✔✔Infected wound classification IV
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 maintaining fluid balance was attained. - ✔✔Blood pressure within acceptable range.
In addition to healthcare workers in surgery, emergency care and OB, children with spina bifida and persons needing indwelling catheters seem to have a common risk factor for allergy development to which of the following? - ✔✔Latex
Terminal cleaning and disinfection of the operating room should be done_____________ - ✔✔Overall housekeeping procedures, such as wall and ceiling washing should be completed on a defined regular basis and terminal cleaning and disinfection of operating and invasive procedure rooms should be performed when scheduled procedures are completed for the day or each regular 24 hour period.
The most common pediatric premedication given in the U. S. is: - ✔✔Midazolam
Which of the following is a true statement about the use of liquids in the OR? - ✔✔Skin prepping solution can cause chemical burns
Which of the following are the sources of radiation exposure in an operating room setting? - ✔✔Lasers and C-arms
Samuel Garcia, 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? - ✔✔The debridement will remove dead tissue that could support infection [Show Less]