Periop 101 Final Exam

a

Evidence-based practice questions are typically formatted as PICO questions. What does PICO stand for?

a) Patient, Intervention, Comparison, Outcome

b) Patient, Investigation, Comparison, Outlier

c) Population, Intervention, Counter-Intervention, Outlier

d) Problem, Investigation, Counter-Intervention, Outcome

d

Every member of the healthcare team has a role to play in cost containment. Which of the following is an example of how the perioperative RN can participate in cost containment in the OR?

a) Ask the surgeon to use a less expensive implant

b) Begin cleaning the OR for the next case before the patient leaves the room

c) Open all supplies listed on preference card, including "available" supplies

d) Verify with surgeon before opening suture

c

An RN who attends continuing nursing education and has verified skills, knowledge, and attitudes about perioperative nursing is demonstrating accountability in his/her:

a) Certification requirements for professional achievement in perioperative nursing

b) Collaboration among team members

c) Professional growth and maintenance of competency

d) Verification of nursing knowledge

d

Which of the following statements is TRUE concerning use of the AORN Guidelines for Perioperative Practice?

a) Both medical and nursing licensing boards require health care institutions to comply with the AORN guidelines

b) The AORN Guidelines legally supersede departmental and institutional policies

c) The AORN Guidelines reflect scientific evidence of how nurses actually practice in perioperative settings

d) Work setting and situation variations may determine the extent to which AORN Guidelines can be applied

c

Which of the following is NOT an example of an ethical dilemma that perioperative nurses may encounter?

a) Do-not-resuscitate (DNR) order for a surgical patient

b) Family disagreement regardings possible organ donation

c) Family disagreement about a below the knee amputation on an 18 year old who has already given consent

d) Human experimentation

b

The phrase "At least one individual failed to do what a similarly situated, reasonable, and prudent professional would have done under similar circumstances" is the definition of:

a) Abandonment

b) Negligence

c) Unethical behavior

d) Malpractice

d

All of the following are accurate descriptions of "professional accountability" EXCEPT:

a) Becoming certified in your specialty

b) Collaborating with peers in selecting the right instruments and right equipment for each patient

c) Pursuing a higher academic degree

d) Relying ONLY on peer evaluations

e) Staying current with changes in your specialty

b

Part of the AORN standards of Professional Practice mandate that nurses evaluate the quality of their nursing practice. Four ways to ensure professional practice related to the AORN practice include: maintaining competency, the use of evidence-based practice, certification, and:

a) Mentoring student nurses

b) Pursuit of lifelong learning

c) Achieving a minimum of an associate's degree

d) Achievement of an advanced practice nurse degree

c

After transferring a male patient into the Phase I PACU, the perioperative RN could reasonably expect the PACU RN to FIRST:

a) Administer medication to the patient for nausea and vomiting

b) Ask the patient is he has any pain

c) Assess the patient's airway and respirations

d) Care for this patient and two other patients as assigned

b

During a handover report to the PACU RN, the perioperative RN may use a communication method identified by the acronym "SBAR." What does SBAR stand for?

a) Safety, Background, Actions, Recovery expectations

b) Situation, Background, Assessment, Recommendation

c) Safety concerns, Background, Assessment, Responsibility

d) Surgeon, Background, Assessment, Recovery time

c

A 40-year-old male patient is awake and alert in the post anesthesia care unit after right shoulder surgery. What is the BEST measure to assess the patient's pain?

a) Discuss the patient's pain with a close family member

b) Observe facial expressions and behaviors

c) Ask patient to describe his pain or use a standardized pain scale

d) Monitor vital sign changes

d

What would be the MOST important information for a nurse in Preadmission Testing (PAT) to collect on an insulin dependent diabetic patient?

a) How long the patient has been diabetic

b) If there is someone to drive them home

c) The last time the patient ate or drank

d) The type of insulin the patient takes

c

The Perianesthesia nurse has ASPAN to guide their practice. What does ASPAN stand for?

a) American Sterilization of PeriAnesthesia Nurses

b) Association of Specialized PeriAnesthesia Nursing

c) American Society of PeriAnesthesia Nursing

d) Association of Surgical Post Anesthesia Nursing

c

You have completed your case and must now transport your patient to PACU. To give report to the PACU nurse, your facility requires that you provide report in SBAR, which stands for:

a) Safety, Background, Actions, Recovery, Expectations

b) Safety concerns, Background, Assessment, Responsibilities

c) Situation, Background, Assessment, Recommendations

d) Surgeon, Background, Assessment, Recovery time

c

You have just transferred your patient into the Phase I PACU. Which activities would you expect to observe FIRST?

a) Administering medication for nausea and vomiting

b) Asking patients if they have any pain

c) Assessing patient airway and respirations

d) Caring for patients in 1:3 ratio

c

A hand-over communication report is given by the anesthesia professional and the _________________?

a) Surgical resident

b) Medical student

c) OR nurse

d) Inpatient nurse

c

What should be included as part of the psychological nursing assessment?

a) Anxiety, temperature, and religious beliefs

b) Anxiety, temperature, and cultural practices

c) Cultural beliefs, perception of surgery, and religious beliefs

d) Cultural practice, religious beliefs, and age

a

During a preoperative interview, a patient reports that a surgical prep solution made him breakout in hives after a previous surgical procedure. What action should the perioperative RN take?

a) Alert the surgeon and discuss the selection of preoperative skin antiseptic.

b) Ask the surgeon for an antihistamine to be administered preoperatively

c) Monitor the patient more closely after administrating preoperative sedation

d) Notify the anesthesia professional of a potential interaction with anesthetic agents

e

During the preoperative interview, the perioperative RN should ask the patient's about their use of:

a) Alcohol

b) Herbal preparations

c) Recreational Drugs

d) Tobacco products

e) All of the above

a

The PRIMARY purpose of conducting a preoperative assessment is to:

a) Define the patient's risk factors and develop a plan of care

b) Determine the length of the procedure and needed supplies

c) Introduce the patient to the surgical team

d) Provide information necessary for discharge

a

Which of the following sensory assessment findings is common among elderly patients?

a) Decrease in vision including color and depth perception

b) Decreased ability to understand explanations

c) Increased perception of pain

d) Memory impairment

c

A child in which of the following age groups can be described as "likes to socialize and can interpret terms"?

a) 1 to 12 months

b) 1 to 3 years

c) 3 to 6 years

d) 6 to 12 years

d

Which of the following statements is true?

a) Blood pressure remains constant with age

b) Body temperature increases with increasing age

c) Heart rate increases with increasing age

d) Lung capacity decreases with increasing age

a

Which of the following factors make geriatric patients more sensitive to injury and cold?

a) Decrease in subcutaneous fat

b) Lung capacity decreases with age

c) Bilirubin and hemoglobin shift

d) Medication absorption is decreased

b

A preoperative nursing assessment should be conducted by a perioperative RN at what point?

a) Prior to discharge

b) Before the surgery

c) In the surgeon's office

d) Before the surgical consent is signed

d

In relation to transcultural needs of the patient, it is important to include _______________ needs in the nursing assessment.

a) Medical

b) Activities of daily living

c) Pharmacological

d) Spiritual

b

A directive interview is:

a) Open-ended and unstructured

b) Structured with predetermined questions

c) Used to determine personality traits

d) An observation of the patient's nonverbal behavior

a, b, c

Factors that may affect postoperative pain are? Select all that apply.

a) The surgical site

b) The nature and intended purpose of the surgery

c) The patient's fears regarding anesthesia or surgery

d) The level of anxiety of the patient's family members

b

Which of the following BEST illustrates the purpose of perioperative patient and family education?

a) To convey genuine caring for the patient's well-being

b) To increase patient and family adherence to the plan of care

c) To increase the patient's and family's satisfaction with the quality of care

d) To support legal, ethical, and regulatory mandates

d

Sally is a 43-year-old female scheduled for a laparoscopic cholecystectomy. The perioperative RN should provide preoperative education to Sally and her family, including:

a) Detailed information about the surgical procedure, including risks and benefits

b) Obtaining informed consent from Sally and suspending any DNR orders

c) Verification of financial resources

d) Wound care and pain management

a

Which of the following practices violates a patient's ethical right to self-determination?

a) Automatic intraoperative suspension of a do-not-resuscitate decision

b) Including family members in the education process

c) Performing emergency surgery without informed consent

d) Providing information about the scientific evidence for planned care

b

Obtaining informed consent is a two-step process of:

a) Weighing the benefits and burdens of tx options

b) Communicating information and documenting the decision

c) Determining patient competency and authenticity of the signature

d) Communicating the plan of care and reaching a decision

b

How does the perioperative nurse test patient's level of understanding?

a) By checking to see whether the patient feels knowledgable enough to sign the consent

b) By asking questions about the procedure and evaluating the answer

c) By offering reassurance

d) By returning at another time to test recall

c

A preoperative patient's do-not-resuscitate order is:

a) Irrevocable and unchanged once established

b) Not intended to be upheld in the perioperative environment

c) Reconsidered to ensure that the risks and benefits of anesthesia and surgery are discussed before surgery

d) Not reinstated until the patient leaves the perioperative environment

3, 2, 1

Match the designated surgical area with the correct surgical zone:

a) Perioperative patient care area

b) Work area for processing instruments

c) Individual OR suite with sterile supplies opened

1 - Restricted

2 - Semi-restrict

3 - Unrestricted

*(Answer with and separate numbers w/commas)

*(Use numbers to correctly match w/"a, b, c" order)

b

Clean supplied do NOT need to be separated from sterile supplies inside the surgical suite:

a) True

b) False

b

The relative humidity in the OR suite should be maintained within a range of:

a) 20-30%

b) 20-60%

c) 30-70%

d) 40-50%

c

A surgical mask should cover both mouth and nose, and should be:

a) Allowed to hang around the neck between procedures

b) Changed after two hours of use

c) Removed and discarded after every case

d) Tied snugly with strings crossed

b

The ventilation system in the restricted area of the OR should have an air exchange rate of at least _____ air exchanged per hour.

a) 5

b) 20

c) 10

d) 15

a

The pathology laboratory and blood bank are usually situated in which of the following areas?

a) Unrestricted area

b) Semi-restricted area

c) Restricted area

d) Fully-restricted area

c

___________________________ stockings are used to prevent deep vein thrombosis during a surgical procedure.

a) Symmetrical compression

b) Spatial compression

c) Sequential compression

d) Secondary compression

b

Which of the following humidity levels are considered optimal environmental conditions for OR?

a) 10% to 50%

b) 20% to 60%

c) 30% to 60%

d) 40% to 80%

c

The patient's hair should be covered before entering the:

a) Semi-restricted zone

b) Unrestricted zone

c) Restricted zone

d

Nursing interventions to reduce inadvertent hypothermia include all of the following EXCEPT:

a) Initiating forced air warming

b) Infusing warm IV fluids

c) Applying warm blankets preoperatively

d) Lowering the relative humidity below 20%

b

The following statements concerning the surgical suite zone areas are true EXCEPT:

a) Equipment and sterile supply storage are semi-restricted

b) Operating rooms are semi-restricted

c) Sterile processing department is semi-restricted

d) The pre-op holding area is unrestricted

d

When transporting soiled instruments from the OR to the decontamination area, the correct traffic pattern follows movement:

a) From the semi-restricted area to the unrestricted area

b) From the unrestricted area to the restricted area

c) From the restricted area to the unrestricted area

d) From the restricted area to the semi-restricted area

b

A 65-year-old patient is the the pre-operative holding area. The patient's preoperative laboratory test results show several critical values. Which of the following actions should the circulating nurse complete first?

a) Ask the laboratory to draw confirmatory lab tests

b) Inform the anesthesia provider of the lab values

c) Notify the charge nurse of your findings

d) Proceed with the scheduled case

d

Which statement about immediate use steam sterilization (IUSS) is the recommended practice?

a) After an item is immediate use steam sterilized, it may be packaged and stored for future use

b) Because the instrument is needed quickly, the cleaning process may be omitted

c) Instruments may be immediate use steam sterilized when there is inadequate inventory

d) Instruments may be immediate use steam sterilized only when there is insufficient time to process by the preferred wrapped or container method

d

What is the BEST method for keeping instruments clean on the sterile field?

a) Soak instruments in a basin of normal saline

b) Wipe instruments with a sponge moistened with sterile water

c) Spray instruments with an enzymatic detergent

d) Wipe instruments with a sponge moistened with sterile water and flush lumens with sterile water

2, 3, 1

Select the appropriate Spaulding Classification System category for each item listed:

a) Blood pressure cuff

b) Laryngoscope blade

c) Orthopedic implants

1 - Critical

2 - Non-critical

3 - Semi-critical

*(Answer with and separate numbers w/commas)

*(Use numbers to correctly match w/"a, b, c" order)

a

What is the FIRST step in reprocessing surgical instruments after they have been used in a procedure?

a) Cleaning

b) Decontamination

c) Disinfection

d) Transport to the sterilizer

b

Biological monitoring:

a) Is utilized to document the sterility of an item

b) Indicates that the intended physical conditions in the sterilizer were met

c) Can be read immediately after the sterilization cycle is complete

d) Should never be used in immediate use steam sterilizers (IUSS)

c

A ___________ does not permit a person to excuse an error but rather to admit and rectify one readily.

a) Adherence to aseptic technique

b) Practice of professional

c) Surgical conscience

d) Just culture

c

Endoscopic instrumentation maintenance may be enhanced by the following EXCEPT

a) Cleaning off external debris during the case

b) Flushing channels with sterile water during surgery to remove gross soil

c) Irrigating channels with normal saline at the end of each case

d) Testing scissors for sharpness prior to sterilization

b

According to AORN Recommended Practices, the shelf life of a sterile package kept in storage is:

a) Time-related

b) Event-related

c) Content-related

d) Sterilization-related

b

According to Spaulding's Classification System, to prepare items such as blood pressure cuffs for patient use the appropriate process is:

a) Decontamination

b) Low-level disinfection

c) High-level disinfection

d) Sterilization

b

An integrator is a multiparameter indicator designed to measure which of the following parameters?

a) Pressure, steam, and temperature

b) Temperature, time, and presence of steam

c) Pressure and sterility

b

In which surgical wound category should a total abdominal hysterectomy be classified?

a) Clean

b) Clean contaminated

c) Contaminated

d) Dirty

b

Immediate use steam sterilization can be used:

a) For implants

b) In urgent situations

c) Under no circumstances

d) For all items

b, c, d

The AORN Surgical Wound Classification Decision Tree is helpful in determining: Select all that apply.

a) If closed drainage is necessary

b) If a major break in technique will affect the wound class

c) What constitutes an old injury

d) Which wound class a surgery should be assigned

a

What are the three types of transmission-based precautions?

a) Contact, Droplet, Airborne

b) Direct Contact, Enteric, Standard

c) Indirect Contact, Direct Contact, Standard Contact

d) MRSA, VRE, C-Diff

c

Which is the BEST method for preventing blood-borne pathogen exposure?

a) Allowing for proper air exchange to occur between cases

b) Inspecting all sharps to ensure they are intact after use

c) Using PPE and handwashing

d) Wearing non-sterile gloves at all times when in the surgical suite

d

You are circulating on a laparoscopic appendectomy. Upon entering the abdomen, the surgeon encounters purulent inflammation and asks for a culture. The procedure using the laparoscope without need to open the abdomen. In completing your documentation of wound class, the best choice would be:

a) Clean

b) Clean contaminated

c) Contaminated

d) Dirty

a

What are the principle elements required for infection to occur?

a) A method of transmission, a reservoir, a susceptible host

b) A susceptible host, middle age patient, skin integrity

c) A susceptible host, a warm, moist environment, a method of transmission

d) Limited air flow in the OR suite, a source or reservoir, a method of transmission

a

The body's first line of defense against infection is:

a) The skin

b) Surgical gloves

c) The bones

d) Prepping with povidone-iodine (Betadine) solution

d

Which of the following environmental sanitation practices is used to limit the transmission of microorganisms?

a) All contaminated disposable items should be considered potentially infectious

b) Place soiled linens in cloth bags that can be laundered along with the linens

c) Use a spray bottle with hospital approved disinfectant to clean small spills

d) Use personal protective equipment when handling body fluid spills

a

Which of the following is a method for preventing blood-borne pathogen exposure?

a) Changing gloves after each patient or procedure

b) Using surgical gowns made from material that allow air and fluid to move freely in order to minimize thermal discomfort of the team during the case

c) Wearing exam gloves under surgical gloves as an additional barrier

d) Wearing reading glasses to improve sight accuracy during the procedure

c

The best method that a perioperative nurse can utilize to prevent the spread of infection is to:

a) Isolate all patients who are suspected of having an infection

b) Rinse hands with a strong antiseptic solution

c) Wash hands before and after each patient contact

d) Wear sterile gloves while performing nursing procedures

b

Which of the following strategies should be considered for implementing successful infection control?

a) Leaving the syringe in a vial of bupivacaine to facilitate dispensing additional medication if needed during the case

b) Washing your hands prior to greeting the patient in the pre-operative area

c) Wearing an extra warm-up jacket when prepping the patient who has an infected wound

d) Wiping down the OR table with saline at the end of each case to prevent mattress deterioration

3

Vaccine-preventable disease against which health care providers should be immunized include:

a) Hepatitis B

b) Seasonal influenza

c) Tuberculosis

d) Varicella

1 - B and C

2 - A and D

3 - A, B, and D

4 - A, B, C, and D

*Answer with the correct NUMBER only.

c

Which of the three elements required for an infection to occur is related to inanimate environmental surfaces?

a) Method of transmission

b) Susceptible host

c) Source or reservoir

a

Which of the following observations are critical when doing skin antisepsis on pediatric patients?

a) Take measures to prevent the loss of body heat

b) The relatively small bodies of ped. patients require smaller amounts of antimicrobial agents

c) Children are not sensitive to chemical agents

d) The whole body must be prepped irrespective of the operative site

b

If a highly contaminated area is part of the surgical procedure, the area with lower bacterial count should be:

a) Confined and contained

b) Prepped first

c) Prepped last

d) Prepped with gentle friction

a

A patient is scheduled for reconstruction of her external ear following a dog bite injury. Which skin prep agent is indicated for use in this case?

a) Aqueous iodophor

b) CHG-alcohol

c) CHG

d) Iodophor-alcohol

c

A patient is scheduled for reconstruction of her external ear following a dog bite injury. Which of the following skin prep agents is contraindicated for this case:

a) Alcohol

b) Cationic phenolic mixture

c) Chlorhexidine gluconate

d) Povidone-iodine

d

Which statement correctly describes recommendations for preoperative patient skin antisepsis?

a) In determining the area to be prepped, expose the smallest area possible to protect the patient's privacy

b) Prep dirty areas before clean areas

c) Remove hair with a razor immediately before prepping

d) The prep should start at the site of incision and move outwards

c

When performing surgical skin prep, the antiseptic agent should be applied for the length of the time designated by the

a) AORN Guideline on Preoperative Patient Skin Antisepsis

b) Available evidence-based research

c) Manufacturer's instructions for use (IFU)

d) Recommendations from the facility's infection control dept.

c

The skin can be sterilized:

a) Always

b) Easily

c) Never

d) None of the above

b

Chlorhexidine gluconate (CHG) is an antimicrobial skin prepping agent used:

a) Above the neck

b) For topical skin application only below the neck

c) For vaginal or mucous membrane preps

d) In the brain or meninges

b

Which agents are effective in removing resident microorganisms?

a) Mechanical agents

b) Chemical agents

c) Biochemical agents

d) Hydrostatic agents

c

Which of the following should be avoided during hair removal?

a) Use of clippers

b) Clipping of hair against the grain of growth

c) Nicking or cutting of the skin

d) Removal of loose hair from prepped area

c

Which device should be used while carrying out an extremity prep?

a) Cuff

b) Tape

c) Assistive prop

d) Clip

c, e, a, d, b

Identify the correct sequence for prepping:

a) Dip the sponge into the antimicrobial solution, squeezing out any excess liquid

b) Once the prepping is completed, discard the sponge into a trash container

c) Perform hand hygiene

d) Beginning at the site of the incision, use friction and scrub in a circular motion

e) Don sterile gloves and prepare the prep set

*Use the letters separated w/commas to indicate correct order (first through last step)

a

Iodophors with added detergent are referred to as "________," and those without added detergents are referred to as "________."

a) Scrubs; paints

b) Paints; scrubs

c) Gels; film-forming

d) Scrubs; gels

a

Transient microorganisms live in the ______ layer of the skin.

a) Epidermal

b) Dermal

c) Fatty (adipose)

d) All of the above

a

Which nerve is MOST frequently injured as a result of improper positioning of the patients arms?

a) Brachial plexus

b) Lumbar plexus

c) Sciatic

d) Radial

c

The basic surgical positions, each with their own variations are:

a) Kraske, Sitting, Supine

b) Supine, Prone, Kraske

c) Supine, Prone, Lateral

d) Prone, Supine, Lithotomy

d

In the planning and provision for safe patient care related to the prevention of positioning injury, the perioperative RN should:

a) Depend on the patient's natural defense mechanisms to indicate the need for positioning alterations

b) Rely on the surgeon's and anesthesia providers' assessments to guide positioning

c) Use a consistent method of procedure-specific positioning for each patient

d) Use additional precautions as appropriate based on unique patient considerations

b

What is an important consideration related to transferring a patient who has received general anesthesia from the OR bed to a gurney for transport to PACU?

a) One staff member should routinely be available for pt transfers

b) Transfer with a minimum of four staff members in attendance

c) Pre-medicate the pt to make them less anxious during transport

d) Wait until the pt is fully awake and able to transfer him/herself from the OR bed to the gurney

b

An area of painful skin that is abraded, blistered, or has shallow craters would be classified as which stage ulcer?

a) Stage I

b) Stage II

c) Stage III

d) Stage IV

a

What physiological effect is MOST likely to result from positioning a patient in the lithotomy position?

a) Hip dislocation

b) Venous pooling in the legs

c) Damage to the brachial nerve

d) Severe hypertension

b

The table is flexed 90° for the _______ position, which is a variation of the ______ position,

a) Lateral, prone

b) Jack-knife (Kraske), prone

c) Trendelenburg, supine

d) Jack-knife (Kraske), supine

b

A 72-y/o patient who has atherosclerosis of both legs (more severe in the right leg) is scheduled for laser-assisted balloon angioplasty under local anesthesia. After the patient has been positioned on the OR table, which one of the following perioperative nursing actions would be most appropriate?

a) Provide a small roll in the lumbar area

b) Provide padding under the lower extremities allowing the heels to float

c) Place a foam headrest under the occiput

d) Provide protectors for the olecranon processes

c

Which surgical position does not adversely affect the diaphragmatic movement?

a) Trendelenburg position

b) Prone position

c) Sitting or Semi-Sitting position

d) Lateral position

a

In the supine position, areas especially susceptible to skin breakdown include the:

a) Occipital area, shoulder blades, coccyx, and elbows

b) Elbows, the ileum, and the back of the heels

c) Coccyx, back of the heels, and brachial plexus

d) Shoulder blades, the buttocks, and the clavicle

c

What response is the result of tissue layers moving on each other?

a) Pressure ulcers

b) Maceration

c) Shearing

d) Friction

c

The minimum number of personnel that should be available to move an anesthetized patient from a supine-to-prone position is:

a) Two

b) Three

c) Four

d) Five

c

What is included in the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery?

a) Briefing and time out

b) Preoperative verification and handover report

c) Preoperative verification, surgical site marking, and time out

d) Surgical site marking and time out

e) Transfer de-briefing, site marking, and time out

c

During the surgical count before closure of the peritoneum, the scrub person and the RN circulator are unable to locate a laparotomy sponge. What is the FIRST thing the RN Circulator should do?

a) Contact the radiology dept. scheduler to obtain a stat x-ray for instrument and sponge verification

b) Inform the RN supervisor and ask for assistance

c) Notify and receive verbal acknowledgment of the discrepancy from the surgeon

d) Re-open all bagged and discarded sponges, and recount them

c

According to the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery, what is an acceptable method to identify a patient?

a) Ask a patient his or her room number

b) Confirm the patient's name by reviewing the surgical consent

c) Ask the patient to state his/her full name and date of birth

d) Check the patient's armband for a hospital MRN and social security number