AORN Periop 101 Final Exam Study Guide

AORN Periop 101 Final Exam Study Guide This type of needle point is what you would expect to be needed for suturing friable tissue such as the liver. - ✔Blunt needle These particular wound closing items are available in a wide variety of instrument sizes.

- ✔disposable stapler The surgical wound classification for a total abdominal hysterectomy. - ✔clean contaminated Following an excisional breast biopsy, the circulating nurse would anticipate the need to have available this type of drain - ✔jackson pratt This position can cause physiological effects of circulatory and respiratory compromise due to pressure on the abdomen. - ✔lithotomy It is recommended to inspect the active electrode for insulation defects to prevent this from occurring during MIS - ✔capacitive coupling The disadvantage of using this type of wound closure is because they often cause more scarring than other skin closure methods. - ✔skin clips An automatic intraoperative suspension of a do-not-resuscitate decision violates a patient's ethical right to... - ✔self-determination This type of human factor error is responsible when a perioperative nurse is trying to attend to several tasks at once - ✔situational-based Restricting pathogenic organisms from the patient, environment, equipment, and supplies is the definition of.... - ✔aseptic technique The most important consideration when selecting these materials is to prevent risk of contaminating patients with endogenous and exogenous microorganisms; and risk of exposing healthcare workers to patient's blood and body fluids - ✔drapes Postop care at home is the primary focus of this Phase of post anesthesia care. ✔phase II This statement about gloving technique is true What is... a. When gloving another person, always glove the left hand first. b. The scrub gown should be fastened in the back before donning gloves

c. Open glove technique is used for initial donning of the sterile gown and gloves. d. Closed glove technique is used to glove the surgeon or assistant. - ✔b. The scrub gown should be fastened in the back before donning gloves Draping material is this source in the fire triangle? (fuel, ignition, oxidizer) - ✔fuel The safest way to pass a cutting instrument to a surgeon is: - ✔neutral zone To place a patient safely in this particular position the knees are over the break in the procedure bed to allow for knee flexion. - ✔Trendelenberg A packaging system for items undergoing sterilization should possess this characteristic: What is....

1. Made of only disposable materials 2. to permit aseptic delivery of contents to the sterile field 3. Maintain sterility of the items for a specified length of time.

4. Compatible with all sterilization processes - ✔to permit aseptic delivery of contents to the sterile field Silicone catheters should be stocked on this particular cart in the surgical suite. ✔Latex-safe cart Open this package carefully over a small basin to prevent splashing of the packaging solution. - ✔natural absorbable sutures (plain, chromic) An example of administrative controls to assure safe use of lasers, is the appointment of a person in this role: - ✔laser safety officer This statement about the perioperative nurse's role in bioethical decision making is most justifiable. The perioperative nurse should... WHAT IS... a. Try to avoid involvement in ethical dilemmas unless they are personally engaged in a situation. b. Refer all ethical dilemmas to the institution's ethics committee to decide the best course of action. c. act according to the terms of agreement establishing the nature of the relationship between the pt and the nurse d. Defer to surgeons judgment when there is disagreement about the right course of action. - ✔c. act according to the terms of agreement establishing the nature of the relationship between the pt and the nurse A precaution that should be taken when using this hemostatic agent intraoperatively is to avoid using it with an autologous blood salvage unit (cell saver). - ✔microfibrillar collagen

A designation of 4-0 on a suture package indicates this about the suture material. ✔diameter A recommended means of promoting the safety of personnel in the surgical suite is: What is.... a. Routine screening of patients for HIV and hepatitis C b. Providing access to MSDS (material safety data sheets) for hazardous agents in that environment c. Double-glove for every procedure d. Leaving the room when x-rays are being used, even if scrubbed. - ✔b. Providing access to MSDS (material safety data sheets) for hazardous agents in that environment This type of healing the wound remains open - ✔granulation An abstract concept that has been developing since Socrates. - ✔critical thinking This item is placed as close to the operative site as possible - ✔dispersive electrode This is desired patient outcome most closely related to the use of local anesthesia for a procedure: What is.... a. The pt is the recipient of competent and ethical care within legal standards of practice. b. The pt is normothermic at the conclusion of the procedure c. The patient reports adequate pain control throughout the perioperative process d. The pt's respiratory function is consistent with preoperative baseline levels. - ✔c. The patient reports adequate pain control throughout the perioperative process Antibiotics are most commonly administered during the intraoperative phase through this route - ✔irrigation Recent research studies on the value of certification found that: WHAT is.... a. Non-certified nurse managers saw little value in certification related to professional growth. b. The most frequent reason for achieving certification is the expectation of higher salary and career advancement c. Most facilities do not offer any incentives for achieving certification. d. Nurse Managers would prefer to hire a certified nurse over an otherwise equally qualified non-certified nurse. - ✔d. Nurse Managers would prefer to hire a certified nurse over an otherwise equally qualified non-certified nurse.

The recommended practice for flash sterilization is the item should be processed with this: - ✔What is a routine process monitoring device (chemical indicator, integrator).

When documenting the placement of surgical drains, it should include: - ✔Location of the drain

The action that the perioperative nurse should take if the pt states he/she is allergic to shellfish and breaks out in hives when ingested. - ✔Alert surgeon for the need for appropriate selection of skin prep solution Principles of care for forceps during a procedure should include this: WHAT IS... a. Stand them upright along the sides of the instrument tray so that handles are easily grasped when needed b. Move them from the mayo stand to the back table if the surgeon says that they are not working properly. c. frequently inspect tips and wipe clean of blood or tissue as needed d. Organize them on the may stand or back table by placing one inside another. - ✔c. frequently inspect tips and wipe clean of blood or tissue as needed A critical perioperative nursing diagnosis within the PNDS is: - ✔Risk for perioperative positioning injury?

There are 3 process monitors in the sterilization process; this particular monitor indicates that the intended physical conditions in the sterilizer were met. - ✔biological monitoring This is the most reliable early indication of malignant hyperthermia - ✔Increase in endtidal CO2 This statement concerning the use of AORN Recommended Practices is true: a. RPs supersede departmental and institutional policies b. Work setting and situation variations may determine the extent to which the RPs can be applied c. RPs are based on scientific evidence of how nurses actually practice in perioperative settings d. Licensed and accredited institutions are required to comply with the RPs - ✔b. Work setting and situation variations may determine the extent to which the RPs can be applied This can be performed through smaller incisions - ✔MIS procedure/Laparoscopy After this is procured by the surgeon, the scrub person should keep it moist with saline and in a sterile basin until it can be passed to the circulating nurse. - ✔specimen Skin prep agent contraindicated for use during reconstruction of the external ear. ✔CHG AORN RP states, this should be matched to the type of laser, optical density, and wavelength - ✔eyewear

What is recommended for transferring medication from a multi-use vial to the sterile field? - ✔sterile transfer device What are 2 assessment factors when screening pts for potential risk of malignant hyperthermia? - ✔Family history of problems related to anesthesia; and pts previous experience with anesthesia The space where direct, scattered, or reflected laser radiation exceeds maximal permissible exposure - ✔nominal hazard zone for laser use First step in the sterilization process of surgical instruments that have been used in a procedure - ✔decontamination This is affected by pt and staff beliefs, staff attitudes, and individual and collective values - ✔culture of a clinical setting Most important reason for maintaining endoscopic instruments at optimal level of function - ✔can cause unseen thermal burns According to Dewey and Glaser this statement about critical thinking is incorrect. a. Logical inquiry and thoughtful reasoning b. Active, persistent and careful consideration of the evidence supporting a decision c. Passive acceptance of an unreflective jump to conclusion required in the OR. d. Skill in applying the methods of logical inquiry and reasoning - ✔Passive acceptance of an unreflective jump to conclusion required in the OR. During this phase of wound healing contraction occurs - ✔proliferation Exposure to this sterilization method is potentially carcinogenic and mutagenic to personnel and patients. - ✔ethylene oxide The AORN RP that most directly pertains to this phase of cleaning in the Periop environment states that a safe, clean environment should be reestablished after each surgical procedure. - ✔interim cleaning Placing it in a sterile plastic container is the proper handling of this item when removed from a patient for forensic evidence. - ✔bullet Which type of cleaning includes the entire floor, moving the OR bed to clean 3-4 feet around it - ✔post-procedure cleaning Clinical nurse progression from Novice to Expert requires enhancement of this, and the development and refinement of this is affected by Clinical narratives, simulation,

questioning; Partnering with proficient nurses; and the nurse's level of knowledge and experience - ✔Critical Thinking Skills List 4 team members who wear sterile gowns and gloves. - ✔a. Scrub person b. Surgical assistant c. Surgeon d. Medical student/resident/PA/NP Name 3 risks to patients and staff members associated with laser use: - ✔a. Eye injury b. Fire hazards c. Inhalation of laser plume Name 4 types of powered cutting instruments used in surgery - ✔a. Bone reamers b. Dissectors c. Saws d. Tissue shavers Name 2 ways that health care workers are most likely to become sensitized to latex ✔a. Airborne contact b. Cutaneous contact During admission of a patient to Phase 1 in PACU, what 5 things are the Perianesthesia nurse responsible for? - ✔a. Assessing patient's level of consciousness b. Assessing the patient's pain level c. Assessing the surgical dressing d. Maintaining a patent airway e. Monitoring BP, HR, and O2 saturation Name 4 types of biopsies that require specialized methods of preparation and preservation to preserve the cells - ✔a. Bone marrowb. Musclec. Nerved. TesticularList 4 items necessary included in Preoperative documentation - ✔a. medicationsb. Oral verification by the pt of the procedure to be performedc. Patient allergies to medications and materials d. Patient identification List Clinical manifestation of a true allergic response to latex - ✔a. Contact urticarialb. Periorbital edema and itchingc. WheezingList 4 components that should be included in documentation of intraoperative patient position. - ✔a. Names of personnel assisting with positioning-

b. Placement of armsc. Position that pt is placed in for procedured. Use of specific positioning devicesAORN guidelines for a "time-out" specify that all surgical team members must agree on the following 3 things - ✔a. Name of ptb. Procedure to be performedc. Site of procedure4 Barriers to effective pt and family education in the perioperative setting. - ✔a. Anxiety about an uncertain outcomeb. Discomfort or painc. Fear of unknownd. Short period of time for assessment and teachingThe 3 purposes of the surgical hand scrub - ✔a. Reduce risk of microbial contaminationb. Remove soil and debrisc. Suppress growth of microorganismsList the 5 Recommended Practices for sponge count procedures - ✔a. Count all sponges at the beginning of the caseb. Separate sponges as they are countedc. Simultaneous counting by two people, including an RN circulatord. Count out loud e. Document all counts List 2 ways that the Perioperative nurse assists with general anesthesia induction - ✔a.

Apply cricoid pressure if needed during intubationb. Remain at the pts side to offer reassurance and promote safetyList 3 steps that should be followed to remove of the gown and gloves at the end of the procedure - ✔a. Grasp gown at shoulders and pull downward, turning sleeves inside outb. Remove gown firstc. Use a glove-to-glove and skin-to-skin technique to remove glovesList 5 actions that should be included in the perioperative nursing care of a pt with a suspected latex allergy. - ✔a. Assess pts cross-sensitivities and previous reactions to latexb. Indicate latex precaution on door signs for every room pt occupiesc. Use latex-free supplies for IVs, hair covering, dressing materials, etc.d. Verify surgeon is aware of the allergye. Schedule pt as first case of the day if possible

List 5 steps that should be followed in correctly draping the sterile field - ✔a. Drape from sterile to unsterile areasb. Drape from operative site outwardc. Form a cuff with the drape and place gloved hands under the cuffd. Handle each drape as little as possiblee. If draping without assistance, walk around the OR bed to drape the other sideState 4 reasons why perioperative pt and family education is important - ✔a. Conveying genuine caring for the pts well-beingb. Increasing pt and family adherence to the plan of carec. Increasing pts and family satisfaction with quality of cared. Legal, ethical, and regulatory mandates2 Characteristics included in the elements of a culture of safety within a healthcare organization: - ✔a. Commitment to safety as the first priority in providing care* b. Trust among healthcare team members* 4 things the perioperative nurse should do when setting up the insufflation equipment for an abdominal endoscopic procedure - ✔a. Have a back up tank availableb. Verify that CO2 pressure and supply alarms are on and functioningc. Position the insufflator at pts heart level or above d. Verify that the tank valve is open Name 4 ways to prevent or minimize ESU injuries to the pt - ✔a. dry prep solutions b. confirm settings c. Inspect each circuit component if the surgeon repeatedly requests higher power settingsd. Inspect the ESU to verify electrical integrity List 4 things the perioperative nurse should do when a Bier Block is used during a procedure - ✔a. Check the calibration of the tourniquet before applying itb. Monitor the length of time the tourniquet is inflatedc. Deflate the tourniquet slowly d. Inflate the proximal cuff first A psychosocial assessment of your pt should include these 4 things: - ✔a. Cultural beliefs and practicesb. Expectations of perioperative carec. Spiritual or religious beliefsd. Understanding of the surgical procedureThe Perioperative nurse's documents of the skin prep procedure should include these 5 things - ✔a. Body area preppedb. Name of person performing prepc. Preoperative assessment of skin at the operative site-

d. Skin prep agente. Type and extent of hair removal if orderedWhat 3 special care procedures are required for microsurgical instruments - ✔a. Keep stainless steel and titanium instruments separatedb. Use a non-fibrous sponge wipe to clean the instrument tip if recommendedc. Use tip covers or protective sleeves when instruments are not being usedWhat phases of the nursing process that the perioperative nurse practices during the preoperative phase of the surgical experience? - ✔a. Assessmentb. Identification of desired outcomec. Nursing diagnosisd. PlanningWhat are practices from AORN RP V that states "a sterile field should be maintained and monitored constantly." - ✔a. The sterile field should be constantly monitoredb. The sterile field should be prepared as close as possible to the time of usec. The sterile field may be covered with a sterile drapeWhat are 3 Safety precautions when handling and caring for powered instrument - ✔a.

Hand the powered instrument to the surgeon with the safety mechanism onb. Have irrigation ready to use with the drill or sawc. Use the instrument with the blade or drill guard in placeA patient is unable to transfer independently to the procedure bed. To achieve the PNDS outcomes related to safe patient transfer, name 4 measures that may be used to prevent shearing injury? - ✔a. Request additional personnel to assist with pt transferb. Use a friction-reducing transfer sheetc. Use a slider or roller boardd. Use the draw sheet to lift the pt slightly to allow the skin to realign with skeletal structureWhat 3 Practices are recommended during decontamination of used instruments - ✔a.

Open box locks and disassemble instrument with multiple partsb. Use enzymatic detergent on heavily soiled instrumentsc. Wear PPEWhat is the Perioperative nurses role in preparing and administering meds - ✔a. Assess allergies b. Verify correct med, dose, and routec. Writing down and reading back oral orders d. Verify expiration date The EPA registered germicides labeled as hospital disinfectants must demonstrate effectiveness against these 3 microorganisms: - ✔a. Pseudomonas aeruginosa-

b. Salmonella cholera suisc. Staphylococus aureus-