Periop 101 Final Exam Complete Solutions and Rated A

Periop 101 Final Exam 1, 3, 2 - ✔Match the latex sensitivity categories with their correct description: a) Delayed Type IV Hypersensitivity b) Immediate Type I c) Irritant contact dermatitis 1 - Localized delayed allergic reaction occurring 24-72 hrs. after exposure 2 - Non-allergic skin reaction usually aggravated by glove powder and chemical agents added to raw latex 3 - Occurs within 5-30 min. after exposure. The onset may be delayed 10-12 hrs. *Use numbers separated w/commas to match 1, 4, 2, 3 - ✔Many national organizations are focusing on ways to improve patient care.

Match the organization with their associated safety activity. a) Centers for Medicare and Medicaid Services (CMS) b) Institute of Medicine (IOM) c) The Joint Commission (TJC) d) World Health Organization (WHO) 1 - Health Insurance Portability and Accountability Act 2 - National Patient Safety Goals 3 - Safe Surgery Saves Lives 4 - To Err is Human: Building a Safer Health System *Use numbers separated w/commas in the correct/matching order w/the letters.

2, 3, 1 - ✔Match terms with correct definitions: a) Surgical conscience b) Sterile c) Sterile technique 1 - The use of specific actions and activities to prevent contamination and maintain sterility of identified areas during operative or other invasive procedures 2 - Allows for no compromise in the principles of sterile technique 3 - The absence of all living microorganisms *Use numbers to match with the terms in order of a-c.

2, 3, 1 - ✔Match the hemostatic agent to the corresponding method: a) Bone wax b) Laser c) Thrombin

1 - Chemical method 2 - Mechanical method 3 - Thermal method *Use numbers w/commas to match 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) 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.

3, 1, 2 - ✔An immediate latex allergy response has three stages. Match the following stages with the appropriate symptoms: a) Can progress to a sudden drop in blood pressure, increased HR, and potential circulatory collapse b) Contact urticaria presenting as redness and swelling at the site of exposure c) Response spreads beyond the area of contact and can include itching around the eyes, shortness of breath, and acute rhinitis 1 - Stage I 2 - Stage II 3 - Stage III

*Use numbers separated w/commas to match 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) 3, 4, 2, 1 - ✔Place the four basic steps of fire safety in the correct order: a) Confine the fire, shut the doors b) Evacuate according to facility plan c) Notify the fire department d) Rescue patients and staff members in immediate danger *Use numbers separated w/commas in order of a-d.

3, 5, 2, 1, 4 - ✔Match the specimen type with the appropriate description: a) Frozen b) Culture c) Cytology d) Routine e) Forensic 1 - Does not require immediate pathology examination 2 - For studying cell biology 3 - Requires immediate pathology examination 4 - Retrieved from the patient involved as a suspect or victim in a crime 5 - Suspected of infection *Use numbers w/commas to match the correct order 4, 1, 3, 2 - ✔Match the instruments to the appropriate category: a) Army Navy b) Kelly c) Needle Holder d) Rongeur 1 - Clamping 2 - Cutting 3 - Grasping 4 - Retracting

*Use the numbers separated w/commas in the correct matching order.

4, 2, 3, 1, 5 - ✔Match the anesthesia term to its definition a) General b) Regional c) Monitored Anesthesia Care (MAC) d) Moderate sedation e) Local 1 - Administration of anesthetic agents by an anesthesiologist, CRNA, or specially trained perioperative RN 2 - An injection of local anesthetics near nerve fibers to cause a reversible loss of sensation over an area of the body 3 - Anesthesia provider monitoring and sedation of the patient 4 - Drug-induced, reversible state of unconsciousness 5 - Infiltration or topical administration of agents to anesthetize a body part *Use numbers separated w/commas to match a - ✔_________ should not be placed on the sterile field until final counts are completed. a) Dressing sponges b) Closing stitches c) Irrigating fluid d) Skin staples a - ✔A ______ is a designated area on the sterile field where the scrub person and the surgeon place all sharp instruments. a) Neutral zone b) Hands-free zone c) Scrub area d) Sharps area a - ✔A 72-y/o man is scheduled for a procedure to repair his right hip fracture. He has a history of smoking and diabetes and is currently taking prednisone for his RA. Based on this history, what would you be MOST concerned about? a) Delayed wound healing b) Postop pain control c) Maintaining normothermia d) Intraoperative fluid management a - ✔A 79-y/o patient undergoing laparoscopic cholecystectomy is being induced under general anesthesia. The anesthesiologist notices an unexplained tachycardia, tachypnea, and jaw tightness. The capnography shows an elevated end-tidal CO2.

What is the immediate action the perioperative RN should take to treat this suspected MH?

a) Call for the MH cart and Dantrolene b) Initiate cooling measures c) Administer sodium bicarb d) Change the soda lime canister 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 a - ✔A popular type of grasping clamp that has no teeth is the a) Babcock clamp b) Allis clamp c) Kocher clamp d) Ochsner clamp a - ✔After the perioperative RN sets up for a total joint procedure before the pt enters the room, she discovers a dirty instrument on the sterile back table. What step should the perioperative RN take NEXT? a) Break down the back table and reestablish the sterile field b) Bring the pt in the room and document the contamination in the pt's chart c) Cover the area where the dirty instrument was found with a sterile towel d) Remove the dirty instrument from the sterile field and replace it w/another sterilized instrument a - ✔An example of a self-retaining retractor is the: a) Balfour b) Richardson c) Deaver d) Army-Navy a - ✔An important difference between minimally invasive and open surgical procedures is that minimally invasive: a) Can be performed through smaller incisions b) Increases the patient's pain and hospital stay c) Is complication and risk-free d) Requires less surgical time in the OR a - ✔At what point in the healing process do most wound disruptions occur? a) Beginning of proliferative phase - (Phase 2) 2 to 10 days b) End of proliferative phase (Phase 2) 10 to 22 days c) Beginning of maturation phase (Phase 3) 21 days to 6 weeks d) End of maturation phase (Phase 3) 6 wks to 2 yrs

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 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 a - ✔For a patient with a known latex allergy or sensitivity, a recommended risk reduction strategy is: a) Schedule the case as the first procedure of the day b) Schedule the case for any time of the day c) Handle the surgery as any other procedure d) Schedule the surgery as the last procedure of the day a - ✔Halfway through a bilateral lower-extremity debridement and skin graft on a pt with third-degree burns, the surgeon requests that the drapes be repositioned farther apart to achieve better surgical access. According to AORN recommendations, what is the scrub RN's MOST appropriate action? a) Inform the surgeon that once the drapes are placed, they should not be removed b) Move the drapes to best accommodate the surgeon's access to the surgical site c) Requests a laparotomy drape to re-drape the entire field d) Use sterile towels to cover the edges of the original drapes 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 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 - ✔Perioperative nursing care documentation must include a description of the patient care delivered and the patient response to that care. a) True b) False a - ✔Potential sources of fuel for surgical fires include: a) Draping materials b) Fiberoptic cables c) Lasers d) Nitrous oxide a - ✔Principles of care for forceps during a procedure include: a) Frequently inspect tips and wipe clean of blood or tissue as needed b) Organizing them on the Mayo stand or back table by placing one inside another c) Place them back in the instrument set if the surgeon says that they are not working properly d) Stand them upright along the sides of the instrument tray so that the handles are easily grasped when needed a - ✔Scrubbed personnel changing positions within a sterile field should turn: a) Back to back b) Front to back c) With hands kept below the level of the waist d) Only if single-use sterile gowns are being worn a - ✔Surgical tissue banking is: a) The retrieval, processing, preserving, and storing of selected human tissue for later transplantation back into the patient or into another patient b) The retrieval and storing of selected human tissue for later transplantation into another patient c) The preserving and storing of selected human tissue for later transplantation back into the patient or into another patient d) The retrieval, preserving, and storing of human tissue for later transplantation back into the patient a - ✔Terminal Cleaning must be done: a) Once during each 24-hr period b) Twice during a 24-hr period c) Once in a week-long period d) Twice in a week-long period 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 a - ✔The dispersive pad should be applied: a) As close to the operative site as possible b) Before the pt is positioned c) Distal to any tourniquet in use d) So that it covers as small an area as possible 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 a - ✔The perioperative nurse prepares the OR suite before the first scheduled procedure by: a) Damp dusting the furniture, equipment, and surgical lights b) Terminally cleaning the furniture, equipment, and floors c) Cleaning the floor and walls with diluted bleach d) Replacing all linen and trash bags a - ✔The phases of general anesthesia, in order, are: a) Induction, Maintenance, Emergence b) Emergence, Maintenance, Induction c) Maintenance, Emergence, Induction d) Induction, Emergence, Maintenance 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 - ✔The primary reason for documenting sharp, sponge, and instrument counts is: a) To prevent injury to the patient from a retained foreign object b) To maintain an inventory for the sterile processing dept. c) To provide an accurate item charge for the pt d) To track instruments that might be needed for the next procedure a - ✔Transient microorganisms live in the ______ layer of the skin. a) Epidermal b) Dermal c) Fatty (adipose) d) All of the above

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 - ✔What are the three methods used to accomplish hemostasis? a) Mechanical, chemical, and thermal b) Mechanical, physical, and chemical c) Physical, pharmacological, and chemical d) Thermal, harmonic, and ESU 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 a - ✔What biting instrument is used for cutting tough tissue or bone? a) A rongeur b) A rasp c) An osteotome d) A curette a - ✔What is the BEST strategy to reduce the risk associated with ignition of prep solution vapors? a) Allow the prep solution to dry before draping b) Insert blotting towels after performing skin prep to prevent the solution from pooling on the pt's skin c) Reduce the amount of prep solution applied if an ignition source will be used during surgery d) Use a suction device to remove the vapors during the procedure 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 a - ✔What is the MOST important reason for maintaining endoscopic instruments at an optimal level of function? a) Insulation defects can cause unseen thermal burns b) It is easier to maintain the sharpness of their edges

c) They are expensive to repair or replace if damaged d) They are not available in disposable or reposable forms a - ✔What is the perioperative RN's responsibility regarding informed consent? a) Ensure that the consent is correct, signed, and witnessed b) Obtain verbal consent if there is no written consent c) Provide the patient a list of alternative treatments to the proposed surgery d) Review the procedure and expected outcome with the patient a - ✔What is the rationale for wearing gloves when handling or transporting surgical specimen? a) To avoid exposure to biohazardous substances b) To avoid imprints on the specimen c) To prevent contamination of the specimen d) To prevent misdiagnosis 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 a - ✔What type of needle point should you expect to be needed for suturing friable tissue such as the liver? a) Blunt b) Reverse cutting c) Taper a - ✔When is NOT considered the best time to do a surgical count for sponges, sharps, and instruments? a) When the wound has been completely closed b) Before the procedure begins c) When wound closure begins d) Before a cavity closure a - ✔When setting up the insufflator for a laparoscopy, the perioperative RN should verify that the: a) Carbon dioxide (CO2) pressure and supply arms are functioning b) Insufflator equipment is lower than the level of the surgical incision c) Scrub person flushes the insufflator tubing with NS for injection before connecting the tubing d) Valve on the CO2 tank is closed a - ✔Which actions can the scrub person take to help prevent incidental thermal burns?

a) Inspect laparoscopic instrumentation for excessive wear or obvious breaks and replace when necessary b) Clean all instruments with antibiotic solution c) Watch the surgery carefully d) Use instruments that have damaged insulation a - ✔Which example illustrates how you should care for forceps during a procedure? a) Inspect tips and wipe off blood or tissue as needed b) Organize them on the Mayo stand or back table or placing one inside another c) Place them back in the instrument set if the surgeon says that they are not working properly d) Stand them upright along the sides of the instrument tray so that the handles are easily grasped when needed 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 a - ✔Which of the following examples is included on the Joint Commission's list of DoNot-Use Abbreviations, Acronyms, and Symbols? a) MS b) mcg c) mL d) unit 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 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 a - ✔Which of the following is associated with increased risk for perioperative hypothermia? a) Female sex b) Higher than normal body weight

c) Hyperthyroidism d) Hypertension 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 a - ✔Which of the following practices violates a patient's ethical right to selfdetermination? 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 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 a - ✔Which practice will MOST likely reduce the patient's risk of intraoperative skin injury? a) Allowing prep solutions to dry before draping b) Leaving blotting towels in place to absorb any blood from the wound c) Using a draw sheet to pull the pt from the stretcher to the OR table d) Removing skin prepping agent prior to start of case a - ✔Which region of the patient's abdomen is traditionally used to establish pneumoperitoneum for laparoscopic surgery? a) Periumbilical b) Supraumbilical c) Subumbilical d) Umbilical a - ✔While waiting for the prep solution to dry, the circulating RN observes the laparotomy drape fall below waist level of the scrub person. What is the best action for the nurse to take? a) Alert the team that the drape is contaminated and replace with a sterile drape b) Allow the team to use the drape since the prep solution will minimize the risk of infection c) Assist in draping the pt by handling only the area of the drape that is contaminated

d) Reposition the drape after the drape is placed to assure the contaminated area remains below table level 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 a, b, c - ✔What steps should be followed in correctly draping the sterile field? Select all that apply. a) Drape from sterile to unsterile field b) Drape from operative site outward c) Cuff the drapes over a gloved hand d) If the drape is placed incorrectly it can be moved and repositioned e) If draping without assistance, reach across the pt to drape the other side a, c, d - ✔Identify the instruments that can be used for laparoscopic surgery. Select all that apply. a) Babcock forceps b) Mosquitoes forceps c) Needle holder forceps d) Dissector forceps a, c, d - ✔What are the most common roles of the perioperative RN in preparing medications and solutions? Select all that apply. a) Preparing medications and solutions per the physician's preference card b) Administering medications intravenously c) Preparing and labeling medications and solutions d) Document and verify by verbally reading back to the provider all verbal orders, per facility policy a, d - ✔Which of the following types of anesthesia require an anesthesia professional?

Select all that apply. a) General b) Local c) Moderate sedation d) Monitored anesthesia care (MAC) b - ✔________________ hemostasis is achieved by occluding severed vessels until platelet formation occurs. a) Thermal b) Mechanical c) Chemical

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 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 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 b - ✔A patient is scheduled for a modified radial mastectomy, performed by a general surgeon, immediately followed by a breast reconstruction performed by a plastic surgeon. The Time-Out takes place: a) Prior to the beginning of the initial procedure only b) Prior to the beginning of both procedures c) At the discretion of the surgeon d) When one of the surgeons is in the facility 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 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 - ✔According to the AORN Guidelines, when should the scrubbed team members change their gloves during invasive surgical procedures? a) Every hour b) Every ninety to 150 minutes c) Three hours after start of the procedure and every hour thereafter, until the end of the procedure d) Three to four hours after the start of the procedure b - ✔After the surgical hand scrub, the scrub person should keep the fingers pointed in which direction to allow water to drop off away from the attire? a) Downwards b) Upwards c) Straight d) Curved towards the palm 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 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 - ✔Based on your knowledge of knives and blades, identify the correct statement about handling knives. a) When passing a knife, it should be held using an assistive device such as a needle holder b) When passing a knife, it should be carefully held between the thumb and index finger c) When passing a knife, it is preferable to pass the blade separate from the blade handle d) When passing a knife, the cutting edge of the knife should point toward the surgeon 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) 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 - ✔Clean supplied do NOT need to be separated from sterile supplies inside the surgical suite: a) True b) False b - ✔Curved Mayo scissors are used for which of the following? a) To cut delicate tissue b) To cut heavy tissue c) To hold suture material d) To grasp tissue b - ✔Damp dusting of horizontal surfaces in the OR suite should be performed: a) Before every single procedure set up b) Beginning with the highest surfaces and moving to the lowest c) Using a disposable cloth moistened with isopropyl alcohol d) When the OR suite has been vacant for 24 hrs 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 b - ✔During closed assisted gloving, pull the gown cuffs up over the wrists towards the elbows before donning gloves. a) True b) False b - ✔During intubation, the patient has chest movement but no air exchange. The perioperative RN's first priority is to: a) Prepare for re-intubation b) Assure that suction is available for the anesthesia care provider c) Provide racemic epinephrine for the anesthesia care provider

d) Provide positive-pressure ventilation 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 b - ✔How many identifiers should be used to verify the correct patient, site, and procedure? a) 1 b) 2 c) 3 d) 4 b - ✔Identify one of the characteristic differences between laparoscopic instruments and those used in open procedures. a) All laparoscopic scissors are "taken-apart" b) Laparoscopic instruments have long, thin shafts to accommodate trocar cannulas c) One cannot dissect tissue with laparoscopic instruments d) All laparoscopic instruments are disposable 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 b - ✔If draping without assistance, the scrub person should reach across the pt to drape the other side. a) True b) False b - ✔If the surgeon continuously asks for higher power settings, what is the first action that the perioperative RN should take? a) Get another ESU unit immediately b) Check the circuitry for possible disruption c) Switch to a bipolar generator and electrode d) Change the active electrode and dispersive electrode b - ✔Immediate use steam sterilization can be used: a) For implants b) In urgent situations

c) Under no circumstances d) For all items b - ✔In addition to giving Dantrolene, which of the following treatment options for MH should the RN anticipate and prepare? a) Cool pt, restart succinylcholine at lower doses b) Provide 100% oxygen, use iced saline to cool pt c) Replace potassium loss, continue w/safe anesthetic agents d) Avoid pt shivering, contact blood bank for platelets b - ✔In what phase of healing do hemostasis, phagocytosis, and edema occur? a) Granulation b) Inflammation c) Proliferation d) Remodeling b - ✔In which order do the body's defence mechanisms take place during healing: 1. Seal the wound against infection 2. Stop the blood loss 3. Repair deeper tissue damage 4. Regenerate the natural epidermal covering 5. Clean up pathogens and debris in the wound a) 5, 2, 1, 3, 4 b) 2, 5, 1, 4, 3 c) 2, 1, 5, 3, 4 d) 5, 1, 2, 4, 3 b - ✔In which surgical wound category should a total abdominal hysterectomy be classified? a) Clean b) Clean contaminated c) Contaminated d) Dirty b - ✔In which type of healing does the wound remain open and allowed to heal on its own without additional surgery? a) Delayed primary closure b) Granulation c) Infected d) Primary union b - ✔Laparoscopic instruments with small, blunt tips are used for: a) Cutting tissue b) Dissecting tissue c) Grasping tissue

d) Moving tissue from one place to other 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 - ✔Once donned, which area of a surgical gown is considered sterile? a) The front, from the chest to six inches below the surgical field b) The front, from chest to the level of the surgical field c) The neck and shoulders d) The axillary area b - ✔Over pressurization of a tourniquet cuff may cause a) Blood in the surgical field b) Compression injuries to blood vessels c) Muscle spasms d) Shock 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 b - ✔Procedures of the head and neck area carry an increased risk for fire due to the: a) Presence of non-combustible anesthetic gases b) Presence of an oxygen-enriched environment c) Use of povidone-iodine prepping agents d) Mixing of medical air and oxygen b - ✔Select the proper order for removal of drapes: a) Last suture placed--incision site dressed--removal of drapes--removal of instruments-disposable material disposed of b) Last suture placed--incision site dressed--removal of instruments--removal of drapes-disposable material disposed of c) Last suture placed--incision site dressed--disposable material disposed of--removal of instruments--removal of drapes d) Last suture placed--incision site dressed--removal of instruments--disposable material disposed of--removal of drapes

b - ✔The capacity of a suture to regain its former shape after being reformed is known as ________. a) Elasticity b) Memory c) Knot tensile strength d) Capillarity 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 b - ✔The name of the clamp designed to hold bowel tissue and has opposing smooth blunt edges is: a) Allis b) Babcock c) Deaver d) Kocher b - ✔The perioperative RN discovers that a sponge is missing during the closing count for a left lung lobectomy. The RN's first action would be to: a) Repeat the count b) Notify the surgeon c) Notify the supervisor d) Document the incident b - ✔The perioperative RN prepares the medications and solutions after receiving orders from everyone EXCEPT: a) Anesthesiologist b) First Assistants c) Surgeons d) Advanced Practice Nurses b - ✔The perioperative RN should be aware that risks for pt injury from argon-enhanced electrosurgery include: a) Cardiac arrest b) Gas embolism c) Respiratory arrest d) VTE b - ✔The perioperative RN who is circulating for a breast lumpectomy should anticipate the need to add which suction drain to the sterile field? a) Nasogastric tube

b) Jackson-Pratt c) Penrose drain d) T-tube 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 b - ✔The point of the forceps should be facing ________ while passing it to the surgeon. a) Upward b) Downward c) Forward d) Backward b - ✔The regulatory agency responsible for surveying facilities' compliance with the Universal Protocol is: a) Institute of Medicine b) The Joint Commission c) National Quality Forum d) Occupational Safety and Health Administration 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% b - ✔The sterility of an item is: a) Dependent on multi-disciplinary team decisions b) Event-related and dependent on the integrity of the item being maintained c) Regulated by hospital protocol and community standards. d) Affected by time and the maintenance of item integrity 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 - ✔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 b - ✔To minimize the potential for injury to patients from the use of the ESU, the perioperative RN should implement which of the following safety measures? a) Anticipate the use of NS for irrigation and place the container on top of the ESU generator b) Remind the team to place the ESU pencil in the holster when not in use c) Turn down the volume of the audible alarm on the ESU generator to decrease the noise level in the OR d) Use the cord to pull the plug from the wall when finished using the ESU unit b - ✔To prevent contamination of the sterile field, unscrubbed team members should face the field when approaching it, should not walk between two fields, and should stay at least _______ away from a sterile field. a) 6 inches b) 12 inches c) 18 inches d) 24 inches b - ✔Vicryl is a type of non-absorbable suture. a) True b) False b - ✔What is a recommendation for limiting the transmission of microorganisms in the surgical setting? a) Allowing used sponges to hang over the edge of the kick bucket for counting b) Discarding soiled sponges and items contaminated with body fluids into biohazard waste receptacles c) Recapping needles using a two-handed method d) Using a spray bottle filled with hospital-approved disinfectant to clean small spills 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 - ✔What is the BEST method for keeping instruments clean in the sterile field?

a) Soak instruments in a basin of normal saline b) Wipe instruments with a sponge and sterile water c) Spray instruments with an enzymatic detergent d) Thoroughly flush instruments with sterile water b - ✔What is the BEST type of drape to use for an open umbilical hernia repair? a) Extremity b) Laparotomy c) Perineal d) Split sheet b - ✔What is the most consistent indicator of MH during a surgical intervention? a) Tachycardia b) Unexplained increase in end-tidal CO2 c) Elevated temperature d) Sustained muscle contraction b - ✔What is the MOST serious negative outcome that can result from the loss, mislabeling, or mishandling of a surgical specimen? a) The medical facility could be sued for negligence b) The patient's condition could be misdiagnosed c) The medical facility's reputation could be damaged d) The patient may be dissatisfied with the treatment received b - ✔What is the reversal agent for heparin? a) Warfarin b) Protamine c) Thrombin d) Lipids b - ✔What should the perioperative team do if they are unable to extinguish a fire in the OR? a) Continue to fight the fire until it is extinguished b) Evacuate the pt and the perioperative team following the organizational fire plan c) Obtain and use a different type of fire extinguisher d) Request additional perioperative team members to assist b - ✔When an electrosurgical unit (ESU) is used in surgery, proper documentation includes placement of the dispersive pad, identification of the ESU, and: a) The brand name of the ESU b) The setting used during the surgical procedure c) The brand name of the electrocautery pencil d) The last date of the preventative maintenance b - ✔Which agents are effective in removing resident microorganisms?

a) Mechanical agents b) Chemical agents c) Biochemical agents d) Hydrostatic agents 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 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% b - ✔Which of the following illustrates safe use of an endoscopic light source? a) Placing the light cord on the sterile field when not in use b) Placing the light in standby mode when not in use c) Turning the light source on before connecting the cable to the telescope 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 b - ✔Which type of anesthesia care can a perioperative RN manage after receiving education and competency verification? a) General b) Local c) MAC d) Regional b - ✔Which type of suturing technique is considered the strongest and MOST secure? a) Continuous b) Interrupted c) Purse-string d) Subcuticular

b - ✔While a scalpel is bring changed during a hemicolectomy, the blade snaps and breaks into several pieces. The scrub nurse is unable to find a small piece of the blade.

Which statement regarding counts is true? a) The count is considered correct b/c the blade broke on the back table and not near the wound b) The count is considered incorrect unless the entire blade is found c) The count is considered correct after the room and sterile field is searched d) The count is considered incorrect even if the entire blade is found b - ✔While setting up for an emergency C-section before the patient enters the OR suite, the scrub RN notices that there are no radiopaque strips on the lap sponges.

What should the scrub RN do? a) Ask the RN circulator to make a note of the missing strips on the perioperative record b) Hand off the lap sponges and ask the RN circulator to remove them from the OR suite c) Isolate the lap sponges on the sterile field by hiding them under towels d) Proceed w/the sponge count to avoid delaying the start of the emergency procedure 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 c - ✔_________ can also be used in spray form. a) Plasma-Lyte pH 7.4 b) Microfibrillar Collagen c) Topical Thrombin d) Liquaemin c - ✔_________ recommend prompt cleanup of items stained with blood, tissue, or body fluids. a) Manufacturer guidelines b) Local, state, and federal regulations c) Confine and contain principles d) Hospital specifications c - ✔____________ needles are in continuity with the suture material: a) French eyed b) Eyed c) Swaged d) All of the above

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 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 - ✔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 c - ✔A 56-y/o pt is undergoing an incision and drainage (I&D) of the right knee and upper thigh after a MVA. A tourniquet is applied to the patient's upper right thigh by the surgeon. Which of the following is the reason why a rubber bandage would not be used for exsanguinations of the of the pt's extremity? a) Open wounds do not require exsanguinations b) Nerve damage may be too extensive c) Infection is present in the extremity d) Tourniquet pressures are adequate 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 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 - ✔A neighbor call the preoperative area and asks the perioperative RN, "How is my friend? I missed her at church and I heard she was in the hospital." What is the RN's appropriate response? a) "Here's her daughter's telephone number; she can give you more information." b) "She's doing well but I cannot give you any more information." c) "The patient has requested that we share her information only with her family." d) "We are getting ready for surgery so you can talk with her in a few hours." 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 c - ✔A precise way of looking at general anesthesia is to divide it into 3 phases: a) Phase I: Initial Administration, Phase II: Maintenance, Phase III: Excitement b) Phase I: Initial Administration, Phase II: Maintenance, Phase III: Emergence c) Phase I: Induction, Phase II: Maintenance, Phase III: Emergence d) Phase I: Induction, Phase II: Intrasurgery, Phase III: Excitement 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 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 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 c - ✔According to AORN Standards, Recommended Practices, and Guidelines, sterile gowns are considered sterile: a) In front from neckline to sleeves b) In front and back from waist up c) In front from chest to level of sterile field

d) Entirely c - ✔According to the AORN Guidelines, what is the correct documentation for this medication? a) M.S. 2.0 mg b) MS 2 mg c) Morphine sulfate 2 mg d) Morphine sulfate 2.0 mg 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 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 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 c - ✔By which route are antibiotics most commonly administered by the perioperative RN during the intraoperative phase? a) Intramuscular b) Intravenous c) Irrigation Solution d) Subcutaneous c - ✔Damp dusting of the OR as part of the preliminary room preparation should be done: a) In the morning the day of the surgery b) The night before the scheduled surgery c) Before bringing in any surgical supplies d) After the surgery

c - ✔During a vascular procedure where a vessel is harvested for bypass, the surgeon may request the addition of ______ to be added to the heparin saline solution for its antispasmodic effect on the wall of the vessel. a) Ancef b) Thrombin c) Papaverine hydrochloride d) Esmolol 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 - ✔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 c - ✔Following an appendectomy, a blistered area on the left thigh of the pt is noted. In addition to documenting the findings, the perioperative RN should: a) Retrieve the prep set used on the procedure and obtain its lot number b) Apply a thin coating of povidone-iodine (Betadine) solution to the area c) Check the preoperative assessment for documentation of impaired skin integrity d) Remove the ESU from service and save all the active and dispersive electrode pads c - ✔Guidelines for safe use of endoscopic light source include: a) Following surgeon preferences when setting parameters b) Placing the light on the sterile field when not in use c) Placing the light in standby mode when not in use d) Turning the light source on before connecting the cable to the telescope c - ✔Identify the needle that is also known as a pop-off needle: a) Double-armed eyeless needle b) Permanently swaged needle c) Controlled release needle d) French needle 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 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 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 - ✔The most appropriate needle point for performing a vascular anastomosis is a: a) Blunt b) Cutting c) Taper d) Taper-cut c - ✔The patient's hair should be covered before entering the: a) Semi-restricted zone b) Unrestricted zone c) Restricted zone 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 - ✔The skin can be sterilized: a) Always b) Easily c) Never d) None of the above c - ✔These types of sponges prove blunt dissection as they absorb fluids: a) Neuro-patties b) Laparotomy sponges

c) Cherry dissectors d) Radiopaque sponges c - ✔To reduce the possibility of an injury or burn, which of the following most accurately describes where the perioperative RN should place the dispersive electrode? a) As far from the operative site as feasible b) Directly on the operative site c) As close to the operative site as feasible d) Anywhere it will be easy to access c - ✔What action below is the best course to take when a hair is found in an instrument tray on the back table? a) Using a sterile clamp, the scrub person should remove the hair and pass it off to the RN circulator b) The scrub person should pass off the entire instrument tray and request a replacement c) The entire sterile field should be broken down and a sterile field reestablished d) The scrub person should pass off the instrument tray and change gown and gloves c - ✔What area in the OR suite is considered "high-touch" and should be cleaned after each surgical procedure? a) Air vents b) Ceilings and walls c) OR bed control d) Shelving and storage bins 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 - ✔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 - ✔What is recommended for managing excised breast cancer tissue specimens? a) Keep the tissue dry until transfer from the sterile field b) Place the breast cancer specimen on a sterile, dry, nonabsorbent material before placing it into a sterile container for transport to pathology

c) The time from excision to fixation of the breast cancer specimens should be less than one hour c - ✔What response is the result of tissue layers moving on each other? a) Pressure ulcers b) Maceration c) Shearing d) Friction 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 c - ✔What statment about surgical hand rubs is TRUE? a) Apply surgical hand rub only to hands, concentrating on the finger tips b) Dry hands with a sterile towel after applying a surgical hand rub c) If visibly soiled, wash hands w/soap and water before performing a surgical hand rub d) The surgical hand rub method should never be performed before setting up orthopedic surgeries c - ✔When a count discrepancy occurs, what should be the FIRST action taken by the RN Circulator? a) Call for anterior and lateral x-ray b) Inform the nurse supervisor c) Inform the surgical team of the discrepancy d) Instruct the scrub person to search for the missing item c - ✔When is closed glove technique used? a) During a surgical procedure b) During insertion of an IV cut down c) During the initial donning of sterile gown and gloves only d) When changing one or both gloves c - ✔When performing a plastic surgery skin closure, which choice of suture size would be most appropriate? a) 15-0 b) 2-0 c) 5-0 d) 0 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 - ✔When using argon-enhanced coagulation (AEC), there is a risk of _________. a) Electrosurgical injuries b) Carbon dioxide purge c) Gas emboli d) Decreased insufflator pressure c - ✔Where should the scrub person's sterile gown be opened? a) As far away from the instrument tray as possible b) In the back corner of the instrument table c) On a separate Mayo stand d) On top of the gloves for the scrub person c - ✔Which device should be used while carrying out an extremity prep? a) Cuff b) Tape c) Assistive prop d) Clip c - ✔Which is NOT a local anesthetic drug used for regional anesthesia? a) Bupivacaine b) Lidocaine c) Fentanyl d) Tetracaine 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 c - ✔Which of the following "AORN Position Statement on Correct Site Surgery" statement is true? a) Family members should not be involved in identifying the correct site b) The surgical site should be marked with a washable marker c) The staff member should verbally verify the correct site with each member of the surgical team d) Wrong-site surgery is most common in ophthalmologic procedures c - ✔Which of the following actions should NOT be included in the perioperative nursing care of a patient with a suspected latex allergy? a) Assess the patient's cross-sensitivities and previous reactions to latex

b) Indicated latex precautions on door signs for every room that the patient occupies c) Schedule the patient as the last procedure of the day if possible d) Use latex-free supplies for IVs, hair covering and dressing material e) Verify that the surgeon is aware of the allergy c - ✔Which of the following describes capacitive coupling? a) Pt injury caused by ESU device that occurs away from the dispersive electrode site b) Radio-frequency coagulation from an ESU generator that is capable of delivering monopolar current through a flow of ionized argon gas c) The transfer of electrical current from the active electrode through intact insulation to adjacent conductive items such as tissue or trocars d) The contact of an energized inactive electrode tip with another metal instrument or object within the surgical field c - ✔Which of the following drugs should be available to treat a Malignant Hyperthermia (MH) crisis? a) Diazepam (Valium) b) Meperidine (Demerol) c) Dantrolene (Dantrium) d) Sodium Bicarbonate c - ✔Which of the following is a strategy to reduce medication errors? a) Knowing the prescribing surgeon's preferences b) Transferring all required intraoperative medications into a container on the sterile field before the start of surgery c) Using computerized physician order entry for medication management d) Using multi-dose versus single-use medication vials c - ✔Which of the following is not a characteristic that promotes a culture of safety within a health care organization? a) Commitment to safety as the first priority in providing care b) Dissemination of information to all levels of staff c) Prompt disciplinary action when errors occur d) Trust among healthcare team members 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 c - ✔Which of the following practices should be used to implement the Joint Commission's Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery?

a) Asking the patient to mark the correct surgical site with an "X" b) Asking the patient to verify the expected procedure in writing c) Using a time-out procedure before beginning the procedure d) Using three unique patient identifiers 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 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 c - ✔Which one is not part of the seven rights of medication administration? a) Right Indication b) Right Time c) Right Response d) Right Patient e) Right Route f) Right Medication g) Right Documentation h) Right Dose c - ✔Which statement best describes the path for bipolar surgical current? a) Current leaves the generator, is applied to tissue using a pencil device, is collected in the dispersive pad, and returns to the generator b) Current leaves the generator, is applied to tissue using a pencil device, and returns to the generator c) Current leaves the generator, is applied using a two-poled instrument, and returns to the generator 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 c - ✔Which type of human factor is responsible for an error that occurs when a perioperative nurse is trying to attend several tasks at once? a) Device user error b) Knowledge-based c) Situational

d) Skill-based 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 - ✔Your pt is scheduled for removal of multiple nevi on his face and neck. The anesthesia professional will provide MAC, including administering oxygen via nasal cannula. What should the team include in their fire safety precautions for this pt? a) Anesthesia professional administers the highest tolerable level of oxygen to the pt b) Scrub person wipes off skin prep solution at the site of the proposed incision with an alcohol-soaked sponge immediately before draping the pt c) Scrub person moistens sponges and places them near the incision site d) Surgeon uses only monopolar technology 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) d - ✔A patient is undergoing transurethral resection of the prostate (TURP) under spinal anesthesia starts to experience chest pain and restlessness with all the signs of congestive heart failure. The most likely cause is: a) Too high a level of anesthesia b) An adverse reaction to the bladder's being filled and emptied rapidly during surgery c) Hemorrhage from opening the venous sinuses d) Absorption of irrigation fluid causing fluid overload d - ✔A safe, clean environment should be reestablished after each surgical procedure.

This includes: a) Cleaning all areas of ceiling and walls

b) Cleaning from the dirtiest to cleanest areas c) Emptying the linen hamper only when it's full d) Ensuring full contact time for the hospital disinfectant d - ✔After receiving a handoff report at a shift change, the perioperative RN notices an unlabeled solution on the sterile field. What should the perioperative RN do? a) Ask the scrub person to label the container with the name of the empty medication bottle on the case cart b) Continue caring for the patient c) Discuss the situation w/the surgeon to determine the best plan d) Instruct the scrub person to discard the solution 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 d - ✔All of the following organizations provide guidance related to surgical tissue banking EXCEPT: a) The American Association Tissue Banks (AATB) b) US Food and Drug Administration (FDA) c) AORN d) American National Standards Institute (ANSI) d - ✔During an inguinal hernia repair, the surgeon asks for a self-retaining retractor.

Which of the following retractors would be the most appropriate to choose? a) Army-Navy b) Richardson c) Senn d) Weitlander d - ✔During laparoscopic surgery, perioperative RN's can reduce the chances of capacitive-coupling injuries by: a) Using a combination of insulated and non-insulated instruments b) Using coagulation wave form and a high setting c) Using metal and plastic cannulas together d) Using the lowest power setting and the low-voltage cutting waveform 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 d - ✔How should a perioperative RN transfer medication from a medication vial to the sterile field? a) Clean the vial stopper with alcohol and hold the vial steady while the scrub person draws up the medication b) Remove the stopper from the vial and pour the solution into a container on the sterile field c) Transfer all prescribed intraop. medications into a container on the sterile field d) Use a commercially available sterile transfer device d - ✔If the patient is scheduled for surgery and general anesthesia eats a cheeseburger, according to the American Society of Anesthesiologists, how long should they wait before having anesthesia for surgical procedure? a) 2 hours b) 4 hours c) 6 hours d) 8 hours 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 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 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% d - ✔Put the following steps in order when opening a wrapped sterile package: 1. Open the nearest wrapper flap 2. Open the side flaps

3. Open the farthest wrapper flap a) 3, 1, 2 b) 2, 1, 3 c) 1, 2, 3 d) 3, 2, 1 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 d - ✔Terminal cleaning of operative and procedural rooms should be done a) After every scheduled procedure b) After cases involving ruptured bowel c) Only if the room has been used that day d) When scheduled procedures are completed for the day d - ✔The best method if transferring medication to the sterile field is to: a) Dispense only what is needed, then recap the container to preserve the sterility of the unused solution b) Remove the stopper from vials and pour the solution onto the sterile field c) Transfer all intraoperative and postop medications to the sterile field prior to the start of the case d) Use a sterile transfer device d - ✔The CDC's Classification of Surgical Wound system is intended to _________. a) Categorize surgical wounds based on coexisting diseases and according to origin, diagnosis, and treatment b) Elaborate on the CDC principles of universal precautions by establishing guidelines for treating infections should they occur c) Suggest emergency criteria for dealing w/infections inside the procedure room d) Monitor postoperative infections and suggest steps to take to reduce these infections d - ✔Using a neutral zone for passing sharp instruments and devices and not recapping needles, are examples of what type of a sharps hazard controls method? a) Administrative controls b) Elimination of the hazard c) Engineering controls d) Work practice controls d - ✔Using a neutral zone for passing sharp instruments and devices and not recapping needles, are examples of which type of a sharps hazard control method?

a) Administrative controls b) Elimination of the hazard c) Engineering controls d) Work practice controls d - ✔What is a method to reduce the risk of a mishap, event, or fire when electrosurgical equipment is used? a) Always use alcohol-based skin preparation when electrosurgery will be utilized b) Use monopolar electrosurgery during a facial procedure when oxygen is being delivered by nasal cannula to the pt c) If the ESU is not functioning properly at normal settings, ask the surgeon by how much the power settings should be increased d) Visually check the integrity and insulation of all cords and coagulation instruments before use d - ✔What is a suggested action from the recommendation, "a sterile field should be maintained and monitored constantly?" a) If a delay occurs after a sterile field is set up, the sterile field may be covered with sterile drapes until the delay is resolved b) If a delay occurs after a sterile field is set up, personnel may leave the room as long as someone remains in the room to maintain continuous visual observation of the sterile field c) The sterile field should be prepared as close as possible to the time of use d) All of the above 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 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 d - ✔What is the BEST way to conduct a Time Out? a) Perform the Time Out in the pre-procedure area if all team members are present. b) Perform the Time Out when the pt enters the room so that s/he may participate. c) The circulating RN leads the Time Out and documents it on the count board within the OR for all to agree d) The Time Out occurs after the patient is prepped, draped, and involves the entire team

d - ✔What is the correct definition of an incisional biopsy? a) A fine gauge needle and syringe are used to aspirate the sample b) An entire section of tissue is sent for examination c) A small portion of fluid is drawn and sent for examination d) A small portion of tissue is incised and sent for examination 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 d - ✔When documenting the use of pneumatic tourniquet which items may not be included? a) Cuff pressure b) Location where the cuff was placed c) Name of the person who applied the tourniquet cuff d) Name of the person who inflated the tourniquet e) Serial number of the unit 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 d - ✔Which characteristic promotes a culture of safety within a health care organization? a) Commitment to safety as the first priority in providing care b) Ongoing education to staff members about patient safety c) Trust among healthcare team members d) All of the above 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 d - ✔Which of the following illustrates how the RN circulator can advocate for the pt to help decrease the risk of pt injury when using and energy-generating device in a surgical procedure?

a) Activating the foot pedal for the surgeon b) Placing the packaged accessories for the energy-generating device on top of the machine so they can be quickly opened when requested c) Reminding the scrub person to secure the cables to the sterile drapes with a metal clamp or towel clip d) Suggesting to the surgeon to use the lowest power settings for the energy-generating device being used d - ✔Which of the following is a correct application of the AORN Guidelines for Perioperative Practice for use of appropriate eyewear during laser use? a) Personnel should not use protective eyewear in common b) Protective eyewear is required only for certain types of lasers c) Regular corrective lenses, including contact lenses, are sufficient for most types of lasers d) The eyewear should be matched to the type of laser, optical density, and wavelength d - ✔Which of the following is true in handling hemostatic agents such as collagen or gelatin sponges? a) Should be moistened prior to use b) Should not be left in the wound, since they are not absorbable c) Are highly perishable and should be refrigerated prior to use d) Must not be injected or allowed to enter large vessels, as extensive intravascular clotting may occur d - ✔Which of the following statements about the gowning procedure is correct? a) As the gown unfolds, slide your hands through the cuffs to allow access for closed gloving b) Hold your hands at chest level and slip both arms into the armholes one at a time c) Open your gown on the back table prior to performing your surgical scrub d) Step back from the table into an unobstructed area to let the gown unfold 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 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

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 - ✔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 d - ✔Which statements about surgical wound dressings is TRUE? a) All dressings are associated with improved outcomes b) Primary dressings are bulkier than secondary dressings c) Primary dressings are usually made of adherent material d) Secondary dressings absorb discharge, protect wounds, and promote hemostasis 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 d - ✔You are RN circulator on a laparoscopic appendectomy. Upon entering the abdomen, the surgeon encounters purulent inflammation of the appendix and asks for a culture. The procedure is completed suing the laparoscope w/o need to open the abdomen. What should you document the wound class? a) Stage I b) Stage II c) Stage III d) Stage IV 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 e - ✔What is a safety practice that decreases exposure and fire from specimen fixatives such as formalin? a) Bringing several containers into the OR suite during a surgery in which ESU equipment is used b) Keeping the formalin container open and ready to receive a specimen from the scrub person c) Placing formalin containers on top of the ESU during surgery d) Storing formalin in a location that provides convenient access for all employees e) Wearing PPE and avoiding splashing when dispensing formalin e - ✔When medication is administered from the sterile field, it is removed from an original container by the RN circulator and presented to the scrub person. It should be immediately and clearly labeled with everything EXCEPT: a) Concentration and amount b) Date prepared c) Expiration date when not used w/in 24 hrs. d) Expiration time if less than 24 hrs. e) Initials of the pharmacist e, c, d, f, a, b - ✔Indicate the proper sequence for removing gown and gloves at the end of a procedure: a) Scrub RN removes using a glove-to-glove and skin-to-skin technique b) Scrub RN discards gloves and performs hand hygiene c) Scrub RN grasps gown at shoulds and pulls downward d) Scrub RN rolls the contaminated gown and sleeves inside out e) RN circulator unfastens neck and back of gown f) Scrub RN discards rolled gown into laundry hamper or trash *Use letters separated w/commas to put the above in the correct sequence. e, g, f, c, a, d, b - ✔Based on what you have learned about various biopsy procedures, match the procedure with the appropriate feature/description.

1. Incisional biopsy 2. Excisional biopsy 3. Needly biopsy 4. Bone marrow biopsy 5. Muscle biopsy 6. Culture 7. Slide

a) Requires specialized forceps that are applied to the tissue before it is removed and keeps the tissue stretched during the process b) Pap smear c) Requires specialized needle that can puncture directly or with a twisting motion d) Performed to determine the exact organism and which treatment it will be sensitive to once identified e) A portion of the tumor removed f) A core of tissue removed for diagnosis g) Whole tumor removed *Use the letters, separated w/commas, to match with the numbers above