(Test Bank) Berry and Kohns Operating Room Technique

Phillips, 14

Nursing

Test Bank

14th Edition

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Test Bank for Berry and Kohns Operating Room Technique, The downloadable file consists of 190 pages, and the total size of the file is 1.87 MB. Purchase now only for highly discounted price.

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Berry and Kohns Operating Room Technique 14th Edition Phillips Test Bank Chapter 01: Perioperative Education Phillips: Berry & Kohn’s Operating Room Technique, 14th Edition MULTIPLE CHOICE 1. Communication is an essential part of working as a team. What is another key element of communication? a. Attitude b. Body language c. Education d. Constant talking ANS: B Appropriate body language is also necessary for successful communication. Body language can send a message. Sometimes it can send a negative message, such as rolling of the eyes. REF: p. 11 2. Entry -level education for perioperative practice prepares nurses to be a. urologists. b. orthopedists. c. neurologists. d. generalists. ANS: D Basic perioperative nursing elective programs focus on the role of the nurse as a generalist scrub person and circulating nurse. REF: p. 3 3. Perioperative experience teaches that minor procedures may be fairly quick, but still have risks such as a. cardiac arrest. b. hypoglycemia and hyperglycemia. c. severe bleeding. d. All are correct ANS: D All procedures carry a risk and can become unpredictable. REF: p. 10 4. Skills are best learned through a. listening to an expert tell how to do it. b. watching a movie about a task. c. actual hands -on experience. d. reading about it. ANS: C Skills are best learned through actual han ds-on experience in applying the theory learned in the classroom or self -study laboratory. REF: p. 10 5. Which objective should a perioperative learner strive to attain? a. Realize that a team approach to surgical procedures cannot always occur. b. Validate the need for constant patient observation. c. Maintain the belief that competent behaviors are more vital than humane behaviors. d. Hands -on experience is the most important means to understand ing surgery. ANS: B Constant patient observation is essential to maintain their safety. REF: p. 10 6. The team approach involves a. a coordinated effort by all caregivers. b. working to obtain specific personal goals. c. incompetence. d. direct caregivers with access t o patient data. ANS: A A team effort is necessary to meet the patient's preoperative goals. REF: p. 11 7. Not everyone learns at the same speed or attains information in the same manner. Knowing how a student learns will help the educator come up with the right . a. answer b. environment c. teaching methods d. learning styles ANS: C Learning is a process and takes time to master skills. With the right teaching methods, a student will be able to apply their knowledge of basic sciences with hands on practice to master their skills. REF: p. 4 | p. 10 8. Describe one way a relatively safe procedure can rapidly become a catastro phic or fatal event. a. Preoperative patient anxiety b. Postoperative pain c. Unknown patient allergies d. Subjective responses to OR activities ANS: C Answers include patient development of uncontrollable bleeding; seizure; irreversible shock; overwhelming postoperative infection; cardiac arrest; or an unknown allergy or sensitivity to a chemical, substance, medication, or anesthetic. REF: p. 10 9. What i s the common goal of a perioperative team? a. Do not report any surgical mishaps to patients or family members. b. Keep general anesthesia to a minimum. c. Complete every surgical procedure in less than 4 hours. d. Deliver efficient patient care for each procedure. ANS: D The common goal is effective delivery of care in a safe, efficient, and timely manner. REF: p. 11 10. What is a realistic time frame for a practitioner to feel confident as a functioning perioperative team member. a. Three months b. One to two years c. Six months to one year d. Three months to six months ANS: D A transition from dependent learner to independent practitioner evo lves over a period of time. The realities of the work environment and the emotional and ethical dilemmas of some situations are experienced as basic competencies are developed. It can take 6 months to 1 year to feel confident as a functioning perioperative team member. REF: p. 12 MATCHING Match each term with the correct description below. a. Works with orientees and learners according to a prescribed task -oriented lesson plan b. Has more experience with personnel and the OR’s climate; provides insight into the department’s social atmosphere c. Staff member who is emulated and respected for his or he r clinical competence 1. Mentor 2. Role model 3. Preceptor 1. ANS: B REF: p. 12 2. ANS: C REF: p. 13 3. ANS: A REF: p. 12 TRUE/FALSE 1. A surgical procedure may be invasive, minimally invasive, or noninvasive. ANS: T Any invasive or minimally invasive procedure enters the body either through an opening in tissue or a natural body orifice. Noninvasive procedures do not enter the body and are usually for diagnostic purposes. REF: p. 2 2. Students may work for compensation during official clinical hours. ANS: F Some students are hired into apprenticeships before graduation enabling them to work in the OR in a limited capacity in anticipation of a permanent position. Schools that permit students to work whi le they are still participating in the education process should have a policy in place to delineate the student role from the employee role. Thus students may not work for compensation while completing clinical hours in the operating room setting. REF: p. 3 3. A perioperative nurse’s role only encompasses supervision of unlicensed personnel who scrub and requires knowledge of practic es and procedures. ANS: F The nurse can function as a scrub person after proper training. REF: p. 4 | p. 5 4. The term educator refers to the person responsible for planning, implementing, and evaluating the learner’s experiences in the classroom and clinical setting. ANS: T This definition desc ribes the responsibilities of the perioperative nurse educator. REF: p. 5 5. Students should have a tour of the perioperative environment and know the basic standards and protocol before starting clinicals. ANS: T This prevents learning questionable shortcuts or improper technique. REF: p. 4 6. Surgical technology programs focus primarily on scrubbing in to prepare and maintain the sterile field and handle instruments. ANS: T Most surgical technology programs provide scrub experiences in many specialties. REF: p. 3 7. The perioperative caregiver should display attributes and communication skills that inspire confidence and trust in patients. ANS: T A patient’s sense of security is grounded in how he or she perceives the behavior of the perioperative team. This leaves a la sting impression on the patient. REF: p. 10 1 Chapter 02: Foundations of Perioperative Patient Care Standards Phillips: Berry & Kohn’s Operating Room Technique, 14th Edition MULTIPLE CHOICE 1. Who is responsible for documenting the final counts at the end of the case as correct or incorrect? a. Scrub person b. Surgeon c. Anesthesiologist d. Circulating nurse ANS: D The circulating nurse is responsible for final documentation. REF: p. 22 | p. 23 2. Optimal patient care requires which element? a. Deterring an admission of fault in sterile technique b. Anatomic separation c. Dynamic tension of surgical team members d. Application of asepsis and sterile technique principles ANS: D Asepsis and sterile technique are expected and necessary practices in the OR setting for favorable patient outcomes. REF: p. 22 3. The circulating nurse should assess a patient for which type of injury before entering the OR? a. Medication error b. Wrong IV site c. Skin inj ury d. Sharp object ANS: C Skin injuries can be caused by many things in the OR. The nurse should assess the skin before and after the procedure to make sure no damage has been done. REF: p. 23 4. Caregivers should always know why they are doing a particular action. Actions should be based on . a. self-taught methods b. preceptor actions c. nursing process d. evidence -based practice ANS: D Evidence -based practice is a systematic process that is based on research. The research is the base for best practices. Practices are constantly evaluated for the best methods for performing patient care. REF: p. 25 | p. 26 5. When does the intraoperative phase begin? a. Placement of the patient on the OR bed b. When the patient enters the OR c. When waiting in the holding area d. When taken to the recovery area or PACU ANS: A The intraoperative phase begins with the patient on the OR bed and continues until the patient is transported to the PACU. REF: p. 28 6. What documentation goes into the patient’s chart and becomes part of the permanent record? a. Specimen results b. Intraoperative notes only c. All routine and individualized care d. Physical changes ANS: C All patient care interventions and observations are documented. Standardized language provides legal evidence for the plans of care and revisions of those plans. REF: p. 31 2 7. Which identifies one aspect of safe patient movement from the OR table to the stretcher? a. The circulating nurse counts to synchronize the patient’s movement. b. The person guiding the head counts to synchronize the movement. c. The person at the left side of the patient also guides the head and counts to start the movement. d. Two people are needed to move an anesthetized patient from the table to the stretcher. ANS: B There should be at least one person on either side of the patient, one at the foot, and one at the head to monitor the airway . The person guiding the patient’s head should be the one who counts “one, two, three” to pace the synchronized movement from one surface to another. REF: p. 22 8. Which is one of the “seven rights” of medication administration for each patient? a. Right pharmacy b. Right color c. Right route d. Right answer ANS: C The seven rights of medication administration include right patient, right drug, right dose, right reason, right time, right route, and right documentation. REF: p. 24 9. All are included in the definition of professionalism except a. self-centered for profit group. b. requires special skills and knowledge. c. has its own standards and code of ethics. d. acts responsibly to gain public trust. ANS: A Professionalism is the combination of knowledge, skil ls, ethics, and ideas that regulate a profession. It also uses critical thinking and judgement. REF: p. 25 10. Which event is included on Medicare’s “No Pay List” and will not be reimbursed? a. Myocardial infarction b. Wrong site surgery c. Documented Alzheimer’s d. Incision and drainage of a chronic hip abscess ANS: B Wrong site surgery is an easily preventable occurrence and is not reimbursed for by Medicare. REF: p. 18 TRUE/FALSE 1. Surgical conscience is considered the Golden Rule: Do unto the patient as you would have others do unto you. ANS: T Surgical conscience develops over time. The caregiver should consider each patient as himself or herself or as a loved one. I t is just one element f or optimal patient care. REF: p. 16 2. A patient advocate is the person who accompanies the patient to the facility. ANS: F A patient advocate is a caregiver, who recognizes the patient and family’s need for information and assistance. They act as t he patient’s representative to help make informed decisions. They identify specific care needs and assist in coping. REF: p. 16 3. Access to health care is a privilege of every human being. ANS: F Access is a right, not a privilege, of all patients. REF: p. 16 4. Accountability means being responsible for only one’s self. ANS: F Accountability means answering to someone for an obligatory action. Caregivers are accountable to their patients, employer, t eam members, profession, and upholding standards of practice. REF: p. 16 3 5. Failure of a caregiver to provide accountability is considered negligence. ANS: T Lack of accountability can result in patient injury. Health care providers have a legal and moral obligation to keep their patients safe. Every caregiver is responsible for his or her ow n negligent acts. REF: p. 16 6. Standards of care are guidelines put in place for all personnel to follow based on recommended practices and scientific research. ANS: T Every facility has written policies and procedures to standardize practice. Each profession has a set of standards that sets guidelines for behavior, education, responsibility, education, and performance. There are also agencies governed by laws to help ke ep patients safe. REF: p. 17 7. Health care providers are required to sign a document acknowledging policies, procedures, and HIPPA laws. ANS: T Some policies and procedures are for all employees, others may vary according to department. These documents are mandatory to follow and describe how to perform procedures correctly. REF: p. 18 8. A plastic identification wristband is the only way patients are identified. ANS: F The patient’s wrist band is checked while they state or spell their name. They must also acknowledge their birthdate. If the patient cannot do this, a parent, guardian, or power of attorney may do this identification. At least two f orms of identification are required. REF: p. 20 9. A universal checklist provides documentation for each step of care for patients undergoing a surgical procedure. ANS: T Three points are confirmed by the surgical team throughout the process: “sign -in” (be fore administration of surgical drugs), “time out” (identifying correct patient and surgical procedure), and “sign -out” summary of what was completed in surgery. REF: p. 21 10. Identifying the surgical site is always done by placing an “X” over the site. ANS: F An “X” is inappropriate because it may be misunderstood. Every facility has its policy for identifications. REF: p. 20 | p. 21 11. Postoperative infection can originate only in the OR from a break in technique by the surgeon or team. ANS: F Infection can occur in any area where microorganisms can be transferred into the body through any orifice. REF: p. 22 1 Chapter 03: Legal, Regulatory, and Ethical Issues Phillips: Berry & Kohn’s Operating Room Technique, 14th Edition MULTIPLE CHOICE 1. Who can be named in a lawsuit? a. The patient b. Any caregiver c. The head nurse d. The surgeon ANS: B Any caregiver can be named in a lawsuit. Attorneys frequently name everyone involved with the patient in the suit. REF: p. 36 2. Negligence is a. professional misconduct. b. unreasonable lack of skill. c. the failure to use care or skills that any caregiver in a similar situation might use. d. illegal or immoral conduct. ANS: C These acts of omission or commission that can cause damage to a patient can lead to a lawsuit. REF: p. 36 3. Who obtains the informed consent for a surgical procedure? a. Perioperative nurse b. Surgeon/physician c. Scrub person d. Head nurse ANS: B Informed consent must be obtained by the surgeon or physician. REF: p. 42 4. Which component is included in an informed consent? a. Risks and benefits b. Cost of surgery c. DNR orders d. Length of hospital stay ANS: A Included in an informed consent are name of the procedure, who is performing the procedure, risks and benefits, and procedure alternatives. REF: p. 42 5. Which is an example of a reportable sentine l event? a. Surgery on the wrong site b. Any near miss c. Going into surgery 3 hours late d. Unsuccessful suicide attempt ANS: A Surgery on the wrong patient or the wrong body part is one example of a reportable sentinel event. REF: p. 40 6. Which best describes a DNR order? a. Does not hold up in the OR b. Patients cannot have surgery. c. Before going to the OR, the DNR order should be clarified. d. Does not hold up in an emergency ANS: C Any patient with a standing DNR order should have the order clarified by the patient, guardian, or power of attorney. The phy sician must be clear of the action of t he order. REF: p. 50 2 7. Which is one of the four “D’s” of malpractice? a. Deviation of duty by omission b. Demonstration of standards of care c. Damage to subcutaneous tissue d. Divided surgical care of the patient. ANS: A The 4 D’s of malpractice include: (1) a duty to deliver a standard of care proportional to training received, (2) a deviation from that duty by omission or commission, (3) direct causation of a personal injury or damage because of deviation of duty, and (4 ) damages to a patient or personal property caused by the deviation from the standard of care. REF: p. 36 8. Which is a charting modality used to document patient care? a. Hand -over reporting b. Verbal report c. Block charting d. Paper and pen charting ANS: C Modalities include narrative charting; block charting; focus charting; subjective -objective charting; problem -oriented charting; computer -generated charting; and computer software programs, check -off forms, and flow sheets. REF: p. 45 9. Which is a coping method that may help OR team members when a patient dies? a. Identify with the loss b. Identify those responsible for the patient death c. Reduce the dependence on teamwork to maintain patient safety in a crisis d. Take ownership for the patient death and review actions with risk management team ANS: A Coping methods include realization that everyone involved is part of a team effort; believe in a power greater than the skill s of the team; share feelings with others; identify personally with the loss; attend a support group to help deal with the loss; and visit with the hospital chaplain or rabbi. REF: p. 51 10. A “Never Event” as defined by CMS includes a. bariatric surgical procedure. b. myocardial infarction. c. poor blood sugar control. d. coronary artery disease. ANS: C Poor blood sugar control is an event that CM S deems not to be consistent with quality patient care rendered to hospitalized individuals. REF: p. 40 11. Which is a benefit of EMR in the hospital setting? a. Documentation can be transmitted to multiple caregivers quickly. b. Patients can ask for copies of their health care records. c. Everyone can view the health care records of any patient within a particular facility. d. Laboratory results are hard to decipher when downloaded. ANS: A Electronic medical records (EMR) allow multiple health care providers access quickly and easily in order to plan treatments and care to patients. REF: p. 45 | p. 46 COMPLETION 1. consists of leaving the patient for any reason when the patient’s condition is contingent on the presence of the caregiver. ANS: Abandonment Abandonment consists of leaving the patient for any reason when the patient’s condition is contingent on the pres ence of the caregiver. If the caregiver leaves the room knowing there is a potential need for care during his or her absence, even under the order of a physician, the caregiver is liable for his or her own actions. REF: p. 39 3 TRUE/FALSE 1. The person who initiates a lawsuit is a defendant. ANS: F The person who initiates a lawsuit is known as a plaintiff. REF: p. 35 | p. 36 2. Professional associations do not recommend that health care workers carry professional liability insurance. ANS: F Most facilities carry insurance that covers incidents that result in harm to a patient when policies and procedures are followed; however, they may not cover the empl oyee who fails to follow the established protocol. Carrying personal liability insurance protects against a possible discrepancy with the facility’s insurance coverage and provides the employee with the opportunity for representation by a personal attorney . REF: p. 37 3. When writing an incident report, it is acceptable to include interpretations and opinions. ANS: F Details written in the report should be statements of fact that are objective, complete, and accurate. REF: p. 47 4. Euthanasia is derived from the Greek words meaning “harsh or painful death.” ANS: F Euthanasia is derived from the Greek words meaning “good or merciful death.” REF: p. 50 5. A 17 -year-old mentally competent person can execute a living will or an advance directive. ANS: F A mentally competent adult older than the age of 18 can execute a living will or advance directive. REF: p. 50 6. One of AST’s Codes of Ethics for surgical technologists is to always maintain the highest standards of professional conduct a nd patient care. ANS: T Professions have codes of conduct and documents that include value statements derived from moral concepts. The Code of Ethics of the Association of Surgical Technologists (AST) provides guidance for surgical technologists. REF: p. 48 7. When a mishap occurs in patient care, the cause of the event is compared with other cases similar to that one. ANS: F The cause of the event is compared with local or national standards of care. REF: p. 37 8. National Patient Safety Goals were implemented by the Joint Commission to keep patients safe. ANS: T NPSGs are part of Universal Protocol to prevent wrong patient, wrong site, and wrong surgery. REF: p. 40 9. Assault is an unlawful physical threat to harm another person. ANS: T Assault is an unlawful threat to harm another physically. REF: p. 38 1 Chapter 04: The Perioperative Patient Care Team and Professional Credentialing Phillips: Berry & Kohn’s Operating Room Technique, 14th Edition MULTIPLE CHOICE 1. The works to promote the best interests of the patient every single minute. a. perianesthesia team b. perioperative team c. scrub person d. anesthesiologist ANS: B For the welfare and safety of the patient, the entire perioperative team must work efficiently as a functioning single unit. REF: p. 53 2. Licensure implies a. a well -trained individual. b. an enthusiastic employee. c. a certain amount of appropriate independence in actions. d. graduation from an accredited program. ANS: C Licensure implies a certain amount of appropriate independence in actions. On completion of a formal academic education, heal th care providers such as nu rses and physicians who successfully pass a state examination receive a license to practice in that state. REF: p. 53 3. Directing the activities of all learners is the role of the a. surgeon. b. first assistant. c. anesthesiologist. d. circulating nurse. ANS: D The circulating nurse must have the teaching skills needed to ensure maintenance of a safe and therapeutic environment. REF: p. 56 4. The role of a first assistant includes a. maintaining visibility of the surgical site. b. maintaining membership in the local hospital. c. organization of the back table and Mayo stand. d. starting the procedure before the surgeon gets there. ANS: A A first assistant helps maintain visibility of the surgical site, controls bleeding, closes wounds, and applies dressings and also assists with other surgical duties at the sterile field. REF: p. 58 5. What is the scrub person’s responsibility? a. Establish an d maintain the sterile field b. Assist anesthesia providers with patient positioning c. Complete procedure documentation and specimen requisitions d. Maintain communication with waiting patient family members ANS: A The scrub person must remain sterile and establis hes and maintains the safety, integrity, and efficiency of the sterile field throughout the procedure. REF: p. 58 6. Which is a member of the nonsterile perioperative team? a. Surgeon b. Circulating nurse c. Scrub person d. First assistant ANS: B The nonsterile team members consist of the anesthesia provider, circulating nurse, and perianesthesia nurse, and also can inc lude such people as students, sales representatives, and laboratory or radiograph personnel. REF: p. 54 2 7. Which is a member of the sterile perioperative team? a. Scrub person b. Anesthesia provider c. Circulating nurse d. Radiograph technician ANS: A The sterile team members consist of the surgeon, first assistant, second assistant (if needed), and scrub person. REF: p. 54 8. Which member of the sterile team provides exposure and hemostasis during a surgical procedure? a. Anesthesia provider b. Circulating nurse c. Sales representative d. First assistant ANS: D The surgical assistant provides exposure and hemostasis. This person can be a physician, RNFA, SA, PA, or a CST who is specia lly trained and certified as a first assistant. REF: p. 58 9. Why does credentialing exist? a. To create revenue for the nursing profession b. To maintain quality of the personnel’s education and performance c. To encourage professionals to further their education d. To remain competitive with the medical profession ANS: B Credentialing exists to establish q uality, identity, protection, and control for the competency -based education and performance of professional and allied technical health care personnel. REF: p. 53 10. The scrub person a. does not participate in the surgical “time out.” b. is a member of the nonsterile team. c. provides hemostasis of the surgical wound. d. may be a nurse or surgical technologist. ANS: D The scrub role may be a member of the sterile team who may be an RN, LPN/LVN, or ST who actively participates in the surgical “time ou t” process with the other members of the perioperative team. REF: p. 58 11. A perioperative nurse may initially obtain a CNOR certification a. after being in clinical preoperative practice for 1 year. b. after working 5 years in the intensive care unit setting. c. once he or she has passed a national exam set forth by CCI. d. after reading five AORN journal articles and precepting five new perioperative employees. ANS: C A perioperative nurse must have worked 2 years in the perioperative clinical setting and passed a national exam in order to obtain the CNOR certification. REF: p. 56 12. What are the surgeon’s duties? a. Selection and performance of the surgery b. Preoperative diagnosis c. Ethical surgical practice d. All are correct ANS: D The surgeon’s responsibilities include: pr e-op diagnosis and care, selection and performance of the procedure, and post -op management of care. REF: p. 57 3 13. The circulating nurse plays a critical role in a patient’s care from the beginning and extends throughout the entire perioperative environment. Select the terms which describe this role. a. Witness; guardian b. Circulating nurse; first assistance c. Anesthesia provider; advocate d. Advocate; protector ANS: D The circulating nurse’s role as the patient’s advocate and protector is critical and extends throughout the entire perioperative environment. A qualified surgical technologist (ST) or LPN/LVN may also assist with circulating duties under the supervision of the RN. REF: p. 55 TRUE/FALSE 1. The term anesthetist refers to a quali fied RN, anesthesiologist assistant (AA), dentist, or physician who administers anesthesia. ANS: T All of these are anesthesia providers. The RN and AA work under the direction of the anesthesiologist who is an MD or DO. REF: p. 54 2. The sterile team may include a perianesthesia nurse. ANS: F The perianesthesia nurse cares for the patient before, during, or after the surgical procedure. If caring for the patient during the procedure, the person is as part of the nonsterile team. REF: p. 54 1 Chapter 05: The Surgical First Assistant Phillips: Berry & Kohn’s Operating Room Technique, 14th Edition MULTIPLE CHOICE 1. The surgical first assistant’s knowledge and skill level involves an understanding of a. surgical anatomy and physiology. b. biochemical engineering. c. psychomotor kinesiology. d. advanced airway placement. ANS: A Every surgical procedure interrupts multiple facets of a patient’s anatomic structure and physiologic function. Knowledge of anatomic structures is critical to the first assistant. REF: p. 61 2. It is important to and think in advance about each step to help the procedure run smoothly. a. guess every move b. anticipate c. retract every time d. react ANS: B It is important to anticipate and think in advance about each step to help the procedure move smoothly. The first assistant should have clear knowledge about not only the functional steps but also the indications for the procedure. REF: p. 62 3. Which is a type of surgical hazard? a. Biologic b. Psychologic c. Social d. Biomedical ANS: A Primary surgical hazards are biologic, physical, and chemical. REF: p. 68 4. Knot tying for conventional surgery is performed using the a. one-handed tie. b. freehanded tie. c. stapling. d. backhanded tie. ANS: A Knot tying for conventional surgery is performed using one of the following methods: Two -handed tie, instrument tie, and the one-handed tie. REF: p. 67 | p. 68 | p. 69 5. Which is an example of a physical hazard in the OR? a. Medication b. Needlestick injury c. Prep solution d. Anesthesia gases ANS: B Physical hazards include the risk for sharps puncture, fire, tissue damage, pressure injury, burns, physical mechanical stress, electrocution, or other physiologic damage to the patient or team. REF: p. 68 6. Why is intraoperative suturing performed? a. To remove a tissue mass b. To dissolve a tumor or benign mass c. Evidence that the procedure was performed as scheduled d. To stabilize an orga n ANS: D Intraoperative suturing is performed to attain hemostasis, stabilization of a part, traction, or other tissue manipulation. REF: p. 66 2 7. The control of bleeding and blood loss is referred to as: a. Cauterization b. Pasteurization c. Hemostasis d. Embolization ANS: C The clearing of the field is part of the exposure process, but the control of bleeding and blood loss is referred to as hemostasis. REF: p. 64 8. Hemostasis is provided by which methods: a. Mechanical; chemical b. Heat c. Brachytherapy d. Laser therapy ANS: A Hemostasis is provided by mechanical, chemical, or thermal means. REF: p. 64 TRUE/FALSE 1. The first assistant usually assists in positioning the patient, surgical site exposure, closing skin incisions and applying dressings. ANS: T The first assistant commonly assists in closing the skin and applying dressings or supportive materials, such as casts. They frequently position the patient after the anesthesia provider indicates it is safe to do so. REF: p. 62 2. It is in the scope of the surgical technologists practice to hold retractors if asked by the surgeon. ANS: F Many times surgeons will ask for a surgi cal technologist to hold a retractor. It is an unacceptable and unsafe practice. REF: p. 61 3. The RNFA should simultaneously perform as a scrub nurse during a surgical procedure. ANS: F The RNFA should function solely as a first assistant and never simultaneously perform the duties of the scrub or circulating nurse. REF: p. 69 4. AORN is the official accrediting body for the surgical technologist. ANS: F AORN is the Association of periOperative Registered Nurses. REF: p. 69 5. A physician assistant (PA) can assist in the OR and write prescriptions. ANS: T The PA can first assist in the OR as well as function in others areas of health care. They have the authori ty to write prescriptions based on specialized academic and clinical training. REF: p. 73 1 Chapter 06: Administration of Perioperative Patient Care Services Phillips: Berry & Kohn’s Operating Room Technique, 14th Edition MULTIPLE CHOICE 1. What is the definition of SCIP? a. Surgical Care Improvement Project b. Surgical Cost Infection Project c. Surgical Control Policy d. Surveillance Control ANS: A Surgical Care Improvement Project (SCIP) takes measures to improve postoperative infections by adhering to best practices. REF: p. 84 2. Which department is responsible for routine monitoring of the electrical and lighting systems? a. Preadmission testing b. Facilities engineering c. Materials management d. Central processing ANS: B The facilities engineering department personnel work closely with the OR department by providing a preventive maintenance program. This includes routine monitoring of ventilation and heating, electrical and lighting systems, emergency warning syst ems, and water supply. REF: p. 82 3. Which is the responsibility of the central processing department? a. Biomedical testing b. Biohazard material transport c. Distributing supplies d. Linen storage ANS: C One area of the hospital is designed specifically for processing, storing, and distributing supplies and equipment used in patient care. This department may be referred to as central service or central supply; central processing; supply, processing, and distribution; or materials management. REF: p. 82 4. Which group conducts hazard surveillance programs and decreases hazardous conditions within the hospital and on hospital grounds? a. Ethics committee b. Disaster planning committee c. Hospital safety committee d. Continuous performance improvement committee ANS: C Representatives from administration, nursing service, medical staff, infection control, engineering and maintenance departments, environmental/housekeeping services, and the safety director form the nucleus of the hospital safety committee. This group wr ites policies and procedures designed to enhance safety within the hospital and on hospital grounds. REF: p. 85 5. Practices that continue despite lack of scientific evidence are referred to as a. protocols. b. bad excuses. c. sacred cows. d. national standards. ANS: C Practices that continue despite lack of scientific evidence are referred to as sacred cows. REF: p. 87 6. Which form of communication is effective for patient transfer or hand -over? a. CPR b. STEP c. STEMMI d. SBAR ANS: D SBAR: Situation, background, assessment, recommendation, and request REF: p. 76 2 7. Which best describes the roles of a preceptor? a. Assigns activities b. Teaches a group orientation c. Observes a student or employee d. Teaches an orientee one -on-one; advises and encourages until the orientee can function on his or her own ANS: D The preceptor is an experienced staff member who teaches one -on-one, counsels, advises, and encourages until he or she can function independentl y. REF: p. 79 8. Which is one aspect of downward violence in the workplace? a. Physical abuse towards one’s peers b. Verbal abuse directed toward a lower -ranked employee c. Verbal abuse toward one’s administrative staff d. Emotional abuse aimed at patient’s families ANS: B Downward violence is any abusive behavior directed at lower ranked individuals by higher ranked individuals. REF: p. 89 9. Which is one benefit of Magnet status for a facility? a. It provides the opportunity f or professional growth and enrichment. b. Nursing salaries are increased. c. Nursing retention is minimized and increased turnover results. d. The cost of care provided at the facility is higher. ANS: A Some benefits of Magnet status include increased opportunities for nursing growth and development, increased nursing recruitm ent and retention of staff, more stable managerial environment, and opportunities to publicize the Magnet status by the facility’s marketing department. Magnet recognition is the highest acknowledgement on a national level of ongoing nursing care excellence. REF: p. 75 | p. 76 10. Which communication tool involves being continually vigilant for progress or regression of g oals? a. SBAR b. Team STEPPS c. Hands -free communication d. STEP ANS: D STEP (status of patient, team members, the environment, and progress toward a goal) is a standardized mechanism for relaying information and enhancing team performance. REF: p. 76 11. What special qualities do advanced practice nurse use to make decisions relative to direct and indirect patient care in the perioperative environment. a. Book knowledge b. Sound judgment and skills c. Research d. Professionalism ANS: B Advanced practice nurses make decisio ns relative to direct and indirect patient care in the perioperative environment, using specialized judgments and skills. Problem solving and decision making are the heart of professional management and profession al leadership. REF: p. 78 12. An order for an infection control program to be effective, it must attain which two goals. a. Collect records; provide essential cleaning b. Sterilize everything; provide surveillance c. Reduce infections; control sources d. Reduce reporting; provide surveillance ANS: C An effective infection control program aims to reduce the incidence of infections and to control sources. Information collect ed through surveillance serves as a basis for corrective action. This information inc ludes written records and reports of known or potential infections among patients and personnel. REF: p. 84 3 13. What term describes a way to improve the quality of care and help set standards to meet the needs of the facility and patient population. a. Quality assurance b. Critical thinking c. Facility management d. Systems thinking ANS: D Systems thinking is a way to improve the quality of care and help set standards that can be expanded or contracted to meet th e needs of the facility and the patient po pulation. When the learning organization has a process of systems thinking in place, the emphasis is on the system, not the individual staff member. REF: p. 86 TRUE/FALSE 1. All perioperative team members must be certified in CPR. ANS: T All personnel, regardless of role, are to be certified in cardiopulmonary resuscitation. REF: p. 76 2. Basic policies are updates and statements of task -oriented and skill -oriented actions to be taken in the impleme ntation of policies. ANS: F Procedures are statements of task -oriented and skill -oriented actions to be taken in the implementation of policies. REF: p. 76 3. The perioperative nurse manager must have a strong knowledge of the OR, management, nursing theory, and practice. ANS: T The manager retains accountability for all related activities in the perioperative environment. The perioperative manager must also possess leadership skills, business knowledge, and financial management and uphold professional standards of patient care. REF: p. 76 4. The head nurse or charge nurse acts as a liaison between staff members and administrative personnel. ANS: T The head nurse or charge nurse functions in a line management position as a liaison between staff members and administrative personnel. In some hospitals the title of head nurse is given to the person whose position is comparable to that of a coordinator. REF: p. 77 5. An infection control committee investigates hospital -acquired infections and seeks to prevent or control them. ANS: T The infection control committee investigates hospital -acquired (formerly referred to as nosocomial) infections (HAIs) and seeks to prevent or control them. A health care facility has a moral duty to provide a safe environment for its patients. The infectio n control committee aids the hospital in fulfilling this duty. Surveillance personnel assist in directing infection control policie s, procedures, and practices. REF: p. 83 | p. 84 6. The sales representative may never render direct patient care at any time. ANS: T See the AORN Position Statement regarding sales representatives in the operating room. They set guidelines about working with sales representatives. Each facility has its own policies. REF: p. 91 1 Chapter 07: The Patient: The Reason for Your Existence Phillips: Berry & Kohn’s Operating Room Technique, 14th Edition MULTIPLE CHOICE 1. One definition of a patient is a. a healthy person using medical services. b. an individual recipient of health care services. c. adults or children who are sick. d. a person trying to feel better. ANS: B A patient may be defined as an individual recipient of health care services. REF: p. 93 2. Which is Sister Callista Roy’s conceptual model for nursing? a. Caring b. Self-care c. Adaptation d. Transition ANS: C Sister Roy’s theory states that a patient takes in stimuli, processes the information, and produces a response. Because of the changing environment, the patient responds favorably or unfavorably to the changes. Adaptations may be rapid, slow, sensory, motor, or s ensorimotor. REF: p. 94 | p. 95 3. At what point is a patient considered undernourished? a. When the body weight is less than 60% to 70% of ideal body weight (IBW) b. When the body weight is more than 50% to 65% of ideal body weight (IBW) c. When the body weight is less than 70% to 80% of ideal body weight (IBW) d. When the body weight is less than 40% to 50% of ideal body weight (IBW) ANS: C Patients who are undernourished have less than 70% to 80% of IBW and suffer greatly from the lack of caloric intake. REF: p. 98 4. What form of diabetes mellitus involves the pancreas producing little or no insulin and usually occurs in juveniles and adults up to 40 years of age? a. Type 1 b. Type 2 c. Type 3 d. Diabetes associated with other syndromes ANS: A Type 1, or insulin -dependent diabetes mellitus (IDDM), occurs when the pancreas produces little or no insulin and regular insulin injections are needed. Onset may be at any age but usually occurs in juvenile’s ages 12 to 16, and adults up to age 40. REF: p. 99 5. At what time of day should diabetic patients be scheduled for surgical procedures? a. Middle of day b. Late afternoon c. Early in the day d. Last case of the day ANS: C Scheduling diabetic patients early in the day minimizes the period during which oral intake is restricted. REF: p. 101 6. On what foundations are cancer treatment and prognoses based? a. Type of cancer and extent of the disease b. Type of insurance the patient has c. Type of surgery the patient chooses to have performed d. Type of cancer -causing agents the patient was exposed to ANS: A Each type of cancer differs in its symptoms, behavior, and response to treatment. REF: p. 103 2 7. What does the “no -touch” technique mean? a. The skin over the site of a tumor is not cleaned or prepped before the procedure. b. Vigorous scrubbing is needed to clean and prep the skin over a tumor site. c. The tumor is handled as little as possible during its removal. d. The skin over the tumor site is to be manipulated before prepping. ANS: C With vascular tumors, manipulation during positioning or skin preparation could cause vascular complications such as emboli o r hemorrhage. The tumor is handled as little as possible to avoid any complications. REF: p. 105 8. Which irrigation is commonly used during a mastectomy procedure? a. Sterile normal saline b. Sterile water c. Sterile ice cold saline d. Marcaine with polymyxin ANS: B Using sterile water to irrigate causes the destruction of cancerous cells by crenation. REF: p. 105 9. Patients are routinely asked to stop taking what medication 2 weeks before having a surgical procedure? a. Antibiotics b. Antihistamines c. Albuterol inhalers d. Aspirin ANS: D Because the ingredients of aspirin may prevent hemostasis and increase the potential for hemorrhage, patients are asked to st op taking aspirin 2 weeks before their surgery date. REF: p. 110 10. A surgical patient with AIDS may present with which of the follo wing? a. Pneumocystis jiroveci pneumonia (PCP) b. Hormonal receptor infection c. Negative nitrogen imbalance d. Anticholinergic impairment ANS: A Because AIDS causes the body to be susceptible to opportunistic and chronic infections, three that present most frequently are PCP, MDR -TB, and Kaposi’s sarcoma. REF: p. 111 | p. 112 11. In order for a victim of sexual trauma to regain a sense of control and security, the caregiver must a. not wear gloves and use quick, brisk moves. b. create loud noises and speak in loud tones in order to distract the patient. c. approach the victim with patience and understanding. d. constantly touch the patient to assure her or him that the hospital is a safe environment. ANS: C Quick, brisk moves can create undue emot ional stress. A caregiver must wear gloves for personal safety and to depersonalize touch. A calm demeanor can provide a sense of security for the victim. The OR should reflect a sense of stability with prevention of nonessential noise. REF: p. 114 12. When allowing family members to view a deceased patient before the body is transported to the morgue, the perioperative nurse should a. remain with the body and lend support. b. use clichés when speaking with the family. c. allow other patients to view the body as a rem inder that life is short. d. place blame on the surgeon who allowed this to happen. ANS: A The perioperative nurse should be present in the room with the family and the deceased in order to answer questions and provi de emotional support as needed. REF: p. 116 | p. 117 13. The body of a patient who dies in the OR or dies as a result of a crime becomes the property of the a. hospital. b. police department. c. patient’s family. d. coroner. ANS: D The coroner has the right to the body to further investigate the situation that caused the death. REF: p. 116 3 14. What is one step a circulator can take when treating a patient who does not speak the same language being used in the operati ng room? a. Speak loud and slow to the patient. b. Write all instructions on paper for patient or family to read. c. Use an interpreter to s hare information. d. Insist that the patient understands basic instructions before entering the OR. ANS: C For a patient who does not speak the language used in the OR, use nonverbal body language (eye contact, facial expressions, g entle touch); obtain an int erpreter. The patient’s anxiety can be lessened by using positive body language, and to ensure the patient is adequately informed of the procedure, an interpreter is used to share information with the patient and health care team. REF: p. 97 15. What term de scribes the conversion of nutritive material into complex living matter? a. Catabolism b. Metabolism c. Retabolism d. Anabolism ANS: D Also called constructive metabolism , anabolism is the conversion of nutritive material into complex living matter, also referred to as tissue construction . REF: p. 99 16. Which is a condition that an obese patient is predisposed to? a. Hypolipidemia b. Hypotension c. Congestive heart failure d. Carpal tu nnel syndrome ANS: C Increased demand on the heart, hypertension, varicose veins and edema, pulmonary function abnormalities, respiratory compromise, digestive system diseases, osteoarthritis, diabetes mellitus, and malnutrition are all conditions to which an obese patient is predisposed. REF: p. 102 17. What type of cancer is contained in the organs of its origin? a. Localized b. Metastatic c. Disseminated d. Regional ANS: A Localized cancer is contained within the organ of its origin, whereas with regional cancer, it is common that the invaded area extends from the periphery of the organ or tissue of origin to include tumor cells in adjacent organs or tissues. REF: p. 104 18. The chain of evidence incorporates which documentation information. a. Observational findings, consent, incident, name of perpetrator b. Name of the pr imary care doctor c. Psychological exam d. Forensic evidence only ANS: D The chain of evidence must be constructed as the consent for treatment for the victim is obtained. REF: p. 112 TRUE/FALSE 1. Before administration of anesthetics, a patient may be acutely aware of the surroundings and activities. ANS: T During this segment of intraoperative care, patients want to know what is happening as it takes place and want reassurance from the circulator at their side. REF: p. 96 2. When radiation sources are delivered to the OR, each needle, seed, or capsule must be counted by the surgeon with the radiati on therapist and that number is recorded. ANS: T The radiation sources must be verified to ensure that all are accounted for before being inserted into the patient. REF: p. 109 4 3. In every state, it is mandated that a health care worker who suspects child abuse must notify the child welfare authorities. ANS: T If it is suspected that a child is a victim of abuse, it is the legal responsibility of the health care worker to report the abuse to the proper child welfare authority. REF: p. 115 1 Chapter 08: Perioperative Pediatrics Phillips: Berry & Kohn’s Operating Room Technique, 14th Edition MULTIPLE CHOICE 1. Which type of injury is the leading cause of death in children? a. Head b. Intestinal c. Lethal d. Accidental ANS: D Accidental injury is the leading cause of death in children. REF: p. 119 2. Into what stage would Erikson place a 24 -month -old child to determine his or her psychologic development? a. Trust versus mistrust b. Autonomy versus shame/doubt c. Initiative versus guilt d. Intimacy versus isolation ANS: B The characteristics of this stage are developing a two -way relationship with the primary caregiver, suffering separation anxiety when isolated from established relationships, personality becoming introverted or extroverted, establishing a sense of will, using sentences for communication, having fear of immediate threats, and not projecting thoughts beyond the present. REF: p. 120 3. Neonates born before completion of 37 week’s gestation are referred to as a. preterm. b. postterm. c. infant. d. fetus. ANS: A A true preterm’s gestational age is less than 37 weeks. REF: p. 119 4. Which condition was mandated by the government and screened in schools at an early age? a. Osteoporosis b. Talipes equinovarus c. Dysplasia d. Scoliosis ANS: D Scoliosis is a lateral curvature and rotation of the spine, most frequently seen in rapidly growing school -aged children. The government has mandated a screening program in the schools. REF: p. 141 5. When greater than of estimated blood volume is lost, hypotension is apparent in the pediatric patient. a. 40% b. 50% c. 60% d. 75% ANS: B Hypotension in an infant is not apparent until 50% of the circulating volume is lost. REF: p. 122 6. A newborn’s heart rate ranges from a. 120 to 140 beats per minute (bpm). b. 80 to 120 bpm. c. 110 to 130 bpm. d. 100 to 165 bpm. ANS: D The heart rate of a n ewborn can range from 100 to 165 bpm. REF: p. 124 2 7. During a pediatric bowel case, a surgeon may opt to use a instead of a Richardson retractor to retract blood vessels or small structures. a. vessel loop b. Balfour retractor c. Bookwalter retractor d. Gelpi retractor ANS: A Umbilical tape or vessel loops are used frequently to retract blood vessels and small structures, giving the surgeon greater visibility in a small surgical site and eliminating the weight of retractors. REF: p. 134 8. Anorectal malformation occurs during what weeks of fetal development? a. 13th to 16th weeks b. 4th to 12th weeks c. 3rd to 6th weeks d. 17th to 20th weeks ANS: B Anorectal malformation generally occurs during the 4th to 12th week of fetal development. REF: p. 135 9. Which type of tube is placed during a gastrostomy procedure? a. EGD b. PEG c. RBC d. PPD ANS: B Percutaneous placement of the gastrostomy tube (percutaneous endoscopic gastrostomy [PEG]) is commonly performed. REF: p. 135 10. In the school -aged child, the most common ca use for an abdominal surgical procedure is a. obstructive stomach lesion. b. bezoars. c. appendicitis. d. intussusception. ANS: C Appendicitis, an acute inflammation of the appendix, is the most common cause for an abdominal surgical procedure in the school -aged child. REF: p. 138 11. Talipes means the forefoot is inverted and talipes means the forefoot is everted. a. venous; valgus b. varus ; valgus c. equines; various d. venous; variegated ANS: B In talipes varus, the forefoot is inverted and rotated, whereas in talipes valgus, the forefoot is everted. REF: p. 141 12. What procedure may have to be performed as a result of a child ingesting caustic agents that may burn the mouth, lips, pharyn x, and esophagus? a. Adenoidectomy b. Tonsillectomy c. Esophageal dilation d. Herniorrhaphy ANS: C Long -term gradual esophageal dilation with balloon catheters or bougies may be necessary to restore adequate oral intake after this traumatic injury. REF: p. 144 13. Which is a congenital anomaly characterized by a fusion of two or more fingers or toes? a. Dyndactyly b. Syndactyly c. Polydactyly d. Manydactyly ANS: B Syndactyly is a congenital anomaly characterized by fusion of two or more fingers or toes. REF: p. 145 3 14. What type of shunt is placed when attempting to drain fluid from the ventricles to the right atrium of the heart? a. Ventriculoperitoneal shunt b. Ventric uloamniotic shunt c. Ventriculoatrial shunt d. Ventriculocoronary shunt ANS: C Surgical treatment of hydrocephalus involves implanting a shunt that carries fluid from the lateral ventricle to the right at rium of the heart. REF: p. 146 15. When is pulmonary ventilation established? a. 1 to 3 weeks after birth b. At birth c. 2 to 3 months after birth d. At conception ANS: B At birth the pulmonary ventilation is established and the increasing pressure causes increased left atrial force that causes the foramen ova le to close. REF: p. 148 | p. 149 16. What are the two ways in which an atrial septal defect can be closed? a. Suture, patch graft b. Wires, antibiotics c. Valve, ligating clips d. Electrosurgery, antibiotics ANS: A The opening in the septum between the left and right atria may be closed with suture, or a patch graft may be inserted. REF: p. 149 17. In a Jantene procedure, which two vessels are anatomically switched? a. Aorta and pulmonary artery b. Superior vena cava and left pulmonary vein c. Aortic arch and pulmonary artery d. Right pulmonary vein and inferior vena cava ANS: A In the Jantene procedure, the aorta and pulmonary artery are transposed. This procedure is useful in infants with a ventricular septal defect or a large patent ductus arteriosus. REF: p. 151 18. What valve allows normal blood flow between the right atrium and ventricle? a. Tricuspid b. Mitral c. Pulmonary d. Bicuspid ANS: A The right atrioventricular valve, also called the tricuspid valve, prevents blood from flowing backward. It sits between the right atrium and ventricle. REF: p. 151 19. Choose the palliative procedure performed on an infant with tra nsposition of the great vessels. a. Mustard procedure b. Jantene procedure c. Rashkind procedure d. Senning procedure ANS: C The Rashkind procedure involves placing a deflated balloon catheter into the right atrium through the foramen ovale and into the left atrium, where it is inflated and pulled across the atrial septum to create an ASD. REF: p. 151 20. Which is one of the seven physical anomalies referred to in the VACTERL association or syndrome? a. Lateral gastric fistula b. Aortic deficiency c. Cardiac anomaly d. Retinal detachment ANS: C VACTERL stands for vertebral defect, anal malformation, cardiac anomaly, tr acheoesophageal fistula, esophageal fistula, renal anomaly, limb defect. The presence of three or more physical anomalies is referred to as the VACTERL association or syndrome. REF: p. 118 | p. 119 4 21. What is the average blood volume of the average newborn? a. 10 to 12 mL b. 40 mL c. 100 mL d. 250 mL ANS: D The average blood volume of the average newborn is 250 mL or approximately 75 to 100 mL/kg of body weight. The infant who is 6 weeks to 2 years old has a blood volume of approximately 80 mL/kg (Table 8 -3). REF: p. 122 22. What condition occurs when a portion of the bowel slides into another segment and causes obstruction? a. Intussusception b. Intubation c. Internation d. Infraterning ANS: A Intussusception occurs when a portion of the bowel slides into another segment and causes obstruction. The motion is like a telesco pe. REF: p. 136 23. What body part is affected with the condition of cryptorchidism? a. Lack of breast tissue b. Testicles that are undescended c. Nasal tissue d. Toenail fungal infection ANS: B Undescended testicles are usually repaired at age 5 or 6 before the boy begins school. REF: p. 140 24. What criteria is fetal viability based on? a. Gestational age greater than 18 weeks b. Birthweight greater than 250 g c. Ability to sustain life outside the uterus d. Able to exchange oxygen using a ventilator ANS: C Potential viability, as defined by the World Health Organization, includes gestational age more than 24 weeks, birthweight mo re than 500 g, and being capable of sustaining life outside the uterus. REF: p. 119 25. Which is one of the “rule of tens” in regard to cleft lip repair? a. Over 10 years in age b. 10% of body fat c. Less than 10 cm of lip tissue d. 10 pounds in body weight ANS: D Some surgeons prefer to wait until the patient is 10 weeks old, laboratory values contain hemoglobin of 10 g, and patient is at least 10 pounds in weight. REF: p. 145 26. What is one specific feature of patients with “pectus excavatum”? a. Barrel -shaped chest b. Extreme convex -shaped chest tissue c. Concave depression over lower end of sternum d. Under developed pectus muscle ANS: C Pectus excavatum is a congenital malformation of the chest wall that is characterized by a pronounced funnel -shaped concave depression over the lower end of the sternum. Children with this malformation have displacement of the heart and lung tissue. REF: p. 147 27. Which is one of the four defects that make up the tetralogy of Fallot? a. Left ventricular hypertrophy b. Displacement of aorta to the left c. Pulmonary valve dilation d. Ventricular septal defect ANS: D Ventricular septal defect is usually located in the membranous portion of the septum between the right and left ventricles. REF: p. 150