CNOR Practice Questions & Answers, 100% Accurate. Verified.

CNOR Practice Questions & Answers, 100% Accurate. Verified. When should assistive technology be used when transfering a patient? - When one team member is required to lift more than 35lbs of patient Time for surgeon to authenticate verbal orders (federal mandate, not hospital policy) - 48 hours Examples of clinical alarms - alarms on cardiac monitors anesthesia machines, ventilators (visual, auditory or both) Universal Protocol - prevent wrong site, wrong procedure, and wrong surgery 1. Preop/ procedure verification process 2. marking site 3. time out * part of assessment phase of Nursing Process National Patient Safety Goals Examples of full body patient transfer devices - air-assisted transfer mattresses (hovermats), full body slides, mechanical lifting equipment Examples of safety-engineered devices to prevent sharps injuries - blunt suture needles, safety scalpels, needless systems, alternate wound closures Contact time - specific length of time disinfectants can remain in contact w/ microorganisms to achieve disinfection For every time of equipment of supply used on or for patient, what document should always be followed? - IFU- manufacturer's instructions for use Adverse reactions to polymethymethacrylate (bone cement) - hypotension, cardiac arrest, CVA, pulmonary embolism, fat embolism, hypersensitivity, thrombophlebitis, death RN's action after hearing a verbal order from Dr - read back the order Symptoms of local anesthetic systemic toxicity - metallic taste, confusion, dizziness, numbness (initial phase) Indication for use of BSS (Endosol) (balanced salt solution) - keep eye moist during surgery Effective meds to reduce postop N/V - Droperidol, Ondansetron, Promethazine Maximum number of meds prep RN should compound in periop suite - Three What type of muscle cell is affected during MH? - Skeletal Examples of research evidence - RCTs, systematic reviews, quasi-experimental studies Standardized language that reflects period nursing practices? - Perioperative Nursing Data Set (PNDS) Examples of non-absorbable suture materials - cotton, milk, nylon sutures implant that reduces tremors, involuntary movements, gait problems for Parkinson's - Deep brain stimulator What is Unique Device Identification? - FDA requirement; every device has a number (also on package); for implantable life-supporting, sustaining devices Risk assessment for pressure injuries - Braden Scale, Munro Scale, Scott Triggers Tool Using prophylactic dressings applied to healthy skin that is at risk for pressure injury may reduce effects of - pressure, shear, friction Scatter radiation - reflected off patient, table, shielding, material (secondary radiation) risk to personnel in room Leakage Radiation - emanates from X-ray tube housing (secondary radiation) Remnant Radiation - exits patient & imparts image on film poses little threat to personnel The timing of the administration of a preoperative prophylactic antibiotic, when ordered for a patient whose plan of care includes the use of a pneumatic tourniquet, should be based on the - goal of achieving optimal tissue concentration & policy/ procedures of hospital Limb occlusion pressure is the pneumatic tourniquet pressure required to occlude ___________ blood flow in the limb. - arterial Before the pneumatic tourniquet is inflated, guidelines include the extremity may be exsanguinated by - using an elastic wrap elevating the limb The orthopedic surgeon and the anesthesia professional should determine the initial tourniquet inflation pressure by measuringthe patient's - limb occlusion pressure During application of a pneumatic tourniquet to an extremity, the perioperative RN should position the cuff tubing on or near the ___________ aspect of the extremity. - lateral A perioperative RN develops a plan of care for a patient whose surgery includes the use of a pneumatic tourniquet placed on her right lower extremity. Monitoring the patient's temperature throughout the perioperative period is considered what part of the nursing process for this patient? - intervention Maximum tourniquet cuff pressure for the thigh should not exceed - 350mmHg When the use of monopolar electrosurgery is anticipated, after the application of a pneumatic tourniquet, the perioperative RN should place a single-use dispersive electrode _____________ to the cuff. - proximal The employer must maintain the employee'sexposure record (ie, sharp incidents) for the duration of employment plus ___ years? - 30 years Using the Gown Liquid Barrier Performance Class rating, a surgical gown classified as a Barrier Level 4 should be worn when the anticipated level of exposure to fluids, splashes, or pressure on the gown is - high The perioperative RN should anticipate classifying a surgical wound when there is a controlled entry into the GI tract without spillage of gastric or bowel content as - Class II (Clean-contaminated) Bonewax is made of - beeswax, paraffin, and isopropyl palmitate. Which of the following is NOT a type of skeletal traction? - Cervical halo Gardner-Wells tongs ***Hip Spica cast*** Thomas splint balance suspension Key points related to the use of methyl methacrylate include the following EXCEPT A. It is a respiratory, eye, and skin irritant. B. It is a vasoconstrictor. C. It is used to secure prostheses in bone. D. Patients and staff can be allergic to it. - B- vasoconstrictor It is a vasodilator that causes hypotension Osteotomes, gouges, and chisels are what type of surgical instrument? - dissecting What injectable medication used in urologic surgery colorizes tissue and vessels? - indigo carmine Medications administered to decrease intracranial pressure may include all EXCEPT a. cefazolin. b. mannitol. c. propofol (Diprivan). d. thiopental (Pentothal). - cefazolin To control bleeding on the dura of the brain and spinal cord, the perioperative RN should anticipate the surgeon using - bipolar The standard means of vascular access for long-term renal dialysis is - AV fistula Which modification of the supine position should be made for the OB patient? - Insert a wedge under the patient's right pelvis orlumbar region Which of the following medications is used in ophthalmologic surgery to topically inhibit scar formation in glaucoma filtering procedures? a. Dexamethasone b. Mannitol c. Mitomycin d. Tobramycin - Mitomycin After a pneumoretinopexy to repair a tear in the retina near the macula, the patient should be positioned in the ____________ position. - prone (for several weeks) Which medication commonly used in otologic surgery is an anti-inflammatory/antibiotic? - cortisporin otic The perioperative RN should anticipate applying the preoperative skin antiseptic solution to what area in preparation for the patient's surgery scheduled as "left tympanomastoidectomy"? - behind the left ear A patient is in PACU after having surgery to remove a mass from his left lung. One chest tube was inserted connected to a sterile water seal, closed-chest drainage chamber. During the hand-over report, the perioperative RN reminds the PACU RN to immediately notify the surgeon or contact the rapid response team if a. drainage from the chest tube is greater than 25 mL/hour. b. gentle bubbling is observed in water-seal chamber when patient exhales. c. . patient has sudden onset or increase in intensity of dyspnea. d. b and c only - patient has sudden onset or increase in intensity of dyspnea. The perioperative RN is helping the perioperative team transfer a 10-year-old girl onto the stretcher after a tonsillectomy procedure. How should the patient be positioned on the stretcher for transport to the PACU? - Three-quarters prone with the head turned to the side, with arms and legs flexed A patient in is the PACU after surgery involving an open reduction internal fixation of a fractured right femur. The perioperative RN observes the following signs: the patient is experiencing respiratory distress as demonstrated by tachypnea, the patient's heart rate is 160, the patient appears anxious and agitated, and there are petechiae present on the patient's chest. The patient is most likely exhibiting signs of - fat embolism syndrome What is the minimum amount of urine output expected for a postoperative adult patient with an indwelling urinary catheter to ensure proper hydration and kidney function? - 30mL/ hour A healthy 40-year-old woman is transferred to the PACU after a total left knee replacement with no complications. During a transfer of care report, the perioperative RN describes the patient as having an indwelling urinary catheter in place, which is draining clear, yellow urine. The perioperative RN and PACU RN agree that the best time to remove the catheter is - as soon as possible, preferably within 24 hours after surgery A 50-year-old woman is awake and alert in the PACU after a left knee arthroplasty. What is the best measure below for the perioperative RN to assess the patient's pain intensity? - Self-report on a standardized pain scale Shoulder pain after a patient undergoes a laparoscopic cholecystectomy is most likely caused by - retained carbon dioxide in the peritoneal cavity. What nonpharmacological interventions may reduce pain and anxiety in the preoperative period for pediatric patients? - play therapy & music A perioperative RN's documentation for a postoperative patient, "the patient is free from pain or numbness associated with surgical positioning," is an example of a nursing - outcome statement The first choice of therapy to treat bronchospasm is - inhaled bronchodilators Which symptom would indicate a sub-optimal thyroid level in a patient taking levothyroxine? - chronic constipation "Risk for patient injury due to the use of electrosurgery" is an example of a perioperative RN documenting a nursing - diagnosis A perioperative RN collecting and analyzing patient data is executing which step of the nursing process? - Assessment "The patient's procedure is performed on the correct side, site, and level" is an example of a nursing - outcome After the perioperative RN has assessed the patient, collected and interpreted data, identified nursing diagnoses, and established outcomes, what is the next step in the nursing process? - Developing a plan of care Checking, observing, and appraising the results of nursing interventions is what part of the nursing process? - Evaluation Positioning a patient using FDA-approved positioning devices is an example of a nursing - intervention Describing a nurse-sensitive, measurable, and quantifiable desirable patient condition is what part of the nursing process? - outcome identification An RN's documentation "anxiety and ineffective coping mechanisms" is which part of the nursing process? - Diagnosis The method of identifying and classifying data collected in the assessment of the patient is the nursing - Diagnosis The perioperative RN administering a medication to a patient is what part of the nursing process? - implementation According to the AORN Guidelines, at what time during an invasive surgical procedure should the scrubbed team members change their gloves? - 90-150 minutes After caring for a patient who is known to be infected withClostridioides difficile, the perioperative RN should ensure the environmental surfaces and non-critical devices are cleaned by using - EPA-registered disinfectant that is effective against C difficile spores. A perioperative RN caring for a patient receiving moderate sedation/analgesia may use a bispectral index monitor as an adjuncttechnology to monitor the patient's - level of sedation If exposure to blood or other potentially infectious materials is anticipated, team members at the sterile field should - change gloves every 30-60min The water temperature for hand hygiene should be - between 70° F and 80° F (21.1° C and 26.7° C). According to the AORN Guidelines, patients should be instructed to bathe or shower before surgery - on at least the night before or the day of surgery with either soap or a skin antiseptic. According to the Spaulding Classification System, semi-critical items should be - high-level disinfected or sterilized. When should graduated compression stockings and/or intermittent pneumatic compression devices be applied? - Before the administration of regional or general anesthesia If a tooth cannot be replanted immediately after a traumatic detachment, what storage medium does the International Society for Dental Traumatology recommend? - milk The relative humidity in a sterile storage area should be no higher than - 60% Obtaining the informed consent and discussing the risks, benefits, and alternatives for an operative or invasive procedure is a responsibility of the - surgeon In addition to the patient's identity, which of the following should be confirmed to help decrease the risk for wrong site surgery? - Procedure and site Who should the RN circulator notify audibly about the results of the surgical counts? - Surgeon If a patient experiences local anesthetic systemic toxicity, the perioperative RN should be prepared to assist with the administration of - 20% lipid emulsion therapy. The weight of any instrument tray should not exceed - 25lbs According to AORN Guidelines, immediate use steam sterilization (IUSS) should be used for implantable devices - if the manufacturer's instructions for use state IUSS cycles and no other option is available. According to the AORN Guidelines, when should you cover a sterile field? - - Cover sterile field during times of increased activity (eg, preincision, repositioning patient) - Cover sterile field when it will not be used immediately Scrubbed team members should use isolation technique during - bowel surgery, procedures involving resection of metastatic tumors After obtaining ordered blood products of platelets and plasma, the perioperative RN should: - maintain both products at the appropriate temperature storage requirements until the time of transfusion. According to the Safe Medical Devices Act of 1990 amended in March 2000, the perioperative RN's documentation for an implant procedure should include the - device components implanted. A delivery man can deliver supplies into which zone of a magnetic resonance imaging (MRI) suite? - Zone 1 The broad statement within an AORN guideline that represents what is believed to be optimal and achievable perioperative nursing practice is - a recommendation During design of a new operating room and when determining the size and floor plan, the area should be divided into these zones: - sterile field, circulation pathway, movable equipment zone, and anesthesia zone. A patient who is experiencing severe pain, a lack of sensation, swelling, vascular compromise, and restricted movement in the extremity after the use of a pneumatic tourniquet is most likely exhibiting the clinical manifestations of - compartment syndrome. The integrity of a sterile package and the sterility of an instrument is based on the premise that contamination is - event related (?) The time from an excision of a breast cancer specimen to the time of fixation of the specimen should be less than - 1 hour Before reimplantation of an amputated limb, what action is beneficial to maintaining muscle viability of the amputated limb? - Cooling amputated limb The restrictions and requirements for heating, cooling, ventilation and air conditioning (HVAC), surgical attire, and traffic pattern in the surgical suite - are intended to provide the cleanest environment in the restricted area. Alcohol-based skin antiseptic agents, collodion, drapes, and gowns are considered _____________in the fire triangle. - fuels The periop RN is interviewing a 35-year-old female patient in preop area. - scheduled for right knee arthroscopy - Patient states that she drank a cup of clear tea w/ sugar approximately 3 hours ago and ate a full dinner 12 hours ago. - unable to shower at home b/c her water was not working - Vitals are BP 120/80, T 37 degrees Celsius, Pulse 72 and regular, Respirations 14/min -Lab values are w/in normal limits. Weighs 202 lb (BMI is 31, and she states that she is healthy with no medical issues and no previous surgery) -No orders written for preop hair removal. - RN notices a reddened area with several white bumps in the area of the proposed incision. According to AORN's Ergonomic Tool #3 for lifting and holding extremities, how should the perioperative RN plan to lift the patient's leg into the leg holder for this procedure? - One team member and assistive technology should be used to lift the lower extremity. The periop RN is interviewing a 35-year-old female patient in preop area. - scheduled for right knee arthroscopy - Patient states that she drank a cup of clear tea w/ sugar approximately 3 hours ago and ate a full dinner 12 hours ago. - unable to shower at home b/c her water was not working - Vitals are BP 120/80, T 37 degrees Celsius, Pulse 72 and regular, Respirations 14/min -Lab values are w/in normal limits. Weighs 202 lb (BMI is 31, and she states that she is healthy with no medical issues and no previous surgery) -No orders written for preop hair removal. - RN notices a reddened area with several white bumps in the area of the proposed incision. According to American Society of Anesthesiologists Committee on Standards and Practice Parameters Practice guidelines for preoperative fasting, what is the appropriate action for the RN to take regarding the patient's reported oral liquid intake? - Consult w/ assigned anesthesiologist. The periop RN is interviewing a 35-year-old female patient in preop area. - scheduled for right knee arthroscopy - Patient states that she drank a cup of clear tea w/ sugar approximately 3 hours ago and ate a full dinner 12 hours ago. - unable to shower at home b/c her water was not working - Vitals are BP 120/80, T 37 degrees Celsius, Pulse 72 and regular, Respirations 14/min -Lab values are w/in normal limits. Weighs 202 lb (BMI is 31, and she states that she is healthy with no medical issues and no previous surgery) -No orders written for preop hair removal. - RN notices a reddened area with several white bumps in the area of the proposed incision. To apply AORN Guidelines, what is the most appropriate action for the RN to take regarding removal of hair on the patient's knee? - Leave the hair in place -- no hair removal is required. The periop RN is interviewing a 35-year-old female patient in preop area. - scheduled for right knee arthroscopy - Patient states that she drank a cup of clear tea w/ sugar approximately 3 hours ago and ate a full dinner 12 hours ago. - unable to shower at home b/c her water was not working - Vitals are BP 120/80, T 37 degrees Celsius, Pulse 72 and regular, Respirations 14/min -Lab values are w/in normal limits. Weighs 202 lb (BMI is 31, and she states that she is healthy with no medical issues and no previous surgery) -No orders written for preop hair removal. - RN notices a reddened area with several white bumps in the area of the proposed incision. The orthopedic surgeon requests a pneumatic tourniquet be available for this patient to be placed on the extremity when the patient is in the OR suite. He and the anesthesia professional should determine the tourniquet inflation pressure based on the patient's - systolic blood pressure and circumference of the extremity. RN is interviewing a 73-year-old woman in the preoperative ready area Patient is alone and scheduled for placement of a gastrostomy tube. Eldest daughter is currently on speaker phone with the perioperative RN, surgeon, and the anesthesia professional in attendance. There are physician orders for "do not resuscitate" and the patient is wearing a "do not resuscitate" band on her left wrist. RN observes patient is aphasic, & her left upper extremity appears flaccid Surgeon states, "give her a little something to relieve her anxiety and place a bladder catheter in her after she is asleep." The anesthesia professional comments, "I anticipate this will be a difficult intubation". A flexible endoscope often used by this anesthesia professional is clean and available in the storage closet. The perioperative RN directs the patient care assistant, an unlicensed assistive team member, to insert the bladder catheter after the patient is under anesthesia. What question should the perioperative RN ask about the surgeon's orders? - What do you want to give for anxiety? RN is interviewing a 73-year-old woman in the preoperative ready area Patient is alone and scheduled for placement of a gastrostomy tube. Eldest daughter is currently on speaker phone with the perioperative RN, surgeon, and the anesthesia professional in attendance. There are physician orders for "do not resuscitate" and the patient is wearing a "do not resuscitate" band on her left wrist. RN observes patient is aphasic, & her left upper extremity appears flaccid Surgeon states, "give her a little something to relieve her anxiety and place a bladder catheter in her after she is asleep." The anesthesia professional comments, "I anticipate this will be a difficult intubation". A flexible endoscope often used by this anesthesia professional is clean and available in the storage closet. The perioperative RN directs the patient care assistant, an unlicensed assistive team member, to insert the bladder catheter after the patient is under anesthesia. After receiving orders to fill out paperwork for the surgical consent, the perioperative RN should - participate in determining whether the patient can sign the consent. RN is interviewing a 73-year-old woman in the preoperative ready area Patient is alone and scheduled for placement of a gastrostomy tube. Eldest daughter is currently on speaker phone with the perioperative RN, surgeon, and the anesthesia professional in attendance. There are physician orders for "do not resuscitate" and the patient is wearing a "do not resuscitate" band on her left wrist. RN observes patient is aphasic, & her left upper extremity appears flaccid Surgeon states, "give her a little something to relieve her anxiety and place a bladder catheter in her after she is asleep." The anesthesia professional comments, "I anticipate this will be a difficult intubation". A flexible endoscope often used by this anesthesia professional is clean and available in the storage closet. The perioperative RN directs the patient care assistant, an unlicensed assistive team member, to insert the bladder catheter after the patient is under anesthesia. According to AORN's Position Statement Perioperative Care of Patients with Do-Not-Resuscitate or Allow-Natural-Death Orders , a discussion about this patient's health care wishes should include all EXCEPT - costs for the procedure based on her insurance coverage. RN is interviewing a 73-year-old woman in the preoperative ready area Patient is alone and scheduled for placement of a gastrostomy tube. Eldest daughter is currently on speaker phone with the perioperative RN, surgeon, and the anesthesia professional in attendance. There are physician orders for "do not resuscitate" and the patient is wearing a "do not resuscitate" band on her left wrist. RN observes patient is aphasic, & her left upper extremity appears flaccid Surgeon states, "give her a little something to relieve her anxiety and place a bladder catheter in her after she is asleep." The anesthesia professional comments, "I anticipate this will be a difficult intubation". A flexible endoscope often used by this anesthesia professional is clean and available in the storage closet. The perioperative RN directs the patient care assistant, an unlicensed assistive team member, to insert the bladder catheter after the patient is under anesthesia. According to the AORN Position Statement Allied Healthcare Providers and Support Personnel in the Perioperative Practice Setting, the perioperative RN who delegates the nursing task of inserting the bladder catheter to the patient care assistant should expect the patient care assistant to: - ask questions if he or she does not understand the nature of the task delegated. RN is interviewing a 73-year-old woman in the preoperative ready area Patient is alone and scheduled for placement of a gastrostomy tube. Eldest daughter is currently on speaker phone with the perioperative RN, surgeon, and the anesthesia professional in attendance. There are physician orders for "do not resuscitate" and the patient is wearing a "do not resuscitate" band on her left wrist. RN observes patient is aphasic, & her left upper extremity appears flaccid Surgeon states, "give her a little something to relieve her anxiety and place a bladder catheter in her after she is asleep." The anesthesia professional comments, "I anticipate this will be a difficult intubation". A flexible endoscope often used by this anesthesia professional is clean and available in the storage closet. The perioperative RN directs the patient care assistant, an unlicensed assistive team member, to insert the bladder catheter after the patient is under anesthesia. In preparation for the procedure, the perioperative RN should instruct the patient care assistant to - bring the Difficult Airway Cart and supplies into the OR. A 67-year-old man was in surgery undergoing a left thoracotomy and removal of a lesion on the left lung. The RN circulator was relieved for a break. When the RN circulator returned, the dressings were being applied and the surgical team was ready to transfer the patient from the OR bed onto his unit bed. The relief RN stated, "Everything is done" and then went to help the anesthesia professional. The RN circulator helped transport the patient to the intensive care unit. Four days later, the patient was returned to the operating room and a laparotomy sponge was removed from his chest. An intensive committee review of this patient's care occurred after the second surgery.Question 1According to the AORN Guidelines, when the RN circulator returned from the break, what communication processes should have occurred between the RN circulator and the relief RN? - A face-to-face interaction so that the RN circulator and relief RN were able to ask and answer questions. A 67-year-old man was in surgery undergoing a left thoracotomy and removal of a lesion on the left lung. The RN circulator was relieved for a break. When the RN circulator returned, the dressings were being applied and the surgical team was ready to transfer the patient from the OR bed onto his unit bed. The relief RN stated, "Everything is done" and then went to help the anesthesia professional. The RN circulator helped transport the patient to the intensive care unit. Four days later, the patient was returned to the operating room and a laparotomy sponge was removed from his chest. An intensive committee review of this patient's care occurred after the second surgery.Question 2Several state and federal agencies, accrediting bodies, and professional health care organizations consider a retained surgical item as a - sentinel event. A 22-year-old male unidentified trauma victim is in the OR undergoing an exploratory laparotomy as a result of a gunshot wound to the abdomen. He is wearing an ID band with his trauma name and medical record number on his left wrist. The patient's vital signs are BP 84/60, temperature 36 degrees Celsius, pulse 120. No lab results have been reported. The patient is intubated and the anesthesia professional is hanging IV normal saline that is alternating with infusion of the blood products. The massive transfusion protocol was initiated and 10 units of packed red blood cells have been administered. The surgeon is removing a metal object that was located in the patient's abdomen and the law enforcement officer is present in the OR suite. The perioperative RN notices that there is a blood splash on the floor. Question 2According to the AORN Guidelines, what is an appropriate action by the surgical technologist for managing the instruments used to remove the metal object that remain on the sterile field but will no longer been needed for this procedure? - Separate the heavy instruments from the more delicate instruments. A 22-year-old male unidentified trauma victim is in the OR undergoing an exploratory laparotomy as a result of a gunshot wound to the abdomen. He is wearing an ID band with his trauma name and medical record number on his left wrist. The patient's vital signs are BP 84/60, temperature 36 degrees Celsius, pulse 120. No lab results have been reported. The patient is intubated and the anesthesia professional is hanging IV normal saline that is alternating with infusion of the blood products. The massive transfusion protocol was initiated and 10 units of packed red blood cells have been administered. The surgeon is removing a metal object that was located in the patient's abdomen and the law enforcement officer is present in the OR suite. The perioperative RN notices that there is a blood splash on the floor. Question 3 What is the most appropriate action the perioperative RN should take regarding the blood splash on the floor? - Use an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant to clean the area as soon as possible. A 22-year-old male unidentified trauma victim is in the OR undergoing an exploratory laparotomy as a result of a gunshot wound to the abdomen. He is wearing an ID band with his trauma name and medical record number on his left wrist. The patient's vital signs are BP 84/60, temperature 36 degrees Celsius, pulse 120. No lab results have been reported. The patient is intubated and the anesthesia professional is hanging IV normal saline that is alternating with infusion of the blood products. The massive transfusion protocol was initiated and 10 units of packed red blood cells have been administered. The surgeon is removing a metal object that was located in the patient's abdomen and the law enforcement officer is present in the OR suite. The perioperative RN notices that there is a blood splash on the floor. Question 4 According to the AABB Standards of Blood Banks and Transfusion Services, which ABO blood type and which blood product should be transfused to this patient? - ABO group O and red blood cells A 22-year-old male unidentified trauma victim is in the OR undergoing an exploratory laparotomy as a result of a gunshot wound to the abdomen. He is wearing an ID band with his trauma name and medical record number on his left wrist. The patient's vital signs are BP 84/60, temperature 36 degrees Celsius, pulse 120. No lab results have been reported. The patient is intubated and the anesthesia professional is hanging IV normal saline that is alternating with infusion of the blood products. The massive transfusion protocol was initiated and 10 units of packed red blood cells have been administered. The surgeon is removing a metal object that was located in the patient's abdomen and the law enforcement officer is present in the OR suite. The perioperative RN notices that there is a blood splash on the floor. The primary assessment of this patient should have included the activities of the mnemonic "A, B, C, D, E" meaning Airway, Breathing, Circulation, and - Disability, and Exposure and Environmental control. A 75-year-old woman is in the OR undergoing a total abdominal hysterectomy and a minimally invasive approach. She is 5 feet tall and weighs 100 pounds. Her vital signs are BP 90/68, temperature 36.4 degrees Celsius, and pulse 76 and regular, and she is under general anesthesia with an endotracheal tube in place. A forced-air warming device has been on the patient since her arrival into the preoperative ready area. A new sterile specialty drape that was requested by the surgeon several months ago was placed on the patient in the OR. There is a sterile wrapped tray of extra instruments in the case cart available for use.Question 1The perioperative RN should determine how to safely move the patient from the stretcher to the OR bed and first - assess whether the patient can self-transfer. A 75-year-old woman is in the OR undergoing a total abdominal hysterectomy and a minimally invasive approach. She is 5 feet tall and weighs 100 pounds. Her vital signs are BP 90/68, temperature 36.4 degrees Celsius, and pulse 76 and regular, and she is under general anesthesia with an endotracheal tube in place. A forced-air warming device has been on the patient since her arrival into the preoperative ready area. A new sterile specialty drape that was requested by the surgeon several months ago was placed on the patient in the OR. There is a sterile wrapped tray of extra instruments in the case cart available for use According to the AORN Guidelines, what other effective interventions can be implemented to prevent unplanned hypothermia for this patient? - Administer warm intravenous fluids and warm irrigation fluids. A 75-year-old woman is in the OR undergoing a total abdominal hysterectomy and a minimally invasive approach. She is 5 feet tall and weighs 100 pounds. Her vital signs are BP 90/68, temperature 36.4 degrees Celsius, and pulse 76 and regular, and she is under general anesthesia with an endotracheal tube in place. A forced-air warming device has been on the patient since her arrival into the preoperative ready area. A new sterile specialty drape that was requested by the surgeon several months ago was placed on the patient in the OR. There is a sterile wrapped tray of extra instruments in the case cart available for use.Question 3 According to the AORN Guidelines, the specialty drape that was requested for this procedure should have been - evaluated by an multidisciplinary team including perioperative RNs. A 75-year-old woman is in the OR undergoing a total abdominal hysterectomy and a minimally invasive approach. She is 5 feet tall and weighs 100 pounds. Her vital signs are BP 90/68, temperature 36.4 degrees Celsius, and pulse 76 and regular, and she is under general anesthesia with an endotracheal tube in place. A forced-air warming device has been on the patient since her arrival into the preoperative ready area. A new sterile specialty drape that was requested by the surgeon several months ago was placed on the patient in the OR. There is a sterile wrapped tray of extra instruments in the case cart available for use. The gas distension media used for this patient should have been chosen based on the - properties of the gas media, the procedure, and the patient's history. A healthy 65-year-old man is scheduled for an excision of a dime-sized lesion on his right shoulder and the physician orders include "local anesthesia." It's a busy day and the RN circulator asks the patient only about allergies to medications and informs the patient that the surgeon plans to inject numbing medication into the surgery site. As he is being wheeled into the operating room, the patient remarks to the RN circulator, "I have never had a surgery on my shoulder before."The RN replies, "Shoulder? I thought this was on your forearm. Let's go back to the preoperative area and check this out." After confirmation that the correct location is the right shoulder, the patient is transported into the procedure room and the procedure begins with the surgeon administering 10 mL of lidocaine into the area of incision. During the procedure, the patient appears relaxed and his baseline vital signs are BP 130/84, temperature 37 degrees Celsius, pulse 76, and respirations 14 per minute. At approximately 15 minutes into the procedure, the RN monitoring the patient notifies the physician that the patient's BP is 140/82, pulse is 80, and respirations are 16 per minute. The surgeon gives the tissue specimen to the surgical technologist, who places the tissue specimen into the specimen container. The RN circulator sends the specimen to the laboratory with the patient's information on a label on the side of the specimen cup. The patient is in the operating room for 25 minutes. Following the procedure, the perioperative RN meets with his nurse manager. After reviewing the patient's intraoperative record together, the nurse manager notices that there is no information about a specimen recorded in medical record. What tool could the RN circulator have used to preoperatively assess the patient's level of anxiety? - State-Trait Anxiety Inventory A healthy 65-year-old man is scheduled for an excision of a dime-sized lesion on his right shoulder and the physician orders include "local anesthesia." It's a busy day and the RN circulator asks the patient only about allergies to medications and informs the patient that the surgeon plans to inject numbing medication into the surgery site. As he is being wheeled into the operating room, the patient remarks to the RN circulator, "I have never had a surgery on my shoulder before."The RN replies, "Shoulder? I thought this was on your forearm. Let's go back to the preoperative area and check this out." After confirmation that the correct location is the right shoulder, the patient is transported into the procedure room and the procedure begins with the surgeon administering 10 mL of lidocaine into the area of incision. During the procedure, the patient appears relaxed and his baseline vital signs are BP 130/84, temperature 37 degrees Celsius, pulse 76, and respirations 14 per minute. At approximately 15 minutes into the procedure, the RN monitoring the patient notifies the physician that the patient's BP is 140/82, pulse is 80, and respirations are 16 per minute. The surgeon gives the tissue specimen to the surgical technologist, who places the tissue specimen into the specimen container. The RN circulator sends the specimen to the laboratory with the patient's information on a label on the side of the specimen cup. The patient is in the operating room for 25 minutes. Following the procedure, the perioperative RN meets with his nurse manager. After reviewing the patient's intraoperative record together, the nurse manager notices that there is no information about a specimen recorded in the medical record. The nurse manager points out to the perioperative RN that the Universal Protocol was not followed for this patient and that the perioperative RN neglected to - perform a preoperative verification, confirm site marking, and perform the time-out process. An 82-year-old woman is scheduled at 0900 for an Open Reduction Internal Fixation (ORIF) of her right femur with fluoroscopy. The patient states that she is in pain and her "bottom hurts." The surgeon has specified the type of implants she plans to use. During the transfer, the perioperative RN assesses a reddened area on the patient's sacrum: approximately the size and shape of a silver dollar, the skin is intact, no blistering apparent, and it feels warm to touch. The patient is positioned supine on a fracture table with the unaffected leg supported comfortably in a padded stirrup device. The patient's right arm is positioned comfortably over her chest in a sling device and the left arm is on a padded arm board. The surgery progresses smoothly, and the patient is transported to the post anesthesia care unit. Question 1 According to the National Pressure Ulcer Advisory Panel definitions of pressure injuries, the perioperative RN should stage the patient's skin on her sacrum as a - Stage 1 An 82-year-old woman is scheduled at 0900 for an Open Reduction Internal Fixation (ORIF) of her right femur with fluoroscopy. The patient states that she is in pain and her "bottom hurts." The surgeon has specified the type of implants she plans to use. During the transfer, the perioperative RN assesses a reddened area on the patient's sacrum: approximately the size and shape of a silver dollar, the skin is intact, no blistering apparent, and it feels warm to touch. The patient is positioned supine on a fracture table with the unaffected leg supported comfortably in a padded stirrup device. The patient's right arm is positioned comfortably over her chest in a sling device and the left arm is on a padded arm board. The surgery progresses smoothly, and the patient is transported to the post anesthesia care unit The perioperative RN has identified the patient is at risk for infection and hypothermia which is - a nursing diagnosis. A Spanish-speaking 25-year-old woman is scheduled for an elective left carpal tunnel release with a local anesthetic and moderate sedation. She is ready in the preoperative area. It's a busy operating room and the perioperative team members, including the anesthesia professionals, have been working all night. The patient is sedated in the preoperative area and taken into an OR suite by the anesthesia care professional, and the following activities occur: a general anesthesia is administered by the anesthesia care professional, and the patient is positioned in the lithotomy position by the patient care assistant, prepped by a nursing student, and draped by the surgical technologist and the surgical resident. The perioperative RN stops the procedure and calls the surgeon. After the surgeon discusses the situation with the family, the patient is awakened and transported to the post anesthesia care unit. After recovering from the anesthesia, the surgeon discusses the events and tells the patient that he will reschedule her surgery in 10 days. Which of the following risk factors for wrong site surgery apply to this situation? - Communication breakdowns and inadequate procedures to verify the correct surgical site A Spanish-speaking 25-year-old woman is scheduled for an elective left carpal tunnel release with a local anesthetic and moderate sedation. She is ready in the preoperative area. It's a busy operating room and the perioperative team members, including the anesthesia professionals, have been working all night. The patient is sedated in the preoperative area and taken into an OR suite by the anesthesia care professional, and the following activities occur: a general anesthesia is administered by the anesthesia care professional, and the patient is positioned in the lithotomy position by the patient care assistant, prepped by a nursing student, and draped by the surgical technologist and the surgical resident. The perioperative RN stops the procedure and calls the surgeon. After the surgeon discusses the situation with the family, the patient is awakened and transported to the post anesthesia care unit. After recovering from the anesthesia, the surgeon discusses the events and tells the patient that he will reschedule her surgery in 10 days. How should the patient's wrist have been marked prior to surgery? - Marked by the physician performing the surgery A Spanish-speaking 25-year-old woman is scheduled for an elective left carpal tunnel release with a local anesthetic and moderate sedation. She is ready in the preoperative area. It's a busy operating room and the perioperative team members, including the anesthesia professionals, have been working all night. The patient is sedated in the preoperative area and taken into an OR suite by the anesthesia care professional, and the following activities occur: a general anesthesia is administered by the anesthesia care professional, and the patient is positioned in the lithotomy position by the patient care assistant, prepped by a nursing student, and draped by the surgical technologist and the surgical resident. The perioperative RN stops the procedure and calls the surgeon. After the surgeon discusses the situation with the family, the patient is awakened and transported to the post anesthesia care unit. After recovering from the anesthesia, the surgeon discusses the events and tells the patient that he will reschedule her surgery in 10 days. What actions should have been taken by the RN circulator to decrease the risk for a wrong-site, wrong-procedure, wrong-person surgery? - Perform a Time Out with the surgeon, anesthesia professional, RN circulator, and scrubbed person in attendance. A Spanish-speaking 25-year-old woman is scheduled for an elective left carpal tunnel release with a local anesthetic and moderate sedation. She is ready in the preoperative area. It's a busy operating room and the perioperative team members, including the anesthesia professionals, have been working all night. The patient is sedated in the preoperative area and taken into an OR suite by the anesthesia care professional, and the following activities occur: a general anesthesia is administered by the anesthesia care professional, and the patient is positioned in the lithotomy position by the patient care assistant, prepped by a nursing student, and draped by the surgical technologist and the surgical resident. The perioperative RN stops the procedure and calls the surgeon. After the surgeon discusses the situation with the family, the patient is awakened and transported to the post anesthesia care unit. After recovering from the anesthesia, the surgeon discusses the events and tells the patient that he will reschedule her surgery in 10 days.Question 4What processes should have been in place at this facility to decrease the chance of a wrong-site, wrong-procedure, or wrong-person surgery happening to this patient - Require patients to mark their own operative sites preoperatively the available diagnostic testing to determine a predisposition for MH includes - genetic testing and/or muscle biopsy. How many vials of Dantrolene should be available in a health care facility? - 36 Steps after transfusion reaction occurs - Stop the blood component immediately and keep the IV patent with normal saline, notify the surgeon and the Blood Bank, provide any specific treatment as ordered by the physician, and then initiate the transfusion reaction report. The optical density markings on a pair of laser goggles indicates the - ability of a filter to absorb a specific wavelength. According to the AORN Guidelines, which of the following statements is true regarding the laser plume generated during this bronchoscopy with laser removal of lesion on vocal cords? - A smoke evacuator system should have been used to remove the laser plume. According to the AORN Guidelines, which of the following statements is true regarding the role of the laser assistant? - Assignments that would require a laser operator to leave the laser unattended while the surgeon is activating the laser are not recommended. For patient having surgery on arm w/ tourniquet, intraoperative medical record should include the RN circulator's documentation of the patient's - left arm's peripheral pulses distal to the tourniquet cuff placement What actions should RN take in regard to the total inflation time of pneumatic tourniquet? - Inform the surgeon regularly of the pneumatic tourniquet inflation time. A radiation safety program must include annual exposure limits for radiation health care workers and not exceed limits set by the Nuclear Regulatory Commission. For a radiation health care worker the total effect dose equivalent per year must not exceed - 5 rem A thin, outer covering of bone containing nutrient arteries for nourishment of bones cells is called - periosteum Complications of excessive fluid intravasation of distension media during TURBT - hyponatremia, hypervolemia, cardiovascular, and pulmonary complications. Which nerve is affected by direct pressure and can develop a nerve palsy if the graduated compression stockings are too tight for obese patient? - Peroneal What are the three primary factors in the etiology of venous thromboembolism? - Venous stasis, endothelial damage, and hypercoagulability of blood According to the AORN Guidelines, after this patient has left the OR, the high-touch surfaces in the OR should be cleaned with - Environmental Protection Agency-registered hospital-grade disinfectant. At the time, what was the most appropriate action for the perioperative RN to take regarding the ST's observation that there was water in the bottom of the tray containing the power equipment? The perioperative RN should - notify the ST that the tray is unsterile and remove the tray containing the power equipment from the sterile field.