Table of Contents
TEST BANK FOR ALEXANDERS CARE OF THE
Unit 1: Foundations for Practice
PATIENT IN SURGERY 16TH EDITION BY 1. Concepts Basic to Perioperative Nursing
2. Patient Safety and Risk Management
ROTHROCK ISBN10: 0323479146 ISBN13: 3. Workplace Issues and Staff Safety
4. Infection Prevention and Control
9780323479141 5. Anesthesia
6. Positioning the Patient for Surgery
7. Sutures, Sharps, and Instruments
8. Surgical Modalities
9. Wound Healing, Dressings, and Drains
10. Postoperative Patient Care and Pain Management
Unit 2: Surgical Interventions
11. Gastrointestinal Surgery
12. Surgery of the Liver, Biliary Tract, Pancreas, and Spleen
13. Hernia Repair
14. Gynecologic and Obstetric Surgery
15. Genitourinary Surgery
16. Thyroid and Parathyroid Surgery
17. Breast Surgery
18. Ophthalmic Surgery
19. Otorhinolarygologic Surgery
20. Orthopedic Surgery
21. Neurosurgery
22. Reconstructive and Aesthetic Plastic Surgery
22. Thoracic Surgery
23. Vascular Surgery
24. Cardiac Surgery
Unit 3: Special Considerations
26. Pediatric Surgery
27. Geriatric Surgery 28. Trauma Surgery
29. Interventional and Image-Guided Procedures
30. Integrative Health Practices: Complementary and Alternative Therapies
,Chapter 01: Concepts Basic to Perioperative Nursing 7. Which of the following actions best describes an element of the perioperative nursing assessment?
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition a. Scanning the surgical schedule for the day before morning report.
b. Reading the pick/preference list attached to the case cart.
c. Reviewing the patient medical record.
MULTIPLE CHOICE d. Studying an on-line tutorial about the intended surgical procedure.
1. The Perioperative Patient Focused Model presents key components of nursing influence that guide patient care. Select the ANS: C
statement that best describes the dynamic relationship within the model. Assessment is the collection and analysis of relevant health data about the patient. Sources of data may be a preoperative interview
a. The patient experience and the nursing presence are in continuous interaction. with the patient and the patient’s family; review of the planned surgical or invasive procedure; review of the patient’s medical
b. Structure, process, and outcome are the foundation domains of the model.
record; examination of the results of diagnostic tests; and consultation with the surgeon and anesthesia provider, unit nurses, or
c. The perioperative nurse is the central dynamic core of the model.
other personnel.
d. The interrelated nursing process rings bind the patient to the model.
8. A frail 76-year-old diabetic woman is scheduled for major surgery. She is vulnerable and at high risk for harm because of several
ANS: A factors related to her preexisting conditions and overall health status. As part of developing a plan to guide her care, the nurse uses
The Perioperative Patient Focused Model consists of domains or areas of nursing concern: nursing diagnoses, nursing standardized descriptive terms. This step of the nursing process is called:
interventions, and patient outcomes. These domains are in continuous interaction with the health system that encircles the focus of a. nursing diagnosis.
perioperative nursing practice—the patient. b. nursing assessment.
c. nursing outcome.
2. The Association of PeriOperative Registered Nurses’ (AORN) Standards of Perioperative Nursing describes nursing interactions, d. nursing intervention.
interventions, and activities with patients. This is based on which standards category?
a. Evidence-based ANS: A
b. Process Nursing diagnosis is the process of identifying and classifying data collected in the assessment in a way that provides a focus to
c. Outcome plan nursing care. Nursing diagnosis components include a definition of the diagnostic term, defining characteristics and risk
d. Structural factors.
ANS: B 9. During the admission interview, the nurse initiated the discharge teaching and demonstrated crutch-walking activities. The teaching
Process standards relate to nursing activities, interventions, and interactions. They are used to explicate clinical, professional, and activities are what stage of the nursing process?
quality objectives in perioperative nursing. a. Assessment
b. Implementation
3. Which order best describes the process used to implement evidence-based professional nursing? c. Outcome identification
a. Literature search, theory review, data analysis, policy development d. Evaluation
b. Regional survey, literature search, meta-analysis, practice change
c. Identify problem, scientific evidence, develop policy, evaluate outcome ANS: B
d. Identify issue, analyze scientific evidence, implement change, evaluate process
Implementation is performing the nursing care activities and interventions that were planned and responding with critical thinking
and orderly action to changes in the surgical procedure, patient condition, or emergencies. Implementation is the “work” of nursing.
ANS: D
Evidence-based practice is a systematic, thorough process by which to identify an issue, to collect and evaluate the best evidence to 10. While conducting the preoperative interview with a patient scheduled for a septoplasty, the perioperative nurse learned that the
design and implement a practice change, and to evaluate the process. patient was latex sensitive. Based on this knowledge, the nurse reviewed the pick/preference list and reassembled the surgical case
cart setup to reflect this new information and change in care delivery. Which two phases of the nursing process are represented in
4. The ambulatory surgery unit is planning to develop a standardized skin preparation practice for their unit. The best process to the nurse’s actions?
gather scientific information is to: a. Assessment and planning
a. conduct a survey of skin prep policies at the next AORN chapter meeting. b. Assessment and implementation
b. review their surgical site infection data from the last 6 months. c. Planning and implementation
c. conduct a literature search on antimicrobial agents and infection prevention. d. Nursing diagnosis and intervention
d. review the scientific literature from the leading manufacturers of prep solutions.
ANS: C
ANS: C Planning is preparing in advance for what will or may happen and determining the priorities for care. Planning is based on patient
Perioperative nurses have an ethical responsibility to review practices and to modify them based on the best available scientific assessment results in knowing the patient and the patient’s unique needs. Implementation is performing the nursing care activities
evidence. Using research to guide practice is called evidence-based practice (EBP). and interventions that were planned and responding with critical thinking and orderly action. Implementation is the “work” of
nursing.
5. The cardiac team is developing a standardized sterile back table setup and is unable to find sufficient research evidence for their
project. Where might they look for information on best practices? 11. The perioperative nurse implements protective measures to prevent skin or tissue injury caused by thermal sources. Successful
a. Survey regional surgical technology programs for their back table models accomplishment of this intervention would meet which of the following desired nursing outcomes?
b. Review case studies and expert opinions on sterile back table setups a. The patient is free from signs and symptoms of injury from anxiety.
c. Review AORN’s Guidelines for Perioperative Practice on sterilization and b. The patient is free from signs and symptoms of impaired skin integrity.
disinfection c. The patient is free from signs and symptoms of surgical site infection.
d. Consult with facility instrument vendor representatives for their advice d. The patient is free from signs and symptoms of hyperthermia.
ANS: B ANS: B
When there is not enough evidence to guide practice, perioperative nurses should consider gathering information from varied Chemical and thermal sources used in surgery can cause skin and tissue burns (e.g., electrosurgery, povidine-iodine, radiation,
trusted sources that reflect best practices. lasers). The patient being free from signs and symptoms of chemical injury, radiation injury, and electrical injury are approved
NANDA International nursing diagnoses.
6. How do institutional standards of care, such as policies and procedures, differ from national standards, such as AORN’s Standards
of Perioperative Nursing? 12. The nursing diagnosis is derived from:
a. They are written by nurses. a. patient data retrieved from the nursing assessment.
b. They are written specifically to address responsibilities under specific b. synthesized clues from the admitting diagnosis and surgery schedule.
circumstances. c. the approved NANDA International list attached to the patient medical record.
c. They are collaborative and collective agreement statements. d. the admission form on the front of the chart.
d. They are rarely based on research.
ANS: A
ANS: B Nursing diagnosis is the process of identifying and classifying data collected in the assessment in a way that provides a focus to
Institutional standards apply to the system or facility that develops them and can be directive about specific actions in specific plan nursing care.
circumstances; national standards provide generalized authoritative statements that can be implemented in all settings.
1 2
,13. A 36-year-old woman was preoperatively admitted for laparoscopic cholecystectomy with operative cholangiogram. She was then 19. A registered nurse first assistant (RNFA) is considered an advanced practice nurse (APN) when he/she has achieved:
interviewed by her perioperative nurse in the preoperative intake lounge. The patient’s weight on admission was 245 lb. After the a. RNFA certification.
assessment, the nurse returned to the operating room (OR) and modified the standard plan of care by instituting risk reduction b. clinical performance ladder Level 4 or above.
strategies that were derived from information from the preoperative assessment. A good example of this action would best be c. graduate degree in nursing (MSN).
described by: d. facility practice privileges.
a. replacing the regular OR bed with a bariatric-specific OR bed.
ANS: C
b. providing protective lead aprons for all staff during the procedure.
APNs must have graduate nursing education (at least a master’s degree).
c. writing the patient’s name, allergies, and body weight on the whiteboard.
d. administering antibiotics to the patient 1 hour before the incision.
20. Emerging perioperative nursing roles are defined by the tremendous growth in science and technology combined with the
ANS: A increasing complexity of surgery and the interventional disciplines. An example of an emerging nursing role is:
Planning is preparing in advance for what will or may happen and determining the priorities for care. Planning based on patient a. sterile processing clinical specialist.
assessment results in knowing the patient and the patient’s unique needs so that alterations in events, such as positioning the patient b. general surgery service liaison.
on a bariatric-specific OR bed as opposed to a regular OR bed, can be readily accommodated. Replacing the OR bed with a larger c. weekend resource nurse.
OR bed is a nurse-sensitive preventive intervention that provides equipment based on patient need. d. informatics nurse specialist.
ANS: D
14. Adoption of an electronic medical record requires the use of consistent terminology. Empirically validated, standardized
Informatics is another specialty in which some perioperative nurses are focusing. Pressures for more efficient management of
perioperative nursing language may be found in the:
fiscal, material, and human resources have stimulated the development of electronic information systems for diverse functions in
a. Perioperative Patient Focused Model.
perioperative patient care settings.
b. Nursing Alliance for Quality Care (NAQC).
c. Perioperative Nursing Data Set (PNDS).
21. The relationship between the Perioperative Patient Focused Model and the PNDS is evidenced by their unique language and use of
d. Standards of Perioperative Nursing.
the nursing process to guide care. The most notable feature of their similarity is that the PNDS:
ANS: C a. promotes standardized perioperative documentation.
After 6 years of research and validation, the Perioperative Nursing Data Set (PNDS) was recognized as a specialty nursing b. fosters research on best practices.
language, providing a uniform and systematic method to document the basic elements of perioperative nursing care. c. begins with outcome statements.
d. promotes standardized perioperative documentation and begins with outcome
15. When delegating a task, such as removing an intravenous (IV) catheter, to an unlicensed individual, the perioperative nurse: statements.
a. retains responsibility for evaluating the outcome of the task.
ANS: C
b. must comply with the seven “rights” of delegation.
Similar to the Perioperative Patient Focused Model, the PNDS begins with patient outcomes. Each outcome is defined and
c. transfers the authority to perform the related assessments.
interpreted and presents criteria by which to measure outcome achievement.
d. transfers the supervision of the competent person to another competent person.
ANS: C 22. In a research study by Kleiner and colleagues (2014), use of crew resource management (CRM) principles was a practical and
Delegation transfers to a competent person the authority to perform a selected nursing task in a selected situation according to the effective means to:
“five rights” of delegation. When delegating care activities, perioperative nurses retain accountability for analyzing and evaluating a. identify potential surgical defects in the OR.
the outcomes of delegated tasks. b. monitor central processing productivity.
c. promote teamwork.
16. A hospital nursing excellence center for education developed standards for nursing advancement that would reflect high-level d. improve the quality of OR briefings and debriefings.
achievement of professional performance. They developed a clinical advancement ladder based on the leading skill and knowledge
ANS: D
acquisition model and established worthy criteria for each level. Select the response that might best describe the highest level of
Kleiner and colleagues (2014) found while there was no difference in the frequency of briefings and debriefings observed in this
achievement for a perioperative staff nurse.
study, there were significant differences in the quality of the communication observed. Coaching appeared to be an effective
a. Certified nurse, OR (CNOR) credential, BSN, and chair of the nursing research
intervention, improving the quality of communication among team members.
committee
b. Published article in the hospital newsletter and 15 years’ service pin 23. In a research study by Steelman and colleagues (2013), perioperative nurses were surveyed to prioritize perioperative patient safety
c. BCLS instructor and weekend Emergency Medical Technician (EMT) transport issues. The majority of nurses placed the highest priority and heightened awareness on preventing which patient safety risk?
d. Patient safety champion and nurses’ union representative
a. Surgical fires
ANS: A b. Wrong-site/procedure/patient surgery
Achieving certification (CNOR), pursuing lifelong learning, and maintaining competency and current knowledge in perioperative c. Retained surgical items
nursing are the hallmarks of the professional. d. Medication errors
ANS: B
17. Performance improvement activities in the perioperative practice setting are designed to promote:
The majority of nurses considered preventing wrong-site, procedure, or patient surgery (69%) and preventing retained surgical
a. cost savings by eliminating fines for near-misses and never events.
items (61%) to be high-priority safety issues in need of heightened attention.
b. customer satisfaction and loyalty.
c. time measurement activities. 24. Malley and colleagues (2015) conducted a focus group survey to identify nursing’s contributions to transitions in care in the
d. efficient, effective, and ethical quality care. perioperative environment. The study suggests the preoperative assessment:
ANS: D a. serves as not just as a clearance for surgery, but also for managing the transitions
Performance improvement efforts encompass improvements in quality and effectiveness, based on ethical and economic of patient care throughout the perioperative experience.
perspectives. A performance measurement and improvement approach facilitates the delivery of safe, high-quality perioperative b. significantly impacted circulator nurse performance due to increased knowledge
patient care. of the patient.
c. primarily identifies risk factors impacting the intraoperative period.
18. Perioperative nursing diagnoses and interventions are directed toward, and guided by, the tremendous risks for harm to the patient d. has little application for intraoperative to postoperative transitions.
inherent in surgery and interventional procedures; therefore, nursing actions can generally be categorized as:
ANS: A
a. therapeutic/restorative.
Malley concluded that the nurse’s role in the preoperative assessment during the transition of preoperative care is that of advocate
b. preventive/protective.
who identifies the patient’s needs and risk factors that may be affected by the surgical experience. This study suggests that the
c. caring/comforting.
nursing preoperative assessment can be useful in identifying and defining patients’ risk factors not just for surgery, but for the
d. advocating/justifying.
entire perioperative care trajectory. The study did not include intraoperative staff.
ANS: B
In contrast to some nursing specialties in which nursing diagnoses are derived from signs and symptoms of a condition, much of 25. Ensuring a rapid recovery from anesthesia and discharging the patient when it is safe to so is one goal of ambulatory surgery.
perioperative nursing care is preventive in nature, based on knowledge of inherent risks to patients undergoing surgical and Factors that may contribute to a delayed discharge include:
invasive procedures. Perioperative nurses identify these risks and potential problems in advance and direct nursing interventions a. prompt administration of opiates for pain relief.
toward prevention of undesirable outcomes, such as injury and infection. Much of the work of perioperative nursing involves b. early postoperative oral intake.
patient safety, protecting patients from risks related to the procedure, positioning, equipment, and the environment. c. use of a forced air–warming blanket.
d. administration of a preoperative fluid bolus.
ANS: A
Enhanced recovery after surgery (ERAS) protocols include avoidance of opiated for pain management, prevention of hypothermia,
early oral intake and replacement of any intraoperative vascular volume loss.
3 4
, COMPLETE TEST BANK FOR ALEXANDER'S CARE OF THE PATIENT IN SURGERY 16TH EDITION ROTHROCK COMPLETE TEST BANK FOR ALEXANDER'S CARE OF THE PATIENT IN SURGERY 16TH EDITION ROTHROCK
Chapter 02: Patient Safety and Risk Management
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition 4. A patient was positioned, prepped, and draped following general endotracheal anesthesia
induction. The team assembled to perform the time-out as described in the WHO surgical
checklist. Successful employment of the time-out can only be ensured when:
MULTIPLE CHOICE a. the time-out is initiated by the surgeon.
b. each member of the team has an equal role and voice.
1. Governmental and professional agencies and organizations, whether voluntary or involuntary, c. perioperative services have a physician champion and surgeon buy-in.
have a significant influence on patient safety policies in the healthcare setting. Select the d. the checklist is committed to memory by all team members.
agency or organization statement that presents a true reflection of its focus or purpose.
a. The Joint Commission (TJC): Nonvoluntary bureau that tests healthcare ANS: B
All members of the team must introduce themselves by name and role and participate in
institutions against evidence-based elements of performance
b. Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics
sharing critical elements of care. The team includes the surgeon, anesthesia provider, and
c. American Society of Anesthesiologists (ASA): Professional organization of
nursing staff, plus any allied or ancillary care providers contributing to the procedure when
the time-out is performed.
anesthesia providers and technologists
d. World Health Organization (WHO): United Nations (UN)–based and supported
5. When unexpected events occur that have, or could have, compromised patient safety, a
authority on health throughout most of the world systematic investigatory process takes place. Significant information is gained through this
ANS: D meticulous exploration. The primary motive for carrying out a root cause analysis is to:
The UN created WHO to function as its health oversight and coordination authority for all UN a. establish cause and trends based on who was involved.
N U R S Y T E S T S . C O M
N U R S Y T E S T S . C O M
member nations who in turn have joined WHO. In 2004, WHO launched the World Alliance b. determine precisely what happened and why.
on Patient Safety, by which it began to examine patient safety in acute as well as in primary c. find out what needs to take place to prevent a recurrence of the event.
care settings relevant to all WHO member nations. WHO was created by and functions within d. uncover factors that contributed to the environment and the event.
the UN as the directing and coordinating authority for health throughout UN member nations.
ANS: C
Root cause analysis is a systematized process to identify variations in performance that cause,
2. Since its organization and establishment as a professional nursing association in the early
or could cause, a sentinel event. The analysis phase of root cause analysis progresses from
1950s, the Association of periOperative Registered Nurses (AORN) continues its endeavor to:
“why” questions to “what can be done to prevent this” questions that flow and ultimately
a. promote guidelines influenNcU inRg S
paYtiTeE
ntSsT
afS
et.
y.COM
b. create professional operating room (OR) nursing care delivery models. result in an action plan. Root cNaU
usReSanYaT
lyEsiSs T
coSn.ceCnOtrM
ates on systems and processes, not
c. interpret healthcare statistics critical to perioperative nursing care. individuals.
d. ensure risk reduction strategies are the foundation of perioperative education.
6. The Joint Commission (TJC) designates sentinel events as unexpected occurrences involving
ANS: A death or risk of serious physical or psychologic injury. In 2003, TJC mandated the Universal
AORN provides an array of standards, recommended practices (RPs), guidelines, Protocol to address perioperative sentinel events. This protocol includes:
publications, videos, and tool kits that specifically address patient safety from the a. improving the safety of using medications.
perioperative team’s point of view. b. reporting critical results of tests in a timely manner.
c. performing a preprocedure verification process.
3. A healthy 32-year-old nursing student is scheduled for excision of a left-sided subglottal cyst d. establishing alarm system safety as a priority.
with frozen section and possible radical neck dissection. The preoperative verification process
ANS: C
provides the opportunity to collect and verify information about the patient to ensure patient
safety. Among the patient data that must be verified are: Preprocedure verification process ensures that all relevant documents (e.g., the history and
a. emergency contact name. physical examination, surgical consent, required laboratory studies) and imaging studies
b. laboratory and imaging results. (properly labeled and displayed) are available before the start of the procedure. Preprocedure
c. advance directive on file. verification is best conducted when the patient and/or guardian can be involved and should be
d. immunization records. complete before the patient leaves the preprocedure area. The surgical team must agree that
this is the correct patient and the planned procedure on the specified side and site. The
ANS: B preprocedure verification process also includes confirming availability of necessary
Preprocedure verification process ensures that all relevant documents (e.g., the history and equipment, implants and prostheses, which is reconfirmed during the time-out.
physical examination, surgical consent, required laboratory studies) and imaging studies
(properly labeled and displayed) are available before the start of the procedure. Preprocedure
verification is best conducted when the patient can be involved and should be completed
before the patient leaves the preprocedure area.
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TEST BANK FOR ALEXANDERS CARE OF THE
Unit 1: Foundations for Practice
PATIENT IN SURGERY 16TH EDITION BY 1. Concepts Basic to Perioperative Nursing
2. Patient Safety and Risk Management
ROTHROCK ISBN10: 0323479146 ISBN13: 3. Workplace Issues and Staff Safety
4. Infection Prevention and Control
9780323479141 5. Anesthesia
6. Positioning the Patient for Surgery
7. Sutures, Sharps, and Instruments
8. Surgical Modalities
9. Wound Healing, Dressings, and Drains
10. Postoperative Patient Care and Pain Management
Unit 2: Surgical Interventions
11. Gastrointestinal Surgery
12. Surgery of the Liver, Biliary Tract, Pancreas, and Spleen
13. Hernia Repair
14. Gynecologic and Obstetric Surgery
15. Genitourinary Surgery
16. Thyroid and Parathyroid Surgery
17. Breast Surgery
18. Ophthalmic Surgery
19. Otorhinolarygologic Surgery
20. Orthopedic Surgery
21. Neurosurgery
22. Reconstructive and Aesthetic Plastic Surgery
22. Thoracic Surgery
23. Vascular Surgery
24. Cardiac Surgery
Unit 3: Special Considerations
26. Pediatric Surgery
27. Geriatric Surgery 28. Trauma Surgery
29. Interventional and Image-Guided Procedures
30. Integrative Health Practices: Complementary and Alternative Therapies
,Chapter 01: Concepts Basic to Perioperative Nursing 7. Which of the following actions best describes an element of the perioperative nursing assessment?
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition a. Scanning the surgical schedule for the day before morning report.
b. Reading the pick/preference list attached to the case cart.
c. Reviewing the patient medical record.
MULTIPLE CHOICE d. Studying an on-line tutorial about the intended surgical procedure.
1. The Perioperative Patient Focused Model presents key components of nursing influence that guide patient care. Select the ANS: C
statement that best describes the dynamic relationship within the model. Assessment is the collection and analysis of relevant health data about the patient. Sources of data may be a preoperative interview
a. The patient experience and the nursing presence are in continuous interaction. with the patient and the patient’s family; review of the planned surgical or invasive procedure; review of the patient’s medical
b. Structure, process, and outcome are the foundation domains of the model.
record; examination of the results of diagnostic tests; and consultation with the surgeon and anesthesia provider, unit nurses, or
c. The perioperative nurse is the central dynamic core of the model.
other personnel.
d. The interrelated nursing process rings bind the patient to the model.
8. A frail 76-year-old diabetic woman is scheduled for major surgery. She is vulnerable and at high risk for harm because of several
ANS: A factors related to her preexisting conditions and overall health status. As part of developing a plan to guide her care, the nurse uses
The Perioperative Patient Focused Model consists of domains or areas of nursing concern: nursing diagnoses, nursing standardized descriptive terms. This step of the nursing process is called:
interventions, and patient outcomes. These domains are in continuous interaction with the health system that encircles the focus of a. nursing diagnosis.
perioperative nursing practice—the patient. b. nursing assessment.
c. nursing outcome.
2. The Association of PeriOperative Registered Nurses’ (AORN) Standards of Perioperative Nursing describes nursing interactions, d. nursing intervention.
interventions, and activities with patients. This is based on which standards category?
a. Evidence-based ANS: A
b. Process Nursing diagnosis is the process of identifying and classifying data collected in the assessment in a way that provides a focus to
c. Outcome plan nursing care. Nursing diagnosis components include a definition of the diagnostic term, defining characteristics and risk
d. Structural factors.
ANS: B 9. During the admission interview, the nurse initiated the discharge teaching and demonstrated crutch-walking activities. The teaching
Process standards relate to nursing activities, interventions, and interactions. They are used to explicate clinical, professional, and activities are what stage of the nursing process?
quality objectives in perioperative nursing. a. Assessment
b. Implementation
3. Which order best describes the process used to implement evidence-based professional nursing? c. Outcome identification
a. Literature search, theory review, data analysis, policy development d. Evaluation
b. Regional survey, literature search, meta-analysis, practice change
c. Identify problem, scientific evidence, develop policy, evaluate outcome ANS: B
d. Identify issue, analyze scientific evidence, implement change, evaluate process
Implementation is performing the nursing care activities and interventions that were planned and responding with critical thinking
and orderly action to changes in the surgical procedure, patient condition, or emergencies. Implementation is the “work” of nursing.
ANS: D
Evidence-based practice is a systematic, thorough process by which to identify an issue, to collect and evaluate the best evidence to 10. While conducting the preoperative interview with a patient scheduled for a septoplasty, the perioperative nurse learned that the
design and implement a practice change, and to evaluate the process. patient was latex sensitive. Based on this knowledge, the nurse reviewed the pick/preference list and reassembled the surgical case
cart setup to reflect this new information and change in care delivery. Which two phases of the nursing process are represented in
4. The ambulatory surgery unit is planning to develop a standardized skin preparation practice for their unit. The best process to the nurse’s actions?
gather scientific information is to: a. Assessment and planning
a. conduct a survey of skin prep policies at the next AORN chapter meeting. b. Assessment and implementation
b. review their surgical site infection data from the last 6 months. c. Planning and implementation
c. conduct a literature search on antimicrobial agents and infection prevention. d. Nursing diagnosis and intervention
d. review the scientific literature from the leading manufacturers of prep solutions.
ANS: C
ANS: C Planning is preparing in advance for what will or may happen and determining the priorities for care. Planning is based on patient
Perioperative nurses have an ethical responsibility to review practices and to modify them based on the best available scientific assessment results in knowing the patient and the patient’s unique needs. Implementation is performing the nursing care activities
evidence. Using research to guide practice is called evidence-based practice (EBP). and interventions that were planned and responding with critical thinking and orderly action. Implementation is the “work” of
nursing.
5. The cardiac team is developing a standardized sterile back table setup and is unable to find sufficient research evidence for their
project. Where might they look for information on best practices? 11. The perioperative nurse implements protective measures to prevent skin or tissue injury caused by thermal sources. Successful
a. Survey regional surgical technology programs for their back table models accomplishment of this intervention would meet which of the following desired nursing outcomes?
b. Review case studies and expert opinions on sterile back table setups a. The patient is free from signs and symptoms of injury from anxiety.
c. Review AORN’s Guidelines for Perioperative Practice on sterilization and b. The patient is free from signs and symptoms of impaired skin integrity.
disinfection c. The patient is free from signs and symptoms of surgical site infection.
d. Consult with facility instrument vendor representatives for their advice d. The patient is free from signs and symptoms of hyperthermia.
ANS: B ANS: B
When there is not enough evidence to guide practice, perioperative nurses should consider gathering information from varied Chemical and thermal sources used in surgery can cause skin and tissue burns (e.g., electrosurgery, povidine-iodine, radiation,
trusted sources that reflect best practices. lasers). The patient being free from signs and symptoms of chemical injury, radiation injury, and electrical injury are approved
NANDA International nursing diagnoses.
6. How do institutional standards of care, such as policies and procedures, differ from national standards, such as AORN’s Standards
of Perioperative Nursing? 12. The nursing diagnosis is derived from:
a. They are written by nurses. a. patient data retrieved from the nursing assessment.
b. They are written specifically to address responsibilities under specific b. synthesized clues from the admitting diagnosis and surgery schedule.
circumstances. c. the approved NANDA International list attached to the patient medical record.
c. They are collaborative and collective agreement statements. d. the admission form on the front of the chart.
d. They are rarely based on research.
ANS: A
ANS: B Nursing diagnosis is the process of identifying and classifying data collected in the assessment in a way that provides a focus to
Institutional standards apply to the system or facility that develops them and can be directive about specific actions in specific plan nursing care.
circumstances; national standards provide generalized authoritative statements that can be implemented in all settings.
1 2
,13. A 36-year-old woman was preoperatively admitted for laparoscopic cholecystectomy with operative cholangiogram. She was then 19. A registered nurse first assistant (RNFA) is considered an advanced practice nurse (APN) when he/she has achieved:
interviewed by her perioperative nurse in the preoperative intake lounge. The patient’s weight on admission was 245 lb. After the a. RNFA certification.
assessment, the nurse returned to the operating room (OR) and modified the standard plan of care by instituting risk reduction b. clinical performance ladder Level 4 or above.
strategies that were derived from information from the preoperative assessment. A good example of this action would best be c. graduate degree in nursing (MSN).
described by: d. facility practice privileges.
a. replacing the regular OR bed with a bariatric-specific OR bed.
ANS: C
b. providing protective lead aprons for all staff during the procedure.
APNs must have graduate nursing education (at least a master’s degree).
c. writing the patient’s name, allergies, and body weight on the whiteboard.
d. administering antibiotics to the patient 1 hour before the incision.
20. Emerging perioperative nursing roles are defined by the tremendous growth in science and technology combined with the
ANS: A increasing complexity of surgery and the interventional disciplines. An example of an emerging nursing role is:
Planning is preparing in advance for what will or may happen and determining the priorities for care. Planning based on patient a. sterile processing clinical specialist.
assessment results in knowing the patient and the patient’s unique needs so that alterations in events, such as positioning the patient b. general surgery service liaison.
on a bariatric-specific OR bed as opposed to a regular OR bed, can be readily accommodated. Replacing the OR bed with a larger c. weekend resource nurse.
OR bed is a nurse-sensitive preventive intervention that provides equipment based on patient need. d. informatics nurse specialist.
ANS: D
14. Adoption of an electronic medical record requires the use of consistent terminology. Empirically validated, standardized
Informatics is another specialty in which some perioperative nurses are focusing. Pressures for more efficient management of
perioperative nursing language may be found in the:
fiscal, material, and human resources have stimulated the development of electronic information systems for diverse functions in
a. Perioperative Patient Focused Model.
perioperative patient care settings.
b. Nursing Alliance for Quality Care (NAQC).
c. Perioperative Nursing Data Set (PNDS).
21. The relationship between the Perioperative Patient Focused Model and the PNDS is evidenced by their unique language and use of
d. Standards of Perioperative Nursing.
the nursing process to guide care. The most notable feature of their similarity is that the PNDS:
ANS: C a. promotes standardized perioperative documentation.
After 6 years of research and validation, the Perioperative Nursing Data Set (PNDS) was recognized as a specialty nursing b. fosters research on best practices.
language, providing a uniform and systematic method to document the basic elements of perioperative nursing care. c. begins with outcome statements.
d. promotes standardized perioperative documentation and begins with outcome
15. When delegating a task, such as removing an intravenous (IV) catheter, to an unlicensed individual, the perioperative nurse: statements.
a. retains responsibility for evaluating the outcome of the task.
ANS: C
b. must comply with the seven “rights” of delegation.
Similar to the Perioperative Patient Focused Model, the PNDS begins with patient outcomes. Each outcome is defined and
c. transfers the authority to perform the related assessments.
interpreted and presents criteria by which to measure outcome achievement.
d. transfers the supervision of the competent person to another competent person.
ANS: C 22. In a research study by Kleiner and colleagues (2014), use of crew resource management (CRM) principles was a practical and
Delegation transfers to a competent person the authority to perform a selected nursing task in a selected situation according to the effective means to:
“five rights” of delegation. When delegating care activities, perioperative nurses retain accountability for analyzing and evaluating a. identify potential surgical defects in the OR.
the outcomes of delegated tasks. b. monitor central processing productivity.
c. promote teamwork.
16. A hospital nursing excellence center for education developed standards for nursing advancement that would reflect high-level d. improve the quality of OR briefings and debriefings.
achievement of professional performance. They developed a clinical advancement ladder based on the leading skill and knowledge
ANS: D
acquisition model and established worthy criteria for each level. Select the response that might best describe the highest level of
Kleiner and colleagues (2014) found while there was no difference in the frequency of briefings and debriefings observed in this
achievement for a perioperative staff nurse.
study, there were significant differences in the quality of the communication observed. Coaching appeared to be an effective
a. Certified nurse, OR (CNOR) credential, BSN, and chair of the nursing research
intervention, improving the quality of communication among team members.
committee
b. Published article in the hospital newsletter and 15 years’ service pin 23. In a research study by Steelman and colleagues (2013), perioperative nurses were surveyed to prioritize perioperative patient safety
c. BCLS instructor and weekend Emergency Medical Technician (EMT) transport issues. The majority of nurses placed the highest priority and heightened awareness on preventing which patient safety risk?
d. Patient safety champion and nurses’ union representative
a. Surgical fires
ANS: A b. Wrong-site/procedure/patient surgery
Achieving certification (CNOR), pursuing lifelong learning, and maintaining competency and current knowledge in perioperative c. Retained surgical items
nursing are the hallmarks of the professional. d. Medication errors
ANS: B
17. Performance improvement activities in the perioperative practice setting are designed to promote:
The majority of nurses considered preventing wrong-site, procedure, or patient surgery (69%) and preventing retained surgical
a. cost savings by eliminating fines for near-misses and never events.
items (61%) to be high-priority safety issues in need of heightened attention.
b. customer satisfaction and loyalty.
c. time measurement activities. 24. Malley and colleagues (2015) conducted a focus group survey to identify nursing’s contributions to transitions in care in the
d. efficient, effective, and ethical quality care. perioperative environment. The study suggests the preoperative assessment:
ANS: D a. serves as not just as a clearance for surgery, but also for managing the transitions
Performance improvement efforts encompass improvements in quality and effectiveness, based on ethical and economic of patient care throughout the perioperative experience.
perspectives. A performance measurement and improvement approach facilitates the delivery of safe, high-quality perioperative b. significantly impacted circulator nurse performance due to increased knowledge
patient care. of the patient.
c. primarily identifies risk factors impacting the intraoperative period.
18. Perioperative nursing diagnoses and interventions are directed toward, and guided by, the tremendous risks for harm to the patient d. has little application for intraoperative to postoperative transitions.
inherent in surgery and interventional procedures; therefore, nursing actions can generally be categorized as:
ANS: A
a. therapeutic/restorative.
Malley concluded that the nurse’s role in the preoperative assessment during the transition of preoperative care is that of advocate
b. preventive/protective.
who identifies the patient’s needs and risk factors that may be affected by the surgical experience. This study suggests that the
c. caring/comforting.
nursing preoperative assessment can be useful in identifying and defining patients’ risk factors not just for surgery, but for the
d. advocating/justifying.
entire perioperative care trajectory. The study did not include intraoperative staff.
ANS: B
In contrast to some nursing specialties in which nursing diagnoses are derived from signs and symptoms of a condition, much of 25. Ensuring a rapid recovery from anesthesia and discharging the patient when it is safe to so is one goal of ambulatory surgery.
perioperative nursing care is preventive in nature, based on knowledge of inherent risks to patients undergoing surgical and Factors that may contribute to a delayed discharge include:
invasive procedures. Perioperative nurses identify these risks and potential problems in advance and direct nursing interventions a. prompt administration of opiates for pain relief.
toward prevention of undesirable outcomes, such as injury and infection. Much of the work of perioperative nursing involves b. early postoperative oral intake.
patient safety, protecting patients from risks related to the procedure, positioning, equipment, and the environment. c. use of a forced air–warming blanket.
d. administration of a preoperative fluid bolus.
ANS: A
Enhanced recovery after surgery (ERAS) protocols include avoidance of opiated for pain management, prevention of hypothermia,
early oral intake and replacement of any intraoperative vascular volume loss.
3 4
, COMPLETE TEST BANK FOR ALEXANDER'S CARE OF THE PATIENT IN SURGERY 16TH EDITION ROTHROCK COMPLETE TEST BANK FOR ALEXANDER'S CARE OF THE PATIENT IN SURGERY 16TH EDITION ROTHROCK
Chapter 02: Patient Safety and Risk Management
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition 4. A patient was positioned, prepped, and draped following general endotracheal anesthesia
induction. The team assembled to perform the time-out as described in the WHO surgical
checklist. Successful employment of the time-out can only be ensured when:
MULTIPLE CHOICE a. the time-out is initiated by the surgeon.
b. each member of the team has an equal role and voice.
1. Governmental and professional agencies and organizations, whether voluntary or involuntary, c. perioperative services have a physician champion and surgeon buy-in.
have a significant influence on patient safety policies in the healthcare setting. Select the d. the checklist is committed to memory by all team members.
agency or organization statement that presents a true reflection of its focus or purpose.
a. The Joint Commission (TJC): Nonvoluntary bureau that tests healthcare ANS: B
All members of the team must introduce themselves by name and role and participate in
institutions against evidence-based elements of performance
b. Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics
sharing critical elements of care. The team includes the surgeon, anesthesia provider, and
c. American Society of Anesthesiologists (ASA): Professional organization of
nursing staff, plus any allied or ancillary care providers contributing to the procedure when
the time-out is performed.
anesthesia providers and technologists
d. World Health Organization (WHO): United Nations (UN)–based and supported
5. When unexpected events occur that have, or could have, compromised patient safety, a
authority on health throughout most of the world systematic investigatory process takes place. Significant information is gained through this
ANS: D meticulous exploration. The primary motive for carrying out a root cause analysis is to:
The UN created WHO to function as its health oversight and coordination authority for all UN a. establish cause and trends based on who was involved.
N U R S Y T E S T S . C O M
N U R S Y T E S T S . C O M
member nations who in turn have joined WHO. In 2004, WHO launched the World Alliance b. determine precisely what happened and why.
on Patient Safety, by which it began to examine patient safety in acute as well as in primary c. find out what needs to take place to prevent a recurrence of the event.
care settings relevant to all WHO member nations. WHO was created by and functions within d. uncover factors that contributed to the environment and the event.
the UN as the directing and coordinating authority for health throughout UN member nations.
ANS: C
Root cause analysis is a systematized process to identify variations in performance that cause,
2. Since its organization and establishment as a professional nursing association in the early
or could cause, a sentinel event. The analysis phase of root cause analysis progresses from
1950s, the Association of periOperative Registered Nurses (AORN) continues its endeavor to:
“why” questions to “what can be done to prevent this” questions that flow and ultimately
a. promote guidelines influenNcU inRg S
paYtiTeE
ntSsT
afS
et.
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b. create professional operating room (OR) nursing care delivery models. result in an action plan. Root cNaU
usReSanYaT
lyEsiSs T
coSn.ceCnOtrM
ates on systems and processes, not
c. interpret healthcare statistics critical to perioperative nursing care. individuals.
d. ensure risk reduction strategies are the foundation of perioperative education.
6. The Joint Commission (TJC) designates sentinel events as unexpected occurrences involving
ANS: A death or risk of serious physical or psychologic injury. In 2003, TJC mandated the Universal
AORN provides an array of standards, recommended practices (RPs), guidelines, Protocol to address perioperative sentinel events. This protocol includes:
publications, videos, and tool kits that specifically address patient safety from the a. improving the safety of using medications.
perioperative team’s point of view. b. reporting critical results of tests in a timely manner.
c. performing a preprocedure verification process.
3. A healthy 32-year-old nursing student is scheduled for excision of a left-sided subglottal cyst d. establishing alarm system safety as a priority.
with frozen section and possible radical neck dissection. The preoperative verification process
ANS: C
provides the opportunity to collect and verify information about the patient to ensure patient
safety. Among the patient data that must be verified are: Preprocedure verification process ensures that all relevant documents (e.g., the history and
a. emergency contact name. physical examination, surgical consent, required laboratory studies) and imaging studies
b. laboratory and imaging results. (properly labeled and displayed) are available before the start of the procedure. Preprocedure
c. advance directive on file. verification is best conducted when the patient and/or guardian can be involved and should be
d. immunization records. complete before the patient leaves the preprocedure area. The surgical team must agree that
this is the correct patient and the planned procedure on the specified side and site. The
ANS: B preprocedure verification process also includes confirming availability of necessary
Preprocedure verification process ensures that all relevant documents (e.g., the history and equipment, implants and prostheses, which is reconfirmed during the time-out.
physical examination, surgical consent, required laboratory studies) and imaging studies
(properly labeled and displayed) are available before the start of the procedure. Preprocedure
verification is best conducted when the patient can be involved and should be completed
before the patient leaves the preprocedure area.
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