Test Bank For Alexander's Care of the Patient in Surgery 16 Th Edition By Jane Rothrock

Chapter 03: Workplace Issues and Staff Safety Test Bank MULTIPLE CHOICE 1. What one factor describes the high incidence of musculoskeletal disorders (MSDs) among surgical technologists and perioperative nurses? a. Pulling a large, heavy piece of equipment rather than pushing it b. The cumulative effect of repeated patient handling events c. The growing high obesity rate and heavier patients and care providers d. The cumulative effect of pushing, pulling, and carrying heavy instrument sets and rolling carts ANS: B The high incidence of MSDs among nurses is the cumulative effect of repeated patient handling events, often involving unsafe loads. Nurses and surgical technologists often lift, transfer, or reposition patients on OR beds and transport vehicles, and assist with prepping with their arms outstretched or their bodies bent forward in awkward postures and positions, increasing the risk for injury. REF: p. 47 2. The lifting equation provides a mathematical equation to determine the recommended weight limit (RWL) and lifting index (LI) for selected two-handed manual lifting tasks. What is the recommended maximum weight limit for one person in a patient handling task, and what is the best option when the weight limit exceeds the recommendation? a. 25 lb; bend from the knees, not the waist b. 32 lb; use good body mechanics c. 35 lb; wear a support belt d. 37 lb; use assistive lift devices ANS: D The concept behind the lifting equation is to start with a recommended weight that is considered safe for an ideal lift and then to reduce the weight as the task becomes more stressful. In general, the revised equation yields a recommended 35-lb maximum weight limit for use in patient handling tasks. When the weight to be lifted exceeds this limit, assistive devices should be used. REF: pp. 49-50 3. Wet floors are a common hazard causing slips, trips, and falls (STFs). Select a prevention strategy that is a best practice for preventing STFs from spills on wet floors. a. Transport liquids in covered containers with lids in place. b. Place bright yellow low-profile pop-up signs in areas where STFs are most likely to occur. c. Position highly visible yellow absorptive pads in areas where STFs are most likely to occur. d. Use a dripless, brush-free gel solution for surgical patient skin preps. ANS: A Planning to avoid wet spots can reduce the rate of falls. Providing lids for all cups or other open containers being transported helps to avoid spills. REF: p. 50 4. An STF hazard is present when the scrub person stands on a lift, or foot stool, to reach an acceptable height for ergonomic comfort with the sterile field. Whether the scrub person uses one stool, stacked stools, or a “runway” of stools, the danger exists that a fall could occur. What classification of cause and prevention factor does this situation represent? a. Proper footwear b. Unobstructed pathways c. Uneven floor surface d. Lighting ANS: C Falls on the same level also occur at transition areas, such as from dry to wet, on uneven surfaces, or from one type of floor surface to another. Healthcare facilities should ensure that there are no uneven surfaces, including thresholds, on floors. In stairwells with potentially low visibility, the nosing on the top and bottom steps can be painted to provide visual cues. REF: p. 50 5. A sharps-safe area on the sterile field between the scrub person and the surgeon—where sharps can be transferred to the surgeon from the scrub person and returned to the scrub person after use—is referred to as the: a. sharps zone. b. hands-free zone. c. neutral zone. d. safety zone. ANS: C The “neutral zone” has been defined as a location on the surgical field where sharps are placed in a predesignated sterile basin or tray or on a magnetic pad, from which the surgeon or assistant can retrieve them. After use, the items are returned to the neutral zone, and the scrub person retrieves them. This technique eliminates hand-to-hand passing of sharps between the surgeon and the scrub person, so that no two individuals touch the same sharp at the same time. REF: p. 52 6. Select the appropriate nursing action that supports hands-free instrument passing and sharps safety. a. Create a neutral hands-free area between the scrub person and surgeon with a basin or magnetic mat. b. Use a hands-free area for sharps and all small clamps or sponges. c. Announce the transfer of the sharp or clamp as soon as possible after it is placed. d. During the hand-off report, ask the relief scrub person if he/she will want to use the hands-free technique for passing sharps. ANS: A A magnetic pad or basin may be used to create the neutral zone; if a basin is used, it should be placed on the field and not held by the scrub person. Dedicate the neutral zone to sharps only; these include suture and hypodermic needles, scalpels, and other sharp instruments. Place only one sharp at a time in the neutral zone. Announce the transfer of a sharp before placing it in the neutral zone (such as “knife down”). Include identification of the neutral zone during hand-off communications to relief scrub persons. REF: p. 52 7. Select the true statement that best explains the Occupational Safety and Health Administration (OSHA) exposure control plan (ECP). a. OSHA has developed the Hierarchy of Controls model, which protects the workplace from lawsuits stemming from worker injury from sharps and blood exposure. b. The OSHA ECP is similar to the Health Insurance Portability and Accountability Act (HIPAA) in that it protects the workplace from being exposed when a worker injury occurs that could harm the facility’s reputation. c. The OSHA ECP is designed to provide guidelines to control risks and protect workers from sharps injury and bloodborne pathogens. d. The OSHA ECP is a materials management strategy to explore replacements for sharps and other healthcare devices that can cause sharps injury and blood exposure. ANS: C OSHA regulations require healthcare organizations to protect their workers and to have a sharps injury and bloodborne pathogen ECP. At a minimum, the following must be included in the ECP: determination of employee exposure; implementation of exposure control methods, including universal precautions, engineering and work-practice controls, personal protective equipment (PPE) and housekeeping, hepatitis B vaccination, postexposure evaluation and follow-up, communication of hazards to employees and training, recordkeeping, and procedures to evaluate exposure incidents. REF: pp. 54-55 8. Select the true statement that best describes a key component of the culture of safety in regards to blood exposure. a. A goal of the culture of safety is to reduce the risk of blood exposure and sharps injuries to staff. b. The culture of safety is a model for ensuring The Joint Commission survey expectations are met. c. The culture of safety is mandated by regulatory agencies to structure environmental rounds. d. The ECP was designed to provide the framework for the culture of safety. ANS: A A healthcare institution’s culture of safety profoundly impacts its success or failure in reducing employees’ blood exposure risk. For sharps safety in particular, success factors include effective systematic review of exposure data, workers’ perceptions of exposure risk, availability and use of safety devices, and comprehensive education on bloodborne pathogen exposure risk and safety device use. REF: p. 55 9. Select the guideline that complements the design of the culture of safety model. a. Take advantage of a personal injury event to learn about future prevention strategies. b. Comply with those policies that fit your current practice. c. Incorporate safe practices into your daily work when handling sharps. d. Observe local, state, and federal regulations as they fit your current practice. ANS: C You can take significant measures toward ensuring your personal safety and avoiding injuries from sharps if you do the following: Adopt and incorporate safe habits into daily work activities when preparing and using sharp devices. Observe local, state, and federal (OSHA) regulations. Comply with methods to protect yourself from disease transmission (e.g., get the hepatitis B vaccination). Participate in education about bloodborne pathogens, and follow recommended infection prevention practices. Know the location in your department of the ECP. Finally, follow the exposure control policy if injured, including immediate reporting of the incident and commencement of exposure response procedures. REF: pp. 55, 61 10. What is the purpose of a Safety Data Sheet (SDS)? a. To recommend exposure limits of all chemicals in the workplace over a working lifetime b. To inform all employees of the presence, characteristics, handling, and risks of chemicals in the workplace c. To provide a structured design for inservices and skill stations on hazardous chemical safety d. To promote the development of manuals and log books for The Joint Commission (TJC) survey ANS: B The purpose of the OSHA standards is to ensure that all hazards of chemicals produced or imported are evaluated and that information concerning hazards is transmitted to employers and employees. Responsibility to inform workers about chemical hazards and to use control measures, including providing PPE, rests with the employer. The OSHA hazard communication standard requires all manufacturers and importers of hazardous chemicals to develop SDSs for all chemicals and mixtures of chemicals. REF: p. 62 11. Where are the sources of radiation exposure in an operating room setting? a. Ionizing sources (e.g., ultrasound machines) and nonionizing sources (e.g., magnetic resonance imaging [MRI] scanners) b. Nonattenuated fluorescent lights and portable X-ray machines without lead guards c. Radioactive seed implants not contained in a lead container and nonionizing lasers d. Nonionizing sources (e.g., lasers) and ionizing sources (e.g., X-ray machines and C-arms) ANS: D Sources of radiation exposure in the OR include ionizing sources, such as portable radiography (X-ray) machines and portable fluoroscopy units (C-arm), and nonionizing sources, such as lasers. REF: p. 63 12. Which of the following may be a consequence of high-dose or full-body radiation? a. Contrast media reaction b. Perioral numbness and tingling c. Nausea, vomiting, and diarrhea d. Wheezing, dyspnea, and tachycardia ANS: C Acute exposure to ionizing radiation can result in dermatitis and reddening of the skin (erythema) at the point of exposure, while large, full-body exposures can lead to radiation poisoning, symptoms of which may include nausea, vomiting, diarrhea, weakness, and death. REF: p. 63 13. Latex allergy develops from exposure to natural rubber latex and plant cytosol, used extensively to manufacture medical gloves and other devices, as well as numerous consumer products. Allergic reactions to latex range from skin disease to asthma and anaphylaxis that can result in chronic illness, disability, career loss, hardship, and death. Which signs and symptoms would be indicative of an allergic contact dermatitis response to contact with natural rubber latex? a. Pruritus, edema, erythema, and vesicles that develop 6 to 48 hours after exposure b. Dry, reddened, itchy skin with hives and peeling patches c. Cracked hands, nausea, vomiting, and perioral numbness and tingling d. Generalized urticaria, wheezing, dyspnea, and tachycardia ANS: A Allergic contact dermatitis is a delayed reaction, usually appearing 6 to 48 hours after exposure. Symptoms are similar to those from irritant contact dermatitis (i.e., drying papules, crusting and thickening of the skin), except that the reaction may extend beyond the actual point of contact. Allergic contact dermatitis (also called chemical contact dermatitis) is a delayed cell-mediated type IV localized allergy caused by chemicals used to manufacture rubber products. REF: p. 64 14. A nurse anesthesia provider has an allergy to latex. When she is at work, she always carries an epinephrine autoinjector and a beta-agonist inhaler. What type of latex allergy does she have? a. Allergic contact dermatitis b. Irritant contact dermatitis c. Type I IgE-mediated hypersensitivity reaction d. Combined-effect latex allergy ANS: C A true latex allergy is a type I IgE-mediated hypersensitivity reaction that involves systemic antibody formation to proteins in products made from natural rubber latex. The allergic response is immediate and anaphylactic. Medications include epinephrine for reaction (may be autoinjector and carried by individual), beta-agonist inhaler, prednisone, and other anaphylactic life-supporting medications. REF: pp. 64-65 15. Healthcare professionals should employ strategies to reduce their risk of allergic reaction to latex in the perioperative environment. Which of the following represents a best practice for minimizing the risk of latex allergy development in nonallergic patients and the risk of a reaction in sensitive or allergic patients? a. Use powder-free gloves that have low levels of protein and chemical allergens. b. Use sterile oil-based hand creams before donning gloves if latex gloves must be worn. c. Before donning latex gloves, sprinkle hands with cornstarch to create a barrier between skin and gloves. d. Wear an OR hat without an elastic band and do not wear rubber tennis shoes. ANS: A Use powder-free gloves that are low in protein and chemical allergens. Use nonlatex gloves for activities that are not likely to involve contact with infectious materials. REF: p. 65 16. Which list of medications best reflects medications indicated for latex sensitivity therapeutic management? a. Epinephrine, prednisone, and a beta-agonist inhaler b. Atropine, dopamine, and beta-blockers c. Dopamine, mannitol, and sodium bicarbonate d. Dimethylxanthine, atropine, and mannitol ANS: A Medications used during a reaction include epinephrine (may be autoinjector and carried by individual), beta-agonist inhaler, prednisone, and other anaphylactic life-supporting medications. REF: p. 66 17. Perioperative personnel historically have relied on numerous types of precautions to protect themselves and others from bloodborne pathogens and other infectious diseases. Select the statement that best differentiates between universal and standard precautions. a. Universal precautions and standard precautions are the same; however, standard precautions require more hand hygiene and prevention of sharps injuries. b. Many similarities and differences exist between universal and standard precautions; however, they both are equally effective against transmission-based disease. c. Standard precautions apply to blood; all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood; mucous membranes; and nonintact skin. d. Universal precautions is the same as blood and body fluid precautions. ANS: C Standard precautions apply to (1) blood; (2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood; (3) mucous membranes; and (4) nonintact skin. REF: p. 62 18. Contact with infected patients or infectious material places healthcare workers at risk for occupational-acquired infection. Which communicable disease are healthcare workers at risk for acquiring or transmitting? a. Mumps b. Varicella c. Seasonal influenza d. Hepatitis C ANS: C Patients transmit influenza to healthcare workers and, in turn, healthcare workers who are clinically or subclinically infected with influenza can transmit seasonal influenza to patients or others. Studies demonstrate seasonal influenza antibodies in healthcare workers who did not recall ever having a respiratory tract infection. By receiving the seasonal influenza vaccination, healthcare workers protect themselves, their patients, and their families. REF: p. 63 19. What vaccine should healthcare workers receive if they are caring for immunocompromised patients? a. Live attenuated influenza vaccine (LAIV) b. Inactivated influenza vaccine c. Immunoglobulin d. Bordetella vaccine ANS: B Inactivated influenza vaccine and live attenuated influenza vaccine (LAIV) are widely available for workers in the healthcare professions. LAIV is approved only for nonpregnant healthy persons, ages 5 to 49 years. Healthcare workers caring for severely immunocompromised patients should not receive LAIV. Instead, the inactivated influenza vaccine is the preferred vaccine for workers who come into direct contact with this group of patients. Bordetella is a gram-negative coccobacilli of the phylum Proteobacteria and the most common cause of tracheobronchitis (kennel cough) in dogs. REF: p. 63 20. Waste anesthetic gases are small amounts of gases that may leak either from the patient’s anesthetic breathing circuit into the OR air while anesthesia is being administered or from exhalation of the patient during recovery. Both mechanisms of exposure create risks for OR personnel. What is an effect of short-term exposure for the healthcare worker? a. Spontaneous abortion b. Infertility c. Cancer d. Lethargy and fatigue ANS: D Short-term exposure causes lethargy and fatigue. Long-term exposure may be linked to spontaneous abortion, congenital abnormalities, infertility, premature births, cancer, and renal and hepatic disease. Today, perioperative staff members are exposed to trace amounts of waste anesthetic gas, and although this exposure cannot be eliminated, it can be controlled. REF: p. 61 21. If a staff person receives a needlestick injury, what is the first corrective action? a. Immediately report to employee health, the emergency department (ED), or the designated facility. b. Wash wound with soap and water; flush mucous membranes. c. Alert the supervisor of the injury. d. Undergo immediate testing; ensure confidentiality for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections. ANS: B If a needlestick or other occupational contact (e.g., splashing or spraying) that could result in a bloodborne pathogen exposure does occur, the injured person should wash with soap and water all wounds and skin sites that have been contacted by blood or body fluids. Procedures following include alerting the supervisor and initiating the injury reporting system used in the workplace; identifying the source patient; testing the patient for HIV, HBV, and HCV infections; immediately reporting to employee health, the ED, or the designated facility; and documenting the exposure in detail, for your own records as well as for the employer and for workers’ compensation purposes. REF: p. 55 22. A neutral zone is a predetermined location on the surgical field where sharps are placed for retrieval by the surgeon. Which of the following is a best practice for the use of the neutral zone? a. Place all sharps that will be used during surgery in the neutral zone before the start of the procedure. b. When a sterile basin is designated as the neutral zone, have the scrub person hold the basin. c. Announce the transfer of each sharp before placing it in the neutral zone. d. Use the neutral zone for non-sharp instruments when it is the most convenient location. ANS: C Guidelines for the best use of the neutral zone include the following: only one sharp at a time should be placed in the zone; if a sterile basin is used, it should be placed on the field and not held by the scrub person; transfers should be announced before a sharp is placed in the zone; the neutral zone should be dedicated to sharps only. REF: p. 53 23. The Hierarchy of Controls model defines a method to control exposure to occupational hazards as a fundamental approach to protect workers. Which control measure is of the highest priority of those listed? a. Engineering controls b. Substitution c. Elimination d. PPE ANS: C Elimination is the highest priority. After elimination in the hierarchy comes substitution, then engineering control, administrative controls, and finally PPE. The concept of the hierarchy is that the control methods at the top of the list are potentially more effective and protective than those at the bottom. REF: p. 55 24. A new graduate perioperative nurse was consistently verbally criticized and teased by her preceptor. The ensuing stress caused her to make mistakes and contributed to lost time from work. She was experiencing: a. unlawful discrimination. b. physical violence. c. horizontal violence. d. psychological demise. ANS: C Horizontal (or lateral) violence occurs when nurses inflict psychologic injury on one another. While patients are the main perpetrators of physical violence, staff members are the main perpetrators of psychological violence. REF: p. 65 MULTIPLE RESPONSE 1. Exposure to bloodborne pathogens occurs during all phases of the perioperative process. Observing safety precautions during all phases of surgery, from setup to cleanup, reduces the number of injuries and exposures for all OR personnel. For the prevention of sharps injuries in the preprocedure and postprocedure phases, which safe handling practices reflect appropriate nursing actions? (Select all that apply) a. Use standardized sterile field setups throughout the surgical services department. b. Organize the Mayo stand with all sharps visible and pointed toward the setup person. c. Transport reusable sharps in a safe, closed container to the decontamination cleanup area. d. Safely grasp the sharp tip with gloved fingers when disposing in sharps container. e. Do not place hands or fingers into a container to dispose of a device. f. Inspect the sharps container for overfilling before discarding disposable sharps in it. ANS: A, C, E, F During preparation for surgery, use standardized sterile field setups throughout the surgical services department. Organize the work area (Mayo stand, back table) so that sharps are always pointed away from the person setting up. During postprocedure cleanup, transport reusable sharps in a closed, secure container to the designated cleanup area. Inspect the surgical setup used during the procedure for sharps. Keep hands behind the sharp tip when disposing. Do not place hands or fingers into a container to dispose of a device. Inspect the sharps container for overfilling before discarding disposable sharps in it. REF: p. 52 Chapter 01: Concepts Basic to Perioperative Nursing Test Bank MULTIPLE CHOICE 1. The Perioperative Patient Focused Model presents key components of nursing influence that guide patient care. Select the statement that best describes the dynamic relationship within the model. a. The patient experience and the nursing presence are in continuous interaction. b. Structure, process, and outcome are the foundation domains of the model. c. The perioperative nurse is the central dynamic core of the model. d. The interrelated nursing process rings bind the patient to the model. ANS: A The Perioperative Patient Focused Model consists of domains or areas of nursing concern: nursing diagnoses, nursing interventions, and patient outcomes. These domains are in continuous interaction with the health system that encircles the focus of perioperative nursing practice—the patient. REF: p. 3 2. The Association of Perioperative Registered Nurses’ (AORN) Standards of Perioperative Nursing Practice that describes nursing interactions, interventions, and activities with patients falls under which standards category? a. Evidence-based b. Process c. Outcome d. Structural ANS: B Process standards relate to nursing activities, interventions, and interactions. They are used to explicate clinical, professional, and quality objectives in perioperative nursing. REF: p. 3 3. Which order best describes the process used to implement evidence-based professional nursing? a. Literature search, theory review, data analysis, policy development b. Regional survey, literature search, meta-analysis, practice change c. Identify problem, scientific evidence, develop policy, evaluate outcome d. Identify issue, analyze scientific evidence, implement change, evaluate process ANS: D Evidence-based practice is a systematic, thorough process by which to identify an issue, to collect and evaluate the best evidence to design and implement a practice change, and to evaluate the process. REF: p. 15 4. The ambulatory surgery unit is planning to develop a standardized skin preparation practice for their unit. The best process to gather scientific information is to: a. conduct a survey of skin prep policies at the next AORN chapter meeting. b. review their surgical site infection data from the last 6 months. c. conduct a literature search on antimicrobial agents and infection prevention. d. review the scientific literature from the leading manufacturers of prep solutions. ANS: C Perioperative nurses have an ethical responsibility to review practices and to modify them based upon the best available scientific evidence. Using research to guide practice is called evidence-based practice (EBP). REF: p. 10 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? a. Survey regional surgical technology programs for their back table models b. Review case studies and expert opinions on sterile back table setups c. Review AORN’s Standards and Recommended Practices on sterilization d. Consult with facility instrument vendor representatives for their advice ANS: B When there is not enough evidence to guide practice, perioperative nurses should consider gathering information from varied trusted sources that reflect best practices. REF: pp. 10-11 6. How do institutional standards of care, such as policies and procedures, differ from national standards, such as AORN’s Standards of Perioperative Nursing Practice? a. They are written by nurses. b. They are written specifically to address responsibilities and circumstances. c. They are collaborative and collective agreement statements. d. They are rarely based on research. ANS: B Institutional standards apply to the system or facility that develops them and can be directive about specific actions in specific circumstances; national standards provide generalized authoritative statements that can be implemented in all settings. REF: p. 10 7. Which of the following actions best describes an element of the perioperative nursing assessment? 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 d. Studying an on-line tutorial about the intended surgical procedure ANS: C Assessment is the collection and analysis of relevant health data about the patient. Sources of data may be a preoperative interview with the patient and the patient’s family; review of the planned surgical or invasive procedure; review of the patient’s medical record; examination of the results of diagnostic tests; and consultation with the surgeon and anesthesia provider, unit nurses, or other personnel. REF: p. 3 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 factors related to her preexisting conditions and overall health status. As part of developing a plan to guide her care, the nurse uses standardized descriptive terms. This step of the nursing process is called: a. nursing diagnosis. b. nursing assessment. c. nursing outcome. d. nursing intervention. ANS: A Nursing diagnosis is the process of identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care. REF: p. 5 9. During the admission interview, the nurse initiated the discharge teaching and demonstrated crutch-walking activities. The teaching activities are what stage of the nursing process? a. Nursing assessment b. Nursing implementation c. Nursing outcome preparation d. Nursing evaluation ANS: B 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. REF: p. 6 10. While conducting the preoperative interview with a patient scheduled for a septoplasty, the perioperative nurse learned that the 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 the nurse’s actions? a. Assessment and planning b. Assessment and implementation c. Planning and implementation d. Nursing diagnosis and intervention ANS: C Planning is preparing in advance for what will or may happen and determining the priorities for care. Planning is based on patient assessment results in knowing the patient and the patient’s unique needs. Implementation is performing the nursing care activities and interventions that were planned and responding with critical thinking and orderly action. Implementation is the “work” of nursing. REF: p. 6 11. The perioperative nurse implements protective measures to prevent skin or tissue injury caused by thermal sources. Successful accomplishment of this intervention would meet which of the following desired nursing outcomes? a. The patient is free from signs and symptoms of injury from anxiety. b. The patient is free from signs and symptoms of impaired skin integrity. c. The patient is free from signs and symptoms of surgical site infection. d. The patient is free from signs and symptoms of hyperthermia. ANS: B Chemical and thermal sources used in surgery can cause skin and tissue burns (e.g., electrosurgery, povidine-iodine, radiation, lasers). The patient being free from signs and symptoms of chemical injury, radiation injury, and electrical injury are approved NANDA- International nursing diagnoses. REF: p. 5 12. The nursing diagnosis is derived from: a. patient data retrieved from the nursing assessment. b. synthesized clues from the admitting diagnosis and surgery schedule. c. the approved NANDA-International list attached to the patient medical record. d. the admission form on the front of the chart. ANS: A Nursing diagnosis is the process of identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care. REF: p. 5 13. A 36-year-old woman was preoperatively admitted for laparoscopic cholecystectomy with operative cholangiogram. She was then interviewed by her perioperative nurse in the preoperative intake lounge. The patient’s weight on admission was 245 lb. After the assessment, the nurse returned to the operating room (OR) and modified the standard plan of care by instituting risk reduction strategies that were derived from information from the preoperative assessment. A good example of this action would best be described by: a. replacing the regular OR bed with a bariatric-specific OR bed. b. providing protective lead aprons for all staff during the procedure. c. writing the patient’s name, allergies, and body weight on the white board. d. administering antibiotics to the patient 1 hour before the incision. ANS: A Planning is preparing in advance for what will or may happen and determining the priorities for care. Planning based on patient assessment results in knowing the patient and the patient’s unique needs so that alterations in events, such as positioning the patient on a bariatric- specific OR bed as opposed to a regular OR bed, can be readily accommodated. Replacing the OR bed with a larger OR bed is a nurse-sensitive preventive intervention that provides equipment based on patient need. REF: p. 6 14. Accurate documentation is an integral part of all phases of the nursing process. For this reason, perioperative nursing care documentation: a. should not include technical care. b. must include a description of patient care delivered and patient response to that care. c. must be aligned with appropriate Perioperative Nursing Data Set (PNDS) elements. d. will have PNDS integrated into all mandatory fields. ANS: B Documentation of the nursing care given should include more than the technical aspects of care, such as the sponge count or the application of the electrosurgical dispersive pad. Nursing care documentation should be associated with the assessment and nursing diagnoses, with pre- established outcomes against which the appropriateness and effectiveness of care may be judged. REF: p. 9 15. When delegating a task, such as removing an intravenous (IV) catheter, to an unlicensed individual, the perioperative nurse: a. still retains responsibility and authority for the outcome of the task. b. must comply with the seven “rights” of delegation. c. transfers the authority to perform the task to a competent person. d. transfers the supervision of the competent person to another competent person. ANS: C Delegation transfers to a competent person with the authority to perform a selected nursing task in a selected situation according to the five “rights” of delegation. When the perioperative nurse delegates a task, he or she retains accountability for that delegation. REF: p. 8 16. A hospital nursing excellence center for education developed standards for nursing advancement that would reflect high-level achievement of professional performance. They developed a clinical advancement ladder based on the leading skill and knowledge acquisition model and established worthy criteria for each level. Select the response that might best describe the highest level of achievement for a perioperative staff nurse. a. Certified nurse, OR (CNOR) credential, BSN, and chair of the nursing research committee b. Published article in the hospital newsletter and 15 years’ service pin c. BCLS instructor and weekend Emergency Medical Technician (EMT) transport d. Patient safety champion and nurses' union representative ANS: A Achieving certification (CNOR), pursuing lifelong learning, and maintaining competency and current knowledge in perioperative nursing are the hallmarks of the professional. REF: p. 3 17. Performance improvement activities in the perioperative practice setting are designed to promote: a. cost savings by eliminating fines for near-misses and never events. b. customer satisfaction and loyalty. c. time measurement activities. d. efficient, effective, and ethical quality care. ANS: D Performance improvement efforts encompass improvements in quality and effectiveness, based on ethical and economic perspectives. A performance measurement and improvement approach facilitates the delivery of safe, high-quality perioperative patient care. REF: p. 10 18. Perioperative nursing diagnoses and interventions are directed toward, and guided by, the tremendous risks for harm to the patient inherent in surgery and interventional procedures; therefore nursing actions can generally be categorized as: a. therapeutic/restorative. b. preventive/protective. c. caring/comforting. d. advocating/justifying. ANS: B Perioperative nurses possess a unique understanding of desired outcomes that apply to all patients. In contrast to some nursing specialties in which nursing diagnoses are derived from signs and symptoms of a condition, much of perioperative nursing care is preventive in nature, based upon knowledge of inherent risks to patients undergoing surgical and invasive procedures. Perioperative nurses identify these risks and potential problems in advance and direct nursing interventions toward prevention of undesirable outcomes, such as injury and infection. Much of the work of perioperative nursing involves patient safety, protecting patients from risks related to the procedure, positioning, equipment, and the environment. REF: p. 2 19. A registered nurse first assistant (RNFA) is considered an advanced practice nurse (APN) when he/she has achieved: a. RNFA certification. b. clinical performance ladder level 4 or above. c. graduate degree in nursing (MSN). d. facility practice privileges. ANS: C APNs must have graduate nursing education (at least a master’s degree). REF: p. 13 20. Emerging perioperative nursing roles are defined by the tremendous growth in science and technology combined with the increasing complexity of surgery and the interventional disciplines. An example of an emerging nursing role is: a. sterile processing clinical specialist. b. general surgery service liaison. c. weekend resource nurse. d. informatics nurse specialist. ANS: D Informatics is another specialty in which some perioperative nurses are focusing. Pressures for more efficient management of fiscal, material, and human resources have stimulated the development of electronic information systems for diverse functions in perioperative patient care settings. REF: p. 13 21. The relationship between the Perioperative Patient Focused Model and the PNDS is evidenced by their unique language and use of the nursing process to guide care. The most notable feature of their similarity is that the PNDS: a. promotes standardized perioperative documentation. b. fosters research on best practices. c. begins with outcome statements. d. promotes standardized perioperative documentation and begins with outcome statements. ANS: C Similar to the Perioperative Patient Focused Model, the PNDS begins with patient outcomes. Each outcome is defined and interpreted and presents criteria by which to measure outcome achievement. REF: p. 8 22. In a research study by Bandari and colleagues, of surgical briefings and debriefings, they concluded that this communication model was a practical and effective means to: a. identify potential surgical defects in the OR. b. monitor central processing productivity. c. promote teamwork. d. quantify equipment and instrument issues. ANS: A Bandari and colleagues (2012) found a total of 6,202 reported defects over years—an average of 141 defects per month. The researchers concluded that briefings and debriefings are practical and effective strategies to identify potential surgical defects in the OR. REF: p. 7 23. In a research study by Steelman and colleagues, perioperative nurses were surveyed to prioritize perioperative patient safety issues. The majority of nurses placed the highest priority and heightened awareness on preventing which patient safety risk? a. Surgical fires b. Wrong site/procedure/patient surgery c. Retained surgical items d. Medication errors ANS: B The majority of nurses considered preventing wrong site, procedure, or patient surgery (69%) and preventing retained surgical items (61%) to be high-priority safety issues in need of heightened attention. REF: p. 8 24. All anesthetized surgical patients are at risk for unplanned hypothermia. Select the most effective preventative intervention. a. Forced air warming b. Prewarming prior to incision c. Heated cotton blankets d. Ambient room air above 98.6° F (37° C) ANS: A Numerous clinical trials have demonstrated that intraoperative forced air warming (FAW) is an effective intervention for preventing perioperative hypothermia. REF: p. 10 25. Researchers in Toronto (Wong J, et al, 2009) developed a research tool to evaluate recovery after ambulatory surgery, focusing on functional abilities after discharge. Select the true statement about the benefits of a functional recovery index for ambulatory surgery patients. a. It determines readiness for discharge. b. It evaluates financial incentives for early discharge. c. It determines criteria for readmission. d. It determines criteria for extended observation. ANS: A Ambulatory surgery centers regularly perform complex procedures on higher-risk patients. Therefore, it becomes important not only to determine patients’ readiness for discharge from the ambulatory surgery center but also how well patients fare in their recovery and rehabilitation after discharge. REF: p. 12