AORN PERIOP 101 FINAL EXAM QUESTIONS AND
ANSWERS
Indemnity Payment - Answers - Payment made on behalf of the policy holder
Liability - Answers - A legal responsibility
Negligence - Answers - An act or failure to act that deviates from the standard of care
Nursing Malpractice - Answers - A nurse's negligence or any intentional act that causes
physical, financial, emotional, psychosocial, and/or cognitive damage to the person in
the nurse's care
Respondeat Superior - Answers - An employer is legally responsible for the nurse
employee only when:
o The nurse acts within the scope of practice
o Any allegations brought against the nurse occurred during the nurse's employment
o The nurse's actions were within the employer's best interests.
Tort - Answers - A breach of duty to another person as outlined by law
What are the four elements of malpractice? - Answers - • Duty
• Breach of duty
• The breach of duty caused an injury
• The injury was harmful to the patient
Elements of Informed Consent - Answers - • Must be obtained by the licensed
professional who is performing the procedure
• The patient must give consent voluntarily with the full understanding of all implications
• Must include
o Diagnosis
o Proposed treatment
o Treatment alternatives
o Consequences of accepting or declining the proposed treatment
Five Rights of Delegation - Answers - Right task
Right circumstance
Right person
Right communication and direction
Right supervision and evaluation
Four types of patient privacy health care providers and personnel have an ethical and
legal responsibility to always maintain - Answers - • Medical information
,• Physical exposure
• Personal privacy
• Electronic privacy
Eight factors to consider before determining what anesthetic to use for a particular
patient - Answers - • Patient's age
• Length & type of surgery
• Patient & surgeon preferences
• Patient's co-existing diseases
• Patient's mental & psychological status
• Patient's previous experiences with anesthesia
• Plans & protocols for postoperative pain management
• Position of the patient during surgery
The American Society of Anesthesiologist's NPO Guidelines - Answers - • Clear liquids -
stop 2 hours before surgery
• Breast milk - stop 4 hours before surgery
• Infant formula - stop 6 hours before surgery
• Light meal (toast & a clear liquid) - stop 6 hours before surgery
• Fried foods, fatty foods, meat - stop 8 hours before surgery
Circulator RN duties during Induction of anesthesia and assisting anesthesia
professional with Cricoid Pressure - Answers - • Cricoid pressure application is not
released until the endotracheal (ET) tube cuff is inflated, tube placement is confirmed,
and anesthesia provider has given a verbal confirmation to the nurse that the cricoid
pressure can be released.
• If intubation or ventilation of the patient becomes difficult, the perioperative nurse
should retrieve additional airway equipment and supplies.
General anesthesia - Answers - • A drug-induced reversible state of unconsciousness
• Results in amnesia, analgesia, and loss of responsiveness, decreased stress
response, and loss of skeletal muscle reflexes to a varying degree
Regional anesthesia - Answers - • An injection of local anesthetics near nerve fibers that
causes reversible loss of sensation over an area of the body
• Examples include spinal, epidural, and peripheral nerve blocks.
Monitored anesthesia care (MAC) - Answers - An anesthesia provider monitors the
patient, administers sedatives and other agents as needed, and provides medical
services as required.
Moderate sedation - Answers - • The administration of sedative, analgesic, and/or
anxiolytic agents by a physician or by a nurse under physician supervision
• Depending on state laws and hospital policies, an RN may administer moderate
sedation.
,Local anesthesia - Answers - • The infiltration or topical administration of agents to
anesthetize a part of the body
• The perioperative nurse provides patient monitoring and supportive care.
Phases of general anesthesia - Answers - • Phase I: Induction
o IV medications and inhalational agents are administered by the anesthesia provider.
• Phase II: Maintenance
o Medications and inhalational agents are administered to keep the patient
anesthetized.
• Phase III: Emergence o At the end of the procedure, the anesthetic agents are
discontinued or reversed to allow the patient to wake up.
Anesthesia Reversal agents: Muscle relaxants: - Answers - 1. neostigmine
2. edrophonium.
Note: There is no reversal agent for succinylcholine
Anesthesia Reversal agents: Sugammadex: - Answers - reversal agent for rocuronium,
vecuronium, and pancuronium
Anesthesia Reversal agents: Benzodiazepines: Midazolam - Answers - Flumazenil
Anesthesia Reversal agents: Narcotics: Fentanyl: - Answers - Naloxone
Patients at Increased Risk for Hypothermia - Answers - • Older adults
• Infants and children
• Women
• Patients with lower-than-normal body weight
Medical Conditions Associated with Increased Risk for Hypothermia - Answers - •
Hypothyroidism
• Hypoglycemia
• Burns
• Trauma
• Hypotension
• Congestive heart failure
• Cardiac vessel disease
Signs of Malignant Hyperthermia (MH) - Answers - • ΜΗ is triggered by inhalation
anesthetic gases and succinylcholine
• Increased end-tidal carbon dioxide is the most specific sign of MH.
• Other signs include skeletal muscle rigidity, ventricular dysrhythmia, skin mottling, and
hyperthermia.
, Medical professionals who can provide anesthesia services are: - Answers - •
Anesthesiologists
• Certified registered nurse anesthetists (CRNAs)
• Anesthesiologist assistants (AAs)
Surgical Safety Checklist Includes: - Answers - • Μοbility
• Preexisting health conditions
• Planned duration of the procedure.
• Type of anesthesia
The Preoperative Nurse Visit Should Include: - Answers - • Introduce yourself and ask
your patient how they would like to be addressed.
• Confirm your patient's identity with two patient identifier
• If your patient discusses suicidal thoughts during the preoperative visit, report this
immediately by following your facility's policy and procedure.
• Use the same scale for pain assessment throughout all patient care areas.
• Consider all elements of patient care needs prior to surgery.
• Consider how the required surgical position may impact a current condition that the
patient contends with.
A Medication Assessment Should Include: - Answers - • Prescription medications
• Herbal preparations:
o may accentuate the toxicity of anesthetics.
o interfere with drug metabolism or clearance.
o might affect bleeding times.
• Recreational/street drugs
*It is also important to ask if the patient is using any recreational/street drugs. Close
observation must be maintained for symptoms of withdrawal, especially during and after
long procedures.
• Drugs, alcohol, and smoking can alter lab values or system assessment. A chemically
dependent patient who is recovering may have concerns about medication he or she is
given.
• Patient risk factors due to alcoholism include:
- Lowered immunity
- Prolonged bleeding times
- Increased stress response
- Cardiac complications
Physiological Effects of Cannabis Include: - Answers - - Tachycardia
- atherosclerosis
- Airway edema
- chronic bronchitis
- Increased appetite
- hyperemesis
- Paranoia
- BIS elevation
ANSWERS
Indemnity Payment - Answers - Payment made on behalf of the policy holder
Liability - Answers - A legal responsibility
Negligence - Answers - An act or failure to act that deviates from the standard of care
Nursing Malpractice - Answers - A nurse's negligence or any intentional act that causes
physical, financial, emotional, psychosocial, and/or cognitive damage to the person in
the nurse's care
Respondeat Superior - Answers - An employer is legally responsible for the nurse
employee only when:
o The nurse acts within the scope of practice
o Any allegations brought against the nurse occurred during the nurse's employment
o The nurse's actions were within the employer's best interests.
Tort - Answers - A breach of duty to another person as outlined by law
What are the four elements of malpractice? - Answers - • Duty
• Breach of duty
• The breach of duty caused an injury
• The injury was harmful to the patient
Elements of Informed Consent - Answers - • Must be obtained by the licensed
professional who is performing the procedure
• The patient must give consent voluntarily with the full understanding of all implications
• Must include
o Diagnosis
o Proposed treatment
o Treatment alternatives
o Consequences of accepting or declining the proposed treatment
Five Rights of Delegation - Answers - Right task
Right circumstance
Right person
Right communication and direction
Right supervision and evaluation
Four types of patient privacy health care providers and personnel have an ethical and
legal responsibility to always maintain - Answers - • Medical information
,• Physical exposure
• Personal privacy
• Electronic privacy
Eight factors to consider before determining what anesthetic to use for a particular
patient - Answers - • Patient's age
• Length & type of surgery
• Patient & surgeon preferences
• Patient's co-existing diseases
• Patient's mental & psychological status
• Patient's previous experiences with anesthesia
• Plans & protocols for postoperative pain management
• Position of the patient during surgery
The American Society of Anesthesiologist's NPO Guidelines - Answers - • Clear liquids -
stop 2 hours before surgery
• Breast milk - stop 4 hours before surgery
• Infant formula - stop 6 hours before surgery
• Light meal (toast & a clear liquid) - stop 6 hours before surgery
• Fried foods, fatty foods, meat - stop 8 hours before surgery
Circulator RN duties during Induction of anesthesia and assisting anesthesia
professional with Cricoid Pressure - Answers - • Cricoid pressure application is not
released until the endotracheal (ET) tube cuff is inflated, tube placement is confirmed,
and anesthesia provider has given a verbal confirmation to the nurse that the cricoid
pressure can be released.
• If intubation or ventilation of the patient becomes difficult, the perioperative nurse
should retrieve additional airway equipment and supplies.
General anesthesia - Answers - • A drug-induced reversible state of unconsciousness
• Results in amnesia, analgesia, and loss of responsiveness, decreased stress
response, and loss of skeletal muscle reflexes to a varying degree
Regional anesthesia - Answers - • An injection of local anesthetics near nerve fibers that
causes reversible loss of sensation over an area of the body
• Examples include spinal, epidural, and peripheral nerve blocks.
Monitored anesthesia care (MAC) - Answers - An anesthesia provider monitors the
patient, administers sedatives and other agents as needed, and provides medical
services as required.
Moderate sedation - Answers - • The administration of sedative, analgesic, and/or
anxiolytic agents by a physician or by a nurse under physician supervision
• Depending on state laws and hospital policies, an RN may administer moderate
sedation.
,Local anesthesia - Answers - • The infiltration or topical administration of agents to
anesthetize a part of the body
• The perioperative nurse provides patient monitoring and supportive care.
Phases of general anesthesia - Answers - • Phase I: Induction
o IV medications and inhalational agents are administered by the anesthesia provider.
• Phase II: Maintenance
o Medications and inhalational agents are administered to keep the patient
anesthetized.
• Phase III: Emergence o At the end of the procedure, the anesthetic agents are
discontinued or reversed to allow the patient to wake up.
Anesthesia Reversal agents: Muscle relaxants: - Answers - 1. neostigmine
2. edrophonium.
Note: There is no reversal agent for succinylcholine
Anesthesia Reversal agents: Sugammadex: - Answers - reversal agent for rocuronium,
vecuronium, and pancuronium
Anesthesia Reversal agents: Benzodiazepines: Midazolam - Answers - Flumazenil
Anesthesia Reversal agents: Narcotics: Fentanyl: - Answers - Naloxone
Patients at Increased Risk for Hypothermia - Answers - • Older adults
• Infants and children
• Women
• Patients with lower-than-normal body weight
Medical Conditions Associated with Increased Risk for Hypothermia - Answers - •
Hypothyroidism
• Hypoglycemia
• Burns
• Trauma
• Hypotension
• Congestive heart failure
• Cardiac vessel disease
Signs of Malignant Hyperthermia (MH) - Answers - • ΜΗ is triggered by inhalation
anesthetic gases and succinylcholine
• Increased end-tidal carbon dioxide is the most specific sign of MH.
• Other signs include skeletal muscle rigidity, ventricular dysrhythmia, skin mottling, and
hyperthermia.
, Medical professionals who can provide anesthesia services are: - Answers - •
Anesthesiologists
• Certified registered nurse anesthetists (CRNAs)
• Anesthesiologist assistants (AAs)
Surgical Safety Checklist Includes: - Answers - • Μοbility
• Preexisting health conditions
• Planned duration of the procedure.
• Type of anesthesia
The Preoperative Nurse Visit Should Include: - Answers - • Introduce yourself and ask
your patient how they would like to be addressed.
• Confirm your patient's identity with two patient identifier
• If your patient discusses suicidal thoughts during the preoperative visit, report this
immediately by following your facility's policy and procedure.
• Use the same scale for pain assessment throughout all patient care areas.
• Consider all elements of patient care needs prior to surgery.
• Consider how the required surgical position may impact a current condition that the
patient contends with.
A Medication Assessment Should Include: - Answers - • Prescription medications
• Herbal preparations:
o may accentuate the toxicity of anesthetics.
o interfere with drug metabolism or clearance.
o might affect bleeding times.
• Recreational/street drugs
*It is also important to ask if the patient is using any recreational/street drugs. Close
observation must be maintained for symptoms of withdrawal, especially during and after
long procedures.
• Drugs, alcohol, and smoking can alter lab values or system assessment. A chemically
dependent patient who is recovering may have concerns about medication he or she is
given.
• Patient risk factors due to alcoholism include:
- Lowered immunity
- Prolonged bleeding times
- Increased stress response
- Cardiac complications
Physiological Effects of Cannabis Include: - Answers - - Tachycardia
- atherosclerosis
- Airway edema
- chronic bronchitis
- Increased appetite
- hyperemesis
- Paranoia
- BIS elevation
