Chapter 18. Surgical Skills I, Planning a Case, Opening, and Start of Surgery

Chapter 18. Surgical Skills I: Planning a Case, Opening, and Start of Surgery MULTIPLE CHOICE 1. The containing towels, drapes, and gowns is centered on the back table and opened using aseptic technique. A. wrapped basin C. basic pack B. instrument tray D. surgical drape ANS: C The basic pack containing towels, drapes, and gowns is centered on the back table and opened using aseptic technique. PTS: 1 DIF: 2 REF: p. 420 2. Using a approach to all setups improves efficiency. A. nonstressful C. surgical B. educated D. methodical ANS: D Using a methodical approach to all setups improves efficiency and greatly decreases stress and errors in the learning phase. PTS: 1 DIF: 2 REF: p. 421 3. Before organizing and preparing supplies during setup, the sterile area. A. dry top C. decrease the size of B. increase the size of D. remove supplies from ANS: B Before organizing and preparing supplies, increase the size of the sterile area. PTS: 1 DIF: 2 REF: p. 421 4. Avoid shifting items around from one place to another during setup. Try to handle an item only once. Shifting items from one location to another without purpose increases the chance of and is not productive. A. injury C. contamination B. confusion D. missing items ANS: C Avoid shifting items around from one place to another during setup. Try to handle an item only once. Shifting items from one location to another without purpose increases the chance of contamination and is not productive. PTS: 1 DIF: 2 REF: p. 422 5. You may have up to 10 trays on a complex case. This is why it is important to think about what you need, locate it among all the supplies, and then put it in a specific place. If instrument trays must be stacked, place the ones on the bottom. A. least-used C. empty B. heavier D. large This study source was downloaded by from CourseH on :26:27 GMT -05:00 ANS: B Heavier trays are stacked on the bottom. PTS: 1 DIF: 2 REF: p. 423 6. are usually distributed after the case is underway or just before the case begins. A. Sutures C. Irrigation and soaking solutions B. Medications D. Dressings ANS: C Irrigation and soaking solutions are usually distributed after the case is underway or before the case begins. PTS: 1 DIF: 2 REF: p. 423 7. The sponge, sharps, and instrument count is performed . A. during the time out C. at the circulator’s convenience B. during the setup D. after incision is made ANS: B Counts are performed during the setup, per protocol. PTS: 1 DIF: 2 REF: p. 424 8. is/are responsible for ensuring that no item is left in a patient. A. Licensed professionals only C. The surgeon B. The certified surgical technologist D. All team members ANS: D All team members are responsible for ensuring that no item is left in a patient. The scrubbed technologist or nurse and circulator normally perform the count together. In turn, they report the count to the surgeon, whether it is correct or incorrect. PTS: 1 DIF: 2 REF: p. 425 9. The count is performed by two people. Professional standard for counts as published by AORN requires a and another health care worker such as the surgical technologist to perform the count. A. circulator C. surgical assistant B. surgeon D. licensed practical nurse ANS: A The scrubbed technologist or nurse and circulator normally perform the count together. PTS: 1 DIF: 2 REF: p. 425 10. Inadequate lighting increases . The surgical technologist adjusts lights as needed. A. the procedure length C. the risk of error B. tension in the surgical suite D. patient’s time under anesthesia ANS: C This study source was downloaded by from CourseH on :26:27 GMT -05:00 Inadequate lighting increases the risk of surgery errors. The surgical technologist adjusts lights as needed. Overhead lights produce a small, shadowless beam that spreads peripherally to focus on a large or small area as needed. PTS: 1 DIF: 2 REF: p. 428 11. Every surgical sponge is sewn or impregnated with a that helps identify its location in the wound in case it is retained or lost. A. thin steel wire C. wide blue thread B. radiopaque strip D. luminescent thread ANS: B All sponges used in a surgical procedure must be radiopaque (detectable by x-ray). PTS: 1 DIF: 2 REF: p. 427 12. The name comes from manufactured in the 1940s and 1950s, when sponges were not square, but long and rectangular; hence the name tape. A. Ray-tecs C. laparotomy sponges B. cottonoids D. tonsil sponges ANS: C Today we occasionally refer to laparotomy sponges as “lap tapes.” The name comes from laparotomy sponges manufactured in the 1940s and 1950s, when sponges were not square, but long and rectangular; hence the name tape. PTS: 1 DIF: 2 REF: p. 438 13. During the surgical procedure, all instruments are passed unless the surgeon requests otherwise. A. in their closed (locked) position B. in an open position C. in the same condition they were returned D. by laying them on the surgical drape ANS: A During the surgical procedure, all instruments are passed in the closed position unless the surgeon requests otherwise. PTS: 1 DIF: 2 REF: p. 430 14. All sharps should be passed with . If hospital policy or an individual surgeon has not implemented this technique, the scrub must pass sharps in the traditional manner. A. the technique requested on surgeon’s preference card B. care C. the left hand D. a neutral zone (no-hands) technique ANS: D All sharps should be passed with a neutral zone technique. If hospital policy or an individual surgeon has not implemented this technique, the scrub must pass sharps in the traditional manner. The neutral zone is a physical location on the sterile field designated and understood by the surgical team as a This study source was downloaded by from CourseH on :26:27 GMT -05:00 physical space (basin or magnetic board) where sharps are placed and retrieved. PTS: 1 DIF: 2 REF: p. 431 15. Gentle handling of tissues and prevention of drying, heating, hemorrhage, and trauma reduce inflammation and lead to . A. less scar tissue C. less blood loss B. faster recovery D. less postoperative pain ANS: B Gentle handling of tissues and prevention of drying, heating, hemorrhage, and trauma reduce inflammation and lead to faster recovery. PTS: 1 DIF: 2 REF: p. 433 16. The surgical technologist must keep track of the amount of used in the wound so that estimated blood loss can be calculated. A. lap sponges C. irrigation fluid B. Ray-tecs D. local anesthetic ANS: C The surgical technologist must keep track of the amount of irrigation fluid used in the wound so that estimated blood loss can be calculated. PTS: 1 DIF: 2 REF: p. 423 17. carries responsibility for the specimen’s protection, preservation, and accurate identification. A. The circulator C. Every person who handles a specimen B. The surgeon D. The certified surgical technologist ANS: C The scrubbed surgical technologist is directly responsible for receiving and handling specimens on the surgical field. The surgeon communicates information about the exact site and tissue of origin, and the orientation of margins for malignancy (ifapplicable), to the scrubbed technologist and nurse circulator. PTS: 1 DIF: 2 REF: p. 434 18. Two types of are commonly taken during surgery. These are aerobic and anaerobic. A. biopsies C. images B. x-rays D. bacterial cultures ANS: D Two types of bacterial cultures are commonly taken during surgery: aerobic and anaerobic. Each requires a designated type of transfer tube. Anaerobic sampling can be performed with a needle and syringe or using a Dacron swab as described earlier. PTS: 1 DIF: 2 REF: p. 436 19. Any tissue or item removed from the patient’s body during surgery is and is maintained in a specific way on the surgical field to prevent loss or damage. A. always saved for the patient C. biohazard waste This study source was downloaded by from CourseH on :26:27 GMT -05:00 B. counted D. a specimen ANS: D Any tissue or item removed from the patient’s body during surgery is a specimen and is maintained in a specific way on the surgical field to prevent loss or damage. PTS: 1 DIF: 2 REF: pp. 433-434 20. The is responsible for maintaining an organized and safe surgical field. A. scrub person C. surgeon B. CST-CFA D. anesthesia provider ANS: A The scrub person is responsible for maintaining an organized and safe surgical field. PTS: 1 DIF: 2 REF: p. 415 | p. 426 21. The process preceded by patient verification process detailed by the Joint Commission is called . A. assignment board B. TIMEOUT ANS: B The surgical TIMEOUT (universal protocol) has been developed in response to the high rate of wrong site and wrong patient surgeries. The protocol is specific, precise, and mandatory in all accredited health facilities. PTS: 1 DIF: 1 REF: p. 439 22. When the microorganisms have colonized, they are examined for type and sensitivity to specific antibiotics. This procedure is called a . A. culture B. frozen section ANS: A When the microorganisms have colonized, they are examined for type and sensitivity to specific antibiotics. This procedure is called a culture. PTS: 1 DIF: 1 REF: p. 436 23. A time-related set of procedures in which sterile supplies are distributed and arranged on the sterile table is referred to as case . A. setup B. planning ANS: A A time related set of procedures in which sterile supplies are distributed and arranged on the sterile table is referred to as a case setup. PTS: 1 DIF: 1 REF: p. 420 24. Any objects that can penetrate the skin and have the potential for causing injury and infection are referred to as . A. implants B. sharps ANS: B Any objects that can penetrate the skin and have the potential for causing injury and infection are This study source was downloaded by from CourseH on :26:27 GMT -05:00 referred to as sharps. PTS: 1 DIF: 1 REF: p. 426 25. Removal of a sample of tissue for pathological analysis is called a . A. culture B. biopsy ANS: B Tissue biopsy is the removal of tissue or cells for gross identification and microscopic analysis. Microscopic analysis results in a definitive diagnosis, such as malignancy, or is used to determine the nature of an abnormality. Biopsy is performed during endoscopic, image-guided surgery, or as part of an open procedure. PTS: 1 DIF: 1 REF: p. 435 26. A tissue implant derived from another person, animal, or the patient is called a(n) . A. graft B. implant ANS: A A tissue implant derived from another person, animal, or the patient is called a graft. An implant used to replace or augment existing tissue. A graft may be obtained from the patient, another person, an animal source, or synthetic or biosynthetic materials. PTS: 1 DIF: 1 REF: p. 418 27. A method used for gathering supplies for a case is referred to as a(n) system. A. assignment board B. case cart ANS: B A method used for gathering supplies for a case is referred to as a case cart system. PTS: 1 DIF: 1 REF: p. 419 28. A(n) is a database containing each surgeon’s particular routines for a specific instruments for a particular surgery. A. surgeon’s preference card B. assignment board ANS: A A surgeon’s preference card is a database containing each surgeon’s particular routines for a specific instruments for a particular surgery. PTS: 1 DIF: 2 REF: p. 423 29. Gathering needed diagnostic studies, such as radiographs, magnetic resonance images, or other data the surgeon needs during the case is part of . A. preparing the room B. terminal cleaning ANS: A Gathering needed diagnostic studies, such as radiographs, magnetic resonance images, or other data the surgeon needs during the case is part of preparing the room. PTS: 1 DIF: 1 REF: p. 420 This study source was downloaded by from CourseH on :26:27 GMT -05:00 30. are not brought to the Mayo stand until the superficial wound layers are closed and the final sponge counts have been completed. A. Dressings B. Moist Ray-tecs ANS: A Dressings are not brought to the Mayo stand until the superficial wound layers have been closed and the final sponge counts have been completed. PTS: 1 DIF: 1 REF: pp. 437-438 MATCHING Choose from the terms listed and match them with their most correct description. You will use the same answer more than once. A. Surgical technologist C. Surgeon B. Circulator/registered nurse 1. The wound is then closed according to his or her protocol. 2. Must keep track of all counted items throughout a surgical procedure. He or she must know what kind and how many items are inside the patient at any point during the procedure. 3. Responsible for maintaining an organized and safe surgical field 4. Receives the specimen from the sterile field in a designated container 5. Handling and passing instruments are important tasks of this person. 6. When blood loss must be estimated, he or she may be required to weigh each sponge. 7. Anesthesia begins only after he or she has arrived and is ready to scrub. 8. The anesthesia care provider and this person focus on preparing the patient for anesthesia. 9. If the count is incorrect, this person is notified and the count repeated. 10. Sharps are opened during the setup. This person opens the outer package and the scrubbed technologist removes them and places them in a sharps holder. 1. ANS: C PTS: 1 DIF: 3 REF: pp. 415-416 2. ANS: A PTS: 1 DIF: 3 REF: pp. 415-416 3. ANS: A PTS: 1 DIF: 3 REF: pp. 415-416 4. ANS: B PTS: 1 DIF: 3 REF: pp. 415-416 5. ANS: A PTS: 1 DIF: 3 REF: pp. 415-416 6. ANS: B PTS: 1 DIF: 3 REF: pp. 415-416 7. ANS: C PTS: 1 DIF: 3 REF: pp. 415-416 8. ANS: B PTS: 1 DIF: 3 REF: pp. 415-416 9. ANS: C PTS: 1 DIF: 3 REF: pp. 415-416 10. ANS: B PTS: 1 DIF: 3 REF: pp. 415-416 Choose from the terms listed and match them with their most correct description. You will use the same answer more than once. A. Preoperative C. Intraoperative B. Postoperative 11. The patient is transferred to PACU (postanesthesia recovery unit). 12. The scrub and circulator open the case 13. The patient arrives from the holding area and is transferred to the operating bed. 14. The scrub person gowns and gloves and immediately sets up sterile supplies. This study source was downloaded by from CourseH on :26:27 GMT -05:00 15. The first sponge, sharps, and instrument count is performed. 16. Specimens are documented and transported to a designated area for pick up. 17. The patient is positioned for surgery. 18. The circulator continues to distribute sterile supplies as needed. 19. The scrub person performs hand antisepsis or scrub. 20. The surgical suite is cleaned and decontaminated for the next case. 11. ANS: B PTS: 1 DIF: 3 REF: pp. 415-416 12. ANS: A PTS: 1 DIF: 3 REF: pp. 415-416 13. ANS: A PTS: 1 DIF: 3 REF: pp. 415-416 14. ANS: C PTS: 1 DIF: 3 REF: pp. 415-416 15. ANS: C PTS: 1 DIF: 3 REF: pp. 415-416 16. ANS: B PTS: 1 DIF: 3 REF: pp. 415-416 17. ANS: A PTS: 1 DIF: 3 REF: pp. 415-416 18. ANS: C PTS: 1 DIF: 3 REF: pp. 415-416 19. ANS: A PTS: 1 DIF: 3 REF: pp. 415-416 20. ANS: B PTS: 1 DIF: 3 REF: pp. 415-416