AORN Periop 101 Final Exam with 89 Questions and Answers Graded A+

AORN Periop 101 Final Exam with 89 Questions and Answers Graded A+ Who can provide anesthesia care? (4) Correct ans - 1. Anesthesiologists 2. CRNA's 3. Anesthesia assistants 4. Periop nurses 4 types anesthesia Correct ans - General - loss of consciousness Regional - loss of sensation Local - small area loss of sensation MAC - IV Whose responsibility during MAC to monitor pt? Correct ans - RN What should RN monitor during MAC? (3) Correct ans - 1. Extravasation of IV 2. Reduction of arterial O2 sat 3. Difficulty breathing 4 Stages of anesthesia Correct ans - 1. Initial administration 2. Excitement - unconscious to loss of eyelid reflex 3. Intrasurgery 4. Possibility of resp failure 3 Phases of Anesthesia Correct ans - 1. Induction - admin until 1st incision 2. Maintenance - incision to completion 3. Emergence - from when pt awakens until pt exits OR What is often used for upper extremity nerve blocks? Correct ans - IV regional anesthetic/Bier block Where is epidural anesthetic injected? Correct ans - between ligamentum flavum and dura (NOT spinal canal) What helps ensure proper needle placement during peripheral nerve block with regional anesthesia? Correct ans - continuous nerve stimulation First sign of Malignant Hyperthermia Correct ans - increased end-tidal CO2 What should be done for pt with MH crisis? Correct ans - 1. Stop surgery & stop triggering agents 2. Give dantrolene 3. Give 100% O2 4. Cool pt with iced saline Mentor or preceptor? "One who provides encouragement and acts as a guide and facilitator while modeling professional nursing behaviors" Correct ans - Mentor Mentor or preceptor? "One who teaches, counsels, inspires, serves as a role model, and supports the growth and development of the novice for a fixed and limited period" Correct ans - Preceptor Mentor or preceptor? Guides nurse through a wide range of professional activities Correct ans - Mentor Mentor or preceptor? Guides nurse through defined clinical activities Correct ans - Preceptor What should intra-abd pressure be maintained under in an adult pt during CO2 insufflation for endoscopic surgery? Correct ans - 12 mm Hg Single most important factor in minimizing microorganism transfer Correct ans - Hand hygiene The most effective method for floor care in surgical suite Correct ans - Wet vacuuming When should air sampling be done in OR? (3) Correct ans - 1. Before construction begins 2. After demolition 3. At end of project examples of mechanical hemostasis (8) Correct ans - 1. Manual pressure (sponges) 2. Clamps 3. Sutures 4. Staples 5. Clips 6. Ligatures 7. Pledgets 8. Bone wax What type of hemostasis is achieved by occluding severed vessels until platelet formation occurs Correct ans - Mechanical Strand of material tied around blood vessel to occlude lumen and prevent bleeding Correct ans - Ligature non-absorbable suture support used when there is possibility of sutures tearing through tissue Correct ans - Pledget What type of hemostasis uses pharmacological or topical products? Correct ans - Chemical Ex of thermal hemostasis (3) Correct ans - Laser Argon beam electrosurgery Ex of chemical hemostasis methods Correct ans - 1. Microfibrillar collagen 2. Oxidized cellulose 3. Collagen sponge 4. Gelatin sponge 5. Fibrin sealant 6. Phenol solution 7. Thrombin 8. Styptics Who is involved in sponge counts? Correct ans - ALL periop personnel What types of surgery are JP suction drains frequently used in? Correct ans - Abdominal or breast What should be labeled on a medication on or off sterile field (5) Correct ans - 1. Med name 2. Concentration 3. Initials of RN preparing 4. Expiration 5. Date prepared S&S of systemic toxicity from medications Correct ans - Metallic taste Tinnitus Lightheaded Vision disturbances Numb tongue/lips Confusion Tremors Shivering Siezures Tachy/HTN Brady/HypoTN Ventricular arrhymias Resp arrest Goals of pt and family education Correct ans - Increase knowledge and satisfaction Patient's right to make informed choices based on truthful information Correct ans - Self determination What is the first thing the RN should pay attention to in post anesthesia care? Correct ans - Airway What is monitored with the Aldrete scale in PACU? (5) Correct ans - 1. Mobility 2. Resp 3. Circulation 4. LOC 5. O2 What things should be documented when taking pt hx before surgery? (5) Correct ans - 1. Allergies/implants/prostheses/piercings 2. D/c plans 3. Med profile (& herbals) 4. Nutritional status 5. Cultural considerations Documentation of pt positioning in OR (5) Correct ans - 1. Pt position & devices 2. Person who positioned 3. Safety belt 4. Arms placement 5. Postop eval What should be documented when giving meds in OR (5) Correct ans - 1. Drug 2. Concentration 3. Route 4. Dose 5. Time Potential sources of fuel for surgical fires (5) Correct ans - 1. Linens/drapes 2. Skin degreasers/tinctures/aerosols 3. Prep solutions 4. Body tissues/pt hair 5. Intestinal gases What questions should you ask when identifying a pt preop? (3) Correct ans - Name DOB Planned procedure What do you need to document for Time Out? (3) Correct ans - 1. 2 Pt identifiers checked 2. Site/side 3. Verification of procedure What can increase pt risk for skin injury in OR? (6) Correct ans - 1. Preexisting metabolic conditions (DM) 2. Unusual position 3. ESU 4. Length of surgery 5. Reduced tissue perfusion 6. Chemical agents What can be done to reduce introp skin injuries? (5) Correct ans - 1. Positioning (protect areas) 2. Use electric/thermal equip properly 3. Manage electromagnetics 4. Never place heavy objects or lean on pt 5. Remove excess prep solution What occurs when pt has irritant contact dermatitis latex sensitivity? Correct ans - non-allergic* skin rxn. Confined to area in contact with irritant What occurs with Immediate Type I Hypersensitivity reaction to latex? Correct ans - (allergy) 5-30 min after exposure OR delayed onset of 10-12 hrs What happens with delayed type IV hypersensitivity rxn to latex? Correct ans - Delayed *allergic rxn 24-72 hrs after contact 3 stages of latex rxn Correct ans - I. Contact uticaria at site II. Allergic rxn spreads III. (If allowed to progress) BP drop, increased HR, anaphylaxis Factors that make elderly pt skin more sensitive to injury (4) Correct ans - 1. Less subcu fat 2. Less skin elasticity 3. Thin/wrinkling skin 4. Atrophy of sweat glands (decreased temp change tolerance) What should preop psychosocial assessment include? (4) Correct ans - 1. Expectations of periop care (including stress levels) 2. Understanding of procedure 3. Philosophical/religious beliefs 4. cultural beliefs/practices Who determines pt position in OR? Correct ans - Surgeon What main precaution should you take with pt in prone position? Correct ans - Pad eyes - avoid pressure Goals of surgical skin prep (3) Correct ans - 1. Remove soil/transient microorganisms from skin 2. Reduce resident microbes below pathogenic levels 3. Inhibit rapid rebound growth of microbes When can CHG prep be used/not used? Correct ans - Use: for topical ONLY NOT: above neck Which type of prep has quickest reduction in microbe counts? Correct ans - Alcohol How far from incision site should prep area extend? Correct ans - At least 6-8" past What should be documented with skin prep? (6) Correct ans - 1. Area prepped 2. Type/extent of hair removal 3. Who prepped 4. Skin assessment at site 5. Prep agent used 6. Dry time What do direct expenses for hospital include? Correct ans - Medical supplies Personnel Purchases services What do indirect expenses to hospital include? Correct ans - Heating/cooling Electricity Admin/support personnel (housekeeping) Where should you avoid placing ESU dispersive electrode grounding pads? Correct ans - Bony prominences Implanted prosthesis Hairy areas Tattooed areas Scar tissue Term: Organisms on wet skin soak through & contaminating sterile gown Correct ans - Strike through What gloving technique does initial donning of sterile gown/gloves use? Correct ans - Closed gloving Fine gauge needle & syringe are used to aspirate the sample Correct ans - Needle aspiration Small portion of tissue is incised and sent for examination Correct ans - Incisional biopsy An entire section of tissue is sent for examination Correct ans - Excisional biopsy Type of surgical specimen: Will be microscopically studied by pathologist and may undergo histologic or cytologic analysis Correct ans - Biopsy Type of surgical specimen: tissue is frozen and thinly sliced into sections to be examined under a microscope by the pathologist Correct ans - Frozen section Type of surgical specimen: Specimens obtained for studying cell biology Correct ans - Cytology Type of surgical specimen: Specimens that do not require immediate processing by the pathologist Correct ans - Routine specimen Type of surgical specimen: Specimens of tissue or fluid suspected of being infected Correct ans - Culture After how long should you change your surgical gloves? Correct ans - 150 min (max) 1st step in sterilization process Correct ans - Cleaning - removing gross soil/moistening at point of use 2nd step in sterilization process Correct ans - Decontamination What conditions are important in storage area of sterile items? Correct ans - Cleanliness Temp Humidity Air exchange