RNFA quiz 1B Latest 2023 with Complete Solutions

RNFA quiz 1B Latest 2023 with Complete Solutions Marvin Deloitte, a 19 year-old male, received in intravenous peripheral nerve block (PNB/Bier block) for an ORIF of about ankle fracture. The anesthesia provider injected a a distal dorsal vein of Marvin's right foot with 2% lidocaine, after placing a single cuffed pneumatic tourniquet circumferentially around Marvins upper thigh. The surgeon looked through the OR window to check on anesthesia progress as he scrubbed at the sink outside of the OR. The circulating nurse had the leg elevated and was prepping the ankle. The surgeon noticed that the cuff seemed to be deflating and that the anesthesia provider was turned away from the patient. The circulating nurse also noticed the movement under the protective towel placed over the cuff, and saw the tourniquet tubing fall to the floor. The nurses first response should be: Alert the anesthesia provider, reconnect thw tubing to cuff and inflate, and send the surgeon for the code cart The perioperative nurse visited Mr. Jennings in the ICU the next day and noticed abrasions on the elbow. Mr. Jennings told her that the ICU nurses had difficulty pulling him back up in bed every time he slid down toward the bottom and he was not able to be much help in moving himself. The skin injury was probably the result of which physical force A friction from the elbows rubbing over the sheets when slid up in the bed. Malignant hyperthermia (MH) is a rare, multifaceted syndrome with an increased incidence in individuals with central core diseases such as: Congenital myopathies David Reese, a 14 year-old patient with marked scoliosis, is in prone position with gel rolls, gel pads, and pillows for a spinal fusion Before the skin is begun, the perioperative nurse should check the positioning for pressure areas of the: Genitals, knees, toes, and eyes A reverse cutting needle is preferred for _________________ suturing. Cutaneous The installation of a local anesthetic into the subarachnoid space is termed: Spinal anesthesia Susie Reynolds, a 9 year old softball player, has arrived in the OR for emergency repair of superficial facial and deep arm lacerations when she ran into the chain link fence during practice. The perioperative nurse discovers that Susie has an insulin pump that should remain connected during the short procedure. The RNFA should consider which of the following options for energy generated hemostasis? Bipolar electrosurgery unit Lateral, lateral chest and lateral kidney positions all place pressure on structures of the dependent side: ears, shoulder, ribs, hips, greater femoral head, knees and ankles. The potential for injury to the patient is significant, based on these pressure areas. Which resultant injury or harm could not be related to these lateral positions? ********look at pg 174 in 15th Ed and 173-174 in 16th Ed. ******** Which of the following regarding specimen labeling is a regulatory requirement? Biohazard information pg 32 15th Ed pg 27 16th Ed. Which of the following is a major infectious risk for healthcare workers? Hepatitis B The ideal suture material is one that has handling characteristics such as: Pliability The perianesthesia nurse completes a systematic and comprehensive secondary assessment of the patient (e. g. Head to toe assessment or major body systems approach). Select the response that best reflects the parameters of a comprehensive respiratory assessment. Rate, rhythm and breath sounds Ketamine is a short acting induction and IV or IM maintenance agent. Patients are able to maintain their airways. It is a suitable agent to use with small children and burn patients. The concerns with this agent is that in large doses it may cause: Respiratory depression Tissue reaction characteristics that need considered when choosing suture include: Absorption Sandra Williams was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled vaginal assisted laparoscopic hysterectomy. She demonstrates and verbalized that she understood al of the tenets of the procedure, risks, expected outcome, complications and procedural process. Before she signed the consent form, she informed the surgeon that she did not want any medical students or surgical residents performing any parts of the procedure other than assisting and did not want any photographs of her body taken. The surgeon agreed and she crossed out those portions of the form and initialed them before she signed. Sandy was exercising her: Right to informed consent What vaccine should healthcare workers receive if they are caring for immunocompromised patients? Inactivated influenza vaccine Sponge counts should be performed at the time of permanent relief of either the scrub person or the circulating nurse, and __________________ Pg 25 16th Ed In several studies, it was determined that the risk of contamination and subsequent infection to the wearer can be reduced by wearing two pair of sterile surgical gloves, as opposed to wearing one pair. Select the correct statement that refers to double gloving in terms of best practice. The cdc, the American college of surgeons and the American academy of orthopedic surgeons support double gloving during invasive surgical procedures. Pg 95 16 th Ed. Pg. 113 15th Ed. Suture can be used for more than repairing tissue. Choose uses of suture from the following. Ligate, suture and close tissue New synthetic polymer such as PDS provide wound support up to ______ months 3 What kind of needle would be used on the skin? Reverse cutting The highest risk of injury per needle use is attributed to the: Keith needle Which of the following statements reflect the location of the arcuate line? One third of the distance between the umbilicus and the symphysis pubis The intracorporeal suture technique uses the suture tying process analogous to the Instrument tie A stitch that is tied and cut before placing another stitch is called: Interrupted The surgical hand scrub is designed to render the hands, nails and arms Surgical clean If a sterile glove becomes contaminated during the procedure, the best practice odor corrective action is: Reglove with assisted gloving technique Jacob Sutzkever had a temperature of 103 degree f and returned to the OR for the debridement and washout of purple my drainage from his wound on postoperative day 3. What was wound classification at the time of his debridement and washout surgery? Infected wound classification IV The pediatric patient is at risk for imbalanced fluid volume related to invasive surgery and accompanying blood loss. Select the outcome indicator that would best reflect that the goal of maintaining fluid balance was attained. Blood pressure within acceptable range. In addition to healthcare workers in surgery, emergency care and OB, children with spina bifida and persons needing indwelling catheters seem to have a common risk factor for allergy development to which of the following? Latex Terminal cleaning and disinfection of the operating room should be done_____________ Overall housekeeping procedures, such as wall and ceiling washing should be completed on a defined regular basis and terminal cleaning and disinfection of operating and invasive procedure rooms should be performed when scheduled procedures are completed for the day or each regular 24 hour period. The most common pediatric premedication given in the U. S. is: Midazolam Which of the following is a true statement about the use of liquids in the OR? Skin prepping solution can cause chemical burns Which of the following are the sources of radiation exposure in an operating room setting? Lasers and C-arms Samuel Garcia, a 48 year old tetraplegic with a chronic sacral wound, is scheduled for another wound debridement. What is the purpose of doing a wound debridement on a chronic wound? The debridement will remove dead tissue that could support infection To protect the forearms, hands and clothing from contacting bacteria on the outside of the used gown and gloves, members of the scrubbed surgical team should use the following procedure to remove soiled gowns and gloves. Which choice lists the appropriate first 3 steps in the removal of the sterile gown? Wipe gloves clean, untie side gown closure, grasp gown at one shoulder seam After prepping the face, neck and upper chest for a radical neck dissection, the protective towels around the prep site were removed. The RNFA applied the head drape and completed draping the patient. During the preincision surgical time out, the fire risk score was determined to be high. When the surgeon noticed an area on the neck that did not look prepped. She asked for prep solution ona. Sponge and sponge forceps to complete the prep area, taking care not to moisten the head drape. After handing off the used sponge forceps she asked for the scalpel. What step was omitted in this process? The new prep area was not given time to dry. Whichinhalation anesthetic agent has the fastest onset of induction, emergence and recovery? Pg. 119 16th Ed. (Not desflurane) The manufacturer process of permanently connecting the suture thread to the needle is known as: Swaged Select the position device commonly used for the bariatric patients prior to intubation Upper body ramp Pressure against the skin above_______mmHg interferes with tissue perfusion 32 Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral and __________ nerve, which can result in injury from __________ Common peroneal; direct compression from the stirrup bars Rigo Vegas, a 24 year old tennis coach was scheduled as the first case for a knee arthroscopy. He has a family history of anesthesia and surgical complications. He admitted to eating a cheese steak and drinking 2 cans of beer the night before at 11:30 pm. On attempt at intubation, it was evident that total muscle relaxation had not been had not been achieved. The circulating nurse gently restrained Rigo's arms as he began to move and gag on the laryngoscopes. Rigo vomited undigested stomach contents. Intubation was achieved and a NG tune was inserted and connected to suction. Rigo experienced respiratory distress on extubation and was transferred to ICU with acute respiratory distress syndrome. Based on his preanesthetic history, aspiration could have been prevented by which measure? The perioperative nurse applying cricoid pressure during induction through intubation. The immature blood brain barrier and decreased protein binding in infants increase their sensitivity to which group of drugs? Opioids and hypnotics The nursing research and practice committee searched the scientific literature for information on smoke evacuation as they planned for a unit wide initiative to use this safety measure on all procedures where smoke or plume is generated. Their main concerns is that the surgeons will not be as willing to comply as the staff. Select the safety measure that will be the most critical and most challenging to enforce. Hold the smoke evacuation suction tube close to the tissue interaction site to remove as much plume as possible From the following g, choose the correct statement regarding closed gloving It can only be used for the initial gloving It is important for the RNFA to be aware of the ESU safety hazard when assisting with endoscopic surgery. Choose the correct answer from the following. Insulation failure While tucking the arms at the sides of the patient in supine position offers comfort, safety and easy access to the patient by the scrubbed team, improper positioning and securing of the arms can result in significant injury. Injury can be avoided by tucking the draw sheet__________ the arms and under the _________ Over, body Silk, when buried in tissue, loses its tensile strength after which period of time? 1 year While hypothermia was historically credited as the therapeutic modality benefitting all surgery because it decreases metabolism and reduces oxygen demand, inadvertent hypothermia is now recognized as impacting many critical physiologic functions and patient outcomes. Which of the following impairments can contribute to surgical site infections? Impaired wound healing