,DOWNLOAD THE Test Bank for Alexander's Care of the Patient in Surgery16th Ed
h h h h h h h h h h h h h
ition Rothrock h
Chapter 02: Patient Safety and Risk Management
h h h h h h
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition
h h h h h h h h h
MULTIPLEhCHOICE
1. Governmentalhandhprofessionalhagencieshandhorganizations,hwhetherhvoluntaryhorhinvoluntary,h
havehahsignificanthinfluencehonhpatienthsafetyhpolicieshinhthehhealthcarehsetting.hSelecththehagenc
yhorhorganizationhstatemenththathpresentshahtruehreflectionhofhitshfocushorhpurpose.
a. ThehJointhCommissionh(TJC):hNonvoluntaryhbureauhthathtestshhealthcarehi
nstitutionshagainsthevidence-basedhelementshofhperformance
b. SurgicalhCarehImprovementhProjecth(SCIP):hTrendshsurgicalhsitehinfectionhstatistics
c. AmericanhSocietyhofhAnesthesiologistsh(ASA):hProfessionalhorganizationhofh
anesthesiahprovidershandhtechnologists
d. WorldhHealthhOrganizationh(WHO):hUnitedhNationsh(UN)–
basedhandhsupportedhauthorityhonhhealthhthroughouthmosthofhthehworld
ANS:h D
ThehUNhcreatedhWHOhtohfunctionhashitshhealthhoversighthandhcoordinationhauthorityhforhallhUNh
memberhnationshwhohinhturnhhavehjoinedhWHO.hInh2004,hWHOhlaunchedhthehWorldhAlliancehon
hPatienthSafety,hbyhwhichhithbeganhtohexaminehpatienthsafetyhinhacutehashwellhashinhprimaryhcarehs
ettingshrelevanthtohallhWHOhmemberhnations.hWHOhwashcreatedhbyhandhfunctionshwithinhthehUNh
ashthehdirectinghandhcoordinatinghauthorityhforhhealthhthroughouthUNhmemberhnations.
2. Sincehitshorganizationhandhestablishmenthashahprofessionalhnursinghassociationhinhthehearlyh1950
s,hthehAssociationhofhperiOperativehRegisteredhNursesh(AORN)hcontinueshitshendeavorhto:
a. promotehguidelineshinfluencinghpatienthsafety.
b. createhprofessionalhoperatinghroomh(OR)hnursinghcarehdeliveryhmodels.
c. interprethhealthcarehstatisticshcriticalhtohperioperativehnursinghcare.
d. ensurehriskhreductionhstrategiesharehthehfoundationhofhperioperativeheducation.
ANS:h A
AORNhprovideshanharrayhofhstandards,hrecommendedhpracticesh(RPs),hguidelines,h
publications,hvideos,handhtoolhkitshthathspecificallyhaddresshpatienthsafetyhfromhthehp
erioperativehteam’shpointhofhview.
3. Ahhealthyh32-year-oldhnursinghstudenthishscheduledhforhexcisionhofhahleft-
sidedhsubglottalhcysthwithhfrozenhsectionhandhpossiblehradicalhneckhdissection.hThehpreoperativeh
verificationhprocesshprovideshthehopportunityhtohcollecthandhverifyhinformationhabouththehpatienth
tohensurehpatienthsafety.hAmonghthehpatienthdatahthathmusthbehverifiedhare:
a. emergencyhcontacthname.
b. laboratoryhandhimaginghresults.
c. advancehdirectivehonhfile.
d. immunizationhrecords.
ANS:h B
Preprocedurehverificationhprocesshensureshthathallhrelevanthdocumentsh(e.g.,hthehhistoryhandhp
hysicalhexamination,hsurgicalhconsent,hrequiredhlaboratoryhstudies)handhimaginghstudiesh(prop
erlyhlabeledhandhdisplayed)harehavailablehbeforehthehstarthofhthehprocedure.hPreprocedurehverific
ationhishbesthconductedhwhenhthehpatienthcanhbehinvolvedhandhshouldhbehcompletedhbeforehthehp
atienthleaveshthehpreprocedureharea.
mynursytest.store
,DOWNLOAD THE Test Bank for Alexander's Care of the Patient in Surgery16th Ed
h h h h h h h h h h h h h
ition Rothrock h
4. Ahpatienthwashpositioned,hprepped,handhdrapedhfollowinghgeneralhendotrachealhanesthesiahi
nduction.hThehteamhassembledhtohperformhthehtime-
outhashdescribedhinhthehWHOhsurgicalhchecklist.hSuccessfulhemploymenthofhthehtime-
outhcanhonlyhbehensuredhwhen:
a. thehtime-outhishinitiatedhbyhthehsurgeon.
b. eachhmemberhofhthehteamhhashanhequalhrolehandhvoice.
c. perioperativehserviceshhavehahphysicianhchampionhandhsurgeonhbuy-in.
d. thehchecklisthishcommittedhtohmemoryhbyhallhteamhmembers.
ANS:h B
Allhmembershofhthehteamhmusthintroducehthemselveshbyhnamehandhrolehandhparticipatehinhsha
ringhcriticalhelementshofhcare.hThehteamhincludeshthehsurgeon,hanesthesiahprovider,handhnursi
nghstaff,hplushanyhalliedhorhancillaryhcarehprovidershcontributinghtohthehprocedurehwhenhthehti
me-outhishperformed.
5. Whenhunexpectedheventshoccurhthathhave,horhcouldhhave,hcompromisedhpatienthsafety,hahsyst
ematichinvestigatoryhprocesshtakeshplace.hSignificanthinformationhishgainedhthroughhthishmeti
culoushexploration.hThehprimaryhmotivehforhcarryinghouthahroothcausehanalysishishto:
a. establishhcausehandhtrendshbasedhonhwhohwashinvolved.
b. determinehpreciselyhwhathhappenedhandhwhy.
c. findhouthwhathneedshtohtakehplacehtohpreventhahrecurrencehofhthehevent.
d. uncoverhfactorshthathcontributedhtohthehenvironmenthandhthehevent.
ANS:h C
Roothcausehanalysishishahsystematizedhprocesshtohidentifyhvariationshinhperformancehthathcause,ho
rhcouldhcause,hahsentinelhevent.hThehanalysishphasehofhroothcausehanalysishprogresseshfromh“why
”hquestionshtoh“whathcanhbehdonehtohprevenththis”hquestionshthathflowhandhultimatelyhresulthinhan
hactionhplan.hRoothcausehanalysishconcentrateshonhsystemshandhprocesses,hnothindividuals.
6. ThehJointhCommissionh(TJC)hdesignateshsentinelheventshashunexpectedhoccurrenceshinvolvingh
deathhorhriskhofhserioushphysicalhorhpsychologichinjury.hInh2003,hTJChmandatedhthehUniversalhP
rotocolhtohaddresshperioperativehsentinelhevents.hThishprotocolhincludes:
a. improvinghthehsafetyhofhusinghmedications.
b. reportinghcriticalhresultshofhtestshinhahtimelyhmanner.
c. performinghahpreprocedurehverificationhprocess.
d. establishinghalarmhsystemhsafetyhashahpriority.
ANS:h C
Preprocedurehverificationhprocesshensureshthathallhrelevanthdocumentsh(e.g.,hthehhistoryhandhphy
sicalhexamination,hsurgicalhconsent,hrequiredhlaboratoryhstudies)handhimaginghstudiesh(properlyh
labeledhandhdisplayed)harehavailablehbeforehthehstarthofhthehprocedure.hPreprocedurehverification
hishbesthconductedhwhenhthehpatienthand/orhguardianhcanhbehinvolvedhandhshouldhbehcompletehbef
orehthehpatienthleaveshthehpreprocedureharea.hThehsurgicalhteamhmusthagreehthaththishishthehcorrec
thpatienthandhthehplannedhprocedurehonhthehspecifiedhsidehandhsite.hThehpreprocedurehverificatio
nhprocesshalsohincludeshconfirminghavailabilityhofhnecessaryhequipment,himplantshandhprosthese
s,hwhichhishreconfirmedhduringhthehtime-out.
mynursytest.store
, DOWNLOAD THE Test Bank for Alexander's Care of the Patient in Surgery16th Ed
h h h h h h h h h h h h h
ition Rothrock h
7. Ahpatienthwashtransferredhtohthehpostanesthesiahcarehunith(PACU)hbyhthehanesthesiahproviderhan
dhperioperativehnurse.hAhhand-
offhreporthwashgiven,husinghsituation,hbackground,hassessment,hrecommendationh(SBAR)hforma
t,htohthehacceptinghPACUhnurse.hThehfirsthelementhofhinformationhthathshouldhbehpresentedhinhtheh
hand-offhreporthis:
a. thehexpectedhdischargehcriteria.
b. thehnameshandhroleshofhthehnursehandhanesthesiahprovider.
c. patienthidentificationhandhprocedurehperformed.
d. painhmanagementhorders.
ANS:h C
Allhpatienthencountershshouldhbeginhwithhpatienthidentificationhverification.hThehreceivinghhea
lthcarehproviderhbearshthehresponsibilityhforhobtaininghallhofhthehinformationhneededhtohsafelyhc
arehforhthehpatienthbeforehthehtransferringhstaffhleaveshtheharea.hTimehforhclarificationhandhquest
ioninghmusthbehprovided.hThehpurposehofhhand-
offhcommunicationhandhreportshishtohprovidehessential,hup-to-
date,handhspecifichinformationhabouththehpatient.hStandardized
hand-offhcommunicationhmusthincludehanhopportunityhtohaskhandhrespondhtohquestions.
8. ThehORhishahdanger-
pronehareahforhbothhpatientshandhstaff.hProvidinghahsafehenvironmenthofhcarehforhthehpatienthinv
olveshidentifying,hmitigating,handhmanaginghthehhazardshinherenthinhsurgicalhcare.hChoosehtheh
answerhbelowhthathcompleteshthehblankshinhthishsentence:hthehriskhofhthehsurgicalhhazardhof
canhbehmitigatedhthrough
.
a. wronghpatient,hwronghsite,handhwronghsidehsurgery;hsitehmarkinghandhpresurgicalhc
hecklists
b. electricalhandhthermalhburns;halcohol-freehprephsolution
c. surgicalhsitehinfection;hflashhsterilization
d. surgicalhairwayhfire;hfirehextinguishershinheveryhOR
ANS:h A
Evidencehshowshthathwronghsitehsurgeryhnothonlyhcanhdevastatehthehpatienthandhfamilyhbuthalsohc
anhimpacththehperioperativehteamhadversely.hAllhinstitutionshaccreditedhbyhTJChmusthfollowhtheh
UniversalhProtocolhforhPreventinghWronghSite,hWronghProcedure,hWronghPersonhSurgery.hTheh
surgicalhteamhmusthagreehthaththishishthehcorrecthpatienthandhthaththehplannedhprocedurehishonhtheh
specifiedhsidehandhsite.hMarkinghthehsurgicalhsitehmusthbehdonehsohthaththehintendedhsitehofhincisi
onhorhinsertionhishclearhandhunambiguous.
9. Laparoscopichprocedureshthathemergentlyhconverthtohopenhprocedureshplacehthehpatienthathriskhf
orhunintentionalhretainedhsurgicalhitemsh(RSIs).hWhathnewhandhevolvinghriskhreductionhstrateg
yhcouldhpreventhRSIshandhfrustrating,htime-
consuminghmiscounthadventureshaththehendhofhthesehprocedures?
a. Creatinghprecountedhlaparotomyhsetshwithhonlyhthehfewhnecessaryhinstruments
b. Performinghradiologichsurveillancehonhallhconversionhprocedureshathclosure
c. Countinghallhinstrumentshincludinghahlaparotomyhsethbeforehthehlaparoscopy
d. Replacinghorhtagginghspongeshandhlaparotomyhinstrumentshwithhradiofrequencyhi
dentificationh(RFID)hchips
ANS:h D
mynursytest.store
h h h h h h h h h h h h h
ition Rothrock h
Chapter 02: Patient Safety and Risk Management
h h h h h h
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition
h h h h h h h h h
MULTIPLEhCHOICE
1. Governmentalhandhprofessionalhagencieshandhorganizations,hwhetherhvoluntaryhorhinvoluntary,h
havehahsignificanthinfluencehonhpatienthsafetyhpolicieshinhthehhealthcarehsetting.hSelecththehagenc
yhorhorganizationhstatemenththathpresentshahtruehreflectionhofhitshfocushorhpurpose.
a. ThehJointhCommissionh(TJC):hNonvoluntaryhbureauhthathtestshhealthcarehi
nstitutionshagainsthevidence-basedhelementshofhperformance
b. SurgicalhCarehImprovementhProjecth(SCIP):hTrendshsurgicalhsitehinfectionhstatistics
c. AmericanhSocietyhofhAnesthesiologistsh(ASA):hProfessionalhorganizationhofh
anesthesiahprovidershandhtechnologists
d. WorldhHealthhOrganizationh(WHO):hUnitedhNationsh(UN)–
basedhandhsupportedhauthorityhonhhealthhthroughouthmosthofhthehworld
ANS:h D
ThehUNhcreatedhWHOhtohfunctionhashitshhealthhoversighthandhcoordinationhauthorityhforhallhUNh
memberhnationshwhohinhturnhhavehjoinedhWHO.hInh2004,hWHOhlaunchedhthehWorldhAlliancehon
hPatienthSafety,hbyhwhichhithbeganhtohexaminehpatienthsafetyhinhacutehashwellhashinhprimaryhcarehs
ettingshrelevanthtohallhWHOhmemberhnations.hWHOhwashcreatedhbyhandhfunctionshwithinhthehUNh
ashthehdirectinghandhcoordinatinghauthorityhforhhealthhthroughouthUNhmemberhnations.
2. Sincehitshorganizationhandhestablishmenthashahprofessionalhnursinghassociationhinhthehearlyh1950
s,hthehAssociationhofhperiOperativehRegisteredhNursesh(AORN)hcontinueshitshendeavorhto:
a. promotehguidelineshinfluencinghpatienthsafety.
b. createhprofessionalhoperatinghroomh(OR)hnursinghcarehdeliveryhmodels.
c. interprethhealthcarehstatisticshcriticalhtohperioperativehnursinghcare.
d. ensurehriskhreductionhstrategiesharehthehfoundationhofhperioperativeheducation.
ANS:h A
AORNhprovideshanharrayhofhstandards,hrecommendedhpracticesh(RPs),hguidelines,h
publications,hvideos,handhtoolhkitshthathspecificallyhaddresshpatienthsafetyhfromhthehp
erioperativehteam’shpointhofhview.
3. Ahhealthyh32-year-oldhnursinghstudenthishscheduledhforhexcisionhofhahleft-
sidedhsubglottalhcysthwithhfrozenhsectionhandhpossiblehradicalhneckhdissection.hThehpreoperativeh
verificationhprocesshprovideshthehopportunityhtohcollecthandhverifyhinformationhabouththehpatienth
tohensurehpatienthsafety.hAmonghthehpatienthdatahthathmusthbehverifiedhare:
a. emergencyhcontacthname.
b. laboratoryhandhimaginghresults.
c. advancehdirectivehonhfile.
d. immunizationhrecords.
ANS:h B
Preprocedurehverificationhprocesshensureshthathallhrelevanthdocumentsh(e.g.,hthehhistoryhandhp
hysicalhexamination,hsurgicalhconsent,hrequiredhlaboratoryhstudies)handhimaginghstudiesh(prop
erlyhlabeledhandhdisplayed)harehavailablehbeforehthehstarthofhthehprocedure.hPreprocedurehverific
ationhishbesthconductedhwhenhthehpatienthcanhbehinvolvedhandhshouldhbehcompletedhbeforehthehp
atienthleaveshthehpreprocedureharea.
mynursytest.store
,DOWNLOAD THE Test Bank for Alexander's Care of the Patient in Surgery16th Ed
h h h h h h h h h h h h h
ition Rothrock h
4. Ahpatienthwashpositioned,hprepped,handhdrapedhfollowinghgeneralhendotrachealhanesthesiahi
nduction.hThehteamhassembledhtohperformhthehtime-
outhashdescribedhinhthehWHOhsurgicalhchecklist.hSuccessfulhemploymenthofhthehtime-
outhcanhonlyhbehensuredhwhen:
a. thehtime-outhishinitiatedhbyhthehsurgeon.
b. eachhmemberhofhthehteamhhashanhequalhrolehandhvoice.
c. perioperativehserviceshhavehahphysicianhchampionhandhsurgeonhbuy-in.
d. thehchecklisthishcommittedhtohmemoryhbyhallhteamhmembers.
ANS:h B
Allhmembershofhthehteamhmusthintroducehthemselveshbyhnamehandhrolehandhparticipatehinhsha
ringhcriticalhelementshofhcare.hThehteamhincludeshthehsurgeon,hanesthesiahprovider,handhnursi
nghstaff,hplushanyhalliedhorhancillaryhcarehprovidershcontributinghtohthehprocedurehwhenhthehti
me-outhishperformed.
5. Whenhunexpectedheventshoccurhthathhave,horhcouldhhave,hcompromisedhpatienthsafety,hahsyst
ematichinvestigatoryhprocesshtakeshplace.hSignificanthinformationhishgainedhthroughhthishmeti
culoushexploration.hThehprimaryhmotivehforhcarryinghouthahroothcausehanalysishishto:
a. establishhcausehandhtrendshbasedhonhwhohwashinvolved.
b. determinehpreciselyhwhathhappenedhandhwhy.
c. findhouthwhathneedshtohtakehplacehtohpreventhahrecurrencehofhthehevent.
d. uncoverhfactorshthathcontributedhtohthehenvironmenthandhthehevent.
ANS:h C
Roothcausehanalysishishahsystematizedhprocesshtohidentifyhvariationshinhperformancehthathcause,ho
rhcouldhcause,hahsentinelhevent.hThehanalysishphasehofhroothcausehanalysishprogresseshfromh“why
”hquestionshtoh“whathcanhbehdonehtohprevenththis”hquestionshthathflowhandhultimatelyhresulthinhan
hactionhplan.hRoothcausehanalysishconcentrateshonhsystemshandhprocesses,hnothindividuals.
6. ThehJointhCommissionh(TJC)hdesignateshsentinelheventshashunexpectedhoccurrenceshinvolvingh
deathhorhriskhofhserioushphysicalhorhpsychologichinjury.hInh2003,hTJChmandatedhthehUniversalhP
rotocolhtohaddresshperioperativehsentinelhevents.hThishprotocolhincludes:
a. improvinghthehsafetyhofhusinghmedications.
b. reportinghcriticalhresultshofhtestshinhahtimelyhmanner.
c. performinghahpreprocedurehverificationhprocess.
d. establishinghalarmhsystemhsafetyhashahpriority.
ANS:h C
Preprocedurehverificationhprocesshensureshthathallhrelevanthdocumentsh(e.g.,hthehhistoryhandhphy
sicalhexamination,hsurgicalhconsent,hrequiredhlaboratoryhstudies)handhimaginghstudiesh(properlyh
labeledhandhdisplayed)harehavailablehbeforehthehstarthofhthehprocedure.hPreprocedurehverification
hishbesthconductedhwhenhthehpatienthand/orhguardianhcanhbehinvolvedhandhshouldhbehcompletehbef
orehthehpatienthleaveshthehpreprocedureharea.hThehsurgicalhteamhmusthagreehthaththishishthehcorrec
thpatienthandhthehplannedhprocedurehonhthehspecifiedhsidehandhsite.hThehpreprocedurehverificatio
nhprocesshalsohincludeshconfirminghavailabilityhofhnecessaryhequipment,himplantshandhprosthese
s,hwhichhishreconfirmedhduringhthehtime-out.
mynursytest.store
, DOWNLOAD THE Test Bank for Alexander's Care of the Patient in Surgery16th Ed
h h h h h h h h h h h h h
ition Rothrock h
7. Ahpatienthwashtransferredhtohthehpostanesthesiahcarehunith(PACU)hbyhthehanesthesiahproviderhan
dhperioperativehnurse.hAhhand-
offhreporthwashgiven,husinghsituation,hbackground,hassessment,hrecommendationh(SBAR)hforma
t,htohthehacceptinghPACUhnurse.hThehfirsthelementhofhinformationhthathshouldhbehpresentedhinhtheh
hand-offhreporthis:
a. thehexpectedhdischargehcriteria.
b. thehnameshandhroleshofhthehnursehandhanesthesiahprovider.
c. patienthidentificationhandhprocedurehperformed.
d. painhmanagementhorders.
ANS:h C
Allhpatienthencountershshouldhbeginhwithhpatienthidentificationhverification.hThehreceivinghhea
lthcarehproviderhbearshthehresponsibilityhforhobtaininghallhofhthehinformationhneededhtohsafelyhc
arehforhthehpatienthbeforehthehtransferringhstaffhleaveshtheharea.hTimehforhclarificationhandhquest
ioninghmusthbehprovided.hThehpurposehofhhand-
offhcommunicationhandhreportshishtohprovidehessential,hup-to-
date,handhspecifichinformationhabouththehpatient.hStandardized
hand-offhcommunicationhmusthincludehanhopportunityhtohaskhandhrespondhtohquestions.
8. ThehORhishahdanger-
pronehareahforhbothhpatientshandhstaff.hProvidinghahsafehenvironmenthofhcarehforhthehpatienthinv
olveshidentifying,hmitigating,handhmanaginghthehhazardshinherenthinhsurgicalhcare.hChoosehtheh
answerhbelowhthathcompleteshthehblankshinhthishsentence:hthehriskhofhthehsurgicalhhazardhof
canhbehmitigatedhthrough
.
a. wronghpatient,hwronghsite,handhwronghsidehsurgery;hsitehmarkinghandhpresurgicalhc
hecklists
b. electricalhandhthermalhburns;halcohol-freehprephsolution
c. surgicalhsitehinfection;hflashhsterilization
d. surgicalhairwayhfire;hfirehextinguishershinheveryhOR
ANS:h A
Evidencehshowshthathwronghsitehsurgeryhnothonlyhcanhdevastatehthehpatienthandhfamilyhbuthalsohc
anhimpacththehperioperativehteamhadversely.hAllhinstitutionshaccreditedhbyhTJChmusthfollowhtheh
UniversalhProtocolhforhPreventinghWronghSite,hWronghProcedure,hWronghPersonhSurgery.hTheh
surgicalhteamhmusthagreehthaththishishthehcorrecthpatienthandhthaththehplannedhprocedurehishonhtheh
specifiedhsidehandhsite.hMarkinghthehsurgicalhsitehmusthbehdonehsohthaththehintendedhsitehofhincisi
onhorhinsertionhishclearhandhunambiguous.
9. Laparoscopichprocedureshthathemergentlyhconverthtohopenhprocedureshplacehthehpatienthathriskhf
orhunintentionalhretainedhsurgicalhitemsh(RSIs).hWhathnewhandhevolvinghriskhreductionhstrateg
yhcouldhpreventhRSIshandhfrustrating,htime-
consuminghmiscounthadventureshaththehendhofhthesehprocedures?
a. Creatinghprecountedhlaparotomyhsetshwithhonlyhthehfewhnecessaryhinstruments
b. Performinghradiologichsurveillancehonhallhconversionhprocedureshathclosure
c. Countinghallhinstrumentshincludinghahlaparotomyhsethbeforehthehlaparoscopy
d. Replacinghorhtagginghspongeshandhlaparotomyhinstrumentshwithhradiofrequencyhi
dentificationh(RFID)hchips
ANS:h D
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