COMPLETE TEST BANK FOR
ALEXANDER’S CARE OF THE PATIENT IN SURGERY 15TH EDITION
BY ROTHROCK ALL CHAPTERS 1-27
,TABLE OF CONTENTS
CHAPTER 01: CONCEPTS BASIC TO PERIOPERATIVE NURSING ...................................................................... 3
CHAPTER 02: PATIENT SAFETY AND RISK MANAGEMENT ........................................................................... 13
CHAPTER 03: WORKPLACE ISSUES AND STAFF SAFETY ............................................................................... 26
CHAPTER 04: INFECTION PREVENTION AND CONTROL............................................................................... 37
CHAPTER 05: ANESTHESIA ........................................................................................................................... 55
CHAPTER 06: POSITIONING THE PATIENT FOR SURGERY ............................................................................ 73
CHAPTER 07: SUTURES, NEEDLES, AND INSTRUMENTS .............................................................................. 84
CHAPTER 08: SURGICAL MODALITIES .......................................................................................................... 96
CHAPTER 09: WOUND HEALING, DRESSINGS, AND DRAINS...................................................................... 110
CHAPTER 10: POSTOPERATIVE PATIENT CARE AND PAIN MANAGEMENT................................................ 121
CHAPTER 11: GASTROINTESTINAL SURGERY ............................................................................................. 134
CHAPTER 12: SURGERY OF THE LIVER, BILIARY TRACT, PANCREAS, AND SPLEEN ..................................... 143
CHAPTER 13: HERNIA REPAIR .................................................................................................................... 154
CHAPTER 14: GYNECOLOGIC AND OBSTETRIC SURGERY........................................................................... 165
CHAPTER 15: GENITOURINARY SURGERY .................................................................................................. 177
CHAPTER 16: THYROID AND PARATHYROID SURGERY .............................................................................. 188
CHAPTER 17: BREAST SURGERY................................................................................................................. 200
CHAPTER 18: OPHTHALMIC SURGERY ....................................................................................................... 212
CHAPTER 19: OTORHINOLARYNGOLOGIC SURGERY ................................................................................. 222
CHAPTER 20: ORTHOPEDIC SURGERY........................................................................................................ 244
CHAPTER 21: NEUROSURGERY .................................................................................................................. 257
CHAPTER 22: RECONSTRUCTIVE AND AESTHETIC PLASTIC SURGERY........................................................ 269
CHAPTER 23: THORACIC SURGERY ............................................................................................................ 281
CHAPTER 24: VASCULAR SURGERY............................................................................................................ 292
CHAPTER 25: CARDIAC SURGERY .............................................................................................................. 303
CHAPTER 26: PEDIATRIC SURGERY ............................................................................................................ 315
CHAPTER 27: GERIATRIC SURGERY ............................................................................................................ 325
CHAPTER 28: TRAUMA SURGERY .............................................................................................................. 337
CHAPTER 29: INTERVENTIONAL AND IMAGE-GUIDED PROCEDURES........................................................ 348
CHAPTER 30: INTEGRATIVE HEALTH PRACTICES ....................................................................................... 358
,CHAPTER 01: CONCEPTS BASIC TO PERIOPERATIVE NURSING
MULTIPLE CHOICE
1. THE PERIOPERATIVE PATIENT FOCUSED MODEL PRESENTS KEY COMPONENTS OF NURSING
INFLUENCE THAT GUIDE PATIENT CARE. SELECT THE STATEMENT THAT BEST DESCRIBES THE DYNAMIC
RELATIONSHIP WITHIN THE MODEL.
A. THE PATIENT EXPERIENCE AND THE NURSING PRESENCE ARE IN CONTINUOUS INTERACTION.
B. STRUCTURE, PROCESS, AND OUTCOME ARE THE FOUNDATION DOMAINS OF THE MODEL.
C. THE PERIOPERATIVE NURSE IS THE CENTRAL DYNAMIC CORE OF THE MODEL.
D. THE INTERRELATED NURSING PROCESS RINGS BIND THE PATIENT TO THE MODEL.
ANSWER: A
THE PERIOPERATIVE PATIENT FOCUSED MODEL CONSISTS OF DOMAINS OR AREAS OF NURSING
CONCERN: NURSING DIAGNOSES, NURSING INTERVENTIONS, AND PATIENT OUTCOMES. THESE
DOMAINS ARE IN CONTINUOUS INTERACTION WITH THE HEALTH SYSTEM THAT ENCIRCLES THE
FOCUS OF PERIOPERATIVE NURSING PRACTICE—THE PATIENT.
REF: P. 3
2. THE ASSOCIATION OF PERIOPERATIVE REGISTERED NURSES’ (AORN) STANDARDS OF
PERIOPERATIVE NURSING PRACTICE THAT DESCRIBES NURSING INTERACTIONS, INTERVENTIONS,
AND ACTIVITIES WITH PATIENTS FALLS UNDER WHICH STANDARDS CATEGORY?
A. EVIDENCE-BASED
B. PROCESS
C. OUTCOME
D. STRUCTURAL
ANSWER: B
PROCESS STANDARDS RELATE TO NURSING ACTIVITIES, INTERVENTIONS, AND INTERACTIONS. THEY
ARE USED TO EXPLICATE CLINICAL, PROFESSIONAL, AND QUALITY OBJECTIVES IN PERIOPERATIVE
NURSING.
REF: P. 3
3. WHICH ORDER BEST DESCRIBES THE PROCESS USED TO IMPLEMENT EVIDENCE-BASED PROFESSIONAL
NURSING?
A. LITERATURE SEARCH, THEORY REVIEW, DATA ANALYSIS, POLICY DEVELOPMENT
B. REGIONAL SURVEY, LITERATURE SEARCH, META-ANALYSIS, PRACTICE CHANGE
,C. IDENTIFY PROBLEM, SCIENTIFIC EVIDENCE, DEVELOP POLICY, EVALUATE OUTCOME
D. IDENTIFY ISSUE, ANALYZE SCIENTIFIC EVIDENCE, IMPLEMENT CHANGE, EVALUATE PROCESS
ANSWER: D
EVIDENCE-BASED PRACTICE IS A SYSTEMATIC, THOROUGH PROCESS BY WHICH TO IDENTIFY AN ISSUE,
TO COLLECT AND EVALUATE THE BEST EVIDENCE TO DESIGN AND IMPLEMENT A PRACTICE CHANGE,
AND TO EVALUATE THE PROCESS.
REF: P. 15
4. THE AMBULATORY SURGERY UNIT IS PLANNING TO DEVELOP A STANDARDIZED SKIN
PREPARATION PRACTICE FOR THEIR UNIT. THE BEST PROCESS TO GATHER SCIENTIFIC
INFORMATION IS TO:
A. CONDUCT A SURVEY OF SKIN PREP POLICIES AT THE NEXT AORN CHAPTER MEETING.
B. REVIEW THEIR SURGICAL SITE INFECTION DATA FROM THE LAST 6 MONTHS.
C. CONDUCT A LITERATURE SEARCH ON ANTIMICROBIAL AGENTS AND INFECTION PREVENTION.
D. REVIEW THE SCIENTIFIC LITERATURE FROM THE LEADING MANUFACTURERS OF PREP SOLUTIONS.
ANSWER: C
PERIOPERATIVE NURSES HAVE AN ETHICAL RESPONSIBILITY TO REVIEW PRACTICES AND TO MODIFY
THEM BASED UPON THE BEST AVAILABLE SCIENTIFIC EVIDENCE. USING RESEARCH TO GUIDE
PRACTICE IS CALLED EVIDENCE- BASED PRACTICE (EBP).
REF: P. 10
5. THE CARDIAC TEAM IS DEVELOPING A STANDARDIZED STERILE BACK TABLE SETUP AND IS
UNABLE TO FIND SUFFICIENT RESEARCH EVIDENCE FOR THEIR PROJECT. WHERE MIGHT THEY
LOOK FOR INFORMATION ON BEST PRACTICES?
A. SURVEY REGIONAL SURGICAL TECHNOLOGY PROGRAMS FOR THEIR BACK TABLE MODELS
B. REVIEW CASE STUDIES AND EXPERT OPINIONS ON STERILE BACK TABLE SETUPS
C. REVIEW AORN’S STANDARDS AND RECOMMENDED PRACTICES ON STERILIZATION
D. CONSULT WITH FACILITY INSTRUMENT VENDOR REPRESENTATIVES FOR THEIR ADVICE
ANSWER: B
WHEN THERE IS NOT ENOUGH EVIDENCE TO GUIDE PRACTICE, PERIOPERATIVE NURSES SHOULD
CONSIDER GATHERING INFORMATION FROM VARIED TRUSTED SOURCES THAT REFLECT BEST
PRACTICES.
REF: PP. 10-11
,6. HOW DO INSTITUTIONAL STANDARDS OF CARE, SUCH AS POLICIES AND PROCEDURES, DIFFER
FROM NATIONAL STANDARDS, SUCH AS AORN’S STANDARDS OF PERIOPERATIVE NURSING
PRACTICE?
A. THEY ARE WRITTEN BY NURSES.
B. THEY ARE WRITTEN SPECIFICALLY TO ADDRESS RESPONSIBILITIES AND CIRCUMSTANCES.
C. THEY ARE COLLABORATIVE AND COLLECTIVE AGREEMENT STATEMENTS.
D. THEY ARE RARELY BASED ON RESEARCH.
ANSWER: B
INSTITUTIONAL STANDARDS APPLY TO THE SYSTEM OR FACILITY THAT DEVELOPS THEM AND CAN BE
DIRECTIVE ABOUT SPECIFIC ACTIONS IN SPECIFIC CIRCUMSTANCES; NATIONAL STANDARDS PROVIDE
GENERALIZED AUTHORITATIVE STATEMENTS THAT CAN BE IMPLEMENTED IN ALL SETTINGS.
REF: P. 10
7. WHICH OF THE FOLLOWING ACTIONS BEST DESCRIBES AN ELEMENT OF THE PERIOPERATIVE NURSING
ASSESSMENT?
A. SCANNING THE SURGICAL SCHEDULE FOR THE DAY BEFORE MORNING REPORT
B. READING THE PICK/PREFERENCE LIST ATTACHED TO THE CASE CART
C. REVIEWING THE PATIENT MEDICAL RECORD
D. STUDYING AN ON-LINE TUTORIAL ABOUT THE INTENDED SURGICAL PROCEDURE
ANSWER: C
ASSESSMENT IS THE COLLECTION AND ANALYSIS OF RELEVANT HEALTH DATA ABOUT THE PATIENT.
SOURCES OF DATA MAY BE A PREOPERATIVE INTERVIEW WITH THE PATIENT AND THE PATIENT’S
FAMILY; REVIEW OF THE PLANNED SURGICAL OR INVASIVE PROCEDURE; REVIEW OF THE PATIENT’S
MEDICAL RECORD; EXAMINATION OF THE RESULTS OF DIAGNOSTIC TESTS; AND CONSULTATION WITH
THE SURGEON AND ANESTHESIA PROVIDER, UNIT NURSES, OR OTHER PERSONNEL.
REF: P. 3
8. A FRAIL 76-YEAR-OLD DIABETIC WOMAN IS SCHEDULED FOR MAJOR SURGERY. SHE IS VULNERABLE
AND AT HIGH RISK FOR HARM BECAUSE OF SEVERAL FACTORS RELATED TO HER PREEXISTING
CONDITIONS AND OVERALL HEALTH STATUS. AS PART OF DEVELOPING A PLAN TO GUIDE HER CARE, THE
NURSE USES STANDARDIZED DESCRIPTIVE TERMS. THIS STEP OF THE NURSING PROCESS IS CALLED:
A. NURSING DIAGNOSIS.
B. NURSING ASSESSMENT.
,C. NURSING OUTCOME.
D. NURSING INTERVENTION.
ANSWER: A
NURSING DIAGNOSIS IS THE PROCESS OF IDENTIFYING AND CLASSIFYING DATA COLLECTED IN THE
ASSESSMENT IN A WAY THAT PROVIDES A FOCUS TO PLAN NURSING CARE.
REF: P. 5
9. DURING THE ADMISSION INTERVIEW, THE NURSE INITIATED THE DISCHARGE TEACHING AND
DEMONSTRATED CRUTCH-WALKING ACTIVITIES. THE TEACHING ACTIVITIES ARE WHAT STAGE OF
THE NURSING PROCESS?
A. NURSING ASSESSMENT
B. NURSING IMPLEMENTATION
C. NURSING OUTCOME PREPARATION
D. NURSING EVALUATION
ANSWER: B
IMPLEMENTATION IS PERFORMING THE NURSING CARE ACTIVITIES AND INTERVENTIONS THAT
WERE PLANNED AND RESPONDING WITH CRITICAL THINKING AND ORDERLY ACTION TO CHANGES
IN THE SURGICAL PROCEDURE, PATIENT CONDITION, OR EMERGENCIES. IMPLEMENTATION IS THE
“WORK” OF NURSING.
REF: P. 6
10. WHILE CONDUCTING THE PREOPERATIVE INTERVIEW WITH A PATIENT SCHEDULED FOR A
SEPTOPLASTY, THE PERIOPERATIVE NURSE LEARNED THAT THE PATIENT WAS LATEX SENSITIVE. BASED
ON THIS KNOWLEDGE, THE NURSE REVIEWED THE PICK/PREFERENCE LIST AND REASSEMBLED THE
SURGICAL CASE CART SETUP TO REFLECT THIS NEW INFORMATION AND CHANGE IN CARE DELIVERY.
WHICH TWO PHASES OF THE NURSING PROCESS ARE REPRESENTED IN THE NURSE’S ACTIONS?
A. ASSESSMENT AND PLANNING
B. ASSESSMENT AND IMPLEMENTATION
C. PLANNING AND IMPLEMENTATION
D. NURSING DIAGNOSIS AND INTERVENTION
ANSWER: C
PLANNING IS PREPARING IN ADVANCE FOR WHAT WILL OR MAY HAPPEN AND DETERMINING THE
PRIORITIES FOR CARE. PLANNING IS BASED ON PATIENT ASSESSMENT RESULTS IN KNOWING THE
PATIENT AND THE PATIENT’S UNIQUE NEEDS. IMPLEMENTATION IS PERFORMING THE NURSING CARE
ACTIVITIES AND INTERVENTIONS THAT WERE PLANNED AND RESPONDING WITH CRITICAL THINKING
AND ORDERLY ACTION.
IMPLEMENTATION IS THE “WORK” OF NURSING.
,REF: P. 6
11. THE PERIOPERATIVE NURSE IMPLEMENTS PROTECTIVE MEASURES TO PREVENT SKIN OR TISSUE
INJURY CAUSED BY THERMAL SOURCES. SUCCESSFUL ACCOMPLISHMENT OF THIS INTERVENTION
WOULD MEET WHICH OF THE FOLLOWING DESIRED NURSING OUTCOMES?
A. THE PATIENT IS FREE FROM SIGNS AND SYMPTOMS OF INJURY FROM ANXIETY.
B. THE PATIENT IS FREE FROM SIGNS AND SYMPTOMS OF IMPAIRED SKIN INTEGRITY.
C. THE PATIENT IS FREE FROM SIGNS AND SYMPTOMS OF SURGICAL SITE INFECTION.
D. THE PATIENT IS FREE FROM SIGNS AND SYMPTOMS OF HYPERTHERMIA.
ANSWER: B
CHEMICAL AND THERMAL SOURCES USED IN SURGERY CAN CAUSE SKIN AND TISSUE BURNS (E.G.,
ELECTROSURGERY, POVIDINE-IODINE, RADIATION, LASERS). THE PATIENT BEING FREE FROM SIGNS
AND SYMPTOMS OF CHEMICAL INJURY, RADIATION INJURY, AND ELECTRICAL INJURY ARE APPROVED
NANDA- INTERNATIONAL NURSING DIAGNOSES.
REF: P. 5
12. THE NURSING DIAGNOSIS IS DERIVED FROM:
A. PATIENT DATA RETRIEVED FROM THE NURSING ASSESSMENT.
B. SYNTHESIZED CLUES FROM THE ADMITTING DIAGNOSIS AND SURGERY SCHEDULE.
C. THE APPROVED NANDA-INTERNATIONAL LIST ATTACHED TO THE PATIENT MEDICAL RECORD.
D. THE ADMISSION FORM ON THE FRONT OF THE CHART.
ANSWER: A
NURSING DIAGNOSIS IS THE PROCESS OF IDENTIFYING AND CLASSIFYING DATA COLLECTED IN THE
ASSESSMENT IN A WAY THAT PROVIDES A FOCUS TO PLAN NURSING CARE.
REF: P. 5
13. A 36-YEAR-OLD WOMAN WAS PREOPERATIVELY ADMITTED FOR LAPAROSCOPIC
CHOLECYSTECTOMY WITH OPERATIVE CHOLANGIOGRAM. SHE WAS THEN INTERVIEWED BY HER
PERIOPERATIVE NURSE IN THE PREOPERATIVE INTAKE LOUNGE. THE PATIENT’S WEIGHT ON
ADMISSION WAS 245 LB. AFTER THE ASSESSMENT, THE NURSE RETURNED TO THE OPERATING ROOM
(OR) AND MODIFIED THE STANDARD PLAN OF CARE BY INSTITUTING RISK REDUCTION STRATEGIES
THAT WERE DERIVED FROM INFORMATION FROM THE PREOPERATIVE ASSESSMENT. A GOOD
EXAMPLE OF THIS ACTION WOULD BEST BE DESCRIBED BY:
A. REPLACING THE REGULAR OR BED WITH A BARIATRIC-SPECIFIC OR BED.
B. PROVIDING PROTECTIVE LEAD APRONS FOR ALL STAFF DURING THE PROCEDURE.
C. WRITING THE PATIENT’S NAME, ALLERGIES, AND BODY WEIGHT ON THE WHITE BOARD.
,D. ADMINISTERING ANTIBIOTICS TO THE PATIENT 1 HOUR BEFORE THE INCISION.
ANSWER: A
PLANNING IS PREPARING IN ADVANCE FOR WHAT WILL OR MAY HAPPEN AND DETERMINING THE
PRIORITIES FOR CARE. PLANNING BASED ON PATIENT ASSESSMENT RESULTS IN KNOWING THE
PATIENT AND THE PATIENT’S UNIQUE NEEDS SO THAT ALTERATIONS IN EVENTS, SUCH AS
POSITIONING THE PATIENT ON A BARIATRIC- SPECIFIC OR BED AS OPPOSED TO A REGULAR OR BED,
CAN BE READILY ACCOMMODATED. REPLACING THE OR BED WITH A LARGER OR BED IS A NURSE-
SENSITIVE PREVENTIVE INTERVENTION THAT PROVIDES EQUIPMENT BASED ON PATIENT NEED.
REF: P. 6
14. ACCURATE DOCUMENTATION IS AN INTEGRAL PART OF ALL PHASES OF THE NURSING PROCESS.
FOR THIS REASON, PERIOPERATIVE NURSING CARE DOCUMENTATION:
A. SHOULD NOT INCLUDE TECHNICAL CARE.
B. MUST INCLUDE A DESCRIPTION OF PATIENT CARE DELIVERED AND PATIENT RESPONSE TO THAT
CARE.
C. MUST BE ALIGNED WITH APPROPRIATE PERIOPERATIVE NURSING DATA SET (PNDS) ELEMENTS.
D. WILL HAVE PNDS INTEGRATED INTO ALL MANDATORY FIELDS.
ANSWER: B
DOCUMENTATION OF THE NURSING CARE GIVEN SHOULD INCLUDE MORE THAN THE TECHNICAL
ASPECTS OF CARE, SUCH AS THE SPONGE COUNT OR THE APPLICATION OF THE ELECTROSURGICAL
DISPERSIVE PAD. NURSING CARE DOCUMENTATION SHOULD BE ASSOCIATED WITH THE ASSESSMENT
AND NURSING DIAGNOSES, WITH PRE- ESTABLISHED OUTCOMES AGAINST WHICH THE
APPROPRIATENESS AND EFFECTIVENESS OF CARE MAY BE JUDGED.
REF: P. 9
15. WHEN DELEGATING A TASK, SUCH AS REMOVING AN INTRAVENOUS (IV) CATHETER, TO AN
UNLICENSED INDIVIDUAL, THE PERIOPERATIVE NURSE:
A. STILL RETAINS RESPONSIBILITY AND AUTHORITY FOR THE OUTCOME OF THE TASK.
B. MUST COMPLY WITH THE SEVEN “RIGHTS” OF DELEGATION.
C. TRANSFERS THE AUTHORITY TO PERFORM THE TASK TO A COMPETENT PERSON.
D. TRANSFERS THE SUPERVISION OF THE COMPETENT PERSON TO ANOTHER COMPETENT PERSON.
ANSWER: C
DELEGATION TRANSFERS TO A COMPETENT PERSON WITH THE AUTHORITY TO PERFORM A
SELECTED NURSING TASK IN A SELECTED SITUATION ACCORDING TO THE FIVE “RIGHTS” OF
DELEGATION. WHEN THE PERIOPERATIVE NURSE DELEGATES A TASK, HE OR SHE RETAINS
ACCOUNTABILITY FOR THAT DELEGATION.
REF: P. 8
,16. A HOSPITAL NURSING EXCELLENCE CENTER FOR EDUCATION DEVELOPED STANDARDS FOR
NURSING ADVANCEMENT THAT WOULD REFLECT HIGH-LEVEL ACHIEVEMENT OF PROFESSIONAL
PERFORMANCE. THEY DEVELOPED A CLINICAL ADVANCEMENT LADDER BASED ON THE LEADING SKILL
AND KNOWLEDGE ACQUISITION MODEL AND ESTABLISHED WORTHY CRITERIA FOR EACH LEVEL.
SELECT THE RESPONSE THAT MIGHT BEST DESCRIBE THE HIGHEST LEVEL OF ACHIEVEMENT FOR A
PERIOPERATIVE STAFF NURSE.
A. CERTIFIED NURSE, OR (CNOR) CREDENTIAL, BSN, AND CHAIR OF THE NURSING RESEARCH
COMMITTEE
B. PUBLISHED ARTICLE IN THE HOSPITAL NEWSLETTER AND 15 YEARS’ SERVICE PIN
C. BCLS INSTRUCTOR AND WEEKEND EMERGENCY MEDICAL TECHNICIAN (EMT) TRANSPORT
D. PATIENT SAFETY CHAMPION AND NURSES' UNION REPRESENTATIVE
ANSWER: A
ACHIEVING CERTIFICATION (CNOR), PURSUING LIFELONG LEARNING, AND MAINTAINING COMPETENCY
AND CURRENT KNOWLEDGE IN PERIOPERATIVE NURSING ARE THE HALLMARKS OF THE PROFESSIONAL.
REF: P. 3
17. PERFORMANCE IMPROVEMENT ACTIVITIES IN THE PERIOPERATIVE PRACTICE SETTING ARE DESIGNED TO
PROMOTE:
A. COST SAVINGS BY ELIMINATING FINES FOR NEAR-MISSES AND NEVER EVENTS.
B. CUSTOMER SATISFACTION AND LOYALTY.
C. TIME MEASUREMENT ACTIVITIES.
D. EFFICIENT, EFFECTIVE, AND ETHICAL QUALITY CARE.
ANSWER: D
PERFORMANCE IMPROVEMENT EFFORTS ENCOMPASS IMPROVEMENTS IN QUALITY AND
EFFECTIVENESS, BASED ON ETHICAL AND ECONOMIC PERSPECTIVES. A PERFORMANCE
MEASUREMENT AND IMPROVEMENT APPROACH FACILITATES THE DELIVERY OF SAFE, HIGH-QUALITY
PERIOPERATIVE PATIENT CARE.
REF: P. 10
18. PERIOPERATIVE NURSING DIAGNOSES AND INTERVENTIONS ARE DIRECTED TOWARD, AND
GUIDED BY, THE TREMENDOUS RISKS FOR HARM TO THE PATIENT INHERENT IN SURGERY AND
INTERVENTIONAL PROCEDURES; THEREFORE NURSING ACTIONS CAN GENERALLY BE
CATEGORIZED AS:
A. THERAPEUTIC/RESTORATIVE.
B. PREVENTIVE/PROTECTIVE.
, C. CARING/COMFORTING.
ALEXANDER’S CARE OF THE PATIENT IN SURGERY 15TH EDITION
BY ROTHROCK ALL CHAPTERS 1-27
,TABLE OF CONTENTS
CHAPTER 01: CONCEPTS BASIC TO PERIOPERATIVE NURSING ...................................................................... 3
CHAPTER 02: PATIENT SAFETY AND RISK MANAGEMENT ........................................................................... 13
CHAPTER 03: WORKPLACE ISSUES AND STAFF SAFETY ............................................................................... 26
CHAPTER 04: INFECTION PREVENTION AND CONTROL............................................................................... 37
CHAPTER 05: ANESTHESIA ........................................................................................................................... 55
CHAPTER 06: POSITIONING THE PATIENT FOR SURGERY ............................................................................ 73
CHAPTER 07: SUTURES, NEEDLES, AND INSTRUMENTS .............................................................................. 84
CHAPTER 08: SURGICAL MODALITIES .......................................................................................................... 96
CHAPTER 09: WOUND HEALING, DRESSINGS, AND DRAINS...................................................................... 110
CHAPTER 10: POSTOPERATIVE PATIENT CARE AND PAIN MANAGEMENT................................................ 121
CHAPTER 11: GASTROINTESTINAL SURGERY ............................................................................................. 134
CHAPTER 12: SURGERY OF THE LIVER, BILIARY TRACT, PANCREAS, AND SPLEEN ..................................... 143
CHAPTER 13: HERNIA REPAIR .................................................................................................................... 154
CHAPTER 14: GYNECOLOGIC AND OBSTETRIC SURGERY........................................................................... 165
CHAPTER 15: GENITOURINARY SURGERY .................................................................................................. 177
CHAPTER 16: THYROID AND PARATHYROID SURGERY .............................................................................. 188
CHAPTER 17: BREAST SURGERY................................................................................................................. 200
CHAPTER 18: OPHTHALMIC SURGERY ....................................................................................................... 212
CHAPTER 19: OTORHINOLARYNGOLOGIC SURGERY ................................................................................. 222
CHAPTER 20: ORTHOPEDIC SURGERY........................................................................................................ 244
CHAPTER 21: NEUROSURGERY .................................................................................................................. 257
CHAPTER 22: RECONSTRUCTIVE AND AESTHETIC PLASTIC SURGERY........................................................ 269
CHAPTER 23: THORACIC SURGERY ............................................................................................................ 281
CHAPTER 24: VASCULAR SURGERY............................................................................................................ 292
CHAPTER 25: CARDIAC SURGERY .............................................................................................................. 303
CHAPTER 26: PEDIATRIC SURGERY ............................................................................................................ 315
CHAPTER 27: GERIATRIC SURGERY ............................................................................................................ 325
CHAPTER 28: TRAUMA SURGERY .............................................................................................................. 337
CHAPTER 29: INTERVENTIONAL AND IMAGE-GUIDED PROCEDURES........................................................ 348
CHAPTER 30: INTEGRATIVE HEALTH PRACTICES ....................................................................................... 358
,CHAPTER 01: CONCEPTS BASIC TO PERIOPERATIVE NURSING
MULTIPLE CHOICE
1. THE PERIOPERATIVE PATIENT FOCUSED MODEL PRESENTS KEY COMPONENTS OF NURSING
INFLUENCE THAT GUIDE PATIENT CARE. SELECT THE STATEMENT THAT BEST DESCRIBES THE DYNAMIC
RELATIONSHIP WITHIN THE MODEL.
A. THE PATIENT EXPERIENCE AND THE NURSING PRESENCE ARE IN CONTINUOUS INTERACTION.
B. STRUCTURE, PROCESS, AND OUTCOME ARE THE FOUNDATION DOMAINS OF THE MODEL.
C. THE PERIOPERATIVE NURSE IS THE CENTRAL DYNAMIC CORE OF THE MODEL.
D. THE INTERRELATED NURSING PROCESS RINGS BIND THE PATIENT TO THE MODEL.
ANSWER: A
THE PERIOPERATIVE PATIENT FOCUSED MODEL CONSISTS OF DOMAINS OR AREAS OF NURSING
CONCERN: NURSING DIAGNOSES, NURSING INTERVENTIONS, AND PATIENT OUTCOMES. THESE
DOMAINS ARE IN CONTINUOUS INTERACTION WITH THE HEALTH SYSTEM THAT ENCIRCLES THE
FOCUS OF PERIOPERATIVE NURSING PRACTICE—THE PATIENT.
REF: P. 3
2. THE ASSOCIATION OF PERIOPERATIVE REGISTERED NURSES’ (AORN) STANDARDS OF
PERIOPERATIVE NURSING PRACTICE THAT DESCRIBES NURSING INTERACTIONS, INTERVENTIONS,
AND ACTIVITIES WITH PATIENTS FALLS UNDER WHICH STANDARDS CATEGORY?
A. EVIDENCE-BASED
B. PROCESS
C. OUTCOME
D. STRUCTURAL
ANSWER: B
PROCESS STANDARDS RELATE TO NURSING ACTIVITIES, INTERVENTIONS, AND INTERACTIONS. THEY
ARE USED TO EXPLICATE CLINICAL, PROFESSIONAL, AND QUALITY OBJECTIVES IN PERIOPERATIVE
NURSING.
REF: P. 3
3. WHICH ORDER BEST DESCRIBES THE PROCESS USED TO IMPLEMENT EVIDENCE-BASED PROFESSIONAL
NURSING?
A. LITERATURE SEARCH, THEORY REVIEW, DATA ANALYSIS, POLICY DEVELOPMENT
B. REGIONAL SURVEY, LITERATURE SEARCH, META-ANALYSIS, PRACTICE CHANGE
,C. IDENTIFY PROBLEM, SCIENTIFIC EVIDENCE, DEVELOP POLICY, EVALUATE OUTCOME
D. IDENTIFY ISSUE, ANALYZE SCIENTIFIC EVIDENCE, IMPLEMENT CHANGE, EVALUATE PROCESS
ANSWER: D
EVIDENCE-BASED PRACTICE IS A SYSTEMATIC, THOROUGH PROCESS BY WHICH TO IDENTIFY AN ISSUE,
TO COLLECT AND EVALUATE THE BEST EVIDENCE TO DESIGN AND IMPLEMENT A PRACTICE CHANGE,
AND TO EVALUATE THE PROCESS.
REF: P. 15
4. THE AMBULATORY SURGERY UNIT IS PLANNING TO DEVELOP A STANDARDIZED SKIN
PREPARATION PRACTICE FOR THEIR UNIT. THE BEST PROCESS TO GATHER SCIENTIFIC
INFORMATION IS TO:
A. CONDUCT A SURVEY OF SKIN PREP POLICIES AT THE NEXT AORN CHAPTER MEETING.
B. REVIEW THEIR SURGICAL SITE INFECTION DATA FROM THE LAST 6 MONTHS.
C. CONDUCT A LITERATURE SEARCH ON ANTIMICROBIAL AGENTS AND INFECTION PREVENTION.
D. REVIEW THE SCIENTIFIC LITERATURE FROM THE LEADING MANUFACTURERS OF PREP SOLUTIONS.
ANSWER: C
PERIOPERATIVE NURSES HAVE AN ETHICAL RESPONSIBILITY TO REVIEW PRACTICES AND TO MODIFY
THEM BASED UPON THE BEST AVAILABLE SCIENTIFIC EVIDENCE. USING RESEARCH TO GUIDE
PRACTICE IS CALLED EVIDENCE- BASED PRACTICE (EBP).
REF: P. 10
5. THE CARDIAC TEAM IS DEVELOPING A STANDARDIZED STERILE BACK TABLE SETUP AND IS
UNABLE TO FIND SUFFICIENT RESEARCH EVIDENCE FOR THEIR PROJECT. WHERE MIGHT THEY
LOOK FOR INFORMATION ON BEST PRACTICES?
A. SURVEY REGIONAL SURGICAL TECHNOLOGY PROGRAMS FOR THEIR BACK TABLE MODELS
B. REVIEW CASE STUDIES AND EXPERT OPINIONS ON STERILE BACK TABLE SETUPS
C. REVIEW AORN’S STANDARDS AND RECOMMENDED PRACTICES ON STERILIZATION
D. CONSULT WITH FACILITY INSTRUMENT VENDOR REPRESENTATIVES FOR THEIR ADVICE
ANSWER: B
WHEN THERE IS NOT ENOUGH EVIDENCE TO GUIDE PRACTICE, PERIOPERATIVE NURSES SHOULD
CONSIDER GATHERING INFORMATION FROM VARIED TRUSTED SOURCES THAT REFLECT BEST
PRACTICES.
REF: PP. 10-11
,6. HOW DO INSTITUTIONAL STANDARDS OF CARE, SUCH AS POLICIES AND PROCEDURES, DIFFER
FROM NATIONAL STANDARDS, SUCH AS AORN’S STANDARDS OF PERIOPERATIVE NURSING
PRACTICE?
A. THEY ARE WRITTEN BY NURSES.
B. THEY ARE WRITTEN SPECIFICALLY TO ADDRESS RESPONSIBILITIES AND CIRCUMSTANCES.
C. THEY ARE COLLABORATIVE AND COLLECTIVE AGREEMENT STATEMENTS.
D. THEY ARE RARELY BASED ON RESEARCH.
ANSWER: B
INSTITUTIONAL STANDARDS APPLY TO THE SYSTEM OR FACILITY THAT DEVELOPS THEM AND CAN BE
DIRECTIVE ABOUT SPECIFIC ACTIONS IN SPECIFIC CIRCUMSTANCES; NATIONAL STANDARDS PROVIDE
GENERALIZED AUTHORITATIVE STATEMENTS THAT CAN BE IMPLEMENTED IN ALL SETTINGS.
REF: P. 10
7. WHICH OF THE FOLLOWING ACTIONS BEST DESCRIBES AN ELEMENT OF THE PERIOPERATIVE NURSING
ASSESSMENT?
A. SCANNING THE SURGICAL SCHEDULE FOR THE DAY BEFORE MORNING REPORT
B. READING THE PICK/PREFERENCE LIST ATTACHED TO THE CASE CART
C. REVIEWING THE PATIENT MEDICAL RECORD
D. STUDYING AN ON-LINE TUTORIAL ABOUT THE INTENDED SURGICAL PROCEDURE
ANSWER: C
ASSESSMENT IS THE COLLECTION AND ANALYSIS OF RELEVANT HEALTH DATA ABOUT THE PATIENT.
SOURCES OF DATA MAY BE A PREOPERATIVE INTERVIEW WITH THE PATIENT AND THE PATIENT’S
FAMILY; REVIEW OF THE PLANNED SURGICAL OR INVASIVE PROCEDURE; REVIEW OF THE PATIENT’S
MEDICAL RECORD; EXAMINATION OF THE RESULTS OF DIAGNOSTIC TESTS; AND CONSULTATION WITH
THE SURGEON AND ANESTHESIA PROVIDER, UNIT NURSES, OR OTHER PERSONNEL.
REF: P. 3
8. A FRAIL 76-YEAR-OLD DIABETIC WOMAN IS SCHEDULED FOR MAJOR SURGERY. SHE IS VULNERABLE
AND AT HIGH RISK FOR HARM BECAUSE OF SEVERAL FACTORS RELATED TO HER PREEXISTING
CONDITIONS AND OVERALL HEALTH STATUS. AS PART OF DEVELOPING A PLAN TO GUIDE HER CARE, THE
NURSE USES STANDARDIZED DESCRIPTIVE TERMS. THIS STEP OF THE NURSING PROCESS IS CALLED:
A. NURSING DIAGNOSIS.
B. NURSING ASSESSMENT.
,C. NURSING OUTCOME.
D. NURSING INTERVENTION.
ANSWER: A
NURSING DIAGNOSIS IS THE PROCESS OF IDENTIFYING AND CLASSIFYING DATA COLLECTED IN THE
ASSESSMENT IN A WAY THAT PROVIDES A FOCUS TO PLAN NURSING CARE.
REF: P. 5
9. DURING THE ADMISSION INTERVIEW, THE NURSE INITIATED THE DISCHARGE TEACHING AND
DEMONSTRATED CRUTCH-WALKING ACTIVITIES. THE TEACHING ACTIVITIES ARE WHAT STAGE OF
THE NURSING PROCESS?
A. NURSING ASSESSMENT
B. NURSING IMPLEMENTATION
C. NURSING OUTCOME PREPARATION
D. NURSING EVALUATION
ANSWER: B
IMPLEMENTATION IS PERFORMING THE NURSING CARE ACTIVITIES AND INTERVENTIONS THAT
WERE PLANNED AND RESPONDING WITH CRITICAL THINKING AND ORDERLY ACTION TO CHANGES
IN THE SURGICAL PROCEDURE, PATIENT CONDITION, OR EMERGENCIES. IMPLEMENTATION IS THE
“WORK” OF NURSING.
REF: P. 6
10. WHILE CONDUCTING THE PREOPERATIVE INTERVIEW WITH A PATIENT SCHEDULED FOR A
SEPTOPLASTY, THE PERIOPERATIVE NURSE LEARNED THAT THE PATIENT WAS LATEX SENSITIVE. BASED
ON THIS KNOWLEDGE, THE NURSE REVIEWED THE PICK/PREFERENCE LIST AND REASSEMBLED THE
SURGICAL CASE CART SETUP TO REFLECT THIS NEW INFORMATION AND CHANGE IN CARE DELIVERY.
WHICH TWO PHASES OF THE NURSING PROCESS ARE REPRESENTED IN THE NURSE’S ACTIONS?
A. ASSESSMENT AND PLANNING
B. ASSESSMENT AND IMPLEMENTATION
C. PLANNING AND IMPLEMENTATION
D. NURSING DIAGNOSIS AND INTERVENTION
ANSWER: C
PLANNING IS PREPARING IN ADVANCE FOR WHAT WILL OR MAY HAPPEN AND DETERMINING THE
PRIORITIES FOR CARE. PLANNING IS BASED ON PATIENT ASSESSMENT RESULTS IN KNOWING THE
PATIENT AND THE PATIENT’S UNIQUE NEEDS. IMPLEMENTATION IS PERFORMING THE NURSING CARE
ACTIVITIES AND INTERVENTIONS THAT WERE PLANNED AND RESPONDING WITH CRITICAL THINKING
AND ORDERLY ACTION.
IMPLEMENTATION IS THE “WORK” OF NURSING.
,REF: P. 6
11. THE PERIOPERATIVE NURSE IMPLEMENTS PROTECTIVE MEASURES TO PREVENT SKIN OR TISSUE
INJURY CAUSED BY THERMAL SOURCES. SUCCESSFUL ACCOMPLISHMENT OF THIS INTERVENTION
WOULD MEET WHICH OF THE FOLLOWING DESIRED NURSING OUTCOMES?
A. THE PATIENT IS FREE FROM SIGNS AND SYMPTOMS OF INJURY FROM ANXIETY.
B. THE PATIENT IS FREE FROM SIGNS AND SYMPTOMS OF IMPAIRED SKIN INTEGRITY.
C. THE PATIENT IS FREE FROM SIGNS AND SYMPTOMS OF SURGICAL SITE INFECTION.
D. THE PATIENT IS FREE FROM SIGNS AND SYMPTOMS OF HYPERTHERMIA.
ANSWER: B
CHEMICAL AND THERMAL SOURCES USED IN SURGERY CAN CAUSE SKIN AND TISSUE BURNS (E.G.,
ELECTROSURGERY, POVIDINE-IODINE, RADIATION, LASERS). THE PATIENT BEING FREE FROM SIGNS
AND SYMPTOMS OF CHEMICAL INJURY, RADIATION INJURY, AND ELECTRICAL INJURY ARE APPROVED
NANDA- INTERNATIONAL NURSING DIAGNOSES.
REF: P. 5
12. THE NURSING DIAGNOSIS IS DERIVED FROM:
A. PATIENT DATA RETRIEVED FROM THE NURSING ASSESSMENT.
B. SYNTHESIZED CLUES FROM THE ADMITTING DIAGNOSIS AND SURGERY SCHEDULE.
C. THE APPROVED NANDA-INTERNATIONAL LIST ATTACHED TO THE PATIENT MEDICAL RECORD.
D. THE ADMISSION FORM ON THE FRONT OF THE CHART.
ANSWER: A
NURSING DIAGNOSIS IS THE PROCESS OF IDENTIFYING AND CLASSIFYING DATA COLLECTED IN THE
ASSESSMENT IN A WAY THAT PROVIDES A FOCUS TO PLAN NURSING CARE.
REF: P. 5
13. A 36-YEAR-OLD WOMAN WAS PREOPERATIVELY ADMITTED FOR LAPAROSCOPIC
CHOLECYSTECTOMY WITH OPERATIVE CHOLANGIOGRAM. SHE WAS THEN INTERVIEWED BY HER
PERIOPERATIVE NURSE IN THE PREOPERATIVE INTAKE LOUNGE. THE PATIENT’S WEIGHT ON
ADMISSION WAS 245 LB. AFTER THE ASSESSMENT, THE NURSE RETURNED TO THE OPERATING ROOM
(OR) AND MODIFIED THE STANDARD PLAN OF CARE BY INSTITUTING RISK REDUCTION STRATEGIES
THAT WERE DERIVED FROM INFORMATION FROM THE PREOPERATIVE ASSESSMENT. A GOOD
EXAMPLE OF THIS ACTION WOULD BEST BE DESCRIBED BY:
A. REPLACING THE REGULAR OR BED WITH A BARIATRIC-SPECIFIC OR BED.
B. PROVIDING PROTECTIVE LEAD APRONS FOR ALL STAFF DURING THE PROCEDURE.
C. WRITING THE PATIENT’S NAME, ALLERGIES, AND BODY WEIGHT ON THE WHITE BOARD.
,D. ADMINISTERING ANTIBIOTICS TO THE PATIENT 1 HOUR BEFORE THE INCISION.
ANSWER: A
PLANNING IS PREPARING IN ADVANCE FOR WHAT WILL OR MAY HAPPEN AND DETERMINING THE
PRIORITIES FOR CARE. PLANNING BASED ON PATIENT ASSESSMENT RESULTS IN KNOWING THE
PATIENT AND THE PATIENT’S UNIQUE NEEDS SO THAT ALTERATIONS IN EVENTS, SUCH AS
POSITIONING THE PATIENT ON A BARIATRIC- SPECIFIC OR BED AS OPPOSED TO A REGULAR OR BED,
CAN BE READILY ACCOMMODATED. REPLACING THE OR BED WITH A LARGER OR BED IS A NURSE-
SENSITIVE PREVENTIVE INTERVENTION THAT PROVIDES EQUIPMENT BASED ON PATIENT NEED.
REF: P. 6
14. ACCURATE DOCUMENTATION IS AN INTEGRAL PART OF ALL PHASES OF THE NURSING PROCESS.
FOR THIS REASON, PERIOPERATIVE NURSING CARE DOCUMENTATION:
A. SHOULD NOT INCLUDE TECHNICAL CARE.
B. MUST INCLUDE A DESCRIPTION OF PATIENT CARE DELIVERED AND PATIENT RESPONSE TO THAT
CARE.
C. MUST BE ALIGNED WITH APPROPRIATE PERIOPERATIVE NURSING DATA SET (PNDS) ELEMENTS.
D. WILL HAVE PNDS INTEGRATED INTO ALL MANDATORY FIELDS.
ANSWER: B
DOCUMENTATION OF THE NURSING CARE GIVEN SHOULD INCLUDE MORE THAN THE TECHNICAL
ASPECTS OF CARE, SUCH AS THE SPONGE COUNT OR THE APPLICATION OF THE ELECTROSURGICAL
DISPERSIVE PAD. NURSING CARE DOCUMENTATION SHOULD BE ASSOCIATED WITH THE ASSESSMENT
AND NURSING DIAGNOSES, WITH PRE- ESTABLISHED OUTCOMES AGAINST WHICH THE
APPROPRIATENESS AND EFFECTIVENESS OF CARE MAY BE JUDGED.
REF: P. 9
15. WHEN DELEGATING A TASK, SUCH AS REMOVING AN INTRAVENOUS (IV) CATHETER, TO AN
UNLICENSED INDIVIDUAL, THE PERIOPERATIVE NURSE:
A. STILL RETAINS RESPONSIBILITY AND AUTHORITY FOR THE OUTCOME OF THE TASK.
B. MUST COMPLY WITH THE SEVEN “RIGHTS” OF DELEGATION.
C. TRANSFERS THE AUTHORITY TO PERFORM THE TASK TO A COMPETENT PERSON.
D. TRANSFERS THE SUPERVISION OF THE COMPETENT PERSON TO ANOTHER COMPETENT PERSON.
ANSWER: C
DELEGATION TRANSFERS TO A COMPETENT PERSON WITH THE AUTHORITY TO PERFORM A
SELECTED NURSING TASK IN A SELECTED SITUATION ACCORDING TO THE FIVE “RIGHTS” OF
DELEGATION. WHEN THE PERIOPERATIVE NURSE DELEGATES A TASK, HE OR SHE RETAINS
ACCOUNTABILITY FOR THAT DELEGATION.
REF: P. 8
,16. A HOSPITAL NURSING EXCELLENCE CENTER FOR EDUCATION DEVELOPED STANDARDS FOR
NURSING ADVANCEMENT THAT WOULD REFLECT HIGH-LEVEL ACHIEVEMENT OF PROFESSIONAL
PERFORMANCE. THEY DEVELOPED A CLINICAL ADVANCEMENT LADDER BASED ON THE LEADING SKILL
AND KNOWLEDGE ACQUISITION MODEL AND ESTABLISHED WORTHY CRITERIA FOR EACH LEVEL.
SELECT THE RESPONSE THAT MIGHT BEST DESCRIBE THE HIGHEST LEVEL OF ACHIEVEMENT FOR A
PERIOPERATIVE STAFF NURSE.
A. CERTIFIED NURSE, OR (CNOR) CREDENTIAL, BSN, AND CHAIR OF THE NURSING RESEARCH
COMMITTEE
B. PUBLISHED ARTICLE IN THE HOSPITAL NEWSLETTER AND 15 YEARS’ SERVICE PIN
C. BCLS INSTRUCTOR AND WEEKEND EMERGENCY MEDICAL TECHNICIAN (EMT) TRANSPORT
D. PATIENT SAFETY CHAMPION AND NURSES' UNION REPRESENTATIVE
ANSWER: A
ACHIEVING CERTIFICATION (CNOR), PURSUING LIFELONG LEARNING, AND MAINTAINING COMPETENCY
AND CURRENT KNOWLEDGE IN PERIOPERATIVE NURSING ARE THE HALLMARKS OF THE PROFESSIONAL.
REF: P. 3
17. PERFORMANCE IMPROVEMENT ACTIVITIES IN THE PERIOPERATIVE PRACTICE SETTING ARE DESIGNED TO
PROMOTE:
A. COST SAVINGS BY ELIMINATING FINES FOR NEAR-MISSES AND NEVER EVENTS.
B. CUSTOMER SATISFACTION AND LOYALTY.
C. TIME MEASUREMENT ACTIVITIES.
D. EFFICIENT, EFFECTIVE, AND ETHICAL QUALITY CARE.
ANSWER: D
PERFORMANCE IMPROVEMENT EFFORTS ENCOMPASS IMPROVEMENTS IN QUALITY AND
EFFECTIVENESS, BASED ON ETHICAL AND ECONOMIC PERSPECTIVES. A PERFORMANCE
MEASUREMENT AND IMPROVEMENT APPROACH FACILITATES THE DELIVERY OF SAFE, HIGH-QUALITY
PERIOPERATIVE PATIENT CARE.
REF: P. 10
18. PERIOPERATIVE NURSING DIAGNOSES AND INTERVENTIONS ARE DIRECTED TOWARD, AND
GUIDED BY, THE TREMENDOUS RISKS FOR HARM TO THE PATIENT INHERENT IN SURGERY AND
INTERVENTIONAL PROCEDURES; THEREFORE NURSING ACTIONS CAN GENERALLY BE
CATEGORIZED AS:
A. THERAPEUTIC/RESTORATIVE.
B. PREVENTIVE/PROTECTIVE.
, C. CARING/COMFORTING.
