ROTHROCK ALEXANDER’S CARE OF THE PATIENT IN SURGERY, 16TH EDITION TEST BANK ALL CHAPTERS COVERED.

Chapter 03: Workplace Issues and Staff Safety Test Bank MULTIPLE CHOICE 1. What one factor describes the high incidence of musculoskeletal disorders (MSDs) among surgical technologists and perioperative nurses? a. Pulling a large, heavy piece of equipment rather than pushing it b. The cumulative effect of repeated patient handling events c. The growing high obesity rate and heavier patients and care providers d. The cumulative effect of pushing, pulling, and carrying heavy instrument sets and rolling carts ANS: B The high incidence of MSDs among nurses is the cumulative effect of repeated patient handling events, often involving unsafe loads. Nurses and surgical technologists often lift, transfer, or reposition patients on OR beds and transport vehicles, and assist with prepping with their arms outstretched or their bodies bent forward in awkward postures and positions, increasing the risk for injury. REF: p. 47 2. The lifting equation provides a mathematical equation to determine the recommended weight limit (RWL) and lifting index (LI) for selected two-handed manual lifting tasks. What is the recommended maximum weight limit for one person in a patient handling task, and what is the best option when the weight limit exceeds the recommendation? a. 25 lb; bend from the knees, not the waist b. 32 lb; use good body mechanics c. 35 lb; wear a support belt d. 37 lb; use assistive lift devices ANS: D The concept behind the lifting equation is to start with a recommended weight that is considered safe for an ideal lift and then to reduce the weight as the task becomes more stressful. In general, the revised equation yields a recommended 35-lb maximum weight limit for use in patient handling tasks. When the weight to be lifted exceeds this limit, assistive devices should be used. REF: pp. 49-50 3. Wet floors are a common hazard causing slips, trips, and falls (STFs). Select a prevention strategy that is a best practice for preventing STFs from spills on wet floors. a. Transport liquids in covered containers with lids in place. b. Place bright yellow low-profile pop-up signs in areas where STFs are most likely to occur. c. Position highly visible yellow absorptive pads in areas where STFs are most likely to occur. d. Use a dripless, brush-free gel solution for surgical patient skin preps. ANS: A Planning to avoid wet spots can reduce the rate of falls. Providing lids for all cups or other open containers being transported helps to avoid spills. REF: p. 50 4. An STF hazard is present when the scrub person stands on a lift, or foot stool, to reach an acceptable height for ergonomic comfort with the sterile field. Whether the scrub person uses one stool, stacked stools, or a “runway” of stools, the danger exists that a fall could occur. What classification of cause and prevention factor does this situation represent? a. Proper footwear b. Unobstructed pathways c. Uneven floor surface d. Lighting ANS: C Falls on the same level also occur at transition areas, such as from dry to wet, on uneven surfaces, or from one type of floor surface to another. Healthcare facilities should ensure that there are no uneven surfaces, including thresholds, on floors. In stairwells with potentially low visibility, the nosing on the top and bottom steps can be painted to provide visual cues. REF: p. 50 5. A sharps-safe area on the sterile field between the scrub person and the surgeon—where sharps can be transferred to the surgeon from the scrub person and returned to the scrub person after use—is referred to as the: a. sharps zone. b. hands-free zone. c. neutral zone. d. safety zone. ANS: C The “neutral zone” has been defined as a location on the surgical field where sharps are placed in a predesignated sterile basin or tray or on a magnetic pad, from which the surgeon or assistant can retrieve them. After use, the items are returned to the neutral zone, and the scrub person retrieves them. This technique eliminates hand-to-hand passing of sharps between the surgeon and the scrub person, so that no two individuals touch the same sharp at the same time. REF: p. 52 6. Select the appropriate nursing action that supports hands-free instrument passing and sharps safety. a. Create a neutral hands-free area between the scrub person and surgeon with a basin or magnetic mat. b. Use a hands-free area for sharps and all small clamps or sponges. c. Announce the transfer of the sharp or clamp as soon as possible after it is placed. d. During the hand-off report, ask the relief scrub person if he/she will want to use the hands-free technique for passing sharps. ANS: A A magnetic pad or basin may be used to create the neutral zone; if a basin is used, it should be placed on the field and not held by the scrub person. Dedicate the neutral zone to sharps only; these include suture and hypodermic needles, scalpels, and other sharp instruments. Place only one sharp at a time in the neutral zone. Announce the transfer of a sharp before placing it in the neutral zone (such as “knife down”). Include identification of the neutral zone during hand-off communications to relief scrub persons. REF: p. 52 7. Select the true statement that best explains the Occupational Safety and Health Administration (OSHA) exposure control plan (ECP). a. OSHA has developed the Hierarchy of Controls model, which protects the workplace from lawsuits stemming from worker injury from sharps and blood exposure. b. The OSHA ECP is similar to the Health Insurance Portability and Accountability Act (HIPAA) in that it protects the workplace from being exposed when a worker injury occurs that could harm the facility’s reputation. c. The OSHA ECP is designed to provide guidelines to control risks and protect workers from sharps injury and bloodborne pathogens. d. The OSHA ECP is a materials management strategy to explore replacements for sharps and other healthcare devices that can cause sharps injury and blood exposure. ANS: C OSHA regulations require healthcare organizations to protect their workers and to have a sharps injury and bloodborne pathogen ECP. At a minimum, the following must be included in the ECP: determination of employee exposure; implementation of exposure control methods, including universal precautions, engineering and work-practice controls, personal protective equipment (PPE) and housekeeping, hepatitis B vaccination, postexposure evaluation and follow-up, communication of hazards to employees and training, recordkeeping, and procedures to evaluate exposure incidents. REF: pp. 54-55 8. Select the true statement that best describes a key component of the culture of safety in regards to blood exposure. a. A goal of the culture of safety is to reduce the risk of blood exposure and sharps injuries to staff. b. The culture of safety is a model for ensuring The Joint Commission survey expectations are met. c. The culture of safety is mandated by regulatory agencies to structure environmental rounds. d. The ECP was designed to provide the framework for the culture of safety. ANS: A A healthcare institution’s culture of safety profoundly impacts its success or failure in reducing employees’ blood exposure risk. For sharps safety in particular, success factors include effective systematic review of exposure data, workers’ perceptions of exposure risk, availability and use of safety devices, and comprehensive education on bloodborne pathogen exposure risk and safety device use. REF: p. 55 9. Select the guideline that complements the design of the culture of safety model. a. Take advantage of a personal injury event to learn about future prevention strategies. b. Comply with those policies that fit your current practice. c. Incorporate safe practices into your daily work when handling sharps. d. Observe local, state, and federal regulations as they fit your current practice. ANS: C You can take significant measures toward ensuring your personal safety and avoiding injuries from sharps if you do the following: Adopt and incorporate safe habits into daily work activities when preparing and using sharp devices. Observe local, state, and federal (OSHA) regulations. Comply with methods to protect yourself from disease transmission (e.g., get the hepatitis B vaccination). Participate in education about bloodborne pathogens, and follow recommended infection prevention practices. Know the location in your department of the ECP. Finally, follow the exposure control policy if injured, including immediate reporting of the incident and commencement of exposure response procedures. REF: pp. 55, 61 10. What is the purpose of a Safety Data Sheet (SDS)? a. To recommend exposure limits of all chemicals in the workplace over a working lifetime b. To inform all employees of the presence, characteristics, handling, and risks of chemicals in the workplace c. To provide a structured design for inservices and skill stations on hazardous chemical safety d. To promote the development of manuals and log books for The Joint Commission (TJC) survey ANS: B The purpose of the OSHA standards is to ensure that all hazards of chemicals produced or imported are evaluated and that information concerning hazards is transmitted to employers and employees. Responsibility to inform workers about chemical hazards and to use control measures, including providing PPE, rests with the employer. The OSHA hazard communication standard requires all manufacturers and importers of hazardous chemicals to develop SDSs for all chemicals and mixtures of chemicals. REF: p. 62 11. Where are the sources of radiation exposure in an operating room setting? a. Ionizing sources (e.g., ultrasound machines) and nonionizing sources (e.g., magnetic resonance imaging [MRI] scanners) b. Nonattenuated fluorescent lights and portable X-ray machines without lead guards c. Radioactive seed implants not contained in a lead container and nonionizing lasers d. Nonionizing sources (e.g., lasers) and ionizing sources (e.g., X-ray machines and C-arms) ANS: D Sources of radiation exposure in the OR include ionizing sources, such as portable radiography (X-ray) machines and portable fluoroscopy units (C-arm), and nonionizing sources, such as lasers. REF: p. 63 12. Which of the following may be a consequence of high-dose or full-body radiation? a. Contrast media reaction b. Perioral numbness and tingling c. Nausea, vomiting, and diarrhea d. Wheezing, dyspnea, and tachycardia ANS: C Acute exposure to ionizing radiation can result in dermatitis and reddening of the skin (erythema) at the point of exposure, while large, full-body exposures can lead to radiation poisoning, symptoms of which may include nausea, vomiting, diarrhea, weakness, and death. REF: p. 63 13. Latex allergy develops from exposure to natural rubber latex and plant cytosol, used extensively to manufacture medical gloves and other devices, as well as numerous consumer products. Allergic reactions to latex range from skin disease to asthma and anaphylaxis that can result in chronic illness, disability, career loss, hardship, and death. Which signs and symptoms would be indicative of an allergic contact dermatitis response to contact with natural rubber latex? a. Pruritus, edema, erythema, and vesicles that develop 6 to 48 hours after exposure b. Dry, reddened, itchy skin with hives and peeling patches c. Cracked hands, nausea, vomiting, and perioral numbness and tingling d. Generalized urticaria, wheezing, dyspnea, and tachycardia ANS: A Allergic contact dermatitis is a delayed reaction, usually appearing 6 to 48 hours after exposure. Symptoms are similar to those from irritant contact dermatitis (i.e., drying papules, crusting and thickening of the skin), except that the reaction may extend beyond the actual point of contact. Allergic contact dermatitis (also called chemical contact dermatitis) is a delayed cell-mediated type IV localized allergy caused by chemicals used to manufacture rubber products. REF: p. 64 14. A nurse anesthesia provider has an allergy to latex. When she is at work, she always carries an epinephrine autoinjector and a beta-agonist inhaler. What type of latex allergy does she have? a. Allergic contact dermatitis b. Irritant contact dermatitis c. Type I IgE-mediated hypersensitivity reaction d. Combined-effect latex allergy ANS: C A true latex allergy is a type I IgE-mediated hypersensitivity reaction that involves systemic antibody formation to proteins in products made from natural rubber latex. The allergic response is immediate and anaphylactic. Medications include epinephrine for reaction (may be autoinjector and carried by individual), beta-agonist inhaler, prednisone, and other anaphylactic life-supporting medications. REF: pp. 64-65 15. Healthcare professionals should employ strategies to reduce their risk of allergic reaction to latex in the perioperative environment. Which of the following represents a best practice for minimizing the risk of latex allergy development in nonallergic patients and the risk of a reaction in sensitive or allergic patients? a. Use powder-free gloves that have low levels of protein and chemical allergens. b. Use sterile oil-based hand creams before donning gloves if latex gloves must be worn. c. Before donning latex gloves, sprinkle hands with cornstarch to create a barrier between skin and gloves. d. Wear an OR hat without an elastic band and do not wear rubber tennis shoes. ANS: A Use powder-free gloves that are low in protein and chemical allergens. Use nonlatex gloves for activities that are not likely to involve contact with infectious materials. REF: p. 65 16. Which list of medications best reflects medications indicated for latex sensitivity therapeutic management? a. Epinephrine, prednisone, and a beta-agonist inhaler b. Atropine, dopamine, and beta-blockers c. Dopamine, mannitol, and sodium bicarbonate d. Dimethylxanthine, atropine, and mannitol ANS: A Medications used during a reaction include epinephrine (may be autoinjector and carried by individual), beta-agonist inhaler, prednisone, and other anaphylactic life-supporting medications. REF: p. 66 17. Perioperative personnel historically have relied on numerous types of precautions to protect themselves and others from bloodborne pathogens and other infectious diseases. Select the statement that best differentiates between universal and standard precautions. a. Universal precautions and standard precautions are the same; however, standard precautions require more hand hygiene and prevention of sharps injuries. b. Many similarities and differences exist between universal and standard precautions; however, they both are equally effective against transmission-based disease. c. Standard precautions apply to blood; all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood; mucous membranes; and nonintact skin. d. Universal precautions is the same as blood and body fluid precautions