AORN Periop 101 Final Exam Questions with Correct Solutions.

AORN Periop 101 Final Exam Questions with Correct Solutions Indemnity Payment - ANS: Payment made on behalf of the policy holder Liability - ANS: A legal responsibility Negligence - ANS: An act or failure to act that deviates from the standard of care Nursing Malpractice - ANS: A nurse's negligence or any intentional act that causes physical, financial, emotional, psychosocial, and/or cognitive damage to the person in the nurse's care Respondeat Superior - ANS: An employer is legally responsible for the nurse employee only when: o The nurse acts within the scope of practice o Any allegations brought against the nurse occurred during the nurse's employment o The nurse's actions were within the employer's best interests. Tort - ANS: A breach of duty to another person as outlined by law What are the four elements of malpractice? - ANS: • Duty • Breach of duty • The breach of duty caused an injury • The injury was harmful to the patient Elements of Informed Consent - ANS: • Must be obtained by the licensed professional who is performing the procedure • The patient must give consent voluntarily with the full understanding of all implications • Must include o Diagnosis o Proposed treatment o Treatment alternatives o Consequences of accepting or declining the proposed treatment Five Rights of Delegation - ANS: Right task Right circumstance Right person Right communication and direction Right supervision and evaluation Four types of patient privacy health care providers and personnel have an ethical and legal responsibility to always maintain - ANS: • Medical information • Physical exposure • Personal privacy • Electronic privacy Eight factors to consider before determining what anesthetic to use for a particular patient - ANS: • Patient's age • Length & type of surgery • Patient & surgeon preferences • Patient's co-existing diseases • Patient's mental & psychological status • Patient's previous experiences with anesthesia • Plans & protocols for postoperative pain management • Position of the patient during surgery The American Society of Anesthesiologist's NPO Guidelines - ANS: • Clear liquids - stop 2 hours before surgery • Breast milk - stop 4 hours before surgery • Infant formula - stop 6 hours before surgery • Light meal (toast & a clear liquid) - stop 6 hours before surgery • Fried foods, fatty foods, meat - stop 8 hours before surgery Circulator RN duties during Induction of anesthesia and assisting anesthesia professional with Cricoid Pressure - ANS: • Cricoid pressure application is not released until the endotracheal (ET) tube cuff is inflated, tube placement is confirmed, and anesthesia provider has given a verbal confirmation to the nurse that the cricoid pressure can be released. • If intubation or ventilation of the patient becomes difficult, the perioperative nurse should retrieve additional airway equipment and supplies. General anesthesia - ANS: • A drug-induced reversible state of unconsciousness • Results in amnesia, analgesia, and loss of responsiveness, decreased stress response, and loss of skeletal muscle reflexes to a varying degree Regional anesthesia - ANS: • An injection of local anesthetics near nerve fibers that causes reversible loss of sensation over an area of the body • Examples include spinal, epidural, and peripheral nerve blocks. Monitored anesthesia care (MAC) - ANS: An anesthesia provider monitors the patient, administers sedatives and other agents as needed, and provides medical services as required. Moderate sedation - ANS: • The administration of sedative, analgesic, and/or anxiolytic agents by a physician or by a nurse under physician supervision • Depending on state laws and hospital policies, an RN may administer moderate sedation. Local anesthesia - ANS: • The infiltration or topical administration of agents to anesthetize a part of the body • The perioperative nurse provides patient monitoring and supportive care. Phases of general anesthesia - ANS: • Phase I: Induction o IV medications and inhalational agents are administered by the anesthesia provider. • Phase II: Maintenance o Medications and inhalational agents are administered to keep the patient anesthetized. • Phase III: Emergence o At the end of the procedure, the anesthetic agents are discontinued or reversed to allow the patient to wake up. Anesthesia Reversal agents: Muscle relaxants: - ANS: 1. neostigmine 2. edrophonium. Note: There is no reversal agent for succinylcholine Anesthesia Reversal agents: Sugammadex: - ANS: reversal agent for rocuronium, vecuronium, and pancuronium Anesthesia Reversal agents: Benzodiazepines: Midazolam - ANS: Flumazenil Anesthesia Reversal agents: Narcotics: Fentanyl: - ANS: Naloxone Patients at Increased Risk for Hypothermia - ANS: • Older adults • Infants and children • Women • Patients with lower-than-normal body weight Medical Conditions Associated with Increased Risk for Hypothermia - ANS: • Hypothyroidism • Hypoglycemia • Burns • Trauma • Hypotension • Congestive heart failure • Cardiac vessel disease Signs of Malignant Hyperthermia (MH) - ANS: • ΜΗ is triggered by inhalation anesthetic gases and succinylcholine • Increased end-tidal carbon dioxide is the most specific sign of MH. • Other signs include skeletal muscle rigidity, ventricular dysrhythmia, skin mottling, and hyperthermia. Medical professionals who can provide anesthesia services are: - ANS: • Anesthesiologists • Certified registered nurse anesthetists (CRNAs) • Anesthesiologist assistants (AAs) Surgical Safety Checklist Includes: - ANS: • Μοbility • Preexisting health conditions • Planned duration of the procedure. • Type of anesthesia The Preoperative Nurse Visit Should Include: - ANS: • Introduce yourself and ask your patient how they would like to be addressed. • Confirm your patient's identity with two patient identifier • If your patient discusses suicidal thoughts during the preoperative visit, report this immediately by following your facility's policy and procedure. • Use the same scale for pain assessment throughout all patient care areas. • Consider all elements of patient care needs prior to surgery. • Consider how the required surgical position may impact a current condition that the patient contends with. A Medication Assessment Should Include: - ANS: • Prescription medications • Herbal preparations: o may accentuate the toxicity of anesthetics. o interfere with drug metabolism or clearance. o might affect bleeding times. • Recreational/street drugs *It is also important to ask if the patient is using any recreational/street drugs. Close observation must be maintained for symptoms of withdrawal, especially during and after long procedures. • Drugs, alcohol, and smoking can alter lab values or system assessment. A chemically dependent patient who is recovering may have concerns about medication he or she is given. • Patient risk factors due to alcoholism include: - Lowered immunity - Prolonged bleeding times - Increased stress response - Cardiac complications Physiological Effects of Cannabis Include: - ANS: - Tachycardia - atherosclerosis - Airway edema - chronic bronchitis - Increased appetite