Deck 8: Surgical Modalities

Question 1

Flexible fiberscopes and flexible videoscopes share many of the same components; however,in a video gastroscope,the eyepiece and lens of the fiberscope are replaced by a:

A) charge-coupled device (CCD) image intensifier.
B) high-definition video monitor.
C) video chip.
D) light-guided sensor.

Answer 1

C
There are two types of flexible endoscopes: fiberoptic endoscopes and videoscopes.
Videoscopes have,at their distal end,a video chip that provides an image that is directly viewed on a monitor; a videoscope does not have an eyepiece for direct viewing; the eyepiece is replaced with an endoscopic video camera.

Question 2

To help visualize abdominal structures and to enhance safety during laparoscopic procedures,a pneumoperitoneum is created.After Veress needle confirmation,insufflation tubing is connected and the process begun.CO₂ gas is used to insufflate the abdominal cavity at an ideal flow rate of ___________ to achieve an ideal intra-abdominal pressure of ___________.

A) less than 9 L/min; 10 to 12 mm Hg
B) 10 L/min; 10 to 12 mm Hg
C) 9 L/min; 14 to 16 mm Hg
D) 14 to 16 L/min; 9 mm Hg

Answer 2

C
The peritoneal cavity is filled,first at a low flow rate that is increased to a high flow rate of at least 9 L/min ideally.Flow rate refers only to how quickly a predetermined intra-abdominal pressure can be reached.Intra-abdominal pressure is the actual measure that must be closely monitored and should be maintained between 14 and 16 mm Hg.

Question 3

The nursing research and practice committee searched the scientific literature for information on smoke evacuation,because they planned for a unit-wide initiative to use this safety measure on all procedures where smoke or plume is generated.Their main concern was that the surgeons will not be as willing to comply as the staff with the new recommendations.Select the safety measure that will be the most critical and most challenging to enforce.

A) Use a reducer fitting to adapt a large smoke evacuation tube to a smaller suction or evacuation tube.
B) Hold the smoke evacuation suction tube close (<2 inch away) to the tissue interaction site to remove as much plume as possible.
C) Evacuate surgical smoke generated during endoscopic or laparoscopic procedures.
D) Wear a surgical mask that provides adequate filtration to protect against residual smoke particulate that has not been evacuated.

Answer 3

B
Compliance studies have been performed to note the acceptance and implementation of smoke evacuation recommendations.Education has clearly been the reason for compliance with using appropriate smoke evacuation practices.The main barriers to compliance have been that the equipment and supplies are not available,the surgeon refuses to allow smoke evacuation to be performed during the procedure,the smoke evacuator is too noisy,and the staff is complacent and just won't use available smoke evacuation equipment and devices.The surgeon may perceive that the close proximity of the smoke evacuation to active electrosurgery unit (ESU)or laser electrode is obstructive.Continuing education helps healthcare personnel to understand the hazards of surgical smoke and encourages the use of appropriate methods for evacuation.

Question 4

The surgeon used the electrosurgical unit (ESU)in monopolar mode to cut and coagulate through the subcutaneous tissue on opening the abdomen during a bariatric bypass procedure.As she began to proceed through the muscle and fascia layer,she asked the circulating nurse to increase the cut and coagulation modes on the ESU.Which measure could the scrub person take to enhance energy delivery?

A) Unwrap the ESU cord from around the towel clamp handle.
B) Clean the charred tissue from the active electrode blade.
C) Remind the surgeon that adipose tissue offers less impedance than muscle.
D) Replace the active electrode blade with a coated blade.

Question 5

The new general surgery fellow placed the three trocar ports for the laparoscopic appendectomy.She was focused on the concept of exact geometric triangulation of the three port accesses,to avoid the concept of sword fighting after inserting her instruments.She knew she had to proceed with caution and determination since this hospital was not able to provide the protected blade trocars she was used to using at the university medical center.The procedure was completed without incident; however,on postoperative day 1,the patient demonstrated signs and symptoms of sepsis.What might have been the unusual occurrence that could have resulted in patient sepsis?

A) Unrecognized appendiceal rupture
B) Significant break in sterile technique
C) Inadvertent trocar puncture through the bowel on insertion
D) Recent H1N₁ outbreak on the surgery unit at the hospital

Question 6

A female patient arrived at the endoscopy center 2 days before her scheduled interventional bronchoscopy to receive an injection of a photosensitive intravenous dye that the pulmonologist explained would highlight the dysplastic tissues of her bronchi that were precancerous.He scheduled her for an ablative procedure called photodynamic therapy (PDT),where the highlighted tissues would be affected by the laser light that is color-specific for uptake of the dye.Select the laser tissue interaction that describes the patient's treatment.

A) Reflection
B) Absorption
C) Transmission
D) Scattering

Question 7

The light transmission through a fiberoptic endoscope is achieved by way of:

A) a charge-coupled device chip in the tip of the scope.
B) a chain of small connected micro light bulbs.
C) bundles of glass rods.
D) electrified silicon cables.

Question 8

An endoscope is a diagnostic or therapeutic instrument that enters the body through:

A) a straight catheter via a paraumbilical incision.
B) a large incision into a body compartment.
C) an internalized sinus tract.
D) a natural orifice.

Question 9

The OR was trialing a new insufflation system and the vendor representative was out of the room taking a phone call.The perioperative nurse was concerned that the flow rate was well above 14 L/min,and the pressure had risen to 17 mm Hg.She alerted the surgeon and reduced the rate and pressure because she feared that the elderly patient was at high risk for:

A) gastroesophageal reflux.
B) hypercarbia.
C) postoperative nerve damage and shoulder pain.
D) hypocarbia.

Question 10

Endoscopic instruments are designed to perform the intervention at the target tissue site through the tubular endoscope.The endoscopic instrument is considered:

A) an extended instrument with a working head.
B) an extension of the surgeon's hand.
C) a means to perform hands-free surgery.
D) much less accurate than a surgeon's hand.

Question 11

A 9-year-old female 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 after school.The perioperative nurse discovers that the patient has diabetes and has an insulin pump that should remain connected during the short procedure.The best option for energy-generated hemostasis is:

A) battery-generated eye electrosonic cautery.
B) bipolar electrosurgery.
C) hemoelectrocoagulated plasma capacitor.
D) monopolar electrosurgery.

Question 12

The surgeon prefers the argon beam coagulator for dissection in his liver procedures,because the liver bleeds easily,and traditional monopolar electrosurgery often causes more bleeding than it stops.What is the application characteristic of the argon beam coagulator that enhances liver tissue hemostasis?

A) Use of argon gas markedly reduces the risk of overpressurization.
B) Argon gas is heavier than air, inert, and noncombustible and does not tear tissue.
C) Argon gas results in decreased chance of combustion, formation of surgical smoke, and burned tissue.
D) Argon gas provides noncontact tissue coagulation with reduced risk of rebleeding.

Question 13

A 72-year-old man with a single early-stage liver tumor has an implanted automatic internal defibrillator that the anesthesia provider has decided not to disarm for the procedure.What energy-generated dissection device should the doctor use to replace the argon beam coagulator?

A) An ultrasonic dissector
B) A monopolar suction-irrigator
C) A monopolar hydrodissector
D) A CO₂ laser with articulating arm and handpiece

Question 14

The instrument tips in laparoscopic instruments are designed to produce the same tissue effects as a traditional instrument used for open surgery.Because of the process challenges of the laparoscopic approach,it is time-consuming to insert and withdraw instruments repeatedly during the procedure.Instrument manufacturers have attempted to make their products efficient by combining functions.An appropriate combined function for a laparoscopic instrument would be:

A) ultrasound capability in suturing forceps.
B) electrosurgery conduction through the tips of a Babcock grasper.
C) scissors that cut, blunt dissect, and coagulate tissue.
D) suction and irrigation combined with an argon beam coagulation handpiece.

Question 15

The surface tissue effect of the CO₂ laser has a shallow penetration of 0.1 to 0.2 mm photothermal effect which serves as the laser of choice for:

A) urologic lithotripsy.
B) plastic surgery or dermatologic removal of tattoos and hemangiomas.
C) laparoscopic cholecystectomy.
D) endoscopic ablation of Barrett's esophageal dysplasia.

Question 16

High-pressure insufflation rates can cause increased intra-abdominal pressure that can result in life-threatening sequelae.The perioperative nurse reduces the flow rate in collaboration with the surgeon,while monitoring the patient for signs of:

A) CO₂ gas embolism.
B) hemostasis.
C) deep vein thrombosis (DVT).
D) hypoxia.

Question 17

Lasers,dependent on their wavelength,can produce absorption,reflection,transmission,and scatter.The effect of laser wavelength scatter does not have any therapeutic benefit at this time and can be destructive to both staff and instruments.Select a safety measure that would prevent inadvertent scatter or heating of the endoscope channel from laser energy during a surgical procedure.

A) Ebonize the surface of laser mirrors that are used in laparoscopic cholecystectomies.
B) Surround the surface drapes and endoscope trocar with moist sterile towels and cover the glass windows.
C) Advance the laser fiber at least 1 cm beyond the tip of the endoscope within operator's view.
D) Cover the laser fiber with medical-grade tubing along its entire length.

Question 18

The design of laparoscopic instruments aims to provide a clamping,cutting,dissecting,electrocoagulating,suturing,or stapling instrument on the tip of a shaft that is long or short enough to reach the target tissue.The hand control on the surgeon's end of the instrument is engineered to provide:

A) ergonomic comfort and control.
B) smooth operation of the lubricated instrument tips to prevent tissue adherence or entrapment.
C) a perception of haptic and tactile sense to prevent crushing or losing tissue.
D) adaptors for monopolar electrosurgery connection and laser fibers.

Question 19

The challenge of suturing intra-abdominally is not as great as the process needed to tie and tighten the surgical knot.The knot-tying process can be achieved within or outside of the abdominal compartment.The intracorporeal suture technique uses the suture-tying process analogous to the:

A) instrument tie.
B) two-handed tie.
C) one-handed tie.
D) stapled ligature.

Question 20

The original equipment manufacturer (OEM)instructions that came with the new rigid endoscope system did not recommend a particular sterilization modality; however,high temperatures and ultrasonic cleaning were discouraged,and the facility recently removed the ethylene oxide sterilizers from the sterile processing department.The minimally invasive surgery (MIS)team collaborated on developing a processing procedure for their new equipment.What modality is their best option?

A) Outsource to a facility that uses ethylene oxide or gamma radiation.
B) Sterilize the entire set in the low-temperature plasma sterilization system.
C) Perform high-level disinfection in glutaraldehyde.
D) Steam sterilize the metal components and soak the nonmetal components in glutaraldehyde.

Question 21

Direct coupling during the use of monopolar electrosurgery is caused by __________ and is usually within the control of the ______.

A) metal-to-metal sparking; the scrub person
B) metal to tissue; the scrub person
C) active burns; the surgeon
D) metal-to-metal sparking; the surgeon

Question 22

Select the statement(s)that best reflect the benefits of laser surgery for the surgical services department.

A) Decreases postoperative scarring that could lead to stenosis.
B) Reduces operative and anesthesia use of antibiotics.
C) Sterilizes tissue from the heat generated at the laser-tissue impact site.
D) Promotes a shift to more laparoscopic surgery procedures.

Question 23

The diode laser is most often used in which specialties?

A) Ophthalmology
B) Dermatology
C) Hepatopancreatic surgery
D) Podiatry

Question 24

A neonate has burns over 45% of his body from a scalding incident.He was prepared for surgical fasciotomy for ensuing compartment syndrome of his legs and trunk.In planning for the use of electrosurgery,the perioperative nurse's assessment revealed a limited surface area for the dispersive electrode,and the appropriate choice was made to use the:

A) dispersive pad cut in half to the upper unburned back.
B) large capacitive coupling pad under the neonate.
C) adhesive pad wrapped circumferentially around the arm.
D) battery-operated eye cautery and silver nitrate sticks.

Question 25

The new endoscopy and surgery center called in an outsource company to present the options and advantages of reprocessing single-use devices at their staff meeting.Select the appropriate question(s)that the staff should ask before making their decision.

A) Can the disposable device be adequately cleaned?
B) Is the device tested and checked for form and function after cleaning?
C) Can the device withstand disinfection or sterilization?
D) How many times can a device be reprocessed and reused?

Question 26

A neutral plasma coagulator is an energy source that produces pure plasma to provide coagulation.Why is patient risk reduced with this directed energy source?

A) The plasma is formed from activated carbon dioxide, an inert gas.
B) The plasma approximates tissue with a low heat welding process.
C) No electrical current passes through the patient.
D) The coagulation results in minimal tissue eschar.

Question 27

The perioperative educator is teaching the OR assistant to change the smoke evacuation filters when they have met their usage life.Which priority teaching element(s)must be taught?

A) Change the filters on all generators on a regular monthly schedule.
B) Treat the used filter as contaminated waste.
C) Place used filter back in its original container before disposal.
D) Dispose of the used filter as regulated biohazard waste.

Question 28

The sterile processing department technician checks each fiberoptic light cord for transmission of light before decontamination and again before it is prepared for sterilization.What would indicate that the cord must be replaced?

A) Peppering spots of 20% of the bright light
B) Peppering spots of 35% of the bright light
C) Opacity with peppering spots of 1% of the outer ring of the bright light
D) An opacity crescent of 1% of the outer ring of the bright light

Question 29

The new physician-owned endoscopy and surgery center opened with ample-sized procedure rooms and a large sterile storage core.The gastroenterologists had a busy practice.They used the best and most expensive reusable endoscopic biopsy forceps on every gastroscopy and colonoscopy.The endoscope processing and decontamination room used the same manufacturer's endoscopic cleaning brushes on every scope.These devices received considerable use and abuse and were often discarded after one or a few uses.Based on the characteristics of the new center and the gastroenterology practice,what would be the best option for the biopsy forceps and cleaning brushes?

A) Disinfect the forceps and brushes in the same high-level cycle with the scope for efficiency.
B) Secure a contract with a repair company to facilitate ongoing repair of the brushes and forceps.
C) Buy more reusable brushes and biopsy forceps and only open them when needed.
D) Trial several manufacturers' single-use biopsy forceps and cleaning brushes.