Question 1

Which of the following are important components of developing an educational program for a patient and their family? Choose all that apply.

Accepted Answer

When developing an educational program for a patient and their family, it is important to consider the patient's reading abilities and their relationship with their family members. The nurse needs to assess the patient's abilities to take in information; if they are unable to read or have a low reading level, presenting information that is clinical and complex can be confusing. The nurse should also assess the patient's main support system for after the patient is discharged.

Question 2

Which of the following types of mechanical cleaners uses a process called cavitation to rid the instruments of debris?

Accepted Answer

An ultrasonic washer uses a process called cavitation to rid the instruments of debris. Cavitation involves sending sound waves through the water to create gas bubbles that produce a vacuum. This type of cleaning system requires regular maintenance to ensure there is clean water for use, particularly when instruments or materials have gross blood and debris on them.

Question 3

What is the purpose of a steam integrator strip that is kept with a tray of instruments?

Accepted Answer

The steam integrator strip that is kept with a tray of instruments indicates that the items went through the flash sterilization process. When items are unwrapped for flash sterilization, it may be difficult to determine that the products are ready for use. The strip should have the time, date and autoclave used as markings to identify that the instruments were flash sterilized.

Question 4

What is the purpose of covering reconstituted disinfectant solutions when not in use?

Accepted Answer

The purpose of covering reconstituted disinfectant solutions is that the solutions may emit noxious fumes or odors. Disinfectant solutions can contain very powerful odors because they are created from chemical compounds designed to kill microorganisms. However, noxious odors and fumes from these chemicals can become overwhelming to staff when left unattended and may be very uncomfortable for the patient who is recovering.

Question 5

Which of the following steps is part of the terminal process of cleaning instruments used in surgery?

Accepted Answer

Disinfection and sterilization are both parts of the terminal process of cleaning instruments used in surgery. Both disinfection and sterilization involve eliminating microorganisms that have the potential to cause disease so instruments may be used again for future procedures. The process follows the decontamination stage and is done before supplies are stored for use.

Question 6

What items must the perioperative nurse check to ensure safety during a surgery that uses electrocautery?

Accepted Answer

The perioperative nurse should ensure that the alarm for the electrocautery unit has been turned on and can be heard by those in the room. This alarm typically activates if the ground pad is not working or if the patient is at risk of becoming burned. The nurse can also check for this by ensuring the ground pad stays dry during the procedure and that it maintains consistent contact with the patient.

Question 7

Which of the following factors may have an effect on a patient's risk of developing an infection after a surgical procedure?

Accepted Answer

Both the patient's condition before surgery and the state of the surgical wound at closure have an effect on the patient's risk of developing an infection after a surgical procedure. Some patients with certain medical conditions are more likely to develop infections than others; for example, a patient with diabetes may be at higher risk. A wound that is kept clean during the surgical procedure is less likely to become infected.

Question 8

A nurse in the operating room helps the surgeon by using surgical instruments, providing suturing and handling tissue specimens. The most likely title of this nurse would be:

Accepted Answer

The most likely title of this nurse would be an RN first assistant. This type of nurse works in the perioperative setting but may have duties that exceed those of the circulating or scrub nurse. The RN first assistant usually assists the physician directly, but their actual scope of practice may vary between states.

Question 9

While administering blood products during a surgical procedure, the nurse notes that the patient has spiked a fever to 101 degrees, their skin is flushing and their heart rate has increased. What is the nurse's first reaction?

Accepted Answer

The nurse's first action is to stop the transfusion and notify the physician. When giving a blood transfusion, if the patient develops a fever, flushing and becomes tachycardic, they are most likely having a transfusion reaction. The nurse needs to notify the physician who placed the order, as well as the Blood Bank; treat the signs of transfusion reaction; and begin another transfusion, if ordered.

Question 10

Which of the following is a potential complication associated with spinal anesthetic?

Accepted Answer

A post-dural puncture headache is a complication associated with spinal anesthetic. This can occur when the spinal needle punctures the dura during anesthesia administration. The patient may develop a headache if cerebrospinal fluid leaks from the puncture site.

Question 11

Which of the following procedures most likely requires the patient to be placed in the Kraske position?

Accepted Answer

The Kraske position would most likely be used for a coccygectomy. The Kraske position is also called the jackknife position, in which the patient lies prone with the middle of the bed raised. The patient's hips are flexed to 90 degrees, with the legs pointed downward. This position raises the patient's buttocks, allowing access for surgeries related to the rectum, anus, and coccyx.

Question 12

During surgery, a patient's respiratory rate drops and they begin to have heart arrhythmias. The physician orders a blood gas panel, and the results show pH 7.20, PCO₂ 62, P02 86, and HCO323. Which of the following conditions is the patient most likely to have?

Accepted Answer

The patient in this situation is most likely suffering from respiratory acidosis. This occurs when the pH level drops lower than normal and the PCO₂ is increased. Additionally, the patient may have respiratory or cardiac changes, which tell the nurse that they need to provide greater respiratory support to try and normalize blood gas levels.

Question 13

Upon arrival in the operating room, the nurse is reviewing some information about the procedure with the patient before anesthesia is given. Which of the following questions or statements is most appropriate for the nurse to say in this situation?

Accepted Answer

The nurse should prepare the patient for the induction of anesthesia by saying, "We're going to give you something that will make you sleepy." When the nurse conveys this message in a calm manner, they can reduce patient anxiety. Asking the patient if they are ready or asking about family may make the patient more anxious about the outcome. Asking the patient to discuss concerns should be done during the admission evaluation, not on the operating room table.

Question 14

The surgeon is planning to perform insufflation for an abdominal surgery. What information should the nurse give to the patient regarding this procedure?

Accepted Answer

The patient may have bruising on the abdomen after the surgeon takes hold of the tissue. The surgeon grabs the tissue and pulls up before inserting the needle to start insufflation. This provides access to the cavity and is not done laparoscopically. The surgeon typically uses CO₂, which is safer than nitrous oxide.

Question 15

Which of the following is a true statement regarding sponge counts in the operating room?

Accepted Answer

Sponges should be kept separate from towels to avoid confusion and miscounting. Because both sponges and towels are soft items that could be left inside a patient, keeping them separate ensures count accuracy. Once sponges or towels have gotten wet during surgery, it may be difficult to discern which they are. The nurse can keep the counts accurate by keeping them separate.

Question 16

When preparing a frozen section for laboratory analysis, what must the nurse do to prepare a specimen?

Accepted Answer

When preparing this type of specimen, the nurse should place the frozen section on a damp towel until it is ready for transport. A frozen section is typically analyzed during the surgical procedure and must be in an available state for the lab to work with. This provides quick results that can be reported to the surgeon during the procedure.

Question 17

What is the meaning of the term 'contact precautions' during infection control measures?

Accepted Answer

Contact precautions recognizes that the patient can transmit disease if the nurse touches equipment used for their care. Contact precautions also mean that the nurse may become infected by directly touching the patient. These types of precautions require gloves and gowns when coming into contact with the patient or their equipment.

Question 18

Which of the following patients is at highest risk of developing intraoperatively acquired neuropathy?

Accepted Answer

The patients in this group at highest risk of developing neuropathy during surgery include patients with type 1 diabetes mellitus and patients who are morbidly obese. Neuropathy occurs when the patient sustains nerve damage during the surgical procedure. Increased risks include excess body weight and poor circulation to the nerves. Additionally, the patient may become injured due to positioning during surgery or having a long surgical experience.

Question 19

Which of the following symptoms is a potential outcome of botulism contamination?

Accepted Answer

Botulism contamination can cause blurred vision, muscle weakness and paralysis. Careful measures and aseptic technique must be used in all surgical situations to reduce the potential for contamination. Botulism is not transferred between people, so the nurse should utilize standard precautions.

Question 20

All of the following are essential guidelines for a nurse who is scrubbing in for a procedure EXCEPT:

Accepted Answer

All of the above are correct except to rinse thoroughly, keeping the hands lower than the body. In order to scrub appropriately the nurse must keep the hands above the elbows both during the scrub and when approaching the surgical suite. This moves excess water and potential microbes away from the hands.

Quiz 1: Essential Nursing Considerations During the Perioperative Period