Question 1

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

Accepted Answer

Direct coupling occurs when the active electrode accidentally touches a noninsulated metal instrument,allowing the electrical energy to flow from one to the other (metal-to-metal sparking).Direct coupling may also occur if an active electrode is activated while in contact with a clip.When the metal instrument or clip receives electrical energy,a burn can easily result.This coupling is often called "pilot error" because it is within the surgeon's control to avoid.The surgeon should not activate the active electrode until the target site is within the field of vision,and the active electrode is in proximity or direct contact with target tissue and not a metal object.

Question 2

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.

Accepted Answer

Following are some advantages that have been associated with laser technology,depending on the procedure performed:
·Seals small blood vessels (less intraoperative and postoperative blood loss)
·Seals lymphatics (decreases postoperative edema and potential spread of malignant cells in the lymphatic system)
·Seals nerve endings (on selective procedures,decreases postoperative pain)
·Sterilizes tissue (from the heat generated at the laser-tissue impact site)
·Decreases postoperative stenosis (by decreasing the amount of scarring that could lead to stenosis)
·Produces minimal tissue damage (from precision of the laser beam)
·Reduces operative and anesthesia time
·Allows a shift to more ambulatory surgery procedure
·Allows more use of local anesthetics instead of general anesthetics
·Provides quicker recovery and return to daily activities

Question 3

The diode laser is most often used in which specialties?
A) Ophthalmology
B) Dermatology
C) Hepatopancreatic surgery
D) Podiatry

Accepted Answer

The diode laser is a compact,reliable laser system most often used for ophthalmology and dermatology procedures.

Question 4

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.

Accepted Answer

The large capacitive pad eliminates the need for an individual adhesive dispersive electrode pad,which is problematic if an ESU is used without dispersive electrode monitoring capabilities,and the pad tents during a procedure.The bulk resistivity of this unique capacitive pad ensures that current densities are kept to a clinically safe level such that pad site burns rarely occur.Adhesive pads also can irritate sensitive skin,may require a shaved area for placement,or may become a hazard if not placed on the patient appropriately.

Question 5

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?

Accepted Answer

Questions to ask when determining whether to reprocess single-use devices include the following:
·Can the disposable device be adequately cleaned?
·Can the device withstand disinfection or sterilization?
·Can it be adequately aerated if ethylene oxide sterilization is used?
·Is the device tested and checked for proper form and function after cleaning has been completed?
·Has device integrity been destroyed during reprocessing,or is equipment available to test the integrity of the device?
·How is the integrity of insulation checked on an electrosurgical instrument?
·Can the device be returned to its original intended use?
·Will cost savings be passed on to the patient,if appropriate?
·What is the maximum number of safe reuses,as determined through comprehensive testing?
·How is the number of reuses indicated on the device?
·Should the patient be informed that a reprocessed device may be used?

Question 6

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.

Accepted Answer

Patient risk is reduced because no electrical current passes through the patient.Plasma is created when a low flow of argon gas is excited within the handpiece,consisting of an anode (where current enters)and cathode (where current exits).The gas,in the plasma state,emerges from the handpiece tip as an electrically neutral pale blue jet stream that coagulates tissue.When the plasma reaches bleeding tissue,it releases its kinetic energy as heat and causes coagulation of the bleeding surface as well as cutting capabilities.Because the electrodes are contained within the handpiece,no dispersive pad is used.

Question 7

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.

Accepted Answer

Standard precautions should be used when changing a contaminated filter because of the possibility of bacterial and/or viral contamination.Many manufacturers recommend that the contaminated filter be treated as infectious and disposed of as regulated medical waste (biohazardous).

Question 8

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

Accepted Answer

To check the transmission of light within a fiberoptic cable,one end of the cable is held pointing toward a bright light while the other end is checked for any peppering,which indicates broken fibers.When approximately 20% of the fibers are broken,the cable must be replaced.

Question 9

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.

Accepted Answer

Advantages of single-use items include sharpness,reliability related to function,guaranteed sterility,and safety.Indirect advantages include no reprocessing,no repair costs,and comparable levels of patient care.Upgraded designs are more easily brought to market when the device is labeled for single use.Disadvantages include the need for increased storage space,budgetary implications,and environmental concerns related to disposal of biohazardous waste.

Quiz 8: Surgical Modalities

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

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

The diode laser is most often used in which specialties?

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

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?

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?