Organizational Influences
Week 1
Week 1
A organization with a culture of safety:
a. focuses on errors
b. changes care delivery as a result of an error
c. encourages health care providers to report another provider's near miss.
d. All of the above
b. changes care delivery as a result of an error
During surgery, the surgeon verbally orders a medication they want to administer to the patient at the sterile field. What should the periop RN do FIRST to decrease the risk of a communication error?
a. Read back the order
b. Document the order
c. verify the order is correct for the situation
d. administer the medication immediately
a. Read back the order
This is technique used to prevent the transfer of organisms and cells from one site to another. It is best practice to use this technique during bowel surgery and cases involving malignancy.
Isolation Technique
Which of the following describes the mode of transmission in the chain of infection?
1. The individual that is vulnerable to infection
2. The microbe's entry site
3. A microbe's route from the portal of exit
4. The microbe's environment
3. A microbe's route from the portal of exit
_________cleaning is conducted in between surgical procedures.
Turnover
What are the key elements of ERAS, Enhanced Recovery After Surgery?
Patient and Family Education
Minimal fasting prior to surgery
Return to regular diet and activities on the day of surgery
Geobacillus stearothermophilus is a biological indicator for _______.
Ethylene oxide sterilizers
Hallways leading to the OR and the sterile processing areas are designated as _________ areas of the perioperative environment.
Semi-restricted
Which law mandates that a hospital must report all incidents resulting from defective equipment or user error that contribute to a patient's death or serious injury?
Safe Medical Device Act of 1990
Which of the following would be an appropriate action for the perioperative nurse when assisting with anesthesia?
1. Extubate the patient
2. Apply cricoid pressure if needed during intubation
3. Document anesthetic agent used, dose, route, and time
4. Administer the muscle relaxant reversal agent if needed
2. Apply cricoid pressure if needed during intubation
Your patient is scheduled for a bariatric gastric bypass procedure, has a body mass index of 55, and is Type 1 diabetic. What ASA classification should you anticipate for your patient?
ASA 3
A goal of patient- and family-centered care is to:
1. focus on one point person for all communication
2. make the patient aware of their reliance on medical personnel
3. achieve short-term behavioral changes
4. improve the patient's knowledge regarding their care
4. improve the patient's knowledge regarding their care
AORN advocates for the patient and worker safety through the Guidelines for Perioperative Practice and:
a. position statements
b. tool kits
c. Mission, Vision, and Values statements
d. All of the above
d. All of the above
Management of potential loss of patient care data should be part of:
a. intraoperative to postoperative handover information
b. EHR downtime protocols
c. PNDS vocabulary
d. the patient consent form
b. EHR downtime protocols
When should the sterile field should be prepared?
As close to the time of surgery as possible
Drug diversion is a result of a facility's ______________.
1. Daily patient harm assessment
2. prompt reporting to law enforcement
3. active detection systems
4. lack of narcotic security measures
4. lack of narcotic security measures
This action is considered to be the single most important action that can prevent the spread of infection.
Hand Hygiene
The Nursing Alliance for Quality Care (NAQC) emphasizes patient-centered care that includes patient engagement. Which of the following is one of the nine assumptions of patient engagement?
1.Cicumstances surrounging the need for health care interventions do not influence the patient's level of engagement.
2. Nurses must form an active partnership with their patient, the patient's support system, and the patient's care providers.
3. Cultural, racial, and ethnic diversity cannot be considered when healthcare providers make decisions for the patient.
4. Physicians must make the decisions about the patient's care.
2. Nurses must form an active partnership with their patient, the patient's support system, and the patient's care providers.
What is the first step of instrument processing?
Cleaning
The airflow in an OR has a ________ pressure relationship to the adjacent OR hallway.
Positive
Protective eyewear worn during laser surgery must be specific to what?
Must be specific to the laser, its wavelength, and its optical density
Which of the following is not included in basic monitoring of the patient for anesthesia?
1. Blood pressure
2. Arterial line
3. ECG
4. Pulse oximetry
2. Arterial line
Your are the RN assigned to circulate on an organ recovery procedure on a patient who is determined to be brain dead. What ASA should you anticipate for your patient?
ASA 6
For patient- and family-centered care to succeed, which of the following must occur?
1. Decreased likelihood of medical errors
2. Active patient engagement in the education process
3. Physician-provided patient education
4. Improvement in the nurse-patient relationship
2. Active patient engagement in the education process
The 2010 Future of Nursing report outlined four key messages. Which of the statements below is NOT one of them?
a. The US health care redesign should empower nurses
b. Data collection is necessary and adequate
c. Nurses should practice to the full extent of their education
d. Nurses should strive for higher levels of education.
b. Data collection is necessary and adequate
a. CARES Act
b. HAC Reduction Act
c. Public Health Service Act
d. HIPAA
d. HIPAA
Best practice for transferring sterile fluids onto a sterile field?
Which of the following outlines sharps safety for the health care provider?
1. Bloodborne Pathogen Standard
2. Standard precautions
3. Transmission-based precautions
4. Standard of care
1. Bloodborne Pathogen Standard
In the perioperative setting, this surface is always considered contaminated.
The floor
An element that is not part of the Surgical Checklist Pre-Procedure Check-In is:
1. Presence of the consent and H&P
2. Introduction of team members
3. Confirmation of the surgical site marking(s).
4. Confirmation of the procedure and procedure site.
2. Introduction of team members
What type of monitor is an external strip or tape?
Chemical
Which areas in a perioperative environment are considered restricted areas?
Operating room
After elimination and substitution, what is the next highest level of control to decrease patients' and team members' exposure to surgical smoke?
Surgical smoke evacuation
Which drug is used to reverse valium and midazolam?
1. Pancuronium
2. Neostigmine
3. Succinylcholine
4. Flumazenil
4. Flumazenil
The hand off process between the intraoperative team and the PACU RN requires attention to the post-surgical patient's condition.
Which of the following elements is NOT correct when considering the hand-off?
1. Standardize the hand off process for all patient populations
2. Allow only urgent clinical interruptions when giving or listening to the report.
3. Provide data about the patient's condition
4. Employ the read-back method to confirm patient information.
4. Employ the read-back method to confirm patient information.
Identify a goal of ERAS.
1. Opiods prescribed every 4 hours for 48 hrs
2. Reduce the patient's stress response
3. Limit activity for 48 hrs
4. Muscle strengthening exercise 2 days prior to surgery
2. Reduce the patient's stress response
The Surgical Safety Checklist was an initiative of:
a. CDC
b. TJC
c. AORN
D. WHO
D. WHO
Which statement about standing orders/preprinted orders is TRUE?
a. Standing orders/preprinted orders should not be used in the OR.
b. Standing orders/ preprinted orders do not need to be documents
c. Surgeons should review their standing orders/preprinted orders of accuracy.
d. Standing orders/preprinted orders always expire after 6 months
c. Surgeons should review their standing orders/preprinted orders of accuracy.
When scrubbed team member move in and around the sterile field, they should do this to prevent contamination.
Move back to back or face to face when changing positions.
Your patient is scheduled to have a bronchoscopy in the OR. The patient has a diagnosis of influenza and has been place on droplet precautions.
What type of respiratory precautions should the RN take during the procedure?
1. Wear a fit-tested N95 respirator
2. Wear a face shield
3. Wear a surgical hood
4. Wear a standard surgical mask
1. Wear a fit-tested N95 respirator
In the morning, before the start of the first procedure of the day, what should be done to remove dust and debris?
Damp Dusting
The focused assessment collects data for a specific health issue and is continuous throughout all nurse-patient interactions. Which element would the nurse assess for the integumentary system?
1. Edema
2. Fall risk
3. Dyspnea
4. Turgor
4. Turgor
What steps are done when assembling an instrument tray?
Instruments are counted as they are placed in a tray
Instruments are opened when being placed on a stringer
Instruments are placed with heavier instruments on the bottom
Which team member establishes the sterile field and passes instruments to the surgeon?
Scrub person
Where should the dispersive pad for the electrosurgical unit be placed on the patient?
Close to the surgical site over a large well-perfused muscle
Which method is used to prevent aspiration during endotracheal intubation?
1. Inserting a nasal/oral airway
2. Applying cricoid pressure
3. Invasive techniques
4. Laryngoscopy
2. Applying cricoid pressure
The__________ is a postanesthesia scoring system to establish postoperative discharge criteria.
Aldrete scale
_______________ are the conditions where people are born, where they grow up, where they work, and where they live.
1. Social determinants of health
2. Health equity
3. Patient- and family-centered care
4. Social justice
1. Social determinants of health
Which of the following publishes regulatory requirements to which facilities and health care workers must adhere?
a. Centers for Medicare & Medicaid Services
b. The Joint Commission
c. Association of Perioperative Registered Nurses
d. All of the above
a. Centers for Medicare & Medicaid Services
What is recommended if a correction is required on a paper health care record?
a. Cover the existing content using black ink and add the correction
b. Do not make corrections on a paper health care record
c. Always use red ink
d. Follow your facility's policies for corrections
d. Follow your facility's policies for corrections
What should perioperative team members do when a break in sterile technique is discovered?
Speak up
The CDC has issued a statement regarding PAPRs in the OR.
What is the recommendation?
PAPRs are not recommended for use during surgical procedures
What is the term to describe the amount of time designated by the manufacturer that a cleaning agent must remain wet on the surface to achieve disinfection?
Contact time
Which of the following contains the elements of economic stability and built environment?
1. The Joint Commission requirements for the H&P
2. Patients' Bill of Rights
3. Enhanced Recovery After Surgery
4. Social determinants of health
4. Social determinants of health
Which fluid should be used for instrument cleaning at the point-of-use?
Sterile water
What is the primary medication to treat a patient experiencing a malignant hyperthermia (MH) crisis?
Dantrolene sodium
Which of the following practices may increase the risk for fire during surgery?
A graduate of normal saline is on the sterile instrument table
The electrosurgical pencil is lying on the drapes close to the surgeon's hand
The preoperative skin antisepsis was completely dry before draping began
A fire extinguisher is attached to the wall in the OR
How can the perioperative nurse assist the anesthesia provider with placement of a spinal or epidural block?
1. Thread the catheter through the needle
2. Calm the patient
3. Identify landmarks for insertion of the needle
4. Inject local anesthetic
2. Calm the patient
During which phase of care does the perianesthesia nurse focus on preparing the patient for care at home?
Phase II
What is one way the RN circulator can support a family member in the waiting room during their loved one's surgical procedure?
1. Have lunch during the procedure with the family while your assigned patient is one the operating room bed.
2. Phone call to the family member
3. Avoid making a phone call because you are too busy
4. Ask the surgeon to talk to the family member after the procedure
2. Phone call to the family member
Surgical site marking is a regulatory requirement. Which of the following statements about surgical site marking is TRUE?
a. the patient should not be involved in site marking
b. Site marking is done immediately prior to the incision
c. the patient should be identified prior to site marking
d. site marking processes are determined by the operating provider
c. the patient should be identified prior to site marking
A benefit of including the Perioperative Nursing Data Set in a perioperative documentation format is that it ______________.
a. describes patient care using standardized and unambiguous terms
b. addresses only the intraoperative phase of a patient's experience
c. determines patient-specific interventions
d. provides evidence-based guidelines
a. describes patient care using standardized and unambiguous terms
The definition of _____________ is when moisture soaks though drapes, gowns and packages and renders the item contaminated.
Strikethrough
When caring for a patient on airborne precautions, in what location is the respirator removed?
Outside the AIIR
What is the common term for the directions provided by a manufacturer on how to accurately use their product?
IFU
Anxiety and stress cause unpleasant physiological reactions in patient before surgery. What can patients do to lessen their preoperative anxiety?
Listen to music
Practice aromatherapy
Perform meditation
Which statement about cleaning and decontamination of contaminated surgical instruments and equipment is FALSE?
The manufacturer's IFU outlines the necessary steps for cleaning and decontamination
SPD personnel should wear a fluid-resistant gown in the decontamination area.
All instruments should be submerged in a hot water solution.
Blood removal on instruments is more difficult with hot water.
Name a fire prevention practice during surgery...
Include a discussion of the fire risk assessment during the preoperative briefing
Have fluids for irrigation immediately available on the sterile field
Place the electrosurgical pencil in a holster when not in use
Give an example of ionizing radiation therapy....
X-ray
CT
Nuclear Medicine
Brachytherapy
Gamma Knife
What complication can arise with tourniquet deflation at the end of a Bier Block?
Bolus of anesthetic
The purpose of the ASA Physical Status Classification System is:
1. to predict length of time needed for recovery
2. to evaluate the surgical risk to the patient
3. to assist in predicting the length of stay needed in Phase 1.
4. To determine the anesthetic agent that will be used.
2. to evaluate the surgical risk to the patient
What is an example of health equity?
1. Offering noon appointments for people working during the day
2. Requiring people to take public transportation for a check up
3. Providing low-cost health services for those living in low income housing
4. Providing resources to one patient population
3. Providing low-cost health services for those living in low income housing
Organizational elements of a culture of safety include:
a. an environment that emphasizes individual recriminations
b. teams and disciplines that operate in silos
c. a commitment of resources that focus on accidents
d. consistent and safe delivery of services.
d. consistent and safe delivery of services.
a. Discussing your assignments with your manager
b. Limiting documentation to a major episode in the patient's care
c. Maintaining confidentiality
d. Using standardized documentation
b. Limiting documentation to a major episode in the patient's care
What is an essential activity performed to prevent the spread of nasal and oropharyngeal secretions?
Masking
Which level of the Hierarchy of Controls addresses changing the way people work?
1. Engineering controls
2. Hazard elimination
3. Administrative controls
4. Work practice controls
3. Administrative controls
Terminal cleaning is performed after an environmental contamination event such as flooding due to a natural disaster or building maintenance issue. Which of the following additional measures is taken when there is a pest infestation?
Containing biological waste
Removing food waste
Cleaning common areas
Which of the following drugs is an anticoagulant?
1. Lovenox
2. Retavase
3. Eliquis
4. Pradaxa
1. Lovenox
Which of the following describes bioburden?
A physical barrier created by cleaning agents on an instrument surface.
The amount of microbial contamination on an instrument surface.
A chemical interaction between blood and cleaning agents.
Biological material that adheres to the surfaces of instruments and inhibits effective cleaning.
Name ignition sources that may cause a fire to ignite during surgery?
Electrosurgery and laser
Occupational exposure to radiation can be reduced by following the principles of time,______, and _______.
....distance, and shielding.
What is the most consistent indicator of MH during a surgical intervention?
Increased end-tidal CO2
The initial assessment of the patient entering Phase 1 consists of the following EXCEPT for:
1. breathing
2. circulation
3. pain
4. airway
3. Pain
What is a SDOH resource that can enhance population health outcomes?
1. Public safety
2. Fast foods
3. Unsanitary housing conditions
4. Intermittent internet services
1. Public safety
In November 1999, the Institute of Medicine (IOM), now the National Academy of Medicine (NAMI), published the landmark report "To Err is Human: Building a Safer Health System" and reported:
a. to prevent errors, a safer system needs to be designed
b. when an error occurs, the system needs to be examined
c. standardization of process
d. all of the above
d. all of the above
A patient's neighbor calls into the OR while in surgery is in process and asks, How is my friend? Will she be okay?
What is the BEST response?
a. I cannot give you any information
b. How did you get this number? She is in surgery right now?
c. Please call back and talk with the postop nurse.
d. She is doing fine and will be out of surgery in about an hour.
a. I cannot give you any information
Only ___________ items should come into contact with the sterile field.
Sterile
Which of the following is included in OSHA's Bloodborne Pathogens Standard?
1. Water is permissible in the semi-restricted area
2. Applying lip balm in the restricted area is permissible.
3. Use PPE for any anticipated blood or body fluid exposure.
4. Use an alcohol-based hand rub immediately after an exposure to body fluids.
3. Use PPE for any anticipated blood or body fluid exposure
Your patient has an airborne transmissible disease. Following this patient's surgical procedure, your OR would need to reduce the airborne particle contaminants by remaining unoccupied for a specific period of time without an aerosolizing source. Give an example of an airborne transmissible disease?
Tuberculosis
Covid
Measles
When should anticoagulants be discontinued prior to surgery?
1. 12 hrs
2. 36 hrs
3. 48 hrs
4. 24 hrs
3. 48 hrs
Which chemical sterilization method uses a toxic substance that requires aeration?
Ethylene oxide
Which intervention should be implemented when a fire occurs in a patient's airway?
Remove the endotracheal tube and any segments of the burned tube that remain in the airway
Complete an occurrence report
Gather all supplies and equipment involved in the fire
Lower the flow of the breathing gases to the patient
What resource should be available to the surgical team when questions arise on how to safely use surgical equipment?
The manufacturer's instruction for use
What are signs the patient is experiencing local anesthetic systemic toxicity?
Ringing in the ears
Dizziness
Tingling sensation around the lips
The PACU is divided into two phases of care, Phase 1 and Phase II. Which of the following is one of the determining factors for unit placement for the patient directly out of surgery?
1. Insurance coverage
2. Weight
3. Comorbid conditions
4. Physician preference
3. Comorbid conditions
What is a hallmark of an accountable care organization?
1. Decrease in errors
2. Increased costs
3. Physician-controlled care
4. Duplication of services
1. Decrease in errors
Which of the following is NOT is skill-based behavior error?
a. the nurse programs a new electrosurgical unit based on the machine she has used in the past
b. the nurse fails to respond to a device alarm
c. the nurse forgets to retrieve a unit of blood when called to do a sponge count
d. the nurse hits the wrongs button instead of the correct button beside it
b. the nurse fails to respond to a device alarm
Lawsuits may be derived from failure to:
a. follow standards of care
b. assess and monitor the patient
c. document accurately
d. all of the above
d. all of the above
Before opening a packaged item, the item is inspected for this.
Package integrity
Why is an employee screened for certain diseases that have an associated vaccination?
The diseases are preventable
The best method to use to complete turnover cleaning?
The standardized cleaning method
Virtually every body system is affected by Cannabis. Tetrahydrocannabinol (THC) is metabolized through the liver. Which of the following is not a route of elimination?
1. Sweat
2. Urine
3. Bile
4. Feces
1. Sweat
Instrument assembly stipulates that instruments need to be _______ when assembled.
Dry
Open
In a patient with local anesthetic systemic toxicity, the perioperative RN should be prepared to assist with the administration of _________________.
20% lipid emulsion therapy
A patient who is experiencing severe pain, a lack of sensation, edema, vascular compromise, and restricted movement in the extremity after the use of a pneumatic tourniquet is most likely exhibiting the clinical manifestations of _____________.
compartment syndrome
Which assessment factor is important to include when screening patients for potential risk of MH?
1. Patient's use of herbal and vitamin supplements
2. Patient's age
3. Patient's use of OTC medications
4. Family history of problems related to anesthesia
4. Family history of problems related to anesthesia
Patients may bypass Phase 1 and be transferred directly to Phase II care depending on which of the following?
1. Pain
2. Type of anesthesia
3. Vital signs
4. Age
2. Type of anesthesia
Teach-back is a particularly valuable tool for perioperative nurses when providing:
1. preoperative teaching
2. perioperative discharge instructions
3. information for informed consent
4. information about surgical treatment options
2. perioperative discharge instructions
A situational factor error can occur because of:
a. incorrect dosage calculation
b. an assumption concerning a medication dosage
c. a mistake in judgement
d. a lack of attention
d. a lack of attention
Which of the following statements is TRUE?
a. Documentation cannot be used to analyze regulatory compliance
b. documentation can be used to align service with reimbursement
c. if an electronic record is amended, the original record is deleted.
d. For efficiency, each health care system should have its own unique, structured vocabulary
b. documentation can be used to align service with reimbursement
When opening a rigid container, the lid is moved this way to prevent contamination.
Open up, away from the container and toward yourself.
Which of the following is NOT an emergency warning sign of SARS-CoV-2?
1. Pressure or persistent chest pain
2. New confusion
3. Ability to stay awake or awaken
4. Pale, grey, or blue-colored lips, nailbeds, or skin
3. Ability to stay awake or awaken
____________ is the removal of pathogenic and other microorganisms from the surfaces by using chemical or physical means.
Disinfection
What is an important element when assessing your patient's pain?
1. Always using the same scale with the same patient
2. Asking the family member what level the patient's pain level is
3. Always having the patient read the pain scale
4. Checking the patient's pain across two pain scales
1. Always using the same scale with the same patient
When the IFU for a surgical device, sterilizer, or packaging system conflict, follow the __________ IFU.
Device manufacturer's
Primary means to prevent health care-associated infections?
Perform hand hygiene
Give an example of non-ionizing radiation therapy.....
Laser
Microwave
TV
Tanning beds
The RN caring for the patient receiving moderate sedation/analgesia should:
1. Turn up the monitor alarms when prepping the patient
2. Be competent in the use of emergency resuscitation procedures
3. Call anesthesia provider to administer reversal medications
4. All of the above
Be competent in the use of emergency resuscitation procedures
The ASPAN standards have delineated levels of care for postanesthesia care. According to the standards, what is the most important staffing consideration in all perianesthesia departments?
1. Patient acuity
2. Shift timing day, evenings, and nights
3. Surgery schedule
4. Use of travelers
1. Patient acuity
What is one hallmark of patient-centered car?d1. Decisions are make and shared with the patient and family
1. Decisions are made and shared with the patient and family
2. New information is delivered within 48hrs
3. Families have specific visiting hours
4. Physical comfort and emotional well-being are priorities
4. Physical comfort and emotional well-being are priorities