Environment
Based on what you have learned about the three surgical phases, identify the nursing processes that are part of the intraoperative phase. (ID ALL)
A. Data collection
B. Coordination of interventions
C. Evaluation of nursing interventions
D. Development of plans of care
E. Implementation of the plan of care
F. Communicate care given
B. Coordination of interventions
C. Evaluation of nursing interventions
E. Implementation of the plan of care
Professional nurses seek to support and encourage their peers by: Select all that apply.
A. Mentoring
B. Role modeling
C. Providing periodic feedback on clinical performance
D. Precepting
A. Mentoring
B. Role modeling
C. Providing periodic feedback on clinical performance
D. Precepting
Would a task checklist be a form of “active” thinking in John Dewey’s definition?
A. Yes
B. No
B. No
Which phase of the nursing process begins with a discussion and planning with the patient and his or her family?
A. Clinical documentation
B. Perioperative Assessment
C. Implementation
D. Outcome identification
B. Perioperative Assessment
Most glove-related skin reactions are of this type:
A. Irritant contact dermatitis
B. Immediate type I hypersensitivity
C. Delayed type IV hypersensitivity
D. Delayed allergic contact dermatitis
A. Irritant contact dermatitis
Intraoperative responsibilities of the nurse caring for a patient undergoing a procedure with general anesthesia may include which of the following? Select all that apply.
A. Applying cricoid pressure during intubation, if necessary
B. Double-checking blood, if administered
C. Inserting an LMA if requested by the anesthesia care provider
D. Obtaining warming blankets and emergency equipment as necessary
E. Assessing the patient throughout the operative procedure
A. Applying cricoid pressure during intubation, if necessary
B. Double-checking blood, if administered
D. Obtaining warming blankets and emergency equipment as necessary
E. Assessing the patient throughout the operative procedure
Based on the understanding you have gained about AORN’s Guidelines for Perioperative Practice, indicate whether the statement is true or false.
AORN Guidelines for Perioperative Practice can replace departmental and institutional policies.
A. True
B. False
B. False
___________ is the information, or data, on which a conclusion might be based.
A. Logic
B. Knowledge
C. Evidence
D. Judgment
C. Evidence
Which of the following statements are true about objective data?
A. Data that consists of a patient’s own feelings and perceptions
B. Age, religion, or culture are examples of objective data
C. Data that is the information written in the patient’s record and nursing notes
D. History, physical, and laboratory data are examples of objective data
C. Data that is the information written in the patient’s record and nursing notes
D. History, physical, and laboratory data are examples of objective data
Which of the following practices is recommended when transferring a patient from the OR bed to a gurney?
A. Apply a safety strap around the patient’s hips once the patient is centered on the gurney
B. Lock the wheels of the gurney and the OR bed before beginning the transfer
C. One person may transfer a patient who is alert and able to cooperate
D. Remove the sheet covering the patient before asking the patient to move laterally
B. Lock the wheels of the gurney and the OR bed before beginning the transfer
A perioperative nurse who is providing moderate sedation for a patient should have all of the following qualifications EXCEPT:
A. Ability to concurrently function as the circulating nurse
B. Access to and ability to administer appropriate reversal medications
C. ACLS certification
D. Competency in monitoring patients with sedation, including airway assessment and the use of monitoring and emergency resuscitative equipment and drugs
A. Ability to concurrently function as the circulating nurse
Non-research parts of evidence ratings include the following: Check all that apply.
A. Summaries of the evidence
B. Organizational experience
C. Consensus on appraisal scores
D. Community standards
E. Clinician experience and expert opinion
F. Consumer preferences
A. Summaries of the evidence
B. Organizational experience
D. Community standards
E. Clinician experience and expert opinion
F. Consumer preferences
When there was a problem calibrating the camera, the RN circulator advised the nurse in the preoperative area and the OR charge nurse and then called the company representative for advice. With these actions, she displayed:
A. Knowledge
B. Judgment
C. Communication
C. Communication
What indicators should be checked when you assess the skin condition of a patient? Select all that apply.
A. Color
B. Texture
C. Turgor
D. Thickness
E. Water content
A. Color
C. Turgor
D. Thickness
Which of the following practices is recommended to reduce the patient’s risk for intraoperative skin injury?
A. Drag the patient’s body across sheets when moving patient
B. Leave blotting towels in place after the skin prep is completed
C. Place the hose of the patient warmed under the patient’s blankets, avoiding contact with the skin
D. Remove skin antiseptic before dressings are applied
D. Remove skin antiseptic before dressings are applied
The _________ assists the surgeon in suturing, ligating, and other tasks required during the procedure.
A. Scrub person
B. First assistant
C. Anesthesia assistant
D. RN circulator
B. First assistant
Key business metrics over which you can have control to affect the “bottom line” are: Select all that apply.
A. Length of procedures
B. On-time starts
C. Physician satisfaction
D. Turnover time
E. Volume of procedures
A. Length of procedures
B. On-time starts
D. Turnover time
E. Volume of procedures
The RN circulator took a number of nursing actions to prevent perioperative positioning injury. In doing so, she demonstrated the critical thinking component of knowledge.
A. True
B. False
A. True
Patients in which of the following age groups have the greatest blood volume per unit of body weight?
A. Children
B. Elderly adults
C. Middle adults
D. Young adults
A. Children
AORN guidelines for the time out recommend that all team members verbally verify their agreement on the following: Select all that apply.
A. The name of the surgeon
B. The name of the patient
C. The site of the procedure, including right/left distinction
D. The procedure to be performed
B. The name of the patient
C. The site of the procedure, including right/left distinction
D. The procedure to be performed
Based on the knowledge you have gained about the three surgical zone, identify the statements that are true to these zones. Select all that apply.
A. “Racetrack” is a floorplan design
B. The blood bank is a part of the semi-restricted zone
C. There is unidirectional traffic in the semi-restricted zone
D. The humidity in the restricted zone should be maintained below 50% at all times
E. Temperature in the restricted zone can be maintained at 70°
F. Air in the surgical suite is cleaned by passing through HEPA filters
A. “Racetrack” is a floorplan design
C. There is unidirectional traffic in the semi-restricted zone
E. Temperature in the restricted zone can be maintained at 70°
F. Air in the surgical suite is cleaned by passing through HEPA filters
Based on the knowledge you have gained about ethics and ethical decision making, identify the situations where a decision would be based on ethical grounds. Select all that apply.
A. Using new technology at your facility
B. Implementing or suspending the do-not-resuscitate orders on a patient
C. After the patient gives consent for surgery; refusing to proceed until all involved personnel discuss the situation
D. Participating in human experiments that are conducted at your facility
E. Strongly supporting organ donation even though the family disagrees
A. Using new technology at your facility
B. Implementing or suspending the do-not-resuscitate orders on a patient
D. Participating in human experiments that are conducted at your facility
E. Strongly supporting organ donation even though the family disagrees
As a new perioperative nurse, you are assigned to work with a preceptor in general surgery. Rather than “show you and tell you” how to do things, this preceptor often asks you questions. She explains to you that she wants to help you discover the connections and relationships between perioperative patient care activities. Your preceptor is helping you build which component of critical thinking:
A. Communication
B. Context
C. Relevant criteria
D. Questioning
C. Relevant criteria
Which of the following statements is true?
A. Blood pressure remains constant with age
B. Body temperature increases with increasing age
C. Heart rate increases with increasing age
D. Lung capacity decreases with increasing age
D. Lung capacity decreases with increasing age
Mechanical issues and problems that can cause skin injury include: Select all that apply.
A. Placing heavy objects on the patient
B. Placing an electrosurgical unit hand piece on the patient
C. Dragging the patient’s body across the sheets
D. Improperly applying sequential compression stockings
E. Allowing prep solution to pool under the patient
F. Failing to remove prep solutions from skin postoperatively
A. Placing heavy objects on the patient
C. Dragging the patient’s body across the sheets
D. Improperly applying sequential compression stockings
Based on the knowledge you have gained about the surgical attire, identify the correct statements. Select all that apply.
A. All hair, including beards and eyebrows, must be covered by surgical team members during surgical procedures
B. Protective gloves should be worn when removing shoe covers
C. A disposable sterile gown, once worn, can be reused
D. A mask can be reused
E. A pathologist may wear a one-piece coverall
F. The mask should never dangle around the neck
B. Protective gloves should be worn when removing shoe covers
E. A pathologist may wear a one-piece coverall
F. The mask should never dangle around the neck
Some of the ways by which professional nurses can protect themselves from legal action include maintaining: Select all that apply
A. Documentation of performance appraisals
C. Documentation of continuing education
D. Knowledge of the state nurse practice act
A. Documentation of performance appraisals
C. Documentation of continuing education
D. Knowledge of the state nurse practice act
John Dewey defined “reflective thinking” as: “Active, persistent, and careful consideration of a belief or supposed form of knowledge in the light of the grounds which support it and the further conclusions to which it tends.”
The last part of that definition: “and the further conclusions to which it tends” refers to which of the following:
A. What matters are the reasons we have for believing/accepting something
B. It matters that we identify the implications of our beliefs or acceptance of the received knowledge
C. We should not memorize the product of others’ thinking
D. We all tend to make snap judgments based on the situation at hand
B. It matters that we identify the implications of our beliefs or acceptance of the received knowledge
Which of the following factors make geriatric patients more sensitive to injury and cold?
A. Decrease in subcutaneous fat
B. Decrease in lung capacity
C. Bilirubin and hemoglobin shift
D. Decreased range of medication absorption
A. Decrease in subcutaneous fat
Based on the knowledge you have gained about handling positioning devices, identify the correct safety measures. Select all that apply.
A. The positioning device should be of the correct size for the patient
B. Extremities once positioned should not be rearranged
C. Gel pads should be used to relieve pressure
D. Sensitive genital areas should be placed in normal anatomical position
E. Patient’s arms must be supported by the arms of the surgical bed
F. The patient should be properly secured to the bed
A. The positioning device should be of the correct size for the patient
C. Gel pads should be used to relieve pressure
D. Sensitive genital areas should be placed in normal anatomical position
F. The patient should be properly secured to the bed
Which of the following reflects complications of an epidural block?
A. Dural puncture, subarachnoid injection, intravascular injection
B. Hypotension, high spinal paralysis, spinal headache
C. Subarachnoid injection, spinal headache, dural puncture
D. High spinal paralysis, intravascular injection, hypotension
A. Dural puncture, subarachnoid injection, intravascular injection
Based on the knowledge you have gained about legal and risk management issues, identify ways to enhance one’s professional practice. Select all that apply.
A. Documentation of orientation program
B. Documentation of clinical competency
C. Documentation of employee performance evaluations
D. Knowledge of the nursing practice act in your state
E. Documentation of continuing education activities
A. Documentation of orientation program
B. Documentation of clinical competency
D. Knowledge of the nursing practice act in your state
E. Documentation of continuing education activities
Michael has pulled a case following Dr. Cortez’s preference card exactly. If he is thinking critically, what should he do next to be sure the scrub person has what is needed for Mr. O’Malley’s procedure?
A. Nothing—if he followed the card precisely, they should be set until they open
B. Use the time out pause to ask what else Dr. Cortez needs
C. Assess the patient and record for indicated additions
D. Both B and C
C. Assess the patient and record for indicated additions
What interventions can the perioperative nurse perform to protect elderly patients? Select all that apply.
A. Employ deep vein thrombosis prophylactic devices
B. Position the patient for effective air exchange
C. Slide patient onto the OR bed without use of assistive device
D. Use warming devices to maintain the normothermia
A. Employ deep vein thrombosis prophylactic devices
B. Position the patient for effective air exchange
D. Use warming devices to maintain the normothermia
Based on the understanding you have gained about the time out, identify the correct statements. Select all that apply.
A. The procedure should not begin until the missing patient information is completed and agreed upon
B. Time out documentation should include agreement on the procedure
C. Time out can occur before the patient is prepped and draped
D. Time out should take place in the room where the procedure is to be performed
A. The procedure should not begin until the missing patient information is completed and agreed upon
B. Time out documentation should include agreement on the procedure
D. Time out should take place in the room where the procedure is to be performed
Based on the knowledge you have gained about perioperative documentation, identify the information that should be included in patient records. Select all that apply.
A. Surgical consent for the procedure
B. Nursing care plan using the PNDS
C. Education levels
D. Preoperative and postoperative skin condition
E. Allergies
A. Surgical consent for the procedure
B. Nursing care plan using the PNDS
D. Preoperative and postoperative skin condition
E. Allergies
AORN’s Guidelines for Perioperative Practice provides: Select all that apply.
A. Information on administrative topics
B. Mandatory regulations that must be followed
C. Rationale for following the AORN Guidelines instead of regulatory standards
D. Information that can be used to develop institution-specific policies
E. Scientific evidence for clinical practices
A. Information on administrative topics
D. Information that can be used to develop institution-specific policies
E. Scientific evidence for clinical practices
A perioperative nurse experienced in general, orthopedic, and neurosurgery has started a preceptorship in the cardiovascular (CV) service. What aspects of the CV service should be especially emphasized by the nurse’s preceptor?
1. Electrosurgical safety, preoperative medication history
2. Location of vascular implants and devices
3. Advanced cardiovascular anatomy and physiology, surgeon preferences
4. Common cardiovascular procedures, possible complications, and related potential safety risks.
A. 1, 3, 4
B. 2, 3, 4
C. 1, 2, 4
D. All of the above
B. 2, 3, 4
During the preoperative interview, why should the perioperative nurse ask patients about their use of herbal preparations, alcohol, tobacco products, and recreational drugs? Select all that apply.
A. Herbal supplements may affect the metabolism of drugs administered
B. Patients who use alcohol heavily are unable to tolerate general anesthesia
C. Recreational drug use may affect the choice of preoperative sedation
D. Smoking may affect circulatory and respiratory system assessment results
A. Herbal supplements may affect the metabolism of drugs administered
C. Recreational drug use may affect the choice of preoperative sedation
D. Smoking may affect circulatory and respiratory system assessment results
Which of the following factors increase the patient’s risk for skin injury? Select all that apply.
A. Use of the wrong type of linen
B. Unusual positions or positioning devices
C. Use of electrical equipment
D. Use of chemical agents
E. Prolonged length of surgery
F. Reduced tissue perfusion
B. Unusual positions or positioning devices
C. Use of electrical equipment
D. Use of chemical agents
E. Prolonged length of surgery
F. Reduced tissue perfusion
Based on the knowledge you have gained about patient charting, identify the information that the perioperative nurse should document. Select all that apply.
A. Positioning and positioning devices used
B. Patient’s family history
C. The universal protocol or “time out”
D. Sponge, sharp, and instrument counts
E. Skin prep and solution(s) used
A. Positioning and positioning devices used
C. The universal protocol or “time out”
D. Sponge, sharp, and instrument counts
E. Skin prep and solution(s) used
Which of the following are true about AORN’s Guidelines for Perioperative Practice? Select all that apply.
A. They are based on what nurses do in ideal situations
B. They can replace your department and institution’s policies
C. They contain information that must be followed as mandatory practice
D. They may be fulfilled to varying degrees in different situations
A. They are based on what nurses do in ideal situations
D. They may be fulfilled to varying degrees in different situations
Surgical site infection (SSI) is a dreaded complication of surgery. Knowledge of both risk factors and effective interventions is important for preparing the patient for surgery and preventing infection. Which of the following discussion topics might be especially important between an advanced beginner and the preceptor?
1. Susceptibility to infection: (eg, patient history of immunosuppression, presence of type 2 diabetes mellitus, hepatic disorders, renal failure, alcoholism)
2. Immune status: (eg, expected range of white blood cells within normal limits 3 to 30 days after surgery)
3. Clinical factors (eg, proposed length of the procedure, wound class, prophylactic antibiotic infusion)
4. Situational factors (eg, exposure to community-acquired infectious agents, lack of immunizations, limited personal hygiene, chronic diseases)
A. 1, 2, 3
B. 1, 3, 4
C. 1, 2, 4
D. All of the above
B. 1, 3, 4
Which items below are included in a psychosocial assessment?
A. Coping styles
B. Cultural beliefs and practices
C. Expectations of perioperative care
D. Sensory impairment
E. Spiritual or religious beliefs
F. Understanding of the surgical procedure
A. Coping styles
B. Cultural beliefs and practices
C. Expectations of perioperative care
E. Spiritual or religious beliefs
F. Understanding of the surgical procedure
Based on the understanding you have gained about patient verification and marking a surgical site, identify the true statements. Select all that apply.
A. Asking the patient to state the planned procedure is a valid procedure identifier
B. The patient’s room number is a valid patient identifier
C. The site marking should be visible after prepping and draping
D. The site should be marked by visually showing the site to the patient or verbal confirmation
E. Confirming the consents given for the procedure is a valid procedure identifier
A. Asking the patient to state the planned procedure is a valid procedure identifier
C. The site marking should be visible after prepping and draping
D. The site should be marked by visually showing the site to the patient or verbal confirmation
E. Confirming the consents given for the procedure is a valid procedure identifier
Which of the following is considered a critical perioperative nursing diagnosis within the PNDS?
A. Impaired tissue integrity
B. Pain
C. Risk for fluid volume deficit
D. Risk for perioperative positioning injury
D. Risk for perioperative positioning injury
Which of the following statements reflect the importance of certification? Select all that apply.
A. Certification is mandatory
B. Certification relates to a sense of personal accomplishment
C. Certification helps to validate specialized knowledge
D. Certification relates to processional growth
B. Certification relates to a sense of personal accomplishment
C. Certification helps to validate specialized knowledge
D. Certification relates to processional growth
A clinically proficient nursing colleague is helping a novice nurse to prepare a 75-year-old patient scheduled for cataract surgery. The patient’s history and physical examination include a history of coronary artery disease, pacemaker insertion 3 years earlier, and a history of occasional chest discomfort. The patient’s blood pressure, heart rate, and temperature are within normal limits, his weight is 140 lb (63.5 kg). Medication is one “baby” aspirin daily. In planning the care for the patient, which of the following might the proficient nurse emphasize in discussions with the novice nurse?
1. Having the crash cart readily available
2. Ensuring availability of 2 units packet red blood cells
3. Applying a pulse oximeter finger cot
4. Applying electrocardiographic leads
5. Starting an intravenous line
A. 2, 3, 4, 5
B. 1, 2, 3, 4
C. 1, 3, 4, 5
D. All of the above
C. 1, 3, 4, 5
Why is it important to assess the use of herbal supplements or recreational drugs before surgery? Select all that apply.
A. Herbal preparations can decrease the toxicity of other drugs administered during anesthesia
B. Herbal preparations can affect bleeding times
C. Herbal preparations can interfere with drug metabolism
D. Recreational drug use can result in withdrawal symptoms
E. Recreational drug users may require higher doses of anesthetic medications
B. Herbal preparations can affect bleeding times
C. Herbal preparations can interfere with drug metabolism
D. Recreational drug use can result in withdrawal symptoms
E. Recreational drug users may require higher doses of anesthetic medications
When a discrepancy in the count is identified, the surgical team should carry out the steps below. Put the steps in the correct sequence.
A. Intraoperative imaging should be read by a radiologist and the results communicated directly to the surgeon
B. The perioperative team performs a search of the surgical field instrument table, count bags, and trash and linen receptacles
C. The RN circulator notifies and receives verbal acknowledgment from the surgeon and surgical team
D. If the missing item is not recovered, intraoperative imaging should be performed to rule out a retained item before the final closure of the wound
E. The surgeon suspends wound closure and conducts a thorough search of the wound
F. Facility policies and procedures for documentation and subsequent notifications should be followed
C, E, B, D, A, F
1. The RN circulator notifies and receives verbal acknowledgment from the surgeon and surgical team
2. The surgeon suspends wound closure and conducts a thorough search of the wound
3. The perioperative team performs a search of the surgical field instrument table, count bags, and trash and linen receptacles
4. If the missing item is not recovered, intraoperative imaging should be performed to rule out a retained item before the final closure of the wound
5. Intraoperative imaging should be read by a radiologist and the results communicated directly to the surgeon
6. Facility policies and procedures for documentation and subsequent notifications should be followed