MV RNFA 2
- ANS-A packaging system for items undergoing sterilization should possess which of the
following characteristics?
a. Compatible with all sterilization processes.
b. Made of only disposable materials.
c. Maintains sterility of the items for a specified length of time.
d. Permits aseptic delivery of contents to the sterile field.
- ANS-Chapter 1
- ANS-In a situation of workplace violence, which group is usually responsible for physical
violence?
Patients
- ANS-The structure requiring repair in direct, indirect, and femoral hernias is the:
posterior inguinal floor.
- ANS-Wenceslao Forcum is scheduled for a TURP procedure. Review the list below and select
the irrigant that the nurse and surgical technician will prepare for his procedure.
Glycine
- ANS-What information should be reviewed in the preoperative phone call with the patient?
a. Insurance verification
b. Patient allergies
c. What to bring to the hospital
d. All of the above
- ANS-What is an important safety consideration when using a light source?
a. Leave the light cord on the sterile field at all times.
b. Place the light source in standby mode whenever it is not in use.
c. Coil the light cord tightly to keep its fibers in shape.
d. Replace light cords only when more that 50% of the fibers are broken.
- ANS-Which of the following represents a break in sterile technique?
Using the closed-gloving technique to replace a torn glove during a surgical procedure
- ANS-Which of the following represents the correct sequence for a closing count?
,Surgical site → immediate surrounding area → Mayo stand → back table → items discarded
from the field Correct
- ANS-Which of the following statements are accurate regarding the documentation required for
equipment used during operative procedures?
a. Location of the dispersive electrode pad
b. the use of any warming/cooling blankets
c. the identification number on the laser.
d. identification of the person that applied the tourniquet
e. all of the above
- ANS-Which of the following statements describing sliding hernias is correct?
Sliding hernias involve the bladder in direct hernias.
- ANS-Which of the following statements is true about capacitative coupling?
Capacitative coupling occurs when energy is transferred through intact insulation on an
instrument to nearby conductive tissue.
- ANS-Which statement below best describes the mechanism of action of a closed drainage
system?
The system creates negative pressure in the reservoir that is attached to the drain.
?b. it contains the lungs - ANS-All of the following are true of the mediastinum except:
?b. it contains the lungs - ANS-All of the following are true of the mediastinum except:
"We have a count discrepancy. We started with 70 sponges and find only 68. We are missing 2
lap sponges. Everyone, please check your areas. - ANS-Early on, during the preliminary sponge
count on closure of a repair of a ruptured abdominal aortic aneurysm, the circulating nurse was
unable to account for 2 lap sponges. He had meticulously maintained accountability for all
sponges and instruments discarded from the sterile field and bagged each sponge carefully. He
immediately turned and addressed the entire team in a clear voice. Select the appropriate
communication that the circulating nurse must employ during this count discrepancy.
(c and d) - ANS-Eschar buildup on the active electrode ESU tip impedes the desired current
flow and can tear tissue, causing rebleeding and serve as a foreign body
if deposited in the wound. Appropriate methods to remove debris from the tip include:
a) Scraping the non-coated ESU tip carefully with the scalpel
b) Soaking the coated ESU tip in sterile water
c) Wiping with moist sponge to clean non-stick coated ESU tips
,d) Abrasive electrode cleaning pad to remove eschar from non-coated electrodes
e) Electrode tips should not be cleaned. They should always be replaced if there is a buildup of
eschar.
*A major risk is the failure to "speak up" or 'question' when the RN notices* (is aware) of certain
'cues': actual risks may be the appearance of premature ventricular contractions (PVCs) or a
sudden drop in blood pressure; potential risks may be a family history of malignant hyperthermia
or allergies to (eg latex, silk dressing tape). - ANS-What are some actual and potential risks to
patient safety?
*Accuracy in documentation is essential:* questions about the precise name of the procedure or
the accurate location of a specimen must be answered by the surgeon and documented
property.
*Documentation must be complete*; the RN must be competent in the use of EHR menus,
shortcuts, and other EHR-specific elements; down-time forms must be readily available. -
ANS-What are some 'KEY' issues to address during the management of health care
information?
*Although the formal components of professionalism are known and respected by perioperative
nurses,* experienced clinicians are also alert to clinical 'exceptions' necessitating creative
thinking and clinical reasoning to address a patient's unique needs. The student should discuss
possible situations with the preceptor. An example- performing surgery is a non-sterile location.
It's against the rules (ie, guidelines) but if a patient arrests postop in a nursing unit or ICU and
the patient's status is so unstable as to preclude transporting the patient to a sterile OR
environment, surgery may have to be performed in the unit. Clinical reasoning, critical thinking
and clinical judgment will all be needed to achieve a positive outcome. - ANS-What are some
'KEY' issues related to professionalism?
*Available resources* - suture, liga-clips, staples; hemostats; gauze sponges; pledgets;
electrocautery; other. - ANS-What are some other key issues affecting hemostasis and patient
outcomes?
*Careful planning, preparation, selection, and use of instruments* promotes efficient, effective
and safe surgery. - ANS-How is clinical reasoning specifically related to surgical
instrumentation?
*clean the wound daily with soap and water
*change dressings as instructed by your nurse or physician
*Take showers; do not swim or put your wound under water
*keep your physician visit as planned - ANS-In post discharge home care of the postoperative
patient, which statements reflect best practice by the patient?
*Communication must be clear, active, & conscise.* Questions, imprecuse directions, conflicting
information, and too much ambiguity must be corrected.
, *Situational Awareness refers to assessing one's surroundings and identifying risks* and an
increased potential for error. Patients with excessive bleeding who require the use of a large
number of sponges, may be at risk for retention of bloody sponges. By maintaining track of the
sponges inside & outside the patient, the RN exerts independent thinking and plays a key role in
reducing risk. - ANS-What are some "KEY" issues during the management of health care
information?
*Communication* (with MDs, manufacturer's rep, team members)
*Awareness of complications*, possible responses, resources to address complications. -
ANS-What are some "KEY" safety issues to address during the use of surgical equipment?
*Components such as practicing according to evidenced- based guidelines, standards, and
clinical policies* form the intellectual foundation for practice. Clinical experience augments the
didactic aspect of practice and creates a more robust level of professionalism. - ANS-What are
some of the components of professionalism that affect clinical practice?
*creating mechanical tension on the tissues and pulling wound edges together
*causing macro-deformation and wound contraction - ANS-A 70-year-old male patient was fitted
with a negative-pressure wound therapy system (NPWT), also called vacuum-assisted closure,
after his most recent surgical wound debridement. This device works by?
*Determine the clinical situation*- Bleeding from artery or vein? Muscle? Is blood pumping or
oozing? Is the color bright red or darker red?
*How do team members know?*- Directly visible? Adequate lighting? Suction working? Level of
experience (RN, MD, Tech)? - ANS-How is clinical reasoning specifically employed during
hemostasis?
*Determine the risks for bleeding*- history of anticoagulants; bleeding disorder; the kind of
tissue being repaired; anatomic anomalies.
*Determine the surgeon's preferences for hemostasis*- eg tissue type, suture. - ANS-What are
some of the ways to think about hemostasis during a patient's surgery?
*Different types of energy can affect devices* in ways that can injure internal programming or
components; misuse of equipment. - ANS-What are some potential dangers in the use of
surgical equipment?
*Differentiating what the goals* are for draping and what is acceptable technique.
*Asking yourself what opportunities exist* to be creative without departing from guidelines? -
ANS-How is clinical reasoning specifically employed during surgical draping?
*Education provides a sense of commitment and engagement*; patients (and family) can
become more active participants in their care and play a role in their success. - ANS-How does
the education of a patient and/or family member relate to optimal clinical outcomes?
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