Test Bank For Alexanders Care of the Patient in Surgery 14th Edition Rothrock TB

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Test Bank For Alexanders Care of the Patient in Surgery 14th Edition Rothrock TB

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WITH ANSWERS

 

Alexanders Care of the Patient in Surgery 14th Edition Rothrock TB

 

Rothrock: Alexanders Care of the Patient in Surgery, 14th Edition

 

Chapter 01: Concepts Basic to Perioperative Nursing

 

Test Bank

 

MULTIPLE CHOICE

 

  1. The Perioperative Patient Focused Model presents key components of nursing influence that guide patient care. Select the statement that best describes the dynamic relationship within the model.
a. The patient experience and the nursing presence are in continuous interaction.
b. Structure, process, and outcome are the foundation domains of the model.
c. The perioperative nurse is the central dynamic core of the model.
d. The interrelated nursing process rings bind the patient to the model.

 

 

ANS:  A

The Perioperative Patient Focused Model consists of domains or areas of nursing concern: nursing diagnoses, nursing interventions, and patient outcomes. These domains are in continuous interaction with the health system that encircles the focus of perioperative nursing practicethe patient.

 

REF:   Pages 2-3

 

  1. AORNs Standards of Perioperative Nursing Practice that describe nursing interactions, interventions, and activities with patients fall under which standards category?
a. Evidence-based
b. Process
c. Outcome
d. Structural

 

 

ANS:  B

Process standards relate to nursing activities, interventions, and interactions. They are used to explicate clinical, professional, and quality objectives in perioperative nursing.

 

REF:   Page 4

 

  1. Which order best describes the process used to implement evidence-based professional nursing?
a. Literature search, theory review, data analysis, policy development
b. Regional survey, literature search, meta-analysis, practice change
c. Identify problem, scientific evidence, develop policy, evaluate outcome
d. Identify issue, analyze scientific evidence, implement change, evaluate process

 

 

ANS:  D

Evidence-based practice is a systematic, thorough process by which to identify an issue, to collect and evaluate the best evidence to design and implement a practice change, and to evaluate the process.

 

REF:   Page 12

 

  1. The ambulatory surgery unit is planning to develop a standardized skin preparation practice for their unit. The best process to gather scientific information is to:
a. conduct a survey of skin prep policies at the next AORN chapter meeting.
b. review their surgical site infection data from the last 6 months.
c. conduct a literature search on antimicrobial agents and infection prevention.
d. review the scientific literature from the leading manufacturers of prep solutions.

 

 

ANS:  C

Perioperative nurses have an ethical responsibility to review practices and to modify them, based upon the best available scientific evidence, using research and other forms of high-quality evidence to guide practice.

 

REF:   Page 12

 

  1. The cardiac team is developing a standardized sterile back table setup and is unable to find sufficient research evidence for their project. Where might they look for information on best practices?
a. Survey regional facilities that perform cardiac surgery for their back table models.
b. Review case studies and expert opinions on sterile back table setups.
c. Review AORNs recommended practice on creating the sterile field.
d. All of the options are correct.

 

 

ANS:  D

When there is not enough evidence to guide practice, perioperative nurses should consider gathering information from varied trusted sources that reflect best practices.

 

REF:   Pages 13-14

 

  1. How do institutional standards of care, such as policies and procedures, differ from national standards, such as AORNs Standards of Perioperative Nursing Practice?
a. They are written by nurses.
b. They are written specifically to address responsibilities and circumstances.
c. They are collaborative and collective agreement statements.
d. They are rarely based on research.

 

 

ANS:  B

Institutional standards apply to the system or facility that develops them and can be directive about specific actions in specific circumstances; national standards provide generalized authoritative statements that can be implemented in all settings.

 

REF:   Pages 3, 12

 

  1. Which of the following actions best describes an element of the perioperative nursing assessment?
a. Scanning the surgical schedule for the day before morning report
b. Reading the pick/preference list attached to the case cart
c. Reviewing the patient medical record
d. Studying an on-line tutorial about the intended surgical procedure

 

 

ANS:  C

Assessment is the collection of relevant health data about the patient. Sources of data may be a preoperative interview with the patient and the patients family; review of the planned surgical or invasive procedure; review of the patients medical record; examination of the results of diagnostic tests; and consultation with the surgeon and anesthesia provider, unit nurses, or other personnel.

 

REF:   Page 5

 

  1. Lonna Weber is a frail 76-year-old diabetic woman who is scheduled for major surgery. She is vulnerable and at high risk for harm because of several factors related to her preexisting conditions and overall health status. As part of developing a plan to guide Lonnas care, the nurse uses standardized descriptive terms to guide care. This step of the nursing process is called:
a. nursing diagnosis.
b. nursing assessment.
c. nursing outcome.
d. nursing intervention.

 

 

ANS:  A

Nursing diagnosis is the process of identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care.

 

REF:   Page 7

 

  1. During the admission interview, the nurse initiated the discharge teaching and demonstrated crutch-walking activities. The teaching activities are what stage of the nursing process?
a. Nursing assessment
b. Nursing implementation
c. Nursing outcome preparation
d. Nursing evaluation

 

 

ANS:  B

Implementation is performing the nursing care activities and interventions that were planned and responding with critical thinking and orderly action. Implementation is the work of nursing.

 

REF:   Page 9

 

  1. While conducting the preoperative interview with Clair Conners, a patient scheduled for a septoplasty, the perioperative nurse learned that Clair was latex sensitive. Based on this knowledge, the nurse reviewed the pick/preference list and reassembled the surgical case cart setup to reflect this new information and change in care delivery. Which two phases of the nursing process are represented in the nurses actions?
a. Assessment and planning
b. Assessment and implementation
c. Planning and implementation
d. Nursing diagnosis and intervention

 

 

ANS:  C

Planning is preparing in advance for what will or may happen and determining the priorities for care. Planning is based on patient assessment results in knowing the patient and the patients unique needs. Implementation is performing the nursing care activities and interventions that were planned and responding with critical thinking and orderly action. Implementation is the work of nursing.

 

REF:   Pages 8-9

 

  1. The perioperative nurse implements protective measures to prevent skin or tissue injury caused by thermal sources. Successful accomplishment of this intervention would meet which of the following desired nursing outcomes?
a. The patient is free from signs and symptoms of chemical injury.
b. The patient is free from signs and symptoms of electrical injury.
c. The patient is free from signs and symptoms of radiation injury.
d. All of the options are correct.

 

 

ANS:  D

Chemical and thermal sources used in surgery can cause skin and tissue burns (e.g., electrosurgery, povidine-iodine, radiation, lasers). The patient is free from signs and symptoms of chemical injury, radiation injury, and electrical injury are approved NANDA-International nursing diagnoses.

 

REF:   Pages 8, 10

 

  1. The nursing diagnosis is derived from:
a. patient data retrieved from the nursing assessment.
b. synthesized clues from the admitting diagnosis and surgery schedule.
c. the approved NANDA-International list attached to the patient medical record.
d. the admission form on the front of the chart.

 

 

ANS:  A

Nursing diagnosis is the process of identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care.

 

REF:   Page 7

 

  1. Doreen Jasper, a preoperative admission for laparoscopic cholecystectomy with operative cholangiogram, was interviewed by her perioperative nurse in the preoperative intake lounge. Doreens weight on admission was 245 lb. After the assessment, the nurse returned to the OR and modified the standard plan of care by instituting risk reduction strategies that were derived from information from the preoperative assessment. A good example of this action would best be described by:
a. replacing the regular OR bed with a bariatric-specific OR bed.
b. providing protective lead aprons for all staff during the procedure.
c. writing the patients name, allergies, and body weight on the white board.
d. administering antibiotics to the patient 1 hour before the incision.

 

 

ANS:  A

Planning is preparing in advance for what will or may happen and determining the priorities for care. Planning based on patient assessment results in knowing the patient and the patients unique needs so that alterations in events, such as positioning the patient on a bariatric-specific OR bed as opposed to a regular OR bed, can be readily accommodated. Replacing the OR bed with a larger OR bed is a nurse-sensitive preventive intervention that provides equipment based on patient need.

 

REF:   Page 8

 

  1. Accurate documentation is an integral part of all phases of the nursing process. For this reason, perioperative nursing care documentation:
a. should not include technical care.
b. must include a description of patient care delivered and patient response to that care.
c. must be aligned with appropriate PNDS elements.
d. will have PNDS integrated into all mandatory fields.

 

 

ANS:  B

Documentation of the nursing care given should include more than the technical aspects of care, such as the sponge count or the application of the electrosurgical dispersive pad. Nursing care documentation should be associated with the assessment and nursing diagnoses, with preestablished outcomes against which the appropriateness and effectiveness of care may be judged.

 

REF:   Page 10

 

  1. When delegating a task, such as a preoperative skin prep, to an unlicensed individual, the perioperative nurse:
a. still retains responsibility and authority for the outcome of the task.
b. must comply with the seven rights of delegation.
c. transfers the authority to perform the task to a competent person.
d. transfers the supervision of the competent person to another competent person.

 

 

ANS:  C

Delegation transfers to a competent person the authority to perform a selected nursing task in a selected situation according to the five rights of delegation. When the perioperative nurse delegates a task, he or she retains accountability for that delegation.

 

REF:   Page 10

 

  1. The nursing excellence center for education at Sunny Shores Hospital developed standards for nursing advancement that would reflect high-level achievement of professional performance. They developed a clinical advancement ladder based on the leading skill and knowledge acquisition model and established worthy criteria for each level. Select the response that might best describe the highest level of achievement for a perioperative staff nurse.
a. CNOR credential, BSN, and chair of the nursing research committee
b. Published article in the Sunny Shores newsletter and 15 years service pin
c. BCLS instructor and weekend EMT transport
d. All of the options are correct.

 

 

ANS:  A

Achieving certification (certified nurse, operating room [CNOR]), pursuing lifelong learning, and maintaining competency and current knowledge in perioperative nursing are the hallmarks of the professional.

 

REF:   Page 4

 

  1. Performance improvement activities in the perioperative practice setting are designed to promote:
a. cost savings by eliminating fines for near-misses and never events.
b. customer satisfaction and loyalty.
c. performance measurement activities.
d. efficient, effective quality care.

 

 

ANS:  D

Performance improvement efforts encompass improvements in quality and effectiveness, based on ethical and economic perspectives. A performance measurement and improvement approach facilitates the delivery of safe, high-quality perioperative patient care.

 

REF:   Page 14

 

  1. Perioperative nursing diagnoses and interventions are directed toward, and guided by, the tremendous risks for harm to the patient inherent in surgery and interventional procedures; therefore nursing actions can generally be categorized as:
a. therapeutic/restorative.
b. preventive/protective.
c. caring/comforting.
d. advocating/justifying.

 

 

ANS:  B

Perioperative nurses possess a unique understanding of desired outcomes that apply to all patients. In contrast to some nursing specialties in which nursing diagnoses are derived from signs and symptoms of a condition, much of perioperative nursing care is preventive in nature, based upon knowledge of inherent risks to patients undergoing surgical and invasive procedures. Perioperative nurses identify these risks and potential problems in advance and direct nursing interventions toward prevention of undesirable outcomes, such as injury and infection.

 

REF:   Page 3

 

  1. A registered nurse first assistant (RNFA) is considered an advanced practice nurse when he/she has achieved:
a. RNFA certification.
b. clinical performance ladder level 4 or above.
c. graduate degree in nursing (MSN).
d. facility practice privileges.

 

 

ANS:  C

APNs must have graduate nursing education (at least a masters degree).

 

REF:   Page 16

 

  1. Emerging perioperative nursing roles are defined by the tremendous growth in science and technology combined with the increasing complexity of surgery and the interventional disciplines. An example of an emerging nursing role is:
a. sterile processing clinical specialist.
b. general surgery service liaison.
c. weekend resource nurse.
d. Informatics nurse specialist.

 

 

ANS:  D

Informatics is another specialty in which some perioperative nurses are focusing. Pressures for more efficient management of fiscal, material, and human resources have stimulated the development of electronic information systems for diverse functions in perioperative patient care settings.

 

REF:   Page 16

 

  1. The relationship between the Perioperative Patient Focused Model and the Perioperative Nursing Data Set (PNDS) is evidenced by their unique language and use of the nursing process to guide care. The most notable feature of their similarity is that the PNDS:
a. promotes standardized perioperative documentation.
b. fosters research on best practices.
c. begins with outcome statements.
d. promotes standardized perioperative documentation and begins with outcome statements.

 

 

ANS:  C

Similar to the Perioperative Patient Focused Model, the PNDS begins with patient outcomes. Each outcome is defined and interpreted, and presents criteria by which to measure outcome achievement.

 

REF:   Page 11

Rothrock: Alexanders Care of the Patient in Surgery, 14th Edition

 

Chapter 03: Infection Prevention and Control in the Perioperative Setting

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Surgical site infections (SSIs) are most often caused by gram-positive cocci and may arise from the patients own endogenous sources. The most typical causative microorganism cultured from SSIs is:
a. Staphylococcus epidermidis.
b. Streptococcus pyogenes.
c. Staphylococcus aureus.
d. Enterococcus.

 

 

ANS:  C

The organisms most commonly found in postoperative SSIs include staphylococcal, enterococcal, pseudomonal, and streptococcal species. S. aureus is the most frequently identified organism.

 

REF:   Page 48

 

  1. A swab of a fluid collection from an edematous, red, and separating postoperative wound is sent to the microbiology lab for culture, sensitivity, and Gram stain. The surgeon expects that the result will show a gram-positive coccus. This Gram stain designation is based on the:
a. ability to cause plasma to coagulate and form a microscopic clot.
b. physical and chemical properties of the cell wall.
c. formation of aerobic clustered spheres.
d. appearance of a thicker and brownish colored cell wall.

 

 

ANS:  B

Gram stain is a procedure for staining bacteria; it is the first step in classifying and differentiating bacteria into two large groups (gram-positive and gram-negative) based on the chemical and physical properties of their cell walls. A gram-positive microorganism has a thicker cell wall than a gram-negative microorganism.

 

REF:   Pages 48-49

 

  1. The hospital epidemiologist was alerted when several cultures had recently revealed suspicious similarities. He was concerned about two unrelated patients with similar abscesses in similar body regions. Susan Grant, a 72-year-old diabetic patient taking immunosuppressive medications for chronic Crohns disease, had an incision and drainage of a perianal fistula. Shawn Ames, a healthy 22-year-old college student and motocross racer, had an incision and drainage plus excision of a pilonidal cyst. Both patients cultured out a new subtype of S. aureus. Susans specimen results showed a significant colony growth of S. aureus plus differential growth of coagulase-negative S. epidermidis, while Shawns specimen was a high colony growth coagulase-positive, similar subtype of S. aureus. The epidemiologist charged his department to be alert for this S. aureus subtype and cross-check for trends. He was most concerned about one of these patients in particular and pulled up the medical record for review. Which patient may be at higher risk with the more virulent strain and why?
a. Susan because she is immunocompromised and elderly and has Crohns disease
b. Shawn because he has pilonidal sinus tracts from sacral pressure caused by racing
c. Susan because she has a mixed microorganism culture that is coagulase negative
d. Shawn because he has a high microbial load that is coagulase positive

 

 

ANS:  D

Coagulase-positive staphylococci are more virulent or pathogenic than coagulase-negative staphylococci. S. aureus is hemolytic, parasitic, pathogenic, and coagulase positive. S. epidermidis is parasitic, less pathogenic, and coagulase negative. Virulence is the potency of a pathogen measured in the numbers required to kill the host.

 

REF:   Pages 48-49

 

  1. While antibiotics have been credited with saving lives, misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs). Antibiotic use is prolific in the perioperative setting. Select the antibiotic application has evidence to support it as a best practice and not, potentially, a misuse of antibiotics.
a. Antibiotics given IV within 1 hour of the incision for every procedure with an incision or entered body system
b. Vancomycin paste applied to cut edges of the sternum in cardiac surgery
c. Tobramycin and methylmethacrylate bead implants into deep orthopedic incisions at risk for osteomyelitis
d. Bacitracin ointment on a clean subcuticular sutured incision as part of the dressing

 

 

ANS:  A

Drug resistance from treatment-related causes is often the result of misuse (e.g., incorrect use, overuse, or underuse) of antibiotics. It is believed that 50% of all antibiotic use in the United States can be characterized by misuse in one form or another, and efforts to reduce surgical site infections include appropriate prophylactic antibiotic use in surgical patients. It is estimated that half of all antibiotic prescriptions written are not warranted. During antibiotic therapy, the patient may have retained a few resistant organisms. By natural selection, as the susceptible organisms are killed, the resistant organisms multiply and become predominant. Failure to perform sensitivity testing along with inappropriate dosing can contribute to resistance. Although some surgical complications are unavoidable, surgical care can be improved through decisions and subsequent care focusing on evidence-based practice recommendations. Research shows that delivering antibiotics to a patient within 1 hour of beginning surgery can dramatically decrease SSI rates, yet this practice is not followed in all situations.

 

REF:   Pages 55, 58

 

  1. The Centers for Disease Control and Prevention (CDC) has identified pathogens that could pose a threat to national and world security and safety through bioterrorism. Select the four most probable agents that could be used to cause mass transmission, mortality, panic, and social disruption.
a. Anthrax, tuberculosis, C. difficile, tularemia
b. Smallpox, plague, botulism, tularemia
c. Smallpox, monkeypox, avian influenza, anthrax
d. Anthrax, H1N1 influenza, botulism, smallpox

 

 

ANS:  B

The potential for bioterrorism is a reality in todays world. The CDC has identified agents that may pose a risk to national security because of their (1) easy dissemination or transmission from person to person, (2) potential to cause high mortality and have a major public health impact, (3) potential to cause public panic and social disruption, and (4) necessity for special action for public health preparedness.

 

REF:   Pages 64-66

 

  1. Willard Braun was admitted to the ICU 3 weeks ago for heart failure and intractable atrial fibrillation. He has had diarrhea for 4 days that has cultured C. difficile. The transmission-based precautions sign on the door to his room alerts the staff to employ:
a. Contact Precautions with eye protection.
b. both Standard Precautions and Contact Precautions.
c. body substance isolation.
d. droplet Precautions with standard isolation technique.

 

 

ANS:  B

In addition to Standard Precautions, Contact Precautions should be used for patients known or suspected to be infected or colonized with epidemiologically important organisms that can be transmitted by (1) direct contact, as occurs when the caregiver touches the patients skin, or (2) indirect contact, as occurs when the caregiver touches patient care equipment or environmental surfaces in the patients room.

 

REF:   Page 64

 

  1. Ernesto Horn was admitted to the emergency department (ED) with respiratory symptoms, facial and upper body abrasions, burns, and moist lesions after a small package, delivered to his office, exploded and sprayed him with dried powder and glass shards. In response to the reported mechanism of injury, the ED team sequestered him in a secluded area away from the rest of the patients. The team believed that this was highly suspicious of a bioterrorism event. The epidemiologist was called and the patient was transferred to a negative-pressure isolation room and placed on Standard, Contact, Airborne, and Droplet Precautions. Based on these actions, what microorganism agents might be suspected to be involved?
a. Plague and tuberculosis
b. Smallpox and tuberculosis
c. Ebola virus and anthrax
d. Anthrax and smallpox

 

 

ANS:  D

Anthrax: Cutaneous lesions can occur from direct contact and inhalation from droplet, aerosolization. Use Standard Precautions with special attention to protection and containment of any draining wounds, inclusive of cutaneous lesions. Smallpox: Inhalation of droplets, droplet nuclei, aerosols, and direct or indirect contact; Standard, Droplet, Airborne, and Contact Precautions for patients with vesicular rash pending diagnosis. Avoid contact with organism while handling contaminated bedding. Wear protective attire to include gloves, gown, and N95 respirator.

 

REF:   Page 65

 

  1. Positive-pressure air handling systems with unidirectional flow of non-recirculated air from the ceiling to the floor are designed to:
a. create mild air turbulence to prevent dust from settling on surfaces.
b. augment the oxygen-enriched environment with dust-free air.
c. flow clean air over the patient and prevent corridor air intake.
d. All of the options are correct.

 

 

ANS:  C

To control bioparticulate matter in the OR environment, ventilating air should be delivered to the room at the ceiling and exhausted near the floor and on walls opposite to those containing inlet vents. Airflow should be in a downward directional flow, moving down and through the location with a minimum of draft, to the floor and exhaust portals. Air pressure in the OR should be greater than that in the surrounding corridor; this is called positive pressure in relation to corridors and adjacent areas. This positive pressure helps maintain the unidirectional airflow in the room and minimizes the amount of corridor air (less clean area) entering the OR (more clean area).

 

REF:   Page 67

 

  1. The design of the physical space within an OR attempts to minimize horizontal surfaces by placing cabinets flush with the wall. This prevents dust settling on multiple surfaces and decreases the areas that have to be monitored and cleaned. Another concern with horizontal surfaces is that air turbulence from staff movement and activity plus door movement, when it opens and closes, can:
a. mobilize resting dust from these surfaces.
b. contaminate sterile areas.
c. disrupt the unidirectional airflow.
d. All of the options are correct.

 

 

ANS:  D

Movement and activity in the OR can create a turbulent airflow and may recirculate settled bacteria. Doors to ORs should be kept closed to maintain correct ventilation, airflow, and air pressure. Cabinets should be recessed into the wall if possible. For noncabinet shelving, open wire shelves are preferred because dust and bacteria do not accumulate, and air can circulate freely around shelf contents.

 

REF:   Page 67

 

  1. All surgical patients present with the risk for hypothermia from a variety of factors inherent in the surgical experience. Hypothermia has been shown to be a factor that may place the surgical patient at risk for infection and delayed healing. Select the intervention that is an engineered control factor to protect the patient from hypothermia.
a. Surround the patient with a forced airwarming blanket and foil head covering.
b. Set the ambient room temperature between 68 and 73 F and limit exposure.
c. Line the OR bed with a circulating fluid mat and insert a rectal temperature probe.
d. Cover and surround the patient with several warm bath blankets and change them at frequent intervals.

 

 

ANS:  B

Maintaining the ambient room temperature and limiting patient exposure is the first line of defense in protecting the patient from hypothermia. Temperatures in ORs should be maintained at 68 F (20 C) to 73 F (23 C).

 

REF:   Page 67

 

  1. The mechanism of lethality (microbial death) with steam sterilization is achieved with this event.
a. Time, temperature, and steam pressure
b. Reduced and limited mitosis within the bioburden
c. Saturated vaporization of the microbial cytoplasm
d. Denaturation and coagulation of enzyme proteins

 

 

ANS:  D

Microorganisms are believed to be destroyed by moist heat through a process of denaturation and coagulation of the enzyme-protein system when steam sterilized. This fact is based on the theory that all chemical reactions, including coagulation of proteins, are catalyzed by the presence of water.

 

REF:   Pages 67-68

 

  1. Within a steam sterilizer, at a temperature of 100 C (212 F), the water condensation and the steam are the same temperature. This scientific phenomenon is called ___________________ and will __________________.
a. Steam saturation; not kill microorganisms
b. Steam distribution; promote microbial kill
c. Sterilization; kill all microorganisms to 106
d. Saturated steam; kill microbes at 106

 

 

ANS:  A

When a cold item is introduced into the steam, some of the steam releases its latent energy to the object and changes back to liquid water. This phenomenon allows items to be heated much more rapidly in steam than in dry heat. The phenomenon of steam changing to liquid water is called condensation, and the steam and the liquid water are at a temperature of 100 C (212 F) when this occurs. At this point, the steam is said to be saturated. This 100 C (212 F) temperature is insufficient to kill microorganisms, however. To kill microorganisms, a saturation temperature of 250 F (121 C) is necessary.

 

REF:   Page 68

 

  1. With the production of more steam in the sterilizer chamber, the pressure increases as well. The steam should contain little or no entrapped liquid water. Steam quality is the term that describes the amount of water mixed with the steam. The constitution of high-quality steam would be measured by:
a. 97% or greater.
b. 100%.
c. <3% of the mixture is liquid water.
d. All of the values are correct.

 

 

ANS:  D

The higher the steam pressure, the higher the temperature. The steam is the sterilizing agent. Any compressed air remaining in the chamber mixes with the steam and lowers the steam temperature. This reduced-temperature steam is incapable of sterilization. Steam entering the sterilizer chamber should contain little or no entrapped liquid water. The term steam quality describes the amount of steam vapor and liquid water in the mixture. A steam quality of 100% indicates that no liquid water is present in the steam. A steam quality of 97% or greater (i.e., <3% of the mixture is liquid water) is recommended to achieve an efficient sterilization process.

 

REF:   Page 68

 

  1. Sterilization prepares instruments to be used within, and on, sterile tissues. It kills vegetative microorganisms and endospores within a probability of 106. The process of decontamination prepares instruments to be:
a. handled without gloves and prepared for sterilization.
b. free of bioburden and safely handled with gloves.
c. clean at a high level of disinfection.
d. None of the options are correct.

 

 

ANS:  B

The efficacy of the sterilization process depends in part on lowering or limiting the amount of bioburden present on the item to be sterilized. Items to be sterilized should be precleaned to lower the bioburden to the lowest possible level. Items that were soiled with blood or body fluids and that have only been cleaned may not have been sufficiently decontaminated to allow handling by workers not wearing protective attire. If such an item tolerates high-pressure water washing, it can be decontaminated further by processing through an unwrapped washer/disinfector cycle. It is then safe to handle. It is recommended that gloves be worn during preparation and wrapping until meticulous inspection has cleared the instruments to be handled without gloves.

 

REF:   Pages 68-69

 

  1. Qualities of an effective packaging material must include these key characteristics. Select the three most important qualities.
a. Cost, good barrier, lint-free writable surface
b. Good steam penetration and removal, good barrier, aseptic presentation
c. Aseptic presentation, event-related sterility indicators, writable surface
d. Stackable in sterilizer/storage shelf, comparable cost, low toxicity

 

 

ANS:  B

To be effective, packaging material should have the following characteristics: allows for adequate steam penetration and removal; provides an adequate microbial barrier; resists tearing or punctures; has proven seal integrity (i.e., does not delaminate when opened and does not allow a reseal after opening); allows for aseptic delivery of package contents; is free of toxic ingredients and nonfast dyes; is low-linting; is cost-effective by cost and value analysis.

 

REF:   Page 71

 

  1. The final step, after decontamination and before sterilization, is the prep, pack, and wrap process. The sterile processing technologist has taken the laparotomy set from the washer/decontaminator to prepare for sterilization. Select the most appropriate order that the instrument set must travel before reaching the steam sterilizer.
a. Air-dry, inventory, inspect, lubricate, assemble and string instruments, wrap and tape
b. Inspect, unlock locked clamps, count and string instruments, place indicators, wrap and tape
c. Inspect, unlock locked clamps, string instruments, inventory, replace missing items, wrap
d. Inspect, inventory against list, assemble, place integrators, wrap and tape

 

 

ANS:  D

The final step before sterilization for reuse includes instrument preparation and packaging. These activities occur in a clean area, separate from the area where decontamination occurred. Instruments are inspected carefully for cleanliness and functionality. Soiled instruments are returned for further cleaning. Instruments with movable parts are treated with a water-soluble lubricant solution that contains an antimicrobial agent to retard growth in the lubricant solution. Broken or worn instruments are set aside for repair. Instruments are assembled into sets according to set content lists prepared by perioperative nursing staff.

 

REF:   Page 71

 

  1. Both sterilization and disinfection describe the elimination of microbial contamination and the achievement of a state suitable for patient care in select situations. However, disinfection differs from sterilization in that the process for disinfection uses:
a. contact Precautions as well as Universal Precautions.
b. hospital-grade disinfectant/sterilants.
c. semicritical medical devices used for ambulatory procedures.
d. agents to disinfect and eliminate most, if not all, pathogenic microbes.

 

 

ANS:  D

Disinfection is defined as the process of eliminating many or all pathogenic organisms, except bacterial spores, from inanimate objects. In healthcare facilities, equipment is usually soaked in liquid chemicals for a specified period to achieve disinfection of the equipment or item. The disinfection process may destroy tubercle bacilli and inactivate hepatitis viruses and enteroviruses but usually does not kill resistant bacterial spores. The term disinfection also may refer to treatment of body surfaces that have been contaminated with infectious material. Chemicals used to disinfect inanimate objects are referred to as disinfectants. Chemicals used for body surfaces are known as antiseptics. The term germicide refers to any solution that destroys microorganisms.

 

REF:   Page 81

 

  1. An integrator is a multiparameter indicator designed to measure:
a. time and pressure.
b. pressure, steam, and temperature.
c. temperature, time, and presence of steam.
d. sterility and pressure.

 

 

ANS:  C

Integrators are so named for their ability to integrate time, temperature, and the presence of steam. They reduce the risk of using an unsterile pack and may be used with numerous types of sterilization processes.

 

REF:   Page 74

 

  1. The evening before the procedure was scheduled, the central sterile processing department received two complete sets of an orthopedic spine fusion system that contained titanium-implantable instrumentation, four flexible coated retractor blades, and a sterilized internal paper inventory form. The sterilization instructions provided by the vendor representative recommended steam sterilization for the implants, but stated that the flexible coated blade retractors could not be exposed to temperatures higher than 220 F. The appropriate sterilization option for these instruments and devices would be:
a. hydrogen peroxide gas plasma sterilization for everything.
b. steam sterilization for the implant sets and paper inventory form, hydrogen peroxide gas plasma for the retractors, wrapped separately.
c. steam sterilization for the implant sets, hydrogen peroxide gas plasma for the retractors and paper inventory form, wrapped separately.
d. steam sterilization for everything with a shortened dry time.

 

 

ANS:  B

Low-temperature hydrogen peroxide gas plasma sterilization should be used for moisture-sensitive and heat-sensitive items and when indicated by the device manufacturer. Cellulosic-based products, such as paper and linen, are not recommended for use with plasma systems because they tend to absorb the vapor and cause the sterilization cycle to abort.

 

REF:   Page 80

 

  1. The circulating nurse prepped the face, neck, and upper chest for a radical neck dissection. After removing the protective towels around the prep site, the surgical fellow applied the head drape and the rest of the patient was draped. During the preincision surgical time-out, the fire risk score was determined to be high. When the surgeon reentered the room, after leaving the room to scrub, and donned her gown and gloves, she noticed an area on the neck that did not look prepped. She asked for prep solution on a sponge and sponge forceps to complete the prep area, taking care not to moisten the head drape. After handing off the used sponge forceps she asked for the scalpel. What step was omitted in this process?
a. The new prep area was not given time to dry.
b. The time-out should have been repeated with the surgeon scrubbed.
c. The patient should have been reprepped and redraped with all new drapes.
d. The scrub person should have given the surgeon a sterile towel to cover the unprepped area.

 

 

ANS:  A

Avoid pooling of preparation solution. If linens on the OR bed or the patient become soaked with solution, remove them from the area. Allow preparation solution to dry completely (3 to 5 minutes) before surgical drapes are applied. This may be incorporated as a time-out or all-clear announcement before proceeding with the draping process.

 

REF:   Page 104

 

  1. The skin preparation for a vaginal-assisted laparoscopic hysterectomy begins ______________ and _____________ before and after the procedure.
a. At the vagina and perineum; the nurse should check with the anesthesia provider before touching the patient
b. At the incision site to the periphery of the abdomen only the nurse should begin and complete perioperative documentation of skin preparation including wound classification
c. At the cleanest area first and proceeds to less clean areas (abdomen then vagina/perineum); a skin assessment should be performed
d. At the vagina and perineum first with urinary catheter insertion and then proceeds to the pelvic abdomen; a skin assessment should be performed

 

 

ANS:  C

Factors to be considered in skin disinfection are as follows: condition of the involved area, number and kinds of contaminants, general physical condition of the patient, characteristics of the skin to be disinfected, and patient allergies. The surgical principle followed when preparing the patients skin for surgery (prepping) is to prepare (prep) the cleanest area first and then move to the less clean areas (clean to dirty). The skin at the surgical site should be exposed and inspected before beginning the skin prep.

 

REF:   Pages 101, 103

 

  1. Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however:
a. it can only be used for the initial gloving.
b. it requires two people to execute without contamination.
c. there is a risk of contamination if the thumbs are not extended.
d. All of the options are correct.

 

 

ANS:  A

The closed method of gloving is the technique of choice when initially donning a sterile gown and gloves. Because the cuffs of a sterile gown collect moisture, become damp during wearing, and are considered unsterile, the closed-gloving technique can be used only for initial gloving. Cuffs may not be pulled down over the wearers hand for subsequent gloving. For subsequent gloving, an alternative technique must be used, such as assisted gloving or open gloving.

 

REF:   Page 99

 

  1. Which glove lubricant, used to facilitate easy donning, is considered a best practice?
a. Sterile talcum or corn starch powder
b. Sterile petroleum-based oils
c. Sterile silicone film
d. None of the options is a best practice.

 

 

ANS:  D

The use of powder as a glove lubricant is not recommended because of three primary hazards: the potential for postoperative complication of powder granulomas; powder fallout from hands and gloves, which provides a convenient vehicle for dissemination of microorganisms throughout the OR; and the ability of powder to carry and disperse latex proteins, contributing to an increased latex sensitivity among healthcare workers and others.

 

REF:   Page 98

 

  1. Which of the following lists the correct order of the proper steps in the removal of soiled sterile attire when breaking scrub?
a. Mask, gown, gloves, shoe covers
b. Gown, lead apron, shoe covers, mask, gloves
c. Mask, gown, hat, gloves
d. Gown, gloves, mask

 

 

ANS:  D

Members of the scrub surgical team should use the following procedure to remove soiled sterile scrub attire: gowns, gloves, and then masks. Hands must be washed after removing soiled sterile attire.

 

REF:   Page 99

 

  1. To protect the forearms, hands, and clothing from contacting bacteria on the outside of the used gown and gloves, members of the scrubbed surgical team should use the following procedure to remove soiled gowns and gloves. Which choice lists the appropriate first 3 steps in the removal of the sterile gown?
a. Wipe gloves clean, untie side gown closure, grasp gown at one shoulder seam.
b. Wipe gloves clean, grasp gown at both shoulder seams, pull over and off arms.
c. Unfasten gown back closures, grasp gown at one shoulder seam, pull down over both arms and gloves while everting glove cuffs.
d. Grasp both gown shoulders, slide gown down over arms, grasp gloves inside gown sleeves and pull gown and gloves off together.

 

 

ANS:  A

Bring the neck and sleeve of the gown forward and off the gloved hand, turning the gown inside out and everting the cuff of the glove. Repeat the previous two steps for the other side. Keep arms and gown away from body while turning the gown inside out and discarding carefully in the designated receptacle.

 

REF:   Pages 100-101

 

  1. Describe the best practice for aseptic removal of sterile gloves after removal of the sterile gown at the end of the procedure. Select the best practice to protect the wearer from cross-contamination.
a. Remove both gloves together using the gloved fingers of one hand to secure the everted cuffs of the other hand, turning both gloves inside out. Discard gloves in regular trash since they are inside out. Remove mask by the ties and wash hands.
b. Using the gloved fingers of one hand to secure the everted cuff, remove the glove, turning it inside out. Discard appropriately. Using the ungloved hand, grasp the fold of the everted cuff of the other glove and remove the glove, inverting the glove as it is removed. Discard in biohazard trash. Remove mask by the ties and discard. Wash hands.
c. Both practices are appropriate.
d. Neither practice is appropriate.

 

 

ANS:  B

Using the gloved fingers of one hand to secure the everted cuff, remove the glove, turning it inside out. Discard appropriately. Using the ungloved hand, grasp the fold of the everted cuff of the other glove and remove the glove, inverting the glove as it is removed. Discard appropriately. After leaving the restricted area, remove the mask by touching the ties or elastic only. Discard in the designated receptacle. Wash hands and forearms.

 

REF:   Pages 100-101

 

  1. The surgical hand scrub is designed to render the hands, nails, and arms:
a. surgically clean.
b. free of transient microorganisms, dirt, and skin oils.
c. coated with residual antimicrobial residue to prevent microbial regrowth.
d. All of the options are correct.

 

 

ANS:  D

The purposes of surgical hand hygiene are as follows: to remove dirt, skin oil, and transient microorganisms from the nails, hands, and forearms; to reduce the resident microbial count to as near zero as possible; and to leave an antimicrobial residue on the skin to prevent regrowth of microbes for several hours. The skin can never be rendered sterile, but it can be made surgically clean by reducing the number of microorganisms present.

 

REF:   Page 93

 

  1. Decontamination of the hands can be done by a variety of methods. The Joint Commission (TJC) states that a thorough handwash with an antimicrobial agent may be as effective as the traditional surgical scrub using a brush or sponge. Facility infection control procedures govern the selection of materials and the methods used for surgical hand hygiene. Select the best practice for surgical hand hygiene.
a. Alcohol-based hand rub
b. Anatomic counted strokes with 4% chlorhexidine gluconate brush
c. Anatomic timed strokes with povidine iodine sponge
d. Any of the options with an antimicrobial hand wash

 

 

ANS:  D

For the traditional, standardized surgical scrub, individually packaged disposable brushes and sponges or synthetic sponges without a brush may be used. The use of synthetic sponges in place of brushes has gained wide acceptance, especially where long and repeated scrubbing may be traumatic to the skin. A thorough handwash with an antimicrobial agent may be as effective as the traditional surgical scrub using a brush or sponge. An anatomic scrub, using a prescribed amount of time or number of strokes plus friction, is employed for effective cleansing of the skin. The prescribed number of strokes with a brush is usually 30 strokes to the nails and 20 strokes to each area of the skin. When using the timed approach, the institutions policies and procedures should be followed. A standardized procedure for handwashing should be established and followed within the healthcare setting. This may be accomplished by a surgical scrub or with the use of an approved hand rub agent.

 

REF:   Page 93

 

  1. Which of the following choices reflects the appropriate order of four of the steps in preparing for the surgical hand scrub procedure?
a. Wash hands and wrists, remove jewelry, replace mask and eye protection, contain hair.
b. Contain hair and earrings in hat, wash hands and clean under nails, place mask and eye protection, remove jewelry.
c. Remove jewelry, contain hair, don fresh mask and eye protection, wash hands and forearms.
d. Don fresh mask, contain hair, place eye protection, clean under nails.

 

 

ANS:  C

A standardized procedure for handwashing should be established and followed within the healthcare setting. Remove all jewelry, including rings, watches, and bracelets, from the hands and forearms. Cover all head and facial hair. Don a surgical mask. If other personnel are at the scrub sink, a surgical mask should be worn in the presence of hand scrub activity. Protective eyewear, such as goggles with side shields or a full-face shield, should be adjusted to ensure clear vision and to avoid lens fogging. If visibly soiled, wash hands and forearms with soap and running water immediately before beginning the scrub procedure.

 

REF:   Pages 93-94

 

  1. If a sterile glove becomes contaminated during the procedure, the best practice for corrective action is:
a. reglove with open-glove or assistive glove technique.
b.

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