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2024 CNOR FLASHCARDS| 142 QUESTIONS
WITH ANSWERS COMPLETE
INTRAOPERATIVE CARE QUESTION
What is the preferred type of needle for subcutaneous suturing? A. Blunt B. Keith C. Reverse cutting D. Taper cut CORRECT ANSWERS: C. Reverse cutting Reverse cut a needle is preferred for subcutaneous suturing when it transects the skin lateral to the wall on the outside cutting edge points away from the wound edge and the inside flat edge is parallel to the edge of the loan thereby reducing the tendency for suture to tear through tissue INTRAOPERATIVE CARE QUESTION 56-year-old patient is undergoing an incision and drainage (I&D) of the right knee and upper thigh after a motorcycle accident. A tourniquet applied to the patient's upper thigh surgeon. Why should the patient's extremity not be exsanguinated prior to cuff inflation? A. Open wounds do not require exsanguination. B. Nerve damage may be too extensive. C. Infection is present in the extremity. D. Tourniquet pressures are adequate. CORRECT ANSWERS: C. Infection present the extremity. Exasanguination can cause infectious materials, and any thrombus or potentially malignant cells to be forced into the torso in these situations elevation of the limb alone may be performed to create exsanguination INTRAOPERATIVE CARE QUESTION Double-armed needles are most commonly used for procedures. A. bowel B. Liver C. vascular D. ophthalmic CORRECT ANSWERS: C. Liver Vascular anastomosis are usually zone with double armed sutures to allow for the suture line to run circumferentially and joint at one point INTRAOPERATIVE CARE QUESTION The normal craniotomy scalp flap is created by entering the ———-space. A. subgaleal B. subcutaneous C. periosteal D. pericranium CORRECT ANSWERS: A. Subgaleal
The subgaleal space contains adipose tissue and allows for easy in mobility of the scalp it is in this bloodless plane that the standard craniotomy scout flap is created INTRAOPERARIVE CARE QUESTION The most common cause of delayed wound healing is A. immunocompromised status. B. diabetes. C. smoking D. surgical site infection (SSI) CORRECT ANSWERS: D. surgical site infection Delayed wound healing among patients undergoing a surgical or other invasive procedures is most often link to SSI's which is typically occur within 30 days of the procedure INTRAOPERATIVE CARE QUESTION The best of suture choice for a fascial closure would be A. polydioxanone, Maxon, or Monocryl. B. surgical chromic gut. C. Prolene. D. Ethibond. CORRECT ANSWERS: A. Polydioxanone, Maxon, or monocryl Facial tissue requires a closure that maintain strength for approximately three months synthetic absorbable sutures (polydioxanone maxon or monocryl) are used for tissue that requires extended time to absorb and maintain tissue strength eventual absorbability decreases the risk for infection related to the presence of a foreign substance. INTRAOPERATIVE CARE QUESTION A vaginal hysterectomy receives which of the following wound classifications? A. Clean (Class I) B. Clean-contaminated (Class lI) C. Contaminated (Class III) D. Dirty-infected (Class IV) CORRECT ANSWERS: B. Clean contaminated (class II) Clean contaminated wounds are those in which the respiratory alimentary or genitourinary tract is entered under controlled conditions INTRAOPERATIVE CARE QUESTION The superior thyroid artery supplies the thyroid gland and originates from which vessel? A. Internal carotid artery B. External carotid artery C. Inferior thyroid artery D. Subclavian artery CORRECT ANSWERS: B. External carotid artery Blood supply to the thyroid is from the superior thyroid artery which originates from the external carotid artery and from the inferior thyroid artery which originates from the thyrocervical trunk of the subclavian artery INTRAOPERATIVE CARE QUESTION Moving a patient who weighs less than 73 pounds from supine to lateral requires A. 2 to 3 caregivers to assist with transfer B. 3 to 4 caregivers to assist with transfer. C. use of a mechanical lift device.
INTRAOPERATIVE CARE QUESTION
When receiving a verbal pathology report, the perioperative nurse should A. relay the message to the surgical assistant. B. document it in the patient record using a write-down, read-back format. C. summarize the report to the surgeon. D. request the pathologist to email the report. CORRECT ANSWERS: B. document it in the patient record using a write-down, read-back format. Direct communication between the pathologist and surgeon is the best method to minimize risk of communication errors, if direct communication is not possible, the perioperative nurse may receive the information but, it should be documented in the write down, read back format including date and time INTRAOPERATIVE CARE QUESTION Short-term exposure to waste anesthesia gas may cause A. infertility. B. miscarriage. C. lethargy and fatigue. D. cancer CORRECT ANSWERS: C. lethargy and fatigue. Short term exposure results in lethargy and fatigue and can be reduced with the use of scavenging systems all other choices are the result of long-term exposure INTRAOPERATIVE CARE QUESTION Prophylactic antibiotics should be administered A. within 1 hour after skin incision. B. at the discretion of the admitting nurse. C. for 48 hours postoperatively for clean and clean - contaminated cases D. within 1 hour before skin incision. CORRECT ANSWERS: D. within 1 hour before skin incision.
The optimal level of the antibotic must be present in the tissues at the time of incision the antibiotic of choice should be administered within one hour before skin incision antibiotic therapy is discontinued within 24 hours for clean and clean contaminated cases INTRAOPERATIVE CARE QUESTION The minimum requirements for labeling intraoperative specimens include patient name and identification number, laterality (if indicated), and A. primary care doctor. B. operating room phone number. C. origin of the specimen. D. nurse's name. CORRECT ANSWERS: C. origin of the specimen The specimen information should always be read back and confirmed by the surgeon The operating room phone number is used for pathology when performing unique testing. additional requirements apply only in specific circumstances INTRAOPERATIVE CARE QUESTION A do-not-resuscitate (DNR) order is rescinded during the immediate perioperative period via A. automatic suspension of the order. B. the surgeon. C. presedation discussion with the patient. D. the anesthesia care professional. CORRECT ANSWERS: C. presedation discussion with the patient. A discussion with the patient and the preoperative area as to the effect of a directive will have on the immediate perioperative period should include the patient, perioperative nurse anesthesia care professional and surgeon. automatic suspension or continuation of DNR orders is not justified under either legal or ethical analysis INTRAOPERATIVE CARE QUESTION To prevent patient injury, all electrical equipment should be tested periodically and A. before every use. B.biannually.
A. Determination of the patient's pain level. B. Evaluation of peripheral pulses. C. Measurement of abdominal girth. D. Examination of urine output for hematuria. CORRECT ANSWERS: B. Evaluation of peripheral pulses The surgeon will request a check of the pedal pulses which are distal to the repair site the nurse should verify and Mark these pulses prior to the start of the procedure so that they can be easily located INTRAOPERATIVE CARE QUESTION 75-year-old male has undergone transurethral resection of the prostate (TURP) under a spinal anesthetic. The patient was alert preoperatively. As he arrives in the postanesthesia care unit, he is disoriented and incoherent. The patient's condition is most likely a result of A. a reaction to pain stimuli. B. hyponatremia C. hyperkalemia. D. the patient's age. CORRECT ANSWERS: B. Hyponatremia During therapy the patient's bladder is distended with a large amount of fluid if the patient absorbs excess fluid systematically a decrease in sodium may occur leading to hyponatremia INTRAOPERATIVE QUESTION In addition verifying the correct patient, which of the following options are other tenets of the seven rights of correct medication administration? A Right dose, route, and indication. B. Right medication, container, and time C. Right documentation, route, and clinician. D. Right route, dose, and infusion setting CORRECT ANSWERS: A Right dose, route, and indication Patient safety considerations include the seven rights of safe medication administration: right patient, medication dose, time, route, indication and documentation INTRAOPERATIVE CARE QUESTION
In the event facility's electronic health record system fails, perioperative nurses need to be prepared to continue to document in a legal and ethical manner. Which of the following is one strategy to facilitate appro- priate documentation? A. Place greater reliance on clear verbal communication. B. Report that the system is down to the information technology department. C. Have backup paper forms for documenting care. D. Request a scribe to take notes. CORRECT ANSWERS: C. Have backup paper forms for documenting care Verbal communication does not constitute legal documentation of care. documentation must be written (electronically or on a paper form) each patient care facility responsible for creating forms and charting formats for personnel to use in hardcopy documentation INTRAOPERATIVE CARE QUESTION When placing a patient in the supine position for an abdominal surgery, the circulating nurse should A. position the arms above the head. B. rest the patient's heels on a pillow. C. avoid having the legs crossed. D. tuck the arms tightly with a draw sheet. CORRECT ANSWERS: C. Avoid having the legs crossed Preventing the patients legs from crossing facilitate circulation in the legs tight arm tuckingbending the arms at greater than 90° and placing pillows under the hills versus the ankle can produce injury to tissue and nerves INTRAOPERATIVE CARE QUESTION A combination of Lactated Ringer's, lidocaine, and epinephrine is rou- tinely injected in fatty areas prior to liposuction in order to A. minimize the chance of infection. B. decrease fluid volume shift. C. prevent intraoperative hypothermia.
B. upper transverse. C. midline abdominal. D. lower midline. CORRECT ANSWERS: A. Right subcostal The pt. Undergoing a hepatic resection is prepped frim rhe nipples to the midthigh area. The mist common incision is a rt. Subcoatal, allowing for expansion into A left subcostal as needed. INTRAOPERATIVE CARE QUESTION If the patient's arms are placed palm-side down during positioning, what structure is most commonly injured? A. Obturator nerve B. Ulnar nerve C. Brachial plexus D. Median nerve CORRECT ANSWERS: B. Ulnar nerve Themain goal protecting the ulnar nerve is to eliminate pressure on it the patient's arm should be positioned on the arm boards with the palms up Supinated this position place is the ulnar nerve in a protected position INTRAOPERATIVE CARE QUESTION Administrative controls for an ergonomically healthy perioperative environment include A. having appropriate assistive, patient-handling equipment available. B. limiting the weight of instrument trays to 25 pounds or less. C. providing adequate lighting. D. using patient-care ergonomic assessment protocols CORRECT ANSWERS: D. using patient- care ergonomic assessment protocols Administrative controls include developing and educating staff about an ergonomically safe environment. All other options are examples of engineering controls for ergonomic safety. INTRAOPERATIVE CARE QUESTION Multidose medications used for more than one patient A. can be stored with single-dose medications.
B. have the same expiration date as single-dose vials. C. possess the potential for cross-contamination. D. increase the cost for medications. CORRECT ANSWERS: C. Possess the potential for cross contamination Primary safety concerns for the use of multidose vials include cross-contamination, misinterpretting the dose, confusing expiration dates and separate storage from the single-dose vials INTRAOPERATIVE CARE QUESTION Which organization created the Needlestick Safety and Prevention Act? A. The Joint Commission (TJC) B. Occupational Safety and Health Administration (OSHA) C. World Health Organization (WHO) D. Centers for Disease Control and Prevention (CDC) CORRECT ANSWERS: B. OSHA COMMUNICATION QUESTION Goals for safe patient discharge after varicose vein surgery include educating the patient A. about potential complications that require physician contact. B. about exercise regimen to minimize activity. C. about removal of compression garments after 24 hours. D. with written instructions using medical terminology. CORRECT ANSWERS: A. About potential complications that require physician contact Instructions should be written and lay terms to enhance understanding and should include when to contact the healthcare provider.Sitting should be limited and compression garment should be worn consummateconstantly for two weeks after the procedure COMMUNICATION QUESTION Proper documentation serves as a legal record of care and a/an tool. A. risk management
The use of———hand offs and transfer protocols have been identified as methods to prevent communication breakdowns between caregivers. A. patient-focused B. standardized C. surgeon-led D. nurse-led CORRECT ANSWERS: B. Standardized Standardization of processes for transfer a patient information improve the accuracy reliability and quality of information exchanged the handoff or transfer method should be standardized in both process and content make up and should be tailored to the needs of the organization COMMUNICATION QUESTION Medications should be verbally reviewed and confirmed A. before the procedure begins. B. before the procedure ends. C. after transfer to the sterile field. D. before transfer to the sterile field. CORRECT ANSWERS: D. before transfer to the sterile field Before administering any medication the verification process should include a review of the product label for the medication name strength and expiration date this process should involve active communication and occur before medications are transferred to the sterile field COMMUNICATION QUESTION Conducting briefings before the surgical procedure helps ensure that team members A. understand what their staff roles will be. B. are aware of the surgical plan and any changes to it. C. verify the surgical procedure to be listed on the record. D. identify what specimens were collected. CORRECT ANSWERS: B. are aware of the surgical plan and any changes to it. Performing briefings before the start of procedures offers the opportunity for all team members to be aware of the surgical plan and any changes to that plan it also allows time to ask questions and clarify uncertainties COMMUNICATION QUESTION Medication containers on the sterile field should be labeled A. before the procedure begins. B. before the procedure ends. C. before transfer to the sterile field. D. immediately upon receipt of the medication. CORRECT ANSWERS: D. Immediately upon receipt of medication Immediate labeling medications decreases the risk for errors the use of standardize work processes serves to minimize the chance of error
COMMUNICATION QUESTION
What is a common cause of adverse events as found through root cause analysis? A. Incompetence B. Equipment failure C. Process errors D. Ineffective communication CORRECT ANSWERS: D. Ineffective communication Root cause analysis often identifies communication failure as the cause of errors associated with adverse events An environment that encourages effective communication strategies will decrease the risk of adverse events COMMUNICATION QUESTION The Patient Safety and Quality Improvement Act of 2005 encourages a A. reporting culture. B. culture of safety. C. universal reporting system. D. hand-off culture. CORRECT ANSWERS: B. Culture of safety voluntary reporting that is encouraged without fear of retaliation leads to more accurate reporting of errors and near miss occurrences patient safety is increased when personnel feel safe to report potential or actual errors the environment that encourages this type of reporting is called a culture of safety 4COMMUNICATION QUESTION The hand-over process should include A. assigning roles and responsibilities of team members. B. using the same process for all patient populations. C. the opinions and preferences of the facility's administrative personnel. D. a process for multitasking CORRECT ANSWERS: A. Assigning roles and responsibilities of team members The handover process should include assigning the roles and responsibilities of team members the process should be individualized for specific patient populations the process should be developed by interdisciplinary team and should not be placed on the opinions of facility administrative personnel multitasking should not be performing during patient handovers COMMUNICATION QUESTION
COMMUNICATION QUESTION
Standardized hand-off communication facilitate safe patient care transitions is best demonstrated by A. use of an evidence-based tool (eg, SBAR) B. read-back of all verbal orders. C. use of a structured written report between caregivers. D. use of a standardized list of do-not-use abbreviations CORRECT ANSWERS: A. use of an evidence-based tool (eg, SBAR) Standardized documentation format provide adequate and purposeful information to ensure safe patient care transitions to standardize transfers are handoff protocols have the potential to reduce communication breakdowns SBAR is an example of a standardized evidence-based format COMMUNICATION QUESTION Postoperative complications that require additional assistance when the patient status changes quickly may necessitate the need for A. the call team B. an additional circulating nurse. C. the rapid response team D. the unit supervisor CORRECT ANSWERS: C. The rapid response team When a patient exhibits signs of clinical deterioration a rapid response team maybe called to the bedside immediately to assess and treat the patient RRT's may be used in the perioperative sitting in our recommended by the joint commission COMMUNICATION QUESTION A standardized documentation format (eg, SBAR, 5 Ps) provides which of the following benefits? A. Allows for assumptions. B. Eliminates the need for questions. C. Decreases communication breakdown. D. Does not include family status. CORRECT ANSWERS: C. Decreases communication breakdown Standardization of the processes for transfer of patient care information improves the accuracy reliability and quality of communication and the information being exchanged COMMUNICATION QUESTION
Barriers to effective communication between health care professionals can result in A. improved patient outcomes. B. adverse events. C. decreased errors D. decreased duplication of laboratory tests. CORRECT ANSWERS: B. Adverse events Barriers to effective communication can result in miscommunication and adverse events COMMUNICATION QUESTION An example of an internal distraction that may impede team communication is A. beepers. B. music. C. anxiety. D. conversations. CORRECT ANSWERS: C. Anxiety Distractions can be internal or external distractions are related to the individuals nontechnical skills and individual resilience to human factors (e.g. hunger thirst, anxiety, anger, fatigue ) when communicating with in the team COMMUNICATION QUESTION Which of the following is a valuable teaching method for team members to improve communication during hand offs and prevent mistakes from occurring? A. Video B. Simulation C. Test D. Lecture CORRECT ANSWERS: B. Simulation Simulation-based training helps build the skills and confidence necessary to establish effective communication and teamwork during the transfer a patient information TRANSFER OF CARE QUESTION An example of a standardized format for hand-off/hand-over communication is the SBAR technique, an acronym that stands for A. situation, background, allergies, and responsiveness. B. site marking, background, application, and readiness. C. situation, background, assessment, and recommendation. D. subjective data, background, assessment, and responsiveness. CORRECT ANSWERS: C. Situation background assessment and recommendation SBAR situation background assessment and recommendation is a communication tool that supports the nursing process while providing a standardized format
TRANSFER OF CARE QUESTION
Standardized hand offs/hand overs during the transfer of care should include to ask and respond to question opportunity A. An opportunity to ask and respond to questions B. The exchange of paper documents C. The names of the perioperative team members D. all Current patient medications CORRECT ANSWERS: A. An opportunity to ask and respond to questions Handoffs/handover should be performed in an environment where an opportunity to ask and respond to questions can be generated to maintain or improve patient care between care providers TRANSFER OF CARE QUESTION Postoperative phone calls to patients should be completed within A. 24 hours. B. 48 hours. C. 72 hours
. D. 96 hours. CORRECT ANSWERS: B. 48 hours Most complications occur within the first 48 hours after surgery a postoperative phone call from the nurse to assess the patient and reinforce postoperative instructions is an important part of addressing potential complications TRANSFER OF CARE QUESTION The patient in the postanesthesia care unit during Phase II is A. preparing for self-care or care in an extended care facility. B. preparing for discharge. C. immediately postoperative. D. ready for Phase IV and then discharge. CORRECT ANSWERS: B. Preparing for discharge There are three phases of a post anesthesia care patients entering a phase 1 or immediately post surgery And require the most nursing care phase 2 patients are more awake and are starting to need less nursing caree phase 3 pt has returned to us a physiologic level and is ready to be discharged TRANSFER OF CARE QUESTION What normal physiologic change in the geriatric patient's respiratory increase the chances of aspiration pneumonia after a general system may anesthetic?
A. Increased elasticity of chest wall B. Decreased lung size C. Rhonchi heard during auscultation D. Decreased ability to cough and clear secretions CORRECT ANSWERS: D. Decreased ability to cough and clear secretions Normal respiratory changes in the geriatric population include loss of lungs elasticity, increaselung size and decreased ability to cough and clear secretions rhonchi or Adnentitious lung sounds that are abnormal in any age group TRANSFER CARE QUESTION A patient arrives to the postanesthesia care unit (PACU) after skin graft procedure. The patient is calm and his facial expression displays minimal grimacing. patient states his pain level is 8 out of 10. The PACU nurse understands the most reliable indicator for patient pain level assessment is A. severity of facial expressions. B. history related to drug usage. C. the patient's demeanor. D. patient self-assessment. CORRECT ANSWERS: D. Patient self assessment Patient is subjective and not always clearly demonstrated in facial expressions the patient is the most reliable resource to determine his or her pain level it is important to complete preoperative teaching on the use of the pain assessment scale to ensure accuracy in communicating post operative pain levels TRANSFER OF CARE QUESTION A patient who has undergone a thyroidectomy should receive postoperative education and instruction about Turning to prevent A. pain. B. a stiff neck. C. headache. D. strain on the incision. CORRECT ANSWERS: D. Strain on the incision The incision for a thyroidectomy is usually created in the natural crease line of the neck patients may be concerned about body image with the scar on their neck to decrease the risk of complications related to strain on the incision and possible separation of the incision edges while turning the head and neck the patient should be instructed on safe turning methods TRANSFER OF CARE QUESTION A standardized approach hand-off/hand-over communication can A. reduce the risk of error.
