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AORN PERIOP 101 Advanced Review Solution Qs&As
All the following professionals are qualified to provide anesthesia to a patient EXCEPT:
a) anesthesiologist
b) CRNA
c) anesthesiology assistant
d) operating surgeon - CORRECT ANS->d) operating surgeon
Of the following, which is not used to secure airway:
a) ET tube
b) LMA
c) nasal cannula
d) oral airway - CORRECT ANS->c) nasal cannula
The perioperative team should know the location of equipment stored in the OR and in the department. Equipment that the anesthesia provider may request includes:
a) video laryngoscopy devices
b) fiberoptic bronchoscopes
c) suction tips and devices
d) all of the above - CORRECT ANS->d) all of the above
General Anesthesia - CORRECT ANS->a drug-induced reversible state of unconsciousness, it includes amnesia, analgesia, loss of responsiveness, decreased stress response, and loss of skeletal muscle reflexes to varying degree
Regional Anesthesia - CORRECT ANS->an injection of local anesthetics near nerve fibers to cause reversible loss of sensation over an area of the body, common examples include spinal, epidural, and peripheral nerve blocks
Monitored Anesthesia Care (MAC) - CORRECT ANS->when an anesthesia provider monitors the patient, administers sedatives and other agents as needed, and provides medical services as needed
Moderate Sedation - CORRECT ANS->the administration of sedative, analgesic, and/or anxiolytic agents by a physician or under physician supervision. Depending on state laws and hospital policies, a perioperative nurse may be able to administer this type of anesthesia
Local Anesthesia - CORRECT ANS->The infiltration or topical administration of agents to anesthetize a part of the body. It is typically used for minor procedures, does not involve an anesthesia provider, and does not involve sedation. A perioperative nurse monitors the patient and provides supportive care if needed.
The phases of general anesthesia, in order, are:
a) induction, maintenance, emergence
b) emergence, maintenance, induction
c) maintenance, emergence, induction
d) induction, emergence, maintenance - CORRECT ANS->a) induction, maintenance, emergence
Propofol - CORRECT ANS->IV induction agent
etomidate - CORRECT ANS->IV induction agent
methohexitol - CORRECT ANS->IV induction agent
IV induction agent - CORRECT ANS->ketamine
sevoflurane with or without nitric oxide - CORRECT ANS->inhaled induction agent
sugammadex - CORRECT ANS->reversal agent for rocuronium, vecuronium, and pancuronium
flumazenil - CORRECT ANS->reversal agent for benzos (midazolam)
naloxone - CORRECT ANS->reversal agent for narcotics (fentanyl)
which of the following type of airway maintenance usually requires muscle relazants?
a) spontaneous respiration
b) mask ventilation
c) laryngeal mask airway
d) endotracheal intubation - CORRECT ANS->d) endotracheal intubation
When should cricoid pressure be released?
a) if the patient coughs
b) when the patient loses consciousness
c) if the anesthesia provider cannot see the vocal cords
d) after the cuff of the ET tube is inflated and the position is confirmed - CORRECT ANS->d) after the cuff of the ET tube is inflated and the position is confirmed
lidocaine - CORRECT ANS->local anesthetic
bupivacaine - CORRECT ANS->local anesthetic
ropivacaine - CORRECT ANS->local anesthetic
tetracaine - CORRECT ANS->for long-acting spinal anesthesia
epinephrine (anesthesia) - CORRECT ANS->added to increase density and duration of a regional block
bicarbonate (anesthesia) - CORRECT ANS->sometimes added to reduce the acidity of the local anesthetic and speed the onset of the block
Spinal Anesthesia - CORRECT ANS->the subarachnoid space is entered and local anesthetic is injected directly into the spinal canal, pt sitting or lateral
Epidural Anesthesia - CORRECT ANS->the anesthesia care provider finds the space between the ligamentum flavum and dura, this space is identified by a loss of resistance as the needle is advanced, a single dose of anesthetic can be injected, or a catheter can be placed
IV regional anesthesia (Bier Block) - CORRECT ANS->used for procedures on hand, wrist, or forearm (double tourniquet method)
Local Anesthetic System Toxicity (LAST) - CORRECT ANS->can occur if unsafe amount of local anesthetic enters bloodstream, can occur slowly as med is absorbed over time, or quickly if accidentally injected into blood vessel
CAN PROGRESS TO SEIZURES AND CARDIAC OR RESP ARREST
Symptoms of LAST - CORRECT ANS->-ringing in ears
-tingling lips
-metallic taste in mouth
-dizziness
Sedation can be used with any of the following types of anesthesia except:
a) regional anesthesia
d) increased ambient room temperature
e) surgical drapes
d) warmed IV fluids - CORRECT ANS->a) circulating water garments
c) forced-air warming devices
d) increased ambient room temperature
f) warmed IV fluids
Which of the following would be an appropriate action for the perioperative nurse when assisting with anesthesia?
a) administer the muscle relaxant reversal agent if needed?
b) apply cricoid pressure if needed during intubation
c) document anesthetic agents used, dose, route, and time
d) extubate the patient - CORRECT ANS->b) apply cricoid pressure if needed during intubation
Which of the following is NOT included in basic monitoring of the patient for anesthesia?
a) pulse oximetry
b) ECG
c) arterial line
d) blood pressure - CORRECT ANS->c) arterial line
Which drug is used to reverse valium and midazolam?
a) neostigmine
b) pancuronium
c) flumazenil
d) succinylcholine - CORRECT ANS->c) flumazenil
Which method is used to prevent aspiration during endotracheal intubation?
a) applying cricoid pressure
b) inserting a nasal/oral airway
c) laryngoscopy
d) invasive techniques - CORRECT ANS->a) applying cricoid pressure
How can the perioperative nurse assist the anesthesia provider with placement of a spinal or epidural block?
a) inject local anesthetic
b) thread the catheter through the needle
c) calm the patient
d) identify landmarks for insertion of the needle - CORRECT ANS->c) calm the patient
During IV regional anesthesia the tourniquet should be deflated slowly to prevent which of the following from entering the bloodstream?
a) bacteria
b) lymphatic fluids
c) thrombus
d) bolus of anestheitc - CORRECT ANS->d) bolus of anesthetic
Depending on state laws and hospital policies, which of the following can be performed without a professional anesthesia provider?
a) general anesthesia
b) regional anesthesia
c) monitored anesthesia care
d) moderate sedation - CORRECT ANS->d) moderate sedation
operative endoscope - CORRECT ANS->channeled scopes that provide the ability to irrigate, suction, insert, and connect a variety of accessories
capacitive coupling - CORRECT ANS->transfer of electrical current from the active electrode through intact insulation to adjacent conductive items (tissue, trocars)
Based on your knowledge of laparoscopic surgery, identify the potential complications related to it:
a) pneumonia
b) hypoxemia
c) hypercarbia
d) cardiac dysrhythmia
e) hypocarbia
f) CO2 embolism - CORRECT ANS->b) hypoxemia
c) hypercarbia
d) cardiac dysrhythmia
f) CO2 embolism
Which are the major components of medical video imaging?
a) electrosurgical unit
b) fiber-optic light cable
c) verres needle
d) camera control unit - CORRECT ANS->b) fiber-optic light cable
d) camera control unit
Based on your knowledge of cameras in endoscopic surgery, identify the tasks that should be completed while setting up the camera before surgery
a) inspect the camera head for smudges or debris
b) clean the camera head using sterile water
c) plug the camera into the CCU and turn on the unit
d) complete white balancing of the camera - CORRECT ANS->a) inspect the camera head for smudges and debris
c) plug the camera into the CCU and turn on the unit
d) complete white balancing of the camera
Metal Halide Light Source - CORRECT ANS->emits continuous blue light, cheaper but less bright than xenon light source
Xenon light source - CORRECT ANS->emit pulsing high intensity white light, expensive but brigher
Pneumoperitoneum - CORRECT ANS->air or gas introduced into the body cavity as a distention medium (ex. carbon dioxide, nitrous oxide, helium)
Verres needle (blunt tipped trocar) - CORRECT ANS->used to deliver CO2 into the peritoneal cavity, creates working space
Laparoscopic instruments with small, blunt tips are used for:
a) cutting tissue
b) dissecting tissue
c) grasping tissue
d) moving tissue from one place to other - CORRECT ANS->b) dissecting tissue
Identify the instruments that can be used in laparoscopic surgery
a) babcocks forceps
b) mosquitoes forceps
c) cold soak the camera head for 20 min in glutamate
d) wipe the camera head and cord with alcohol and arrange on sterile field - CORRECT ANS->a) put the camera head in a sterile pouch
b) gas-sterilize the camera head
Which pieces of equipment are used during laparoscopic surgery?
a) CO2 insufflator
b) ESU
c) smoke evacuator
d) fiberoptic headlight
e) traction apparatus - CORRECT ANS->a) CO2 insufflator
b) ESU
c) smoke evacuator
What actions can the scrub person take to help prevent incidental thermal burns
a) inspect laparoscopic instrumentation for excessive wear or obvious breaks and replace when necessary
b) clean all instruments with sterile water
c) watch the surgery carefullt
d) replace instruments that have damaged insulation - CORRECT ANS->a) inspect laparoscopic instrumentation for excessive wear or obvious breaks and replace when necessary
d) replace instruments that have damaged insulation
Identify one characteristic difference between laparoscopic instruments and those used in open procedures:
a) all laparoscopic scissors are "take apart"
b) laparoscopic instruments have long, thin shafts to accommodate trocar cannulas
c) one cannot dissect tissue with laparoscopic instruments
d) all laparoscopic instruments are disposable - CORRECT ANS->b) laparoscopic instruments have long, thin shafts to accommodate trocar cannulas
What region of the patients abdomen is traditionally used to establish pneumoperitoneum for MIS?
a) periumbilical
b) supraumbilical
c) subumbilical
d) umbilical - CORRECT ANS->a) periumbilical
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 cord 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 than 50% of the fibers are broken - CORRECT ANS->b) place the light source in standby mode whenever it is not in use
CO2 is the gas used for abdominal insufflation because it:
a) is not readily absorbed by the body
b) is inexpensive
c) suppresses combustion
d) is rapidly eliminated from the body - CORRECT ANS->b) is inexpensive
c) suppressed combustion
d) is rapidly eliminated from the body
Bacteria common to OR - CORRECT ANS->staphylococci
and _________________________________________________. - CORRECT ANS->Pseudomonas aeruginosa
staphylococcus aureus
salmonella choleraesuis
Tuberculocidals are a special class of disinfectants. In order to be labeled 'tuberculocidal', products need to have demonstrated potency against:
a) Pseudomonas
b) Staphylococcus
c) Mycobacteria
d) Salmonella - CORRECT ANS->C
Post Procedure Clean - CORRECT ANS->purpose is to break cycle of contamination from pt to environment to staff to subsequent patient
Terminal Clean - CORRECT ANS->a more thorough cleaning and disinfection of periop environment decreases the number of pathogens and amount of dust and debris created during the day, done at end of day
Identify the best practices to follow when performing environmental sanitation
a) when cleaning spills of blood or any other potentially infectious material, use gloves and any other PPE appropriate to the task
b) visibly soiled OR equipment, furniture, and floors should be cleaned with a hospital-grade germicide
c) infectious waste should be segregated from noninfectious waste in the general waste stream
d) color coded or labeled bags should be used to facilitate separation of the various wastes - CORRECT ANS->a
b
c
d
HIV - CORRECT ANS->only survives in blood and body fluids that contain white blood cells, fragile and easily destroyed outside the body
Creutzfeldt-Jakob disease - CORRECT ANS->a rare but progressive fatal disease caused by prions
MRSA - CORRECT ANS->one of the hardiest bacteria and most difficult to treat
VRE (vancomycin-resistant enterococcus) - CORRECT ANS->usually spread by the hands of caregivers or patients and contaminated equipment or environmental surfaces
Select the correct statements about spray bottles
a) spray bottles can aerosolize potentially infectious materials
b) spray bottles are occasionally used to apply disinfectant
c) spray bottles are not used to apply disinfectant
d) spray bottles are an easy way to clean the environment - CORRECT ANS->a
c
Hemostasis - CORRECT ANS->1) the stoppage of bleeding or hemorrhage
the stoppage of blood flow through a blood vessel or body part
the stagnation of blood
Mechanical Hemostasis - CORRECT ANS->achieved by occluding severed vessels until platelet formation occurs
Thermal Hemostasis - CORRECT ANS->application of extreme cold or heat to body tissues
T Tube - CORRECT ANS->inserted into biliary tract to allow for drainage of bile, left for 10 days or more to develop tract through which bile can drain after removing tube
Suction Drain - CORRECT ANS->to drain accumulated blood and fluid from operative site
JP drain - CORRECT ANS->Used to drain fluid or blood after abdominal, urologic, thoracic, and head and neck procedures
abdominal or breast surgery
Hemovac - CORRECT ANS->orthopedic
Chest Tube - CORRECT ANS->conduit for drainage of air, blood, and other fluid from intrapleural or mediastinal space, and reestablishment of negative pressure in intrapleural space
Occlusive dressing - CORRECT ANS->prevent drying of wound, increase proliferation of epithelial cells
bioclusive, dermicell, duoderm hydrocolloids, opsite, dermagel, tagaderm, vasoline gauze, xeroform
Gauze dressing - CORRECT ANS->protect wound, absorb fluid (impregnated: vaseline, xeroform) (nonimpregnated: adaptic, telfa, nu-gauze, 4x4, ABD)
Hydrogel dressing - CORRECT ANS->hydrate and soothe tissue (tegagel, nu-gel, vigilon, karaya, collonplast)
Pressure dressing - CORRECT ANS->minimize intracellular fluid, eliminate dead space, distribute pressure evenly
fluffed gauze, non-radiopaque and gauze covered pads
Biological dressing - CORRECT ANS->control infection in denuded area, prevent loss of serum, decrease pain
allograft of human skin, xenograft of porcine skin, added antimicrobial or chemotherapeutic ointments (silver)
silvadene, scarlet red
Rigid support dressing - CORRECT ANS->immobilize
cast, splint
Sponge counts are done for all the following reasons EXCEPT
a) account for used sponges
b) prevent injury by retained foreign object
c) bc state law requires specific count procedure - CORRECT ANS->C
Reasons to avoid using radiopaque sponges in dressing - CORRECT ANS->1) possible invalidation of subsequent count if returns to OR with dressing
- may appear as foreign body on post op x ray
Cardiac Agents - CORRECT ANS->used to reduce mammary artery spasm, test patency and integrity of graft, and sustain radial artery dilatation
Otic Agents - CORRECT ANS->anesthetize, stop or slow bleeding, irrigate, anti-infective
Hormonal Agent - CORRECT ANS->stimulate smooth muscle
