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RNFA FINAL PRACTICE Exam Questions
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The process of decontamination should initially begin at what point? - ✔✔Completion of the surgical procedure Side effects the patient may encounter as a result of extracoproreal circulation include: - ✔✔Inflammatory responses After retracting the nerve roots during a laminectomy, this structure is incised before getting to the disc.
- ✔✔Posterior longitudinal ligament Of the following, which is not a symptom of compartment syndrome? - ✔✔Moderate pain Fibrocystic changes in the breast describe many different breast changes. These changes affect almost all women at some time in their lives. Nipple discharge is more commonly associated with benign lesions than with cancer; however, discharge is usually significant only if it is spontaneous, persistent, and: - ✔✔bloody Jan Stuyvesant, a perioperative nurse, was the scrub person during a robotic-assisted laparoscopic cholecystectomy. She locked the robotic endoscissor into the adaptor on the robotic arm and positioned the tip end into the trocar port in order for the surgeon to dissect the cystic duct and artery, while the surgical assistant placed the clips on the cystic duct and artery. As she reached across the sterile field to insert the cholangiocatheter through the port, the anesthesia provider accidentally made contact with the distal end of the catheter as he stood up to reach the monitor controls. The contaminated end of the catheter touched the endoscopic clip applier, the endoscissor connector that the surgeon was using, the glove of the assistant, and Jan's gown sleeve. The surgeon ordered everyone to change their gown and gloves and covered the port area with a sterile towel. What was the rationale for the surgeon to co - ✔✔The surgeon was not in contact with the sterile field because he worked from the robotic console. The ability to maintain thermoregulation is compromised in elders because of changes in the: - ✔✔vascular system
Because herbal products are so readily available and have such widespread media attention, many people think that they can safely self-medicate. Why should the public be aware and educated about dietary supplements and potential harmful effects? - ✔✔Unknown substances may be present in these products. Talia Mendelson, a 27 - year-old patient who had a lumpectomy for early-onset breast cancer, is now scheduled for infusion port insertion. Talia is very nervous because during the previous lumpectomy, performed using a local anesthetic, she was not entirely sedated. Talia tells the perioperative nurse that she was uncomfortable and heard everything in the room, but admitted that she did not feel pain. The nurse recognized Talia's anxiety related to the surgical intervention and prepared to implement corrective actions in the OR. What nursing intervention best reflects one that would ensure support or contribute to Talia realizing her expected outcome? - ✔✔Ensure a quiet and calm environment of care A 2 6 - year-old female is rushed to the operating room after a primary and secondary survey in the emergency department. She was hit by a small truck as she was riding her bicycle through a busy intersection. She has sustained rib fractures and several fractured transverse vertebral processes. Renal injury is suspected. As the perioperative nurse prepares to insert a urinary catheter, she notices blood at the urinary meatus. What should the nurse's next action be? - ✔✔Discontinue the catheter insertion Open parathyroidectomy is currently being replaced with less invasive and more targeted techniques; however, the amount of parathyroid tissue that should be removed remains controversial and relates to whether single or multiple glands are involved. A portion of a gland must remain to: - ✔✔prevent hypocalcemia and its complications. Which of the following supplies blood to the transverse colon? - ✔✔Middle colic artery Which of the following structures form the mouth? - ✔✔cheeks, the hard palate, the mandible, and the tongue The salivary glands produce saliva, which serves to moisten the mouth and initiate: - ✔✔carbohydrate digestion. Potential development of a direct inguinal hernia results from _and weakening or tearing. - ✔✔Aponeurosis of transversus abdominus and transversalis muscle
The Glasgow Coma Scale (GCS) is commonly used to assess patients with brain injury using three indicators of cerebral function: eye opening, verbal communication, and motor response to verbal and noxious stimuli. Within the scoring range for the GCS, the best possible score is and the worst possible score is _. - ✔✔ 15 ; 3 What mouth structure is considered the boundary between the buccal cavity and the lingual cavity? - ✔✔Teeth Laryngoscopy is direct visual examination of the interior of the larynx by means of a rigid, lighted speculum known as a laryngoscope to obtain a specimen of tissue or secretions for pathologic examination. What risk reduction strategy should the perioperative nurse employ in preparing for the conclusion of the procedure? - ✔✔Maintain instrument setup until the patient leaves the OR. Marissa Walton is transferred to the OR from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia. What important preparation for the procedure will the perioperative nurse perform before Marissa arrives in the OR? - ✔✔Prewarm the OR to above the ambient high temperature for an adult. FESS provides a more functional approach to treat sinus disease. FESS involves the endoscopic resection of inflammatory and anatomic defects of the sinuses while preserving natural function in a surgical procedure that is minimally invasive. From the following, choose an important finding that should be communicated to the surgeon immediately during this procedure. - ✔✔Encroachment of the orbit Administration of cyclogyl should be used in caution with which of the following patient groups? - ✔✔Patients on tricyclics What drug can be used to reverse the effects of heparin? - ✔✔Protamine sulfate When assisting with an open inguinal hernia repair, the surgeon makes an incision through which of the following to access the cremaster muscle, inguinal canal, and cord structures? Choose the correct answer. - ✔✔External oblique muscle Identify the type of fracture that has more than two fragments. - ✔✔Comminuted
Identify the correct path of the cardiac conduction system. - ✔✔From the SA node to the AV node to the bundle of His to the Purkinje system Transsphenoidal hypophysectomy (TSH) is performed with the patient administered a general endotracheal anesthetic, combined with a local anesthetic. The surgical team places the patient in a semisitting position, with the head against the headrest. A transnasal or a sublabial incision can be used for rapid access to the sella turcica. Select the diad ( 2 ) of conditions that would be appropriate indications for TSH. - ✔✔Hypopituitarism and small pituitary tumors Describe a pantaloon hernia. - ✔✔A combination direct and indirect hernia In renal transplantation a kidney with artery(ies) is preferred. - ✔✔single With injury to the brain, swelling may occur quickly, requiring aggressive decisions to manage increasing intracranial pressure (ICP). What is an appropriate diuretic medication to give and what nursing actions would be indicated for an older adult patient with traumatic brain injury, increased ICP, and a history of congestive heart failure (CHF)? - ✔✔Furosemide (Lasix) 20 - 80 mg IV; monitor for hypotension and note extent of diuresis The production of CSF occurs where? - ✔✔Choroid plexus of the ventricles Select the true statement about antimetabolite drugs and their indications for use. - ✔✔ 5 - Fluorouracil and mitomycin can both be administered topically to inhibit scars and pterygium excision Select the statement that best reflects the functional components of the gastrointestinal (GI) tract. - ✔✔The alimentary canal extends from the mouth to the anus. As the surgeon prepared to clamp and transect the bowel during a small bowel resection for tumor, the scrub person transferred instruments from the Mayo stand to the back table and prepared the sterile field for bowel isolation technique. The rationale for this technique in tumor removal/cancer procedures is to: - ✔✔Prevent mechanical metastasis
A minimally invasive video-assisted thyroidectomy (MIVAT) procedure relies on Miccoli instruments added to the standard thyroid or neck dissection setup, a 30 - degree endoscope, and an ultrasonic (harmonic) scalpel with scissors to ligate and divide the vessels. An important risk reduction strategy for any minimally invasive procedure would be? - ✔✔consider and plan for the possibility of conversion to open thyroidectomy. When laryngoscopy, bronchoscopy, and esophagoscopy are performed in a single session on a patient, the procedure is termed triple endoscopy or panendoscopy. The purpose of triple endoscopy is usually diagnostic. A critical role of the perioperative nurse during this complex diagnostic procedure is that of: - ✔✔identifying, containing, and labeling all specimens accurately. Which of the following is not a reason to convert a case from laparoscopic to an open abdominal case? - ✔✔Lack of warmer for insufflation gas The liver is essential in the metabolism of carbohydrates, proteins, and fats, generating nutrient stores of which substance that supplies energy sources to the brain and body? - ✔✔Glycogen The kidneys are highly vascular organs. Approximately how much of the entire circulating blood volume do the kidneys process at any one time? - ✔✔One fifth Metastases to the spine occur most often in the thoracic spine, followed by the lumbar and cervical areas. Select the statement that best reflects a therapeutic spinal procedure goal for a secondary metastatic tumor. - ✔✔Surgery is directed toward decompressing and stabilizing the spine. The scaphoid, also called the navicular, links the proximal row of carpal bones as it: - ✔✔stabilizes and coordinates the movement of the proximal and distal rows. Identify the name of the procedure that is an alternative treatment for patients with chronic pulmonary emphysema. - ✔✔Lung volume reduction surgery Pamela Morris is a 62 - year-old woman with a 4 - year history of Graves' disease that has not responded to medical therapy. She is scheduled for a subtotal thyroidectomy. What condition, a complication of Graves' disease, is her probable indication for a subtotal thyroidectomy? - ✔✔Tracheal obstruction
The most common congenital cyst found in the neck is: - ✔✔Thyroglossal duct cysts A stapedotomy is removal of the stapes superstructure and creation of a fenestra (opening) in the fixed stapes footplate for treatment of abnormal bone growth around the footplate that results in its immobility. The patient scheduled for a stapedotomy will typically not have a surgical diagnosis of: - ✔✔otosclerosis. Which structure supports the uterus and contains the uterine artery and vein? - ✔✔Cardinal ligaments A positive Kehr's sign is. - ✔✔Left shoulder pain Miotics and mydriatics produce opposite effects on the pupil of the eye. Select the most appropriate statement about miotic and mydriatic drugs. - ✔✔Mydriatic drugs, such as phenylephrine, dilate the pupil. In the pulmonary circulatory system, blood is pumped from the right ventricle (RV) through the pulmonary valve into the main pulmonary artery (PA). The PA divides into the right and left pulmonary arteries, which further subdivide into the arterioles and capillaries of the lungs. Where does the blood from the lungs flow next? - ✔✔Through the pulmonary veins to the left atrium Of the following ocular blocks, which carries the highest risk? - ✔✔Retrobulbar block An example of an amphiarthrotic joint includes: - ✔✔Intervertebral joints What composes the lining of a herniated abdominal sac? - ✔✔Peritoneum A neurologist is about to perform a lumbar puncture on a patient presenting with altered neuro status due to a possible intracranial mass. Why would this procedure be contraindicated? - ✔✔The change in ICP from the lumbar puncture can result in brain herniation There are many factors that influence the behavioral manifestations of pain in the pediatric population. Which of the following is not an influencing factor? - ✔✔Parental involvement
and symptoms of jaundice, petechiae, and lethargy and: - ✔✔reviews his chart for bleeding and coagulation times and the platelet count. The absence of distinct teniae serves as a visual landmark for what abdominal structure? - ✔✔Upper margin of the rectum Which of the following operations require general anesthesia? - ✔✔MVR Exophthalmos can be associated with which of the following? - ✔✔Hyperthyroidism When a thyroglossal duct cyst is present in an adult, it exists as a pretracheal cystic pouch attached to what structure? - ✔✔Hyoid What special consideration should be made when assessing a pediatric trauma patient for level of consciousness? - ✔✔Use the modified Glasgow Coma Scale for children. Young children are predisposed to parasympathetic hypertonia (increased vagal tone), which can be induced by: - ✔✔painful stimuli such as eye surgery or abdominal retraction. For indirect hernia repair, the _. - ✔✔Hernia contents are reduced to the abdominal cavity Twelve pairs of cranial nerves arise within the cranial cavity. Although they are part of the peripheral nervous system, from a surgical standpoint they are considered part of the anatomy of the head. Which three pairs of nerves, conveniently considered together because of their motor influence on the eye, are subject to toxic, inflammatory, vascular, and neoplastic lesions? - ✔✔Third, fourth, and sixth cranial nerves An important landmark during perineal prostatectomy is the: - ✔✔True prostatic capsule Select the semi-invasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function. - ✔✔Radionuclide imaging
Suction applied directly to neural tissue can be harmful To prevent tissue damage, a should be placed between the neural tissue and the suction tip. - ✔✔Cottonoid Select the statement about the prostate that best reflects its location, size, and weight. - ✔✔The prostate sits below the base of the bladder, is 4 cm at the base, and weighs 20 to 30 g. During ventriculoperitoneal shunt placement,. - ✔✔The unit is soaked in NS & antibiotic solution, never lubricated. If cervical spine precautions were not implemented before arrival at the hospital, the emergency department team initiates them before performing any other procedures on the patient. A trauma team member can stabilize the head and neck, if necessary, until a cervical collar is placed. What event needs to take place before the team removes the cervical collar and continues care? - ✔✔A cervical radiograph is obtained to rule out injury to the neck. The pelvic floor consists of which muscle groups? - ✔✔Levator ani and coccygeal muscles Damage to this area of the brain is often devastating and life-threatening because it can affect movement, senses, consciousness, perception, and cognition. Choose the correct answer from the following. - ✔✔Brainstem Commonly implicated in SAH, the vessels of the Circle of Willis include: - ✔✔Posterior communicating artery Lasers assist in vaporization of scar tissue, granulomas, and cholesteatomas without damaging surrounding tissue and may be used for select otolaryngologic procedures. Lasers can be secured to the operating microscope and laser energy delivered to the tissue by means of a: - ✔✔micromanipulator. During the preoperative assessment for a patient scheduled for nasal surgery using a local anesthetic that includes epinephrine, what important consideration, relevant to epinephrine use, should be explored? - ✔✔Cardiac status Which of the following is not included in the the bony pelvis? - ✔✔Ileum
The part of the femur that is most susceptible to fracture in conjunction with osteoporosis is: - ✔✔neck. A patient that presents to the OR with midface fractures should not have NG or nasal intubation performed due to a fracture of this particular structure can result in tube placement in the brain. Identify the structure from the following. - ✔✔Cribriform plate What is the correct rationale for not using methylene blue as a skin marker in the neurosurgical OR? - ✔✔Methylene blue produces an inflammatory reaction in CNS tissue. The rotator cuff consists of which group of muscles? - ✔✔Supraspinatus, infraspinatus, teres minor, and subscapularis Which of the following correctly identifies the phagocytic cells of the liver? - ✔✔Kupffer cells Depending on the surgical defect, head and neck surgical procedures to remove malignant tumors may also involve reconstructive procedures. The wound may be closed primarily, or local flaps and split- thickness skin grafts or full-thickness skin grafts may be used to restore function as well as cover defects. An important role of the perioperative nurse in the ongoing assessment of graft integrity includes which assessment tool? - ✔✔Use of intraoperative and postoperative Doppler to detect presence of graft pulse Impaired nutritional status is highly prevalent among the elderly; as many as 12 % of men and 8 % of women in the healthy geriatric population are considered undernourished. During the preoperative assessment and interview, what information will the perioperative nurse review, in addition to a thorough assessment including body mass index and Mini Nutritional Assessment? - ✔✔The serum albumin level Identify the class of medications that can increase the risk or severity of a reaction to contrast media. - ✔✔Beta Blockers Matilda Gunderson, a 55 - year-old woman with uterine cancer, is scheduled for an open panhysterectomy. She is positioned in low lithotomy with her legs symmetrically arranged in padded cradle stirrups. After the incision is made and primary dissection accomplished, she will be positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area. Matilda is at risk for compromise and injury related to prolonged Trendelenburg tilt, which promotes: - ✔✔decreased pulmonary compliance and functional residual capacity.
Surgeons use open reduction and internal fixation when they are unable to reduce a fracture by closed methods and skeletal traction is not indicated. What would be an advantage for an open rather than a closed fracture reduction technique? - ✔✔Direct observation and verification of fracture alignment The right and left coronary arteries originate in the corresponding sinuses of Valsava which are located
. - ✔✔Posterior to the cusps of the aortic valve Which of the following regarding PMMA ( bone cement) is not an affect local tissue? - ✔✔Skin burns due to exothermic reaction During a stapedotomy, it is important to save which of the following nerves that control taste on the anterior 2 / 3 's of the tongue? - ✔✔Chorda tympani nerve Acquired valvular heart disease most commonly affects the _valves. Choose the correct answer. - ✔✔mitral Bone grafting can be completed using Allografts or Autografts. The type of graft used is not dependent on which of the following factors? - ✔✔The weight bearing ability of the bone affected A rapid rise in thyroid hormone levels is not caused by which of the following? - ✔✔Idodized table salt use Thyroid hormone medication Several types of diagnostic imaging studies visualize structures by producing serial sections through different anatomic planes, highlighting specific structures or tissue densities. Which of the following is contraindicated in pregnancy? - ✔✔CT scan. The cricoid cartilage is a complete cartilaginous ring that resembles a signet ring; it rests beneath the thyroid cartilage and supports the airway. What membrane, attached to the midline of the upper thyroid cartilage, protects the larynx during swallowing? - ✔✔Epiglottis
related to her size and the positional requirements and OR bed manipulations required for this procedure. An appropriate nursing implementation for positioning this patient would be to: - ✔✔place two safety belts over the thighs and lower legs to prevent the patient from sliding out of position when the surgeon tilts the table for better exposure and access, and place a positioning lift under the lower right side of the chest to elevate the lower rib cage for exposure and access to the viscera in the right upper quadrant of the abdomen. Which of the following factors might the RNFA recognize as having the potential to produce pressure? - ✔✔a self-retaining retractor post clamped to the OR bed rail and tightened against the patient's side The Joint Commission (TJC) suggests that surgical consents be written at what level to meet health literacy needs of all patients? - ✔✔ 5 th grade Many factors have contributed to the evolution and progressive growth of ambulatory surgery. Select the three anesthetic agents that promote fast induction, rapid emergence, and minimal side effects and have been credited as a significant factor in this trend. - ✔✔Sevoflurane, propofol, desflurane Which statement best explains the mechanism of action of general anesthetic agents? - ✔✔Inhibition of synaptic transmission of nerve impulses High-pressure insufflation rates can cause increased intra-abdominal pressure that can result in life- threatening sequelae. The perioperative nurse reduces the flow rate in collaboration with the surgeon, while monitoring the patient for signs of: - ✔✔CO 2 gas embolism A type of suture to help eliminate tension on the primary suture line is known as: - ✔✔Retention The incidence of intraoperative awareness (IOA) may increase in high risk patient populations. From the following, choose the group that is considered high risk for IOA. - ✔✔Cardiac surgery patients The safest practice for passing sharps and instruments during the procedure is to: - ✔✔establish a neutral zone or separate area to place reusable sharps
Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral, and nerve, which can result in injury from _.
✔✔common peroneal; Direct compression from the stirrup bars What is the appropriate action if the doctor is delayed after the room and instruments have been opened? - ✔✔Cover the instruments with a sterile drape and have the scrub nurse continually visually observe the room for breaches in sterility Which of the following are the sources of radiation exposure in an operating room setting? - ✔✔Lasers and C-arms Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below: - ✔✔ 32 mm Hg Proper care and handling of surgical specimens is imperative for correct diagnosis, treatment, and prognosis planning of the patient. Select the response that best reflects correct specimen care and handling. - ✔✔Avoid placing specimens for frozen section in formalin. Sherry Ames is an endoscopy nurse in a busy free-standing ambulatory surgery center. She is an RN with additional documented competency in providing an anesthesia modality to healthy patients having screening colonoscopies, bronchoscopies, and upper GI endoscopies. This modality will allow this patient population to tolerate potentially uncomfortable procedures while maintaining their own airway and be easily aroused from light sleep. Sherry is competent and legally qualified to provide which modality of anesthesia? - ✔✔Conscious sedation/analgesia David Reese, a 14 - year-old patient with marked scoliosis, is in prone position with gel rolls, gel pads, and pillows for a spinal fusion. Before the skin prep is begun, the perioperative nurse should check the positioning for pressure areas of the: - ✔✔genitals, knees, toes, and eyes The anesthesia department at Evergreen Medical Center has a total staff of 102 persons. These employees serve in many roles as care providers, technical assistants, materials management, clinical engineers, and clerical staff. Select the list of direct-care anesthesia providers. - ✔✔Anesthesia provider, AA, CRNA
The RNFA instructed the new anesthesia resident in the proper positioning of the arm and hands on the OR bed armboards. The resident was cautioned to avoid pressure on the elbow to prevent: - ✔✔ulnar nerve injury Silk, when buried in tissue, loses its tensile strength after which period of time? - ✔✔ 1 year Which of the following is a major infectious risk for healthcare workers? - ✔✔Hepatitis B 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: - ✔✔steam sterilization for the implant sets and paper inventory form, hydrogen peroxide gas plasma for the retractors, wrapped separately. Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained foreign objects (RFOs). What new and evolving risk reduction strategy could prevent RFOs and frustrating, time-consuming miscount adventures at the end of these procedures? - ✔✔Performing radiologic surveillance on all conversion procedures at closure Waste anesthetic gases are small amounts of gases that may leak either from the patient's anesthetic breathing circuit into the OR air while anesthesia is being administered or from exhalation of the patient during recovery. Both mechanisms of exposure create risks for OR personnel. Select the appropriate risk reduction strategy that protects the environment and perioperative worker from exposure to ambient waste anesthetic gas. - ✔✔Ensure that the scavenging system is properly connected to the gas outlet. When unexpected events occur that have, or could have, compromised patient safety, a systematic investigatory process takes place. Significant information is gained through this meticulous exploration. The primary motive for carrying out a root cause analysis is to: - ✔✔find out what needs to take place to prevent a recurrence of the event. The most common pediatric premedication given in the U.S. is: - ✔✔Midazolam
Surgical hand scrub products should have which of the following attributes? - ✔✔Inhibit the regrowth of microorganisms The bariatric unit was experiencing an alarming rate of postoperative wound dehiscence and evisceration on postoperative day 1 , as the patients began to ambulate independently. Select the response below that reflects significant surgical team influence on wound healing. - ✔✔Sterile technique, wound closure materials, hemostasis methods Select from the following a medication that is used for PONV and has the potential to prolong the QT interval - ✔✔Droperidol An instrument that is used to occlude a vessel is known as: - ✔✔hemostat What action is considered a best practice when communicating with geriatric patients with cognitive impairments? - ✔✔Approach the patient from the front and identify yourself Which members of the surgical team can be held liable in litigation for retained foreign bodies? - ✔✔the entire team Sponge counts should be performed at the time of permanent relief of either the scrub person or circulating nurse, and _. - ✔✔Before the procedure, before closure of each body cavity, before wound closure, at skin closure or end of procedure. The perioperative nurse visited Mr. Jennings in the ICU the next day and noticed abrasions on his elbows. Mr. Jennings told her that the ICU nurses had difficulty pulling him back up in bed every time he slid down toward the bottom and he was not able to be much help in moving himself. This skin injury was probably the result of which physical force? - ✔✔friction from his elbows rubbing over the sheets when slid up in bed Select the nursing activity that would reduce the impact of an extrinsic factor that could cause a pressure injury to the patient. - ✔✔Removing all but one layer of linen from the dry polymer elastomer gel mattress surface of the OR bed before patient transfer
