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NIFA Study Guide Questions and
Answers 2024
The number one patient safety issue identified in a survey of peri-operative nurses is preventing: - answer Wrong site/procedure/patient surgery Reprocessing (flashing) instruments in the OR is high risk because: - answer OR personnel not properly trained to reprocess instruments To safely transfer and position patients in a manner that prevents shearing, personnel should use a mechanical lifting device for a supine-to-supine transfer of a patient weighing more than: - answer 157 lbs should be the primary decision makers for what equipment and supplies are purchased and stocked in the difficult airway management cart. - answer Anesthesia personnel Proper specimen management techniques prevent errors and include all of the following EXCEPT: - answer Receiving specimens from the surgical field then affixing patient label to each Preventing surgical fires is a top priority for all OR personnel and members of the surgical team should perform all of the following duties EXCEPT: - answer Perform a weekly fire risk assessment Peri-operative hypothermia is an important issue for all anesthetized patients because of all of the following EXCEPT: - answer Increases risk of renal failure Recommendations for preventing retained surgical items include all of the following EXCEPT: - answer Utilizing a multidisciplinary team to resolve incorrect counts
Select the appropriate order for administering blood and blood products. - answer Verify informed consent for blood, verify patient identification and blood type and unit numbers against blood tag and requisition slip with second licensed person, sign slips Weighing sponges is a valuable tool for meticulous calculation of blood and fluid loss when conducted correctly and used in appropriate circumstances. Select the response that correctly reflects the best practice in weighing sponges. - answer Keep a running total blood loss calculated from available sponges during procedure 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? - answer Replacing or tagging sponges and laparotomy instruments with radiofrequency identification (RFID) chips A female patient with end-stage pancreatic cancer was admitted from hospice for a celiac plexus block to treat intractable pain. She had a Whipple procedure 18 months earlier and enjoyed a good quality of life until 3 weeks ago. She wanted to be able to complete "getting her things in order" and saying good-bye to her friends and family while enjoying her last days pain- free. The patient insisted that her Do Not Resuscitate (DNR) status NOT be rescinded. She was conscious and competent and knew - answer PSDA and advance directives A patient was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled vaginal-assisted laparoscopic hysterectomy. She demonstrated and verbalized that she understood all of the tenets of the procedure, risks, expected outcome, complications, and procedural process. Before she signed the consent form, she informed the surgeon that she did not want any medical students or surgical residents performing any parts of the procedure other than a - answer right to informed consent. Early on, during the preliminary sponge count on closure of a repair of a ruptured abdominal aortic aneurysm, the circulating nurse was unable to account for 2 lap sponges. He had meticulously maintained accountability for all sponges and instruments discarded from the sterile field and bagged each sponge carefully. He immediately turned and addressed the entire
The OR is a danger-prone area for both patients and staff. Providing a safe environment of care for the patient involves identifying, mitigating, and managing the hazards inherent in surgical care. Choose the answer below that completes the blanks in this sentence: The risk of the surgical hazard of can be mitigated through.
- answer wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists A patient was transferred to the postanesthesia care unit (PACU) by the anesthesia provider and perioperative nurse. A hand-off report was given, using situation, background, assessment, recommendation (SBAR) format, to the accepting PACU nurse. The first element of information that should be presented in the hand-off report is: - answer patient identification and procedure performed. If a staff person receives a needlestick injury, what is the first corrective action? - answer Wash wound with soap and water; flush mucous membranes. Contact with infected patients or infectious material places healthcare workers at risk for occupational-acquired infection. Which communicable disease are healthcare workers at risk for acquiring or transmitting? - answer Seasonal influenza Select the appropriate nursing action that supports hands-free instrument passing and sharps safety. - answer Create a neutral hands-free area between the scrub person and surgeon with a basin or magnetic mat. Select the guideline that complements the design of the culture of safety model. - answer Incorporate safe practices into your daily work when handling sharps. A neutral zone is a predetermined location on the surgical field where sharps are placed for retrieval by the surgeon. Which of the following is a best practice for the use of the neutral zone? - answer Announce the transfer of each sharp before placing it in the neutral zone.
Which of the following may be a consequence of high-dose or full-body radiation? - answer Nausea, vomiting, and diarrhea Exposure to blood-borne pathogens occurs during all phases of the perioperative process. Observing safety precautions during all phases of surgery, from setup to cleanup, reduces the number of injuries and exposures for all OR personnel. For the prevention of sharps injuries in the pre-procedure and post-procedure phases, which safe handling practices reflect appropriate nursing actions? - answer Use standardized sterile field setups throughout the surgical service department. Transport reusable sharps in a safe, closed container to the decontamination cleanup area. Do not place hands or fingers into a container to dispose of a device. Inspect the sharps container for overfilling before discarding disposable sharps in it. Which list of medications best reflects medications indicated for latex sensitivity therapeutic management? - answer Epinephrine, prednisone, and a beta-agonist inhaler While antibiotics have been credited with saving lives, misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs). Select the antibiotic application that has evident to support it as a best practice and not, potentially, a misuse of antibiotics. - answer Antibiotics given intravenously within 1 hour of the incision for every procedure with an incision or entered body system. 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: - answer <3% of the mixture is liquid water. A 47-year-old man was admitted to the emergency department (ED) with respiratory symptoms, facial and upper body abrasions, burns, and moist
office, exploded and sprayed him 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 bio-terrorism event. The epidemiologist was called, and the - answer Anthrax and smallpox Qualities of an effective packaging material must include several key characteristics. Select the three most important qualities. - answer Good steam penetration and removal, good microbial barrier, aseptic presentation. 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 is turbulence from staff movement and activity plus door movement, when it opens and closes, can: - answer mobilizing resting dust from these surfaces. An 86-year-old male was admitted to the intensive care unit (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 which practice precaution?
- answer Both standard precautions and contact precautions Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however: - answer it can only be used for the initial gloving. 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. - answer Inspect, inventory against list, assemble, place integrators, wrap and tape A patient undergoing a laparoscopic Nissen fundoplication procedure will be positioned in both high and low lithotomy during the procedure. After the patient is re-positioned into lo lithotomy, the perioperative nurse should: - answer reassess the patient for body alignment, tissue integrity, and
pressure areas.
A frail and thin 91-pound, 83-year-old woman is scheduled for a right pneumonectomy for non- small cell lung cancer. She will be positioned in left lateral position for her procedure. Based on the perioperative nurse's preoperative assessment, identify three position-related nursing diagnoses for this procedure and four relevant nursing interventions. Select from the options to fill in the blanks. - answer Hypothermia; impaired skin integrity; falls; remain at patient's side during induction; use under- and over-body forced air warming blanket; use at least four people to assist with lift and transfer; pad all bony prominences with foam or gel pads. The lateral kidney position allows approach to the retro-peritoneal area of the flank. To render the kidney region readily accessible, the is raised, and the bed flexed so that the area between the twelfth rib and the iliac crest is elevated. Compression of the can occur when the flank is raised too high. - answer kidney bridge; vena cava A veteran perioperative nurse remembers a time when all suture needles had eyes, and she even had her own needle rack. She hand-threaded all sutures according to the surgeon's preference. The newer sutures were originally called "atraumatic" sutures because they did not double back through a needle eye and cause tissue trauma during pulling or suturing through the tissue. Today, we call this manufacturing process of connecting the suture thread to the needle: - answer swaged The ideal suture material is one that has handling characteristics such as: - answer ease of tying Careful counting (according to established policy), situational awareness, and conscientious and meticulous attention to the field are believed to prevent miscounts and lost items. A recent patient safety statement about preventing retained foreign objects recommends which of these practices? - answer Verbal handoff must include count status at time of relief. An older surgeon explains his justification for this suture choice to the new perioperative nurse in the scrub role. He prefers to suture his intestinal anastomosis with a suture that has multiple filaments braided together because it ties well and holds the knot, which tightens when the thread absorbs the tissue fluids. He also needs a strand that is easy to see and only needs to retain its tensile strength for about 1 year, at which time the intestinal junction will be healed, even though this - answer Sofsilk
Flat neurosurgical patties are flat sponges composed of soft compressed cotton or rayon with an embedded radiopaque element and string attached. They are often used in neurosurgical procedures. While used for hemostasis and exposure, what other use would be important in surgery? - answer Application of topical steroids the circulating nurse received the trauma call from the emergency department (ED) and called sterile supply to assemble the instruments for an abdominal trauma case with possible aortic rupture. When the cart arrived, she saw the vascular set; however , the most important set was missing. What important instrument set was needed for this procedure besides the vascular set? - answer Basic laparotomy set The primary use for suture is essentially to: - answer ligate, suture, and close tissue. Wound tissue healing is enhanced by the use of stapling instruments that mechanically apply internal staples for ligation and division, resection, and anastomoses. What feature of the mechanical process reduces tissue manipulation, edema, and inflammation? - answer The non- crushing B shape of the staples allows nutrients to pass through. According to a 2010 article published in The Journal of the American College of Surgeons and citing data from a 1998 study, where do more that half of needle-stick injuries involving suture needles occur? - answer During the suturing of fascia or muscle tissue The nerve supply for the female pelvis comes from the autonomic nerves that enter the pelvis through the - answer Superior hypogastric plexus Which of the following is an important statement regarding the prevention of degenerative orthopedic conditions - answer Weight-bearing activities and joint movement prevent cartilage from becoming thin or damaged The cerebellar tentorium supports which structures of the cerebral hemispheres - answer Temporal lobe
An example of an indication for liver transplantation would be - answer primary hepatic cancer he largest part of the mammary gland rests on the - answer Pectoralis major muscle and serratus anterior During ventriculoperitoneal shunt placement, - answer The unit is soaked in NS & antibiotic solution, never lubricated. Patients with chronic venous insufficiency (CVI) are not typically treated surgically as often as patients with arterial disease because: - answer CVI is not life-threatening or limb-threatening 35% of the refractive power of the eye is credited to which part of the eye - answer Lens Oculocardiac reflex (OCR) is an intraoperative emergency that can occur during eye surgery. Select the definition of the response and contributing factor(s) - answer Trigeminal-vagal response caused by pressure on the globe or retrobulbar block The perioperative nurse must be prepared for which additional procedure when head and neck surgery is performed? - answer Tracheostomy The perioperative nurse preparing for a procedure where STSGs will be taken to cover several large burn areas will need to have available: - answer sterile mineral oil, tongue blades, and a mesher dermatome the correct term to describe the inward turning of one or both eyes - answer Esotropia The nerve supply for the female pelvis comes from the autonomic nerves that enter the pelvis through the - answer Superior hypogastric plexus
which surgical approach reduces the morbidity and mortality in removal of an acoustic tumor - answer Translabyrinthine approach Pt with hepatobiliary disease, The perioperative nurse, during the preoperative assessment, questions and examines the patient for signs and symptoms of jaundice, petechiae, and lethargy and: - answer review chart for bleeding and coagulation times and the platelet count. The external ear canal lining - answer reduces bacterial levels in the outer ear Miotics and mydriatics produce opposite effects on the pupil of the eye. Select the most appropriate statement about miotic and mydriatic drugs - answer Mydriatic drugs, such as phenylephrine, dilate the pupil. Vascular access in pediatric patients may be established intraoperatively for short-term (weeks) or long-term (months, years) use - answer Central venous line What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp - answer Subgaleal space Pericardial tamponade includes which of the following signs or symptoms - answer Narrow pulse pressure Which statement regarding level III and level IV trauma centers best describes the difference between the two types of centers - answer A level III trauma center provides advanced cardiac life support (ACLS), surgery, stabilization, and transfer, while a level IV only provides ACLS services before immediate transfer to a higher level center A percutaneous method of instituting femoral vein-femoral artery cardiopulmonary bypass (CPB) can be used for minimally invasive (or conventional open) procedures and in emergency situations where the environment is not conducive to traditional CPB methods. Select the areas where percutaneous CPB would be indicated - answer Cardiac catheterization unit and intensive care unit
The perioperative nurse should plan to remain close to the elderly patient during induction because - answer Airway anatomy changes in the elderly The child inhales the favorite flavor while drifting off to sleep. This complementary therapy falls within the category of: - answer clinical aromatherapy Which of the following sulci is of particular anatomic importance during surgery? - answer Two sulci of particular anatomic importance during surgery are: (1) the lateral sulcus, or sylvian fissure, which divides the temporal lobe from the frontal and parietal lobes, and (2) the central sulcus, or fissure of Rolando, which separates the frontal from the parietal lobe Which of the following associations is incorrect pertaining to the blood supply of the brain - answer Vertebral arteries --- supplies the occipital lobe TURP syndrome is often seen during the intraoperative period. Signs and symptoms exhibited by patients include - answer restlessness, apprehension, irritability, confusion, nausea, slow pulse rate, seizures, dysrhythmias, and rising blood pressure may be suggestive of TURP syndrome, he blood is oxygenated in the lungs and returns to the left atrium through the pulmonary veins. Where does the blood flow after leaving the left atrium
- answer Through the mitral valve into the left ventricle Which of the following is not contained within the anterior mediastinum - answer Great Vessels Definitive information about the extent and location of ischemic heart disease can be obtained from which of the following tests - answer Cardiac catherization An interventional radiology procedure used to open a blocked or narrowed blood vessel as a result of atherosclerosis - answer Percutaneous transluminal angioplasty
The mitral valve is anchored to the - answer left ventricular wall the semi-invasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function - answer Radionuclide imaging Primary divisions of a nerve are known as - answer Rami the correct branch of the Left main coronary artery - answer Circumflex coronary artery When a thyroglossal duct cyst is present in an adult, it exists as a pretracheal cystic pouch attached to what structure - answer Hyoid statement regarding risk factors for developing vascular disease is true - answer Arteriosclerosis is a natural part of the aging process. Which of the following is an indication for damage control surgery - answer Indications for the potential need for damage control surgery include hemodynamic instability, hemorrhagic shock, coagulopathy, hypotension, tachycardia, tachypnea, inaccessible major anatomic injury, concomitant major injury, and altered mental status The most common congenital cyst found in the neck is - answer Thyroglossal duct cysts The potential for development of a direct inguinal hernia is - answer When a weakening or a tear in the aponeurosis of the transversus abdominis and the transversalis fascia occurs, A vena cava filter (Greenfield filter) maintains a patent vena cava but prevents pulmonary emboli (PE) by trapping the emboli at the apex of the device. This procedure may be performed in the OR, radiology suite, or ICU for critical patients - answer Right jugular and right femoral
The tensile strength of lactic & glycolic acid polymers is sufficient for approximation of tissues for weeks. - answer 2- New synthetic polymers such as PDS provide wound support up to months - answer 3 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 - answer Avoid placing specimens for frozen section in formalin. Terminal cleaning and disinfection of the operating room should be done - answer daily when the areas are being used A needletype frequently used in microsurgery is - answer cutting taper
