-Uses a structured vocabulary that includes the nursing process and representation of each phase.
-Intraoperative (inside the OR, there needs to be one RN in each OR room)
-Postoperative (recovery room, has to be an RN, PACU)
-The intraoperative phase of the surgical intervention is the PRIMARY FOCUS of perioperative nursing
-The approximate time for surgery is at the convenience of the patient; failure to have surgery is not catastrophic
-The condition requires surgery within a few weeks
-The surgical problem requires attention within 24-48 hours (cancer)
-Situation requires immediate surgical attention without delay (intestinal obstruction)
-Reinforce physician’s explanation and insturction
-SITE VERIFICATION CHECKLIST
-blood transfusion consent
-current vital signs
-Anesthesiologist/ Nurse Anesthetist
-Surgical Assistant (MD, PA, RNFA)
-First assistant (assists surgeon, controls patient bleeding, provides wound exposure, suturing, requires additional education)
-Scrub nurse (prepares and maintains integrity, safety, and efficiency of the sterile field)
A. Observing for signs of infection
B. Maintaining a patent airway
C. recording the intake/output
D. Checking vital signs every hours
The role of the circulating nurse in the OR is to handle the sterile equipment during surgery?
The preoperative phase ends when the patient is safely transported to the OR and care is assumed by the OR nurse?
-Risk for injury r/t positioning
-Ineffective airway clearance r/t anesthesia.
a. Clara Barton
b. Florence Nightingale
c. Lillian Wald
d. Mary Breckinridge
e. Mary Ezra Mahoney
c. Bellevue Hospital
d. The National League of Nursing
e. The Nightingale Society
a. Always follow the instructions of surgeons
b. Maintain the patient as the focus of all team activities
c. Minimize communication in order to work efficiently
d. Never deviate from protocol, even if an error may result
a. Lawsuits from the patient and their family are avoided
b. New nurses perform their work as expected
c. Surgical supplies are not wasted before or after surgery
d. Staff begin shifts on schedule and relieve one another as needed
e. The plan of care is implemented correctly before, during, and after surgery
a. All perioperative team members
b. All perioperative team members except anesthesia professionals
c. Perioperative RNs
d. Scrub nurses only
e. Surgeons only
a. PACU nurse
b. Pre-admission nurse
c. RN circulator
d. Registered nurse first assistant (RNFA)
e. Scrub person
surgical practice area?
a. Has work areas for processing and storing instruments
b. Includes the OR
c. Permits wearing of street clothes
d. Requires that all patients wear masks
e. Used for communication of information between the surgical suite and the rest of the health care facility
a. Call the surgeon away from the operation, but only if the support person demands it.
b. Discuss a projected time frame for completion of the surgery
c. Discuss the patient’s expected prognosis
d. Provide details of the surgery and describe any problems
e. Tell the patient that she is not allowed to talk to the support person
a. Direct patient care
b. Help implement improvements in healthcare systems
c. Perform surgery in an emergency without a surgeon being present
d. Serve as first assistant during surgery
e. Teach self-care to patients and their support team
a. Almost never happen
b. Are the sole responsibility of the surgeon to prevent
c. Are usually due to incorrect information provided by the patient
d. Can result from failure to perform the TIME OUT before surgery
e. Should be concealed from the patient as much as possible
a. < 1% b. 10% c. 50% d. 80% e. 100%
a. Information is confirmed from the patient’s history
b. The circulating RN and scrub nurse count instruments, sponges, needles, and other sharps
c. The patient’s name, date of birth, procedure, and procedure site are confirmed
d. The anesthesia plan is confirmed, and consent for anesthesia is obtained
e. The surgical site is confirmed and marked
a. Admission to the PACU to transfer to a patient
b. Admission to the PACU to patient’s death
c. Closure of the incision to admission to the PACU
d. Discharge from hospital to patient’s return home
e. Leaving the OR to admission to the PACU
c. Anti-emetic and pain control drugs
e. Vitamin C
a. Administer prophylactic antibiotics as directed
b. Keep the OR doors closed during the operative procedure
c. Minimize movement and talking during the operative procedure
d. Perform a TIME OUT before beginning the procedure
e. Perform a thorough skin prep and hand scrub
a. Help anesthesia professionals anesthetize patients
b. Perform the skin prep
c. Perform a thorough hand scrub before surgery
d. Providing needed instruments to the surgeon and first assistant during the surgical procedure.
e. Scrub dirty/used surgery instruments before
they are sterilized.
a. Assist with the surgical procedure
b. Clean up the OR after surgery
c. Concurrently perform the duties of a scrub nurse
d. Perform the skin prep
e. Practice at the direction of a RN Circulator
focus is on preparing the patient for self-care, care by support persons, or care in an extended-care environment.
a. Phase I
b. Phase II
c. Phase III
d. Phase IV
e. Not possible to state based on this information
a. Try to catch the instrument before it touches the floor
b. Discard and replace the instrument with a sterile one
c. Pick up the instrument and return it to the table
d. Follow the 5-second rule (OK if not on floor for more than 5 seconds)
e. Inspect for visible particulate matter and use if clean
-White blood cell count
-Blood typing and cross matching
-PT and PTT
-Urine analysis (in women it is used to check for pregnancy)
-BUN and creatinine
-Greatly impairs wound healing
-The patient may also have an increased tolerance to anesthetics
-Pre-operative verification (identifying/interviewing patients):
-Marking the operative site:
-To identify the correct operative/procedure site. Clearly marking the surgical site to eliminate any ambiguity and ensures correct bilaterally/level.
-To prevent medical error by conducting a final verification of correct patient, procedure and site. Active two way communication among al surgical/procedural team members that is consistently preformed prior to all procedures.
d. all of the above.
a. the patient.
b. the patient’s family members.
c. other health care providers.
d. all of the above.
perioperative nurse should
a. obtain informed consent from the patient.
b. ensure that a signed informed consent is in the patient’s chart.
c. explain the risks and alternatives of the planned procedure.
d. all of the above for this information.
interview, the nurse should
a. use the patient’s first name.
b. use the patient’s title and last name.
c. ask permission before using the patient’s first name.
d. wait for the patient to say how he or she wishes to be addressed
a. is always assumed to be correct.
b. may not always be correct and should be checked against another source if there is any question about its accuracy.
c. should always be checked against another source.
d. must be accepted; there is no other source for this information.
vibration is called
a. verbally (whenever possible).
b. by checking the patient’s chart.
c. by checking the patient’s identification bracelet or wristband.
d. all of the above.
a. when the surgery involves limbs.
b. when the surgery involves bilateral organs.
c. when the surgery involves multiple structures or levels.
d. all of the above.
that the patient is taking, it is important to
a. physician prescribed medications.
b. over the counter medications and vitamins.
c. herbal medications that the patient may be taking.
d. all of the above.
hearing impaired patient, it may be helpful to
a. have the patient face toward the light to facilitate lip reading.
b. shout at the patient.
c. ask short, direct questions.
d. let the surgeon conduct the assessment.
a. over the shin for five seconds, and then release.
b. over the neck veins for five seconds, and then release.
c. over the shin for 15 seconds, and then release.
d. over the axilla for five seconds, and then release.
a. sitting, with legs dangling over the side of the examination table.
b. sitting, with the legs up on the examination table.
c. supine, with the legs dangling over the side of the examination table.
d. supine, with the knees bent and the feet on the examination table.
a. not necessary.
b. not reliable.
d. best obtained in the presence of family members.
a. assessment phase.
b. planning phase.
c. implementation phase.
d. evaluation phase.
a. inadequate room heating.
b. poor circulation.
d. a febrile illness.
c. poor coping mechanisms.
d. type A behavior.
a. denial of illness.
b. a perception that recommended therapeutic
regimens are ineffective.
c. a lack of understanding of the seriousness of the patient’s health problems.
d. any of the above.
for outpatients, hospitals have
a. increased laboratory use.
b. increased surgical cancellation rates.
c. decreased length of stay for surgical patients.
d. improved patient outcomes.
A. arrives in the holding area and ends in PACU
B. Arrives in the hospital and ends with discharge
C. Is informed of the need for surgery and ends with discharge from the hospital
D. Is informed of the need for surgery and ends with the patient’s return to his or her usual activities.
A. patient teaching
B. patient and family support
C. diagnostic testing
D. preparation for discharge
A. the patient arrives at the hospital for surgery
B. The patient enters the operating room
C. The anesthesia provider induces the patient
D. The surgeon makes the initial incision
A. transferring the patient to the PACU
B. Supporting the patient’s physiological systems
C. Preparing the patient for discharge
D. Making arrangements for the patient to return to normal activity
A. AORN decided it sounded more contemporary
B. To eliminate the “Or mystique” and encourage more nurses to join the specialty
C. The responsibilities of nurses in this specialty have expanded to support and care for the surgical patient through the continuum of care
D. Because PACU nurses wanted to be included.
A. patient safety, physiologic response, behavioral responses, the health system
B. patient teaching, patient safety, behavioral responses, discharge planning
C. patient safety, patient assessment, discharge planning, the health system
D. patient assessment, plan of care, discharge planning, the health system
A. in collaboration with the surgeon and the anesthesia provider
B. that primarily focuses on patient and family education and support
C. within the framework of the nursing process: assessment, planning, intervention, and evaluation of the patient outcomes
D. that is focused primarily on the patient’s surgical diagnosis.
A. takes place in a number of settings and time frames
B. begins with a telephone call to the patient prior to surgery for teaching, support, and data gathering
C. is based on data collected by other healthcare professionals
D. usually takes place just prior to surgery and includes an interview, chart review, and physical inspection
A. knowledge deficit and high risk for infection
B. prevention of adverse outcomes and patient teaching
C. high risk for infection and support of patient and family
D. maintenance of normothermia and anatomical body alignment
A. prior to the procedure, based on information about the patient from the surgeon and other healthcare providers
B. in the holding area based on interview and assessment data
C. prior to the procedure based on knowledge of the planned procedure, typical related nursing diagnoses, and resources required.
D. when the patient enters the operating room and all attention is focused on supporting the patient
A. the surgeon’s preferences related to the surgical procedure
B. the patient’s medical diagnosis and comorbidities
C. the needs of the healthcare team participating in the surgical procedure
D. identified standards of clinical practice and professional performance.
A. the goals of the surgical procedure were met and the patient was transferred to the appropriate recovery area.
B. The desired patient outcomes have been achieved
C. The hospital policy and professional standards were upheld.
D. the patient and family express satisfaction with the entire surgical experience.
A. standardized nursing vocabulary used to describe perioperative nursing practice
B. A collection of recommended practices to guide patient care
C. Used by all electronic health record systems to standardize patient records
D. a set of evaluation tools to determine the extent to which patient care has been successful
A. task oriented and designed to care effectively for surgical patient
B. nursing science related to surgical patients
C. patient oriented, using knowledge, judgment, and skill
D. a framework to evaluate patients’ responses to surgical and other invasive procedures.
A. the patient is free from signs and symptoms of electrical injury
B. the patient receives appropriately administered medications
C. the patient’s wound perfusion is consistent with or improved from baseline levels
D. the patient’s comorbidities are managed effectively during the operative or other invasive procedure
A. participating in research activities
B. participating in professional organization activities
C. mentoring and precepting other perioperative nurses
D. all of the above
A. an RNFA is an advanced practice perioperative nurse, regardless of his or her academic levels of preparation
B. The RNFA position is an expanded role in perioperative nursing
C. The RNFA practices under the license of the physician
D. The RNFA must have an advanced degree in nursing
A. reimbursement guidelines
B. technological advances in surgical technique
C. Patient preference
D. The nursing shortage
A. perioperative registered nurse
B. licensed vocational or licensed practice nurse
C. surgical technologist
(select all that apply)
B. facility policy
C. state board of medicine
D. state board of nursing
A. managing the operating room environment
B. patient safety and achieving the desired patient outcomes
C. supervising the scrub person
D. documenting intraoperative patient care
C. first assistant
D. surgical technologist
A. to serve as the basis for the plan of care developed by the perioperative nurse
B. to increase NANDA’s database of nursing diagnoses
C. to eliminate the need for the perioperative nurse to develop an individualized plan of care
D. to increase awareness of perioperative nursing
A. clarifying expectations of the patient’s participation in recovery and rehabilitation
B. reinforcing the patient’s understanding of the risks delineated on the consent form
C. eliminating the patient’s anxiety and feet
D. clarifying the events anticipated in the preoperative and immediate postoperative periods
A. often have comorbid conditions
B. are at higher risk for surgical-site infection
C. do not respond well to antibiotics
D. are more fearful of surgery than nonobese patients
A. protocol, which states the dosage and specifies that it be given 1 hour before surgery
B. the attending surgeon
C. the anesthesia provider
D. the optimal level of antibiotic in the patient’s serum and tissue at the time of the surgery
A. determine which information must be communicated
B. provide a framework for comprehensive and concise communication
C. are mandated by TJC’s National Patient Safety Goals
D. become part of the patient’s record
A. knowledge deficit and risk of injury
B. Risk of injury and risk of infection
C. risk of infection and anxiety
D. Knowledge deficit and anxiety
A. the focus of fear is specific
B. the focus of anxiety is specific
C. it is more common for a patient to be fearful than anxious
D. it is more difficult to allay anxiety than fear
A. providing all of the information the patient should know
B. reassuring the patient that there is nothing to worry about
C. listening attentively and providing emotional support
D. promising the patient that everything will go well
A. the patient confirms the consent
B. the patient describes the expected sequence of events
C. the patient denies anxiety or fear
D. the patient confirms procedures to be followed upon discharge
A. not waking up from anesthesia
B. waking up during the procedure
C. postoperative pain
D. possible changes in body images
A. leaves the preoperative holding area
B. enters the actual operating room
C. is transferred to the operating room table
D. is induced by the anesthesia provider
A. side or wrong level
D. patient, body part, side, level, or procedure
A. site marking, time-out, and better documentation
B. time-out, better documentation, and consent form
C. pre procedure verification, site marking, and time-out
D. site marking, consent form, and time-out
A. verification of the patient’s identity and surgical procedure
B. ensuring that the surgeon is in the room
C. ensuring the scrub person has completed setting up the sterile field
D. ensuring that family members are present in the waiting area.
A. telling the patient everything he or she needs to know
B. attentive listening and reassuring touch
C. giving information to the family instead of the patient
D. postponing patient teaching until after the procedure
A. elderly patients are more frightened than anxious
B. they have difficulty with written materials
C. they do not need as much instruction because others will be caring for them.
D. their short-term memory may be impaired
A. toddlers may feel that surgery is punishment for bad behavior
B. school-age children have a short attention span
C. becoming familiar with items they will encounter in surgery gives pediatric patients a sense of comfort
D. preschoolers will benefit from discussing the steps involved in the procedure
A. adults learn best from printed materials
B. printed material must be tailored to the needs of the learner
C. the patient’s literacy level and health literacy influence the value of printed teaching materials
D. the nurse should solicit feedback to determine the degree the patient’s level of understanding of the printed material.
A. level of health and well-being
B. highest level of education
C. ability to assimilate information from printed literature
D. capacity to obtain, process, and understand health information
A. written communication using the SBAR or I PASS THE BATON format
B. a standardized hand-off protocol that includes the opportunity to ask and respond to questions
C. a communication competency checklist to be completed by all healthcare providers
D. the surgeon, perioperative nurse, and anesthesia provider to al be in the operating room before the patient can be brought it.