Chapter 37: Intraoperative Care Nursing School Test Banks

MULTIPLE CHOICE

1. The charge nurse is assigning duties in the surgical arena. Which member of the surgical team should be assigned to the role of circulating nurse?

a.

Registered nurse (RN)

b.

Licensed practical nurse (LPN)

c.

Certified surgical technologist (CST)

d.

Licensed nursing assistant

ANS: A

The circulating nurse is always an RN who is the charge nurse in the operating room.

DIF: Cognitive Level: Application REF: Text reference: p. 908

OBJ: Describe the roles of a registered nurse in the operating room.

TOP: The Circulating Nurse KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

2. Which of the following is true about the circulating nurses primary responsibility?

a.

She is a sterile member of the surgical team.

b.

She provides the surgeon with instruments.

c.

She is a nonsterile member of the surgical team.

d.

She performs delegated medical functions or skills.

ANS: C

The circulating nurse is a nonsterile member of the surgical team who assumes responsibility and accountability for maintaining patient safety and continuity of quality care. This includes supervising the conduct of the scrub technician and delegating tasks to licensed and unlicensed nursing assistive personnel (NAP) as appropriate. The circulating nurse is also an assistant to the first assistant, the scrub nurse/technician, and the surgeon. The scrub nurse/technician provides the surgeon with instruments and supplies. The registered nurse first assistant (RNFA) performs a combination of nursing and delegated medical functions and/or skills.

DIF: Cognitive Level: Application REF: Text reference: p. 908

OBJ: Describe the roles of a registered nurse in the operating room.

TOP: The Circulating Nurse KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

3. The scrub nurses hands are being washed in preparation for a surgical procedure. As the nurse finishes, the scrub nurse accidentally touches the faucet with one hand. Which action should the nurse take next?

a.

Apply sterile gloves.

b.

Apply a sterile gown.

c.

Apply a sterile mask.

d.

Wash her hands.

ANS: D

The scrub nurse/technician who accidentally touches the faucet with one hand while rinsing will rescrub. This is an example of following a sterile conscience and being committed to safe, quality patient care.

DIF: Cognitive Level: Application REF: Text reference: pp. 908-909

OBJ: Describe the meaning of a sterile conscience. TOP: Sterile Conscience

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

4. The nurse recognizes that evidence-based care is appropriate when the nurse witnesses the surgeon take which step?

a.

Washing hands for a minimum of 15 minutes with soap and water

b.

Using alcohol hand scrub for 15 minutes

c.

Using alcohol combined with chlorhexidine gluconate hand scrubs

d.

Using a combination of soap and alcohol as a scrub

ANS: C

Recent research demonstrates that hand scrub preparations containing 50% to 90% alcohol combined with chlorhexidine gluconate are just as effective as the traditional scrubbing method in preventing SSI.

DIF: Cognitive Level: Analysis REF: Text reference: p. 910

OBJ: Identify guidelines for the use of sterile technique in the operating room.

TOP: Hand Scrub KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity

5. When planning care for a surgical patient, the nurse implements which technique to maintain sterility in the operating room?

a.

Keeps the hands below the waist

b.

Tucks the hands under the axilla

c.

Uses sterile gloved hands to move a sterile drape under a table

d.

Has anyone who is unscrubbed stay at least 1 foot away from the sterile field

ANS: D

Unscrubbed persons should always stay at least 1 foot away from the sterile field while keeping it in constant view and should contact only unsterile areas. Sterile persons must keep their hands in view, above waist level and below the neckline, to avoid contamination. When wearing a sterile gown, do not fold the arms with hands tucked in the axillary region. This area is not considered sterile once operating room personnel have donned gowns. Sterile-draped tables are sterile only at table level. The sides of the drape extending below table level are unsterile.

DIF: Cognitive Level: Application REF: Text reference: p. 911

OBJ: Identify guidelines for the use of sterile technique in the operating room.

TOP: Principles of Sterile Technique KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

6. When one prepares to enter the operating room, which technique demonstrates the safest outcome?

a.

Keeping the hands below the elbows

b.

Applying surgical gloves before the scrub

c.

Scrubbing for at least 3 to 5 minutes with an antimicrobial

d.

Drying the hands and arms, starting at the elbow and moving toward the fingers

ANS: C

The Association of periOperative Registered Nurses (AORN) recommends a 3- to 5-minute hand and arm scrub with an approved antimicrobial agent for all surgical procedures. Rinse hands and arms thoroughly under running water. Grasp one end of the sterile towel to dry one hand thoroughly, moving from fingers to elbow in a rotating motion. Use the opposite end of the towel to dry the other hand.

DIF: Cognitive Level: Application REF: Text reference: p. 911

OBJ: Correctly perform surgical hand antisepsis. TOP: The Surgical Hand Scrub

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

7. When evaluating a health care team members ability to put on a sterile gown and perform closed gloving, it is most important for the nurse to assess for which outcome?

a.

Opening the sterile gown pack on a sterile surface

b.

Holding the gown close to the body before applying

c.

Having the circulating nurse tie the gown at the hip

d.

Keeping the hands inside the sleeves of the gown until the gloves are applied

ANS: D

Apply gloves using the closed-glove method, with hands covered by gown cuffs and sleeves. Open the sterile gown and glove package on a clean, dry, flat surface. This can be done by the scrub nurse (before scrubbing hands) or the circulating nurse. While keeping it at arms length away from the body, allow the gown to unfold with the inside of the gown toward the body. Do not touch the outside of the gown, and do not allow it to touch the floor. Have the circulating nurse tie the gown at the neck and waist. If the gown is wraparound style, the sterile front flap is not touched until the scrub nurse has gloved.

DIF: Cognitive Level: Application REF: Text reference: p. 916

OBJ: Correctly apply sterile gloves using the closed technique.

TOP: Applying Gloves Via Closed Technique

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

8. The charge nurse is assigning members of the surgical team; the nurse recognizes that which member is responsible for ensuring preoperative and postoperative patient management in collaboration with other health care providers?

a.

RN

b.

LPN

c.

Circulating RN

d.

RNFA

ANS: D

The role of the RNFA is an expansion of the traditional perioperative nursing role, and areas of responsibility will overlap. Responsibilities specific to the practice of first assisting include participating in time out procedures with other surgical team members (safety measures taken to ensure correct patient, correct procedure, correct site and side, correct patient position, and correct implants/equipment present), providing surgical exposure (assisting in retraction of tissues and suctioning of surgical field), providing hemostasis (control of bleeding), handling and/or cutting tissue, using surgical instruments/medical devices and suturing, performing wound closure, applying human anatomical and physiological considerations in practice, recognizing structure, function, and location of tissues and organs, manipulating tissues accordingly to avoid injury, and ensuring preoperative and postoperative patient management in collaboration with other health care providers. The scrub nurse gowns and gloves surgeons and assistants as they enter the operating room, provides the surgeon with instruments and supplies, disposes of soiled sponges, and accounts for sponges, needles, and instruments in the surgical field.

DIF: Cognitive Level: Application REF: Text reference: p. 909

OBJ: Describe the roles of a registered nurse in the operating room.

TOP: Role of the Registered Nurse First Assistant

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

9. When planning care for a surgical patient, which nursing diagnosis has the highest priority?

a.

Risk for infection

b.

Risk for constipation

c.

Risk for falls

d.

Risk for knowledge deficit

ANS: A

Surgical patients are at risk for surgical site infection from the stress of surgery and their procedure. Studies have found that surgical staff may transmit pathogens via contact with patients and contaminated items.

DIF: Cognitive Level: Application REF: Text reference: p. 910

OBJ: Describe the meaning of a sterile conscience.

TOP: Evidence-Based Practice Trends KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

10. While supervising the surgical team, the charge nurse notices that a team members nails are long and chipped. Which action should the nurse take next?

a.

Allow the team member to complete the task.

b.

Remove the team member to have the nails cut.

c.

Turn the team member in to the RNFA.

d.

Ask the team member why the nails are long and chipped.

ANS: B

The team member must be removed immediately to allow cutting of the nails. Long nails and chipped or old polish harbor greater numbers of bacteria. Long fingernails can puncture gloves, causing contamination.

DIF: Cognitive Level: Application REF: Text reference: pp. 910-911

OBJ: Describe the meaning of a sterile conscience. TOP: Surgical Hand Antisepsis

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. Who of the following can assume the role of the scrub nurse/assistant? (Select all that apply.)

a.

RN

b.

LPN

c.

CST

d.

Licensed nursing assistant

e.

Medical transcriptionist

ANS: A, B, C

RNs, LPNs, and CSTs may assume the scrub nurse role.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 908

OBJ: Describe the roles of a registered nurse in the operating room.

TOP: The Scrub Nurse KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

2. The consequences of double gloving during surgery include which of the following? (Select all that apply.)

a.

Decreased need for handwashing

b.

Decreased risk for exposure to bloodborne pathogens

c.

Increased perforations to the innermost glove

d.

Decreased risk for surgical wound infection

e.

Increased patient cost

ANS: B, D

Benefits of double gloving during surgery include decreasing the risk for exposure to bloodborne pathogens for surgical team members and decreasing the risk for surgical wound infection for the patient. Double gloving significantly reduces perforations to the innermost glove. Handwashing remains the cornerstone of surgical asepsis.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 915

OBJ: Identify guidelines for the use of sterile technique in the operating room.

TOP: Double Gloving KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

3. Which of the following are principles of sterile procedure? (Select all that apply.)

a.

Gowns are sterile from the chest and shoulder to table level.

b.

Sterile persons must keep hands in view and above the waist and below the neck.

c.

Sterile persons must fold arms across chest with hands tucked into the axillary region.

d.

Unscrubbed persons must stay at least 6 inches away from the sterile field.

e.

Sterile persons may position themselves with their back to the sterile field.

ANS: A, B

Once in place, gowns are sterile from the front chest and shoulders to table level and on the sleeves to 2 inches (5 cm) above the elbow. Sterile persons must keep their hands in view, above waist level and below the neckline, and must not turn their back to the sterile field to avoid contamination. When wearing a sterile gown, do not fold arms with hands tucked into the axillary region. This area is not considered sterile once operating room personnel have donned gowns. Perspiration can lead to strike through, or contamination that occurs when moisture permeates a sterile barrier. Unscrubbed persons always stay at least 1 foot away from the sterile field while keeping it in constant view; they touch only unsterile areas.

DIF: Cognitive Level: Application REF: Text reference: pp. 910-911

OBJ: Identify guidelines for the use of sterile technique in the operating room.

TOP: Principles of Sterile Technique KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

4. Through the use of an antimicrobial agent and sterile brushes or sponges, which of the following occurs? (Select all that apply.)

a.

Debris and transient microorganisms are removed from the nails, hands, and forearms.

b.

The resident microbial count is reduced to a minimum.

c.

The skin is sterilized.

d.

Rapid/rebound growth of microorganisms is inhibited.

e.

The need to wash between patients is reduced.

ANS: A, B, D

Although the skin cannot be sterilized, operating room personnel can greatly reduce the number of microorganisms by chemical, physical, and mechanical means. Through the use of an antimicrobial agent and sterile brushes or sponges, the surgical hand scrub removes debris and transient microorganisms from the nails, hands, and forearms, and inhibits rapid/rebound growth of microorganisms.

DIF: Cognitive Level: Comprehension REF: Text reference: pp. 911-912

OBJ: Correctly perform surgical hand antisepsis. TOP: The Surgical Hand Scrub

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

5. Which of the following are sources of contamination in the operating room? (Select all that apply.)

a.

A wristwatch

b.

Chipped nail polish

c.

Artificial fingernails

d.

Abrasions on the hands

e.

Tattoos to the arms

ANS: A, B, C, D

Jewelry harbors and protects microorganisms from removal. Allergic skin reactions may occur as a result of scrub agent or glove powder accumulating under jewelry. Long nails and chipped or old polish harbor great numbers of bacteria. Long fingernails can puncture gloves, causing contamination. Artificial nails harbor gram-negative microorganisms and fungus. Cuts, abrasions, exudative lesions, and hangnails tend to ooze serum, which may contain pathogens. Broken skin permits microorganisms to enter various layers of the skin, providing deeper microbial breeding.

DIF: Cognitive Level: Comprehension REF: Text reference: pp. 911-912

OBJ: Identify guidelines for the use of sterile technique in the operating room.

TOP: Sources of Contamination KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

6. The surgeon is about to finish surgery and requests a sponge count. Who would normally perform this task? (Select all that apply.)

a.

Scrub nurse

b.

Registered nurse first assistant

c.

Circulating nurse

d.

Certified registered nurse anesthetist

e.

Surgical technician

ANS: A, C

Part of the role of the scrub nurse is to perform sponge, sharps, and instrument counts with the circulating nurse before an incision is made, at the beginning of wound closure, and at the end of the surgical procedure.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 909

OBJ: Describe the roles of a registered nurse in the operating room.

TOP: Role of the Scrub Nurse and Circulating Nurse

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

7. While the patient is in the OR and the OR team is gowned and gloved, the nurse recommends completion of a safety checklist. The nurse understands that the checklist verifies which of the following? (Select all that apply.)

a.

Patient identity

b.

Patient allergies

c.

Accurate marking of surgical site

d.

Patient cultural preferences

e.

Questions posed by the patient

ANS: A, B, C

While the patient is in the OR and the OR team is gowned and gloved, it is recommended that a surgical safety checklist or the World Health Organization (WHO) checklist be conducted. The WHO checklist verifies the patients identity, ascertains whether the patient has any allergies, checks if the surgical site is marked and reverifies the site marking, and asks the patient if he or she has any questions.

DIF: Cognitive Level: Application REF: Text reference: pp. 909-910

OBJ: Describe the roles of a registered nurse in the operating room.

TOP: Role of the Checklist Coordinator KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

COMPLETION

1. The _______________ phase begins when the patient enters the operating room suite and ends with admission to the postanesthesia care unit (PACU).

ANS:

intraoperative

The intraoperative phase begins when the patient enters the operating room suite and ends with admission to the PACU.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 908

OBJ: Describe the roles of a registered nurse in the operating room.

TOP: The Intraoperative Phase KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

2. The _________________ is a nurse with advanced education who assists the surgeon with the surgical procedure, performing a combination of nursing and delegated medical functions and/or skills.

ANS:

registered nurse first assistant (RNFA)

The RNFA is a nurse with advanced education who assists the surgeon with the surgical procedure, performing a combination of nursing and delegated medical functions and/or skills.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 908

OBJ: Describe the roles of a registered nurse in the operating room.

TOP: The Registered Nurse First Assistant

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. The ________________ is a sterile team member who provides the surgeon with instruments and supplies, disposes of soiled sponges, and accounts for sponges, sharps, and instruments in the surgical field.

ANS:

scrub nurse/technician

The scrub nurse/technician is a sterile team member who provides the surgeon with instruments and supplies, disposes of soiled sponges, and accounts for sponges, sharps, and instruments in the surgical field.

DIF: Cognitive Level: Knowledge REF: Text reference: pp. 908-909

OBJ: Describe the roles of a registered nurse in the operating room.

TOP: The Scrub Nurse KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

Leave a Reply