1.
In the event that a child needs emergency surgery, and the parents cannot be located to sign the permission
Correct Answer
D. A written consultation by two pHysicina other than the surgeon will suffice
Explanation
In the event that a child needs emergency surgery and the parents cannot be located to sign the permission, a written consultation by two physicians other than the surgeon will suffice. This means that if the parents cannot be found, the two independent physicians can provide their professional opinion and give consent for the surgery on behalf of the child. This ensures that the child receives the necessary medical treatment in a timely manner, even if the parents are not available to give permission.
2.
The patient is scheduled for an appendectomy. After completing this procedure the surgeon decides to remove a mole from the shoulder while the patient is still under anesthesia. No permission was obtained for this. The circulating nurse should
Correct Answer
C. Report it to the supervisor or proper administrative authority
Explanation
The correct answer is to report it to the supervisor or proper administrative authority. This is because the surgeon performed an additional procedure without obtaining proper consent from the patient. It is important to follow proper protocols and report any unethical or unauthorized actions to the appropriate authority for investigation and resolution.
3.
The surgical consent form can be witnessed by each of the following EXCEPT
Correct Answer
D. The patient's spouse
Explanation
The surgical consent form can be witnessed by the surgeon, a nurse, or an authorized hospital employee, but not the patient's spouse. This is because the spouse may have a personal or emotional connection to the patient, which could potentially compromise their ability to provide an unbiased witness. It is important to have witnesses who are objective and can ensure that the patient is fully informed and consenting to the surgery.
4.
The patient is premedicated and brought to the operating room for a cystoscopy and an open reduction of the wrist. Upon arrival in the operating room, it is observed that the patient has only signed for the cystoscopy. The correct procedure would be to
Correct Answer
A. Cancel surgery until a valid permission can be obtained
Explanation
If the patient has only signed for the cystoscopy and not for the open reduction of the wrist, it means that they have not given their informed consent for the additional procedure. Informed consent is a legal and ethical requirement for any medical procedure, and it is important to ensure that the patient fully understands the risks, benefits, and alternatives of the procedure before proceeding. Therefore, the correct procedure would be to cancel the surgery until a valid permission can be obtained, ensuring that the patient has given their informed consent for both procedures.
5.
A general consent form is
Correct Answer
A. A form authorizing all treatments or procedures
Explanation
The correct answer is "a form authorizing all treatments or procedures." This means that a general consent form is a document that grants permission for any type of medical treatment or procedure that may be necessary for a patient's care. It is a comprehensive authorization that covers a wide range of medical interventions and ensures that the patient's consent is obtained before any treatment is performed.
6.
The ultimate responsibility for obtaining consent lies with the
Correct Answer
C. Surgeon
Explanation
The ultimate responsibility for obtaining consent lies with the surgeon because they are the medical professional who will be performing the procedure on the patient. It is their duty to explain the risks, benefits, and alternatives of the procedure to the patient and ensure that the patient fully understands and gives their informed consent. The surgeon is also responsible for answering any questions or concerns the patient may have before proceeding with the surgery. While other healthcare professionals may assist in the consent process, the surgeon holds the primary responsibility.
7.
The surgical consent is signed
Correct Answer
D. Before administration of preoperative medications
Explanation
It is important for the surgical consent to be signed before administration of preoperative medications because these medications can affect the patient's ability to make informed decisions and understand the risks involved in the surgery. By obtaining the consent before administering any medications, the patient is able to make a clear and informed decision about the surgery and its potential risks. This ensures that the patient's autonomy and right to make decisions about their own healthcare are respected.
8.
An informed consent
Correct Answer
D. B & C
Explanation
An informed consent is a legal document that authorizes routine duties carried out at the hospital and protects the patient from unratified or unwanted procedures. It also protects the surgeon and the hospital from claims of an unauthorized operation. Therefore, the correct answer is B & C.
9.
Implied consent
Correct Answer
B. Is allowed by law in emergencies when no other authorized person may be contacted
Explanation
Implied consent is allowed by law in emergencies when no other authorized person may be contacted. This means that in situations where immediate medical intervention is necessary and there is no time to obtain explicit consent from the patient or their authorized representative, healthcare providers are permitted to proceed with treatment based on the assumption that the patient would consent if they were able to do so. This is a legal concept that allows healthcare professionals to act in the best interest of the patient's well-being when time is of the essence.
10.
Which statement regarding the withdrawal of a consent by a patient is NOT true?
Correct Answer
D. The surgeon may do the procedure if he documents that it is necessary as a lifesaving measure
Explanation
The statement "the surgeon may do the procedure if he documents that it is necessary as a lifesaving measure" is not true because if a patient withdraws their consent, the surgeon cannot proceed with the procedure, even if it is deemed necessary to save the patient's life. Consent is a fundamental principle in medical ethics, and the patient's autonomy and right to make decisions about their own body must be respected.
11.
Which position would be the most desirable for a pilonidal cystectomy or a hemorrhoidectomy?
Correct Answer
B. Kraske
Explanation
The most desirable position for a pilonidal cystectomy or a hemorrhoidectomy is the Kraske position. This position involves the patient lying on their stomach with their hips flexed, allowing for better access to the surgical site. The Kraske position provides optimal exposure and accessibility for the surgeon to perform the procedure effectively.
12.
A position often used in cranial procedures is called
Correct Answer
A. Fowler's
Explanation
Fowler's position is often used in cranial procedures. It involves the patient lying on their back with the head elevated at a 45-degree angle. This position helps to improve access to the cranial area and provides better visualization for the surgeon. Kraske position is used for rectal surgeries, Trendelenburg position involves the patient being tilted with the head lower than the feet, and lithotomy position is used for gynecological procedures. Therefore, Fowler's position is the correct answer for cranial procedures.
13.
In positioning for laminectomy, rolls or bolsters are placed
Correct Answer
B. Longitudinally to support the chest from axilla to hip
Explanation
Rolls or bolsters are placed longitudinally to support the chest from axilla to hip during positioning for laminectomy. This positioning helps to ensure proper alignment of the spine and provides support to the chest area, allowing for better access to the surgical site and reducing the risk of complications during the procedure. Placing the rolls or bolsters horizontally under the chest and thighs, longitudinally from sternum to hip, or below the knees would not provide the same level of support and alignment needed for a laminectomy.
14.
The position used for a patient in hypovolemic shock is
Correct Answer
A. Mofified Trendelenburg
Explanation
The correct answer is "modified Trendelenburg." This position is used for patients in hypovolemic shock because it helps to improve blood flow to vital organs. In the modified Trendelenburg position, the patient's head is lowered, and the legs are elevated. This helps to increase venous return to the heart and improve cardiac output. By improving blood flow, this position can help stabilize the patient's condition and prevent further complications.
15.
A Mayfield table would be used for which type of surgery?
Correct Answer
C. Neurologic
Explanation
A Mayfield table is specifically designed for neurologic surgery. It is a specialized surgical table that provides precise positioning and stability for patients undergoing neurosurgical procedures. The table allows for the head to be securely immobilized and positioned in various angles, providing optimal access to the surgical site. This type of table is not typically used for ophthalmic, gynecologic, or urologic surgeries, as those procedures do not require the same level of head immobilization and positioning.
16.
Good exposure for thyroid surgery is ensured by all of the following EXCEPT
Correct Answer
D. Firm retraction of the laryngeal nerve and surrounding structures
Explanation
Good exposure for thyroid surgery is ensured by all of the given options except for firm retraction of the laryngeal nerve and surrounding structures. The laryngeal nerve is a crucial structure that innervates the vocal cords, and retracting it firmly during surgery can lead to damage and potential complications such as hoarseness or vocal cord paralysis. Therefore, it is important to avoid firm retraction of the laryngeal nerve and surrounding structures to ensure a successful thyroid surgery.
17.
A procedure requiring the patient to be positioned supine in modified lithotomy is
Correct Answer
B. Abdominoperineal resection (APR)
Explanation
The correct answer is abdominoperineal resection (APR). This procedure involves removing the anus, rectum, and part of the sigmoid colon. The patient is positioned supine in modified lithotomy, which means lying on their back with their legs raised and supported in stirrups. This position allows the surgeon better access to the perineal area during the surgery. Colonoscopy, marsupilization of pilonidal cyst, and ileostomy do not require the patient to be positioned supine in modified lithotomy.
18.
In which procedure may the patient be placed in a supine position with the right side slightly elevated by a wedge to tilt the patient to the left?
Correct Answer
D. Cesarean section
Explanation
In a cesarean section procedure, the patient may be placed in a supine position with the right side slightly elevated by a wedge to tilt the patient to the left. This positioning helps to prevent compression of the inferior vena cava, which can occur when the uterus is compressed by the weight of the fetus. By tilting the patient to the left, the pressure on the inferior vena cava is reduced, ensuring adequate blood flow and oxygenation to both the mother and the baby during the procedure.
19.
The position for most open bladder surgery would be
Correct Answer
B. Supine, bolster under pelvis
Explanation
The correct answer is supine with a bolster under the pelvis. This position allows for easy access to the bladder during surgery. Placing a bolster under the pelvis helps to elevate the area, providing better visibility and access to the surgical site. The supine position also allows for the patient's legs to be comfortably positioned in stirrups, further facilitating the procedure.
20.
In which circumstance could the patient sustain injury to the pudendal nerves?
Correct Answer
A. Positioned on the fracture table
Explanation
The patient could sustain injury to the pudendal nerves if they are positioned on the fracture table. The pudendal nerves are responsible for providing sensation to the genital area, so if the patient is positioned in a way that puts pressure on these nerves, it can lead to nerve damage and potential injury.
21.
Which factor is important to consider when positioning the aging patient?
Correct Answer
D. All of the above
Explanation
When positioning an aging patient, it is important to consider all of the factors mentioned: skeletal changes, limited range of motion of joints, and tissue fragility. Skeletal changes can affect the patient's posture and stability, while limited range of motion of joints can impact their comfort and mobility. Additionally, tissue fragility is a crucial factor to consider in order to prevent skin breakdown and pressure ulcers. Therefore, all of these factors should be taken into account when positioning an aging patient.
22.
When positioning the patient for a procedure, which of the following provides maximum patient safety and maximum surgical site exposure?
Correct Answer
D. All of the above
Explanation
Positioning the patient for a procedure requires ensuring maximum patient safety and maximum surgical site exposure. This includes ensuring that the patient's body does not touch metal on the table, that equipment, Mayo stand, or personnel are not resting on the patient, and that bony prominences are padded. By following all of these measures, the risk of injury or discomfort to the patient is minimized, and the surgical team can have optimal access to the surgical site.
23.
When preparing a patient for a breast biopsy, a breast scrub is either eliminated or done very gently because of
Correct Answer
B. Dispersal of cancer cells
Explanation
When preparing a patient for a breast biopsy, a breast scrub is either eliminated or done very gently to avoid dispersal of cancer cells. Scrubbing the breast vigorously can potentially cause the cancer cells to spread to other areas of the breast or even to nearby lymph nodes, increasing the risk of metastasis. Therefore, it is important to handle the breast with care during the preparation process to minimize the risk of cancer cell dispersal.
24.
The ideal place to do the shave prep is in the
Correct Answer
C. Holding area of the OR
Explanation
The holding area of the OR is the ideal place to do the shave prep because it allows for proper sterilization and preparation of the patient before surgery. This area is specifically designed to provide a clean and controlled environment for pre-operative procedures. Doing the shave prep in the patient's room may not have the same level of cleanliness and equipment available as the holding area. The operating room suite is typically reserved for the actual surgery and may not be the most suitable place for shave prep. The room where the surgery will be performed may also lack the necessary equipment and cleanliness required for shave prep.
25.
Any area that is considered contaminated
Correct Answer
A. Should be scrubbed last or separately
Explanation
The correct answer is "should be scrubbed last or separately". This is because any area that is considered contaminated should be prioritized last or separately to prevent the spread of contaminants to other areas. By scrubbing these areas last or separately, the risk of cross-contamination is minimized, ensuring that the cleaning process is effective and thorough.
26.
In preparation for surgery, skin should be washed and painted
Correct Answer
A. From the incision site to the peripHery in a circular motion
Explanation
The correct answer states that in preparation for surgery, the skin should be washed and painted from the incision site to the periphery in a circular motion. This means that the cleaning and painting should start from the area where the incision will be made and then move outward towards the surrounding skin in a circular motion. This technique helps to ensure that the area around the incision is thoroughly cleaned and prepared before the surgery.
27.
Preliminary preparation of the patient's skin begins
Correct Answer
A. With a preoperative shower
Explanation
The correct answer is with a preoperative shower. Preliminary preparation of the patient's skin before surgery typically involves a preoperative shower. This is done to remove any dirt, oils, or bacteria from the skin, reducing the risk of infection. The shower may involve using a specific antimicrobial soap or solution recommended by the healthcare provider. This step is usually done in the preoperative area or at home prior to coming to the hospital for surgery. Shave preparation may also be necessary in some cases, but the preoperative shower is a standard practice for skin preparation.
28.
Suction tubing is attached to the drapes with a (n)
Correct Answer
B. Nonperforating clamp
Explanation
A nonperforating clamp is used to attach suction tubing to drapes. This type of clamp does not create holes or punctures in the material it is attached to, ensuring that the drapes remain intact and maintain their barrier function. It provides a secure and reliable connection between the suction tubing and the drapes, preventing any leakage or dislodgement during the procedure.
29.
All of the following statements regarding sterility are true EXCEPT
Correct Answer
D. A sterile person faces a nonsterile person when passing
30.
When draping a table, the scrub nurse should drape
Correct Answer
B. Front to back
Explanation
When draping a table, the scrub nurse should drape from front to back. This ensures that the sterile field is maintained and prevents any contamination from occurring. Draping from front to back allows the nurse to work in a systematic manner, starting from the cleanest area and moving towards the dirtier areas. This helps to minimize the risk of introducing any pathogens or contaminants onto the sterile field. Draping in any other direction could compromise the sterility of the field and increase the chances of surgical site infections.
31.
A seamless, stretchable material often used to cover extremities during draping is
Correct Answer
D. Stockinette
Explanation
Stockinette is a seamless and stretchable material that is commonly used to cover extremities during draping. It is a tubular fabric that can easily be stretched over different body parts, providing a smooth and comfortable surface. Stockinette is often used in medical settings, such as during surgeries or wound care, to protect and provide support to the limbs. It is an essential tool in ensuring proper hygiene and preventing contamination during medical procedures.
32.
Drapes are
Correct Answer
D. Placed on a dry area
Explanation
The correct answer is "placed on a dry area." This means that drapes are placed on a surface that is free from moisture or any other liquid. It is important for drapes to be placed on a dry area to prevent any contamination or infection during a surgical procedure. Moisture can harbor bacteria and other microorganisms, so ensuring that the drapes are placed on a dry surface helps maintain a sterile environment in the operating room.
33.
Which statement demonstrates a break in technique during the draping process?
Correct Answer
A. Gloved hands may touch the skin of the patient
Explanation
During the draping process, it is important to maintain a sterile environment. The statement "gloved hands may touch the skin of the patient" demonstrates a break in technique because it introduces the possibility of contaminating the sterile field by allowing direct contact between the gloved hands and the patient's skin. Sterile technique requires that only sterile items come into contact with the sterile field, and any breach in this protocol can increase the risk of infection or complications for the patient.
34.
A head drape consists of
Correct Answer
A. Medium sheets, towel, towel clip
Explanation
A head drape consists of medium sheets, a towel, and a towel clip. These items are used to cover and secure the patient's head during a medical procedure. The medium sheets provide a barrier and protect the patient's hair and face from contamination. The towel is used to absorb any fluids or sweat that may occur during the procedure. The towel clip is used to secure the drape in place and prevent it from slipping or falling off.
35.
Gowns are considered sterile only from
Correct Answer
D. Only in front from chest to sterile field level, and sleeves from elbow to cuffs
Explanation
Gowns are considered sterile only in the front from the chest to the level of the sterile field. Additionally, the sleeves are considered sterile from the elbow to the cuffs.
36.
An acceptable action when drying the hands and arms after the surgical scrub is to
Correct Answer
B. Dry thoroughly, cleanest area first
Explanation
When drying the hands and arms after the surgical scrub, it is important to dry thoroughly to remove any remaining moisture that could harbor bacteria. Starting with the cleanest area first ensures that any potential contaminants are not spread to the cleaner areas. This helps maintain a sterile environment and reduces the risk of infection.
37.
All of the following statements regarding gowning another person are true EXCEPT
Correct Answer
B. Hand the folded gown to the person at the neckband
Explanation
When gowning another person, it is important to avoid handing the folded gown to the person at the neckband. This is because the neckband of the gown is considered a contaminated area, and by handing the gown at this point, there is a risk of contaminating the person's hands or clothing. Instead, the gown should be handed to the person at a clean, non-contaminated area such as the shoulder or waist ties.
38.
Which statement regarding the scrub procedure is not true?
Correct Answer
C. Renders the skin aseptic
Explanation
The statement "renders the skin aseptic" is not true. The scrub procedure is designed to reduce the microbial count on the skin, but it does not completely render the skin aseptic. Aseptic means completely free from any microorganisms, which is not achievable through a scrub procedure alone. The scrub procedure is effective in reducing the number of microorganisms on the skin, but it does not eliminate them entirely.
39.
If the scrub nurse needs to change a glove during a operation
Correct Answer
B. The circulator pulls the glove off
Explanation
The correct answer is "the circulator pulls the glove off." During an operation, if the scrub nurse needs to change a glove, it is the responsibility of the circulator to assist in removing the contaminated glove. The circulator is responsible for maintaining a sterile environment and ensuring that the scrub nurse can safely change gloves without compromising the sterility of the surgical field. This is done by carefully pulling off the contaminated glove without touching the nurse's bare hand.
40.
Which statement regarding the removal of gown and gloves does not meet safe criteria?
Correct Answer
A. The gloves are removed before the gown
Explanation
Removing the gloves before the gown does not meet safe criteria because it increases the risk of contamination. When removing personal protective equipment, such as gloves and gowns, it is important to follow a specific order to minimize the spread of pathogens. The correct sequence is to remove the gown first, ensuring it is pulled off inside-out to prevent contact with the contaminated side. Then, the gloves should be removed, taking care not to touch the outer surface. Removing the gloves before the gown could potentially transfer pathogens from the gloves to the hands or arms during the gown removal process.
41.
An effective surgical scrub procedure is
Correct Answer
D. A and B
Explanation
The correct answer is A and B. This means that both the time method and the brush-stroke method are effective surgical scrub procedures. The time method involves scrubbing the hands and forearms for a specific amount of time, usually around 2-6 minutes. The brush-stroke method involves using a specific pattern of hand and finger movements to thoroughly clean all areas of the hands and forearms. Both methods are considered effective in reducing the risk of surgical site infections.
42.
Regarding the surgical scrub, which statement would violate acceptable practice?
Correct Answer
B. Nail polish may be worn if freshly applied
Explanation
Wearing nail polish, even if it is freshly applied, would violate acceptable practice during a surgical scrub. This is because nail polish can harbor bacteria and prevent proper hand hygiene. It is important to have clean, bare nails to ensure thorough cleaning and reduce the risk of contamination during surgery.
43.
Eyeware, goggles, and / or faceshields should be worn
Correct Answer
A. On every case
Explanation
Eyeware, goggles, and/or faceshields should be worn on every case means that regardless of the type of case (orthopedic, vascular, or positive HIV), it is necessary to wear protective eyewear. This is a general safety precaution to protect the eyes from any potential hazards or splashes that may occur during any case.
44.
The surgical scrub is
Correct Answer
D. Mechanical washing and chemical antisepsis of the skin
Explanation
The surgical scrub involves both mechanical washing and chemical antisepsis of the skin. Mechanical washing refers to the physical removal of dirt, debris, and microorganisms from the skin using friction and water. This helps to physically cleanse the skin and remove any potential contaminants. Chemical antisepsis, on the other hand, involves the use of antiseptic agents such as iodine or chlorhexidine to kill or inhibit the growth of microorganisms on the skin. This combination of mechanical washing and chemical antisepsis ensures a thorough and effective cleansing of the skin before surgery.
45.
Scrub technique ends
Correct Answer
D. 2 inches above the elbow
Explanation
The scrub technique is a method used to clean and disinfect the hands and arms before surgery. It involves scrubbing the hands and arms for a certain amount of time and up to a specific point. In this case, the correct answer is "2 inches above the elbow," which means that the scrub technique should be performed on the arms up to a point that is 2 inches higher than the elbow joint. This ensures that the entire forearm, including the elbow area, is properly cleaned and prepared for surgery.
46.
Which statement regarding the surgical scrub indicates INAPPROPRIATE preparation by the scrub?
Correct Answer
B. Nail polish may be worn, if not chipped
Explanation
The statement "nail polish may be worn, if not chipped" indicates inappropriate preparation for a surgical scrub because nail polish can harbor bacteria and interfere with proper hand hygiene.
47.
Which statement best describes an effective surgical hand scrub?
Correct Answer
C. Time or number of strokes, hand to elbow sequence
Explanation
An effective surgical hand scrub involves a combination of both time and number of strokes, ensuring that all areas of the hand are thoroughly cleaned. The hand to elbow sequence is also important, as it helps to prevent contamination from moving up the arm.
48.
The brush-stoke method of scrubbing prescribes the number of strokes required. Indicate the number for each: nails, fingers, hand (back and palm) and arms.
Correct Answer
C. 30,20,20,20
Explanation
The correct answer is 30 strokes for nails, 20 strokes for fingers, 20 strokes for the back of the hand, and 20 strokes for the palm of the hand.
49.
A surgical treatment for scoliosis could employ the use of
Correct Answer
D. Harrington rods
Explanation
Harrington rods are commonly used in surgical treatment for scoliosis. These rods are implanted along the spine to correct the curvature and provide stability. They are attached to the vertebrae using hooks or screws and then connected with rods. The rods help to straighten the spine and maintain the correction over time. This surgical technique is effective in reducing the curvature and improving the overall alignment of the spine in patients with scoliosis.
50.
What is a Lebsche used for?
Correct Answer
A. To open the sternum
Explanation
A Lebsche is a surgical instrument used to open the sternum. This is typically done during procedures such as open-heart surgery or thoracotomies, where access to the heart or other organs in the chest cavity is required. The Lebsche is designed to safely and effectively separate the sternum, allowing surgeons to access the underlying structures without causing excessive damage or trauma.