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 reached, the medical team can seek the opinion and agreement of two other physicians to proceed with the surgery. This ensures that there is a consensus among medical professionals regarding the necessity of the surgery and helps to protect the child's well-being in urgent situations.
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 permission, which is a violation of medical ethics and legal requirements. The circulating nurse has a responsibility to report this incident to the appropriate authority to ensure that proper action is taken and the patient's rights are protected.
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 conflict of interest or bias, and their presence as a witness may not be considered impartial. It is important to have witnesses who are objective and can ensure that the patient is giving informed consent willingly and without any external pressure.
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
Informed consent is a crucial ethical and legal requirement before performing any medical procedure. In this case, the patient has only signed for the cystoscopy and not the open reduction of the wrist. Therefore, proceeding with the additional procedure without obtaining valid permission would be a violation of the patient's rights. The correct procedure would be to cancel the surgery until the patient provides consent specifically for the open reduction of the wrist or until a valid permission can be obtained. This ensures that the patient is fully informed and has given their explicit consent for the procedure.
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." A general consent form is a document that gives permission for various medical treatments or procedures to be performed on a patient. This form ensures that the patient understands the risks and benefits of the treatments and gives their informed consent for them to be carried out. It is a standard practice in healthcare settings to obtain a general consent form from patients before providing any medical intervention.
6.
The ultimate responsibility for obtaining consent lies with the
Correct Answer
C. Surgeon
Explanation
The surgeon is ultimately responsible for obtaining consent because they are the one performing the procedure and have the most knowledge about the risks and benefits involved. They are the ones who will be directly responsible for the patient's care and outcomes, so it is important for them to have a clear understanding of the patient's consent before proceeding with any procedure. The operating room supervisor, circulating nurse, and unit charge nurse may also play a role in the consent process, but the ultimate responsibility lies with the surgeon.
7.
The surgical consent is signed
Correct Answer
D. Before administration of preoperative medications
Explanation
The surgical consent is signed before administration of preoperative medications to ensure that the patient has fully understood the risks and benefits of the surgery and has given their informed consent. By signing the consent form before receiving any medication, the patient is in a clear state of mind and able to make an informed decision. This also allows the healthcare team to verify that the patient has fully understood the procedure and any potential complications before proceeding with the surgery.
8.
An informed consent
Correct Answer
D. B & C
Explanation
An informed consent protects the patient from unratified or unwanted procedures by ensuring that they have a clear understanding of the risks, benefits, and alternatives to a medical procedure before giving their consent. It also protects the surgeon and the hospital from claims of an unauthorized operation by documenting that the patient was fully informed and agreed to the procedure. 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 certain situations where obtaining explicit consent is not possible, such as when a person is unconscious or unable to communicate, medical professionals are legally allowed to proceed with necessary treatments or procedures based on the assumption that the individual would have consented if they were able to. This ensures that urgent medical care can be provided in critical situations where immediate action is required to save a person's life or prevent further harm.
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. If a patient withdraws their consent, the surgeon cannot proceed with the procedure, even if it is necessary to save the patient's life. Consent is a fundamental principle of medical ethics, and without it, the surgeon cannot perform any procedure on the patient.
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 abdomen with their hips flexed and their knees bent. The Kraske position provides optimal access to the surgical site, allowing the surgeon to effectively remove the cyst or hemorrhoids. Additionally, this position helps to minimize the risk of complications and allows for better visualization during the procedure.
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 as it involves the patient being placed in a semi-sitting position with the head elevated. This position allows for better visualization and access to the surgical site, particularly in procedures involving the head and brain. It helps to reduce swelling and improve drainage, making it a common choice for cranial surgeries. The other options, Kraske, Trendelenburg, and lithotomy, are positions used in different surgical procedures but are not specifically associated with 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 helps provide proper alignment and support to the patient's chest and upper body, ensuring stability and comfort during the procedure. Placing the rolls or bolsters horizontally under the chest and thighs or below the knees would not provide the same level of support and alignment required 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. In hypovolemic shock, the patient's blood volume is significantly reduced, leading to a decrease in blood pressure. The modified Trendelenburg position involves elevating the patient's legs above the level of the heart, which helps to increase venous return and improve blood flow to vital organs. This position promotes the redistribution of blood from the lower extremities to the central circulation, helping to improve perfusion and stabilize the patient's condition.
15.
A Mayfield table would be used for which type of surgery?
Correct Answer
C. Neurologic
Explanation
A Mayfield table would be used for neurologic surgery. This type of surgery involves procedures on the brain and nervous system. The Mayfield table is specifically designed to securely position the patient's head during these surgeries, providing stability and precise positioning. This helps the surgeon access and operate on the delicate structures of the brain and nervous system with accuracy and safety.
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 following except firm retraction of the laryngeal nerve and surrounding structures. The laryngeal nerve and surrounding structures should not be forcefully retracted during thyroid surgery as this can cause injury to the nerve and result in vocal cord paralysis. The other options listed, such as modified dorsal recumbent with shoulder roll, hyperextension of the neck, and utilization of skin-stay sutures, are all techniques that can help provide good exposure for thyroid surgery.
17.
A procedure requiring the patient to be positioned supine in modified lithotomy is
Correct Answer
B. Abdominoperineal resection (APR)
Explanation
Abdominoperineal resection (APR) is a surgical procedure performed to remove the rectum and anus, usually due to cancer or other diseases. The patient is positioned supine in modified lithotomy, which means lying on their back with their legs 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 typically require the patient to be positioned 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, 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 by the uterus, which can lead to decreased blood flow and potential complications 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, bolster under pelvis. In open bladder surgery, the patient is positioned supine, which means lying on their back. Placing a bolster under the pelvis helps to elevate the area and provide better access to the bladder during the surgical procedure. This position allows the surgeon to have a clear view and easier access to the surgical site.
20.
In which circumstance could the patient sustain injury to the pudendal nerves?
Correct Answer
A. Positioned on the fracture table
Explanation
When a patient is positioned on the fracture table, there is a risk of injury to the pudendal nerves. This is because the fracture table is designed to stabilize and immobilize the patient, often requiring the legs to be placed in stirrups. This position can put pressure on the pudendal nerves, which are responsible for providing sensation to the genital area. Compression or stretching of these nerves can lead to injury and subsequent symptoms such as pain, numbness, or tingling in the perineum and genitals.
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 such as osteoporosis can make the patient more prone to fractures, while limited range of motion of joints can affect their ability to move and maintain proper positioning. Additionally, aging skin becomes more fragile and prone to damage, making it crucial to handle the patient with care to avoid skin tears or pressure ulcers. Considering all of these factors is essential for ensuring the safety and comfort of the 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 surgical site exposure. To achieve this, it is important that the patient's body does not touch any metal on the table, as this can cause discomfort or injury. Additionally, equipment, Mayo stand, or personnel should not rest on the patient to avoid unnecessary pressure or obstruction during the procedure. Lastly, padding bony prominences helps prevent pressure ulcers and provides added comfort for the patient. Therefore, all of the above measures contribute to maximum patient safety and surgical site exposure.
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, the breast scrub is either eliminated or done very gently to avoid the dispersal of cancer cells. Scrubbing the breast vigorously can cause the cancer cells to spread to other parts of the breast or even to nearby lymph nodes, potentially leading to the spread of the disease. Therefore, it is important to handle the breast with care during the biopsy preparation 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 is a designated area specifically designed for preoperative preparations. It is equipped with all the necessary tools and supplies needed for the procedure. Additionally, performing the shave prep in the holding area ensures that the patient is in a sterile environment, minimizing the risk of infection. Shaving in the patient's room or the operating room suite may not provide the same level of sterility and may increase the risk of complications.
25.
Any area that is considered contaminated
Correct Answer
A. Should be scrubbed last or separately
Explanation
Contaminated areas should be scrubbed last or separately to prevent the spread of contamination to other areas. This is because scrubbing contaminated areas first could result in the transfer of contaminants to cleaner areas, increasing the risk of contamination. By scrubbing these areas last or separately, the risk of cross-contamination is minimized, ensuring a safer and more effective cleaning process.
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 is "from the incision site to the periphery in a circular motion." This is because washing and painting the skin in this direction helps to minimize the risk of contaminating the incision site. By starting at the incision site and moving outward in a circular motion, any potential bacteria or debris on the skin is pushed away from the incision, reducing the likelihood of infection.
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 a surgery typically involves a preoperative shower. This helps to cleanse the skin and reduce the risk of infection. It is usually done in the hospital or healthcare facility prior to the patient being taken to the operating room. Shave preparation may also be necessary in some cases, but the preoperative shower is a more common and important step in ensuring proper hygiene and minimizing the risk of surgical site infections.
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 the drapes. This clamp is designed to securely hold the tubing in place without causing any damage or puncturing the material. It provides a tight grip to prevent any leakage or dislodging of the tubing during procedures. The use of a nonperforating clamp ensures a reliable and safe connection between the suction tubing and the drapes, maintaining a sterile environment in the operating room.
29.
All of the following statements regarding sterility are true EXCEPT
Correct Answer
D. A sterile person faces a nonsterile person when passing
Explanation
In sterile environments, it is important for sterile persons to face each other when passing in order to maintain sterility. This is because facing each other reduces the risk of contamination from nonsterile areas or individuals. Therefore, the correct answer is that a sterile person faces a nonsterile person when passing. The other statements mentioned in the question are true and are related to maintaining sterility, such as discarding instruments or sutures hanging over the table edge and ensuring that wrapper edges are unsterile.
30.
When draping a table, the scrub nurse should drape
Correct Answer
B. Front to back
Explanation
When draping a table, it is important for the scrub nurse to drape from front to back. This ensures that the sterile field is maintained and reduces the risk of contamination. Draping from front to back allows the nurse to easily cover the table and create a barrier between the sterile and non-sterile areas. It also allows for a smooth and efficient workflow during the surgical procedure. Draping in any other direction could compromise the sterility of the field and increase the risk of infection.
31.
A seamless, stretchable material often used to cover extremities during draping is
Correct Answer
D. Stockinette
Explanation
Stockinette is a seamless, stretchable material commonly used to cover extremities during draping. It provides a smooth and comfortable surface, allowing for easy application and removal. Stockinette is often used in medical settings to protect the skin, provide padding, and promote hygiene. It is made from a soft and breathable fabric that helps to prevent irritation and pressure sores. Overall, stockinette is a practical and versatile material that is widely used in healthcare settings.
32.
Drapes are
Correct Answer
D. Placed on a dry area
Explanation
The correct answer is "placed on a dry area." This means that after the drapes are adjusted for the correct position and unfolded, they are placed on a dry area before being carried to the OR table. This ensures that the drapes remain clean and free from any moisture or contaminants that could potentially compromise the sterile field during the surgical procedure.
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 potential for contamination. Gloved hands should not come into direct contact with the patient's skin to prevent the transfer of microorganisms.
34.
A head drape consists of
Correct Answer
A. Medium sheets, towel, towel clip
Explanation
A head drape is a covering used during medical procedures to protect the patient's head and prevent contamination. It typically consists of medium sheets, a towel, and a towel clip. The medium sheets provide a large enough surface area to cover the head adequately, while the towel helps absorb any fluids or sweat. The towel clip is used to secure the drape in place and prevent it from slipping during the procedure. This combination of materials ensures proper coverage and hygiene during the medical procedure.
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
The correct answer is "only in front from chest to sterile field level, and sleeves from elbow to cuffs". This means that gowns are considered sterile only in the front area from the chest to the level of the sterile field, and the sleeves are considered sterile from the elbow to the cuffs. The rest of the gown, including the back and neck area, is not considered sterile.
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. Starting with the cleanest area first ensures that any contaminants or bacteria that may still be present on the hands and arms are not spread to other areas. This helps maintain a sterile environment.
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
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 and remove skin oil, but it does not render the skin completely aseptic. Aseptic means completely free from microorganisms, which is not achievable through a scrub procedure alone.
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." In an operating room, the circulator is responsible for assisting the scrub nurse and maintaining a sterile environment. If the scrub nurse needs to change a glove during an operation, it is the circulator's role to remove the glove for the scrub nurse to reglove. This is done to prevent contamination and maintain sterility in the operating room.
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 can lead to contamination. The gloves act as a barrier between the hands and the gown, preventing any potential pathogens or contaminants from transferring onto the hands. By removing the gloves first, there is a risk of touching the contaminated gown with bare hands, increasing the likelihood of cross-contamination. It is recommended to remove the gown first, followed by the gloves, to ensure proper infection control procedures are followed.
41.
An effective surgical scrub procedure is
Correct Answer
D. A and B
Explanation
An effective surgical scrub procedure involves both the time method and the brush-stroke method. The time method ensures that the scrub is performed for a sufficient duration to effectively remove microorganisms from the hands and arms. The brush-stroke method involves using a specific technique to thoroughly scrub all surfaces of the hands and arms, including between the fingers and under the nails. By combining these two methods, healthcare professionals can achieve a thorough and effective surgical scrub, minimizing the risk of infection during surgical procedures.
42.
Regarding the surgical scrub, which statement would violate acceptable practice?
Correct Answer
B. Nail polish may be worn if freshly applied
Explanation
Nail polish should not be worn during a surgical scrub, even if it is freshly applied. This is because nail polish can harbor bacteria and interfere with proper hand hygiene. It is important to have clean, bare nails during a surgical scrub to minimize the risk of contamination.
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 as a precautionary measure to protect the eyes and face from potential hazards or splashes that may occur during any type of case. This includes orthopedic cases, vascular cases, and positive HIV cases. Wearing protective eyewear helps to prevent any potential injuries or exposure to infectious materials, ensuring the safety and well-being of healthcare professionals involved in the procedures.
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 water, soap, and friction. This helps to physically clean the skin and remove any potential contaminants. Chemical antisepsis, on the other hand, involves the use of antiseptic solutions or agents to kill or inhibit the growth of microorganisms on the skin. This step helps to further reduce the risk of infection during surgery. Therefore, the correct answer is "mechanical washing and chemical antisepsis of the skin".
45.
Scrub technique ends
Correct Answer
D. 2 inches above the elbow
Explanation
The scrub technique is a method used to clean and sanitize the hands and forearms before performing a medical procedure. The question asks where the scrub technique ends, and the correct answer is "2 inches above the elbow." This means that the scrubbing should be done on the hands and forearms, stopping 2 inches before reaching the elbow joint. This ensures that the entire area that may come into contact with the patient or equipment is properly cleaned and reduces the risk of infection.
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. In a surgical setting, it is important to have clean and bare nails to minimize the risk of contamination.
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 scrubbing for a specific amount of time or a specific number of strokes, and the scrubbing motion should start from the hand and move towards the elbow. This ensures that all areas of the hands and arms are thoroughly cleaned and reduces the risk of contamination during surgery.
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 brush-stoke method of scrubbing prescribes that for nails, 30 strokes are required. For fingers, 20 strokes are required. For the hand (back and palm), 20 strokes are required. And for the arms, 20 strokes are required.
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 and help to correct the curvature by providing stability and support. They are attached to the vertebrae using hooks and screws, and then connected with a rod to straighten the spine. This surgical procedure aims to reduce the spinal deformity and improve the patient's posture and overall quality of life.
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 during procedures such as open heart surgery. It is specifically designed to safely and effectively separate the sternum, allowing access to the heart and other organs in the chest cavity. This instrument helps surgeons to perform the necessary procedures while minimizing the risk of damage to surrounding structures and ensuring patient safety.