Test Bank For Alexanders Care Of the Patient in Surgery 14th Edition Rothrock

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Test Bank For Alexanders Care Of the Patient in Surgery 14th Edition Rothrock

Rothrock: Alexander’s Care of the Patient in Surgery, 14^th Edition

Chapter 02: Patient Safety and Risk Management

Test Bank

MULTIPLE CHOICE

1. Governmental and professional agencies and organizations, whether voluntary (governmental) or involuntary, have a significant influence on patient safety policies in the healthcare setting. Select the agency or organization statement that presents a true reflection of its focus or purpose.

a.	The Joint Commission (TJC): Nonvoluntary bureau that tests healthcare institutions against evidence-based elements of performance
b.	Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics
c.	American Society of Anesthesiologists (ASA): Professional organization of anesthesia providers and technologists
d.	World Health Organization (WHO): United Nations based and supported authority on health throughout most of the world

ANS: D

WHO was created by and functions within the United Nations (UN) as the directing and coordinating authority for health throughout UN member nations.

REF: Page 21

2. Since its organization and establishment as a professional nursing association in the early 1950s, the Association of periOperative Registered Nurses (AORN) continues its endeavor to:

a.	promote guidelines influencing patient safety.
b.	create professional OR nursing care delivery models.
c.	interpret healthcare statistics critical to perioperative nursing care.
d.	ensure risk reduction strategies are the foundation of perioperative education.

ANS: A

The Association of Operating Room Nurses (now called the Association of periOperative Registered Nurses [AORN]) began organizing in the early 1950s. AORN’s conferences and publications were replete with patient safety information. Its first conference in 1954 included programs on methods’ improvement, explosion prevention, bacteria destruction, the surgeon-nurse relationship, and positioning.

REF: Page 18

3. The perioperative environment is a dangerous place for both patients and staff. The surgical patient is at risk for harm, regardless of age, surgical diagnosis, or planned procedure. Select the physical risks.

a.	Chemical, thermal, and radiation burns
b.	Anxiety and knowledge deficit
c.	Lost or mislabeled specimen
d.	Breaches of confidentiality, privacy, and dignity

ANS: A

A physical risk is some damaging or noxious element that comes into contact with the patient to cause harm, such as electrosurgical/laser beam, pooled prep solution, glutaraldehyde retained in an endoscope, or a retained foreign object.

REF:Pages 34, 37-38

4. Sara Martin, a healthy 32-year-old nursing student, is scheduled for excision of a left-sided subglottal cyst with frozen section and possible radical neck dissection. In addition to comfort and caring behaviors and reassurance from the perioperative nurse to mitigate Sara’s nervousness and fears, the admission process provides the opportunity to collect and verify information about the patient to ensure patient safety. Among the patient data that must be verified are:

a.	allergies, history and physical report, level of anxiety.
b.	lab and imaging results, blood transfusion orders.
c.	signed consent, advance directives, and personal belongings.
d.	All of the options must be verified.

ANS: D

Key features of the Universal Protocol for perioperative patient care are performing a preoperative verification process, marking the operative site, and conducting a “time out” immediately before starting the procedure. A properly performed “time out” includes information about the patient and the procedure.

REF: Page 19

5. Sara was positioned, prepped, and draped following general endotracheal anesthesia induction. The team assembled around Sara and the sterile field to perform the time-out as described in the WHO surgical checklist. Successful employment of the time-out can only be ensured when:

a.	the time-out is initiated by the surgeon.
b.	the entire team stops and focuses attention together.
c.	perioperative services has a physician champion and surgeon buy-in.
d.	someone simultaneously checks the patient ID band.

ANS: B

All members of the team must introduce themselves by name and role and participate in sharing critical elements of care. The team includes the surgeon, anesthesia provider, and nursing staff, plus any allied or ancillary care providers contributing to the procedure when the time-out is performed.

REF: Pages 21, 24

6. When unexpected events occur that have, or could have, compromised patient safety, a systematic investigatory process takes place. Significant information is gained through this meticulous exploration. The primary motive for carrying out a root cause analysis is to:

a.	establish cause and trends based on who was involved.
b.	determine precisely what happened and why.
c.	find out what needs to take place to prevent a recurrence of the event.
d.	uncover factors that contributed to the environment and the event.

ANS: C

Root cause analysis is a systematized process to identify variations in performance that cause, or could cause, a sentinel event. The analysis phase of root cause analysis progresses from “why” questions to “what can be done to prevent this” questions that flow and ultimately result in an action plan. Root cause analysis concentrates on systems and processes, not individuals.

REF: Page 19

7. The National Patient Safety Goals (NPSG) are intimately aligned with the perioperative nursing–sensitive interventions that define the daily role functions of the perioperative nurse. In the early days of the twentieth century (1900s), as perioperative nursing evolved as a specialty of nursing practice, history was chronicled when someone remarked that: ____________________________________________________________________.

Select the quote that best relates perioperative nursing care to the NPSG.

a.	“Surgical nurses are the glue that holds surgical care together.”
b.	“A nurse is always there to be the patient’s advocate.”
c.	“The primary role of the surgical nurse is to protect the patient from the surgery.”
d.	“Primum non nocere” (first do no harm).”

ANS: C

Most perioperative nursing interventions are aimed at protecting patients from the unintended insults of regular surgical care and the risks inherent in surgery. Tightly coupled systems are most prone to accidents, and surgical suites, emergency departments, and intensive care units are examples of complex, tightly coupled systems.

REF: Pages 18-20

8. After Sara Martin emerged from anesthesia and was extubated, she was transferred to the PACU by the anesthesia provider and perioperative nurse. She had an excision of a benign subglossal cyst. A hand-off report was given to the accepting PACU nurse. The anesthesia provider and perioperative nurse described the procedure, allergies, weight in kilograms, intake and fluid loss, anesthetics and medications, pain, and several other critical parameters of physiologic status. Choose the answer below that completes the blanks in this sentence: _________________________ is the first element of information that should be shared in the hand-off report; the ______________________ has the responsibility for the ultimate transfer of information.

a.	PACU bed space number; anesthesia provider
b.	The names and roles of the perioperative nurse and anesthesia provider; receiving PACU nurse
c.	Patient identification; receiving PACU nurse
d.	Patient identification; anesthesia provider

ANS: C

All patient encounters should begin with patient identification verification. The receiving healthcare provider bears the responsibility of obtaining all of the information needed to safely care for the patient before the transferring staff leave the area. Time for clarification and questioning must be provided. The purpose of hand-off communication and reports is to provide essential, up-to-date, and specific information about the patient. Standardized hand-off communication must include an opportunity to ask and respond to questions.

REF: Page 26

9. The OR is a danger-prone area for both patients and staff. Providing a safe environment of care for the patient involves identifying, mitigating, and managing the hazards inherent in surgical care. Choose the answer below that completes the blanks in this sentence: The risk of the surgical hazard of _________________ can be mitigated through ________________________.

a.	Wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists
b.	Electrical and thermal burns; alcohol-free prep solution
c.	Surgical site infection; flash sterilization
d.	Surgical airway fire; fire extinguishers in every OR

ANS: A

Evidence shows that wrong site surgery not only can devastate the patient and family but also can impact the perioperative team adversely. All institutions accredited by TJC must follow the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. The surgical team must agree that this is the correct patient and that the planned procedure is on the specified side and site. Marking the surgical site must be done so that the intended site of incision or insertion is clear and unambiguous.

REF: Page 31

10. Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained foreign objects (RFOs). What new and evolving risk reduction strategy could prevent RFOs and frustrating, time-consuming miscount adventures at the end of these procedures?

a.	Creating precounted laparotomy sets with only the few necessary instruments
b.	Performing radiologic surveillance on all conversion procedures at closure
c.	Counting all instruments including a laparotomy set before the laparoscopy
d.	Replacing or tagging sponges and laparotomy instruments with RFID chips

ANS: D

At a minimum, all facilities should have a “count” policy that reflects AORN’s Recommended Practices for Sponge, Sharp, and Instrument Counts. While standard counting prevented 82% of retained sponges, bar-coded and RFID-tagged sponges prevented about 97.5% of retained sponges. The bar-coded sponges were the most cost-effective. Researchers suggest that, given medical and liability costs of more than $200,000 per incident, sponge tracking technologies can substantially reduce the incidence of retained surgical sponges at an acceptable cost.

REF: Page 34

11. Norma Miller, a 49-year-old long-distance runner with dysfunctional uterine bleeding, was scheduled for a hysteroscopy. During the procedure, sterile saline was used to expand the intrauterine compartment and enhance visualization. The perioperative nurse meticulously monitored fluid use and documented infiltration to the uterus and fluid collected as drainage from the uterus. The perioperative nurse was concerned that approximately 500 ml of fluid was unaccounted for and alerted the surgeon. The nurse’s motive for this surveillance was to:

a.	determine the potential for intravascular uptake of fluid or third spacing.
b.	estimate the likelihood for fluid puddles on the floor, causing a fall hazard.
c.	determine the potential for dependent pooling under the patient and subsequent electrical burn.
d.	determine the potential for dependent pooling under the patient and sacral maceration.

ANS: A

Fluid and electrolyte imbalances may occur rapidly in the surgical patient, and can be caused by numerous factors, including preoperative fluid and food restrictions, intraoperative fluid loss, or the stress of surgery or uptake of surgery-infused diagnostic fluids. The surgical patient is unable to regulate body fluid and electrolyte requirements by normal activities of drinking, eating, excreting, and breathing unaided. It is therefore imperative that the perioperative nurse monitor and collaborate in controlling the fluid and electrolyte status of the patient intraoperatively.

REF: Pages 42-44

12. Spencer Robertson is a 4-week-old frail neonate who had a rectal exam and dilatation under anesthesia following prior surgery for imperforate anus. When the drapes were removed from Spencer, the perioperative nurse noted an area of redness, swelling, and abrasions on the buttocks of the patient. Spencer had been positioned prone for 20 minutes. The nurse who noted the skin condition had relieved the circulating nurse and quickly reviewed the perioperative record and patient chart, but had not seen the patient before positioning. Which of the following safety factors may have contributed to this event?

a.	Neonates have extremely delicate skin prone to injury.
b.	Preoperative skin condition was not assessed and documented.
c.	The relieving nurse did not receive a hand-off report from the circulating nurse.
d.	All of these options are contributing factors.

ANS: D

All of the above factors could have collectively contributed to the skin injury. The skin condition could also have been present on admission to the OR and not seen or noted. Findings from sentinel event reports over the last 2 decades demonstrate that the individual efforts of the best nurses, surgeons, and anesthesia providers, combined with a recognized need for teamwork, may not be sufficient in the perioperative setting.

REF: Page 19

13. Weighing sponges is a valuable tool for meticulous calculation of blood and fluid loss when conducted correctly and used in appropriate circumstances. Select the response that correctly reflects the best practice in weighing sponges.

a.	Calculate all sponge weight results at the end of the case.
b.	Use the following to calculate loss: 1.5 grams = 1.2 milliliters = 1.5 cc.
c.	Consider saline-soaked sponges equal to blood-soaked sponges when urine is involved in the operative field.
d.	Combine sponge weight values with irrigation measurement values to calculate estimated blood loss.

ANS: D

When blood loss estimates must be more accurate, weighing sponges provides a reliable means of judging the amount of blood lost and of gauging the need for transfusion. Add the amount of blood loss calculated from suction canisters to the total recorded from sponges to obtain accurate blood loss estimates.

REF: Pages 39-40

14. During a particularly long and bloody spinal fusion procedure for scoliosis, the perioperative nurse collected, monitored, and spun down the blood collected in the autotransfusion cell salvage system. She was able to provide the anesthesia provider with three units of packed red blood cells (PRBCs) by the end of the procedure. As the team calculated the estimated blood loss (EBL) as wound closure ended, the perioperative nurse also:

a.	added the total from the suction canister.
b.	excluded the suction canister since cell salvage returned blood to the patient.
c.	included suction content, subtracting irrigation amount used.
d.	requested hemoglobin and hematocrit levels to quantify EBL.

ANS: C

Measure blood in the suction canister(s) at regular intervals, subtracting the amount of any irrigating solution used.