Anatomy and Physiology: Hernia, Nerve Injuries, and Wound Healing, Exams of Medicine

Download Anatomy and Physiology: Hernia, Nerve Injuries, and Wound Healing and more Exams Medicine in PDF only on Docsity! Certified Registered Nurse First Assistant (CRNFA) Questions and Answers. The region between the rectus abdominus muscle, the inguinal ligament and medial to the inferior epigastric artery. - Correct Answer Hesselbachs Triangle Which type of Hernia occurs inside Hesselbachs Triangle - Correct Answer Direct Hernia Peritoneal sac containing intestines protrudes through the internal inguinal ring and passes down the inguinal canal outside of Hesselbachs triangle indicates what? - Correct Answer Indirect Hernia After care instructions for hernia surgery - Correct Answer Seek medical attention if: bleeding from the incision wound dehiscence fever pain, edema, erythema, warmth , purulent drainage, foul odor from incision, abdominal distention, nausea, vomiting, and separation of wound edges What is indicative of firm, tender, globular, irreducible swelling in the groin or abdomen? - Correct Answer Hernia reoccurance What piece of equipment helps with supporting the legs while in lithotomy position giving access to the perineal and rectal area? - Correct Answer Allen Stirrups What inhibits platelet aggregation? - Correct Answer Aspirin Test during assessment used to determine arterial blood flow to the hands? - Correct Answer Allens Test Sound which occurs because of over inflation of the lung(as in emphysema or pneumothorax)? - Correct Answer Hyperresonance Assessment of the abdomen includes? - Correct Answer In order: Inspection Auscultation Palpation Percussion While doing an axillary dissection be aware of? - Correct Answer Serratus anterior nerve thoracodorsal nerve Why is an axillary roll used during lateral positioning? - Correct Answer To create enough space to prevent compression of vessels and nerves in the brachial plexus What are you protecting by placing padding at the lateral aspect to the bottom knee and ankle? - Correct Answer Common Peroneal Nerve Distal fibula During lateral positioning what position is the lower arm in and why? - Correct Answer Palm up, To protect ulnar nerve Used to diagnose injury to ulnar nerve - Correct Answer Pin prick to pinky (3rd,4th,5th fingers affected with ulnar nerve injury) What type of suture is used in vascular procedures? - Correct Answer Monofilament Normal PT - Correct Answer 11-13.5 seconds Normal INR - Correct Answer 0.8-1.1 Normal PTT - Correct Answer 25-35 seconds What structure do you need to be aware of while doing a hysterectomy? - Correct Answer Ureters Can stretch during pregnancy and cause pain - Correct Answer Round ligaments unstable B/P What does Chvostek sign indicate? - Correct Answer Clinical sign of hypocalcemia Cranial Nerve I - Correct Answer Olfactory- Smell Cranial Nerve II - Correct Answer Optic- vision Cranial Nerve III - Correct Answer Occulomotor- eye movement: damage can cause diplopia and the inability to coordinate eye movements Cranial Nerve IV - Correct Answer Trochlear- Eye Movement Cranial Nerve V - Correct Answer Trigeminal- controls muscles of chewing and provides sensation to the skin of the face Cranial Nerve VI - Correct Answer Abducens- eye movement Cranial Nerve VII - Correct Answer Facial- Facial expression (bells palsy) Taste on Anterior 2/3 of the tongue Cranial Nerve VIII - Correct Answer Vestibulocochlear Balance and hearing Cranial Nerve IX - Correct Answer Glossopharyngeal Sensation, taste, salivation Cranial Nerve X - Correct Answer Vagus Affects Para Sympathetic Nervous System(PNS) Increase or decrease in B/P Recurrent laryngeal nerve is a branch: damage can cause hoarseness Cranial Nerve XI - Correct Answer Spinal Accessory Nerve: turning of head and shoulders, Ipsilateral weakness in the trapezius muscle. Cranial Nerve XII - Correct Answer Hypoglossal Affects Speech and Swallowing Acute movement to the hip in lithotomy position can cause damage to what? - Correct Answer Femoral and popliteal nerve or artery The pancreatic duct and the common bile duct join at? - Correct Answer Hepatopancreatic Sphincter and enter the duodenum at the ampulla of vater Right and left Hepatic ducts join to form the? - Correct Answer Common hepatic duct The Muscles that compose the Rotator cuff? - Correct Answer Supraspinatus Infraspinatus teres minor Subscapularis Wound class for laparoscopic Sigmoid or colectomy is? - Correct Answer Clean Contaminated Band of smooth muscle extending from the junction of the duodenum to the left crux of the diaphragm and functions as a suspensory ligament - Correct Answer Ligament of Treitz Superficial muscle that overlaps the sternocleidomastoid? - Correct Answer Platysma Muscle Name the layers of an artery - Correct Answer Intima Media Adventitia Signs of hypocalcemia? - Correct Answer numbness and tingling of the hands, feet or lips, muscle cramps muscle spasms seizures facial twitching muscle weakness light headedness slow heartbeat(bradycardia) What kind of sound would be produced by percussing over the liver? - Correct Answer Dull sound What kind of drain is used for bile duct exploration? - Correct Answer T- Tube Heparin cannot be used if a patient suffers from? - Correct Answer Thrombocytopenia Carotid Triangle landmarks? - Correct Answer Posteriorly:Sternocleidomastoid Inferiorly: omohyoideus Superiorly: stylohyoideus What is the most inferior of the 3 anterior branches of the carotid arteries? - Correct Answer Superior Thyroid Artery On which artery is the the last clamp to be removed when performing a Carotid Endarterectomy? - Correct Answer Internal Carotid Artery Strength layer of the dermis is the? - Correct Answer Reticulum Blanching is a sign of? - Correct Answer Compromised blood supply Which type of suture creates the greatest tissue reaction? - Correct Answer absorbable Most common cognitive impairment for patients over 70? - Correct Answer Dementia In recovery after head surgery, the patients head should be at what angle? - Correct Answer 45 degree What will recovery be watching for in a patient that just had head surgery? - Correct Answer Increased ICP When placing a trocar in the abdomen laterally what structure do you want to avoid? - Correct Answer lateral and medial epigatrics The suture used to ligate a uterine artery is always a _______________ suture? - Correct Answer absorbable Following a tubular structure to the side wall during a hysterectomy help identify it as the ? - Correct Answer round ligament What structure mark the end of the fundus and the beginning of the corpus? - Correct Answer The cornea of the uterine tubes The mesentery of the ovary and ovarian ligament is called the ? - Correct Answer Mesovarium Valid indications for a hysterectomy are? - Correct Answer Fibroids Cancer Abnormal bleeding endometriosis Abdominal wall structure that is encased by the anterior and posterior rectus sheath? - Correct Answer rectus abdominis muscle peritoneum which lines the abdominopelvic organs is called the ? - Correct Answer Visceral Why do some surgeons choose to approximate the rectus abdominus muscles? - Correct Answer To prevent rectus diastasis By opening the anterior leaf of the broad ligament, what structure can be dissected from the lower uterus and cervix? - Correct Answer Urinary bladder The Ureter passes more closely to the uterus at this level? - Correct Answer Cervix Finger-like projections at the open end of the uterine tubes are referred to as the? - Correct Answer Fimbria Assessment of the gynecologic surgery patient includes: - Correct Answer Bleeding Hx Skin integrity anxiety level continence status contraceptive Hx maternal diethylstilbestrol therapy core body temp sexually transmitted disease his/hx allergies pain/discomfort abdominal girth menstural cycle hormone replacement therapy positional considerations Rh factor status Possible diagnostic studies indicated for a hysterectomy ? - Correct Answer CBC blood chemistry pap smear CT MRI U/S ECG Chest Xray colposcopy UA Blood type D&C The process of insufflation includes? - Correct Answer CO2 via veress needle seeing at 15mm HG maintaining pneumoperitoneum During LAVH surgery where is the uterus excised from? - Correct Answer Excision of the uterus from the superior aspect to the uterine vessels Advantages of LAVH/Robotic AVH are? - Correct Answer faster recovery shorter length stay less adhesions Post op considerations for LAVH - Correct Answer avoid heavy lifting/driving for 7-10 days avoid intercourse, douching, tampons until seen by dr call DR if redness, swelling at the incision site Limitations on contraindications for performing LAVH/RAVH would be? - Correct Answer pulmonary disease size of uterus Name the Phases of wound healing - Correct Answer Inflammatory proliferative remodeling (maturation) how long is the inflammatory phase of wound healing ? - Correct Answer 1-5 days The proliferative stage of wound healing can last up to ? - Correct Answer 3 weeks Remodeling(maturation) phase of wound healing can take how long? - Correct Answer 21 days to months What occurs during the Remodeling(maturation) phase of wound healing? - Correct Answer Collagen fibers reorganize and tighten to reduce scar tensile strength increases What takes place in the Inflammatory phase of wound healing? - Correct Answer vasoconstriction platelet aggregation and formation phagocytosis What happens during the Proliferative stage of wound healing? - Correct Answer Collagen is produced wound tensile strength increases granulation tissue forms, Healing is evident with sub tissue being replaced by soft skin and connective tissue What is Chvostek sign? - Correct Answer When facial nerve is tapped in front of tragus, the facial muscles on the same side the face will contract momentarily. (typically a twitch of the nose or lips. Sign of hypocalcemia Research has shown that administering antibiotics within ______ hour(s) of surgery can decrease surgical site infections - Correct Answer 1 Heparin antagonist, used to reverse heparin anticoagulation? - Correct Answer Protamine Study of mental processes and human behavior? - Correct Answer Psychology A patient with malignancy, chronic infection, chronic GI disease may be in a? - Correct Answer Poor state of nurtition Abnormally low range of HGB may indicate? - Correct Answer Blood loss Reverse Trendelenburg position is used for procedures of the? - Correct Answer Head and neck During positioning the patient, it is important to remember that areas of pressure vulnerability include? - Correct Answer eyes fingers breasts perineum During abdominal surgery, too much pressure on the ___________ can cause blood loss or even death? - Correct Answer liver Excessive bleeding obscures visualization and interferes with the? - Correct Answer healing process What can alter clotting mechanisms besides over the counter medication? - Correct Answer Herbs When at all possible the RNFA uses _________ to provide exposure? - Correct Answer Fingers What kind of knot does not ensure that tissue will be held together and vessels remain closed is the ? - Correct Answer Granny knot What can form when skin is stretched when tape is applied? - Correct Answer Blisters After application of a cast, pulses _________ to the immobilization device should be monitored - Correct Answer distal A philosophical basis for informed consent in health care? - Correct Answer Self determination or autonomy Statements about actual health problems or clinical conditions? - Correct Answer Nursing diagnosis The RNFA works in __________with the surgeon and health care team members to achieve optimal patient outcomes. - Correct Answer collaboration Used to refer to reasons for decision about how one ought to act. - Correct Answer Ethical positioning for a Lap chole? - Correct Answer Reverse trendelenburg with table tilted to the left. characteristics first intention wound healing - Correct Answer clean and uninfected surgically incised without much loss of cells and tissue edges of wound are approximated by surgical sutures characteristics of 2nd intention wound healing - Correct Answer open with large tissue defect, at time infected having extensive loss of cells and tissues the wound is not approximated by surgical sutures but is left open characteristics of 3rd intention wound healing - Correct Answer delayed primary closure occurs when two granulated surfaces are approximated. The traumatic surgical wound is debrided and purposely left open to heal by second intention for approximately 4-6 days PNDS - Correct Answer Perioperative Nursing Data Set signs of hypovolemic shock - Correct Answer cool, clammy skin confusion decreased or no urine output general weakness pallor rapid breathing sweating, moist skin Name the landmarks of Hesselbachs triangle - Correct Answer rectus abdominus muscle inguinal ligament medial to inferior epigastric artery Hernia that is lateral to the inferior epigastric artery - Correct Answer Indirect hernia Hernia that is Medial to the inferior epigastric artery - Correct Answer Direct hernia What is the number one non-pharmacologic way to prevent a post-op infection? - Correct Answer Good Surgical Technique What organism causes rapidly progressive erythema and tenderness to develop in wound edges early in the post-op course? - Correct Answer Group B strep A maneuver of applying pressure over the left iliac fossa deeply in and directed toward the right side to illicit pain in the appendicular region is called? - Correct Answer Rovsing's sign (sign of appendicitis) What antibiotics are known as "triple antibiotics" - Correct Answer Flagyl Ampicillin Gentamicin When performing a physical assessment of the abdomen, what is the correct order of the assessment skills? - Correct Answer inspection auscultation palpation percussion A needle that is classified as reverse cutting is used primarily on? - Correct Answer ligaments The amount of blood ejected by the left ventricle per minute is a product of heart rate times the stroke volume and is known as ? - Correct Answer Cardiac Output In a laparoscopic procedure, the peritoneal cavity is insufflated with CO2 to an intraoperative pressure of ? - Correct Answer 12-15 mmHG When a tissue defect decreases in size by wound contraction, it is designated as healing by? - Correct Answer Secondary intention What cells are responsible for the synthesis and secretion of collagen and elastin? - Correct Answer Fibroblasts The most common organisms isolated from SSI's - Correct Answer S. Aureus, Staphylococcus, Enterococcus, Pseudomonas Multiple antibiotic resistant organisms are most often transmitted by? - Correct Answer The hands of health care providers The RNFA can have a direct effect on the stress response by? - Correct Answer Providing preoperative teaching and comfort measures to decrease anxiety During the inflammatory phase of wound healing, the vascular response is? - Correct Answer Vasoconstriction The height of the operating room table should reach the level of the? - Correct Answer elbows The desired position of the wrist of an assistant is slight? - Correct Answer extension To prevent beveled edges, the scalpel blade should be held____________ to the skin? - Correct Answer Perpendicular Impaired leukocyte function can be a result of? - Correct Answer Hyperglycemia Normal serum Total Protein - Correct Answer 6.0-8.0 Uninfected operative wounds in which no inflammation is encountered and the respiratory, alimentary and gI tracts are not entered? - Correct Answer Clean Wound Operative wounds in which the respiratory, alimentary, or GI tract is entered under controlled conditions? - Correct Answer Clean Contaminated wound Wounds that are open, fresh, accidental wounds, such as penetrating trauma, open fractures or operations with major breaks in aseptic technique - Correct Answer Contaminated wounds Wounds that include old physically induced wounds with retained devitalized tissue and wounds that involve and existing clinical infection or perforated viscera? - Correct Answer Dirty or Infected wounds When placed in the prone position, female breasts should be? - Correct Answer angled toward the sternum Respiratory system is most vulnerable in what position? - Correct Answer Prone For what procedure do you identify calot's triangle? - Correct Answer Laparoscopic Cholecystectomy What are clipped and cut when doing a Laparoscopic Cholecystectomy? - Correct Answer Cystic Artery Cystic Duct What type of tissue is a cutting needle used on? - Correct Answer skin periosteum bone What the of tissue is a Taper needle used on? - Correct Answer Any tissue that is easy to penetrate: peritoneum fat muscle most fascia bowel dura vessels What type of catheter is used when performing a prostatectomy? - Correct Answer Indwelling Catheter Pancreatic duct and the common bile duct enter the duodenum at? - Correct Answer Ampulla of vater What is associated with common bile duct stone? - Correct Answer Pancreatitis Malignant hyperthermia is brought on by? - Correct Answer inhalation agents What is surgeons knot? - Correct Answer Throw two ties the same direction and then one in the opposite direction. Incision which is made on an angle extending rom the midline laterally. Running just underneath the lower ribs? - Correct Answer Kocher oblique incision