Surgical Procedures and Related Complications: A Review of Various Cases, Exams of Nursing

Download Surgical Procedures and Related Complications: A Review of Various Cases and more Exams Nursing in PDF only on Docsity! 1 NBSTSA CSFA Exam Prep 1 1.A complication of steep reverse Trendelenburg position is A. deep vein thrombosis. B. arterial compression. C. cardiac overload. D. respiratory alkalosis.ANSWER - A. deep vein thrombosis. Which of the following positions should be utilized for posterior colpotomy? A. prone B. supine C. lithotomy D. Fowler'sANSWER - C. lithotomy Which of the following BEST prevents hypothermia in the OR? A. forced air warming blanket B. warmed IV solution C. warmed irrigation solution D. multiple layers of warm blanketsANSWER - A. forced air warming blanket OR humidity must be maintained between which of the following ranges? A. 5% to 20% B. 20% to 60% C. 2 40% to 80% D. 50% to 90%ANSWER - B. 20% to 60% An important process in which all team members must participate just prior to incision is called the A. huddle. B. timeout. C. debriefing. D. consent.ANSWER - B. timeout. Which of the following is Mohs surgery used to treat? A. malignant melanoma and basal cell carcinoma B. basal cell and squamous cell carcinoma C. malignant melanoma and squamous cell carcinoma D. basal cell and Merkel cell carcinomaANSWER - B. basal cell and squamous cell carcinoma When reviewing the chart for a patient scheduled for a mammoplasty, it is noticed that the patient's K+ is 5.4. The patient is suffering from which of the following? A. hyperkalemia B. hypokalemia C. hypercalcemia D. hypocalcemiaANSWER - A. hyperkalemia Which of the following are the preferred positioning devices used during surgical procedures? 5 B. cervical conization C. Bartholin cyst marsupialization D. vulvectomyANSWER - A. anterior colporrhaphy Which of the following is a type of shunt used during a carotid endarterectomy? A. Javid B. Fogarty C. Swan-Ganz D. RummelANSWER - A. Javid Which of the following organs has a fragile collagen-rich capsule and must be handled carefully? A. kidney B. gallbladder C. liver D. spleenANSWER - D. spleen Which of the following procedures would require a pneumatic tourniquet? A. femoral-popliteal bypass B. arteriovenous (AV) fistula creation C. total knee replacement D. intramedullary tibial nailingANSWER - C. total knee replacement 6 When applying clamps to a major vessel that is to be preserved, which of the following is the preferred clamp to use? A. Peon B. Crile C. Satinsky D. OchsnerANSWER - C. Satinsky Which of the following is a role of the surgical first assistant during robotics cases? A. Place access cannula. B. Exchange instrument arms. C. Position the patient cart. D. Operate instruments from console.ANSWER - B. Exchange instrument arms. Which of the following can be done to prevent wrong site surgeries? A. Bring the patient to the OR prior to the surgeon marking the site. B. Surgical first assistant should mark the patient if the surgeon is not available. C. Surgeon must mark the surgical site preoperatively. D. Put an "X" or write the word "NO" on the non-operative side.ANSWER - C. Surgeon must mark the surgical site preoperatively. When placing a drain for an abdominoplasty, which of the following is MOST commonly used? A. Jackson-Pratt B. Malecot C. Pleur-Vac 7 D. T-tubeANSWER - A. Jackson-Pratt Injury to which of the following arteries is commonly seen in the temporal lobes, where the skull is the thinnest and meningeal blood vessels are numerous, and is the usual cause of epidural hematomas? A. middle meningeal B. posterior meningeal C. temporal D. cerebralANSWER - A. middle meningeal Which of the following is the desired effect when applying a partially threaded cancellous screw to a bone fragment? A. distraction B. rotation C. compression D. subluxationANSWER - C. compression During an abdominal hysterectomy, the surgeon initially isolates the uterus by separating it from the A. bladder. B. round ligaments. C. broad ligaments. D. cervix.ANSWER - B. round ligaments. During a carotid endarterectomy, the final occlusion clamp to be removed after anastomosis is on the 10 after the thoracic cavity is closed B. immediately upon insertion C. within an hour of the procedure D. upon arrival in the PACUANSWER - A. after the thoracic cavity is closed A 60-year-old obese patient with a history of diabetes and renal insufficiency has undergone drainage of an abdominal abscess through a midline incision. Which of the following should be considered for wound closure? A. Multifilament, absorbable suture material provides for optimal wound healing. B. A continuous suture line should be used. C. An interrupted retention suture should be used. D. Use of blunt surgical needles is a consideration in the presence of infection.ANSWER - C. An interrupted retention suture should be used. A 54-year-old female presents to the OR with a 4 cm oblique volar forearm laceration and a 9 cm transverse dorsal forearm laceration from a dog bite. Which of the following suturing methods and materials is the BEST choice for closure of the wound? A. interrupted silk B. continuous polyglactin C. interrupted polypropylene D. continuous polyesterANSWER - C. interrupted polypropylene In a previously infected wound that has been opened and debrided, which of the following is the preferred suture material in the event that subcutaneous tissue is closed? A. braided absorbable B. braided non-absorbable 11 C. monofilament absorbable D. monofilament non-absorbableANSWER - C. monofilament absorbable During arterial cannulation in cardiopulmonary bypass (CPB), the cannula tip must be directed into which of the following arteries? A. pulmonary B. brachiocephalic C.√ aorta D. coronariesANSWER - C. aorta The primary purpose of a chest tube is to A. irrigate the chest. B. eliminate leaks in the lungs. C. prevent pulmonary emboli. D. re-establish negative pressure.ANSWER - D. re-establish negative pressure. During surgical treatment for a cerebral aneurysm, the aneurysm clip is placed at the A. neck of the aneurysm. B. apex of the aneurysm. C. arterial bifurcation. D. parent vessel.ANSWER - A. neck of the aneurysm. Which mechanical method of hemostasis should a surgical first assistant use in neurosurgery? 12 A. Avitene B. thrombin spray C. Surgicel D. bone waxANSWER - D. bone wax Which of the following procedures is usually performed in conjunction with a Nissen or Toupet Fundoplication? A. sleeve gastrectomy B. gastric bypass (Roux-N-Y) C. Transoral Incisionless Fundoplication (TIF) D. hiatal hernia repairANSWER - D. hiatal hernia repair A patient with both anterior and posterior knee joint instability and buckling during downhill ambulation is BEST treated by which of the following surgical interventions? A. ACL reconstruction B. total joint arthroplasty C. MCL reconstruction D. femoral chondroplastyANSWER - A. ACL reconstruction Unused culture tubes are placed on the back table prior to incision. Which of the following should the surgical first assistant do NEXT? A. Swab the affected area. B. Obtain new culture swabs. C. Pass the culture swabs to the surgeon. D. 15 D. laparoscopic cholecystectomyANSWER - A. open appendectomy In minimally invasive surgery, which of the following would involve Cartesian coordinate geometry? A. robotic endowrist B. total joint design C. synthetic heart valve manufacture D. alignment of compound facial fracturesANSWER - A. robotic endowrist Which of the following is a direct complication resulting from a total laryngectomy with a radical neck dissection? A. pneumothorax B. cranial aneurysm C. ischemic stroke D. salivary fistulaANSWER - D. salivary fistula Following an arteriovenous fistula procedure, a patient develops a condition known as "steal syndrome." Which of the following is the MOST appropriate action to remedy this condition? A. Revise fistula. B. Continue anticoagulant therapy C. Discontinue anticoagulant therapy. D. Revise fistula using an argyle shunt.ANSWER - A. Revise fistula. Which of the following is the reason a surgeon would choose to use a locking plate rather than a non-locking plate when repairing a bone fracture? 16 A. low bone density B. comminuted fracture C. compound fracture D. high bone densityANSWER - A. low bone density After a coronary artery bypass procedure, the patient is having difficulty transitioning off the cardiopulmonary bypass machine. Which of the following is the MOST frequently used intervention to address this situation? A. ventricular assist device B. high dose epinephrine C. intra-aortic balloon pump (IABP) D. extracorporeal membrane oxygenation (ECMO)ANSWER - C. intra-aortic balloon pump (IABP) A patient requires breast reconstructive surgery for breast cancer. When the surgeon places a tissue expander, which of the following muscles are lifted to allow for the placement of the expander? A. pectoralis major, deltoid, and superior rectus sheath B. pectoralis minor, serratus anterior, and superior rectus sheath C. pectoralis major, serratus anterior, and superior rectus sheath D. pectoralis minor, serratus anterior, and latissimus dorsiANSWER - C. pectoralis major, serratus anterior, and superior rectus sheath Which of the following conditions may be induced when thrombin is used in the management of hemostasis during a vascular procedure? A. thalassemia B. disseminated intravascular clotting 17 C. thrombocytopenia D. von Willebrand's diseaseANSWER - B. disseminated intravascular clotting A patient presents with a traumatic soft tissue injury with a Class III wound. Which of the following is the MOST appropriate dressing? A. Dermabond B. Telfa C. Tegaderm D. wound VACANSWER - D. wound VAC Which of the following is an example of a secondary dressing? A. ACE bandage B. 4 X 4 sponge C. wound VAC D. TelfaANSWER - A. ACE bandage Which type of drain is generally used for large open contaminated wounds such as perirectal, perianal fistulas, and subcutaneous abscess cavities? A. Penrose B. Jackson-Pratt C. Hemovac D. BlakeANSWER - A. Penrose Which of the following is a CONTRAINDICATION for the use of negative-pressure wound therapy? 20 B. non-ionizing C. columnar D. ionizingANSWER - D. ionizing During the timeout, why are all OR personnel required to stop all activity? A. to effectively communicate patient identification issues or concerns B. to allow the prep solution to dry C. to allow equipment to be set up for procedure D. to allow anesthesia to anesthetize the patientANSWER - A. to effectively communicate patient identification issues or concerns For efficiency and safety, the MOST appropriate approach for the surgical first assistant to indicate that the long instrument may be needed and should be opened while preparing for an exploratory laparotomy on an obese patient is to A. determine that it is needed and open the long instrument set that the CST had on hold. B. consult with the CST in order to have the long instrument set placed on the field now. C. wait until the circulator returns from pre-op and ask him/her to have the set counted and on the field. D. have the surgeon determine the need for the long instrument set after the procedure begins.ANSWER - B. consult with the CST in order to have the long instrument set placed on the field now. A patient in the preoperative holding area has questions about a surgical procedure. The surgical first assistant should A. ask the surgeon to speak with the patient. B. answer the questions. C. proceed with the procedure. D. 21 ask the anesthesia provider to answer the questions.ANSWER - A. ask the surgeon to speak with the patient. The surgical team is beginning their timeout. The x-ray tech walks in and states he is going to leave C-Arm outside the OR. Which of the following should the surgical team do NEXT? A. Continue with the timeout. B. Tell the x-ray tech OK and continue with timeout. C. Start over with the timeout. D. Tell the x-ray tech to be quiet or get out.ANSWER - C. Start over with the timeout. To help reduce the risk of an electrostatic spark, which of the following should be done? A. Maintain relative humidity in the correct range. B. Ask the circulator to move the electrocautery machine farther away from the field. C. Wait until the patient is asleep to plug in the electrocautery and turn it on. D. Use synthetic fiber blankets.ANSWER - A. Maintain relative humidity in the correct range. In the event of a chemical spill in the OR, which of the following is the MOST appropriate reference for exposure control and clean up? A. OSHA manual B. chemical label C. JCAHO standards D. Safety Data SheetsANSWER - D. Safety Data Sheets If the OR's humidity increases above 70% before the patient arrives to the OR, which of the following steps should be taken? A. 22 Tear down the sterile field and reset once the humidity level is normal. B. Proceed as normal. C. Monitor room and proceed once the humidity has reached normal levels. D. Rinse all instrumentation in saline.ANSWER - A. Tear down the sterile field and reset once the humidity level is normal. During a radical mastectomy, in addition to providing exposure, it is imperative that the surgical first assistant A. inquires if a local anesthetic is available for the end of the procedure. B. ensures saline is on the field for irrigation. C. weighs the specimen. D. evacuates the smoke plume.ANSWER - D. evacuates the smoke plume. A skin tag is removed from a patient under general anesthesia. It is not part of the procedure and is not within the surgical site. Under which of the following categories does this fall? A. negligence B. malpractice C. assault and battery D. Borrowed Servant RuleANSWER - C. assault and battery A patient requires an I&D of the thigh. The team has anticipated using 6 bottles of warm saline and brings them to the OR. During the 2-hour case, only four of the bottles are used while the other two have become room temperature. Which of the following actions should be taken with cool saline? A. Return to warmer within one hour. B. Immediately return to warmer. C. 25 A. Kleppinger forceps B. Harmonic scalpel C. L-hook cautery D. Maryland grasperANSWER - A. Kleppinger forceps Which of the following instruments is a traumatic laparoscopic dissecting instrument? A. Prestige B. scissors C. Davis and Geck forceps D. tenaculumANSWER - B. scissors After completion of a femoral popliteal bypass, which of the following should be used to detect blood flow to the foot? A. CT scan B. x-ray C. MRI D. DopplerANSWER - D. Doppler When a sterilized craniotomy set is opened, a hair is discovered in the set. Which of the following is the MOST appropriate action? A. Remove the hair from the set. B. Proceed with the case as the set was sterilized. C. Replace the set. D. 26 Clean affected instruments with betadine.ANSWER - C. Replace the set. Which of the following is the MOST common staple used during a laparoscopic right hemi-colectomy to transect the ilium? A. Insorb B. EEA C. ENDO-GIA D. linearANSWER - C. ENDO-GIA In the instance of dermoid cyst rupture, which of the following irrigants is used to prevent chemical peritonitis caused by the sebaceous material? A. water B. lactated Ringer's C. normal saline D. bacitracinANSWER - B. lactated Ringer's Which of the following gases is less soluble in blood and could persist long enough to cause a form of a gas embolus? A. carbon dioxide B. argon C. nitrogen D. kryptonANSWER - B. argon When placing a patient prone using chest rolls, which direction should the breasts be diverted? A. 27 inward B. outward C. upward D. downwardANSWER - A. inward When placing a patient in the lateral position, right side down with the aid of a Vac-Pac bean bag, which of the following structures is compressed, impairing blood flow? A. common iliac B. vena cava C. great saphenous vein D. aortaANSWER - B. vena cava Using a mesher on a split-thickness skin graft allows for A. greater coverage of the wound. B. better-looking results postoperatively. C. a smooth surface graft. D. retained serum on the recipient site.ANSWER - A. greater coverage of the wound. Winged scapula is a condition brought on by an injury to which of the following nerves? A. axillary B. medial pectoral C. long thoracic D. thoracodorsalANSWER - C. long thoracic 30 A. foramen of Monro B. aqueduct of Sylvius C. foramina of Luschka D. foramina of MagendieANSWER - B. aqueduct of Sylvius Which of the following types of hernia consists of a protrusion of fat through defects in the abdominal wall located between the umbilicus and the xiphoid process and symptoms of nausea and slight upper abdominal pain? A. spigelian B. epigastric C. interparietal D. umbilicalANSWER - B. epigastric Which of the following bones is the MOST superior tarsal and articulates with the distal end of the tibia? A. calcaneus B. navicular C. talus D. cuboidANSWER - C. talus A latissimus dorsi flap used for breast reconstruction following a mastectomy gets its main blood supply from which of the following arteries? A. thoracodorsal B. long thoracic C. 31 superior epigastric D. inferior epigastricANSWER - A. thoracodorsal A surgeon is performing a lumbar laminectomy and discectomy for an L5-S1 disc herniation that has protruded into the epidural space. Which of the following parts of the disc should be removed? A. nucleus pulposus B. annulus fibrosus C. anterior annulus D. anterior ligamentANSWER - A. nucleus pulposus During heart transplant surgery, which of the following is the correct order of chamber/vessel anastomosis? A. right atrium, left atrium, aorta, pulmonary artery B. left atrium, right atrium, aorta, pulmonary artery C. aorta, pulmonary artery, left atrium, right atrium D. left atrium, right atrium, pulmonary artery, aortaANSWER - D. left atrium, right atrium, pulmonary artery, aorta During a Nissen fundoplication, care should be taken when placing medial traction on the stomach to prevent avulsion of the A. splenic artery. B. gastric arteries. C. common duct. D. pancreatic duct.ANSWER - B. gastric arteries. 32 To reconstruct the pelvis after prolapse, which of the following anatomical structures could be used as a supportive repair in conjunction with the repair of a rectocele? A. transversalis fascia B. pelvic diaphragm C. levator ani D. perivaginal fasciaANSWER - C. levator ani During chest tube placement, it is MOST important to place the tube in the inferior aspect of the intercostal space to avoid A. neurovascular injury. B. pneumothorax. C. lung injury. D. rib fracture.ANSWER - A. neurovascular injury. When performing a culdoscopy, the Sims tenaculum should be placed on which of the following aspects of the cervix to assist with visualization of the operative area? A. medial B. posterior C. anterior D. lateralANSWER - B. posterior During a carotid endarterectomy, the patient's heart rate drops to 30 beats/min. This is likely due to stimulation of the A. hypoglossal nerve. B. vagus nerve. 35 A. parietal B. frontal C. occipital D. temporalANSWER - B. frontal A patient presents with a large benign tumor located 3 cm proximal to the anal verge. The surgical first assistant should assist the team in preparing for a A. low anterior resection. B. anoperineal repair. C. total colectomy. D. hemorrhoidectomy.ANSWER - A. low anterior resection. A patient undergoing an aortic valve replacement is having difficulty converting to NSR (normal sinus rhythm) and cannot be weaned from cardiopulmonary bypass. Continued failure of the heart to beat correctly after aortic valve replacement is MOST commonly caused by A. occlusion of the right coronary artery. B. high blood level potassium. C. remaining cardioplegia. D. defective defibrillator paddles.ANSWER - A. occlusion of the right coronary artery. When performing a hysterectomy and ligating the broad ligament, which of the following vascular structures lies within the broad ligament? A. internal iliac artery B. external iliac artery C. 36 uterine artery D. medial superior genicular arteryANSWER - C. uterine artery During laparoscopic pelviscopy, a trocar is accidentally placed into the urinary bladder. The surgical first assistant should anticipate repair of which smooth muscle layer? A. adventitia B. vesical plexus C. detrusor D. epitheliumANSWER - C. detrusor A surgeon is performing an arthroscopic ACL reconstruction and needs precise placement of the graft. Which of the following would aid in correct graft placement? A. drill sleeve B. Hohmann retractors C. tension isometer D. interference screwsANSWER - C. tension isometer A 91-year-old woman presents to the OR with a hip fracture. Efforts should be made to correct the fracture as soon as possible to avoid complications related to A. sartorius muscle injury. B. thrombophlebitis. C. lateral inferior genicular artery avulsion. D. peroneal nerve injury.ANSWER - B. thrombophlebitis. While trying to arrest the heart during an aortic valve replacement surgery, the surgical first assistant notices that the heart is not responding to the instillation of cardioplegia 37 and the left ventricle is distending. Which of the following is the MOST likely cause of this situation? A. incorrect cardioplegia solution B. aortic insufficiency C. aortic dissection D. coronary artery diseaseANSWER - B. aortic insufficiency Which skin cancer is MOST likely to require the use of a radioactive isotope tracing in conjunction with isosulfan blue sentinel node mapping and excision? A. fibrosarcoma B. basal cell carcinoma C. squamous cell carcinoma D. malignant melanomaANSWER - D. malignant melanoma Which of the following is a potentially lethal pathogen that causes surgical site infections and spreads via the lymphatic system? A. Streptococcus pyogenes B. Pseudomonas aeruginosa C. Clostridium perfringens D. Salmonella entericaANSWER - A. Streptococcus pyogenes Which of the following bacteria is found in the lining of the colon? A. Staphylococcus aureus B. Escherichia coli C. 40 30 minutes before incision Which local anesthetic has the longest analgesic effect? A. bupivacaine B. lidocaine C. procaine D. mepivacaineANSWER - A. bupivacaine Prior to liposuction, 40 mL 1% lidocaine with epinephrine 1:100,000 and 1,000 mL saline are combined to create which solution? A. tumescent B. papaverine C. Dakin's D. Lugol'sANSWER - A. tumescent During induction of anesthesia, the administration of propofol (Diprivan®) would cause A. a hypnotic state and sedation to unconsciousness. B. thinning of the blood and prevention of clotting. C. relaxation of muscles and dilation of arteries. D. relaxation of the bladder and production of urine.ANSWER - A. a hypnotic state and sedation to unconsciousness. Comparatively, which of the following patients is at greatest risk for anesthesia complication during the operative phase? A. a patient who is undernourished B. a patient who is immunosuppressed 41 C. a patient with COPD D. a patient with diabetesANSWER - C. a patient with COPD If a patient does not wish to receive an allogenic blood transfusion, which of the following is an available option to limit the risk of intra-operative blood loss? A. Use Dextrose 5% in 0.9% NACL for an IV drip. B. Give the patient factor 7 intra-operatively. C. Use preoperative autologous blood donation. D. Use FFP instead of PRBC's.ANSWER - C. Use preoperative autologous blood donation. An anesthesiologist is performing spinal anesthesia for a total knee replacement. Shortly after the spinal, the patient develops shortness of breath and respiratory distress. Which of the following has MOST likely happened? A. postdural puncture headache B. hypotension C. total spinal anesthesia D. caudal anesthesiaANSWER - C. total spinal anesthesia Which of the following analgesic drugs produces amnesia? A. ketamine B. propofol C. etomidate D. midazolamANSWER - A. ketamine Which of the following is the MAXIMUM dosage of bupivacaine without epinephrine? 42 A. 150 mg B. 175 mg C. 200 mg D. 225 mgANSWER - B. 175 mg In pre-op, the patient denies taking any anticoagulants. In passing, the patient's family mentions herbal remedies that the patient has been trying. Which of the following remedies should the surgical first assistant be MOST concerned about causing anticoagulation? A. St. John's wort, cinnamon, and vitamin E B. ginseng, licorice, and fish oil C. ginseng, kava-kava, and ginger D. St. John's wort, licorice, and fish oilANSWER - ginseng, licorice, and fish oil The topical hemostatic agent thrombin should never be directly injected or allowed to enter into a vessel because A. it causes uncontrollable vasospasms. B. the effects are reversed when directly injected and cause more severe bleeding. C. it can cause clotting and may ultimately lead to death. D. the risk of infection increases with direct injection.ANSWER - C. it can cause clotting and may ultimately lead to death. A 16-year-old male comes in for an emergency appendectomy. Surgeon states that the abdominal wall is very rigid and asks if muscle relaxation has been given. The patient is tachycardic and the end-tidal CO2 is rising. What is the MOST likely cause? A. sepsis B. malignant hyperthermia