NIFA (120 STUDY QUESTIONS AND ANSWERS) 2024 FINAL EXAM UPDATE, Exams of Nursing

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NIFA (120 STUDY QUESTIONS AND ANSWERS) 2024 FINAL EXAM UPDATE The number one patient safety issue identified in a survey of peri-operative nurses is preventing: - SOLUTION Wrong site/procedure/patient surgery Reprocessing (flashing) instruments in the OR is high risk because: - SOLUTION OR personnel not properly trained to reprocess instruments To safely transfer and position patients in a manner that prevents shearing, personnel should use a mechanical lifting device for a supine-to-supine transfer of a patient weighing more than: - SOLUTION 157 lbs _______________ should be the primary decision makers for what equipment and supplies are purchased and stocked in the difficult airway management cart. - SOLUTION Anesthesia personnel Proper specimen management techniques prevent errors and include all of the following EXCEPT: - SOLUTION Receiving specimens from the surgical field then affixing patient label to each Preventing surgical fires is a top priority for all OR personnel and members of the surgical team should perform all of the following duties EXCEPT: - SOLUTION Perform a weekly fire risk assessment Peri-operative hypothermia is an important issue for all anesthetized patients because of all of the following EXCEPT: - SOLUTION Increases risk of renal failure Recommendations for preventing retained surgical items include all of the following EXCEPT: - SOLUTION Utilizing a multidisciplinary team to resolve incorrect counts Select the appropriate order for administering blood and blood products. - SOLUTION Verify informed consent for blood, verify patient identification and blood type and unit numbers against blood tag and requisition slip with second licensed person, sign slips 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. - SOLUTION Keep a running total blood loss calculated from available sponges during procedure 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? - SOLUTION Replacing or tagging sponges and laparotomy instruments with radiofrequency identification (RFID) chips A female patient with end-stage pancreatic cancer was admitted from hospice for a celiac plexus block to treat intractable pain. She had a Whipple procedure 18 months earlier and enjoyed a good quality of life until 3 weeks ago. She wanted to be able to complete "getting her things in order" and saying good-bye to her friends and family while enjoying her last days pain-free. The patient insisted that her Do Not Resuscitate (DNR) status NOT be rescinded. She was conscious and competent and knew what was best for herself. The patient was taking full advantage of what provision for her care? - SOLUTION PSDA and advance directives A patient was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled vaginal-assisted laparoscopic hysterectomy. She demonstrated and verbalized that she understood all of the tenets of the procedure, risks, expected outcome, complications, and procedural process. Before she signed the consent form, she informed the surgeon that she did not want any medical students or surgical residents performing any parts of the procedure other than assisting and did not want any photographs of her body taken. The surgeon agreed, and she crossed out those portions of the form and initialed them before she signed. The patient was exercising her: - SOLUTION right to informed consent. Early on, during the preliminary sponge count on closure of a repair of a ruptured abdominal aortic aneurysm, the circulating nurse was unable to account for 2 lap sponges. He had meticulously maintained accountability for all sponges and instruments discarded from the sterile field and bagged each sponge carefully. He immediately turned and addressed the entire A 47-year-old man was admitted to the emergency department (ED) with respiratory symptoms, facial and upper body abrasions, burns, and moist lesions after a small package, delivered to his office, exploded and sprayed him dried powder and glass shards. In response to the reported mechanism of injury, the ED team sequestered him in a secluded area away from the rest of the patients. The team believed that this was highly suspicious of a bio-terrorism event. The epidemiologist was called, and the patient was transferred to a negative-pressure isolation room and placed on standard, contact, airborne, and droplet precautions. Based on these actions, which microorganism agents might be suspected to be involved? - SOLUTION Anthrax and smallpox Qualities of an effective packaging material must include several key characteristics. Select the three most important qualities. - SOLUTION Good steam penetration and removal, good microbial barrier, aseptic presentation. The design of the physical space within an OR attempts to minimize horizontal surfaces by placing cabinets flush with the wall. This prevents dust settling on multiple surfaces and decreases the areas that have to be monitored and cleaned. Another concern with horizontal surfaces is that is turbulence from staff movement and activity plus door movement, when it opens and closes, can: - SOLUTION mobilizing resting dust from these surfaces. An 86-year-old male was admitted to the intensive care unit (ICU) 3 weeks ago for heart failure and intractable atrial fibrillation. He has had diarrhea for 4 days that has cultured C. difficile. The transmission-based precautions sign on the door to his room alerts the staff to employ which practice precaution? - SOLUTION Both standard precautions and contact precautions Closed gloving is the technique of choice for the initial donning of sterile gloves by the scrubbed team member; however: - SOLUTION it can only be used for the initial gloving. the final step, after decontamination and before sterilization, is the prep, pack, and wrap process. The sterile processing technologist has taken the laparotomy set from the washer/decontaminator to prepare for sterilization. Select the most appropriate order that the instrument set must travel before reaching the steam sterilizer. - SOLUTION Inspect, inventory against list, assemble, place integrators, wrap and tape A patient undergoing a laparoscopic Nissen fundoplication procedure will be positioned in both high and low lithotomy during the procedure. After the patient is re-positioned into lo lithotomy, the perioperative nurse should: - SOLUTION reassess the patient for body alignment, tissue integrity, and pressure areas. A 68-year-old, American Society of Anesthesiologists (ASA) physical status (OS)-2 male with early-stage prostatic cancer, was intubated and positioned for a robotic-assisted laparoscopic radical prostatectomy. The initial position for insertion of the trocars was supine with arms tucked and secured within under-mattress sled arm positioners padded with gel. His hands were placed in a natural position with the fingers wrapped around gauze rolls and touching his lateral thighs. The new anesthesia provider, who had never seen a robotic prostatectomy, was concerned about anesthesia implications when the patient would be repositioned into extreme Trendelenburg for the dissection and anastomosis. The circulating nurse assured her that they would implement protective measures and work together to ensure the best patient outcome. Select all of the potentially harmful effects of extreme 45-degree Trendelenburg in a robotic pr - SOLUTION Respiratory compromise and ventilation resistance Shearing injury to soft tissues A 325-pound male is scheduled for a 6-hour abdominal surgery. While assessing the patient in the preoperative holding area, the perioperative nurse is concerned about the risk for pressure injury because of the weight of the patient's body pressing against the surface of the operating room bed for a long surgery. Which of these other factors may also produce pressure? - SOLUTION A self-retianing retractor post clamped to the OR bed rail and tightened against the patient's side. Prolonged lithotomy positioning can result in neuropathies of the legs. The most frequently injured nerves are the obturator, sciatic, femoral, and __________nerve, which can result in injury from _________. - SOLUTION common peroneal; full leg pneumatic compression sleeves While tucking the arms at the sides of the patient in supine position offers comfort, safety, and easy access to the patient by the scrubbed team, improper positioning and securing of the arms can result in significant injury. Injury can be avoided by tucking the draw sheet ___________ the arm and under the ____________. - SOLUTION around; body While Fowler's position offers the best respiratory excursion for the patient, the patient is at higher rick for _________ because of dependent pooling in the hips and legs. - SOLUTION venous thromboembolism (VTE) Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below: - SOLUTION 32 mm Hg A frail and thin 91-pound, 83-year-old woman is scheduled for a right pneumonectomy for non-small cell lung cancer. She will be positioned in left lateral position for her procedure. Based on the perioperative nurse's preoperative assessment, identify three position-related nursing diagnoses for this procedure and four relevant nursing interventions. Select from the options to fill in the blanks. - SOLUTION Hypothermia; impaired skin integrity; falls; remain at patient's side during induction; use under- and over-body forced air warming blanket; use at least four people to assist with lift and transfer; pad all bony prominences with foam or gel pads. The lateral kidney position allows approach to the retro-peritoneal area of the flank. To render the kidney region readily accessible, the _________________ is raised, and the bed flexed so that the area between the twelfth rib and the iliac crest is elevated. Compression of the ________________ can occur when the flank is raised too high. - SOLUTION kidney bridge; vena cava A veteran perioperative nurse remembers a time when all suture needles had eyes, and she even had her own needle rack. She hand-threaded all sutures according to the surgeon's preference. The newer sutures were originally called "atraumatic" sutures because they did not double back through a needle eye and cause tissue trauma during pulling or suturing through the tissue. Today, we call this manufacturing process of connecting the suture thread to the needle: - SOLUTION swaged appropriate diuretic medication to give and what nursing actions would be indicated for an older adult patient with traumatic brain injury, increased ICP, and a history of congestive heart failure (CHF) - SOLUTION Furosemide (Lasix) 20-80 mg IV; monitor for hypotension and note extent of diuresis Because herbal products are so readily available and have such widespread media attention, many people think that they can safely self- medicate. Why should the public be aware and educated about dietary supplements and potential harmful effects - SOLUTION Unknown substances may be present in these products. a possible benefit to the paramedian incision - SOLUTION decreased risk for hernia An example of an indication for liver transplantation would be - SOLUTION primary hepatic cancer he largest part of the mammary gland rests on the - SOLUTION Pectoralis major muscle and serratus anterior During ventriculoperitoneal shunt placement, - SOLUTION The unit is soaked in NS & antibiotic solution, never lubricated. Patients with chronic venous insufficiency (CVI) are not typically treated surgically as often as patients with arterial disease because: - SOLUTION CVI is not life-threatening or limb-threatening 35% of the refractive power of the eye is credited to which part of the eye - SOLUTION Lens Oculocardiac reflex (OCR) is an intraoperative emergency that can occur during eye surgery. Select the definition of the response and contributing factor(s) - SOLUTION Trigeminal-vagal response caused by pressure on the globe or retrobulbar block The perioperative nurse must be prepared for which additional procedure when head and neck surgery is performed? - SOLUTION Tracheostomy The perioperative nurse preparing for a procedure where STSGs will be taken to cover several large burn areas will need to have available: - SOLUTION sterile mineral oil, tongue blades, and a mesher dermatome the correct term to describe the inward turning of one or both eyes - SOLUTION Esotropia The nerve supply for the female pelvis comes from the autonomic nerves that enter the pelvis through the - SOLUTION Superior hypogastric plexus which surgical approach reduces the morbidity and mortality in removal of an acoustic tumor - SOLUTION Translabyrinthine approach Pt with hepatobiliary disease, The perioperative nurse, during the preoperative assessment, questions and examines the patient for signs and symptoms of jaundice, petechiae, and lethargy and: - SOLUTION review chart for bleeding and coagulation times and the platelet count. The external ear canal lining - SOLUTION reduces bacterial levels in the outer ear Miotics and mydriatics produce opposite effects on the pupil of the eye. Select the most appropriate statement about miotic and mydriatic drugs - SOLUTION Mydriatic drugs, such as phenylephrine, dilate the pupil. Vascular access in pediatric patients may be established intraoperatively for short-term (weeks) or long-term (months, years) use - SOLUTION Central venous line What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp - SOLUTION Subgaleal space Pericardial tamponade includes which of the following signs or symptoms - SOLUTION Narrow pulse pressure Which statement regarding level III and level IV trauma centers best describes the difference between the two types of centers - SOLUTION A level III trauma center provides advanced cardiac life support (ACLS), surgery, stabilization, and transfer, while a level IV only provides ACLS services before immediate transfer to a higher level center A percutaneous method of instituting femoral vein-femoral artery cardiopulmonary bypass (CPB) can be used for minimally invasive (or conventional open) procedures and in emergency situations where the environment is not conducive to traditional CPB methods. Select the areas where percutaneous CPB would be indicated - SOLUTION Cardiac catheterization unit and intensive care unit Which two similar hernia repair approaches reestablish the integrity of the transversalis fascia and simultaneously reestablish and strengthen the posterior inguinal floor by sewing the transversalis fascia to the Poupart ligament? - SOLUTION The McVay or the Cooper ligament repair Identify the class of medications that can increase the risk or severity of a reaction to contrast media - SOLUTION Beta Blockers The recommended length of time for inflation of an upper extremity tourniquet on a patient under 50 years old is_______while the recommended pressure is _____. - SOLUTION 1 hour; 250-300 mmHg continuous tourniquet pressure less than 1 hour on the upper extremity and less than 2 hours on the thigh. Tourniquet pressure should not exceed the recommended maximum cuff pressure limits of 300 to 350 mm Hg for the thigh and 250 to 300 mm Hg for the arm and the lower leg. the statement that reflects a true special consideration for skin preparation before facial surgery. - SOLUTION Leave the eyebrows and eyelashes intact to preserve facial appearance and expression. A minimally invasive video-assisted thyroidectomy (MIVAT) procedure relies on Miccoli instruments added to the standard thyroid or neck dissection setup, a 30-degree endoscope, and an ultrasonic (harmonic) scalpel with scissors to ligate and divide the vessels. An important risk reduction strategy for any minimally invasive procedure would be - SOLUTION consider and plan for the possibility of conversion to open thyroidectomy he external ear, which includes the auricle (or pinna) and external auditory canal, is composed of cartilage covered with skin. The primary function of the auricle is to - SOLUTION concentrate and conduct incoming sound waves into the external auditory canal. There are several risk factors associated with dehiscence. Which of the following can be controlled by the RNFA - SOLUTION Sutures placed too close together Access to the substernal compartment is typically facilitated by: - SOLUTION using long instruments through a regular thyroid incision. Pressure against the skin above ____mm hg interferes with tissue perfusion - SOLUTION 32 Latex allergy reaction is best prevented by - SOLUTION limiting exposure to latex On postoperative day 2, a patient developed edema, redness, and purulent exudate that appeared to be isolated to the subcutaneous plane above the sternum. What important criteria must be met to conclusively define this as surgical site infection (SSI)? - SOLUTION Positive diagnosis of the SSI by the surgeon or attending physician Suture can be used for more than repairing tissue. - SOLUTION ligate, suture, and close tissue. Which of the following absorbable suture has the best tensile strength - SOLUTION Polydioxanone The light transmission through an endoscope is achieved by way of - SOLUTION bundles of fiberoptic glass rods Precautions apply to blood, all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood, mucous membranes, and nonintact skin. - SOLUTION Standard On extubation, Daniel presented with coughing, wheezing, dyspnea, use of accessory muscles, and tachypnea. Daniel is presenting with _______ probably caused by _______. - SOLUTION bronchospasm; aspiration The tensile strength of lactic & glycolic acid polymers is sufficient for approximation of tissues for _____ weeks. - SOLUTION 2-3 New synthetic polymers such as PDS provide wound support up to _____ months - SOLUTION 3 Proper care and handling of surgical specimens is imperative for correct diagnosis, treatment, and prognosis planning of the patient. Select the response that best reflects correct specimen care and handling - SOLUTION Avoid placing specimens for frozen section in formalin. Terminal cleaning and disinfection of the operating room should be done - SOLUTION daily when the areas are being used A needletype frequently used in microsurgery is - SOLUTION cutting taper