NIFA STUDY GUIDE QUESTIONS AND ANSWERS 2023 -2024 GRADED A+, Exams of Nursing

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NIFA STUDY GUIDE QUESTIONS AND ANSWERS 2023 -2024 The number one patient safety issue identified in a survey of peri-operative nurses is preventing: - answer Wrong site/procedure/patient surgery Reprocessing (flashing) instruments in the OR is high risk because: - answer 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: - answer 157 lbs should be the primary decision makers for what equipment and supplies are purchased and stocked in the difficult airway management cart. - answer Anesthesia personnel Proper specimen management techniques prevent errors and include all of the following EXCEPT: - answer 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: - answer Perform a weekly fire risk assessment Peri-operative hypothermia is an important issue for all anesthetized patients because of all of the following EXCEPT: - answer Increases risk of renal failure Recommendations for preventing retained surgical items include all of the following EXCEPT: - answer Utilizing a multidisciplinary team to resolve incorrect counts Select the appropriate order for administering blood and blood products. - answer 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. - answer 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? - answer 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 - answer 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 a - answer 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 team in a clear voice. Select the appropriate communication that the circulating nurse must employ during this count discrepancy. - answer "We have a count discrepancy. We started with 70 sponges and find only 68. We are missing 2 lap sponges. Everyone, please check your areas. 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 - answer Anthrax and smallpox Qualities of an effective packaging material must include several key characteristics. Select the three most important qualities. - answer 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: - answer 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? - answer 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: - answer 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. - answer 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: - answer 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 - answer 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? - answer 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 . - answer 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 . - answer 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. - answer venous thromboembolism (VTE) Positioning devices should be used according to the original equipment manufacturer's instructions to reduce the capillary interface pressure to below: - answer 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. - answer 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. - answer 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: - answer swaged The ideal suture material is one that has handling characteristics such as: - answer ease of tying Careful counting (according to established policy), situational awareness, and conscientious and meticulous attention to the field are believed to prevent miscounts and lost items. A recent patient safety statement about preventing retained foreign objects recommends which of these practices? - answer Verbal handoff must include count status at time of relief. An older surgeon explains his justification for this suture choice to the new perioperative nurse in the scrub role. He prefers to suture his intestinal anastomosis with a suture that has multiple filaments braided together because it ties well and holds the knot, which tightens when the thread absorbs the tissue fluids. He also needs a strand that is easy to see and only needs to retain its tensile strength for about 1 year, at which time the intestinal junction will be healed, even though this - answer Sofsilk An example of an indication for liver transplantation would be - answer primary hepatic cancer he largest part of the mammary gland rests on the - answer Pectoralis major muscle and serratus anterior During ventriculoperitoneal shunt placement, - answer 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: - answer CVI is not life-threatening or limb-threatening 35% of the refractive power of the eye is credited to which part of the eye - answer Lens Oculocardiac reflex (OCR) is an intraoperative emergency that can occur during eye surgery. Select the definition of the response and contributing factor(s) - answer 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? - answer Tracheostomy The perioperative nurse preparing for a procedure where STSGs will be taken to cover several large burn areas will need to have available: - answer sterile mineral oil, tongue blades, and a mesher dermatome the correct term to describe the inward turning of one or both eyes - answer Esotropia The nerve supply for the female pelvis comes from the autonomic nerves that enter the pelvis through the - answer Superior hypogastric plexus which surgical approach reduces the morbidity and mortality in removal of an acoustic tumor - answer 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: - answer review chart for bleeding and coagulation times and the platelet count. The external ear canal lining - answer 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 - answer 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 - answer Central venous line What is the term for the bloodless plane that contains loose areolar tissue and permits mobility of the scalp - answer Subgaleal space Pericardial tamponade includes which of the following signs or symptoms - answer Narrow pulse pressure Which statement regarding level III and level IV trauma centers best describes the difference between the two types of centers - answer 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 - answer 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? - answer 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 - answer 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 . - answer 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. - answer 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 - answer 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 - answer concentrate and conduct incoming sound waves into the external auditory canal. Describe the internal inguinal ring - answer Structures that traverse the inguinal canal enter it from the abdomen by the internal ring, a natural opening in the transversalis fascia There are several risk factors associated with dehiscence. Which of the following can be controlled by the RNFA - answer Sutures placed too close together Access to the substernal compartment is typically facilitated by: - answer using long instruments through a regular thyroid incision. Pressure against the skin above mm hg interferes with tissue perfusion - answer 32 Latex allergy reaction is best prevented by - answer 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)? - answer Positive diagnosis of the SSI by the surgeon or attending physician Suture can be used for more than repairing tissue. - answer ligate, suture, and close tissue. Which of the following absorbable suture has the best tensile strength - answer Polydioxanone The light transmission through an endoscope is achieved by way of - answer 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. - answer Standard On extubation, Daniel presented with coughing, wheezing, dyspnea, use of accessory muscles, and tachypnea. Daniel is presenting with probably caused by . - answer bronchospasm; aspiration The tensile strength of lactic & glycolic acid polymers is sufficient for approximation of tissues for weeks. - answer 2-3 New synthetic polymers such as PDS provide wound support up to months - answer 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 - answer Avoid placing specimens for frozen section in formalin. Terminal cleaning and disinfection of the operating room should be done - answer daily when the areas are being used A needletype frequently used in microsurgery is - answer cutting taper