NIFA Study Guide Questions and Answers 2024, Exams of Nursing

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NIFA Study Guide Questions and Answers 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 Which of the following may be a consequence of high-dose or full-body radiation? - answer Nausea, vomiting, and diarrhea Exposure to blood-borne pathogens occurs during all phases of the perioperative process. Observing safety precautions during all phases of surgery, from setup to cleanup, reduces the number of injuries and exposures for all OR personnel. For the prevention of sharps injuries in the pre-procedure and post-procedure phases, which safe handling practices reflect appropriate nursing actions? - answer Use standardized sterile field setups throughout the surgical service department. Transport reusable sharps in a safe, closed container to the decontamination cleanup area. Do not place hands or fingers into a container to dispose of a device. Inspect the sharps container for overfilling before discarding disposable sharps in it. Which list of medications best reflects medications indicated for latex sensitivity therapeutic management? - answer Epinephrine, prednisone, and a beta-agonist inhaler While antibiotics have been credited with saving lives, misuse of antibiotics has contributed to the evolution of multidrug-resistant organisms (MDROs). Select the antibiotic application that has evident to support it as a best practice and not, potentially, a misuse of antibiotics. - answer Antibiotics given intravenously within 1 hour of the incision for every procedure with an incision or entered body system. With the production of more steam in the sterilizer chamber, the pressure increases as well. The steam should contain little or no entrapped liquid water. Steam quality is the term that describes the amount of water mixed with the steam. The constitution of high-quality steam would be measured by: - answer <3% of the mixture is liquid water. 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 - 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 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 Flat neurosurgical patties are flat sponges composed of soft compressed cotton or rayon with an embedded radiopaque element and string attached. They are often used in neurosurgical procedures. While used for hemostasis and exposure, what other use would be important in surgery? - answer Application of topical steroids the circulating nurse received the trauma call from the emergency department (ED) and called sterile supply to assemble the instruments for an abdominal trauma case with possible aortic rupture. When the cart arrived, she saw the vascular set; however , the most important set was missing. What important instrument set was needed for this procedure besides the vascular set? - answer Basic laparotomy set The primary use for suture is essentially to: - answer ligate, suture, and close tissue. Wound tissue healing is enhanced by the use of stapling instruments that mechanically apply internal staples for ligation and division, resection, and anastomoses. What feature of the mechanical process reduces tissue manipulation, edema, and inflammation? - answer The non- crushing B shape of the staples allows nutrients to pass through. According to a 2010 article published in The Journal of the American College of Surgeons and citing data from a 1998 study, where do more that half of needle-stick injuries involving suture needles occur? - answer During the suturing of fascia or muscle tissue The nerve supply for the female pelvis comes from the autonomic nerves that enter the pelvis through the - answer Superior hypogastric plexus Which of the following is an important statement regarding the prevention of degenerative orthopedic conditions - answer Weight-bearing activities and joint movement prevent cartilage from becoming thin or damaged The cerebellar tentorium supports which structures of the cerebral hemispheres - answer Temporal lobe the surgeon makes an incision through which of the following to access the cremaster muscle, inguinal canal, and cord structures - answer External oblique muscle a physical barrier used in the prevention of adhesions that can take up to 2 weeks to absorb - answer Interseed Tissue reaction characteristics that need considered when choosing suture include - answer Absorption The diagnostic test that is performed to differentiate between acute and chronic thrombosis - answer Digital subtraction angiography Morbidity and mortality may be greater with penetrating trauma because identification of injuries may be more difficult when injuries are less obvious. In the case of an adult victim with a low-velocity, low-caliber gunshot wound, at far range, of the anterior left quadrant of the lower abdomen, what is the MOI and description of the possible injuries - answer enetrating; small entrance wound, puncture of the anterior wall of the sigmoid colon, no disruption of vessels, and bullet not found in pelvis With injury to the brain, swelling may occur quickly, requiring aggressive decisions to manage increasing intracranial pressure (ICP). What is an 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) - answer 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 - answer Unknown substances may be present in these products. a possible benefit to the paramedian incision - answer decreased risk for hernia 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 The perioperative nurse should plan to remain close to the elderly patient during induction because - answer Airway anatomy changes in the elderly The child inhales the favorite flavor while drifting off to sleep. This complementary therapy falls within the category of: - answer clinical aromatherapy Which of the following sulci is of particular anatomic importance during surgery? - answer Two sulci of particular anatomic importance during surgery are: (1) the lateral sulcus, or sylvian fissure, which divides the temporal lobe from the frontal and parietal lobes, and (2) the central sulcus, or fissure of Rolando, which separates the frontal from the parietal lobe Which of the following associations is incorrect pertaining to the blood supply of the brain - answer Vertebral arteries --- supplies the occipital lobe TURP syndrome is often seen during the intraoperative period. Signs and symptoms exhibited by patients include - answer restlessness, apprehension, irritability, confusion, nausea, slow pulse rate, seizures, dysrhythmias, and rising blood pressure may be suggestive of TURP syndrome, he blood is oxygenated in the lungs and returns to the left atrium through the pulmonary veins. Where does the blood flow after leaving the left atrium - answer Through the mitral valve into the left ventricle Which of the following is not contained within the anterior mediastinum - answer Great Vessels Definitive information about the extent and location of ischemic heart disease can be obtained from which of the following tests - answer Cardiac catherization An interventional radiology procedure used to open a blocked or narrowed blood vessel as a result of atherosclerosis - answer Percutaneous transluminal angioplasty The mitral valve is anchored to the - answer left ventricular wall the semi-invasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function - answer Radionuclide imaging Primary divisions of a nerve are known as - answer Rami the correct branch of the Left main coronary artery - answer Circumflex coronary artery When a thyroglossal duct cyst is present in an adult, it exists as a pretracheal cystic pouch attached to what structure - answer Hyoid statement regarding risk factors for developing vascular disease is true - answer Arteriosclerosis is a natural part of the aging process. Which of the following is an indication for damage control surgery - answer Indications for the potential need for damage control surgery include hemodynamic instability, hemorrhagic shock, coagulopathy, hypotension, tachycardia, tachypnea, inaccessible major anatomic injury, concomitant major injury, and altered mental status The most common congenital cyst found in the neck is - answer Thyroglossal duct cysts The potential for development of a direct inguinal hernia is - answer When a weakening or a tear in the aponeurosis of the transversus abdominis and the transversalis fascia occurs, A vena cava filter (Greenfield filter) maintains a patent vena cava but prevents pulmonary emboli (PE) by trapping the emboli at the apex of the device. This procedure may be performed in the OR, radiology suite, or ICU for critical patients - answer Right jugular and right femoral