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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 what was best for herself. The patient was taking full advantage of what provision for her care? - 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 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: - 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. The OR is a danger-prone area for both patients and staff. Providing a safe environment of care for the patient involves identifying, mitigating, and managing the hazards inherent in surgical care. Choose the answer below that completes the blanks in this sentence: The risk of the surgical hazard of _________________ can be mitigated through _______________________. - ANSWER wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists A patient was transferred to the postanesthesia care unit (PACU) by the anesthesia provider and perioperative nurse. A hand-off report was given, using situation, background, assessment, recommendation (SBAR) format, to the accepting PACU nurse. The first element of information that should be presented in the hand-off report is: - ANSWER patient identification and procedure performed. If a staff person receives a needlestick injury, what is the first corrective action? - ANSWER Wash wound with soap and water; flush mucous membranes. Contact with infected patients or infectious material places healthcare workers at risk for occupational-acquired infection. Which communicable disease are healthcare workers at risk for acquiring or transmitting? - ANSWER Seasonal influenza Select the appropriate nursing action that supports hands-free instrument passing and sharps safety. - ANSWER Create a neutral hands-free area between the scrub person and surgeon with a basin or magnetic mat. Select the guideline that complements the design of the culture of safety model. - ANSWER Incorporate safe practices into your daily work when handling sharps. A neutral zone is a predetermined location on the surgical field where sharps are placed for retrieval by the surgeon. Which of the following is a best practice for the use of the neutral zone? - ANSWER Announce the transfer of each sharp before placing it in the neutral zone. 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