RN A v2: Prophecy- Core Mandatory (Nursing) Exam 2022

RN A v2: Prophecy- Core Mandatory (Nursing) Exam 2022 What type of support would you place to alleviate pressure on the brachial plexus nerve when a patient is in a side-lying position ans: Axillary Roll You are the circulating nurse confirming consent with a patient scheduled for an exploratory laparotomy with colostomy. The patient states they do not want a colostomy. What should you do? ans: Do not take the patient to the operating room and consult the surgeon immediately What equipment is most important for a patient undergoing an emergency trauma surgery who declines a donated blood transfusion ans: Cell Saver You have been asked to take a specimen from an OR during a bronchoscopy and immediately take it to the lab. What must you do first ans: Confirm the specimen label and patient name You suspect long-term substance abuse during the pre-op interview with your patient. Which of the following assessment findings would support this suspicion ans: nasal irritation and frequent sniffing, needle tracks on arms, and burns on fingers and lips After applying an alcohol-based skin preparations for a laser procedure, what should you do next ans: assess for pooling or moisture from the prep What medication should be administered to a patient who has received moderate sedation with midazolam who has unexpected respiratory depression ans: romazicon (flumazenil) After starting a blood transfusion, you observe that a patient undergoing moderate sedation has a temperature increase from 98.2 to 101.3 and coarse breath sounds. What is the first thing you should do ans: Stop the transfusion and notify the surgeon What is the minimum distance unscrubbed personnel should remain from the sterile field ans: 12 inches You are preparing a patient for a laparotomy. What instrument do you anticipate seeing on the back table ans: malleable Which of the following medications is contraindicated for a patient with a family history of malignant hyperthermia ans: Quelicin (succinylcholine) You are caring for a patient who is infected with Methicillin- Resistant Staphylococcus Aureus (MRSA). What infection control practice must you implement after transferring the patient ans: Clean and disinfect all patient care equipment Upon opening a sterile major tray, you discover the chemical indicators are missing. What should you do? ans: Remove and replace the major tray As a circulator, where do you stand during induction ans: at the head of the bed You are the perioperative nurse who is doing the preoperative skin preparation on a clean abdominal case. Where should you start the skin preparation ans: site of incision and move to the periphery A patient was prepared for intubation by mask ventilation with a mixture of sevoflurane, nitrous oxide, and oxygen. One minute after intubation their heart rate increased from 160 to 195 b/m. Soon the patient's end tital carbon dioxide concentration was increased from 35 to 65 mmHg. Also, the patient's oral temperature increased to 38.9 within 5 minutes after induction. What is the patient experiencing ans: Malignant Hyperthermia After draping the left side of the patient, how should you drape the right side ans: From the left side open the drape over the patient Shake the drape open as your assistant places the drape Reach over the patient to place the drape Walk around the operating room table What is the safest location for sharps during a surgical procedure ans: in knife holder/needle board on back table You review the patient's chart and discover that the patient has an allergy to penicillin. What medication order should you be worried about ans: Ancef Upon arrival to PACU you notice your patient is having a laryngospasm. What is the first action ans: Apply positive pressure ventilation When should a surgical "Time Out" be performed ans: When all team members are in the room, the patient is prepped and draped and prior to initial incision Your OR patient has a suspected diagnosis of pulmonary tuberculosis. What type of transmission based precaution is needed ans: Airborne The scrub tech is preparing to count for a laparoscopic cholecystectomy and notices that the lap sponges on the back table have no visible x-ray detectable strip. What should the circulator do ans: Remove the lap sponges from the OR and open a new package of sponges In the preoperative holding area, the patient's preoperative lab values are K+2.9, Hgb 14.3, Hct 42.0 and glucose 89. What should you do? ans: Notify Anesthesia provider A patient is scheduled to have a total knee arthroplasty. What lab value should you be most concerned about and need to inform the surgeon? ans: WBC 12.5 K/UL What type of medication might be used during ophthalmic surgery for severe allergic condition ans: Corticosteroids When prepping a patient for general surgery with laparoscopy, in what order should you drape them? ans: Lap sheet, sterile towels, impervious drape impervious drape, sterile towel, lap sheet sterile towel, impervious drape, lap sheet ***impervious drape, lap sheet, sterile towel***wrong What is the most important action for the circulator to do to prevent post-orthopedic surgery infection ans: place a no traffic sign of the door In what order should you apply a sterile drape ans: from sterile area to unsterile, draping nearest first You are taking a patient to PACU who just had a fractured mandible repaired. What supply do you need to transport with your patient ans: wire cutter When should you and surgical team members perform a surgical count for an open thoracotomy? ans: Prior to skin incision, at the beginning of closure of body cavity or first tissue layer, and during skin closure You are the scrub nurse on a case in which a vendor is present. The vendor has a packaged product that they would like to hand to the surgeon. What should you do? ans: Ask the vendor to hand the product to the circulating nurse You are the circulating nurse and have received 2 units of packed red blood cells that are to be transfused immediately. Present in the room are the surgeon, surgical tech, CRNA and radiology technician. Who should you ask to assist with checking the blood before the transfusion ans: CRNA The anesthesiologist informs you that the next patient is a difficult intubation. Which equipment will you expect to have in the room? ans: Glidescope You are near the entrance to the operating room department when a vendor approaches you and asks where to go. What should you do first? ans: walk them to the area designated by facility policy What is an important step for the prevention of biofilm developing on a flexible endoscope ans: allowing the scope to dry completely after use****wrong** You are the circulating nurse. What class of surgical wound would you document for a patient with preoperative fever who underwent tonsillectomy in the presence of a large amount of purulent drainage for which the surgeon has ordered intravenous antibiotics ans: Class I Class II *****Class III**** WRONG The scub nurse has asked you for a heavy sterile instrument that is wrapped. After opening the package, how should you give them the instrument ans: let the scub nurse grasp it out of the package You are scubbed in during the middle of a procedure when you see a blood soaked sponge on the floor 2 feet from the sterile field. What should you do ans: tell the other team members about it and ask the circulating nurse to remove it without touching the sterile field Which of the following assignments can a circulator delegate to a non licensed surgical associate ans: retrieving sterile trays Immediately after surgery, your patient is exhibiting symptoms of dizzyness, cyanosis, shivering, and disoriented. These findings most likely indicate what condition ans: hypothermia which type of endoscope should you have present for use during a low anterior colon resection ans: proctoscope Who is responsible for documenting the operative time out ans: OR nurse The room has already been set up with latex gloves when your patient reports a mild rash on contact with latex. What should you do first ans: Notify the surgical team and discard sterile field set up What is proper surgical attire for non sterile scrubbed personnel ans: a long sleeved scrub jacket closed in front What is the primary purpose of slowly lowering a patient's legs from the lithotomy position ans: **promotes proper body alignment** prevents hip pain reduces the risk of hypotension decreases strain on abdominal muscles The surgeon is preparing to clamp bleeding vessels. What type of instrument should you prepare for the surgeon ans: hemostats You are preparing the OR for a total knee replacement. What supply do you anticipate needing ans: stockinette What type of gloves should be worn when transporting endoscopes to and from storage cabinets ans: clean A patient is extubated after surgery and is receiving 6l O2 via mask. Upon arrival to the PACU the nurse notices a decrease in SaO2 to 89% from 99% and snoring. What is the first action to take ans: check for airway obstruction Before a case, what reference should you use to understand how the surgical team wants their instruments and equipment to be positioned ans: preference card Immediately upon bringing a medication to the sterile field, the circulator and scrub technologist should ensure that it is labeled, at the minimum, with medication name and what two other pieces of information ans: volume and concentration expiration date and volume expiration date and concentration ***dosage and concentration*** wrong As you prepare the room for an open exploratory laparotomy, what pieces of basic equipment should you prepare to setup ans: ESU, suction set up, major abdominal instrument set A patient is allergic to shellfish and is scheduled for an exploratory laparotomy. What is the solution of choice for prepping the abdomen considering the patient's allergy ans: Chlorahexadine gluconate If a patient reports a family history of malignant hyperthermia, you should be prepared to administer which medication should such an emergency arise ans: dantrolene The surgeon has asked you to hand them a piece of equipment. How should you use closed loop communication to respond ans: state the name of the equipment in your response The first patient in the OR was closed at 0650 and left the OR for PACU at 0700. The surgeon left the room at 0655. The next patient arrives in the OR at 0718. What is the turnover time in this situation ans: 18 minutes What is the surgical start time based on the following events: intubation occurred at 0618, the surgeon entered the room at 0622, the first incision was made at 0631, and the implant was placed at 0714 ans: 0631 in the preoperative holding area the patient's vital signs reveal a heart rate of 45 bpm and blood pressure of 171/95 mmHg. What is your priority action ans: contact the anesthesia provider You assist with transporting a patient to the PACU with the anesthesia provider. The patient is sedated and the PACU nurse is at the bedside. What should you do next ans: help put the patient on the monitor You are assisting with dental cases. During the procedure the team observes the patient having uncontrollable shaking. What is the team's priority action ans: maintaining the airway What temperature is considered the threshold for hypothermia in the postoperative setting ans: less than 38 degree C (100.4 F) less than 37 degree C (98.6 F) less than 36 degree C (96.8 F) ***less than 35 degree C (95.0 F)*** wrong What nerve is most likely to be affected when the patient has a loss of sensation in the lateral portion of a hand and an inability to abduct or oppose the fifth finger (claw hand) ans: Ulnar You are in the operating room with a patient and the anesthesia provider after surgery. As you prepare to transport the patient to PACU you notice that the surgical dressing is saturated with blood. What should be the most appropriate nursing action ans: reinforce the dressing and notify the surgeon A patient with allergy to penicillin receives a test dose of cefazolin and starts to develop hives. What medication would you consider giving ans: prednisone You are the circulating nurse working on a case with a surgical technologist who is confrontational and has an aggressive communication. During the case, the surgical tech repeatedly tells you how to perform nursing tasks. What is the best response ans: speak with them privately after the case