. 1.. . Gregorio, a 54 year old client diagnosed with benign prostatic hyperplasia is being scheduled for TURP at 7am the following day.

. . 1.. . Gregorio, a 54 year old client diagnosed with benign prostatic hyperplasia is being scheduled for TURP at 7am the following day. The circulating nurse anticipates that in order to perform TURP Gregorio must be placed in what position? /• . DorsaI Recumbent • • . Lithotomy /• :. Jack knife / [. Trendelenburg :::: . .E::T .. :, E .: B. Lithotomy :. .TI: . LE: Transurethral resection of the prostate surgery or TURP is done in the Iithotomy position in order for the surgeon to have an ease in the performance of surgery since a scope and a resectoscope is inserted into the clients urethra. 2. . TURP is a surgery that can- be performed in around 1-2 hours. The role of an operating room nurse is to anticipate which possible method of anaesthesia will be used by the anaesthesiologist. TURP can be performed using what method of anesthesia? /ú . Local lnfiltration /ú . General lnhalation ú ú :. Subarachnoid block / [. General lntravenous :::: . .E::T ... :, .. E .: C. Subarachnoid block :. .TI: . LE: Subarachnoid block , The area of surgery is in the pelvic area hence subarachnoid block or spinal anesthesia can be utilized for procedures below the thoracic nerve or at the Ievel of the diaphragm and will Iast for Iess than 3-4 hours. *** Any other useful examples for our users? *** 3. The anesthesiologist of Gregorio incorporated epinephrine with the anesthetic agent. Epinephrine Hcl can be incorporated to bring about which of the following effects? a. Increase the client’s heart rate b. Bring about bronchodilation c. Prolong the effect of the drug d. Promote vasodilation Rationale: Epinephrine is an adrenergic agonist that can stimulate alpha receptors to bring about localized vasoconstriction in spinal anesthesia. Causing vasoconstriction can delay drug absorption thus can prolong the drug effect of the anesthetic agent and les amount if anesthesia will be used. 4. The nurse will anticipate which incision for TURP? A. Supra pubic incision B. Pfannensteil incision C. Inguinal incision D. no incision CORRECT ANSWER: D. no incision RATIONALE: TURP or transurethral resection of the prostate is a surgery that does not require a surgical incision since a scope and a resectoscope is inserted in the client's urethra only. 5. After the TURP , the Scrub Nurse anticipates that she needs to prepare which of the following supplies to help prevent bleeding in the post- op period and to allow the drainage of excess blood clots and retained prostatic fragments? A. 3-way foley catheter B. nelaton catheter and saline wash C. heparinized syringe D. Levine tube French 16 CORRECT ANSWER: A. 3-way foley catheter RATIONALE: The 3-way foley catheter will be used post op for cystoclysis (Continous bladder irrigation) to prevent bleeding by increasing the flow of the fluid into the bladder and to flush blood clots and prostatic fragments from the operative site which can stimulate bladder spasm that leads to bleeding. Option B, nelaton catheter, is not used since this is only used as a single straight catheter to drain urine. If used frequently it can cause irritation and further increase the risk for bleeding. Option C heparin will further cause bleeding due to its anti-coagulant property. Option D. Levine tube is not related since this is the tube used for gastric decompression. 6. Antonio, a 69 year old client was admitted with a chief complaint of gross hematuria and severe lumbar pain. He was diagnosed to have stones in the renal pelvis . What do you call the surgical removal of stones in the renal pelvis using an open approach? A. Cystolithotomy B. Pyelolithotomy C. Nephrectomy D. Pelvic laparotomy CORRECT ANSWER: B. Pyelolithotomy RATIONALE: Pyel- stands for the renal pelvis and lithotomy is the suffix used for the surgical removal of a stone, Cysto stands for the urinary bladder and nephrectomy is for the removal of a kidney. Pelvic laparotomy is a surgery done to explore the pelvic organs such as the Uterus, ovaries and fallopian tubes 7. Another approach for removing stones is with the use of a non invasive procedure called ESWL, ESWL stands for? A. Extra corporeal Shockwave lithotomy B. Extra renal Sonicwave lithotripsy C. Extracorporeal Shock wave lithotripsy D. Extrarenal Sonic wave lithotomy CORRECT ANSWER: C. Extracorporeal Shock wave lithotripsy RATIONALE: This surgery is a non invasive procedure which crushes stones with the use of shock waves , and the stones, after being crushed, are then voided by the client. The client after the procedure is encourage to increase his fluid intake to flush out the stone sediments. 8. Antonio opted to have the open approached surgery for the removal of his kidney stones. In performing the open surgery, the client will be placed in a lumbotomy position. Which of the following positioning equipment is not needed in performing the procedure? D. "donut" CORRECT ANSWER: B. shoulder roll RATIONALE: SHOULDER ROLL is not needed. This is usually used for neck surgeries to hyperextend the neck part. In doing lumbotomy position the client will be placed on a side lying position therefore an axillary roll will be needed to prevent undue pressure on the dependent axilla, pillow rolls can be used in front and at the back to immobilize the patient and the donut will be placed on the clients head. 9. In performing the Open surgery for the removal of urinary stones , the surgeon may need a knife to cut through tubular structures such as the renal pelvis or ureters. Which of the following blades is the most appropriate to aid the surgeon in performing the said surgery? A. Blade 10 B. Blade 11 C. Blade 12 D. Blade 15 CORRECT ANSWER: C. Blade 12 RATIONALE: Blade 12 is also called hooked knife and is usually used to cut through tubular structures and for oropharyngeal surgeries. Blade 10 and 20 are the usual blades used to cut the skin; Blade 15 is the smallest belly and is used for making small and curvilinear incisions; Blade 11 is used for stabbing and puncturing tissues. 10. Antonio was placed on Epidural anesthesia and was given Morphine sulfate along with Sensorcaine (Marcaine) . The anaesthesiologist noted a marked decrease on the clients SaO2 and the RR was down to 8 breaths per minute. She is suspecting opioid toxicity. The circulating nurse anticipates that she needs to prepare an appropriate Antidote to counteract the effects of the morphine. Which of the following drugs should the circulating nurse prepare? D. Vecuronium bromide (norcuron) CORRECT ANSWER: B. Naloxone (narcan) RATIONALE: Naloxone (Narcan) is a narcotic antagonist which can help counter act the effects of an opioid narcotic. A. Nalbuphine (nubain) is incorrect since it is a narcotic agonist-antagonist thus can further aggravate the toxicity, option C Neostigmine (prostigmine) is an Acetylcholinesterase inhibitor which can be used for excess muscle relaxation brought about by neuro muscualr junction blocking agents or myasthenia gravis and option D vecuronium bromide is an example of a neuro-muscular junction blocking agent used as an adjunct drug for general anesthesia. 11. Erlinda a 40 year old female client was admitted due to right upper quadrant pain accompanied by jaundice , She was diagnosed to have cholelithiasis . Cholelithiasis can be managed using Open Cholecystectomy or Laparoscopic Cholecystectomy. This procedure involves the insufflation of a gas in the peritoneal cavity which utilizes A. Carbon Dioxide B. Nitrous oxide C. Oxygen D. Helium CORRECT ANSWER: A. Carbon Dioxide RATIONALE: Carbon dioxide is the common gas utilized to insufflate the peritoneal cavity since it can be absorbed in the surrounding tissues and expelled through the respiratory tract. Oxygen is not used because it supports combustion and can cause burns or fire when cautery is used. Nitrous Oxide is usually used as an anesthetic agent. While helium is commonly used to inflate party balloons 12. Because of the need for insufflation, clients who will undergo laparoscopic cholecystectomy need to undergo the procedure under General Inhalation anesthesia. During the administration of anesthesia when stage II or stage of excitement is reached, the circulating nurse can note the following responses from the client: A. may feel drowsy or dizzy but hearing seems to be exaggerated B. loses consciousness but is still sensitive to external stimuli C. pupils are smaller but the eyelid reflex along with other reflexes are lost D. pupils are fixed and dilated and there is no respiration noted CORRECT ANSWER: B. loses consciousness but is still sensitive to external stimuli RATIONALE: Loses consciousness but is still sensitive to external stimuli, is a characteristic sign of the second stage of anaesthesia. Other signs may include irregular respiration but with increased muscle tone and involuntary responses. It is therefore very important that at this stage the OR suite must be quiet to prevent undue stimulation. Choice A speaks of stage I or induction , Choice C is noted in stage III which is the surgical anaesthesia and Choice D describes the danger stage or stage IV where medullary paralysis occurs. 13. A client is scheduled for an Open Cholecystectomy and the surgeon will utilize a Kocher incision. The circulating nurse therefore must do skin preparation. This will cover what skin areas? A. From neck to symphisis pubis B. From nipple line to anterior 1/3 of the thigh C. From umbilicus to the whole thigh D. From breast to umbilicus CORRECT ANSWER: B. From nipple line to anterior 1/3 of the thigh RATIONALE: From nipple line to anterior 1/3 of the thigh. Kochers incision is also called Right subcostal incision therefore this incision must be prepared covering the mentioned areas 14. After doing the initial incision, the surgeon cuts through the subcutaneous layers and asks for a retractor. Which of the following instruments should the scrub nurse hand to the surgeon? C. Army-navy retractor D. Gelpi retractor CORRECT ANSWER: C. Army-navy retractor RATIONALE: The Army Navy retractor, also known as parabeau or skin retractor, is usually used to retract the first two layers of the abdomen and other areas in surgery; a balfour is used as a self retaining retractor to retra