,DOWNLOAD THE Test Bank for Alexander's Care of the Patient in Surgery 16th Ed
a a a a a a a a a a a a a
ition Rothrock a
Chapter 02: Patient Safety and Risk Management
a a a a a a
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition
a a a a a a a a a
MULTIPLEaCHOICE
1. Governmentalaandaprofessionalaagenciesaandaorganizations,awhetheravoluntaryaorainvoluntary,ah
aveaaasignificantainfluenceaonapatientasafetyapoliciesainatheahealthcareasetting.aSelectatheaagencya
oraorganizationastatementathatapresentsaaatrueareflectionaofaitsafocusaorapurpose.
a. TheaJointaCommissiona(TJC):aNonvoluntaryabureauathatatestsahealthcareai
nstitutionsaagainstaevidence-basedaelementsaofaperformance
b. SurgicalaCareaImprovementaProjecta(SCIP):aTrendsasurgicalasiteainfectionastatistics
c. AmericanaSocietyaofaAnesthesiologistsa(ASA):aProfessionalaorganizationaofa
anesthesiaaprovidersaandatechnologists
d. WorldaHealthaOrganizationa(WHO):aUnitedaNationsa(UN)–
basedaandasupportedaauthorityaonahealthathroughoutamostaofatheaworld
ANS:a D
TheaUNacreatedaWHOatoafunctionaasaitsahealthaoversightaandacoordinationaauthorityaforaallaUNam
emberanationsawhoainaturnahaveajoinedaWHO.aIna2004,aWHOalaunchedatheaWorldaAllianceaonaPa
tientaSafety,abyawhichaitabeganatoaexamineapatientasafetyainaacuteaasawellaasainaprimaryacareasettin
gsarelevantatoaallaWHOamemberanations.aWHOawasacreatedabyaandafunctionsawithinatheaUNaasath
eadirectingaandacoordinatingaauthorityaforahealthathroughoutaUNamemberanations.
2. Sinceaitsaorganizationaandaestablishmentaasaaaprofessionalanursingaassociationainatheaearlya1950s
,atheaAssociationaofaperiOperativeaRegisteredaNursesa(AORN)acontinuesaitsaendeavorato:
a. promoteaguidelinesainfluencingapatientasafety.
b. createaprofessionalaoperatingarooma(OR)anursingacareadeliveryamodels.
c. interpretahealthcareastatisticsacriticalatoaperioperativeanursingacare.
d. ensureariskareductionastrategiesaareatheafoundationaofaperioperativeaeducation.
ANS:a A
AORNaprovidesaanaarrayaofastandards,arecommendedapracticesa(RPs),aguidelines,ap
ublications,avideos,aandatoolakitsathataspecificallyaaddressapatientasafetyafromatheape
rioperativeateam’sapointaofaview.
3. Aahealthya32-year-oldanursingastudentaisascheduledaforaexcisionaofaaaleft-
sidedasubglottalacystawithafrozenasectionaandapossiblearadicalaneckadissection.aTheapreoperativea
verificationaprocessaprovidesatheaopportunityatoacollectaandaverifyainformationaaboutatheapatienta
toaensureapatientasafety.aAmongatheapatientadataathatamustabeaverifiedaare:
a. emergencyacontactaname.
b. laboratoryaandaimagingaresults.
c. advanceadirectiveaonafile.
d. immunizationarecords.
ANS:a B
Preprocedureaverificationaprocessaensuresathataallarelevantadocumentsa(e.g.,atheahistoryaandaphy
sicalaexamination,asurgicalaconsent,arequiredalaboratoryastudies)aandaimagingastudiesa(properlyal
abeledaandadisplayed)aareaavailableabeforeatheastartaofatheaprocedure.aPreprocedureaverificationais
abestaconductedawhenatheapatientacanabeainvolvedaandashouldabeacompletedabeforeatheapatientalea
vesatheapreprocedureaarea.
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ition Rothrock a
4. Aapatientawasapositioned,aprepped,aandadrapedafollowingageneralaendotrachealaanesthesiaai
nduction.aTheateamaassembledatoaperformatheatime-
outaasadescribedainatheaWHOasurgicalachecklist.aSuccessfulaemploymentaofatheatime-
outacanaonlyabeaensuredawhen:
a. theatime-outaisainitiatedabyatheasurgeon.
b. eachamemberaofatheateamahasaanaequalaroleaandavoice.
c. perioperativeaservicesahaveaaaphysicianachampionaandasurgeonabuy-in.
d. theachecklistaisacommittedatoamemoryabyaallateamamembers.
ANS:a B
Allamembersaofatheateamamustaintroduceathemselvesabyanameaandaroleaandaparticipateainasharin
gacriticalaelementsaofacare.aTheateamaincludesatheasurgeon,aanesthesiaaprovider,aandanursingastaf
f,aplusaanyaalliedaoraancillaryacareaprovidersacontributingatoatheaprocedureawhenatheatime-
outaisaperformed.
5. Whenaunexpectedaeventsaoccurathatahave,aoracouldahave,acompromisedapatientasafety,aaasyste
maticainvestigatoryaprocessatakesaplace.aSignificantainformationaisagainedathroughathisametic
ulousaexploration.aTheaprimaryamotiveaforacarryingaoutaaarootacauseaanalysisaisato:
a. establishacauseaandatrendsabasedaonawhoawasainvolved.
b. determineapreciselyawhatahappenedaandawhy.
c. findaoutawhataneedsatoatakeaplaceatoapreventaaarecurrenceaofatheaevent.
d. uncoverafactorsathatacontributedatoatheaenvironmentaandatheaevent.
ANS:a C
Rootacauseaanalysisaisaaasystematizedaprocessatoaidentifyavariationsainaperformanceathatacause,aor
acouldacause,aaasentinelaevent.aTheaanalysisaphaseaofarootacauseaanalysisaprogressesafrom
“why”aquestionsatoa“whatacanabeadoneatoapreventathis”aquestionsathataflowaandaultimatelyaresulta
inaanaactionaplan.aRootacauseaanalysisaconcentratesaonasystemsaandaprocesses,anotaindividuals.
6. TheaJointaCommissiona(TJC)adesignatesasentinelaeventsaasaunexpectedaoccurrencesainvolvingad
eathaorariskaofaseriousaphysicalaorapsychologicainjury.aIna2003,aTJCamandatedatheaUniversalaPro
tocolatoaaddressaperioperativeasentinelaevents.aThisaprotocolaincludes:
a. improvingatheasafetyaofausingamedications.
b. reportingacriticalaresultsaofatestsainaaatimelyamanner.
c. performingaaapreprocedureaverificationaprocess.
d. establishingaalarmasystemasafetyaasaaapriority.
ANS:a C
Preprocedureaverificationaprocessaensuresathataallarelevantadocumentsa(e.g.,atheahistoryaandaphys
icalaexamination,asurgicalaconsent,arequiredalaboratoryastudies)aandaimagingastudiesa(properlyala
beledaandadisplayed)aareaavailableabeforeatheastartaofatheaprocedure.aPreprocedureaverificationaisa
bestaconductedawhenatheapatientaand/oraguardianacanabeainvolvedaandashouldabeacompleteabeforea
theapatientaleavesatheapreprocedureaarea.aTheasurgicalateamamustaagreeathatathisaisatheacorrectapat
ientaandatheaplannedaprocedureaonatheaspecifiedasideaandasite.aTheapreprocedureaverificationaproc
essaalsoaincludesaconfirmingaavailabilityaofanecessaryaequipment,aimplantsaandaprostheses,awhic
haisareconfirmedaduringatheatime-out.
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ition Rothrock a
7. Aapatientawasatransferredatoatheapostanesthesiaacareaunita(PACU)abyatheaanesthesiaaprovideraanda
perioperativeanurse.aAahand-
offareportawasagiven,ausingasituation,abackground,aassessment,arecommendationa(SBAR)aformat
,atoatheaacceptingaPACUanurse.aTheafirstaelementaofainformationathatashouldabeapresentedainatheah
and-offareportais:
a. theaexpectedadischargeacriteria.
b. theanamesaandarolesaofatheanurseaandaanesthesiaaprovider.
c. patientaidentificationaandaprocedureaperformed.
d. painamanagementaorders.
ANS:a C
Allapatientaencountersashouldabeginawithapatientaidentificationaverification.aTheareceivingahealt
hcareaproviderabearsathearesponsibilityaforaobtainingaallaofatheainformationaneededatoasafelyacare
aforatheapatientabeforeatheatransferringastaffaleavesatheaarea.aTimeaforaclarificationaandaquestioni
ngamustabeaprovided.aTheapurposeaofahand-
offacommunicationaandareportsaisatoaprovideaessential,aup-to-
date,aandaspecificainformationaaboutatheapatient.aStandardized
hand-offacommunicationamustaincludeaanaopportunityatoaaskaandarespondatoaquestions.
8. TheaORaisaaadanger-
proneaareaaforabothapatientsaandastaff.aProvidingaaasafeaenvironmentaofacareaforatheapatientainvol
vesaidentifying,amitigating,aandamanagingatheahazardsainherentainasurgicalacare.aChooseatheaans
werabelowathatacompletesatheablanksainathisasentence:atheariskaofatheasurgicalahazardaofa
canabeamitigatedathrough
.
a. wrongapatient,awrongasite,aandawrongasideasurgery;asiteamarkingaandapresurgicalac
hecklists
b. electricalaandathermalaburns;aalcohol-freeaprepasolution
c. surgicalasiteainfection;aflashasterilization
d. surgicalaairwayafire;afireaextinguishersainaeveryaOR
ANS:a A
Evidenceashowsathatawrongasiteasurgeryanotaonlyacanadevastateatheapatientaandafamilyabutaalsoaca
naimpactatheaperioperativeateamaadversely.aAllainstitutionsaaccreditedabyaTJCamustafollowatheaU
niversalaProtocolaforaPreventingaWrongaSite,aWrongaProcedure,aWrongaPersonaSurgery.aTheasu
rgicalateamamustaagreeathatathisaisatheacorrectapatientaandathatatheaplannedaprocedureaisaonatheaspe
cifiedasideaandasite.aMarkingatheasurgicalasiteamustabeadoneasoathatatheaintendedasiteaofaincisionaor
ainsertionaisaclearaandaunambiguous.
9. Laparoscopicaproceduresathataemergentlyaconvertatoaopenaproceduresaplaceatheapatientaatariskaf
oraunintentionalaretainedasurgicalaitemsa(RSIs).aWhatanewaandaevolvingariskareductionastrategy
acouldapreventaRSIsaandafrustrating,atime-
consumingamiscountaadventuresaatatheaendaofatheseaprocedures?
a. Creatingaprecountedalaparotomyasetsawithaonlyatheafewanecessaryainstruments
b. Performingaradiologicasurveillanceaonaallaconversionaproceduresaataclosure
c. Countingaallainstrumentsaincludingaaalaparotomyasetabeforeathealaparoscopy
d. Replacingaorataggingaspongesaandalaparotomyainstrumentsawitharadiofrequencyai
dentificationa(RFID)achips
ANS:a D
mynursytest.store
a a a a a a a a a a a a a
ition Rothrock a
Chapter 02: Patient Safety and Risk Management
a a a a a a
Rothrock: Alexander’s Care of the Patient in Surgery, 16th Edition
a a a a a a a a a
MULTIPLEaCHOICE
1. Governmentalaandaprofessionalaagenciesaandaorganizations,awhetheravoluntaryaorainvoluntary,ah
aveaaasignificantainfluenceaonapatientasafetyapoliciesainatheahealthcareasetting.aSelectatheaagencya
oraorganizationastatementathatapresentsaaatrueareflectionaofaitsafocusaorapurpose.
a. TheaJointaCommissiona(TJC):aNonvoluntaryabureauathatatestsahealthcareai
nstitutionsaagainstaevidence-basedaelementsaofaperformance
b. SurgicalaCareaImprovementaProjecta(SCIP):aTrendsasurgicalasiteainfectionastatistics
c. AmericanaSocietyaofaAnesthesiologistsa(ASA):aProfessionalaorganizationaofa
anesthesiaaprovidersaandatechnologists
d. WorldaHealthaOrganizationa(WHO):aUnitedaNationsa(UN)–
basedaandasupportedaauthorityaonahealthathroughoutamostaofatheaworld
ANS:a D
TheaUNacreatedaWHOatoafunctionaasaitsahealthaoversightaandacoordinationaauthorityaforaallaUNam
emberanationsawhoainaturnahaveajoinedaWHO.aIna2004,aWHOalaunchedatheaWorldaAllianceaonaPa
tientaSafety,abyawhichaitabeganatoaexamineapatientasafetyainaacuteaasawellaasainaprimaryacareasettin
gsarelevantatoaallaWHOamemberanations.aWHOawasacreatedabyaandafunctionsawithinatheaUNaasath
eadirectingaandacoordinatingaauthorityaforahealthathroughoutaUNamemberanations.
2. Sinceaitsaorganizationaandaestablishmentaasaaaprofessionalanursingaassociationainatheaearlya1950s
,atheaAssociationaofaperiOperativeaRegisteredaNursesa(AORN)acontinuesaitsaendeavorato:
a. promoteaguidelinesainfluencingapatientasafety.
b. createaprofessionalaoperatingarooma(OR)anursingacareadeliveryamodels.
c. interpretahealthcareastatisticsacriticalatoaperioperativeanursingacare.
d. ensureariskareductionastrategiesaareatheafoundationaofaperioperativeaeducation.
ANS:a A
AORNaprovidesaanaarrayaofastandards,arecommendedapracticesa(RPs),aguidelines,ap
ublications,avideos,aandatoolakitsathataspecificallyaaddressapatientasafetyafromatheape
rioperativeateam’sapointaofaview.
3. Aahealthya32-year-oldanursingastudentaisascheduledaforaexcisionaofaaaleft-
sidedasubglottalacystawithafrozenasectionaandapossiblearadicalaneckadissection.aTheapreoperativea
verificationaprocessaprovidesatheaopportunityatoacollectaandaverifyainformationaaboutatheapatienta
toaensureapatientasafety.aAmongatheapatientadataathatamustabeaverifiedaare:
a. emergencyacontactaname.
b. laboratoryaandaimagingaresults.
c. advanceadirectiveaonafile.
d. immunizationarecords.
ANS:a B
Preprocedureaverificationaprocessaensuresathataallarelevantadocumentsa(e.g.,atheahistoryaandaphy
sicalaexamination,asurgicalaconsent,arequiredalaboratoryastudies)aandaimagingastudiesa(properlyal
abeledaandadisplayed)aareaavailableabeforeatheastartaofatheaprocedure.aPreprocedureaverificationais
abestaconductedawhenatheapatientacanabeainvolvedaandashouldabeacompletedabeforeatheapatientalea
vesatheapreprocedureaarea.
mynursytest.store
,DOWNLOAD THE Test Bank for Alexander's Care of the Patient in Surgery 16th Ed
a a a a a a a a a a a a a
ition Rothrock a
4. Aapatientawasapositioned,aprepped,aandadrapedafollowingageneralaendotrachealaanesthesiaai
nduction.aTheateamaassembledatoaperformatheatime-
outaasadescribedainatheaWHOasurgicalachecklist.aSuccessfulaemploymentaofatheatime-
outacanaonlyabeaensuredawhen:
a. theatime-outaisainitiatedabyatheasurgeon.
b. eachamemberaofatheateamahasaanaequalaroleaandavoice.
c. perioperativeaservicesahaveaaaphysicianachampionaandasurgeonabuy-in.
d. theachecklistaisacommittedatoamemoryabyaallateamamembers.
ANS:a B
Allamembersaofatheateamamustaintroduceathemselvesabyanameaandaroleaandaparticipateainasharin
gacriticalaelementsaofacare.aTheateamaincludesatheasurgeon,aanesthesiaaprovider,aandanursingastaf
f,aplusaanyaalliedaoraancillaryacareaprovidersacontributingatoatheaprocedureawhenatheatime-
outaisaperformed.
5. Whenaunexpectedaeventsaoccurathatahave,aoracouldahave,acompromisedapatientasafety,aaasyste
maticainvestigatoryaprocessatakesaplace.aSignificantainformationaisagainedathroughathisametic
ulousaexploration.aTheaprimaryamotiveaforacarryingaoutaaarootacauseaanalysisaisato:
a. establishacauseaandatrendsabasedaonawhoawasainvolved.
b. determineapreciselyawhatahappenedaandawhy.
c. findaoutawhataneedsatoatakeaplaceatoapreventaaarecurrenceaofatheaevent.
d. uncoverafactorsathatacontributedatoatheaenvironmentaandatheaevent.
ANS:a C
Rootacauseaanalysisaisaaasystematizedaprocessatoaidentifyavariationsainaperformanceathatacause,aor
acouldacause,aaasentinelaevent.aTheaanalysisaphaseaofarootacauseaanalysisaprogressesafrom
“why”aquestionsatoa“whatacanabeadoneatoapreventathis”aquestionsathataflowaandaultimatelyaresulta
inaanaactionaplan.aRootacauseaanalysisaconcentratesaonasystemsaandaprocesses,anotaindividuals.
6. TheaJointaCommissiona(TJC)adesignatesasentinelaeventsaasaunexpectedaoccurrencesainvolvingad
eathaorariskaofaseriousaphysicalaorapsychologicainjury.aIna2003,aTJCamandatedatheaUniversalaPro
tocolatoaaddressaperioperativeasentinelaevents.aThisaprotocolaincludes:
a. improvingatheasafetyaofausingamedications.
b. reportingacriticalaresultsaofatestsainaaatimelyamanner.
c. performingaaapreprocedureaverificationaprocess.
d. establishingaalarmasystemasafetyaasaaapriority.
ANS:a C
Preprocedureaverificationaprocessaensuresathataallarelevantadocumentsa(e.g.,atheahistoryaandaphys
icalaexamination,asurgicalaconsent,arequiredalaboratoryastudies)aandaimagingastudiesa(properlyala
beledaandadisplayed)aareaavailableabeforeatheastartaofatheaprocedure.aPreprocedureaverificationaisa
bestaconductedawhenatheapatientaand/oraguardianacanabeainvolvedaandashouldabeacompleteabeforea
theapatientaleavesatheapreprocedureaarea.aTheasurgicalateamamustaagreeathatathisaisatheacorrectapat
ientaandatheaplannedaprocedureaonatheaspecifiedasideaandasite.aTheapreprocedureaverificationaproc
essaalsoaincludesaconfirmingaavailabilityaofanecessaryaequipment,aimplantsaandaprostheses,awhic
haisareconfirmedaduringatheatime-out.
mynursytest.store
, DOWNLOAD THE Test Bank for Alexander's Care of the Patient in Surgery 16th Ed
a a a a a a a a a a a a a
ition Rothrock a
7. Aapatientawasatransferredatoatheapostanesthesiaacareaunita(PACU)abyatheaanesthesiaaprovideraanda
perioperativeanurse.aAahand-
offareportawasagiven,ausingasituation,abackground,aassessment,arecommendationa(SBAR)aformat
,atoatheaacceptingaPACUanurse.aTheafirstaelementaofainformationathatashouldabeapresentedainatheah
and-offareportais:
a. theaexpectedadischargeacriteria.
b. theanamesaandarolesaofatheanurseaandaanesthesiaaprovider.
c. patientaidentificationaandaprocedureaperformed.
d. painamanagementaorders.
ANS:a C
Allapatientaencountersashouldabeginawithapatientaidentificationaverification.aTheareceivingahealt
hcareaproviderabearsathearesponsibilityaforaobtainingaallaofatheainformationaneededatoasafelyacare
aforatheapatientabeforeatheatransferringastaffaleavesatheaarea.aTimeaforaclarificationaandaquestioni
ngamustabeaprovided.aTheapurposeaofahand-
offacommunicationaandareportsaisatoaprovideaessential,aup-to-
date,aandaspecificainformationaaboutatheapatient.aStandardized
hand-offacommunicationamustaincludeaanaopportunityatoaaskaandarespondatoaquestions.
8. TheaORaisaaadanger-
proneaareaaforabothapatientsaandastaff.aProvidingaaasafeaenvironmentaofacareaforatheapatientainvol
vesaidentifying,amitigating,aandamanagingatheahazardsainherentainasurgicalacare.aChooseatheaans
werabelowathatacompletesatheablanksainathisasentence:atheariskaofatheasurgicalahazardaofa
canabeamitigatedathrough
.
a. wrongapatient,awrongasite,aandawrongasideasurgery;asiteamarkingaandapresurgicalac
hecklists
b. electricalaandathermalaburns;aalcohol-freeaprepasolution
c. surgicalasiteainfection;aflashasterilization
d. surgicalaairwayafire;afireaextinguishersainaeveryaOR
ANS:a A
Evidenceashowsathatawrongasiteasurgeryanotaonlyacanadevastateatheapatientaandafamilyabutaalsoaca
naimpactatheaperioperativeateamaadversely.aAllainstitutionsaaccreditedabyaTJCamustafollowatheaU
niversalaProtocolaforaPreventingaWrongaSite,aWrongaProcedure,aWrongaPersonaSurgery.aTheasu
rgicalateamamustaagreeathatathisaisatheacorrectapatientaandathatatheaplannedaprocedureaisaonatheaspe
cifiedasideaandasite.aMarkingatheasurgicalasiteamustabeadoneasoathatatheaintendedasiteaofaincisionaor
ainsertionaisaclearaandaunambiguous.
9. Laparoscopicaproceduresathataemergentlyaconvertatoaopenaproceduresaplaceatheapatientaatariskaf
oraunintentionalaretainedasurgicalaitemsa(RSIs).aWhatanewaandaevolvingariskareductionastrategy
acouldapreventaRSIsaandafrustrating,atime-
consumingamiscountaadventuresaatatheaendaofatheseaprocedures?
a. Creatingaprecountedalaparotomyasetsawithaonlyatheafewanecessaryainstruments
b. Performingaradiologicasurveillanceaonaallaconversionaproceduresaataclosure
c. Countingaallainstrumentsaincludingaaalaparotomyasetabeforeathealaparoscopy
d. Replacingaorataggingaspongesaandalaparotomyainstrumentsawitharadiofrequencyai
dentificationa(RFID)achips
ANS:a D
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