Test Bank: Care of the Patient in Surgery
1. The Perioperative Patient Focused Model presents key components of nursing influence that guide patient care. Select the
statement that best describes the dynamic relationship within the model. a. The patient experience and the nursing presence are in
continuous interaction. b. Structure, process, and outcome are the foundation domains of the model. c. The perioperative nurse is
the central dynamic core of the model. d. The interrelated nursing process rings bind the patient to the model. ANS: A The
Perioperative Patient Focused Model consists of domains or areas of nursing concern: nursing diagnoses, nursing interventions,
and patient outcomes. These domains are in continuous interaction with the health system that encircles the focus of perioperative
nursing practice—the patient.
2. The Association of PeriOperative Registered Nurses’ (AORN) Standards of Perioperative Nursing describes nursing
interactions, interventions, and activities with patients. This is based on which standards category? a. Evidence-based b. Process c.
Outcome d. Structural ANS: B Process standards relate to nursing activities, interventions, and interactions. They are used to
explicate clinical, professional, and quality objectives in perioperative nursing.
3. Which order best describes the process used to implement evidence-based professional nursing? a. Literature search, theory
review, data analysis, policy development b. Regional survey, literature search, meta-analysis, practice change c. Identify problem,
scientific evidence, develop policy, evaluate outcome d. Identify issue, analyze scientific evidence, implement change, evaluate
process ANS: D Evidence-based practice is a systematic, thorough process by which to identify an issue, to collect and evaluate the
best evidence to design and implement a practice change, and to evaluate the process.
4. The ambulatory surgery unit is planning to develop a standardized skin preparation practice for their unit. The best process to
gather scientific information is to: a. conduct a survey of skin prep policies at the next AORN chapter meeting. b. review their
surgical site infection data from the last 6 months. c.conduct a literature search on antimicrobial agents and infection prevention. d.
review the scientific literature from the leading manufacturers of prep solutions. ANS: C Perioperative nurses have an ethical
responsibility to review practices and to modify them based on the best available scientific evidence. Using research to guide
practice is called evidence-based practice (EBP).
5. The cardiac team is developing a standardized sterile back table setup and is unable to find sufficient research evidence for their
project. Where might they look for information on best practices? a. Survey regional surgical technology programs for their back
table models b. Review case studies and expert opinions on sterile back table setups c. Review AORN’s Guidelines for
Perioperative Practice on sterilization and disinfection d. Consult with facility instrument vendor representatives for their advice
ANS: B When there is not enough evidence to guide practice, perioperative nurses should consider gathering information from
varied trusted sources that reflect best practices.
6. How do institutional standards of care, such as policies and procedures, differ from national standards, such as AORN’s
Standards of Perioperative Nursing? a. They are written by nurses. b. They are written specifically to address responsibilities under
specific circumstances. c. They are collaborative and collective agreement statements. d. They are rarely based on research. ANS:
B Institutional standards apply to the system or facility that develops them and can be directive about specific actions in specific
circumstances; national standards provide generalized authoritative statements that can be implemented in all settings
7. Which of the following actions best describes an element of the perioperative nursing assessment? a. Scanning the surgical
schedule for the day before morning report. b. Reading the pick/preference list attached to the case cart. c. Reviewing the patient
medical record. d. Studying an on-line tutorial about the intended surgical procedure. ANS: C Assessment is the collection and
analysis of relevant health data about the patient. Sources of data may be a preoperative interview with the patient and the patient’s
family; review of the planned surgical or invasive procedure; review of the patient’s medical record; examination of the results of
diagnostic tests; and consultation with the surgeon and anesthesia provider, unit nurses, or other personnel.
8. A frail 76-year-old diabetic woman is scheduled for major surgery. She is vulnerable and at high risk for harm because of
several factors related to her preexisting conditions and overall health status. As part of developing a plan to guide her care, the
nurse uses standardized descriptive terms. This step of the nursing process is called: a. nursing diagnosis. b. nursing assessment. c.
nursing outcome. d. nursing intervention. ANS: A Nursing diagnosis is the process of identifying and classifying data collected in
the assessment in a way that provides a focus to plan nursing care. Nursing diagnosis components include a definition of the
diagnostic term, defining characteristics and risk factors.
9. During the admission interview, the nurse initiated the discharge teaching and demonstrated crutch-walking activities. The
teaching activities are what stage of the nursing process? a. Assessment b. Implementation c. Outcome identification d. Evaluation
ANS: B Implementation is performing the nursing care activities and interventions that were planned and responding with critical
thinking and orderly action to changes in the surgical procedure, patient condition, or emergencies. Implementation is the “work”
of nursing.
10. While conducting the preoperative interview with a patient scheduled for a septoplasty, the perioperative nurse learned that the
patient was latex sensitive. Based on this knowledge, the nurse reviewed the pick/preference list and reassembled the surgical case
cart setup to reflect this new information and change in care delivery. Which two phases of the nursing process are represented in
the nurse’s actions? a. Assessment and planning b. Assessment and implementation c. Planning and implementation d. Nursing
diagnosis and intervention ANS: C Planning is preparing in advance for what will or may happen and determining the priorities for
care. Planning is based on patient assessment results in knowing the patient and the patient’s unique needs. Implementation is
,performing the nursing care activities and interventions that were planned and responding with critical thinking and orderly action.
Implementation is the “work” of nursing.
11. The perioperative nurse implements protective measures to prevent skin or tissue injury caused by thermal sources. Successful
accomplishment of this intervention would meet which of the following desired nursing outcomes? a. The patient is free from signs
and symptoms of injury from anxiety. b. The patient is free from signs and symptoms of impaired skin integrity. c. The patient is
free from signs and symptoms of surgical site infection. d. The patient is free from signs and symptoms of hyperthermia. ANS: B
Chemical and thermal sources used in surgery can cause skin and tissue burns (e.g., electrosurgery, povidine-iodine, radiation,
lasers). The patient being free from signs and symptoms of chemical injury, radiation injury, and electrical injury are approved
NANDA International nursing diagnoses.
12. The nursing diagnosis is derived from: a. patient data retrieved from the nursing assessment. b. synthesized clues from the
admitting diagnosis and surgery schedule. c. the approved NANDA International list attached to the patient medical record. d. the
admission form on the front of the chart. ANS: A Nursing diagnosis is the process of identifying and classifying data collected in
the assessment in a way that provides a focus to plan nursing care.
13. A 36-year-old woman was preoperatively admitted for laparoscopic cholecystectomy with operative cholangiogram. She was
then interviewed by her perioperative nurse in the preoperative intake lounge. The patient’s weight on admission was 245 lb. After
the assessment, the nurse returned to the operating room (OR) and modified the standard plan of care by instituting risk reduction
strategies that were derived from information from the preoperative assessment. A good example of this action would best be
described by: a. replacing the regular OR bed with a bariatric-specific OR bed. b. providing protective lead aprons for all staff
during the procedure. c. writing the patient’s name, allergies, and body weight on the whiteboard. d. administering antibiotics to
the patient 1 hour before the incision. ANS: A Planning is preparing in advance for what will or may happen and determining the
priorities for care. Planning based on patient assessment results in knowing the patient and the patient’s unique needs so that
alterations in events, such as positioning the patient on a bariatric-specific OR bed as opposed to a regular OR bed, can be readily
accommodated. Replacing the OR bed with a larger OR bed is a nurse-sensitive preventive intervention that provides equipment
based on patient need.
14. Adoption of an electronic medical record requires the use of consistent terminology. Empirically validated, standardized
perioperative nursing language may be found in the: a. Perioperative Patient Focused Model. b. Nursing Alliance for Quality Care
(NAQC). c. Perioperative Nursing Data Set (PNDS). d. Standards of Perioperative Nursing. ANS: C After 6 years of research and
validation, the Perioperative Nursing Data Set (PNDS) was recognized as a specialty nursing language, providing a uniform and
systematic method to document the basic elements of perioperative nursing care.
15. When delegating a task, such as removing an intravenous (IV) catheter, to an unlicensed individual, the perioperative nurse: a.
retains responsibility for evaluating the outcome of the task. b. must comply with the seven “rights” of delegation. c. transfers the
authority to perform the related assessments. d. transfers the supervision of the competent person to another competent person.
ANS: C Delegation transfers to a competent person the authority to perform a selected nursing task in a selected situation
according to the “five rights” of delegation. When delegating care activities, perioperative nurses retain accountability for
analyzing and evaluating the outcomes of delegated tasks.
16. A hospital nursing excellence center for education developed standards for nursing advancement that would reflect high-level
achievement of professional performance. They developed a clinical advancement ladder based on the leading skill and knowledge
acquisition model and established worthy criteria for each level. Select the response that might best describe the highest level of
achievement for a perioperative staff nurse. a. Certified nurse, OR (CNOR) credential, BSN, and chair of the nursing research
committee b. Published article in the hospital newsletter and 15 years’ service pin c. BCLS instructor and weekend Emergency
Medical Technician (EMT) transport d. Patient safety champion and nurses’ union representative ANS: A Achieving certification
(CNOR), pursuing lifelong learning, and maintaining competency and current knowledge in perioperative nursing are the
hallmarks of the professional.
17. Performance improvement activities in the perioperative practice setting are designed to promote: a. cost savings by
eliminating fines for near-misses and never events. b. customer satisfaction and loyalty. c. time measurement activities. d. efficient,
effective, and ethical quality care. ANS: D Performance improvement efforts encompass improvements in quality and
effectiveness, based on ethical and economic perspectives. A performance measurement and improvement approach facilitates the
delivery of safe, high-quality perioperative patient care.
18. Perioperative nursing diagnoses and interventions are directed toward, and guided by, the tremendous risks for harm to the
patient inherent in surgery and interventional procedures; therefore, nursing actions can generally be categorized as: a.
therapeutic/restorative. b. preventive/protective. c. caring/comforting. d. advocating/justifying. ANS: B In contrast to some nursing
specialties in which nursing diagnoses are derived from signs and symptoms of a condition, much of perioperative nursing care is
preventive in nature, based on knowledge of inherent risks to patients undergoing surgical and invasive procedures. Perioperative
nurses identify these risks and potential problems in advance and direct nursing interventions toward prevention of undesirable
outcomes, such as injury and infection. Much of the work of perioperative nursing involves patient safety, protecting patients from
risks related to the procedure, positioning, equipment, and the environment
19. A registered nurse first assistant (RNFA) is considered an advanced practice nurse (APN) when he/she has achieved: a. RNFA
certification. b. clinical performance ladder Level 4 or above. c. graduate degree in nursing (MSN). d. facility practice privileges.
ANS: C APNs must have graduate nursing education (at least a master’s degree).
,20. Emerging perioperative nursing roles are defined by the tremendous growth in science and technology combined with the
increasing complexity of surgery and the interventional disciplines. An example of an emerging nursing role is: a. sterile
processing clinical specialist. b. general surgery service liaison. c. weekend resource nurse. d. informatics nurse specialist. ANS: D
Informatics is another specialty in which some perioperative nurses are focusing. Pressures for more efficient management of
fiscal, material, and human resources have stimulated the development of electronic information systems for diverse functions in
perioperative patient care settings.
21. The relationship between the Perioperative Patient Focused Model and the PNDS is evidenced by their unique language and
use of the nursing process to guide care. The most notable feature of their similarity is that the PNDS: a. promotes standardized
perioperative documentation. b. fosters research on best practices. c. begins with outcome statements. d. promotes standardized
perioperative documentation and begins with outcome statements. ANS: C Similar to the Perioperative Patient Focused Model, the
PNDS begins with patient outcomes. Each outcome is defined and interpreted and presents criteria by which to measure outcome
achievement.
22. In a research study by Kleiner and colleagues (2014), use of crew resource management (CRM) principles was a practical and
effective means to: a. identify potential surgical defects in the OR. b. monitor central processing productivity. c. promote
teamwork. d. improve the quality of OR briefings and debriefings. ANS: D Kleiner and colleagues (2014) found while there was
no difference in the frequency of briefings and debriefings observed in this study, there were significant differences in the quality
of the communication observed. Coaching appeared to be an effective intervention, improving the quality of communication
among team members.
23. In a research study by Steelman and colleagues (2013), perioperative nurses were surveyed to prioritize perioperative patient
safety issues. The majority of nurses placed the highest priority and heightened awareness on preventing which patient safety risk?
a. Surgical fires b. Wrong-site/procedure/patient surgery c. Retained surgical items d. Medication errors ANS: B The majority of
nurses considered preventing wrong-site, procedure, or patient surgery (69%) and preventing retained surgical items (61%) to be
high-priority safety issues in need of heightened attention.
24. Malley and colleagues (2015) conducted a focus group survey to identify nursing’s contributions to transitions in care in the
perioperative environment. The study suggests the preoperative assessment: a. serves as not just as a clearance for surgery, but also
for managing the transitions of patient care throughout the perioperative experience. b. significantly impacted circulator nurse
performance due to increased knowledge of the patient. c. primarily identifies risk factors impacting the intraoperative period. d.
has little application for intraoperative to postoperative transitions. ANS: A Malley concluded that the nurse’s role in the
preoperative assessment during the transition of preoperative care is that of advocate who identifies the patient’s needs and risk
factors that may be affected by the surgical experience. This study suggests that the nursing preoperative assessment can be useful
in identifying and defining patients’ risk factors not just for surgery, but for the entire perioperative care trajectory. The study did
not include intraoperative staff.
25. Ensuring a rapid recovery from anesthesia and discharging the patient when it is safe to so is one goal of ambulatory surgery.
Factors that may contribute to a delayed discharge include: a. prompt administration of opiates for pain relief. b. early
postoperative oral intake. c. use of a forced air–warming blanket. d. administration of a preoperative fluid bolus. ANS: A Enhanced
recovery after surgery (ERAS) protocols include avoidance of opiated for pain management, prevention of hypothermia, early oral
intake and replacement of any intraoperative vascular volume loss.
Chapter 02: Patient Safety and Risk Management Care of the Patient in Surgery
,
CHOICE 1. Governmental and professional agencies and organizations, whether voluntary or involuntary, have a significant
influence on patient safety policies in the healthcare setting. Select the agency or organization statement that presents a true
reflection of its focus or purpose. a. The Joint Commission (TJC): Nonvoluntary bureau that tests healthcare institutions against
evidence-based elements of performance b. Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics c.
American Society of Anesthesiologists (ASA): Professional organization of anesthesia providers and technologists d. World Health
Organization (WHO): United Nations (UN)–based and supported authority on health throughout most of the world ANS: D The
UN created WHO to function as its health oversight and coordination authority for all UN member nations who in turn have joined
WHO. In 2004, WHO launched the World Alliance on Patient Safety, by which it began to examine patient safety in acute as well
as in primary care settings relevant to all WHO member nations. WHO was created by and functions within the UN as the directing
and coordinating authority for health throughout UN member nations
. 2. Since its organization and establishment as a professional nursing association in the early 1950s, the Association of
periOperative Registered Nurses (AORN) continues its endeavor to: a. promote guidelines
influenNcUinRgSpaYtTieEntSsTafSet.y.COM b. create professional operating room (OR) nursing care delivery models. c.
interpret healthcare statistics critical to perioperative nursing care. d. ensure risk reduction strategies are the foundation of
perioperative education. ANS: A AORN provides an array of standards, recommended practices (RPs), guidelines, publications,
videos, and tool kits that specifically address patient safety from the perioperative team’s point of view.
3. A healthy 32-year-old nursing student is scheduled for excision of a left-sided subglottal cyst with frozen section and possible
radical neck dissection. The preoperative verification process provides the opportunity to collect and verify information about the
patient to ensure patient safety. Among the patient data that must be verified are: a. emergency contact name. b. laboratory and
1. The Perioperative Patient Focused Model presents key components of nursing influence that guide patient care. Select the
statement that best describes the dynamic relationship within the model. a. The patient experience and the nursing presence are in
continuous interaction. b. Structure, process, and outcome are the foundation domains of the model. c. The perioperative nurse is
the central dynamic core of the model. d. The interrelated nursing process rings bind the patient to the model. ANS: A The
Perioperative Patient Focused Model consists of domains or areas of nursing concern: nursing diagnoses, nursing interventions,
and patient outcomes. These domains are in continuous interaction with the health system that encircles the focus of perioperative
nursing practice—the patient.
2. The Association of PeriOperative Registered Nurses’ (AORN) Standards of Perioperative Nursing describes nursing
interactions, interventions, and activities with patients. This is based on which standards category? a. Evidence-based b. Process c.
Outcome d. Structural ANS: B Process standards relate to nursing activities, interventions, and interactions. They are used to
explicate clinical, professional, and quality objectives in perioperative nursing.
3. Which order best describes the process used to implement evidence-based professional nursing? a. Literature search, theory
review, data analysis, policy development b. Regional survey, literature search, meta-analysis, practice change c. Identify problem,
scientific evidence, develop policy, evaluate outcome d. Identify issue, analyze scientific evidence, implement change, evaluate
process ANS: D Evidence-based practice is a systematic, thorough process by which to identify an issue, to collect and evaluate the
best evidence to design and implement a practice change, and to evaluate the process.
4. The ambulatory surgery unit is planning to develop a standardized skin preparation practice for their unit. The best process to
gather scientific information is to: a. conduct a survey of skin prep policies at the next AORN chapter meeting. b. review their
surgical site infection data from the last 6 months. c.conduct a literature search on antimicrobial agents and infection prevention. d.
review the scientific literature from the leading manufacturers of prep solutions. ANS: C Perioperative nurses have an ethical
responsibility to review practices and to modify them based on the best available scientific evidence. Using research to guide
practice is called evidence-based practice (EBP).
5. The cardiac team is developing a standardized sterile back table setup and is unable to find sufficient research evidence for their
project. Where might they look for information on best practices? a. Survey regional surgical technology programs for their back
table models b. Review case studies and expert opinions on sterile back table setups c. Review AORN’s Guidelines for
Perioperative Practice on sterilization and disinfection d. Consult with facility instrument vendor representatives for their advice
ANS: B When there is not enough evidence to guide practice, perioperative nurses should consider gathering information from
varied trusted sources that reflect best practices.
6. How do institutional standards of care, such as policies and procedures, differ from national standards, such as AORN’s
Standards of Perioperative Nursing? a. They are written by nurses. b. They are written specifically to address responsibilities under
specific circumstances. c. They are collaborative and collective agreement statements. d. They are rarely based on research. ANS:
B Institutional standards apply to the system or facility that develops them and can be directive about specific actions in specific
circumstances; national standards provide generalized authoritative statements that can be implemented in all settings
7. Which of the following actions best describes an element of the perioperative nursing assessment? a. Scanning the surgical
schedule for the day before morning report. b. Reading the pick/preference list attached to the case cart. c. Reviewing the patient
medical record. d. Studying an on-line tutorial about the intended surgical procedure. ANS: C Assessment is the collection and
analysis of relevant health data about the patient. Sources of data may be a preoperative interview with the patient and the patient’s
family; review of the planned surgical or invasive procedure; review of the patient’s medical record; examination of the results of
diagnostic tests; and consultation with the surgeon and anesthesia provider, unit nurses, or other personnel.
8. A frail 76-year-old diabetic woman is scheduled for major surgery. She is vulnerable and at high risk for harm because of
several factors related to her preexisting conditions and overall health status. As part of developing a plan to guide her care, the
nurse uses standardized descriptive terms. This step of the nursing process is called: a. nursing diagnosis. b. nursing assessment. c.
nursing outcome. d. nursing intervention. ANS: A Nursing diagnosis is the process of identifying and classifying data collected in
the assessment in a way that provides a focus to plan nursing care. Nursing diagnosis components include a definition of the
diagnostic term, defining characteristics and risk factors.
9. During the admission interview, the nurse initiated the discharge teaching and demonstrated crutch-walking activities. The
teaching activities are what stage of the nursing process? a. Assessment b. Implementation c. Outcome identification d. Evaluation
ANS: B Implementation is performing the nursing care activities and interventions that were planned and responding with critical
thinking and orderly action to changes in the surgical procedure, patient condition, or emergencies. Implementation is the “work”
of nursing.
10. While conducting the preoperative interview with a patient scheduled for a septoplasty, the perioperative nurse learned that the
patient was latex sensitive. Based on this knowledge, the nurse reviewed the pick/preference list and reassembled the surgical case
cart setup to reflect this new information and change in care delivery. Which two phases of the nursing process are represented in
the nurse’s actions? a. Assessment and planning b. Assessment and implementation c. Planning and implementation d. Nursing
diagnosis and intervention ANS: C Planning is preparing in advance for what will or may happen and determining the priorities for
care. Planning is based on patient assessment results in knowing the patient and the patient’s unique needs. Implementation is
,performing the nursing care activities and interventions that were planned and responding with critical thinking and orderly action.
Implementation is the “work” of nursing.
11. The perioperative nurse implements protective measures to prevent skin or tissue injury caused by thermal sources. Successful
accomplishment of this intervention would meet which of the following desired nursing outcomes? a. The patient is free from signs
and symptoms of injury from anxiety. b. The patient is free from signs and symptoms of impaired skin integrity. c. The patient is
free from signs and symptoms of surgical site infection. d. The patient is free from signs and symptoms of hyperthermia. ANS: B
Chemical and thermal sources used in surgery can cause skin and tissue burns (e.g., electrosurgery, povidine-iodine, radiation,
lasers). The patient being free from signs and symptoms of chemical injury, radiation injury, and electrical injury are approved
NANDA International nursing diagnoses.
12. The nursing diagnosis is derived from: a. patient data retrieved from the nursing assessment. b. synthesized clues from the
admitting diagnosis and surgery schedule. c. the approved NANDA International list attached to the patient medical record. d. the
admission form on the front of the chart. ANS: A Nursing diagnosis is the process of identifying and classifying data collected in
the assessment in a way that provides a focus to plan nursing care.
13. A 36-year-old woman was preoperatively admitted for laparoscopic cholecystectomy with operative cholangiogram. She was
then interviewed by her perioperative nurse in the preoperative intake lounge. The patient’s weight on admission was 245 lb. After
the assessment, the nurse returned to the operating room (OR) and modified the standard plan of care by instituting risk reduction
strategies that were derived from information from the preoperative assessment. A good example of this action would best be
described by: a. replacing the regular OR bed with a bariatric-specific OR bed. b. providing protective lead aprons for all staff
during the procedure. c. writing the patient’s name, allergies, and body weight on the whiteboard. d. administering antibiotics to
the patient 1 hour before the incision. ANS: A Planning is preparing in advance for what will or may happen and determining the
priorities for care. Planning based on patient assessment results in knowing the patient and the patient’s unique needs so that
alterations in events, such as positioning the patient on a bariatric-specific OR bed as opposed to a regular OR bed, can be readily
accommodated. Replacing the OR bed with a larger OR bed is a nurse-sensitive preventive intervention that provides equipment
based on patient need.
14. Adoption of an electronic medical record requires the use of consistent terminology. Empirically validated, standardized
perioperative nursing language may be found in the: a. Perioperative Patient Focused Model. b. Nursing Alliance for Quality Care
(NAQC). c. Perioperative Nursing Data Set (PNDS). d. Standards of Perioperative Nursing. ANS: C After 6 years of research and
validation, the Perioperative Nursing Data Set (PNDS) was recognized as a specialty nursing language, providing a uniform and
systematic method to document the basic elements of perioperative nursing care.
15. When delegating a task, such as removing an intravenous (IV) catheter, to an unlicensed individual, the perioperative nurse: a.
retains responsibility for evaluating the outcome of the task. b. must comply with the seven “rights” of delegation. c. transfers the
authority to perform the related assessments. d. transfers the supervision of the competent person to another competent person.
ANS: C Delegation transfers to a competent person the authority to perform a selected nursing task in a selected situation
according to the “five rights” of delegation. When delegating care activities, perioperative nurses retain accountability for
analyzing and evaluating the outcomes of delegated tasks.
16. A hospital nursing excellence center for education developed standards for nursing advancement that would reflect high-level
achievement of professional performance. They developed a clinical advancement ladder based on the leading skill and knowledge
acquisition model and established worthy criteria for each level. Select the response that might best describe the highest level of
achievement for a perioperative staff nurse. a. Certified nurse, OR (CNOR) credential, BSN, and chair of the nursing research
committee b. Published article in the hospital newsletter and 15 years’ service pin c. BCLS instructor and weekend Emergency
Medical Technician (EMT) transport d. Patient safety champion and nurses’ union representative ANS: A Achieving certification
(CNOR), pursuing lifelong learning, and maintaining competency and current knowledge in perioperative nursing are the
hallmarks of the professional.
17. Performance improvement activities in the perioperative practice setting are designed to promote: a. cost savings by
eliminating fines for near-misses and never events. b. customer satisfaction and loyalty. c. time measurement activities. d. efficient,
effective, and ethical quality care. ANS: D Performance improvement efforts encompass improvements in quality and
effectiveness, based on ethical and economic perspectives. A performance measurement and improvement approach facilitates the
delivery of safe, high-quality perioperative patient care.
18. Perioperative nursing diagnoses and interventions are directed toward, and guided by, the tremendous risks for harm to the
patient inherent in surgery and interventional procedures; therefore, nursing actions can generally be categorized as: a.
therapeutic/restorative. b. preventive/protective. c. caring/comforting. d. advocating/justifying. ANS: B In contrast to some nursing
specialties in which nursing diagnoses are derived from signs and symptoms of a condition, much of perioperative nursing care is
preventive in nature, based on knowledge of inherent risks to patients undergoing surgical and invasive procedures. Perioperative
nurses identify these risks and potential problems in advance and direct nursing interventions toward prevention of undesirable
outcomes, such as injury and infection. Much of the work of perioperative nursing involves patient safety, protecting patients from
risks related to the procedure, positioning, equipment, and the environment
19. A registered nurse first assistant (RNFA) is considered an advanced practice nurse (APN) when he/she has achieved: a. RNFA
certification. b. clinical performance ladder Level 4 or above. c. graduate degree in nursing (MSN). d. facility practice privileges.
ANS: C APNs must have graduate nursing education (at least a master’s degree).
,20. Emerging perioperative nursing roles are defined by the tremendous growth in science and technology combined with the
increasing complexity of surgery and the interventional disciplines. An example of an emerging nursing role is: a. sterile
processing clinical specialist. b. general surgery service liaison. c. weekend resource nurse. d. informatics nurse specialist. ANS: D
Informatics is another specialty in which some perioperative nurses are focusing. Pressures for more efficient management of
fiscal, material, and human resources have stimulated the development of electronic information systems for diverse functions in
perioperative patient care settings.
21. The relationship between the Perioperative Patient Focused Model and the PNDS is evidenced by their unique language and
use of the nursing process to guide care. The most notable feature of their similarity is that the PNDS: a. promotes standardized
perioperative documentation. b. fosters research on best practices. c. begins with outcome statements. d. promotes standardized
perioperative documentation and begins with outcome statements. ANS: C Similar to the Perioperative Patient Focused Model, the
PNDS begins with patient outcomes. Each outcome is defined and interpreted and presents criteria by which to measure outcome
achievement.
22. In a research study by Kleiner and colleagues (2014), use of crew resource management (CRM) principles was a practical and
effective means to: a. identify potential surgical defects in the OR. b. monitor central processing productivity. c. promote
teamwork. d. improve the quality of OR briefings and debriefings. ANS: D Kleiner and colleagues (2014) found while there was
no difference in the frequency of briefings and debriefings observed in this study, there were significant differences in the quality
of the communication observed. Coaching appeared to be an effective intervention, improving the quality of communication
among team members.
23. In a research study by Steelman and colleagues (2013), perioperative nurses were surveyed to prioritize perioperative patient
safety issues. The majority of nurses placed the highest priority and heightened awareness on preventing which patient safety risk?
a. Surgical fires b. Wrong-site/procedure/patient surgery c. Retained surgical items d. Medication errors ANS: B The majority of
nurses considered preventing wrong-site, procedure, or patient surgery (69%) and preventing retained surgical items (61%) to be
high-priority safety issues in need of heightened attention.
24. Malley and colleagues (2015) conducted a focus group survey to identify nursing’s contributions to transitions in care in the
perioperative environment. The study suggests the preoperative assessment: a. serves as not just as a clearance for surgery, but also
for managing the transitions of patient care throughout the perioperative experience. b. significantly impacted circulator nurse
performance due to increased knowledge of the patient. c. primarily identifies risk factors impacting the intraoperative period. d.
has little application for intraoperative to postoperative transitions. ANS: A Malley concluded that the nurse’s role in the
preoperative assessment during the transition of preoperative care is that of advocate who identifies the patient’s needs and risk
factors that may be affected by the surgical experience. This study suggests that the nursing preoperative assessment can be useful
in identifying and defining patients’ risk factors not just for surgery, but for the entire perioperative care trajectory. The study did
not include intraoperative staff.
25. Ensuring a rapid recovery from anesthesia and discharging the patient when it is safe to so is one goal of ambulatory surgery.
Factors that may contribute to a delayed discharge include: a. prompt administration of opiates for pain relief. b. early
postoperative oral intake. c. use of a forced air–warming blanket. d. administration of a preoperative fluid bolus. ANS: A Enhanced
recovery after surgery (ERAS) protocols include avoidance of opiated for pain management, prevention of hypothermia, early oral
intake and replacement of any intraoperative vascular volume loss.
Chapter 02: Patient Safety and Risk Management Care of the Patient in Surgery
,
CHOICE 1. Governmental and professional agencies and organizations, whether voluntary or involuntary, have a significant
influence on patient safety policies in the healthcare setting. Select the agency or organization statement that presents a true
reflection of its focus or purpose. a. The Joint Commission (TJC): Nonvoluntary bureau that tests healthcare institutions against
evidence-based elements of performance b. Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics c.
American Society of Anesthesiologists (ASA): Professional organization of anesthesia providers and technologists d. World Health
Organization (WHO): United Nations (UN)–based and supported authority on health throughout most of the world ANS: D The
UN created WHO to function as its health oversight and coordination authority for all UN member nations who in turn have joined
WHO. In 2004, WHO launched the World Alliance on Patient Safety, by which it began to examine patient safety in acute as well
as in primary care settings relevant to all WHO member nations. WHO was created by and functions within the UN as the directing
and coordinating authority for health throughout UN member nations
. 2. Since its organization and establishment as a professional nursing association in the early 1950s, the Association of
periOperative Registered Nurses (AORN) continues its endeavor to: a. promote guidelines
influenNcUinRgSpaYtTieEntSsTafSet.y.COM b. create professional operating room (OR) nursing care delivery models. c.
interpret healthcare statistics critical to perioperative nursing care. d. ensure risk reduction strategies are the foundation of
perioperative education. ANS: A AORN provides an array of standards, recommended practices (RPs), guidelines, publications,
videos, and tool kits that specifically address patient safety from the perioperative team’s point of view.
3. A healthy 32-year-old nursing student is scheduled for excision of a left-sided subglottal cyst with frozen section and possible
radical neck dissection. The preoperative verification process provides the opportunity to collect and verify information about the
patient to ensure patient safety. Among the patient data that must be verified are: a. emergency contact name. b. laboratory and
