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1.  A local anesthetic containing epinephrine should not be injected into areas of compromised circulation because the epinephrine causes:

A. vasodilation.
B. vasoconstriction.
C. a decrease in blood pressure.
D. increased rate of absorption of the local anesthetic agent.

Correct answer is B.

Correct answer is B. Reference: Rothrock, J.C. (ed.). (2011). Alexander’s care of the patient in surgery,p. 138. St. Louis, MO: Elsevier/Mosby.

Rationale: Epinephrine, the “flight or fight” hormone, is a potent vasoconstrictor; its use in areas of compromised circulation can lead to ischemia and tissue necrosis. Its vasoconstrictive property slows the rate of absorption of the anesthetic agent.

2. Delegation of a nursing task to unlicensed assistive personnel (UAL) involves knowledge of the:

A. perioperative department’s nurse/patient ratio.
B. age of the patient.
C. results of latest regulatory survey.
D. competency of the UAL to safely complete the task.

Correct answer is D.

Reference: Reference: Rothrock, J.C. (ed.). (2011). Alexander’s care of the patient in surgery, p. 10. St. Louis, MO: Elsevier/Mosby.

 Rationale: Delegated tasks should be assigned to staff with demonstrated competence.

 3. Unless contraindicated for surgical reasons, the optimal method of positioning a patient’s arms in the supine position is to:

A. places the arms on armboards, palms up, at a 110 degree angle.
B. place the arms, palms up, on armboards at an 85 degree angle.
C. tuck the arms at the sides with the drawsheet between the patient and the bed’s mattress.
D. tuck the arms at the sides with the drawsheet under the bed’s mattress.

Correct answer is D]B.

Reference: AORN. (2013). Recommended practices: Positioning the patient. In Perioperative standards and recommended practices, pp. 429, 432. Denver, CO: Author.

Rationale: Unless necessary for surgical reasons, the patient’s arms should not tucked at the sides. To prevent nerve damage, the arms should be placed with the palms facing up; the angle of the arms boards should not be greater than 90 degrees.

 4. The circulating nurse and scrub person have just completed setting up the room for an abdominal hysterectomy when the charge person notifies them that the surgeon has been called to another hospital for an emergency Cesarean section and will not be available to begin their case for at least two hours. The appropriate response to maintain sterility of the instrumentation and supplies is to:

A. seal the OR doors with 3” cloth tape and a sign that says “Do Not Enter”.
B. tear down the back table and run the instruments through an immediate use sterilization cycle when the surgeon notifies them that he is on the way to their hospital.
C. cover the sterile field with two drapes using the appropriate technique and assign a staff member to monitor the room.
D. assist with lunch reliefs in other rooms and if the surgeon is still not available in two hours, tear down the sterile field.

Correct answer is C.

Reference: AORN. (2013). Recommended practices: Sterile technique. In Perioperative standards and recommended practices, p.519-520. Denver, CO: Author.

Rationale: The doors to the OR should not be taped closed as an alternative to monitoring the sterile field. A monitored room makes it possible to determine if a breach in sterility has taken place. When there is an unanticipated delay, a sterile field that has been prepared may be covered with a sterile drape in a manner that allows removal of the drape without contaminating the contents of the sterile field. Immediate-use sterilization should be used only when there is insufficient time to process instruments by terminal sterilization methods.

5. Which of the following will reduce the risk of fire during a laser tonsillectomy?

A. Placing the laser in "standby" mode when not in use.
B. Having a carbon dioxide fire extinguisher in the room.
C. Filling the cuff of a polyvinylchloride endotracheal tube with dye-tinted saline.
D. Keeping a bottle of sterile water on top of the laser machine for quick access in case of fire.

Correct answer is A.

Reference: Phillips, N. (2013). Berry and Kohn’s operating room technique, pp. 359,361. St. Louis, MO: Elsevier/Mosby.

Rationale: Placing the laser in standby mode prevents accidental activation. A fire extinguisher is used to extinguish a fire, not to prevent its occurrence. Polyvinyl chloride endotracheal tubes should not be used because they ignite easily. Spilled fluids can serve as a conductor and short-circuit the laser.