Perioperative Mr.

Neil
Perioperative performance
=

Of
Intra-operative
nursing activities during the

pre-operative, Intra-operative, and

P septic-controlled
+
afcty
environment
post-operative phase Ofthe pt
Positioning
surgical experience. Inputand output
PhaS2:
Post-operative
⑩Pre-operative startwhen the
Temperature and other y s
-

ptdecides to undergo the procedure Oxygenation Status

Level OFConsciousness
or when the the procedure is

scheduled Drainage/
irway
Dressing

&Intra-operative-startwhen
Informed consent -
agreement
the ptis admitted to the OR made by the ptto undergo a
is
procedure provided thatthe pt
bed until the patientis transferred the necessary t complete
given
to the PACU into the
about procedure before
③Post-operative-starts When giving consent

u until
the ptis admitted to PA
Information provided to
the pt:
the
&Nature and Magnitude of
Nursing Activities/considerations
Procedure
Pre-Operative 2. Risks Benefits ofthe procedure
+

Visitthe patient treatment

③.Alternative
nterview/informed consent ④.Prognosis
breparation -

physical
*
+ Psychological
Nurse responsibility is pt
*
preoperative assessment
conduct
advocate
It
* mostbe coherent +
aware
classifications ofsurgery

patient advocate
Eering
to Magnitude
*
*

protectthe pt's right

-

-
either minor or major
-ensure the pt
is given complete Characteristics OFMajor procedure:
into before IC
-

High risk for morbidity mortality

+

Requestioning or demonstration -
Extensive or prolonged
to ensure -

large blood
amountof loss
who cannotgive consent? presence ofcomplications
-

-
Minors * doing
purpose
to

unconscious
Diagnostic
-
-

Mentally-ill
-
-

Exploratory (establish the extent

conditions requiring 12: OFthe conditions
-
curative (to treatthe diseases
Minor and major procedures
-

Ablative -
removal ofa
Anesthesia administration
body
-

part
-

Radiographic exam with use ofcontrast

constructive -

repair ofa
medium
congenital defect
Entry to a body cavity
-

Reconstructive repair of a-

physical preparation ofthe client damaged or

diseased
Health teaching-deep breathing
⑦ +
organ
-

Palliative (to reduce distressful

coughing excercises
A splinting the wound signs +
symptoms)
&.Pre-operative Checklist *
erng
Urgency
to

③Whatis to be removed t retained

pt's
Optional -

according to
-
nail polish, jewelries
discretion/choice
④Methods Hair removal
Of

shaving cosmetic/ desthetic

-
-

-
clipping (surgical clipper) surgery
Depilation (depilatory
-

Elective -

availability Or

cream) convience the

of

pt.
 -
24. Vasecto my Sterilization -
render the ins Free

Required
-

Should be don-within From all microorganisms including

4 Few Weeks spores
ins
exposure of
Cataract surgery physical
-

ex. *

radiatiation
Urgent -

should be performed
*Steam -

Steam under
within 24-48 his
pressure
ex. Appendectomy Autoclave
-

2x.

Emergency -

performed immediately 100-1200/15 mins

-
ex. my
appendecto Flash sterilization -
emergency

(when roptured) sterilization ofunwrapped object

stab wound,youshot XChemical -

052 ofethylene
wound oxide gas
Temp insid-OR-20-24C
*

Steam Sterilization
Humidity 50 55%
-
-
-

steam alone does notsterilize

Treatment) Process For OR Items
↓
Decontamination -

removal OF a certain
steam is exposed to

debris From the instrumentthro Pressure

↓
mechanical or chemical
means
Temp ofthe steam rises

Disinfection -
render the instrument ↓
pathologic
Free From disease causing microorganism Moist
heat
is produced
lowe level =hydrogen peroxide ↓
*
kills the protein bacteria
in
=kills microorganism
limited
Intermediate 70 isoprophy) alcohol
=

High level Glutaraldehyde

=

<capable ofsterilization

of02 ins)
= 10 his nakalublob
 OR Instrument
Types OF
↑
/

Type Arcus it
enters Items Treatment

Mon-critical Does not BP CUFF

usually touch
Intermediate
stath
the pt's body; ifit level
does, touches only disinfection
intact skin

enters intact Gastrointestinal sterilization

Semi-criticaI mucus membranes enRoscope <preferred

blood Laparoscope treatments
butnotthe

stream cystoscope High level

Bronchoscope
disinfection
↑

enters the blood Itneedle

Sterilization
critical
steam/ circulation I Fluid
Implants

Zones OF the OR

zone Definition Areas

rected
provides of entry + dressing rooms

waiting area Forpt

exit
of
personnel,
office ofphysician,
equipment+ pt nurses

access 70
A
recs that
lead to
Semi-restricted provides
rooms
the procedure room
procedure
-

Restricted procedure room procedure room

 Other concepts in OR -
Gastrointestinal +

hepatobillary
Function
Time out-brainstorming ofthe
- Endocrine Function
surgery team
Renal Function assess voiding patterns,
=

-
to preventaccidents
appearance ofurine, creatinin-
BuNt
Surgical conscience
levels, Urinalysis
Sentinal events -

Hematologic Function
Stages ofAnesthesia -
Injection
Induction stag-
*
The conceptofpain
Excitement/Delirium Stage
*

Nature ofpain
surgical stay--startofincision
*

Multidimentional
Danger staye
*

Arniversal experience
General Risk Factors to Surgery Subjective
Age-older
* adults have reduced
And individual
physiologic reserves
stimuli
evoked by
Obesity
*
Indicates a problem
* Poor nutrition

* Fluid and electrolytes imbalances The person is the authority

*
Pre-existing conditions -

DM, respiratory pain

OF
condition
*Alcoholism -
can cause alcohol
physiology ofPain
Withdrawal (delirium tremens)
Severity
* and
urgency ofsurgery
⑩Transduction
-

Release ofbiochemical mediators

*

Pre-operative Assessment
-
Age (bradykinin, histamine, prostay-
- pain landing, substances is From
the site ofinjury
- Nutritional Status
-
Fluid and electrolytes Status ↓
-
Cardiovascular Function Rain stimuli is produced
 ↓
converted to action potential
be curried outto the brain
to

②. Transmission
-

Action potential
-
is conducted to
through:
the cerebral corfex

⑩Primary neuron-transmits
neuron receives
⑳Secondary
-

neuron-transmits to
③.Tertiary
cerebral cortex

③perception
-

Action reaches the

*
potential
cerebral cortex
↓
clientbecomes conscious
of pain
4. Modulation -

reduction ofpain
-
1. When does preoperative phase begin:
a. When the client is transferred to the operating room
b. When client is admitted to PACU
c. When the client is admitted to the hospital on the day of surgery
⑧
d. When the decision to proceed with surgical intervention is made

2. Surgical procedures may be categorized according to their purpose. What type of surgery
involves the removal of a body part?
a. Palliative
⑧
b. ablative
c. diagnostic
d. Constructive

3.Which of the following is a surgical procedure classified as urgent?

a. a repair of multiple stab wound emergency
b. face lift optional
O
c. an appendectomy
·rad
d. cataract surgery requi

4. The nurse knows that the importance of a thorough preoperative assessment is:
a. To ensure that postoperative complications don’t occur
0
b. To identify and correct problems before surgery and establish a baseline for postoperative
-

comparison
c. To provide the doctor with information that may have been missed during the
pre-admission assessment
d. To save time doing an assessment after the patient returns from surgery

5. The perioperative nurse’s primary responsibility in the process of informed consent is:
a. Discuss possible complications of proposed procedure
b. Provide the client with details of proposed surgical procedure
c. Ensure that the anesthetist/anaesthesiologist has met with the patient before the
procedure
⑧
d. Advocate patient to ensure that the client is given necessary information to give consent

6. Which of the following is deemed the most distressing fear the preoperative client is likely
to experience?
a. Fear of changes in body image
Ob. Fear of the unknown
c. Fear of pain
d. Fear of the effects of anaesthesia

Situation: In the OR, there are safety protocols that should be followed. The OR nurse
should be well-versed with all these to safeguard the safety and quality of patient delivery
outcome.

7. Which of the following should be given highest priority when receiving patient in the OR?
a. Assess level of consciousness
b. Assess vital signs
 c. Check for jewelry, gown, manicure and dentures

8
d. Verify patient identification and informed consent

8. Surgeries like I and D (incision and drainage) and debridement are relatively short
procedures but considered “dirty cases”. when are these procedures best scheduled?
a. Last case
b. In between cases
c. According to the surgeons preference
d. According to availability of anaesthesiologist

9. What is the hallmark of nursing responsibility?

a. Filling an incident report
b. Reporting a medication error
O
c. Accurate documentation and reporting
d. Admitting your mistakes

Situation: Nurses hold a variety of roles when providing care to a perioperative client.

10. Which of the following role would be the responsibility of the scrub nurse?
a. Assess the readiness of the client prior to surgery
b. Ensure that the airway is adequate
⑧
c. Account for the number of sponges, needles, supplies used during the surgical procedure
d. Evaluate the type of anesthesia appropriate for the surgical client

11. As a perioperative nurse, how can you best meet the safety need of the client after
administering preoperative narcotic?
a. Send the client to OR with the family
b. Allow client to get up to go to the comfort room
c. Obtain consent form
0
d. Put side rails up and ask the client not to get out of bed

12. It is also the responsibility of the perioperative nurse to do skin prep for patient
undergoing surgery. If hair at the operative site is not shaved, what should be done to make
suturing easy and lessen chance of incision infection?
a. draped
b. shampooed
c. pulled
O
d. clipped

Situation: The perioperative nurse collaborates with the client’s significant others and health
care providers.

13. To control environmental hazards in the OR, the nurse collaborates with the following
departments except:
a. Biomedical division
b. Infection control committee
c. Pathology department
Od. Chaplaincy services
 Situation: Team effort is best demonstrated in the OR.

14. While team effort is needed in the OR for efficient and quality patient care delivery, we
should limit the number of people in the room for infection control. Who comprises this
team?
a. Surgeon, anaesthesiologist, scrub nurse, radiologist, orderly
0
b. Surgeon, assistants, scrub
--
nurse, circulating nurse, anaesthesiologist
c. Surgeon, assistant surgeon, anaesthesiologist, scrub nurse, pathologist
d. Surgeon, assistant surgeon, anaesthesiologist, intern, scrub nurse

15. The breakdown in teamwork is often times failure in:

a. electricity
b. inadequate supply
c. contamination of supplies and instruments
⑧d. communication

16. If you are the nurse in charge for scheduling surgical cases, what important information
do you need to ask the surgeon?
a. Who are your anaesthesiologist, internist and assistant
b. Who is your internist?
c. Who is your anaesthesiologist?
Od. Who is your assistant and anaesthesiologist and what is your preferred time and type of
surgery?

17. In the OR, the nursing tandem for every surgery is:
a. Scrub nurse and nurse anaesthetist
0
b. Scrub and circulating nurse
c. Instrument technician and circulating nurse
d. Nurse anaesthetist and instrument technician

Situation: Concerted work efforts among members of the surgical team is essential to the
success of the surgical procedure.

18. The sterile nurse or sterile personnel touch only sterile supplies and instruments. When
there is a need for sterile supply which is not in the sterile field, who hands out these items
by opening its outer cover?
a. Anaesthesiologist
0b. Circulating nurse
c. Scrub nurse
d. Surgeon

19. The OR team performs distinct roles for one surgical procedure to be accomplished
within a prescribed time frame and deliver a standard patient outcome. While the surgeon
performs the surgical procedure, who monitors the status of the client like urine output, blood
loss?
a. Surgeon
b. Scrub nurse
c. Circulating nurse
⑧
d. Anaesthesiologist

20. Surgery schedules are communicated to the OR usually a day prior to the procedure by
the nurse of the floor or ward where the patient is confined. For orthopedic cases, what
-
department is usually informed to be present in the OR?
a. Laboratory department
0b. Radiology department XRAY
c. Maintenance department
d. Rehabilitation department

21. Minimally invasive surgery is very much into technology. Aside from the usual surgical
team, who else has to be present when a client undergoes laparoscopic surgery?
O
-

a. Biomedical technician
b. Information technician
c. Laboratory technician
d. Electrician

Situation: Sterilization is the process of removing all living microorganisms. To be free of all
living microorganisms is sterility.

22. Which of the following is true with regards to sterility?

a. Sterility is time related, items are not considered sterile after a period of 30 days of being
not use
b. For 9 months, sterile items are considered sterile as long as they are covered with sterile
muslin cover and stored in a dust proof covers
O
c. Sterility is event related, not time related
d. For 3 weeks, items double covered with muslin are considered sterile as long as they
have undergone the sterilization process

23. Two organizations endorsed that sterility are affected by factors other than the time itself,
these are:
a. The PNS and PNRC nursing
b. AORN and JCAHO principles perioperative
c. ORNAP and MCNAP
d. MMDA and DILG

24. The chiefadvantage of using ethylene gas for sterilization is that it is effective for
sterilizing items that:
a. have lumens
⑧
b. are heat sensitive
c. have serrated edges
d. are required quickly

25. Spaulding categorized instruments according to use. Where do you classify endoscopic
instrument?
a. Decontaminated instruments
0
b. High level disinfected instruments
c. High technology instruments
d. Sterile instruments

26. According to Spaulding classification of instruments, gastrointestinal endoscopes,

cystoscopes, and bronchoscopes are considered what type of instruments?
a. critical items
⑧
b. semi-critical items
c. sterile items
d. non-critical items

27. Autoclave or steam under pressure is the most common method of sterilization in the
clinical setting. The nurse knows that the temperature and time is set to the optimum level to
destroy not only the microorganism, but also the spores. At what parameters should the
steam sterilizer should function?
a. 150 ◦C for 1 hour
⑧
b. 121 ◦C for 15 minutes
c. 37 ◦C for 15 minutes
d. 500 ◦C for 1 hour

28. Items that enter sterile tissue or vascular system are categorized as critical items and
should be:
a. Clean
b. Decontaminated
O
c. Sterilized
d. Disinfected

29. As a nurse, you know that intact skin acts as an effective barrier to most
microorganisms. Therefore items that come in contact with the intact skin should be:
0
a. Disinfected
b. Sterile
c. Clean
d. Alcoholized

30. You have a critical heat labile instrument to sterilize and are considering to use a
high-level disinfectant. What should you do?
a. Cover the soaking vessel to contain the vapor
b. Double the amount of high level disinfectant
c. Test the potency of the high level disinfectant
0
d. Prolong the exposure time according to manufacturer’s direction

31. During surgery, movement of personnel should be:

a. eliminated when possible
b. monitored
c. kept to a minimum
0
d. restricted

32. Surgical instruments are expensive and are lifetime investment of the OR. To ensure
quality of these instruments, which criterion is evaluated?
a. reusability
b. shelf life
c. cost
0
d. integrity and functionality after each use and processing

33. There are 3 general types of sterilization used in the hospital. Which one is not included?
a. Steam sterilization
O
b. Sterilization by boiling
c. Chemical sterilization
d. Physical sterilization

34. Chemical indicators communicate that:

a. The items are sterile
O
b. The items had undergone sterilization process but not necessarily sterile
c. The items are disinfected
d. The items had undergone disinfection process but not necessarily sterile

35. If a nurse will sterilize a heat and moisture labile instruments. It is according to AORN
-

recommendation to use which of the following method of sterilization?

⑧a. Ethylene oxide gas
b. Autoclaving
c. Physical sterilization
d. Alcohol immersion

36. If a nurse will sterilize a heat and moisture stable instrument. It is according to AORN
-

recommendation to use which of the following method of sterilization?

a. Ethylene oxide gas
0
b. Autoclaving
c. Physical sterilization
d. Alcohol immersion

37. What is the recommended immersion time in glutaraldehyde for endoscopic equipment
to achieve sterilization?
a. 10 minutes
b. 20 minutes
0
c. 10 hours
d. glutaraldehyde does not sterilize

38. The overall floor plan of a surgical suite is divided into three areas or zones. The
following are the zones except one:
-

a. Unrestricted
b. Semi- restricted
c. Restricted
⑧
d. Highly restricted

39. This area provides an entrance and exit from the surgical suite for personnel, equipment
and patients:
0a. Unrestricted
b. Restricted
 c. Semi- restricted
d. Highly restricted

40. This area provides access to the procedure rooms and the peripheral support area within
the surgical suite
a. Unrestricted
⑧
b. Semi- restricted
c. Restricted
d. Highly restricted

41. This area requires personnel proper operating attire, including a mask since this area
requires maximum protection:
a. Unrestricted
⑧
b. Restricted
c. Semi- restricted
d. Highly restricted

42. According to the three-zone concept of surgical suite design, the dressing rooms are
located in the:
a. Restricted area
b. Clean area
c. Semi-restricted area
⑧
d. Nonrestricted area

43. Personnel entering the restricted area of the surgical suite are required to wear:
a. scrub suit
b. street clothes
c. scrub suit; cap
⑧
d. Proper OR attire with mask

44. When preparing a procedure room for the first case of the day, the perioperative nurse
notices the room humidity level to be 70 percent. The first action should be to:
a. Open the sterile supplies and call plant engineering to report the humidity level
⑧
b. Notify the plant engineering of the problem before opening the sterile supplies
c. Adjust the thermostat to make the room colder
d. Do nothing since this reading is within acceptable limits

45. After the induction of anesthesia, the client is observed to be shouting and laughing, the
pulse is rapid and respirations are irregular. The nurse knows that these are characteristics
of which stage of anesthesia?
a. surgical anesthesia
0
b. excitement stage
c. induction stage
d. danger stage

46. You have a critical heat labile instrument to sterilize and are considering using high level
disinfectant. What should you do?
a. Low level disinfectant immersion in 24 hours
0b. High level disinfectant immersion in 10 hours
c. High level disinfectant immersion in 1 hour
d. Intermediate level disinfectant immersion in 12 hours

47. Bronchoscope, endoscope, ET tube, cystoscope are all best sterilized using which of the
following?
a. Autoclaving at 121 degree Celsius
b. Flash sterilized at 132 degree Celsius in 3 minutes
c. Ethylene oxide gas aeration for 20 hours
⑧
d. 2 % glutaraldehyde immersion for 10 hours

48. The nurse documents that the wound edges are approximated. When the edges of an
incision are said to be approximated, this means edges are:
a. Erythematous and swollen
b. Necrotic and draining
c. Gaping and draining
0
d. Brought together by sutures, tapes or staples

49. Which of the following statements made by a client after a health teaching regarding total
laryngectomy needs clarification?
a. “I will have a stoma in my neck after surgery.”
b. “I need to adjust to a new airway.”
c. “My sense of smell will be affected by the surgery.”
0
d. “I will lose my voice temporarily.”

50. During the immediate postoperative period after a laryngectomy, a nursing priority for the
-

client should be to:

a. provide emotional support
b. promote means of communications
⑧c. keep the trachea free of secretions

d. observe signs of infection

51. The nurse knows that an essential aspect of pre-operative teaching for a client
-
scheduled for total laryngectomy is to explore ways of:
a. preventing complications
b. airway management
⑧
c. alternative means of communication
d. pain relief

52. A patient has received Atropine SO4 as a pre-medication 30 minutes ago and is now
complaining of dry mouth and her PR is higher, than before the medication was
-

administered. The nurse’s best response is:

a. The patient is anxious about upcoming surgery
anti-co
anticholinergic
-

b. The patient is having an allergic reaction to the drug

c. The patient needs a higher dose of this drug
8d. This is normal side-effect of AtSO4
53. An elderly male client is admitted for elective knee surgery. Physical examination reveals
shallow respirations but no sign of respiratory distress. Which of the following is a normal
physiologic change related to aging?
O
a. Decreased vital capacity
b. Increased elastic recoil of the lungs
c. Increased number of functional capillaries in the alveoli
d. Decreased residual volume

54. A patient with Diabete Mellitus underwent abdominal surgery. The patient sxperiences
wound evisceration. Which of the following is the most appropriate immediate nursing
intervention?
a. Ensure to cover the wound with sterile dry gauze.
b. Ensure to cover the wound with gauze soaked in water
c. Leave the wound uncovered and poull the skin edges together
⑧
d. Cove the wound with sterile gauze moistened with sterile normal saline.

55. A patient underwent thyroidectomy. Which of the following are the earliest signs of poor
-

respiratory function and poor skin turgor?

a. pallor, faintness
⑧
b. apprehension, restlessness
c. fast thread pulse, bradypnea
lethargy, cyanosis
Option 5