Test Bank For Alexanders Care Of the Patient in Surgery 14th Edition Rothrock

Test Bank For Alexanders Care Of the Patient in Surgery 14th Edition Rothrock

Rothrock: Alexander’s Care of the Patient in Surgery, 14^th Edition

Chapter 02: Patient Safety and Risk Management

Test Bank

MULTIPLE CHOICE

1. Governmental and professional agencies and organizations, whether voluntary (governmental) 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.

ANS: D

WHO was created by and functions within the United Nations (UN) as the directing and coordinating authority for health throughout UN member nations.

REF: Page 21

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:

ANS: A

The Association of Operating Room Nurses (now called the Association of periOperative Registered Nurses [AORN]) began organizing in the early 1950s. AORN’s conferences and publications were replete with patient safety information. Its first conference in 1954 included programs on methods’ improvement, explosion prevention, bacteria destruction, the surgeon-nurse relationship, and positioning.

REF: Page 18

3. The perioperative environment is a dangerous place for both patients and staff. The surgical patient is at risk for harm, regardless of age, surgical diagnosis, or planned procedure. Select the physical risks.

ANS: A

A physical risk is some damaging or noxious element that comes into contact with the patient to cause harm, such as electrosurgical/laser beam, pooled prep solution, glutaraldehyde retained in an endoscope, or a retained foreign object.

REF:Pages 34, 37-38

4. Sara Martin, 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. In addition to comfort and caring behaviors and reassurance from the perioperative nurse to mitigate Sara’s nervousness and fears, the admission 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:

ANS: D

Key features of the Universal Protocol for perioperative patient care are performing a preoperative verification process, marking the operative site, and conducting a “time out” immediately before starting the procedure. A properly performed “time out” includes information about the patient and the procedure.

REF: Page 19

5. Sara was positioned, prepped, and draped following general endotracheal anesthesia induction. The team assembled around Sara and the sterile field to perform the time-out as described in the WHO surgical checklist. Successful employment of the time-out can only be ensured when:

ANS: B

All members of the team must introduce themselves by name and role and participate in sharing critical elements of care. The team includes the surgeon, anesthesia provider, and nursing staff, plus any allied or ancillary care providers contributing to the procedure when the time-out is performed.

REF: Pages 21, 24

6. When unexpected events occur that have, or could have, compromised patient safety, a systematic investigatory process takes place. Significant information is gained through this meticulous exploration. The primary motive for carrying out a root cause analysis is to:

ANS: C

Root cause analysis is a systematized process to identify variations in performance that cause, or could cause, a sentinel event. The analysis phase of root cause analysis progresses from “why” questions to “what can be done to prevent this” questions that flow and ultimately result in an action plan. Root cause analysis concentrates on systems and processes, not individuals.

REF: Page 19

7. The National Patient Safety Goals (NPSG) are intimately aligned with the perioperative nursing–sensitive interventions that define the daily role functions of the perioperative nurse. In the early days of the twentieth century (1900s), as perioperative nursing evolved as a specialty of nursing practice, history was chronicled when someone remarked that: ____________________________________________________________________.

Select the quote that best relates perioperative nursing care to the NPSG.

ANS: C

Most perioperative nursing interventions are aimed at protecting patients from the unintended insults of regular surgical care and the risks inherent in surgery. Tightly coupled systems are most prone to accidents, and surgical suites, emergency departments, and intensive care units are examples of complex, tightly coupled systems.

REF: Pages 18-20

8. After Sara Martin emerged from anesthesia and was extubated, she was transferred to the PACU by the anesthesia provider and perioperative nurse. She had an excision of a benign subglossal cyst. A hand-off report was given to the accepting PACU nurse. The anesthesia provider and perioperative nurse described the procedure, allergies, weight in kilograms, intake and fluid loss, anesthetics and medications, pain, and several other critical parameters of physiologic status. Choose the answer below that completes the blanks in this sentence: _________________________ is the first element of information that should be shared in the hand-off report; the ______________________ has the responsibility for the ultimate transfer of information.

ANS: C

All patient encounters should begin with patient identification verification. The receiving healthcare provider bears the responsibility of obtaining all of the information needed to safely care for the patient before the transferring staff leave the area. Time for clarification and questioning must be provided. The purpose of hand-off communication and reports is to provide essential, up-to-date, and specific information about the patient. Standardized hand-off communication must include an opportunity to ask and respond to questions.

REF: Page 26

9. The OR is a danger-prone area for both patients and staff. Providing a safe environment of care for the patient involves identifying, mitigating, and managing the hazards inherent in surgical care. Choose the answer below that completes the blanks in this sentence: The risk of the surgical hazard of _________________ can be mitigated through ________________________.

ANS: A

Evidence shows that wrong site surgery not only can devastate the patient and family but also can impact the perioperative team adversely. All institutions accredited by TJC must follow the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. The surgical team must agree that this is the correct patient and that the planned procedure is on the specified side and site. Marking the surgical site must be done so that the intended site of incision or insertion is clear and unambiguous.

REF: Page 31

10. Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained foreign objects (RFOs). What new and evolving risk reduction strategy could prevent RFOs and frustrating, time-consuming miscount adventures at the end of these procedures?

ANS: D

At a minimum, all facilities should have a “count” policy that reflects AORN’s Recommended Practices for Sponge, Sharp, and Instrument Counts. While standard counting prevented 82% of retained sponges, bar-coded and RFID-tagged sponges prevented about 97.5% of retained sponges. The bar-coded sponges were the most cost-effective. Researchers suggest that, given medical and liability costs of more than $200,000 per incident, sponge tracking technologies can substantially reduce the incidence of retained surgical sponges at an acceptable cost.

REF: Page 34