RNFA FINAL PRACTICE Exam 2022/2023 Questions and Answers

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The process of decontamination should initially begin at what point? - ANSWER Completion of the surgical procedure Side effects the patient may encounter as a result of extracoproreal circulation i... nclude: - ANSWER Inflammatory responses After retracting the nerve roots during a laminectomy, this structure is incised before getting to the disc. - ANSWER Posterior longitudinal ligament Of the following, which is not a symptom of compartment syndrome? - ANSWER Moderate pain Fibrocystic changes in the breast describe many different breast changes. These changes affect almost all women at some time in their lives. Nipple discharge is more commonly associated with benign lesions than with cancer; however, discharge is usually significant only if it is spontaneous, persistent, and: - ANSWER bloody Jan Stuyvesant, a perioperative nurse, was the scrub person during a robotic-assisted laparoscopic cholecystectomy. She locked the robotic endoscissor into the adaptor on the robotic arm and positioned the tip end into the trocar port in order for the surgeon to dissect the cystic duct and artery, while the surgical assistant placed the clips on the cystic duct and artery. As she reached across the sterile field to insert the cholangiocatheter through the port, the anesthesia provider accidentally made contact with the distal end of the catheter as he stood up to reach the monitor controls. The contaminated end of the catheter touched the endoscopic clip applier, the endoscissor connector that the surgeon was using, the glove of the assistant, and Jan's gown sleeve. The surgeon ordered everyone to change their gown and gloves and covered the port area with a sterile towel. What was the rationale for the surgeon to continue to dissect and not change his attire? - ANSWER The surgeon was not in contact with the sterile field because he worked from the robotic console. The ability to maintain thermoregulation is compromised in elders because of changes in the: - ANSWER vascular system Because herbal products are so readily available and have such widespread media attention, many people think that they can safely self-medicate. Why should the public be aware and educated about dietary supplements and potential harmful effects? - ANSWER Unknown substances may be present in these products. Talia Mendelson, a 27-year-old patient who had a lumpectomy for early-onset breast cancer, is now scheduled for infusion port insertion. Talia is very nervous because during the previous lumpectomy, performed using a local anesthetic, she was not entirely sedated. Talia tells the perioperative nurse that she was uncomfortable and heard everything in the room, but admitted that she did not feel pain. The nurse recognized Talia's anxiety related to the surgical intervention and prepared to implement corrective actions in the OR. What nursing intervention best reflects one that would ensure support or contribute to Talia realizing her expected outcome? - ANSWER Ensure a quiet and calm environment of care A 26-year-old female is rushed to the operating room after a primary and secondary survey in the emergency department. She was hit by a small truck as she was riding her bicycle through a busy intersection. She has sustained rib fractures and several fractured transverse vertebral processes. Renal injury is suspected. As the perioperative nurse prepares to insert a urinary catheter, she notices blood at the urinary meatus. What should the nurse's next action be? - ANSWER Discontinue the catheter insertion Open parathyroidectomy is currently being replaced with less invasive and more targeted techniques; however, the amount of parathyroid tissue that should be removed remains controversial and relates to whether single or multiple glands are involved. A portion of a gland must remain to: - ANSWER prevent hypocalcemia and its complications. Which of the following supplies blood to the transverse colon? - ANSWER Middle colic artery Which of the following structures form the mouth? - ANSWER cheeks, the hard palate, the mandible, and the tongue The salivary glands produce saliva, which serves to moisten the mouth and initiate: - ANSWER carbohydrate digestion. Potential development of a direct inguinal hernia results from ___________and __________weakening or tearing. - ANSWER Aponeurosis of transversus abdominus and transversalis muscle When the patient arrives in the ED, the trauma team initiates a primary assessment. This is a logical, orderly process of patient assessment for potential life threats. These assessment activities are based on established protocols for advanced trauma life support (ATLS). The mnemonic "ABCDE" is used, representing assessment of the following: Airway, Breathing, Circulation, Disability, and Exposure. The D and E represent what degree of investigation? - ANSWER D = a brief neurologic examination; E = exposure to reveal all life-threatening injuries What structure covers the spermatic cord and contracts to make the testicles ascend in the scrotum? - ANSWER Cremaster muscle Which of the following is not included in the group of tendons that comprise the rotator cuff? - ANSWER Teres Major The cranial meninges are composed of all except _____. - ANSWER Pericranial mater Sara Gardiner is the perioperative nurse in the circulating role in OR 2, and is planning for her three neurosurgical procedures for the day. She is explaining the basic processes of the three procedures to the scrub person and double-scrubbed surgical technology student: (1) a VP shunt insertion, (2) a reconstructive craniosynostosis for an infant with severe deformity, and (3) exploration of a severe head injury with increased intracranial pressure (ICP) to evacuate a hematoma and possible brain tissue. To give the brain room to swell in the third procedure, the bone flap may need to be sterile-wrapped and stored, for later replacement. Sara asks the student to name the appropriate surgical approach to the brain for each of the procedures. She expects the correct sequence to be: - ANSWER burr hole, craniectomy, and craniotomy. Describe the boundaries of the surgical skin prep for the patient about to receive a liver transplant. - ANSWER From the neck to midthigh; bedline to bedline Total thyroidectomy is the removal of both lobes of the thyroid and all thyroid tissue present. Total thyroidectomy is the desired surgical treatment for patients with: - ANSWER thyroid cancer. Which of the following describes a strangulated hernia? - ANSWER A persistent incarceration with a compromised blood supply The Glasgow Coma Scale (GCS) is commonly used to assess patients with brain injury using three indicators of cerebral function: eye opening, verbal communication, and motor response to verbal and noxious stimuli. Within the scoring range for the GCS, the best possible score is _____ and the worst possible score is ______. - ANSWER 15; 3 What mouth structure is considered the boundary between the buccal cavity and the lingual cavity? - ANSWER Teeth Laryngoscopy is direct visual examination of the interior of the larynx by means of a rigid, lighted speculum known as a laryngoscope to obtain a specimen of tissue or secretions for pathologic examination. What risk reduction strategy should the perioperative nurse employ in preparing for the conclusion of the procedure? - ANSWER Maintain instrument setup until the patient leaves the OR. Marissa Walton is transferred to the OR from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia. What important preparation for the procedure will the perioperative nurse perform before Marissa arrives in the OR? - ANSWER Prewarm the OR to above the ambient high temperature for an adult. FESS provides a more functional approach to treat sinus disease. FESS involves the endoscopic resection of inflammatory and anatomic defects of the sinuses while preserving natural function in a surgical procedure that is minimally invasive. From the following, choose an important finding that should be communicated to the surgeon immediately during this procedure. - ANSWER Encroachment of the orbit Administration of cyclogyl should be used in caution with which of the following patient groups? - ANSWER Patients on tricyclics What drug can be used to reverse the effects of heparin ? - ANSWER Protamine sulfate When assisting with an open inguinal hernia repair, the surgeon makes an incision through which of the following to access the cremaster muscle, inguinal canal, and cord structures? Choose the correct answer. - ANSWER External oblique muscle Identify the type of fracture that has more than two fragments. - ANSWER Comminuted Identify the correct path of the cardiac conduction system. - ANSWER From the SA node to the AV node to the bundle of His to the Purkinje system Transsphenoidal hypophysectomy (TSH) is performed with the patient administered a general endotracheal anesthetic, combined with a local anesthetic. The surgical team places the patient in a semisitting position, with the head against the headrest. A transnasal or a sublabial incision can be used for rapid access to the sella turcica. Select the diad (2) of conditions that would be appropriate indications for TSH. - ANSWER Hypopituitarism and small pituitary tumors Describe a pantaloon hernia. - ANSWER A combination direct and indirect hernia In renal transplantation a kidney with __________ artery(ies) is preferred. - ANSWER single With injury to the brain, swelling may occur quickly, requiring aggressive decisions to manage increasing intracranial pressure (ICP). What is an appropriate diuretic medication to give and what nursing actions would be indicated for an older adult patient with traumatic brain injury, increased ICP, and a history of congestive heart failure (CHF)? - ANSWER Furosemide (Lasix) 20-80 mg IV; monitor for hypotension and note extent of diuresis The production of CSF occurs where? - ANSWER Choroid plexus of the ventricles Select the true statement about antimetabolite drugs and their indications for use. - ANSWER 5-Fluorouracil and mitomycin can both be administered topically to inhibit scars and pterygium excision Select the statement that best reflects the functional components of the gastrointestinal (GI) tract. - ANSWER The alimentary canal extends from the mouth to the anus. As the surgeon prepared to clamp and transect the bowel during a small bowel resection for tumor, the scrub person transferred instruments from the Mayo stand to the back table and prepared the sterile field for bowel isolation technique. The rationale for this technique in tumor removal/cancer procedures is to: - ANSWER Prevent mechanical metastasis Heparin sodium is an anticoagulant. The basic mechanism of heparin's action is best described as: - ANSWER prevents the conversion of fibrinogen to fibrin. Which of the following associations is incorrect regarding gallstones? - ANSWER Gallstones in cystic duct = cholangitis The ovarian artery is a branch of which vessel? - ANSWER Aorta The double layer of fatty peritoneum attached to the greater curve of the stomach is known as the ____________. - ANSWER Omentum There are several risk factors associated with dehiscence. Which of the following can be controlled by the RNFA? - ANSWER Sutures placed too close together Skin grafting provides an effective way to cover a wound if vascularity is adequate, infection is absent, and hemostasis is achieved. Skin from the donor site is detached from its blood supply and placed in the recipient site. The best description of a successful skin graft outcome is: - ANSWER the recipient site develops a new blood supply from the base of the wound. Which of the following is the first major branch of the internal carotid artery? - ANSWER Opthalmic artery As a person ages. there is reduced blood flow to the abdominal viscera, reduced amounts of hydrochloric acid, and delayed gastric emptying. The result of of these physical changes include: - ANSWER Altered absorption of drugs From the following, choose where the hypothalamus is located. - ANSWER Along the floor of the third ventricle Select the true statement about dacryocystorhinostomy (DCR). - ANSWER DCR establishes a new passageway for tear drainage into the nasal cavity. A minimally invasive video-assisted thyroidectomy (MIVAT) procedure relies on Miccoli instruments added to the standard thyroid or neck dissection setup, a 30-degree endoscope, and an ultrasonic (harmonic) scalpel with scissors to ligate and divide the vessels. An important risk reduction strategy for any minimally invasive procedure would be ? - ANSWER consider and plan for the possibility of conversion to open thyroidectomy. When laryngoscopy, bronchoscopy, and esophagoscopy are performed in a single session on a patient, the procedure is termed triple endoscopy or panendoscopy. The purpose of triple endoscopy is usually diagnostic. A critical role of the perioperative nurse during this complex diagnostic procedure is that of: - ANSWER identifying, containing, and labeling all specimens accurately. Which of the following is not a reason to convert a case from laparoscopic to an open abdominal case? - ANSWER Lack of warmer for insufflation gas The liver is essential in the metabolism of carbohydrates, proteins, and fats, generating nutrient stores of which substance that supplies energy sources to the brain and body? - ANSWER Glycogen The kidneys are highly vascular organs. Approximately how much of the entire circulating blood volume do the kidneys process at any one time? - ANSWER One fifth Metastases to the spine occur most often in the thoracic spine, followed by the lumbar and cervical areas. Select the statement that best reflects a therapeutic spinal procedure goal for a secondary metastatic tumor. - ANSWER Surgery is directed toward decompressing and stabilizing the spine. The scaphoid, also called the navicular, links the proximal row of carpal bones as it: - ANSWER stabilizes and coordinates the movement of the proximal and distal rows. Identify the name of the procedure that is an alternative treatment for patients with chronic pulmonary emphysema. - ANSWER Lung volume reduction surgery Pamela Morris is a 62-year-old woman with a 4-year history of Graves' disease that has not responded to medical therapy. She is scheduled for a subtotal thyroidectomy. What condition, a complication of Graves' disease, is her probable indication for a subtotal thyroidectomy? - ANSWER Tracheal obstruction The most common congenital cyst found in the neck is: - ANSWER Thyroglossal duct cysts A stapedotomy is removal of the stapes superstructure and creation of a fenestra (opening) in the fixed stapes footplate for treatment of abnormal bone growth around the footplate that results in its immobility. The patient scheduled for a stapedotomy will typically not have a surgical diagnosis of: - ANSWER otosclerosis. Which structure supports the uterus and contains the uterine artery and vein ? - ANSWER Cardinal ligaments A positive Kehr's sign is _____. - ANSWER Left shoulder pain Miotics and mydriatics produce opposite effects on the pupil of the eye. Select the most appropriate statement about miotic and mydriatic drugs. - ANSWER Mydriatic drugs, such as phenylephrine, dilate the pupil. In the pulmonary circulatory system, blood is pumped from the right ventricle (RV) through the pulmonary valve into the main pulmonary artery (PA). The PA divides into the right and left pulmonary arteries, which further subdivide into the arterioles and capillaries of the lungs. Where does the blood from the lungs flow next? - ANSWER Through the pulmonary veins to the left atrium Of the following ocular blocks, which carries the highest risk? - ANSWER Retrobulbar block An example of an amphiarthrotic joint includes: - ANSWER Intervertebral joints What composes the lining of a herniated abdominal sac? - ANSWER Peritoneum A neurologist is about to perform a lumbar puncture on a patient presenting with altered neuro status due to a possible intracranial mass. Why would this procedure be contraindicated? - ANSWER The change in ICP from the lumbar puncture can result in brain herniation There are many factors that influence the behavioral manifestations of pain in the pediatric population. Which of the following is not an influencing factor? - ANSWER Parental involvement Anesthetic management impacts the success of ophthalmic surgery. Safe ambulatory surgery, especially in certain populations, depends on patient selection, preoperative evaluation, preparation, monitoring, and local anesthesia techniques. Select the patient below that would be an appropriate candidate for general anesthesia, instead of local anesthesia alone. - ANSWER A 22-year-old healthy female for a tear duct probing Thyroid storm can occur in patients whose hyperthyroidism is partially controlled or untreated. Thyrotoxic crisis can be precipitated by a stressful event, such as surgery. An example of a nursing action(s) to reduce the risk of thyroid storm is: - ANSWER provide a quiet, calm atmosphere and help the patient relax, and provide comfort measures, including a cooling blanket. Herbal supplements may have a role in the perioperative setting and are an important consideration for nurses. A mistaken assumption is that botanical dietary supplements are safer than prescribed or over-the-counter drugs. What assumption should the nurse make, during the nursing assessment, when the patient describes the use of dietary supplements and herbal products? - ANSWER Botanicals may initiate a pharmacologic response and should be considered as a medication. When coverage for a defect cannot be achieved through skin grafting, plastic surgeons rely on other techniques to replace tissue. After mastectomy, reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap is one of several options for nonsynthetic prosthetic reconstruction. Another descriptive term for the TRAM flap is the: - ANSWER pedicle-based flap The RNFA should anticipate the surgeon making an incision in which region to gain access to the pancreas? - ANSWER Right subcostal A wide range of equipment is used in ophthalmic surgery. The perioperative team's knowledge of proper operation should be confirmed through inservice education and training specific to new equipment, plus demonstrated competency. To ensure patient safety and appropriate function and application of surgical devices, which statement best reflects recommended practice when using complex biomedical equipment? - ANSWER Use the device according to the manufacturer's directions and test for proper performance before the patient enters the OR. Steven Morganstein, a 51-year-old male with hepatobiliary disease, is scheduled for surgery. The perioperative nurse, during the preoperative assessment, questions and examines the patient for signs and symptoms of jaundice, petechiae, and lethargy and: - ANSWER reviews his chart for bleeding and coagulation times and the platelet count. The absence of distinct teniae serves as a visual landmark for what abdominal structure? - ANSWER Upper margin of the rectum Which of the following operations require general anesthesia? - ANSWER MVR Exophthalmos can be associated with which of the following? - ANSWER Hyperthyroidism When a thyroglossal duct cyst is present in an adult, it exists as a pretracheal cystic pouch attached to what structure? - ANSWER Hyoid What special consideration should be made when assessing a pediatric trauma patient for level of consciousness? - ANSWER Use the modified Glasgow Coma Scale for children. Young children are predisposed to parasympathetic hypertonia (increased vagal tone), which can be induced by: - ANSWER painful stimuli such as eye surgery or abdominal retraction. For indirect hernia repair, the _____. - ANSWER Hernia contents are reduced to the abdominal cavity Twelve pairs of cranial nerves arise within the cranial cavity. Although they are part of the peripheral nervous system, from a surgical standpoint they are considered part of the anatomy of the head. Which three pairs of nerves, conveniently considered together because of their motor influence on the eye, are subject to toxic, inflammatory, vascular, and neoplastic lesions? - ANSWER Third, fourth, and sixth cranial nerves An important landmark during perineal prostatectomy is the: - ANSWER True prostatic capsule Select the semi-invasive diagnostic test that illustrates heart wall motion and blood flow through the heart and quantifies cardiac function. - ANSWER Radionuclide imaging Suction applied directly to neural tissue can be harmful To prevent tissue damage, a ___________should be placed between the neural tissue and the suction tip. - ANSWER Cottonoid Select the statement about the prostate that best reflects its location, size, and weight. - ANSWER The prostate sits below the base of the bladder, is 4 cm at the base, and weighs 20 to 30 g. During ventriculoperitoneal shunt placement, _____. - ANSWER The unit is soaked in NS & antibiotic solution, never lubricated. If cervical spine precautions were not implemented before arrival at the hospital, the emergency department team initiates them before performing any other procedures on the patient. A trauma team member can stabilize the head and neck, if necessary, until a cervical collar is placed. What event needs to take place before the team removes the cervical collar and continues care? - ANSWER A cervical radiograph is obtained to rule out injury to the neck. The pelvic floor consists of which muscle groups? - ANSWER Levator ani and coccygeal muscles Damage to this area of the brain is often devastating and life-threatening because it can affect movement, senses, consciousness, perception, and cognition. Choose the correct answer from the following. - ANSWER Brainstem Commonly implicated in SAH, the vessels of the Circle of Willis include: - ANSWER Posterior communicating artery Lasers assist in vaporization of scar tissue, granulomas, and cholesteatomas without damaging surrounding tissue and may be used for select otolaryngologic procedures. Lasers can be secured to the operating microscope and laser energy delivered to the tissue by means of a: - ANSWER micromanipulator. During the preoperative assessment for a patient scheduled for nasal surgery using a local anesthetic that includes epinephrine, what important consideration, relevant to epinephrine use, should be explored? - ANSWER Cardiac status Which of the following is not included in the the bony pelvis? - ANSWER Ileum The spleen's function in the defense of the body is achieved by: - ANSWER Phagocytosis The innermost membrane of of the brain is known as: - ANSWER Pia mater Which of the following structures is responsible for division between left and right chest cavity ? - ANSWER Mediastinum Sharon Close has been diagnosed with severe gastroesophageal reflux disease (GERD) without the dysplastic changes of Barrett's esophagus. Her GERD is unresponsive to proton pump inhibitors and histamine blockers. Her surgeon is hesitant to pursue an open or a laparoscopic Nissen surgical approach. What procedure might her surgeon consider in lieu of a Nissen? - ANSWER Endoluminal plication of the lower esophageal segment Which of the following is the treatment for a patient that has a postoperative empyema? - ANSWER Rib resection What is the mechanism by which the parathyroid glands maintain calcium homeostasis? - ANSWER They produce a hormone that, with calcitonin, takes calcium from the bones and promotes calcium absorption by the intestines. What statement regarding risk factors for developing vascular disease is true? - ANSWER Arteriosclerosis is a natural part of the aging process. The mammary glands are affected by physiologic changes throughout a woman's life span. Select the option that best reflects the life cycle events that impact the anatomy and physiology of the breasts. - ANSWER Growth and development, menstruation, and pregnancy and lactation An important anatomic landmark in thyroid surgery is known as: - ANSWER Poles Which of the following is a complication of patellectomy? - ANSWER Reduced knee extension The part of the femur that is most susceptible to fracture in conjunction with osteoporosis is: - ANSWER neck. A patient that presents to the OR with midface fractures should not have NG or nasal intubation performed due to a fracture of this particular structure can result in tube placement in the brain. Identify the structure from the following. - ANSWER Cribriform plate What is the correct rationale for not using methylene blue as a skin marker in the neurosurgical OR? - ANSWER Methylene blue produces an inflammatory reaction in CNS tissue. The rotator cuff consists of which group of muscles? - ANSWER Supraspinatus, infraspinatus, teres minor, and subscapularis Which of the following correctly identifies the phagocytic cells of the liver? - ANSWER Kupffer cells Depending on the surgical defect, head and neck surgical procedures to remove malignant tumors may also involve reconstructive procedures. The wound may be closed primarily, or local flaps and split-thickness skin grafts or full-thickness skin grafts may be used to restore function as well as cover defects. An important role of the perioperative nurse in the ongoing assessment of graft integrity includes which assessment tool? - ANSWER Use of intraoperative and postoperative Doppler to detect presence of graft pulse Impaired nutritional status is highly prevalent among the elderly; as many as 12% of men and 8% of women in the healthy geriatric population are considered undernourished. During the preoperative assessment and interview, what information will the perioperative nurse review, in addition to a thorough assessment including body mass index and Mini Nutritional Assessment? - ANSWER The serum albumin level Identify the class of medications that can increase the risk or severity of a reaction to contrast media. - ANSWER Beta Blockers Matilda Gunderson, a 55-year-old woman with uterine cancer, is scheduled for an open panhysterectomy. She is positioned in low lithotomy with her legs symmetrically arranged in padded cradle stirrups. After the incision is made and primary dissection accomplished, she will be positioned in Trendelenburg position to facilitate exposure of the lower pelvis and displacement of the small bowel from the operative area. Matilda is at risk for compromise and injury related to prolonged Trendelenburg tilt, which promotes: - ANSWER decreased pulmonary compliance and functional residual capacity. Surgeons use open reduction and internal fixation when they are unable to reduce a fracture by closed methods and skeletal traction is not indicated. What would be an advantage for an open rather than a closed fracture reduction technique? - ANSWER Direct observation and verification of fracture alignment The right and left coronary arteries originate in the corresponding sinuses of Valsava which are located ____________. - ANSWER Posterior to the cusps of the aortic valve Which of the following regarding PMMA ( bone cement) is not an affect local tissue? - ANSWER Skin burns due to exothermic reaction During a stapedotomy, it is important to save which of the following nerves that control taste on the anterior 2/3's of the tongue? - ANSWER Chorda tympani nerve Acquired valvular heart disease most commonly affects the ____________valves. Choose the correct answer. - ANSWER mitral Bone grafting can be completed using Allografts or Autografts. The type of graft used is not dependent on which of the following factors? - ANSWER The weight bearing ability of the bone affected A rapid rise in thyroid hormone levels is not caused by which of the following? - ANSWER Idodized table salt use Thyroid hormone medication [Show More]

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