Alexander’s Care of the Patient in Surgery 16 Th Edition By Jane Rothrock – Test Bank

Complete Test Bank With Answers
Sample Questions Posted Below

Chapter 03: Workplace Issues and Staff Safety Test Bank

MULTIPLE CHOICE

1. What one factor describes the high incidence of musculoskeletal disorders (MSDs) among surgical technologists and perioperative nurses?
   1. Pulling a large, heavy piece of equipment rather than pushing it
   2. The cumulative effect of repeated patient handling events
   3. The growing high obesity rate and heavier patients and care providers
   4. The cumulative effect of pushing, pulling, and carrying heavy instrument sets and rolling carts

ANS:  B

The high incidence of MSDs among nurses is the cumulative effect of repeated patient handling events, often involving unsafe loads. Nurses and surgical technologists often lift, transfer, or reposition patients on OR beds and transport vehicles, and assist with prepping with their arms outstretched or their bodies bent forward in awkward postures and positions, increasing the risk for injury.

REF:   p. 47

2. The lifting equation provides a mathematical equation to determine the recommended weight limit (RWL) and lifting index (LI) for selected two-handed manual lifting What is the recommended maximum weight limit for one person in a patient handling task, and what is the best option when the weight limit exceeds the recommendation?
   1. 25 lb; bend from the knees, not the waist
   2. 32 lb; use good body mechanics
   3. 35 lb; wear a support belt
   4. 37 lb; use assistive lift devices

ANS:  D

The concept behind the lifting equation is to start with a recommended weight that is considered safe for an ideal lift and then to reduce the weight as the task becomes more stressful. In general, the revised equation yields a recommended 35-lb maximum weight limit for use in patient handling tasks. When the weight to be lifted exceeds this limit, assistive devices should be used.

REF:   pp. 49-50

3. Wet floors are a common hazard causing slips, trips, and falls (STFs). Select a prevention strategy that is a best practice for preventing STFs from spills on wet
   1. Transport liquids in covered containers with lids in
   2. Place bright yellow low-profile pop-up signs in areas where STFs are most likely to
   3. Position highly visible yellow absorptive pads in areas where STFs are most likely to
   4. Use a dripless, brush-free gel solution for surgical patient skin

ANS:  A

Planning to avoid wet spots can reduce the rate of falls. Providing lids for all cups or other open containers being transported helps to avoid spills.

REF:   p. 50

4. An STF hazard is present when the scrub person stands on a lift, or foot stool, to reach an acceptable height for ergonomic comfort with the sterile Whether the scrub person usesone stool, stacked stools, or a “runway” of stools, the danger exists that a fall could occur.What classification of cause and prevention factor does this situation represent?
   1. Proper footwear
   2. Unobstructed pathways
   3. Uneven floor surface
   4. Lighting

ANS:  C

Falls on the same level also occur at transition areas, such as from dry to wet, on uneven surfaces, or from one type of floor surface to another. Healthcare facilities should ensure that there are no uneven surfaces, including thresholds, on floors. In stairwells with potentially low visibility, the nosing on the top and bottom steps can be painted to provide visual cues.

REF:   p. 50

5. A sharps-safe area on the sterile field between the scrub person and the surgeon—where sharps can be transferred to the surgeon from the scrub person and returned to the scrub person after use—is referred to as the:
   1. sharps
   2. hands-free
   3. neutral
   4. safety

ANS:  C

The “neutral zone” has been defined as a location on the surgical field where sharps are placed in a predesignated sterile basin or tray or on a magnetic pad, from which the surgeon or assistant can retrieve them. After use, the items are returned to the neutral zone, and the scrub person retrieves them. This technique eliminates hand-to-hand passing of sharps between the surgeon and the scrub person, so that no two individuals touch the same sharp at the same time.

REF:   p. 52

6. Select the appropriate nursing action that supports hands-free instrument passing and sharps
   1. Create a neutral hands-free area between the scrub person and surgeon with a basin or magnetic
   2. Use a hands-free area for sharps and all small clamps or
   3. Announce the transfer of the sharp or clamp as soon as possible after it is
   4. During the hand-off report, ask the relief scrub person if he/she will want to use the hands-free technique for passing

ANS:  A

A magnetic pad or basin may be used to create the neutral zone; if a basin is used, it should be placed on the field and not held by the scrub person. Dedicate the neutral zone to sharps only; these include suture and hypodermic needles, scalpels, and other sharp instruments. Place only one sharp at a time in the neutral zone. Announce the transfer of a sharp before placing it in  the neutral zone (such as “knife down”). Include identification of the neutral zone during

hand-off communications to relief scrub persons.

REF:   p. 52

7. Select the true statement that best explains the Occupational Safety and Health Administration (OSHA) exposure control plan (ECP).
   1. OSHA has developed the Hierarchy of Controls model, which protects the workplace from lawsuits stemming from worker injury from sharps and blood
   2. The OSHA ECP is similar to the Health Insurance Portability and Accountability Act (HIPAA) in that it protects the workplace from being exposed when a worker injury occurs that could harm the facility’s
   3. The OSHA ECP is designed to provide guidelines to control risks and protect workers from sharps injury and bloodborne
   4. The OSHA ECP is a materials management strategy to explore replacements for sharps and other healthcare devices that can cause sharps injury and blood

ANS:  C

OSHA regulations require healthcare organizations to protect their workers and to have a sharps injury and bloodborne pathogen ECP. At a minimum, the following must be included in the ECP: determination of employee exposure; implementation of exposure control methods, including universal precautions, engineering and work-practice controls, personal protective equipment (PPE) and housekeeping, hepatitis B vaccination, postexposure evaluation and follow-up, communication of hazards to employees and training, recordkeeping, and procedures to evaluate exposure incidents.

REF:   pp. 54-55

8. Select the true statement that best describes a key component of the culture of safety in regards to blood
   1. A goal of the culture of safety is to reduce the risk of blood exposure and sharps injuries to
   2. The culture of safety is a model for ensuring The Joint Commission survey expectations are
   3. The culture of safety is mandated by regulatory agencies to structure environmental
   4. The ECP was designed to provide the framework for the culture of

ANS:  A

A healthcare institution’s culture of safety profoundly impacts its success or failure in reducing employees’ blood exposure risk. For sharps safety in particular, success factors include effective systematic review of exposure data, workers’ perceptions of exposure risk, availability and use of safety devices, and comprehensive education on bloodborne pathogen exposure risk and safety device use.

REF:   p. 55

9. Select the guideline that complements the design of the culture of safety
   1. Take advantage of a personal injury event to learn about future prevention
   2. Comply with those policies that fit your current
   3. Incorporate safe practices into your daily work when handling
   4. Observe local, state, and federal regulations as they fit your current

ANS:  C

You can take significant measures toward ensuring your personal safety and avoiding injuries from sharps if you do the following: Adopt and incorporate safe habits into daily work activities when preparing and using sharp devices. Observe local, state, and federal (OSHA) regulations. Comply with methods to protect yourself from disease transmission (e.g., get the hepatitis B vaccination). Participate in education about bloodborne pathogens, and follow recommended infection prevention practices. Know the location in your department of the ECP. Finally, follow the exposure control policy if injured, including immediate reporting of the incident and commencement of exposure response procedures.

REF:   pp. 55, 61

10. What is the purpose of a Safety Data Sheet (SDS)?
    1. To recommend exposure limits of all chemicals in the workplace over a working lifetime
    2. To inform all employees of the presence, characteristics, handling, and risks of chemicals in the workplace
    3. To provide a structured design for inservices and skill stations on hazardous chemical safety
    4. To promote the development of manuals and log books for The Joint Commission (TJC) survey

ANS:  B

The purpose of the OSHA standards is to ensure that all hazards of chemicals produced or imported are evaluated and that information concerning hazards is transmitted to employers and employees. Responsibility to inform workers about chemical hazards and to use control measures, including providing PPE, rests with the employer. The OSHA hazard communication standard requires all manufacturers and importers of hazardous chemicals to develop SDSs for all chemicals and mixtures of chemicals.

REF:   p. 62

11. Where are the sources of radiation exposure in an operating room setting?
    1. Ionizing sources (e.g., ultrasound machines) and nonionizing sources (e.g., magnetic resonance imaging [MRI] scanners)
    2. Nonattenuated fluorescent lights and portable X-ray machines without lead guards
    3. Radioactive seed implants not contained in a lead container and nonionizing lasers
    4. Nonionizing sources (e.g., lasers) and ionizing sources (e.g., X-ray machines and C-arms)

ANS:  D

Sources of radiation exposure in the OR include ionizing sources, such as portable radiography (X-ray) machines and portable fluoroscopy units (C-arm), and nonionizing sources, such as lasers.

REF:   p. 63

12. Which of the following may be a consequence of high-dose or full-body radiation?
    1. Contrast media reaction
    2. Perioral numbness and tingling
    3. Nausea, vomiting, and diarrhea
    4. Wheezing, dyspnea, and tachycardia

ANS:  C

Acute exposure to ionizing radiation can result in dermatitis and reddening of the skin (erythema) at the point of exposure, while large, full-body exposures can lead to radiation poisoning, symptoms of which may include nausea, vomiting, diarrhea, weakness, and death.

REF:   p. 63

13. Latex allergy develops from exposure to natural rubber latex and plant cytosol, used extensively to manufacture medical gloves and other devices, as well as numerous consumer Allergic reactions to latex range from skin disease to asthma and anaphylaxis that can result in chronic illness, disability, career loss, hardship, and death. Which signs and symptoms would be indicative of an allergic contact dermatitis response to contact with natural rubber latex?
    1. Pruritus, edema, erythema, and vesicles that develop 6 to 48 hours after exposure
    2. Dry, reddened, itchy skin with hives and peeling patches
    3. Cracked hands, nausea, vomiting, and perioral numbness and tingling
    4. Generalized urticaria, wheezing, dyspnea, and tachycardia

ANS:  A

Allergic contact dermatitis is a delayed reaction, usually appearing 6 to 48 hours after exposure. Symptoms are similar to those from irritant contact dermatitis (i.e., drying papules, crusting and thickening of the skin), except that the reaction may extend beyond the actual point of contact. Allergic contact dermatitis (also called chemical contact dermatitis) is a delayed cell-mediated type IV localized allergy caused by chemicals used to manufacture rubber products.

REF:   p. 64

14. A nurse anesthesia provider has an allergy to When she is at work, she always carries an epinephrine autoinjector and a beta-agonist inhaler. What type of latex allergy does she have?
    1. Allergic contact dermatitis
    2. Irritant contact dermatitis
    3. Type I IgE-mediated hypersensitivity reaction
    4. Combined-effect latex allergy

ANS:  C

A true latex allergy is a type I IgE-mediated hypersensitivity reaction that involves systemic antibody formation to proteins in products made from natural rubber latex. The allergic response is immediate and anaphylactic. Medications include epinephrine for reaction (may be autoinjector and carried by individual), beta-agonist inhaler, prednisone, and other  anaphylactic life-supporting medications.

REF:   pp. 64-65

15. Healthcare professionals should employ strategies to reduce their risk of allergic reaction to latex in the perioperative Which of the following represents a best practice for minimizing the risk of latex allergy development in nonallergic patients and the risk of a reaction in sensitive or allergic patients?
    1. Use powder-free gloves that have low levels of protein and chemical
    2. Use sterile oil-based hand creams before donning gloves if latex gloves must be
    3. Before donning latex gloves, sprinkle hands with cornstarch to create a barrier between skin and
    4. Wear an OR hat without an elastic band and do not wear rubber tennis

ANS:  A

Use powder-free gloves that are low in protein and chemical allergens. Use nonlatex gloves for activities that are not likely to involve contact with infectious materials.

REF:   p. 65

16. Which list of medications best reflects medications indicated for latex sensitivity therapeutic management?
    1. Epinephrine, prednisone, and a beta-agonist inhaler
    2. Atropine, dopamine, and beta-blockers
    3. Dopamine, mannitol, and sodium bicarbonate
    4. Dimethylxanthine, atropine, and mannitol

ANS:  A

Medications used during a reaction include epinephrine (may be autoinjector and carried by individual), beta-agonist inhaler, prednisone, and other anaphylactic life-supporting medications.

REF:   p. 66

17. Perioperative personnel historically have relied on numerous types of precautions to protect themselves and others from bloodborne pathogens and other infectious Select the statement that best differentiates between universal and standard precautions.
    1. Universal precautions and standard precautions are the same; however, standard precautions require more hand hygiene and prevention of sharps
    2. Many similarities and differences exist between universal and standard precautions; however, they both are equally effective against transmission-based
    3. Standard precautions apply to blood; all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood; mucous membranes; and nonintact
    4. Universal precautions is the same as blood and body fluid

ANS:  C

Standard precautions apply to (1) blood; (2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood; (3) mucous membranes; and (4) nonintact skin.

REF:   p. 62

18. Contact with infected patients or infectious material places healthcare workers at risk for occupational-acquired Which communicable disease are healthcare workers at risk for acquiring or transmitting?
    1. Mumps
    2. Varicella
    3. Seasonal influenza
    4. Hepatitis C

ANS:  C

Patients transmit influenza to healthcare workers and, in turn, healthcare workers who are clinically or subclinically infected with influenza can transmit seasonal influenza to patients or others. Studies demonstrate seasonal influenza antibodies in healthcare workers who did not recall ever having a respiratory tract infection. By receiving the seasonal influenza  vaccination, healthcare workers protect themselves, their patients, and their families.

REF:   p. 63

19. What vaccine should healthcare workers receive if they are caring for immunocompromised patients?
    1. Live attenuated influenza vaccine (LAIV)
    2. Inactivated influenza vaccine
    3. Immunoglobulin
    4. Bordetella vaccine

ANS:  B

Inactivated influenza vaccine and live attenuated influenza vaccine (LAIV) are widely available for workers in the healthcare professions. LAIV is approved only for nonpregnant healthy persons, ages 5 to 49 years. Healthcare workers caring for severely immunocompromised patients should not receive LAIV. Instead, the inactivated influenza vaccine is the preferred vaccine for workers who come into direct contact with this group of patients. Bordetella is a gram-negative coccobacilli of the phylum Proteobacteria and the most common cause of tracheobronchitis (kennel cough) in dogs.

REF:   p. 63

20. Waste anesthetic gases are small amounts of gases that may leak either from the patient’s anesthetic breathing circuit into the OR air while anesthesia is being administered or from exhalation of the patient during Both mechanisms of exposure create risks for OR personnel. What is an effect of short-term exposure for the healthcare worker?
    1. Spontaneous abortion
    2. Infertility
    3. Cancer
    4. Lethargy and fatigue

ANS:  D

Short-term exposure causes lethargy and fatigue. Long-term exposure may be linked to spontaneous abortion, congenital abnormalities, infertility, premature births, cancer, and renal and hepatic disease. Today, perioperative staff members are exposed to trace amounts of waste anesthetic gas, and although this exposure cannot be eliminated, it can be controlled.

REF:   p. 61

21. If a staff person receives a needlestick injury, what is the first corrective action?
    1. Immediately report to employee health, the emergency department (ED), or the designated
    2. Wash wound with soap and water; flush mucous
    3. Alert the supervisor of the
    4. Undergo immediate testing; ensure confidentiality for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)

ANS:  B

If a needlestick or other occupational contact (e.g., splashing or spraying) that could result in a bloodborne pathogen exposure does occur, the injured person should wash with soap and  water all wounds and skin sites that have been contacted by blood or body fluids. Procedures following include alerting the supervisor and initiating the injury reporting system used in the workplace; identifying the source patient; testing the patient for HIV, HBV, and HCV infections; immediately reporting to employee health, the ED, or the designated facility; and documenting the exposure in detail, for your own records as well as for the employer and for workers’ compensation purposes.

REF:   p. 55

22. A neutral zone is a predetermined location on the surgical field where sharps are placed for retrieval by the surgeon. Which of the following is a best practice for the use of the neutral zone?
    1. Place all sharps that will be used during surgery in the neutral zone before the start of the
    2. When a sterile basin is designated as the neutral zone, have the scrub person hold the
    3. Announce the transfer of each sharp before placing it in the neutral
    4. Use the neutral zone for non-sharp instruments when it is the most convenient

ANS:  C

Guidelines for the best use of the neutral zone include the following: only one sharp at a time should be placed in the zone; if a sterile basin is used, it should be placed on the field and not held by the scrub person; transfers should be announced before a sharp is placed in the zone; the neutral zone should be dedicated to sharps only.

REF:   p. 53

23. The Hierarchy of Controls model defines a method to control exposure to occupational hazards as a fundamental approach to protect Which control measure is of the highest priority of those listed?
    1. Engineering controls

1. Substitution
2. Elimination
3. PPE

ANS:  C

Elimination is the highest priority. After elimination in the hierarchy comes substitution, then engineering control, administrative controls, and finally PPE. The concept of the hierarchy is that the control methods at the top of the list are potentially more effective and protective than those at the bottom.

REF:   p. 55

24. A new graduate perioperative nurse was consistently verbally criticized and teased by her The ensuing stress caused her to make mistakes and contributed to lost time from work. She was experiencing:
    1. unlawful
    2. physical
    3. horizontal
    4. psychological

ANS:  C

Horizontal (or lateral) violence occurs when nurses inflict psychologic injury on one another. While patients are the main perpetrators of physical violence, staff members are the main perpetrators of psychological violence.

REF:   p. 65

MULTIPLE RESPONSE

1. Exposure to bloodborne pathogens occurs during all phases of the perioperative Observing safety precautions during all phases of surgery, from setup to cleanup, reduces the number of injuries and exposures for all OR personnel. For the prevention of sharps injuries in the preprocedure and postprocedure phases, which safe handling practices reflect appropriate nursing actions? (Select all that apply)
   1. Use standardized sterile field setups throughout the surgical services
   2. Organize the Mayo stand with all sharps visible and pointed toward the setup
   3. Transport reusable sharps in a safe, closed container to the decontamination cleanup
   4. Safely grasp the sharp tip with gloved fingers when disposing in sharps
   5. Do not place hands or fingers into a container to dispose of a
   6. Inspect the sharps container for overfilling before discarding disposable sharps in

ANS:  A, C, E, F

During preparation for surgery, use standardized sterile field setups throughout the surgical services department. Organize the work area (Mayo stand, back table) so that sharps are always pointed away from the person setting up. During postprocedure cleanup, transport reusable sharps in a closed, secure container to the designated cleanup area. Inspect the surgical setup used during the procedure for sharps. Keep hands behind the sharp tip when disposing. Do not place hands or fingers into a container to dispose of a device. Inspect the sharps container for overfilling before discarding disposable sharps in it.

REF:   p. 52