CNOR Assignments Week 3 2024 with Summary

What do you think about a weekday CNOR course?

We’re trying out a virtual course during the week a couple of times in 2024 to see if it’s something that might work for people. Would you have rather registered for a class during the week?

The dates will be July 1-2 and Dec 12-13 this year. We’ll see how it goes. If this works out well maybe we’ll add a couple more. I just don’t know if it’s better for people or not. I’d love your opinion.

If you’ve been in the study group a while you know I like to run things like this by you and appreciate your feedback!

1. What is the incision site for an appendectomy? What are early s/s of MH?
McBurney’s is the site for appendectmy.
Early signs of MH include increase end tidal CO2, Increase HR/BP/RR, and muscle rigidity.

2. What does hypothermia in the PACU do to the patient’s VS?
Post-op hypothermia is defined as a body temp less than 96.8 (36C). O2 consumption increases by 300-400% and can be dangerous for patients with cardiac problems, even leading to MI. This increase in O2 consumption causes ischemia and acidosis. You will also see CNS deprssion and prologed elimination of muscle relaxants/anesthesia. (Alexander’s 16th ed. pg. 1172)

VS would look like this: decreased SpO2, low BP (hypovolemia and increased bleeding)
HR I would think would be high? to try and compensate for the low BP increased oxygen demands.

3. Spaulding classification for bronchoscope?
Semi-Critical

4. If your patient is hypoventilating what would you expect the pH and CO2 to look like on the ABG?
Not blowing off CO2 would increase the CO2 and drop the pH (ROME). Respiratory acidosis, need to increase RR.

5. Prepping an ear for Otoplasty, what prep do you use? A. Povidone Iodine B. CHG C. Hydrogen peroxide
A. Povidone Iodine
(Alexander’s 16th ed. pg. 4438)
*Alcohol and CHG never used on the face

1. What does a Bowie Dick test do?

– Proper functioning of the vacuum system in the Pre- vacuum autoclave. Zander CNOR Review

2. What is Virchow’s Triad?

– This includes Venous Stasis, the only thing that we have any control {immobility during surgery, sequential compression device}, Endothelial injury{ surgery interrupt vascular endothelium}, Hyper-coagulability{ clothing cascade triggered} Zander CNOR Review

3. What is the definition of Evidence Based Practice (EBP?

-Providing holistic quality care based on the most up-to-date research and knowledge rather than traditional methods advice from colleagues, or personal belief. Google

4. What electrolytes are affected by the parathyroid?

– Calcium and Phosphorus. Zander CNOR Review

5. What is the reversal for Versed (Midazolam)?

-Romacicon Zander CNOR Review

1.What part of the gown is considered sterile?

The front of a sterile gown forms the chest to the level of the sterile field and the gowns sleeves from the cuff to 2 inches above the elbow, circumferentially (AORN 2023, pg.1022).

2.What does anesthesia need for Nissan Fundoplication? A. Bougie, B. McGill forceps C. Nasal airway?

Answer: A =Bougie (Remember it being discussed by Wendy  in video).

3.Can patient hand off communication be faxed?

According to AORN, it states to “Establish and  implement a standardized process  for the transfer of patient information between  individuals and team.” This standardized handover process helps to identify risks during the peri-op phases so the team can take action to minimize threats to the patients safety (AORN 2023, pg.1161). It doesn’t necessarily state it must be done in person though.

4.The anesthesiologist has inserted a subclavian central line and an arterial line. The patient starts having increased work in breathing and decreased oxygen saturation. What likely happened to the patient? (MI, pneumothorax, something else X2).

Pneumothorax (PubMed/NIH). It states that subclavian vein insertion has been reported to have a higher incidence of pneumothorax.

5.What packaging is used with Ethylene Oxide Sterilizers?
Use only packaging and container materials designed and validated by the packaging manufacturer to withstand the high temperatures of dry-heat sterilization (ARON 2023, pg.1073). Also states to use closed containers , to use small containers (when possible) and to keep package low density.

Wendy, can the post summer video have an option to maximize screen like in week#1 video? Video for week#2 doesn’t have that option. I’m a visual learner so I like to see your face & facial reaction when discussing topics and my brain works better seeing it on the big screen.  Thanks for considering this.

Hilda,

I think Chris probably meant to make it expandable. Thanks for letting us know that it doesn’t do that. We’ll fix it.

Thanks Allison!

1. What is the incision site for an appendectomy? McBurney’s is the site for appendectmy.

What are early s/s of MH? Early signs of MH include increase end tidal CO2, Increase HR/BP/RR, and muscle rigidity.

Well, thanks for answering my crazy mashed together question. Good grief. Both are correct. 🙂

2. What does hypothermia in the PACU do to the patient’s VS?
Post-op hypothermia is defined as a body temp less than 96.8 (36C). O2 consumption increases by 300-400% and can be dangerous for patients with cardiac problems, even leading to MI. This increase in O2 consumption causes ischemia and acidosis. You will also see CNS depression and prolonged elimination of muscle relaxants/anesthesia. (Alexander’s 16th ed. pg. 1172)

VS would look like this: decreased SpO2, low BP (hypovolemia and increased bleeding)
HR I would think would be high? to try and compensate for the low BP increased oxygen demands.

Everything slows down. The heart rate too. This decreases cardiac output. Need to keep the patient’s toasty. Hypothermia is bad for you.

3. Spaulding classification for bronchoscope?
Semi-Critical

Correct

4. If your patient is hypoventilating what would you expect the pH and CO2 to look like on the ABG?
Not blowing off CO2 would increase the CO2 and drop the pH (ROME). Respiratory acidosis, need to increase RR.

Awesome job! Exactly right.

5. Prepping an ear for Otoplasty, what prep do you use? A. Povidone Iodine B. CHG C. Hydrogen peroxide
A. Povidone Iodine
(Alexander’s 16th ed. pg. 4438)
*Alcohol and CHG never used on the face

Correct. Betadine is the best option. You an actually use Technicare (PCMX) too. I think you’re looking for Povidone Iodine on the exam though.

Thanks Juan!

1. What does a Bowie Dick test do?

– Proper functioning of the vacuum system in the Pre- vacuum autoclave. Zander CNOR Review

Correct

2. What is Virchow’s Triad?

– This includes Venous Stasis, the only thing that we have any control {immobility during surgery, sequential compression device}, Endothelial injury{ surgery interrupt vascular endothelium}, Hyper-coagulability{ clothing cascade triggered} Zander CNOR Review

Yes. The trifecta of DVT formation. You don’t really need to know what makes up the triad for the exam. Just know what it is. They’ll ask how to avoid Virchow’s Triad. You’ll answer anything that prevents DVTs. I’m pretty sure SCDs is the answer.

3. What is the definition of Evidence Based Practice (EBP?

-Providing holistic quality care based on the most up-to-date research and knowledge rather than traditional methods advice from colleagues, or personal belief. Google

Correct. It’s doing things a certain way because we’ve done studies and looked at results. It’s not ‘because my preceptor told me to’

4. What electrolytes are affected by the parathyroid?

– Calcium and Phosphorus. Zander CNOR Review

Correct

5. What is the reversal for Versed (Midazolam)?

-Romacicon Zander CNOR Review

Correct

Thank you for the answers Hilda.

1.What part of the gown is considered sterile?

The front of a sterile gown forms the chest to the level of the sterile field and the gowns sleeves from the cuff to 2 inches above the elbow, circumferentially (AORN 2023, pg.1022).

Correct

2.What does anesthesia need for Nissan Fundoplication? A. Bougie, B. McGill forceps C. Nasal airway?

Answer: A =Bougie (Remember it being discussed by Wendy  in video).

You’re right! 🙂 Good memory

3.Can patient hand off communication be faxed?

According to AORN, it states to “Establish and  implement a standardized process  for the transfer of patient information between  individuals and team.” This standardized handover process helps to identify risks during the peri-op phases so the team can take action to minimize threats to the patients safety (AORN 2023, pg.1161). It doesn’t necessarily state it must be done in person though.

This is a great answer. It doesn’t. I’ve worked for a hospital that routinely faxed report to the receiving unit. When I first started there it felt wrong. It isn’t. We had to have a cover sheet so that the report was not sitting open on the fax machine but that was it….okay then.

4.The anesthesiologist has inserted a subclavian central line and an arterial line. The patient starts having increased work in breathing and decreased oxygen saturation. What likely happened to the patient? (MI, pneumothorax, something else X2).

Pneumothorax (PubMed/NIH). It states that subclavian vein insertion has been reported to have a higher incidence of pneumothorax.

It does. Correct

5.What packaging is used with Ethylene Oxide Sterilizers?
Use only packaging and container materials designed and validated by the packaging manufacturer to withstand the high temperatures of dry-heat sterilization (ARON 2023, pg.1073). Also states to use closed containers , to use small containers (when possible) and to keep package low density.

I’ve heard from some that we should know that you can put woven materials into an Ethylene Oxide sterilizer. Maybe this person is remembering the same question but just gave it to me worded differently? I think you should remember that woven materials can go into EO.

1, A supraphrenic cyst is found intraop. How do you clean the room after surgery?
2, How often are disaster drills done?
3, Why does the obturator go with the trach patient after surgery to the post op unit?
4, Where are endoscopes stored?
5, 68 y.o. male healthy patient at outpatient surgery center getting herniorrhaphy, periop nurse should expect which local to be for post-op management (1% lido, bupivacaine with epi 0.5%, mepivacaine 1% with epi, etc.)

Answers:  1, Regular turnover   2, Twice a year   3, ?  4,Positive airflow pressure room Dry cabinet storage with HEPA  5,  Lidocaine 1% with epi

1.What does a Bowie Dick test do?

The Bowie-Dick test is performed daily to ensure that the air vacuum pump is functioning properly (Berry and Kohn 13th Edition page 309)

2.What is Virchow’s Triad?

Virchow’s triad are elements or risk factors that trigger venous thrombosis : endothelial injury, venous stasis, and hypercoagulability.(Alexander’s 15th Edition page 904)

3.What is the definition of Evidence Based Practice (EBP)?

Procedure or activity that is validated with scientific proof in a clinical setting (Berry and Kohn 13th Edition page 75)

4.What electrolytes are affected by the parathyroid?

Calcium and Phosphate (Zander CNOR Prep)

5.What is the reversal for Versed (Midazolam)?

Flumazenil (Romazicon) (Zander CNOR Prep)

Thank you Yasuko,

1, A supraphrenic cyst is found intraop. How do you clean the room after surgery?

Regular turnover

Correct. This is not a communicable disease so regular turn over cleaning is adequate.

2, How often are disaster drills done?

Twice a year

Right. Disaster drills are held at least twice a year to test plans deletions by the committee, to improve and familiarize personnel with them. You can find that in Berry & Kohn’s Operating Room Technique page 85

3, Why does the obturator go with the trach patient after surgery to the post op unit?

?

They’re going to need it to change their trach. It stays with the patient.

4, Where are endoscopes stored?

Positive airflow pressure room Dry cabinet storage with HEPA

Here are a few snips from the 2023 Guidelines:

5, 68 y.o. male healthy patient at outpatient surgery center getting herniorrhaphy, periop nurse should expect which local to be for post-op management (1% lido, bupivacaine with epi 0.5%, mepivacaine 1% with epi, etc.)

Lidocaine 1% with epi

Here’s my thinking on this one. We know we’re going to use Epinephrine for post op pain control. Now, Bupivacaine is longer acting Than lidocaine and I believe mepivacaine is used more for nerve blocks. I would choose Bupivicaine with epi. Read Alexander’s pg 282 for more information. Read this question carefully. I want there to be some hint about choosing a longer acting medication.

Thank you Yadan!

1.What does a Bowie Dick test do?

The Bowie-Dick test is performed daily to ensure that the air vacuum pump is functioning properly (Berry and Kohn 13th Edition page 309)

Correct. The Bowie-Dick test is a one trick pony. This is all it does.

2.What is Virchow’s Triad?

Virchow’s triad are elements or risk factors that trigger venous thrombosis : endothelial injury, venous stasis, and hypercoagulability.(Alexander’s 15th Edition page 904)

Correct.

3.What is the definition of Evidence Based Practice (EBP)?

Procedure or activity that is validated with scientific proof in a clinical setting (Berry and Kohn 13th Edition page 75)

Right

4.What electrolytes are affected by the parathyroid?

Calcium and Phosphate (Zander CNOR Prep)

Correct

5.What is the reversal for Versed (Midazolam)?

Flumazenil (Romazicon) (Zander CNOR Prep)

Correct. Great job

A supraphrenic cyst is found intraop. How do you clean the room after surgery?

I couldn’t find supraphrenic cyst, It was coming ups a subphrenic abscess as a coIIection of pus in contact with the under surface of the diaphragm.

Exposure to infectious waste is a hazard to everyone who encounters it. After each surgical procedure the environment should be made safe for the next person to follow in the room.Institutional policies and procedures for routine room cleanup should redesigned to minimize the OR team’s exposure to contamination during the  cleaning process.

How often are disaster drills done?

Disaster drill are held at least twice a year to test the plans developed by the committee, to seek to improve them, and to familiarize personnel with them.

-Berry and Kohns, Administration of Perioperative Patient Care Services, pg 85

Why does the obturator go with the trach patient after surgery to the post op unit?

Patients with a tracheostomy should have the obturator used for initial tracheostomy placement present and readily available. Many health facilities recommend that obturators be taped to the wall at the head of the bed in case of the need for emergency tracheostomy tube reinsertion. Additionally, there should be spare tracheostomy tubes (same size and one size smaller), lubricant, syringe for cuff inflation, and tracheostomy ties (or means to resecure the tracheostomy tube) if reinsertion is required. A bag valve mask should always be kept at the bedside.

-Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Skills [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021. Chapter 22 Tracheostomy Care & Suctioning. Available from: https://www.ncbi.nlm.nih.gov/books/NBK593189/#

Where are endoscopes stored?

Endoscopes should be stored in a drying cabinet. AAMI standard also recommends that cabinets be located in a secure environment. The cabinet doors should be kept closed and located 3 feet from a sink.

-outpatient surgery Division of AORN. “Flexible Endoscope Storage Solutions. Adam Taylor. 8/14/2023

68 y.o. male healthy patient at outpatient surgery center getting herniorrhaphy, periop nurse should expect which local to be for post-op management (1% lido, bupivacaine with epi 0.5%, mepivacaine 1% with epi, etc.)

You would use 0.5% bupivicaine because it is used a good wound infiltration, and the advantages are good relaxation, long acting, and can constrict blood vessels to reduce bleeding at the site.

-Alexanders Care of The Patient in Surgery. Jane Rothrock. 15th edition.page 139.

JULIE

1. What part of the gown is considered sterile?

Gowns are sterile in the front from mid-chest level to the level of the sterile field … The gowns are sterile from two inches above the elbow to the cuff seam. (Standards of Practice for Gowning and Gloving)

2. What does anesthesia need for Nissan Fundoplication? A. Bougie, B. McGill forceps C. Nasal airway?

A. Bougie (Alexander’s care of the patient in surgery 16 th ed. p 316)

3. Can patient hand off communication be faxed?

No. 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 (Alexander’s care of the patient in surgery 16 th ed. p 22)

4. The anesthesiologist has inserted a subclavian central line and an arterial line. The patient starts having increased work in breathing and decreased oxygen saturation. What likely happened to the patient? (MI, pneumothorax, something else X2).

Subclavian line placement may be associated with pneumothorax, chylothorax, pneumomediastinum, recurrent laryngeal nerve injury, tracheal injury, and air embolism. [9] Pneumothorax or pneumomediastinum occurs in about one percent of cases.

5. What packaging is used with Ethylene Oxide Sterilizers?
As we use Ethylene Oxide method for heat and moisture sensitive items, in my opinion the package is supposed to be heat and moisture resistant. From previous lessons I remembered probably in the exam it will be answer WOVEN material.

If your last name starts with C, G, I, J, or K

A supraphrenic cyst is found intraop. How do you clean the room after surgery?
A normal turnover which includes damp dusting all horizontal surfaces with an approved disinfectant. This helps keep the OR clean and dust free for the next patient. Cleaning from the cleanest to the dirtiest areas and from top down (Berry and Kohn 14th edition p. 203-5).

How often are disaster drills done?
“Disaster drills are held at least twice a year to test the plans developed by the committee, to seek to improve them, and to familiarize personnel with them” (Berry and Kohn 14th edition p. 85).

Why does the obturator go with the trach patient after surgery to the post op unit?
The obturator needs to stay with the patient so the trach can be changed. The obturator is a rigid “stylet like” piece that helps get the trach tube in place while inserting the tube then it is removed and saved for future changes (https://tracheostomyeducation.com/tracheostomy-tubes/).

Where are endoscopes stored?
Endoscopes are stored in a closed cabinet in a storage area and are hung in a vertical position to keep the lumens dry (Berry and Kohn 14th edition p. 643).

68 y.o. male healthy patient at outpatient surgery center getting herniorrhaphy, periop nurse should expect which local to be for post-op management (1% lido, bupivacaine with epi 0.5%, mepivacaine 1% with epi, etc.
Bupivacaine 0.5% w/Epi is a long-acting (2-3 hours) anesthetic and should be used to decrease or reduce the use of post op narcotics (Berry and Kohn 14th edition pp. 132, 444).  

1. How is a cytology specimen sent to lab?

Fresh or added solution of pathologist’s choice in a STERILE CONTAINER.  (B & K Table 22.1 pg 387)

2. What are the early s/s of LAST?

Initial phase: metallic taste in mouth, numb tongue and lips, ringing in ears, light headedness, agitation

(Zander lecture/Safe Admin of Anesthesia at 12:50 on slides)

3. If someone is on droplet precautions would Standard Precautions still apply?

Transmission-based precautions are the second tier of basic infection control and are used in addition to Standard Precautions.  (CDC)

4. There is gross spillage of bowel contents during a colon resection.  What is the wound class, the word, not the number.

Contaminated  (Zander lecture on Wound Healing)

5. What are the positioning risk factors for a thoracotomy?

Brachial Plexus injury (Alexander’s pg 522), Pressure injury due to extrinsic factors (Alexander’s pg 503)

How is a cytology specimen sent to pathology?
A cytology specimen is sent to the lab on a Clean container cup, no formalin added. Label the specimen.

What are the early s/s of LAST?
agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste.

https://www.ncbi.nlm.nih.gov/books/NBK499964/#:~:text=Initial%20signs%20and%20symptoms%20include,%2C%20metallic%20taste%2C%20and%20dysarthria.

If somebody is on Droplet precautions, would Standard Precautions still apply?yes..😊

There is a gross spillage of bowel contents during a colon resection. What is the wound class. The word, not the number
Dirty/Infected

What are the positioning risk factors for a thoracotomy?
Pressure ulcers prevention, nerve injury prevention.

What does a Bowie Dick test do?
Unlike physical monitoring data, chemical indicators are also able to report internal conditions. FDA-approved, sterilizer manufacturer-recommended chemical indicators should be placed on the outside and inside of each package to be sterilized, unless the internal indicator is readable through the package material. Chemical indicators are grouped into 6 types, based on how they work (Type 1 and Type 5 indicators are currently the most commonly used). External indicators include:

Type 2 (also called Bowie-Dick tests) detect air leaks, ineffective air removal and the presence of non-condensable gases. Intended for daily use in dynamic-air-removal sterilizers, they should be run through a cycle in an empty chamber before the first load of the day to test the system.(AORN website)z

What is Virchow’s Triad?
A pathological assessment known as Virchow’s Triad attributes thrombosis to the confluence of 3 conditions: vessel wall injury, stasis in blood flow and changes in coagulation. (AORN website)

What is the definition of Evidence Based Practice (EBP)?
Evidence-based practice (EBP) is fundamental to quality patient care. It provides clinicians the tools needed to promote safer patient care and positive patient outcomes in all care settings. (AORN website)

What electrolytes are affected by the parathyroid?
The main function of the parathyroid glands is to make the parathyroid hormone (PTH). This chemical regulates the amounts of calcium, phosphorus and magnesium in the bones and blood. The minerals calcium and phosphorus are crucial for healthy bones. (Better Health Channel Website)

What is the reversal for Versed (Midazolam)?
Flumazenil in a dose of 0.15 mg is a safe drug that reverses the sedative effect of midazolam. (National Library of Health website)

If your last name starts with M, V, W, X, Y, or Z

1. What part of the gown is considered sterile?
The front side of the gown is considered from the level of the OR field to the mid-chest; sleeves from the cuff sleeves to 2 inches above the elbow; Sleeve cuffs should be  covered by the gloves; (AORN, page 1022)

2. What does anesthesia need for Nissen Fundoplication? A. Bougie, B. McGill forceps C. Nasal airway?
A. Bougie

3. Can patient hand-off communication be faxed?
No. Hand-off communication needs to be between the nurse taking care of the patient to the next nurse who will be giving a break or starting a new shift. Also, faxing patient information violates patient information because anyone can potentially ready the information.

4. The anesthesiologist has inserted a subclavian central line and an arterial line. The patient starts having increased work in breathing and decreased oxygen saturation. What likely happened to the patient? (MI, pneumothorax, something else X2).
Pneumothorax. “An increased number of attempts during insertion and a large diameter catheter increases the risk of pneumothorax.”  Deere M, Singh A, Burns B. Central Venous Access of the Subclavian Vein. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482224/

5. What packaging is used with Ethylene Oxide Sterilizers?
A breathable packaging material must be used,

What do you think about a weekday CNOR course?

We’re trying out a virtual course during the week a couple of times in 2024 to see if it’s something that might work for people. Would you have rather registered for a class during the week?

The dates will be July 1-2 and Dec 12-13 this year. We’ll see how it goes. If this works out well maybe we’ll add a couple more. I just don’t know if it’s better for people or not. I’d love your opinion.

I would be interested, but it depends on the time.

Sonya Jackson (last name ends in ‘J’). Here are my responses to the questions.

A  supraphrenic cyst is found intraop. How do you clean the room after surgery?

A regular turnover would be required.

How often are disaster drills done? Twice a year.

Why does the obturator go with the trach patient after surgery to the post op unit?
The obturator must go with the patient after surgery in case the tracheostomy tube needs to be reinserted.

Where are endoscopes stored?
In a scope cabinet.  At my facility the scope cabinet is either temperature or humidity controlled.

68 y.o. male healthy patient at outpatient surgery center getting herniorrhaphy, periop nurse should expect which local to be for post-op management (1% lido, bupivacaine with epi 0.5%, mepivacaine 1% with epi, etc.)
Bupivicane with epi 0.5%

1. I couldn’t find supraphrenic cyst- but subphrenic is inferior to diaphragm and superior to liver so Supra would be above. If it’s a cyst or abcess it’s Regular Turnover.  With Standard Precautions. (From Zander slides)
2. Disaster drills are done twice a year. (Zander module on Trauma)
3. the obturator is kept at the bed in case the cannula becomes dislodged and needs to be reinserted.
   4.  Endoscopes are stored in a drying cabinet.  (Zander Sterile Processing module.
4. Number 5. 1%Lido 4-5mg/kg/day with epi 7mg/kg/day. Bupivacaine w/epi is the longest acting for post op. (Zander Safe Admin of Anesthesia module)

What is the incision site for an appendectomy? What are early s/s of MH?
a.      McBurney

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 86

b.      Trismus (tightened jaw), increase in end tidal CO2, increased muscle rigidity, increased heart rate, increased blood pressure, quick change in soda lime filter’s color.

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 122

What does hypothermia in the PACU do to the patient’s VS?
Hypothermia in the PACU  causes the patient to shiver, which will cause their oxygen saturations to drop, may cause cardiac changes, an increased heart rate.

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 141

Spaulding classification for bronchoscope?
Semi-critical

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 17

If your patient is hypoventilating what would you expect the pH and CO2 to look like on the ABG?
Low pH, high CO2

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 159

Prepping an ear for Otoplasty, what prep do you use? A. Povidone Iodine B. CHG C. Hydrogen peroxide
Povidone iodine for ear, eye, perineum

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 87

If your last name starts with B, A, D, E, or F

1) What is the incision site for an appendectomy? What are early s/s of MH?
Mc Burney’s incision. The early signs of MH include increase end tidal CO2, increase HR, increase BP, increase RR, and muscle rigidity.
2)What does hypothermia in the PACU do to the patient’s Post-op V/S?  Post Op hypothermia is a temp of less than 96.8 (36C).   O2 consumption will increase and can be dangerous for patients with cardiac problems, that may also lead to MI. It will cause ischemia and acidosis. It will cause CNS depression and prolonged elimination of muscle relaxants/anesthesia. (Alexander’s 16th Ed)
3) Spaulding classification for bronchoscope? Semi-Critical ( Alexander’s 16th Ed)
4)If your patient is hypoventilating what would you expect the pH and CO2 to look like on the ABG? Respiratory Acidosis,low pH, high CO2.
5)Prepping an ear for Otoplasty, what prep do you use? A. Povidone Iodine B. CHG C. Hydrogen peroxide.    A. Povidone Iodine

Edlyne, Week 3, 2024

How is a cytology specimen sent to pathology?
In a dry container

Ref: Zander Review

What are the early s/s of LAST?
Signs of systemic local anesthetic toxicity often progress in a stepwise manner. Patients may initially report perioral numbness, a metallic taste in the mouth, ringing in the ears visual disturbances, and/or dizziness.

Ref: Alexander’s page 464

If somebody is on Droplet precautions, would Standard Precautions still apply?
Contact Precautions

Caregivers should wear a mask when working within 3 feet of the patient.

Ref: 265

There is a gross spillage of bowel contents during a colon resection. What is the wound class. The word, not the number
Class 3

Contaminated wounds are open, fresh, accidental wounds, such as penetrating trauma open fractures, or operations with major breaks in aseptic technique, such as the inadvertent intraoperative use of nonsterile instruments or supplies. Incisions with signs of infection or gross spillage from the gastrointestinal tract also are included. Example are a penetrating abdominal trauma involving bowel and a gunshot wound to the abdomen.

Ref: Alexander’s page 822

What are the positioning risk factors for a thoracotomy?
Pressure injuries

Alexander’s page 2860

Thank you Pearl!

1. A supraphrenic cyst is found intraop. How do you clean the room after surgery?

I couldn’t find supraphrenic cyst, It was coming ups a subphrenic abscess as a coIIection of pus in contact with the under surface of the diaphragm.

Exposure to infectious waste is a hazard to everyone who encounters it. After each surgical procedure the environment should be made safe for the next person to follow in the room. Institutional policies and procedures for routine room cleanup should redesigned to minimize the OR team’s exposure to contamination during the  cleaning process.

Regular turnover cleaning is all that is needed. We exercise standard precautions during turnover and that’s adequate for a dirty case. We assume they all are.

2. How often are disaster drills done?

Disaster drill are held at least twice a year to test the plans developed by the committee, to seek to improve them, and to familiarize personnel with them. -Berry and Kohns, Administration of Perioperative Patient Care Services, pg 85

Correct

3. Why does the obturator go with the trach patient after surgery to the post op unit?

Patients with a tracheostomy should have the obturator used for initial tracheostomy placement present and readily available. Many health facilities recommend that obturators be taped to the wall at the head of the bed in case of the need for emergency tracheostomy tube reinsertion. Additionally, there should be spare tracheostomy tubes (same size and one size smaller), lubricant, syringe for cuff inflation, and tracheostomy ties (or means to resecure the tracheostomy tube) if reinsertion is required. A bag valve mask should always be kept at the bedside.

-Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Skills [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2021. Chapter 22 Tracheostomy Care & Suctioning. Available from: https://www.ncbi.nlm.nih.gov/books/NBK593189/#

Correct

4. Where are endoscopes stored?

Endoscopes should be stored in a drying cabinet. AAMI standard also recommends that cabinets be located in a secure environment. The cabinet doors should be kept closed and located 3 feet from a sink.

-outpatient surgery Division of AORN. “Flexible Endoscope Storage Solutions. Adam Taylor. 8/14/2023

Correct

5. 68 y.o. male healthy patient at outpatient surgery center getting herniorrhaphy, periop nurse should expect which local to be for post-op management (1% lido, bupivacaine with epi 0.5%, mepivacaine 1% with epi, etc.)

You would use 0.5% bupivicaine because it is used a good wound infiltration, and the advantages are good relaxation, long acting, and can constrict blood vessels to reduce bleeding at the site.

-Alexanders Care of The Patient in Surgery. Jane Rothrock. 15th edition.page 139.

I agree. With epi

Thank you Julie!

1. What part of the gown is considered sterile?

Gowns are sterile in the front from mid-chest level to the level of the sterile field … The gowns are sterile from two inches above the elbow to the cuff seam. (Standards of Practice for Gowning and Gloving)

Correct

2. What does anesthesia need for Nissan Fundoplication? A. Bougie, B. McGill forceps C. Nasal airway?

A. Bougie (Alexander’s care of the patient in surgery 16 th ed. p 316)

Correct

3. Can patient hand off communication be faxed?

No. 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 (Alexander’s care of the patient in surgery 16 th ed. p 22)

I’ve worked for a hospital that routinely faxed report to the receiving unit. There was a place on the top of the fax for the name and phone number of the nurse who was sending the patient. I never could find anything that says that faxing a report was recommended but I’ve never found anything that says it has to be in person either.

4. The anesthesiologist has inserted a subclavian central line and an arterial line. The patient starts having increased work in breathing and decreased oxygen saturation. What likely happened to the patient? (MI, pneumothorax, something else X2).

Subclavian line placement may be associated with pneumothorax, chylothorax, pneumomediastinum, recurrent laryngeal nerve injury, tracheal injury, and air embolism. [9] Pneumothorax or pneumomediastinum occurs in about one percent of cases.

Right. Pneumothorax is what we should remember for the exam.

5. What packaging is used with Ethylene Oxide Sterilizers?
As we use Ethylene Oxide method for heat and moisture sensitive items, in my opinion the package is supposed to be heat and moisture resistant. From previous lessons I remembered probably in the exam it will be answer WOVEN material.

You’re right. 🙂

Thank you Bradley!

1. A supraphrenic cyst is found intraop. How do you clean the room after surgery?
A normal turnover which includes damp dusting all horizontal surfaces with an approved disinfectant. This helps keep the OR clean and dust free for the next patient. Cleaning from the cleanest to the dirtiest areas and from top down (Berry and Kohn 14th edition p. 203-5).

That’s right

2. How often are disaster drills done?
“Disaster drills are held at least twice a year to test the plans developed by the committee, to seek to improve them, and to familiarize personnel with them” (Berry and Kohn 14th edition p. 85).

Correct

3. Why does the obturator go with the trach patient after surgery to the post op unit?
The obturator needs to stay with the patient so the trach can be changed. The obturator is a rigid “stylet like” piece that helps get the trach tube in place while inserting the tube then it is removed and saved for future changes (https://tracheostomyeducation.com/tracheostomy-tubes/).

Correct

4. Where are endoscopes stored?
Endoscopes are stored in a closed cabinet in a storage area and are hung in a vertical position to keep the lumens dry (Berry and Kohn 14th edition p. 643).

Since 2022 Guidelines it has to be a drying cabinet or a positive pressure HEPA filtered cabinet is okay if you have a table top dryer. I would expect to see drying cabinet on the exam.

5. 68 y.o. male healthy patient at outpatient surgery center getting herniorrhaphy, periop nurse should expect which local to be for post-op management (1% lido, bupivacaine with epi 0.5%, mepivacaine 1% with epi, etc.
Bupivacaine 0.5% w/Epi is a long-acting (2-3 hours) anesthetic and should be used to decrease or reduce the use of post op narcotics (Berry and Kohn 14th edition pp. 132, 444).

I agree.

Thanks Stacey,

1. How is a cytology specimen sent to lab?

Fresh or added solution of pathologist’s choice in a STERILE CONTAINER.  (B & K Table 22.1 pg 387)

The answer on the exam is a dry sterile container. The other options I’m hearing about are silly. Like ‘culture medium’, formalin or on a piece of gauze placed in the container.

2. What are the early s/s of LAST?

Initial phase: metallic taste in mouth, numb tongue and lips, ringing in ears, light headedness, agitation

(Zander lecture/Safe Admin of Anesthesia at 12:50 on slides)

Correct

3. If someone is on droplet precautions would Standard Precautions still apply?

Transmission-based precautions are the second tier of basic infection control and are used in addition to Standard Precautions.  (CDC)

Right. Standard precautions are… standard. Then transmission based precautions are on top of that. 🙂

4. There is gross spillage of bowel contents during a colon resection.  What is the wound class, the word, not the number.

Contaminated  (Zander lecture on Wound Healing)

Correct

5. What are the positioning risk factors for a thoracotomy?

Brachial Plexus injury (Alexander’s pg 522), Pressure injury due to extrinsic factors (Alexander’s pg 503)

I agree. I believe the lateral knee and malleolus (ankle) are mentioned too.

Hi Tania. Thank you for the answers.

1. How is a cytology specimen sent to pathology?
A cytology specimen is sent to the lab on a Clean container cup, no formalin added. Label the specimen.

Correct

2.What are the early s/s of LAST?
agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste.

https://www.ncbi.nlm.nih.gov/books/NBK499964/#:~:text=Initial%20signs%20and%20symptoms%20include,%2C%20metallic%20taste%2C%20and%20dysarthria.

Right. The perioral numbness, metallic taste are definitely mentioned by people who tell me about this question.

3.If somebody is on Droplet precautions, would Standard Precautions still apply?yes..😊

Correct

4.There is a gross spillage of bowel contents during a colon resection. What is the wound class. The word, not the number
Dirty/Infected

If the spill happens during surgery it’s contaminated (class 3). I think that’s what this question is looking for. However, if we opened the patient to find bowel contents in the peritoneum already there, that’s infected (class 4)

5. What are the positioning risk factors for a thoracotomy?
Pressure ulcers prevention, nerve injury prevention.

Brachial plexus and Peroneal nerves are most at risk.

Thanks Patricia!

1. What does a Bowie Dick test do?

Unlike physical monitoring data, chemical indicators are also able to report internal conditions. FDA-approved, sterilizer manufacturer-recommended chemical indicators should be placed on the outside and inside of each package to be sterilized, unless the internal indicator is readable through the package material. Chemical indicators are grouped into 6 types, based on how they work (Type 1 and Type 5 indicators are currently the most commonly used). External indicators include:

Type 2 (also called Bowie-Dick tests) detect air leaks, ineffective air removal and the presence of non-condensable gases. Intended for daily use in dynamic-air-removal sterilizers, they should be run through a cycle in an empty chamber before the first load of the day to test the system.(AORN website)z

Right. The Bowie Dick tests assures that the vacuum cycle is functioning properly

2. What is Virchow’s Triad?
A pathological assessment known as Virchow’s Triad attributes thrombosis to the confluence of 3 conditions: vessel wall injury, stasis in blood flow and changes in coagulation. (AORN website)

Correct. Just remember it’s about DVT formation and you’ll do fine

3. What is the definition of Evidence Based Practice (EBP)?
Evidence-based practice (EBP) is fundamental to quality patient care. It provides clinicians the tools needed to promote safer patient care and positive patient outcomes in all care settings. (AORN website)

Correct. It’s basing practice upon studies instead of tradition

4. What electrolytes are affected by the parathyroid?
The main function of the parathyroid glands is to make the parathyroid hormone (PTH). This chemical regulates the amounts of calcium, phosphorus and magnesium in the bones and blood. The minerals calcium and phosphorus are crucial for healthy bones. (Better Health Channel Website)

Remember Calcium for the exam.

5. What is the reversal for Versed (Midazolam)?
Flumazenil in a dose of 0.15 mg is a safe drug that reverses the sedative effect of midazolam. (National Library of Health website)

Correct.

Thanks Allynne!

1. What part of the gown is considered sterile?
The front side of the gown is considered from the level of the OR field to the mid-chest; sleeves from the cuff sleeves to 2 inches above the elbow; Sleeve cuffs should be  covered by the gloves; (AORN, page 1022)

Correct

2. What does anesthesia need for Nissen Fundoplication? A. Bougie, B. McGill forceps C. Nasal airway?
A. Bougie

Correct

3. Can patient hand-off communication be faxed?
No. Hand-off communication needs to be between the nurse taking care of the patient to the next nurse who will be giving a break or starting a new shift. Also, faxing patient information violates patient information because anyone can potentially ready the information.

When I worked at a hospital that did this it felt wrong to me too. But, there’s nothing in the regulations that I can find that says it can’t be faxed. If you can find something please point me to it. Everything on the printer/fax machine is patient information. So, it’s common practice. The cover sheet and location of the machine make it private.

4. The anesthesiologist has inserted a subclavian central line and an arterial line. The patient starts having increased work in breathing and decreased oxygen saturation. What likely happened to the patient? (MI, pneumothorax, something else X2).
Pneumothorax. “An increased number of attempts during insertion and a large diameter catheter increases the risk of pneumothorax.”  Deere M, Singh A, Burns B. Central Venous Access of the Subclavian Vein. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482224/

Correct

5. What packaging is used with Ethylene Oxide Sterilizers?
A breathable packaging material must be used,

Correct. I believe the answer on the exam has to do with woven material.

Hi Sonya,

Thank you for the answers!

1. A  supraphrenic cyst is found intraop. How do you clean the room after surgery?

A regular turnover would be required.

Correct

2. How often are disaster drills done? Twice a year.

Correct

3. Why does the obturator go with the trach patient after surgery to the post op unit?
The obturator must go with the patient after surgery in case the tracheostomy tube needs to be reinserted.

Correct

4. Where are endoscopes stored?
In a scope cabinet.  At my facility the scope cabinet is either temperature or humidity controlled.

As of 2022 Guidelines it must be a drying cabinet. If you don’t have a drying cabinet, you can alternatively use a table top dryer and then store in a HEPA filtered positive pressure cabinet.

5. 68 y.o. male healthy patient at outpatient surgery center getting herniorrhaphy, periop nurse should expect which local to be for post-op management (1% lido, bupivacaine with epi 0.5%, mepivacaine 1% with epi, etc.)
Bupivicane with epi 0.5%

Correct

Thanks Liz!

1. I couldn’t find supraphrenic cyst- but subphrenic is inferior to diaphragm and superior to liver so Supra would be above. If it’s a cyst or abcess it’s Regular Turnover.  With Standard Precautions. (From Zander slides)

This is what others who had this question found as well. I think that the person who sent me this question simply remembered the word incorrectly. You’re right. Regular turnover cleaning is required.

2. Disaster drills are done twice a year. (Zander module on Trauma)

Correct

3. the obturator is kept at the bed in case the cannula becomes dislodged and needs to be reinserted.

Correct

4.  Endoscopes are stored in a drying cabinet.  (Zander Sterile Processing module.

Correct

5. Number 5. 1%Lido 4-5mg/kg/day with epi 7mg/kg/day. Bupivacaine w/epi is the longest acting for post op. (Zander Safe Admin of Anesthesia module)

Correct

Thank you Juliana!

What is the incision site for an appendectomy? What are early s/s of MH?
a.      McBurney

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 86

b.      Trismus (tightened jaw), increase in end tidal CO2, increased muscle rigidity, increased heart rate, increased blood pressure, quick change in soda lime filter’s color.

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 122

Both are correct! I’m sorry I doubled the question up. 🙂

2. What does hypothermia in the PACU do to the patient’s VS?
Hypothermia in the PACU  causes the patient to shiver, which will cause their oxygen saturations to drop, may cause cardiac changes, an increased heart rate.

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 141

It slows everything down.

3. Spaulding classification for bronchoscope?
Semi-critical

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 17

Correct.

4. If your patient is hypoventilating what would you expect the pH and CO2 to look like on the ABG?
Low pH, high CO2

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 159

Correct. Respiratory Acidosis

5. Prepping an ear for Otoplasty, what prep do you use? A. Povidone Iodine B. CHG C. Hydrogen peroxide
Povidone iodine for ear, eye, perineum

Zander Perioperative Education, LLC Zander CNOR Exam Preparation Course pg 87

Correct

Thank you J.A.!

1) What is the incision site for an appendectomy? What are early s/s of MH?
Mc Burney’s incision. The early signs of MH include increase end tidal CO2, increase HR, increase BP, increase RR, and muscle rigidity.

Both answers are correct

2)What does hypothermia in the PACU do to the patient’s Post-op V/S?  Post Op hypothermia is a temp of less than 96.8 (36C).   O2 consumption will increase and can be dangerous for patients with cardiac problems, that may also lead to MI. It will cause ischemia and acidosis. It will cause CNS depression and prolonged elimination of muscle relaxants/anesthesia. (Alexander’s 16th Ed)

Correct. It slows everything down.

3) Spaulding classification for bronchoscope? Semi-Critical ( Alexander’s 16th Ed)

Correct

4)If your patient is hypoventilating what would you expect the pH and CO2 to look like on the ABG? Respiratory Acidosis,low pH, high CO2.

Right. Respiratory Acidosis

5)Prepping an ear for Otoplasty, what prep do you use? A. Povidone Iodine B. CHG C. Hydrogen peroxide.    A. Povidone Iodine

Correct.

Hi Edlyne.

Thank you for the answers.

1. How is a cytology specimen sent to pathology?
In a dry container

Ref: Zander Review

Right. This is the answer on the exam to this question. There are some cytology specimens sent in alcohol but that is not an option.

2. What are the early s/s of LAST?
Signs of systemic local anesthetic toxicity often progress in a step wise manner. Patients may initially report perioral numbness, a metallic taste in the mouth, ringing in the ears visual disturbances, and/or dizziness.

Ref: Alexander’s page 464

Correct

3. If somebody is on Droplet precautions, would Standard Precautions still apply?
Contact Precautions

Caregivers should wear a mask when working within 3 feet of the patient.

Ref: 265

Standard precautions are always followed. Droplet precautions are in addition to that.

4. There is a gross spillage of bowel contents during a colon resection. What is the wound class. The word, not the number
Class 3

Contaminated wounds are open, fresh, accidental wounds, such as penetrating trauma open fractures, or operations with major breaks in aseptic technique, such as the inadvertent intraoperative use of nonsterile instruments or supplies. Incisions with signs of infection or gross spillage from the gastrointestinal tract also are included. Example are a penetrating abdominal trauma involving bowel and a gunshot wound to the abdomen.

Ref: Alexander’s page 822

Correct

5. What are the positioning risk factors for a thoracotomy?
Pressure injuries

Alexander’s page 2860

Pressure and nerve injuries. I remember hearing about the Brachial Plexus and Peroneal nerve.

1. What does a Bowie Dick test do?

Bowie Dick test is conducted daily, usually on the first run of the day; to check for air entrapment in the prevacuum sterilizer. (B & K, p.312)

2. What is Virchow’s Triad?

Virchow, a pathologist, identified the three elements that trigger venous thrombosis, these elements, or risk factors, are endothelial injury, venostasis, and hypercoagulability. (Alexander’s p. 2692).

3. What is the definition of Evidence Based Practice (EBP)?

Patient care decisions based on scientifically sound evidence rather than the opinion of healthcare     providers are known as evidence-based practice (EBP). (Alexander’s p. 75)

4.What electrolytes are affected by the parathyroid?

Calcium  and Phosphate (Alexander’s p. 1646)

5. What is the reversal for Versed (Midazolam)?

Flumazenil (Romazicon) (Zander and B&K, p. 426)

Sharon Rivera

1. What does a Bowie What Dick test do?
Class 2 chemical indicator used in a prevacuum sterilizer to test the efficacy of the air removal cycle.   Test is performed daily to ensure                that air vacuum pump is functioning properly. B&K Page 312

2.  What is Virchow’s Triad?
Three elements that trigger venous thrombosis. Endothelial injury, venostasis and hypercoagulability. Alexanders 16th page 6292

3.  What is the definition of Evidence Based Practice (EBP)?
Patient care decisions on scientifically sound evidence rather than the opinion of healthcare providers are known as evidence base                      practice. Alexanders 16th page 75

4.   What electrolytes are affected by the parathyroid?
Calcium  Alexander’s 16th edition page 1647

5.     What is the reversal for Versed (Midazolam)?

The reversal is Flumazenil  (Romanzicon) Wendy Zander page 117 slide 2

How is a cytology specimen sent to pathology?

In Berry & Kohn’s (pg 387), Cytology is listed as a fluid test. You send it fresh or in a solution of the pathologist’s choice. Cell washings & Urine are the given examples.

What are the early s/s of LAST?

Locals, other than Bupivacaine, can cause hypotension, convulsions, and tachycardia (if epi is present in the local) when injected into the vascular system. Bupivacaine is associated with cardiac arrest. (Alexander’s Care of the Patient in Surgery pg. 459)

If somebody is on Droplet precautions, would Standard Precautions still apply?

Standard precautions apply to every patient in the facility. A patient on droplet precautions is in a private room when possible, and caregivers wear a mask when within 3 ft of the pt. If transport is necessary, the pt wears the mask. (Alexander’s Care of the Patient in Surgery pg. 265)

There is a gross spillage of bowel contents during a colon resection. What is the wound class? The word, not the number.

This is a contaminated wound. Fresh spillage of an accidental wound (Alexander’s Care of the Patient in Surgery pg. 822)

What are the positioning risk factors for a thoracotomy? 

Pressure injuries are a major consideration. The lateral position requires pillows between the knees, gel roll under the axilla, double arm board, and the bean bag. The lateral position is also restrictive to the cardiopulmonary system (Berry & Kohn’s pg 506).

Thanks Shaanaya!

1. What does a Bowie Dick test do?

Bowie Dick test is conducted daily, usually on the first run of the day; to check for air entrapment in the prevacuum sterilizer. (B & K, p.312)

Correct

2. What is Virchow’s Triad?

Virchow, a pathologist, identified the three elements that trigger venous thrombosis, these elements, or risk factors, are endothelial injury, venostasis, and hypercoagulability. (Alexander’s p. 2692).

Correct.

3. What is the definition of Evidence Based Practice (EBP)?

Patient care decisions based on scientifically sound evidence rather than the opinion of healthcare     providers are known as evidence-based practice (EBP). (Alexander’s p. 75)

Exactly

4.What electrolytes are affected by the parathyroid?

Calcium  and Phosphate (Alexander’s p. 1646)

Correct

5. What is the reversal for Versed (Midazolam)?

Flumazenil (Romazicon) (Zander and B&K, p. 426)

Correct

Thanks Sharon

1. What does a Bowie What Dick test do?
Class 2 chemical indicator used in a prevacuum sterilizer to test the efficacy of the air removal cycle. Test is performed daily to ensure that air vacuum pump is functioning properly. B&K Page 312

Correct

2. What is Virchow’s Triad?
Three elements that trigger venous thrombosis. Endothelial injury, venostasis and hypercoagulability. Alexanders 16th page 6292

Correct

3. What is the definition of Evidence Based Practice (EBP)?
Patient care decisions on scientifically sound evidence rather than the opinion of healthcare providers are known as evidence base practice. Alexanders 16th page 75

Correct

4. What electrolytes are affected by the parathyroid?
Calcium Alexander’s 16th edition page 1647

Calcium and phosphorus. Correct. I think you need to remember calcium for the exam

5. What is the reversal for Versed (Midazolam)?

The reversal is Flumazenil (Romanzicon) Wendy Zander page 117 slide 2

Correct

Hi Leah,

Thank you!

1. How is a cytology specimen sent to pathology?

In Berry & Kohn’s (pg 387), Cytology is listed as a fluid test. You send it fresh or in a solution of the pathologist’s choice. Cell washings & Urine are the given examples.

Correct. The answer on the exam is the dry container.

2. What are the early s/s of LAST?

Locals, other than Bupivacaine, can cause hypotension, convulsions, and tachycardia (if epi is present in the local) when injected into the vascular system. Bupivacaine is associated with cardiac arrest. (Alexander’s Care of the Patient in Surgery pg. 459)

The early signs that you should remember is numbness and tingling around the lips and tongue, metallic taste in the mouth and ringing in the ears. This is what we used to call lidocaine toxicity but now we know it’s the first stage in LAST

3. If somebody is on Droplet precautions, would Standard Precautions still apply?

Standard precautions apply to every patient in the facility. A patient on droplet precautions is in a private room when possible, and caregivers wear a mask when within 3 ft of the pt. If transport is necessary, the pt wears the mask. (Alexander’s Care of the Patient in Surgery pg. 265)

Correct

4. There is a gross spillage of bowel contents during a colon resection. What is the wound class? The word, not the number.

This is a contaminated wound. Fresh spillage of an accidental wound (Alexander’s Care of the Patient in Surgery pg. 822)

Correct

5. What are the positioning risk factors for a thoracotomy?

Pressure injuries are a major consideration. The lateral position requires pillows between the knees, gel roll under the axilla, double arm board, and the bean bag. The lateral position is also restrictive to the cardiopulmonary system (Berry & Kohn’s pg 506).

I would also remember the risk to the brachial plexus and peroneal nerve.