Exam 2: Patient Safety and Risk Management

A patient was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled vaginal-assisted laparoscopic hysterectomy.She demonstrated and verbalized that she understood the procedure,risks,expected outcome,complications,and procedural process.Before she signed the consent form,she informed the surgeon that she did not want any medical students or surgical residents performing any parts of the procedure other than assisting and did not want any photographs of her body taken.The surgeon agreed,and she crossed out those portions of the form and initialed them before she signed.The patient was exercising her:

Since its organization and establishment as a professional nursing association in the early 1950s,the Association of periOperative Registered Nurses (AORN)continues its endeavor to:

Which of the following situations requires informed consent from the patient/family?

Early on,during the preliminary sponge count on closure of a repair of a ruptured abdominal aortic aneurysm,the circulating nurse was unable to account for 2 lap sponges.He had maintained accountability for all sponges and instruments discarded from the sterile field and bagged each sponge carefully.He immediately turned and addressed the entire team in a clear voice.Select the appropriate communication that the circulating nurse must employ during this count discrepancy.

Fires and explosions in the perioperative setting require three components,described as the "fire triangle." The element of the triangle the perioperative nurse has the most control over is:

Proper care and handling of surgical specimens is imperative for correct diagnosis,treatment,and prognosis planning of the patient.Select the response that best reflects correct specimen care and handling.

Proper handling of specimens is crucial for patient safety.What is the most serious negative outcome that could occur as a result of the loss,mislabeling or mishandling of a surgical specimen?

Which nonprofit organization improves patient care through applied research into effectiveness and safety of devices,drugs,procedures,and processes?

A female patient with end-stage pancreatic cancer was admitted from hospice for a celiac plexus block to treat intractable pain.She wanted to be able to complete "getting her things in order" and saying good-bye to her friends and family while enjoying her last days pain-free.The patient insisted that her Do Not Resuscitate (DNR)status NOT be rescinded.She was conscious and competent and knew what was best for herself.The patient was taking full advantage of what provision for her care?

As the placenta was delivered and the uterus prepared for closure,the scrub person gathered up all of the sponges and dropped them in the kick bucket while the circulating nurse frantically stuffed them into sponge bag pockets.Sharps,sponges,and instrument counts were correct on closure of the uterus and again on closure of the peritoneum.On final sharps and sponge counts before skin closure,a needle was missing.Select the appropriate order of corrective action for the team.

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

Demands of the perioperative environment impact how staff dispense and administer medications.Safe perioperative medication practices include:

Researchers in the area of patient safety have proposed an emphasis on transparent systems,asserting that adverse patient events cannot be effectively prevented until the legal and professional licensure systems discontinue their focus on individual error and blame.In order for a transparent system to exist and thrive,it requires:

During a simulation on intraoperative counts in which peer "teams" competed,Team 2 was determined to have demonstrated best practice in performing surgical counts.This team,whose members included a RN,CNOR,and CST,reviewed the unit practice standard and current AORN evidence-based guidelines.Select the appropriate order of counts that they demonstrated to their peers.

The Joint Commission (TJC)designates sentinel events as unexpected occurrences involving death or risk of serious physical or psychologic injury.In 2003,TJC mandated the Universal Protocol to address perioperative sentinel events.This protocol includes:

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

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

Governmental and professional agencies and organizations,whether voluntary or involuntary,have a significant influence on patient safety policies in the healthcare setting.Select the agency or organization statement that presents a true reflection of its focus or purpose.

A healthy 32-year-old nursing student is scheduled for excision of a left-sided subglottal cyst with frozen section and possible radical neck dissection.The preoperative verification process provides the opportunity to collect and verify information about the patient to ensure patient safety.Among the patient data that must be verified are:

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