Exam 2: Patient Safety and Risk Management

Select the appropriate order for administering blood and blood products.

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

Weighing sponges is a valuable tool for meticulous calculation of blood and fluid loss when conducted correctly and used in appropriate circumstances.Select the response that correctly reflects the best practice in weighing sponges.

Loss or mishandling of a surgical specimen could be considered negligence and could result in:

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 meticulously maintained accountability for all sponges and instruments discarded from the sterile field and bagged each sponge carefully.He immediately turned and addresses the entire team in a clear voice.Select the appropriate communication that the circulating nurse must employ during this count discrepancy.

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:

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:

As the pediatric cardiac team prepared to cannulate for a coarctation repair,their neonate patient presented with a sudden dysrhythmia,ectopy,and failure to respond to digitalis.Point-of-care serum electrolyte measurements revealed low potassium,sodium,and magnesium levels.On anesthesia induction,only 35 minutes earlier,these values were at normal levels and the patient status was secure.The electrolyte levels were treated to normal and the patient was cannulated and placed on cardiopulmonary bypass.As the procedure continued the team pondered the cause to prevent a recurrence.What possible event could have caused,or contributed to,this loss of electrolytes?

Ann Ames,RN,CNOR,and Joy Toll,CST,participated in a simulation on intraoperative counts,performing in their usual roles with Ann as the circulating nurse and Joy as the scrub person.They were determined to demonstrate best practice in performing surgical counts.They reviewed the unit practice standard and current AORN evidence-based guidelines.Select the appropriate order of counts that Ann and Joy demonstrated to their peers.

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

As the placenta was delivered and the uterus prepared for closure,the scrub person gathered up all of her 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.

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

Monica Sorensen,a patient with end-stage pancreatic cancer,was admitted from hospice for a celiac plexus block to treat intractable pain.She had a Whipple procedure 18 months earlier and enjoyed good quality of life until 3 weeks ago.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.Monica insisted that her Do Not Resuscitate (DNR)status NOT be rescinded.She was conscious and competent and knew what was best for herself.Monica was taking full advantage of what provision for her care?

Spencer Robertson is a 4-week-old frail neonate who had a rectal exam and dilatation under anesthesia following prior surgery for imperforate anus.When the drapes were removed from Spencer,the perioperative nurse noted an area of redness,swelling,and abrasions on the buttocks of the patient.Spencer had been positioned prone for 20 minutes.The nurse who noted the skin condition had relieved the circulating nurse and quickly reviewed the perioperative record and patient chart,but had not seen the patient before positioning.Which of the following safety factors may have contributed to this event?

Norma Miller,a 49-year-old long-distance runner with dysfunctional uterine bleeding,was scheduled for a hysteroscopy.During the procedure,sterile saline was used to expand the intrauterine compartment and enhance visualization.The perioperative nurse meticulously monitored fluid use and documented infiltration to the uterus and fluid collected as drainage from the uterus.The perioperative nurse was concerned that approximately 500 ml of fluid was unaccounted for and alerted the surgeon.The nurse's motive for this surveillance was to:

Sara Martin,a healthy 32-year-old nursing student,is scheduled for excision of a left-sided subglottal cyst with frozen section and possible radical neck dissection.In addition to comfort and caring behaviors and reassurance from the perioperative nurse to mitigate Sara's nervousness and fears,the admission process provides the opportunity to collect and verify information about the patient to ensure patient safety.Among the patient data that must be verified are:

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

During a particularly long and bloody spinal fusion procedure for scoliosis,the perioperative nurse collected,monitored,and spun down the blood collected in the autotransfusion cell salvage system.She was able to provide the anesthesia provider with three units of packed red blood cells (PRBCs)by the end of the procedure.As the team calculated the estimated blood loss (EBL)as wound closure ended,the perioperative nurse also:

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

Sandra Williams 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 all of the tenets of 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.Sandy was exercising her: