At what point does the intraoperative phase of surgery begin?
When the patient is transferred to the operating room bed
✓
When the decision to perform surgery is made
When the patient arrives in the preoperative holding area
When the surgeon makes the first incision
Correct Answer
When the patient is transferred to the operating room bed
The intraoperative phase starts with transfer to the operating room bed and ends with transfer to the post-anesthesia care unit. When the decision to perform surgery is made marks the start of the preoperative phase. When the patient arrives in the preoperative holding area is still part of the preoperative phase. When the surgeon makes the first incision comes after positioning, anesthesia and the time-out, which are already intraoperative.
Category: Phases and Settings
Question 2
Which task belongs to the RN circulator during a surgical procedure?
Passing instruments to the surgeon at the field
Documenting the procedure in the medical record
✓
Suturing the incision at the surgeon's direction
Developing the patient's anesthesia plan
Correct Answer
Documenting the procedure in the medical record
The RN circulator stays outside the sterile field, coordinating the room, monitoring the team's aseptic technique, managing supplies and communication, and documenting the procedure. Passing instruments to the surgeon at the field is the scrub nurse's role. Suturing the incision at the surgeon's direction is done by a registered nurse first assist. Developing the patient's anesthesia plan is the anesthesiologist's responsibility.
Category: Surgical Team Roles
Question 3
Which surgical team member, after advanced education and credentialing, controls bleeding and sutures wounds at the surgeon's direction?
Scrub nurse
RN circulator
Registered nurse first assist
✓
Certified registered nurse anesthetist
Correct Answer
Registered nurse first assist
A registered nurse first assist has additional education and certification and, at the surgeon's direction, controls bleeding, sutures incisions and helps stabilize the patient, without serving as the scrub nurse at the same time. Scrub nurse prepares and passes sterile instruments. RN circulator coordinates the room from outside the sterile field. Certified registered nurse anesthetist gives anesthesia rather than assisting with the operation.
Category: Surgical Team Roles
Question 4
A patient arrives with a ruptured spleen and active internal bleeding. Using the categories based on timing and necessity, how is the needed surgery classified?
Elective
Urgent
Palliative
Emergency
✓
Correct Answer
Emergency
Emergency surgery is immediate and unplanned, done to save life or prevent severe disability, as with a ruptured organ and active bleeding. Elective surgery is planned in advance for a condition that is not life-threatening. Urgent surgery must happen promptly but is not immediately life-threatening, such as a long bone fracture. Palliative describes the goal of a surgery, comfort, and is not one of the timing categories.
Category: Surgical Categories
Question 5
A patient is scheduled for mammography. What does this procedure involve?
Imaging of breast tissue
✓
Surgical reshaping of the breast
Surgical removal of the breast
An incision into breast tissue
Correct Answer
Imaging of breast tissue
The suffix for imaging or recording tells the team that mammography produces images of breast tissue. Surgical reshaping of the breast is a mammoplasty. Surgical removal of the breast is a mastectomy. An incision into breast tissue would carry the suffix meaning to cut into.
Category: Surgical Terminology
Question 6
Which feature distinguishes sterile technique from aseptic technique?
It reduces pathogens to a safe level
It eliminates all microorganisms, including spores
✓
It relies on hand hygiene and gloves alone
It is used mainly for routine injections
Correct Answer
It eliminates all microorganisms, including spores
Sterile technique aims to eliminate every microorganism, including spores, and is used to create and maintain the sterile field in surgery. It reduces pathogens to a safe level describes aseptic technique. It relies on hand hygiene and gloves alone is incorrect, because sterile technique also requires sterilized instruments, gowns and drapes. It is used mainly for routine injections describes an application of aseptic technique.
Category: Asepsis and Attire
Question 7
When is the surgical time-out performed?
During the preadmission testing visit
After the incision is closed
Immediately before the procedure begins
✓
On arrival in the post-anesthesia care unit
Correct Answer
Immediately before the procedure begins
The time-out is a pause in the operating room just before the procedure, when the team confirms the patient, site, procedure and consent and can raise any concern. During the preadmission testing visit is too early to confirm the final setup. After the incision is closed is too late to prevent a wrong-site or wrong-procedure error. On arrival in the post-anesthesia care unit is after surgery is over.
Category: Time-Out
Question 8
During the time-out, how should the intraoperative nurse state the planned procedure?
Recite it from the posted surgical schedule
Ask the surgeon to describe it from memory
Repeat what the patient said in the holding area
Read it directly from the signed consent form
✓
Correct Answer
Read it directly from the signed consent form
Reading the procedure word for word from the signed consent ties the time-out to the document the patient agreed to and reduces errors. Reciting it from the posted surgical schedule relies on a secondary source that can contain errors. Asking the surgeon to describe it from memory skips the independent check the time-out provides. Repeating what the patient said in the holding area may not match the consent the team must verify.
Category: Time-Out
Question 9
Which position places the patient head down with the feet raised to improve the view of pelvic and lower abdominal organs?
Trendelenburg
✓
Reverse Trendelenburg
Fowler's
Lateral
Correct Answer
Trendelenburg
In the Trendelenburg position the head is lowered and the feet raised, shifting abdominal organs toward the head for better access to the pelvis. Reverse Trendelenburg lowers the feet and raises the head, used for upper abdominal and some neurosurgical procedures. Fowler's raises the head of the bed for cranial, eye and some neck surgery. Lateral places the patient on the side for hip, kidney and chest procedures.
Category: Patient Positioning
Question 10
A patient is scheduled for surgery on the posterior spine. Which position does the team use?
Supine
Prone
✓
Lithotomy
Fowler's
Correct Answer
Prone
The prone position places the patient face down with supports under the chest and pelvis, giving access to the back for spinal surgery. Supine places the patient on the back, which hides the spine. Lithotomy places the patient on the back with legs in stirrups for gynecologic and urologic procedures. Fowler's raises the head of the bed for cranial and some neck surgery.
Category: Patient Positioning
Question 11
Which positioning complication results from prolonged pressure over bony prominences during a long procedure?
Compartment syndrome
Anesthesia awareness
Pressure injury
✓
Malignant hyperthermia
Correct Answer
Pressure injury
Sustained pressure over bony areas reduces blood flow to the skin and underlying tissue, so the team uses padding, pressure-relieving devices and repositioning. Compartment syndrome is rising pressure inside a muscle compartment, often from improper limb positioning. Anesthesia awareness results from inadequate anesthetic depth, not from pressure. Malignant hyperthermia is an inherited reaction to certain anesthetic agents.
Category: Positioning Complications
Question 12
Which description fits moderate sedation?
The patient is unconscious and depends on mechanical ventilation
The patient is fully alert while one limb is numbed by a nerve block
The anesthetic is injected into the cerebrospinal fluid of the lower back
The patient responds to voice or touch and maintains their own airway
✓
Correct Answer
The patient responds to voice or touch and maintains their own airway
Moderate sedation lowers consciousness and anxiety while the patient still responds to verbal commands or touch and breathes without airway support. The patient is unconscious and depends on mechanical ventilation describes general anesthesia. The patient is fully alert while one limb is numbed by a nerve block describes a peripheral nerve block. The anesthetic is injected into the cerebrospinal fluid of the lower back describes spinal anesthesia.
Category: Anesthesia and Sedation
Question 13
After surgery under spinal anesthesia, which safety precaution does the nurse implement?
Fall precautions until sensation and movement in the legs return
✓
Seizure precautions until the anesthetic wears off
Bleeding precautions because spinal anesthesia thins the blood
Isolation precautions because the puncture site is contaminated
Correct Answer
Fall precautions until sensation and movement in the legs return
Spinal anesthesia temporarily removes sensation and motor function in the lower body, so the patient is at increased risk of falling until it wears off. Seizure precautions until the anesthetic wears off address a risk spinal anesthesia does not create. Bleeding precautions because spinal anesthesia thins the blood is incorrect, because local anesthetics do not thin the blood. Isolation precautions because the puncture site is contaminated is incorrect, because the injection is done with sterile technique.
Category: Anesthesia and Sedation
Question 14
Which complication should the nurse watch for in a patient receiving epidural anesthesia?
High blood glucose
Low blood pressure
✓
Excess urine output
High blood pressure
Correct Answer
Low blood pressure
Epidural anesthesia can lower blood pressure, and other possible problems include headache, temporary changes in bladder control, nerve damage and infection. High blood glucose is not a recognized effect of an epidural. Excess urine output is not expected; bladder control problems are more likely. High blood pressure is the opposite of the expected change.
Category: Anesthesia and Sedation
Question 15
During general anesthesia with an inhaled agent, the patient develops a rapidly rising end-tidal carbon dioxide level, tachycardia and generalized muscle rigidity. Which complication do these findings suggest?
Anaphylaxis
Hypothermia
Malignant hyperthermia
✓
Residual neuromuscular blockade
Correct Answer
Malignant hyperthermia
Malignant hyperthermia is a hypermetabolic reaction to volatile anesthetics or succinylcholine; rising carbon dioxide, tachycardia and muscle rigidity are classic findings, and temperature then climbs. Anaphylaxis causes hypotension, swelling and bronchospasm rather than rigidity. Hypothermia lowers body temperature and slows metabolism. Residual neuromuscular blockade causes weakness, not rigidity.
Category: Intraoperative Complications
Question 16
Shortly after an IV antibiotic is started during surgery, the patient develops hypotension, facial swelling and difficulty ventilating. What is the first action?
Slow the infusion rate and recheck in a while
Raise the head of the bed and continue
Document the reaction for the postoperative team
Stop the infusion of the suspected agent
✓
Correct Answer
Stop the infusion of the suspected agent
These findings suggest anaphylaxis, and management begins by stopping the suspected allergen, followed by epinephrine, IV fluids and support of ventilation. Slowing the infusion rate and rechecking later keeps the allergen flowing. Raising the head of the bed and continuing does not remove the trigger. Documenting the reaction for the postoperative team delays treatment of a life-threatening reaction.
Category: Intraoperative Complications
Question 17
Why is hypothermia during surgery dangerous?
It impairs clotting and immune function, raising the risk of bleeding and infection
✓
It speeds metabolism and causes rapid emergence from anesthesia
It triggers malignant hyperthermia once the patient rewarms
It causes excess urine output that leads to dehydration
Correct Answer
It impairs clotting and immune function, raising the risk of bleeding and infection
A core temperature below normal slows metabolism and impairs coagulation and immunity, which can lead to blood loss, surgical site infection and delayed recovery. It speeds metabolism and causes rapid emergence from anesthesia is the opposite of what happens. It triggers malignant hyperthermia once the patient rewarms is incorrect, because that reaction is caused by certain anesthetic agents. It causes excess urine output that leads to dehydration is not the danger the team guards against.
Category: Intraoperative Complications
Question 18
Which patient has the most risk factors for postoperative nausea and vomiting?
A man who smokes and has never had motion sickness
A nonsmoking woman with a history of motion sickness
✓
A man who smokes and had no nausea after a past surgery
A woman who smokes and has never had surgery
Correct Answer
A nonsmoking woman with a history of motion sickness
Female sex, nonsmoking status and a history of motion sickness or prior postoperative nausea each raise the risk, and this patient has every one of them. A man who smokes and has never had motion sickness has none of them. A man who smokes and had no nausea after a past surgery also has none. A woman who smokes and has never had surgery has only one, female sex.
Category: Intraoperative Complications
Question 19
Which procedure is well suited to an ambulatory surgical center?
Emergency repair of a ruptured spleen
Open-heart valve replacement
Cataract removal
✓
Treatment of severe burns
Correct Answer
Cataract removal
Ambulatory surgical centers handle minor and minimally invasive procedures for patients who go home the same day, such as cataract surgery. Emergency repair of a ruptured spleen requires a hospital operating room and inpatient care. Open-heart valve replacement needs inpatient monitoring afterward. Treatment of severe burns is emergency care that requires hospital admission.
Category: Phases and Settings
Question 20
Which type of anesthesia combines regional techniques with nonopioid analgesics to control pain while reducing reliance on opioids?
General anesthesia
Moderate sedation
Monitored anesthesia care
Multimodal anesthesia
✓
Correct Answer
Multimodal anesthesia
Multimodal anesthesia pairs regional techniques with nonopioid drugs such as acetaminophen and NSAIDs, lowering opioid needs and side effects such as respiratory depression and nausea. General anesthesia produces unconsciousness with IV and inhaled agents. Moderate sedation lowers consciousness while the patient keeps their own airway. Monitored anesthesia care combines local anesthesia with IV sedation.
Category: Anesthesia and Sedation