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Exam 8: Surgical Modalities

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Question 1

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The instrument tips in laparoscopic instruments are designed to produce the same tissue effects as a traditional instrument used for open surgery.Because of the process challenges of the laparoscopic approach,it is time-consuming to insert and withdraw instruments repeatedly during the procedure.Instrument manufacturers have attempted to make their products efficient by combining functions.An appropriate combined function for a laparoscopic instrument would be:

A) ultrasound capability in suturing forceps.
B) electrosurgery conduction through the tips of a Babcock grasper.
C) scissors that cut, blunt dissect, and coagulate tissue.
D) suction and irrigation combined with an argon beam coagulation handpiece.

E) None of the above
F) All of the above

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Question 2

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Flexible fiberscopes and flexible videoscopes share many of the same components; however,in a video gastroscope,the eyepiece and lens of the fiberscope are replaced by a:

A) charge-coupled device (CCD) image intensifier.
B) high-definition video monitor.
C) video chip.
D) light-guided sensor.

E) A) and B)
F) None of the above

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Question 3

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A neutral plasma coagulator is an energy source that produces pure plasma to provide coagulation.Why is patient risk reduced with this directed energy source?

The challenge of suturing intra-abdominally is not as great as the process needed to tie and tighten the surgical knot.The knot-tying process can be achieved within or outside of the abdominal compartment.The intracorporeal suture technique uses the suture-tying process analogous to the:

A female patient arrived at the endoscopy center 2 days before her scheduled interventional bronchoscopy to receive an injection of a photosensitive intravenous dye that the pulmonologist explained would highlight the dysplastic tissues of her bronchi that were precancerous.He scheduled her for an ablative procedure called photodynamic therapy (PDT) ,where the highlighted tissues would be affected by the laser light that is color-specific for uptake of the dye.Select the laser tissue interaction that describes the patient's treatment.

A 9-year-old female softball player has arrived in the OR for emergency repair of superficial facial and deep arm lacerations when she ran into the chain link fence during practice after school.The perioperative nurse discovers that the patient has diabetes and has an insulin pump that should remain connected during the short procedure.The best option for energy-generated hemostasis is:

Endoscopic instruments are designed to perform the intervention at the target tissue site through the tubular endoscope.The endoscopic instrument is considered:

The nursing research and practice committee searched the scientific literature for information on smoke evacuation,because they planned for a unit-wide initiative to use this safety measure on all procedures where smoke or plume is generated.Their main concern was that the surgeons will not be as willing to comply as the staff with the new recommendations.Select the safety measure that will be the most critical and most challenging to enforce.

To help visualize abdominal structures and to enhance safety during laparoscopic procedures,a pneumoperitoneum is created.After Veress needle confirmation,insufflation tubing is connected and the process begun.CO₂ gas is used to insufflate the abdominal cavity at an ideal flow rate of ___________ to achieve an ideal intra-abdominal pressure of ___________.

The new general surgery fellow placed the three trocar ports for the laparoscopic appendectomy.She was focused on the concept of exact geometric triangulation of the three port accesses,to avoid the concept of sword fighting after inserting her instruments.She knew she had to proceed with caution and determination since this hospital was not able to provide the protected blade trocars she was used to using at the university medical center.The procedure was completed without incident; however,on postoperative day 1,the patient demonstrated signs and symptoms of sepsis.What might have been the unusual occurrence that could have resulted in patient sepsis?

Select the statement(s) that best reflect the benefits of laser surgery for the surgical services department.

The diode laser is most often used in which specialties?

The new physician-owned endoscopy and surgery center opened with ample-sized procedure rooms and a large sterile storage core.The gastroenterologists had a busy practice.They used the best and most expensive reusable endoscopic biopsy forceps on every gastroscopy and colonoscopy.The endoscope processing and decontamination room used the same manufacturer's endoscopic cleaning brushes on every scope.These devices received considerable use and abuse and were often discarded after one or a few uses.Based on the characteristics of the new center and the gastroenterology practice,what would be the best option for the biopsy forceps and cleaning brushes?

The sterile processing department technician checks each fiberoptic light cord for transmission of light before decontamination and again before it is prepared for sterilization.What would indicate that the cord must be replaced?

The original equipment manufacturer (OEM) instructions that came with the new rigid endoscope system did not recommend a particular sterilization modality; however,high temperatures and ultrasonic cleaning were discouraged,and the facility recently removed the ethylene oxide sterilizers from the sterile processing department.The minimally invasive surgery (MIS) team collaborated on developing a processing procedure for their new equipment.What modality is their best option?

A neonate has burns over 45% of his body from a scalding incident.He was prepared for surgical fasciotomy for ensuing compartment syndrome of his legs and trunk.In planning for the use of electrosurgery,the perioperative nurse's assessment revealed a limited surface area for the dispersive electrode,and the appropriate choice was made to use the:

A 72-year-old man with a single early-stage liver tumor has an implanted automatic internal defibrillator that the anesthesia provider has decided not to disarm for the procedure.What energy-generated dissection device should the doctor use to replace the argon beam coagulator?

The surgeon prefers the argon beam coagulator for dissection in his liver procedures,because the liver bleeds easily,and traditional monopolar electrosurgery often causes more bleeding than it stops.What is the application characteristic of the argon beam coagulator that enhances liver tissue hemostasis?

Lasers,dependent on their wavelength,can produce absorption,reflection,transmission,and scatter.The effect of laser wavelength scatter does not have any therapeutic benefit at this time and can be destructive to both staff and instruments.Select a safety measure that would prevent inadvertent scatter or heating of the endoscope channel from laser energy during a surgical procedure.

The perioperative educator is teaching the OR assistant to change the smoke evacuation filters when they have met their usage life.Which priority teaching element(s) must be taught?