Deck 22: Reconstructive and Aesthetic Plastic Surgery

Question 1

Skin grafting provides an effective way to cover a wound if vascularity is adequate,infection is absent,and hemostasis is achieved.Skin from the donor site is detached from its blood supply and placed in the recipient site.The best description of a successful skin graft outcome is:

A) the skin is a good color match.
B) the recipient site develops a new blood supply from the base of the wound.
C) capillary refill returns within 24 hours.
D) a split-thickness graft is able to regenerate in an area of full-thickness loss.

Answer 1

B
Skin from the donor site is detached from its blood supply and placed on the recipient site,where it develops a new blood supply from the base of the wound.Color match,contour,and durability of the graft are all considerations in selection of an appropriate donor area.

Question 2

The perioperative nurse should verify with the patient that all of the preoperative prescribed skin preparation regimens ordered by the surgeon have been performed.All body jewelry that pierces the skin should be removed before the skin prep.Select the statement that reflects a true special consideration for skin preparation before facial surgery.

A) Use chlorhexidine gluconate (CHG) around the ears and eyes.
B) Leave the eyebrows and eyelashes intact to preserve facial appearance and expression.
C) Prep the skin graft and donor sites together with the same prep set and drape immediately.
D) Isolate rashes, open sores, cuts, or lesions in the prep site with a sterile, clear adhesive patch.

Answer 2

B
The eyebrows and eyelashes,in particular,are left intact to preserve facial appearance and expression.The surgical site is marked before surgery by the surgeon to designate the correct site and to define landmark areas.Either a povidone-iodine solution,an iodine-alcohol mixture,chlorhexidine gluconate (CHG),or another broad-spectrum agent may be selected for the antimicrobial skin prep.The use of CHG should be avoided around the ears and eyes.It is important to place shields on the eyes and/or eye ointment if prepping the periorbital site or performing an extensive head and neck prep,to place plugs in the ear canals,and prevent pooling of the prep agent.

Question 3

In addition to the individualized nursing diagnoses that apply to surgical patients,the patient scheduled for plastic or reconstructive surgery can typically be expected to have which nursing diagnosis?

A) Activity intolerance related to pain
B) Disturbed body image related to congenital or acquired defect or developmental abnormality
C) Risk for perioperative positioning injury related to improper body alignment
D) Risk for impaired skin integrity related to length of surgical intervention

Answer 3

B
Nursing diagnoses related to the care of the patient undergoing plastic and reconstructive surgery might include the following: risk for surgical site infection related to operative/invasive plastic/reconstructive procedure,disturbed body image related to congenital or acquired defect or developmental abnormality,risk for ineffective peripheral tissue perfusion related to surgical intervention,impaired comfort related to surgical/invasive procedure,knowledge deficit related to perioperative process,and anxiety related to surgical interventions or outcomes.

Question 4

The perioperative nurse circulating for a skin contracture release of the ear on a 5-year-old boy transfers 0.25% bupivacaine via syringe to the scrub person's sterile back table.The scrub person questions why she is not giving him bupivacaine with epinephrine,because there may be bleeding expected at the incision site.The nurse's reply is based on the fact that:

A) epinephrine is contraindicated in areas with limited vascularity, such as the ears.
B) the nurse is complying with the surgeon's standardized order on the preference list.
C) epinephrine-induced vasoconstriction may interfere with normal tissue planes.
D) pediatric heart rates are higher than adult heart rates, and epinephrine can cause tachycardia.

Question 5

Dermatomes are used for harvesting split-thickness skin grafts (STSGs)from donor sites.The perioperative nurse,who is preparing for a procedure where STSGs will be taken to cover several large burn areas,will need to have available:

A) sterile petroleum jelly, sterile impregnated gauze sheets, and a dermatome power source
B) sterile mineral oil, tongue blades, a skin mesher, and a dermatome of choice.
C) sterile lubricating jelly, carriers, and dermatome blades
D) a nitrogen tank, sterile gauze fluffs, antibiotic ointment, and a dermatome of choice

Question 6

Microsurgery,a fundamental tool in reconstructive plastic surgery,allows an almost unlimited choice of reconstructive methods,replacement of lost tissue with similar components,and optimal selection of donor sites with minimal morbidity.Today's surgeons skilled in microsurgery can successfully anastomose the ends of a vessel or nerve measuring less than:

A) 2 mm.
B) 1.5 mm.
C) 1 mm.
D) 0.5 mm.

Question 7

A 46-year-old woman had a scar revision of her knee.The knee scar,before revision,was an 8-cm linear,thin scar that extended obliquely across the anterior portion of her knee.The tension of the scar tissue met resistance when she would bend her knee.The surgeon opted to remove the scar with a procedure to break up the linear scar and rearrange the tissue direction to form a natural line.The proper name of this tissue transfer scar revision is the:

A) scar lysis.
B) epidermolysis with remodeling.
C) scarplasty.
D) Z-plasty.

Question 8

A burn patient is transferred to the operating room (OR)from the burn unit for debridement of the partial-thickness burn areas and a dressing change under anesthesia.What is the most important preparation the perioperative nurse should perform before the patient arrives in the OR?

A) Procure the allograft skin from the freezer and begin the thaw process.
B) Procure a basic plastic instrument set plus a knife dermatome and sterile mineral oil.
C) Prewarm the OR to above the normal ambient temperature and humidity.
D) Ensure that silver nitrate is available for dressing wounds.

Question 9

Replantation is an attempt to reattach a completely amputated digit or other body part.Revascularization is the procedure performed on incomplete amputations,when the part remains attached to the body by skin,artery,vein,or nerve.Good candidates for replantation are those with which of the following amputations?

A) Almost any body part of a child
B) Proximal portion of the hand at palm level
C) Distal to middle foot
D) Distal to middle thigh

Question 10

The science of plastic and reconstructive surgery,improves appearance and body image through an understanding of:

A) body geometry.
B) the anatomy and biology of tissue.
C) form and function.
D) body image.

Question 11

When coverage for a defect cannot be achieved through skin grafting,plastic surgeons rely on other techniques to replace tissue.After mastectomy,reconstruction with a transverse rectus abdominis myocutaneous (TRAM)flap is one of several options for nonsynthetic prosthetic reconstruction.Another descriptive term for the TRAM flap is the:

A) pedicle-based flap.
B) free flap.
C) composite flap.
D) rotated tunneled flap.

Question 12

A 46-year-old woman with a second early-stage primary cancer in her left breast has elected to have a bilateral mastectomy with saline implants.She has requested that the surgeon also revise a small unsightly scar on her right knee and pierce her ears.While the patient's breast tumor could be treated with an excisional biopsy,she has decided to have a mastectomy of both breasts,which is considered an appropriate preemptive (preventative)surgery for a woman of her age with two primary cancers of the breast.The saline implant insertion surgery is considered a _______________ procedure,the scar revision is considered a ___________ procedure,and the ear piercing is considered a _______________ procedure.

A) reconstructive; reconstructive; reconstructive
B) reconstructive; cosmetic; reconstructive
C) cosmetic; reconstructive; cosmetic
D) reconstructive; cosmetic; cosmetic

Question 13

Mohs' surgery is a specialized excision used to treat basal and squamous cell skin cancers.Select the statement about Mohs' surgery that best reflects the process,procedure,and outcome goal.

A) Mohs' surgery is diagnostic, an ambulatory procedure, and a definitive treatment.
B) Lesions are mapped, excised, and examined by frozen section until clear margins are found.
C) The procedure can be accomplished quickly while preserving the surrounding healthy tissue.
D) The segments are excised and microscopically examined, and the defect is closed with a drain.

Question 14

A broad range of implant materials are used in plastic and reconstructive surgery.Select the implant that represents a biologic composition of a surgical implant.

A) Autologous human tissue
B) Medical-grade sterile silicone
C) Gold
D) Polypropylene

Question 15

The three most common skin cancers are basal cell,squamous cell,and melanoma.Treated early,skin cancers such as squamous cell and basal cell carcinomas may be cured by simple excision and closure (with pathologic diagnosis to ensure disease-free margins).Melanoma is treated much more aggressively because of its high mortality.The A-B-C-Ds of the warning signs for skin cancer stand for:

A) acute, borderline, color, dysplastic.
B) asymmetry, blanching, cohesion, depth.
C) aplastic, bilateral, chronic, dysplastic.
D) asymmetry, border, color, diameter.

Question 16

Facial fractures are classified according to a system developed by Rene Le Fort in the early 1900s.A fracture that starts at the nasal bones; crosses the frontal process of the maxilla and lacrimal bones; and extends through the orbital floor,infraorbital rim,and lateral maxillary sinus wall is known as a:

A) Le Fort I.
B) Le Fort II.
C) Le Fort III.
D) Le Fort IV.

Question 17

There are approximately 1 million reported cases of skin cancer per year with the majority being the highly curable basal or squamous cell cancers.Not as common is the most serious skin cancer,malignant melanoma.Select the individual who is at the highest risk for skin cancer.

A) An African American outdoor sportsman and airline pilot
B) A fair-complexioned surfer and beach lifeguard who wears sunblock-protective clothing
C) A fair-complexioned person testing positive for exposure to human papillomavirus
D) A dark-complexioned person testing positive for human immunodeficiency virus

Question 18

A 28-year-old firefighter sustained significant full-thickness burns when he fell through the roof of a burning building while fighting an explosive fire.Which of the following best describes the surgical treatments he will most likely need before he is discharged from the burn center to home?

A) Debridement and monitoring of full-thickness skin regeneration
B) Debridement, allograft placement during initial healing
C) Allograft and xenograft placement as temporary dressings until secondary granulation begins
D) Tangential excision of the burn wound with antibiotic-soaked dressings

Question 19

A 6-year-old girl's clothes caught fire during a camping trip when she fell into the campfire.She is admitted with full-thickness burns involving the left lower leg,circumferentially,excluding her foot,over less than 2% of her body surface area and partial-thickness burns over less than 15% of her BSA.Based on the American Burn Association and the "Rule of Nines" classifications,the patient's burns would be classified as ______________ with a burn surface area percentage of approximately ______________.

A) minor; 17%
B) moderate; 17%
C) minor; 9%
D) major; 18%

Question 20

During the planning phase of a procedure for liposuction,the perioperative nurse will assemble and organize supplies and devices,because the procedure may require:

A) repositioning one or more times during surgery.
B) meticulous accounting of fluid loss and blood replacement.
C) the use of implant material.
D) patient transfer to an alternating-pressure bed.

Question 21

A variety of implantable devices are used in aesthetic and reconstructive plastic surgery procedures.Tracking of these devices is critical to patient safety.Institutions must report any incident of death or serious injury relating to the use of a medical device.What regulatory agency,commission,or act mandates this process when medical devices fail or cause injury?

A) The Joint Commission (TJC), agency for sentinel events
B) Original Equipment Manufacturer Device Tracking Commission
C) Food and Drug Administration (FDA) Device Failure and Recall Act
D) Safe Medical Device Act

Question 22

Autologous skin grafts,such as full- and split-thickness,have long been part of the reconstructive ladder as an option to close skin defects.Although they are effective in providing coverage,they require the need for a trained surgeon,use of anesthesia and operating room,and creation of a wound at the donor site.These drawbacks can be overcome with the use of epidermal skin grafts (ESGs).Which of the following statements is true of ESGs?

A) ESGs prevent wound contracture.
B) ESGs can be harvested without the use of anesthesia in an office setting and with minimal to no scarring at the donor site.
C) Secondary dressings can, and should, be used over the wound after application of ESGs.
D) No pretreatment is required at the donor site.
E) For at least 1 week, the primary dressing for ESGs should be changed daily.

Question 23

A 49-year-old post-bariatric surgery patient is scheduled for a VASER®-assisted liposuction with tumescent infiltration.The tumescent is a solution of lactated Ringer's,lidocaine,and epinephrine.The perioperative nurse is aware that using more than 70 mL/kg of wetting solution for infiltration can lead to fluid overload.Select the most appropriate nursing action related to minimizing the risk of tumescent solution overload or disproportion to lipoaspirate.

A) The nurse will monitor the patient for syncope, cough, and bounding pulse.
B) The nurse will keep the tumescent solution cool and monitor fluid volumes.
C) The nurse will communicate and verify with the surgeon and/or anesthesia provider the total lipoaspirate and volume of wetting solution used.
D) The nurse will titrate the flow rate of the tumescent solution in coordination with aspirate outflow.

Question 24

A 52-year-old woman with a left mastectomy followed by a TRAM flap reconstruction was beginning to emerge from anesthesia after her procedure.The perioperative nurse gently moved her arms from the abducted position on the arm boards in preparation for her transfer to her postoperative bed and admission to the postanesthesia care unit (PACU).What risk reduction maneuver did the nurse employ to the patient's bed before transferring her?

A) Flattened the bed to a horizontal plane with slight reverse Trendelenburg to support her airway.
B) Raised the head of the bed to low Fowler flex position to reduce the stretching on the abdominal donor graft wound site.
C) Raised the foot of the bed to minimize deep vein thrombosis formation.
D) Slid a wedge under the top of the mattress on the left side to prevent dependent edema in the graft site.