Deck 7: Surgical Modalities

Question 1

The design of laparoscopic instruments aims to provide a clamping,cutting,dissecting,electrocoagulating,suturing,or stapling instrument on the tip of a shaft that is long or short enough to reach the target tissue.The hand control on the surgeon's end of the instrument is engineered to provide:

A) ergonomic comfort and control.
B) smooth operation of the lubricated instrument tips to prevent tissue adherence or entrapment.
C) a perception of haptic and tactile sense to prevent crushing or losing tissue.
D) adaptors for monopolar electrosurgery connection and laser fibers.

Answer 1

A
The length and working end of the instrument must be adequate to perform surgery at the target site.The hand control is ergonomically designed for the operator's maximum comfort and reduced fatigue.Graspers and other instrumentation used by the assistant in surgery often are built for a shorter hand span because many women function in this role.

Question 2

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 a suturing forceps.
B) electrosurgery conduction through the tips of a Babcock grasper.
C) blunt dissection with the smooth,rounded edge of the closed endoscopic scissors.
D) suction and irrigation combined with an argon beam coagulation handpiece.

Answer 2

C
Dissecting instruments are used to cut,divide,or separate tissue.Scissors and dissectors that are similar to their open-procedure counterparts have been designed for use in MIS procedures.Scissors are available for blunt or sharp dissection.They can be straight or curved (including hook scissors),depending on the location of the target tissue and technique used.Scissors usually have a rounded tip when closed so that they also can be used to manipulate tissue without trauma.When open,both jaws of the scissors should be visualized to prevent inadvertent injury.Some scissors are designed to be connected to an electrosurgical energy source so that coagulation can be provided during cutting.Dissectors are used to separate or divide tissue.Many different tip shapes are available to dissect,spread,divide,grasp,retract,and coagulate structures.

Question 3

An endoscope is a diagnostic or therapeutic instrument that enters the body through a:

A) natural orifice.
B) small incision into a body compartment.
C) externalized sinus tract.
D) All of the options are correct.

Answer 3

D
An endoscope is a tube inserted into a natural body orifice or through a small incision to access internal organs or structures.Endoscopes are flexible,rigid,or semirigid.Flexible endoscopes include angioscopes,bronchoscopes,choledochoscopes,colonoscopes,cystonephroscopes,hysteroscopes,mediastinoscopes,ureteroscopes,and ureteropyeloscopes.Rigid endoscopes include cystoscopes,laparoscopes,sinuscopes,arthroscopes,bronchoscopes,laryngoscopes,and hysteroscopes.

Question 4

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.One technique uses laparoscopic grasping forceps and a laparoscopic needle holder only,and another uses the same instruments plus two obturator sleeves to push,slide,and tighten the knot into place.When sutures are tied and knotted during an open procedure,the surgeon may tie the knot with gloved fingers,called a one- or two-handed tie,or wrap the suture around the tip of a needle holder and grasp the other end of the suture to pull it through the wrapped coils;this is called an instrument tie.The intracorporeal suture technique uses the suture-tying process analogous to the:

A) instrument tie.
B) two-handed tie.
C) one-handed tie.
D) All of these techniques could be accomplished through the intracorporeal approach.

Question 5

Lasers,dependent on their wavelength,can produce absorption,reflection,transmission,and scatter.The effect of 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 of laser energy during a surgical procedure.

A) Ebonize the surface of laser mirrors that are used in laparoscopic cholecystectomies.
B) Surround the surface drapes with moist sterile towels and cover the glass windows.
C) Advance the laser fiber at least 1 cm beyond the tip of the endoscope within operator's view.
D) Cover the laser fiber with medical-grade tubing along its entire length.

Question 6

Dr.Wheeler's patient,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 Dr.Wheeler use to replace the argon beam coagulator?

A) An ultrasonic dissector
B) A monopolar suction-irrigator
C) A monopolar hydrodissector
D) A CO₂ laser with articulating arm and handpiece

Question 7

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

A) an instrument on a stick.
B) an extension of the surgeon's hand.
C) a means to perform hands-free surgery.
D) surgery without tactile sensation.

Question 8

The OR was trialling a new insufflation system and the vendor representative was out of the room taking a phone call.The perioperative nurse was concerned that the flow rate was well above 14 L/min and the pressure had risen to 16 mm Hg.She alerted the surgeon and reduced the rate and pressure because she feared that the elderly patient was at high risk for:

A) gastroesophageal reflux.
B) hypercarbia.
C) postoperative nerve damage and shoulder pain.
D) All of the options are correct.

Question 9

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 .

A) 14 to 16 L/min;9 mm Hg
B) 10 to 12 mm Hg;10 L/min
C) 14 to 16 mm Hg;9 L/min
D) <9 L/min;10 to 12 mm Hg

Question 10

Susie Reynolds,a 9-year-old 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 Susie has diabetes and has an insulin pump that should remain connected during the short procedure.The best option for energy-generated hemostasis is:

A) battery-generated eye electrosurgery.
B) bipolar electrosurgery.
C) hemoelectrocoagulated plasma capacitor.
D) monopolar electrosurgery.

Question 11

High-pressure insufflation rates can cause increased intra-abdominal pressure that can result in life-threatening sequelae.The perioperative nurse reduces the flow rate in collaboration with the surgeon,while monitoring the patient for signs of:

A) CO₂ gas embolism.
B) hemostasis.
C) deep vein thrombosis (DVT).
D) hypoxia.

Question 12

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

A) Change the smoke evacuation filter according to the manufacturer's written instructions.
B) Hold the smoke evacuation suction tube close (<1 inch away) to the tissue interaction site to remove as much plume as possible.
C) Evacuate surgical smoke generated during endoscopic or laparoscopic procedures.
D) Wear a surgical mask that provides adequate filtration to protect against residual smoke particulate that has not been evacuated.

Question 13

The surface tissue effect of the CO₂ laser serves as the laser of choice for:

A) urologic lithotripsy.
B) plastic surgery or dermatologic removal of tattoos.
C) laparoscopic cholecystectomy.
D) endoscopic ablation of Barrett's esophageal dysplasia.

Question 14

Clair Townsend 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 that would be appropriate to use on this patient during a PDT bronchoscopy.

A) CO₂ laser through a beam splitter
B) KTP laser using a Nd:YAG beam passed through a fiber delivery system
C) Argon beam coagulation with the bronchoscopy handpiece
D) Holmium laser with a short cleaved lithotripsy fiber

Question 15

Dr.Wheeler 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?

A) Combined argon gas with electrosurgical energy with rapid coagulation
B) Argon gas is heavier than air,inert,and noncombustible and does not tear tissue
C) Decreased chance of combustion,formation of surgical smoke,and burned tissue
D) Noncontact tissue coagulation with reduced risk of rebleeding

Question 16

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?

A) Unrecognized appendiceal rupture
B) Significant break in sterile technique
C) Inadvertent trocar puncture through the bowel on insertion
D) Recent H1N₁outbreak on the surgery unit at the hospital

Question 17

The surgeon used the ESU in monopolar mode to cut and coagulate through the subcutaneous tissue on opening the abdomen during a bariatric bypass procedure.As she began to proceed through the muscle and fascia layer,she asked the circulating nurse to increase the cut and
Coagulation modes on the ESU.What measure could the scrub person take to enhance energy delivery?

A) Unwrap the ESU cord from around the towel clamp handle.
B) Clean the charred tissue from the active electrode blade.
C) Remind the surgeon that adipose tissue offers less impedance than muscle.
D) Replace the active electrode blade with a coated blade.

Question 18

The light transmission through an endoscope is achieved by way of:

A) a charge-coupled device chip in the tip of the scope.
B) a chain of small connected micro light bulbs.
C) bundles of fiberoptic glass rods.
D) electrified silicon cables.

Question 19

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) CCD image intensifier.
B) high-definition monitor.
C) video camera.
D) light-guided sensor.

Question 20

The perioperative manager and the nurse-educator uncrated the new cryosurgery generator on the loading dock.The generator had been ordered for the OR,but there was no information on who ordered it.The perioperative manager and nurse-educator were new in their positions in this newly opened surgical oncology inpatient unit.The machine was large and on wheels and included an adaptor for a liquid nitrogen tank and a box of protective goggles and gloves.They called Dr.Wheeler,the liver surgeon,and Dr.Chandler,the dermatology plastic surgeon,to ask if they were aware of the delivery or had ordered the device.The most obvious destination for the transfer and placement of this device,after it is uncrated,is:

A) the dermatology clinic.
B) biomedical clinical engineering,and then the dermatology clinic to be examined and tested.
C) the liver OR after it is examined,tested,and released by biomedical clinical engineering.
D) the liver OR.

Question 21

MATCHING
Flexible endoscopes,whether they are a fiberscope with an eyepiece lens or a videoscope,have four distinct components.Match each component with its descriptive statement by drawing a line from the component part name below to the appropriate component part on the image.
a.Control body
b.Insertion tube
c.Light guide connector
d.Bending section
Flexible tube with channels for suction,biopsy,irrigation,light

Question 22

MATCHING
Flexible endoscopes,whether they are a fiberscope with an eyepiece lens or a videoscope,have four distinct components.Match each component with its descriptive statement by drawing a line from the component part name below to the appropriate component part on the image.
a.Control body
b.Insertion tube
c.Light guide connector
d.Bending section
Distal tip,flexible movement,lenses,air-water nozzle,CCD chip

Question 23

The new physician-owned endoscopy and surgery center opened with ample sized procedure rooms and a larger sterile storage core than the former unit.The gastroenterologists had a busy and financially profitable 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?

A) High-level disinfect the forceps and brushes in the same cycle with the scope for efficiency.
B) Secure a contract with a repair company to facilitate ongoing repair of the brushes and forceps.
C) Buy more reusable brushes and biopsy forceps and only open them when needed.
D) Trial several manufacturers' single-use biopsy forceps and cleaning brushes.

Question 24

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 perioperative nurses and surgical technologists in the minimally invasive surgery (MIS)service collaborated on developing a processing procedure for their new equipment.What modality is their best option?

A) Outsource to a facility that uses ethylene oxide or gamma radiation.
B) Sterilize the entire set in the low-temperature plasma sterilization system.
C) Perform high-level disinfection in glutaraldehyde.
D) Steam-sterilize the metal components and soak the nonmetal components in glutaraldehyde.

Question 25

Select the statements that best reflect the benefits of laser surgery for the surgical services department.

A) Decreases postoperative scarring that could lead to stenosis.
B) Reduces operative and anesthesia time.
C) Sterilizes tissue from the heat generated at the laser-tissue impact site.
D) Allows a shift to more ambulatory surgery procedures.

Question 26

MATCHING
Flexible endoscopes,whether they are a fiberscope with an eyepiece lens or a videoscope,have four distinct components.Match each component with its descriptive statement by drawing a line from the component part name below to the appropriate component part on the image.
a.Control body
b.Insertion tube
c.Light guide connector
d.Bending section
Suction,air,water,and light connection adaptors to energy source

Question 27

MATCHING
Flexible endoscopes,whether they are a fiberscope with an eyepiece lens or a videoscope,have four distinct components.Match each component with its descriptive statement by drawing a line from the component part name below to the appropriate component part on the image.
a.Control body
b.Insertion tube
c.Light guide connector
d.Bending section
Angulation knobs,air-water channel buttons,biopsy port

Question 28

The new endoscopy and surgery center called in an outsource company to present the options and advantages of reprocessing single use devices at their staff meeting.Select the appropriate questions that the staff should ask before making their decision.

A) Can the disposable device be adequately cleaned?
B) Is the device tested and checked for form and function after cleaning?
C) Can the device withstand disinfection or sterilization?
D) How many times can a device be reprocessed and reused?