AORN Electrosurgical Safety 1 — Questions and Answers
Question 1: What is the primary mechanism by which a monopolar electrosurgical unit (ESU) cuts tissue?
- Rapid cellular heating causes vaporization of intracellular fluid (Correct answer)
- Mechanical vibration disrupts cell membranes
- Chemical reactions denature cellular proteins
- Cryogenic temperatures destroy tissue
Correct answer: Rapid cellular heating causes vaporization of intracellular fluid
In monopolar electrosurgery, high-frequency electrical current generates intense heat at the active electrode tip, rapidly vaporizing intracellular fluid and causing tissue cutting.
Question 2: Which electrosurgical waveform mode delivers a continuous, unmodulated current primarily used for cutting tissue?
- Coagulation mode
- Blend mode
- Cut mode (Correct answer)
- Bipolar mode
Correct answer: Cut mode
Cut mode delivers a continuous, uninterrupted sinusoidal waveform that rapidly heats tissue cells to cause vaporization and cutting.
Question 3: What is the primary purpose of the dispersive (return) electrode in monopolar electrosurgery?
- To amplify the electrical current at the surgical site
- To provide a large surface area for safe return of current to the ESU (Correct answer)
- To generate the cutting waveform from the generator
- To neutralize electrical charge before it reaches the patient
Correct answer: To provide a large surface area for safe return of current to the ESU
The dispersive electrode provides a large contact surface so that the return current is spread over a wide area, preventing dangerous heat concentration and burn injury.
Question 4: According to AORN guidelines, where is the most appropriate site for placing the dispersive electrode?
- Over a bony prominence closest to the surgical site
- On a well-vascularized, large muscle mass closest to the operative site (Correct answer)
- On the patient's chest, regardless of surgical site location
- Over a scar or skin fold for better adhesion
Correct answer: On a well-vascularized, large muscle mass closest to the operative site
AORN recommends placing the dispersive electrode on a large, well-vascularized muscle mass as close to the operative site as possible to optimize current return and minimize resistance.
Question 5: When a flammable alcohol-based antiseptic skin prep solution is used, what must the perioperative nurse ensure before electrosurgery is activated?
- The solution has been neutralized with saline irrigation
- The solution has completely dried and pooling has been removed (Correct answer)
- A non-flammable drape has been placed over the wet prep area
- The ESU power setting has been reduced to a minimum
Correct answer: The solution has completely dried and pooling has been removed
Alcohol-based prep solutions are highly flammable, so AORN requires that the solution be allowed to fully dry and any pooling be eliminated before electrosurgery is used to prevent surgical fires.
Question 6: What type of injury can result when the dispersive electrode is improperly placed or has inadequate skin contact during monopolar electrosurgery?
- Pressure injury at the dispersive electrode site
- Electrosurgical burn at the dispersive electrode site (Correct answer)
- Nerve stimulation injury at the active electrode site
- Electromagnetic interference with monitoring equipment
Correct answer: Electrosurgical burn at the dispersive electrode site
Poor contact or improper placement of the dispersive electrode concentrates current density at the pad site, generating sufficient heat to cause a full-thickness burn.
Question 7: A patient with an implanted cardiac pacemaker requires monopolar electrosurgery. Which intervention should the perioperative nurse prioritize?
- Use the highest available power setting to minimize procedure time
- Place the dispersive electrode as far from the pacemaker as possible and use short, intermittent bursts (Correct answer)
- Remove the pacemaker before surgery begins
- Switch the ESU to coagulation-only mode for the entire case
Correct answer: Place the dispersive electrode as far from the pacemaker as possible and use short, intermittent bursts
Placing the dispersive electrode to route current away from the pacemaker and using short, intermittent bursts minimizes electromagnetic interference that could reprogram or inhibit the device.
AORN Electrosurgical Safety 1
What is the primary mechanism by which a monopolar electrosurgical unit (ESU) cuts tissue?