AORN Patient Safety 2 — Questions and Answers
Question 1: During a surgical timeout, a discrepancy is noted between the consent form and the surgeon's stated procedure. What is the correct action?
- Proceed if the surgeon verbally confirms the correct site
- Stop the procedure until the discrepancy is resolved (Correct answer)
- Document the discrepancy and continue as the surgeon directs
- Ask the circulating nurse to correct the consent form
Correct answer: Stop the procedure until the discrepancy is resolved
Any discrepancy identified during the surgical timeout requires halting the procedure until all team members reach consensus and the issue is fully resolved.
Question 2: Which electrosurgical unit (ESU) practice best prevents a dispersive electrode burns?
- Placing the dispersive electrode over a bony prominence for firm contact
- Positioning the dispersive electrode on a large, well-vascularized muscle mass close to the operative site (Correct answer)
- Using the lowest possible generator setting regardless of tissue effect
- Applying a second dispersive electrode when the first appears loose
Correct answer: Positioning the dispersive electrode on a large, well-vascularized muscle mass close to the operative site
The dispersive electrode should be placed over a large muscle mass with good vascularity, close to the surgical site, to ensure low-resistance current distribution and prevent burns.
Question 3: A circulating nurse notices a surgical sponge count discrepancy after wound closure. What is the priority action?
- Inform the surgeon immediately and request an X-ray before the patient leaves the OR
- Complete the operative record and report the discrepancy to the charge nurse
- Recount with a second nurse; if still discrepant, notify the surgeon before the patient is transferred (Correct answer)
- Wait until the patient is in the PACU to perform a final recount
Correct answer: Recount with a second nurse; if still discrepant, notify the surgeon before the patient is transferred
AORN guidelines require an immediate recount verified by a second nurse, and if still discrepant, the surgeon must be notified before the patient leaves the OR so intraoperative imaging or exploration can occur.
Question 4: What is the primary rationale for maintaining OR ambient temperature between 68°F and 75°F (20°C–24°C)?
- To reduce staff fatigue during long procedures
- To balance infection control needs with patient normothermia requirements (Correct answer)
- To prevent condensation on sterile instrument trays
- To comply with OSHA ventilation standards for chemical exposure
Correct answer: To balance infection control needs with patient normothermia requirements
OR temperature ranges are set to limit microbial growth risk (lower temps) while also considering the patient's thermoregulatory needs and preventing hypothermia.
Question 5: Which action best reduces the risk of venous thromboembolism (VTE) in a patient undergoing a prolonged orthopedic procedure?
- Applying anti-embolism stockings only in the PACU after surgery
- Using sequential compression devices (SCDs) intraoperatively on the lower extremities (Correct answer)
- Administering a prophylactic anticoagulant 24 hours before surgery
- Keeping the patient in steep Trendelenburg to improve venous return
Correct answer: Using sequential compression devices (SCDs) intraoperatively on the lower extremities
Intraoperative application of sequential compression devices maintains lower-extremity venous flow during prolonged immobility, significantly reducing VTE risk.
Question 6: A patient reports a latex allergy during the preoperative assessment. Which scheduling adjustment is most important?
- Schedule the case last of the day to allow thorough OR cleaning afterward
- Schedule the case as the first case of the day to minimize airborne latex particle exposure (Correct answer)
- Assign an extra scrub technician to monitor for allergic reactions
- Request that the anesthesiologist avoid all IV medications in rubber-stoppered vials
Correct answer: Schedule the case as the first case of the day to minimize airborne latex particle exposure
Scheduling a latex-sensitive patient as the first case minimizes airborne latex allergen accumulation from previous cases, reducing the risk of anaphylaxis.
Question 7: Which parameter is the most reliable indicator of adequate surgical hand antisepsis efficacy?
- Scrub duration of at least 10 minutes with any antimicrobial agent
- Reduction of resident and transient flora to the lowest possible level with persistent effect (Correct answer)
- Visible absence of soil or debris on hands and forearms
- Complete elimination of all skin microorganisms including spore-forming bacteria
Correct answer: Reduction of resident and transient flora to the lowest possible level with persistent effect
Effective surgical hand antisepsis achieves a significant sustained reduction in both resident and transient flora, not just temporary removal or complete sterility.
AORN Patient Safety 2
During a surgical timeout, a discrepancy is noted between the consent form and the surgeon's stated procedure.
What is the correct action?