CNOR Intraoperative Care and Safety 4 — Questions and Answers
Question 1: During a robotic-assisted surgery, the OR team loses all visual display. What is the safest immediate action?
- Continue the procedure using tactile feedback
- Convert to open surgery immediately
- Pause the procedure and troubleshoot the display system (Correct answer)
- Ask the surgeon to proceed by memory of the anatomy
Correct answer: Pause the procedure and troubleshoot the display system
The immediate safe response is to pause and troubleshoot; conversion to open surgery is reserved for situations where the problem cannot be quickly resolved.
Question 2: Which antiseptic agent is contraindicated for skin preparation around the eyes?
- Chlorhexidine gluconate
- Povidone-iodine
- Isopropyl alcohol 70%
- Chlorhexidine gluconate and isopropyl alcohol (Correct answer)
Correct answer: Chlorhexidine gluconate and isopropyl alcohol
Both chlorhexidine and alcohol are ototoxic and can cause serious eye injury; only dilute povidone-iodine is approved for periocular skin prep.
Question 3: When applying a tourniquet to the upper extremity, what is the maximum recommended inflation time before deflation and reperfusion?
- 30 minutes
- 60 minutes
- 90 minutes (Correct answer)
- 120 minutes
Correct answer: 90 minutes
Most guidelines recommend deflating pneumatic tourniquets after no more than 90 minutes on the upper extremity to prevent ischemic nerve and muscle injury.
Question 4: A nurse notices that a sterile package has a small tear in the outer wrapper but the inner wrapper appears intact. What is the correct action?
- Use the item since the inner wrapper is intact
- Consider the item unsterile and replace it (Correct answer)
- Re-wrap the outer layer with sterile drape
- Ask the surgeon if it is acceptable to use
Correct answer: Consider the item unsterile and replace it
A compromised outer wrapper cannot guarantee the sterility of the inner contents; event-related sterility means any breach makes the item unsterile.
Question 5: Which safety measure is most important when using laser in the OR to protect the patient's airway?
- Draping the patient's face with wet towels
- Using a laser-resistant endotracheal tube with the lowest FiO2 possible (Correct answer)
- Placing the patient in reverse Trendelenburg position
- Using a standard PVC tube with a cuffed design
Correct answer: Using a laser-resistant endotracheal tube with the lowest FiO2 possible
Laser-resistant ETTs with the lowest effective FiO2 reduce both ignition risk and fire propagation if the tube is struck by the laser beam.
Question 6: Which of the following is an early sign of air embolism during a procedure performed in the sitting (beach chair) position?
- Hypertension
- Bradycardia
- 'Mill wheel' murmur and a decrease in end-tidal CO2 (Correct answer)
- Increased end-tidal CO2 with tachycardia
Correct answer: 'Mill wheel' murmur and a decrease in end-tidal CO2
A 'mill wheel' murmur heard on precordial Doppler and a drop in end-tidal CO2 are early indicators of venous air embolism in the sitting position.
Question 7: What is the purpose of the 'sterile cockpit' concept applied during the surgical count?
- To keep the sterile field free of nonsterile items
- To restrict all nonessential communication during critical count phases (Correct answer)
- To designate one person as responsible for all counts
- To limit the number of personnel entering the OR during counting
Correct answer: To restrict all nonessential communication during critical count phases
Borrowed from aviation, 'sterile cockpit' in surgery means eliminating nonessential conversation during counts to prevent distractions that lead to count errors.
CNOR Intraoperative Care and Safety 4
During a robotic-assisted surgery, the OR team loses all visual display.
What is the safest immediate action?