Clinical Medical Skills Exam 1

Front 1

What areas on a surgical gown are considered sterile?

Back 1

1) front from shoulder to waist
2) sleeves to 2 in. above elbow

Front 2

What is the hand washing procedure when using an alcohol-based cleanser?

Back 2

1)Wash hands & forearms with NON-antibacterial soap and dry completely
2) apply alcohol-based cleanser
3) make sure hands are completely dry before putting on gloves

Front 3

What materials are utilized for surgical hand scrub?

Back 3

1) chlorhexidine gluconate or povidone-iodine solution
2) sterile disposable scrub brushes impregnated with above solutions or other CDC approved products

Front 4

What materials are utilized to prepare the procedure site?

Back 4

1) disposable razors
2) towels
3) antiseptic soap
4) gauze sponges
5) large clamp or ring forceps to hold the prep sponge or gauze

Front 5

What is the procedure for preparing the operative site?

Back 5

1) scrub with antiseptic solution beginning at the procedure site & working out in a circular motion
2) on reaching the outer boundary, discard the first sponge and repeat with remaining sponges

Front 6

What are the types of drapes used for operative procedures?

Back 6

towels, sheets, split sheets, stockinette, & plastic incision drapes

Front 7

What are the qualities that a drape material must possess?

Back 7

lint-free, antistatic, fluid resistant, abrasive free, & made to fit contours

Front 8

What is the procedure for draping?

Back 8

1) hold drape high to avoid touching unsterile areas
2) walk around the table to drape the opposite side
3) handle drapes as little as possible & don't shake out wrinkles
4) make a cuff & place the folded edge toward the incision site

Front 9

What should you do if you find a hole in your drape?

Back 9

cover it with another drape

Front 10

What should you do with a drape that has been placed incorrectly?

Back 10

discard it or cover with another drape

Front 11

How far away from the sterile field must an unsterile person stay in order to prevent contamination?

Back 11

12 inches

Front 12

When is a surgical mask required?

Back 12

When any sterile items are open

Front 13

What are the contraindications for venipuncture?

Back 13

1) skin infection at site
2) scarring at site
3) upper extremity ipsilateral mastectomy
4) hematoma at site
5) arm with IV line - if the opposite arm cannot be used, draw distal to the IV line
6) fistula or cannula in place; edema

Front 14

What are the potential complications of venipuncture?

Back 14

1) cellulitis (skin infection)
2) phlebitis (vein infection)
3) thrombosis
4) laceration of vein
5) hemorrhage or hematoma at site
6) vasovagal syncope

Front 15

What precautions can be taken to decrease the risk of hemorrhage at the site of venipuncture?

Back 15

1) use the correct angle
2) insert slowly
3) use a smaller gauge needle

Front 16

What should you do if a hematoma develops at the venipuncture site?

Back 16

1) remove the turniquet & needle
2) maintain pressure x 10 min

Front 17

What are the boundaries of the cubital fossa?

Back 17

imaginary line connecting the medial & lateral epicondyles superiorly, the pronator teres medially, & the brachioradialis laterally

Front 18

What are the best veins for venipuncture, in the order of choice?

Back 18

1) median cubital vein
2) cephalic vein
3) basilic vein

Front 19

What is the maximum amt of time a tourniquet can be left on the arm during venipuncture?

Back 19

2 min.

Front 20

What are the methods for finding difficult veins for venipuncture?

Back 20

1) have pt hold extremity below heart for a few minutes
2) apply warm towel no longer than 2 min.
3) use blood pressure cuff as tourniquet

Front 21

Just prior to inserting the needle to draw blood, how do you anchor the vein and limit movement?

Back 21

stretch the skin downward below the anticipated venipuncture site with the opposite hand

Front 22

Which direction should the bevel be facing when the needle is inserted for a blood draw, and at what angle should the needle enter the skin?

Back 22

bevel upward
15-30 degree angle

Front 23

What can happen if the needle is inserted at the wrong angle when drawing blood?

Back 23

the needle may puncture through the far wall of the vein

Front 24

When should syringes be used instead of vacutianer tubes?

Back 24

if pts veins are small or fragile

Front 25

What size needles should be used when drawing blood with a syringe for patients with small or fragile veins?

Back 25

20-21 gauge

Front 26

Where can you draw blood when using an IV fusion set or butterfly?

Back 26

hand or foot

Front 27

Besides bacteremia, what are the indications for ordering blood cultures?

Back 27

severely ill or febrile patients
suspected infective endocarditis
intravascular cath site infection
meningitis
osteomyelitis
septic arthritis
bacterial pmx
fever of unknown origin

Front 28

What are the contraindication of drawing a blood culture?

Back 28

1) pts on Warfarin
2) site of active skin infection
3) if multiple previous cultures have been negative

Front 29

What are the potential complications of drawing blood cultures?

Back 29

1) hematoma
2) continued bleeding
3) cellulitis or phlebitis
4) contaminated samples may lead to inappropriate abx use

Front 30

What are the signs that a blood culture was contaminated?

Back 30

1) component of skin flora is detected
2) several different kinds of bacteria detected
3) growth is found in only 1 of several specimens from separate venipunctures

Front 31

When obtaining a blood culture, do you inoculate the aerobic or anaerobic tube first?

Back 31

anaerobic

Front 32

What are the contraindications for IV therapy?

Back 32

1) Skin infection at IV site
2) Should not be placed distal to any area of preexisting thromophlebitis
3) lower extremity IVs should be avoided in elderly, PVD & venous insufficiency

Front 33

What can you do to prevent thrombosis or thrombophlebitis at the IV site (secondary to trauma) ?

Back 33

tape the cannula securely to prevent movement & avoid inserting IV lines too close to joints

Front 34

What are the systemic complications associated with IV line placement?

Back 34

Catheter embolization
Septicemia
PE
Air Embolism

Front 35

How can you prevent air embolism from an IV line?

Back 35

carefully flush all lines before connection

Front 36

Which 2 veins are used most often for IV lines?

Back 36

metacarpal & cephalic veins

Front 37

What gauge needle would you use to anesthetize the skin prior to inserting an IV line catheter?

Back 37

27 gauge

Front 38

What gauge needle should be used for blood infusions?

Back 38

16 gauge

Front 39

What gauge needle would you use to administer IV fluids?

Back 39

23 gauge (smallest)

Front 40

At what angle should the catheter needle be positioned when entering the arm?

Back 40

15-30 degrees

Front 41

When would you use direct entry rather than indirect entry for IV catheter placement?

Back 41

direct = large veins
indirect = small veins

Front 42

What is the IV catheter of choice for pediatrics?

Back 42

butterfly IV line

Front 43

What are the indications for arterial blood samples?

Back 43

1) diagnosis of acute dysfunction in CO2/O2 exchange
2) Monitoring severity & progress of a documented disease
3) after therapeutic hyperventilation tx or cardiopulmonary resuscitation

Front 44

Which type of blood sample would be needed to get the most accurate ammonia, carbon monoxide, and lactate levels?

Back 44

arterial blood sample

Front 45

What are the contraindications for drawing an arterial blood sample?

Back 45

1) No arterial pulse
2) Negative Allen test (radial artery)
3) When surface landmarks are not visible
4) Arterial Dz, Arterial inflammatory conditions, known/suspected aneurysm
5) coagulopathy, severe thrombocytopenia, or pts on anticoagulopathy tx
6) ESRD
7) Skin irritation

Front 46

What are the complications associated with arterial blood draws?

Back 46

1) hemorrhage or hematoma
2) thrombosis
3) transient arterial spasm
4) nerve damage
5) infection (rare)

Front 47

Which artery is used most often for arterial blood samples?

Back 47

Radial artery

#2 = brachial
#3 = femoral

Front 48

What is the recommended patient position for arterial blood draws?

Back 48

supine

Front 49

If oxygen tx has just been adjusted, or the patient has just been suctioned, how long should you wait before drawing the arterial blood sample?

Back 49

at least 15 min

Front 50

What size needle is used for arterial blood draws?

Back 50

21-25 gauge
1/2 - 5/8 in.

Front 51

How long is an arterial blood sample stable if properly iced?

Back 51

1-2 hours

Front 52

If too much heparin is in the syringe when drawing an arterial blood sample what will happen to the pH?

Back 52

pH will decrease

Front 53

What are the follow up instructions for patients after an arterial blood sample?

Back 53

1) monitor pt to ensure hemostasis has been achieved
2) advise tenderness & ecchymosis may result
3) advise pt to seek medical help if pain or redness increases, or if extremity becomes cool
4) avoid rigorous activity x 24 hrs