CCI First Edition CNOR Exam Prep Chapters 1-9 Questions
Ventilation of OR
*Air should enter from ceiling or high vents *Air should exit through vents low on wall or bar floor *Total of 20 Air exchanges should occur per hour with minimum of 4 exchanges coming from outside.
A surgeon requests the perioperative nurse retrieve a laparoscopy lens that has not completed its aeration cycle after being sterilized via ethylene oxide (EO). The most appropriate response to this request is: A. "Instruments that have not completed the aeration cycle can cause burns to staff and patients." B. "There is an increased risk for cancer from instruments that have not been appropriately processed." C. "Materials that have been appropriately aerated are a fire risk." D. "Our policy states that instruments must complete an eight-hour aeration cycle before they can be released for use."
A. "Instruments that have not completed the aeration cycle can cause burns to staff and patients." Rationale: Insufficiently aerated items can cause skin irritation and tissue burns.
A new plastic surgeon has just joined the staff of an ambulatory surgery center. The surgeon requests a line of suture that is not carried by the facility. How can the nurse best respond in providing rationale for use of the facility's brand of suture? A. "Standardization of products is one way our surgeons can help us control costs." B. "We don't have enough shelf space in the suture room to accommodate more boxes." C. "We don't have a contract with that suture company." D. "The rest of our surgeons won't use that type of suture."
A. "Standardization of products is one way our surgeons can help us control costs." Rationale: Standardization of products can reduce costs.
A 14-year-old patient scheduled for a tonsillectomy has a family history of an unexplained death in the OR. During intubation, the anesthesia professional remarks on how difficult it is to intubate the patient secondary to abnormally stiff neck muscles. The perioperative nurse then notes an elevated CO2 level and heart rate on the monitor. The perioperative nurse has which of the following medication immediately available? A. Dantrolene B. Epinephrine C. Ephedrine D. Amiodarone
A. Dantrolene Rationale: The patient is exhibiting signs and symptoms of malignant hyperthermia. Treatment includes rapid infusion of dantrolene sodium.
A health care facility is considering the purchase of a new electrocautery unit. The new unit would require an upgrade to a new electrocautery dispersive pad. Under which type of financial impact analysis is the new pad considered? A. Direct cost B. Indirect cost C. Reimbursement potential D. Contract pricing
A. Direct cost Rationale: Associated equipment is considered a direct cost.
The RN circulator completing the final count for a knee arthroscopy discovers that an atraumatic needle is missing. After an exhaustive search, an x-ray is ordered. The results are negative and the surgeon closes the wound. How does the RN circulator document the incident? A. Document that the count was incorrect or unreconciled and describe the steps that were taken to rectify the count. B. Document that the count was correct because the x-ray was negative. C. Notify the supervisor and document what he/she instructs according to facility policy. D. Inform the patient that a needle may have been left in the wound.
A. Document that the count was incorrect or unreconciled and describe the steps that were taken to rectify the count. Rationale: If the x-ray is negative, the count is recorded as incorrect or unreconciled and the x-ray results are noted on the patient's intraoperative record, as well as the description of the search process.
7. What part of the preoperative assessment indicates that a patient is at risk for postoperative deep vein thrombosis (DVT)? A. History of varicosities B. History of alcohol abuse C. Recent upper respiratory infection D. Body mass index greater than 26
A. History of varicosities Rationale: During the preoperative assessment, the nurse should assess the patient for conditions that may suggest an increased risk of DVT development. These risks include a personal or family history of thrombosis, coagulopathy, blood clots, blood-clotting disorders, previous deep vein thrombosis or pulmonary embolism, varicosities or leg swelling, smoking, or living sedentary or nonambulatory lifestyle for more than 72 hours.
What is the greatest value of a standardized process for transferring patient information? A. Improves the accuracy, reliability, and quality of information. B. Shortens the time it takes to transfer information from one caregiver to another. C. Ensures that the same information is transferred for every patient. D. Ensures that the transfer process adheres to facility policy.
A. Improves accuracy, reliability, and quality of information. Rationale: Using a standardized format allows for consistent transfer of information and improved communication across the entire patient care continuum.
___________________________ involves the action of forces on the human body and their effects during a traumatic injury. A. Kinematics B. Kinesthetics C. Velocity D. Force
A. Kinematics Rationale: Kinematics is also known as the me the mechanism of injury. "The first EMS team on respond to the scene of an injury must carefully evaluate the patient in relation to the MOI."
5. Which of the following authoritative organizations is responsible for delineating the accepted list of nursing diagnosis? A. NANDA International B. American Nurses Association C. AORN D. The Joint Commission
A. NANDA International Rationale: NANDA International is the organization responsible for creating and updating the current list of nursing diagnoses. NANDA classifies human response patterns and standardizes the terminology for all nursing diagnoses.
The importance of educating patients and family members about prevention of wound infections postoperatively is part of the: A. National Patient Safety Goals B. Surgical Care Improvement Project C. AORN Guidelines for Perioperative Practice D. Centers for Disease Control and Prevention
A. National Patient Safety Goals Rationale: NPSG #7 discusses the importance of preventing hospital-associated infections. It is required that education for prevention of SSI be documented in the patient's medical record.
A patient is scheduled for a total knee replacement. During the time out, the scrub nurse discovers that the incorrect implant is on the back table. The correct implant is available, but unsterile. The surgeon would like to continue with the case. What is the best course of action? A. Notify the surgeon that the correct implant may be sterilized via the immediate-use steam sterilization (IUSS) method if biological and class V indicators are placed in the load. B. Notify the surgeon that the correct implant may be sterilized via the ethylene oxide method if the aeration period is aborted. C. Notify the surgeon that a root cause analysis will be initiated. D. Cancel and reschedule the procedure.
A. Notify the surgeon that the correct implant may be sterilized via the immediate-use steam sterilization (IUSS) method if biological and class V indicators are placed in the load. Rationale: IUSS is reserved for those instances in which there is insufficient time to process by the preferred wrapped or container method. Biological and class V indicators must be run in the load with the implant.
A 12-year-old child with a history of asthma is emerging from general anesthesia following a tonsillectomy. Upon extubation, the child begins wheezing, which rapidly progressed to stridor. The perioperative nurse can anticipate assisting the anesthesia professional with which of the following actions first? A. Suctioning the airway B. Setting up an aerosol mask with 2.5% racemic epinephrine C. Administering Solu-Medrol 2 mg/kg IV. D. Reintubating the child
A. Suctioning the airway. Rationale: The first step is to attempt to remove the irritating substance.
A multidisciplinary team is evaluating a new brand of irrigation fluid. The empty container is recyclable. Which of the following will be affected if this product is chosen? A. The environment B. Patient safety C. End-user satisfaction D. Group purchasing contract
A. The environment Rationale: The environmental effect of a product is influenced by whether it may be recycled.
The Standards of Professional Perioperative Professional Practice identifies key behaviors of a professional that include maintaining competency and current knowledge in the perioperative specialty and: A. a pursuit of lifelong learning. B. an understanding of legislative matters. C. a commitment to precepting. D. an ability to identify patient outcomes.
A. a pursuit of lifelong learning. Rationale: A commitment to and pursuit of lifelong learning are part of AORN's description of professional practice as well as the Institute of Medicine's report The Future of Nursing: Leading Change, Advancing Health. Lifelong learning is necessary for perioperative nurses to stay current with the pace of technological change and to advance nursing professionalism.
MJ is a 53-year-old woman with advanced breast cancer. She has already undergone several surgeries in an attempt to stop the spread of the cancer. She is now comatose and is experiencing difficulty breathing. The pulmonologist wants to schedule her for a bronchoscopy in the OR under anesthesia. The patient's husband gives consent. The perioperative RN is feeling uncomfortable with the proposed procedure. The most appropriate response for the perioperative RN is to: A. call her immediate supervisor and ask for an ethics consult. B. call in another RN to do the procedure. C. refuse to schedule the procedure. D. tell the husband that his wife is not going to to benefit from the procedure.
A. call her immediate supervisor and ask for an ethics consult. Rationale: The nurse facing an ethical dilemma should follow the chain of command by contacting the immediate supervisor.
Effective communication skills are best demonstrated when the caregiver's body language is: A. consistent with the spoken word. B. viewed as more important than the spoken word. C. kept to a minimum or avoided. D. animated.
A. consistent with the spoken word. Rationale: Patients and family members must feel comfortable when interacting with caregivers. Various types of communication are necessary to be effective in all communications with patients and families. Both verbal and nonverbal communication should match to decrease confusion.
4. A patient undergoing placement of a cardiac stent is at highest risk for _____________ secondary to exposure to ionizing radiation. A. impaired skin integrity B. cancer C. decreased cardiac output D. nausea
A. impaired skin integrity Rationale: The patient exposed to ionizing radiation is at greatest risk for impaired skin integrity.
What can compromise the accuracy of the nurse's transfer of patient care? A. interruptions B. patient acuity C. patient diagnosis D. paper charting
A. interruptions Rationale: Interruptions and distractions can lead to errors and a failure to give a complete report, affecting patient safety.
A ______________________ is an environment where actions are analyzed to determine accountability and reparations are enacted when appropriate. A. just culture B. culture of accountability C. culture of communication D. learning culture
A. just culture Rationale: A just culture allows for the discussion of errors in an environment free of fear and punishment. Such discussion includes risk factors and processes that may have contributed to the identified error. A culture of safety is when a facility promotes resources and education for safe patient care and includes the patient and family in the decision-making process.
Discharge education should include adverse effects of opioid pain medication, including constipation, vomiting, and: A. respiratory depression B. hypotension C. hypertension D. diarrhea
A. respiratory depression Rationale: Respiratory and central nervous depression are possible side effects of opioid pain medciations.
When placing one peel pouch inside another: A. the inner pouch should be placed with its plastic side facing the plastic side of the outer pouch. B. the inner pouch should be placed with the plastic side facing the paper side of the outer pouch. C. the inner pouch should be folded over to fit inside the outer pouch. D. the outer pouch should be labeled on the paper side.
A. the inner pouch should be placed with the plastic side facing the plastic side of the outer pouch. Rationale: The inner pouch should fit inside the outer pouch without folding it, and face in the same direction as the outer pouch (eg. plastic faces plastic) to allow for sterilant to pass through both pouches. Labeling ton the plastic side of the pouch will prevent transfer of ink into the contents of the pouch.
A disaster preparedness plan should include the use of a command center, triage center, staffing plan for personnel, and documentation and communication should be held at least _____________________. A. twice a year. B. yearly. C. every three months. D. every two years.
A. twice a year. Rationale: Twice a year disaster drills should be held to test the plans developed by the planning committee and to education staff on roles and plans.
5. An 18-year old patient is hesitant to remove her acrylic tongue piercing before an exploratory laparoscopy for a possible ruptured ovarian cyst. The most appropriate verbal response for the perioperative RN to provide is: A. "You can always get another piercing if the opening for this one closes." B. "If the piercing is dislodged while the breathing tube is put in, it could block your airway or be pushed into your lung." C. "It's our policy that all jewelry be removed prior to surgery." D. "Your tongue could be burned if jewelry serves as an alternate ground for the electrocautery."
B. "If the piercing is dislodged while the breathing tube is put in, it could block your airway or be pushed into your lung." Rationale: A tongue piercing is an aspiration risk and should be removed if at all possible.
In an effort to reduce operating costs, perioperative staff has been instructed to save unused suture packets from the sterile field to be resterilized in their facility's sterile processing department. What is the appropriate response to this request? A. "Will the patient be charged full cost for reused suture?" B. "Is this product on the list for approved reprocessing by the FDA?" C. "How are other facilities reprocessing their suture?" D. "How will the affect our purchasing agreement with our suture manufacturer?"
B. "Is this product on the list for approved reprocessing by the FDA?" Rationale: The product must be listed on the FDA-approved product list to be safely reprocessed.
Massive hemorrhage is treated by transfusion that is equal to replacing _______% of the patient's estimated blood volume in three hours or less. A. 15 B. 50 C. 25 D. 70
B. 50 Rationale: Fifty percent of estimated volume in three hours or less, or one or more blood volumes in 24 hours, should be replaced. Rapid infusion for massive trauma is consistent practice in many facilities.
3. In planning for the transfer of an 18-pound child to the gurney after bilateral myringotomies with insertion of ear tubes, the perioperative nurse plans for which of the following patient transfer aides? A. A lateral transfer device, one caregiver, and the anesthesia professional B. A lateral transfer device, two caregivers, and the anesthesia professional C. A lateral transfer device, three caregivers, and the anesthesia professional D. A mechanical lift device, three caregivers, and the anesthesia professional
B. A lateral transfer device, one caregivers, and the anesthesia professional Rationale: For patients up to 52 pounds, a lateral transfer device, one caregiver, and an anesthesia professional should be used for supine-to-supine patient transfer.
Which of the following is a common root cause of sentinel events? A. Failure to use written communication tools B. Breakdown in communication C. Absence of or failure to follow policies and procedures D. Fear of reprisal for speaking up
B. Breakdown in communication Rationale: Including briefings and debriefings before and after surgery, respectively, allows for improved communication among team members. The goal of effective communication is to ensure that all team members are aware of key safety strategies and prepared for the surgical procedure.
A patient is undergoing a procedure to remove vocal cord polyps using carbon dioxide laser. During the procedure, the endotracheal tube (ETT) ignites. Which of the following actions should be undertaken first? A. Call for assistance B. Remove the ETT C. Pour saline into the patient's airway. D. Turn off the CO2 laser.
B. Remove the ETT Rationale: For fire in the airway or breathing circuit, the ETT should be removed immediately.
A multidisciplinary team has been convened to review several recent incidents where the wrong patient has been brought from the medical-surgical unit to the preoperative holding area. Which of the following actions would prevent this incident from occurring in the future? A. Requiring an RN to accompany the patient to the preoperative holding area. B. Reviewing with transport personnel the process for confirming the correct patient's identity. C. Ensuring that the OR charge nurse calls the unit before transport of the patient. D. Posting the surgical schedule at the nurse's station on the medical-surgical unit.
B. Reviewing with transport personnel the process for confirming the correct patient's identity. Rationale: The patient is accurately identified before transport to the OR.
4. Which of the following is part of the surgical safety checklist? A. When the patient last ate food or drank liquids B. Whether any special equipment, devices, or implants will be needed C. Whom the surgeon should talk to after surgery D. What pharmacy the patient uses
B. Whether any special equipment, devices, or implants will be needed Rationale: The comprehensive surgical checklist is part of the Universal Protocol that is supported and endorsed by both the World Health Organization and The Joint Commission. Identifying if there are any special equipment, devices, or implants needed for the surgical procedure is part of the preoperative check-in.
When delegating a task to unlicensed assistive personnel (UAP), the perioperative nurse retains ___________________ for that delegated task. A. responsibility B. accountability C. authority D. administration
B. accountability Rationale: Delegating transfers authority to a competent individual to perform the task while retaining accountability for the appropriate completion of that task.
10. A 28-year-old Hispanic male is schedule for repair of an incarcerated inguinal hernia. He does not speak English. The consent form is only available in English. The best way for the perioperative nurse to ensure informed consent for this patient is to: A. witness the patient's signature on the consent form. B. arrange for a medical interpreter. C. allow a family member to interpret for the surgeon. D. arrange for a Spanish-speaking staff member to interpret for the surgeon.
B. arrange for a medical interpreter. Rationale: The patient must be provided information related to his surgery in terms that he can understand. To maintain patient confidentiality, a medical interpreter should be provided to assist non-English speaking patients.
Policies and procedures related to transfer of patient information should be: A. reviewed annually B. available in the practice setting C. written by a registered nurse D. written using SBAR format.
B. available in the practice setting Rationale: Health care staff must have access to policies and procedures related to the transfer of patient care information readily available for reference. Reviews are periodic but not within a specified time frame and should be written by an interdisciplinary team.
Placing the patient on the OR bed in the supine position with arms extended on armboards at greater than 90 degrees may cause injury to the: A. axillary nerve B. brachial plexus C. median nerve D. radial nerve
B. brachial plexus Rationale: The brachial plexus is a group of nerves that run between the clavicle and the first rib. Hyperextension of the arm can press the clavicle and first rib together, applying excessive pressure on the brachial plexus.
Structure and processes for transfer of patient information should be developed: A. according to The Joint Commission and Centers for Medicare and Medicaid Services guidelines. B. by a multidisciplinary team comprising caregivers who participate in the transfer of patient information. C. by the health care facility's Risk Management Department. D. using the SBAR format.
B. by a multidisciplinary team comprising caregivers who participate in the transfer of patient information. Rationale: All members of the team should be encouraged to participate and recommend information requirements for the standardized process of sharing patient information. Patient safety is improved when all members of the team contribute to communication standards.
The wound classification for a cesarean section in which meconium is released into the abdominal cavity changes the wound classification from: A. class I to class II B. class II to class III C. class III to class IV D. class IV to class III
B. class II to class III Rationale: Entering the genitourinary tract in controlled situations without unusual contamination is considered a class II. Contamination of the wound will change the classification to a class III.
The goal of performing a follow-up phone call within 48 to 72 hours of the patient's discharge is to: A. monitor the patient's heart rhythm B. confirm patient's understanding of and compliance with instructions. C. finalize paperwork for submission to the patient's insurance provider. D. schedule follow-up apppointments.
B. confirm patient's understanding of and compliance with instructions. Rationale: Instructions are reviews and printed for the patient prior to discharge. A phone call will clarify whether the patient understood the directions and is continuing to be compliant.
Patients placed in the steep Trendelenburg position may be at risk for: A. increased tidal volume B. decreased tidal volume C. decreased intracranial pressure D. increased stroke volume
B. decreased tidal volume Rationale: Patients in the steep Trendelenburg experience decreased tidal volume cause by the pressure of the abdominal contents against the diaphragm.
During an intraoperative hand-over between scrub persons before a change in personnel using the SBAR format, the information under Situation includes pertinent procedural information, name of the procedure, and: A. patient allergies B. name of the patient. C. names of the surgical team. D. medications on the back table.
B. name of the patient. Rationale: The patient name is included in the Situation part of SBAR hand-overs. The other options are all part of the Background information.
The correct parameters for airflow patterns and temperature in the restricted area of the perioperative suite include: A. negative pressure; 68F to 75F (20C to 24C) B. positive pressure; 68F to 75F (20C to 24C) C. negative pressure; 72F to 78F (22C to 26C) D. positive pressure; 70F to 75F (21C to 24C)
B. positive pressure; 68F to 75F (20C to 24C) Rationale: The restricted area of the OR is intended to be the cleanest perioperative area. The intent of parameters placed on heating, ventilation, and air-conditioning settings is to reduce the number of environmental contaminants in the surgical suite.
A split-thickness skin graft is obtained for autotransplantation to occur in one week at the same facility. The best way to preserve the graft is to: A. place the tissue in balanced salt solution. B. refrigerate the tissue in normal saline. C. sterilize the skin using ethylene oxide (ETO). D. sterilize the skin using steam sterilization.
B. refrigerate the tissue in normal saline. Rationale: Autologous skin for delayed autotransplantation may be refrigerated and stored in normal saline.
The Joint Commission has provided guidance on ___________________ processes to address unexpected occurrences that have resulted or may result in patient injury or death. A. root cause analysis B. sentinel event C. error identification D. process analysis
B. sentinel event Rationale: Sentinel events, unexpected patient occurrences, signal the need for immediate investigation. The investigation is a root cause analysis (RCA). An RCA identifies changes in current performance standards that may have led to the occurrence.
Management of a patient infected with anthrax includes using ________________ precautions. A. droplet B. standard C. airborne D. contact
B. standard Rationale: Standard precautions should be used with special attention to containing any open or draining wounds.
Instruments undergoing high-level disinfection should be rinsed after the required exposure time with: A. tap water. B. sterile water. C. sterile saline. D. sodium hypochlorite.
B. sterile water. Rationale: Rinsing with sterile water prevents recontamination of the instrument. Saline and sodium hypochlorite can corrode the finish of the instrument.
The perioperative patient's transition from phase I to phase II level of care is based on: A. the length of time the patient has been in phase I B. the nurse's assessment of the patient C. the patient's blood pressure measurement D. the patient's oxygen saturation
B. the nurse's assessment of the patient Rationale: There is not length of time requirement for the patient's stay in phase I. The length of time is dependent on the nurse's assessment of the patient's status. Although blood pressure measurement and oxygen saturation are both components of a patient assessment, the patient assessment contains blood pressure measurement, oxygen saturation, minimal pain, absent of controlled nausea and vomiting, uncompromised cardiopulmonary status, stable vital signs, urine output of more than 30mL per hour, and the ability to maintain open airway.
10. The perioperative nurse performs a preoperative assessment on a surgical patient to aid in the development of: A. the complete medical record B. the patient's plan of care C. the surgeon's postoperative note D. future research in perioperative nursing
B. the patient's plan of care Rationale: The perioperative nurse must complete a preoperative assessment on his or her patient to facilitate identification of the appropriate nursing diagnosis, development of a plan for the appropriate interventions and care, and achievement of the desired surgical outcomes.
Potential harm from the use of povidone-iodine antiseptic includes: A. deafness B. thyroid dysfunction C. neurotoxicity D. allergic response to iodine
B. thyroid dysfunction Rationale: Iodine may interfere with thyroid function in burn patients, patient undergoing thyroidectomy, neonates and premature neonates, and pregnant or lactating women. Answers A and C are harmful effects of chlorhexidine gluconate antiseptic solutions. An allergic response to iodine-based antiseptic is not related to the iodine.
2. The optimal time to apply intermittent compression pneumatic devices to prevent deep vein thrombosis is: A. when the surgical procedure is scheduled B. when the patient arrives in the preoperative area C. immediately upon arrival in the OR D. before induction of anesthesia
B. when the patient arrives in the preoperative area Rationale: The risk for formation of deep vein thrombosis increases with preoperative immobility.
The Joint Commission's Universal Protocol serves as a guide to prevent: A. wrong-medication, wrong-dose, and wrong-site surgery B. wrong-person, wrong-procedure, and wrong-site surgery C. wrong-procedure, wrong-person, and wrong-medication surgery D. wrong-medication, wrong-dose, and wrong-person surgery
B. wrong-person, wrong-procedure, and wrong-site surgery Rationale: The Universal Protocol guides the prevention of wrong-person, wrong-procedure, and wrong-site surgery. The other answers apply to the five rights of medication administration patient safety measure.
6. Which of the following statements reflects a female patient's accurate understanding of her scheduled total abdominal hysterectomy? A. "I'm having all my female parts removed." B. "I'm having a TAH." C. "I'm having my uterus removed." D. "I'm having my uterus removed through my vagina."
C. "I'm having my uterus removed." Rationale: A total abdominal hysterectomy involves removal of the uterus and cervix.
The minimum distance between ceiling-mounted sprinkler heads and sterile stored items is ____________ inches. A. 6 B. 12 C. 18 D. 24
C. 18 Rationale: Fire code regulations specify that clearance from the top of stored items to the ceiling be 18 inches to allow for sprinkler systems to be effective.
Local anesthesia systemic toxicity (LAST) is treated by administering: A. 10% lipid emulsion B. 15% hetastarch C. 20% lipid emulsion D. 25% hetastarch
C. 20% lipid emulsion Rationale: The only medication that helps to reverse the effects of systemic local anesthetic toxicity (LAST) is 20% lipid emulsion.
7. Each of the following patients is having a lumbar discectomy, L4-L5, performed. Which patient's plan of care will require additional padding to address an identified increased risk for impaired tissue integrity? A. A patient with an A1c of 6.8 B. A patient with a body mass index of 24 C. A patient with intermittent claudication D. A patient with a history of transient ischemic attacks
C. A patient with intermittent claudication Rationale: Patients with peripheral vascular disease are at increased risk for developing pressure ulcers.
When should the scrub person transfer specimens from the sterile field to the RN circulator? A. At the end of the procedure B. When it is conventient for the scrub person C. As soon as possible D. Never, because specimens should not be passed off the sterile field.
C. As soon as possible. Rationale: Passing the specimen off the sterile field as soon as possible reduces the potential for the integrity of the specimen to be compromised or for the specimen to be lost or misplaced.
What professional nursing behavior is evidenced by mutual trust, recognition, and respect among all members of the health care team in shared decision-making process? A. Conflict resolution B. Just culture C. Collaboration D. Advocacy
C. Collaboration Rationale: Collaboration is an effort by the nurse and members of the interdisciplinary health care team to reach a common goal. The key aspect in collaborative cooperation for the team is an effective decision-making process.
The _______________________ is an algorithm that guides EMS personanel through the following four decision points: physiological parameters, anatomic parameters, mechanism of injury (MOI), and other special considerations. A: Triage Tree B. Medical Plan C. Decision Scheme D. Trauma Protocol
C. Decision Scheme Rationale: The American College of Surgeons developed the Decision Scheme to assist EMS personnel with a plan to transfer patients to the health care facility that will provide the most effective care. Level I trauma centers demonstrate a 25% decreased risk of death for treatment of severe injuries.
Which standard of perioperative nursing is represented by completing an individualized orientation based on identified learning needs and seeking experience to maintain skills and competency? A. Quality of practice B. Professional practice evaluation C. Education D. Evaluation
C. Education Rationale: Acquiring and maintaining specialized knowledge and skills related to perioperative nursing practice are essential to representing the standard of perioperative nursing education.
A perioperative nurse is assigned to care for a patient with methicillin-resistant Staphylococcus aureus (MRSA). Which of the following cleaning practices can be anticipated to be required after the procedure? A. Closing the room for 28 minutes to allow for an adequate air exchange. B. Incinerating all disposable instruments. C. Incorporating enhanced environmental cleaning procedures. D. Incorporating routine environmental cleaning procedures.
C. Incorporating enhanced environmental cleaning procedures. Rationale: Enhanced environmental cleaning practices extending beyond routine cleaning practices to all high-touch objects should be implemented to prevent the spread of multiple drug-resistant organisms.
An 18-year-old patient is scheduled for surgery to have cochlear implants placed. The patient refuses to have the implants tracked even after the team has informed her of the possible implications of a recall or adverse event. What is the next course of action? A. Cancel the procedure and have the procedure rescheduled at a different facility. B. Notify the surgeon and let him decide what to do. C. Proceed with the surgery and document in the perioperative notes that the patient has refused to allow tracking of the medical device. D. Report the incident to the US Food and Drug Administration.
C. Proceed with the surgery and document in the perioperative notes that the patient has refused to allow tracking of the medical device. Rationale: Patients have the right to refuse racking of their medical devices. If a patient refuses to have the device tracked, the nurse should document the refusal along with the required product information and report this information to the manufacturer, but should not include the patient-specific information.
3. A perioperative nurse is assessing a patient preoperatively for carpal tunnel surgery. Which of the following would be a possible contraindication to using a tourniquet on the operative side? A. the patient is wearing a wedding ring on the operative side B. The patient drank coffee with milk five hours ago C. the patient has a dialysis access device on the operative side D. the patient's dominant hand is the same as the operative side
C. The patient has a dialysis access device on the operative side Rationale: The perioperative nursing assessment should include any medication conditions that may be contraindicated during the preparation and care of the patient undergoing surgery. Tourniquet use is contraindicated on limbs with a dialysis access device present because use of the tourniquet on that limb will diminish blood flow to the fistula, increasing the risk for clot formation in the fistula.
The person responsible for granting permission for a parent to accompany a child into the operating room is the: A. perioperative department manager. B. circulating nurse. C. anesthesia provider. D. child life specialist.
C. anesthesia provider. Rationale: Based on parental and child preoperative anxiety, anesthesia professionals may encourage parents to accompany the child through induction.
The correct time to label containers designated for medications or solutions is: A. when setting up the sterile field but before the medications are delivered to the field. B. when there are more than two medication being used on the sterile field. C. at the time the medication is delivered to the sterile field. D. just before using the medication on the patient.
C. at the time the medication is delivered to the sterile field. Rationale: Immediately upon receipt of the medication to the sterile field, the scrub person receiving the medication should label the medication container and all devices (eg. syringes) used to deliver or administer the medication.
A sterile field has been prepared for a vaginal hysterectomy. The surgeon has been called away for an emergency cesarean section, delaying the scheduled case by at least one hour. The appropriate method for maintaining the sterile field for the delayed case is to: A. tape the door closed B. cover the sterile field with a sterile drape and leave the room C. cover the sterile field with a sterile drape and remain in the room D. wait for an house and then tear down the back table
C. cover the sterile field with a sterile drape and remain in the room Rationale: After a sterile field is established, it should not be left unattended. It is also appropriate to cover the sterile field with a sterile drape. Covering the field does not negate the need to provide continual observance in the room. The sterility of the back table is not time related.
The Bowie-Dick process indicator is used to: A. demonstrate that an item has been exposed to the sterilization process. B. demonstrate that the conditions for sterilization have been met. C. detect air leaks in dynamic air-removal sterilizer chambers. D. set short-term exposure limits to toxic sterilants.
C. detect air leaks in dynamic air-removal sterilizer chambers. Rationale: The Bowie-Dick process indicator is used to detect air leaks and ineffective air removal in dynamic air-removal sterilizers.
There should be a process in place to ____________________ the efficacy of standardized formats. A. identify B. determine C. evaluate D. share
C. evaluate Rationale: Evaluation of the format is an essential process not only to identify areas for improvment but also to implement any changes deemed necessary. Any compromise of patient safety from deficient data transfer must be addressed.
Collecting and evaluating information to assess current processes are known as: A. research utilization. B. change implementation C. evidence-based practice. D. quality improvements.
C. evidence-based practice Rationale: Evidence-based practice (EBP) is the process of obtaining and analyzing data to address process changes that may be needed to improve patient care. After the evidence is evaluated, a plan is created to use this evidence, a process known as research utilization (RU). Quality improvement is a process that uses both EBP and RU to improve quality measures and patient outcomes.
When risk for exposure to blood and body fluids exist, the following types of personal protective equipment (PPE) should be worn: A. gloves, warm-up jacket, hair protection, and shoe covers. B. gloves, fluid-resistant gowns or aprons, and surgical mask. C. gloves, surgical mask, fluid-resistant gown, and eye protection. D. lab coats, gloves, eye protection, and shoe covers.
C. gloves, surgical mask, fluid-resistant gown, and eye protection. Rationale: The use of appropriate PPE protects the health care provider's mucous membranes, skin, airway, and clothing from coming into contact with blood or body fluids that may contain infectious materials.
8. Actively warming surgical patients with forced air to prevent hypothermia should begin: A. as soon as the patient enters the OR or procedure room B. in the recovery room C. in the preoperative holding area D. just before the surgeon makes the incision
C. in the preoperative holding area Rationale: Research has shown that, to be most effective, forced air warming should be initiated in the preoperative holding area and continued intraoperatively. Preoperatively warming the patient with forced air warming before induction of anesthesia minimizes heat loss more effectively than use of warmed cotton blankets alone.
1. A patient's life-threatening injuries prevent required hair removal before transfer to the OR. The best course of action for the perioperative nurse to follow is to: A. leave the hair at the incision site and prep the patient B. use a razor and 3" cloth tape to remove the hair C. moisten the area to be prepped and use a disposable clipper D. use a depilatory cream on the surgical site
C. moisten the area to be prepped and use a disposable clipper Rationale: Prevention of hair dispersal for hair removed in the OR may be accomplished by wet clipping.
2. The goal of medication reconciliation is to: A. inform the patient of anesthetic medication administered intraoperatively. B. save the surgeon from having to look up medications later. C. promote safe patient outcomes related to medication administration D. save the floor nurse work when admitting the patient
C. promote safe patient outcomes related to medication administration Rationale: Medication reconciliation is done to promote safe patient outcomes. It is a process of comparing the medications that a patient is currently using at home with medications that are ordered for him or her by the current health care provider.
Use of standardized hand-over communication tool has been demonstrated to: A. reduce the need for verbal communication B. reduce the number of caregivers involved in the transfer of patient care. C. reduce the risk for errors. D. Eliminate errors associated with the transfer of patient care.
C. reduce the risk for errors. Rationale: Transfer of patient care requires effective communication among caregivers. Use of systems that provide a standardized format that includes the opportunity for team members to ask and answer questions demonstrates a decreased risk in adverse patient care.
During morning report, the charge nurse relays that a positive biological indicator has been reported by sterile processing personnel for a load processed the day before. The perioperative nurse's first action is to: A. notify surgeons whose patients may have been exposed to improperly sterilized instruments. B. include this information in postoperative calls to patients so that they can follow up with their surgeons. C. remove from use all instrument trays with the suspect load control numbers. D. notify the infection control nurse of a potential increase in surgical site infections.
C. remove from use all instrument trays with the suspect load control numbers. Rationale: Retrievable items should be immediately recalled to prevent harm to patients.
The appropriate method for cleaning an operating room after a procedure? A. disinfecting the back table and Mayo stand while the patient emerges from anesthesia to cut down on turnover time. B. starting at the center of the room and working toward the perimeter. C. starting at the top and working toward the bottom. D. flooding horizontal surfaces with alcohol.
C. starting at the top and working toward the bottom Rationale: Cleaning should progress from top to bottom areas, and from cleaner to dirtier areas.
The primary source of waste anesthesia gas is the result of: A. a leak in the endotracheal tube B. a poor-fitting mask C. the anesthesia professional's practice D. spilling liquid halogenated agents
C. the anesthesia professional's practice Rationale: The major source of waste gas in the OR is intentional outflow of gases from the anesthetic breathing system.
An abdominal retractor is very difficult to assemble, and the surgical technologists have asked that it be sterilized assembled in the position in which it will be used. The most appropriate response to this request is: A. "Our policy states that all equipment must be disassembled prior to sterilization." B. "As long as all the parts are accounted for during counts, this practice would be acceptable." C. "Let's ask the manufacturer's representative to come in and do an in-service on the correct way to assemble the retractor." D. "If the steam cannot reach all areas of the instrument, those areas are considered contaminated."
D. "If the steam cannot reach all areas of the instrument, those areas are considered contaminated." Rationale: Sterilant (in this case steam) must be able to reach all surfaces in order to completely eliminate all organisms.
What should be included during the process used to transfer patient information? A. verbal components B. written components C. face-to-face interactions D. All of the above
D. All of the above Rationale: According to the AORN "Guideline for Transfer of Patient Care Information," the process for transferring patient information should include verbal components and written components in a standardized documentation format, and, if possible, interaction should occur using a face-to-face format.
The purpose of the ___________________ is that contains statements related to ethical obligations, duties, standards, and nurse's commitment of society. A. Guidelines for Perioperative Practice B. Standards of Perioperative Nursing C. The Future of Nursing: Leading Change, Advancing Health report D. Code of Ethics for Nurses
D. Code of Ethics for Nurses Rationale: The Code of Ethics for Nurses is focused on outlining the goals, values, and obligations to the profession of nursing. The foundation of professional nursing is ethics.
Students, health care workers, and retired healthcare workers have a continuing duty to observe and protect patient privacy under HIPPA and: A. The JC. B. AORN. C. CMS. D. HITECH
D. HITECH Rationale: The HITECH Act was developed in 2009 as an addition to HIPAA to address social media risks to patient privacy.
Which biological indicator is validated for use with liquid peracetic acid sterilization? A. Geobacillus stearothermophilus B. Self-contained biologic indicatior (SCBI) C. Bacillus atrophaeus D. No indicator is validated for use with peracetic acid sterilization
D. No indicator is validated for use with peracetic acid sterilization. Rationale: There is no biological indicator available that has been validated for use with liquid peracetic acid sterilant systems.
9. A patient scheduled for a bronchoscopy states he has had a persistent cough with blood-tinged sputum, night sweats, and a loss of appetite with significant weight loss over the past three months. Which type of transmission-based precaution should be undertaken? A. Leave the portable HEPA filter unit "on" while the patient is intubated to supplement normal room air exchange. B. Schedule the patient for the first procedure of the day, when the infection preventionist is available. C. Provide the patient with a NIOSH N-95 fit-tested respirator to wear during transport. D. Notify the environmental services to delay cleaning the OR until the air exchange system has had time to remove 99% of airborne particles.
D. Notify the environmental services to delay cleaning the OR until the air exchange system has had time to remove 99% of airborne particles. Rationale: Cleaning and disinfecting the procedural area should be delayed until 99% of airborne contaminants have been removed via the air exchange system. The amount of time needed to clean the air of 99.9% of airborne pathogens varies by the exchange rate; 15 exchange rates per hour for 28 minutes removes 99.9% of airborne contaminants.
1. Which patient population is more sensitive to dosage errors? A. Male patients ages 25-40 B. Bariatric patients C. A patient with a history of polypharmacy D. Pediatric patients
D. Pediatric patients Rationale: Pediatric patients are at higher risk of medication errors related to dosing for body size. Patient weight should always be recorded in kilograms for medication dosage calculations. Other populations at high risk including geriatric patients and those patient with impaired body systems.
9. Which of the following indicators demonstrates a patient who is at increased risk of developing a pressure ulcer during a surgical procedure? A. Aged 50 or older B. History of recent gallbladder surgery C. Female patient D. Poor preoperative nutritional status
D. Poor preoperative nutritional status Rationale: The perioperative nurse should take additional precautions to decrease the risk of developing a pressure ulcer in patients who are older than 70 years of age; who require vascular procedures or any procedure lasting longer than four hours; who are thin, small in stature, or have poor preoperative nutritional status; who are diabetic or have vascular disease; or who have a preoperative Braden score that is less than 20.
A perioperative nurse is preparing to perform a skin prep for a patient scheduled for a right breast biopsy with needle localization. When the perioperative nurse removes the patient's gown, she discovers a wire inserted into the left breast. What is the appropriate action? A. Leave the wire in place and prep the left breast. B. Remove the wire and prep the right breast. C. Call the radiologist and tell him of the error. D. Postpone prepping until the discrepancy is resolved.
D. Postpose prepping until the discrepancy is resolved. Rationale: Discrepancies in wrong site surgery are addressed before starting the procedure.
6. Surgical site marking should be performed by the: A. patient before coming to the hospital B. surgeon after the site and side (if applicable) have been surgically prepped and draped. C. nurse doing the patient preoperative assessment D. surgeon before the patient receives any sedatives
D. Surgeon before the patient receives any sedatives Rationale: Surgical site marking should be performed by the surgeon before the patient receives any sedatives. The nurse performing the perioperative assessment verifies the site and side (if applicable) and this site verification is performed again with the surgical team before the incision is made.
Patients that present with a body temperature below 95F should not be removed from the operating room due to an increased risk of hypotension, apnea, sudden cardiac arrest, and __________________________. A. tachycardia. B. alkalosis. C. hyperglycemia. D. acidosis.
D. acidosis Rationale: "The patient should not be taken from the OR with a body temperature less than 95F. Below this crucial level, the risk for acidosis, hypoglycemia, bradycardia, hypotension, and apnea increases. This metabolic depression and delayed return of activity set the stage for possible sudden cardiac arrest."
Documentation of transfer-of-care communication should be: A. done by each member of the perioperative team participating in the hand over. B. presented in SBAR format to ensure the consistency of hand-over documentation. C. approved by all personnel involved in the hand over. D. done using a standardized documentation format.
D. done using a documentation format. Rationale: Clear and timely communication is the goal of documentation related to patient care. Use of a standardized format allows for the provision of consistent and reliable communication.
The type of fire extinguisher to be used for an electrical fire is: A. pressurized water B. carbon dioxide C. dry chemical D. halon
D. halon Rationale: A halon fire extinguisher will smother an electrical fire without leaving a residue on the equipment.
8. The primary purpose for developing a perioperative plan of care is to: A. meet Joint Commission requirements for accreditation B. ensure the procedure meets reimbursement criteria by Centers for Medicare & Medicaid Services (CMS) C. eliminate the need to revise goals during the procedure. D. identify nursing interventions to assist the patient in meeting desired outcomes.
D. identify nursing interventions to assist the patient in meeting desired outcomes. Rationale: The plan of care is developed by the perioperative nurse to describe actions undertaken to achieve desired outcomes.
What component of the fire triage does prepping solution represent? A. Oxidizer B. Liquid ignition C. Fuel D. Ignition source
D. ignition source Rationale: Prep solution is a type of fuel and will cause flames when exposed to an ignition source. Prep solution also poses high risk for chemical burns when pooling solution is not removed.
Corrections are made to the medical record, the corrections should: A. be initialed B. start over on a new page. C. be covered with correction fluid. D. include date, time, and initials.
D. include date, time, and initials. Rationale: Including date, time, and initials for the person making the correction is necessary for legal documentation. If a new page is needed, the original page should be included in the record. Correction fluid should never be used.
A healthcare industry representative (HCIR) is present during a total knee arthroplasty. The surgeon has never used this brand of implant before. It is appropriate for the HCIR to: A. assist with positioning the patient prior to the procedure. B. scrub in to assist the surgeon. C. open sterile packaged onto the back table. D. provide instructions to the surgical team on instruments used during the procedure.
D. provide instructions to the surgical team on instruments used during the procedure. Rationale: The role of the HCIR is to provide education and technical support. Acting as part of the clinical team or participating in activities involving the sterile field is beyond the scope of this role.
The perioperative nurse is using an alcohol-based skin antiseptic on a patient with a suspected ruptured appendix. The surgeon is anxious to begin the procedure and wants to begin draping as soon as the nurse completes the prep. The most appropriate response for the nurse to ensure patient safety is to: A. allow the surgeon to drape the patient and begin the procedure before the prep agent dries. B. tell the surgeon that it is against hospital policy to drape before the skin antiseptic is dry. C. inform the surgeon that a flammable antiseptic skin agent has been used and he/she will assume responsibility if there is a fire. D. remind the surgeon that allowing the prep agent to dry will prevent volatile fumes from being trapped under the drape.
D. remind the surgeon that allowing the prep agent to dry will prevent volatile fumes from being trapped under the drape. Rationale: Adequate time should be allowed for flammable skin antiseptics to dry and fumes to dissipate before applying drapes. The accumulation of volatile fumes under the drapes constitutes and additional fire hazard.
Penetrating trauma is the result of ________________________ blast injuries common in explosions. A. initial B. tertiary C. primary D. secondary
D. secondary Rationale: Secondary blast injuries result in penetrating trauma from shrapnel and debris that becomes airborne during the explosion.
An unscrubbed person may perform a two-step skin prep using: A. unsterile exam gloved donned in the closed-glove fashion. B. sterile gloves donned in the closed-glove fashion. C. unsterile gloves donned in the open-glove fashion. D. sterile gloves donned in the open-gloved fashion.
D. sterile gloves donned in the open-gloved fashion. Rationale: Sterile gloves are donned by the person doing the prep using the open glove method for the two-step prep.
The mandated goal to "improve the effectiveness of communication among caregivers" is from: A. the Centers for Medicare & Medicaid Services B. the Occupational Safety and Health Administration C. the United States Department of Health and Human Services D. the Joint Commission's National Patient Safety Goal 2.
D. the Joint Commission's National Patient Safety Goal 2. Rationale: In January 2015, the Joint Commission mandated its Hospital National Patient Safety Goal 2, "Improve the effectiveness of communication among caregivers." The other answers are examples of federal regulatory agencies that mandate compliance issues.
A package containig chemical sterilants is inadvertently punctured and splashes onto the hands of the perioperative nurse as she prepares an endoscope for sterilization. Information on how to handle the spill is best obtained from: A. the facility pharmacist. B. a poison control center. C. the perioperative manager D. the appropriate Safety Date Sheet.
D. the appropriate Safety Data Sheet. Rationale: A current Safety Data Sheet should be readily available for all hazardous materials used in the perioperative suite.
Orthopedic instrument sets and implants have arrived at the sterile processing department to be sterilized prior to scheduled cases for the following day. The sets each weigh 32 pounds. The sterile processing technician should: A. sterilize the sets as delivered B. request that the perioperative nurse assigned to the case process the instruments using immediate-use steam sterilization (IUSS) C. use additional containers to separate the contents so that each set weighs 28 pounds per container. D. use additional containers to separate the contents so that each set weighs 25 pounds per container.
D. use additional containers to separate the contents so that each set weighs 25 pounds per container. Rationale: Weight of instrument pans should not exceed 25 pounds.
Temperature of the OR
maintained between 68F and 75F (20C and 24C)
Humidity of OR
should be maintained between 20% and 60%
