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Quiz Session - Attempts With Random Questions

CCI CNOR Exam Questions

Page 1 of 50

1.

While caring for an accident victim with open fractures to the lower extremities, the vascular surgeon requests a Doppler to check pedal pulses. Which are the pedal pulses?

  • Dorsalis pedis and posterior tibial pulses

  • Dorsalis pedis and posterior popliteal pulses

  • Dorsalis pedis and posterior femoral pulses

  • Dorsalis pedis and posterior ulnar pulses

Correct answer: Dorsalis pedis and posterior tibial pulses

The dorsalis pedis and the posterior tibial pulses are the pedal pulses. The dorsalis pedis pulse is located on the top of the foot, between the first and second metatarsal bones. The posterior tibial pulse is located over the posterior tibial artery, just posterior to the ankle bone (on the inner aspect of the ankle). 

The ulnar pulse is palpable on the anterior and medial aspect of the wrist. The popliteal pulse is located behind the knee. The femoral pulse is found in the groin, where the femoral artery passes through the groin in the femoral triangle.

2.

A patient is undergoing a craniotomy procedure involving an occipital approach. In what position is the patient to be placed for surgery?

  • Fowler's position

  • Reverse Trendelenburg position

  • Kraske's position

  • Lateral position

Correct answer: Fowler's position 

A Fowler's (sitting) position is used on occasion for some otorhinologic and neurosurgical procedures, such as craniotomies involving a posterior or occipital approach. The head is seated forward in a cranial headrest for neurosurgical procedures.

This position begins with the patient supine (on their back), and the upper body section of the OR bed is slowly raised to 90 degrees, while the knees are slightly flexed and the legs lowered. The torso is completely in an upright position; the shoulders and torso should be supported with body straps but not so tightly that respiration and circulation are obstructed in any way. A padded footrest is used to prevent footdrop, and the arms will either rest in the patient's lap on a pillow with elbows flexed to 90 degrees or less, or remain at the sides on padded armboards.

Air embolism is a potential complication that should not be overlooked. In addition, antiembolic stockings or sequential compression devices (SCDs) are used to counteract postural hypotension and assist in supporting venous return.

3.

Manual cleaning would be recommended for all of the following except:

  • OR floors

  • Delicate instruments

  • Power equipment

  • Lensed instruments

Correct answer: OR floors

The purpose of manual cleaning (washing by hand) is to remove residual blood and debris before terminal sterilization or high-level disinfection. It is recommended for delicate and sharp instruments and devices, such as microsurgical and ophthalmic instruments, lensed instruments, power equipment, and other instruments that cannot tolerate an automated cleaning process, or be immersed in liquid. 

OR suites, including the OR floors, should be terminally disinfected between patients, as well as at the end of the day's schedule.

4.

The statement, "A majority of African Americans have hypertension," is an example of:

  • Stereotyping

  • Racism

  • Libel

  • An insult

Correct answer: Stereotyping

Stereotyping involves making a sweeping generalization about a certain group of people. Although African Americans may be at higher risk of hypertension, not all (or most) African Americans are hypertensive. Stereotyping can lead to adverse outcomes and should be avoided.

Libel involves a published false statement that is damaging to a person's reputation. Racism is prejudice, discrimination, or antagonism directed against someone of a different race based on the belief that one's own race is superior. An insult is to speak to or treat another individual with disrespect or scornful abuse.

5.

A female patient who is recovering in the postoperative anesthesia care unit (PACU) after a diagnostic cardiac procedure verbalizes concern to the PACU nurse that she is at greater risk of cardiovascular (CV) disease due to a strong family history of CV issues. She has heard that there are several pharmacologic agents and nutritional supplements to lower CV risk. 

Which of the following statements regarding the use of specific pharmacologic agents or nutritional supplements to prevent the development of CV disease (CVD) is accurate?

  • Aspirin therapy has been successfully used for the prevention of CVD, including thromboembolic stroke, and is commonly recommended as a preventative measure.

  • Folic acid supplementation has been successfully used for the prevention of CVD, including ischemic stroke, and is commonly recommended as a preventative measure.

  • Hormone therapy has been successfully used for the prevention of CVD, including myocardial infarction, and is commonly recommended as a preventative measure.

  • Antioxidant supplementation, including vitamins E and C, has been successfully used for the prevention of CVD and is commonly recommended as a preventative measure. 

Correct answer: Aspirin therapy has been successfully used for the prevention of CVD, including thromboembolic stroke, and is commonly recommended as a preventative measure.

Women are far more likely than men to believe they can prevent or treat CVD by using pharmaceuticals or nutritional supplements, despite the lack of evidence supporting their effectiveness in the treatment of CVD. While hormone replacement therapy has been prescribed by practitioners to female patients to aid in preventing CVD, this practice is controversial and is not recommended by the Women's Health Initiative (WHI). In studies, folic acid supplementation has been shown to decrease the risk of CVD and associated CV injury, including myocardial infarction (MI) and ischemic stroke, but it is not currently recommended for preventing primary or secondary CVD. 

Studies investigating the use of antioxidant vitamin supplements—such as vitamin E, vitamin C, and beta-carotene—to prevent the development of CVD provide conflicting information; observational studies seem to suggest that antioxidant supplementation is associated with a decreased risk of CVD and CVD-related injury, while randomized trials were unable to support those findings. Routine administration of aspirin (ASA) to women under the age of 65 years is not recommended, but its use in healthy women over the age of 65 may be beneficial in preventing ischemic stroke and MI if the risks of gastrointestinal bleeding are low in the specific patient. ASA administration may also be beneficial for women who have a history of atrial fibrillation and are unable to take warfarin. 

6.

After surgery on a patient known to have Creutzfeld-Jakob disease (CJD), the environmental cleaning team was called to decontaminate the operating room (OR). Which of the following statements regarding cleaning and disinfection of the OR in this scenario is accurate?

  •  Horizontal surfaces that are believed to have remained free of contamination by high-risk tissue should be cleaned using standard procedures.

  • All noncritical environmental surfaces should be decontaminated using a 1:5 sodium hypochlorite solution.

  • All environmental surfaces should be decontaminated using a sodium hydroxide solution.

  • Vertical surfaces can be successfully decontaminated by an adjunct dry hydrogen peroxide mist spray system. 

Correct answer: Horizontal surfaces that are believed to have remained free of contamination by high-risk tissue should be cleaned using standard procedures.

Unless it is absolutely necessary to carry out a surgical procedure on a patient known to be infected with Creutzfeld-Jakob disease, exposure to CJD should be avoided at all costs. This prion (protein) disease is resistant to destruction using standard sterilization and disinfection methods and can potentially infect surgical patients via shared surgical equipment if not fully inactivated after being used on patients with known or suspected disease. At this time, the Environmental Protection Agency (EPA) does not have any EPA-approved disinfectants registered with their service. 

If a noncritical environmental surface (horizontal, vertical, etc.) is known or suspected to be contaminated by high-risk (e.g., brain, eye tissue, spinal cord, pituitary gland) tissue, it should be disinfected using a 1:5 (or 1:10) sodium hypochlorite solution or sodium hydroxide solution. A noncritical environmental surface that is believed to have remained free of contamination by high-risk tissue should be cleaned using standard cleaning and disinfection procedures.

Dry-mist hydrogen peroxide systems are approved for use as an adjunct after standard cleaning to eradicate multidrug-resistant organisms (MDROs) from the hospital environment.

7.

What are three OR fire prevention techniques?

  • Let alcohol-based prep solutions dry, lower oxygen level below 21% during tracheotomy/head/neck procedures if possible, use cotton blankets to cover patients

  • Let all prep solutions dry, use wool blankets to cover patients, lower oxygen level below 21% during tracheotomy/head/neck procedure if possible

  • Store Bovie pencil on top of the drape accessible to surgeon, lower oxygen level below 51% during tracheotomy/head/neck procedures if possible, let alcohol-based prep solutions dry

  • Provide oxygen-enriched environment for your patient, let alcohol-based prep solutions dry, store Bovie pencil in holder

Correct answer: Let alcohol-based prep solutions dry, lower oxygen level below 21% during tracheotomy/head/neck procedures if possible, use cotton blankets to cover patients

Fire should be a matter of prime concern in the OR. Fire prevention activities include letting alcohol-based prep solutions dry completely before surgical drapes are applied; using cotton blankets for patients, as wool or synthetic materials are prone to producing static electricity; using lower than 21% oxygen during head/neck surgery if possible; storing laser or ESU handpieces (including Bovie pencils) in a holder on the sterile field when not in use.

8.

A perioperative team member who has been employed at the surgicenter for almost one year reported to the nurse manager that a more tenured perioperative employee consistently rolls her eyes during conversation and frequently makes rude and sarcastic comments. Which of the following statements regarding uncivil behavior in perioperative nursing personnel is accurate? 

  • Nurses who are uncivil are fully aware of their uncivil behavior.

  • When confronted, the uncivil nurse may deny being aware of their behavior.

  • Uncivil nurses most likely engage in uncivil behavior due to feeling dissatisfied in the workplace.

  • The most frequent cause of uncivil behavior in nurses is problems at home.

Correct answer: Nurses who are uncivil are fully aware of their uncivil behavior.

Uncivil behavior in the workplace is now considered to be a form of workplace violence. Behaviors such as bullying, verbal abuse, threatening an employee, physical assault, and even homicide may occur within a healthcare environment. Incivility in the workplace is characterized by eye-rolling, disrespect, inconsideration, name-calling and rude comments, and public shaming of an employee. 

When uncivil behavior is reported to a member of the management and the uncivil nurse is confronted, almost all uncivil nurses will deny knowing that their behavior is uncivil or will deny responsibility for the uncivil behavior. This denial is in contrast to studies that have found that uncivil nurses are fully aware of their behavior and are probably doing it to meet some type of neurotic need (anger, anxiety, etc.). 

9.

You are transporting a patient to the OR suite for surgery via a transport stretcher. Why should you travel slowly?

  • To avoid making the patient feel dizzy and nauseated

  • To avoid making the patient feel unable to catch his breath

  • To avoid making the patient feel rushed and overwhelmed

  • To avoid making the patient feel increased pain

Correct answer: To avoid making the patient feel dizzy and nauseated

When transporting a patient to the OR via a transport stretcher, make sure you push from the head end, so the patient's feet go first. Avoid rapid movements through corridors and around corners, as this may cause dizziness and nausea, especially if the patient has been medicated. Watch for vomiting or respiratory distress during transport, and raise the head of the stretcher if needed to make the patient more comfortable.

10.

An active shooter situation in a perioperative unit resulted in the shooter taking a perioperative nurse hostage in one of the operating rooms (OR). The nurse is unable to escape from the OR, and there is no place to hide. Which of the following actions taken by the nurse is most likely to result in their survival?

  • Attempt to take the shooter down

  • Attempt to call 911 to notify them and provide a location for rescue

  • Attempt to maintain silence and sit quietly, only speaking if the gunman demands a verbal response

  • Attempt to reason with the gunman 

Correct answer: Attempt to take the shooter down

Healthcare employees should be taught to respond to an active shooter situation by first attempting to escape; if escape is not possible, the employee should then attempt to hide in a windowless area, barricading the door with furniture and silencing any potential source of alarm or noise that would draw attention. 

If possible, an employee who is able to escape or hide should also attempt to call 911, leaving the phone line open if they are unable to speak without being heard by the gunman. If the employee was unable to escape or hide for any reason, they should be prepared to fight the gunman. These three steps present the best opportunity for survival in an active shooter situation. 

11.

The perioperative team has completed the final count while the surgeon is closing the patient's abdomen, and one suture needle is unaccounted for. Which of the following steps should be planned for next?

  • Stop the surgical wound closure and obtain a KUB (kidneys, ureter, bladder) x-ray

  • Complete the surgical wound closure and call for a flat plate x-ray to be performed while the patient is still in the OR

  • Stop the surgical wound closure and obtain contrast abdominal x-ray while the patient is still in the OR

  • Complete the surgical wound closure and order an abdominal series be performed while the patient is still in the OR

Correct answer: Stop the surgical wound closure and obtain a KUB (kidneys, ureter, bladder) x-ray

If the surgical count has been completed and a surgical instrument is unaccounted for, the surgical wound closure should be stopped and a simple, noncontrast, flat plate abdominal x-ray, also referred to as a KUB, should be obtained. 

If the patient is unstable and requires wound closure prior to location of the missing surgical instrument, the surgeon should continue to close the wound and plans should be set in place to obtain a flat plate of the abdomen as soon as possible.

12.

A patient who lives on a farm tested positive for anthrax and now requires surgery for a tracheostomy due to their deteriorating condition. When admitting the patient, the perioperative team will likely implement which type of precautions to prevent the spread of anthrax within the perioperative unit? 

  • Standard precautions

  • Contact precautions

  • Droplet precautions

  • Airborne precautions

Correct answer: Standard precautions

Anthrax may be contracted through direct contact with the bacterium Bacillus anthracis or through inhalation of the aerosolized organism when contaminated material is disturbed. The cutaneous form of the disease is most common and is most frequently encountered when caring for individuals who work with livestock that may become infected with the disease after breathing in or ingesting anthrax spores found within their environment. 

When cutaneous anthrax is diagnosed in an individual who does not work in the livestock industry, bioterrorism should be suspected. Infection with anthrax may also occur in humans as a result of inhaling the spores. 

Standard precautions should be put in place when caring for any individual infected with either form of anthrax.

13.

A 62-year-old female who was diagnosed with hyperparathyroidism due to an adenoma underwent imaging studies of her parathyroid glands. A single diseased gland was identified. Which of the following surgical approaches is most likely to be used to remove a single diseased parathyroid gland? 

  • Sestamibi-guided parathyroidectomy

  • PTH-guided parathyroidectomy

  • Open approach to subtotal parathyroidectomy

  • Minimally invasive mediastinotomy

Correct answer: Sestamibi-guided parathyroidectomy

The standard of care in the surgical treatment of hyperparathyroidism due to suspected adenoma was bilateral neck exploration to locate and biopsy all 4 (or more) parathyroid glands. This resulted in a greater risk of bleeding and damage to the recurrent laryngeal nerve, as well as other related surgical complications. Due to advances in technology, several minimally invasive procedures for treating hyperparathyroidism have been developed and have become the first choice for surgical removal of a single affected gland. One such technique—the sestamibi-guided parathyroidectomy (also referred to as radio-guided parathyroidectomy)—utilizes a preoperative injection of technetirum-99m sestamibi followed by intraoperative use of a gamma probe to identify the single affected parathyroid gland. The gland is then excised. This procedure has a high success rate, which can be enhanced by the consultation of an endocrinologist familiar with the procedure and hyperparathyroidism management, and can be completed on an outpatient basis. Ultrasound may be used to help guide the placement of the incision site. 

A PTH-guided parathyroidectomy can be a method of minimally invasive surgical treatment if a "mini" incision is utilized. It is not the treatment of choice for single-gland disease.

An open approach to subtotal parathyroidectomy is an older method of surgical management of hyperparathyroidism and may still be the first surgical choice for patients who have more than one diseased gland.

A mediastinotomy is not considered to be a minimally invasive procedure, and it is only indicated for the treatment of hyperparathyroidism in a very small percentage of patients whose parathyroid glands are located deep in the chest.

14.

All the following scenarios involve situations which require incident reporting, except:

  • When performing the count at the close of surgery, the operating room personnel are unable to locate a sponge; it is later located under the pannus of the morbidly obese patient

  • The spouse of a patient who is undergoing cardiac surgery exits the visitor restroom and informs the operating suite manager that he burned his hand while smoking a cigarette in the restroom

  • A patient undergoing surgery developed hives within two hours of administration of prophylactic antibiotics

  • The perioperative nurse notes that when the patient was discharged from the ambulatory surgery center, he took the stock of pulse oximetry probes that had been present in the drawer in the patient room

Correct answer: When performing the count at the close of surgery, the operating room personnel are unable to locate a sponge; it is later located under the pannus of the morbidly obese patient

Incident reporting is required in each health care facility and is completed per the instructions and guidelines determined by risk management. Incident reports are retained and then reviewed for means of quality improvement.

Situations which require incident reporting include, but are not limited to:

  • Patient or visitor fall
  • Unexpectedly finding a patient, patient visitor, or operating room personnel lying on the floor
  • Injuries experienced by anyone within the facility
  • Needlesticks
  • Any fire or smoke event
  • Theft or possible theft of any item
  • Equipment malfunction
  • Unauthorized personnel within restricted areas
  • Any intruders
  • Medication errors
  • Reaction to medication, including allergic reaction
  • Unresolved, incorrect sponge or instrument count
  • Any object discovered to have been retained within the patient

A sponge which appeared to be missing during the post-surgical count but which was later found to have been retained under the morbidly obese patient's pannus does not warrant incident reporting but should result in a discussion on how to improve practice in the operating room to prevent a potential mishap like this from recurring.

15.

Advantages to using a laser include all the following except:

  • Cost-effective treatment

  • Faster recovery times

  • Less blood loss

  • Treatment of areas that might otherwise be inaccessible

Correct answer: Cost-effective treatment

The costs to start and maintain a laser program are high. Equipment, instrumentation, supplies, and staff education are expensive initial investments. Most of these aspects require frequent updates and maintenance. These are disadvantages of laser surgery. 

Advantages include the following: laser treatments provide for faster recovery, less blood loss, and treatment to areas that might otherwise be inaccessible. Also, they provide more precise control for accurate incision, excision, or ablation of tissues, an unobstructed view of the surgical site, minimal handling of and trauma to tissues, reduced risk of contamination or infection, and reduced operating times. There is also decreased risk of malignant cells traveling through the lymphatic system when lasers are used.

16.

After receiving a proposal requesting full renovation of the perioperative care unit, the hospital management approved the request and instructed the unit management team to determine what furnishings needed to be replaced. In terms of furnishing items for the unit, which disinfectant solution must the chosen items be able to withstand when used for environmental cleaning?

  • 10% diluted bleach solution

  • Glutaraldehyde solution (CidexR)

  • Phenol with glutaraldehyde solution (SporicidinR)

  • 90% isopropyl alcohol

Correct answer: 10% diluted bleach solution

In a perioperative unit, all items must be able to withstand puncturing, tearing, staining, and environmental cleaning and disinfecting. If possible, purchased items should not be manufactured with an exterior that easily absorbs liquids, and each item should be easy to assemble and disassemble for cleaning and disinfection when needed. Furnishings should be able to withstand disinfection using a 10% bleach solution without fading, cracking, flaking, fissuring, or corrosion of the surface. 

High-level disinfectants or chemical sterilant solutions such as glutaraldehyde or phenol-glutaraldehyde combination solutions should not be used for cleaning or disinfecting environmental surfaces or furnishings in the perioperative environment. Isopropyl alcohol solutions should never be used to clean environmental surfaces, including furnishing items, for two reasons: first, alcohol solutions have not been approved for cleaning of any kind but solely for skin antisepsis; second, alcohol poses a fire risk when exposed to oxygen sources and potential sources of flame. 

17.

Unlike other transplants, corneal transplants (keratoplasty) have a low risk of rejection. Why?

  • Avascular cornea secretes factors that suppress rejection mechanisms

  • Vascular cornea secretes factors that suppress rejection mechanisms

  • Avascular cornea contains DNA cells that the body can target

  • Vascular cornea contains DNA cells that the body can target

Correct answer: Avascular cornea secretes factors that suppress rejection mechanisms

Because the cornea is avascular, keratoplasty (corneal transplant) is the most successful transplantation procedure and has considerably fewer rejection phenomena than all other tissues except bone. In addition, the tissue secretes its own immunosuppressant chemicals. 

Avascular cornea does contain DNA cells, but the body does not target these cells.

18.

The perioperative nurse's role related to a patient's pacemaker involves all the following actions except:

  • Interrogate the pacemaker using a pacemaker wand

  • Verify the type of pacemaker. In the case of a defibrillator pacemaker, verify defibrillator function has been deactivated by a sales representative, who plans to return when the patient is in post-anesthesia care to check pacemaker function.

  • If monopolar electrosurgery is planned, do not place the return electrode over the pacemaker

  • Communicate with post-anesthesia care unit staff that the patient has a pacemaker. Follow manufacturer's guidelines and facility policy.

Correct answer: Interrogate the pacemaker using a pacemaker wand

The perioperative nurse must pay attention to the patient as a physical being, as well as to the devices used in care. When dealing with a patient who has a pacemaker, the perioperative nurse must not interrogate the pacemaker because he or she is not trained to do so; it is outside the scope of nursing practice. The patient typically receives a pacemaker interrogation during follow-up appointments (by the physician) after the initial pacemaker implantation, not during the intraoperative phase.

The nurse should verify the type of pacemaker and follow necessary precautions depending on type of device, know what to do if electrosurgery is to be performed (placing a return electrode directly over the pacemaker in monopolar electrosurgery could cause the current to be diverted or not dispersed at all), and communicate with post-anesthesia care unit staff that the patient has a pacemaker. The nurse must always follow manufacturer's guidelines and facility policy.

19.

A perioperative team is preparing to accept a patient who sustained blunt-force trauma injuries related to a high-velocity motor vehicle accident (MVA). The surgeon suspects the patient is experiencing symptoms of abdominal compartment syndrome and requests equipment to measure the patient's intra-abdominal pressure (IAP). Which of the following IAP readings is most likely to be associated with a diagnosis of abdominal compartment syndrome?

  • 25 mm Hg

  • 5 mm Hg

  • 10 mm Hg

  • 20 mm Hg

Correct answer: 25 mm Hg

Abdominal compartment syndrome may result from a traumatic blunt-force injury to the abdomen. In a healthy individual, the IAP typically ranges from 0 to 5 mm Hg. An IAP grading scale can be used to determine the extent of injury, with scales ranging from 12 mm Hg to over 25 mm Hg. Abdominal compartment syndrome is diagnosed when the IAP is greater than 20 mm Hg, and there is corresponding dysfunction of an abdominal organ(s) identified as resulting from the injury. The IAP can be measured by using a needle/syringe set-up with either a stopcock or manometer device or by using a commercially manufactured device. Sustained IAP can result in damage to the cardiovascular, respiratory, and neurological systems. The perioperative nurse should monitor the patients for signs of IAP, such as: 

  • decreased cardiac output
  • oliguria
  • hypoxia

20.

A 25-week preterm infant requires surgery to correct gastroschisis. From whom should the surgeon obtain signature of informed consent?

  • The infant's 15-year-old mother

  • The infant's 21-year-old father who is currently incarcerated

  • The maternal grandmother of the infant with whom the infant's mother has a good relationship but does not reside with

  • An adult member of the foster family with whom the infant's mother currently resides

Correct answer: The infant's 15-year-old mother

Individuals who sign informed consent must be of legal age, mentally competent, not incapacitated by alcohol or other drugs, and not under coercion to sign. A minor parent of an infant or child who requires surgery is allowed to sign informed consent for his or her child as long as he or she is deemed to be mentally competent, not impaired or incapacitated by drugs or alcohol, and is not being coerced to sign. 

Delaying surgery by waiting to obtain informed consent from an incarcerated, but of legal age, parent is not advisable in this situation. While the teenage mother of the infant may desire emotional support and input from her mother, the infant's maternal grandmother, unless the maternal grandmother has already been granted legal guardianship of the infant, is not the correct individual to sign the consent in this scenario.

Teenage parents residing in foster care may benefit from the love and support of their foster family; however, again, a member of the foster family is not the correct individual to sign the consent in this scenario.

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