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Quiz Session - Attempts With Random Questions

CCI CFPN Exam Questions

Page 1 of 22

1.

Which of the following represents a principle underlying the effectiveness of communication in the operating room?

  • All members of the team should be encouraged and feel free to communicate with other team members

  • Staff should only speak up if asked

  • The surgeon should control the flow of information

  • The perioperative nurse is at the center of all communication

A multidisciplinary team's planning and coordination of processes ensures that the needs and perspectives of the patient and all caregivers are included, which can decrease risk and promote the safe transfer of information. An environment that promotes open communication will support safe patient care.

2.

How long can sterile supplies in an empty, unused room be open before they should be discarded?

  • There is no specific amount of time

  • 1 hour

  • 2 hours

  • 4 hours

Correct answer: There is no specific amount of time

In general, the longer a sterile field is open, the higher the likelihood of contamination (even in an empty room). Unless it is under constant surveillance, the sterility of any setup cannot be guaranteed. If a scheduled surgical procedure is delayed and a setup has not been contaminated by the patient's presence in the room, the setup may remain open, under surveillance by someone in the room, with the doors closed. The setup should be used as close to the time of preparation as possible.

3.

The renal pedicle contains the renal artery, vein, and the:

  • lymphatics.

  • ureter

  • glomeruli.

  • arterioles.

The renal artery and vein with their accompanying nerves and lymphatics are referred to as the pedicle of the kidney.

4.

A patient is admitted for surgery following a serious automobile accident. The patient's emergency condition does not permit time for a count of sponges, sharps, and instruments prior to the start of the surgery. In this situation, it is recommended that all of the following steps be taken except

  • the surgeon should be asked to sign a count waiver.

  • the incident should be documented in the record.

  • intraoperative and closing counts should be performed.

  • an x-ray should be performed immediately after the surgery.

Correct answer: the surgeon should be asked to sign a count waiver

When a patient's emergency condition does not permit time for a count, the incident should be documented in the record, intraoperative and closing counts should be performed, and an x-ray should be performed immediately after the surgery. Having the surgeon sign a count waiver is not a normal step in this situation.

5.

A regulatory body that sets national standards that are enforceable by law is the

  • Association for the Advancement of Medical Instrumentation (AAMI).

  • Health Insurance Portability and Accountability Act (HIPPA).

  • Association of periOperative Registered Nurses (AORN).

  • National Fire Protection Agency (NFPA).

Correct answer: Association for the Advancement of Medical Instrumentation (AAMI).

The Association for the Advancement of Medical Instrumentation (AAMI) is the only entity in the answers that meets the definition of a regulatory body that sets national standards  that are enforceable by law.

6.

An excision of a pilonidal cyst and sinus involves removing the pilonidal cyst and sinus tracts from the intergluteal fold on the:

  • posterior surface of the lower sacrum.

  • anterior surface of the lower sacrum.

  • posterior surface of the upper sacrum.

  • anterior surface of the upper sacrum.

Excision of a pilonidal cyst and sinus is removal of the cyst with sinus tracts from the gluteal fold overlying the posterior surface of the lower sacrum. Pilonidal cysts are more common in men, and result from ingrown hairs in the gluteal fold. Treatment consists of drainage in the acute stage and total surgical excision during remission. Complete excision of the cyst and sinus tracts prevents recurrence. The defect resulting from recurrence may be too large for primary closure; if so, the wound is left open to heal by granulation.

7.

A patient is undergoing a repair of a strabismus and is to receive an anticholinergic medication. Which of the following is an expected outcome of this medication?

  • Decrease nausea and vomiting

  • Stimulate gastric emptying

  • Potentiate the effects of narcotics

  • Decrease intraocular pressure

The use of anticholinergic medications by anesthesia providers for surgical premedication is common. Atropine and glycopyrrolate (Robinol) are two commonly administered anticholinergic medications that are given to dry up oral secretions and prevent nausea and vomiting by decreasing vagal tone.

8.

A patient is scheduled for an epidural steroid block for intractable lumbar pain. The pain, which began suddenly 6 months ago, is bilateral and is rated 7/10; relief from narcotic pain medication taken at regular intervals has been minimal. The plan of care will include:

  • helping the patient to cope with pain, explaining the procedure, and assisting with anesthesia or analgesia intraoperatively.

  • developing a trusting nurse-patient relationship, encouraging early postoperative activity, and facilitating communication between patient and physician.

  • encouraging pain relief postoperatively, helping the patient to cope with pain, and relaying patient progress to the family.

  • avoiding judgmental statements, reassuring the patient that the procedure will not cause pain, and documenting pain medications.

Chronic lumbar pain typically results from degenerative or arthritic changes of the lumbar disks. Pain tends to increase gradually. Epidural steroid injection, placement of electrodes or spinal stimulators, or the use of spinal traction or lumbar braces may all be used to treat lumbar pain.

9.

A patient has a pneumatic tourniquet in place during repair of the anterior cruciate ligament. After being inflated for one and one half hours, the alarm on the tourniquet sounded and the nurse reset the alarm for an additional 30 minutes at the request of the surgeon. When the alarm sounds for the second time, the nurse is asked to reset the alarm for an additional 30 minutes. Which of the following actions should the nurse take at this time?

  • Discuss with the surgeon that the tourniquet needs to be released.

  • Reset the alarm as requested and document the request in the OR record.

  • Ask the surgeon if the inflation pressure of the tourniquet can be decreased 50%.

  • Request that the OR nurse manager come to the OR.

Correct answer: Discuss with the surgeon that the tourniquet needs to be released.

A pneumatic tourniquet should not be left in place for more than two hours on the thigh. If the surgeon asks for the tourniquet alarm to be reset for another 30 minutes, this tourniquet will have been on for two and a half hours. The nurse should first discuss this concern with the surgeon.

10.

A patient with ocular trauma is scheduled for vitrectomy. During the preoperative assessment, the patient becomes progressively agitated, expressing a terror of blindness and death. The perioperative nurse would initially

  • speak calmly and provide emotional support.

  • assess the patient's sensorium thoroughly.

  • collaborate with the surgeon.

  • send a blood sample for drug screening.

Correct answer: speak calmly and provide emotional support.

Presurgical anxiety is not unexpected. Speaking calmly and providing emotional support is a good initial intervention. Assessing the patient's sensorium thoroughly or performing a drug screen is not necessary, as their behavior is most likely due to anxiety. Collaboration with the surgeon may be necessary if the patient's anxiety continues to intensify, but is not a good initial intervention.

11.

A patient with bilateral total hip arthroplasties is transported to the OR for gastrostomy tube placement under local anesthesia. The best site on which to apply a flexible, disposable dispersive electrode would be the patient's

  • upper arm

  • buttock

  • thigh

  • lower abdomen

A flexible, disposable dispersive electrode should not be applied to any tissue which is covering an implanted metal device, in this case, prosthetic devices. Studies have found that the tissue temperature is elevated when a dispersive electrode is placed over an implanted metal device, and can result in thermic burns.  

12.

An 80 year-old patient scheduled for a total hip arthroplasty is at an increased risk for developing which of the following complications?

  • Deep vein thrombosis secondary to immobility.

  • Air embolism from the position on the fracture table.

  • Peroneal nerve damage to the operative leg.

  • Hypothermia related to increased subcutaneous fat deposits.

Providing safe, quality care for the older adult in the perioperative setting requires the nurse to have a thorough knowledge of the changes associated with aging and the risk factors for surgical complications. 

One change associated with aging is the increased risk for the development of deep vein thrombosis (DVT). The chances of developing DVT increase with age and double each decade of life over the age of 40 years. In addition, the incidence of DVT is more than 150-fold higher among hospitalized patients (largely due to immobility while hospitalized) than those in the community.  

Prevention of DVT in the older person begins in the preoperative phase of care. Whenever possible, the nurse should contact the patient well in advance of the planned procedure to begin education on DVT precautions (such as avoiding long air travel, walking daily, and drinking adequate fluids).  

13.

The perioperative nurse can expect to implement which of the following nursing interventions first for a trauma patient whose hematocrit is 22%?

  • Obtain a blood specimen for a type and cross match.

  • Ensure a glucometer is in the OR.

  • Request 2 units of O-positive blood from the blood bank.

  • Set up the rapid infuser with sterile water for injection.

Laboratory values aid the trauma team in evaluating a trauma patient's status. Appropriate laboratory tests for a trauma patient include a minimum of a complete blood count (CBC), hemoglobin and hematocrit (H&H) value, blood alcohol level (BAL), and a blood type and screen. 

A hematocrit of 22% is very low, and likely indicates anemia and/or hemorrhage. A crossmatch is needed with the above laboratory tests to safely give the patient blood, which is indicated in this scenario. Most trauma centers have several units of type O-negative blood (universal donor) available in the event that a blood transfusion is required before a type and crossmatch (T&C) can be performed.   

14.

Of the following, which is an example of an expected basic competency for a perioperative nurse?

  • formulating nursing diagnoses based on preoperative assessment data.

  • conducting nursing research to further the practice of perioperative nursing.

  • acting as first assistant in general surgical procedures.

  • assuming managerial and leadership roles in the perioperative arena.

Perioperative nursing implies the delivery of comprehensive patient care within the preoperative, intraoperative, and postoperative periods of the patient's experience during operative and other invasive procedures, using the framework of the nursing process. In doing so, the perioperative nurse assesses the patient. S/he collects, organizes, and prioritizes patient data, establishes nursing diagnoses, identifies desired patient outcomes, develops and implements a plan of nursing care, and evaluates that care in terms of outcomes achieved by and for the patient. The perioperative nurse collaborates with other healthcare professionals, makes appropriate nursing referrals, and delegates and supervises other personnel in providing safe and efficient patient care.

Conducting nursing research, acting as first assistant, and assuming managerial/leadership roles are advanced (not basic) competencies of the perioperative nurse, requiring higher education and/or more experience. 

15.

An example of a nursing diagnosis for a patient undergoing coronary artery bypass graft surgery would be:

  • Anxiety.

  • Effective Coping.

  • Induced Hyperthermia.

  • Improved Tissue Perfusion.

Nursing diagnoses have evolved since they were first introduced in the 1950s, and involve the process of identifying and classifying data collected in the assessment in a way that provides a focus to plan nursing care. They are identified, named, and classified according to human response patterns and functional health patterns. The North American Nursing Diagnosis Association International (NANDA-I) is the authoritative organization responsible for delineating the accepted list of nursing diagnoses. 

Each NANDA-I-approved nursing diagnosis has a set of components, as follows:

  • a definition of the diagnostic term
  • its defining characteristics (e.g., the requisite pattern of signs and symptoms or cues that make the meaning of the diagnosis clear)
  • its related or risk factors (e.g., causative or contributing factors that are useful in determining whether the diagnosis applies to a particular patient)

For a patient planning to undergo coronary artery bypass grafting, anxiety would be an appropriate perioperative nursing diagnosis. The other answer choices are not approved perioperative nursing diagnoses. Ineffective coping, hyperthermia, and ineffective peripheral tissue perfusion are approved nursing diagnoses for the perioperative setting. 

16.

At the end of an orthopedic procedure, unused specialty instruments on the back table should be

  • washed, then terminally sterilized

  • sent back to the preparation area for wrapping and sterilization

  • returned to the instrument-room shelves

  • set on a collection cart for disposition

Regardless of whether or not a surgical instrument was actually used during the planned surgical procedure, all opened instruments should be considered to be contaminated, and should be washed and then terminally sterilized. 

17.

A normal serum potassium (K) level for an adult is:

  • 3.5 – 5.0 mEq/L.

  • 2.5 – 4.0 mEq/L.

  • 3.0 – 4.5 mEq/L.

  • 4.0 – 5.5 mEq/L

Normal potassium levels for adults are as follows: 

  • Serum: 3.5-5 mEq/L
  • Plasma: 3.5-4.5 mEq/L

18.

A perioperative nurse overhears a patient tell a friend that she thinks she is going to die during the surgery. The nurse's next action should be to

  • discuss and verify the patient's feelings and then inform the surgeon.

  • inform the surgeon immediately of what was overheard.

  • discuss with the patient what was overheard and provide reassurance

  • ignore what was overheard.

Correct answer: discuss and verify the patient's feelings and then inform the surgeon.

Preoperative anxiety is to be expected, but if the patient actually thinks they may die during surgery, this should be addressed unless this risk has been discussed with the patient. The nurse should first assess the patient's state of mind then discuss this with the surgeon to ensure the patient's fears are addressed and that they have a realistic understanding of the risks of the surgery.

19.

A patient is brought to the ED after a motor vehicle accident. The patient's abdomen is rigid and painful, and the hematocrit (HCT) is 27%. As the perioperative nurse prepares the OR for the arrival of this patient for surgery, the primary course of action would be to:

  • set up the autotransfusion (cell saving) device and notify the appropriate personnel.

  • set up the invasive monitoring lines needed for patient management.

  • place the fluid/blood warmer in the OR and prepare for blood transfusions.

  • place the sequential compression machine and stockings in the OR.

Due to the patient's condition and major blood loss (active hemorrhaging as evidenced by the patient's very low hematocrit levels), the perioperative nurse must ensure the OR is set up for autotransfusion during surgery. 

Autotransfusion is the reinfusion of a patient's own blood intraoperatively. It is used with increasing frequency in surgery, as predated atuologous blood donation is in decreasing use. During intraoperative autotransfusion (cell salvage), blood is collected as it is lost during the surgical procedure and reinfused to the patient after it is filtered or washed. This is a lifesaving technique during emergency cases (as with major trauma patients), or in procedures with major blood loss. It can also be an option for patients who refuse blood based on religious beliefs. 

20.

A patient is admitted for an elective abortion. The assigned perioperative nurse opposes the procedure because of personal beliefs. In this situation, the nurse may

  • refrain from participation in the procedure.

  • attempt to change the patient's decision.

  • share personal beliefs with the patient.

  • not refrain from participation in the procedure.

Correct answer: refrain from participation in the procedure.

When a nurse has an ethical conflict, refraining from participation in a procedure is appropriate in most situations. A nurse should not normally attempt to change a patient's decision based solely on the nurse's ethical perspective. Nurses generally should not volunteer personal beliefs with the patient.

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