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Quiz Session - Attempts With Random Questions

CCI CFPN Exam Questions

Page 3 of 22

41.

The infection control nurse reports that four patients who underwent coronary artery bypasses in the past month have developed methicillin-resistant staphylococcal sternal infections postoperatively. On the basis of these data, the immediate response of the surgery quality-improvement nurse would be to

  • conduct a retrospective chart review to identify trends.

  • terminally reclean the ORs that were used for the open-heart cases.

  • notify the OR committee of the infection control nurse's findings.

  • have the sternal saws examined, cultured, and terminally sterilized.

Correct answer: conduct a retrospective chart review to identify trends.

The quality-improvement nurse would first attempt to identify commonalities in the cluster of cases that were associated with the infections. Performing specific sterilizations or notifying the OR committee of this finding is not warranted until the system deficiency contributing to this situation is identified.

42.

Which of the following new products is consistent with the guidelines set forth in AORN?

  • A towel that is non-linting

  • A peel-open package that allows resealing after opening

  • A wrapping material that retains its memory

  • A bottle of sterile water with a replaceable lid to prevent contamination of contents between uses

The AORN recommends that all items to be utilized within the perioperative area be evaluated prior to purchase to determine if the item (list is not all inclusive):

  • has been approved by the FDA for its intended use
  • includes the complete manufacturer's IFU
  • is resistant to tearing or puncture
  • can be sealed in a manner that allows for easy identification of tampering or lack of seal integrity
  • is free of toxic components
  • is nonlinting
  •  can be sterilized with the methods used at the surgical facility, and
  • is easy to use

43.

The patient in the post anesthesia care unit during Phase III is:

  • preparing for discharge.

  • preparing for self-care or care in an extended care facility.

  • is immediately post-operative.

  • ready for Phase IV and then discharge.

Correct answer: preparing for discharge.

There are three phases of post anesthesia care. The level of care required for each level decreases as the level increases. A patient in phase three has returned to a safe physiological level and is ready to be discharged.

44.

Providing explanations of monitoring and safety devices is most effective in addressing an adolescent's fear of:

  • death.

  • separation from parents.

  • loss of privacy.

  • altered body image.

Age-appropriate communication is important in implementing the pediatric nursing plan of care. Implementation begins during the perioperative nursing assessment and continues through discharge to the PACU or other area. 

Adolescents may fear altered body image, peer rejection, disability, and loss of control or status. The fear of death is more prevalent in this age-group than any other. Because of this, adolescents may find explanations of monitoring and safety measures reassuring during their surgical experience(s). 

45.

A 35-year-old female patient with breast cancer is scheduled for a radical mastectomy and is anxious and fearful about the surgical procedure. The preoperative nurse knows which of the following interventions would be least effective to alleviate this patient's fear and anxiety?

  • Explain in detail the proposed surgical procedure

  • Attentively listen

  • Provide reassurance

  • Encourage her to express her concerns

Correct answer: Explain in detail the proposed surgical procedure

Explaining every detail of the proposed surgical procedure will likely add to the patient's fear and anxiety. Rather, interventions to alleviate anxiety include factual information and clarification of misunderstandings, as well as giving the patient the opportunity to express her feelings and listening attentively, providing reassurance as necessary. 

46.

Anaphylaxis is an acute allergic reaction that causes cells to release histamine. It is a form of vasogenic shock and immediate symptoms include:

  • Vasodilation, hypotension, and bronchial constriction.

  • Vasoconstriction, hypertension, and bronchospasm.

  • Vasoconstriction, hypertension, and bronchial dilation.

  • Vasovagal response, hypertension, and bronchospasm.

Correct answer: 

Vasodilation, hypotension, and bronchial constriction.Histamine release will cause vasodilation, hypotension, and bronchial constriction. Within seconds, the patient can exhibit signs of edema, wheezing, cyanosis, and dyspnea. Treatment includes epinephrine and antihistamines.

47.

The perioperative nurse asks a patient who has bilateral hernias, about the type of operation that is to be performed. The patient responds, "A hernia repair, on the left side." The operation permit, however, specifies the right hernia. In this situation, the nurse's most appropriate response would be to:

  • inform the surgeon of the discrepancy and await further action.

  • document the patient's conversation.

  • assure the patient that both hernias will be repaired eventually.

  • request that the operating room supervisor cancel this case.

The perioperative nurse in this scenario is ensuring the patient has been informed of the scheduled procedure, as a part of informed consent, and furthermore, that the patient understands the procedure s/he is about to undergo. Nurses with concerns about the adequacy of the patient's understanding should report their concerns to the operating surgeon, or anesthesia provider (if the concerns involve the anesthesia consent), and await further direction. 

Consent documentation must be complete before administration of preoperative medications. On the patient's arrival in the OR, the circulating nurse and anesthesia provider are responsible to verify that consent documentation is in the chart and is correct, properly signed, and witnessed before administration of anesthesia. 

48.

A/An ___________ does not permit a person to excuse an error but rather to admit and rectify one readily.

  • surgical conscience.

  • adherence to aseptic technique.

  • practice of professionalism.

  • just culture.

Correct answer: surgical conscience.

Surgical conscience involves a moral obligation to treat the patient as you would yourself or a loved one undergoing surgery. Identification of errors without concern for any potential consequences of reporting, like delaying a case, is required to have a surgical conscience.

49.

Nursing interventions to reduce inadvertent hypothermia include:

  • applying warm blankets immediately upon arrival to the operating room.

  • removing hat and placing blanket around the head

  • removing blankets while positioning then replace with warm blankets as soon as possible.

  • allowing prep solution to dry for ten minutes before draping.

Correct answer: applying warm blankets immediately upon arrival to the operating room.

Warm blankets allow for prewarming of the patient. Inadvertent hypothermia starts before the patient enters the room. Leaving the plastic cap on the patient has demonstrated decrease in heat loss as compared to other head coverings. Minimizing the time the patient's skin is exposed between prepping and draping will help to decrease heat loss. Follow manufacturer's directions related to drying times.

50.

To meet the needs of a patient with hypovolemia, the perioperative nurse should anticipate treatment that involves which of the following?

  • Fluid volume replacement, positioning techniques, temperature maintenance, oxygen therapy, and administration of various drugs

  • Monitoring of the partial pressure of oxygen to ensure circulation of oxygen to the tissues

  • Administration of various drugs to maintain blood pressure, correct acidosis, or protect the kidneys from failure

  • Administration of whole blood and plasma expanders, or replacement with other IV fluids

Hypovolemia reduces cardiac output and may be caused by hemorrhage, dehydration (inadequate fluid replacement), or increased positive end-expiratory pressure (PEEP). Decreased vascular resistance, which causes relative hypovolemia (interference with venous return to the heart), can be related to medications, general and regional anesthesia, or anaphylaxis. 

Fluid and/or blood replacement is used to treat hypovolemia. Vasodilation can be treated with fluids, vasopressors, elevating the patient's legs, temperature regulation, and oxygen therapy. 

51.

With regard to delegating nursing activities to unlicensed assistant personnel, the perioperative nurse:

  • retains accountability for the activities delegated.

  • is relieved of accountability for judgments about personnel competency.

  • is relieved of accountability for delegated nursing activities.

  • is allowed to delegate the responsibility for supervision to the unlicensed assistive personnel.

Delegation transfers to a competent person the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation to include the selection of competent staff to perform the task. The responsibility of the nurse to supervise cannot be delegated to unlicensed assistive personnel.

52.

Upon transfer of a patient to the OR for a right modified radical mastectomy, the perioperative nurse verifies the patient's identity by checking her identification bracelet. The perioperative nurse notes that the bracelet is on the patient's right wrist. The most appropriate action for the nurse to take is to remove the bracelet and

  • place a new one on the left arm.

  • tape it to the front of the chart.

  • give it to the PACU nurse.

  • tape it to the footboard of the stretcher.

Correct answer: place a new one on the left arm.

A patient should always have an identification bracelet. The identification bracelet should not be on the extremity that may be involved in the surgery, however, they should still wear one if at all possible.

53.

Hypothermia is a condition of lowered body temperature that is possibly caused by all of the following except

  • warmed infusion or irrigating solutions.

  • evaporative/conductive heat loss from exposed areas.

  • use of general or regional anesthesia.

  • surgical exposure of the abdominal or thoracic cavities.

Correct answer: warmed infusion or irrigating solutions.

Hypothermia is a low body temperature, less than 96.8 degrees Fahrenheit or 36 degrees Celsius. This can be caused by cool or room temperature infusion or irrigating solutions, not warm. Evaporative/conductive heat loss from exposed areas, use of general or regional anesthesia, and surgical exposure of the abdominal or thoracic cavities are all potential causes of hypothermia.

54.

Perioperative team members who administer medication within their role in the perioperative environment demonstrate competency by:

  • confirming safe dosage limits and dosage calculations

  • verbal validation of dosages

  • confirming medication with computer validation

  • labeling medications when outside of their original container in the perioperative setting

Administration of medication is different than dispensing medication to the sterile field. Demonstration of competency regarding administration means you must be aware of safe dosages, medication limits, calculations and symptoms related to toxicity.

55.

Mr. J., a 75-year-old male who was alert preoperatively, has had a transurethral resection of the prostate under a spinal anesthetic. As he arrives in the post anesthesia care unit, he is disoriented and incoherent. Mr. J.'s condition is most likely a result of:

  • hyponatremia.

  • a reaction to pain stimuli.

  • hyperkalemia.

  • Mr. J.'s age.

Correct answer: hyponatremia.

During a TURP the patient’s bladder is distended with a large amount of fluid. If the patient absorbs excess fluid systemically, a decrease in sodium may occur as hemodilution occurs.

56.

The medical history of a patient scheduled for a D and C includes rheumatoid arthritis, cholecystectomy, and childhood tonsillectomy and adenoidectomy. Which of the following nursing diagnoses is it imperative for the perioperative nurse to formulate?

  • Impaired physical mobility

  • Sensory/perceptual alterations

  • Altered sexual behavior

  • Altered nutrition

Correct answer: Impaired physical mobility

The patient's history of rheumatoid arthritis combined with a dilation and curettage could lead to impaired physical mobility that could impair recovery.  Sensory/perceptual alterations and altered sexual behavior may be considerations, but are less likely to create a prolonged recovery time, as there are no comorbidities to potentiate these diagnoses. Altered nutrition is unlikely to be an issue.

57.

The anesthesia provider extubated a patient who had a bilateral mastectomy and the patient's oxygen saturation level was 92%. The anesthesia provider performs a jaw-thrust maneuver and the patient is now restless with an oxygen saturation of 89%. Which of the following would be the most appropriate intervention?

  • Attach a face mask to the breathing circuit.

  • Apply cricoid pressure (Sellick's maneuver).

  • Obtain neostigmine (Prostigmin) from the emergency cart.

  • Attach a Yankauer tip to the suction catheter.

Correct answer: Attach a face mask to the breathing circuit.

Postsurgical hypoxia after extubation where airway patency is established should be treated using oxygen. Attaching a face mask to the breathing circuit is the only answer that will help provide oxygen to this patient. 

58.

A geriatric patient is scheduled for a lengthy surgical procedure that will take approximately 8 hours to complete. Which of the following would indicate that the nursing goal of preserving skin integrity intraoperatively, has been met for this patient?

  • No adverse effects to the integumentary system are observed.

  • The dressing remains dry and intact.

  • No adverse flora are revealed in skin cultures taken.

  • The skin remains stained with the disinfectant agent.

Assessment for positioning needs should be made before the patient transfers to the OR bed. The perioperative nursing assessment includes a patient interview, physical examination, and review of medical records. Key points of assessment that are related to surgical positioning include length of procedure, age, height and weight, skin condition, nutritional status, preexisting condtions, and physical mobility/limitations.  It should also be determined if there are any specific areas of discomfort that a particular position may cause, and alleviating interventions to implement to reduce or minimize discomfort. 

Geriatric patients are at high risk for skin problems caused by positioning, as thin skin layers and increased arteriosclerosis make them more prone to skin breakdown because of pressure. Thus, a reasonable outcome for a nursing diagnosis of Risk for Impaired Skin Integrity for a geriatric patient undergoing a lengthy surgical procedure would be to maintain skin and tissue integrity consistent with preoperative status, with no adverse effects observed. 

59.

A 21-year-old patient is admitted to the preoperative holding room for an appendectomy. During the interview, the patient admits to smoking marijuana on a regular basis. The nurse's first action would be to:

  • notify the anesthesiologist of the findings.

  • call the surgeon to the holding room.

  • document the information on the patient's chart.

  • alert the rest of the team in the operating room.

Correct answer: notify the anesthesiologist of the findings.

Active substance use can lead to complications recovering from anesthesia and may mean that a patient is not a candidate for ambulatory surgery. The anesthesiologist will need to know about the patient's substance use due to the complications that this can cause more than the surgeon of the rest of the operating team. Documentating the finding alone is not sufficient action.

60.

Medication containers on the sterile field should be labeled:

  • immediately upon receipt of the medication

  • before the case begins

  • prior to the end of the case

  • before transfer to the sterile field

Immediate labeling of medications decreases the risk for errors in labeling and identification of intraoperative medications. The use of standardized work processes serves to minimize the chance of error.

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