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Quiz Session - Attempts With Random Questions

CCI CFPN Exam Questions

Page 4 of 22

61.

Basic functions of the GI tract are ingestion, __________ , mixing, digestion, propulsion, absorption, and elimination by defecation.

  • secretion

  • swallowing

  • motility

  • reabsorption

The GI tract, or alimentary canal, is a continuous, tubelike structure that spans the human torso. It includes the mouth; pharynx; esophagus; stomach; small intestine, consisting of the duodenum, jejunum, and ileum; and large intestine. The large intestine consists of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anus. The length of the GI tract is about 20 feet (6 meters). 

Basic functions of the GI tract are ingestion, secretion, mixing, digestion, propulsion, absorption, and elimination by defecation.

62.

The perioperative nurse is caring for a 2-year-old patient. A positive outcome for reduced separation anxiety is enhanced by:

  • providing the patient with a favorite toy for comfort.

  • playing loud music in the OR suite.

  • having the family and healthcare team discuss the patient's plan of care away from the patient.

  • talking to the patient about the surgery in medical terms.

A child's comprehension of and responses to the environment are based on developmental age. Nursing care should be tailored to the developmental age of the child to optimize the child's ability to understand the situation, to minimize the child's and family's stress and anxiety, and to facilitate the development of a trusting and supportive medical relationship. The types of fears are also related to the child's level of psychological development. 

A toddler fears separation. Thus, an appropriate nursing intervention would be to allow a personal item into the OR for comfort/security. In turn, this should reduce separation anxiety and create a more positive experience for the child. 

The other answer choices are not acceptable for a 2-year-old patient.  

63.

Delegation of nursing tasks is essential at times to complete interventions within the nursing process. The five rights of delegation include the right task, the right communication and direction, the right person, the right supervision and evaluation, and the right:

  • circumstance.

  • time.

  • patient.

  • right intervention.

“The perioperative nurse considers the patient care setting, the resources available, and other relevant factors. Tasks delegated must be ones that do not require independent nursing judgment.”

64.

Appropriate selection of suture material can help to reduce the immediate complication of:

  • dehiscence.

  • hernias.

  • surgical site infection.

  • fever

Techniques related to closure and slow absorbing suture selection can help to decrease short term complications like dehiscence and hernia's in the long term.

65.

Biological indicators should be placed

  • in the most challenging location inside a package.

  • only inside trays that contain implants.

  • on the outside of the container being sterilized.

  • where the biological indicator can be easily reached.

Correct answer: in the most challenging location inside a package.

Biological indicators are used to determine if the inside of a package continues to be sterile. By placing biological indicators in the most challenging location inside a package, it ensures that the areas that are most difficult to sterlize are continuing to remain sterile. Biological indicators should not only be used inside trays that contain implants.

66.

A standardized approach to hand-off communication is a requirement of The Joint Commission (TJC) to:

  • reduce the risk of error.

  • increase collaboration between multidisciplinary teams.

  • notify the post anesthesia care nurse of patient status.

  • assist with lunch relief communication

Written documentation alone, however crucial, is insufficient to ensure patient safety as care responsibility passes from one team or individual caregiver to another. A hand-off or handover is defined as the verbal transfer of information and responsibility for care of the patient from one provider to another. Evidence related to hand-offs demonstrates that standardized approaches further reduce the risk for error. 

In healthcare settings, occasions for transfer-of-care processes, such as hand-offs, include nursing shift changes, temporary relief or coverage, nursing and physician hand-offs from one department to another, various other transfers of information in inpatient settings, and interhospital transfers. The purpose of hand-off communication and reports is to provide essential, up-to-date, and specific information about the patient. Standardized hand-off communication must include an opportunity to ask and respond to questions.

67.

When assembling instruments to be sterilized, the perioperative nurse should take all of the following measures except

  • place heavier instruments at the top of the tray, with lighter instruments below.

  • place instrument sets in perforated or wire mesh bottom trays.

  • open instruments that have joints (box locks).

  • nest a set of basins with an absorbing towel separating the metal surfaces.

Correct answer: place heavier instruments at the top of the tray, with lighter instruments below.

Lighter instruments should be placed at the at the top of the tray above heavier instruments. The perioperative nurse should place instrument sets in perforated or wire mesh bottom trays, open instruments that have joints, and nest a set of basins with an absorbing towel separating the metal surfaces.

68.

How should radioactive sealed sources such as capsules, seeds and needles be handled by health care workers?

  • Using forceps, tongs or tube racks

  • Wearing radiation protective gloves

  • Wearing examination gloves

  • Using universal precautions

Correct answer: Using forceps, tongs or tube racks

Protection from radiation involves time, distance, and shielding. No protective gloves offer sufficient shielding from radiation, and forceps, tongs or tube racks can provide distance that does offer protection.

69.

Which of the following types of cleaning solutions should the perioperative nurse use when cleaning spills that contain blood or other potential infectious materials?

  • EPA registered disinfectant

  • Bleach

  • FDA approved germicidal detergent

  • Hydrogen peroxide

Spills of blood or other body fluids should be cleaned up immediately or as soon as is feasibly possible. The use of an EPA registered disinfectant which inactivates blood-borne viruses/pathogens is required to clean up bloody spills in order to prevent potential infection to perioperative personnel. If an EPA registered disinfectant is not immediately available, a sodium hypochlorite solution may be utilized instead.

70.

According to AORN Guidelines, safe medication administration in the perioperative setting should include which of the following?

  • Following the five rights (5 R's) of the medication delivery: right patient, medication, dose, route, time

  • Using at least two patient identifiers when administering medications that may include name, social security number, hospital identification number, or patient ID bracelet with barcode

  • Having the circulating nurse and scrub person audibly review and confirm the medication ordered before the surgeon scrubs in

  • Verifying all medication pulled with the doctor's preference card before it is administered

Medication administration safety must be examined within the context of its multidisciplinary system, which includes prescribing, transcribing, procurement and dispensing, as well as administering. Medication administration in the OR is complicated (compared with that found in other nursing care areas), in that the OR often requires that the circulating nurse and scrub person jointly prepare a medication that will be administered by a third person, usually the surgeon. Moreover, two potentially lethal medications are frequently used on the field (e.g., epinephrine and heparin), and both are often clear and come in widely disparate dosages. Additionally, aseptic techniques require the medication to be administered by someone other than the person removing the medication from its original container. 

For these reasons, safely administering medication in the perioperative setting must include following the 5 R's of medication delivery: right patient, medication, dose, route, and time. 

71.

During a surgical hand scrub, the perioperative nurse observes that the private scrub nurse has acrylic nails. In response to this observation, the perioperative nurse's most appropriate response would be to

  • notify the scrub nurse of the AORN Guidelines

  • have the scrub nurse continue with the hand scrub, and document the incident

  • have the scrub nurse break scrub and assist with the circulating responsibilities

  • have the scrub nurse break scrub and leave the OR suite

AORN guidelines on hand hygiene prohibit the wearing of artificial nails for any perioperative employee that has direct contact with patients due to the increased risk of infections with gram-negative bacteria and yeasts that can be harbored in the nails.  

72.

In the preadmission testing interview, the patient should be instructed to suspend which of the following medications prior to surgery?

  • Aspirin

  • Hydrochlorothiazide

  • Lanoxin

  • Phenytoin

During the preadmission testing interview, the perioperative assesses for use of medications (prescription and over-the-counter [OTC]) and herbal products. Aspirin, in addition to other prescription and OTC medications and some herbal products, has anticoagulant properties which may adversely affect the patient both during and after surgery.

73.

Over the patient's strenuous objections, a PACU nurse inserts a Foley catheter in accordance with a p.r.n. order. Legally, the nurse could

  • be liable for assault and battery.

  • not be charged with assault as long as nursing judgment was used.

  • be liable for malpractice.

  • not be charged with malpractice if the action followed physician's orders.

Correct answer: be liable for assault and battery.

Performing any medical procedure without the patient's permission is be assault and battery, even if nursing judgment is used. Malpractice describes incorrectly provided care, not care provided against a patient's will.

74.

During surgery, the scrub nurse's glove is punctured by a needle. The scrub nurse's immediate course of action should be to discard the needle from the sterile field and

  • reglove using the open glove method.

  • apply a sterile glove over the punctured glove.

  • replace both gloves with sterile ones using the open glove method.

  • reglove using the closed glove method.

Correct answer: reglove using the open glove method.

The nurse should use the open glove method to replace the affected glove. The intact glove does not need to be relplaced. Apply a sterile glove over the punctured glove is not an appropriate intervention.

75.

An emergency repair of an abdominal aortic aneurysm is in progress. The perioperative nurse was unable to check the surgical consent form or interview the patient preoperatively. Which of the following is the best way for the nurse to document this situation?

  • "Emergency admission; patient identification and procedure verification confirmed by the chart and the surgeon."

  • "Emergency admission; unable to assess the patient preoperatively."

  • "Emergency admission; identification of the patient preoperatively was not possible."

  • "Emergency admission; family not available for preoperative interview."

Correct answer: "Emergency admission; patient identification and procedure verification confirmed by the chart and the surgeon."

The nurse should document what they were able to do and the measures they took to ensure the patient was safe. The nurse should not document that they were unable to perform an established safety measure without also documenting why they were not able to do it.

76.

An intraoperative autologous blood salvage device may be used:

  • during resection of intact malignant tumors.

  • for a patient undergoing an emergency Cesarean section for abruptio placentae.

  • in conjunction with the use of microfibrillar collagen (Avitene).

  • in patients with sepsis.

Correct answer: during resection of intact malignant tumors.

Intraoperative blood salvage should not be used in conjunction with collagen hemostatic agents, which may not wash out of the salvaged blood. Blood contaminated with amniotic fluid or known systemic infections should not be re-infused. If a malignant tumor can be resected intact, patients with cancer may benefit from autotransfusion.

77.

Which of the following patient outcomes would be appropriate in the nursing plan of care for a patient undergoing the first of two cataract extractions with lens replacement?

  • The patient demonstrates understanding of the surgical procedure and the postoperative plan of care, and is able to avoid injury caused by visual deficits.

  • The patient demonstrates knowledge of postoperative complications, the intraoperative care plan, and the need to delay postoperative activity.

  • The comfort of the patient is maintained, body temperature remains normothermic, and the patient ambulates within 8 hours postoperatively.

  • The patient understands self-care needs, provides own self-care within one week of surgery, and expresses minimal need for pain control.

Since this patient will be undergoing the first cataract extraction and has not yet experienced this sort of surgical procedure before, an appropriate nursing diagnosis related to this scenario would be: deficient knowledge or readiness for enhanced knowledge related to diagnosis, surgical intervention, and home care management.  

Based on this nursing diagnosis, the most appropriate outcome would then be: the patient, family, or significant others will verbalize knowledge of the diagnosis, planned surgical intervention, medication management, and requirements for home care maintenance before discharge. The patient would be able to verbalize an understanding of avoiding injury caused by the visual defects, and surgical management of them. 

78.

The perioperative nurse is preparing the OR for a minimally invasive endoscopic surgery. Given that endoscopic light sources produce different colors of light whenever a camera is used, the perioperative nurse should adjust the camera to all other optical components as soon as: 

  • all cords are attached and light source is on.

  • the camera is attached to the lens.

  • the light is attached to the lens.

  • the surgeon is ready to insert.

Endoscopic light is often referred to as cold light, meaning that the heat from the light source is not transmitted through the length of the scope. Therefore, tissue damage from heat at the distal tip of the endoscope is minimized. Light sources should have adjustable manual and automatic brightness modes. A generic cord can be used with most scopes and light sources, but some light cables can only be used with specific sizes of endoscopes.

Light sources produce different colors of light whenever a camera is used, so white balancing must be performed during each procedure.  White balancing adjusts the camera to all other optical components (endocoupler, light cable, laparoscope). This enables the camera to reference white so that it can identify all primary colors properly. White balancing is done once the scope and light cable are connected (all cords are attached), the light source turned on, and the lens held close to a white gauze or white drape (for white color referencing). 

79.

Which of the following is a potential intraoperative complication for a patient with hyperthyroidism?

  • Thyroid storm.

  • Hypotensive crisis.

  • Hypokalemia.

  • Hypercalcemia.

A rapidly progressive and potentially fatal intraoperative complication for patients with hyperthyroidism is thyroid storm, otherwise known as thyrotoxic crisis. This complication develops suddenly and severely and, if left untreated, death rates are 20% to 30%. 

Thyrotoxic crisis can be precipitated by a stressful event, such as surgery. The perioperative staff must be able to recognize and differentiate between uncomplicated thyrotoxicosis and thyroid storm, and furthermore be prepared to act quickly. Thyroid storm presents abruptly with high-fever, mental deterioration, and decompensation of one or more organ systems as a result of severe hypermetabolism. Causes of this often rapid rise in thyroid hormone levels include thyroid or parathyroid surgery, radiioiodine therapy, withdrawal of antithyroid drug therapy, vigorous thyroid palpation, and thyroid hormone medication, among others. 

80.

Which of the following is an example of a "never event?"

  • A catheter-associated urinary tract infection (CAUTI)

  • An appendix that ruptures during a surgical appendectomy

  • Surgeries that occur simultaneously on multiple trauma victims

  • A hemorrhage after surgery on a cerebral aneurysm

Correct answer: A catheter-associated urinary tract infection (CAUTI)

The Centers for Medicare and Medicaid Services (CMS) took action in 2009 to improve patient care and decrease errors and injury by denying payment for medical errors that result in serious harm or death for patients. The CMS no longer reimburses for care rendered to patients to remedy the consequences of errors. The CMS generated a list of nonreimbursable conditions (termed "never events") or a "No Pay List," for the following injuries acquired during care:

  • Air embolism
  • Blood incompatibility
  • CAUTI
  • Poor control of blood sugar
  • Deep vein thrombosis or pulmonary emboli after total knee or total hip surgery
  • Falls or trauma while in care
  • Removal of a retained object from surgery
  • Pressure injury
  • Surgical site infection (SSI) after coronary artery bypass surgery
  • Catheter-associated vascular (bloodborne) infection
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