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Quiz Session - Attempts With Random Questions

CCI CNAMB Exam Questions

Page 10 of 25

181.

Why is it important to check liver function prior to surgery? 

  • The liver metabolizes many medications and creates clotting factors

  • The liver excretes many medications and is responsible for creating white blood cells

  • The liver stores anesthesia

  • The liver creates T-cells that help fight off infections that might occur because of invasive surgery

Correct answer: The liver metabolizes many medications and creates clotting factors

The liver has many functions. It forms and secretes bile, changes glucose into glycogen and stores it, metabolizes proteins, fats, and carbs, synthesizes cholesterol and plasma proteins (i.e., albumin), and excretes bilirubin and hormones. Many anesthetics are protein-bound, so if albumin levels are low, these drugs will have a prolonged effect and the patient will be more sensitive to them. The liver has a dual blood supply from the portal vein and the hepatic artery. The hepatic artery is supplied directly from the descending aorta and the portal vein contains blood directly from the GI tract. This ensures that oral medications, nutrients, and foreign substances absorbed from the GI tract are processed by the liver first before entering systemic circulation. The liver also synthesizes pseudocholinesterase, which is the principal enzyme that metabolizes succinylcholine and the ester local anesthesics. Any patient with liver problems who has received succinylcholine must be closely monitored for respiratory depression. People with liver dysfunction are at increased risk for bleeding because clotting factors are synthesized by the liver as well. 

182.

Which item would be considered "critical" according to Spaulding's classification system of patient care items' importance? 

  • A hypodermic needle

  • A blood pressure cuff

  • A vaginal sound

  • A nasal cannula

Correct Answer: A hypodermic needle

The Spaulding classification system lists patient care items as critical, semicritical, and noncritical. Critical items have to be sterilized because they cross into sterile tissue. This tier includes items like endoscopes, surgical instruments, catheters, surgical implants, and needles. Semicritical items require at least high-level disinfection because they come in contact with mucous membranes and skin. They can be sterilized, however. Examples of semicritical items are anesthesia equipment, respiratory equipment, and blunt vaginal instruments. Noncritical items are only used externally and only contact intact skin. Examples include linens, food utensils, and blood pressure cuffs. 

183.

Which statement by the preop nurse includes an important piece of information when educating a patient prior to a laparoscopic bilateral salpingectomy, but is worded most sensitively? 

  • You may have some shoulder pain afterward because of the carbon dioxide that is used during surgery; it dissipates and can cause pain in strange places

  • The surgeon will use a knife to cut three small holes in your belly to shove ports in so he can get to your fallopian tubes

  • The nurse will need to prep your vagina and groin after you are placed in stirrupsl; this will all be after you are asleep

  • You will definitely be nauseated after surgery, but we'll give you medication to help with it; I had so much nausea after my surgery

Correct answer: You may have some shoulder pain afterward because of the carbon dioxide that is used during surgery; it dissipates and can cause pain in strange places

When speaking with patients, it is important to assess their level of understanding and only give information that is important for their recovery or information that is specifically requested. It is important to steer clear of using anxiety-inducing words with negative connotations, like knife, nausea, needle, stab, poke, etc. Explanations should be simple and to the point. Make sure and give practical information about what the patient should expect and the basic rationale for certain procedures or policies. Anxiety has been shown to decrease attention spans in patients, so any way to reduce or avoid excess anxiety should be a priority. Anxiety also increases heart rate and blood pressure, among other vital sign changes, and it can increase the need for anesthesia. 

184.

A 10-year-old patient in pre-op who is scheduled for a tonsillectomy and adenoidectomy has bruises all up and down her torso in multiple stages of healing. What should the pre-op nurse do? 

  • Report possible abuse through the proper channels, and assess the child for any further signs of abuse 

  • Continue with the assessment, as children are often bruised from playing 

  • Confront the child's parents and ask them about abuse, and, if their explanation is plausible, continue with preparing for surgery  

  • Ask the child's parents to leave the room and continue the assessment with the child alone 

Correct answer: Report possible abuse through the proper channels, and assess the child for any further signs of abuse 

Suspected abuse should always be reported properly. Multiple bruises on limbs in various stages of healing are a red flag for abuse. They may have a plausible explanation, but it needs to be assessed properly. 

185.

How much of the margin of a sterile wrapper is considered unsterile after it is opened? 

  • 1 inch

  • 2 inches

  • 0.5 inch

  • 0.25 inch

Correct answer: 1 inch

The inside of the wrapper is considered sterile to within 1 inch of each edge. This is important when determining whether or not something has been contaminated and evaluating the margin of safety when opening items. 

186.

A patient in the PACU has a temperature of 39°C. What formula is used to convert celsius to fahrenheit and what is the temperature in °F? 

  • (°C X 9/5) + 32 = 102.2°F

  • (°C-32) x 5/9 = 102.2°F

  • (°C-32) x 3/8 = 98.6°F

  • (°C x 32) + 15 = 98.6°F

Correct answer: (°C X 9/5) + 32 = 102.2°F

(°C X 9/5) + 32 = 102.2°F is the formula for converting Celsius to Fahrenheit and (°F - 32) x 5/9 = 102.2°F is the reverse. Most computer charting systems do this automatically. However, it is important to have a basic understanding of the conversion formulas. 98.6°F equals 37°C and it is important to know quickly when a Celsius temperature reading is outside of parameters without having to look it up. 

187.

Oxygen gas for medical use in acute healthcare settings is typically stored compressed in E-size cylinders. Approximately how many liters of oxygen are contained in a full E-size cylinder? 

  • 660 L

  • 320 L

  • 580 L 

  • 440 L

Correct answer: 660 L

A full E-size oxygen cylinder contains approximately 660 liters at 2000 psi. As the oxygen is used up, the pressure of the tank decreases proportionally. 1000 psi remaining in the tank means that there is 330 liters left and 500 psi means 165 liters are left. 165 liters will last for around 30 minutes at 5 liters/min. When pressure is decreased to around 250 psi, the cylinder should be put out of commission until it is refilled. 

188.

During a needle localization breast lumpectomy, the surgeon sends the specimen down to radiology to check the margins and to the pathologist as a frozen section. What is the best way for the circulator to receive a verbal report from the pathologist and ensure accuracy of the report?  

  • Write down the report, read it back to the pathologist, and pass it on to the surgeon

  • Summarize the report to the surgeon while the pathologist is talking on the phone so nothing is left out

  • Write down the report and tell the surgical assistant the results so they can pass it on to the surgeon

  • Tell the pathologist to enter it into the patient record and then bring the patient record up on the computer screen in the room for the surgeon to read

Correct answer: Write down the report, read it back to the pathologist, and pass it on to the surgeon

This read-back method best ensures the accuracy and timeliness of the report. If the facility phone has the capability, AORN recommends placing the pathologist on speaker phone so he can talk to the surgeon directly. Take care doing this, however, if the patient is not completely anesthetized or is only sedated. 

189.

A patient had a light breakfast of toast and water prior to coming in to the ambulatory surgical center for their ACL repair. How long should their surgery be delayed per NPO guidelines?  

  • 6 hours

  • 8 hours

  • 2 hours

  • 4 hours

Correct answer: 6 hours

The minimal fasting time for a light meal without milk or cream involved is 6 hours. If the meal is a normal size, surgery should be delayed 8 hours. Clear liquids can be had up to 2 hours prior to surgery. Small gulps of water with necessary medication can be done up to an hour prior to surgery. 

190.

A patient scheduled for elective ambulatory surgery is instructed to shower using chlorhexidine for 2 days prior to surgery and the morning of surgery. What is an important piece of information to have on the pre-operative instruction sheet?  

  • Chlorhexidine is an antimicrobial soap that will help decrease the risk of surgical site infections; be careful not to get the soap in your ears or eyes because it can harm corneas and eardrums

  • Chlorhexidine is a soap designed to neutralize body odor so smells aren't offensive to staff or other patients 

  • Chlorhexidine kills all skin microbes to prevent surgical site infections; since the skin will already be prepped for surgery, OR preps aren't necessary and your surgery will go faster

  • Chlorhexidine is an antimicrobial soap used to prevent surgical site infections, and it is optional for use

Correct answer: Chlorhexidine is an antimicrobial soap that will help decrease the risk of surgical site infections; be careful not to get the soap in your eyes or ears because it can harm your corneas and eardrums. 

Chlorhexidine can do damage to corneas and tympanic membranes. It is used as a pre-surgery scrub, as an OR prep, and as a general cleanser (in different solutions and concentrations). Another good thing to have on the pre-op instruction sheet would be to not mix it with personal shampoos/cleansers as they inactivate it. Body lotion shouldn't be used afterward because it stops the residual bacteriostatic properties. 

191.

During a routine laparoscopic cholecystectomy at an ambulatory surgery center, the gallbladder is found to be severely adhesed to the liver and the surgeon unknowingly does not achieve full hemostasis. This is not discovered until the patient is in PACU and begins to show signs of severe hypovolemia. The surgeon immediately has the patient returned to the OR to obtain hemostasis and calls for 2 units of packed red blood cells to be administered. After the patient is returned to PACU the nurse assesses the patient for any transfusion reactions while waiting for the patient to be transferred to the nearest hospital. Among other things, what should the nurse watch for? 

  • Chills, headache, fever, and hypotension

  • Disorientation, increased urine output

  • Circumoral numbness, tinnitus, and visual changes

  • Right lower quadrant pain, shivering, extreme thirst

Correct answer: Chills, headache, fever, and hypotension

The probability of a transfusion reaction if all policies are followed and all requirements are checked is low. However, the probability goes up with each additional unit given. Nurses should be alert for hyperthermia, chills, headache, hypotension, weak pulses, hematuria, decreased urine output, increased bleeding from the operative site, and any signs of an allergic reaction. If a transfusion reaction is suspected, the blood should be stopped immediately and the reaction reported to the surgeon and blood bank. Any ordered antihistamines should be given immediately and the unused blood and tubing should be sent to the blood bank. The patient's symptoms should be treated as they become apparent. Urine and blood samples from the patient should be sent to the lab and an incident report should be filed. 

192.

Which class of microorganisms are most commonly associated with surgical site infections? 

  • Staphylococcus

  • Pseudomonas

  • Clostridium

  • Helicobacter

Correct answer: Staphylococcus

Most surgical site infections are caused by the patient's own skin flora. Staph are gram-positive and are the most implicated in surgeries that are considered clean. Up to 20% of patients' skin flora is found in hair follicles and oil glands and cannot be killed by topical prep solutions. E. coli infections are common after GI surgeries. 

193.

Tourniquets should be tested before use by inspecting them for cleanliness and structural integrity of the various parts. Also, prior to surgery, the circulating nurse should assess the patient's limb and obtain a tourniquet size that will overlap at least how many inches? 

  • 3 inches

  • 6 inches

  • 1 inch

  • 2 inches

Correct answer: 3 inches

Tourniquets should overlap at least 3 inches but no more than 6 inches. 

194.

Which of these definitions best describes the Bohr effect?

  • When the pH of blood becomes acidic due to an increase in CO2, the hemoglobin in the blood loses its affinity for oxygen and unloads it in the tissue to support increased metabolism

  • Named after the Boer War in South Africa, it describes what happens in a sickle cell crisis with the crescent moon-shaped red blood cells

  • The effect by which carbon monoxide takes over hemoglobin so oxygen cannot be transported; hemoglobin has a higher affinity for carbon monoxide than oxygen

  • The effect by which calcium and phosphorus have an inverse relationship

Correct answer: When the pH of blood becomes acidic due to an increase in CO2, the hemoglobin in the blood loses its affinity for oxygen and unloads it in the tissue to support increased metabolism

The Bohr effect describes the fact that metabolically active tissues produce more acid and carbon dioxide and need more oxygen. When metabolism increases, the oxygen-hemoglobin dissociation curve shifts to the right. Increased CO2 decreases hemoglobin's affinity for oxygen, so more oxygen is offloaded in the tissues than is kept in the bloodstream. 

195.

What should the nurse have available for a Robert Jones dressing after an orthopedic case? 

  • A cotton roll

  • A shoulder sling

  • A tegaderm dressing

  • An aquacel dressing

Correct answer: A cotton roll

A Jones dressing is a specific knee bandage that includes a soft cotton roll, webril, and a cotton elastic bandage such as an Ace bandage. The cotton roll is placed on each side of the knee and then held in place with Webril. Lastly, an Ace bandage or similar is placed around the knee, thigh, and leg to provide pressure and promote healing. Sometimes a plaster splint or knee immobilizer is also used on top of the dressing.  

196.

In an active shooter situation, which three things are staff encouraged to do (in order of priority)?

  • Run, hide, fight

  • Fight, hide, run

  • Run, fight, hide

  • Run, distract, fight

Correct answer: Run, hide, fight

In active shooter situations, victims are often random and can often be facility staff. Every staff member should know where panic buttons are located, which rooms are lockable, where the nearest emergency exits are, and be situationally aware at all times. If a shooter is nearby, the best thing to do is run away and evacuate to a safe place. If that is not possible, find a hiding place. As a last resort, the shooter should be confronted and incapacitated, if possible.

197.

What is the normal tidal volume (air inspired or expired during each breath) of an adult female with no respiratory conditions?

  • 550 mL

  • 160 mL

  • 720 mL

  • 1100 mL

Correct answer: 550 mL

Tidal volume is the volume of air moving in and out of the lungs during each respiratory cycle. A healthy adult male usually has a tidal volume around 660 mL. A healthy adult female is around 550 mL.

198.

Counting surgical items during cases should always begin where and end where? 

  • Begin at the sterile field and end at the kickbucket

  • Begin at the kickbucket and end at the sterile field

  • Begin at the back table and end at the kickbucket

  • Begin at the sterile field and end at the mayo stand

Correct answer: Begin at the sterile field and end at the kickbucket

Counting should always be consistent and start at the sterile field and work outward. 

199.

What is the most correct way to send a frozen section to the laboratory for immediate tissue identification? 

  • Hand-delivered in a sterile container with the specimen on a moist telfa pad

  • Hand-delivered in a container with 2% formalin

  • Hand-delivered or tubed to the laboratory  in a sterile container with the specimen wrapped in a raytek

  • Hand-delivered to the laboratory in a basin of saline

Correct answer: Hand-delivered in a sterile container with the specimen on a moist telfa pad

Frozen sections are sent when immediate identification of a tissue or tumor is needed. They are quick-frozen, sliced, stained, and placed under a microscope as quickly as possible. The results are then called to the surgeon by the pathologist. These specimens should never be placed in formalin or saline, but should be kept moist on a telfa pad in a sterile container. Hand-delivering specimens makes sure they arrive safely and eliminates any problems with the vacuum tube that may arise. Never place a specimen in a counted sponge. 

200.

When sterilizing items, where should the internal sterilizing indicator be placed? 

  • Inside the package in a spot that will be most difficult for the steam or other sterilant to penetrate 

  • Directly on top of the thickest part of the load being sterilized

  • To the side of the load being sterilized 

  • Anywhere in the sterilizer, since the site is randomly chosen each time to test all areas of the sterilization chamber 

Correct Answer: Inside the package in a spot that will be most difficult for the steam or other sterilant to penetrate 

The internal indicator should always be placed in the thickest, most difficult part of the pack for the sterilant to penetrate. However, it is important to remember that indicators do not guarantee sterility, they only guarantee that all the parameters for sterilization have been met.  

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