×

Quiz Session - Attempts With Random Questions

CCI CNAMB Exam Questions

Page 2 of 25

21.

A 40-year-old female patient is scheduled for a parathyroidectomy. Parathyroid removal can be a minimally invasive ambulatory surgery when sestamibi scan technology, blood testing protocols, and/or gamma probes are able to be used. In minimally invasive parathyroid gland removal, which lab result must the circulating nurse wait for prior to taking the patient back to the OR? 

  • Parathyroid hormone

  • Thyroid stimulating hormone

  • Magnesium

  • Follicular stimulating hormone

Correct answer: Parathyroid hormone

It is imperative to have a baseline PTH level prior to a parathyroidectomy because parathyroid tissue is often small and difficult to find. Sometimes several specimens are taken to the pathologist for identification before the problematic parathyroid gland is found. Blood samples are taken after removal of tissue at different intervals to verify that the parathyroid that was causing symptoms and wreaking havoc with calcium levels is removed. The levels of PTH will decline dramatically within minutes when the diseased gland is gone.  

22.

A patient in the PACU that underwent a trigger finger release using the WALANT (Wide Awake Local Anesthesia, No Tourniquet) technique is still showing signs of vasoconstrictor-induced ischemia in the surgical hand after several hours. The nurse knows this. Which reversal drug will be needed? 

  • Phentolamine

  • Phenylephrine

  • Phenergan

  • Phentermine

Correct answer: Phentolamine

Phentolamine 1 mg/ml is the reversal agent for epinephrine. The WALANT technique is gaining traction in uncomplicated hand surgery because it is cheaper and safer since there is no general anesthetic involved. Lidocaine diluted with epinephrine is usually used and complications such as the one in the scenario are very rare. 

23.

A patient is scheduled for an EGD. Which of these is an important preoperative consideration? 

  • Remove the patient's dentures

  • Start an IV on their left side, since the patient will be turned on their right side

  • Make sure they took their preoperative prep beforehand

  • Place the blood pressure cuff on their left arm because they will be turned on their right side 

Correct answer: Remove the patient's dentures

The dentures should be removed to allow for the endoscope insertion, to protect the dentures and the scope itself. A mouthguard will be placed to keep the mouth open and protect the gums. The patient is usually kept on their back or turned on their left side, so an IV and BP cuff would be better placed on the right side for access. There is no prep to take for EGDs. 

24.

All of these can be considered communication barriers in the perioperative setting, except which one?

  • Using the Perioperative Nursing Data Set

  • Educational and generational differences

  • Language differences 

  • Multiple caregivers with overlapping duties

Correct answer: Using the Perioperative Nursing Data Set

Using the PNDS gives all perioperative nurses a common language. Barriers to effective communication include educational, generational, cultural, and language differences. Stressful situations, overlapping duties, and uncooperative staff can all be barriers as well. 

25.

A patient scheduled for an excision of a ganglion cyst from the right wrist has an INR of 2. What should the nurse do? 

  • Proceed with surgery

  • Report the INR result to the surgeon and anesthesia provider

  • Recheck the INR to verify its accuracy

  • Give vitamin K per standing order and cancel the surgery 

Correct answer: Proceed with surgery

Normal INRs range from 1.5 to 2.5. A therapeutic range for a patient on blood thinners is 2 to 3. An INR of 2 for a ganglion cyst removal is perfectly acceptable. 

26.

How often should routine radiographic tests be completed on all lead aprons, vests, and skirts?

  • Every 12 months

  • Every 5 years

  • Every 6 months

  • Every 2 years

Correct answer: Every 12 months

Personal radiation protective wear should be x-rayed and manually checked at least annually and whenever damage might have occurred.

27.

What do the Munro and Braden Scales assess for perioperative patients? 

  • The patient's risk for pressure injury of the skin before, during, and after surgery

  • The patient's risk for nausea, vomiting, and aspiration before, during, and after surgery

  • The patient's acuity level for planning their care after surgery

  • The patient's level of sedation and anesthesia during surgery

Correct answer: The patient's risk for pressure injury of the skin before, during, and after surgery

The Munro Scale assesses patients' risk of pressure ulcers using the categories of mobility, nutritional state, BMI, weight loss, age, comorbidities, ASA score, anesthesia type, core body temperature, blood pressure, skin moisture, duration of surgery, blood loss, and surgical positioning. Each category is scored and the risk is calculated based on their score. 5–6 equals a low risk, 7–14 is moderate, and 15 or greater is high. The Braden Scale uses moisture, sensory perception, activity, mobility, nutrition, and friction and shear as its categories. 19–23 is no risk, 15–18 is mild, 13–14 is moderate, 10–12 is high, and 9 or lower is very high.

28.

Most lasers that are used in surgery fall into which hazard classification? 

  • IV

  • III

  • II

  • I

Correct answer: IV

Lasers are classified as potential hazards from I to IV. The most dangerous lasers are classified as IV and most surgical lasers fall in this category. They can cause damage to eyes and skin and are fire hazards. AORN guidelines require all doctors' offices, surgery centers, and hospitals where lasers are used to have a laser safety committee and laser safety officers. All staff using these lasers must be trained and have their knowledge verified and reassessed on a regular basis.  

29.

A pre-op nurse is assessing a 10-year-old pediatric patient for an ORIF of his clavicle. What is an important finding to report to the anesthesia provider? 

  • A loose tooth

  • A small laceration on his right hand

  • A history of RSV as an infant

  • Mild environmental allergies

Correct answer: A loose tooth

Teeth can be knocked out quite easily by a laryngoscope blade and can fall into the airway. The anesthesia provider will take precautions and the tooth may need to be pulled prior to intubation. 

30.

AORN has combined the Joint Commission's Universal Protocol and the WHO's Surgical Safety Checklist to make a Comprehensive Surgical Checklist. The purpose is to reduce surgical errors and harm to patients globally. What are the 3 critical points in perioperative care that must be confirmed verbally and documented by the perioperative nurse? 

  • The "sign-in" prior to anesthesia induction, the "time-out" prior to incision, and the "sign-out" or "debrief" prior to leaving the OR  

  • The "time-out" prior to surgical site incision, the "sign-out" or "debrief" prior to leaving the OR, and the "discharge-out" prior to letting the patient leave the facility 

  • The "time-out" prior to surgical site incision, the "verification" prior to signing out of a patient's chart after all intraoperative charting is done, and the "discharge" prior to letting the patient leave the facility

  • The "sign-in" prior to entering the OR, the "debrief" prior to incision, and the "sign-out" during handoff in the PACU

Correct answer: The "sign-in" prior to anesthesia induction, the "time-out" prior to incision, and the "sign-out" or "debrief" prior to leaving the OR  

According to Universal Protocol, the correct patient, the correct surgery, and the correct site must be verbally verified prior to surgery (and the site marked). The AORN Comprehensive Surgical Checklist incorporates this into its procedure check-in stage. It also includes verifying a history and physical, an anesthesia assessment, lab results, and checking for special equipment/implants. The "sign-in", "time-out", and "sign-out" are the 3 critical steps after the procedure check-in that must be discussed with the surgical team and documented. Each step has a checklist specific to that step, such as patient allergies, aspiration risk, fire risk assessment, surgical counts, etc. 

31.

A patient who has undergone spinal anesthesia during lower extremity orthopedic surgery is recovering in the PACU. They have been in the PACU for 2 hours and the spinal has been wearing off satisfactorily, but all of a sudden the patient's feeling and function in their lower extremities disappears again. What should the nurse do first? 

  • Alert the anesthesia provider

  • Assess the dermatome and chart patient function. It is common for patients to regress after spinal anesthesia 

  • Call a rapid response

  • Administer tPA and turn them on their left side

Correct answer: Alert the anesthesia provider

A sudden loss of feeling and function after they've returned after spinal anesthesia can be indicative of a spinal hematoma. The anesthesia provider needs to reassess the patient as quickly as possible and assess the need for transfer to the nearest hospital with capabilities of dealing with the hematoma. Low back pain, sudden motor changes, and sudden bowel and bladder dysfunction are all symptoms to watch for in the PACU. Treatment is emergency decompression, but prognosis is poor if the surgery doesn't occur in 8 hours. The nurse, in this instance, should alert the anesthesia provider and prepare to transfer the patient as soon as possible. 

32.

Which of these can ambulatory surgery centers and hospitals implement to reduce the length of hospital stays, healthcare costs, the incidence of cancellations, and waste of supplies while greatly increasing the efficiency of the OR and preoperative departments?

  • Dedicate staff and resources to preadmission testing and assessments

  • Increase the number of staff meetings

  • Hire more preoperative nursing staff and nursing aides

  • Have patients arrive at the hospital or surgery center 3–4 hours early for preoperative assessment and care

Correct answer: Dedicate staff and resources to preadmission testing and assessments

Preadmission testing and preoperative anesthetic evaluations can greatly enhance the efficiency of the OR, reduce costs, and increase the quality of patients' experiences. This preemptive action can reduce the length of hospital stays, incidence of cancellations, and waste of supplies. Even only using preadmission phone interviews can be very beneficial in preparing the patient for surgery. Patients are usually asked to arrive 1–2 hours prior to their procedure and with preadmission testing out of the way, this amount of time is usually more than sufficient. 

33.

What is a typical systolic blood pressure range for a healthy toddler (18-30 months)? 

  • 86–106 mm Hg

  • 100–120 mm Hg

  • 40–68 mm Hg

  • 52–76 mm Hg

Correct answer: 86–106 mm Hg

A typical 18–30 month-old toddler has an awake heart rate of 98–140, an asleep heart rate of 80–120, respirations of 22–37, and a systolic blood pressure range of 86–106. 

34.

All of these are correct ways of placing and organizing instruments in trays prior to sterilization except:

  • placing curettes and rongeurs with the bowl side up

  • placing lighter instruments on top of trays with heavier instruments on the bottom

  • opening pivots and box locks of all instruments with hinges

  • disassembling all complex devices and placing the pieces in the tray separately

Correct Answer: placing curettes and rongeurs with the bowl side up

Always place instruments that have concave surfaces facing down to allow for drainage in the sterilizer. All other answers are correct. 

35.

All of these are core principles of ERAS (Enhanced Recovery After Surgery) for gynecological surgery in the intraoperative phase except which one? 

  • Routinely using nasogastric tubes to remove stomach contents and prevent postoperative nausea and vomiting (PONV)

  • Preemptively preventing postoperative nausea and vomiting (PONV) with a scopolamine patch

  • Maintaining a core body temperature above 36 degrees celsius

  • Avoiding giving too much IV fluid

Correct answer: Routinely using nasogastric tubes to remove stomach contents and prevent postoperative nausea and vomiting (PONV)

ERAS in gynecological surgery is a new, evidence-based approach to care in preoperative, intraoperative, and postoperative phases. Core principles of the intraoperative phase include choosing anesthetic agents that decrease PONV, promote rapid wakening, and decrease the need for opioids. Another core principle is the need to maintain normothermia or a core temperature above 36 degrees celsius/96.8 degrees fahrenheit. Avoiding fluid overload, preventing PONV with a scopolamine patch or other medication are two more principles. Lastly, new evidence discourages the use of routine nasogastric tubes because they've been associated with pneumonia, fever, and atelectasis. Other methods of preventing PONV are preferred. 

36.

Which of these is an example of closed-loop communication? 

  • A scrub technician acknowledging a request for local anesthesia by repeating the medication name back to the surgeon while handing him the syringe

  • A circulating nurse saying "yes, I'll grab that" when a surgeon asks for another set of gelpies

  • A CRNA nodding at the surgeon after they request deeper sedation for a carpal tunnel release

  • A circulating nurse giving written instructions to another nurse on how to use the NovaSure machine for an ablation

Correct answer: A scrub technician acknowledging a request for local anesthesia by repeating the medication name back to the surgeon while handing him the syringe

Closed-loop communication is similar to the read-back method in the fact that you acknowledge the communication and rephrase it to let the communicator know you received the correct information. The TeamSTEPPS fundamentals course promotes closed-loop communication as an extremely effective communication strategy. TeamSTEPPS is the result of a joint venture between the Department of Defense and the Agency for Health Research and Quality (AHRQ) to create a program to increase patient safety by teaching effective communication skills to healthcare workers. 

37.

When should discharge planning be instigated? 

  • As soon as the patient is scheduled for surgery or admitted to pre-op

  • In the PACU once the patient is aware of their surroundings

  • During phase II in PACU when the patient is wide awake and the family is present 

  • During the anesthesia provider's assessment right before being taken to the OR

Correct answer: As soon as the patient is scheduled for surgery or admitted to pre-op

The patient and family should go through discharge education as soon as a surgery is scheduled so they can plan before the day of surgery to have any necessary supplies or medications, make necessary arrangements for caregivers, and make any necessary alterations to the home environment. 

38.

Which agency of the federal government regulates HIPAA?

  • The Centers for Medicare and Medicaid Services (CMS)

  • The Food and Drug Administration (FDA)

  • The Joint Commission (TJC)

  • The Agency for Healthcare Research and Quality (AHRQ)

Correct answer: The Centers for Medicare and Medicaid Services (CMS)

CMS administers the Health Insurance Portability and Accountability Act along with several other subsidiary programs. It is responsible for fining facilities with HIPAA breaches and offers other financial disincentives for unsafe patient care and security breaches. 

39.

While completing a patient's medication reconciliation, the pre-op nurse finds that a 60-year-old patient being readied for a laparoscopic cholecystectomy is taking saw palmetto, ginger, and garlic supplements. He has a history of DVTs with warfarin as treatment. He stopped the warfarin several days prior to surgery as directed, but has continued taking the supplements. What should the nurse do? 

  • Notify the surgeon as those supplements can increase bleeding risk in addition to the patient's recent warfarin treatment

  • Notify anesthesia so they can change their anesthetic plan due to the supplements he is taking and their effect on kidney function

  • Do nothing. The patient stopped his warfarin and is ready for surgery

  • Give vitamin k stat

Correct answer: Notify the surgeon as those supplements can increase bleeding risk in addition to the patient's recent warfarin treatment 

Laparoscopic cholecystectomies always come with a risk of liver laceration or uncontrollable bleeding. If a patient is already a bleeding risk, due to medications they are on or supplements they are taking, a surgeon may want to delay surgery. Lab results such as clotting times and CBCs may be ordered. If labs are normal, the surgeon may choose to proceed.

40.

In the lateral position, where should the axillary roll be placed? 

  • Under the rib cage posterior to the axilla

  • In the axilla

  • Under the upper arm, anterior to the axilla

  • Under the lower rib cage directly below the breasts in females and below the nipple line in males

Correct answer: Under the rib cage posterior to the axilla

The axillary roll is a misnomer because it is never actually placed in the axilla. The lower shoulder should be brought slightly forward and the axillary roll should be put under the down side of the rib cage, posterior to the axilla. This places the weight of the upper torso on the rib cage instead of the shoulder and area around the brachial plexus to prevent nerve and blood vessel damage. Blood pressure should be taken on the lower arm. 

×