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Quiz Session - Attempts With Random Questions

CCI CNAMB Exam Questions

Page 3 of 25

41.

Every facility where lasers are used must have a laser safety officer and laser specific training for all employees. The area the laser is being used where there is the potential for injury is known as what? 

  • The Nominal Hazard Zone

  • The Laser Safety Zone

  • The Laser Hazard Area

  • The Irradiance Zone

Correct answer: The Nominal Hazard Zone

The Nominal hazard zone is the space where the level of reflected, direct, or scattered radiation will exceed the maximum permissible laser exposure. Special applicable eye and skin PPE must be worn within the nominal hazard zone. The room where the laser is used is called the laser treatment-controlled area. Closing doors, covering windows, using stand-by mode, limiting OR traffic, using laser safety checklists, and having a laser safety officer in the room are all ways of maintaining safety around lasers. 

42.

According to some studies, children have twice the rate of postoperative vomiting than that of adults. These are all other risk factors that increase the incidence of postoperative nausea and vomiting in children except which one? 

  • Being a toddler

  • Surgery over 30 minutes

  • Being an adolescent

  • A history of PONV in family members

Correct answer: Being a toddler

Toddlers actually have less risk for PONV than school-age or adolescent children (any children over age 3). Longer surgeries and a family history of PONV are also both risk factors. The same assessment that is done on adults to determine the risk of vomiting should be done for children. The following are recommendations to decrease the risk of PONV: Regional anesthesia should be used whenever possible and general anesthesia avoided. Propofol is preferred over nitrous oxide and volatile anesthetics when appropriate. Opioid use should be minimized. Lastly, the patient should be kept well hydrated as this is shown to decrease the incidence of nausea and vomiting. 

43.

In healthy patients, carbon dioxide levels are the main stimulus in ventilation. What is it called when the carbon dioxide response curve shifts to the right in a carbon dioxide response test? 

  • A blunted response

  • Hypocarbnia

  • Oxygen toxicity

  • Hyperventilation

Correct answer: A blunted response

Carbon dioxide is the main stimulus for ventilation. When carbon dioxide response is muted and the response curve on a carbon dioxide response test shifts to the right, there is a decreased ventilatory response and subsequent respiratory depression. This can be caused by hypothyroidism, depression, aging, anesthesia, narcotics, and barbiturate use. This blunted response to carbon dioxide is the main rationale behind giving supplemental oxygen to all patients who are emerging from anesthesia. If the response shifts to the left, then the patient has an increased sensitivity to carbon dioxide and can hyperventilate. This happens in diseases such as thyroid toxicosis and ketosis. 

44.

Horner syndrome can occur most frequently after which of these types of nerve block? 

  • Interscalene brachial plexus block

  • Peroneal interscalene nerve block

  • Neuraxial block

  • Bier block

Correct answer: Interscalene brachial plexus block

Horner syndrome occurs when the stellate ganglion is blocked accidentally. This ganglion is found at the 6th and 7th cervical vertebrae and serves the face and the arm. Symptoms of Horner syndrome are a hoarse voice, a constricted pupil, upper eyelid droop, decreased sweating, and nasal congestion on the affected side. Horner syndrome is temporary, but scary for patients. 

45.

Which is a type of class 1 chemical indicator for sterilization? 

  • External striped indicator tape

  • An autoclave test pack

  • A Bowie-Dick card

  • A biologic indicator for implants

Correct Answer: External striped indicator tape

There are 6 classes of chemical indicators. Class 1 includes exterior visual indicators like striped tape. Class 2 includes autoclave test packs that test for air removal, such as the Bowie-Dick test. Class 3 includes single-variable indicators of one sterilization parameter. Class 4 is a multi-variable monitor strip with two or more sterilization parameters. Class 5 is a chemical indicator strip that reacts similarly to a biologic indicator with the parameters of sterilization. Class 6 is an emulating indicator that responds to all sterilization parameters using a 'process challenge device.' 

46.

The nicotine in cigarettes has what effect on the circulatory system? 

  • Nicotine is a vasoconstrictor

  • Nicotine is a vasodilator

  • Nicotine is an anticoagulant

  • Nicotine is an anti-inflammatory 

Correct answer: Nicotine is a vasoconstrictor

Smoking is harmful in a myriad of ways. In relation to surgery, it increases chances of pulmonary complications, increases blood clot risk, and increases the instance of surgical site infections. Carbon monoxide in cigarette smoke binds with hemoglobin to form carboxyhemoglobin and diminishes oxygen saturation. This in turn decreases healing and precipitates pulmonary complications. In addition to all this, nicotine is a potent vasoconstrictor and can decrease blood flow to vital organs and wounds. 

47.

The central sterile processing area should have what kind of air pressure and how many air exchanges per hour minimum? 

  • Positive pressure, 4 air exchanges per hour

  • Positive pressure, 8 air exchanges per hour

  • Negative pressure, 4 air exchanges per hour

  • Negative pressure, 8 air exchanges per hour

Correct answer: Positive pressure, 4 air exchanges per hour

CSP should have positive pressure (the same as each OR) because it needs to remain a cleaner area than the surrounding corridors and rooms. 4 ACH minimum with 2 fresh exchanges is recommended. Sterile storage areas should be in close proximity to CSP and have the same minimum amount of air exchanges. 

48.

A patient with Addison's disease is being prepped for surgery. The nurse knows that this patient has a high risk for what complication? 

  • Acute adrenal insufficiency

  • A thyroid storm

  • Airway obstruction and emergency tracheostomy

  • Acute respiratory distress syndrome

Correct answer: Acute adrenal insufficiency

Addison's disease is an autoimmune disease that results from destruction of the adrenal cortex. These patients are usually on steroids chronically due to hypoadrenocorticism. This condition requires a stress dose of steroids prior to surgery because infection, injury, surgery, and other stressors can activate the pituitary-adrenal axis and lead to acute adrenal insufficiency. This is also known as an Addisonian crisis and can be life threatening. Symptoms of an Addisonian crisis include nausea, dehydration, vomiting, muscular weakness, and hypotension. These are then followed by fever, flaccidity of limbs, hyponatremia, hyperkalemia, azotemia, and shock. Treatment is steroid administration. Usually decadron is the first choice treatment, then hydrocortisone. 

49.

When cleaning an OR after a procedure is finished, which of these should be cleaned first? 

  • The spotlights

  • The bed and all positioners

  • The floor should be mopped first

  • The back table and mayo stands

Correct: The spotlights

OR room cleaning should always be consistent and follow a clean-to-dirty and top-to-bottom sequence. The lights hang above the surgical field and must always be 100% clean and dry. Consistency ensures that there is a lower chance of forgetting certain things to be cleaned. The floor should be cleaned last in most all situations, unless it is so contaminated with blood and debris that it must be cleaned so personnel don't track blood and tissue out of the OR.

50.

Patients who should be considered at risk for latex allergies include: 

  • patients who are allergic to avocados

  • patients who are allergic to bees

  • patients who are allergic to shellfish

  • patients who are allergic to red 40 dye

Correct answer: patients who are allergic to avocados

Screening patients for potential latex allergies can help prevent reactions during or after surgery. It is important to make environments as latex-free as possible due to the growing percentage of patients and healthcare workers who are latex sensitive or allergic. Patients with histories of contact dermatitis, allergic reactions in a hospital setting without a known cause, neural tube defects, multiple operations or hospitalizations, occupational exposure, and repeated urinary catheterizations are all at risk of developing mild or severe reactions to latex. Food allergies that are sometimes connected to latex allergies are fruits, nuts, bananas, avocados, celery figs, chestnuts, and papayas. 

51.

The circulating nurse is assisting the CNRA place an arterial line on a patient in the PACU who has begun experiencing complications and will be admitted to the hospital instead of being discharged. The CRNA tests the perfusion of the hand while occluding the radial artery and the nurse knows this is called what? 

  • The Allen test

  • The occlusion test

  • The art line test

  • The Robert test

Correct answer: The Allen test

The Allen Test is done whenever an arterial line is placed or if an artery is being harvested for purposes such as a coronary bypass. This ensures that the limb will still receive adequate perfusion from secondary or parallel arteries before going ahead with a procedure that could potentially cause problems with limb perfusion. 

52.

In the middle of an ORIF, a set-specific screwdriver for implanting screws is dropped on the floor and there is no exact replacement. Which of these actions is appropriate? 

  • Use Immediate Use Steam Sterilization (IUSS)

  • Grab another screwdriver from another company's set that is somewhat similar

  • Pick the screwdriver up, disinfect it, and continue using it; give the patient another dose of antibiotics

  • The surgeon will have to use a different type of screw for which there is a sterile screwdriver

Correct answer: Use Immediate Use Steam Sterilization (IUSS)

During orthopedic surgery with implants, only instruments designed for the specific implants should be used. Using other instruments can dent or scratch implants or cause them damage in some other way. IUSS may be used when there is no good alternative for a specific instrument. 

53.

Which of these electrolytes is most important to check on a patient who has just finished a bowel prep for a colonoscopy?  

  • Potassium

  • Magnesium

  • Phosphorus

  • Calcium

Correct answer: Potassium

Bowel preps are necessary prior to colonoscopies and other bowel procedures to help with visualization and to decrease contamination risk if perforation occurs. Solutions like GoLYTELY are commonly used and can clear the bowels out in 4 to 6 hours. Potassium is lost with diarrhea and levels should be checked prior to surgery to prevent any heart rhythm disturbances or other complications. Geriatric patients and those who are malnourished and underweight are at greater risk for electrolyte imbalances from bowel preparations and should be monitored closely. 

54.

Which of these does not emit a thermal plume that interferes with laminar airflow in the OR?

  • The back table

  • OR staff members

  • Electrical equipment

  • Spotlights

Correct answer: The back table

Laminar airflow is clean airflow in the OR that flows from a higher (cleaner) plane to exhaust exits near the floor. This type of airflow allows more air exchanges per hour and may decrease surgical site infections. Thermal plumes interrupt the continuous airflow and create a type of turbulence. They come from anything that emanates heat: the patient, staff, equipment, etc. 

55.

All of these are risk factors for Local Anesthetic Systemic Toxicity (LAST) that should be noted in a preoperative patient assessment, except which one? 

  • Taking garlic supplements

  • Sodium channel blocker use

  • Having a CNS disease

  • Having a history of cardiac disease

Correct answer: Taking garlic supplements

Garlic can increase bleeding times, but is not a risk factor for LAST. 

Risk factors for LAST:

  1. Very young or old
  2. Low muscle mass, frailty, malnourishment
  3. Females
  4. Cardiac, metabolic, kidney, liver, and CNS diseases
  5. Pregnancy
  6. Acidosis
  7. Taking sodium channel blockers like procainamide

56.

Surgical site infections are lowest in cases where hair was:

  • not removed

  • clippered in pre-op 4 hours prior

  • removed with depilatory cream

  • shaved in the OR

Correct answer: not removed

Whenever possible, hair at surgical sites should be left alone. A large study of over 23,600 surgical wounds found a 2.3% infection rate when razors were used, a 1.7% infection rate when hair was clipped, and a 0.9% infection rate when hair was left alone. If fire risk is an issue, water soluble gel should be placed in the hair. Clipping hair is the best method of hair removal, but is recommended to be done prior to entrance to the OR. AORN also ranks depilatory hair removal methods as the same as hair clipping as long as they minimize damage to the skin. Razors are not preferred, but if used, hair should be shaved as near the time of incision as possible to decrease risk of infection due to nicks and abrasions. 

57.

A patient's allergy list includes all amide local anesthetics. This group of medications includes which of these? 

  • Lidocaine

  • Tetracaine

  • Procaine

  • Benzocaine

Correct answer: lidocaine

Amide local anesthetics include bupivacaine, lidocaine, prilocaine, and ropivacaine. Ester local anesthetics include benzocaine, chloroprocaine, cocaine, procaine, and tetracaine. Locals are classified as amides or esters due to lipophilic groups in their respective molecular structures (Esters have -CO- and amides have -HNC- intermediate bonds). This difference in molecular structure affects metabolism and the ability to cross tissue barriers. Esters are metabolized rapidly by cholinesterase in the bloodstream and are shorter acting. Amides are longer acting because they are more lipophilic, bound to proteins, and have to be transported to the liver to be metabolized. Esters have a higher allergy potential than amides, and allergies to amides are rare. There is no cross allergy risk between esters and amides.

58.

The supine position increases what in obese patients? 

  • Intrathoracic pressure and cardiac workload

  • Respiratory function and tidal volume

  • Metabolism and medication absorption

  • Intracranial pressure and peripheral vascular resistance

Correct answer: Intrathoracic pressure and cardiac workload

Obesity increases intrathoracic pressure due to excessive weight in the chest and abdomen. The supine position increases blood flow and subsequently cardiac workload in all patients due to decreased gravity. This increased workload is particularly a problem for obese patients and especially ones who suffer from cardiovascular insufficiencies already. The supine position decreases respiratory function and tidal volume in obese patients. Metabolism and intracranial pressure shouldn't be affected greatly by this position. 

59.

A pre-operative patient has an isotonic crystalloid IV fluid ordered for surgery. The nurse knows that crystalloids do what? 

  • Remain in the extracellular fluid

  • Decrease intracranial pressure

  • Increase intracranial pressure

  • Increase the oxygen carrying capacity of the blood

Correct answer: Remain in the extracellular fluid

Isotonic crystalloids like NS or LR remain in the bloodstream. They are essentially volume expanders that increase urine output and replace lost blood or fluid volume from hemorrhage or NPO status. The normal ratio is 3 ml of crystalloid to replace 1 ml of blood loss. They do not increase oxygen carrying capacity and, since they are not hypertonic or hypotonic, do not have an effect on intracranial pressure. They are usually preferred for maintenance fluids and for replacement of electrolytes. They have an osmolality of 275–310 mOsm/L and a sodium concentration of 130-155 mEq/L. Hypertonic and hypotonic solutions have higher and lower osmolalities and sodium concentrations and cause fluid shifts within the body. Hypertonic (i.e., 3% saline) solutions cause fluid to enter the bloodstream and decrease intracranial pressure and edema, and hypotonic solutions (i.e. D5W) increases intracranial pressure by encouraging water to move out of the plasma and into cells. Colloids are solutions that remain intravascularly and help balance water distribution. Albumin, dextrans, and hetastarch are all colloids. 

60.

A 50-year-old patient in pre-op who has down syndrome is scheduled for a full mouth treatment with multiple extractions by an oral surgeon. The patient is extremely anxious and agitated. It would be appropriate for the nurse to ask the anesthesia provider for an order for premedication with which of these medications?

  • Midazolam

  • Morphine

  • Darvocet

  • Flumazenil

Correct answer: Midazolam

Patients with extreme anxiety can benefit from premedication with benzodiazepines such as midazolam (Versed) or diazepam (Valium). They are relatively short acting, well tolerated, and fast acting. Preemptively treating anxiety can help induction go more smoothly and decrease the likelihood of adverse events related to vital sign changes induced by anxiety. 

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