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Quiz Session - Attempts With Random Questions

CCI CNAMB Exam Questions

Page 4 of 25

61.

A patient is scheduled for laser ablation of condylomata acuminata. What should the nurse have ready in the room?

  • The laser, laser safety PPE, N-95 masks, and 3% acetic acid

  • The laser, laser safety glasses for the patient, and 4% lidocaine

  • The laser, a cystoscope, N-95 masks

  • The laser, laser safety PPE, and monsel's solution

Correct answer: The laser, laser safety PPE, N-95 masks, and 3% acetic acid

3% acetic acid is applied to condylomata acuminata before the procedure begins to localize the lesions. Laser safety PPE, covering windows, and placing warning signs should always be done when lasers are in use. A laser safety officer should also be in the room to run the laser itself. Viral matter has been found in smoke plumes from laser surgery, so N-95 masks and smoke evacuators are required.

62.

All of these are things that nurses can do to maintain competency in their chosen specialty, except which one?  

  • Refuse cross-training to stay with what feels comfortable

  • Identify strengths and weaknesses and seek education

  • Find a mentor and learn from them

  • Obtain specialty certifications

Correct answer: Refuse cross-training to stay with what feels comfortable

Nursing and healthcare is an ever changing field. To maintain competency, nurses should seek out educational and advancement opportunities that help them remain current in evidence-based practices. 

63.

What is the standardized process put in place by the Joint Commission to keep patients safe in surgery and reduce wrong site surgeries called?

  • Universal protocol

  • Standard precautions

  • Standard protocol

  • Universal precautions

Correct answer: Universal protocol

Universal protocol is used to prevent wrong patient, wrong site, and wrong procedure surgeries. It requires that a surgical checklist be followed, a standardized preprocedure verification process be followed, the surgical site be marked by the surgeon, and a time-out be done prior to surgery. 

64.

A 5-year-old male patient is having surgery to correct strabismus. In the middle of the procedure, the nurse hears the pulse oximetry alarm go off and the monitor shows severe bradycardia and hypotension. The surgeon immediately halts what he is doing and within 10 seconds, the patient's heart rate and blood pressure are at baseline. The anesthesia provider and the surgeon monitor the patient for several minutes and then decide to finish the surgery. What is the suspected cause of bradycardia and hypotension? 

  • The oculocardiac reflex was triggered

  • The dive reflex was triggered

  • The opthalmic-facial nerve was overstimulated

  • A brief laryngospasm must have occurred. 

Correct Answer: The oculocardiac reflex was triggered

The oculocardiac reflex is a trigeminovagal reflex arc triggered by traction on extraocular muscles or by putting pressure directly on the eye itself. It causes instant bradycardia, hypotension, and can cause severe dysrhythmias. Atropine or glydopyrrolate can sometimes be given prior to surgery to prevent this reflex from being triggered. It is most commonly seen during pediatric strabismus repair. 

65.

A young adult patient undergoing a laparoscopic gallbladder removal refuses to take out his tongue ring because he had it pierced the week prior to surgery. What is the best course of action for his nurse? 

  • Explain to the patient that he puts himself at risk for aspiration, if it becomes dislodged during intubation, and is at a greater risk for burns from stray electrocautery current 

  • Have him sign a jewelry removal declination form and proceed with surgery 

  • Explain to the patient that it is a huge infection risk and he had better take it out and let it heal 

  • Explain to him that it will block the anesthesia provider's view and make intubation harder prior to surgery

Correct answer: Explain to the patient that he puts himself at risk for aspiration, if it becomes dislodged during intubation, and is at a greater risk for burns from stray electrocautery current 

Metal or acrylic tongue rings are a serious aspiration risk if they become dislodged during intubation. Refusal to remove the tongue ring may result in a cancellation of the surgery if the anesthesia provider is unwilling to take that risk. Metal containing rings are also a burn risk (although this is rare) due to the monopolar electrocautery that is used in most surgeries. If the patient still refuses, the nurse needs to notify the anesthesia provider and surgeon. They can decide whether or not to proceed with surgery and have the patient sign a declination form to mitigate liability. 

66.

The American Society of PeriAnesthesia Nurses (ASPAN) has a patient safety position statement that includes 6 activity characteristics related to a culture of safety. These principles should be present during every care transfer between healthcare providers. Which of these contains all 6 of these characteristics? 

  • Communication, advocacy, competency, efficiency, timeliness, and teamwork

  • Assessment, diagnosis, intervention, evaluation, and knowledge

  • Pain, vital signs, adverse events, responsibility, collaboration

  • Individual needs, family needs, plan of care, surgeon orders, medications, recommendations

Correct answer: Communication, advocacy, competency, efficiency, timeliness, and teamwork

ASPAN has statements on many things related to patient safety and nurse responsibility. All of these characteristics are described in detail in ASPAN's Perianesthsia Nursing Standards, Practice Recommendations, and Interpretive Statements, Standard II: Principles of Safe Perianesthesia Practice. All these characteristics are expected to be present whenever patient care is transferred to another healthcare provider. 

67.

Which of these scenarios involves proper use of social media use? 

  • Using a facility camera to take pictures of a patient and posting it on the official hospital social media page after obtaining their written consent 

  • Taking a selfie with a patient and posting it online on a personal social media page with their verbal consent

  • Posting information about a high profile patient at the hospital on a private, locked page

  • Posting delicate information about a situation at the hospital so the public knows to avoid the ER if possible

Correct answer: Using a facility camera to take pictures of a patient and posting it on the official hospital social media page after obtaining their written consent

Nursing must take care to never disclose personal or sensitive information about patients or sensitive situations online. This is the case even on private pages with stringent security settings. Written consent must always be obtained before posting anything where a patient is identifiable and even then it should usually only be done by a hospital's public relations team and in an official capacity. 

68.

A 4-year-old patient in the PACU just started having a croupy cough, inspiratory stridor, tachypnea, retractions, and increased restlessness. The PACU nurse has someone alert the anesthesia provider while she places oxygen on the patient and helps reposition their airway to decrease obstruction. What medication should she ask another available PACU nurse to have prepared and ready immediately? 

  • Racemic epinephrine

  • Tessalon perles

  • Codeine-guaifenesin

  • Salmeterol

Correct answer: Racemic epinephrine

Racemic epinephrine is given by nebulizer to treat postintubation croup or other causes of laryngeal obstruction. They should also receive humidified oxygen and may be given corticosteroids. In emergency situations with children, especially, tasks that take the nurse away from the bedside should be delegated. Children can deteriorate rapidly and intervention must take place as soon as possible. 

69.

What material is most preferred for positioning devices that will have direct contact with the patient? 

  • Gel

  • Foam

  • Fabric (Rolled towels and blankets)

  • Moldable Beads (bean bags, etc)

Correct answer: Gel

Gel pads are usually preferred to other materials because they redistribute pressure best. According to AORN guidelines, supportive surfaces should allow for at least 1 inch of material between the bed and the body and have an interface pressure between 23-32 mm Hg. AORN does not recommend using towels or blankets as positioners due to wrinkling risk and the possibility of friction injuries. Foam and bean bags are widely used, but must be kept in good repair and fit the guidelines above. 

70.

The circulating nurse is verifying a patient's informed consent form. What is an example of a good question to ask that will show that the patient understands the procedure and is ready to proceed?

  • Can you tell me what Dr. Smith is going to be doing for you today in your own words? 

  • What's the name of the surgery you are having done?  

  • What are you having done today? 

  • Can you verify that you are having a laparoscopic cholecystectomy? 

Correct answer: Can you tell me what Dr. Smith is going to be doing for you today in your own words? 

This answer is specific, but allows the patient to describe their surgery in their own terms and at their own level. It also reiterates which surgeon is completing the procedure and allows the nurse to verify that the patient understands what is about to be done. Interviewing skills are an important nursing skill that is often overlooked and rushed. Patients' levels of understanding should always be assessed prior to interviewing and educating so communication can be tailored to their needs. 

71.

A 2-year-old patient is in the PACU after a myringotomy. The PACU nurse is assessing pain with the FLACC scale. What does the A stand for? 

  • Activity

  • Analgesia

  • Attention

  • Agony

Correct answer: Activity

The FLACC scale is typically used for children aged 2 months to 7 years. FLACC stands for Face, Legs, Activity, Cry, and Consolability. Each category is scored from 0–2. 

72.

Sleep apnea is estimated to affect over 12 million people in the United States. Pre-operative assessment of sleep apnea symptoms or risk factors in adults should include all of these questions except which one?

  • Do you choke on your food often?

  • Do you snore while sleeping?

  • Do you fall asleep during the day at inappropriate times?

  • Are you tired or groggy in the mornings?

Correct answer: Do you choke on your food often?

This question would reflect more of a risk factor for esophageal strictures. The STOP-BANG score is often used in hospitals to assess risk for sleep apnea. It stands for Snore, Tired, Obstruction, Pressure, BMI, Age, Neck, and Gender. 

73.

Prophylactic IV antibiotics should be given how soon before incision? 

  • Within 1 hour of skin incision 

  • 3 hours before surgery to reach peak affect 

  • Right as the incision is being made 

  • As soon as the IV is placed in pre-op 

Correct answer: Within 1 hour of skin incision 

Prophylactic antibiotics should be given 30 min to 1 hour before an incision is made. This allows the antimicrobial agent time to get to therapeutic levels to attack microorganisms before colonization.  

74.

What 4 elements are necessary to prove liability in malpractice litigation?

  • Duty, Breach of duty, Proximate cause, and Injury

  • Responsibility, Accountability, Cause, and Damage

  • Maleficence, Reason,  Duty, and Injury

  • Intent, Negligence, Responsibility, Damage

Correct answer: Duty, Breach of duty, Proximate cause, and Injury

To prove liability, first there must be a duty between the patient and the healthcare provider and then a subsequent breach of that duty. Proximate cause then means that there is verifiable damage or injury directly linked to that breach of duty. 

75.

Which of these would be considered a pressure point in both fowler's and semi-fowler's position?

  • The ischial tuberosities

  • The tibial tuberosities

  • The greater trochanters

  • The iliac crests

Correct answer: The ischial tuberosities

The ischial tuberosities, coccyx, sacrum, calcanei, scapulae, and olecranons would all be considered pressure points in these positions. 

76.

When should you begin actively warming patients to maintain normothermia? 

  • As soon as the patient is in pre-op

  • After the draping is completed, so the forced air warmer doesn't blow air on the surgical field

  • After the time-out so distractions and noise are reduced 

  • In the PACU to warm them up after surgery 

Correct answer: As soon as the patient is in pre-op 

Active warming should begin during the pre-operative assessment. Then warming is continued in the OR and PACU. This minimizes the amount of heat lost under anesthesia. It is correct that the forced air warmer in the OR should not be turned on until after draping (and after the time-out if possible) so the port where the warmer is inserted does not spew air and dust onto the surgical field, but the actual warming should begin in pre-op first. 

77.

If a patient in PACU begins to show signs of severe complications, it is most appropriate for the nurse to call for assistance from whom? 

  • The rapid response team

  • The code blue team

  • The circulating nurse

  • The unit supervisor

Correct answer: The rapid response team

If a patient is decompensating, a rapid response team is appropriate because they can help avert a code. Perioperative areas may have their own rapid response team or they may be a hospital-wide team.  

78.

Measuring limb occlusion pressure preoperatively and before tourniquet use has been associated with all of these except which one? 

  • Greater blood loss

  • Decreased tourniquet pain

  • Less skin breakdown

  • Optimal quality of field

Correct answer: Greater blood loss

Measuring and using the lowest limb occlusion pressure with tourniquets has been associated with a 2.9 times greater chance of optimal quality of the surgical field (QOF), decreased tourniquet pain, fewer skin blisters and less skin breakdown, and fewer tourniquet related adverse events in general. Using the doppler is the gold standard for calculating the LOP, but there are other systems that are FDA approved. Safety margins should be added to the limb occlusion pressure based on the tourniquet manufacturer's IFU. Anesthesia and the surgeon must coordinate together on the inflation of the cuff and the proper pressure.

79.

What should be done prior to immersing items in chemical sterilants?

  • They should be washed and completely free of blood or debris; they should then be rinsed and completely dried, using jets of air for any lumens 

  • They should be rinsed and free of any visible organic matter, then dried and placed in the solution

  • They should be washed thoroughly, then placed in the chemical sterilant immediately after washing 

  • There is no need for washing or rinsing, just place them in the sterilant and the enzymes will dissolve the organic matter 

Correct answer: They should be washed and completely free of blood or debris; they should then be rinsed and completely dried, using jets of air for any lumens 

Always follow Instructions For Use (IFUs) for any item that needs to be chemically sterilized. Some items require precleaning before washing, some do not. Regardless, all items should undergo washing, rinsing, and drying prior to being immersed in a chemical sterilant. Ideally, they should also be manually inspected for any problems prior to being placed in the sterilant. 

80.

A patient in the PACU was given too large a dose of morphine and it caused severe respiratory depression and hypotension. What medication would you expect the physician to order immediately? 

  • Narcan

  • Nabumetone

  • Famciclovir

  • Flumazenil

Correct answer. Narcan

Narcan/naloxone is a narcotic antagonist for use in opioid overdoses. It is usually given via IV in healthcare settings. In the community, it can be given via SQ, IM, and by nasal spray. Flumazenil is the reversal agent for benzodiazepine overdose. 

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