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Quiz Session - Attempts With Random Questions

CCI CNAMB Exam Questions

Page 5 of 25

81.

The circulating nurse sees a certified surgical technician student unclip a towel clip off the drapes and hand it to the surgeon when they ask for one to retract the skin at the incision site. What should the nurse do? 

  • Notify the scrub student and surgeon that that towel clip is considered contaminated since it was attached to the drapes 

  • Do nothing, since towel clips are sometimes used as tissue retractors and it was convenient and ready on the sterile field

  • Get another peel pack of towel clips and give them to the scrub to replace the one that was holding the drapes closed

  • Remind the surgical technician student, in private, that towel clips are only to be used on towels and drapes and that they should have handed the surgeon an allis instead 

Correct answer: Notify the scrub student and surgeon that that towel clip is considered contaminated since it was attached to the drapes 

Towel clips used to clamp drapes should not be removed in surgery unless completely necessary. The points are considered contaminated after clamping drapes, and the towel clip should be removed from the sterile field if it is unclamped. 

82.

During anesthesia induction, which of these should the circulator do? 

  • Turn off the music

  • Count with the scrub tech to save time

  • Open sterile supplies

  • Pour sterile saline and medications onto the back table

Correct answer: Turn off the music

During induction, the circulator should always be close to the patient to assist the anesthesia provider place and maintain the airway. Other tasks can and should wait. The music should be turned down when the patient is brought into the room to make communication easier and because the last sense patients lose when going under anesthesia is their hearing. This doesn't apply if the patient specifically requests music to decrease anxiety. 

83.

According to Dr. Erik Erikson's stages of psychosocial development, which age group correlates with the "identity versus role diffusion" stage? 

  • Adolescents

  • School-age children

  • Early childhood/preschool children

  • Toddlers 

Correct answer: Adolescents

The adolescent age group correlates with the "identity versus role diffusion" stage. During this stage, peer groups increase in importance and body image becomes of paramount concern. Altered body image and death are developmentally based fears of this age group. 

84.

What is a Bowie-Dick test? 

  • A class 2 chemical indicator that is placed in prevacuum sterilizers in order to test whether or not all the air is removed during the cycle

  • A special test indicator that determines whether or not the ultrasonic is sterilizing instruments properly 

  • A biologic indicator that must be placed in every sterilizer load that has implants 

  • A class 1 chemical indicator that tests whether the steam in a gravity displacement sterilizer is a high enough temperature to kill all microorganisms and endospores

Correct answer: A class 2 chemical indicator that is placed in prevacuum sterilizers in order to test whether or not all the air is removed during the cycle 

A Bowie-Dick test is a class 2 chemical indicator that is used in every prevacuum sterilizer daily. It ensures that the air vacuum pump is working correctly to remove all air before steam is pumped in to sterilize packs of instruments at temperatures of 270-276 degrees. If the test fails, the sterilizer cannot be used until the problem is found and fixed. 

85.

Which of these organizations periodically visits and inspects hospitals and surgical centers that use bone and tissue for their compliance in the storage, retrieval, processing, and use of allografts containing bone, cartilage, ligaments, and tendons? 

  • The American Association of Tissue Banks (AATB)

  • The Joint Commission (TJC)

  • The Association of periOperative Registered Nurses (AORN)

  • The Allograft Oversight Committee (AOC)

Correct answer: The American Association of Tissue Banks (AATB)

The AATB accredits and inspects facilities that store and use bone, ligament, cartilage, and tendon allograft. Meticulous records are kept of donors and recipients. 

86.

For open shelving in a storage area where sterile packs are kept, the highest shelf should be at least how far below the ceiling and sprinkler heads and how many inches above the floor? 

  • 18 inches, 8–10 inches

  • 24 inches, 12 inches

  • 20 inches, 12 inches

  • 6 inches, 8-10 inches

Correct answer: 18 inches, 8–10 inches

AORN guidelines allow for closed or open shelves, racks, or cabinets in OR sterile storage rooms. They recommend that the bottom shelves be solid, however. There should be adequate air circulation around all instrument sets and packs. Other AORN guidelines for storage rooms vary and are recommendations. The required 18 inches below the ceiling is part of the environmental fire code, and the 8–10 inches above the floor facilitates mopping and environmental cleaning without risk of splashing. 

87.

What surgical wound class would a laparoscopic hysterectomy fall into? 

  • Clean contaminated (class II)

  • Contaminated (class III)

  • Clean (Class I)

  • Dirty/infected (class IV)

Correct answer: Clean contaminated (class II)

In an uncomplicated laparoscopic hysterectomy, the surgical site is entered under controlled conditions and no sign of infection is encountered, so it would fall into the clean contaminated category. All vaginal surgeries are clean contaminated. 

88.

Nursing specialty certifications such as CNAMB, CNOR, CAPA, and CPAN are ways to exhibit expertise in various perioperative nursing areas. Expertise in nursing is comprised of 3 basic components. What are they? 

  • Knowledge, skill, and experience

  • Education, technicalities, and experience

  • Willingness, technical skills, and work ethic

  • Knowledge, education, and experience

Correct answer: Knowledge, skill, and experience

Expert nurses use knowledge, experience skills, gut feelings, logic, and intuition all together to deliver exemplary nursing care. Building knowledge and practicing skills leads to competence. 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.  

89.

To promote good communication, which of these items of information should the circulating nurse obtain prior to the procedure starting? 

  • The patient's emergency contact phone number

  • The patient's social security number

  • The patient's health insurance member ID

  • The patient's family's home address

Correct answer: The patient's emergency contact phone number

The patient's family, significant other, or emergency contact's phone number should always be verified prior to surgery to ensure that there is a direct line of contact available. If emergencies arise, the surgeon may need to call the patient's family to get verbal consent for another procedure or to receive more information about the patient's medical history. The surgeon also should talk to the patient's family or preferred contact at the end of the case. The circulating nurse should also call with updates according to policy and situation to decrease family anxiety. 

90.

When gathering a tourniquet for use in the OR, the circulating nurse knows to also grab a disposable mesh sleeve to place underneath it. What is the main purpose of padding the tourniquet? 

  • To prevent skin breakdown

  • To make the tourniquet hurt less

  • To protect the edges of the reusable tourniquet sleeve from prep solutions that will stain it

  • To even out the tourniquet pressure around the limb

Correct answer: To prevent skin breakdown

Padding under the tourniquet should be wrinkle free and thick enough to protect the skin from the tourniquet. Prep solutions should not be allowed to soak into the padding because maceration can occur. It can also be a fire risk. Placing a waterproof sticky drape around the tourniquet can decrease risk. 

91.

Printers that use toner should not be in direct patient care areas for what main reason? 

  • Toner powder can be aerosolized and is a contaminant, and it is combustible

  • Printers are loud and disruptive and can startle patients

  • Toner can settle on caregivers' hands and fingertips and transfer to the patient, making skin dusky

  • Toner can spill and can dye the floor and surfaces and is a poison if ingested

Correct answer: Toner powder can be aerosolized and is a contaminant, and it is combustible

Toner powder can be airborne and cause contamination in the OR. People in occupations where they are chronically exposed to toner can have lung irritation and fibrosis. It is combustible and even has some explosive qualities. PPE should be worn when cleaning up spills and a HEPA filter must be used if vacuuming it. 

92.

Guidelines for personal bags and personal cell phones in the OR include all of these except which one? 

  • It is acceptable to take pictures on a personal cell phone as long as the patient isn't identifiable

  • Regular cleaning of personal items brought into the OR is required

  • Bags should not be set on the floor of restricted areas

  • Personal phone calls and texts should be avoided in the OR

Correct answer: It is acceptable to take pictures on a personal cell phone as long as the patient isn't identifiable

Regular cleaning is required for personal phones, tablets, and bags that are brought into the OR. Hand hygiene should also be completed after touching any personal item and before patient contact. Bags should not be set on the floor in patient care areas due to the contamination risk. Personal calls and texts are never appropriate when in the middle of caring for patients. 

93.

What is a "sterile cockpit" in regards to perioperative communication?

  • An environment where staff members stop all nonessential tasks to decrease distractions during more important tasks 

  • The environment of the sterile field and back table that the surgeon, their assistant, and the scrub tech or nurse work from primarily

  • Forming an L-shape with the back table and OR bed to communicate where the sterile field is and that it is continuous

  • The nonverbal cues shared between a scrub technician and a circulating nurse who are paying attention to each others' needs

Correct answer: An environment where staff members stop all nonessential tasks to decrease distractions during more important tasks 

Staff members should ignore and decrease distractions during critical periods of the procedure and critical periods of communication. This is called the "sterile cockpit rule". Instances where this is crucial include the time-out, debrief, induction and cessation of anesthesia, while completing counts, and when communicating with the surgeon. 

94.

Sterile instrument trays and containers should not exceed what weight limit? 

  • 25 lbs

  • 45 lbs

  • 50 lbs

  • 35 lbs

Correct answer: 25 lbs

Instrument sets and containers over 25 lbs put staff at risk of injury and are not ergonomic. 

95.

What is the most common source of surgical site infections? 

  • The surgical team

  • Contaminated instruments

  • Body hair that isn't removed

  • Forced air warmers

Correct answer: The surgical team

People are the main source of microorganism transfer in the OR. Contaminated instruments are the second most common source.

96.

Which nerve can be damaged if the lateral aspect of a patient's knee is allowed to rest against the bar of candy cane stirrups? 

  • The common peroneal nerve

  • The saphenous branch of the femoral nerve

  • The sciatic plexus

  • The intermediate dorsal cutaneous nerve

Correct answer: The common peroneal nerve

The common peroneal nerve runs along the lateral edge of the fibula at the knee and is easily compressed by stirrup bars. The saphenous branch of the femoral nerve runs medially to the knee and upper calf. It can also be of concern with stirrups if they are the boot-type, but the common peroneal is of more concern with candy cane stirrups because of its location. The intermediate dorsal cutaneous nerve is in the foot. 

97.

When prepping a breast, the circulating nurse knows that the breast tissue extends into the axilla and must be prepped  in its entirety. The armpit is always prepped last according to clean-to-dirty technique. What is the portion of breast tissue that is in the axilla called? 

  • The tail of Spence

  • The axillary breast

  • The breast tail

  • The Cooper tail

Correct answer: The tail of Spence 

This portion of the breast extends to the middle of the axilla and is called the tail of Spence. Breasts are held up by Cooper ligaments. The anatomy of the breast is important when it comes time to locate and remove breast lumps. 

98.

A patient in the PACU begins to have hypertension, a headache, disorientation, and blurred vision. The patient should be assessed for all of these as quickly as possible except which one? 

  • If the blood pressure cuff is too big

  • Stroke signs and symptoms

  • Anxiety and pain

  • Hypoxemia, hypothermia

Correct answer: If the blood pressure cuff is too big

Blood pressure cuffs that are too big will give false low readings. Blood pressure cuffs that are too small will give false high readings. 

Hypertensive crises in the PACU need to be addressed as soon as possible. The surgeon and anesthesia provider should be notified right away, and the nurse should do a quick assessment to find the cause and address it. Pain, anxiety, shivering/hypothermia, hypoxemia/hypoventilation, blood loss prior to decompensation, stroke, and hypervolemia can all be potential triggers. The surgeon may order drugs like clonidine, hydralazine, or beta blockers to treat the hypertension, but the underlying cause is an important factor in choosing which drugs will be most effective. For example, the surgeon may order medication that may serve a dual purpose, such as an opioid for pain relief that will also decrease blood pressure, or a drug like demerol that will help with pain, lower the shivering threshold, and lower blood pressure. 

99.

What is the rationale behind using sterile water instead of sterile saline as an irrigant when excising a cancerous tumor?

  • Sterile water destroys many remaining cancerous cells by lysing them

  • Sterile water allows the surgeon to see any oozing or bleeding spots better than saline

  • Sterile water is isotonic and less damaging to the surrounding tissues

  • Sterile water is bacteriostatic and will help prevent surgical site infections in a neutropenic patient

Correct answer: Sterile water destroys many remaining cancerous cells by lysing them

Some surgeons use sterile water because of its hypotonic properties. It is believed that it lyses many remaining cancer cells that are left behind after the excision. 

100.

Facilities that use and implant autologous tissue must register with which agency? 

  • The Food and Drug Administration (FDA)

  • The Joint Commission

  • Occupational Safety and Health Organization (OSHA)

  • The Centers for Disease Control (CDC)

Correct answer: The Food and Drug Administration (FDA)

Any facility that uses autologous tissue must register with the FDA unless the tissue being used is removed and reimplanted in the same individual. The FDA regulates and tracks each tissue used with stringent guidelines. 

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