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Quiz Session - Attempts With Random Questions

CCI CNAMB Exam Questions

Page 6 of 25

101.

With the advancement of ambulatory surgery techniques and the advent of same-day discharge for surgeries that used to require extensive hospitalization, it has become imperative for patients to be checked on after discharge. How soon after surgery should post-operative telephone calls from the facility be completed? 

  • Within 24–48 hours of discharge

  • Within 72–96 hours of discharge

  • Within 1 week of discharge

  • Within 1 month of discharge

Correct answer: 24–48 hours

Most surgical complications take place in the first 48 hours after surgery. Postoperative phone calls can address these complications before they become dire and direct the patient to the proper care. Patient satisfaction also improves after these phone calls. 

102.

In cataract surgery, what is it called when the cataract is broken up by ultrasonic vibration before being aspirated?

  • Phacoemulsification

  • Phagocytosis

  • Phagoemulsifying

  • Phacosynthesis

Correct answer: Phacoemulsification

In cataract surgery, the cloudy lens is broken up by ultrasonic vibration and aspirated out of the eye in pieces. This is called phacoemulsification. There are special phacoemulsifying machines with specialized handpieces and supplies. The phaco handpiece contains a hollow, disposable needle surrounded by a sleeve of silicone. The needle is placed into the anterior chamber of the eye after removing the anterior capsule with a cystotome. The needle is then activated and the cataract is broken up with vibration while the needle is cooled with a constant flow of Balanced Salt Solution saline (BSS). The cataract is then aspirated out of the eye and a new lens can be placed. 

103.

What is the most common work-related health problem reported by healthcare personnel? 

  • Musculoskeletal disorders

  • Infectious diseases

  • Mental illnesses from stress

  • Gastrointestinal issues

Correct answer: Musculoskeletal disorders

Nurses are particularly vulnerable to lower back, shoulder, and upper extremity pain and injuries. The seven ergonomic tools created by AORN are important guidelines for preventing staff injuries in the OR. Some additional guidelines to decrease musculoskeletal injuries include: 

  • The back is strongest in a straight position and therefore correct posture is very important.
  • Keep whatever is being lifted or moved as close to the body as possible.
  • Bend the knees and lift with your legs, not your back.
  • Lift with slow, even motions.
  • Push do not pull heavy beds or equipment.
  • Stand in a wide stance with heels apart.
  • Slightly flex knees whenever possible and shift weight periodically when standing for long periods of time.
  • Align head and neck with the body.
  • Change position or walk around when possible between long periods of standing.
  • Do not twist at the waist, instead pivot the entire body.
  • Avoid overstretching or reaching overhead too much.
  • The OR bed should be adjusted to the most comfortable working height of the tallest team member. Those who are shorter can use steps to get into position.
  • Use transfer devices whenever possible to move patients.

104.

All of these are concerns with multidose medication vials except which one? 

  • Increased cost

  • Cross-contamination

  • Confusing the dose

  • Confusion with single dose vials

Correct answer: Increased cost

Multidose vials decrease healthcare costs due to decreased need for packaging and manufacturing costs. Confusing the dose, cross-contamination between patients, dose confusion and medication errors, and accidental storage with single dose vials are all concerns about multidose vials. 

105.

The Universal Protocol put in place by The Joint Commission to prevent surgical errors consists of 3 major steps. What are they?

  • Preprocedure verification, surgical site marking, and a time out, or pause, prior to the start of the procedure

  • Preprocedure verification, a time out or pause prior to the start of the procedure, and a debrief with the surgeon at the end of surgery

  • History and physical verification with surgical orders, a time out, and prophylactic antibiotics

  • A time out prior to surgery start, instrument and sponge counting with the surgeon, and lab value verification with the anesthesia provider

Correct answer: Preprocedure verification, surgical site marking, and a time out, or pause, prior to surgery

The Universal Protocol was created to prevent wrong-person, wrong-site, and wrong-procedure surgical errors. The first major step is preprocedure verification. This is done with the patient (or family) verbally, the surgical orders, and the history and physical. The next step is surgical site marking for procedures where there is more than one possible surgical site. This must be consistent throughout the organization, and it is not open to interpretation nor is it optional. The patient should be involved in it and it must be done by a licensed independent practitioner who will be there throughout the procedure. The mark must be placed at or as near as possible to the surgical site so it is visible after draping. It should not be able to be washed away by prep solutions. There should be an alternate paper marking process for procedures where the site cannot be marked, such as ureteroscopies or oophorectomies or for instances where the patient refuses marking. The third and final step is a time out, or pause, prior to surgery. This is the final check before beginning the procedure. At bare minimum, it must include the patient's name, the site, and the procedure to be performed. This should be standardized throughout the organization. Often, two identifiers such as name and date of birth are used to identify the patient, then the procedure is named, allergies listed, and any prophylactic antibiotics given are called out. This is the time for team members to voice any concerns about patient safety. All other activity should be stopped while the time out is completed. 

106.

A newly hired central sterile processing technician suddenly comes to the charge nurse's desk complaining of nausea, dizziness, and difficulty breathing. The technician states that they just opened a sterilizer. What do you suspect has happened and how do you treat their symptoms? 

  • Ethylene oxide poisoning; call for emergency services and provide immediate respiratory support with oxygen, or fresh air at the very least, and vital sign monitoring

  • Heat stroke and airway irritation from opening a steam sterilizer too early; calm the technician down and give them a paper bag to breathe into 

  • Fatigue and hypoglycemia from working all day near hot sterilizers with few breaks; lay them down and provide juice.

  • Nitrous oxide gas leak; lay they down and give oxygen and they will breathe it off in a few minutes. 

Correct Answer: Ethylene oxide poisoning; call for emergency services and provide immediate respiratory support with oxygen, or fresh air at the very least, and vital sign monitoring 

There is no antidote to EO poisoning. The technician needs respiratory support and decontamination. Acute EO poisoning causes nausea, vomiting, breathing difficulties, dizziness. In addition, EO is a known carcinogen and can affect reproduction. Limits for exposure to EO under OSHA guidelines are 1 ppm per 8 hour shift in a 40 hour week or 5 ppm for short-term exposure. Records on employee exposure must be kept for 30 years. EO dosimeters are available for measurement. All technicians need proper training prior to using an EO sterilizer and training on the proper PPE that must be worn. . 

107.

Which of these patient populations is the most vulnerable to errors in medication dosage? 

  • Geriatric patients

  • Patients with BMIs over 30

  • Females

  • Caucasian patients with red hair

Correct answer: Geriatric patients

Geriatric patients and pediatric patients are most at risk for medication dosing errors. Geriatric patients metabolize medications more slowly than other populations due to age. Anyone of any age with impaired liver and kidney function is at high risk due to slow metabolism of medication as well. All dosing should be based on weight to avoid overdosing. Geriatric patients are also likely to have polypharmacy or be taking additional supplements that may affect the medications they are given. Side note: Anecdotal evidence claims that red-headed patients actually require more anesthesia and pain medication, in many cases, than non-red-headed patients. 

108.

Which of these is a proper way of protecting a laser fiber when not in use? 

  • Covering the end of the fiber with a moist sponge

  • Clamping the fiber when not in use

  • Coiling and bending the fiber as small as possible to keep it on the sterile field

  • Completely submerging the fiber in saline on the back table

Correct answer: Covering the end of the fiber with a moist sponge

Fiberoptic laser clinical guidelines recommend keeping a moist sponge over the end of the fiber when the surgeon is not using it. It is also recommended to secure the end in a holster device to keep it sterile and also prevent fires. Clamping and bending a fiber more than the IFU states are ways to break a fiber. Fibers should be inspected for damage before and after each use to make sure no harm is done to the patient. 

109.

What is the most frequent cause of respiratory distress and difficulty directly after surgery and anesthesia? 

  • Airway obstruction

  • Opioid overuse and the resulting respiratory depression

  • Increased carbon dioxide retention and decreased drive to breathe

  • Pneumothorax

Correct answer: Airway obstruction

Airway obstruction includes laryngospasm, bronchospasm, the tongue or soft tissue blocking the airway, excessive secretions, and foreign bodies in the airway. The tongue is the most common cause of airway obstruction after surgery because of relaxants and anesthetics in surgery. The patient with airway obstruction may snore, have little or asynchronous chest rise, retractions, decreased pulse oximetry, and slight or no breath sounds. The first course of action is to stimulate the patient. If that doesn't work, the patient can be given supplemental oxygen or positioned on their side. The next course of action is the chin tilt/jaw thrust to open the airway. An OPA or NPA may then be considered. 

110.

Which of these tasks would be appropriate for the RN circulating nurse to delegate to unlicensed assistive personnel?

  • Retrieving a sterile tray from central sterile processing

  • Labeling and taking a specimen to the lab

  • Giving tylenol orally to a patient

  • Removing an allograft out of the freezer and bringing it to the OR

Correct answer: Retrieving a sterile tray from central sterile processing

The 5 rights of delegation include the right task, the right circumstances, the right person, the right communication and direction, and the right supervision and evaluation. Labeling a specimen, medication administration, and removing allografts from the freezer are all non-delegable tasks for unlicensed assistive personnel. These must all be done by a nurse, CRNA, or surgeon. Retrieving a sterile tray is an appropriate task to delegate because it is not nurse specific and allows the RN to stay in the room with the patient. 

111.

A patient who is undergoing an ORIF of his left ankle is waiting in pre-op. He has had a popliteal sciatic nerve block performed already and the surgeon is waiting for it to set up before taking the patient to the OR. Without warning, the patient's EKG shows a new onset atrial fibrillation. The pre-op nurse knows that this needs to be reported immediately to the anesthesia provider because of increased risk of what? 

  • Stroke

  • DVT

  • Myocardial infarction

  • Ventricular fibrillation

Correct answer: Stroke

Atrial fibrillation is one of the most common arrhythmias in patients between 50 and 60 years of age. AF places patients at high risk for stroke caused by an embolus because the atria quiver instead of pumping. Whenever blood is not moving in a normal fashion, emboli can develop. 

112.

Patients with diabetes mellitus types 1 and 2 are susceptible to all of these surgical complications except which one? 

  • Hypotension

  • Delayed wound healing

  • Infection

  • Neurogenic bladder

Correct answer: Hypotension

Diabetics are prone to hypertension, dehydration, infections (due to increased blood glucose), decreased tissue perfusion (due to poor circulation), delayed wound healing, neuropathy, neurogenic bladder (incontinence and UTIs follow), and hypothermia. All of these things must be considered and addressed with preoperative, intraoperative, and postoperative interventions and planning. Patients with diabetes should be scheduled as the first case of the day to reduce the time without oral intake. Blood glucose should be kept between 140 and 180 in adults. Note that the stress of surgery usually increases blood sugar levels.  

113.

A specific ENT surgeon uses a coblator for tonsilectomies. As the nurse is readying the room for the surgeon she should grab what other supply along with the coblator? 

  • A bag of normal saline

  • A bovie pad

  • A plasmablade

  • Coblator electrodes

Correct answer: A bag of normal saline

Coblators use bipolar high-frequency energy to create a focused plasma field. Saline is needed with the coblator to cause a field of charged electrons to break molecular bonds of the target tissue while saving the healthy tissue around it. The temperature of the coblator tip has an average temperature of only 68–158°F versus the high temperatures needed in usual coagulation with an electrosurgical unit. Since it is bipolar energy, there is no need for a bovie pad. Plasmablades work similarly to a coblator, but the handheld devices used with the coblator are called wands, and they have 1–2.5 mm tips that have two tiny electrodes. 

114.

Ambulatory surgery centers should comply with standards set out by 5 healthcare organizations: the Joint Commission, CMS, the AAAHC, the AAAASF, ASCA, and the American Osteopathic Association. What is the AAAASF? 

  • The American Association for the Accreditation of Ambulatory Surgery Facilities

  • The Association of Ambulatory Anesthesiologists in Authentication of Surgical Facilities

  • The Ambulatory Administration for the Accreditation of Anesthesia Skilled Facilities

  • The Association of American Ambulatory Administrators of Surgery Facilities

Correct answer: The American Association for the Accreditation of Ambulatory Surgery Facilities

AAAASF stands for The American Association for the Accreditation of Ambulatory Surgery Facilities.

115.

Advanced directives are incredibly important for anyone undergoing surgery, even if it is considered low risk. DNR orders are not automatically suspended because a patient is having surgery. New standards require that surgeons have a discussion prior to surgery about patients' wishes in this regard. There is another approach to end-of-life planning called the Physician Orders for Life-Sustaining Treatment (POLST). All of these are differences between POLST and advanced directives, except which one? 

  • Advanced directives are specific about treatment wishes; POLST is more general

  • EMS can use POLST, but not advanced directives

  • POLST is a medical order; an advanced directive is a legal document

  • POLST does not appoint a surrogate; advanced directives do

Correct answer: Advanced directives are specific about treatment wishes; POLST is more general

POLST contains more specific medical orders for treatment wishes than advanced directives. POLST forms are geared toward the elderly or seriously ill, but every adult should have an advanced directive. Advanced directives appoint a durable power of attorney or other surrogate in case the patient is incapacitated. The POLST form functions as the surrogate when it is used properly. EMS can use POLST forms, but not advanced directives in every situation. Some states have POLST registries that make this information easy to find. Advanced directives can be difficult to track if there is not a copy in the patient's chart. 

116.

The SOLER acronym for active listening refers to what? 

  • Sit squarely, Open posture, Lean towards the other, Eye contact, Relax

  • Sit securely, Open eyes wide, Look at the patient, Exit strategy, Read facial expressions

  • Stay put, Open arms, Look up, Eye contact, Read nonverbal cues

  • Sit still, Open posture, Look at the patient, Eyes wide, Rapport

Correct answer: Sit squarely, Open posture, Lean towards the other, Eye contact, Relax

SOLER is an acronym used to describe the therapeutic communication techniques employed by active listeners. It is a method most often used by psychological counselors, but has strong applications in nursing as well. Nurses who are most effective at active listening sit squarely towards the patient, maintain an open posture and do not cross their arms, lean towards the speaker, make eye contact, and have relaxed body language. 

117.

When unexpected adverse events occur in the hospital, healthcare providers can use a tool called _________ to respond to patients and families while being transparent and honest? 

  • The Communication and Optimal Resolution Process (CANDOR)

  • The Transparency and Honesty process (TTH)

  • TeamSTEPPS

  • SBAR 

Correct answer: The Communication and Optimal Resolution Process (CANDOR)

The principles of veracity and fidelity underlie the CANDOR philosophy. Veracity is giving accurate and truthful information. Fidelity is loyalty and promise keeping. CANDOR encourages healthcare providers to be honest and transparent about adverse events with patients and families and not merely treat them as a litigation risk. 

118.

The nurse is communicating with a patient who does not speak English, but has an interpreter in the room. Which of these is the most correct way of using an interpreter?

  • Speak to the patient directly and make eye contact while the interpreter repeats your words

  • Speak directly to the interpreter so they can see your mouth and hear you clearly

  • Speak quickly, but clearly ask multiple questions at once so the interpreter only has to spend a few minutes with the patient

  • Ask the bare minimum of questions and give the bare minimum of education so as not to overwhelm the patient and interpreter

Correct answer: Speak to the patient directly and make eye contact while the interpreter repeats your words

When using a medical interpreter, speak to the patient directly, not the interpreter. Acknowledge the interpreter and their part in the conversation, but avoid facing and talking toward them more than the patient. This makes the patient aware that you are addressing them and their specific healthcare needs. Make allowances for the extra time for questions and interpretation back and forth. Do not use slang or words that can be misconstrued, and speak clearly and slowly in a moderate tone. Do not interrupt or talk over the interpreter or patient. Avoid some hand gestures, like the thumbs up sign, as they may have different meanings in various cultures. 

119.

Which of these is considered a barrier to clear communication between nurse and patient? 

  • Using medical jargon to describe anatomy and surgical procedures

  • Giving written discharge instructions that are at a 5th grade level

  • Using a phone interpreter when the patient speaks a foreign language

  • Asking open-ended questions when appropriate

Correct answer: Using medical jargon to describe anatomy and surgical procedures

Patient education should be written at a 5th grade level, interpreters should always be made available for foreign speaking patients, and open-ended questions promote more thorough communication between nurse and patient. Using jargon with patients is not recommended because they may not understand it or retain the information being taught. 

120.

The Perioperative Nursing Data Set (PNDS) is recognized as the specific language of specialty nursing and provides a consistent method of documenting perioperative nursing care. The PNDS is now in its 3rd edition (as of 2019) and has been incorporated into an electronic framework called what? 

  • Syntegrity

  • Evidencare 

  • Synergize

  • Epicwise

Correct answer: Syntegrity

Syntegrity is used to document assessments, interventions, and outcomes on an electronic record. This record then allows Syntegrity to compare and contrast clinical outcomes from large populations within and across various healthcare institutions. This data can then be used to guide research and changes in evidence-based practice nationwide. 

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