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Quiz Session - Attempts With Random Questions

CCI CNAMB Exam Questions

Page 8 of 25

141.

Placing Sequential Compression Devices (SCDs) on a patient's legs prior to surgery addresses which DVT risk factor? 

  • Venous stasis

  • Hypercoagulability

  • Claudication

  • Atherosclerosis

Correct answer: Venous stasis

SCDs treat venous stasis by continually pumping and forcing the blood in the lower extremities back into systemic circulation. They should be turned on before induction of anesthesia because general anesthesia vasodilates and decreases venous return. SCD wraps are divided into chambers so pressure can be applied to each chamber at different times and direct the flow of blood. The strength of pressure used is 40–50 mm Hg applied for 12 seconds and then released for 48 seconds. This ensures that blood and clotting factors are emptied from deep venous sinuses and not allowed to accumulate. 

142.

A patient in the PACU is complaining of 8/10 pain after a shoulder arthroscopy with distal clavicle resection. The nurse chooses to give the patient IV fentanyl based on the severity of the pain. The nurse knows that fentanyl has a fast onset within 5–6 minutes and a duration of action of how long? 

  • 20–40 minutes

  • 60–120 minutes

  • 50–60 minutes

  • 10–20 minutes

Correct answer: 20–40 minutes

Fentanyl is 80–125 times more potent than morphine and, if given IV, has a rapid onset of action of 5–6 minutes and a peak effect of 5–15 minutes. Analgesia lasts 20–40 minutes with fentanyl. Fentanyl can cause respiratory depression, and it is sometimes delayed even after apparent recovery from the drug due to a secondary peak that may occur. Rapid administration may cause bronchial constriction, diagphragmatic rigidity, and intercostal muscle rigidity called fixed chest syndrome. Succinylcholine with ventilatory support is used to treat this syndrome. Fentanyl may cause bradycardia, but usually has no hypotensive effects and does not cause nausea. Since it is an opioid, its reversal agent is naloxone (Narcan).

143.

According to Dr. Jean Piaget, which of his stages of cognition correlates with toddlerhood? 

  • Preoperational

  • Concrete operational

  • Formal operational

  • Sensorimotor

Correct answer: Preoperational

Toddlerhood and early childhood/preschool are associated with the "preoperational" stage. Toddlers can use symbols, engage in creative play, and are very egocentric in this stage. Middle childhood (7–11) marks the "concrete operation" stage where symbols and logic take precedence. Adolescence marks the "formal operations" stage where logical and abstract thinking occur. Infants up to 2 years of age are considered to be in the "sensorimotor" stage. 

144.

What are normal end tidal CO2 levels? 

  • 35–45 mm Hg

  • 50–55 mm Hg

  • 100–120 mm Hg

  • 90–99 mm Hg

Correct answer: 35–45 mm Hg

Capnography, or the measurement of CO2 levels on exhalation, should be monitored throughout surgery and in the PACU. It can be a more reliable indicator of hypoventilation than pulse oximetry alone. It can be measured in the OR through the ET tube and in PACU through a device attached to a nasal cannula. 

145.

What is the Perioperative Nursing Data set? 

  • A structured nursing vocabulary that is used to increase effectiveness and patient safety in perioperative nursing care

  • A set of individual nursing diagnoses dedicated to perioperative nursing care

  • A set of standardized discharge instructions for various common surgeries

  • A structure of lab values and patient parameters that must be reported to the surgeon in pre-op, the OR, and PACU

Correct answer: A structured nursing vocabulary that is used to increase effectiveness and patient safety in perioperative nursing care

Using standardized language and terminology assists in perioperative team communication by eliminating ambiguous and subjective language that can be misinterpreted. This, in turn, increases patient safety.

146.

A 58-year-old male patient is scheduled for an incision and drainage of his left knee due to a spider bite and infection with MRSA. The surgeon's preference card calls for a tourniquet. What would contraindicate tourniquet use in this instance? 

  • The infection

  • The venom of the spider

  • The age of the patient

  • The patient's preference not to use one

Correct answer: The infection

Tourniquets shouldn't be used on dialysis sites, in diabetic neuropathy, in PVD, in sickle cell anemia, with severe infections, with blood clot history, with malignancies, with open fractures/crushing injuries, or with thighs larger than 100 cm in circumference. Tourniquets should be used cautiously with the very young and the very old. In the case of infection or coagulopathies, a bolus of the infection or a clot could be dislodged when the tourniquet is released. 

147.

Substerile rooms adjacent to ORs often hold warming cabinets for blankets and solutions. The blanket warmer should not be set higher than 130°F (54°C). The solution warmer should be set at what temperature to prevent burns to patients from overheated fluids? 

  • 110°F

  • 125°F

  • 120°F

  • 98.6°F

Correct answer: 110°F

Solution warmers should not be set above 110°F (43.4°C). However, each manufacturer of IV and irrigation solutions sets parameters for their products that should be followed. Any warm solution removed from the warmer and cooled to room temperature cannot be placed back in the warmer. All products should be labeled with the date they must be removed from the warmer according to manufacturer guidelines. Temperature monitoring of warmers should be done per facility policy and AORN recommends checking the temperatures of solutions on the back table before using them. 

148.

Which of these regulates and defines the scope of nursing care? 

  • Nurse Practice Acts

  • Health Insurance Portability and Accountability Act (HIPAA)

  • The Statute of Limitations

  • The Health Information Technology for Economic and Clinical Health Act (HITECH)

Correct answer: Nurse Practice Acts

Each state has enacted a nurse practice act that regulates and defines the scope of nursing practice in that particular state. The Nurse Practice Acts contain "standards of care," which are evidence-based standards of what is a reasonable and acceptable level of caregiving. They set out the minimum standards of care for trained nurses and are the benchmark that is used in liability or malpractice lawsuits. 

149.

Which of these medications is specifically given as the reversal agent for the non-depolarizing muscle relaxants rocuronium, pancuronium, and vecuronium? 

  • Sugammadex

  • Succinylcholine

  • Neostigmine

  • Soma

Correct answer: Sugammadex

Sugammadex is the specific reversal agent for rocuronium, pancuronium, and vecuronium. It works by encapsulating the muscle relaxant so it cannot continue working. Succinylcholine is a depolarizing muscle blocker. Neostigmine is a cholinergic that does reverse non-depolarizing muscle relaxants, but is not only specific to rocuronium, pancuronium, and vecuronium. Soma is a prescription muscle relaxant that can help with pain, but is not used as an anesthetic in surgery. 

150.

What Aldrete score must a patient have in order to get discharged from phase I of PACU?

  • 8–10

  • 18–20

  • 4–5

  • 7–9

Correct answer: 8–10

The Aldrete score is based on respiration, O2 saturation, consciousness, circulation, and activity. Each category gets a score between 0–2. A 10 is a perfect score. 

151.

All of these are patient rights except which one? 

  • The right to discriminate against caregivers of a certain race 

  • The right to consent or refuse to take part in research

  • The right to continuity of care

  • The right to know the names and roles of everyone involved in their care

Correct answer: The right to discriminate against caregivers of a certain race

Patients have a multitude of rights that have to do with autonomy, privacy, informed consent, advanced directives, continuity of care, hospital billing practices, etc. However, they do not have the right to discriminate against caregivers based on race.  

152.

A patient is recovering from anesthesia after a total knee replacement. They had spinal anesthesia and moderate sedation. The PACU nurse knows that which nerve function is the last to recover from spinal anesthesia?

  • Sacral autonomic nerve function

  • The peroneal nerve function

  • The Achilles nerve function

  • The nerves that supply the sense of proprioception

Correct answer: Sacral autonomic

Nerve function after spinal or epidural anesthesia returns in the following order: proprioception, movement, touch, pain, temperature sense, and then autonomic sympathetic function. The nerve that supplies the bladder and the sacral autonomic function is last. When this type of anesthesia is induced, these senses leave in the opposite order. 

153.

Which two nerve injuries are most common in the OR? 

  • Ulnar nerve and brachial plexus injuries

  • Median nerve and solar plexus injuries

  • Femoral nerve and popliteal nerve injuries

  • Sciatic nerve and popliteal nerve injuries

Correct answer: Ulnar nerve and brachial plexus injuries

The ulnar nerve travels behind the elbow and serves the 3rd, 4th, and 5th fingers of each hand, as well as the muscles of the middle forearm. It is extremely superficial and is vulnerable to pressure and stretching from armboards and positioning. The brachial plexis is in the shoulder and is vulnerable due to abduction, movement, and pressure from positioning. Extreme positioning of the head (especially away from extended arms) and extending arms more than 90 degrees from the body can stretch and compress the brachial plexus. 

154.

A 38-year-old patient is having ambulatory surgery to remove a breast lump she found while doing a self-examination. She has had lumps removed before and they have all been benign, so she is not worried about this one. The nurse knows which principle about breast masses and will plan the back table set up and specimen retrieval accordingly?

  • They are considered cancerous until proven benign; cancer precautions in back table set up should be taken

  • They are usually benign and there is no cause for concern due to this patient's history 

  • They are usually benign and cancer considerations like maintaining separate instruments for closure and tissue that have not encountered the mass can be discarded because of the patient's history 

  • The surgeon probably won't send the specimen down for identification since it isn't likely to be cancerous and will just cost the patient more money to have pathology tests run 

Correct answer: They are considered cancerous until proven benign; cancer precautions in back table set up should be taken           

Every breast mass is considered cancerous until proven otherwise, no matter the patient's history. All precautions should be taken while removing the mass so that no cancerous cells are spread in the case that it does come back as a malignancy. Surgeons should always send specimens down if there is any risk of malignancy, despite the cost of pathology tests. 

155.

A 25-year-old male is undergoing an ORIF of a left distal radius fracture. The surgeon requests an upper arm tourniquet. How should the arm be exsanguinated before the tourniquet is inflated? 

  • By elevating the arm

  • With a sterile Esmark bandage

  • With a sterile ace wrap

  • By massaging the arm medially while inflating the tourniquet cuff 

Correct answer: By elevating the arm

Esmark and Ace bandages should never be used over a fracture. Massaging the arm is also contraindicated because it can cause tissue damage and it isn't an accepted way of exsanguination. Elevating the arm will provide adequate exsanguination. 

156.

Which is the best phrase to use when explaining to a school-age child about anesthesia? 

  • We are going to give you medicine that will help you take a nap

  • You're going to be put to sleep with medication

  • You're going to be given medication so you don't feel your tonsils being cut out

  • We're going to give you some medication that will make it so you sleep and can't move while the doctor works

Correct answer: We are going to give you medicine that will help you take a nap 

School-age children are most concerned with punishment, fear of bodily injury or mutilation, loss of control, and fear of the unknown. They can think of things logically, but benefit from simple and concrete explanations. Telling the patient they are "being put to sleep" may conjure up images of a beloved pet being euthanized. A nap is something they know and don't fear and they will know that you wake up from. Using words like 'cut' or telling them they won't be able to move might scare them. 

157.

What is the goal of standardized formats for hand-off communication between healthcare providers such as SBAR, I PASS the BATON, and SHARED?

  • To ensure all critical information is relayed and reduce communication breakdown between providers

  • To make things clearer for patients about which portions of their health information is being shared

  • To make hand-off communication take longer and for charting purposes in case of a lawsuit

  • To educate patients on their health history and help them prioritize which things are most important to share

Correct Answer: To ensure all critical information is relayed and reduce communication breakdowns

Studies show that 70% of all adverse events pertaining to surgery are caused by breakdowns in communication among healthcare providers. The scholarly literature recommends using checklists and standardized formats to prevent as many communication errors as possible. 

158.

A patient in the PACU has a Ramsay score of 2. What should the nurse do? 

  • Nothing, since the patient is calm

  • Given sedatives as ordered

  • Stimulate the patient and have them do the stir up regimen

  • Give Narcan or Flumazenil depending on the cause of the sedation and overdose

Correct answer: Nothing, since the patient is calm 

The Ramsay Scale measures sedation level. A Ramsay score of 2 means the patient is cooperative, oriented, and tranquil. The scale goes from 1–6, with 6 being completely sedated with no response, and 1 being anxious, restless, and agitated. 

159.

Which of these items would be considered a semi-critical item according to Spaulding's classification system? 

  • An anesthesia laryngoscope blade

  • A total hip implant

  • A pair of Metzenbaum scissors

  • A pulse oximetry probe

Correct Answer: An anesthesia laryngoscope blade

The Spaulding classification system lists patient care items as critical, semicritical, and noncritical. Critical items have to be sterilized because they cross into sterile tissue. This tier includes items like endoscopes, surgical instruments, catheters, surgical implants, and needles. Semicritical items require at least high-level disinfection because they come in contact with mucous membranes and skin. They can be sterilized, however. Examples of semicritical items are anesthesia equipment, respiratory equipment, and blunt vaginal instruments. Noncritical items are only used externally and only contact intact skin. Examples include linens, food utensils, and blood pressure cuffs. 

160.

What nursing care plan correlates with the perioperative Scott Triggers tool? 

  • Risk for impaired skin integrity

  • Risk for malnutrition

  • Risk for imbalanced fluid volume

  • Risk for impaired temperature regulation

Correct answer: Risk for impaired skin integrity

The Scott Triggers tool and the Munro Scale were developed to help perioperative RNs identify patients at risk of pressure injury in surgery. The Braden Scale is widely used for pressure injury risk, but does not address specific surgical patient concerns like the other two. The Scott Triggers tool uses age, serum albumin, ASA score, and the length of the surgical procedure to assess a risk score. 

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