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Quiz Session - Attempts With Random Questions

CCI CNAMB Exam Questions

Page 9 of 25

161.

A sales representative brings a loaner instrumentation set with necessary implants in it to the ambulatory surgery center minutes before the elective surgery is due to begin. He states it was sterilized at a nearby local facility and is ready for use. What do you do next? 

  • Delay the surgery and take the set to central sterile processing for cleaning and terminal sterilization with biologic indicators

  • Take the set to central sterile processing for cleaning and flash sterilization with biologic indicators; delay the surgery slightly until it is done with IUSS 

  • Take the instrument set to the OR and open it to the sterile field; proceed with surgery as planned

  • Explain the situation to the patient and get their written consent to use the set that was sterilized at the other facility, and once you have their consent, proceed with surgery as planned

Correct answer: Delay the surgery and take the set to central sterile processing for cleaning and terminal sterilization with biologic indicators 

Loaner instrumentation must be sterilized on site and is considered contaminated until processed. It should be decontaminated and processed according to the manufacturer's Instructions For Use (IFU). These sets should be brought to the facility to allow time for inventorying, decontaminating, and terminally sterilizing them without being rushed. Implants should never be flash sterilized unless there is no other option and surgery cannot be delayed. 

162.

A patient in the PACU after an ORIF of their right ankle states that their pain is 10/10, but is resting peacefully and has no painful expressions on their face. What should the nurse document? 

  • 10/10

  • Give a 0 on the FLACC scale

  • 5/10

  • A 4 on the Wong-Baker scale

Correct answer: 10/10

Pain is subjective and is what the patient says it is, regardless of what the nurse observes or personally believes. Severe pain does not always show in the patient's demeanor and what the patient reports should be charted. The FLACC and Wong-Baker scales are usually used when a patient cannot verbalize their pain rating or in pediatrics. 

163.

How do you measure and choose the correct size of oropharyngeal airway (OPA)?

  • Measure from the middle of the mouth to the angle of the jaw

  • Measure from the tip of the nose to the earlobe

  • Measure from the corner of the mouth to the cricoid cartilage

  • Measure from the corner of the mouth to the insertion of the sternocleidomastoid

Correct answer: Measure from the middle of the mouth to the angle of the jaw  

Guidelines from various sources differ on whether you should measure from the corner of the mouth or the middle of the mouth to the angle of the jaw. Recent studies suggest that measuring from the middle of the mouth to the angle of the jaw is slightly more accurate and leads to fewer accidental obstructions from OPA insertion. OPAs that are too big may push down on the epiglottis and obstruct it. OPAs that are too small can obstruct the airway by pressing down on the base of the tongue. Nasopharygeal airways (NPAs) are measured from the tip of the nose to the earlobe. 

164.

A 35-year-old female patient undergoing laparoscopic adhesiolysis should be educated to expect which of these in the postoperative period? 

  • Shoulder pain

  • Large incisions

  • Headache

  • A JP drain

Correct answer: Shoulder pain

Shoulder pain is often a result of visceral peritoneal pain triggered by retained insufflation gases. It may last for several days and patients should be educated prior to surgery so they are not caught unaware by unexpected pain not associated with the surgical site. 

165.

Which of these best reflects an attempt by the nurse to respect a patient's autonomy? 

  • Is it okay if I put these SCD sleeves on your legs now?

  • I am going to place the blood pressure cuff on your arm now.

  • Hold still for just a minute, this IV won't hurt a bit.

  • We are taking you back to the OR now.

Correct answer: Is it okay if I put these SCD sleeves on your legs now?

Autonomy is a patient's right to determine their own treatment and plan of care. Every patient deserves dignity, respect, and the ability to make their own decisions. By asking the patient's permission for what the nurse is about to do rather than merely telling them what the nurse is about to do, the patient's autonomy is respected. The patient must give consent for all interventions on their behalf.  

166.

Before discharging a patient, what is the best way for the recovery nurse to assess whether or not the patient and family understand their discharge instructions and what medications they need to take? 

  • Ask them to verbalize what they learned from the discharge paperwork and which medications to take and when

  • Ask them if they've read the paper handouts and feel ready to be discharged

  • Ask them if they have any questions before discharge; answer any questions they have, and send the paperwork home with them to read later

  • Have them watch the discharge video and ask if they have any medication questions

Correct answer: Ask them to verbalize what they learned from the discharge paperwork and which medications to take and when

The teach-back method is a very important tool in evaluating patient and family understanding. Patients do not learn well from just written handouts because they may not be very literate or have other barriers to communication. Patients may not know what questions to ask and not be able to come up with them on the spot. Discharge videos can be important and helpful, but they do not help the nurse evaluate what the patients have retained. Teaching methods must be adapted to each specific patient and family and different combinations of written, verbal, and visual teaching methods should be implemented. 

167.

A patient's chart lists their allergies to bee stings, lemons, simvastatin, iodine, sulfa, and pollen. Which of these should the circulator remove from the room? 

  • The ioban drape

  • The chlorhexidine sponge prep kit

  • The bacitracin 50,000 units in the 3,000 ml NS irrigation fluid

  • The latex foley catheter

Correct answer: The ioban drape

Ioban drapes contain iodine impregnated adhesive and are used to isolate the area surrounding the incision. They are contraindicated for use on patients with iodine allergy. 

168.

Which method of heat loss occurs when air currents pass over the patient's skin in the OR? 

  • Convection

  • Conduction

  • Evaporation

  • Radiation

Correct answer: Convection

The four events that result in heat loss are convection, conduction, evaporation, and radiation. Convection involves air currents whisking away heat as they pass over the skin. Conduction involves heat loss when the patient is placed on something cool like an OR bed or gel pad. Radiation is when heat transfers from the patient to the atmosphere. Evaporation happens when the skin gets wet and then dries, creating a cooling effect. 

169.

What is it called when a work environment balances system errors and individual errors with individual accountability and system-wide improvement? 

  • Just culture

  • Accountability culture

  • Evidence-Based Culture

  • Root Cause culture

Correct answer: Just culture

Just culture uses root cause analysis to fix broken systems and learn how mistakes occur. Individuals are not blamed and punished for mistakes. Instead, they are encouraged to help find solutions to the problems in the system that led to the mistake. 

170.

How many air exchanges should each OR have per hour minimum? 

  • 15

  • 12

  • 3

  • 8

Each OR should have a minimum of 15 air exchanges per hour. AORN and Berry & Kohn's Operating Room Technique 14th Edition recommend 20 based on newer studies, but 15 is the minimum. Also, ORs should always be positive pressure. This ensures that, when the door is opened, air is pushed out into the corridor instead of rushing into the OR and bringing contaminants with it. The corridor is considered less clean since it is more of a common area. No cooling fans, humidifiers, or dehumidifiers should ever be used in the OR. Forced heating devices should only be turned on when they are connected properly to the warming blanket/device and preferably after draping to reduce the chance of recirculating bacteria that has settled on surfaces. 

171.

A 16-year-old girl undergoing an laparoscopic appendectomy is worried about scarring. Which of these is the most appropriate nursing diagnosis? 

  • Disturbed body image

  • Risk for complicated grieving

  • Readiness for enhanced resilience

  • Readiness for enhanced decision making

Correct answer: Disturbed body image

The main developmentally-based fears that adolescents face in regards to surgery are altered body image and death. Disturbed body image is the most appropriate nursing diagnosis in this instance. Nursing interventions should be geared towards addressing these fears. 

172.

Which of these devices is important to prevent complications common to the reverse Trendelenburg position? 

  • Sequential Compression Devices

  • Chest strap

  • Shoulder braces

  • Stirrups

Correct answer: Sequential Compression Devices

In the reverse Trendelenburg position, the patient is supine while the legs are lowered below the head. This position is usually used for laparoscopic surgery of the upper abdomen. Respiratory function is optimized to be similar to when the patient is standing, but venous circulation can be decreased due to gravity. So, SCDs are an important preventative tool for mechanical prophylaxis of DVTs in this position. A safety strap across the thighs would be a necessity in this position and a padded footboard should be considered. A chest strap would be contraindicated as it might not stay in place and could compromise the airway or dislodge the ET tube. Shoulder braces are no longer used in Trendelenburg position and would not even be necessary for reverse Trendelenburg. Stirrups would never be used in this position. 

173.

Which surgical position causes the most injuries to lower extremity nerves? 

  • Lithotomy

  • Lateral decubitus

  • Prone

  • Supine

Correct answer: Lithotomy

Lower extremity nerve injuries most commonly occur with prolonged lithotomy positioning. They are usually apparent within a few hours after surgery. The peroneal, sciatic, and femoral nerves are most often injured. The length of time in this position, whether or not it is high or low, and the type of stirrup all affect the likelihood of injury. 

174.

What is the purpose of "white balancing" an endoscopic camera before endoscopic or laparoscopic cases begin? 

  • To compensate for the glare from the light source and make organs a natural color

  • To warm the camera and reduce fogging from the cold carbon dioxide gas

  • To clear the tip of the scope of any debris or film from cleaning and make sure it is usable prior to putting it inside the patient

  • To test the visualization of the scope and that there are no shorts or breaks in the fiberoptic light cables

Correct answer: To compensate for the glare from the light source and make organs a natural color

White balancing ensures that the visual that the camera produces of the inside of the body is the natural coloring and not off-color due to the glare from the light source. If it is too dark or light, organs can be mistaken for ischemic or ill-colored. White balancing returns the colors to neutral.

175.

A patient who is about to be wheeled back to surgery is talking and laughing loudly and sounds cheerful and optimistic, but her eyes are welling with tears and her hands are shaking. The nurse knows that what relationship exists between verbal and nonverbal communication? 

  • In face-to-face communication, words only account for 7% of communication meaning, and 93% of face-to-face communication is nonverbal

  • Verbal communication accounts for most of face-to-face communication; nonverbal communication makes up a very small portion of communication

  • Verbal and nonverbal communication always complement each other; the patient is crying because she is so cheerful and excited

  • Verbal communication and cues are much more telling than nonverbal cues and should be given more value in communication

Correct answer: In face-to-face communication, words only account for 7% of communication meaning, and 93% of face-to-face communication is nonverbal

TeamSTEPPS is a teamwork system that is designed to help promote communication and patient safety in healthcare facilities. It was created by the Agency for Healthcare Research and Quality and the Department of Defense to improve communication and collaboration between healthcare providers. According to the TeamSTEPPS program, words only count for 7% of face-to-face communication meaning, and nonverbal communication makes up the other 93%. Of the nonverbal communications, tone of voice counts for 38% of the meaning, and body language accounts for 55%. In other words, nonverbal communication makes up the bulk of our communication and can be very powerful. It does not always completely complement verbal communication and can even completely contradict it, as is the case in this scenario. Nurses must be aware of nonverbal cues from coworkers and patients to maintain good communication between team members, provide therapeutic communication for patients, and maintain situational awareness at all times.

176.

A 20-year-old male patient undergoing a left orchiectomy for testicular cancer is worried about having children later on in life. What should the nurse tell him? 

  • Fertility is still possible with one testicle 

  • He should see a reproductive specialist and freeze his sperm as soon as possible 

  • He will have to do in vitro fertilization and may want to adopt instead 

  • This type of cancer will sterilize him with or without an orchiectomy 

Correct answer: Fertility is still possible with one testicle. 

Testicular cancer is the most common solid cancer in 15–35 year-old males. A unilateral orchiectomy does not sterilize the patient and fertility is often not affected. 

177.

After draping and creating a sterile field, but before incision, the surgeon decides that they need the drapes moved over several inches. What is the correct course of action? 

  • Discard the drapes without contaminating, and redrape the surgical site with new drapes 

  • Pick up the drapes, break the adhesive barrier, and move them where the surgeon directs; a good prep leaves a large enough sterile margin that the drapes can be moved safely 

  • Move the drapes and open a prep stick sterilely for the surgeon so they can prep the new margin of the surgical site after the drape is in place

  • Do not move the drapes; use scissors from the back table to cut the drape to make the fenestration larger to incorporate the site the surgeon needs

Correct answer: Discard the drapes without contaminating, and redrape the surgical site 

Once drapes are in place, they should not be moved. If they are not placed correctly, new sterile drapes should be opened and placed. 

178.

Which volatile inhalation anesthetic is most associated with emergence delirium in children? 

  • Sevoflurane

  • Desflurane

  • Halothane

  • Isoflurane

Correct answer: Sevoflurane

The prevalence of emergence delirium is 10–50% in children under 10, and may be up to 80% in preschoolers and toddlers. Volatile inhalation anesthetics like sevoflurane are rapidly breathed off and subsequently cause faster emergence. This may cause a faster return of pain and anxiety. Children must be monitored closely in the PACU.

179.

A surgeon has asked to have several different types of drains and sizes available for possible use in surgery. Which of these is an example of a passive drain?

  • A penrose drain

  • A Jackson-Pratt Drain

  • A hemovac

  • Accordion drains

Correct answer: A penrose drain

Passive drains like penrose drains and T-tubes use gravity and capillary action to remove fluids. Active drains like JP drains, hemovacs, and accordion drains use negative pressure to draw fluid out of the body. 

180.

The circulating nurse brings back a patient undergoing a breast lumpectomy with needle localization to the OR. When prepping the patient's breast, the nurse notes a wire sticking out of the breast, loosely covered with gauze and tape. What is the proper way to prep this surgical site? 

  • Remove the loose dressings, leave the wire in place, start prepping at the wire and move outward, prep the entire wire, without dislodging or pushing it in further, then the entire breast and a large swath around the breast, next prep the shoulder and past the midline of the sternum, and then prep down to the bed on the surgical side and prep the armpit last

  • Remove the loose dressings, remove the wire, start prepping at the incision site and move outward, then prep the entire breast and a large swath around the breast down to the bed, prep the shoulder and past the midline of the sternum, and then prep the armpit last

  • Prep the dressings and wire by saturating them with prep solution, then move outward from there and prep the entire breast, shoulder, and side down to the bed; prep the armpit last

  • Prep the breast, shoulder, and armpit first, then prep a large swath from the midline of the chest to the bed; remove the wire prior to incision 

Correct answer: Remove the loose dressings, leave the wire in place, start prepping at the wire and move outward, prep the entire wire, without dislodging or pushing it in further, then the entire breast and a large swath around the breast, next prep the shoulder and past the midline of the sternum, and then prep down to the bed on the surgical side and prep the armpit last

Needle localization is done under fluoroscopy in the radiology department. The wire is placed to direct the surgeon to the lump and must remain intact during prepping and surgery. The entire wire should be prepped after removing the temporary dressing and tape. Then the breast should be prepped in the usual fashion with the armpit prepped last. More than one prep stick may be needed. 

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