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Quiz Session - Attempts With Random Questions

CCI CNOR Exam Questions

Page 10 of 50

181.

Your patient is scheduled for tubal ligation. What document must be included in the perioperative record?

  • Authorization for and Special Consent to Reproductive Sterilization

  • Authorization for and Consent to Surgery

  • Authorization for the Administration of Blood/Blood Products

  • Authorization and Special Consent for Instrument Sterilization Procedure

Correct answer: Authorization for and Special Consent to Reproductive Sterilization

Voluntary reproductive sterilization as a contraceptive method may be contrary to moral, ethical, or religious beliefs of a caregiver. This is a special consent that is required and identifies that the patient will be sterile following the procedure. The circulating nurse should verify and document that the surgeon has notified the patient that she will be unable to procreate and that she understands the purpose and nature of the procedure. Some facilities require consent from a patient's spouse as well.

Consent for the surgery itself and for blood products are critically important for all surgeries, but the reproductive sterilization consent is specific to sterilization surgeries.

182.

Preoperative assessment of a geriatric patient should identify needed resources that will be accessible when the patient is discharged. 

Community resource services include all the following except:

  • Family and friends

  • Rehabilitation facilities

  • Home health services

  • Transportation services

Correct answer: Family and friends

The level of independence exercised by the geriatric patient may depend on the resources available. In developing the plan of care, the nurse should consider how the patient will meet postoperative needs at home. Community resources accessible to meet needs include transportation services to get the patient to and from surgery follow-up visits, home health services to supplement care once home, and rehabilitation services and facilities.

Family and friends are the patient's resources, not community resources.

183.

You check a patient's vital signs prior to surgery. The patient's oxygen saturation is 89%. 

What should you do FIRST?

  • Ensure that the probe is situated on the patient's finger properly 

  • Verify that the patient's pulse correlates with the waveform

  • Administer supplemental oxygen via a non-rebreather mask

  • Notify the surgeon and anesthesiologist 

Correct answer: Ensure that the probe is situated on the patient's finger properly 

Always check the equipment first to ensure that it is positioned correctly and functioning properly. The sensor must be maintained flush with the skin surface and positioned so that the light source and photodetector are in direct alignment. The sensor is attached to an oximeter, which is plugged into a power source. Once you've ensured the probe is positioned correctly on the patient's finger, you can then check that the pulse correlates with the monitor's waveform. 

Applying oxygen may be warranted, but this is not the first step to take. Always inform the surgeon and anesthesiologist of any abnormal vital signs that are found preoperatively, but again, this should not be the first intervention that is performed.  

184.

The family of an 18-year-old male who was the victim of a hit-and-run accident earlier in the day is informed by the perioperative team that they may be unable to save the life of the teen. Which is true regarding organ donation in the event of brain death? 

  • The teen's organs may be harvested for donation if he has indicated his desire to be an organ donor as noted on his driver's license or state identification card

  • The family must be asked if they wish to allow the teen's organs to be harvested for transplantation

  • If the teen has indicated that he wishes to donate his organs as evidenced by information on his state's driver's license, his family may opt to override his decision

  • The teen must have completed an organ donation card as well as having indicated this on his driver's license in order for his organs to be harvested for donation

Correct answer: The teen's organs may be harvested for donation if he has indicated his desire to be an organ donor as noted on his driver's license or state identification card

The decision to donate one's organs in the event of legally defined brain death is an individual right for all Americans of driving age. This decision can be noted on most state driver's licenses or identification cards and serves as a legal basis to allow a transplantation team to harvest organs. The caveat in the situation of teenage organ donors is that if the teenager is younger than 18 years of age and has indicated on their driver's license their intent to donate their organs in the event of their brain death, two surgeons from the perioperative team are required to obtain consent from the parent(s) or guardian(s) of the underage teenager.

Teenagers that are 18 years of age or older may indicate their unequivocal intent to donate their organs; this decision cannot be overruled by the decision of any family member. Some individuals also opt to carry a separate organ donation card; this is not necessary for organ donation to take place as long as it is also noted on the driver's license.

185.

You have been ordered to insert a Foley catheter in a male patient who was involved in a motor vehicle accident (MVA) and is headed to surgery. As you are preparing to insert the catheter, you notice blood at the urethral orifice. 

What should you do? 

  • Do not insert the catheter and notify the physician

  • Insert the smallest-sized catheter available to prevent further trauma to the urethra, stopping if resistance is felt upon insertion

  • Insert a three-way catheter because you anticipate the patient will require bladder irrigation

  • Insert the catheter and report the amount of bloody urine in the drainage bag; this is an expected finding in a trauma victim 

Correct answer: Do not insert the catheter and notify the physician

Blood at the urethral orifice may indicate a pelvic fracture that has damaged the urethra or bladder. Notify the physician immediately and do not insert the catheter until the patient has been cleared, possibly by imaging studies.

186.

Your patient is scheduled for an inguinal hernia repair. When you are checking the patient's chart in the pre-op holding room, you see he is also diagnosed with obstructive sleep apnea (OSA), which may complicate his perioperative period. 

The patient's sleep apnea puts him at increased risk for all the following complications EXCEPT: 

  • Severe bradycardia 

  • Systemic and pulmonary hypertension

  • Neurologic dysfunction

  • Cardiac dysrhythmias

Correct answer: Severe bradycardia 

With OSA, a patient's breath can become very shallow, or they may even briefly stop breathing during sleep (apneic episodes), causing oxygen desaturation and possible oxygen deprivation to vital organs. Upper airway obstruction may be caused by nasal obstruction, a deviated nasal septum, hypertrophied adenoids and/or tonsils, or mandibular retrognathism (overbite). OSA can lead to life-threatening complications including systemic and pulmonary hypertension, cardiac dysrhythmias, and neurologic dysfunction if left untreated. 

Sleep apnea could lead to bradypnea (slow and shallow breathing) in the perioperative period, as mentioned above. However, because vitals are closely monitored, this would likely be corrected quickly before bradycardia ensues. 

187.

A surgical site involving a particular side of the body (left or right) should be clearly marked. How should the site be marked? 

  • With a Sharpie that won't wash off during skin prep

  • With a thick, black ballpoint pen

  • With a water-based marker, being gentle during prep not to wash it off

  • With adhesive tape that has the surgical site clearly written on it

Correct answer: With a Sharpie that won't wash off during skin prep

The surgeon should mark the site with his or her initials in indelible ink that does not wash off during intraoperative skin preparation, such as a Sharpie.

Normal ballpoint pens may damage the skin. Markers that are water-based may be easily washed off during surgical skin prep. Marking with an 'X' is inappropriate and may be misunderstood. Ensure the surgeon marks with his or her initials. 

188.

If there is any uncertainty regarding the count of an item:

  • The scrub nurse and the circulator should immediately repeat the count in question together

  • The scrub nurse should immediately repeat the count in question aloud 

  • The circulator should immediately repeat the count in question aloud 

  • The surgeon and the scrub nurse should immediately repeat the count in question, and the circulator should record the number

Correct answer: The scrub nurse and the circulator should immediately repeat the count in question together

If there is any question regarding the count of an item, the scrub nurse and circulator should repeat the count immediately. In addition, if either the scrub or circulating nurse is permanently relieved by another person during the surgical procedure, the incoming person should verify all counts before the person being relieved leaves the room. 

Personnel who perform the final counts are held accountable for the entire count. Surgeons will not be involved in the counting procedure unless an item is deemed to be missing or when any count is incorrect.

189.

Safe patient transfers require an adequate number of staff members to accomplish what for the patient?

  • Maintain body alignment of patient, support patient's extremities, and maintain patient's airway

  • Maintain body alignment of patient and staff, and support the patient's extremities

  • Maintain body alignment of patient and staff, while maintaining the patient's airway

  • Maintain body alignment of staff, support the patient's extremities and maintain the patient's airway

Correct answer: Maintain body alignment of patient, support patient's extremities, and maintain patient's airway

This question pertains to protecting the patient during transfer. Maintaining the patient's body alignment and airway while supporting the extremities are crucial parts of safe transfer. Staff issues are not pertinent in this question.

190.

You are providing preoperative teaching to the mother of a 7-year-old who is scheduled for a tonsillectomy. Versed (midazolam) has been ordered as a pre-op medication to be given 1 hour prior to surgery. The mother asks you what the purpose of this medication is. 

You explain that the drug will:

  • Induce amnesia

  • Prevent vomiting during and after surgery

  • Ease anxiety preoperatively 

  • Dry secretions in the throat to prevent aspiration

Correct answer: Induce amnesia

Versed (midazolam) is a benzodiazepine. It is often given for its excellent short-term amnesic effects. It is given intravenously (IV) or intramuscularly (IV) and has a rapid onset. It is a central nervous system and respiratory depressant and is rapidly metabolized.

While it also may help to ease anxiety prior to surgery, it's primary purpose is to induce amnesia in this scenario. 

191.

During emergence from anesthesia after completion of a surgical procedure to treat a traumatic eye injury, a patient who was suspected of having Creutzfeldt-Jakob disease (CJD) was disoriented and became combative. The patient ripped out his endotracheal tube (ETT) with the cuff still inflated, which resulted in gross blood spray around the operating room (OR) bed, and knocked over a kick bucket that contained soiled surgical sponges used during the ophthalmic procedure. 

Which of the following statements regarding potential environmental contamination by CJD is accurate?

  • Decontaminating environmental surfaces with a dilute sodium hypochlorite solution is adequate after potential CJD contamination.

  • Environmental surfaces remain a regular mode of CJD transmission for hospitalized patients.

  • Sodium hydroxide is the only disinfectant solution that has been effective in eliminating CJD from environmental surfaces.

  • The blood spray is the greatest concern regarding potential CJD transmission due to the wide area of environmental contamination.

Correct answer: Decontaminating environmental surfaces with a dilute sodium hypochlorite solution is adequate after potential CJD contamination.

Despite the grim outlook for patients known to be infected with Creutzfeldt-Jakob disease and a paucity of available sterilization and disinfection methods known to eliminate the organism from surfaces known to be contaminated with CJD, there have been no reported transmissions of CJD as a result of contact with an environmental surface. Any surgical equipment that will come into direct contact with high-risk tissue (e.g., brain, eye, spinal, pituitary) should either be a single-use disposable item or able to withstand extensive steam-heat sterilization or immersion in a sodium hydroxide solution for several hours. 

When possible, environmental surfaces in the operating room should be covered with impermeable plastic sheeting, which can be discarded and incinerated after use. Noncritical environmental surfaces that are known to have become contaminated with high-risk tissue should first be thoroughly cleaned using an appropriate detergent and should then undergo disinfection using a dilute sodium hypochlorite or sodium hydroxide solution. The disinfectant solution should be allowed to stay in contact with the contaminated surface for 30 minutes to 1 hour, and the surface should be able to withstand extended contact with the disinfectant solution without demonstrating signs of damage (e.g., chipping or flaking).

192.

Which of the following statements is true regarding hair removal in the OR?

  • Remove any stray clipped hair with tape or other adhesive-type product (e.g., an adhesive glove designed for picking up hair) to prevent contamination of the surgical site

  • Sterile gloves are necessary to prevent contamination of a surgical wound

  • Use a surgical clipper and stroke in the same direction of hair growth

  • Using a razor rather than a clipper is recommended as it provides a closer shave

Correct answer: Remove any stray clipped hair with tape or other adhesive-type product (e.g., an adhesive glove designed for picking up hair) to prevent contamination of the surgical site

Clean disposable gloves will suffice; sterile gloves are not necessary. With electric clippers, the skin is held taught and is shaved by stroking against the direction that the hair is growing using short strokes. Short hair stubble may still be evident after clipping, and does not typically interfere with skin antisepsis or exposure of the surgical site. Razor shaves are not recommended as they may increase the risk of infection and leave skin abraded. Care is taken not to let stray hair remain in the surgical field. A wide piece of adhesive tape can be used to collect stray hair.

193.

The length of aeration time required after gas sterilization with ethylene oxide (EO) is dependent upon all the following factors except:

  • The biologic indicator of the EO gas sterilizer

  • The type of wrapper used

  • The composition of the items

  • The temperature reached during the aeration process

Correct answer: The biologic indicator of the EO gas sterilizer

Length of aeration time depends on the type of wrapper (packaging material), composition (density, porosity, weight, and configuration) of the items, and temperature reached during aeration. In addition, aeration time is also dependent upon the concentration of ethylene oxide used and the airflow rate. 

194.

When planning for tourniquet usage on your patient, nursing assessment should screen your patient for contraindications. 

What are three contraindications for tourniquet usage?

  • Thromboembolism, known peripheral vascular disease (PVD), and extremity infection

  • Hypertension, thromboembolism, and extremity infection

  • Known peripheral vascular disease (PVD), extremity infection, and cardiac dysrhythmias

  • Extremity infection, thromboembolism, and diabetes

Correct answer: Thromboembolism, known peripheral vascular disease (PVD), and extremity infection

Nursing assessment for tourniquet usage must consider contraindications. Tourniquets are not used in the presence of infection or venous stasis in the limb. A bolus of infectious material or a clot could become dislodged. Known peripheral vascular disease (PVD) or history of DVT, malignant disease in the limb (may cause spread), vascular access ports or shunts (can destroy structure patency), neonates or elderly, rheumatoid arthritis, and skin grafts are other situations in which a tourniquet should not be used.

Hypertension, cardiac dysrhythmias, and diabetes are not contraindications to tourniquet use.

195.

How should you store flexible endoscopes with detachable parts?

  • Hang the endoscope disassembled with the distal end pointed downward 

  • Gently place the endoscope on a cart by itself and allow it to dry 

  • Hang the endoscope disassembled with the distal end pointed upward 

  • Use a dryer to dry the scope thoroughly, then gently place it, disassembled, on a cart by itself 

Correct answer: Hang the endoscope disassembled with the distal end pointed downward 

To prevent contamination and promote drying, flexible endoscopes with detachable parts should be stored disassembled, hung in a vertical position with the distal end pointed downward. Accessories may also be hung. The lumens should be flushed with alcohol to facilitate fluid evaporation and thorough drying.

Clean, dry, unwrapped, rigid endoscopes should be stored on a soft material such as plastic sheeting or foam. Towels hold a residue of laundry detergent that can tarnish metal. 

196.

While using a smoke evacuator, you detect an odor from the surgical field. Troubleshooting actions should include all the following except:

  • Checking to make sure a 0.7 micron filter is being used

  • Checking whether the filter should be replaced (replace if required)

  • Checking to make sure the vacuum nozzle is being held close to the surgical site

  • Checking the inline filter to see if the vacuum system is clogged

Correct answer: Checking to make sure a 0.7 micron filter is being used

When a smoke evacuator is functioning properly, no odor should be detected. To troubleshoot, check whether the filter should be replaced (OR personnel can change the filter in some evacuators, whereas others require maintenance by a biomedical technician), whether the vacuum nozzle is being held close enough to the surgical site, and whether the filter is clogged and not suctioning. Wall suction only filters 5 ft^3 per minute and is not recommended for large volumes of smoke evacuation. An inline filter is necessary to avoid clogging the department vacuum system, and should be checked regularly to ensure it is not clogged. The correct filter size is a 0.1 (not 0.7) micron filter.

197.

During a continuing education conference, the speakers discussed how to prevent the spread of infection within the perioperative environment if an individual infected as a result of a bioterrorism attack requires surgical care. Each of the following bioterrorism agents has been classified as Category A (agents that pose the highest risk to the public and national security) by the Centers for Disease Control (CDC), except:

  • Ricin

  • Anthrax

  • Plague

  • Botulism 

Correct answer: Ricin

Agents of bioterrorism have been used to win wars since as early as 184 BC when Hannibal defeated his enemies by releasing pots of poisonous snakes among the enemy troops. Bioterrorism has continued to be utilized historically as a means of conquering or defeating people groups. Unfortunately, bioterrorism continues to be used in more modern times against specific people in assassination attempts or against groups of people in an attempt to defeat and control.

The CDC developed a system of categorization for identifying the most deadly/dangerous potential bioterrorism agents. Category A includes those agents that pose the highest risk to the public and national security, are most easily transmitted from person to person, and cause the greatest panic and disruption to the social infrastructure. Included in Category A are the following agents:

  • anthrax
  • botulism
  • plague
  • smallpox
  • tularemia
  • viral hemorrhagic fevers such as Ebola, Lassa, and Marburg viruses

Category B includes those agents which pose the second highest risks, are moderately easy to spread, and cause moderate morbidity and mortality in infected individuals. Ricin is a Category B agent.

Category C includes those agents which have newly emerged and could potentially be used as a weapon of bioterrorism due to their ease of spread, availability, and potential to cause high morbidity and mortality.

198.

Health care workers face an increased risk of developing what condition and why?

  • Latex allergy because of repeated exposure to latex

  • Allergic dermatitis because of repeated exposure to hand sanitizer

  • Dry skin because of repeatedly washing hands and using hand sanitizer

  • Allergic dermatitis because of repeatedly using nitrile gloves

Correct answer: Latex allergy because of repeated exposure to latex

Any group of people with constant latex exposure face a higher risk of developing an allergy. According to the CDC, 8% to 12% of all health care personnel are sensitive to latex, compared with 1% to 6% of the general population. Health care workers can decrease their exposure by wearing latex-free gloves.

199.

You hear the anesthesiologist asking your patient, "Have you or any biological family members had problems from general anesthesia?" 

You know he is asking about which inherited anesthesia-induced crisis?

  • Malignant hyperthermia

  • Malignant hypertension

  • Malignant hypothermia

  • Malignant hemophilia

Correct answer: Malignant hyperthermia

Malignant hyperthermia (MH) is a hypermetabolic crisis in susceptible people (familial genetic transmission exists as an autosomal dominant trait with variable multifactor inheritance patterns) and is a potentially fatal complication of inhalant anesthesia. 

MH is triggered by potent halogenated anesthetic agents and depolarizing skeletal muscle relaxants. It is characterized by an uncontrolled acceleration of muscle metabolism and is accompanied by tremendous oxygen consumption with the production of heat and carbon dioxide. If left untreated, the body temperature can rapidly rise to dangerously high levels.

The other answer choices are not inherited anesthesia-induced crises. 

200.

In Maslow's hierarchy of needs, which of the following is essential for survival?

  • Physical

  • Security

  • Psychosocial

  • Spiritual

Correct answer: Physical

In following Maslow's concept of a motivational hierarchy of needs to set priorities for care, the basic lower level (physiologic needs) essential for survival must be met first. Included in physical needs is breathing, circulation, elimination, etc. Satisfaction of higher level needs for safety and security, belonging and acceptance (psychosocial), self-esteem, and finally self-actualization (spiritual) can then be met.

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