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Quiz Session - Attempts With Random Questions

CCI CNOR Exam Questions

Page 2 of 50

21.

Preoperative teaching given to a patient with diabetes includes all the following measures to prevent thrombophlebitis except:

  • Monitoring and control of his blood sugar

  • Foot and ankle exercises

  • Anti-embolism stockings on legs

  • Sequential anti-embolism foot/leg wraps

Correct answer: Monitoring and control of his blood sugar

A diabetic patient faces increased risk of thrombophlebitis. Preoperative teaching will include patient education on foot and ankle exercises to practice, and that he will be wearing antiembolic stockings during the surgical procedure and postoperatively, as well as sequential compression foot/leg wraps to prevent deep vein thrombosis during long periods of immobility.

Blood sugar monitoring and control is vitally important in diabetic patients but does not reduce the risk of thrombophlebitis.

22.

Patients within the perioperative environment may feel most alone and anxious in which specific area of perioperative services?

  • Holding area

  • PACU

  • Preoperative area

  • OR prior to administration of sedation

Correct answer: Holding area

Once the patient has been prepared for surgery in the preoperative area, they can be transported to the presurgical holding area to await surgery. Many activities may take place within this area, including removal of body hair if needed, marking of the surgical site, insertion of the IV catheter or other invasive lines, and administration of any ordered preanesthesia medications, including regional blocks.

Despite the many activities that take place in the holding area, patients typically describe it as being an area that is both unfriendly and impersonal, and rife with stressful experiences. This results in feelings of loneliness and subsequently anxiety, which the perioperative nurse must strive to abate. The anxious patient looks to the nurse for comfort, reassurance, and attention. Maintaining personal contact with the patient through frequent "check-ins" and gentle touch, as well as explaining what is happening to the patient or in the surrounding environment can help to improve the feelings experienced by the patient while awaiting transfer to the operating suite. 

23.

You are on call for the weekend, and get called in to work as the circulating nurse for a trauma patient who was involved in a motor vehicle accident (MVA). As you are preparing the OR, you chat with the scrub nurse, who was also called in at the last minute. You detect the odor of alcohol on her breath as you are talking. 

How should you handle the situation?

  • Call your supervisor and report your colleague

  • Ask how many alcoholic beverages were consumed

  • Inform the surgeon and let him or her address the situation

  • Be vigilant of her and if you notice any inappropriate actions during the surgical procedure, ask her to leave the OR and call your supervisor 

Correct answer: Call your supervisor and report your colleague

Liability is the act of being legally bound and responsible for personal actions that adversely affect another person. Every patient care provider should always perform duties in accordance with standards and practice guidelines. The patient's safety is your first responsibility. Notify your supervisor immediately about your colleague.

The amount of alcohol consumed is not at issue; even a single glass of wine could impair a person's judgment. Ignoring the situation (and just keeping an eye on her) is not an option. You could also be held liable if an adverse event occurs. Action must be taken. 

24.

The World Health Organization (WHO) Universal Protocol has been included in the Comprehensive Checklist advocated by the Association of periOperative Registered Nurses (AORN). What are the preoperative (or pre-procedure) components of this checklist?

  • Patient identity, procedure and procedure site, consent(s), history and physical including diagnostic and radiologic test results, and site marking

  • Patient identity, procedure and procedure site, consent(s), difficult airway assessment, history and physical including diagnostic and radiologic test results

  • Procedure and procedure site, consent(s), history and physical including diagnostic and radiologic test results, anticipated blood loss, and site marking

  • Procedure and procedure site, consent(s), history and physical including diagnostic and radiologic test results, site marking, and sterilization indicators

Correct answer: Patient identity, procedure and procedure site, consent(s), history and physical including diagnostic and radiologic test results, and site marking

Universal Protocol is a standardized means for keeping a patient safe in surgery. These details are critically important to give quality care to your patients and should be checked in the holding area, prior to entering the operating room. Other components included in the pre-procedure check-in list are ensuring a preanesthesia assessment has been completed, blood products are readily available, and any special equipment, devices, or implants should be confirmed. Patient identity must be included every time.

Airway assessment, anticipated blood loss, and sterilization indicators are intraoperative components.

25.

Your preoperative patient has anemia. What potential side effects does this patient face during surgery and anesthesia?

  • Hypoxia and hypotension

  • Hypotension and hemorrhage

  • Hypercalcemia and hemorrhage

  • Hypovolemia and hypertension

Correct answer: Hypoxia and hypotension

Anemic patients have a deficiency in the quantity or quality of red blood cells (erythrocytes). Hemoglobin, the main component of these cells, delivers oxygen to tissues. Normal hemoglobin values are 14 to 18 g/dL in males, 12 to 16 g/dL in females, and 11 to 16 g/dL in children. These values are lower in patients with anemia.

The patient will potentially experience tissue hypoxia and hypotension (low blood pressure), not hypertension. Fluid volume and calcium are not affected with anemia. Hemorrhage during surgery would certainly worsen the patient's already-existing condition, but isn't a potential side effect of anemia itself.

26.

Before the circulating nurse gives any medication to the scrub nurse to administer to the patient, they should verify the rights of medication administration. 

Which of the following is NOT an appropriate right of medication administration? 

  • Right patient using at least one patient identifier 

  • Right infusion pump settings (if applicable)

  • Right documentation

  • Right route

Correct answer: Right patient using at least one patient identifier 

Safe drug and pharmaceutical administration in the OR is practiced according to the seven rights of medication administration in any setting. Before administering medication, verify the:

  • Right patient using at least two patient identifiers
  • Right medication
  • Right dose
  • Right route
  • Right time
  • Right reason
  • Right documentation, and
  • Right infusion pump settings, if applicable

It is not necessary to verify the manufacturer at this time.

27.

A 59-year-old male patient who underwent a Symes amputation of his right foot due to severe peripheral neuropathy resulting from poor diabetes management has now been scheduled for a lumbar sympathectomy to improve the healing of the amputation area. The procedure will be completed through an incision made in the right flank. 

At the hand-off to the postoperative care unit (PACU) nurse, which of the following postoperative nursing instructions is most likely to be given?

  • "Check the dressing for urine."

  • "Reinforce the dressing with a gauze pressure dressing if you see blood seeping through the dressing."

  • "The Jackson-Pratt drain should be emptied every 8 hours."

  • "The wound vac dressing should be removed before the patient is discharged home."

Correct answer: "Check the dressing for urine."

A lumbar sympathectomy is most frequently performed to treat intractable pain resulting from complex regional pain syndrome or neuropathic pain or to treat ischemia to the lower extremity/extremities if the patient is not a candidate for vascular reconstruction. It may also be performed in an attempt to improve wound healing for patients who have undergone amputation (including Symes amputation) of a lower extremity. During lumbar sympathectomy, a flank incision is typically made through which the vascular surgeon resects the lumbar sympathetic nerve chain and ganglions; this results in reduction or cessation of the sympathetic nervous system response (vasospasm) and a subsequent improvement in blood flow to the affected area. 

The procedure may also be performed using radiofrequency ablation, electrocautery, and sclerosing agents injected into the sympathetic nerve chain. When the procedure is performed using an open or laparoscopic or thoracoscopic approach, there is a risk of damaging both the vena cava and the contralateral ureter. A dry dressing is typically placed over the surgical incision; any bleeding may be indicative of damage to the vena cava and should be promptly reported, and the presence of urine on the dressing indicates damage to the ureter.  

28.

As part of the preoperative assessment, a patient who was admitted to the day surgery unit had his temperature checked using an oral thermometer. The nurse recorded the temperature reading. When the patient was in surgery, the intraoperative nurse compared the patient's current core temperature (bladder) reading with the preoperative temperature. Several hours later, the patient was transferred to the postanesthesia care unit (PACU), where his temperature was checked a third time, this time using a temporal artery thermometer. 

Which of the following statements regarding methods of assessing a patient's thermoregulation status is accurate?

  • Temporal artery temperature measurement does not correlate with oral or bladder (core) temperature measurement in the same patient. 

  • Oral temperature measurement correlates well with temporal artery temperature measurement .

  • When using multiple methods of measuring temperature for the same patient, the nurse should identify trends for optimal temperature assessment.

  • For female individuals, oral and temporal artery temperature measurements are closely correlated and reliable methods for temperature measurement.

Correct answer: Temporal artery temperature measurement does not correlate with oral or bladder (core) temperature measurement in the same patient. 

It is not uncommon for a surgical patient to have their temperature measured using various methods during the same hospital stay. Invasive methods of measuring the core temperature—including the use of probes placed in the rectum, bladder, distal esophagus, or nasopharynx—are common and provide the most accurate measure of the patient's temperature. While these methods are highly accurate, the ability to use these methods outside the operating room (except for critical care areas such as the intensive care unit) is low due to lack of ease and impracticality. 

When a patient's temperature is measured using several different methods during the same surgical experience, the ability to translate the results of the temperature readings, and intervene when necessary, becomes impaired. Despite the many available methods of non-invasive temperature measurement, none can correlate accurately with the invasive methods of core temperature measurement. A study evaluating the use of three different methods of temperature measurement (bladder, oral, temporal artery) on the same patient found that temporal artery temperature measurements did not correlate with either oral or bladder temperature measurements. While oral temperature did not perfectly correlate with bladder temperature measures, it was found to be an accurate and acceptable method of temperature measurement. 

29.

Quality improvement programs are designed to accomplish all the following except:

  • Measure room turnover times to improve financial status

  • Ensure nurses are meeting hospital-specific and state and national requirements of care

  • Ensure that charting is performed in accordance with guidelines

  • Ensure that errors identified are acted upon/improved

Correct answer: Measure room turnover times to improve financial status

Hospitals often have their own quality assurance programs to improve patient quality of care. In addition, institutions must meet state and federal mandates for patient care. These performance improvement committees monitor routine activities, evaluate clinical outcomes, review incident reports, and conduct problem-focused studies in an effort to identify practices deemed substandard. Overall, the goal is to identify areas for improvement, eliminate real or potential problems, and ensure that nurses are meeting the accepted standards of care for all patients.

30.

A patient who has completed surgery at an ambulatory surgery center (ASC) is being monitored in the PACU until recovered enough to qualify for discharge. Which of the following discharge parameters is the BEST method of ensuring the patient is stable and appropriate to be discharged to home?

  • Patient assessment data

  • The Aldrete Scoring System

  • The modified Aldrete Scoring System

  • The Post-Anesthetic Recovery Scoring System (PAS)

Correct answer: Patient assessment data

The Aldrete Scoring System is a post-anesthesia scoring scale which is commonly used to determine a patient's eligibility for discharge following surgery. The scale is comprised of five categories (activity, respiration, circulation, consciousness, and color) in which the patient is attributed points based upon parameters which are met (or unmet) at certain times following the patient's admission to the PACU. The modified Aldrete Scoring System replaces the use of color as a parameter with oxygen saturation. Patients must meet a certain score in order to be considered eligible for discharge to home. Facilities may vary regarding which scores are acceptable for discharge.

Despite the common and frequent use of the Aldrete systems for establishing post-surgical discharge parameters, scale score should not replace the patient's basic assessment data. The patient may have other assessment findings outside those scored within the Aldrete system that would make a discharge to home questionable or even dangerous. 

The Post-Anesthetic Recovery Scoring System (PAS) is typically used within the PACU to establish whether the patient meets criteria to be discharged from Phase I to Phase II recovery.

31.

Documentation of surgical counts MUST include all the following EXCEPT:

  • Signatures of all counting personnel 

  • Names of staff involved with counting

  • Surgeon notification of correct count

  • How many counts were performed and by whom 

Correct answer: Signatures of all counting personnel 

Documentation of counts includes what was counted at baseline (beginning), number of counts (minimum of baseline before procedure, first closing, and final closing), names of staff involved with counting, results of counts, surgeon notification of correct count (only after a physical count by number actually has been completed), notification of any packing left in the patient, and actions for count discrepancy and/or retained device fragments left in the wound. In addition, omitted counts because of an extreme patient emergency should be recorded in the patient's record and the event documented according to policy and procedure.

Facility policy dictates whether, or not, the signatures of all counting personnel are to be included in documentation. 

32.

A vascular surgeon and their intraoperative team are discussing a surgical patient that is on the surgical schedule. The patient is scheduled for endoscopic thoracic sympathectomy to treat issues that are interfering with their employment performance. For which of the following conditions is the patient most likely to experience positive postoperative results after undergoing thoracic sympathectomy? 

  • Emotional facial blushing

  • Essential hypertension

  • Thermoregulatory facial blushing

  • Secondary hypertension

Correct answer: Emotional facial blushing

Prior to the advent of safe, effective anti-hypertensive medications in the late 1950s, the primary treatment for essential hypertension was thoracic (or thoracolumbar) sympathectomy. During the procedure, the patient would be positioned prone, and bilateral paravertebral incisions would be made to allow for surgical ablation of the thoracic and splanchnic nerves, along with the first, second, and third lumbar chains and their ganglions. While the procedure is no longer used to treat essential hypertension, it is still used for conditions affecting the upper extremities, such as Raynaud's phenomenon, complex regional pain syndrome (reflex sympathetic dystrophy), and hyperhidrosis. 

Severe facial blushing caused by anxiety or emotional factors or as a result of a vasodilator-mediated response may also be relieved by thoracic sympathectomy if the condition interferes with daily life. Patients whose facial blushing results from emotional factors are most likely to experience a positive postoperative result from the surgery.

Sympathectomy has not been indicated as a treatment for secondary hypertension.

33.

The circulating nurse must perform immediate use steam sterilization (IUSS) for a small instrument set and small powered instrument that was forgotten and is urgently needed for surgery. No alternative method can be used. The instrument set is stainless steel, nonporous, and has no lumens. The nurse is using a gravity displacement sterilizer.

What will the routine exposure time for this particular cycle be?

  • Follow manufacturer's instructions for device and container use

  • 6 minutes 

  • 4 minutes 

  • 10 minutes 

Correct answer: Follow manufacturer's instructions for device and container use

Steam sterilization is the easiest, safest, surest, and fastest method of onsite sterilization. Heat- and moisture-stable items that can be steam-sterilized without damage should be processed with this method.

A flash/high-speed pressure sterilizer may have either a gravity displacement or a pre-vacuum cycle for IUSS (formerly referred to as flash sterilization). The high-speed pressure sterilizer operates at a pressure of 27 psi (at sea level) to increase the temperature in the chamber to between 270 degrees F to 275 degrees F (132 C to 135 C).

Cleaning and handling instructions recommended by the device manufacturer can vary widely. Some instruments, especially powered instruments, can require special cleaning and maintenance procedures. Though specific exposure times for certain instruments are given, the nurse should always refer to the manufacturer's instructions/recommendations before starting any sterilizer cycle.

In general, for unwrapped, nonporous, uncomplicated stainless steel items without lumens, exposure time is 3 minutes. When porous items or instruments with instrument marking tape of lumens are included in the load, timing is increased to 4 minutes or longer in a pre-vacuum sterilizer and to 10 minutes or longer in a gravity displacement sterilizer.

34.

Which of the following statements regarding individuals who die during the commission of a crime is MOST accurate?

  • The coroner can choose to donate the individual's organs and has the right to overrule the wishes of the family 

  • The body becomes the property of the state and is considered potential evidence in regard to the crime which was committed

  • The body becomes the property of the closest relative, who can make decisions about the disposition of the body and organ donation

  • The body becomes the property of the coroner's office, which must then consult with the family as to the disposition and disposal of the body

Correct answer: The coroner can choose to donate the individual's organs and has the right to overrule the wishes of the family 

Hospital OR personnel will likely be called upon to provide care to individuals who have been involved in the commission of a crime who have expired as a direct result of their involvement in the crime. The bodies of these deceased individuals automatically become the property of the coroner (not the state) and should be transferred to the coroner's office for autopsy and investigation. 

As "owner" of the deceased, the coroner's office can determine the outcome of the deceased, including donation of the individual's organs, even if this is in direct opposition to the wishes of the family. Individual state law and institutional policy determine the postmortem care of the patient's body. Hospital staff must ensure that they strictly adhere to transfer policy before the body is handed over to the coroner's office. 

35.

All the following obstetric and gynecologic patients are good candidates for surgical treatment using uterine artery embolization (UAE), except:

  • A 35-year-old female with infertility due to a uterine fibroid 

  • A 42-year-old female with a leiomyofibroma who has been experiencing menometrorrhagia

  • A 32-year-old female with adenomyosis who has EssureTM in place

  • A 29-year-old female who experienced postpartum hemorrhage 10 days after giving birth

Correct answer: A 35-year-old female with infertility due to a uterine fibroid 

Uterine artery embolization (UAE) is a minimally invasive surgical procedure during which the uterine arteries are occluded through a sclerosing solution or hemostatic gelatin. The procedure may also be referred to as uterine fibroid embolization when it is used specifically to treat uterine fibroids (leiomyofibroma), effectively cutting off blood flow to the fibroid. UAE is also used to treat adenomyosis and life-threatening obstetric hemorrhage caused by placental disorders such as placenta previa and placenta accreta. It may also be used to treat obstetric hemorrhage due to an ectopic pregnancy (abdominal or cervical ectopic sites). 

The treatment is not indicated for women who wish to achieve future pregnancy.

36.

Ethylene oxide (EO) gas sterilization depends on four parameters. Which of the following is not a parameter included in this complex process? 

  • Item being sterilized

  • Concentration of EO gas

  • Exposure time

  • Temperature

Correct answer: Item being sterilized

EO gas is used to sterilize items that are sensitive to heat or moisture. EO gas sterilization depends on four parameters: pressure within the chamber (concentration of EO gas), exposure time, humidity (moisture), and temperature. Each variable affects the other dependent parameters.

The item being sterilized is not a parameter that impacts EO sterilization. However, it does affect the amount of aeration time needed after sterilization to render the item free of toxic byproducts and harmful residues that can form in the presence of moisture during EO exposure.

37.

Recommended air exchanges in storage areas where sterile items and packages are kept are how many per hour?

  • 4

  • 10

  • 6

  • 8

Correct answer: 4

How sterile items and packages are handled and stored is as important as how long they can remain sterile. Store them under conditions that protect them from the extremes of temperature and humidity. Prolonged storage in warm environments at high humidity can cause moisture to condense inside the packages and thus destroy the microbial barrier of some packaging materials. Ventilating and air-conditioning systems with filtered air should maintain a temperature below 75 degrees F and a relative humidity between 20% and 60%. Four air exchanges per hour are recommended by the AAMI (Association for the Advancement of Medical Instrumentation).

38.

A postanesthesia care unit (PACU) nurse called the surgeon to report concerning symptoms in the postoperative patient, and the surgeon came to evaluate the patient. While the surgeon was examining the patient, they received an emergency call stating that he was needed immediately in the operating room (OR). Before rushing to the OR, they gave the nurse a verbal order concerning changes to the patient's currently ordered medications. 

Which of the following statements regarding the authentification of verbal orders is accurate?

  • If facility or state policy on the authentification of verbal orders is unclear or does not exist, a verbal order must be authenticated within 48 hours.

  • The time frame regarding the necessity for a verbal order to be authenticated is at the discretion of the states.

  • The states have afforded the right to determine when a verbal order is required to be authenticated to individual healthcare facilities.

  • The surgeon is required to authenticate the verbal order before the patient is discharged from the perioperative unit. 

Correct answer: If facility or state policy on the authentification of verbal orders is unclear or does not exist, a verbal order must be authenticated within 48 hours.

Verbal orders and telephone orders are to be avoided as much as possible, unless an extenuating circumstance prohibits the healthcare provider from being able to transcribe the written order. Each facility must have a policy in place that clearly states the time frame necessary for the authentification of a verbal order. 

The facility policy is typically determined based on the individual state's statutory guidelines. If the state does not have a guideline for the authentification of verbal orders, then the fallback guideline is that determined by the federal government: a verbal order must be authenticated by the healthcare provider within 48 hours of the order being entered.

39.

Preoperative risk assessment of deep venous thrombosis (DVT) includes diseases which increase this risk. All the following conditions apply except:

  • Chronic obstructive pulmonary disease

  • Obesity

  • Heart disease

  • Thrombophilia

Correct answer: Chronic obstructive pulmonary disease

Venous stasis, age, obesity, immobility, damage to vessel walls, a history of thromboembolic or cardiovascular disease, and changes in clotting factors in the blood are all predisposing factors that increase the risk of developing deep venous thrombosis (DVT). The type, location, and extent of the surgical procedure can contribute also. Preoperative prophylactic interventions, including anticoagulants, sequential compression devices, or antiembolic stockings, can reduce the risk of postoperative pulmonary embolism, which is a life-threatening complication of DVT.

Chronic obstructive pulmonary disease does not increase DVT risk.

40.

Which of the following blood tests measures the ability of the patient's blood to clot by assessing factors V, VII, X, and fibrinogen?

  • PT (prothrombin time)

  • PTT (partial thromboplastin time)

  • Platelets

  • Serum vitamin K

Correct answer: PT (prothrombin time)

A prothrombin time (PT) measures how long it takes blood to clot by assessing factors V, VII, X, and fibrinogen. A PT test can be used to check for bleeding problems. Patients with a decreased ability to clot may be considered too high risk for surgery due to the potential risk of hemorrhage and may need to have surgery postponed until their clotting ability improves.

A partial thromboplastin time (PTT) is often ordered in conjunction with PT for preoperative testing, and also looks at how long it takes for clotting to occur by assessing different factors. Platelet counts determine the number of platelets in the blood, which can also indicate potential bleeding problems if the count is too low (thrombocytopenia). Vitamin K enables the liver to produce clotting factors in the blood. To reduce the possibility of intraoperative hemorrhage, patients who have been receiving anticoagulant therapy and those who have faulty metabolism or absorption of Vitamin K are given Vitamin K preoperatively.

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