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Quiz Session - Attempts With Random Questions

CCI CNOR Exam Questions

Page 3 of 50

41.

When delegating duties in the OR and assigning the role of the circulator, the OR manager needs to consider:

  • State law may determine to whom the role of circulator may be assigned

  • The role of circulator may only be assigned to a registered nurse

  • The role of circulator may only be assigned to an individual with CNOR certification

  • Regulatory standards set forth by the Association of periOperative Registered Nurses (AORN) determine to whom the role of circulator may be assigned

Correct answer: State law may determine to whom the role of circulator may be assigned

The manager of the OR needs to be cognizant of the facility, state, or regulatory standards and guidelines which may guide, or even dictate, to whom specific tasks may be delegated. Regarding the role of circulator, many states have laws within their nursing practice act that dictate to whom the role of circulator may be assigned.

While the AORN backs the states' ultimate right to determine who may participate in the role of circulator, they strongly advocate for the use of a registered nurse as circulator in every OR assigned to every patient.

42.

NPO (nothing by mouth) refers to no food or water before surgery. NPO time is reduced for what patient groups?

  • Infants, small children, diabetic patients, older adults prone to dehydration

  • Infants, small children, school age children, diabetic patients

  • Infants, small children, ventilator-assisted patients, older adults prone to dehydration

  • Infants, small children, malnourished patients, older adults prone to dehydration

Correct answer: Infants, small children, diabetic patients, older adults prone to dehydration

To prevent regurgitation or emesis, and aspiration of gastric contents, the patient should not ingest solid foods before surgery. These instructions are usually stated as NPO after midnight. Clear fluids may be unrestricted until 2 to 3 hours before the surgical procedure, but only at the discretion of the surgeon or anesthesia provider in selected patients. NPO time is usually reduced for infants, small children, patients with diabetes, and older adults prone to dehydration.

43.

Documentation of implanted materials (total knee arthroplasty) includes what information?

  • Company name, description of component, catalog number, lot number, and expiration date

  • Company name, description of component, catalog number, and expiration date

  • Company name, description of component, catalog number, lot number, and manufacture date

  • Company name, description of component, catalog number, lot number, manufacture and expiration dates

Correct answer: Company name, description of component, catalog number, lot number, and expiration date

Documentation of implants must include all these details: 

  • company name
  • description of component
  • catalog number
  • lot number
  • expiration date

The lot number is documented in case the company issues a recall, and the expiration date ensures that the patient gets the best quality implants. Manufacture date is not necessary to include in documentation. 

44.

An 18-month-old girl is brought to the ER by her parents who state she has been intermittently crying inconsolably for the last six to eight hours and has vomited several times. The child is suspected to be experiencing intussusception. 

All the following interventions would be appropriate, first-line treatment options for intussusception in this scenario, except: 

  • Open laparotomy through a right lower quadrant incision

  • Hydrostatic reduction using barium enema

  • Gas enema to insufflate the colon and small bowel

  • Hydrostatic reduction using tap water

Correct answer: Open laparotomy through a right lower quadrant incision

Intussusception is a surgical emergency for the pediatric patient. It most often occurs in children between the ages of five months and one year of age, and affects males more often than females. In intussusception, a portion of the intestine "telescopes" (slides into another segment of bowel), upon itself, causing an intestinal blockage. Most commonly, the child begins experiencing severe, intermittent abdominal pain, lethargy, nausea and vomiting;  bloody, jelly-like stools often referred to as "currant jelly" stools may occur if hemorrhagic damage to the intestine has begun to occur 

If the intussusception has been present for less than 12 hours, and the child is without any symptoms of intestinal blockage or hemorrhage, the most appropriate treatment choices are: gas enema in which the intestines are insufflated in an attempt to push the intestine back into normal position; or hydrostatic reduction by use of barium enema, tap water enema, or saline or Ringer's lactate enema, in which case the fluid pushes the telescoping intestine back into its normal position.

Surgical intervention through open laparotomy is typically reserved for patients who are showing signs of intestinal obstruction, hemorrhage, or necrosis.

45.

After the initial surgical instrument count is taken, count any instruments added to the table, with one exception. What is that exception?

  • Do not adjust the count for an instrument that has dropped to the floor or been passed off the table and been decontaminated and sterilized for immediate use during the procedure

  • Do not adjust the count for an instrument that has been dropped, recovered from the floor by the circulating nurse and not sterilized, but rather retained by the circulating nurse until the procedure is complete

  • Do not adjust the count for detachable and disassembled parts, such as screws or ratchets

  • Do not adjust the count when an instrument breaks during use and a replacement instrument is used

Correct answer: Do not adjust the count for an instrument that has dropped to the floor or been passed off the table and been decontaminated and sterilized for immediate use during the procedure

If the circulating nurse decontaminates and sterilizes an instrument for immediate use that has dropped to the floor or accidently been passed off the table, an adjustment in the count is unnecessary. This is the only exception. Instruments that are recovered from the floor or passed off the table and not sterilized are retained by the circulator and reconciled at the closing count. Sterilization for immediate use is not recommended, but rather used when no other alternative is available.

Do account for all detachable and dissembled parts. These must be counted or accounted for during assembly and once again during disassembly at the end of the case. Recover and retain all pieces of an instrument that breaks during use. A replacement instrument is added to the count sheet by the circulator.

46.

The perioperative nurse is caring for a four-month-old infant who has undergone craniofacial surgery. Which of the following would not be an appropriate method to assess this patient's pain? 

  • The Wong-Baker FACES pain scale

  • The FLACC pain assessment scale

  • By monitoring physiological parameters

  • By assessment of body movements and facial cues

Correct answer: The Wong-Baker FACES pain scale

The Wong-Baker FACES pain rating scale is an important pain indicator tool which can be used to assess pain in pediatric school-aged children. It is best suited for use in pediatric patients over the age of three years.

The FLACC (Face, Legs, Activity, Cry, and Consolability) behavioral pain assessment scale is a pain scale which can be used by the provider to assess for pain in pediatric patients between the ages of two months and seven years. The inexperienced provider must remember that the infant or young child should not be assessed immediately after they have been made anxious through the presence or activities of the health care provider, as their mere presence may cause the infant or young child to cry or become inconsolable.

Physiologic parameters, such as heart rate and oxygen saturation, can also be utilized to monitor for expression or presence of pain. Elevations in heart rate may result from pain, while pain which is exacerbated by deep breathing may result in the infant or child slowing their breathing or taking shallow breaths, resulting in changes to the oxygen saturation.

Facial cues, such as grimacing, frowning, furrowing of the brow, squeezing shut or narrowing of the eyes, or simply refusing to smile or engage with the nurse can also be indicators of pediatric pain.

47.

A patient is scheduled to have a bodily sample sent to the laboratory for a frozen section analysis. Which of the following specimen types is appropriate for this test?

  • The margin of a potentially malignant lesion

  • The margin of a diseased organ

  • A small section of the ovum

  • Semen for an infertility study

Correct answer: The margin of a potentially malignant lesion

When immediate tissue identification of malignancy is needed, specimens are quick-frozen, sliced, stained, and examined in the laboratory under a microscope. This method of tissue examination is referred to as a frozen section analysis.

The margin of a potentially malignant lesion is excised, and the specimen should be removed from the sterile field immediately upon surgical removal to prevent accidental discard of the specimen. It should be placed in a dry basin or specimen container (without any added preservative, such as formalin or normal saline solution). Formalin or normal saline solution will alter the freezing process used in the specialized pathologic study. Label the clean, dry container with the patient's information, then send it immediately to pathology for tissue examination. The circulating nurse should notify the pathologist that a frozen section will be sent. When the tissue examination is complete, the pathologist will report the results directly to the surgeon in the OR.

A biopsy of a diseased organ is used for a permanent section, not a frozen section. An ovum is a mature female reproductive cell obtained for egg preservation for in vitro fertilization (IVF). Serum for infertility studies is retrieved for cell count analysis.

48.

When attempting to ensure that a culture of justice pervades in the perioperative environment, the nurse manager may need to sacrifice which of the following elements?

  • Productivity

  • Outcomes

  • Safety

  • Effectiveness

Correct answer: Productivity

Maintenance of a culture of justice within the perioperative environment is crucial for maintaining safety and effective performance. If human factors such as pecking order, defensiveness, fatigue, excess workload, distractions, or lack of role clarity begin to jeopardize what should be the just environment of the OR, the manager may need to sacrifice some productivity to ensure safety, performance, and positive outcomes.

49.

When cleaning an anesthesia breathing circuit after a surgical procedure to enable it to be safely used for the next patient scheduled for surgery, the breathing circuit should be cleaned using which of the following methods? 

  • Pasteurization

  • Hydrogen peroxide

  • Ethylene oxide gas sterilization

  • Microwave sterilization

Correct answer: Pasteurization

Pasteurization is a hot water disinfection process completed at a high-level which is used for surgical items which must be reused between patients but cannot be sterilized (reusable items such as respiratory devices and anesthesia breathing circuits). Chlorine detergents are also used in the pasteurization process to aid in killing microorganisms. Endospores are not eliminated by the pasteurization process. 

Hydrogen peroxide disinfection can be used in room-fogging devices to disinfect operating room surfaces. Ethylene oxide gas sterilization is a method of chemical sterilization, and microwave sterilization is a method of radiation sterilization; the anesthesia breathing circuit cannot be cleaned using sterilization methods.

50.

You are about to perform an abdominal skin prep on your patient when you notice that the umbilicus has a piercing present. You should:

  • Remove the jewelry and cleanse the piercing site with alcohol

  • Leave the jewelry in place, but cleanse around the piercing site with povidone-iodine (betadine)

  • Leave the jewelry in place, but cleanse around the piercing site with alcohol

  • Remove the jewelry; it is not necessary to cleanse the piercing site before the skin prep 

Correct answer: Remove the jewelry and cleanse the piercing site with alcohol

Remove all body jewelry that pierces the skin in the surgical area to be prepped, then cleanse the pierced site with alcohol. Piercings should be removed before the patient enters the OR, but this does not always happen in an emergency situation. 

Jewelry, including piercings, should be removed to prevent electrosurgical burns.

51.

A patient with a family history of malignant hyperthermia (MH) comes to the OR for surgery. Anesthesia care providers avoid the MH triggers, and the patient has no complications. 

Which intravenous (IV) anesthesia drug did they avoid?

  • Enflurane

  • Propofol (Diprivan)

  • Ketamine (Ketalar)

  • Dantrolene 

Correct answer: Enflurane

MH is a hypermetabolic crisis triggered by potent halogenated anesthetic agents and depolarizing skeletal muscle relaxants. 

The agents recognized as being the main triggers for MH in susceptible individuals include succinylcholine and the anesthesia gases halothane, enflurane, desflurane, and isoflurane. Non-triggering anesthetic agents should be administered to MH-susceptible individuals. 

The drugs given for avoiding an MH crisis include propofol, ketamine, barbiturates, benzodiazepines, and narcotics. Dantrolene is a specific drug for treatment of MH. 

52.

Abdominal evisceration is best treated in which of the following ways? 

  • Returning to the OR to repair the evisceration

  • Gently pushing the exposed loops back into the abdomen while wearing sterile gloves

  • Calling a code

  • Covering the exposed loops of bowel with a dry, sterile dressing

Correct answer: Returning to the OR to repair the evisceration

Evisceration occurs when viscera (primarily the intestines) protrudes through the full thickness of an abdominal incision. Although wound disruption of any degree calls for emergency care, an evisceration requires immediate replacement of viscera and reclosure of the incision. An emergency call should be placed to the surgeon and a nasogastric (NG) tube should be ready for insertion to relieve distention (if appropriate). Sterile towels saturated with saline solution should be applied to the evisceration to keep the area moist. The patient should be prepared for return to the OR. Treatment in the OR consists of secondary wound closure. Grossly infected wounds may require delayed primary closure. 

Dry gauze may adhere to the exposed bowel loops. Exposed bowel loops should be covered with NaCl (sodium chloride) moistened sterile gauze. Do not attempt to push the loops back into the abdominal cavity. Notify the surgeon immediately for return to the OR.

53.

A patient who underwent an anterior cruciate ligament (ACL) repair suffers a postoperative graft infection and consequently a delayed return to full mobility and injury to the contralateral knee. The patient alleges his injuries resulted from the negligence of the surgeon; he sues the surgeon, the surgical facility where the surgeon is employed and where the surgery took place, and the surgical team involved in his surgery.

Under which of the following legal doctrines may an employer be held liable for the negligence of its employees?

  • Doctrine of respondeat superior

  • Doctrine of the reasonable man

  • Doctrine of res ipsa loquitur

  • The borrowed servant rule

Correct answer: Doctrine of respondeat superior

An employer may be legally held responsible for the negligence of its employees under the doctrine of respondeat superior because the employee functions in the role of a "servant" within a master-servant employment relationship. If it is determined that the employee was correctly adhering to the policy or procedure of the employer, and the policy or procedure was responsible for the injury sustained by the patient, the employee may be removed from the legal suit and the employer held solely responsible for having unsafe or outdated policies or procedures.

The doctrine of reasonable man states that the health care provider can be expected to provide care at a level commensurate with that of other same reasonably prudent professionals who are practicing in similar situations.

The doctrine of res ipsa loquitur allows the patient's injuries, alleged to be sustained at the hands of the health care personnel, to "speak for themselves," or attest to the inference of medical negligence. 

The borrowed servant rule is an older legal rule in which the surgeon was automatically understood to be responsible for and in control of the actions of the entire surgical team, and could be held liable for their negligence. This rule is no longer adhered to in such a broad manner; the surgeon can now only be held liable for the actions of other members of the surgical team if his or her actions prohibit or prevent the surgical team from completing their necessary task.

54.

The thoracic surgeon is meeting with a 72-year-old male who is scheduled to undergo a thoracotomy to treat small-cell carcinoma of his right lung. The surgeon attempts to explain the surgery and possible outcomes, but the patient interrupts and hurriedly signs the informed consent form while stating, "I don't want to hear anymore; just do the surgery and get this over with."

According to informed consent for surgical procedures, what steps should the surgeon take in this scenario?

  • Document what components of the informed consent the patient received and the patient's waiving of the remainder of the explanation of surgery and possible surgical outcomes and proceed with surgery per protocol

  • Require that the patient listen to the full informed consent disclosure, including risks, benefits, and possible complications or refuse to move forward with the surgery

  • Request to speak with the patient's wife, provide her with the full informed consent, and obtain her signature prior to moving forward with the surgical procedure

  • Request a patient advocate meet with the patient to discuss the need for the patient to receive full informed consent prior to proceeding with the surgical procedure

Correct answer: Document what components of the informed consent the patient received and the patient's waiving of the remainder of the explanation of surgery and possible surgical outcomes and proceed with surgery per protocol

It is necessary for informed consent to be obtained prior to performing any surgical procedure. While the surgeon is responsible for providing information about the risks, benefits, and possible complications from the surgery, as well as a general description of the surgery and who will be performing the surgery, the legal age, unimpaired, mentally competent patient is solely responsible for receipt of and signature of consent. Patients have the right to waive the explanation of the essential details and consequences of the surgical procedure and may sign consent for the specific procedure.

A spouse or other family member may be required to sign consent if the patient is unable to sign consent due to an emergency situation or if the patient is incompetent to sign consent. Patient advocates may be beneficial in providing support to the patient if he has concern about signing the consent. Forcing the patient to receive the full explanation is not allowable.

55.

You are the circulator. A patient is being induced when she suddenly begins to yell and thrash around on the operating table. How should you respond?

  • Restrain the patient and remain at her side, ensuring that noise is kept to a minimum

  • Try to stimulate the patient to get her attention

  • Whisper soothing words in the patient's ear while gently holding her hand

  • Administer an increased dose of sedation to move the patient into the relaxation stage quickly

Correct answer: Restrain the patient and remain at her side, ensuring that noise is kept to a minimum

The patient is in the excitement phase of anesthesia, which extends from the time of the loss of consciousness to the time of loss of lid reflex. This stage is characterized by struggling, shouting, talking, singing, laughing, or even crying, and will pass as she moves deeper under the anesthetic agent. These things are avoided in most patients if the anesthetic is administered smoothly and quickly; however, some patients are more susceptible, despite a smooth induction process.

In the patient who does experience some of these reactions during the excitement phase, noise and touch should be kept to a minimum. The patient should be gently restrained as quickly as possible to decrease the risk of injury to the patient and to staff. Remain at the patient's side, quietly but ready to assist the anesthesia provider as needed. 

Do not attempt to stimulate the patient any more than absolutely necessary (with gentle restraint), as she may be susceptible to external stimuli during this time. Do not whisper into her ear or hold her hand, as you may accidentally get struck by a flailing limb. Do not administer more sedation medication, as this is considered to be a normal phase of the induction process that should pass.

56.

Name a short-acting, rapid-onset and recovery muscle relaxant. Then name a long-acting muscle relaxant.

  • Succinylcholine (Anectine); Pancuronium (Pavulon)

  • Midazolam (Versed); Mivacurium (Mivacron)

  • Vecuronium (Norcuron); Atracurium (Tracrium)

  • Rocuronium (Zemuron); Succinylcholine (Anectine)

Correct answer: Succinylcholine (Anectine); Pancuronium (Pavulon)

Succinylcholine (Anectine), Midazolam (Versed), and Mivacurium (Mivacron) are short-acting muscle relaxants with rapid onset and recovery. Atracurium (Tracrium), Vecuronium (Norcuron), and Rocuronium (Zemuron) are intermediate-acting, and Pancuronium (Pavulon) is a long-acting muscle relaxant. 

57.

Your patient is a non-smoker who will be undergoing a lung resection for a fungal infection. All the following interventions will contribute to optimal respiratory status postoperatively EXCEPT: 

  • Shallow breathing and splinting the operative side

  • Deep breathing and coughing

  • Pain control

  • Incentive spirometry (IS) use

Correct answer: Shallow breathing and splinting the operative side

The patient experiencing lung surgery will require adequate and effective pain control to be able to perform incentive spirometry (IS), deep breathing and coughing. These measures may help to prevent atelectasis and infection following surgery. 

Shallow breathing will not allow adequate air supply into the lower lung lobes and splinting the operative side will restrict chest movement.

58.

In what position is the patient typically placed for the initial administration of a general anesthetic?

  • Supine

  • Semi Fowler's 

  • Fowler's 

  • Reverse Trendelenburg

Correct answer: Supine

The patient is initially placed in a supine position (lying flat on the back). This position is used in the event that the patient has a reaction to the induction medication. Do not move or begin prepping the patient until the anesthesia provider says it is safe to do so. 

While supine, the patient is usually placed in a "sniffing position," a combination of flexion of the neck and extension of the head. This is considered to be suitable for the performance of endotracheal intubation after general anesthesia takes effect. To place a patient in this position, anesthesiologists usually put a pillow under a patient's occiput.

59.

A fire prevention plan in the perioperative setting should include all the following EXCEPT: 

  • A code blue call list 

  • An operation manual of fire alarms and extinguishers

  • Evacuation routes and procedures

  • Directions on the proper use of surgical prep solutions that are flammable

Correct answer: A code blue call list 

A written fire prevention plan includes locations and instructions on the use of fire pulls and fire extinguishers, evacuation routes and procedures, and fire prevention techniques. Fire drills should be scheduled routinely and be part of competency testing. In addition, perioperative staff should be knowledgeable about the proper use of surgical prep solutions that are flammable, and should know the uses of fire extinguishers, be able to distinguish among the three main classes of them, and know how to operate them. 

The code blue call list to call in more staff is not included in a fire prevention plan.

60.

Essential elements of endoscopic procedures include all the following except:

  • A flexible endoscope

  • Specimen collection

  • Instruments to manipulate tissue

  • Evacuation

Correct answer: A flexible endoscope

Endoscopic technology, regardless of whether it is performed with a rigid scope or flexible scope, has eight elements in common. These eight aspects provide successful endoscopic surgery:

  1. Access (portal or natural body opening)
  2. Working space within the body
  3. Illumination of the working space
  4. A camera or lens to view inside the body
  5. Instruments to manipulate tissue
  6. Capture of specimens within the working space
  7. Evacuation of gases, fluids, and solids from the body
  8. Closure of the access portal(s)
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