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Quiz Session - Attempts With Random Questions

CCI CNOR Exam Questions

Page 5 of 50

81.

Your patient is scheduled for a mastectomy after a positive diagnosis of breast cancer. The surgeon requests a receptor site evaluation of the primary breast tumor. How should you care for the breast tissue specimen removed during surgery?

  • Place the tissue specimen fresh or in saline solution in sterile container and send to the lab

  • Place the tissue specimen on culture swab in sterile tube and send to the lab

  • Cut the tissue specimen into sections, place dry in sterile container and send to the lab

  • Place the tissue specimen in formalin preservative solution in sterile container and send to the lab

Correct answer: Place the tissue specimen fresh or in saline solution in sterile container and send to the lab

Identifying the hormonal dependence of the primary breast tumor through studies of the receptor site is a fairly reliable way of selecting patients who will benefit from pre- or postoperative endocrine manipulation, which does not cure, but can control dissemination of the disease. After a positive diagnosis of cancer, the tumor tissue specimen removed by surgical resection (during the mastectomy) should be sent to the lab fresh or in saline. It should not be placed in formalin preservative solution because doing so will alter the receptor cells enough to negate the hormonal study. Only fluid specimens that are tested for bacteriology are sent on culture swabs, and cutting up the tissue specimen is not necessary.

82.

Prior to the completion of gastrointestinal (GI) surgery, a patient with a distal esophageal core temperature monitoring device in place is noted to be hypothermic. All the following factors are closely associated with the development of perioperative hypothermia, except:

  • Administration of unwarmed intravenous (IV) fluid

  • The type of anesthesia used

  • The dose of anesthesia used

  • The amount of surgical exposure

Correct answer: Administration of unwarmed intravenous (IV) fluid

Many factors can contribute to the development of perioperative hypothermia. Certain individuals are at greater risk of developing perioperative hypothermia, including the very young (under age 2) and the elderly, as well as individuals who have preexisting issues such as burns, cachexia, female gender, or a history of diabetes with autonomic dysfunction. 

Risk factors associated with the surgical experience include the length of time of the surgery, the amount of surgical exposure of the patient, the administration of unwarmed irrigant solution, the type and dose of anesthetic administered, and the ambient temperature of the operating room. 

83.

What are three reasons for specialized hand hygiene?

  • Remove soil and transient microorganisms, decrease resident microorganism count to minimum, and reduce the hazard of microbial contamination of surgical wound by skin flora

  • Remove soil, decrease resident bacteria count to zero, and reduce the hazard of microbial contamination of surgical wound by skin flora

  • Remove transient bacteria, decrease resident bacteria count to minimum, and reduce the hazard of microbial contamination of surgical wound by skin flora

  • Remove soil and transient microorganisms, decrease resident microorganism count to zero, and reduce the hazard of microbial contamination of surgical wound by skin flora

Correct answer: Remove soil and transient microorganisms, decrease resident microorganism count to minimum, and reduce the hazard of microbial contamination of surgical wound by skin flora

Surgical or specialized hand hygiene is the process of removing as many microorganisms as possible from the skin of the hands and arms before donning sterile surgical attire. Despite the antimicrobial component of the hand- and arm-cleansing process, skin is never considered sterile. It is not possible to decrease the microorganism count to zero during hand hygiene. The goal is to remove or deactivate soil, debris, natural skin oils, hand lotions, and transient microorganisms; to decrease the number of resident microorganisms on the skin to an irreducible minimum and to reduce the hazard of microbial contamination of the surgical wound by skin flora.

84.

You are performing preoperative teaching with a patient and his wife. Your documentation of the teaching session should include all the following information except:

  • Environment where teaching occurred

  • Others who were present in addition to the patient

  • The presence of a language barrier

  • Level of understanding shown by the patient

Correct answer: Environment where teaching occurred

Documentation should include who attended the teaching with the patient, the presence of any language barrier, the topic of teaching done, and the level of understanding shown by the patient at the end of teaching.

The environment where teaching occurred does not need to be documented in the patient's chart.

85.

A perioperative nurse was made aware that the surgical team would be receiving a surgical trauma patient transferred from the emergency department (ED). The patient was severely injured when a fight broke out at a club where he was using MDMA (Ecstasy) with friends. The ED physician believes the patient may be experiencing toxicity due to the high dose of MDMA taken. 

The nurse should be prepared to manage all the following symptoms associated with toxicity due to high-dose MDMA ingestion, except:

  • Seizures

  • Hyperthermia

  • Paranoia

  • Tachycardia

Correct answer: Seizures

MDMA (Ecstasy) is an illegal, laboratory-produced, synthetic, hallucinogenic stimulant drug often abused in nightclubs and at rave parties. The drug provides a euphoric, energizing effect, with users claiming loss of inhibitions and feelings of closeness to and empathy for others. 

MDMA has effects similar to amphetamines and cocaine; when taken at high doses, it produces symptoms such as tachycardia, hypertension, and hyperthermia. These symptoms may be life-threatening. Users may experience paranoia and anxiety. In addition to the administration of benzodiazepine drugs, cardiovascular toxicity should be treated with an adrenergic antagonist with a vasodilator.

86.

What is a common coping mechanism sometimes seen in children preoperatively?

  • Regression

  • Repression

  • Identification

  • Denial

Correct answer: Regression

To meet a patient's needs, the health care team should be sensitive to the patient's feelings about the illness. A patient's reactions influence his or her behaviors and the staff's behavioral responses. An understanding of the patient's basic methods of coping is helpful to the caregiver in developing the plan of care. When in a scary or threatening situation, such as facing surgery, a child may cope by regressing (reverting to a more primitive state of being), acting like he did at a younger age. The other options are also coping mechanisms, but children tend to regress more frequently than they display denial (refusing to accept), repression (blocking out thoughts or feelings), or identification (acting as the hero) when faced with surgery.

87.

What types of sponges used in surgery are primarily used on delicate tissues, have a radiopaque element, and have a thread attached?

  • Cottonoids

  • Lap pads

  • Raytex sponges

  • Kitners

Correct answer: Cottonoids

Compressed absorbent cottonoids (also known as patties) are small square or rectangular sponges made of compressed rayon or cotton; they are very absorbent and resemble a strip of felt. They have a radiopaque element and a thread attached, so they can be located in the wound. They are moistened with Ringer's lactate or a topical hemostatic agent, such as thrombin, for use on delicate structures (e.g., nerves, brain, spinal cord). They are pressed out flat after moistening and before handing them to the surgeon.

Lap pads (laparotomy tapes) are used for retaining the viscera and keeping them moist and warm. Raytex (gauze) sponges are used during blunt dissection. Kitner sponges are small, firm, cylindrical rolls of heavy, tightly wound cotton dental tape that are held in a Kelly clamp for use during blunt dissection. All of these types of sponges are radiopaque.

88.

Related to prepping skin graft sites, all the following statements are true except:

  • You may use the same setups for both donor and recipient sites

  • Prep the donor and recipient sites separately 

  • Use a colorless antiseptic agent on the donor site

  • Do not cross-contaminate between donor and recipient graft sites during prepping

Correct answer: You may use the same setups for both donor and recipient sites

Separate setups are necessary for skin preparation of recipient and donor sites before skin, bone, or vascular grafting procedures. Donor and recipient sites are prepped and draped separately. The donor site is usually scrubbed first (surgeon preference). Meticulous care is taken that cross-contamination does not occur from one site to the other. The donor site for a skin graft should be scrubbed with a colorless antiseptic agent, so that the surgeon can visualize the true skin color, and properly evaluate the vascularity of the graft postoperatively. 

89.

A perioperative nurse working in the postanesthesia care unit (PACU) assesses a patient after transfer from the operating room (OR) and finds that the patient's temperature is within normal limits. Regarding the perioperative nursing guidelines on the prevention of hypothermia in postoperative patients, which of the following statements describes what the nurse's next steps should be? 

  • The nurse should institute passive warming methods for the remainder of the patient's time in the PACU.

  • The nurse should return to re-evaluate the patient's temperature within 30 minutes. 

  • The nurse should instruct the patient to call if they begin to feel cold. 

  • The nurse should apply a skin temperature-monitoring device to the patient's chest. 

Correct answer: The nurse should institute passive warming methods for the remainder of the patient's time in the PACU.

Because of the inherent risks associated with the development of postoperative hypothermia, some of the perioperative nurse's main tasks in caring for a postsurgical patient are monitoring for and preventing hypothermia. Regular temperature assessment should be undertaken; if normothermia is found, the nurse should institute passive warming methods for the remainder of the patient's time in the PACU. The goal of passive warming is to maintain the patient's normothermic state, and this is typically accomplished in the PACU through the application of warmed blankets that are changed every 5 to 10 minutes. 

The nurse should also ensure the patient's PACU room temperature is maintained at above 24 degrees Celsius (above 75 degrees Fahrenheit) as an additional method of maintaining normothermia. If, during a later assessment of the patient's temperature, hypothermia is identified, then the nurse should employ active heating methods of rewarming the patient. The patient's temperature should be rechecked every 15 minutes until normothermia is re-achieved. 

90.

Your patient is undergoing an emergency splenectomy following a motor vehicle accident. He has lost a considerable amount of blood. Suddenly, the cardiac monitor alarms, and you note that the patient's rhythm has changed from a normal sinus rhythm to ventricular fibrillation. The patient is pulseless. A code has been called. The patient is lying supine, and IV fluids are being administered with a pressure infuser. CPR is in progress, and a dose of epinephrine has been given. 

What should be done next?

  • Defibrillate the patient

  • Give a second dose of epinephrine 10 ml of a 1:10,000 solution

  • Cardiovert the patient (50-100 joules)

  • Give an antiarrhythmic drug

Correct answer: Defibrillate the patient

Defibrillation should be performed (biphasic defibrillator - 200 joules; monophasic defibrillator - 360 joules), followed by two minutes of CPR (the ratio of compressions to ventilations is 30  to 2 for the adult patient, and 15 to 2 for a pediatric patient). CPR is important immediately after shock delivery. Many victims demonstrate asystole or pulseless electrical activity (PEA) for the first several minutes after defibrillation. CPR can convert these rhythms to a perfusing rhythm. Epinephrine may be repeated every three to five minutes.

91.

When a patient discloses her bulimia nervosa during the preoperative interview, the anesthesiologist should be notified of the patient's eating disorder. 

All the following are associated with bulimia except:

  • Jaundice and liver failure

  • Unstable vital signs

  • Electrolyte imbalances

  • Inadequate kidney function

Correct answer: Jaundice and liver failure

A patient with bulimia and subsequent malnutrition may experience poor tolerance of anesthetic agents due to inadequate excretion of toxins by the kidneys, unstable vital signs, and electrolyte imbalances (low potassium, magnesium, and calcium), among other complications. For these reasons, the anesthesia care provider should be notified of the patient's eating disorder.

There may be a decreased metabolism of chemicals by the liver, but bulimia is not associated with jaundice or liver failure.

92.

Hypotension in an infant is not apparent until what percentage of circulating blood volume is lost? 

  • 50% of the circulating volume

  • 25% of the circulating volume

  • 10% of the circulating volume

  • 40% of the circulating volume

Correct answer: 50% of the circulating volume

Even apparently small blood losses in an infant can be harmful due to the relatively small overall blood volume of these little patients. A blood loss as small as 30 mL can represent a loss as great as 20% of the circulating blood volume in very small patients. 

A narrowed pulse pressure may be the first, subtle indicator of blood loss. Hypotension in an infant is not apparent until 50% of the circulating blood volume is lost, making it a very late indicator of significant blood loss. 

93.

What emergency should perioperative staff watch for as the pediatric patient is waking up from anesthesia?

  • Laryngospasm

  • Bradycardia

  • Hypothermia

  • Decreased respiratory rate 

Correct answer: Laryngospasm

Airway problems, including laryngospasms, obstructions, and aspiration, are the most common concerns on emergence from anesthesia and immediately postoperatively (after extubation), usually resulting from an irritable airway. At the conclusion of the surgical procedure, the oropharynx is suctioned to prevent this from occurring. Treatment involves oxygen administration with positive pressure. 

Hypothermia is a hazard in the recovery period. Perioperative staff and anesthesia care providers must be extremely vigilant during emergence from anesthesia.

94.

Which of the following may be removed from the OR during a procedure?

  • A suture attached to a frozen section sent to the pathologist

  • Soiled linen

  • Paper waste

  • Broken instruments

Correct answer: A suture attached to a frozen section sent to the pathologist

Nothing is permitted to leave the OR during a procedure until the final count is completed and is found to be correct. The only exception is when the surgeon removes a piece of tissue and wants an immediate diagnosis. The tissue specimen sent to the lab may have a "counted" item (such as a suture for orientation or a clamp) attached. The "counted" item must be documented on the intraoperative record.

95.

What is the advantage of bipolar vs. monopolar electrosurgery?

  • It does not require a Bovie pad

  • Energy current flows through the patient's body

  • It generates relatively high output voltage

  • It creates a high-frequency plasma field

Correct answer: It does not require a Bovie pad

Bipolar electrosurgery does not require a Bovie pad (inactive dispersive electrode) because the energy current does not flow through the patient's body as in monopolar electrosurgery. The current is instead directed from the generator to a special Bovie forceps with one active tip and one inactive tip. The current flows from the generator to the active tip and returns to the generator through the inactive tip. Output voltage is relatively low. This provides extremely precise control of the coagulated area. Bipolar electrosurgery is safe for patients with pacemakers and internal defibrillators (since the electrical current is not passing through the body, causing potential disruption in such devices). 

Coblation creates a high-frequency plasma field for ENT and plastic specialties.

96.

You have just finished cleaning an endoscope with a high-level disinfectant. What should you rinse the endoscope with before patient use, so as to prevent tissue irritation?

  • Sterile water

  • Tap water

  • 70% Isopropyl Alcohol (IPA) solution

  • Sterile normal saline solution

Correct answer: Sterile water

Scopes and all accessories should be well rinsed in sterile distilled water before patient use (after disinfecting), to rinse out any remaining solution and prevent tissue irritation. Sterile water is necessary because it does not contain the organisms that ordinary tap water (including boiled water) might. 

Normal saline and IPA solutions are not necessary for rinsing.

97.

You are recovering an adult patient in the PACU. His heart rate is 52 beats per minute, and he is in normal sinus rhythm (NSR) on the cardiac monitor. 

His other vitals are as follows: 

  • BP 112/58
  • Temperature is 36.2 degrees Celsius (97.2 degrees Fahrenheit)
  • Respirations are 16/minute and unlabored
  • Oxygen saturation is 95% with oxygen running at 2 liters/min via nasal prongs

What should you do for this patient?

  • Place a warm blanket over him

  • Increase his oxygen to 5 liters/minute

  • Administer a 500 mL fluid bolus

  • Give morphine 20 mg intravenously (IV)

Correct answer: Place a warm blanket over him

Bradycardia is common in the PACU in adult patients and may be due to hypoxemia, hypothermia, and certain medications. In this case, the patient's temperature is slightly low, so providing a warm blanket is appropriate.

The patient's blood pressure doesn't warrant a fluid bolus as he is not hypotensive and the dosage of morphine (20 mg) is far too high, thus not indicated either. He is oxygenating well at 95% on 2L of supplemental oxygen, and therefore, increasing his oxygen is not necessary.

98.

Assessment of pain in the elderly can be difficult. All the following tools are appropriate when assessing pain in the cognitively intact senior EXCEPT: 

  • Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)

  • Verbal Descriptor Scale (VDS) 

  • Numeric Rating Scale (NRS) 

  • Faces Pain Scale-Revised (FPS-P) 

Correct answer: Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC)

Because assessing pain in the elderly can be difficult, standardized, evidence-based tools and unbiased communication of the results can be the most effective for the cognitively intact and the cognitively impaired. The PACSLAC is an observational tool which can be valuable when assessing pain in the cognitively impaired senior. 

Tools such as the VDS, the NRS, and the FPS-P are generally used with cognitively intact seniors. 

99.

How do you know chemical indicator tape has been subjected to a successful sterilization cycle?

  • Generally, steam sterilization tape starts out tan in color, and the stripes turn dark brown or black during the steam cycle

  • Generally, steam sterilization tape starts out red in color, and the stripes turn yellow during the steam cycle

  • Generally, steam sterilization tape starts out light green and reveals dark brown or black stripes during the steam cycle

  • Steam sterilization tape starts out yellow and turns red during the steam cycle

Correct answer: Generally, steam sterilization tape starts out tan in color, and the stripes turn dark brown or black during the steam cycle

Class 1 chemical indicators involve immediate visual indicators on the exterior of the processed pack, such as striped tape or a tab that changes color in response to the sterilizer. Generally, steam sterilization tape is used and starts out tan in color (not green, yellow or red); the stripes then turn dark brown or black during the cycle.

100.

An earthquake rocks the area and causes injuries and damage to buildings. Each facility has a disaster plan to follow. 

All the following actions would all be included in a disaster plan except:

  • Activate the evacuation plan even if the building appears safe

  • Each department will have a telephone list to call off-duty employees to work

  • A command center will be set up, and disaster protocol will be activated, including communication

  • Triage protocol will be used to prioritize and care for patients

Correct answer: Activate the evacuation plan even if the building appears safe

A facility disaster plan includes a comprehensive plan to care for mass casualties and outlines the plans for both internal and external (such as an earthquake) disasters. Both require rapid activation of all services within the hospital. Each department should have a telephone list to call off-duty employees to work. A command center should be set up, and the disaster protocol activated, including communication. Triage protocol should be used to prioritize and care for patients. 

Provided the facility is intact, an evacuation plan will not be needed.

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