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CCI CNOR Exam Questions
Page 6 of 50
101.
Which of the following personnel is typically responsible for the administrative and supervisory duties within the perioperative patient care services area?
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Registered nurse (RN)
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Business manager
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Chief of surgery
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Administrative financial officer
Correct answer: Registered nurse (RN)
The perioperative patient care center of any health care facility is a high-cost department that requires management as a business. This management style results in cost management and effective delivery of patient care services; the individual in this role is also responsible for supervision of direct patient care.
The individual best suited to this critical, complex role in the perioperative area is the RN. The perioperative nurse manager is required to have a strong background in OR nursing, experience in management, and education or knowledge of business and financial management. Her leadership skills should support and guide direct patient care through a strong knowledge of nursing theory and evidence-based practices.
102.
After prewarming in the operating room (OR), a patient's temperature was checked and found to be normothermic. The anesthesia provider induced anesthesia, and the procedure started. Within 30 minutes of starting the procedure, the perioperative nurse notices that the patient's temperature has dropped.
Which of the following statements regarding perioperative temperature loss is accurate?
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The most significant drop in core temperature occurs during the first hour of surgery.
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Core temperature loss stabilizes approximately 1 to 2 hours into surgery.
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Changes in the core temperature occur in a linear manner, gradually dropping during the surgery.
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Perioperative temperature loss is most affected by the type and dose of anesthetic.
Correct answer: The most significant drop in core temperature occurs during the first hour of surgery.
All surgical patients experience a drop in their core temperature during surgery, regardless of their underlying health status, comorbidities, gender, age, type and dose of anesthetic used, or type and length of surgery. The mechanisms behind this core temperature drop are many. The initial drop in temperature is because an anesthetized patient has no ability to respond to peripheral temperature changes resulting from the ambient room temperature, surgical exposure, and the application of wet cleansing products to bare skin. The responses of the autonomic nervous system to cold stimuli are blunted by anesthetic effects, preventing a patient from shivering and reducing vasoconstriction, in addition to the obvious inability of the patient to get up and move about to generate heat production. Furthermore, general anesthesia both decreases metabolic heat production and increases heat lost through the skin.
The most significant drop in core temperature occurs during the first hour of surgery, with an average drop in temperature between 1 degree Celsius to 1.5 degrees Celsius. After the first hour, heat loss slows and becomes more linear, plateauing over the next 2 to 3 hours. The core temperature does not begin to stabilize until approximately 2 to 4 hours into the surgery due to a reactivation of the autonomic response.
103.
All the following must be recorded on the intraoperative patient care record EXCEPT:
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The name of the person who provided preoperative teaching
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Instrument counts before and after surgery
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The condition of the patient's skin before and after surgery
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The position the patient is placed in for the surgical procedure
Correct answer: The name of the person who provided preoperative teaching
Preoperative teaching is done before surgery and is typically recorded on the preoperative record, not the intraoperative record.
The intraoperative record documents important information such as instrument count, patient's skin condition, and patient's position during surgery.
104.
During which of the following surgeries are ebonized surgical instruments most likely to be used?
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Cervical laser vaporization for CIN III
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Implantation of an artificial hip in which the femoral stem was manufactured using vitallium
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Conventional phacoemulsification
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Any surgery in which the surgical site is known to be infected
Correct answer: Cervical laser vaporization for CIN III
Surgical instruments may be finished (in the manufacturing process) and receive a special coating designed to improve their surgical function. Stainless steel items are typically highly polished to withstand corrosion, but the shiny appearance can cause glare for the surgeon or interfere with the surgeon's ability to visualize structures during surgery. Polished steel instruments may also reflect the operating room (OR) lights, also interfering with visualization during surgery. Other devices may be finished using deposits of nickel or chromium that are adhered to the steel using an electrolytic process. These anodized instruments have a dull metallic appearance, effectively preventing glare or other visual interference during surgery, but they are much more prone to corrosion of the surface of the instruments.
Ebonized instruments have received surface darkening through a chemical oxidation process. These instruments are typically used during laser procedures, such as cervical laser vaporization for CIN III or laser phacoemulsification for cataracts. Some surgeons prefer to use these darker-colored instruments during all surgical procedures, as they feel the instruments are better visualized against the internal tissues. Ebonized instruments should be carefully inspected before sterilization and use during surgery to assess for any damage to the coating, as this would render the instrument unusable.
105.
A new free-standing ambulatory surgery center that is owned by a private orthopedic surgical group is under construction, and the human resources manager has begun to advertise for hiring. When hiring individuals to work in the sterile processing area, which of the following OR personnel are well-suited for this role?
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Surgical technologists
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Perioperative nurses
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Scrub nurses
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Surgical first assistants
Correct answer: Surgical technologists
The surgical technologist is a member of the perioperative team who typically works under the direction of the circulating nurse in the OR, generally supporting the anesthesia provider and surgeon. They are responsible for the preparation and provision of instruments, surgical supplies, and OR equipment, with the ultimate goal being the preservation of a safe, sterile surgical environment.
The surgical technologist may be prepared for practice through several different clinical programs, ranging from a nine-month certificate program to a two-year associate's degree program. Surgical technologists are excellent choices for working in the sterile processing area due to their technical background.
Perioperative nurses and scrub nurses are not educationally prepared for technical work.
A surgical first assistant may be a registered nurse (RN) who has achieved certified perioperative nurse (CNOR) certification, an RN who has achieved RNFA (Registered Nurse First Assistant) status through further education and certification, an advanced practice nurse with OR background, or a surgical technologist who has completed a postgraduate first-assisting program. These individuals have a clinical education, not a technical one.
106.
Following cleaning and high-level disinfection, what should be done first to internal channels of a flexible endoscope?
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Flush with sterile distilled water
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Hang to dry
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Rinse with 70-90% ethyl or isopropyl alcohol
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Pressure test for leaks
Correct answer: Flush with sterile distilled water
Following high-level disinfection, flexible endoscopes should be well rinsed/flushed (and internal channels flushed) with sterile distilled water before they are used, to prevent tissue irritation from disinfecting solution. The endoscope is then rinsed/flushed with 70-90% ethyl or isopropyl alcohol, and lastly, air blow-dried. The scope should be inspected for damage after thorough mechanical cleaning, but before sterilization occurs.
Preferably, all endoscopic equipment should be terminally sterilized; otherwise it should be high-level disinfected after thorough mechanical cleaning.
107.
While planning for a total hip revision surgery, you check your patient's lab work. Mrs. H.'s HgB is listed as 9.6. You recognize the potential for blood loss during a hip revision. You bring the Cell Saver (autotransfusion) machine into the OR; then you discuss this option with the anesthesia care provider and surgeon.
What Standards of Perioperative Nursing involve using the Cell Saver to collect and return the patient's blood through autotransfusion?
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Assessment, Diagnosis, Outcome Identification, Planning, Implementation
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Diagnosis, Outcome Identification, Planning, Implementation, Collaboration
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Assessment, Outcome Identification, Planning, Implementation, Research
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Assessment, Diagnosis, Outcome Identification, Planning, Ethics
Correct answer: Assessment, Diagnosis, Outcome Identification, Planning, Implementation
The six Standards of Perioperative Nursing Practice include assessment, diagnosis, outcome identification, planning, implementation, and evaluation. Using these Standards, perioperative staff recognize the patient's risk of hypovolemia and anemia (through assessment, diagnoses, and outcome identification), and they plan and work together, implementing the interventions planned to save the patient's blood and autotransfuse. The only Standard not yet used in the scenario is evaluation.
Collaboration, Research, and Ethics are not a part of the six Standards of Perioperative Nursing Practice.
108.
The frequent or prolonged use by the scrub nurse of which of the following instruments or instrument techniques may result in carpal tunnel syndrome?
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Manual retractors
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Tripod grip on scissors
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Tissue forceps
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Sharp scissors dissection
Correct answer: Manual retractors
The scrub nurse must be skilled and knowledgeable in the correct use of many surgical instruments and surgical instrumentation methods. Even if instruments have been ergonomically designed to not cause harm to the patient or to the individual handling the instrument, lack of knowledge or skill in the correct use may cause damage.
Manual retractors are designed ergonomically in order to provide ample exposure of the surgical tissues without causing fatigue to the operator. Use of manual retractors can be physically demanding, however, and prolonged use can contribute to repetitive stress injuries of the user's wrist and arm causing carpal tunnel syndrome. If the scrub person is noticing strain or fatigue while using retractors, an alternate retractor-type should be requested and utilized. Ensuring that correct or appropriate instruments are used to prevent injury is a necessary component of risk management.
109.
The perioperative team is preparing to receive a patient requiring surgical intervention to repair craniosynostosis. Which of the following methods of reducing blood loss is most appropriate for this patient?
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The use of hypotensive anesthesia
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Hemodilution through the removal of the patient's blood and replacement of the blood volume with a plasma volume expander
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The administration of blood volume expanders such as dextran
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The administration of vasodilator medications such as sodium nitroprusside
Correct answer: The use of hypotensive anesthesia
There are several methods which may be used to reduce blood loss in surgeries that are known to result in high-volume blood loss. The use of hemodilution (brought on by removing some of the patient's blood and replacing it with a plasma volume expander), the administration of a blood volume expander such as dextran, the administration of vasodilator medications, and the use of hypotensive anesthesia are all methods which may be used for this purpose. The choice of method is dependent upon the type of surgery being performed, the location of the surgery on the body, the overall condition of the patient, and the extent and duration of the surgery.
Head and neck surgeries, such as repair of craniosynostosis, are typically surgeries that involve the loss of an extreme volume of blood. Knowing this, the perioperative team typically takes preemptive steps to minimize potential blood loss and the resultant sequelae. The use of hypotensive anesthesia in head and neck surgeries has been found to reduce blood loss by as much as 40%. During this anesthetic technique, the mean arterial pressure is deliberately lowered through the use of one of the several combinations of anesthesia drugs and techniques which may be used for inducing controlled hypotension, in order to produce an essentially bloodless field.
110.
A 15-year-old female patient with a history of scoliosis is scheduled for spinal fusion and has a Risser jacket in place. The surgery will be completed through a window made in the jacket. Which of the following surgical equipment/tools is it most critical to keep on hand when performing surgery on a patient in a Risser jacket?
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An electric cast cutter
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Casting material to repair the window defect
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Skeletal traction equipment
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An extra endotracheal tube
Correct answer: An electric cast cutter
A Risser jacket is a type of plaster cast applied to the torso to treat scoliosis. It is typically applied to the patient just a few days ahead of a scheduled posterior spinal fusion in an attempt to achieve optimal correction of the spinal deformity. The cast may be applied with the patient positioned on a Risser table, or the patient may stand upright for the procedure. A chin strap is first applied with counter traction, then applied by a pelvic girdle, and the spine is straightened as much as possible by increasing the traction. Once the spine has been straightened as much as possible using the traction device, the Risser jacket is applied, enclosing the body and the head of the patient. The patient wears the casting device for several days, and then a surgical procedure (or a series of procedures) to fuse the spine is undertaken.
When a spinal fusion is completed with a Risser jacket in place, it is necessary to cut a window into the posterior of the jacket cast to allow access to the surgical site. Because respiratory issues may arise during surgery due to administered anesthetics, patient positioning, or surgical complications, an electric cast cutter must be kept on hand to remove the case in an emergency.
111.
What is the most reliable indicator of a patient's existence and intensity of postoperative pain?
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The patient's self-report
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The surgeon's report
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The perioperative nurse's report
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The anesthesia provider's report
Correct answer: The patient's self-report
Patients are assessed for vital signs and level of discomfort. Pain is considered to be the fifth vital sign and has been referred to as both physiologic and psychologic. A pain assessment provides the foundation for good pain control and includes obtaining location, intensity, and pain rating scale (based on age and cognition). The gold standard for assessing the existence and intensity of pain is the patient's self-report.
The nurse's report, surgeon's report, and anesthesia provider's report all aid in the clinical picture of pain assessment, but the patient report is the most valuable.
112.
Patient stretcher transportation from the preoperative holding room to the OR involves all the following actions except:
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Attach the IV pole to the stretcher near the patient's head
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Push from the head end so the patient's feet go first
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Make sure the staff member is at the patient's head
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Ensure slow and smooth travel
Correct answer: Attach the IV pole to the stretcher near the patient's head
The IV pole should be placed at the foot of the stretcher for safety, away from the patient's head.
Transporting a patient involves the patient going feet first with the staff member pushing the stretcher at the patient's head, and the travel should be slow and smooth. Rapid movements through corridors and around corners can cause dizziness and nausea, especially if the patient has been medicated. The staff member at the head end can observe the patient for respiratory distress and/or vomiting.
113.
A large amount of blood is spilled onto the operating room floor during surgery. You are the circulating nurse. What should you do?
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Put on appropriate PPE and clean up the spill using an EPA-approved disinfectant
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Throw a towel over the spill until it can be properly cleaned, and warn others to be careful
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Call housekeeping to come in and clean up the spill immediately
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Put on appropriate PPE and clean up the spill using bleach
Correct answer: Put on appropriate PPE and clean up the spill using an EPA-approved disinfectant
Blood or body fluids that have spilled on the floor during a procedure should be wiped up immediately and the area decontaminated. You should use an EPA-approved (Environmental Protection Agency) and registered disinfectant to clean up blood or body fluids. Gloves, masks, and eyewear are worn for cleaning procedures.
Throwing a towel down presents a hazard to others. Calling in housekeeping during surgery would not be appropriate. Bleach is not an approved disinfectant.
114.
Intraoperative monitoring of oxygen saturation can be achieved by a combination of methods. Which of the following combinations is recommended by the American Society of Anesthesiologists (ASA)?
Choose the best answer.
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Oxygen analyzer, pulse oximeter, and observation of skin/nail bed color
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Pulse oximeter, blood pressure, and heart rate
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Oxygen analyzer, heart rate, and nail bed color
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Skin/nail bed color, blood pressure, and oxygen saturation
Correct answer: Oxygen analyzer, pulse oximeter, and observation of skin/nail bed color
Oxygen saturation is best determined using a pulse oximeter, oxygen analyzer, and observation of skin and nail bed color.
Although heart rate and blood pressure may change if the patient is very hypoxic, this is not a reliable indicator of oxygenation status.
115.
A patient who has undergone diagnostic testing in nuclear medicine is scheduled for surgery. How long should surgery be delayed to prevent exposure of the OR team to radiation?
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24 hours
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48 hours
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12 hours
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No delay is required for patients who have undergone diagnostic testing in nuclear medicine
Correct answer: 24 hours
Diagnostic testing may be required as part of the preoperative preparation for patients scheduled to undergo surgery. A patient who has received radioactive substances for diagnostic studies may emit up to 2 milliroentgens (mR)/hr. If possible, surgery should be delayed for at least 24 hours after the test to prevent the OR team from being unnecessarily exposed to radiation.
116.
You should communicate your patient's contraindications to pneumatic compression devices (deep vein thrombosis prevention) to the surgeon.
Contraindications include all the following except:
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A healed wrist fracture
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Uncontrolled congestive heart failure
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Lower extremity ischemic vascular disease
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Lower extremity conditions such as dermatitis, infection, unhealed injuries and surgical sites
Correct answer: A healed wrist fracture
Contraindications for pneumatic compression devices for deep vein thrombosis (DVT) prevention include lower extremity conditions such as dermatitis, infection, unhealed injuries and surgical sites, gangrene, lower extremity ischemic vascular disease, and uncontrolled congestive heart failure. Other measures to augment venous flow and assist in venous return include anticoagulants, antiembolic stockings, elevation of the legs as little as 15% above horizontal, frequent turning, flexion and extension of the legs and feet, and early ambulation (unless contraindicated).
A healed fracture of the wrist would not be a contraindication for use of pneumatic compression devices to aid in DVT prevention.
117.
A scrub person and a circulating nurse are completing the preoperative count of the surgical equipment. Included in the count are several Babock clamps. The Babcock clamp is most likely to be used in all the following surgeries, except:
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Aneurysm repair
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Prostatectomy
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Tubal ligation
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Appendectomy
Correct answer: Aneurysm repair
A Babcock clamp is a type of straight, ring-handled forceps that may be locked in place with a ratcheting feature. The jaw end of a Babcock clamp (forceps) has broad round or flared ends that are used to grasp tubular body structures or tissue without crushing or damaging the tissue.
This type of clamp/forceps is most often used in surgery such as prostatectomy (to hold the bladder), tubal ligation (to hold the fallopian tubes), appendectomy, or other intestinal and laparotomy-type procedures.
118.
A patient who is undergoing knee arthroplasty during which polymethylmethacrylate (PMMA) bone cement is being used is most at risk of experiencing which of the following significant adverse reactions related to skin contact with the PMMA product?
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Burns
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Contact dermatitis
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Transitory hypotension
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Emboli
Correct answer: Burns
Polymethylmethacrylate is an acrylic product that continues to be regularly utilized during orthopedic surgery during which bone stabilization or artificial joint implants are needed. The liquid portion of the product is highly flammable and, when mixed with the powder portion of the compound, causes the release of vapors that are highly irritating to the eyes and respiratory system of anyone in the vicinity. PMMA should only be mixed using a closed vacuum system (ideally), with the individual doing the mixing using a special personal hood protectant system.
The liquid component of PMMA can also be absorbed through the skin if it comes into contact with unprotected skin; once mixed with the powder component, the product has been known to penetrate both plastic and latex gloves. Skin contact with the product can provoke contact dermatitis (less significant) and, if incidentally applied to the patient's skin, may cause burns (significant) as the product cures. PMMA inserted into the surgical joint can also cause transient hypotension, emboli, thrombophlebitis, cerebrovascular accidents, myocardial infarction, and cardiac arrest.
119.
An OB/GYN is interviewing a female patient and her spouse who have been struggling with infertility and wish to pursue in vitro fertilization (IVF) to achieve pregnancy. If discovered during the subsequent examination, which of the following issues that can cause infertility would be most likely to preclude the couple from undergoing in vitro fertilization?
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Uterine myoma
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Tubal occlusion
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Incompetent cervix
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Diminished ovarian reserve
Correct answer: Uterine myoma
While couples who have struggled to achieve a successful pregnancy often believe that IVF is available to anyone who wishes to become pregnant, many infertile couples are not candidates for IVF. Most commonly, infertility is caused by tubal occlusion (female) but may also be caused by female issues such as uterine myxoma; uterine deformities such as a unicornuate, bicornate, or septate uterus; diminished ovarian reserve; issues with ovulation caused by disorders such as polycystic ovarian syndrome (PCOS) or thyroid hormone problems; or issues with cervical mucus.
Male infertility is also possible; issues such as spermatocele can contribute to a decreased number of viable sperm or occlude the sperm's ability to leave the epididymis. Female issues such as PCOS or problems with the cervical mucus may be amenable to less invasive methods of achieving pregnancy, such as the use of medications to treat the underlying disorder, while other issues that contribute to infertility may require more complex management. Women who have uterine myomas (fibroids) or uterine deformities are not candidates for IVF due to the negative effects they can have on both achieving pregnancy and the ability to maintain a pregnancy. Tubal occlusion is the most common reason for undergoing IVF; women with a diminished ovarian reserve may also be candidates for IVF.
An incompetent cervix is typically not diagnosed until a pregnancy has been achieved and has entered the second trimester.
120.
Which of the following individuals may serve as a surgical first assistant without having completed a registered nurse first assistant (RNFA) program?
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A certified nurse midwife (CNM)
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An advanced practice nurse (APN)
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A certified perioperative nurse (CNOR)
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A circulating nurse
Correct answer: A certified nurse midwife (CNM)
Most states allow a CNM who has undergone additional surgical training to function in the role of surgical first assistant for obstetric patients requiring surgical intervention, such as cesarean delivery. This privilege may shorten the time to surgery for the patient, as it is not necessary to call in the necessary surgical staff since the CNM is typically already present with the laboring woman. The CNM's ability to function as surgical first assistant does not typically extend past her ability to assist in obstetric procedures, although some facilities may allow for her participation in certain gynecologic surgeries after completion of additional surgical education.