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Quiz Session - Attempts With Random Questions

CCI CNOR Exam Questions

Page 7 of 50

121.

The MOST effective means of preventing the spread of infection is:

  • Proper hand hygiene 

  • Wearing gloves during procedures requiring their use

  • Wearing a mask when you are ill

  • Wearing a gown to prevent the transfer of microorganisms from your clothing

Correct answer: Proper hand hygiene 

Thorough handwashing with an approved antimicrobial agent after every contact with a patient, contaminated items, or suspected contamination protects both the patient and personnel, and cannot be overemphasized. 

Washing your hands before entering the OR and before and after each contact with a patient is the most effective means of reducing the spread of microorganisms. Hands should be washed after removing contaminated gloves because gloves are not 100% impervious (all gloves have microscopic holes and may be permeable to certain substances or microorganisms). 

All the other choices are reasonable and good actions, but are not as important as proper hand hygiene.

122.

A 29-year-old female patient who was diagnosed with infertility due to tubal occlusion returned to the surgical center for embryo transfer. Once the embryo has been inserted, which of the following steps is most likely to be taken to help ensure the successful implantation of the embryo?

  • The patient will be given an injection of progesterone.

  • The patient will be positioned supine with her hips elevated on two pillows for one hour.

  • The patient will receive daily estrogen and progesterone injections for the next 12 to 15 days.

  • The patient will be instructed to drink 2 liters of fluid every day for the next 12 to 15 days.

Correct answer: The patient will be given an injection of progesterone.

In vitro fertilization (IVF) is indicated for patients who have been diagnosed with infertility and who have failed more conventional methods of treating infertility. For a patient to be a candidate for IVF, the cause of infertility must be amenable to IVF (i.e., the patient cannot have congenital uterine deformities such as a unicornuate uterus or septate uterus, or uterine myomas that interfere with maintaining pregnancy). Once the patient has been approved for IVF, she will undergo medical stimulation to release an optimal number of mature ova and then will undergo retrieval of the ova using a transvaginal, transvesical, or transabdominal approach. The ova are then fertilized in the lab, and approximately 48 hours later, the patient is asked to return for implantation of the embryo(s). 

The patient is not anesthetized for the insertion of the embryo(s). She is positioned in the knee-chest position for the insertion and asked to remain in that position for at least one hour following the procedure. She will be given a progesterone injection immediately following the procedure to help support the implantation of the embryo and receive daily injections of progesterone for 12 to 15 days. After 12 to 15 days, the patient's ovaries will likely support the early pregnancy. 

123.

When preparing the OR for a geriatric patient who will be undergoing surgery, which of the following actions can the perioperative nurse take to best ensure the patient does not experience hypothermia as a result of environmental factors?

  • Warm IV fluids prior to administration

  • Obtain a warming lamp to be placed at the OR bedside

  • Place warmed bags of IV fluids against the patient's trunk

  • Set the OR temperature to 77 degrees Fahrenheit

Correct answer: Warm IV fluids prior to administration

Geriatric patients are at greater risk for inadvertent hypothermia within the intraoperative environment due to several factors associated with aging: decreased basal metabolic rate, thinner skin, limitations in the cardiovascular reserve, and decreased muscle mass. A basal body temperature below 96.8 degrees Fahrenheit can be indicative of hypothermia. 

The perioperative nurse should take proactive steps to ensure the geriatric patient does not experience hypothermia. Measures which can be utilized include ensuring the ambient room temperature is maintained between 68 degrees Fahrenheit to 75 degrees Fahrenheit; using warm blankets and warm air circulating devices such as the Bair Hugger; warming intravenous (IV) fluids and blood products prior to administration; warming and humidifying anesthetic gases; and covering the patient's head to prevent heat loss. 

Heat lamps were used years ago to aid in maintaining body temperature; however, their use resulted in frequent burns and is no longer recommended. Placing warmed bags of IV fluids around the patient's torso may result in inadvertent second- or third-degree burns and also is not advised. While the use of warmed IV fluids and warm air circulating devices such as the Bair Hugger are standard accepted practice for preventing hypothermia, these devices still may cause thermal burns; patients should be monitored carefully when these devices are in use.

The ambient OR temperature should not be raised above 75 degrees Fahrenheit per TJC standards.

124.

The surgeon says he wants tissue sent for permanent section. How do you care for it?

  • Put the tissue in a chemical (usually formalin), label with patient and specimen identification, and send to lab after procedure

  • Put the tissue in a dry container, label with patient and specimen identification, and send to lab after procedure

  • Put the tissue in NaCl, label with patient and specimen identification, and send to lab after procedure

  • Put the tissue in a dry container, label with patient and specimen identification, and send to lab immediately during procedure

Correct answer: Put the tissue in a chemical (usually formalin), label with patient and specimen identification, and send to lab after procedure

Permanent section specimens are put in a fixative (commonly formalin), labeled properly and sent to the lab after the procedure. They sit in the solution for several hours to cause the cells to become firm. The fixed specimen is placed in a machine to remove all water from tissues, replacing it with paraffin, then embedded into a block of wax. The wax is cut into thin slices and placed onto glass slides for diagnosis.

Permanent section specimens are not sent to the lab dry or in NaCl, and it is not necessary that the specimen be sent immediately.

125.

The byproducts of low-temperature hydrogen peroxide vapor sterilization do not require a special aeration process. Why is this?

  • Because the byproducts are oxygen and water vapor

  • Because the byproducts are carbon dioxide and water vapor

  • Because the byproducts are nitrogen and water vapor

  • Because the byproducts are ethylene oxide and water vapor

Correct answer: Because the byproducts are oxygen and water vapor

After the sterilization process is completed, the byproducts of hydrogen peroxide vapor sterilization are oxygen and water vapor and require no aeration; they are safely evacuated into the room atmosphere. This system is much safer for central supply workers than using ethylene oxide, which does require aeration.

126.

You are the circulating nurse. Your patient is undergoing a laser procedure using carbon dioxide (CO2). You notice that the relief scrub nurse is not wearing the recommended protective eyewear. What should you do?

  • Ensure the laser is on standby and provide the proper eyewear

  • Ensure the laser is on standby and ask the relief scrub nurse to leave the OR

  • Resolve to complete an incident report when the surgical procedure has been completed

  • Ensure the laser is on standby and page the OR manager to come and deal with the situation

Correct answer: Ensure the laser is on standby and provide the proper eyewear

The eye is the most susceptible organ to laser surgery. Make sure the laser is on standby and provide the recommended eyewear to the relief scrub nurse. Explain the need for proper eyewear to protect the eyes from damage. All protective eyewear must shield the wearer's eyes from the top, bottom, and sides of the visual field. 

127.

Your patient is 16 weeks pregnant. Which position best maximizes oxygenation to the fetus and prevents hypotension in the patient during a surgical procedure?

  • Supine with the right hip slightly elevated

  • Supine with the left side slightly elevated

  • Reverse Trendelenburg

  • Left dorsal recumbent

Correct answer: Supine with the right hip slightly elevated

In the supine position, the gravid uterus compresses the inferior vena cava and aorta, resulting in diminished venous return to the heart, stroke volume, and cardiac output. To avoid this, positioning the patient supine with the right side slightly elevated by a wedge (placed under the right hip) to tilt the uterus to the left and displace pressure off the aorta and inferior vena cava maximizes oxygenation to the fetus and reduces the risk of hypotension in the patient. The OR bed may also be tilted 30 degrees to the left. A slight Trendelenburg's position may assist venous return in the patient.

128.

What is one antibiotic given preoperatively that can potentiate anesthesia neuromuscular blocking agents?

  • Clindamycin (Cleocin, ClindaMax)

  • Vancomycin (Vancocin)

  • Cefazolin (Ancef, Cefacidal)

  • Ciprofloxacin (Cipro, Cetraxal)

Correct answer: Clindamycin (Cleocin, ClindaMax)

Skeletal muscle relaxant drugs, referred to as neuromuscular blockers, facilitate muscle relaxation for smoother endotracheal intubation and working conditions during the surgical procedure. Clindamycin can enhance the effect of these drugs. The anesthesia care provider should be reminded that the patient received clindamycin so the dosage of muscle relaxant (the neuromuscular blocker) given can be adequately adjusted.

129.

Safe Bovie pad (inactive dispersive electrode or IDE) application includes all of these actions except:

  • Use as small a pad as possible

  • Place the Bovie pad (IDE) as close as possible to the surgical site

  • Position patient before applying the IDE and never move or reuse the disposable pad

  • Avoid placing the pad over implants, bony prominences, scar tissue, or hairy skin

Correct answer: Use as small a pad as possible

The IDE should cover as large an area of the patient's skin as possible (in an area free of hair or scar tissue); the surface area affects heat buildup and dissipation.

Proper application and usage of a Bovie pad (IDE) prevents patient injury. Proper actions include the following: positioning the patient before applying the IDE to prevent it from becoming dislodged or buckled during patient positioning; never moving or reusing the disposable pad; placing the Bovie pad as close as possible to the surgical site to minimize current through the body; and avoiding placing the pad over implants, bony prominences, scar tissue, or hairy skin (which tend to act as insulation). Also important to note, the return electrode should never be cut to fit. 

130.

According to the American Society of Anesthesiologists (ASA), a patient with a severe systemic disease, such as chronic obstructive pulmonary disease (COPD), would be classified as:

  • Class III

  • Class II

  • Class VI

  • Class V

Correct answer: Class III

The American Society of Anesthesiologists (ASA) and AANA (American Association of Nurse Anesthetists) have established guidelines and standards for safely administering and monitoring anesthesia care. The ASA also developed a grading system for classifying patients by physical status from class 1, the lowest risk, to class 6, the highest risk. This grading system is simply to assess the degree of a patient’s "sickness" or "physical state" prior to selecting the anesthetic or prior to performing surgery:

  • Class I: Normal healthy patients
  • Class II: Patients with mild systemic disease (e.g., diabetes mellitus controlled by oral hypoglycemic agents or diet)
  • Class III: Patients with severe systemic disease that limits activity but is not totally incapacitating
  • Class IV: Patients with an incapacitating disease that is a constant threat to life (cardiovascular or renal disease)
  • Class V: Moribund patients who are not expected to survive 24 hours with or without the surgical procedure. They are operated on in an attempt to save their lives.
  • Class VI: A declared brain-dead patient whose organs are being removed for donor purposes

131.

Unsterile staff should avoid the sterile area(s) in the OR by all the following means except:

  • Reaching over the sterile field to dispense medication

  • Facing the sterile field when walking past to avoid touching it

  • Avoiding walking between two sterile areas (tables, etc.)

  • Keeping at least 12 inches (1 foot) between them and the sterile field

Correct answer: Reaching over the sterile field to dispense medication

Unsterile staff (circulating nurse) never reaches over a sterile field to transfer sterile items or dispense medication. 

Unsterile staff should face and observe a sterile field when walking past to avoid touching it, should never walk between two sterile areas (tables, etc.), and should maintain a distance of at least 12 inches (1 foot) from any area of the sterile field. In addition, the circulating nurse should restrict all activity near the sterile field to a minimum.

132.

When you check your diabetic patient's chart preoperatively, what information do you want to know about blood sugar?

  • Last blood sugar test results and time; last dose and time of diabetic medicine given

  • Last blood sugar test results; last dose and time of diabetic medicine given

  • Last blood sugar test results; time of last diabetic medicine given

  • Last blood sugar test results and time; last dose of diabetic medicine given

Correct answer: Last blood sugar test results and time; last dose and time of diabetic medicine

Blood sugar levels within the normal range help prevent surgical complications such as infection, delayed wound healing, dehydration, and electrolyte imbalance. Pertinent information for controlling blood sugar involves the preoperative blood sugar result and time, and the time and last dose of diabetic medicine.

133.

How often should water in the ultrasonic cleaner (UC) be changed?

  • At least once per shift

  • Every two hours

  • After each use

  • Once a week

Correct answer: At least once per shift

Instruments and devices must be initially rinsed and decontaminated to remove gross debris before being placed in the ultrasonic cleaner (UC). They are then completely immersed in the cleaning solution. Water in the UC should be changed at least once per shift and whenever the detergent solution is visibly soiled. The inside of the tank should be cleaned between fillings.

134.

You are the circulating nurse. During surgery, the sterile field becomes contaminated. The patient is stable. What should you do FIRST? 

  • Correct the contamination 

  • Inform the surgeon so the appropriate postoperative antibiotic(s) can be ordered

  • Fill out an incident report

  • Inform the scrub nurse to correct the situation

Correct answer: Correct the contamination 

Correct the contamination immediately, as long as the patient is stable and not in any danger. 

When the procedure is over, you may be required to fill out an incident report, depending on your facility's policy. It is always a good idea for the surgical team to discuss what went wrong and identify areas for improvement.

135.

A patient sustained a fracture to the os coxae after falling down a flight of steps. Which of the following bones was most likely damaged during the fall? 

  • The pelvis

  • The humerus

  • The skull

  • The ankle

Correct answer: The pelvis

The os coxae, also referred to as the innominate bone, is comprised of three fused bones: the ilium, the ischium, and the pubis. This enormous, irregularly shaped bone structure makes up the pelvis and supports the trunk by dispersion of weight across the bone and down onto the two lower extremities. The ischium and pubis fuse between the ages of 4 and 8 years, forming the ischiopubic ramus. Between the ages of 11 and 15 years in females and 14 and 17 years in males, the ilium then fuses to the combined ischiopubic bone. 

Pelvic fractures may be stable and not require surgical intervention, or they may be unstable and require surgical intervention consisting of external fixation of the fracture or open repair using plates and screws. 

136.

A postsurgical patient has been transferred from the OR to the PACU. Which of the following statements is true regarding the presence of visitors in the PACU?

  • Parents may be allowed in the PACU environment, depending on institutional policy

  • PACU visitors are required to scrub prior to entering the PACU environment

  • Visitors are not allowed in the PACU environment

  • A clean gown must be placed over a visitor's clothing prior to entering the PACU

Correct answer: Parents may be allowed in the PACU environment, depending on institutional policy

Individual health care facilities determine the specifics of their PACU visitor policy. Some facilities may not allow any family members within the PACU, while others may allow a limited number of visitors, or parents only, within the PACU.

Visitors to the PACU are not required to wear any special clothing or gowns and are not required to complete a scrub prior to entering the PACU. If the patient requires some type of isolation precautions, visitors are expected to comply with these precaution restrictions.

137.

A 39-week pregnant female was scheduled for Cesarean section (CS) due to persistent fetal malpresentation. For which of the following types of abnormal fetal presentation is the patient most likely to require a classic uterine incision to ensure the safe delivery of the newborn?

  • Transverse lie

  • Breech lie

  • Face presentation

  • Oblique lie

Correct answer: Transverse lie

A classic uterine incision (high vertical midline) is rarely used in CS delivery anymore due to the high risk of uterine rupture in subsequent pregnancies. It may be necessary to utilize this surgical approach in an instance of a low-lying anterior placenta, which could be accidentally incised if a low transverse incision was used (Pfannenstiel-Kerr incision), if the maternal patient has cervical cancer or varicose veins of the lower uterine segment, or with multiple gestation pregnancies. 

A breech presentation is most likely to be delivered via CS using a Kronig incision (low vertical midline).

A face presentation (persistent mentum posterior presentation) may be delivered by (difficult) vaginal delivery but is more likely to be delivered using CS delivery.

An oblique lie (diagonal position with the fetal head to the side of the cervix/pelvic outlet) can be delivered vaginally if the fetus slips into position over the pelvic outlet during labor, but it ultimately may require a CS delivery. 

138.

The surgeon requests that the scrub person hand her an instrument to compress a small blood vessel without cutting it. Which of the following tools is most likely to be used to compress a small vessel with only a minimal risk of causing tissue injury?

  • A Halsted mosquito clamp

  • A curved Kelly clamp

  • The Kocher clamp

  • The Babcock clamp

Correct answer: A Halsted mosquito clamp

A Halsted mosquito clamp is a type of delicate hemostat that is used for compressing (clamping) small vessels to occlude bleeding. Hemostats may be smooth or serrated and may have straight or curved jaws that end in a tapered or rounded point. They are considered to be a crushing type of instrument; the Halsted hemostat has deep transverse serrations that are designed to close a bleeding vessel while also causing minimal damage to the clamped tissue.

A Kelly clamp is a much heavier, much less delicate type of clamp that would not be used for small vessels. Kelly clamps may be straight or curved. 

A Kocher clamp, also referred to as an Ochsner clamp, is a large traumatic hemostatic clamp with transverse serrations and large teeth that is used for grasping tough, slippery tissue, such as fascia that will ultimately be excised.

The Babcock clamp is not hemostatic; it is a ring-handled, locking ratchet-style clamp with rounded jaws that are designed to fit around tubular organ structures.

139.

Which of the following scenarios describes the intended meaning of the phrase "error at the sharp end"?

  • A surgeon operates on the wrong side of the brain, permanently damaging the healthy tissue due to the magnetic resonance imaging (MRI) scan being inadvertently inverted on the image scanner.

  • A perioperative nurse deliberately tears a finger of his glove when inserting an intravenous (IV) catheter to allow him to better palpate the vein before inserting the IV.

  • A registered nurse first assist (RNFA) accidentally punctures her finger with a curved suture needle while closing the patient.

  • A medication storage device that allows for the storage of multiple types of medications in one drawer without restrictions placed on how medications can be withdrawn is the primary method of medication storage in a perioperative unit.

Correct answer: A surgeon operates on the wrong side of the brain, permanently damaging the healthy tissue due to the magnetic resonance imaging (MRI) scan being inadvertently inverted on the image scanner.

The phrase "error on the sharp end" refers to errors made in health care that are high-profile, eyebrow-raising, and often have deadly consequences. Errors on the sharp end are active errors that occur at the point of patient contact and are typically not quickly forgotten. The healthcare provider who is responsible for the active error is often vilified and may face harsh penalties, while in reality, most sharp-end errors result from less noticeable, blunt-end errors (also referred to as latent errors). Latent errors are errors most often associated with problems with healthcare systems or policies that ultimately can result in active errors, without the latent error ever being discovered unless the healthcare facility changes its focus from determining to punish the responsible person to seeking to find out what caused or contributed to the person making the error in the first place. 

A neurosurgeon who operates on the wrong side of the brain as a result of an MRI image being scanned incorrectly is an example of an error on the sharp end. The blunt-end error in that scenario would be determining what deficit in the system allowed the image to be scanned incorrectly.

Employing a medication storage device system that does not have safeguards within the device or restrictions on how medications may be withdrawn is an example of a blunt-end error.  

140.

A perioperative nurse prepares to take a patient's temperature using a rectal thermometer. Which of the following statements regarding the use of rectal thermometers/probes is accurate?

  • Rectal thermometers are slow to register changes in body temperature.

  • A rectal probe temperature reading correlates closely with a bladder probe temperature reading.

  • A rectal thermometer reading is an accurate measurement of the core temperature.

  • Rectal thermometer reading results obtained during the completion of a surgical gastrointestinal (GI) procedure may be affected by the procedure.

Correct answer: Rectal thermometers are slow to register changes in body temperature.

Core temperature is always the most accurate measure of an individual's current temperature. Core temperature measurement may be obtained through the use of a probe placed in the esophagus, nasopharynx, bladder, or rectum. Even more invasive methods may be utilized, including placing a catheter probe in the pulmonary artery or on the tympanic membrane. 

While once the mainstay of temperature monitoring and believed to be the most accurate of the noninvasive methods of measuring temperature, rectal thermometers/probes are now known to be less accurate than the other measures of core temperature due to the possibility of the temperature reading being skewed by stool in the rectum and the slower response of the thermometer/probe to the patient's core temperature.

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