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CCI CNOR Exam Questions
Page 9 of 50
161.
An 18-week pregnant female is being transferred from the emergency department (ED) after a pelvic ultrasound showed a shortening of the cervical length and funneling of the cervix. Which of the following complications associated with pregnancy is this patient most likely experiencing?
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Cervical incompetence
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Threatened miscarriage
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Spontaneous abortion
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Ectopic pregnancy
Correct answer: Cervical incompetence
Cervical incompetence is most often seen in pregnant women between 18 and 26 weeks of gestation. Symptoms include painless dilation and effacement of the cervix; ultrasonography typically reveals a shortened and funneled appearance of the cervix. Women with a history of cervical incompetence are likely to have experienced spontaneous abortion during the second trimester. Unless the placement of a cervical cerclage is precluded by the presence of uterine infection, ruptured membranes, vaginal bleeding, gestation past 26 weeks, or active labor, cervical cerclage is the treatment of choice for supporting an incompetent cervix.
A cervical cerclage is typically placed after the patient has been anesthetized using general anesthesia.
162.
A 24-week pregnant female was transferred from her OB/GYN office with painless cervical dilation and bulging of the fetal membranes to have an emergency cerclage placed. Which of the following statements describes the process of rescue (emergency) cerclage placement for this patient?
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The vagina should not be prepped.
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A sterile amniocentesis needle should first be passed through the cervical opening to decompress the cervical membranes and allow for cerclage placement.
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The patient should be positioned using a modified Trendelenburg position.
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The Shirodkar procedure is most likely to be used to close the cervical opening.
Correct answer: The vagina should not be prepped.
Emergency cerclage (rescue cerclage) may be necessary when a pregnant patient, typically greater than 18 to 20 weeks of pregnancy, presents with painless cervical dilation and bulging amniotic membranes visible through the opening cervix. When a rescue cerclage is indicated, the patient should be placed in steep Trendelenberg to take pressure off the incompetent cervix, and a cerclage is placed without prepping of the vagina in an attempt to prevent accidental rupture of the membranes. An amniocentesis using an abdominal approach may be necessary to further reduce pressure on the cervix by removing a percentage of the amniotic fluid.
The McDonald cerclage approach is most frequently used to close the cervix. This approach passes a suture through four points on the cervix, securing the cervical opening.
The Shirodkar procedure is another method of cervical cerclage but is not utilized as frequently.
163.
Ideal characteristics of a housekeeping/disinfectant cleaning agent include all the following except:
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Already mixed to proper concentration
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Can be easily rinsed off
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Biodegradable
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Effective against a broad spectrum of microorganisms
Correct answer: Already mixed to proper concentration
Housekeeping agents should ideally be detergent-disinfectants that are biodegradable, nontoxic and nonirritating to patients and personnel, and able to be rinsed off easily (not leave a residual film that could affect electrical conductivity or transfer to the patient). They must be effective against a broad spectrum of microorganisms (including P. aeruginosa and M. tuberculosis) and compatible with tap water for dilution. Other desirable characteristics include low-foaming and prevent waterborne deposits, long shelf-life, cost-effective, and virtually odorless.
164.
You are called out for an emergency laparoscopic appendectomy on a 75-year-old patient. When your setup is ready, you go to the floor to get the patient and meet the anesthesiologist who tells you this patient is on hold. The patient has forgotten to tell the ER doctor and surgeon that he took his warfarin (Coumadin) this morning. A prothrombin time is being drawn stat, and the results will dictate whether the patient is ready for the OR.
Why is this communication breakdown significant?
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A prolonged prothrombin time (PT) means the patient could bleed more easily
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A prolonged prothrombin time (PT) means the patient is ready for surgery
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A prolonged prothrombin time (PT) means the patient's partial thromboplastin is depressed, and he may bleed
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A prolonged prothrombin time (PT) means the patient's platelet function is depressed, and he may bleed
Correct answer: A prolonged prothrombin time (PT) means the patient could bleed more easily
Preoperative evaluation of the patient's clotting time and history of bleeding is a necessary precaution, especially when the patient is already on blood thinners such as warfarin (Coumadin). Typically, a patient is asked to hold Coumadin therapy for surgical procedures to ensure sufficient hemostasis. When a patient is anticoagulated (inability to clot), prolonged clotting times happen, which could result in hemorrhage during surgery. A baseline coagulation result (prothrombin time) tells anesthesia and the surgeon whether to proceed with semi-emergent surgery or to delay.
Partial thromboplastin time (PTT) and platelet function are not involved with clotting, but with other aspects of anticoagulation.
165.
The bactericidal activity of alcohol sharply drops when it falls below what concentration?
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50%
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45%
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55%
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60%
Correct answer: 50%
Ethyl or isopropyl alcohol, 70% to 95%, kills microorganisms by coagulation of cell proteins. Alcohol is volatile; it will act only as long as it is in solution. It becomes ineffective as soon as it evaporates, and loses its microbicidal activity in concentrations below 50%; because of this, it should be discarded at frequent intervals.
166.
Your patient has been in the lithotomy position with his legs in stirrups. At the conclusion of surgery, you must remove both legs from the stirrups. What is the primary reason it is recommended to remove both extremities from the stirrups slowly and simultaneously?
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Doing so prevents a dramatic drop in blood pressure
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Doing so prevents back strain
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Doing so prevents blood clots from escaping into the circulation
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Doing so prevents dislocation of the hip(s)
Correct answer: Doing so prevents a dramatic drop in blood pressure
At the conclusion of the surgical procedure, the leg section of the OR bed is raised, and the lower section of the mattress is replaced. The patient's legs are removed simultaneously from the stirrups and slowly lowered one at a time to prevent hypotension (a dramatic drop in blood pressure) as blood reenters the legs and leaves the torso.
While this action does aid in preventing back strain and hip dislocation, the main objective is preventing hypotension in the patient.
167.
A postoperative patient who underwent an open-chest cardiac procedure developed an arterial thrombosis during recovery in the intensive care unit. Which of the following was the most likely cause of arterial thrombosis?
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An intraarterial line placed for arterial blood pressure monitoring
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Blood stasis from prolonged immobility in the intensive care unit
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Hypercoagulable state following surgery
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Inconsistent use of sequential compression boots in the intensive care unit
Correct answer: An intraarterial line placed for arterial blood pressure monitoring
Patients who undergo cardiac procedures such as coronary artery bypass graft (CABG) or valve surgery are at risk of developing both cardiac and noncardiac complications following cardiac surgery. Factors such as advanced age, the presence of comorbidities, the length of the surgical procedure, and the use of cardiopulmonary bypass during the procedure, among others, can increase a patient's risk of developing associated complications. Cardiac complications may include myocardial infarction, heart failure, tamponade, dysrhythmia, and cardiac arrest, while noncardiac complications may include hemorrhage, dehiscence or infection of the wound, hypovolemia or hypervolemia, permanent or temporary neurological defects, renal failure, gastrointestinal bleeding, and arterial or venous thrombus formation. An arterial thrombosis is most likely to develop secondarily to the placement of an intraarterial line or intraaortic balloon pump.
Blood stasis due to prolonged immobility and inconsistent use of sequential compression boots in the intensive care unit and a postsurgical hypercoagulable state are most likely to contribute to the development of a venous thrombus.
168.
An orthopedic surgery team is preparing to complete a surgical procedure to fuse the left epiphysis to the femoral neck to correct the slipping of the upper femoral epiphysis that has caused the displacement of the femoral head in a pediatric-aged patient. Which of the following patients is most likely to experience this issue as a chronic disability that can cause limb length discrepancy?
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A 14-year-old obese male patient
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A 16-year-old anorexic female patient
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A 1-month-old female infant with congenital hip dislocation
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A 5-year-old male with achondroplasia dwarfism
Correct answer: A 14-year-old obese male patient
Limb length discrepancies can be caused by a variety of factors. There may be interference with the epiphyseal plates (growth plates) that can cause retardation of bone growth, such as injuries to the growth plate, or biological conditions that cause overactivity of only one growth plate in a limb, contributing to too rapid growth in the affected limb. Metabolic bone disease, congenital deformities, and infection may also contribute to the development of limb length discrepancies.
If there is a limb length discrepancy noted in the lower extremities, the orthopedic surgeon may elect to stop the growth of the longer limb by removing a portion of the longer femur to shorten it or by fusing the growth plate (epiphyseal arrest). Another type of lower limb length discrepancy can result from childhood obesity caused by chronic traumatic injury when the epiphysis slips out of place, causing displacement of the femoral head from the acetabulum. The orthopedic surgeon may elect to fuse the epiphysis to the femoral neck to prevent further slipping and shortening of the affected leg. The injury most commonly occurs with the start of puberty (ages 13 to 15 in males) and is most commonly diagnosed in obese teenage males.
169.
What ethical principle involves a devotion to truthfulness?
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Veracity
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Nonmaleficence
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Autonomy
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Fidelity
Correct answer: Veracity
The ethical principle of veracity involves telling the truth. Nursing as a profession is highly respected by the public who trusts us because of our ethical behaviors, which include a devotion to truthfulness and giving accurate information.
The other choices are also ethical principles. Nonmaleficence is the duty to do no harm. Autonomy refers to self-determination and the ability to make decisions to determine one's own course of action. Fidelity involves faithfulness; it is based on trust and honesty and protects the rights of individuals.
170.
Drawbacks to the use of quaternary ammonium compounds as disinfectants include all the following EXCEPT:
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They are irritating to the skin
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They are unable to kill all viruses
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They are inactivated in the presence of organic soil
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They can be absorbed by cotton and other fabrics
Correct answer: They are irritating to the skin
"Quats," as these compounds are often called, are a type of chemical disinfectant that causes gradual alteration of cell membranes to produce leakage of protoplasm of some microorganisms, primarily vegetative bacteria. These compounds possess detergent properties and are used to sanitize noncritical surfaces.
Problems with the use of quaternary ammonium compounds as disinfectants include:
- The microbicidal effect can be reversed by adding a neutralizer, such as soap
- They are ineffective against tuberculosis or hydrophilic viruses, such as poliovirus
- Their active agent can be selectively absorbed by fabrics, including cotton, thus reducing the strength to an ineffectively low level. Gauze or a towel must not be put in the basin used for immersing instruments.
These compounds are nonirritating to the skin.
171.
All the following behaviors by perioperative staff reflect respect for human dignity EXCEPT:
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Speaking loudly to facilitate communication with a hearing impaired patient
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Addressing the patient by Mr. or Mrs. followed by their last name
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Recognizing the patient has the right to refuse surgery and life-saving measures
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When teaching, focusing on need-to-know information and asking the patient to "teach-back" the material to you
Correct: Speaking loudly to facilitate communication with a hearing impaired patient
Respect for human dignity is a core principle of nursing practice. Addressing the patient and family in a respectful manner (using Mr. or Mrs. followed by their last name), respecting decisions about receiving health care, and focusing on need-to-know information when teaching, results out of respect for the patient.
If your patient has a hearing impairment, speak clearly and slowly in a moderate (not loud) tone of voice, with visible but not exaggerated lip movements. Eye contact, facial expressions, touch, and body gestures can help communicate feelings and instructions.
172.
What is the best method of communicating with a patient who has a visual impairment/blindness?
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The speaker should address the patient by name and then introduce himself
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Gently touching the patient's arm before introducing oneself can help provide comfort
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Speak slowly and clearly in an elevated pleasant tone to ensure a friendly mood is aptly communicated
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Protect the patient from potential distress from unexpected sounds by ensuring that the environment is kept quiet
Correct answer: The speaker should address the patient by name and then introduce himself
When communicating with patients who have sensory impairments such as significant vision loss or blindness, the perioperative nurse must take deliberate steps to ensure the patient feels safe and comfortable in the unfamiliar environment. Speakers should make some type of gentle noise as they enter the patient's area to alert of them of their presence, and then address the patient by name and introduce themselves using a moderate tone.
Prior to touching a patient, the speaker should speak to the patient, and even alert them that they are going to touch them in an attempt to prevent startling the patient. If the patient will be exposed to unexpected noises or sensations in the surrounding environment, the perioperative nurse should inform the patient and describe what the patient is about to experience to prevent any distress to the patient. Assist the patient in guiding his hand within the environment to provide him with a sense of security.
173.
You are reviewing your female patient's laboratory results prior to surgery. The patient's hematocrit is 51%. What might this indicate?
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The patient is dehydrated
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The patient's kidneys are not functioning adequately
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The patient has an infection
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The patient has a clotting abnormality that will require further follow-up
Correct answer: The patient is dehydrated
Normal hematocrit in females is 37 to 47%. An increased hematocrit indicates a decrease in plasma volume, normally caused by dehydration and loss of sodium. Fluid and electrolyte balance are important for maintenance of blood volume during any surgical procedure.
174.
Which of the following is NOT an effective strategy when performing preoperative teaching?
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Using accurate medical terms to explain the procedure and what the patient should expect postoperatively
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Requesting a translator to assist while you provide preoperative teaching
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Closing the door and turning off the television while providing preoperative teaching to your hearing-impaired patient
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Looking directly at your hearing-impaired patient while speaking, being sure to speak slowly and clearly
Correct answer: Using accurate medical terms to explain the procedure and what the patient should expect postoperatively
Medical terminology should not be used while performing preoperative teaching. Use terms that the patient will comprehend, and frequently ask if the patient understands important points. Do not equate intelligence level with educational level.
Provide an interpreter for a patient who does not speak/understand English well. Make eye contact with all patients, but especially those who have hearing issues. Create a distraction-free environment for patient teaching times.
175.
Your patient is undergoing intramedullary nailing to repair a femoral shaft fracture. What type of complication is associated specifically with this procedure?
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Fat embolism
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Dislocation
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Infection
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Pulmonary embolism
Correct answer: Fat embolism
An intramedullary nail, rod, or pin is driven into the medullary canal through the site of the fracture. This brings together the ends for union, splints the fracture, and eases pain.
Fractures of long bones put the patient at risk of suffering a fat embolism due to the injury itself, which may allow fat (adipose cells) from the bone marrow to escape into the circulation. This risk is increased during the procedure due to the nailing and reaming required for repair.
Infection and pulmonary embolism are complications of all types of surgery. Dislocation of one or more bones at a joint may occur with or without an associated fracture, and is not specific to this particular procedure.
176.
The World Health Organization (WHO) created a comprehensive surgical checklist for keeping patients safe during surgery. The purpose of the checklist is to globally reduce surgical harm to patients in a manner that can be applied universally.
What are the intraoperative components of this checklist that should always be discussed during "Time Out" practices?
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Patient identity, procedure, incision site (laterality), consent(s), relevant images available, implants (if pertinent) available, equipment concerns, anticipated critical events, antibiotic prophylaxis given, sterilization indicators confirmed
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Patient identity, procedure, incision site (laterality), consent(s), relevant images available, implants (if pertinent) available, blood products, anticipated critical events, antibiotic prophylaxis given, sterilization indicators confirmed
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Patient identity, procedure, incision site (laterality), relevant images available, implants (if pertinent) available, equipment concerns, anticipated critical events, antibiotic prophylaxis given, sterilization indicators confirmed
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Patient identity, procedure, incision site (laterality), consent(s), relevant images available, implants (if pertinent) available, briefing, equipment concerns, antibiotic prophylaxis given, sterilization indicators confirmed
Correct answer: Patient identity, procedure, incision site (laterality), consent(s), relevant images available, implants (if pertinent) available, equipment concerns, anticipated critical events, antibiotic prophylaxis given, sterilization indicators confirmed
These components of the surgical safety checklist make up "Time Out" practices, which are done before the surgeon makes the surgical site skin incision.
Availability of blood products is confirmed in the holding area, during preprocedure check-in. Briefing, when all members of the team have discussed the care plan and addressed concerns, is done before induction of anesthesia during sign-in.
177.
For which of the following preoperative patients is a chest x-ray part of the standard preoperative diagnostic workup?
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Patients suspected of having pulmonary edema
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Patients who are older than 39 years of age
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Patients who have a pacemaker
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Patients who have had a previous myocardial infarction
Correct answer: Patients suspected of having pulmonary edema
A preoperative chest x-ray is considered to be a standard component of the plan of care for patients who are suspected of having pulmonary abnormalities, such as pulmonary edema, tuberculosis, pneumonia, or other lung-related issues, or for patients who have known pulmonary abnormalities and are experiencing symptoms.
In some facilities, preoperative chest x-ray may also be standard for all patients over the age of 40; however, this varies from facility to facility.
178.
What prep solution can cause deafness if it enters the inner ear through a perforated eardrum?
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Chlorhexidine gluconate
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Iodophor
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Triclosan
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Alcohol
Correct answer: Chlorhexidine gluconate
Chlorhexidine is an antiseptic solution commonly used as a skin cleansing soap preoperatively. It is an irritant to the eyes and is ototoxic. It can cause sensorineural deafness if it enters the inner ear and is therefore contraindicated for facial antisepsis.
Iodophor, otherwise known as iodine, is known for its potential hazards of skin irritations and burns and if used, should dry and then be rinsed off with 70% alcohol to neutralize the damaging effect. Cumulative suppressive action develops slowly with triclosan, only with prolonged routine use. It is considered generally safe and nontoxic for use on the face, but do not allow the solution to enter the eyes. Alcohol is not to be applied to mucous membranes or used on an open wound because it coagulates protein. Since it is volatile and flammable, it cannot pool around or under the patient, especially if an electrosurgical unit or laser will be used.
179.
Your 21-year-old male patient has just undergone a partial splenectomy to stage his recently diagnosed Hodgkin's disease. He is in the PACU, but is not yet fully awake from anesthesia. His parents are at the bedside and ask you what was found during the patient's surgery. How should you best respond?
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"I'm sorry, but because your son is legally an adult, I must have his permission to give you any information about his diagnosis."
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"You will need to talk to the surgeon if you have any questions."
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"My nursing supervisor can tell you, but I am not allowed."
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"He has stage 4 cancer, and it's very serious."
Correct answer: "I'm sorry, but because your son is legally an adult, I must have his permission to give you any information about his diagnosis."
Patient confidentiality and privacy is a right of all patients. This patient is legally an adult and therefore you must have his permission before divulging any personal information, even to his parents.
180.
You are caring for a 2-year-old child who is awaiting surgery for a traumatic injury to the leg and are assessing the child's pain.
Which of the following pain-rating scales would be best suited for a child of this age?
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FLACC Scale
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Wong-Baker FACES Scale
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Verbal Rating Scale
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Word Descriptor Scale
Correct answer: FLACC Scale
The Face, Legs, Activity, Cry, Consolability scale (FLACC scale) is appropriate for use in young children. The FLACC scale is a measurement used to assess pain in children between the ages of 2 months and 7 years or individuals that are unable to communicate their pain. The scale is scored in a range of 0 to 10 with 0 representing no pain. The scale has five criteria, which are each assigned a score of 0, 1, or 2.
| Criteria | Score 0 | Score 1 | Score 2 |
|---|---|---|---|
| Face | No particular expression or smile | Occasional grimace or frown, withdrawn, uninterested | Frequent to constant quivering chin, clenched jaw |
| Legs | Normal position or relaxed | Uneasy, restless, tense | Kicking, or legs drawn up |
| Activity | Lying quietly, normal position, moves easily | Squirming, shifting, back and forth, tense | Arched, rigid or jerking |
| Cry | No cry (awake or asleep) | Moans or whimpers; occasional complaint | Crying steadily, screams or sobs, frequent complaints |
| Consolability | Content, relaxed | Reassured by occasional touching, hugging or being talked to, distractible | Difficult to console or comfort |
All of the other rating scales are self-report scales and would not be appropriate for a child who is two years of age and unable to adequately verbally articulate pain.