CCI CNAMB Exam Questions

Page 1 of 25

1.

A 5-year-old patient scheduled for a tonsilectomy is in pre-op and the surgeon is talking to the parents prior to signing the informed consent. The patient's mother informs the surgeon that the patient gets frequent nosebleeds whenever his nose is bumped even slightly. The ENT surgeon tells the parents he will try to help with that and adds nasal cautery to the informed consent and his history and physical addendum. What should the nurse anticipate having in the room?  

  • Silver nitrate sticks

  • Monsell's solution

  • Lugoll's

  • A nasopharyngeal airway

Correct answer: Silver nitrate sticks

Silver nitrate sticks are often used to cauterize small vessels in the nose that bleed excessively. 

2.

ORs are kept as free from microorganisms as possible, but even in well cleaned, restricted areas there is a microbial count in the air that cannot be eliminated. When is this microbial count at its peak during a procedure? 

  • When incision is made

  • At the end of the procedure

  • During intubation

  • Midway through the procedure

Correct answer: When incision is made

The microbial count in the air is at its peak around the time when the incision is made. This is due to the entering and exiting of staff, draping, and excess movement around the sterile field that occurs most at the beginning of cases. 

3.

How do isopropyl and ethyl alcohol work to prep skin for surgery? 

  • They denature proteins in cells by coagulating them 

  • They bind with negative ions in cell walls and cause death

  • They cause oxidation and cause cell death by apoptosis

  • They cause cell death by creating an anaerobic environment

Correct answer: They denature proteins in cells by coagulating them 

Alcohols are broad spectrum antimicrobials that denature and coagulate protein in cells. 70% concentration for several minutes is enough for skin antisepsis. 

4.

Which departments should be involved in using a standardized hand-off process? 

  • All departments and locations that provide patient care

  • Pre-op, OR, and PACU

  • Pre-op and PACU

  • The OR and PACU

Correct answer: All departments and locations that provide patient care

All departments, from doctor's offices, to admissions and scheduling, to the PACU, should be using a consistent, standardized hand-off process to decrease communication errors. 

5.

According to AORN guidelines, what is the preferred method of delivering medications in vials to the sterile field? 

  • Using a sterile transfer device

  • Removing the stopper and pouring

  • Drawing up all medications in syringes at the beginning of the day and squirting them on the sterile field when needed

  • The circulating nurse should clean the stopper with alcohol, then hold the vial up so the scrub personnel can take a sterile syringe and draw up the medication 

Correct answer: Using a sterile transfer device

Using sterile transfer devices such as sterile vial spikes, sterile syringes, and filter straws are the preferred method of medication transfer to the sterile field. Removing rubber stoppers is not recommended unless they are specifically designed to be removed. Drawing up medications should happen immediately prior to transfer to the sterile field and they should be labeled if not used immediately. Medications should be drawn up and placed on the sterile field as close to the time of use as possible. Verification of the medication name, dosage, and expiration date should be done concurrently with the scrub personnel. Holding vials for a scrub person to puncture the stopper with a needle puts personnel at risk for a needlestick injury.  

6.

A patient who just underwent a carpal tunnel release under a regional block and sedation is deemed well enough to go to phase II of the PACU and skip phase I. What is this called? 

  • Fast-Tracking

  • Phase skipping

  • Fast phasing

  • Patient centered recovery

Correct answer: Fast-Tracking

Whenever a patient meets the criteria of moving from phase I to phase II before leaving the OR, the anesthesia provider is allowed to decide to let them skip the first phase. This lessens their time in the recovery room, decreases the time period of immobility, and frees up staff for higher acuity patients. At minimum, they have to meet vital sign criteria, have minimal to no nausea and pain, be hemodynamically stable, be awake or arousable, and breathe effectively on room air. 

7.

A pre-op nurse is assessing a patient's pain goal for after surgery. The patient states that a pain level of 3 is tolerable. The nurse then asks the patient what kinds of pain relieving techniques other than medicine usually work for their pain. This question is an example of what? 

  • An open-ended question

  • Closed-loop communication

  • A closed question

  • A distractor

Correct answer: An open-ended question

This is an example of an open-ended question because it allows the patient to answer thoroughly and not merely with yes or no. Closed-ended questions are not considered therapeutic communication. They are necessary in some instances to get basic medical information, but open-ended questions are a much better communication technique. Open-ended questions allow the patient to answer freely without leading them to the answer that is expected or wanted. 

8.

A surgical conscience is best defined by which of these statements? 

  • A personal sense of responsibility and moral obligation to the patient with a sincere desire to do the right thing

  • Continually being aware of your coworkers and what they need to be successful

  • Following your nurse practice act and never deviating from the scope of practice

  • Being professional at all times while caring for patients

Correct answer: A personal sense of responsibility and moral obligation to the patient with a sincere desire to do the right thing

The concept of surgical conscience is best described by the golden rule: "Do unto patients as you would have others do unto you." According to Florence Nightingale, the caregiver is responsible for creating and maintaining an optimal environment to promote healing. A nurse with a strong surgical conscience should be caring, empathetic, conscientious, selfless, disciplined, and should know how to apply intelligence and education to sterility, asepsis, and all aspects of physical patient care. 

9.

In the middle of a tonsillectomy, a 9-year-old patient becomes severely bradycardic. Atropine is given, but the patient's heart rate does not respond to it. The heart rhythm then shows asystole. What is the first course of action? 

  • Chest compressions at a rate of 15 compressions to 2 breaths

  • Give epinephrine based on the child's weight

  • Run and grab the crash cart

  • Defibrillate as soon as possible

Correct answer: Chest compressions at a rate of 15 compressions to 2 breaths

The crash cart will need to be brought to the OR, but that can be done by assistive personnel. The nurse should begin chest compressions immediately and another staff member or the surgeon should activate the code blue emergency response system. The anesthesia provider maintains the airway and will give epinephrine according to ACLS guidelines. Asystole is not a shockable rhythm, so the defibrillator will not be used until some sort of rhythm is obtained. 

10.

A patient is having a trapeziectomy done and the surgeon has chosen to do it under bier block. What type of special supply is needed for the block? 

  • A double cuffed tourniquet

  • An ultrasound machine

  • A doppler

  • A pressure bag

Correct answer: A double cuffed tourniquet 

Bier blocks are a type of regional anesthesia. Local anesthesia is injected via IV near the surgical site below the level of a double cuffed tourniquet. They are only used for surgery that will last an hour or less. The tourniquet is applied before prepping and the arm is exsanguinated after draping using an esmark or ace bandage. The proximal cuff is then inflated. The doctor then injects the local anesthetic into the IV. When the local anesthetic takes effect, the distal cuff of the tourniquet is inflated and the proximal cuff is released. The patient should be completely numb under, and below, the tourniquet. The patient should be monitored closely at the end of surgery for any adverse effects stemming from a bolus of leftover drugs and metabolic waste when the tourniquet is released.   

11.

The stir up regimen is used postoperatively to decrease the chance of respiratory complications. What is the main purpose of the sustained maximal inspiration (SMI) maneuver?

  • Increase the Functional Residual Capacity (FRC)

  • Expand all the alveoli at the same time

  • Decrease the residual reserve

  • Increase the tidal volume

Correct answer: Increase the Functional Residual Capacity (FRC)

The SMI maneuver is used to increase the functional residual capacity (FRC). The FRC is the sum of the expiratory reserve volume (ERV)and the residual volume (RV).

12.

A load of instruments has just finished a sterilization cycle. What is the next step? 

  • Open the sterilizer door when it is safe to do so, and leave the load untouched to dry for 15-60 minutes

  • Leave them in the closed sterilizer for 15-60 minutes to make sure they are completely dry 

  • Open the sterilizer door, remove the load to a waiting cart, and allow them to dry for 10 minutes before putting them away 

  • Open the sterilizer door and leave the items in the sterilizer for 2 hours to cool down before handling 

Correct Answer: Open the sterilizer door when it is safe to do so, and leave the load untouched to dry for 15-60 minutes

The times required for cooling and drying are unique to each type of sterilizer and the type of items that are being sterilized. For example, large packages take longer. After they are dry and cool, they can be taken out and placed on a cart. If they are not completely cool and dry, the colder surface they are placed on can get damp from condensation and then the load is contaminated by strike-through moisture. 

13.

Which of these pre-operative lab values must the surgeon be notified of? 

  • An INR of 5

  • Potassium of 3.5

  • PTT of 30 seconds

  • Platelet count of 400k

Correct answer: An INR of 5

The international normalized ratio's (INR) normal range is 1.5–2.5. An INR of 5 would put the patient at increased risk for bleeding and the surgeon may cancel an elective case based on this number. Potassium is normal between 3.5–4.5, PTT is normal at 25–32 seconds, and platelet counts should be between 200,000 to 450,000. 

14.

Which statement made by a patient's mother would cause the anesthesia provider to delay or cancel an elective tonsillectomy for a 4-year-old patient? 

  • He's had a bad cold for the past two weeks

  • He has sleep apnea at night and snores nonstop

  • He has a history of asthma and environmental allergies

  • He has an allergy to latex

Correct answer: He's had a bad cold for the past two weeks

Respiratory infections in children are a huge reason to cancel surgery due to the risk of obstruction of their small airways. Intubating inflamed tissues causes further inflammation and edema. Even a runny nose can turn into a large problem. Some simple viral infections don't fully resolve for 6–8 weeks, even after external symptoms have resolved. 

15.

The acronym R.A.C.E is used in hospitals to help personnel remember their priority of duties in the case of a fire. What does R.A.C.E stand for? 

  • Rescue, Activate, Contain, Evacuate or Extinguish

  • Respond, Aim, CO2 fire extinguisher, Extinguish

  • Rescue, Alert, Control, Emergency

  • Run, Activate, Confine, Evacuate or extinguish

Correct answer: Rescue, Activate, Contain, Evacuate or Extinguish

There are several variations of R.A.C.E. Rescue/remove, Activate/alarm, Contain/confine, and Evacuate/extinguish are the two most popular. This is the order of priority of duties during a fire. First, remove patients from harm. Second, activate the fire alarm. Third, contain the fire if possible by shutting fire doors or other methods. Lastly, evacuate from the fire or extinguish it if possible.  

16.

In the middle of a procedure, a surgeon becomes irate and begins throwing instruments and screaming at staff. What should the circulating nurse do? 

  • Inform a manager

  • Confront the surgeon and tell them to stop

  • Walk out of the room and leave the surgeon alone

  • Remain calm and quiet, and then apologize for everything to deescalate the situation

Correct answer: Inform a manager

The circulating nurse should go through the proper chain of command and possibly file an internal incident report. This is a type of downward violence and cannot be tolerated. Throwing instruments is a safety hazard.

17.

Which pre-op order should the nurse question? 

  • Versed 10 mg/kg prn for pre-operative anxiety

  • 1 Scopolamine patch, TD, place 1 hour prior to surgery

  • Fentanyl 25 mcg prn

  • 5 units of humalog for a blood glucose of 250

Correct answer: Versed 10 mg/kg prn for pre-operative anxiety

Versed is usually given in 2–3 mg doses for adults. 10 mg/kg is an error and would result in severe over sedation.  

18.

According to a statement from the American Heart Association, high-reliability teams have 6 elements in common. What are they? 

  • Communication, coordination, cooperation, cognition, conflict resolution, and coaching

  • Advocacy, ethics, intelligence, communication, camaraderie, and compassion

  • Enthusiasm, empathy, ethics, ethos, eagerness, and earnestness

  • Optimism, oathkeeping, obedience, objectivity, open-mindedness, observancy

Correct answer: Communication, coordination, cooperation, cognition, conflict resolution, and coaching

High-reliability teams contain these 6 characteristics, and work almost flawlessly as a team in high stress situations. These core elements have been studied in code situations by the AHA for years and are updated every time evidence-based practice changes in relation to CPR. 

19.

An 8-year-old boy undergoing an ORIF of his clavicle says he is most scared about the IV being placed and the needle staying in his arm. What would be a good intervention by the nurse? 

  • Show him an IV cannula and the needle retraction device; explain each step

  • Tell him to be brave and it will only take a second to put the IV in

  • Promise him a sticker if he holds perfectly still while the IV is placed 

  • Place the IV as quickly as you can in the antecubital area, since that will be hard to miss

Correct answer: Show him an IV cannula and the needle retraction device; explain each step

Many patients incorrectly think that IV cannulas still contain the needle used to place them. With children who are frightened of the pain associated with shots and needles, it may be beneficial to compare it to a drinking straw instead. Children are often comforted by being able to touch or see masks, tubes, and other medical supplies before being forced to comply with their use. Comfort, empathy, being a good listener, and thorough preoperative teaching may be all that some patients need to decrease anxiety. Sometimes premedication through coordination with the anesthesia provider may be needed. 

20.

Initiating CPR on a patient who has an unambiguous DNR order in place and has reiterated its power even under anesthesia can be considered what? 

  • Battery

  • Assault

  • Negligence

  • Beneficence 

Correct answer: Battery

Any unauthorized touching of a patient can be considered battery — even lifesaving measures if they are directly against the patient's documented wishes. Advanced directives should always be followed completely. Assault is a threat that results in the patient fearing for physical injury. Negligence is a failure to provide the care that any reasonable healthcare worker would in the same situation.