CCI CFPN Exam Questions

Page 10 of 22

181.

The most appropriate method of evaluating a patient's understanding of preoperative instructions would be to

  • ask the patient to give a personal verbal summary of what has been explained.

  • conduct a retrospective chart review.

  • review the nurse's notes to see if there have been any changes in behavior.

  • verify the patient's statements against the surgeon's notes.

Correct answer: ask the patient to give a personal verbal summary of what has been explained.

The patient's understanding is best assessed by having the patient give a personal verbal summary of what has been explained in their own words. This allows for the easy identification of knowledge deficits and follow up questions if necessary.

182.

A patient with a mild systemic disease, such as hypertension and cardiovascular disease requiring minimal restrictions on activity, would receive which American Society of Anesthesiologists (ASA) classification?

  • II

  • I

  • III

  • IV

Correct answer: II

An American Society of Anesthesiologists (ASA) classification of P2 or "II", indicates that the patient has a mild systemic disease that does not limit activity. A classification of P3 would indicate that activity is limited by activity and a classification of P1 indicates a healthy patient without systemic disease.

183.

The name of the clamp that is designed to hold bowel tissue and has opposing smooth flared edges is:

  • Babcock.

  • Allis.

  • Deaver.

  • Kocher.

Clamps are instruments specifically designed for holding tissue or other materials, and most have an easily recognizable design. They have finger rings, for ease of holding; shanks, whose length is appropriate to the wound depth; ratchets on the shanks near the rings, which allow for the distal tip to be locked on the tissue or object grasped; a joint, which joins the two halves of the instrument and allows opening and closing of the instrument.

The Babcock clamp has broad, flared ends with smooth tips, and it atraumatically grips or encloses delicate structures, such as bowel, ureters, or fallopian tubes. The Allis clamp has multiple, interdigitating short teeth on the tip, minimizing crushing or damaging tissue. The Kocher (also referred to as an Ochsner) clamp has transverse serrations and large teeth at its tip to grasp tightly on tough, slippery tissue such as fascia. A Deaver is a type of manual retractor. 

184.

What type of skin cancer rarely metastasizes?

  • Basal.

  • Squamous.

  • Melanoma.

  • Epithelial.

The estimated number of new skin cancer cases diagnosed in 2012 was 2 million, and the three most common skin cancers are basal cell, squamous cell, and melanoma. Basal cell cancer accounts for approximately 70% of all skin cancers and, if left untreated, will grow locally, but will rarely metastasize. Treated early, basal cell skin cancer may be cured by simple excision and closure (with pathologic diagnosis to ensure disease-free margins). 

The second most common form of cancer is squamous cell carcinoma (SCC), and is considered more aggressive. Surgical treatment is the same as that for basal cell carcinomas. Melanoma accounts for the smallest percentage of skin cancers but is treated much more aggressively because of its high mortality rate. 

185.

The perioperative nurse should do which of the following first when an OR count is not reconciled?

  • Notify the surgeon

  • Call for an x-ray

  • Fill out an incident report

  • Report the incident to the charge nurse

Retained surgical items (RSIs) are a major concern in all facilities where surgery is performed. Physiologic consequences of RSIs include possible infection, obstruction, fistula formation, perforation or consequent pain, suffering and possible death, and the likely need for additional surgery. 

In ORs, conducting count processes according to evidence-based policies (audible, visual, and concurrent) is considered a key risk reduction and patient safety strategy. Research indicates that a discrepancy of a count at any time during a surgical procedure is a safety variance associated with elevated RSI risk. 

The circulating nurse must initially inform the surgeon of the results of a count that is unreconciled (the number of items on the count record or worksheet fails to match the number of items recovered during a closing count). If a count remains unresolved, the circulating nurse must again notify the surgeon of the unresolved count, and a search must be made for the missing item, including the surgical wound, field, floor, linen, and trash. All personnel must direct their immediate attention to locating the missing item. 

If it is not found, an x-ray film may be taken and read by the radiologist or surgeon as specified in institutional policy. If the x-ray is negative, the count is recorded as incorrect or unreconciled and the x-ray results noted on the patient's intraoperative record. 

An incident/occurrence/event report should be initiated according to institution policy. Accurate counting and recording of soft goods, sharps, and instruments are essential for the protection of the patient, personnel, and the institution, and are integral to effective risk management.

186.

Life threatening complications that are rare but could result from the use of bone cement include _________, cardiac arrest, and death.

  • pulmonary embolism

  • hypotension

  • cerebral vascular accident

  • hyperthermia

Bone cement can have several adverse reactions including hypotension, thrombophlebitis, CVA, and hypersensitivity. Life threatening complications include cardiac arrest, pulmonary embolus, and death.

187.

When two radiation monitoring devices are used they monitor exposures differently. One should be located outside the thyroid shield and the other should be worn:

  • on the inside of the x-ray apron

  • under the thyroid shield

  • on the sleeve of the scrubs

  • on the outer waistband of the x-ray apron

The external thyroid shield dosimeter checks for radiation levels of the head, neck, and eyes. The second dosimeter should be worn underneath the lead apron to monitor full body levels of exposure.

188.

Information that may identify a need for the nurse to exercise problem-solving skills is first obtained during which phase of the nursing process?

  • Assessment 

  • Nursing diagnosis

  • Implementation

  • Evaluation

Nursing process is the bedrock of all nursing actions. This process of critical thinking may require that the nurse utilize her problem solving skills during the first step of the nursing process, assessment of the patient.

189.

Providing information to the patient to obtain informed consent is the responsibility of the

  • physician.

  • perioperative nurse.

  • RN first assistant.

  • physician assistant.

Correct answer: physician.

While a perioperative nurse, RN first assistant, or physician assistant may reinforce information provided by a physician for the informed consent, only a physician can provide information to the patient to obtain this consent. 

190.

Which of the following patients is at greatest risk for developing intraoperative hypothermia?

  • A 76-year old male scheduled for bilateral femoral-popliteal bypass

  • An 18-month old female scheduled for bilateral tympanostomies with insertion of ear tubes

  • A 26-year old male scheduled for a laparoscopic inguinal herniorrhaphy

  • A 46-year old female scheduled for a modified radical mastectomy

The risk for developing hypothermia is greater for older patients and those undergoing general or major regional anesthesia for longer than 1 hour

191.

A patient had a partial colectomy with a colostomy 3 years ago for ulcerative colitis and is now being admitted for a total colectomy with ileostomy. The perioperative nurse can most effectively determine what the patient knows about this procedure by

  • interviewing the patient using open-ended questions to encourage dialogue.

  • reviewing the chart to assess the patient's knowledge base.

  • having the patient fill out a questionnaire that tests recall of knowledge.

  • discussing with the physician the patient's knowledge of the proposed procedure.

Correct answer: interviewing the patient using open-ended questions to encourage dialogue.

The patient's knowledge can be best assessed by directly talking to the patient, using open-ended questions that facilitate understanding of their knowledge. While having the patient fill out a questionnaire would be a method of engaging with the patient, communicating with them directly enables better communication and the ability to use follow up questions.

192.

A patient who is in the OR holding area is scheduled for a left orchiectomy. The patient agrees that it is the left testis that is to be removed. The following information is contained in the surgeon's preoperative documentation: Right testis was found to be enlarged with a palpable hard, pea-sized mass on the left. Before proceeding to the OR, the perioperative nurse should first

  • inform the surgical team that clarification is needed.

  • ask the patient to mark the correct site with an "X".

  • obtain the patient's testicular ultrasonography films.

  • document the nurse's observations in the patient's chart.

Correct answer: inform the surgical team that clarification is needed.

When there is a discrepancy during site verification, the discrepancy must be addressed. Asking the patient to mark the correct site with an "X" will not provide more information than he has already given. Obtaining the patient's testicular ultrasonography films may be appropriate, but the nurse should first inform the surgical team.

193.

A 62-year-old patient with a history of heart disease and deep vein thrombosis is scheduled for an elective lumbar laminectomy with discectomy and hardware removal. The perioperative nurse reviewing the preoperative record would take immediate action to do which of the following?

  • Apply sequential compression stockings

  • Administer a prescribed sedative

  • Obtain a blood specimen for a stat coagulation studies

  • Request that the patient be typed and crossed for 2 units of blood

The use of mechanical means to prevent venous thromboembolism (VTE) is standard when preparing a patient for surgery. Application of intermittent pneumatic compression devices and graduated compression stockings should be completed prior to the patient receiving any regional or general anesthesia. A patient with a known history of VTE is at risk of sustaining another VTE. 

194.

A 15-year-old male patient is scheduled for a meniscectomy. While applying the tourniquet, the perioperative nurse should do all the following except

  • inflate the tourniquet and then elevate the extremity to prevent edema formation.

  • isolate the scrotum from the tourniquet to prevent testicular damage.

  • prevent prep solutions from pooling under the tourniquet to protect the patient from chemical burns.

  • pad the tourniquet thoroughly to prevent skin breakdown.

Correct answer: inflate the tourniquet and then elevate the extremity to prevent edema formation.

The limb should be elevated prior to inflation of the tourniquet to promote exanguination of the extremity. While applying the tourniquet, the perioperative nurse should isolate the scrotum from the tourniquet to prevent testicular damage, prevent prep solutions from pooling under the tourniquet, and pad the tourniquet thoroughly.

195.

Which of the following disinfectants cannot come into direct contact with a patient?

  • Phenolic

  • Hydrogen peroxide

  • Iodophor

  • Alcohol

Correct answer: Phenolics

Phenolics have toxic effects and may cause depigmentation and hyperbilirubinemia . For these reasons, phenolics should not come into direct contact with a patient. Hydrogen peroxide, iodophors and alcohol may safely come into direct contact with a patient. 

196.

What is the purpose of using padding material under the pneumatic tourniquet?

  • Maintain skin integrity

  • Ease removal of the tourniquet after the completion of the surgical procedure

  • Prevent transfer of organisms from one patient to the next

  • Make the cuff fit better

Wrinkle free and adequate padding has been shown to decrease skin complications in patients with tourniquet use.

197.

During a routine laparotomy, the surgeon notes that the patient has a dissecting aortic aneurysm and decides to do an aorta-bifemoral bypass graft. The scrub nurse is unfamiliar with this procedure. The most appropriate action for the scrub nurse would be to

  • request that the circulator inform the charge nurse of the situation.

  • convey the unfamiliarity with the procedure to the surgeon.

  • switch roles with the circulator.

  • request that a preceptor come to the OR.

Correct answer: request that the circulator inform the charge nurse of the situation.

The nurse has a responsibility to notify their supervisor that they are not familiar with the procedure. The nurse may also convey their unfamiliarity with the procedure to the surgeon, however, their first responsibility is to notify their supervisor. The charge nurse can determine which next steps will be best to take.

198.

Which of the following humidity levels are considered optimal environmental conditions for the OR?

  • 30% to 60%.

  • 10% to 50%.

  • 15% to 60%.

  • 40% to 80%.

Correct answer: 30% to 60%.

Low humidity increases the risk of electrostatic charges and a potential fire. High humidity increases the risk of microbial growth and patient infection. An ideal humidity levle is in the range of 30% to 60%.

199.

The common factor for groups at high risk for sensitivity to latex is that they all:

  • have frequent exposure to latex.

  • have chronic respiratory problems.

  • are over the age of 3a0.

  • are sensitive to other skin irritants.

Latex allergy and sensitivity have become more common among healthcare personnel due to their repeated exposure to natural rubber latex products. Perioperative personnel are at greater risk of frequent exposure to latex than those who work in other areas of the healthcare industry due to many commonly used items in the operating room (OR) containing natural rubber latex: gloves, vial stoppers, tubing, catheters of all kinds, and anesthesia breathing circuits, among others.

200.

Continuous quality improvement in the OR focuses on

  • evaluating patient outcomes to determine methods of improving care

  • checking on the amount of work done by the nurses in the OR

  • collecting data on problems that cannot be resolved

  • finding ways to save money for the hospital

The use of a quality management program should be in place to guide in determining methods of improving patient care. Documentation of patient outcomes along with regular review of this data can provide the framework for determining the need to implement necessary changes in the perioperative environment.