CCI CFPN Exam Questions

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21.

Most abdominal aortic aneurysms:

  • have minimal symptoms.

  • carry a high mortality rate when electively repaired.

  • occur below the aortic bifurcation.

  • involve weakening of the tunica adventitia

Abdominal aortic aneurysms (AAAs) account for most aneurysms and occur primarily between the renal arteries and the aortic bifurcation. They involve intimal aortic damage and weakening of the tunica media (elastic portion) of the arterial wall. The vessel wall in the damaged area slowly expands, and atheroma develops within the aneurysm sac. 

Because an AAA has minimal symptoms, it is generally diagnosed by routine history and physical examinations. Diagnosis is made if the diameter of the infrarenal aorta is 3 cm or larger for men, or 2.6 cm or larger for females. With elective surgical repair of the aneurysm, mortality is low. Aortic dissection is thought to arise from an abrupt tear in the aortic intima, opening the way for blood to enter into the aortic wall. Operative mortality dramatically increases with aortic dissection and rupture, because of the abrupt and massive hemorrhagic shock that accompanies the rupture. 

22.

Ethylene oxide is a form of chemical sterilization and a known human carcinogen. The permissible exposure limits are regulated by the:

  • National Institute for Occupational Safety and Health Administration

  • Joint Commission on Accreditation of Healthcare Organizations

  • Food and Drug Administration

  • Environmental Protection Agency

Correct answer: National Institute for Occupational Safety and Health Administration

Healthcare providers are exposed to many hazardous chemicals daily. The hazards of these chemicals include irritation to the eyes or mucous membranes, contact dermatitis or burns, toxicity that causes renal or liver disease, and exposure to carcinogens or mutagens (such as ethylene oxide). Hazardous chemicals in the workplace are controlled by various government regulations.

The National Institute for Occupational Safety and Health Administration (OSHA) sets standards for ventilation systems and environmental protection in the workplace; permissible exposure limits to ethylene oxide (EO) are regulated by OSHA.

23.

Patients selected to have moderate sedation must meet criteria established by:

  • an interdisciplinary group of caregivers.

  • the surgeon.

  • the anesthesiologist.

  • the primary care physician.

Selection of patients for moderate sedation/analgesia depends on established criteria developed by an interdisciplinary team. 

Patients undergo a comprehensive thorough assessment physiologically and psychologically before the procedure by a team of caregivers. This assessment includes a review of physical examination findings; current medications; existing allergies; current medical problems; history of smoking, alcohol intake, or substance abuse; current chief complaint; baseline vital signs, height, and weight; age; emotional state; any communication deficits; and patient perceptions of moderate sedation/analgesia. 

24.

A patient is scheduled for laparoscopic cholecystectomy and intraoperative cholangiogram using fluoroscopy. In addition to supplying leaded aprons, the perioperative nurse may do all of the following to ensure staff safety except

  • ensure that unprotected staff stand behind protected staff

  • provide thyroid shields and leaded glasses to all personnel

  • provide radioprotective gloves to all members of the sterile team

  • plan on standing at least 6 feet from the fluoroscopic beam

In order to minimize radiation exposure of the perioperative team and provide protection against radiation exposure and/or injury, the perioperative nurse should ensure that the perioperative team maintain a distance of at least 6 feet from the radiation source when at all possible, and should provide the team with the appropriate protective equipment:  leaded aprons, vests, skirts, or wraparound attire; thyroid shields; leaded gloves when appropriate; head coverings if the head of the perioperative team member cannot be moved to a location away from the radiation source (fluoroscopic procedures). In addition, team members should be instructed to stand behind structural components of the perioperative environment (protective cubicles, control booths) when possible to prevent exposure to radiation. 

25.

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

Assigning a physical status classification depends on the physiologic condition of the patient, and is independent of the surgical procedure the patient is planning to undergo. This classification system was developed by the ASA to provide standardized guidelines and evaluate the severity of systemic diseases, physiologic dysfunction, and anatomic abnormalities. It is utilized widely to estimate perioperative risk, and is as follows: 

  • P1: Normal healthy patient with no physiologic, psychologic, biochemical, or organic disturbance 
  • P2: Patient with mild systemic disease (cardiovascular disease with minimal restriction of activity; hypertension, asthma, chronic bronchitis, obesity, diabetes mellitus, or tobacco use; mild asthma or well-controlled hypertension. No significant impact on daily activity. Unlikely impact on anesthesia and/or surgery)
  • P3: Patient with severe systemic disease that limits activity, but is not incapacitating 
  • P4: Patient with severe systemic disease that is a constant threat to life or requires intensive therapy
  • P5: Moribund patient who is not expected to survive 24 hours or without operation
  • P6: Patient declared brain dead whose organs are being removed for donor purposes

26.

When assessing a patient scheduled for an indirect inguinal hernia repair, the perioperative nurse remembers that indirect hernias

  • are more common than direct hernias.

  • originate above the inguinal ligament.

  • occur most often in males under 30 years of age.

  • rarely enter the scrotum.

Correct answer: are more common than direct hernias.

Indirect hernias do not originate above the inguinal ligament. Incidence of indirect hernias increases with age, and is not more likely to occur individuals under 30 years of age than those over 30 years of age.

27.

Signs and symptoms of a moderate adverse reaction to contrast media include laryngeal edema, tachycardia or bradycardia, and:

  • bronchospasm.

  • altered taste.

  • diaphoresis

  • swelling of eyes or face.

Bronchospasm and wheezing are symptoms of a moderate reaction and also include dyspnea, erythema, hypertension or mild hypotension. All other options are part of a mild reaction.

28.

A patient is scheduled for a breast biopsy with frozen section under local anesthesia. Appropriate intraoperative care would include:

  • keeping room traffic and noise levels to a minimum.

  • playing lively music and discouraging the patient from talking.

  • encouraging team members to be cheerful and upbeat.

  • allowing the patient time alone by staying busy with circulating duties.

The surgical suite should be designed to minimize the spread of infectious organisms and to facilitate movement of patients and personnel within that framework. Ideally, the suite is divided into three areas: the unrestricted area, the semirestricted area, and the restricted area. Personnel entering semirestricted or restricted areas should do so through prescribed routes which contain vestibular areas (serving as transition zones between the outside and inside of the suite). 

Air is a potential source of pathogenic microorganisms, and airborne contamination increases with movement of the surgical team. Movement should be kept to a minimum during the operative procedure. 

In addition, noise can cause distraction, increasing the potential for miscommunication and errors within the perioperative team. While the patient is in the OR, especially during induction and emergence, every effort should be made to maintain a calm, quiet environment. Hearing multiple voices can create patient anxiety and confusion during an already very scary time. 

29.

The use of _________________ handoffs and transfer protocols have been identified as methods to prevent communication breakdowns between caregivers

  • standardized

  • patient-focused

  • surgeon-led

  • nurse-led

Standardization of transfer of patient information processes improves the accuracy, reliability and quality of information exchanged. The method should standardize both process and content and should be tailored to organization needs.

30.

If a patient goes into cardiac arrest, the first action the circulating nurse should take is to

  • activate the emergency alarm to alert personnel and to summon assistance.

  • help to reposition the patient in the supine position, if necessary.

  • lower the OR bed and provide the person performing resuscitation with a platform to stand on.

  • document all medications given, with time and amount, and the sequence of procedures performed.

Correct answer: activate the emergency alarm to alert personnel and to summon assistance.

When a cardiac arrest occurs, once the fact that the patient is in cardiac arrest has been established, the first response should be to get assistance by activating the emergency alarm to alert personnel. Documentation and interventions should only be performed after the emergency alarm has been activated.

31.

Risk factors for postoperative ileus include intra-abdominal infection, intra-abdominal inflammation, retroperitoneal hemorrhage and:

  • manipulation of the bowel during surgery

  • lack of bowel sounds.

  • intestinal gases.

  • lack of intestinal gas

Patients undergoing surgical intervention for GI disorders vary greatly in length of time and complexity of recovery. Most patients experience a temporary decrease in bowel activity for about 3 days after GI surgery, called “postoperative ileus." Motility of the small intestine usually returns to normal within a few hours after GI surgery. Stomach motility returns to normal within 24 to 48 hours, and the large intestine returns to normal within 48 to 72 hours. Prolonged postoperative ileus should be considered when it lasts beyond the expected 3 days. Signs and symptoms of prolonged ileus are absence of bowel sounds, abdominal distention, diffuse abdominal pain, nausea, and vomiting. 

Causes of prolonged ileus vary, and can arise from neurogenic, inflammatory, hormonal, pharmacologic, or mechanical effects of surgery, as well as: 

  • overmanipulation of the intestines during surgery
  • intra-abdominal infection or inflammation
  • retroperitoneal hemorrhage

Identifying early bowel sounds through abdominal auscultation may signal the return of small intestine motility. However, only the passage of flatus or stool indicates full return of bowel function and resolution of ileus. 

32.

A basic principle of protecting information regarding a patient is that only individuals involved with the patient's care should be allowed to hear or view protected information. This will ensure compliance with the _____________________ regulations.

  • HIPAA

  • OSHA

  • AAMI

  • Joint Commission

Those individuals that are part of the patient care team have access to the health information. Confidentiality ensures compliance with the Health Insurance Portability and Accountability Act (HIPAA).

33.

In relation to transcultural needs of the patient, it is important to include __________ needs in the nursing assessment.

  • spiritual

  • medical

  • activities of daily living

  • pharmacological

Correct answer: spiritual

Transcultural needs include spiritual, ethnic, and family patterns. Standard assessment of patient needs involve physical, physiological, and any other health status considerations.

34.

The process of collecting blood as it is lost during a surgical procedure, and re-infusing it into the patient after it has been filtered or washed is known as:

  • autotransfusion.

  • pheresis.

  • hematopoiesis.

  • type and screen.

Autotransfusion is simply the reinfusion of a patient's own blood intraoperatively, and is used with increasing frequency in surgery as autologous blood donation is in decreasing use. During intraoperative autotransfusion (cell salvage), blood is collected as it is lost during the surgical procedure and reinfused to the patient after it is filtered or washed. This technique can be lifesaving in emergency situations, as with major trauma, or in procedures with major blood loss, as in liver transplantation. It is also used for patients who refuse blood based on religious beliefs.

Phresis is a procedure in which blood is removed from a donor, separated, and a portion retained, and the remainder is returned to the donor. Hematopoiesis is the process through which the body manufactures blood cells. A type and screen in a blood test that determines both the ABO-Rh of the patient and screens for the presence of the most commonly found unexpected antibodies within said patient's blood. 

35.

When performing Immediate Use Steam Sterilization (IUSS) in a gravity displacement autoclave for a load containing both metal items with lumens and porous items, the correct cycle would be:

  • to follow the written instructions from the manufacturer for the device and container

  • to follow the FDA recommendations

  • 1211º C (250º F) for 10 minutes

  • 1322º C (270º F) for 4 minutes

IUSS should be kept to a minimum. The written instructions from the manufacturer of the device and container must be followed regarding temperature settings, exposure time and drying time.

36.

A pre-vacuum sterilizer requires daily monitoring in order to ensure

  • maintenance of an adequate vacuum for air removal.

  • proper mixing of steam and air.

  • maintenance of proper venting for air removal.

  • destruction of heat-resistant microbes.

Correct answer: maintenance of an adequate vacuum for air removal.

A pre-vacuum sterilizer uses a vacuum to remove air from a sterilizer chamber. To be effective, there must be adequate vacuum for air removal. While proper mixing of steam and air, maintenance of proper venting for air removal, and destruction of heat-resistant microbes are all important considerations, these are not the reasons for daily monitoring of pre-vacuum sterilizers.

37.

Part of the AORN Standards of Professional Practice mandate that nurses evaluate the quality of their nursing practice. Four ways to ensure professional practice related to the AORN practice standards include: maintaining competency, the use of evidence-based practice, certification, and:

  • pursuit of lifelong learning.

  • mentoring student nurses.

  • achieving a minimum of an associate’s degree.

  • achievement of an advanced practice nurse degree.

As nursing practice changes based on research, the AORN Standards of Professional Practice will be updated. Pursuing lifelong learning will ensure the professional nurse is up to date on evidence-based practice as it evolves.

38.

While assessing a patient in the preoperative area who is scheduled for a splenectomy, the perioperative nurse notes that the patient has been on warfarin sodium (Coumadin). The nurse should give priority to reviewing which of the following laboratory test results?

  • Prothrombin time

  • Platelet count

  • Creatinine clearance

  • White blood cell count

Correct answer: Prothrombin time

Warfarin alters prothrombin time, and prothrombin time should be measured to assess if the effects of warfarin are still present, as this can significantly increase the risk of bleeding. Platelet count, creatinine clearance, and white blood cell count are unlikely to be affected by prothrombin time.

39.

Procedures of the head and neck area carry an increased risk for fire due to the:

  • presence of an oxygen-enriched environment

  • presence of non-combustible anesthetic gasses

  • use of povidone-iodine prepping agents

  • mixing of medical air and oxygen

In an oxygen-enriched environment the temperature and energy required for fuels to ignite is lower than that of medical air. An oxygen-enriched environment, like that of head neck procedures, may be present due to the presence of anesthesia gas.

40.

According to Spaulding's Classification System, to prepare items such as blood pressure cuffs for patient use the appropriate process is:

  • low-level disinfection.

  • decontamination.

  • high-level disinfection.

  • sterilization.

Using the Spaulding Classification System, a blood pressure cuff would be classified as a non-critical item which would only come into contact with intact skin. The preparation for a non-critical item is low-level disinfection.