CCI CFPN Exam Questions

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81.

One of the measurable goals of the Surgical Care Improvement Project (SCIP) is the prevention of venous thromboembolism (VTE), requiring an appropriate prophylaxis to be administered to patients:

  • 24 hours before their surgery or within 24 hours after it.

  • 48 hours before their surgery or within 24 hours after it.

  • 72 hours prior to the day of surgery.

  • 48 hours after the surgical procedure.

SCIP is a national quality partnership interested in improving surgical care by significantly reducing surgical complications. SCIP created an original goal of reducing by 25% the national incidence of three types of surgical complications by 2010 (surgical site infections, perioperative myocardial infarction, and deep vein thrombosis/pulmonary embolism [DVT/PE]).

To reduce the incidence of DVT/PE in at-risk surgical patients, intermittent pneumatic compression devices (IPCDs), graduated compression stockings, or pharmacologic prophylaxis should be administered 24 hours before surgery, or within 24 hours after surgery. 

82.

The minimum requirements for labeling intraoperative specimens include patient name and identification number, laterality, if indicated, and:

  • origin of specimen.

  • primary care doctor.

  • operating room phone number.

  • nurses name.

Proper management of specimens is critical to the outcome of a patient's surgery. It is the responsibility of the surgical team to identify, document, and care properly for specimens. Complete and accurate identification and labeling of specimens and timely delivery to the proper laboratory for analysis are imperative. A mislabeled specimen may result in misdiagnosis and consequently inappropriate treatment of the patient.

At a minimum, each specimen must bear a label with the correct patient name and identification number, specific origin of the specimen, and laterality (e.g., Mary Jane, 10101010, left breast biopsy). In addition, the surgeon should provide descriptive information about the specimen (e.g., "suture tag at 12 o'clock"), and the nurse should "repeat back" to the surgeon information being sent to the laboratory (e.g., patient name, type of specimen, source/location, required tests, special handling needs). All specimens and their disposition must be documented in the patient's intraoperative record.

83.

A perioperative nurse is developing a care plan for a 16-month-old toddler who will be having surgery for an intestinal obstruction. Which of the following preparations is most important to include in this patient's care plan?

  • Increase the room temperature before the child's surgery.

  • Carry the child to the operating room to decrease the child's anxiety

  • Allow the child to bring a favorite toy to the operating room.

  • Allow the parents to join the child in the holding area.

When preparing for pediatric surgery, the perioperative nurse must know that infants and young children are most at risk for hypothermia secondary to their increased body surface area-to-weight ratio, and thin fat layer. Once the pediatric patient gets cold, oxygen consumption increases, and resultant hypoxia ensues. In addition, the child is likely to experience respiratory depression, acidosis, hypoglycemia, and pulmonary vasoconstriction. Hypothermia alters drug metabolism, prolongs the action of neuromuscular blockers, and delays emergence from anesthesia.

It is imperative for the perioperative nurse to closely monitor the child's temperature throughout the intraoperative experience, because the child must remain normothermic for optimal outcomes. The easiest way to do this is by exposing only the area on which surgery is being performed. Other thermoregulatory interventions include altering the room temperature before the child enters the room, using a water-filled temperature-regulating blanket under the patient, or using a forced-air warming blanket over nonsurgical areas of the child. In addition, an overhead heater can be used during the induction and patient preparation period, and warmed solutions should be available for use for procedures with large body areas of exposure. 

The other answer choices should be taken into consideration when preparing a pediatric patient for surgery, but the priority intervention is temperature regulation. 

84.

Prior to the use of an ultrasonic cleaning process, instrumentation should have:

  • undergone gross debris removal.

  • undergone flash sterilization (IUSS).

  • been treated with instrument lubricant or milk.

  • been soaked in an antimicrobial solution.

The ultrasonic cleaning process is designed to remove fine soil from crevices and lumens of complex devices and from box-lock areas and serrations of instrumentation. It should be used only after gross debris has been removed.

Ultrasonic energy occurs in waveforms and is generated by transducers on the sides or bottom of a specially constructed chamber that is filled with water or a water and detergent solution. The ultrasonic waves pass through the water, creating tiny bubbles that collapse or implode. This creates a negative pressure, which pulls debris away from surfaces (known as cavitation). Ultrasonic cleaning is not biocidal, and after sonication the instruments should be rinsed to remove the loose debris.

85.

Sponges being discarded from the surgical field during surgery with a minimal amount of blood, should be placed in:

  • commercial plastic sponge counter bags

  • red biohazard bag

  • standard trash bag

  • a plastic-lined container

Use of a sponge counter type bag for placement of sponges during the surgical procedure will assist with counting. This procedure decreases the risk for retained surgical items during the operative procedure. The amount of blood present does not negate the placement of the sponge for counting.

86.

The neurosurgeon is using a power drill for a trauma patient, making a burr hole in the cranial bone to release pressure from intracranial bleeding. The power drill inadvertently heats the bone. What action should the perioperative nurse take to prevent overheating of the tissue? 

  • Intermittently irrigate the tip of the drill with saline solution during drilling.

  • Recommend that less pressure be placed on the drill.

  • Stop the drilling until the bone is cooled.

  • Obtain a drill that produces less heat.

Powered surgical instruments are commonly used in neurosurgery. Multiple drills, drill bits, and accessories are available. These tools may be powered by air, battery, or electricity and are operated by a hand control or foot pedal. All drills have a safety control that should be engaged at all times the instrument is not in use. 

The perioperative nurse should monitor the sterile field to ensure that the drills and other equipment being used makes bone work easier and reduces operating time. Irrigating the tip of the drill while it is in use prevents overheating of the tissues. 

87.

A nurse holds personal beliefs that conflict with caring for a patient undergoing a therapeutic pregnancy termination. In this situation, the nurse should

  • request reassignment and plan for appropriate substitute nursing.

  • care for the patient and speak with the nursing administrator later.

  • care for the patient and inform the surgical team of the personal opposition.

  • refuse to care for the patient and inform the patient of the reason.

Correct answer: request reassignment and plan for appropriate substitute nursing.

The nurse is not obligated to perform care that conflicts with their personal beliefs, but does have the responsibility to ensure the patient has access to appropriate substitute nursing care. The nurse cannot refuse to care for the patient once they have established a duty to provide care, but can provide care in the form of transferring care to another provider. 

88.

A patient receiving local anesthesia should be monitored by the:

  • registered nurse

  • anesthesia technician

  • certified technician

  • surgeon

Per AORN guidelines for monitoring of patients who are receiving local-only anesthesia, an additional perioperative RN is required to provide monitoring of the patient throughout the surgical procedure. 

89.

A patient is scheduled to undergo a surgical procedure under moderate sedation. The perioperative nurse should inform the patient that

  • a responsible adult escort is necessary for discharge.

  • a 2-hour recovery period is necessary prior to discharge.

  • activities of daily living can be resumed immediately after surgery.

  • verbal postoperative instructions will be given in the PACU.

Correct answer: a responsible adult escort is necessary for discharge.

Moderate sedation does not require a 2-hour recovery period prior to discharge, but does require a responsible adult escort. The ability to resume activities of daily living is related to the procedure, not to the sedation used. Written instructions should be given, as some anterograde amnesia may be present.

90.

Topical skin adhesives used for surgical skin closure normally slough off in ________ days.

  • seven to ten

  • ten to fourteen

  • four to five

  • ten to twelve

A topical skin adhesive is a type of surgical adhesive. It is best used in areas not subject to high skin tension or across areas in which tension may increase (such as knuckles, elbows, or knees), and can be used to replace subcuticular sutures that are 4-0 or smaller in diameter, as long as the skin edges are tension free and well approximated. It provides a flexible water-resistant protective coating that naturally sloughs off the incision in 7-10 days and may offer equivalent wound cosmesis to sutures.

91.

A patient is brought to the operating room with a subdural hematoma. Which of the following is the most likely cause of deterioration in the patient's condition?

  • Increased intracranial pressure

  • Decreased cerebrospinal fluid

  • Cerebral thrombosis

  • Neurogenic shock

Increasing intracranial pressure (ICP) due to hematoma formation can cause rapid deterioration in the patient's condition, and requires emergency decompression craniotomy.

92.

All of the following increase a patient's risk of developing a deep vein thrombosis except

  • surgery lasting less than 30 minutes

  • using oral contraceptives

  • prolonged bed rest

  • inserting a central venous catheter

Part of the preoperative patient assessment includes a thorough assessment for risk factors related to venous thromboembolism (VTE). Risk factors include, but are not limited to:

  • the use of any estrogen therapy, including contraceptives
  • previous history of VTE
  • pregnancy
  • dehydration
  • smoking
  • varicose veins
  • trauma, and
  • length of surgical time greater than 90 minutes (or 60 minutes if the procedure involves the lower limbs or pelvis)

93.

The Joint Commission (TJC) requires health care organizations to have a defined process for obtaining informed consent. At a minimum, this process should include the patient's being able to verbalize an understanding of the

  • benefits and risks of the proposed procedure.

  • guaranteed outcome of the surgical procedure.

  • right to choose the anesthetic agent.

  • surgeon's competency to perform the procedure.

Correct answer: benefits and risks of the proposed procedure.

Informed consent indicates that the patient is able to understand why they need a procedure and the risks of undergoing the procedure. The outcome of the procedure is not guaranteed. The patient does not necessarily have the right to choose the anesthetic agent. While the surgeon should have the competency needed to perform the procedure, this is not part of informed consent.

94.

The concurrent implementation of personal protective equipment (PPE), work practices, and engineering controls is known as:

  • standard precautions.

  • sharps safety.

  • universal protocol.

  • isolation precautions.

Standard Precautions are designed to reduce the transmission risk of bloodborne and other pathogens from recognized and unrecognized sources of infection. Standard Precautions should be applied to all patients receiving care regardless of their diagnosis or presumed infection status, and are considered the first (and most important), tier of precautions and a primary strategy for successful infection prevention and control. They apply to blood, all body fluids and secretions and excretions (except sweat), mucous membranes, and nonintact skin. 

Standard Precautions include the following:

  1.  Hand hygiene
  2. Gloves
  3. Masks, eye protection, face shields
  4. Gowns
  5. Sharps
  6. Patient care equipment
  7. Linens
  8. Environmental control
  9. Patient placement

95.

During cleanup after a procedure, a moisture stain is noted on the wrapper of an unused instrument set that had been sterilized in ethylene oxide. The perioperative nurse should

  • reprocess the set before use

  • allow the wrapper to air-dry

  • open the set and rinse the items with sterile water

  • open the set and allow the items to air-dry

Any sterilized pack that shows evidence of having become contaminated by moisture should be removed from immediate-use circulation and resterilized.  Moisture penetration of a previously sterilized pack compromises the sterility of the pack.

96.

A trauma patient is admitted to the emergency department and has an isolated hemothorax. Lost blood is collected in a chest drainage device for autotransfusion, and must be reinfused within:

  • 4 hours

  • 6 hours

  • 8 hours

  • 2 hours

Correct answer: 4 hours 

Autotransfusion is often used for blood volume replacement. A double-lumen suction tip is used to remove blood for autotransfusion and is filtered; only blood intended for reuse is suctioned into the autotransfusion machine. Reinfusion must occur within 4 hours to avoid bacterial contamination. Autotransfusion provides immediate volume replacement, decreases the amount of bank blood used, and reduces the possibility of transfusion reactions or risk of transfusion with bloodborne pathogens.

97.

During the preoperative interview, which of the following statements by the patient would alert the perioperative nurse to a susceptibility to malignant hyperthermia?

  • "My mother died from a fever after she had surgery years ago."

  • "I was very nauseated the last time I had surgery."

  • "I don't remember anything about my last operation."

  • "My uncle died from a heart attack during his chest surgery."

Correct answer: "My mother died from a fever after she had surgery years ago."

Malignant hyperthermia is a complication of anesthesia caused by altered cellular calcium transport. One of the most common symptoms of this condition is hyperthermia that occurs during or following the administration of anesthesia. This condition is often fatal and has a strong genetic component. A direct relative dying from a fever after surgery should raise the suspicion of malignant hyperthermia. While this could be describing a post-surgical infection, malignant hyperthermia cannot be ruled out based on this description.

98.

While separating the basin set during set-up on the ring stand, the scrub nurse discovers that the basins are nested together without porous material between them. What course of action should the scrub nurse take?

  • Replace the basin set and reglove.

  • Notify the surgeon that a sterile basin set is not available.

  • Consider the table setup unsterile and replace everything.

  • Continue to set up the procedure.

Correct answer: Replace the basin set and reglove.

If the basins are nested together, it is likely that full sterilization may not have been achieved due to the contact of the two surfaces. The basin set should be replaced, but the table setup should not be considered unsterile.

99.

Tissue procured from a human cadaver is called a/an: 

  • allograft.

  • xenograft.

  • autograft.

  • heterograft.

An allograft is a tissue graft from a donor (cadaver) of the same species as the recipient, but not genetically identical. An allograft may be used to cover burned areas during the initial healing process, but the graft must be carefully tested prior for immunodeficiency diseases. 

A xenograft is a tissue graft or organ transplant from a species different from that of the recipient. A xenograft (e.g., pig skin) may also be used for covering a burn area. A heterograft is another term for xenograft. An autograft is a graft of tissue from one point to another of the same individual's body. 

100.

All the following emergency equipment must be readily available when intravenous (IV) moderate sedation is administered, except:

  • malignant hyperthermia cart.

  • pulse oximeter, blood pressure monitor, and an electrocardiogram (EKG) machine.

  • defibrillator, valve-mask-bag resuscitation equipment, and airway equipment.

  • difficult intubation scope and suction.

Moderate sedation/analgesia (conscious sedation) is administered for specific short-term surgical, diagnostic, and therapeutic procedures performed within a hospital or ambulatory center. 

Malignant hyperthermia (MH) is a life-threatening pharmacogenetic reaction that occurs on administration of general anesthesia. It is characterized by hypermetabolism, resulting in dangerously high body temperature, rigid muscles or spasms, and tachycardia. A MH cart is not necessary for moderate sedation, as general anesthesia is not utilized.

All the other equipment should be readily available for moderate sedation/analgesia.