CCI CFPN Exam Questions

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101.

The type of regional anesthesia involving a double-cuff tourniquet and injection of a local anesthetic intravenously is known as a:

  • Bier block.

  • brachial plexus peripheral nerve block.

  • interscalene block.

  • femoral nerve block.

IV regional anesthesia was first described by Bier in 1908 and is frequently called a Bier block. Although it can be used on a lower extremity, it is used more often on the upper extremities. It is highly reliable and straightforward to accomplish. 

A small IV catheter is inserted as distal to the surgical site as feasible, and a single-cuffed or double-cuffed pneumatic tourniquet is placed around the limb proximal to the surgical site. The limb is raised and exsanguinated by wrapping it with an Esmarch bandage. The tourniquet is inflated to approximately 100 mm Hg above the patient's systolic blood pressure, and the Esmarch bandage removed. About 50 mL of 0.5% lidocaine is injected through the catheter. Onset of anesthesia is rapid and lasts until the tourniquet is deflated.

When a double-cuffed pneumatic tourniquet is used, the proximal cuff is initially inflated. When the patient experiences discomfort from the cuff pressure, the distal cuff, which is positioned over an anesthetized area, is inflated and the proximal cuff deflated. The proximal cuff remains inflated until the distal cuff has been inflated to prevent loss of the IV anesthetic from the limb. 

102.

Which of the following is not a primary purpose of "time out" immediately before beginning a surgical procedure?

  • Allow OR staff members a short break 

  • Verify patient identity, positioning, and surgical site

  • Confirm any implants and all equipment is available and ready

  • Ensure all team members are prepared, involved and in agreement

Correct answer: Allow OR staff members a short break 

Before making the first surgical incision, the entire team pauses for a "time out" to prevent wrong-site surgery. This is an intentional stop to verbally confirm the patient's identity, verify the patient's position, state and agree on the procedure and surgical site, and review that all implants and necessary equipment are available and ready. The nurse documents this process according to hospital policy. It is critical that all team members are involved, and that everyone is in agreement in accordance with institutional policy.

"Time out" is not intended to give staff members a short break before beginning surgery, but rather a tool to prevent and conduct a final check that the correct patient, correct site, and correct procedure are identified before an operative or invasive procedure begins.

103.

In addition to tachycardia, tachypnea, and fever, the primary signs of malignant hyperthermia (MH) include: 

  • generalized rigidity and respiratory and metabolic acidosis.

  • generalized flaccidity and respiratory acidosis.

  • generalized rigidity and metabolic alkalosis.

  • generalized flaccidity and respiratory and metabolic alkalosis.

First identified in the late 1960s, MH is a rare, life-threatening complication that may arise from medications commonly used in anesthesia. Inhalational anesthetics and succinylcholine are the most frequently implicated triggering agents. The incidence of MH increases in patients with central core disease (a congenital myopathy) and some muscular dystrophies.

The MH syndrome begins with a hypermetabolic condition in skeletal muscle cells that involves altered mechanisms of calcium function at the cellular level. Characteristics include cellular hypermetabolism resulting in hypercarbia, tachypnea, tachycardia, hypoxia, metabolic and respiratory acidosis, cardiac dysrhythmias, and elevation of body temperature at a rate of 1° to 2° C every 5 minutes. Increase in body temperature is a late manifestation of MH. Muscle stiffness or rigidity often accompanies MH as well. These signs may occur during induction or maintenance of anesthesia, although MH can occur postoperatively or even after repeated exposures to anesthesia. It is seen most frequently in children and adolescents. 

104.

According to AORN Guidelines, how often should the surgeon be informed of the pneumatic tourniquet interval time?

  • 60 mins

  • 30 mins

  • 15 mins

  • At intervals specified by the surgeon

The entire perioperative team should be kept aware of pneumatic tourniquet application, tourniquet pressure, and interval time through the use of activation indicators and displays within the perioperative environment. The surgeon should be notified when the tourniquet has been in place for one hour, and at 15-minute intervals thereafter.

105.

Upon deflation of the pneumatic tourniquet following an IV regional block with 0.5% bupivacaine (Marcaine), the patient reports dizziness and blurred vision. The perioperative nurse should prepare to

  • assist the anesthesia provider in supporting the patient's respiratory and cardiovascular systems.

  • reinflate the tourniquet to prevent a systemic reaction to bupivacaine.

  • provide psychological support to assist the patient in overcoming anxiety.

  • communicate the patient's symptoms to the PACU nurse.

Correct answer: assist the anesthesia provider in supporting the patient's respiratory and cardiovascular systems.

Bupivacaine (Marcaine) can lead to cardiac collapse in some patients. The deflation of the pneumatic tourniquet allows bupivacaine to have a more systemic effect, causing initial symptoms that could include dizziness and blurred vision. Reinflating the tourniquet will not prevent a systemic reaction to bupivacaine. The patient's symptoms are not likely due to anxiety and require immediate attention.

106.

A female patient with a history of infertility has just arrived in the OR for a laparoscopy. She confides that she really does not want to have the procedure, but that the physician said it would be her only chance at becoming pregnant. The perioperative nurse's most appropriate response would be to:

  • ask what concerns the patient has about the procedure.

  • invite the patient to further share her feelings about infertility.

  • ask if the patient wants to obtain a second opinion about the procedure.

  • inquire about the patient's spouse's feelings about the surgery.

Gynecologic patient information is gathered through nursing and physician interviews, evaluation of the patient's systems, physical examination, collection of medical and surgical histories, and thorough diagnostic testing. Throughout the assessment, the perioperative nurse remains open, nonbiased, compassionate, and supportive to assist in establishing a trusting therapeutic relationship. 

Once a therapeutic relationship has been established, and a patient confides that she is unsure of her impending surgery, it is imperative to ask questions to gain a better understanding of the patient's concerns. The nurse can then better gauge from there, what the most appropriate next steps may be. 

107.

How many identifiers should be used to verify the correct patient, site, and procedure?

  • 2

  • 1

  • 3

  • 4

Verification of the correct patient, site and procedure, utilizing two patient identifiers, is an example of the pre-procedure verification process. The National Patient Safety Goals states the need for a formalized process using two patient identifiers for safe patient care.

108.

_________ is defined as the desirable and measurable physiological and psychological responses of patients to nursing interventions.

  • Outcome

  • Process

  • Output

  • Efficiency

Patient outcomes are an essential indicator of the quality of care based on the nursing process. Outcomes are determined by nursing diagnoses and interventions to resolve the nursing diagnosis.

109.

A sterilized container is opened and moisture is noted inside the container. What is the best course of action for the perioperative nurse to follow?

  • Do not use the instruments, notify Sterile Processing of the wet load and obtain another instrument set.

  • Do nothing as the contents are sterile.

  • Call Sterile Processing to report the moisture and possible wet load, and continue to use the product.

  • Do not use the instruments until allowed to dry.

After removal from the sterilizer, freshly sterilized packs should be left untouched on the loading carriage until they have cooled to room temperature. If freshly sterilized packages are placed on cool surfaces such as metal tabletops, vapor still inside the essentially dry package may condense to water. This water may dampen the package from the inside to the outside. When the outside is wet, bacteria may follow the moist tract into the contents of the package. Because bacteria are capable of passing through layers of wet material, any packages that are wet (as evidenced by moisture inside the container) must be considered unsterile and contaminated. The instruments should not be used, should be resterilized, and other instrument set should be obtained. 

110.

A patient undergoing a small bowel resection for Crohn's disease suffers a perforated viscus with spillage of intestinal contents during the procedure. 

What wound classification is this?

  • Dirty-contaminated (Class IV).

  • Clean (Class I)

  • Clean-contaminated (Class II).

  • Contaminated (Class III).

The Centers for Disease Control and Prevention (CDC) have described four surgical wound classifications: clean wounds (Class I), clean contaminated wounds (Class II), contaminated wounds (Class III), and dirty or infected wounds (Class IV). This classification scheme reflects the probability of infection and enables appropriate preventive measures to be taken.

Class IV wounds can be infected wounds that include old, physically induced (traumatic) wounds with retained devitalized tissue, or wounds that involve an existing clinical infection or perforated viscera. This class of wound is considered dirty-contaminated. These include wounds that have been exposed to fecal material, such as the patient above who suffers a perforated viscus (otherwise known as an intestinal or bowel perforation). 

111.

Perioperative nurses are accountable to their patients, their profession, their employer, and

  • co-workers.

  • quality assurance department.

  • hospital legal department.

  • certification organization.

Correct answer: co-workers.

Nurses are ultimately accountable to their patients, their profession, their employer, and their colleagues. While they may have some responsibilites related to the hospital's quality assurance or legal departments, they are not accountable to these stakeholders.

112.

An unconscious patient should be moved only

  • with the permission of the anesthesia provider.

  • with a transfer device.

  • with the help of at least five people.

  • upon regaining consciousness.

Correct answer: with the permission of the anesthesia provider.

Patients who are unconscious may be repositioned, but only with the permission of the anesthesia provider. The patient does not need to be conscious to be moved. A transfer device or five people may be used to help reposition the patient, but neither is always essential.

113.

The purpose of an occurrence (incident) report is to:

  • serve as an internal document for quality improvement and risk management.

  • identify the person responsible for the adverse event so that punitive action may be taken.

  • provide an opportunity for the persons involved to express their opinion of what happened.

  • be used as evidence in a court of law as part of the patient’s permanent record.

Correct answer: serve as an internal document for quality improvement and risk management.

Incident (occurrence) reports should objectively, completely, and accurately describe the event without interpretation or opinion by the person(s) completing the form. They are considered facility work documents used to improve processes, not to attach blame to an individual. The fact that an incident report was completed should never be documented in the patient’s record, which is a legal document and subpoenable in a court of law.

114.

A perioperative nurse has been asked by a doctor to witness a consent. The nurse's signature as witness attests to

  • identification of the patient or legal substitute and voluntary signing by the patient.

  • the patient's being mentally competent.

  • the patient's not being under the influence of drugs and/or alcohol.

  • the fact that the patient was properly informed of all risks and potential complications.

Correct answer: identification of the patient or legal substitute and voluntary signing by the patient.

When the nurse witnesses a consent, they are only attesting that the patient signed the consent willingly. The nurse does not assess the patient's competency to sign and is not responsible for ensuring that the patient is properly informed of all risks and potential complications.

115.

If a patient refuses to have their surgical site marked, or the surgical site cannot be marked, the nurse should:

  • follow the facility’s policy.

  • ensure there is a sticker with the doctor’s initials near the site.

  • tell the patient it is a mandatory regulation.

  • report the refusal to the charge nurse.

Correct answer: follow the facility’s policy.

Organizational policy is the ruling document in this situation. The Joint Commission published the “Speak Up” document. The document describes patient refusal and sites that are unable to be marked, but states you must follow your policy.

116.

Which of the following represents an open-ended question during an assessment of a patient's learning readiness?

  • "What do you expect to happen on the day of surgery?"

  • "What is your address?"

  • "Do you expect to go home after your surgery?"

  • "What kind of surgery are you scheduled to have?"

Correct answer: "What do you expect to happen on the day of surgery?"

An open-ended question is one that is not intended to be answered with a single word or phrase. Questions that are require a "yes" or "no" answer or require a piece of data, such as a time or location, are not open ended questions. 

117.

When preparing a preschool child for surgery, the perioperative nurse should allow the child to:

  • participate in any way possible.

  • play with the instruments.

  • ambulate with his or her parents.

  • act out anxiety-producing situations.

A child's comprehension of and responses to the environment are based on developmental age. Perioperative care should be tailored to the developmental age of the child to optimize the child's ability to understand the situation, to minimize the child's and family's stress and anxiety, and to facilitate the development of a trusting and supportive medical relationship. 

For preschool children (ages 3-4), the nurse should allow him or her to handle (but not play with) unfamiliar objects to decrease stress (e.g., mask, pulse oximeter probe), and give the child a sense of control. Participation in care is key at this age. The nurse should also allow a personal item into OR for comfort/security.

118.

A preoperative nursing diagnosis of "altered emotional state" may be derived from

  • an interview with the patient and a comparison of the patient's behavior to accepted norms.

  • a spouse's statement that the patient is "upset."

  • the unit nurse's statement that the patient is demanding.

  • a review of the chart for medical diagnosis, diagnostic work-up, and history and physical.

Correct answer: an interview with the patient and a comparison of the patient's behavior to accepted norms.

A preoperative nursing diagnosis of "altered emotional state" requires assessment of the patient's emotional wellbeing by the nurse themselves and a comparison of their emotional state to accepted norms.

119.

Which of the following positions and positioning devices are associated with causing injury to the common peroneal nerves?

  • Lithotomy position and the use of stirrups.

  • Supine position and the use of a shoulder brace.

  • Trendelenburg position and the use of a footboard.

  • Modified Fowler position and the use of a headrest.

Lower extremity neuropathies result most frequently from prolonged lithotomy positioning and tend to manifest symptoms within hours after surgery. The common peroneal, sciatic, and femoral nerves are most frequently implicated.

The common peroneal nerve branches from the sciatic nerve behind the knee and becomes superficial as it wraps around the lateral head of the fibula. At this level, it is vulnerable to direct compression by stirrup bars. This risk may be increased in extremely thin patients who have minimal overlying tissue in this area. It is important to ensure that the lateral head of the fibula does not rest against stirrup bars or any other rigid surface. 

120.

According to AORN Guidelines for hair removal, the perioperative nurse should:

  • leave the hair at the surgical site, unless hair removal is indicated

  • remove hair using a sterile straight-edge razor

  • remove hair using an electrical razor with a sterile disposable head

  • leave the hair at the surgical site, unless requested for surgeon preference

While hair removal at or near the surgical site was standard of care for many years, more recently the focus in perioperative care has been on the question of whether perioperative hair removal actually contributes to the development of surgical site infection (SSI). A multitude of studies addressing this question have been completed, with varying outcome findings. Unless the hair at the surgical site will interfere with the surgical procedure (wound closure, impaired ability to visually assess the surgical area, interference with the adhesive material of skin drapes, fire risk from alcohol-based skin preparation products), hair at the surgical site, including during neurosurgical procedures, should be left intact.