CCI CFPN Exam Questions

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121.

Which of the following is a priority for the perioperative nurse to collect during the assessment from a patient who is having elective surgery?

  • The patient's understanding and expectations of the surgery

  • The plan for the patient's anesthesia care

  • The psychosocial status of the patient's family

  • The plan for the patient's fluid and electrolyte maintenance

Assessing the patient's understanding of the planned surgery should be of primary importance to the perioperative nurse. Any misunderstanding or confusion about what the surgery is to entail should be documented and reported immediately to the primary surgeon.

122.

Which of the following statements, expressed by a patient scheduled for hernia surgery, may require additional preoperative teaching?

  • "I may resume normal activity following surgery."

  • "I may need a urinary catheter."

  • "I will have some pain".

  • "I will need someone to drive me home".

When discussing home care for the hernia patient, the nurse should give the patient and the caregiver verbal and written instructions. With regard to activity, discuss allowances and limitations with respect to occupation, recreation, or activities. Instruct the patient to avoid coughing, straining, stretching, constipation, heavy lifting (>10 lb), strenuous exercise, and sports for at least 3 weeks (or as directed). Stress the importance of activity restrictions and splinting the incision for up to 6 weeks after surgery. Advise returning to work in 2 weeks for desk work and 6 weeks for heavy labor.

The patient should not resume normal activity following surgery, and needs additional teaching if s/he states this. The other answer choices are correct. The patient may needs a urinary catheter, have some pain, and will need someone to drive him or her home, following surgery. 

123.

According to Guidelines for Perioperative Practice, what is the preferred frequency that steam sterilizers should be monitored with a biological indicator?

  • Daily

  • With each load

  • Monthly

  • Weekly

Biological indicators should be used to monitor sterilizer efficacy. Efficacy monitoring should be performed at least weekly and preferably daily.

124.

Standard Precautions are to be utilized during all patient care activities regardless of the patient's diagnosis, and apply to all the following secretions, except:

  • sweat.

  • blood.

  • synovial fluid.

  • amniotic fluid.

Standard Precautions are intended to reduce the transmission of microorganisms 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. They are considered the first, and most important, tier of precautions and, as such, are a primary strategy for successful infection prevention and control. 

Standard Precautions apply to (1) blood, (2) all body fluids and secretions and excretions (except sweat) regardless of whether they contain visible blood, (3) mucous membranes, and (4) nonintact skin.

125.

A patient who is intoxicated arrives in the OR for emergency repair of facial fractures. The perioperative nurse would initially prepare for possible: 

  • aspiration.

  • liver failure.

  • restraint of the patient.

  • cardiac arrest.

For emergent procedures, the perioperative nurse knows the trauma patient is at a higher risk of aspiration, and must prepare accordingly. Particularly in the case of intoxication, in which the patient has a greater likelihood of vomiting. 

A rapid-sequence induction or an "awake" fiberoptic intubation may be planned. In these instances, the perioperative nurse must be ready to assist by applying cricoid pressure. This is done by exerting downward pressure on the cricoid cartilage with the thumb and index finger of one hand (referred to as Sellick maneuver). This action occludes the esophagus, which lies immediately posterior to the trachea, enhancing the view required for intubation. The pressure should not be released until proper placement of the ETT has been confirmed and the cuff inflated. 

126.

The circulating nurse must perform immediate use steam sterilization (IUSS) for a small instrument set containing metal and nonporous items that were accidently dropped onto the floor during a surgical procedure. The nurse should follow which routine cycle parameters?

  • Refer to the manufacturer's recommendations

  • 270 degrees Fahrenheit for 4 minutes

  • 250 degrees Fahrenheit for 10 minutes

  • 212 degrees Fahrenheit for 15 minutes

Correct answer: Refer to the manufacturer's recommendations

IUSS is a process used to sterilize items that are not intended to be stored for use at a later time. The cycle used has a very short or no dry time, which decreases the total time for processing. Items processed using IUSS should be used as soon as possible after they are removed from the sterilizer. Because cleaning and handling instructions recommended by the device manufacturer can vary widely, the nurse should always follow the manufacturer's instructions for express IUSS cycles to determine the number of times permitted and the cycle times appropriate for the particular items needing sterilization.

127.

Oxygen tanks need to be kept separate from industrial gases and in an area:

  • with controlled access

  • accessible by all staff

  • where anesthesiologists have access

  • where the code team has access

The FDA considers compressed gas a medication and should be dispensed by prescription only. These types of medication must have controlled access.

128.

Which of the following might aid the perioperative nurse in identifying an increased risk of unplanned hypothermia in preoperative patients?

  • A history of organ transplantation

  • A high body mass index (BMI)

  • A history of hyperthyroidism

  • An immunocompromised state

All perioperative patients are at risk for the development of hypothermia as a result of multifactoral causes related to the perioperative environment. The perioperative nurse should be aware of additional patient factors which increase their risk of developing unplanned hypothermia, including:

  • age
  • gender
  • low BMI
  • congestive heart failure
  • cardiac vessel disease or a history of cardiac surgery
  • several preexisting medical conditions, including hypothyroidism, hypoglycemia, and malnourishment among others
  • history of organ transplantation

129.

During a surgical procedure the electrosurgical pencil was accidentally activated while it was lying on the sterile field. Smoke was detected. No injury occurred to the patient. Documentation should:

  • include a report to risk management as a potential serious injury

  • include an entry in the patient's record.

  • be sent to the manufacturer of the ESU.

  • not be needed but a verbal notification to the supervisor is necessary.

Correct answer: include a report to risk management as a potential serious injury

Regardless of whether an event led to injury or may have led to injury, the event needs to be reported. An event that may have led to serious injury needs to be reported immediately, investigated and a decision issued about how to prevent a reoccurrence. The event may have led to a patient injury and a root cause analysis should be completed.

130.

Which of the following factors is most important in determining the death of microbes in heat sterilization?

  • Length of time at a given temperature

  • Initial pressure in the sterilizer

  • Type of heat

  • Size of the sterilizer

Correct answer: Length of time at a given temperature

When heat sterilization is used, heat of a specific minimum temperature is applied over a specific minimum length of time to achieve sterilization. Pressure is not an important factor when heat sterilization is used. The type of heat or the size of the sterilizer is not important.

131.

The perioperative nurse is preparing a patient who is to receive local anesthesia. Which of the following is a priority for the nurse to explain to the patient?

  • Sequence of events before, during, and after the procedure

  • The type of needle that the surgeon will use to inject the local anesthetic

  • The amount of local anesthetic that the surgeon is likely to administer

  • The type of solution that will be used to disinfect the surgical site

Provision of patient education continues to be one of nursing's primary responsibilities. Patients who are preparing to undergo surgical procedures which utilize local anesthesia should be educated as to the sequence of perioperative events before, during, and after the procedure. In addition, these patients should be educated on how to complete a pain assessment/communicate their pain and how to request analgesia (pharmacologic or otherwise), and reportable post-procedure symptoms.

132.

An example of a gravity drain used to prevent fluid accumulation and infection in a surgical wound is a _____________ drain.

  • Penrose

  • Jackson Pratt

  • Foley catheter

  • Hemovac

Drains control ecchymosis and provide exits through which air and fluids (such as serum, blood, lymph, intestinal secretions, bile, urine, and pus), can be evacuated from the operative site. They also may be used to prevent the development of deep wound infections, and are usually inserted at the time of surgery, primarily through a separate small incision known as a stab wound, close to the operative site. 

In some instances (e.g., peritoneal cavity or skin wound), drainage of pus or blood is primarily along the outside surface of the drain by capillary action and gravity (as with the Penrose drain) into a dressing. In other instances (e.g., chest, common bile duct, bladder), drainage is directly through the lumen of the tube (as with a Foley retention catheter). 

Jackson Pratt and Hemovac drains are closed drainage systems, and do not drain by gravity. 

133.

What Spaulding Classification is assigned to items that enter the vascular system?

  • Critical

  • Disinfected

  • Semicritical

  • Extracritical

Spaulding's system has been used by infection preventionists for years to determine the most effective sterilization methods related to use. Items used on tissues within the vascular system and mucosal membranes are at the highest risk, or critical, for causing patient infections.

134.

To maintain a professional level of performance and knowledge, the perioperative staff nurse

  • acquires and maintains proficiency in nursing practice.

  • achieves and maintains certification.

  • attends all mandatory educational sessions.

  • maintains current licensure in the practice state.

Correct answer: acquires and maintains proficiency in nursing practice.

The perioperative staff nurse has the responsibility to acquire and maintain proficiency in nursing practice. Achieving and maintaining certification may be necessary for employment or may enhance professional knowledge, but is not necessary to practice proficiently. Attending mandatory educational sessions also may be necessary for employment, but is not necessary to practice nursing proficiently. Maintaining current licensure in the practice state is necessary to legally practice but does not convey a professional level of performance and knowledge.

135.

As a perioperative nurse, you are helping to evaluate three brands of single-use drapes. What is the most important aspect to consider?

  • Effectiveness of the drapes as a barrier to microorganisms

  • Cost of the drapes as compared to the woven drapes being used

  • Color and texture of the drapes, in order to provide a non-glare surface

  • Availability of drapes similar to those the staff and physicians have been using

The drapes serve as a barrier between sterile and non-sterile areas. The drape protects the patient from an increased risk of infection. Other options may be a factor but not the most important one to consider.

136.

The most common cause of delayed wound healing is:

  • a surgical site infection.

  • immunocompromised status.

  • diabetes.

  • smoking.

The most common cause of delayed wound healing in a surgical patient is surgical site infection (SSI). There are many possible causes of SSIs, including patient susceptibility to and severity of illness, microbial contamination by the patient's microflora, and exogenous wound contamination from the OR environment and personnel. Adherence to strict aseptic principles, careful observation of sterile techniques, and thorough antimicrobial preparation of the patient and operative site are essential to minimize the risk of postoperative SSI.

Other less common causes of delayed wound healing are a patient history of diabetes, smoking, and/or an immunicompromised status. 

137.

Postoperative complications may require additional assistance when the patient status changes quickly and may necessitate the need for __________.

  • the rapid response team.

  • the call team.

  • an additional circulating nurse.

  • the house supervisor.

When a patient exhibits signs of clinical deterioration, a rapid response team (RRT) may be called to the bedside immediately to assess and treat the patient. RRTs may be used in the perioperative setting and are recommended by the Joint Commission.

138.

A bariatric surgical patient will be free from injury related to perioperative positioning when the:

  • OR team obtains any needed positioning aids and padding materials.

  • patient is placed in the supine position with no other positioning aids.

  • eyes and anatomic areas are left unprotected.

  • patient is secured to the OR bed with multiple sheets.

While the quality of mattress pads of operating room (OR) beds have improved greatly since their inception, the use of standard OR foam mattress pads are not appropriate for bariatric patients. The patients require the use of an alternate OR mattress, as well as the use of dry visicoelastic polymer gel products to safely position the bariatic patient for surgery. 

139.

The patient's diet is reintroduced following gastrointestinal (GI) surgery only after:

  • GI motility returns.

  • it is 2 days post-op

  • the patient feels like eating.

  • the surgeon writes the order.

The postoperative patient who undergoes GI surgery may have decreased peristalsis for at least 24 hours, which could persist for several days. Increased fluid intake and early ambulation promote return of peristalsis. Bowel sounds are auscultated with a stethoscope to ensure that peristalsis has returned, and the abdomen assessed for distention. The patient should only begin eating solid foods after peristalsis returns. 

140.

After the sterilization of implantable orthopedic devices, the perioperative nurse interprets the biological indicator (BI) to be negative. A negative BI demonstrates

  • that conditions for sterilization were achieved.

  • that a second BI cycle should be completed for all implantables.

  • a possible sterilization failure.

  • that sterilization occurred.

Correct answer: that conditions for sterilization were achieved.

A biological indicator consists of highly resistant spores and is used to determine if a sterilization process has effectively sterilized the indicator.  A negative BI demonstrates that the BI was effectively sterilized, but can only indicate that conditions for sterilization were achieved, not that sterilization definitely occurred.