CCI CFPN Exam Questions

Page 8 of 22

141.

Hospital-processed supplies and instruments should be transported to the surgical suite or storage area in a manner that

  • maintains sterility, cleanliness, and protection from physical damage

  • follows manufacturer's recommendations

  • ensures package integrity and consistent temperature levels

  • complies with infection control guidelines

Of key importance when transporting sterilized supplies and instruments is that of maintaining sterility, cleanliness, and protection from damage. Items should be transported in such a manner to prevent unnecessary handling or jostling of the items, and to prevent deliberate tampering or mishandling of the items. Sterility is event dependent.

142.

When caring for a patient undergoing a below the knee (BK) amputation, the perioperative nurse recognizes that the procedure:

  • is done to promote maximum independence.

  • will relieve phantom limb pain.

  • involves an incision at the junction between the middle and lower thirds of the lower leg.

  • has fewer risks than reconstruction.

Amputations involving the lower extremity are performed to eliminate ischemic, gangrenous, necrotic, or infected tissue; relieve pain; and promote maximum independence. Amputations may be necessary because of trauma or malignancy or when the lower limb cannot be salvaged by arterial reconstruction. 

Immediately following amputation, patients may experience phantom limb pain, which is characterized by burning, throbbing, shooting, or stabbing pain in the area where the limb has been amputated. Though it may recur, it becomes less frequent in the months following surgery. 

Operative risks for amputation are higher than those for reconstruction, possibly because of more extensive vascular disease. BK amputations are best done at the junction of the upper and middle thirds of the lower leg. This allows for an immediate postoperative prosthesis, aids in better healing, and may reduce phantom limb pain. 

143.

The on-call surgeon arrives for an emergency procedure and appears disheveled, is staggering, and smells of alcohol. The surgeon becomes verbally abusive when confronted with the observed behavior by the perioperative nurse. The nurse's next immediate action should be to

  • seek assistance from administrative staff to prevent the surgeon from performing surgery.

  • continue trying to persuade the surgeon to postpone surgery, and physically prevent it if the surgeon will not desist.

  • document the behavior in an incident report, and notify the nursing supervisor at the conclusion of the procedure.

  • inform the patient that the surgeon is inebriated, and suggest that the patient refuse surgery.

Correct answer: seek assistance from administrative staff to prevent the surgeon from performing surgery.

A staff member who is unfit to practice should be prohibited from participating in a surgery, especially if it is the surgeon. The nurse should quickly approach their chain of command to ensure the patient's safety. The nurse should not physically prevent the surgeon from practicing or leave it up to the patient to refuse the sugeon's care.

144.

The best method that a perioperative nurse can utilize to prevent the spread of infection is to:

  • wash hands before and after each patient contact.

  • . isolate all patients who are suspected of having an infection

  • rinse hands with a strong antiseptic solution.

  • wear sterile gloves while performing nursing procedures.

Hand hygiene is the single most important factor in preventing the spread of infection. It is a primary method of decreasing healthcare-related infections.

145.

The Material Safety Data Sheet (MSDS) / Safety Data Sheet (SDS) for first-aid treatment should be immediately accessible in the

  • patient care area

  • safety director's office

  • perioperative director's office

  • employee health department

Employees should be aware of how and where to access the MSDS/SDS for each of the potentially hazardous substances they may come into contact with during their standard workday. MSDS/SDS may be available in print format or online, and should be easily accessible within the patient care area. Instructions for first-aid treatment in cases of exposure are included in each MSDS/SDS. 

146.

Which of the following complications may occur after the insertion of polymethylmethacrylate cement during a joint replacement procedure?

  • Embolic phenomena

  • Hypertension 

  • Bradycardia

  • Hypoglycemic event

Correct answer: Embolic phenomena

The insertion of polymethylmethacrylate cement during orthopedic surgery can cause a rise in intramedullary canal pressure, leading to increased incidence of embolic phenomena. The use of polymethylmethacrylate cement does not commonly cause hypertension, bradycardia, or hypoglycemic events.

147.

An immediate complication of extubation is

  • laryngospasm.

  • arrhythmia.

  • aspiration.

  • restlessness.

Correct answer: laryngospasm.

Extubation can create irritation to the larynx, causing spasms that occlude the airway. Laryngospasms normally occur immediately after extubation and require immediate intervention. Arrhythmias are unlikely to be caused immediately after extubation. Restlessness is more common with intubation, not extubation. Aspiration is a potential complication of extubation, but does not occur immediately.

148.

An instrument is flash sterilized (IUSS) in a gravity displacement sterilizer. The chemical indicator color is unchanged when the instrument is removed. The autoclave monitor recorded a pressure of 30 psi and a temperature of 132.2° C (270° F) for a duration of 3 minutes. At this point, the perioperative nurse should

  • recognize that all criteria for sterilization have not been met

  • reprocess the instrument for 10 minutes

  • report a malfunction of the autoclave

  • reprocess the instrument with the same chemical indicator

Should the perioperative nurse discover any signs that there has been a failure within the sterilization process-- chemical indicator color remains unchanged, autoclave pressure is not adequate or is not maintained, insufficient autoclave temperature, wet packs or loads-- she should recognize that all criteria for sterilization have not been met. Sterilization failures need to be reported to the appropriate department, and then the sterilization failure should be thoroughly investigated to determine both the reason for the failure as well as to determine the full extent of the failure, i.e., were any insufficiently sterilized instruments inadvertently used, were patients affected, etc. 

149.

When a victim of a crime or a perpetrator is in a health care facility, which of the following statements is correct about who has the rights to privacy?

  • Both individuals have the right to privacy

  • Neither individual has the right to privacy

  • Only the victim of the crime has the right to privacy

  • Only the perpetrator of the crime has the right to privacy

Correct answer: Both individuals have the right to privacy

All patients have a right to privacy, regardless of their background. There may be certain exceptions to normal privacy considerations for victims of crime and perpetrators of crime, however, their basic right to privacy is still maintained.

150.

An example of a standardized format for hand off communication is the SBAR. This acronym represents:

  • Situation, background, assessment, and recommendation

  • Situation, background, allergies, and responsiveness

  • Site marking, background, application, and readiness

  • Subjective data, background, assessment, and responsiveness

The standardized documentation format SBAR represents: situation, background, assessment, and recommendation. This addresses the nursing process while utilizing a standardized tool as recommended in the NPSG.

151.

Witnessing a signature to an informed consent assures that:

  • the patient's signature, time, and date are valid.

  • the patient understands the reason for the surgical procedure.

  • the surgeon has explained the risks, benefits, and alternatives to the planned procedure.

  • the surgical procedure listed on the consent is correct.

Except in emergencies, every surgical procedure must have documentation of the patient's consent in the chart prior to being performed. The practitioner performing the surgical procedure is legally responsible to inform the patient about the proposed operation or other invasive procedure and its inherent risks, benefits, alternatives, and complications before obtaining the patient's verbal and written consent. Every facility has a policy regarding how to document this "informed consent," but generally, documentation is accomplished by means of a signed consent form and/or the primary surgeon's entry into the progress notes.

Nurses who are witnesses to the signing of the consent form attest only to the validity of the patient's signature, time, and date, and not to the adequacy of the patient's understanding because that assurance remains the duty of the surgeon or physician performing the procedure.

152.

A glove puncture during a surgical procedure when double gloving is used requires:

  • replacing both gloves.

  • replacing the outer glove.

  • removing the outer glove.

  • use of a closed gloving technique

Correct answer: If a puncture occurs, both sets of gloves are considered contaminated. Both gloves should be removed and regloving should be completed using an open gloving or assisted gloving technique. Closed gloving is not appropriate during a surgical procedure related to contamination risk of pulling the sleeve down over the hand.

153.

Before the first procedure of the day, which of the following OR surfaces should be dusted with a cloth dampened with a facility-approved disinfecting agent?

  • Lights and all horizontal surfaces

  • Inside all closed storage cabinets

  • Lights, floors, and bed

  • Walls, back table, and ring stand

All surgical patients should be considered to be potentially infected with bloodborne or other infectious material. For patient and personnel safety, cleaning procedures should be uniform throughout the OR and for all patients, and should be carried out in a manner that protects patients and personnel from exposure to potentially infectious microorganisms. Cleaning measures are needed before, during, and after surgical procedures, as well as at the end of each day. A safe, clean environment should be reestablished after each surgical or invasive procedure. 

Before beginning the first procedure of the day, lights and all horizontal surfaces in the ORs should be dusted with a cloth dampened with a facility-approved disinfecting agent. Dust and lint deposited on lights and horizontal surfaces during the night can become airborne vectors for organisms if not removed. 

154.

The Glasgow coma scale (GCS) cannot be used on patients:

  • suspected of drug and alcohol intoxication.

  • under 2 years or over 85 years of age.

  • who are hypotensive and hypothermic.

  • who are unresponsive and tachycardic.

The GCS is commonly used to assess patients with brain injury. Three indicators of cerebral function—eye opening, verbal communication, and motor response to verbal and noxious stimuli—are assessed, and the appropriate number of points for each is assigned and totaled. The best possible score is 15, and the worst possible score is 3. 

Patients under the influence of drugs and/or alcohol have altered brain functioning, but not brain injury. Therefore, the GCS cannot be used on these patients. It can be used on patients under two and over 85 years of age, patients who are hypotensive and hypothermic, and patients  who are unresponsive and tachycardic. 

155.

A 7-year-old patient had a tonsillectomy and arrived in PACU 10 minutes ago. The nurse observes the patient is snoring, respiration is 12, and pulse oximetry is 88% with oxygen at 8 L/min via face mask. The immediate nursing response should be to:

  • stimulate the patient to take deep breaths.

  • open the patient's airway using a chin tilt/jaw thrust technique.

  • insert an artificial oral/nasal airway into the patient.

  • increase the patient's oxygen to 10 liters per minute.

Many factors influence emergence from anesthesia. The objective is to move the patient from the OR bed to the PACU bed as soon as the dressing is applied. During emergence, the anesthesia provider suctions the oropharynx before extubation to decrease the risk of aspiration and laryngospasm after extubation, reverses any residual neuromuscular blockade. and allows the washout of N2O and volatile agents by giving 100% O2 several minutes before extubation. 

After extubation, the patient is taken to the PACU to fully awaken and recover. In some cases, the patient may be transferred to the PACU before extubation and the ETT removed when the patient is fully awake. 

Untoward events that can occur with general anesthesia include hypoxia; respiratory, cardiovascular, or renal dysfunction; hypotension; hypertension; fluid or electrolyte imbalance; residual muscle paralysis; dental damage; neurological problems; hypothermia; and malignant hyperthermia (MH). 

If the patient is groggy upon PACU arrival (as evidenced by the above vital signs), the nurse should immediately and initially stimulate the patient to take deep breaths, as this is a fairly common finding upon emergence from anesthesia. The other steps may need to be taken if the patient does not respond to verbal and tactile stimulation. 

156.

Trauma to what part of the body accounts for half of all trauma deaths?

  • Head.

  • Chest.

  • Abdomen.

  • Extremity.

Half of all trauma deaths occur when there is injury to the head. The skull usually takes the full force, but the soft tissues of the brain result in deaths related to the injury. Hematomas and clots may result in brain death despite treatment.

157.

If a patient is positioned prone with their arms palm-side down for a surgical procedure, what structure is most commonly injured?

  • Ulnar nerve.

  • Obturator nerve.

  • Brachial plexus.

  • Median nerve

When a patient is prone (abdomen facing down) with arms pronated (palm-side down) on armboards, the ulnar nerve is vulnerable to pressure from the elbow, and the patient at an increased risk for an ulnar nerve injury. Padding placed proximal and distal to the elbow frees the nerve from pressure. 

The upper extremities should be evaluated both intraoperatively and postoperatively. Any changes from the preoperative condition should be verbally reported and documented.

158.

Which of the following agents is a long-acting local anesthetic used for regional blocks? 

  • bupivacaine (Marcaine).

  • chloroprocaine (Nesacaine).

  • lidocaine (Xylocaine).

  • tetracaine (pontocaine).

Bupivacaine (Marcaine, Sensorcaine) is a long-acting local anesthetic commonly used as an epidural or spinal block (both are examples of regional anesthesia). It has good infiltration and good relaxation properties. It can constrict blood vessels to reduce bleeding at the site. It has the disadvantage of causing cardiac collapse if overdosed. 

159.

One factor that influences the efficacy of chemical agents for high-level disinfection is

  • exposure time

  • humidity

  • non-active ingredients

  • surfactants

There are several factors which may interfere with the efficacy of high-level disinfection:  if the concentration of the disinfection solution is too low as a result of either inappropriate dilution or incorrect volumes of solution, if the temperature is not appropriate for the disinfection process, and inadequate exposure time of the contaminated item to the disinfection process.

160.

Proper documentation serves as a legal record of care and a/an ___________ tool.

  • risk management

  • nursing process

  • evaluation

  • hand off

Requirements of documentation include multiple safety measures completed to prevent patient injury. The need to document these items helps to remind the nurse of interventions needed to mitigate risk associated with injuries.