CCI CFPN Exam Questions

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161.

The best resource to use when determining the correct processing method for instrumentation or equipment (i.e., instruments, a BP cuff, laryngoscope blades) is the:

  • Spaulding Classification System.

  • Centers for Disease Prevention and Control (CDC).

  • Association for Professionals in Infection Control and Epidemiology (APIC).

  • Joint Commission on Accreditation of Healthcare Organizations (JC).

The Spaulding Classification System is a long-standing, time-tested mechanism used to determine the processing method for patient use items. The level of disinfection needed is based on the nature of the item and the manner in which it is to be used.

162.

A medication given preoperatively that does not decrease the risk of aspiration is:

  • midazolam (Versed).

  • metoclopramide (Reglan).

  • ondansetron (Zofran).

  • ranitidine (Zantac).

The primary purpose of premedication before anesthesia is to sedate the patient and reduce anxiety. Medications that may be given preoperatively include sedatives and hypnotics, anxiolytics, amnestics, tranquilizers, narcotics or other analgesics, antiemetics, and anticholinergics. A single medication may possess the properties of several medication classes.

To decrease the risk of aspiration, metoclopramide (Reglan) may be given to empty the stomach and to reduce nausea and vomiting. In addition, an antacid or an H2-receptor–blocking medication, such as cimetidine (Tagamet), ranitidine (Zantac), or famotidine (Pepcid), may be included to decrease gastric acid production or the acidity of the gastric contents, or both. Chemoprophylaxis, with medications such as these, is part of safe airway management. Ondansteron (Zofran) is effective at blocking receptors that can cause nausea and vomiting, thus decreasing the risk of aspiration from vomiting; patients at risk for postoperative nausea and vomiting (PONV) receive either one or a combination of agents that block one or more of these receptor sites. 

Midazolam (Versed) is administered frequently to relieve apprehension and to provide amnesia, not to decrease the risk of aspiration. 

163.

A patient who is undergoing nasal reconstruction with local anesthesia has a history of low back pain. Appropriate care for this patient should include

  • placing a pillow under the knees.

  • placing a pillow under the feet.

  • elevating the foot of the bed.

  • lowering the head of the bed.

Correct answer: placing a pillow under the knees.

Placing a pillow under the knees reduces stress on the low back and enhances patient comfort. Placing a pillow under the feet, elevating the foot of the bed, or lowering the head of the bed will not improve low back comfort.

164.

To ensure that the patient and family have an understanding of their discharge medications, the perioperative nurse should encourage the patient/family to:

  • repeat or teach back important considerations.

  • sign for their medications.

  • watch a videotape regarding the medication.

  • verbalize their receipt of the medications.

Repeating or teaching back important considerations about the medication ensures a higher level of comprehension. The other methods are more passive in nature. This teaching can be supplemented with handouts and further documentation.

165.

A patient scheduled for a total hip replacement because of a traumatic fracture is considered as a potential bone-bank donor. To assess this patient's suitability as a donor, the perioperative nurse would note what the patient's history reveals about

  • infectious, malignant, and autoimmune diseases.

  • gastrointestinal diseases.

  • diabetes mellitus, past fractures of the femur, and kidney failure.

  • congestive heart failure and kidney failure.

Correct answer: infectious, malignant, and autoimmune diseases.

Infectious, malignant, and autoimmune diseases may all disqualify a patient from being a bone-bank donor, as these conditions could affect the recipient.. Gastrointestinal diseases, diabetes mellitus, past fractures, congestive heart failure, and kidney failure would all not affect a patient's ability to be a bone-bank donor. 

166.

Freezer storage of tissue for implantation should have an alert system to notify personnel when the temperature is not within the acceptable range, have emergency power, and temperature recorded:

  • daily

  • weekly

  • once per shift

  • monthly

Temperature documentation should be completed daily and is an accreditation requirement.

167.

A patient has been transferred to the PACU following insertion of an implantable vascular access device for administration of chemotherapy. A postoperative portable x-ray has been ordered to validate placement. Radiation safety measures are implemented by the PACU nurse and radiation technician based on

  • time, distance, and shielding.

  • dose, duration, and anatomical site.

  • angle, beam, and radiation source.

  • scatter, exposure, and tissue density.

Correct answer: time, distance, and shielding.

The three factors that all radiation safety measures are based on are time, distance, and shielding. While the dose does matter, the anatomical site, angle, radiation source, and tissue density are all not important factors.

168.

A 72-year-old patient is scheduled for a hip pinning using the fracture table. After formulating the nursing diagnosis, "High risk for ineffective thermoregulation," the perioperative nurse will plan to maintain body temperature by all the following methods, except:

  • adjusting the OR suite humidity to 30%.

  • placing heat-retaining covers over as much body surface as possible.

  • observing for shivering 

  • preparing for warming of irrigation fluids and blood products.

Ineffective thermoregulation related to surgical procedures can be caused by any of the following: anesthetic agents, length of surgery, age of patient, OR environment, irrigation, type of surgery, or genetic predisposition to malignant hyperthermia (MH). 

Interventions to maintain a normal body temperature throughout surgery include the following: 

  • Measure body temperature on admission; document temperature and route of measurement.
  • Use same route of measurement for each temperature documented.
  • Assess peripheral circulation.
  • Monitor vital signs and oxygen saturation.
  • Observe for shivering.
  • Initiate measures to warm patient if hypothermic: place warmed blankets on patient's body and head; use forced-air warming device to rewarm patient; used warmed irrigation fluids and blood products
  • Initiate appropriate measures for malignant hyperthermia, if indicated
  • Maintain ongoing temperature monitoring until discharge.

Adjusting OR suite humidity to 30% will not assist in maintaining effective thermoregulation in the surgical patient. 

169.

A 78-year-old, 190-lb patient is undergoing total knee replacement. The perioperative nurse's plan of care during surgery should include

  • informing the surgeon of the tourniquet times.

  • turning the tourniquet off when the tourniquet time reaches one hour.

  • turning the tourniquet pressure up if there is breakthrough bleeding.

  • informing the anesthesia provider of the tourniquet times on a regular basis.

Correct answer: informing the surgeon of the tourniquet times.

The nurse's responsibility is to inform the surgeon of the tourniquet times at regular intervals to avoid limb ischemia, not to make the determination about when the tourniquet should be turned off or have its pressure increased. The nurse should inform the surgeon, not the anesthesia provider, of the tourniquet times as they do not relate to the patient's anesthetic care.

170.

During a Cesarean Section, the birth partner may be allowed into the surgical suite. It is the perioperative nurse who ensures the visitor is properly attired, and may need to:

  • encourage them to coach and support the birth mother.

  • ask them to stand against the wall due to risk of contamination.

  • tell them pictures are not allowed.

  • ask them not to speak to the surgeon.

Patients that will undergo a cesarean section will need careful assessment and support. Many patients feel that they have failed at child birth if a cesarean birth is required. The birth partner needs to comfort and support the birth mother. The surgical environment can be overwhelming for both the birth mother and the birth partner.

171.

During a surgical procedure, the perioperative nurse notices that the patient has tachycardia and a continuously rising temperature, and the blood in the operative field has turned dark red. These assessment findings are consistent with:

  • malignant hyperthermia.

  • blood transfusion reaction.

  • hypovolemic shock.

  • malignant hypermetabolism.

Tachycardia, a continuously rising temperature, desaturated blood in the operative field, tachypnea and muscle stiffness and rigidity may all be seen with malignant hyperthermia.

172.

If moisture is found on the inside wrap of a sterilized basin set when the set is opened, the basin is considered

  • unsterile, because moisture allows bacterial wicking from the unsterile outside to the sterile inside.

  • unsterile, because moisture in any form cannot be sterilized.

  • sterile, because moisture inside the wrapper has been sterilized along with the item.

  • sterile, as long as external and internal sterilization indicators show that sterilization has occurred.

Correct answer: unsterile, because moisture allows bacterial wicking from the unsterile outside to the sterile inside.

Moisture can wick bacteria from unsterile outside surfaces, making it necessary to consider the basin unsterile. Moisture in some forms can be sterilized. While the moisture inside the wrapper has been sterilized, it can wick bacteria and lead to disrupted sterility. Sterilization indicators do not indicate continued sterility. 

173.

The trade name for Midazolam is:

  • Versed.

  • Valium.

  • Sublimaze.

  • Duramorph.

Correct answer: Versed.

Midazolam, also known as Versed, is the most popular and most extensively used benzodiazepines for procedural sedation.

174.

A patient undergoing ureteral surgery is placed in the lateral position with the OR bed flexed and the kidney rest device elevated. The correct placement of the kidney rest is:

  • underneath the patient's dependent iliac crest.

  • just below the patient's waist.

  • between the patient's twelfth rib and iliac crest.

  • underneath the patient's femoral head.

The site of the incision and position of the patient depend on the nature of the proposed ureteral surgery. The patient may be placed in the supine position for abdominal surgery, in the modified Trendelenburg position for low abdominal or pelvic surgery, or in the lateral position for high- or midureteral obstructing calculi. 

The perioperative nurse ensures that the patient's arms are supinated when on armboards. In the lateral position, the upper arm is placed on an overbed armboard such as the Allen lateral arm support, and the lower arm is supinated on a padded armboard. The kidney rest should lie just under the dependent iliac crest.

175.

Which of the following lists of Personal Protective Equipment (PPE) will provide the best protection during manual cleaning of instruments?

  • Caps, gloves, face shields, and waterproof apron.

  • Gloves, mask with shield, surgical gown.

  • Caps, gloves, mask, apron.

  • Goggles, mask, gloves.

Correct answer: Caps, gloves, face shields, and waterproof apron.

Risk of contamination of personnel by splashing and aerosolized biohazard materials is reduced with the use of caps, gloves, face shields, and waterproof aprons.

176.

Under which of the following circumstances is flash sterilization (IUSS) acceptable?

  • When the manufacturer's written instructions allow for flash sterilization (IUSS)

  • Upon the physician's request

  • Between each case to avoid opening new instrument packages

  • When the instrument inventory levels are insufficient

Immediate use steam sterilization (IUSS), or flash sterilization is only acceptable for use if both the device manufacturer and the sterilizer manufacturer have provided written instructions on the use of IUSS for the item to be flash sterilized. 

177.

A perioperative nurse is asked to present on the AORN Guidelines and institutional policies and procedures on electrosurgical safety at the next staff meeting. The MOST appropriate way for the nurse to begin the presentation would be to

  • explain the reason for the presentation to the audience.

  • go immediately to the applicable AORN Guidelines.

  • ask someone in the audience to start the presentation.

  • hand out a pretest.

Correct answer: explain the reason for the presentation to the audience.

When presenting clinical information to a group of one's peers, the beginning of the presentation should include explaining the reason for the presentation to the audience. The nurse should start the presentation themselves. If a pretest is used, it should be given after the initial background has been provided.

178.

During admission, which of the following steps should be taken first to protect a patient's rights?

  • Identifying the patient and explaining the patient's right to privacy, choices regarding care, and confidentiality

  • Explaining the use of safety devices, maintaining confidentiality, and obtaining signatures on legally appropriate forms

  • Assessing the patient, developing a plan of care, establishing goals, and obtaining signed consents

  • Establishing goals and explaining the Patient's Bill of Rights

Correct answer: Identifying the patient and explaining the patient's right to privacy, choices regarding care, and confidentiality

An important step in protecting a patient's rights is to be sure that the patient is aware of these rights. Explaining the patient's right to privacy, choices regarding care, and confidentiality is more comprehensive than the limited scope of the Patient's Bill of Rights. 

179.

For best practice, the operative site should be marked by:

  • the physician performing the procedure.

  • the circulating nurse.

  • any member of the surgical team.

  • the first assistant for the procedure.

An entire team of individuals is involved in the identification of the surgical site, ideally including the patient and his or her support person. Each member of the team confirms the identification of the correct surgical site, but the surgeon is ultimately responsible for the actual physical marking of the site, in indelible ink, with his or her initials.

180.

What type of communication is essential when the perioperative nurse delegates a task?

  • Direct.

  • Written.

  • Verbal.

  • Non-verbal.

Clear, concise, and direct communication is important when delegating tasks. An opportunity to ask questions and clarify is also important. Communication should never be relayed through another person.