CCI CNOR Exam Questions

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61.

When performing intraoperative ultrasonography, which of following solutions or liquids should not be used to moisten the tissues which will be in contact with the transducer head?

  • Povidone iodine 

  • Peritoneal fluid

  • Sterile saline solution

  • Sterile acoustic gel

Correct answer: Povidone iodine 

Ultrasonography may be utilized intraoperatively by use of a sterile transducer head or probe placed on the tissues to examine the vascularity or density of the tissue. This modality may also be used to assist in diagnosing a pathologic condition. The tissue to be evaluated must first be moistened in order to ensure acoustic coupling with the transducer head. Appropriate solutions which may be used for this purpose include sterile saline solution, sterile water-soluble jelly, sterile acoustic gel, or even peritoneal fluid (if the transducer is placed on the abdomen). 

Povidone iodine is a common antiseptic soap used for surgical preparation, and should not be used to moisten tissue that will come into contact with a transducer during intraoperative ultrasonography. 

62.

Communication between OR and post-anesthesia care unit (PACU) staff should include the hazards of cancer treatments to the PACU staff related to all the following patient treatments except:

  • Afterloading radiation treatment

  • Brachytherapy

  • Preloading radiation treatment

  • Intraoperative chemotherapy treatment

Correct answer: Afterloading radiation treatment

The afterloading radiation techniques afford the greatest safety for OR and PACU personnel. In the OR, a cold, unloaded, hollow plastic or metal applicator is inserted into or adjacent to the tissues that will receive radiation. After x-ray verification of correct placement, the radiation source is loaded into the applicator at the patient's bedside.

These cancer treatments involve insertion of radiation/chemotherapy drugs which might be dangerous to PACU staff: brachytherapy, preloading radiation, and intraoperative chemotherapy.

63.

Which of the following is an example of a physical barrier to effective communication?

  • Pain

  • A blood sugar of 150 mg/dL

  • BP of 135/85

  • Emaciation

Correct answer: Pain

Pain may prevent a person from communicating effectively. Before administration of medication for pain, the patient's communication level should be determined regardless of age. Assessing vision, speech, language, and hearing can give the nurse significant clues about the patient's understanding of the pain scales in use. The prudent nurse should address the patient's pain before attempting any in-depth communication.

Mild hyperglycemia, mild hypertension, and emaciation generally will not interfere with communication to the degree that pain is likely to. 

64.

A neurosurgical team is commencing a craniotomy to remove an intracranial tumor in a patient who presented with symptoms of personality change and depression. In which of the following anatomic locations is the perioperative team most likely to identify the responsible tumor?

  • Frontal lobe

  • Parietal lobe

  • Occipital lobe

  • Left frontotemporal lobe

Correct answer: Frontal lobe

Both malignant and benign intracranial tumors contribute to symptomology consistent with their anatomic location within the skull. Large tumors may cause symptoms due to an increase in intracranial pressure (ICP), while smaller tumors may initially remain asymptomatic or may cause symptoms most consistent with the area of infiltration of the tumor. Tumors affecting the left or right (or both) frontal lobes often cause significant changes in personality, including mood swings and depression. 

Tumors of the left frontotemporal lobe often cause aphasia.

Tumors of the parietal lobe often cause weakness of the affected side, sensory changes, and defects in the ability to perceive objects.

Tumors of the occipital lobe often cause the loss of half of the visual field in one or both eyes. 

65.

Documentation of surgical patient positioning includes which of the following?

  • Preoperative limitations in patient's range of motion; skin assessment before and after surgical procedure; patient position including use of special positioning equipment; staff involved in positioning including name, role, and title

  • Skin assessment before and after surgical procedure; patient position including use of special positioning equipment; and staff involved in positioning including name, role, and title

  • Preoperative limitations in patient's range of motion; patient position including use of special positioning equipment; staff involved in positioning including name, role, and title; and postoperative skin assessment

  • Skin assessment before and after surgical procedure; type and location of equipment used in positioning; and staff involved in positioning including name, role, and title

Correct answer: Preoperative limitations in patient's range of motion; skin assessment before and after surgical procedure; patient position including use of special positioning equipment; staff involved in positioning including name, role, and title

The circulating nurse should document preoperative limitations in the patient's range of motion, the condition of the skin before and after the surgical procedure, and the position in which the patient was positioned during the procedure, including any special equipment used. Personnel performing the positioning should be listed by name, role, and title.

66.

Infants and children are especially susceptible to heat loss in the OR via radiation, which occurs when heat transfers from the child's body surface to the room atmosphere. How can the circulating nurse overcome radiation heat loss in pediatric surgical cases?

  • Monitor core body temperature continuously

  • Put a warming blanket on the patient

  • Keep the patient covered and protected from air currents

  • Avoid excessive draping of the patient

Correct answer: Monitor core body temperature continuously

Preventing hypothermia in pediatric patients is critical to ensuring successful surgical outcomes. Cooling from air conditioning within the surgical suites coupled with open body cavities greatly decreases body temperature via the mechanism of radiation. The best ways to combat radiation heat loss are by maintaining an OR room temperature as warm as 85°F and continuously monitoring core body temperature (skin temperature sensors may be adequate for shorter procedures).

Conduction heat loss occurs when a patient is placed on a cold operating bed, thus causing heat to transfer from the patient's body to the surface of the bed. This can be minimized by a hyperthermia blanket or water mattress placed on the operating bed. Convection heat loss involves air currents passing over the skin and can be combated by keeping the patient covered and protected from air currents. Evaporation heat loss occurs when skin becomes wet. Excessive drapes can cause sweating. As sweat evaporates, it elicits a cooling effect. The nurse can avoid excessive draping of the patient to prevent heat loss by evaporation.

67.

How can a circulating nurse overcome convection heat loss in a patient?

  • Keep the patient covered and protected from air currents

  • Turn up the room heat

  • Use a warming blanket on the patient

  • Avoid excessive draping of the patient

Correct answer: Keep the patient covered and protected from air currents

Convection heat loss involves air currents passing over the skin and can be combated by keeping the patient covered and protected from air currents.

Putting a warming blanket on the patient helps prevent conduction heat loss, which occurs when a patient is placed on a cold operating bed and body heat is transferred to the surface of the cold bed. Radiation heat loss occurs when heat transfers from the body surface to the room atmosphere. The best way to combat this is to turn up room temperature. Evaporation heat loss occurs when skin becomes wet. Excessive drapes can cause sweating. As sweat evaporates, it elicits a cooling effect. The nurse can avoid excessive draping of the patient to prevent heat loss by evaporation.

68.

Which of the following patients is most likely to be scheduled to undergo a varicocelectomy?

  • A 29-year-old male with infertility

  • A 36-week pregnant female with painful pelvic varicosities

  • A morbidly obese 15-year-old female with vulvar varicosities

  • A 40-year-old male who experienced late complications of vasectomy

Correct answer: A 29-year-old male with infertility

Varicoceles are believed to be caused by faulty valves located within the vasculature of the scrotum that allows for the retrograde flow of blood from the gonadal veins. The back pressure caused by the retrograde flow causes engorgement of the spermatic vein, resulting in tortuosity of the cords. The condition most often affects the left side due to anatomical differences in normal vein anastomosis. Men may present with complaints of tenderness and swelling of the scrotal sac that resembles a bag of worms or may be asymptomatic. 

Male infertility is associated with varicocele as a result of the elevation of temperature within the scrotum because of the backlog of blood within the affected spermatic vein. A varicocelectomy can be performed to improve fertility if the condition has not been chronic, which can result in atrophy of the testis on the affected side.

Pelvic varicosities can be treated after the pregnancy is over through nonsurgical embolization of the pelvic varicosities. Sclerotherapy is the treatment of choice for vulvar varicosities. Late complications of vasectomy include spermatocele and (rarely) hydrocele.

69.

After a surgical procedure is complete, you move your anesthetized patient from the OR bed to a cart to transfer him to the post-anesthesia care unit. Appropriate actions to protect the patient during this move include all the following except:

  • Lift or roll the patient quickly, synchronizing the action of all people helping, to prevent circulatory depression

  • Have a minimum of four people to help move the patient

  • Protect the patient's airway

  • Protect the patient's tubes including IV, catheters, etc.

Correct answer: Lift or roll the patient quickly, synchronizing the action of all people helping, to prevent circulatory depression

A minimum of four people is required to safely move the patient from the OR bed to the transfer cart. Usually, the anesthesia provider lifts the head and manages the airway, one lifts the feet and controls the Foley catheter, one stands beside the stretcher or bed to pull, and one stands beside the patient to lift the patient from the OR bed. The actions of all four people should be synchronized. Make sure to protect IV(s), solution bags, and the IV pole, as well as the patient's extremities from dangling.

Lift or roll the patient gently and slowly to avoid circulatory depression.

70.

You are speaking with the family of a patient who died during surgery. As you attempt to express your condolences, the mother of the patient yells at you, stating, "This is all your fault! You killed my son!" 

What should you do? 

  • Recognize that the family is lashing out at you because they are grieving

  • Understand that the family is grieving, but call your lawyer to be prepared for legal action 

  • Warn the physician that legal action is imminent because the family is not coping with the death 

  • Understand that the family is grieving, and try to talk them out of holding you and the surgical team responsible

Correct answer: Recognize that the family is lashing out at you because they are grieving

People who are grieving may lash out at anyone they perceive as playing a role in a patient's death. They may feel powerless. As the nurse, you should not take such actions personally, but should respect their feelings by allowing them to vent. Afterward, relay the conversation to your manager.

71.

Identify the action that ensures continuous use of fresh supplies that have not become outdated.

  • Newer supplies should be placed at the back, and older supplies should be placed at the front

  • Older supplies should be placed at the back, and newer supplies should be placed at the front

  • Items of differing dates should be intermingled to ensure equal usage of both

  • It doesn't matter how supplies are stocked, just as long as the expiration date is checked prior to use, and expired supplies are thrown out 

Correct answer: Newer supplies should be placed at the back, and older supplies should be placed at the front

Older supplies should always be used first to minimize storage. The acronym FIFO (first in/first out) is helpful to remember for the rotation of supplies, particularly sterile supplies. Place new supplies in the back, with older supplies near the front so that the older supplies are used first. This helps prevent supplies in the back from not getting used and becoming outdated.

Sterile supplies should be checked daily for the integrity of the packages, and any expiration dates checked to ensure viability. Some items deteriorate with repeated sterilization or prolonged storage (e.g., latex items). Any sterile packages that become contaminated are reprocessed and resterilized.

72.

The perioperative nurse is attempting to formulate the plan of care for a recently immigrated young traditional Muslim woman who is awaiting surgery for suspected adenomyosis. The patient's husband has provided all the health information for the patient while the patient has remained quiet throughout the health interview. An older female relative who also accompanied the patient appears to be attending to all the physical needs of the patient.

When developing the plan of care for this patient, the perioperative nurse needs to consider all the following factors except:

  • Strict adherence to the surgical facility's standardized plans of care

  • The most current, evidence-based nursing practices

  • The psychosocial needs of the patient's husband

  • The spiritual needs of the patient's female support person

Correct answer: Strict adherence to the surgical facility's standardized plans of care

While standardized plans of care are typically developed to help streamline care and ensure adherence to best practice, flexibility, modification to the standardized plan, and individualization of the plan to account for unique patient needs is necessary to ensure provision of the best care.

When developing the perioperative plan of care, the perioperative nurse must take into consideration many factors, including:

  • Whether the patient will be an active participant in her own care
  • Participation of the patient's family or support persons in her care
  • Medical diagnosis
  • Postoperative effects of the surgical procedure on the patient's physiology
  • Psychosocial and spiritual needs of both the patient and any family or support persons
  • Ensuring safety, comfort, and the patient's best interests within the perioperative environment
  • Ensuring adequate supplies and equipment and staff expertise necessary to meet the patient's needs
  • Adherence to the most current, evidence-based nursing practice

73.

A 22-year-old female patient who was involved in a motor vehicle accident (MVA) is in the holding area prior to going into surgery. The patient's parents arrive and state they know their daughter was "probably drunk and high" when the accident occurred. They request to see the emergency room record. 

How should you respond?

  • "The record is confidential."

  • "The patient's blood alcohol level was twice the legal limit."

  • "Ask the ER staff, and they will talk more to you regarding what you want to know."

  • "I cannot share that information, but will ask the surgeon to come and discuss further with you."

Correct answer: "The record is confidential."

The right of privacy precludes access to patients' health care data by unauthorized others. HIPAA protects the patient's right to privacy. The patient has the right to expect that all communications and records pertaining to individualized care will be treated as confidential and will not be misused. 

74.

A patient, Mrs. Anna Jones, has arrived in the holding area. You are the circulator on duty. You should identify the patient by:

  • Asking the patient to give her full name and date of birth, and comparing this information to her identification bracelet and chart

  • Asking the patient, "Are you Anna Jones?" and asking her to state her date of birth, and comparing this information to her identification bracelet and chart

  • Reading the patient's full name and date of birth off the paper label at the foot of her bed, asking her for verification, and comparing this information to her identification bracelet and chart

  • Reading the patient's full name and age on the patient's identification bracelet and chart, and asking her if this information is correct

Correct answer: Asking the patient to give her full name and date of birth, and comparing this information to her identification bracelet and chart

In the holding area, the nurse should introduce him/herself. The patient should be addressed as Mr., Mrs., or Ms. - not by the first name. It is appropriate to ask the patient to state or spell his or her name. The patient should be asked his or her full name and date of birth. These, including the identification number, should be compared to the patient's identification (ID) bracelet and medical record.

Do not attempt identification by stating their name in your question, as this may lead to misidentification (i.e., "Are you Anna Jones?"). Reading a label off the bed is not sufficient. A person's age isn't an identifier.

75.

How far away from a sterile field should the unsterile staff (circulating nurse, anesthesia provider, etc.) remain?

  • At least 1 foot

  • At least 18 inches

  • At least 2 feet

  • At least 6 inches

Correct answer: At least 1 foot

Unsterile personnel should maintain an awareness of sterile, unsterile, clean, and contaminated areas and their proximity to each. They must be aware of their closeness to the sterile field and must maintain a distance of at least 1 foot from any area of the sterile field. Also, they must never walk between two sterile areas (e.g., between sterile instrument tables) and must always face and observe a sterile area when passing it to be sure they do not touch it.

76.

The perioperative nurse educator of a busy hospital conducted an informal study of the perioperative employees who were required to complete surgical hand antisepsis. According to hand-washing data captured by the security cameras posted in the scrub area, most of the employees complied with the required 3-minute surgical scrub, 5 employees consistently scrubbed for under 3 minutes, and 2 employees consistently scrubbed for over 5 minutes. 

Which statement regarding recommendations on the length of a surgical hand scrub is correct?

  • Scrubbing for longer than 5 minutes increases bacterial counts on the hands when compared to scrubbing for 2 to 5 minutes.

  • Scrubbing for longer than 5 minutes is no more effective at reducing bacterial skin counts than scrubbing for 2 to 5 minutes.

  • Perioperative employees who scrub for longer than 5 minutes are more likely to experience issues with contact dermatitis.

  • Perioperative employees are more likely to scrub for longer than 5 minutes if they have natural, unpolished nails than if they wear nail polish. 

Correct answer: Scrubbing for longer than 5 minutes increases bacterial counts on the hands when compared to scrubbing for 2 to 5 minutes.

Performing surgical hand antisepsis is the first line of defense for preventing potentially pathogenic microorganisms from coming into contact with a surgical patient and causing a surgical site infection (SSI). While donning sterile gloves is also critical to preventing SSI, gloves can be easily broken, causing inadvertent exposure of the patient to microorganisms on the perioperative team member's hands. Healthcare personnel who have followed recommendations and requirements for surgical hand antisepsis can help protect the patient in this case. 

Currently, every surgical hand scrub should follow the recommended time limit set by the manufacturer of the specific antiseptic solution. Most manufacturers recommend a scrub between 2 and 5 minutes. Scrubbing for longer than 5 minutes is not advised, as this has been found to increase the bacterial count on the hands; this is due to bacteria that live deep within the dermal layers being raised to the surface through prolonged scrubbing. 

77.

When using woven fabrics to package surgical materials for steam sterilization, the perioperative nurse should make sure all the following characteristics of the material are present except:

  • The material is lint free

  • The material is comprised of 140-thread count, carded, 100% cotton muslin

  • The material has been rehydrated through laundering prior to resterilization

  • The material has been laundered less than 75 times previously

Correct answer: The material is lint free

Instrument packaging may be comprised of several different materials, each of which must be suitable for the sterilization process. These materials may be reusable or disposable. One such reusable material is woven fabric, often referred to as muslin or linen. These fabrics must be 140-thread count, carded, 100% cotton muslin, which is sewn together in such a manner so as to leave no exposed holes (blind hem). The woven material may be laundered up to 75 times before it should be discarded due to excessive wearing which will prevent it from providing an effective microbial barrier. Prior to reuse, the woven material should be rehydrated through laundering, as the moisture level of the woven material is important for steam sterilization. 

Fabric may create free-floating lint in the OR (lint-free material is not a requirement). 

78.

The perioperative nurse completed a phone interview with a patient scheduled to undergo a knee joint replacement, and later met with the patient to provide preoperative education. When compared to patients who do not receive face-to-face preoperative education, patients who receive preoperative education while interacting face-to-face with a nurse experience all the following, except:

  • Similar tolerance to the surgical procedure

  • Decreased apprehension about the surgical procedure

  • Improved recall of the preoperative education material

  • Improved comfort after surgery

Correct answer: Similar tolerance to the surgical procedure

Face-to-face preoperative education which allows for personal interaction between the patient and the perioperative nurse, has been found to be beneficial to patients preparing to undergo surgery.

Improved tolerance to the surgical procedure, better recall of the education material, an appearance of improved comfort after the surgery, and decreased apprehension/anxiety prior to surgery are some of the benefits experienced by patients who have been able to receive their preoperative education directly from the perioperative nurse.

79.

A patient has been involved in a motor vehicle crash and requires immediate surgery to control abdominal bleeding. His family members tell you that the patient ate a full and heavy meal just before the accident occurred. 

What should be your first priority for this patient?

  • Assisting the anesthesiologist with rapid sequence induction

  • Assisting the anesthesiologist to place a nasogastric tube which will be attached to wall suction

  • Administering intravenous pantoprazole (Pantoloc)

  • Ensuring that the suction units are in working condition in case the patient vomits

Correct answer: Assisting the anesthesiologist with rapid sequence induction

Assisting with rapid sequence induction is the priority. Insertion of an endotracheal tube will protect the patient's airway should vomiting occur. The other measures may be necessary but will not take priority over securing the patient's airway.

80.

Your patient just came out of the OR after undergoing open reduction and internal fixation (ORIF) of the femur. Upon arrival to the PACU, you assess for neurovascular impairment in the affected extremity, which includes the six P's. What are they?

  • Pallor, pulses, pain, paresthesia, puffiness, and paralysis

  • Pallor, poor reflexes, pain, pulses, puffiness, and paresthesia

  • Pulses, pain, paresthesia, puffiness, persistent redness, and paralysis

  • Pallor, pulses, pain, paresthesia, puffiness, and pus present

Correct answer: Pallor, pulses, pain, paresthesia, puffiness, and paralysis

Assessment for signs and symptoms of neurovascular impairment in an extremity includes pallor (a pale appearance), pulses, pain, paresthesia (tingling or burning sensation), puffiness, and paralysis. The six P's are assessed post-operatively and monitored until support devices, such as castor splints, are removed from the surgical site. Critical aspects in the diagnosis of compartment syndrome is based on neurovascular status.