CNOR Exam questions with verified answers.

CNOR Exam 2 Several experimental studies have shown a significant decrease in SSI for Class ______ procedures when using pulsed xenon ultraviolet light systems A. I B. II C. III D. IV - Correct answer A. I researchers have found that pulsed xenon UV light systems significantly decreased SSI rates in Class I procedures, hospital-acquired vancomycin-resistant enterococci infection rates and contamination of high touch surfaces in the OR" "improved communication and use of __________ is associated with a significant reduction in post op complication rates and mortality A. AORN tool kits B. Surgical care improvement program (SCIP) measures C. The Who surgical safety checklist (SSC) D. hand-off tools - Correct answer C. The WHO SSC a valuable tool that has been associated with a significant reduction in the number of post op complications and should be universally implemented in all surgical settings" "Surgery of the liver requires incising the external covering, which is referred to as the A. Glisson capsule B. Gerota fascia C. porta hepatis D. hepatic fascia - Correct answer A. Glisson Capsule" "When wearing a single dosimeter, the preoperative RN should place the dosimeter A. inside the lead apron along the neckline B. inside the lead apron along the waistline C. outside the lead apron along the neckline D. outside the lead apron along the waistline - Correct answer C. outside the lead apron along the neckline dosimeters are used to measure radiation exposure." "Joey is a 4 year old scheduled to have surgery. during pre op teaching, the preoperative nurse knows that Joey's age-specific needs can best be met by A. allowing his parent or caregiver to explain what will happen B. providing him with privacy whenever possible C. allowing him to handle the oxygen mask and ride in the wagon to the OR D. giving him a thorough explanation of everything that will happen - Correct answer C. allowing him the handle the oxygen mask and ride in the wagon to the OR The preschooler needs to explore and interact with his environment. Allowing him to familiarize himself ahead of time with some objects he may encounter can ease anxiety" "flammable antiseptic solutions differ from combustible ones in that A. flammable solutions have a flash point above 101.5 F B. flammable solutions will not ignite C. combustible solutions have a flash point above 100.0 F D. Combustible solutions will not ignite - Correct answer C. combustible solutions have a flash point above 100.0 The threshold between flammable and combustible solutions is the flash point of 100.0 F, with flammable ones being below this temperature and combustible ones being above. all saturated flammable solutions should be removed prior to draping the patient. Fumes from volatile or combustible solutions may ignite w/o a direct connection to the source of ignition." "Which of the following is the most important action by the circulating nurse to reduce specimen error? A. seeking clarification from the surgeon about the specimen site and side B. calling the lab to confirm the proper storage solution for the specimen C. asking the scrub person to verify the specimen D. paging the surgical assistant post op to identify the specimen - Correct answer A. seek clarification from the surgeon about the specimen site and side" "using the nursing process, nursing interventions lead to A. planning B. implementation C. assessment D. outcomes identification - Correct answer D. outcomes identification outcomes identification describes the desired patient condition that can be achieved through nursing interventions" "a hemostatic agent that may be used by a neurosurgeon to control bleeding bone is A. heparin B. protamine sulfate C. methylene blue D. bone wax - Correct answer D. Bone Wax Bone Wax is a hemostatic agent used to control bleeding from open bone via the creation of a mechanical tamponade barrier" "When delegating a task, the circulating nurse should A. verify that the task is with in the scope of practice of the designee B. provide a minimum of instructions on how to complete the task C. give feedback to the designee based on personal experience D. assume the designee has the skills to perform the task - Correct answer A. verify that the task in within the scope of practice of the designee" "A medication that should be administered for treatment of local anesthetic systemic toxicity (LAST) crisis is A. lidocaine B. epinephrine C. 20% lipid emulsion D. propofol - Correct answer C. 20% lipid emulsion The lipid emulsion is used to draw the local anesthetic out of the bloodstream" "hospital policy should include the requirement of PPE for all personnel who are likely to come in contact with blood or infectious material based on A. OSHA regulations B. TJC standards C. AORN guidelines D. CDC recommendations - Correct answer A. OSHA regulations hospital policy must comply with OSHA regulations" "When double gloving, personnel should wear A. gloves one size larger for the first layer B. gloves one size smaller for the first layer C. gloves that are the same size for both layers D. hypoallergenic gloves for the outer layer - Correct answer A. gloves one size large for the first layer using an inner glove that is one size larger allows for an air pocket that will prevent constriction when the outer glove is applied." "Which of the following core body temperatures would indicate post op hypothermia? A. 36 C B. 37 C C. 38 C D. 39 C - Correct answer A. 36 C post op hypothermia, which can prolong recovery time and contribute to post op morbidity, is defined as a core body temp less than 36 C (96.9 F)" "The power drill or saw used to divided bone with a side-to-side cutting action is a/an A. reciprocating saw B. oscillating saw C. drill D. reamer - Correct answer B. Oscillating saw reciprocating saw uses and in-and-out action the drill and reamer both use a rotary action" "Deviation from a standardized procedure that is hospital policy suggests the need for A. a root cause analysis B. a verbal warning C. an evaluation of the procedure or staff D. better communication - Correct answer C. an evaluation of the procedure or staff standardization of procedures help staff develop skill and efficiency. Policies and procedures based on standards and guidelines help to incorporate evidence-based practice into patient care. Deviation from those policies should lead to an evaluation of the processes and staff involved to discover if the process needs to be improved." "A patient reports to the ambulatory surgery center for local anesthesia w/o sedation and claims that the surgeon gave him permission to drive himself home. The most appropriate actin for the peri op nurse is to A. cancel the surgery and reschedule when the patient has a ride B. contact the social worker to assist in finding transportation for the patient C. check for an order stating that the patient may drive himself home D. allow the patient to leave when his post op Aldrete score is 10 - Correct answer C. check for an order stating that the patient may drive himself home it may be permissible for the patient to drive himself home if the surgery was performed under local anesthesia w/o sedation and if there is a physician's order" "Which of the following are methods of sterilization? A. Chemical, mechanical, biological B. decontamination, disinfection, pasteurization C. thermal, chemical, radiation D. low-level disinfection, intermediate-level disinfection, high-level disinfection - Correct answer C. thermal, chemical, radiation sterilization processes are either physica (steam), chemical (ethylene oxide gas), or radiation (XRAY)" "a 36 year old male presents to the OR for reaper of a fractured right medial malleolus. he weighs 85 kg, does not smoke, and takes no medications at home. which of the following characteristics increases the patients risk for developing a venous thromboembolism (VTE) A. his age B. his injury C. his weight D. his smoking status - Correct answer B. his injury procedure-related VTE risk factors include ankle fracture." "During the pre op assessment of an 82 year old malnourished woman, the RN circulator determines that the patient is at an increased risk of A. post op hyperthermia B. unplanned hypothermia C. ineffective tissue perfusion D. excess fluid volume - Correct answer B. unplanned hypothermia the pre op assessment should include factors that may contribute to unplanned hypothermia, including patient related factors such as age (older than 65), sex (female), low body surface area or weight, and pre existing medical conditions (malnourishment)" "gelatin pads used for hemostasis absorb in A. 7 to 10 days B. 10 to 20 days C. 20 to 40 days D. 60 to 90 days - Correct answer C. Absorbable gelatin is used to treat retard absorption, which allows the hemostatic agent to absorb 20 to 40 days after placement. the gelatin pad absorbs 40 times its weight and may be used wet or dry" "A collection of blood in a body cavity or space caused by uncontrolled bleeding or oozing is called a A. hematoma B. pseudoaneurysm C. varicosity D. contusion - Correct answer A. hematoma the hematoma may cause pain and require drainage" "prophylactic antibiotics should be administered A. for 48 hours post op B. within 1 hour before skin incision C. within 1 hour after the skin incision D. at the time of incision - Correct answer B. within 1 hour before incision optimal levels of the prophylactic antibiotic should be present at the time of incision. therefore, the prophylactic antibiotic of choice should be administer within 1 hour before the incision is made. additionally, prophylactic abx therapy should typically be discontinued within 24 hours" "A peri op nurse is reviewing a patient's chart and notes that the patient will undergo a brain biopsy for symptoms of progressive dementia. which of he following suspected pathogens would prompt the nurse to take additional actions during the peri op period of this patient's care A. Treponema pallidum B. culex triaeniorhynchus C. neurocutaneus leishmania protozoa D. proteinaceous prion - Correct answer D. proteinaceous prion prions are proteinaceous infectious agents that are resistant to routine sterilization and disinfection practices." "when a discrepancy is identified in the surgical count, the peri op RN should A. organize the sterile field B. perform a methodical wound exploration C. remain in the room until the item is found D. call for assistance - Correct answer D. call for assistance The RN calls for assistance, the scrub person should organize the sterile field, the surgeon and first assist should perform a methodical wound exploration. the surgeon should remain in the room until the item is found or determined not to be in the patient." "A health care industry representative should A. not participate in direct patient care B. bring additional equipment that was not requested C. check in with materials management D. open requested implants - Correct answer A. not participate in direct patient care sales representatives should never participate in direct patient care and must not enter the sterile field. Only the requested equipment is brought in and sales reps must check in and out with the appropriate hospital staff." "Which of the following demonstrates nursing professional development? A. arriving to work on time every day B. assisting with room turnover b/t care C. helping a coworker with his or her cases D. achieving certification - Correct answer D. Achieving certification" "the peri op nurse identifies the patient's medical hx in which phase of the nursing process? A. assessment B. diagnosis C. planning D. evaluation - Correct answer A. assessment assessment is the collection and analysis of relevant health data about the patient." "most complications occur within the first _____ after surgery A. 4 hours B. 12 hours C. 48 hours D 72 hours - Correct answer C. 48 hours aN RN should call to check on the patients progress and to reiterate post op instructions the next day or at most within 2 days of discharge" "the handoff/hand over report should be a standardized transfer of patient information from the current caregiver to the receiving caregiver. strategies to accord a break down in handover communication include A. ensuring that the person reporting has had a rest break B. documenting the unit personnel receiving the report C. using a standardized documentation format D. asking the anesthesia professional to confirm the accuracy of the hand-over report - Correct answer C. using a standardized documentation format A standardized format, like SBAR (situation, background, assessment, recommendations) for passing crucial patient information from the operative staff on to the staff of the receiving unit (PACU) facilitates communication. Communication breakdown is the root cause of many sentinel events according to TJC" "for which of the following should an incident report be completed A. the surgeon arriving late for the scheduled surgery B. equipment malfunctioning during the procedure C. sponge, sharps, and instrument counts being correct D. the scrub person not being relieved for lunch - Correct answer B. equipment malfunctioning during the procedure accidents or unusual occurrences involving a patient, employee, or property should be reported according to facility policy. unusual situations requiring an incident report include falls, needle sticks, fire, theft, malfunctioning equipment, medication error or reaction and retained surgical items." "The briefing should include confirmation of the A. presence or absence of surgical complications B. complete and signed H&P by the attending physician C. surgical count status D. EBL - Correct answer B. complete and signed H&P by the attending physician the briefing is a standardized procedure that should take place before the surgical procedure. the pre op briefing process should include identification of the patient, introduction of team members, signed consent, and all required documentation" "When correcting a patient care entry in the electronic health record, the peri op nurse should A. highlight the correction in a different color B. double strikethrough the incorrect entry C. add a rationale for the correction D. enter the corrected information at the end of the documentation - Correct answer C. add a rationale for the correction any correction to the patient health record should include the rationale for the correction above the inaccurate entry (if room is available) or in the margin of the document" "a superficial surgical site infection (SSI) is defined as A. an infection of a organ/space that is routinely evident on X-ray film and that occurs within 30 days of surgery B. an infected burn wound that extends in to the fascial and muscle layers C. purulent drainage originating from proximate organs or compartments D. an infection with purulent incisional drainage involving only skin or incisional subcutaneous tissue that occurs within 30 days of the surgical procedure - Correct answer D. an infection with purulent drainage involving only skin or incisional subcutaneous tissue that occurs within 30 days of the surgical procedure SSI's fall into 3 catagories: superficial incisional, deep incisional, and organ/space" "which of the following is a measure of the surgical care improvement project (SCIP) A. performing strict hand hygiene protocols B. administering prophylactic abx 1 hour before surgery C. damp-dusting poor to the first case of the day D. performing a surgical count prior to the start of surgery - Correct answer B. administering prophylactic abx 1 hour before surgery" "Which of the following statements regarding radiation safety is true? A. all personnel in the OR should wear wrap around lead aprons when ironing radiation is used B. when a c-arm is in use, radiation emanates from the top part of the c-arm that is over the patient C. time, distance, shielding are important components of radiation safety D. when only on x-ray badge is worn, the proper placement is underneath the lead apron along the neckline - Correct answer C. time, distance, shielding are important components of radiation safety" "at the end of the case loaned instruments should be A. disassembled, cleaned, decontaminated, inspected and returned to the lending facility B. disassembled, cleaned, decontaminated, inspected, sterilized, and returned to the lending facility C. disassembled, decontaminated, sterilized, inspected, reassembled and returned to the lending facility D, placed in a biohazard plastic container, sealed, labeled and returned to the lending facility - Correct answer A. disassembled, cleaned, decontaminated, inspected and returned to the lending facility instruments do not have to be sterilized, as they will have to undergo sterilization at the lending facility." "post op phone calls to the patient A. should be documented in the intra op record B. should be made after the first week to accurately assess for complications C. should not be part of a quality improvement initiative due to possible HIPPA violations D. can be used to measure patient satisfaction - Correct answer D. can be used to measure patient satisfaction post op phone calls can be used to measure patient satisfaction, outcomes, and quality improvement data" "The relative humidity in a restricted area should be maintained within a range of A. 15% to 60% B. 15% to 70% C. 20% to 60% D. 20% to 70% - Correct answer C. 20% to 60%" "What are the five rights of delegation? A. right task, right circumstances, right practice, right communication and direction, and right supervision and evaluation B. right task, right circumstances, right person, right communication and direction, and right supervision and evidence C. right task, right circumstances, right person, right communication and direction, and right supervision and evaluation D. right assignment, right circumstances, right person, right communication and direction, and right supervision and evaluation - Correct answer C. right task, right circumstances, right person, right communication and direction, and right supervision and evaluation peri op nurses must continually be involved in the assessment, evaluation and judgement needed for peri op patient care" "An oxygen-enriched environment is present when the oxygen-concentration in the OR is greater than A. 21% B. 22% C. 26% D. 28% - Correct answer A. 21% in an oxygen-enriched environment, the temperature and energy required for fuels to ignite is lower that that of ambient or medical environments" "which of the following forms of protection is not considered part of standard precautions A. gloves B. eye protection C. head covers D. sharps safety - Correct answer C. head covers" "oxidized cellulose is a hemostatic agent that is absorbable but is contraindicated to left in place after closure on A. bone B. organs C. vessels D. ovaries - Correct answer A. bone oxidized cellulose left on bone inhibits regrowth and can interfere with healing" "When a surgical item is left in the patient, which of the following is a potential result of ensuing litigation? A. the surgical team could be found guilty of assault and battery B. the surgical team could be found liable under the doctrine of resondeat superior (let the master answer) C. the facility could be found liable under the doctrine of corporate negligence D. the surgical team could be found liable under the doctrine of res ipsa loquitur (the thing speaks for itself) - Correct answer D. the surgical team could be found liable under the doctrine of res ipsa loquitur (the thing speaks for itself) used to prove medical negligence and make the litigation nearly indefensible" "corrective measures that may be implemented based on a multidisciplinary risk assessment following a variance in the parameters of the heating, ventilation, and air conditioning (HVAC) system include A. taking no action B. discarding all disposable surgical supplies C. terminal cleaning of the entire peri op area D. inventorying all peri op supplies - Correct answer A. taking no action based on the risk assessment, corrective measures may include rescheduling or redirecting procedures to areas of the surgical suite where the HVAC system is functioning within parameters, delaying elective procedures, limiting surgical procedures to emergency procedures only, closing the affected OR(S), or taking no action. The other options are measures that may be taken to restore the surgical suite to full function after the HVAC system variance has been restored" "Marking the surgical site for procedures that involve laterality A. should be performed after the patient is anesthetized and positioned in the OR B. can use different methodology depending on surgeon preference C. should use markings that are clear and unambiguous D. can be performed by any member of the surgical team - Correct answer C. should used markings that are clear and unambiguous marking the surgical site must occur so that the intended site of incision or insertion is clear and unambiguous. procedures that involve left/right distinction, multiple structures, or multiple levels (spinal surgery) require specific markings. initials, a "yes", or a line at or near the incision site are all acceptable examples of unambiguous markings. The marking methodology should be consistently used throughout the facility" "When using a medical interpreter to speak with a patient, the peri op nurse should A. maintain eye contact with the interpreter B. speak loudly to ensure understanding C. talk directly to the patient D. smile at the interpreter for reassurance - Correct answer C. talk directly to the patient" "which of the following factors should be considered when selecting products for use in the OR A. indirect costs and reimbursement potential B. reimbursement potential and group purchasing organization contract pricing C. direct costs and group purchasing organization contract pricing D. direct costs, indirect costs, reimbursement potential, and group purchasing organization contract pricing - Correct answer D. direct costs, indirect costs, reimbursement potential, and group purchasing organization contract pricing the financial impact analysis should include cost of the product, replacement strategy, associated equipment, training, depreciation, reimbursement potential, and GPO contract pricing" "what is a desirable characteristic of antimicrobial skin cleansing agents? A. broad spectrum B. slow acting C. abrasive D. pathogen specific - Correct answer A. broad spectrum other desirable characteristics: fast acting, effective non-irritating and non-sensitizing, and prolonged action (ie leaves an antimicrobial residue on the skin to temporarily prevent the growth of microorganisms)" "When a parent os present during the induction of a 6 month old patient, the peri op nurse explains the sequence of events and the atmosphere or the OR. This is done to A. ensure cooperation of the child B. decrease the parent's anxiety C. comply with the surgical consent form D. minimize anesthesia distractions - Correct answer B. decrease parents anxiety during induction, a parent will watch his or her child go from being animated to lethargic to anesthetized. This gives the appearance of helplessness or death and can be upsetting to parents. walking parents through the process helps to manage their expectations and decrease their anxiety" "Which type of indicator should be used to validate air removal in a sterilizer cycle? A. class I B. CLASS II C. CLASS III D. CLASS IV - Correct answer B. CLASS II class II chemical indicators are used as sterilizer test packs. they are used to test for air removal during the cycle" "Shock resulting for anaphylaxis or sepsis is ________ shock A. hemorrhagic B. cardiogenic C. vasogenic D. neurogenic - Correct answer C. vasogenic anaphylaxis and sepsis from infection are the most common types of vasogenic shock" "How many personnel are required to transfer an unconscious supine patient from the OR bed to a patient bed when a lifting frame or patient roller is used? A. 2 B. 3 C. 4 D. 5 - Correct answer C. 4" "Which action should be taken when moisture is noted on the outside of a wrapped instrument tray? A. open the tray starting with the closest flap B. leave the tray until it has cooled C. open the tray and return for reprocessing D. consult with the surgeon - Correct answer C. open the tray and return for reprocessing any sterile item that has any type of moisture on it is considered contaminated. the item must be opened to prevent others from mistakingly thinking that the item is sterile" "When should discharge teaching begin? A. in the PACU B. during pre op teaching C. on the day of discharge D. in the surgeons office prior to surgery - Correct answer B. during pre op teaching the patient needs to know pre op when to get assistance with discharge care if needed" "Which of the following is true about chromic sutures? A. they are used most often as fine suture material for the eye B. they should be used immediately after removal from the packet C. they are well suited for closing skin edges D. they are synthetic, absorbable sutures produced from strands of polymers. - Correct answer B. they should be used immediately after removal from the packet surgical gut sutures are wet-packaged in an alcohol solution to provide maximal pliability and should be used immediately after removal from the packet. when a gut suture is removed from its packet and not used immediately, the alcohol evaporates, which causes the strand to lose pliability" "The Agency for Healthcare Research and Quality (AHRQ) is one of the 12 agencies with the Department or Health and Human Services (DHHS). The AHRQ is committed to safety, quality, effectiveness, and A. equality B. culture C. public information D. efficiency - Correct answer D. efficiency the overall focus of AHRQ activities is: safety and quality, effectiveness, and efficiency. Safety and quality reduce the risk or harm. Effectiveness improves healthcare outcomes with the use of research. Efficiency then transforms research into practice" "A body mass index (BMI) equal to or above ______ kg/m2 is considered obese A. 22 B. 28 C. 30 D. 40 - Correct answer C. 30" "A surgical blood loss of 750ml to 1500ml is categorized as A. minor B. moderate C. major D. catastrophic - Correct answer B.. moderate" "When preparing a room for the next patient after use by a confirmed tuberculosis patient, in addition to performing routine environmental decontamination, the air exchanges should be _____% complete A. 99 B. 50 C. 65 D. 85 - Correct answer A. 99 This may take 20 to 30 minutes. personnel should wear appropriate filtration masks during room cleaning." "When using a skin preparation solution that contains isopropyl alcohol, drape application should occur A. after wiping the area dry B. after the skin and hair have dried C. immediately after applying the prep D. after waiting 5 minutes - Correct answer B. after the skin and hair have dried" "Before the patient's discharge and transfer to the surgical unit, the nurse completes a final A. assessment B. evaluation C. hand-off/hand-over report D. standardized scoring - Correct answer A. assessment before a patient can be discharged, the RN completes a final assessment to verify patient status for discharge to the next level of care" "critical items should be processed by A. low-level disinfection B. high-level disinfection C. intermediate-level disinfection D. sterilization - Correct answer D. sterilization critical items contact sterile tissue or the vascular system and thus require sterilization" "The biggest risk associated with the supine position for obese patients is A. respiratory distress B. spinal pressure C. Foot drop D. shearing - Correct answer A. respiratory distress obese patients have decreased respiratory reserve and are at an increased risk for rapid respiratory distress in the supine position" "what is the correct workflow traffic pattern for instrument processing? A. decontamination area, set assembly room, sterile processing area, sterile storage, and case cart packing room B. set assembly room, sterile processing area, sterile storage, case cart packing room, and decontamination area C. case cart packing room, decontamination area, set assembly room, sterile processing area, and sterile storage D. decontamination area, sterile processing area, set assembly room, sterile storage, and case cart packing room - Correct answer A. first the instruments must be decontaminated and disinfected prior to use. then they are assembled in sets/trays and sterilized per the manufacture's instructions for use and care. next, they are transported to sterile storage where they are rotated out to be placed on case carts for posted procedures" "ventricular fibrillation is characterized by A. an ectopic focus in the ventricles, causing the heart to beat prematurely B. a rapid heartbeat caused by ventricular ischemia or irritability C. an impulse originating in the ventricles and traveling to the rest of the myocardium D. a total disorganization of ventricular activity - Correct answer D. a total disorganization of ventricular activity because the impulse does not travel via the rapid, specialized conduction system, depolarization of both ventricles takes longer and is not simultaneous" "evidence based practice (EBP) is a systematic, thorough process to identify a _______ issue, collect and evaluate evidence, design and implement a change, and evaluate the process A. personal B. clinical C. corporate D. nonclinical - Correct answer B. Clinical" "When the patient's arms are extended on armbands, the palms should be positioned face up to decrease pressure on the A. brachial plexus B. median nerve C. ulnar nerve D. radial nerve - Correct answer C. Ulner Nerve Arm boards should be at least 90 degrees and padded, and the patients arms/wrists should be in neutral alignment" "Which patient population is more sensitive to dosage errors? A. male patients aged 25 to 40 years B. bariatric patients C. patients with a hx of polypharmacy D. pediatric patients - Correct answer D. pediatric patients pediatric patients are at higher risk for medication errors r/t dosing for body size. patient weight should always he recorded in kilograms for medication dosage calculations. other populations at high risk include geriatric patients and patients with impaired body systems" "the national patient safety goals directed at improving staff communication review the need for A. ensuring important test results are communicated to the right person on time B. transferring patients to the correct next level of care C. completing peri op charting prior to transfer to the PACU D. conducting a daily huddle on the unit - Correct answer A. ensuring important test results are communicated to the right person in time test results are critical to maintaining patient safety and must be communicated in a timely manner to the appropriate personnel" "Which of the following is a potential contraindication to the use of a pneumatic tourniquet? A. the patient has undergone previous joint replacement surgery B. the patient is older than 80 years C. the patient has sickle cell anemia D. the patients operative extremity has been shaved - Correct answer C. the patient has sickle cell anemia other potential contraindications for a tourniquet include: Venous thromboembolism, impaired circulation or peripheral vascular compromise, previous revascularization of the extremity, extremities with dialysis access, acidosis, hemoglobinopathy (sickle cell anemia), and extremity infection" "Which of the following is part of the surgical safety checklist? A. When the patient last ate food or drank fluids B. whether any special equipment, devices, or implants will be needed C. whom the surgeon should talk to after surgery D. what pharmacy the patient uses - Correct answer B. whether any special equipment, devices or implants will be needed the comprehensive surgical checklist is part of the Universal Protocol that is supported and endorsed by both The Who and TJC" "A patient taking ginger pre op is at risk for surgical complications that include bleeding, hypotension, and A. hypoglycemia B. bradycardia C. hypokalemia D. liver dysfunction - Correct answer B. bradycardia Ginger is often used as an antiemetic, digestive aid, cough suppressant, and agent to relieve menstral cramps. potential complications include: bradycardia, bleeding and hypotension" "a patient is on long term ASA therapy. pre op, the patient should be counseled to stop taking the medication ________ prior to surgery A. 1 week B. 2 weeks C. 3 weeks D. 4 weeks - Correct answer B. 2 weeks" "A patient- specific risk factor for developing venous thromboembolism (VTE) is A. a previous stroke hx B. the duration of surgery C. the intraoperative position D. the use of pneumatic tourniquet - Correct answer A. previous stroke hx the other options are procedure-specific risk factors" "Patients who are warmed with forced air show ______ compared to those warmed with a warm water circulating device A. a faster return to baseline temperature B. a higher final core body temperature C. a higher occurrence of adverse outcomes D. an increased incidence of hypothermia - Correct answer C. a higher occurrence of adverse outcomes such as more blood loss, Lowrys core body temperatures, and longer hospital stays" "which of the following patient characteristics indicates increased risk for developing a pressure ulcer during a surgical procedure? A. aged 50 years or older B. hx of recent gallbladder surgery C. female D. poor pre op nutritional status - Correct answer D. poor pre op nutritional status the peri op nurse should take additional precautions to decrease the risk of pressure ulcer development in patients who are older than 70 years of age, who require vascular procedures or any procedure lasting longer than 4 hours, who are thin, small in stature or have poor pre op nutritional status, who are diabetic or have vascular disease, or who have a pre op Braden score of less than 20" "based on data collected during the patient assessment, the peri op RN A. identifies outcomes B. formulates a nursing dx C. develops a plan of care D. performs nursing interventions - Correct answer B. formulates a nursing dx outcomes and a plan of care are derived from formulated nursing dx. interventions are performed after the plan of care has been developed" "a patients life-threatening injuries prevent required hair removal before transfer to the OR. the nest course of action for the peri op nurse to follow is to A. leave the hair at the incision site and prep to patient B. use a razor and 3" both tape to remove the hair C. moisten the area to be prepped and use a disposable clipper D. test a depilatory cream on the surgical site - Correct answer C. moisten the area to be prepped and use a disposable clipper prevention of hair dispersal for hair removed in the OR may be accomplished by wet clipping" "When prescribed, intermittent pneumatic compression devices should be applied and functioning A. after the administration of regional or general anesthesia B. before the administration of regional or general anesthesia C. before the patient arrived in the operating or procedure room D. after the patient arrives in the operating or procedure room - Correct answer B. before the administration of regional or general anesthesia" "in planning for the transfer of an 18 kg child to the gurney after bilateral myringotomies with insertion of ear tubes, the peri op nurse plans for which of the following patient transfer aids? A. a lateral transfer device, 1 caregiver, and the anesthesia professional B. a lateral transfer device, 2 caregivers, and the anesthesia professional C. a lateral transfer device, 3 caregivers, and the anesthesia professional D. a mechanical lift device, 3 caregivers, and the anesthesia professional - Correct answer C. a lateral transfer device, 3 caregivers, and the anesthesia professional" "lead shielding used to minimize the patients exposure to ionizing radiation should be placed A. between the patient and the source of radiation but not within the path of the beam that originates from the X-ray tube B. between the patient and the source of radiation and within the path of the beam that originates from the X-ray tube C. between the patient and the image intensifier side of the the fluoroscopic unit but not within the path of the beam that originates from the X-ray tube D. between the patient and the image intensifier side of the fluoroscopic unit and within the path of the beam that originates from the X-ray tube - Correct answer A. between the patient and the source of radiation but not within the path of the beam that originates from the X-ray tube lead shielding should not be placed within the beam that originates from the X-ray tube and it should not be placed between the patient and the image intensifier side of the fluoroscopic unit" "an 18 year old patient is hesitant to remove her acrylic tongue piercing before an exploratory laparoscopy for a possible ruptured ovarian cyst. which verbal response is most appropriate for the peri op RN to provide? A. you can always get another piercing if the opening for this one closes B. if the piercing is dislodged while the breathing tube is put in , it could block your airway or be pushed into your lung C. its our policy that all jewelry be removed prior to surgery D. your tongue could be burned of your jewelry serves as an alternate ground for the electrocautery - Correct answer B. if the piercing is dislodged while the breathing tube is put ion, it could block your airway or be pushed into your lung" "which of the following statements reflects a female patients accurate understanding of her scheduled total abdominal hysterectomy? A. I'm having all my female parts removed B. im having a TAH C. im having my uterus removed D. im having my uterus removed through my vagina - Correct answer C. im having my uterus removed a total abdominal hysterectomy involves removal of the uterus and cervix" "the plan of care for an obese patient in the supine position include A. using 2 chest supports that extend from he clavicle to the iliac crest B. placing a axillary roll under the patients dependent thorax C. elevating the head 25 degrees D. using foam heel padding - Correct answer C. elevating the head 25 degrees patients who are obese may have difficulty breathing in a recumbent position. elevating the patients head and neck helps establish a patent airway, ease intubation, decrease ventilator pressure, and prevent aspiration" "assessing the surgical patients psychosocial state allows the peri op RN to contribute to the plan of care by A. suggesting modifications to the patient's position B. communicating effectively with other peri op team members C. ensuring that the requisite supplies and equipment are readily available D. providing explanations, comfort, and emotional support - Correct answer D. providing explanations, comfort and emotional support planning requires knowledge of the patient's psychosocial state and feelings about the proposed operation so that the peri op RN can provide explanation, comfort, and emotional support" "a patient scheduled for a bronchoscopy states that he has had a persistent cough with blood tinged sputum, night sweats, and loss of appetite with significant weight loss over the past 3 months. which action should be taken? A. leave the portable HEPA filter unit on while the patient is intubated to supplement normal room air exchanges B. schedule the patient for the first procedure of the day, when the infection preventionist is available C. provide the patient with a NIOSH N-95 fit-tested respirator to wear during transport D. notify environmental services to delay cleaning the OR until the air exchange system has had time to remove 99% of airborne particles - Correct answer D. notify environmental services to delay cleaning the OR until the air exchange system has had time to remove 99% of airborne particles" "a 28 year old hispanic male is scheduled for repair of an incarcerated inguinal hernia. he does not speak English. the consent form is only available in English. the best way for the peri op nurse to ensure informed consent for this patient is to A. witness the patients signature on the consent form B. arrange for a medical interpreter C. allow a family member to interpret for the surgeon D. arrange for a Spanish-speaking staff member to interpret for the surgeon - Correct answer B arrange for a medical interpreter the patient must be provided information related to his surgery by a medical interpreter in terms that he can understand" "reusable eyewear should be throughly disinfected A. immediately before application B. when visibly soiled C. at the end of the day D. after each use - Correct answer D. after each use" "A(n) ______ should be used to remove waste anesthesia gases from operating rooms A. ventilation system B. anesthesia delivery system C. scavenging system D. air sampling system - Correct answer C. scavenging system is a regulatory requirement" "Local anesthesia systemic toxicity (LAST) is treated by administering A. 10% lipid emusion B. 15% hetastarch C. 20% lipid emulsion D. 25% hetastarch - Correct answer C. 20% lipid emulsion" "placing the patient on the OR bed in the supine position with the arms extended on arm boards greater than 90 degrees may cause injury to the A. axillary Nerve B. brachial plexus C. median nerve D. radial nerve - Correct answer B. brachial plexus the brachial plexus is a group of nerves that run between the clavicle and the first rib. hyperextension of the arm cam press the clavicle and first rib together, applying excessive pressure on the brachial plexus" "the correct time to label containers designated for medications or solutions is A. when setting up the sterile field but before the medications are delivered to the field B. when there are more than 2 medications being used on the sterile field C. at the time the medication is delivered to the sterile field D. just before using the medication on the patient - Correct answer C. at the time the medication is delivered to the sterile field the scrub person receiving the medication should label the medication container and all devices (eg syringes) used to deliver or administer the medication" "a peri op nurse is preparing to preform a skin prep for a patient scheduled for a right breast biopsy with needle localization. when the peri op nurse removes the patients gown, she discovers a wire inserted into the left breast. What is the appropriate action? A. leave the wire in place and prep the left breast B. remove the wire and prep the right breast C. call and tell the radiologist of the error D. postpone prep until the discrepancy is resolved - Correct answer D. postpone prep until the discrepancy is resolved discrepancies in wrong site surgery are addressed before starting the procedure" "potential harm from the use of providing-iodine antiseptics includes A. deafness B. thyroid dysfunction C. neurotoxicity D. allergic response to iodine - Correct answer B. Thyroid dysfunction iodine may interfere with thyroid function in burn patients, patients undergoing thyroidectomy, neonates and premature neonates, and pregnant or lactating women. Options A and C are harmful effects of chlohexidine gluconate antiseptic solutions. An allergic response to an iodine-based antiseptic is not r/t the iodine" "a specific directive, written by a physician, about end-of-life decisions is a/an A. do-not-resuscitate order B. allow-natural-death order C. advance directive D. required consideration - Correct answer B. allow-natural-death order it provides clarity about the intent of the care that will be provided to the patient." "patients in the steep Trendelenburg position may be at risk for A. increased tidal volume B. decreased tidal volume C. decreased intracranial pressure D. increased stroke volume - Correct answer B. decreased tidal volume caused by pressure of the abdominal contents against the diaphragm" "When performing pre op patient skin antisepsis, the peri op RN should perform A. a surgical hand scrub and wear a sterile gown B. a surgical hand scrub and wear short sleeved scrub attire C. hand hygiene and wear a sterile gown D. hand hygiene and wear long-sleeved scrub attire - Correct answer D. hand hygiene and wear long-sleeved scrub attire the peri op team member should wear surgical attire that covers his or her arms while performing pre op patient skin antisepsis. A sterile gown is not required." "the type of extinguisher to be used for an electrical fire is A. pressurized water B. carbon dioxide C. dry chemical D. halon - Correct answer D. halon a halon fire extinguisher will smother an electrical fire without leaving a residue on the equipment" "When a risk for exposure to blood and other body fluids exists, which type of PPE would be worn? A. gloves, warm-up jackets, hair protection, and shoe covers B. gloves, fluid resistant gowns or aprons, and surgical masks C. gloves, surgical masks, fluid-resistant gowns and eye protection D. lab coats, gloves, eye protection, and shoe covers - Correct answer C. gloves, surgical masks, fluid-resistant gowns, and eye protection" "which of the following airflow pressures and total air exchanges per hour is most appropriate for sterile storage areas that do not open into an operating room? A. negative airflow pressure with a minimum of 4 total air exchanges per hour B. positive airflow pressure with a minimum of 4 total air exchanges per hour C. negative airflow pressure with a minimum of 10 total air exchanges per hour D. positive airflow pressure with a minimum of 10 total air exchanges per hour - Correct answer B. positive airflow pressure with a minimum or 4 total air exchanges per hour" "what incision should be used for a C-Section of a baby in the breech position? A. Kerr B. Kronig C. Low Transverse D. Classic Uterine - Correct answer B. Kronig an 8cm vertical incision, Kronig, is made in the lower uterine segment after the bladder is separated and retracted. The incision is used when the fetus is small, preterm, and in the breech position" "A sterile field has been prepared for a vaginal hysterectomy. The surgeon has been called away for an emergency C-section, delaying the scheduled case by at least 1 hour. the appropriate method for maintaining the sterile field for the delayed case is to A. tape the door closed B. cover the sterile field with a sterile drape and leave the room C. cover the sterile field with a sterile drape and remain in the room D. wait for an hour and the tear down the back table - Correct answer C. cover the sterile field with a sterile drape and remain in the room after a sterile field has been established, it should not be left unattended. it is also appropriate to cover the sterile field with a sterile drape. covering the field does not negate the need to provide continual observance in the room. the sterility of the back table is not time related." "A patient has lost 750ml of blood intra op. Vital signs are within normal limits. Which of the following interventions should the circulating nurse anticipate? A. send a blood specimen for a stat type and cross-match B. set up an autologous blood transfusion unit C. send an order for 2 units of O-negative blood D. obtain additional crystalloids - Correct answer D. obtain additional crystalloids for patients with an EBL of less than 1000ml, crystalloids are the recommended fluid replacement." "The RN circulator completing the final count for a knee arthroscopy discovers that an atraumatic needle is missing. After an exhaustive search, an x-ray is ordered. The x ray is negative, and the surgeon closes the wound. How does the RN circulator document this incident? A. document that the count was incorrect or unreconciled and describe the steps that were taken to rectify the count B. document that the count was correct because the x ray was negative C. notify the supervisor and document what he or she instructs according to facility policy D. inform the patient that a needle may have been left in the wound - Correct answer A. document that the count was incorrect or unreconciled and describe the steps that were taken to rectify the count" "A patient is scheduled for a total knee replacement. during the time out, the scrub nurse discovers that the incorrect implant is on the back table. The correct implant is available but unsterile. The surgeon would like to continue with the case. what is the best course of action? A. notify the surgeon that the correct implant may be sterilized via IUSS method if biological and Class V indicators are placed in the load B. notify the surgeon that the correct implant mat be sterilized via the ethylene oxide method if the aeration period is aborted C. notify the surgeon that a root cause analysis will be initiated D. cancel and reschedule the procedure - Correct answer A. notify the surgeon that the correct implant may be sterilized via IUSS method if biological and Class V indicators are placed in the load IUSS is reserved for instances in which there is insufficient time to process by the preferred wrapped or container method. Biological and Class V indicators must be run in the load with the implant" "an 18 year old patient is schedule to have cochlear implants placed. The patient refuses to have the implants tracked even after the team has informed her of the possible implications of recall or adverse event. What is the next course of action? A. cancel the procedure and have the procedure rescheduled at a different facility B. Notify the surgeon and let him or her decide what to do C. proceed with the surgery and document in the peri op notes that patient has refused to allow tracking of the medical device D. report that incident to the US Food and Drug Administration - Correct answer C. proceed with the surgery and document in the peri op notes that the patient has refused to allow tracking of the medical device patients have the right to refuse tracking of their medical devices. if a patient refuses to have the device tracked, the nurse should document the refusal along with the required product information and report this information to the manufacturer, but patient-specific information should not be included" "When should the scrub person transfer specimens from the sterile field to the RN Circulator? A. at the end of the procedure B. when it is convenient for the scrub person C. as soon as possible D. when temporarily relieved - Correct answer C. as soon as possible ASAP to reduce the potential for the integrity of the specimen to be compromised or for the specimen to be lost or misplaced" "Which of the following is a common root cause of sentinel events? A. failure to use written communication tools B. breakdown in communication C. absence of or failure to follow policies and procedures D. fear of reprisal for speaking up - Correct answer B. breakdown in communication including briefings and debriefings before and after surgery, respectively, allows for improved communication among team members. the goal of effective communication is to ensure that all team members are aware of key safety strategies and prepared for the surgical procedure" "When Communicating patient information to other team members, peri op RNs should A. speak loudly and slowly B. avoid using body language C. use read- back method D. provide information in writing - Correct answer C. use read-back method" "What is the greatest value of a standardized process for transferring patient information? A. improves the accuracy, reliability, and quality of information B. shortens the time it takes to transfer information from one caregiver to another C. ensures that the same information is transferred for every patient D. ensures that the transfer process adheres to facility policy - Correct answer A. improves the accuracy, reliability, and quality of information" "The structure and processes for the transfer of patient information should be developed A. according to TJC and Centers for Medicare and Medicaid Services guidelines B. by a multidisciplinary team comprised of caregivers who participate in the transfer of patient information C. by the health care facility's risk management Department D. using SBAR format - Correct answer B. by a multidisciplinary team comprised of caregivers who participate in the transfer of patient information patient safety is improved when all team members contribute to communication standards" "During an intra op hand-over (ie hand-off) between scrub persons before a change in personnel using the SBAR format, the information under "situation" includes pertinent procedural information, the name of the procedure, and A. patient allergies B. the name of the patient C. the names of the surgical team members D. the medications on the back table - Correct answer B. the name of the patient the other options are all part of the background format" "Which of the following situations should the patient be educated about to understand as an expected outcome immediately following inguinal hernia repair? A. swelling B. nausea and Vomiting C. a popping sensation D. rash - Correct answer A. swelling the effects of anesthesia and surgery can easily be mistaken for problems. it is important to let the patient know what is normal and what is not. Pain, swelling, bowel changes, and fatigue are all expected." "There should be a process in place to _______ the efficacy of electronic documentation. A. identify B. determine C. evaluate D. share - Correct answer C. evaluate Evaluate peri op electronic documentation systems for their effect on the clinical workflow and patient safety and their ability to accommodate the organization/s objectives for the implementation site." "Effective communication skills are best demonstrated when the caregiver's body language is A. consistent with the spoken word B. viewed as more important than the spoken word C. kept to a minimum or avoided D. animated - Correct answer A. consistent with the spoken word" "if corrections are made to the medical record, the correction should A. be initialed B. start on a new page C. be covered with correction fluid D. include the date and time and be initialed - Correct answer D. include the date and time and be initialed this is necessary for legal documentation. if a new page is needed, the original page should be included in the record. Correction fluid should never be used." "The Health Information Technology for Economic and Clinical Health (HITECH) Act A. guarantees the privacy of individuals receiving health services and the confidentiality of identifiable health information B. addresses the use of electronic health information technology to improve health care quality C. enhances the ability of the United States government to monitor and detect activities that indicate support for terrorism D. gives citizens some control over the information collected about them by the federal government and its agencies - Correct answer B. addresses the use of electronic health informations technology to improve health care quality the HITECH Act is a component of the American Recovery and Reinvestment Act that addresses the use of electronic health information technology to improve health care quality, coordination of care, and health information privacy and security." "A multidisciplinary team has been convened to review several recent incidents where the wrong patient was brought from the medical-surgical unit to the pre op holding area. which of the following actions would prevent this from occurring in the future? A. requiring an RN to accompany the patient to the pre op holding area B. reviewing with transport personnel the process for confirming the correct patients identity C. ensuring that the OR charge nurse calls the unit before the transport of the patient D. posting the surgical schedule at the nurse's station on the medical-surgical unit - Correct answer B. reviewing with transport personnel the process for confirming the correct patients identity" "the importance of educating patient's and family members about the prevention of wound infections post op is part of the A. National Patient Safety Goals B. Surgical Care Improvement Project C. AORN Guidelines for Perioperative Practice D. CDC guidelines - Correct answer A. National Patient Safety Goals NPSG #7 discusses the importance of preventing hospital associated infections. It is required that SSI education for prevention be documented in the patient's medical record" "Documentation of transfer-of-care communication should be A. done by each member of the peri op team participating in the hand-over B. presented in SBAR format to ensure consistency of the hand-over documentation C. approved by all personnel involved in the hand-over D. done using a standardized documentation format - Correct answer D. done using a standardized documentation format clear, timely communication is the goal of documentation r/t patient care. Use of a standardized format allows for the provision of consistent, reliable communication" "policies and procedures r/t the transfer of patient information should be A. reviewed annually B. available in the practice setting C. written by a registered nurse D. written in SBAR format - Correct answer B. available in the practice setting Health care staff must have the policies and procedures r/t the transfer of patient care information readily available for reference. Policies should be written by an interdisciplinary team" "the peri op patients transition for Phase I to Phase II care is based on A. the length of time the patient has been in Phase I B. the nurse's assessment of the patient C. the patient's BP D. the patient's oxygen saturation - Correct answer B. the nurse's assessment of the patient there is no length of time requirement for the patient's stay in phase I. The length of time is dependent on the nurse's assessment of the patient's status" "the goal to get important test results to the right person on time is proposed by A. the Centers for Medicare and Medicaid Services B. OSHA C. the US dept of health and human services D. TJC - Correct answer D. The Joint Commission Goal #2 of TJC's Hospital National Patient Safety Goals is to "get important test results to the right staff person on time." The other options are examples of federal regulatory agencies that mandate compliance issues" "Discharge education should include an explanation of the adverse effects of opioid pain medications, including constipation, vomiting and A. respiratory depression B. hypotension C. HTN D. diarrhea - Correct answer A. respiratory depression" "The goal of performing a follow-up telephone call within 48 to 72 hours of the patient's discharge is to A. monitor the patient's heart rhythm B. confirm the patient's understanding of and compliance with instructions C. finalize paperwork for submission to the patient's insurance company D. schedule follow-up appointments - Correct answer B. confirm the patient's understanding of and compliance with instructions instructions are reviewed and printed for the patient prior to discharge. A phone call will clarify whether the patient understood the directions and is continuing to be compliant" "Which teaching method has been shown to improve communication and teamwork? A. role-playing B. case studies C. online modules D. simulation - Correct answer D. simulation preventing communication errors when transferring patient care information is essential to safe patient care. Simulation has demonstrated the most improvements to communication and teamwork skills" "What can compromise the accuracy of the nurse's transfer of patient care? A. interruptions B. patient acuity C. patient Diagnosis D. paper charting - Correct answer A. interruptions interruptions and distractions can lead to error and failure to give a complete report, affecting patient safety." "the minimum distance between ceiling-mounted sprinkler heads and sterile stored items should be ________ inches A. 6 B. 12 C. 18 D. 24 - Correct answer C. 18 fire code regulations specify that the clearance from the top of stored items to the ceiling should be 18 inches to allow for sprinkler systems to be effective" "Which biological indicator should be used for routine load release with liquid peracetic acid sterilization? A. Geobacillus stearothermophilus B. self-contained biological indicators (SCBI) C. Bacillus atrophaeus D. No indicator is validated for use with peracetic acid sterilization - Correct answer A. Geobacillus sterarothermophilus use Geobacillus sterarothermophilus spore biological indicators for routine load release, routine sterilizer efficacy monitoring, and sterilizer qualification testing" "physical parameters that should be monitored at the end of the sterilization cycle include time, temperature and A. load control number B. disposition C. weight of the load D. sterilant concentration - Correct answer D. sterilant concentration review physical monitors (eg time, temp, pressure, humidity, sterilant concentration) at the end of each cycle. Verify that all sterilization parameters were met for every cycle and every sterilization method" "A package containing a chemical sterilant is inadvertently punctured, and the sterilant splashes onto the hands of the peri op nurse as she prepares an endoscope for sterilization. Information on how to handle the spill is best obtained from A. the facility pharmacist B. a poison control center C. the peri op manager D. the appropriate safety data sheet (SDS) - Correct answer D. the appropriate safety data sheet (SDS) a current SDS should be readily available fo all hazardous materials in the peri op suite" "When placing one peel pouch inside another, A. the inner pouch should be placed with its plastic side facing the plastic side of the outer pouch B. the inner pouch should be placed with the plastic side facing the paper side of the outer pouch C. the inner pouch should be folded over to fit inside the outer pouch D. the outer pouch should be labeled on the paper side - Correct answer A. the inner pouch should be placed with its plastic side facing the plastic side of the outer pouch to allow for sterilant to pass through both pouches" "instruments undergoing high-level disinfection should be rinsed after the required exposure time with A. tap water B. sterile water C. sterile saline D. sodium hypochlorite - Correct answer B. sterile water rinsing with sterile water prevents recontamination of the instrument. Saline and sodium hypochlorite can corrode the finish of the instrument" "a surgeon requests that the peri op nurse retrieve a laparoscopy lens that has not completed its aeration cycle after bring sterilized via ethylene oxide (EO) sterilization. Which of the following responses to this request is most appropriate? A. instruments that have not completed the aeration cycle can cause burns to the staff and patients B. there is an increased risk for cancer from instruments that have n