CMSRN Perioperative 4 — Questions and Answers
Question 1: The nurse is performing a preoperative assessment and learns the patient has a latex allergy. Which intervention is MOST important?
- Place the patient last on the surgical schedule
- Notify the entire perioperative team and ensure a latex-free environment (Correct answer)
- Have diphenhydramine available at bedside
- Avoid using rubber-tipped instruments only
Correct answer: Notify the entire perioperative team and ensure a latex-free environment
The entire perioperative team must be notified and a fully latex-free environment ensured to prevent potentially life-threatening anaphylaxis.
Question 2: A patient is scheduled for a thyroidectomy. Which preoperative assessment is most specific to this procedure?
- Renal function tests
- Baseline voice quality and neck range of motion (Correct answer)
- Coagulation studies
- Cardiac stress test
Correct answer: Baseline voice quality and neck range of motion
Baseline voice quality and neck mobility are critical because thyroidectomy risks injury to the recurrent laryngeal nerve, affecting voice postoperatively.
Question 3: Which of the following is the correct order for the surgical hand scrub?
- Nails → fingertips → hands → forearms (Correct answer)
- Fingertips → nails → hands → forearms
- Forearms → hands → fingertips → nails
- Hands → forearms → nails → fingertips
Correct answer: Nails → fingertips → hands → forearms
The surgical scrub begins at the nails/fingertips (most contaminated) and progresses to the forearms, working from most-to-least contaminated.
Question 4: A patient is being discharged after same-day surgery under monitored anesthesia care. Which discharge criterion is most important to verify?
- The patient has eaten a full meal
- The patient has a responsible adult driver (Correct answer)
- The patient's SpO2 is 94% on room air
- The patient has voided at least once
Correct answer: The patient has a responsible adult driver
Having a responsible adult driver is critical because residual sedation impairs judgment and driving ability, creating significant safety risk.
Question 5: Intraoperatively, the scrub technician's gown is splashed with blood. The correct response is to:
- Continue the procedure and change the gown after the case
- Notify the surgeon; the gown must be changed immediately using sterile technique (Correct answer)
- Cover the soiled area with a sterile towel and continue
- Only change the gown if the blood penetrates to clothing underneath
Correct answer: Notify the surgeon; the gown must be changed immediately using sterile technique
A contaminated gown compromises sterile technique and must be changed immediately to maintain sterility and prevent infection.
Question 6: A postoperative patient receiving PCA morphine has a respiratory rate of 8 breaths/min and is difficult to arouse. The FIRST nursing action is:
- Administer naloxone and stop the PCA (Correct answer)
- Stimulate the patient and apply supplemental oxygen
- Call the rapid response team immediately
- Decrease the PCA demand dose and basal rate
Correct answer: Administer naloxone and stop the PCA
Opioid-induced respiratory depression with somnolence requires immediate naloxone administration and PCA cessation to reverse narcosis.
Question 7: The nurse is reviewing a consent form signed by a patient who is now medicated with midazolam. The nurse should:
- Accept the consent because the patient signed before sedation was given
- Verify with the chart when the consent was signed relative to medication administration (Correct answer)
- Have the patient re-sign the consent under observation
- Proceed — midazolam does not affect consent validity
Correct answer: Verify with the chart when the consent was signed relative to medication administration
Consent must be obtained before sedation; the nurse must verify the timeline, as midazolam impairs cognition and renders post-medication consent invalid.
CMSRN Perioperative 4
The nurse is performing a preoperative assessment and learns the patient has a latex allergy.
Which intervention is MOST important?