CNOR Certification Exam — Questions and Answers

Question 1: When a sharps injury occurs to a scrub person during an active procedure, the FIRST action is:

Stop the procedure to complete an incident report immediately
Remove the contaminated glove and apply a sterile glove over the injured hand
Continue the procedure and report the injury after the case
Pass the sharp off the field, allow the scrub to wash the wound, and have a replacement scrub relieve them (Correct answer)

Correct answer: Pass the sharp off the field, allow the scrub to wash the wound, and have a replacement scrub relieve them

Immediate wound care is the priority; passing the sharp off the field and replacing the scrub person allows proper wound management while maintaining sterile field integrity.

Question 2: Which body structure is at greatest risk for injury when a patient is placed in the lithotomy position?

Femoral nerve and peroneal nerve (Correct answer)
Ulnar nerve
Brachial plexus
Radial nerve

Correct answer: Femoral nerve and peroneal nerve

The lithotomy position places the femoral nerve and common peroneal nerve at risk due to compression and stretch from hip flexion and stirrup placement.

Question 3: What does the term 'chain of custody' mean in the context of intraoperative specimen handling?

The order in which surgeons perform a procedure
The sequence of nurses assigned to a patient's care
The process of sterilizing instruments before and after a case
The documented transfer of a specimen from collection to the laboratory, maintaining accountability at each step (Correct answer)

Correct answer: The documented transfer of a specimen from collection to the laboratory, maintaining accountability at each step

Chain of custody documents every person who handles a specimen, ensuring its integrity and traceability from collection through laboratory analysis.

Question 4: A perioperative nurse identifies a gap between current practice and AORN evidence-based guidelines. The BEST professional response is to:

Follow the existing practice until a new policy is officially published
Bring the gap to the attention of the manager and recommend a practice improvement plan (Correct answer)
Apply the guideline only to patients at highest risk
Adapt the guideline informally to match current unit practice

Correct answer: Bring the gap to the attention of the manager and recommend a practice improvement plan

Professional accountability includes identifying practice gaps and advocating for evidence-based improvements through formal channels.

Question 5: A patient is in the Trendelenburg position for 3 hours. Which postoperative complication related to positioning is the nurse most concerned about?

Sacral pressure ulcer
Peripheral neuropathy of the femoral nerve
Brachial plexus injury
Intraocular pressure increase leading to vision changes (Correct answer)

Correct answer: Intraocular pressure increase leading to vision changes

Prolonged Trendelenburg increases intraocular pressure, which can cause postoperative vision loss especially in patients with pre-existing glaucoma.

Question 6: Which finding during preoperative skin assessment requires immediate communication to the surgeon before proceeding?

A well-healed surgical scar near the operative site
Dry skin requiring moisturizer
Redness, warmth, and exudate at the planned incision site (Correct answer)
A small tattoo distant from the operative field

Correct answer: Redness, warmth, and exudate at the planned incision site

Signs of infection at the planned incision site may necessitate postponement to prevent surgical site infection.

Question 7: After a sterile package falls on the floor, the scrub person should:

Consider it contaminated and discard it (Correct answer)
Use it if the outer wrap remains intact
Wipe the outside with an alcohol swab and use it
Pick it up only if the floor is visibly clean

Correct answer: Consider it contaminated and discard it

Any item that falls to the floor is considered contaminated regardless of visible soiling or intact packaging.

Question 8: A dispersive electrode (grounding pad) used during monopolar electrosurgery should be placed:

Over a bony prominence for best conductivity
On a well-vascularized muscle mass, close to the surgical site (Correct answer)
On the patient's hand for easy access
Over the surgical site for direct current flow

Correct answer: On a well-vascularized muscle mass, close to the surgical site

The dispersive electrode should be placed over a well-vascularized, large muscle mass close to the surgical site to ensure safe current return and prevent burns.

Question 9: A patient is NPO but has been taking oral medications as prescribed. Which medication should be held before surgery?

Proton pump inhibitor for GERD
Beta-blocker for hypertension
Oral hypoglycemic agent for Type 2 diabetes (Correct answer)
Thyroid hormone replacement

Correct answer: Oral hypoglycemic agent for Type 2 diabetes

Oral hypoglycemics should typically be held preoperatively to prevent hypoglycemia during the fasting and surgical period.

Question 10: An OR fire involving dry surgical drapes is BEST extinguished using which type of fire extinguisher?

Class K (wet chemical)
Class A (water-based) (Correct answer)
Class D (dry powder)
Class C (carbon dioxide)

Correct answer: Class A (water-based)

Class A fires involve ordinary combustibles like drapes and paper; a Class A water-based extinguisher or CO2 can be used, but Class A designation covers ordinary combustible materials in the OR.

Question 11: A patient emerges from general anesthesia with severe shivering. The nurse should recognize that shivering increases:

Core body temperature by vasoconstriction
Risk of bradycardia
Depth of sedation
Oxygen consumption by up to 400% (Correct answer)

Correct answer: Oxygen consumption by up to 400%

Postoperative shivering dramatically increases metabolic rate and oxygen consumption, which can compromise patients with limited cardiopulmonary reserve.

Question 12: Which of the following is an early sign of air embolism during a procedure performed in the sitting (beach chair) position?

'Mill wheel' murmur and a decrease in end-tidal CO2 (Correct answer)
Hypertension
Bradycardia
Increased end-tidal CO2 with tachycardia

Correct answer: 'Mill wheel' murmur and a decrease in end-tidal CO2

A 'mill wheel' murmur heard on precordial Doppler and a drop in end-tidal CO2 are early indicators of venous air embolism in the sitting position.

Question 13: A patient expresses significant fear and anxiety about the upcoming surgery. The perioperative nurse's most therapeutic response is to:

Acknowledge the patient's feelings and provide specific information about what to expect (Correct answer)
Tell the patient everything will be fine and not to worry
Administer the prescribed anxiolytic immediately
Refer all emotional concerns to the surgeon

Correct answer: Acknowledge the patient's feelings and provide specific information about what to expect

Acknowledging anxiety and providing accurate procedural information is evidence-based and helps reduce preoperative fear.

Question 14: When documenting informed consent during the preoperative phase, the perioperative nurse's role is to:

Explain the surgical procedure, risks, and alternatives to the patient
Witness the patient's signature after confirming the surgeon explained the procedure (Correct answer)
Obtain the patient's signature on the consent form
Determine if the patient has decision-making capacity

Correct answer: Witness the patient's signature after confirming the surgeon explained the procedure

The nurse's role in informed consent is to witness the signature after verifying that the surgeon has provided the explanation; obtaining consent is the surgeon's responsibility.

Question 15: Flash sterilization (IUSS) should be used in which circumstance?

When a dropped instrument is urgently needed and no alternative exists (Correct answer)
For all implants to save time
When the sterile processing department is backlogged
As a routine sterilization method for high-use instruments

Correct answer: When a dropped instrument is urgently needed and no alternative exists

IUSS is reserved for urgent situations when a dropped or contaminated item is needed immediately and no sterile alternative is available.

Question 16: A pediatric patient is brought to the preoperative area accompanied by both parents and a stepparent. Which individual(s) can legally provide informed consent?

Only the biological mother
The stepparent if married to the custodial parent
The biological or legal guardian with legal custody (Correct answer)
Any of the three adults present

Correct answer: The biological or legal guardian with legal custody

Informed consent for a minor must be obtained from the individual with legal custody or legal guardianship.

Question 17: The harmonic scalpel differs from conventional electrosurgery because it:

Is only used for laparoscopic cholecystectomy
Uses electrical current at higher voltage
Requires a grounding pad on the patient
Uses ultrasonic vibration to cut and coagulate simultaneously with minimal thermal spread (Correct answer)

Correct answer: Uses ultrasonic vibration to cut and coagulate simultaneously with minimal thermal spread

The harmonic scalpel converts electrical energy into ultrasonic mechanical vibration, producing less lateral thermal damage than monopolar ESU.

Question 18: Ethylene oxide (EtO) sterilization is preferred for which category of items?

Implants that require biological indicator confirmation before use
Items with heavy bioburden that steam cannot penetrate
Heat- and moisture-sensitive items such as flexible endoscopes (Correct answer)
Items requiring rapid turnover between cases

Correct answer: Heat- and moisture-sensitive items such as flexible endoscopes

EtO sterilization is used for heat- and moisture-sensitive items that would be damaged by steam.

Question 19: A patient on the OR table develops ST-elevation on the cardiac monitor during a non-cardiac procedure. The nurse should:

Continue the procedure and recheck in 5 minutes
Administer aspirin 325mg per standing order
Increase the rate of intravenous fluids
Notify the anesthesia provider and surgeon immediately and prepare for potential cardiac intervention (Correct answer)

Correct answer: Notify the anesthesia provider and surgeon immediately and prepare for potential cardiac intervention

ST elevation suggests myocardial infarction; immediate notification of the anesthesia and surgical team is essential to decide whether to continue, abort, or modify the procedure.

Question 20: When a cardiac arrest occurs in the OR, which team member is responsible for documenting the resuscitation timeline?

The charge nurse outside the room
The anesthesia provider
The surgeon
A designated circulating nurse (Correct answer)

Correct answer: A designated circulating nurse

A designated circulating nurse should assume documentation responsibility during resuscitation to ensure accurate timing of interventions, drugs, and defibrillation attempts.

Question 21: A circulating nurse is completing the handoff report for a patient transferring to the PACU. Using the SBAR (Situation, Background, Assessment, Recommendation) format, which statement best represents the 'Assessment' component?

"I recommend monitoring the patient's neurovascular status hourly and administering the prescribed analgesic as needed for pain."
"The patient is Jane Doe, post-op right total knee arthroplasty performed by Dr. Smith."
"The patient has a history of hypertension and received 100 mcg of fentanyl and 2 mg of midazolam intraoperatively."
"The patient's vital signs are stable, the surgical dressing is dry and intact, and estimated blood loss was 150 mL." (Correct answer)

Correct answer: "The patient's vital signs are stable, the surgical dressing is dry and intact, and estimated blood loss was 150 mL."

The 'Assessment' component of SBAR involves a summary of the patient's current clinical status. Stating that vital signs are stable, the dressing is dry and intact, and providing the estimated blood loss gives a concise and objective assessment of the patient's condition at the time of handoff. 'Situation' identifies the patient and procedure. 'Background' provides relevant history. 'Recommendation' suggests the plan of care. [16, 20, 22]

Question 22: A patient undergoing a prolonged procedure in the lithotomy position develops rhabdomyolysis postoperatively. Which intraoperative finding would have been the earliest indicator of this developing complication?

A rise in end-tidal CO2
Decreasing urine output with dark, tea-colored urine (Correct answer)
A drop in SpO2 to 94%
Increasing peak airway pressures

Correct answer: Decreasing urine output with dark, tea-colored urine

Dark, myoglobin-containing urine and decreased output are the hallmarks of rhabdomyolysis, which can occur from compartment syndrome or ischemia-reperfusion injury in the compressed limbs.

Question 23: Which intraoperative finding is the EARLIEST reliable indicator of malignant hyperthermia?

Ventricular fibrillation on ECG
Rising end-tidal CO2 (EtCO2) (Correct answer)
Elevated body temperature
Mottled skin and cyanosis

Correct answer: Rising end-tidal CO2 (EtCO2)

Rising EtCO2 is the earliest and most sensitive sign of MH because accelerated cellular metabolism produces CO2 before temperature rises significantly.

Question 24: Which is the correct criterion for removing a surgical case from an IUSS (immediate-use steam sterilization) cycle and using the item?

The item is cooled, double-wrapped, and stored for up to 24 hours
Only a chemical indicator is needed; biological monitoring is optional for IUSS
The operator visually confirms steam penetration before releasing the item
The biological and chemical indicators confirm a successful cycle and the item is used immediately without storage (Correct answer)

Correct answer: The biological and chemical indicators confirm a successful cycle and the item is used immediately without storage

IUSS items must pass all cycle parameters and be delivered immediately to the sterile field without storage, wrapping, or delay.

Question 25: Which of the following biological markers should be passed through sterilizers at a minimum frequency?

Bimonthly and with all implants.
Once a week and with all implants. (Correct answer)
Once a month.
Once a day.

Correct answer: Once a week and with all implants.

It is recommended that biological indicators be passed through sterilizers at least once every week to make sure the products are being sterilized adequately. Before implants are inserted into a patient, a bio run should always be performed to confirm their sterility.

Question 26: A surgeon requests the Trendelenburg position for a pelvic laparoscopy. Which physiological effect should the perioperative nurse anticipate?

Reduced intracranial pressure
Cephalad shift of the diaphragm (Correct answer)
Increased functional residual capacity
Decreased venous return to the heart

Correct answer: Cephalad shift of the diaphragm

Trendelenburg causes abdominal viscera and the diaphragm to shift cephalad, reducing lung compliance and functional residual capacity.

Question 27: During a robotic-assisted surgery, the OR team loses all visual display. What is the safest immediate action?

Pause the procedure and troubleshoot the display system (Correct answer)
Convert to open surgery immediately
Ask the surgeon to proceed by memory of the anatomy
Continue the procedure using tactile feedback

Correct answer: Pause the procedure and troubleshoot the display system

The immediate safe response is to pause and troubleshoot; conversion to open surgery is reserved for situations where the problem cannot be quickly resolved.

Question 28: The primary purpose of wound irrigation during surgery is to:

Cool the electrosurgical site
Replace the need for surgical drains
Increase the risk of dehiscence
Reduce bacterial load and remove debris from the wound (Correct answer)

Correct answer: Reduce bacterial load and remove debris from the wound

Wound irrigation dilutes and removes bacteria, necrotic tissue, and foreign material, reducing the risk of surgical site infection (SSI).

Question 29: Flash sterilization (immediate-use steam sterilization) is appropriately used for:

Items that were dropped and are immediately needed, with no biofilm present (Correct answer)
Implantable devices as a routine sterilization method
Heat-sensitive items requiring rapid turnaround
All instruments when time between cases is less than 30 minutes

Correct answer: Items that were dropped and are immediately needed, with no biofilm present

Flash sterilization is reserved for dropped or contaminated instruments urgently needed when no other sterile item is available and the item is free of biofilm.

Question 30: What is the purpose of documenting tourniquet application time and pressure in the intraoperative record?

To record the brand of tourniquet used for equipment tracking
To monitor for potential ischemic injury by tracking duration and inflation pressure (Correct answer)
To document the scrub technician's technique
To fulfill billing requirements for tourniquet use

Correct answer: To monitor for potential ischemic injury by tracking duration and inflation pressure

Tourniquet time and pressure must be documented to monitor for limb ischemia risk; prolonged inflation or excessive pressure can cause nerve or tissue damage.

Question 31: Which federal regulation governs the privacy of patient health information documented in the perioperative record?

HIPAA Privacy Rule (Correct answer)
CMS Conditions of Participation only
OSHA Bloodborne Pathogen Standard
Joint Commission Accreditation Standards

Correct answer: HIPAA Privacy Rule

The HIPAA Privacy Rule sets national standards for protecting individually identifiable health information, including all perioperative documentation.

Question 32: Which microorganism is most commonly associated with surgical site infections (SSIs) in the perioperative setting?

Pseudomonas aeruginosa
Escherichia coli
Candida albicans
Staphylococcus aureus (Correct answer)

Correct answer: Staphylococcus aureus

Staphylococcus aureus, including MRSA strains, is the most frequently identified pathogen in surgical site infections.

Question 33: A surgeon asks the perioperative nurse to sign off on a surgical count that the nurse did not personally perform. The nurse should:

Refuse to sign and explain that falsifying records is an ethical and legal violation (Correct answer)
Ask another nurse to sign in their place
Sign only if the count results appear correct upon visual inspection
Sign the form because the surgeon was present during the count

Correct answer: Refuse to sign and explain that falsifying records is an ethical and legal violation

Signing documentation you did not perform is falsification of records, which is both an ethical breach and a legal violation.

Question 34: Which situation requires the perioperative nurse to complete an incident report (occurrence report) in addition to the medical record?

A correctly labeled specimen sent to pathology
A surgeon who arrives on time for the case
A patient fall during transfer from the OR table to the stretcher (Correct answer)
A routine instrument count that is correct

Correct answer: A patient fall during transfer from the OR table to the stretcher

A patient fall is an adverse event requiring both an incident/occurrence report for risk management purposes and accurate documentation in the medical record.

Question 35: Which action best demonstrates closed-loop communication during a surgical procedure?

The anesthesiologist documents all drugs independently
The circulator writes notes without verbal confirmation
The surgeon requests a medication and the nurse repeats the order back before administering (Correct answer)
The scrub tech hands instruments without speaking

Correct answer: The surgeon requests a medication and the nurse repeats the order back before administering

Closed-loop communication requires the receiver to repeat back the message to confirm understanding before acting, reducing the risk of error.

Question 36: How should the perioperative nurse respond when a visitor or observer in the OR is observed repeatedly touching their face and then touching the sterile field?

Inform the observer quietly after the case ends
Continue monitoring and intervene only if they touch the patient directly
Immediately instruct the observer to move away from the sterile field and notify the surgeon (Correct answer)
Document the incident and submit an incident report after the procedure

Correct answer: Immediately instruct the observer to move away from the sterile field and notify the surgeon

Any breach of the sterile field must be addressed immediately to prevent patient harm; the nurse is accountable for maintaining aseptic technique.

Question 37: A medication on the sterile field is drawn into a syringe but not immediately labeled. The error is caught before administration, and the medication is discarded. According to patient safety principles, why is it important for the perioperative nurse to complete an incident report for this 'near miss'?

To ensure the involved staff member receives punitive action.
To collect data that can identify system vulnerabilities and prevent future errors. (Correct answer)
To document the event for potential future litigation against the hospital.
To allow the hospital to bill the patient for the wasted medication.

Correct answer: To collect data that can identify system vulnerabilities and prevent future errors.

Reporting near misses, also known as close calls or good catches, is a cornerstone of a robust safety culture. The purpose is not to punish individuals but to gather data that can reveal weaknesses in systems and processes. [9, 10] Analyzing these events helps the organization learn and implement changes to prevent a similar event from actually reaching and harming a patient in the future.

Question 38: A patient receiving a blood transfusion intraoperatively develops hypotension, hemoglobinuria, and back pain. The nurse should FIRST:

Stop the transfusion and maintain IV access with normal saline (Correct answer)
Document the reaction and notify the blood bank after the case
Administer diphenhydramine and continue the transfusion
Slow the transfusion rate and continue monitoring

Correct answer: Stop the transfusion and maintain IV access with normal saline

These signs indicate an acute hemolytic transfusion reaction; stopping the transfusion immediately while maintaining IV access is the critical first step.

Question 39: A scrubbed team member accidentally bumps into an unsterile mayo stand. The correct action is to:

Consider the gown contaminated and change it immediately (Correct answer)
Inform the circulator and continue monitoring for signs of contamination
Continue if only the side of the gown made contact
Wipe the contaminated area of the gown with a sterile towel

Correct answer: Consider the gown contaminated and change it immediately

Any contact between a sterile gown and an unsterile surface contaminates the gown; the scrubbed person must regown immediately.

Question 40: A nurse notes a colleague is impaired during a surgical procedure. The PRIORITY action is to:

Discuss the concern privately with the colleague after the case
Document the observations and submit an incident report the next day
Cover for the colleague until the case ends to avoid disrupting care
Immediately notify the charge nurse or supervisor and ensure patient safety (Correct answer)

Correct answer: Immediately notify the charge nurse or supervisor and ensure patient safety

Impairment in the OR poses an immediate threat to patient safety requiring immediate supervisory notification and removal of the impaired provider.

Question 41: A patient scheduled for a laparoscopic cholecystectomy tells the perioperative nurse they have changed their mind and want to cancel the surgery. The nurse should:

Reassure the patient and proceed as planned
Notify the surgeon and support the patient's right to withdraw consent (Correct answer)
Remind the patient of financial penalties for last-minute cancellations
Administer pre-medication to calm the patient before reconsidering

Correct answer: Notify the surgeon and support the patient's right to withdraw consent

A competent patient retains the right to withdraw informed consent at any time, and the care team must be notified immediately.

Question 42: A circulating nurse needs to pour a sterile irrigation solution into a basin on the back table. To adhere to the principles of aseptic technique, which action is correct?

Hold the bottle so that the label is facing away from the sterile basin.
Maintain a distance of at least 12 inches above the basin while pouring.
Place the bottle cap on the sterile field with the inside facing up.
Pour the entire contents of the solution into the basin at once to prevent contamination of the bottle's edge. (Correct answer)

Correct answer: Pour the entire contents of the solution into the basin at once to prevent contamination of the bottle's edge.

According to AORN recommended practices, once a sterile solution container is opened, its edge is considered contaminated. Therefore, the entire contents should be poured at once, and the container should be discarded. Placing the cap on the field is incorrect as its outside is non-sterile. Holding the bottle with the label toward the palm can prevent dripping onto and obscuring the label, but the primary principle is to pour the entire contents. A distance of 12 inches is excessive and increases the risk of splashing.

Question 43: What does a biological indicator (BI) confirm during sterilization monitoring?

That sterilization conditions were adequate to kill highly resistant bacterial spores (Correct answer)
That the correct temperature was reached inside the sterilizer chamber
That all chemical indicators inside the package changed color
That the sterilizer passed its mechanical printout review

Correct answer: That sterilization conditions were adequate to kill highly resistant bacterial spores

Biological indicators contain highly resistant bacterial spores (e.g., Geobacillus stearothermophilus) and are the gold standard to confirm the sterilization process achieved lethality.

Question 44: A patient's preoperative ECG shows new ST-segment changes that were not present 6 months ago. The perioperative nurse should:

Proceed with surgery as the changes are minor
Notify the anesthesia provider and surgeon before proceeding (Correct answer)
Repeat the ECG in one hour before notifying anyone
Administer aspirin and continue preparations

Correct answer: Notify the anesthesia provider and surgeon before proceeding

New ECG changes may indicate acute cardiac pathology and must be reported immediately to determine surgical safety.

Question 45: During the preoperative assessment for a patient scheduled for a cholecystectomy, the perioperative nurse discovers the patient has been taking a daily herbal supplement containing garlic, ginger, and ginkgo biloba. Which of the following is the most critical action for the nurse to take?

Advise the patient to discontinue the supplement a week after surgery.
Instruct the patient to double the dose on the morning of surgery.
Document the use of the supplement in the patient's chart.
Inform the anesthesia care provider and surgeon immediately. (Correct answer)

Correct answer: Inform the anesthesia care provider and surgeon immediately.

Herbal supplements such as garlic, ginger, and ginkgo biloba can increase the risk of bleeding by affecting platelet aggregation. It is crucial to inform the anesthesia care provider and surgeon immediately as this may impact the surgical plan and anesthetic management, and may require postponement of the surgery. While documentation is important, immediate communication is the priority for patient safety.

Question 46: During a robotic-assisted procedure, the robotic system experiences a critical malfunction and cannot be safely disengaged. The FIRST nursing priority is:

Contact the robotic system manufacturer's technical support
Follow the facility's robotic emergency protocol and alert the surgeon (Correct answer)
Document the malfunction in the electronic health record
Attempt to manually override the robotic arms

Correct answer: Follow the facility's robotic emergency protocol and alert the surgeon

Patient safety requires immediate activation of the facility's emergency robotic protocol and alerting the surgeon to take control and prevent patient injury.

Question 47: The 'time to first antibiotic dose' standard for surgical prophylaxis is:

Administered 24 hours before surgery to achieve tissue levels
Within 60 minutes before incision (120 minutes for vancomycin and fluoroquinolones) (Correct answer)
Administered at the discretion of the surgeon with no defined window
Given immediately after skin closure to prevent postoperative infection

Correct answer: Within 60 minutes before incision (120 minutes for vancomycin and fluoroquinolones)

Evidence-based guidelines require prophylactic antibiotics within 60 minutes of incision (extended to 120 minutes for vancomycin/fluoroquinolones) to achieve effective tissue concentrations.

Question 48: A 68-year-old male is scheduled for a total knee arthroplasty. His medical history includes well-controlled hypertension and type 2 diabetes managed with oral medication. He quit smoking 10 years ago and has no other systemic diseases. According to the American Society of Anesthesiologists (ASA) Physical Status Classification System, which classification would be most appropriate for this patient?

ASA III
ASA I
ASA IV
ASA II (Correct answer)

Correct answer: ASA II

The ASA Physical Status Classification System categorizes patients based on their overall health and the presence of systemic disease. An ASA II classification is for a patient with mild systemic disease. This patient's well-controlled hypertension and type 2 diabetes fall into this category. ASA I is a normal healthy patient. ASA III is a patient with severe systemic disease. ASA IV is a patient with severe systemic disease that is a constant threat to life.

Question 49: Which personal protective equipment (PPE) combination is required when handling a patient with active pulmonary tuberculosis in the OR?

N95 respirator, gown, gloves, and eye protection (Correct answer)
Surgical mask, gown, and gloves only
Powered air-purifying respirator (PAPR) alone
Standard surgical mask and gloves are sufficient

Correct answer: N95 respirator, gown, gloves, and eye protection

Airborne precautions for TB require a fit-tested N95 or higher respirator along with gown, gloves, and eye protection.

Question 50: Which type of anesthesia is most appropriate for a patient undergoing a cesarean section who desires to remain awake?

Monitored anesthesia care (MAC)
Spinal or epidural anesthesia (Correct answer)
General anesthesia with endotracheal intubation
Intravenous sedation with propofol

Correct answer: Spinal or epidural anesthesia

Spinal or epidural (regional) anesthesia allows the patient to remain conscious and is the standard of care for cesarean sections.

Question 51: When setting up a sterile back table, which area of a sterile gown is considered non-sterile?

The back of the gown (Correct answer)
Sleeves from cuff to 2 inches above elbow
Front panel below the waist
Chest panel from axilla to table level

Correct answer: The back of the gown

The back of the surgical gown is considered non-sterile because it cannot be continuously visualized by the scrubbed team member.

Question 52: According to The Joint Commission's Universal Protocol, what is the final step performed in the operating room, just before the initial incision, to confirm the correct patient, procedure, and site?

Time-out (Correct answer)
Surgical site marking
Preoperative verification
Patient identification

Correct answer: Time-out

The "time-out" is a critical safety check and the final step of the Universal Protocol. It is conducted immediately before the start of the invasive procedure or incision. The entire surgical team actively communicates and confirms the correct patient, correct procedure, and correct surgical site. Preoperative verification and site marking are earlier, essential components of the protocol.

Question 53: During a procedure, a scrubbed team member who is double-gloved contaminates the outer glove by touching a non-sterile surface. What is the MOST appropriate immediate action?

Wipe the contaminated glove with a sterile alcohol wipe.
The individual removes the outer contaminated glove and dons a new sterile glove over the inner glove. (Correct answer)
The individual must leave the field to perform a full re-scrub, re-gown, and re-glove.
The contaminated outer glove is removed by the circulator, and the team member continues with the single inner glove.

Correct answer: The individual removes the outer contaminated glove and dons a new sterile glove over the inner glove.

The standard and most efficient practice when a single glove is contaminated is for the individual to remove the outer glove without contaminating the inner glove. A new sterile glove is then donned, a process often assisted by another sterile team member or performed using an open-gloving technique. This restores the sterile barrier without major disruption. Continuing with a single glove is not ideal, wiping is not sterilization, and a full re-scrub is unnecessary if only the glove was contaminated.

Question 54: A patient with a pacemaker is about to undergo monopolar electrosurgery. What precaution is most important?

Increase the ESU power setting to reduce procedure time
Use only bipolar electrosurgery
Disable the pacemaker before the procedure
Place the dispersive electrode as far as possible from the pacemaker (Correct answer)

Correct answer: Place the dispersive electrode as far as possible from the pacemaker

Placing the dispersive electrode away from the pacemaker directs current away from the device and reduces the risk of pacemaker interference or damage.

Question 55: The normative requirement for sterile packing is that it

Be waterproof
Resist tears, punctures, and abrasions (Correct answer)
Prevent infiltration and degrees of sterilant
Be punctured

Correct answer: Resist tears, punctures, and abrasions

Explanation: Safety requirements for wrapping materials used during sterilization include resistance to tears, punctures, and abrasions. Other prerequisites are as follows: The ability to maintain the sterility of the contents until opening. Enough porosity to allow for steam or gas penetration and venting. Effective air and microorganism barrier. Secure enclosure of contents for moisture resistance. The absence of toxic ingredients and non-fast dyes is sufficient to maintain seal integrity. Aseptic delivery of contents to the sterile field requires correct labeling. Appropriate size for even content distribution.

Question 56: Which principle guides the documentation of a critical event such as unexpected hemorrhage during surgery?

Delay documentation until after the patient is stable
Document only the final outcome of the event
Have the surgeon document the event to avoid liability
Record events in real time or as close to real time as possible with accurate timestamps (Correct answer)

Correct answer: Record events in real time or as close to real time as possible with accurate timestamps

Real-time or near-real-time documentation with accurate timestamps provides the most legally defensible and clinically accurate account of critical intraoperative events.

Question 57: During preoperative assessment, the nurse identifies that the patient has an implanted cardiac pacemaker. The most critical action is to:

Notify the surgeon and determine if electrosurgery requires pacemaker management (Correct answer)
Schedule a cardiology consult to reprogram the device to a fixed rate postoperatively
Document the finding and proceed without further action
Remove the pacemaker before surgery

Correct answer: Notify the surgeon and determine if electrosurgery requires pacemaker management

Electrosurgical units can interfere with pacemaker function, requiring pre-planned management strategies before surgery begins.

Question 58: Which action BEST reduces the risk of surgical site infection (SSI) related to hair removal?

Using depilatory cream 12 hours before the scheduled incision
Performing no hair removal at any time regardless of hair density
Shaving the operative site the night before surgery with a safety razor
Clipping hair at the operative site immediately before the procedure if removal is necessary (Correct answer)

Correct answer: Clipping hair at the operative site immediately before the procedure if removal is necessary

Clipping immediately before surgery is preferred over shaving because razors create micro-abrasions that harbor bacteria and increase SSI risk.

Question 59: Which element is ESSENTIAL for a valid surgical informed consent?

The anesthesia provider must co-sign the consent form
The signature must be witnessed by two licensed nurses
Consent must be obtained on the day of surgery
The patient must be informed of alternatives, risks, benefits, and the right to refuse (Correct answer)

Correct answer: The patient must be informed of alternatives, risks, benefits, and the right to refuse

Valid informed consent requires disclosure of the procedure, its risks, benefits, alternatives, and the patient's right to refuse or withdraw consent.

Question 60: When a patient is placed in the Trendelenburg position during surgery under general anesthesia, which respiratory complication is most likely?

Reduced functional residual capacity (Correct answer)
Hypocapnia
Increased tidal volume
Bronchospasm

Correct answer: Reduced functional residual capacity

Trendelenburg position causes abdominal contents to press on the diaphragm, reducing functional residual capacity and worsening ventilation.

Question 61: During a surgical timeout, which team member has the authority to call a stop if a safety concern is raised?

Only the circulating nurse
Only the anesthesiologist
Any member of the surgical team (Correct answer)
Only the surgeon

Correct answer: Any member of the surgical team

Any member of the surgical team has both the authority and the responsibility to call a stop when a safety concern arises during the timeout.

Question 62: During a robotic-assisted laparoscopic procedure, the patient is placed in steep Trendelenburg. Which complication is MOST likely with prolonged positioning?

Intraocular pressure increase (Correct answer)
Corneal abrasion
Pressure injury to the occiput
Compartment syndrome of the legs

Correct answer: Intraocular pressure increase

Steep Trendelenburg position significantly increases intraocular pressure, which is especially concerning for patients with glaucoma.

Question 63: Which action is MOST important when a power outage occurs in the OR during an active surgical procedure?

Immediately evacuate all OR personnel
Switch critical equipment to emergency battery backup and notify engineering (Correct answer)
Cancel remaining cases for the day
Restart all equipment to restore normal function

Correct answer: Switch critical equipment to emergency battery backup and notify engineering

Switching life-support and critical equipment to emergency power and notifying facilities engineering ensures patient safety while restoring power.

Question 64: Which indicator is considered the gold standard for confirming sterilization efficacy?

Mechanical printout showing correct time, temperature, and pressure
Biological indicator using resistant bacterial spores (Correct answer)
Type 1 process indicator (autoclave tape)
Class 5 chemical integrating indicator

Correct answer: Biological indicator using resistant bacterial spores

Biological indicators using resistant spores are the gold standard because they directly test whether the sterilization process killed microorganisms.

Question 65: The perioperative nurse notes the anesthesia provider is using a laryngeal mask airway (LMA). This device is BEST described as:

An endotracheal tube inserted nasally
An oral airway adjunct to maintain tongue position
A device inserted through the cricothyroid membrane
A supraglottic airway device that sits above the larynx (Correct answer)

Correct answer: A supraglottic airway device that sits above the larynx

An LMA is a supraglottic airway that forms a seal over the laryngeal inlet without entering the trachea.

Question 66: A patient undergoing general anesthesia develops masseter muscle rigidity after succinylcholine administration. What condition should be suspected immediately?

Opioid-induced rigidity
Malignant hyperthermia (Correct answer)
Neuroleptic malignant syndrome
Laryngospasm

Correct answer: Malignant hyperthermia

Masseter muscle rigidity following succinylcholine is an early warning sign of malignant hyperthermia, a life-threatening hypermetabolic crisis triggered by certain anesthetic agents.

Question 67: What is the minimum safe distance an unsterile person must maintain from a sterile field?

6 inches
24 inches
18 inches (Correct answer)
12 inches

Correct answer: 18 inches

Unsterile personnel must maintain at least 18 inches from any sterile field to prevent inadvertent contamination.

Question 68: A surgical instrument tray wrapped in a woven textile has been processed in a steam sterilizer. The external chemical indicator has changed color, but the internal indicator has not. What is the most appropriate action for the perioperative nurse to take?

Send the tray to be re-sterilized immediately without opening it. (Correct answer)
Document the discrepancy and use the instruments for the current case only.
Use the instruments since the external indicator shows the package was processed.
Open the tray in the sterile field but inspect instruments for any visible residue before use.

Correct answer: Send the tray to be re-sterilized immediately without opening it.

If the internal chemical indicator has not changed appropriately, it signifies a failure in the sterilization process; the sterilant may not have penetrated the package or reached the necessary parameters. The tray is considered unsterile and must be removed from service and reprocessed. The external indicator only shows that the package has been exposed to the process, not that sterility was achieved.

Question 69: Which layer of the surgical gown is considered sterile and must be protected from contamination?

The front from the neck to the knees
Only the front from the waist down
The front from the chest to the sterile field level and sleeves to 2 inches above the elbow (Correct answer)
The entire gown including the back

Correct answer: The front from the chest to the sterile field level and sleeves to 2 inches above the elbow

The sterile area of the gown is considered to be the front from chest to the level of the sterile field, and the sleeves from above the elbow to the cuff.

Question 70: When using a fracture table for a hip procedure, the well-leg stirrup must be positioned to avoid pressure on which structure?

Obturator nerve
Femoral vein
Popliteal artery
Saphenous nerve at the medial knee (Correct answer)

Correct answer: Saphenous nerve at the medial knee

The saphenous nerve runs medially near the knee and is susceptible to compression injury from the well-leg stirrup post used with fracture tables.

Question 71: What is the purpose of the 'time-out' procedure performed immediately before a surgical incision?

To confirm anesthesia medications have been given
To verify patient identity, surgical site, procedure, and consent (Correct answer)
To ensure the instrument count has been completed
To allow the surgeon to review the operative report

Correct answer: To verify patient identity, surgical site, procedure, and consent

The time-out is a final safety check to prevent wrong-site, wrong-patient, and wrong-procedure errors.

Question 72: Which of the following is a correct principle regarding the passage of items across the sterile field boundary?

The circulator may place non-sterile items on the sterile field if gloved
Non-sterile team members may reach across the sterile field to pass items quickly
Non-sterile items are presented to the sterile field by opening packaging so the scrub person retrieves the contents without contamination (Correct answer)
Sterile items may be handed directly from a non-sterile team member to the scrub person

Correct answer: Non-sterile items are presented to the sterile field by opening packaging so the scrub person retrieves the contents without contamination

The circulator opens outer packaging and presents the inner sterile item for the scrub person to self-retrieve, maintaining sterility without contact across the boundary.

Question 73: A 68-year-old patient reports occasional confusion and memory lapses. Which preoperative assessment tool is most appropriate to screen for cognitive baseline?

Mini-Mental State Examination (MMSE) (Correct answer)
Braden Scale
AUDIT-C questionnaire
Glasgow Coma Scale

Correct answer: Mini-Mental State Examination (MMSE)

The MMSE is a validated tool for assessing cognitive function and establishing a baseline to monitor for postoperative delirium.

Question 74: A patient is positioned in the lateral decubitus position for a thoracic procedure. Which anatomical structure is most at risk for compression injury?

Sciatic nerve
Femoral nerve
Brachial plexus (Correct answer)
Radial nerve

Correct answer: Brachial plexus

The brachial plexus is most vulnerable in lateral decubitus positioning due to pressure on the dependent shoulder and arm stretching.

Question 75: Which statement about event-related sterility is accurate?

Items sterilized more than 12 months ago must be re-sterilized regardless of packaging integrity
Event-related sterility applies only to items stored in high-traffic areas
Sterility is maintained as long as the expiration date has not passed
Sterility is maintained until the package is opened or compromised, regardless of time (Correct answer)

Correct answer: Sterility is maintained until the package is opened or compromised, regardless of time

Event-related sterility holds that a properly packaged sterile item remains sterile until an event compromises the packaging, not based solely on time.

Question 76: During preoperative assessment, a patient discloses recreational marijuana use. What is the most important implication for anesthesia?

It may alter anesthetic requirements and interact with sedatives (Correct answer)
The surgery must be cancelled
The patient requires a urine drug screen before consent
It has no anesthetic implications

Correct answer: It may alter anesthetic requirements and interact with sedatives

Marijuana use can affect anesthetic depth requirements, cause drug interactions, and increase airway reactivity.

Question 77: After an aortic valve replacement procedure, a patient is being cared for by a PACU nurse. Which of the following heart arrhythmias most frequently occur after this kind of surge?

Tachycardia
Atrial fibrillation (Correct answer)
Heart block
Bradycardia

Correct answer: Atrial fibrillation

Explanation: According to the American College of Cardiology, atrial fibrillation occurs after aortic valve replacement surgery at a rate of about 12%, making it the most frequent cardiac arrhythmia. Acute or late-onset atrial fibrillation raises a person's chance of dying or having a stroke.

Question 78: Which position is MOST associated with the risk of venous air embolism during neurosurgical procedures?

Supine
Sitting (beach chair) (Correct answer)
Lateral decubitus
Prone

Correct answer: Sitting (beach chair)

The sitting position elevates the surgical site above the heart, creating negative venous pressure that can draw air into open venous sinuses.

Question 79: Which AORN recommended practice guides the management of documentation in the perioperative setting?

Documentation templates are optional as long as verbal handoffs occur
Only adverse events require formal documentation in the intraoperative record
Perioperative nursing documentation should reflect the nursing process and be accurate, timely, and complete (Correct answer)
Documentation is the responsibility of the anesthesia provider alone

Correct answer: Perioperative nursing documentation should reflect the nursing process and be accurate, timely, and complete

AORN standards require perioperative documentation to reflect assessment, planning, implementation, and evaluation — ensuring accountability and continuity of care.

Question 80: Which solution is recommended for processing flexible endoscopes classified as semi-critical items?

Steam sterilization at 270°F
High-level disinfection (HLD) using a chemical such as glutaraldehyde or peracetic acid (Correct answer)
Dry heat sterilization
Low-level disinfection with soap and water

Correct answer: High-level disinfection (HLD) using a chemical such as glutaraldehyde or peracetic acid

Semi-critical items that contact mucous membranes require high-level disinfection to eliminate all microorganisms except high numbers of bacterial spores.

Question 81: What is the recommended minimum number of air exchanges per hour in an operating room?

15-20 (Correct answer)
35-40
5-10
25-30

Correct answer: 15-20

AORN guidelines recommend a minimum of 15 air changes per hour in the OR, with at least 3 of those being fresh outside air.

Question 82: Which behavior BEST demonstrates that a perioperative nurse is fulfilling lifelong learning obligations?

Relying on experienced colleagues to update them on new guidelines
Completing only the CE hours required for CNOR recertification
Actively pursuing continuing education, reading current literature, and applying new evidence to practice (Correct answer)
Attending mandatory annual competency reviews

Correct answer: Actively pursuing continuing education, reading current literature, and applying new evidence to practice

Professional accountability includes proactively seeking knowledge beyond minimum requirements to deliver the highest standard of care.

Question 83: Which action represents a break in sterile technique during a total knee arthroplasty?

The scrub person reaches across the sterile field to hand an instrument to the surgeon on the opposite side (Correct answer)
The surgeon requests a second pair of sterile gloves mid-case
The scrub person keeps hands above the level of the sterile drapes at all times
The circulator opens a sterile package and drops the contents onto the sterile field

Correct answer: The scrub person reaches across the sterile field to hand an instrument to the surgeon on the opposite side

Reaching across the sterile field risks contamination from unsterile areas above and around the drapes, violating aseptic technique.

Question 84: Which pulse oximetry limitation is most clinically significant when monitoring a patient who has received large amounts of intravenous dye (methylene blue)?

Nail polish prevents light transmission
Motion artifact causing falsely low readings
Methylene blue causes falsely low SpO2 readings transiently (Correct answer)
Peripheral vasoconstriction causes signal dropout

Correct answer: Methylene blue causes falsely low SpO2 readings transiently

Methylene blue absorbs light at wavelengths used by pulse oximetry and causes a transient but significant drop in the SpO2 reading that does not reflect true oxygenation status.

Question 85: During preoperative assessment, a patient rates their pain as 8/10 at rest. The nurse's best action is to:

Reassure the patient that postoperative pain will be controlled
Document the rating and proceed with surgical preparations
Administer the prescribed PRN analgesic and reassess
Notify the surgeon and anesthesia provider, as uncontrolled pain may indicate a new or worsening condition (Correct answer)

Correct answer: Notify the surgeon and anesthesia provider, as uncontrolled pain may indicate a new or worsening condition

Severe uncontrolled preoperative pain at rest may signal a change in condition or complication that could affect the surgical plan.

Question 86: A patient undergoing preoperative assessment has a history of sleep apnea but does not use their CPAP device. The nurse's priority is to:

Document the history and inform the anesthesia team (Correct answer)
Cancel the procedure immediately
Proceed with surgery since CPAP is optional
Instruct the patient to bring their CPAP to the hospital

Correct answer: Document the history and inform the anesthesia team

Sleep apnea significantly affects anesthetic management and respiratory monitoring; the anesthesia provider must be informed.

Question 87: A preoperative patient with known renal insufficiency is scheduled for a procedure requiring IV contrast. The perioperative nurse's priority action is to:

Check creatinine level and hold the procedure if elevated
Notify the radiologist and surgeon of the renal insufficiency before contrast administration (Correct answer)
Administer the contrast without concern since it is IV
Increase oral fluid intake the morning of surgery

Correct answer: Notify the radiologist and surgeon of the renal insufficiency before contrast administration

Renal insufficiency is a major risk factor for contrast-induced nephropathy and must be communicated to allow for preventive strategies or alternative imaging.

Question 88: Which type of wound is considered a Class III (contaminated) surgical wound?

Clean elective procedure on an uninfected hollow viscus
Infected wound with devitalized tissue present
Open traumatic wound with gross spillage from the GI tract (Correct answer)
Elective clean procedure with no break in aseptic technique

Correct answer: Open traumatic wound with gross spillage from the GI tract

Class III wounds include open traumatic wounds, operations with major breaks in sterile technique, or gross GI spillage.

Question 89: Which of the following best encapsulates proper patient care documentation in a perioperative setting?

It should be on a preprinted form that is easy to fill in.
It should describe the patient’s nursing diagnoses and outcomes. (Correct answer)
It should be read between the nurses during report at the change of shift.

Correct answer: It should describe the patient’s nursing diagnoses and outcomes.

Explanation: The nursing diagnoses and outcomes for the patient should be included in the patient care documentation. Despite the fact that some forms are preprinted, various sites will use various kinds of documentation. The nurse will save time if the information is simple to fill out. Unless the information is relevant to the report, nurses are not required to read through all of the documents during the shift report.

Question 90: Which suture material is classified as nonabsorbable and commonly used for vascular anastomoses?

Polyglactin 910 (Vicryl)
Polypropylene (Prolene) (Correct answer)
Polyglycolic acid (Dexon)
Chromic gut

Correct answer: Polypropylene (Prolene)

Polypropylene (Prolene) is a nonabsorbable monofilament suture with excellent tensile strength and low tissue reactivity, ideal for vascular anastomoses.

Question 91: During the final count for a laparotomy, the scrub person and circulating nurse identify a missing surgical sponge. After a thorough search of the sterile field, trash, and linen hampers is unsuccessful, what is the MOST appropriate next action?

Inform the surgical team and obtain an intraoperative radiograph. (Correct answer)
Document the count as incorrect and send the patient to recovery.
Disassemble and search all sterile instrument trays again.
Close the surgical incision and obtain a postoperative radiograph.

Correct answer: Inform the surgical team and obtain an intraoperative radiograph.

According to AORN guidelines, when a count discrepancy occurs and the item is not found, the surgeon must be notified immediately. The next step is typically to perform an intraoperative X-ray to rule out a retained surgical item before the final closure of the wound. This is a critical patient safety measure to prevent harm.

Question 92: During the preoperative nursing assessment, a patient reports a previous adverse reaction to anesthesia involving prolonged paralysis after receiving succinylcholine. This history most likely indicates:

Malignant hyperthermia susceptibility
Pseudocholinesterase deficiency (Correct answer)
Latex allergy
Neuroleptic malignant syndrome

Correct answer: Pseudocholinesterase deficiency

Pseudocholinesterase deficiency impairs the metabolism of succinylcholine, leading to prolonged neuromuscular blockade.

Question 93: During sterile gloving using the closed-glove technique, which statement is correct?

The gown cuff is pulled back to expose the hand before donning the glove
The gloves may be donned before the gown to protect the hands
The hands remain inside the gown sleeves while the gloves are donned (Correct answer)
The circulator assists by holding the glove open for the scrub person

Correct answer: The hands remain inside the gown sleeves while the gloves are donned

In closed-glove technique, the hands remain inside the gown sleeves throughout glove donning, preventing ungloved skin from touching the exterior of the sterile glove.

Question 94: Which class of SSI involves infection only of the skin and subcutaneous tissue of the incision?

Remote infection
Superficial incisional SSI (Correct answer)
Organ/space SSI
Deep incisional SSI

Correct answer: Superficial incisional SSI

A superficial incisional SSI is limited to the skin and subcutaneous tissue without involvement of deeper fascial layers.

Question 95: Which classification of surgical wound has the HIGHEST risk of postoperative infection?

Class II - Clean-contaminated
Class I - Clean
Class III - Contaminated
Class IV - Dirty/Infected (Correct answer)

Correct answer: Class IV - Dirty/Infected

Class IV (dirty/infected) wounds involve existing infection or perforated viscera and carry the highest postoperative infection risk.

Question 96: When is the final instrument, sponge, and sharp count performed?

Before the first incision only
Only after skin closure is complete
At the beginning of wound closure and before the patient leaves the OR (Correct answer)
When the anesthesiologist requests it

Correct answer: At the beginning of wound closure and before the patient leaves the OR

Final counts are performed before wound closure begins and verified again before the patient leaves the OR to detect any discrepancy.

Question 97: What is the primary purpose of the perioperative handoff report when transferring a patient from the OR to the PACU?

To ensure continuity of care by communicating critical patient information (Correct answer)
To document surgeon preferences for future cases
To record room turnover time
To fulfill billing requirements

Correct answer: To ensure continuity of care by communicating critical patient information

The handoff report ensures the receiving PACU nurse has all critical information needed to safely continue patient care.

Question 98: A patient is scheduled for surgery under regional anesthesia. Which preoperative assessment finding would most likely change the anesthetic plan?

Mild hypertension controlled with medication
Anticoagulant therapy with recent therapeutic INR of 2.8 (Correct answer)
BMI of 27
A history of general anesthesia with no complications

Correct answer: Anticoagulant therapy with recent therapeutic INR of 2.8

Therapeutic anticoagulation significantly increases the risk of spinal hematoma with neuraxial anesthesia.

Question 99: How long must a perioperative RN practice before being eligible to sit for the CNOR exam?

3 years with any clinical nursing experience
2 years with 2,400 hours in perioperative nursing (Correct answer)
6 months with 300 hours in perioperative nursing
1 year with 1,200 hours in perioperative nursing

Correct answer: 2 years with 2,400 hours in perioperative nursing

CNOR eligibility requires an RN with 2 years (24 months) of perioperative nursing practice and a minimum of 2,400 hours in the specialty.

Question 100: A patient undergoing an abdominal procedure under general anesthesia is at GREATEST risk for which thermoregulatory complication?

Fever from inflammatory cytokine release
Hypothermia due to heat loss from the open body cavity and anesthesia effects (Correct answer)
Diaphoresis causing evaporative cooling only
Hyperthermia due to metabolic stimulation

Correct answer: Hypothermia due to heat loss from the open body cavity and anesthesia effects

General anesthesia impairs thermoregulation and open body cavities cause significant radiant and evaporative heat loss, making hypothermia the primary risk.

Question 101: An incorrect needle count is discovered after wound closure in a laparoscopic case. What is the most appropriate next step?

Recount needles and if still incorrect, proceed with patient transfer
File an incident report and notify the charge nurse only
Notify the surgeon so an X-ray can be obtained before the patient leaves the OR (Correct answer)
Document the discrepancy and notify risk management after the case

Correct answer: Notify the surgeon so an X-ray can be obtained before the patient leaves the OR

An incorrect needle count after closure requires immediate surgeon notification and an intraoperative X-ray to locate the missing needle.

Question 102: A patient arrives in the preoperative area speaking only Spanish and no interpreter is present. What should the perioperative nurse do?

Use gestures and diagrams to communicate
Proceed with the case since consent was previously signed
Obtain a qualified interpreter before proceeding with assessment and consent verification (Correct answer)
Ask a family member to interpret the consent

Correct answer: Obtain a qualified interpreter before proceeding with assessment and consent verification

A qualified interpreter must be used to ensure informed consent and accurate preoperative assessment; using family members is not a recommended standard.

Question 103: When documenting irrigation fluid used during a procedure, the perioperative nurse should record which of the following?

Color of the fluid only
Brand name of the irrigant only
Temperature of the irrigation fluid only
Type, volume instilled, and volume returned (Correct answer)

Correct answer: Type, volume instilled, and volume returned

Accurate fluid balance documentation requires recording the type of irrigant, the volume instilled, and the volume retrieved to track fluid absorption.

Question 104: Which electrosurgical unit (ESU) mode uses alternating current to simultaneously cut and coagulate tissue?

Blend mode (Correct answer)
Pure cut mode
Desiccation mode
Fulguration mode

Correct answer: Blend mode

Blend mode combines cutting and coagulation by interrupting the current cycle, producing both a cutting effect and hemostasis simultaneously.

Question 105: A sterile team member must move around the sterile field. The safest method is to:

Face the sterile field at all times while moving (Correct answer)
Step back and pass between two sterile fields if space is limited
Move quickly to reduce time near non-sterile areas
Pass unsterile persons back-to-back

Correct answer: Face the sterile field at all times while moving

Sterile team members must always face the sterile field to maintain visualization and prevent accidental contamination.

Question 106: When performing a surgical count, the scrub technician and circulating nurse discover an incorrect sponge count before wound closure. What is the FIRST action?

Request an intraoperative X-ray
Document the discrepancy
Notify the surgeon immediately
Perform a recount (Correct answer)

Correct answer: Perform a recount

The first step in a count discrepancy is to recount all items before escalating to the surgeon or requesting imaging.

Question 107: A surgeon requests that a bovie electrosurgical unit be used near a patient with a pacemaker. What is the perioperative nurse's priority action?

Refuse to use the ESU entirely
Use bipolar electrosurgery instead of monopolar when possible (Correct answer)
Place the dispersive electrode as close to the surgical site as possible and use the lowest effective setting
Notify the biomedical engineer

Correct answer: Use bipolar electrosurgery instead of monopolar when possible

Bipolar electrosurgery limits current flow to the tissue between the two tips, minimizing electromagnetic interference with the pacemaker.

Question 108: Which of the following is true of the perioperative setting's clinical pathways?

Clinical pathways are another name for hospital policies
Clinical pathways are practice guidelines based on research and outcomes (Correct answer)
Clinical pathways are standards that outline the roles of each professional level of nursing
Clinical pathways are step-by-step processes that tell the nurse how to perform certain procedures

Correct answer: Clinical pathways are practice guidelines based on research and outcomes

Explanation: Clinical pathways are recommendations for best practices based on research and results. The best practices are updated based on the most recent research and include an explanation of the patient care activities. Clinical pathways guide nurses in their tasks within the surgical context and show them how to deliver the best treatments for diverse patient circumstances as perioperative technology and nursing abilities progress.

Question 109: The electrosurgical unit (ESU) dispersive electrode should be placed:

On the patient's chest regardless of the operative site
On a well-vascularized muscle mass closest to but not over the operative site (Correct answer)
Over a bony prominence closest to the operative site
Over a metal implant for best conduction

Correct answer: On a well-vascularized muscle mass closest to but not over the operative site

The dispersive electrode must be placed on a well-vascularized muscle mass near the operative site to ensure adequate current dispersion and prevent burns.

Question 110: Which patient population is at highest risk for latex allergy in the perioperative setting?

Patients with a history of asthma
Elderly patients undergoing elective procedures
Patients with multiple previous surgeries, spina bifida, or healthcare worker history (Correct answer)
Pediatric patients undergoing first surgeries

Correct answer: Patients with multiple previous surgeries, spina bifida, or healthcare worker history

Repeated latex exposure through surgeries, spina bifida management, or occupational contact significantly increases sensitization risk.

Question 111: When a sterile field is broken, what is the primary documentation and communication action required?

Document it only if a patient complication occurs
Address the breach silently to avoid disrupting the team
Immediately report the breach to the surgeon and document the event, corrective action taken, and patient notification (Correct answer)
File an incident report only after the case is complete

Correct answer: Immediately report the breach to the surgeon and document the event, corrective action taken, and patient notification

A break in sterile technique must be immediately communicated to the surgeon and documented along with the corrective action taken to maintain patient safety.

Question 112: When reviewing a patient's medication list preoperatively, which herbal supplement is most important to report to the anesthesia team due to risk of prolonged bleeding?

Echinacea
Probiotics
Melatonin
Ginkgo biloba (Correct answer)

Correct answer: Ginkgo biloba

Ginkgo biloba inhibits platelet-activating factor and can significantly increase bleeding risk perioperatively.

Question 113: What does the Spaulding classification system categorize as 'critical' items requiring sterilization?

Items that contact intact mucous membranes only
Items used exclusively in the substerile corridor
Items that enter sterile tissue or the vascular system (Correct answer)
Items that contact only intact skin

Correct answer: Items that enter sterile tissue or the vascular system

Critical items contact sterile body tissue or the bloodstream and carry the highest infection risk, requiring sterilization before use.

Question 114: A patient develops intraoperative anaphylaxis to latex. After administering epinephrine, which intervention addresses the UNDERLYING trigger?

Administering a second dose of epinephrine prophylactically
Increasing anesthetic depth to suppress the response
Switching to non-latex gloves and removing all latex from the field (Correct answer)
Applying a tourniquet to slow allergen absorption

Correct answer: Switching to non-latex gloves and removing all latex from the field

Removing all latex products from the surgical field eliminates ongoing allergen exposure, which is essential to prevent continued or escalating anaphylaxis.

Question 115: A fire ignites in the surgical field. Per the RACE mnemonic, the FIRST step is:

Extinguish the fire
Confine the fire by closing doors
Activate the alarm
Rescue patients in immediate danger (Correct answer)

Correct answer: Rescue patients in immediate danger

RACE stands for Rescue, Alarm, Confine, Extinguish — rescuing patients in immediate danger is always the first priority.

Question 116: A sterile field becomes compromised when a scrubbed team member's gown sleeve contacts the unsterile back table edge. What is the appropriate response?

Continue the procedure if contamination was minimal
Apply sterile tape over the contact area
Change the contaminated gown immediately (Correct answer)
Reinforce the area with a sterile drape

Correct answer: Change the contaminated gown immediately

Any compromise to a sterile gown requires immediate changing of the gown to maintain aseptic technique.

Question 117: The scrub person drops a sterile instrument onto the floor. The correct action is to:

Pour sterile saline over it to decontaminate it
Pass it off the sterile field and obtain a replacement (Correct answer)
Use it only for non-critical steps of the procedure
Wipe it with a sterile towel and return it to the field

Correct answer: Pass it off the sterile field and obtain a replacement

Any item that contacts a non-sterile surface must be removed from the sterile field and replaced; it cannot be reclaimed by cleaning in the OR.

Question 118: A patient undergoing general anesthesia develops masseter muscle rigidity after succinylcholine administration. The perioperative nurse should FIRST:

Administer a second dose of succinylcholine
Increase the anesthetic gas concentration
Alert the team to potential malignant hyperthermia (Correct answer)
Position the patient in Trendelenburg

Correct answer: Alert the team to potential malignant hyperthermia

Masseter muscle rigidity after succinylcholine is a classic early warning sign of malignant hyperthermia and the entire team must be alerted immediately.

Question 119: Which of the following is the primary strategy for preventing an operating room fire when an electrosurgical unit (ESU) is in use?

Using only non-flammable anesthetic gases.
Ensuring the surgical site is completely dry before activation.
Allowing all alcohol-based prep solutions to fully dry. (Correct answer)
Keeping the ESU power setting below 30 watts.

Correct answer: Allowing all alcohol-based prep solutions to fully dry.

The fire triangle consists of an ignition source (ESU), a fuel source (e.g., alcohol-based prep), and an oxidizer (e.g., oxygen). Allowing flammable agents like alcohol-based skin prep to fully dry and for vapors to dissipate is a critical step to eliminate the fuel source and prevent a surgical fire. While other options are components of fire safety, pooled or vaporized alcohol prep is a common and preventable fuel source.

Question 120: A scrub person notices that a suture package has a compromised seal. What is the correct action?

Hand it to the surgeon for evaluation
Place it back in the suture drawer for later use
Open it and use it if the suture looks intact
Pass it off to the circulator and open a new package (Correct answer)

Correct answer: Pass it off to the circulator and open a new package

A compromised seal means sterility cannot be guaranteed; the item must be removed from the sterile field and replaced.

Question 121: Which information is MOST critical to include when labeling a specimen on the sterile field?

Patient name, medical record number, specimen site/type, and date/time collected (Correct answer)
The scrub technician's initials and the instrument count
Surgeon's pager number and OR room number
Pathologist's name and insurance information

Correct answer: Patient name, medical record number, specimen site/type, and date/time collected

Specimen labels must include patient identification, medical record number, site of origin, and collection date/time to prevent misidentification errors.

Question 122: Which sign differentiates tension pneumothorax from simple pneumothorax in the intraoperative setting?

Absent breath sounds on the affected side only
Tracheal deviation toward the affected side
Hypotension with distended neck veins and tracheal deviation away from the affected side (Correct answer)
Pleuritic chest pain reported by the awake patient

Correct answer: Hypotension with distended neck veins and tracheal deviation away from the affected side

Tension pneumothorax causes mediastinal shift away from the affected side, leading to tracheal deviation away, hypotension, and elevated venous pressure — a surgical emergency.

Question 123: A Bovie scratch pad on the sterile field is used to:

Clean dried eschar from the active electrosurgical electrode tip (Correct answer)
Absorb electrosurgical smoke plume
Ground the patient during monopolar use
Calibrate the ESU generator

Correct answer: Clean dried eschar from the active electrosurgical electrode tip

The scratch pad removes carbonized tissue (eschar) from the ESU tip to maintain efficient electrical conduction during surgery.

Question 124: The purpose of applying cricoid pressure (Sellick's maneuver) during rapid sequence induction (RSI) is to:

Increase oxygen delivery to the alveoli
Occlude the esophagus to prevent passive regurgitation (Correct answer)
Prevent laryngospasm
Facilitate laryngoscopy visualization

Correct answer: Occlude the esophagus to prevent passive regurgitation

Cricoid pressure compresses the esophagus against the vertebral body, reducing the risk of passive regurgitation and aspiration during RSI.

Question 125: The surgical time-out is performed primarily to:

Verify correct patient identity, procedure, and operative site before incision (Correct answer)
Ensure anesthesia equipment has been checked
Confirm the patient's NPO status before incision
Document antibiotic administration timing in the chart

Correct answer: Verify correct patient identity, procedure, and operative site before incision

The time-out, per The Joint Commission Universal Protocol, verifies correct patient, correct procedure, and correct site/side immediately before the procedure begins.

Question 126: Which organization sets the primary scope and standards of perioperative nursing practice in the United States?

The Joint Commission (TJC)
AORN (Association of periOperative Registered Nurses) (Correct answer)
The American Nurses Association (ANA)
The National Council of State Boards of Nursing (NCSBN)

Correct answer: AORN (Association of periOperative Registered Nurses)

AORN establishes the guidelines, standards, and recommended practices specific to perioperative nursing practice.

Question 127: Which sterilization method leaves the most toxic residue that requires extended aeration before the item is safe to use?

Hydrogen peroxide plasma sterilization
Ethylene oxide (EtO) sterilization (Correct answer)
Steam autoclave sterilization
Dry heat sterilization

Correct answer: Ethylene oxide (EtO) sterilization

EtO leaves toxic ethylene oxide residue that requires a mandatory aeration period (often 8–12+ hours) before items are safe for patient use.

Question 128: A patient receiving spinal anesthesia suddenly develops hypotension, bradycardia, and nausea. The perioperative nurse should recognize these as signs of:

High spinal block affecting sympathetic fibers (Correct answer)
Vasovagal syncope from surgical stimulation
Anaphylaxis to the local anesthetic
Pulmonary embolism

Correct answer: High spinal block affecting sympathetic fibers

A high or total spinal block causes widespread sympathetic blockade resulting in hypotension, bradycardia, and nausea due to loss of vascular tone.

Question 129: While a patient is in the PACU, the perioperative nurse is recording their assessment of their discomfort. They mention that morphine sulfate was administered to the patient to manage postoperative pain. Which of the following does this intervention not require documentation for?

The fact the patient rated his pain at a ‘7’ on the 0-10 pain scale
The effects of the morphine on the patient’s pain
The time the morphine arrived to the unit from pharmacy (Correct answer)
Where the patient’s pain is located

Correct answer: The time the morphine arrived to the unit from pharmacy

Explanation: It is not necessary to note in the patient's file the precise moment the morphine arrived at the unit from the pharmacy. The amount, timing, and location of the drug administration to the patient, as well as the patient's reaction to the medication, should all be recorded by the nurse for pain control.

Question 130: Which statement BEST describes the perioperative nurse's responsibility regarding cultural competence?

Cultural competence is the responsibility of the patient educator, not the OR nurse
Cultural practices should be accommodated only if they do not inconvenience the OR team
The nurse should recognize and respect cultural, religious, and individual differences that may affect perioperative care (Correct answer)
Standardized care protocols eliminate the need for cultural accommodation in the OR

Correct answer: The nurse should recognize and respect cultural, religious, and individual differences that may affect perioperative care

Cultural competence requires acknowledging and integrating patients' cultural backgrounds into individualized perioperative care planning.

Question 131: What is the primary purpose of a sterile drape placed over the surgical field?

To create a sterile barrier between the surgical site and surrounding environment (Correct answer)
To absorb blood and surgical fluids
To monitor skin temperature during surgery
To provide cushioning and patient comfort

Correct answer: To create a sterile barrier between the surgical site and surrounding environment

Drapes establish and maintain a sterile field by creating a microbial barrier around the operative site.

Question 132: The term 'retained surgical item' (RSI) refers to:

Any foreign object unintentionally left in a patient after surgery (Correct answer)
Only sponges and needles accidentally left inside the patient
Items documented as missing from the count sheet
Instruments left at the sterile field after the case ends

Correct answer: Any foreign object unintentionally left in a patient after surgery

An RSI is any foreign object — including sponges, instruments, needles, or devices — unintentionally left inside a patient after surgery.

Question 133: During spinal anesthesia, hypotension occurs most commonly due to:

Sympathetic blockade causing vasodilation (Correct answer)
Parasympathetic blockade
Increased cardiac output
Hyperventilation by the patient

Correct answer: Sympathetic blockade causing vasodilation

Spinal anesthesia blocks sympathetic nerve fibers, causing vasodilation and venous pooling that reduces preload and blood pressure.

Question 134: An intraoperative cardiac arrest (Code Blue) is called. As the circulating nurse, which of the following responsibilities is a primary part of your role in the initial response?

Leading the resuscitation efforts and calling out orders.
Maintaining the sterility of the surgical field.
Performing chest compressions.
Activating the emergency response system and managing personnel and equipment. (Correct answer)

Correct answer: Activating the emergency response system and managing personnel and equipment.

The circulating nurse's primary role in a Code Blue is to manage the overall OR environment. This includes formally activating the hospital's emergency response system, ensuring the code cart and defibrillator are at the patient's side, directing additional responding personnel, and documenting the events of the code. The anesthesia provider typically leads the resuscitation, the scrub person maintains sterility, and chest compressions are performed by any available BLS/ACLS-certified team member.

Question 135: Which question is most important when assessing fall risk during the preoperative period?

How many hours of sleep do you get per night?
Do you use any assistive devices for ambulation? (Correct answer)
Have you ever had a broken bone?
Do you follow a regular exercise program?

Correct answer: Do you use any assistive devices for ambulation?

Use of assistive devices indicates impaired mobility and balance, which are key indicators of fall risk in the perioperative setting.

Question 136: A patient with an implanted pacemaker is scheduled for electrosurgery. Which ESU setting BEST minimizes the risk of pacemaker interference?

Disable the pacemaker before the procedure
Use monopolar ESU at the highest available setting for speed
Use bipolar electrosurgery whenever possible (Correct answer)
Place the dispersive electrode on the patient's chest near the pacemaker

Correct answer: Use bipolar electrosurgery whenever possible

Bipolar electrosurgery limits current to the immediate tissue between the forceps tips, minimizing electromagnetic interference with implanted cardiac devices.

Question 137: A patient receiving monitored anesthesia care (MAC) becomes unresponsive to verbal stimulation and requires airway intervention. This represents a transition to:

Minimal sedation
General anesthesia (Correct answer)
Moderate sedation
Deep sedation

Correct answer: General anesthesia

When a patient requires airway intervention under MAC, the level has progressed to general anesthesia regardless of the original intent.

Question 138: During a laparoscopic procedure, the circulator notices the patient's end-tidal CO2 is rising rapidly and the capnography waveform changes. The FIRST priority is:

Increase pneumoperitoneum pressure to improve visualization
Alert the surgeon and anesthesiologist immediately (Correct answer)
Administer IV sodium bicarbonate per standing orders
Document the finding and reassess in five minutes

Correct answer: Alert the surgeon and anesthesiologist immediately

Rapidly rising EtCO2 may indicate CO2 embolism or inadvertent subcutaneous emphysema; immediate notification of the surgical team is the priority action.

Question 139: A patient reports a previous anesthetic complication where they experienced a very high fever and muscle rigidity during surgery. The nurse should prioritize communicating this history because it suggests:

An adverse reaction to antibiotics
Chronic pain disorder
Malignant hyperthermia susceptibility (Correct answer)
An allergy to latex

Correct answer: Malignant hyperthermia susceptibility

Malignant hyperthermia is a life-threatening pharmacogenetic disorder triggered by certain anesthetic agents, requiring specific preparation and alternative agents.

Question 140: What is the correct sequence for donning sterile attire in the OR?

Gloves first, then gown
Gown first, then gloves (Correct answer)
Mask and cap first, then gown and gloves simultaneously
Either gown or gloves can be donned first — order does not matter

Correct answer: Gown first, then gloves

The gown is donned first, secured, then sterile gloves are applied to maintain the integrity of the sterile field; gloves over the gown cuffs complete the sterile barrier.

Question 141: A patient experiences laryngospasm during emergence from anesthesia. The FIRST nursing action is to:

Assist the anesthesia provider with jaw thrust and positive pressure ventilation (Correct answer)
Place the patient in high-Fowler's position
Administer 100% oxygen via non-rebreather mask
Prepare succinylcholine for immediate administration

Correct answer: Assist the anesthesia provider with jaw thrust and positive pressure ventilation

Laryngospasm is an airway emergency; the first response is supporting the anesthesia provider with jaw thrust and positive pressure ventilation to break the spasm.

Question 142: When the surgeon requests that the C-arm gadget be relocated to another part of the patient's body during an orthopedic treatment, the circulating nurse is already in the middle of it. Which of the following employees is allowed to move this equipment?

The radiology tech (Correct answer)
The orthopedic vendor.
any MD
Only the circulating RN.

Correct answer: The radiology tech

Only the radiology tech should be able to move the C-arm in this scenario. These gadgets should only be used by licensed, well trained individuals.

Question 143: Which type of suture material is MOST appropriate for closing a contaminated wound where absorption over several weeks is needed?

Polyester (Mersilene) – non-absorbable braided
Silk (non-absorbable, braided)
Stainless steel wire
Polydioxanone (PDS) – synthetic absorbable monofilament (Correct answer)

Correct answer: Polydioxanone (PDS) – synthetic absorbable monofilament

PDS is a synthetic monofilament absorbable suture that resists infection better than braided materials and maintains tensile strength for 4–6 weeks.

Question 144: When assessing a patient's social history preoperatively, which information is most relevant to postoperative planning and discharge safety?

Whether the patient owns a car
Whether the patient has a responsible adult to accompany them home (Correct answer)
The patient's education level
The patient's occupation and work schedule

Correct answer: Whether the patient has a responsible adult to accompany them home

Outpatient surgical patients must have a responsible adult to drive them home and monitor them, as anesthesia impairs judgment and reflexes.

Question 145: The circulating nurse notices the surgical smoke evacuator has stopped functioning. The PRIORITY concern is:

Increased operative field visibility
Exposure of personnel and patient to carcinogenic surgical plume (Correct answer)
Noise reduction in the OR
Procedure delay cost

Correct answer: Exposure of personnel and patient to carcinogenic surgical plume

Surgical smoke contains carcinogens, mutagens, and infectious particles; loss of smoke evacuation creates a direct health hazard for the patient and entire OR team.

Question 146: When should prophylactic antibiotics be administered to achieve the highest benefit in preventing SSIs?

Within 60 minutes before surgical incision (Correct answer)
Immediately postoperatively in the PACU
30 minutes after the patient enters the OR
At the time of incision

Correct answer: Within 60 minutes before surgical incision

Prophylactic antibiotics should be administered within 60 minutes before incision to ensure adequate tissue levels at the time of the cut.

Question 147: When positioning a patient in the lateral decubitus position, which structure is most at risk for a pressure injury if not properly protected?

Heel
Sacrum
Occiput
Fibular head and peroneal nerve (Correct answer)

Correct answer: Fibular head and peroneal nerve

The fibular head is a bony prominence in lateral positioning that can compress the common peroneal nerve, leading to foot drop if not padded.

Question 148: The term 'flash sterilization' (now called immediate-use steam sterilization, IUSS) should be used:

Only in urgent situations when there is no time to wrap and fully sterilize an item (Correct answer)
For all implants before every case
As the primary sterilization method for all instruments
Routinely to save time on instrument processing

Correct answer: Only in urgent situations when there is no time to wrap and fully sterilize an item

IUSS is intended only for urgent, unplanned situations and should not replace standard packaged sterilization cycles.

Question 149: Before passing a sharp instrument on the sterile field, the scrub person should:

Hand it directly handle-first to the surgeon rapidly
Place it on the back table until asked
Use a neutral/hands-free technique or announce 'sharp' before transfer (Correct answer)
Recap any needles to protect the surgical team

Correct answer: Use a neutral/hands-free technique or announce 'sharp' before transfer

The neutral/hands-free zone technique or verbal announcement prevents sharps injuries during instrument transfer.

Question 150: The perioperative nurse is reviewing the preoperative laboratory results for a 55-year-old female scheduled for a total abdominal hysterectomy. The nurse notes a serum potassium level of 2.8 mEq/L. What is the nurse's primary concern?

Impaired wound healing.
Risk of cardiac dysrhythmias under anesthesia. (Correct answer)
Potential for intraoperative hypoglycemia.
Increased risk of postoperative infection.

Correct answer: Risk of cardiac dysrhythmias under anesthesia.

The normal range for serum potassium is typically 3.5 to 5.0 mEq/L. A level of 2.8 mEq/L indicates hypokalemia, which can increase the risk of cardiac irritability and lead to life-threatening dysrhythmias, especially during anesthesia and surgery. This finding must be reported to the anesthesia and surgical teams immediately for correction before the procedure.

Question 151: Which action best prevents retained foreign bodies during procedures in deep cavities or with limited visualization?

Relying on the surgeon's tactile assessment to confirm removal
Performing counts before and after each phase of the procedure
Counting only at the beginning and end of the case
Using only radiopaque sponges and instruments (Correct answer)

Correct answer: Using only radiopaque sponges and instruments

Using exclusively radiopaque items ensures that if a count discrepancy occurs, imaging can locate any retained body with high reliability.

Question 152: Which of the following actions by a non-scrubbed (circulating) team member represents a break in sterile technique?

Facing the sterile field when passing by it.
Tossing a sterile item from 6 inches away onto the center of the back table.
Maintaining a minimum distance of 12 inches from the sterile field.
Reaching over the sterile back table to point to an instrument. (Correct answer)

Correct answer: Reaching over the sterile back table to point to an instrument.

A fundamental principle of asepsis is that non-scrubbed personnel should never reach over a sterile field. This action can shed microorganisms from their body and attire onto the sterile surface, causing contamination. Non-scrubbed personnel should always face the sterile field when passing, maintain a safe distance, and transfer items securely without crossing the sterile barrier.

Question 153: When a patient is positioned in the prone position, chest rolls or a Wilson frame are used primarily to:

Prevent brachial plexus injury
Allow free abdominal excursion and reduce vena caval compression (Correct answer)
Protect the eyes from direct pressure
Maintain the cervical spine in neutral alignment

Correct answer: Allow free abdominal excursion and reduce vena caval compression

Chest rolls or a Wilson frame relieve abdominal compression, allowing the diaphragm to move freely and reducing inferior vena caval compression that would otherwise increase surgical bleeding.

Question 154: What is the recommended room air exchange rate per hour in an operating room to reduce airborne contamination?

5 air changes per hour total
25 air changes per hour of recirculated air only
10 air changes per hour with HEPA filtration optional
A minimum of 15 air changes per hour, with at least 3 of outdoor air (Correct answer)

Correct answer: A minimum of 15 air changes per hour, with at least 3 of outdoor air

AORN and CDC guidelines recommend a minimum of 15 total air changes per hour with at least 3 fresh outdoor air changes in the OR.

Question 155: When using a monopolar electrosurgical unit (ESU), the dispersive electrode (patient return electrode) should be placed:

On a well-vascularized muscle mass between the ESU site and the grounding pad (Correct answer)
Over a metal orthopedic implant to improve conductivity
On a bony prominence closest to the operative site
As far from the operative site as possible to reduce current density

Correct answer: On a well-vascularized muscle mass between the ESU site and the grounding pad

Placement over a well-vascularized muscle mass near but not over implants ensures low current density and adequate heat dispersal to prevent burns.

Question 156: A laser in the operating room requires all team members present to:

Wear standard surgical masks only
Wear appropriate optical density eyewear specific to the laser wavelength in use (Correct answer)
Leave the room during activation
Use anti-static shoe covers

Correct answer: Wear appropriate optical density eyewear specific to the laser wavelength in use

Each laser wavelength requires eyewear with the correct optical density rating to protect team members from retinal or corneal injury.

Question 157: The purpose of maintaining a moist wound environment during healing is to:

Prevent the need for wound irrigation
Promote bacterial growth for faster healing
Facilitate cell migration, prevent tissue desiccation, and promote re-epithelialization (Correct answer)
Eliminate the need for wound closure

Correct answer: Facilitate cell migration, prevent tissue desiccation, and promote re-epithelialization

A moist wound environment supports cellular migration and proliferation, reducing healing time compared to wounds allowed to dry out.

Question 158: Which biological indicator organism is used to monitor the efficacy of steam sterilization?

Geobacillus stearothermophilus (Correct answer)
Clostridium sporogenes
Staphylococcus aureus
Bacillus atrophaeus (subtilis)

Correct answer: Geobacillus stearothermophilus

Geobacillus stearothermophilus spores are the standard biological indicator for steam sterilization because of their high heat resistance.

Question 159: A patient scheduled for outpatient surgery under general anesthesia has a BMI of 42. Which preoperative assessment is most critical?

Serum lipid levels
Liver function tests
Airway assessment and respiratory function (Correct answer)
Nutritional status and serum albumin

Correct answer: Airway assessment and respiratory function

Morbid obesity significantly increases the risk of difficult intubation and respiratory complications requiring thorough airway and pulmonary assessment.

Question 160: Which document serves as the legal operative record and must be signed by the operating surgeon?

Operative report / dictated operative note (Correct answer)
Perioperative nursing care plan
Pre-admission testing results
Anesthesia induction record

Correct answer: Operative report / dictated operative note

The operative report, dictated or written by the surgeon, is the legal document describing the procedure performed and must be completed promptly.

Question 161: A surgical tray wrapped for terminal sterilization has been processed in a steam autoclave. The external chemical indicator on the wrapper has changed color, but the internal chemical indicator has not. What is the MOST appropriate action?

Send the tray for immediate-use steam sterilization (IUSS) to ensure sterility.
Open the tray but separate the instruments in the middle from those on the outside.
Use the instruments, as the external indicator confirms exposure to the sterilant.
Consider the entire tray unsterile and remove it from service for reprocessing. (Correct answer)

Correct answer: Consider the entire tray unsterile and remove it from service for reprocessing.

The external indicator only shows that the pack has been exposed to the sterilization process. The internal indicator demonstrates that the sterilant (e.g., steam) has penetrated the package and reached the instruments inside. A failed internal indicator means the sterilization parameters were not met within the tray, rendering the contents unsterile and unsafe for use. The entire tray must be reprocessed.

Question 162: During preoperative assessment, the nurse notes the patient has a latex allergy. Which action is most appropriate?

Alert the entire surgical team and prepare a latex-free environment (Correct answer)
Reschedule the surgery for a later date
Document the allergy and proceed normally
Apply a latex allergy wristband only

Correct answer: Alert the entire surgical team and prepare a latex-free environment

A latex allergy requires preparation of a latex-free OR environment and notification of all team members to prevent anaphylaxis.

Question 163: A patient under general anesthesia for a major abdominal surgery begins to exhibit muscle rigidity, a rapid rise in end-tidal CO2, and sinus tachycardia. The surgical team suspects malignant hyperthermia (MH). Which of the following is the first and most critical intervention?

Begin active cooling with ice packs and chilled saline.
Discontinue all volatile anesthetic agents and succinylcholine. (Correct answer)
Draw an arterial blood gas to assess for metabolic acidosis.
Administer intravenous dantrolene sodium.

Correct answer: Discontinue all volatile anesthetic agents and succinylcholine.

The absolute first step in managing a malignant hyperthermia crisis is to immediately stop all triggering agents, which include all volatile inhalation anesthetics (e.g., sevoflurane, desflurane) and the depolarizing muscle relaxant succinylcholine. This action removes the cause of the hypermetabolic state. While administering dantrolene, cooling the patient, and assessing blood gases are all crucial subsequent steps, they are performed only after the triggering agents have been discontinued.

Question 164: A perioperative nurse is asked to co-sign a documentation entry made by a nursing student. What does co-signing legally imply?

The nurse is acknowledging the entry exists but has no responsibility for it
The nurse is taking financial responsibility for the student's actions
The nurse is confirming the student's identity only
The nurse reviewed the entry and was present or supervised the care described (Correct answer)

Correct answer: The nurse reviewed the entry and was present or supervised the care described

Co-signing a student's entry signifies that the supervising nurse reviewed the documentation and either performed or directly supervised the care described.

Question 165: What is the recommended approach when the perioperative nurse disagrees with a surgeon's order that may harm the patient?

Refuse the order without explanation
Ask another nurse to carry out the order
Follow the order to avoid conflict
Use assertive communication, escalate through the chain of command, and document the interaction (Correct answer)

Correct answer: Use assertive communication, escalate through the chain of command, and document the interaction

Perioperative nurses are obligated to advocate for patient safety using assertive communication, escalation protocols, and thorough documentation when orders appear harmful.

Question 166: Which preoperative skin antiseptic agent is CONTRAINDICATED near the eyes and ears?

Chlorhexidine gluconate (CHG) (Correct answer)
Iodophor-based paint solutions
Isopropyl alcohol 70%
Povidone-iodine solution

Correct answer: Chlorhexidine gluconate (CHG)

Chlorhexidine gluconate is ototoxic and can cause corneal damage, making it contraindicated for skin preparation near the eyes and ears.

Question 167: Which instrument count discrepancy action is required if counts do not reconcile before wound closure?

Wait until the patient is in PACU to investigate
Notify the surgeon immediately and search the field, drapes, floor, and trash before closing (Correct answer)
Proceed with closure and document the discrepancy
Recount once and proceed if the second count also differs

Correct answer: Notify the surgeon immediately and search the field, drapes, floor, and trash before closing

An unresolved count discrepancy requires immediate notification of the surgeon and a thorough search of all potential locations before wound closure.

Question 168: During a laparotomy, the surgeon inadvertently enters the aorta. Which nursing action is HIGHEST priority?

Call for break relief for the scrub person
Obtain additional suture and prepare for vascular repair (Correct answer)
Document the event in the incident report
Prepare the specimen for pathology

Correct answer: Obtain additional suture and prepare for vascular repair

Life-threatening hemorrhage requires immediate preparation of vascular repair supplies to support the surgeon in controlling bleeding.

Question 169: What does the term 'surgical conscience' mean in perioperative nursing?

Following hospital policy even when inconvenient
Documenting all intraoperative events accurately
Advocating for the patient's surgical preferences
Personal commitment to maintain sterile technique and report breaks immediately (Correct answer)

Correct answer: Personal commitment to maintain sterile technique and report breaks immediately

Surgical conscience is the internalized ethic of maintaining sterile technique and self-reporting any contamination without waiting to be observed.

Question 170: A patient who received spinal anesthesia 24 hours prior calls the hospital complaining of a severe headache that is significantly worse when sitting up and relieved by lying flat. The perioperative nurse should recognize these symptoms as characteristic of which complication?

Meningitis
Anesthetic neurotoxicity
Post-dural puncture headache (PDPH) (Correct answer)
Subdural hematoma

Correct answer: Post-dural puncture headache (PDPH)

The hallmark symptom of a post-dural puncture headache (PDPH) is its positional nature; it intensifies in an upright position and is alleviated by lying supine. This is caused by the leakage of cerebrospinal fluid from the puncture site in the dura mater, which reduces the fluid cushion around the brain.

Question 171: The perioperative nurse should recognize that nitrous oxide is CONTRAINDICATED in patients with:

Pneumothorax or bowel obstruction (Correct answer)
Type 1 diabetes
Controlled hypertension
Mild asthma

Correct answer: Pneumothorax or bowel obstruction

Nitrous oxide diffuses into closed gas-filled spaces faster than nitrogen exits, expanding volume and increasing pressure in pneumothorax or bowel obstruction.

Question 172: Which sterilization method is preferred for heat-sensitive surgical instruments such as endoscopes?

Dry heat sterilization
Ethylene oxide (EtO) or hydrogen peroxide plasma sterilization (Correct answer)
Gravity displacement steam sterilization
Flash (IUSS) steam sterilization

Correct answer: Ethylene oxide (EtO) or hydrogen peroxide plasma sterilization

Low-temperature sterilization methods such as ethylene oxide and hydrogen peroxide gas plasma are used for heat- and moisture-sensitive items like flexible endoscopes.

Question 173: After completing a surgical hand scrub, the scrub person is gowning. Which part of the sterile gown is considered sterile once it is donned?

The front of the gown from the chest to the level of the sterile field, and the sleeves from 2 inches above the elbow to the cuff. (Correct answer)
The cuffs of the gown, once covered by sterile gloves.
The entire front of the gown from the neckline to the bottom hem.
The back of the gown from the waist to the neckline.

Correct answer: The front of the gown from the chest to the level of the sterile field, and the sleeves from 2 inches above the elbow to the cuff.

AORN guidelines specify that the sterile area of a surgical gown includes the front from the chest line down to the level of the sterile field (or waist level). The sleeves are also considered sterile from 2 inches above the elbow down to the cuff, circumferentially. The neckline, shoulders, underarms, back, and sleeve cuffs are not considered sterile.

Question 174: When dantrolene is administered for malignant hyperthermia, what is the initial recommended dose?

2.5 mg/kg IV (Correct answer)
10 mg/kg IV
5 mg/kg IV
0.5 mg/kg IV

Correct answer: 2.5 mg/kg IV

The initial dose of dantrolene for malignant hyperthermia is 2.5 mg/kg IV, repeated every 5 minutes as needed up to 10 mg/kg.

Question 175: A patient has a documented latex allergy. Which glove alternative is preferred for the surgical team?

Nitrile gloves
Polyisoprene gloves (Correct answer)
Vinyl gloves
Neoprene gloves

Correct answer: Polyisoprene gloves

Polyisoprene gloves provide the best tactile sensitivity and barrier protection as a latex-free alternative for sterile surgical procedures.

Question 176: Which principle guides the placement of instruments on the sterile back table?

Items should be grouped by surgeon preference only
Instruments should be placed in alphabetical order
Items are arranged in order of use with frequently used items closest to the scrub person (Correct answer)
All instruments must be placed in a single row to save space

Correct answer: Items are arranged in order of use with frequently used items closest to the scrub person

Organizing instruments by order of use and placing frequently needed items closest to the scrub person promotes efficiency and reduces breaks in sterile technique.

Question 177: A patient scheduled for elective surgery reports taking warfarin daily. What is the perioperative nurse's priority action?

Cancel the surgery without consulting the surgeon
Administer vitamin K immediately
Notify the surgeon and anesthesia provider of the anticoagulant use (Correct answer)
Proceed with surgery as scheduled

Correct answer: Notify the surgeon and anesthesia provider of the anticoagulant use

Anticoagulant use must be reported to the surgical team to allow appropriate management and reduce bleeding risk.

Question 178: During a malignant hyperthermia (MH) crisis, which medication is the FIRST-LINE treatment?

Succinylcholine
Dantrolene sodium (Correct answer)
Propofol
Epinephrine

Correct answer: Dantrolene sodium

Dantrolene sodium is the specific antidote for malignant hyperthermia and must be administered immediately upon recognition of MH crisis.

Question 179: Which of the following best defines an additional aspect of proper drapery that the scrub and circulating Registered Nurse should be aware of?

They should ensure that the prep solutions have dried before applying surgical drapes. (Correct answer)
The surgeon should perform the procedure quickly to minimize potential infections.
The scrubbed team members should hold the drapes below waist level.
The scrubbed team members never cuff the drapes over gloved hands.

Correct answer: They should ensure that the prep solutions have dried before applying surgical drapes.

It is important to make sure that the prep solutions have dried before using surgical drapes to guarantee proper draping. Pooled preparation fluids may harm your skin. These substances can catch fire while they're still in liquid form, especially ones that contain alcohol.

Question 180: A patient scheduled for a right total knee arthroplasty tells the perioperative nurse in the holding area, "I'm really not sure about this. My daughter thinks I should wait, and I'm having second thoughts." The consent form is signed and the surgical site is marked. What is the nurse's primary ethical responsibility?

Notify the surgeon immediately that the patient is expressing doubt and may be revoking consent. (Correct answer)
Ask the patient's daughter to convince the patient to proceed with the surgery.
Reassure the patient that they made the right decision and that the surgeon is excellent.
Proceed with preoperative preparations as the consent form has already been signed.

Correct answer: Notify the surgeon immediately that the patient is expressing doubt and may be revoking consent.

The nurse's primary role as a patient advocate is to ensure that consent is not just signed, but truly informed and voluntary. When a patient expresses doubt or revokes consent, the surgeon must be notified immediately to have another discussion with the patient. Proceeding without addressing the patient's concerns would violate their right to self-determination.

Question 181: Which wound classification describes a surgical incision made under ideal conditions with no inflammation encountered?

Class II – Clean-Contaminated
Class I – Clean (Correct answer)
Class III – Contaminated
Class IV – Dirty/Infected

Correct answer: Class I – Clean

Class I (Clean) wounds are uninfected operative wounds with no break in sterile technique and no entry into the respiratory, alimentary, or genitourinary tracts.

Question 182: When assessing a patient's airway preoperatively, the nurse notes a Mallampati class IV. This finding suggests:

General anesthesia is contraindicated
Easy intubation is anticipated
Potentially difficult intubation requiring advance planning (Correct answer)
Regional anesthesia will not be effective

Correct answer: Potentially difficult intubation requiring advance planning

Mallampati class IV indicates minimal pharyngeal structures are visible, suggesting a potentially difficult airway for intubation.

Question 183: Which wound classification is assigned to a colorectal resection performed for cancer without gross spillage of bowel contents?

Class III – Contaminated
Class IV – Dirty/Infected
Class I – Clean
Class II – Clean-Contaminated (Correct answer)

Correct answer: Class II – Clean-Contaminated

Elective colorectal surgery with controlled entry into the GI tract but no gross spillage is classified as Clean-Contaminated (Class II).

Question 184: The nurse is reviewing a preoperative checklist and notes the surgical site has not been marked. What is the correct action?

Notify the surgeon to mark the site before the patient enters the OR (Correct answer)
Ask the anesthesia provider to mark the site
Proceed since the OR team will identify the site during the time-out
Mark the site using the operative report as a guide

Correct answer: Notify the surgeon to mark the site before the patient enters the OR

Per AORN guidelines and Universal Protocol, the surgeon (or licensed independent practitioner performing the procedure) is responsible for marking the surgical site.

Question 185: Which of the following BEST describes the responsibility of the registered nurse first assistant (RNFA) in the OR?

Replacing the scrub technician when a second scrub is not available
Performing independently without surgeon supervision in any state
Assisting the surgeon intraoperatively by handling tissue, providing hemostasis, and suturing under surgeon direction (Correct answer)
Administering anesthesia when the CRNA is on break

Correct answer: Assisting the surgeon intraoperatively by handling tissue, providing hemostasis, and suturing under surgeon direction

The RNFA works under surgeon direction to assist with tissue handling, hemostasis, exposure, and closure as an adjunct to — not a replacement of — the surgical team.

Question 186: Which ethical principle is MOST directly applied when a perioperative nurse ensures a patient fully understands the risks of a surgical procedure before signing consent?

Justice
Beneficence
Nonmaleficence
Autonomy (Correct answer)

Correct answer: Autonomy

Autonomy requires that patients receive adequate information to make voluntary, informed decisions about their own care.

Question 187: Which action best prevents retained surgical items (RSIs)?

Relying on surgeon memory of item usage
Performing counts before, during, and after all procedures per AORN policy (Correct answer)
Limiting the number of team members who handle items
Using only reusable instruments

Correct answer: Performing counts before, during, and after all procedures per AORN policy

Standardized counting protocols at key intervals are the primary evidence-based strategy for preventing retained surgical items.

Question 188: Which of the following statements about surgical attire is most consistent with current AORN guidelines for infection prevention?

Surgical masks may be untied and worn around the neck between cases.
Shoe covers are mandatory for all personnel entering the semi-restricted areas.
Surgical attire contaminated with blood or body fluids should be changed promptly before leaving the work area. (Correct answer)
Lanyards made of porous material are acceptable if they remain under a cover gown.

Correct answer: Surgical attire contaminated with blood or body fluids should be changed promptly before leaving the work area.

AORN guidelines emphasize that surgical attire visibly contaminated with blood, body fluids, or other potentially infectious materials should be changed as soon as possible. Wearing masks around the neck and the routine use of lanyards are discouraged as they can become contaminated and serve as a vehicle for transmission. Shoe cover requirements are determined by the facility's risk assessment.

Question 189: Which of the following patient statements during a preoperative assessment would indicate the highest risk for a potential latex allergy?

"I have a family history of seasonal allergies."
"I get a rash from the adhesive on bandages."
"I am allergic to penicillin."
"My lips swell whenever I eat bananas or avocados." (Correct answer)

Correct answer: "My lips swell whenever I eat bananas or avocados."

There is a known cross-reactivity between latex and certain foods, including bananas, avocados, kiwis, and chestnuts. A patient reporting an allergic reaction to these foods is at a significantly higher risk for a latex allergy. While an allergy to tape adhesive can indicate sensitivity, the food cross-reactivity is a stronger predictor. Seasonal allergies and penicillin allergies are not directly related to latex allergies.

Question 190: The bispectral index (BIS) monitor is used intraoperatively to:

Assess depth of anesthesia and reduce awareness risk (Correct answer)
Measure neuromuscular blockade recovery
Monitor cardiac output continuously
Detect malignant hyperthermia early

Correct answer: Assess depth of anesthesia and reduce awareness risk

BIS monitoring analyzes EEG data to provide a numerical score reflecting depth of anesthesia, helping to prevent awareness under anesthesia.

Question 191: Preoperative chlorhexidine gluconate (CHG) bathing of a surgical patient is most beneficial for which purpose?

Replacing the need for surgical site hair removal
Substituting for intraoperative antiseptic prep
Reducing skin bacterial burden to lower SSI risk (Correct answer)
Eliminating all skin flora permanently before surgery

Correct answer: Reducing skin bacterial burden to lower SSI risk

Preoperative CHG bathing reduces colonization on the patient's skin, which is associated with decreased SSI rates.

Question 192: A patient states they last ate solid food 4 hours ago. The surgery is scheduled to begin in 30 minutes. What should the perioperative nurse do?

Give the patient a small sip of water to take medications
Document and continue preoperative preparations
Proceed since 4 hours is sufficient fasting time
Notify the anesthesia provider immediately (Correct answer)

Correct answer: Notify the anesthesia provider immediately

NPO guidelines typically require 6-8 hours for solids; the anesthesia provider must be notified to determine if surgery should be delayed.

Question 193: An obese patient is placed in the lithotomy position. Which complication is specifically increased in this population?

Pressure injury to the occiput
Radial nerve palsy
Brachial plexus stretch injury
Compartment syndrome of the lower extremities (Correct answer)

Correct answer: Compartment syndrome of the lower extremities

Obese patients in lithotomy are at increased risk for lower extremity compartment syndrome due to elevated pressures from leg weight and restricted perfusion.

Question 194: What percentage of the perioperatively focused model is broken into components?

Three
Eight
Four (Correct answer)
Six

Correct answer: Four

Explanation: The perioperative patient-focused model is divided into four quadrants. One relates to the healthcare facility where the care is being administered, and three are patient-focused.

Question 195: When applying a tourniquet to the upper extremity, what is the maximum recommended inflation time before deflation and reperfusion?

30 minutes
60 minutes
90 minutes (Correct answer)
120 minutes

Correct answer: 90 minutes

Most guidelines recommend deflating pneumatic tourniquets after no more than 90 minutes on the upper extremity to prevent ischemic nerve and muscle injury.

Question 196: What does the term 'scope of practice' define for the perioperative RN?

The range of activities, skills, and responsibilities a nurse is legally and professionally authorized to perform (Correct answer)
The geographic region where a nurse's license is valid
The specific surgical specialties a nurse may assist with
The number of patients a nurse can safely care for in one shift

Correct answer: The range of activities, skills, and responsibilities a nurse is legally and professionally authorized to perform

Scope of practice is defined by state nursing practice acts and outlines the legal boundaries of a nurse's professional role.

Question 197: Which documentation practice best supports accurate accounting of implantable devices used during surgery?

Verbally reporting the device to the PACU nurse
Recording the device brand in the nurse's notes
Photographing the device before implantation
Affixing the manufacturer's label/sticker to the operative record (Correct answer)

Correct answer: Affixing the manufacturer's label/sticker to the operative record

Affixing the manufacturer's label with lot number and device identification to the operative record provides a permanent, traceable implant record.

Question 198: Which abbreviation has been identified by The Joint Commission as 'Do Not Use' in medical documentation?

NPO
U (for units) (Correct answer)
PRN
BID

Correct answer: U (for units)

'U' for units is on The Joint Commission's Do Not Use list because it can be mistaken for the number zero or four.

Question 199: A patient is scheduled for a cardiac procedure. The scrub person notes a small, healing laceration on their own forearm. What is the most appropriate action?

Report to the charge nurse and be assessed for fitness to scrub (Correct answer)
Wear two pairs of gloves and continue as planned
Apply a bandage and proceed without notification
Cover the laceration with a sterile glove and continue

Correct answer: Report to the charge nurse and be assessed for fitness to scrub

Any open wound or skin break on a scrub team member must be assessed by a supervisor to determine if the employee poses an infection risk.

Question 200: Which action is required before any item is considered sterile and safe to use in a sterile field?

A 10-minute aeration period after removal from the sterilizer
Visual inspection of the packaging only
Verification of chemical indicator color change, intact packaging, and expiration date (Correct answer)
Confirmation by the surgeon that the item appears clean

Correct answer: Verification of chemical indicator color change, intact packaging, and expiration date

All three elements — chemical indicator, packaging integrity, and expiration date — must be verified before using any sterile item.

Question 201: When a patient develops suspected MH intraoperatively, what is the PRIORITY nursing action?

Apply cooling blankets and ice packs to reduce temperature
Immediately administer dantrolene sodium
Administer 100% oxygen and notify the attending anesthesiologist (Correct answer)
Obtain arterial blood gas and serum CK levels

Correct answer: Administer 100% oxygen and notify the attending anesthesiologist

The priority action is to notify anesthesia and provide 100% oxygen; dantrolene is then administered immediately, but it requires a physician order.

CNOR Certification Exam

The CNOR (Certified Perioperative Nurse) exam, administered by the Competency & Credentialing Institute (CCI), validates the specialized knowledge and skills of perioperative nurses working in surgical and procedural settings.

200

Questions

225 min

Time Limit

78%

To Pass

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