CNOR - Certification Intraoperative Care and Safety Questions and Answers — Questions and Answers
Question 1: 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?
- Document the count as incorrect and send the patient to recovery.
- Inform the surgical team and obtain an intraoperative radiograph. (Correct answer)
- Close the surgical incision and obtain a postoperative radiograph.
- Disassemble and search all sterile instrument trays again.
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 2: 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 3: A patient is placed in the lithotomy position for a gynecological procedure. To minimize the risk of nerve injury, the perioperative nurse should ensure which of the following precautions is taken?
- The legs are raised and lowered slowly and simultaneously. (Correct answer)
- The patient's hands are tucked tightly at their sides.
- The legs are abducted as far as possible for maximum exposure.
- The stirrups are padded only at the point of contact with the foot.
Correct answer: The legs are raised and lowered slowly and simultaneously.
Raising and lowering the legs simultaneously prevents sacroiliac joint dislocation and undue stress on the lumbar spine. Slow and careful movement minimizes the risk of sudden stretching of the femoral, obturator, and peroneal nerves. Extreme abduction can cause nerve stretch injuries, and padding should be sufficient along the entire leg and foot resting in the stirrup.
Question 4: Proper handling of a surgical specimen is critical for accurate diagnosis. Which of the following actions by the circulating nurse is essential for all specimens?
- Placing the specimen in formalin solution immediately upon receipt.
- Confirming the specimen name and source aloud with the surgeon. (Correct answer)
- Sending the specimen to pathology with a verbal report only.
- Handling the specimen with bare hands to maintain tactile sense.
Correct answer: Confirming the specimen name and source aloud with the surgeon.
Verbal confirmation between the surgeon and the circulating nurse is a crucial step to ensure the specimen is correctly identified, labeled, and laterality is confirmed (if applicable). This closed-loop communication minimizes the risk of a diagnostic error due to misidentification. Not all specimens go in formalin (e.g., frozen sections, cultures), and all specimens require careful handling with appropriate personal protective equipment.
Question 5: During the universal protocol's 'Time Out' immediately before skin incision, the entire surgical team is expected to pause and actively verify key information. What is the primary responsibility of the circulating nurse during this process?
- To monitor the patient's vital signs and document them.
- To ensure the surgeon has the correct preference card.
- To initiate and lead the Time Out, ensuring all members actively participate. (Correct answer)
- To prepare the surgical dressings for the end of the case.
Correct answer: To initiate and lead the Time Out, ensuring all members actively participate.
While all team members are active participants, AORN guidelines and The Joint Commission's Universal Protocol often designate the circulating nurse to initiate and lead the Time Out. This ensures that the checklist is followed, and all members—including the surgeon, anesthesia professional, and scrub person—actively confirm correct patient, correct procedure, and correct site, along with other critical items.
Question 6: A patient who received a large volume of local anesthetic for a regional block suddenly becomes agitated and reports a metallic taste and circumoral numbness. The perioperative nurse should be prepared for which potential medical emergency?
- Anaphylactic shock.
- Malignant hyperthermia.
- Local Anesthetic Systemic Toxicity (LAST). (Correct answer)
- Hemorrhagic stroke.
Correct answer: Local Anesthetic Systemic Toxicity (LAST).
The classic early signs of Local Anesthetic Systemic Toxicity (LAST) include central nervous system excitement, such as agitation, and neurological symptoms like metallic taste, tinnitus, and circumoral numbness. These can progress to seizures, respiratory arrest, and cardiovascular collapse. Recognizing these early signs is critical for prompt intervention, including the administration of lipid emulsion therapy.
CNOR - Certification Intraoperative Care and Safety Questions and Answers
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?