CNOR - Certification Surgical Asepsis and Sterility Questions and Answers — Questions and Answers
Question 1: 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?
- Place the bottle cap on the sterile field with the inside facing up.
- Hold the bottle so that the label is facing away from the sterile basin.
- Pour the entire contents of the solution into the basin at once to prevent contamination of the bottle's edge. (Correct answer)
- Maintain a distance of at least 12 inches above the basin while pouring.
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 2: 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 back of the gown from the waist to the neckline.
- 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 entire front of the gown from the neckline to the bottom hem.
- The cuffs of the gown, once covered by sterile gloves.
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 3: 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 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.
- The individual removes the outer contaminated glove and dons a new sterile glove over the inner glove. (Correct answer)
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 4: 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.
- Maintaining a minimum distance of 12 inches from the sterile field.
- Reaching over the sterile back table to point to an instrument. (Correct answer)
- Tossing a sterile item from 6 inches away onto the center of the back table.
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 5: Biological indicators (BIs) are essential for sterility assurance. For monitoring steam sterilization cycles, the BI contains spores from which highly heat-resistant microorganism?
- Bacillus atrophaeus
- Clostridium difficile
- Geobacillus stearothermophilus (Correct answer)
- Staphylococcus aureus
Correct answer: Geobacillus stearothermophilus
Geobacillus stearothermophilus is a thermophilic bacterium that produces highly heat-resistant spores, making it the industry standard biological indicator for validating the efficacy of steam sterilization processes. Bacillus atrophaeus is used for ethylene oxide (EtO) and dry heat sterilization.
Question 6: 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?
- Use the instruments, as the external indicator confirms exposure to the sterilant.
- 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.
- 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.
CNOR - Certification Surgical Asepsis and Sterility Questions and Answers
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?