CNOR Certification Exam — Questions and Answers

Question 1: 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
Increase oral fluid intake the morning of surgery
Notify the radiologist and surgeon of the renal insufficiency before contrast administration (Correct answer)
Administer the contrast without concern since it is IV

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 2: Which action best prevents surgical site infections related to instrument handling during a procedure?

Confining instruments to the sterile field until needed (Correct answer)
Rinsing instruments with sterile water between uses
Wiping instruments with alcohol between passes
Soaking instruments in povidone-iodine during the procedure

Correct answer: Confining instruments to the sterile field until needed

Keeping instruments on the sterile field and passing them back promptly maintains aseptic technique and reduces contamination risk.

Question 3: During a surgical emergency, the surgeon gives the circulating nurse a verbal order for a critical medication. To ensure patient safety and proper documentation, what is the nurse's MOST important immediate action after receiving the order?

Administer the medication as quickly as possible.
Ask the scrub person to confirm they also heard the order.
Wait for the surgeon to enter the order into the electronic health record before acting.
Write down the order and then read it back to the surgeon for verification. (Correct answer)

Correct answer: Write down the order and then read it back to the surgeon for verification.

The single most critical step to prevent errors from verbal orders is the 'read-back' process. The nurse should first write down the order (to avoid memory errors) and then verbally read the complete order back to the prescriber. [8, 17, 30] This allows the prescriber to confirm that the order was heard and transcribed correctly before the medication is administered. Waiting for electronic entry is not practical in an emergency, and while a witness is helpful, the direct read-back to the prescriber is the primary safety check.

Question 4: After a surgical procedure, the instrument and sponge counts are correct. However, the circulating nurse is aware that a piece of monitoring equipment malfunctioned mid-procedure, requiring it to be replaced. Which action demonstrates the highest level of professional accountability?

Omitting the event from the record because the surgical counts were correct.
Ensuring the equipment is sent for repair but not charting the intraoperative event.
Documenting the equipment malfunction and its resolution in the perioperative record. (Correct answer)
Verbally informing the charge nurse is sufficient since the patient was not harmed.

Correct answer: Documenting the equipment malfunction and its resolution in the perioperative record.

Professional accountability requires accurate, complete, and honest documentation of all events that occur during a patient's intraoperative care. The patient's record is a legal document, and it must reflect all aspects of the procedure, including equipment issues. This documentation is crucial for quality improvement, risk management, and maintaining a transparent legal record of care.

Question 5: Which of the following techniques is most appropriate for the surgeon to use when marking a surgical site?

Placing an X on the surgical site.
Writing NO on the nonsurgical site.
Writing YES on the surgical site.
Placing his initials on the surgical site. (Correct answer)

Correct answer: Placing his initials on the surgical site.

It is advised that the surgeon write his initials on the surgical site to prevent confusion. Other approaches may be perplexing and result in surgery at the incorrect spot.

Question 6: Which question is most important when assessing fall risk during the preoperative period?

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

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 7: Which patient position is CONTRAINDICATED in a patient with suspected air embolism detected intraoperatively?

Left lateral decubitus (Durant's maneuver)
Trendelenburg
Right lateral decubitus
Head of bed elevated 30 degrees (Correct answer)

Correct answer: Head of bed elevated 30 degrees

Elevating the head of the bed increases risk of air moving into the cerebral circulation; the correct position is left lateral decubitus with head down to trap air in the right ventricle.

Question 8: When placing a patient in the lateral decubitus position, which structure is at greatest risk for pressure injury if padding is not applied correctly?

Common peroneal nerve at the fibular head (Correct answer)
Brachial plexus at the axilla
Medial malleolus
Femoral artery

Correct answer: Common peroneal nerve at the fibular head

The common peroneal nerve wraps around the fibular head and is vulnerable to compression injury in the lateral position if the lower leg is not properly padded.

Question 9: The purpose of applying cricoid pressure (Sellick's maneuver) during rapid sequence induction (RSI) is to:

Prevent laryngospasm
Increase oxygen delivery to the alveoli
Occlude the esophagus to prevent passive regurgitation (Correct answer)
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 10: During a spinal fusion procedure, a pedicle screw is implanted. Which set of information is MOST critical for the circulating nurse to document on the intraoperative record for this implant?

The cost of the implant and the corresponding billing code.
The name of the sales representative and the time they entered the OR.
The manufacturer, lot number, serial number, and size/type of the screw. (Correct answer)
The surgeon's verbal confirmation of placement and the torque setting used.

Correct answer: The manufacturer, lot number, serial number, and size/type of the screw.

For traceability and patient safety, especially in the event of a recall, it is imperative to document the specific details of any permanent implant. This includes the manufacturer, lot number, serial number (if applicable), size/type, and expiration date. [13] This information allows the specific device to be tracked back to its origin. While other details may be noted, the implant's specific identifiers are the most critical for the permanent record.

Question 11: Intraoperative temperature monitoring is critical because hypothermia (core temp below 36°C) can cause all of the following EXCEPT:

Increased surgical site infection risk
Impaired coagulation and increased bleeding
Reduced anesthetic agent requirements (Correct answer)
Prolonged neuromuscular blockade duration

Correct answer: Reduced anesthetic agent requirements

Hypothermia actually increases anesthetic requirements slightly because shivering and thermoregulatory responses remain active; the other options are all known adverse effects of intraoperative hypothermia.

Question 12: Which of the following best defines an additional aspect of proper drapery that the scrub and circulating Registered Nurse should be aware of?

The scrubbed team members should hold the drapes below waist level.
The scrubbed team members never cuff the drapes over gloved hands.
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.

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

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

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 14: Which of the following medications is used to treat opioid-induced respiratory depression in the PACU?

Neostigmine
Flumazenil
Sugammadex
Naloxone (Correct answer)

Correct answer: Naloxone

Naloxone is a pure opioid antagonist that reverses respiratory depression, sedation, and analgesia caused by opioids.

Question 15: When a perioperative nurse disagrees with a physician's order on ethical grounds, the MOST appropriate course of action is to:

Consult only with nursing peers before taking any action
Carry out the order to avoid conflict and report concerns later
Refuse the order and leave the patient's bedside without further communication
Use the chain of command and, if needed, invoke the conscience clause (Correct answer)

Correct answer: Use the chain of command and, if needed, invoke the conscience clause

Nurses have a professional and ethical obligation to use the chain of command and may invoke conscientious objection when an order conflicts with their moral integrity.

Question 16: During a procedure under local anesthesia, a patient reports sudden chest tightness and difficulty breathing. The nurse's FIRST action should be:

Transfer the patient to the ICU
Administer supplemental oxygen and notify the surgeon (Correct answer)
Administer an anxiolytic
Perform a 12-lead ECG immediately

Correct answer: Administer supplemental oxygen and notify the surgeon

Airway and oxygenation are always the first priority; providing O2 and alerting the surgeon allows rapid assessment and preparation for escalation if needed.

Question 17: Which preoperative laboratory value would most concern the perioperative nurse in a patient scheduled for a major abdominal procedure?

Serum sodium of 138 mEq/L
White blood cell count of 8,000/mm³
Hemoglobin of 13 g/dL
Platelet count of 45,000/mm³ (Correct answer)

Correct answer: Platelet count of 45,000/mm³

A platelet count of 45,000/mm³ is critically low and significantly increases the risk of intraoperative hemorrhage.

Question 18: Which of the following is the MOST reliable sign of adequate reversal of neuromuscular blockade before extubation?

Spontaneous respiratory rate > 8 breaths/min
Absence of fasciculations
Train-of-four ratio ≥ 0.9 (Correct answer)
SpO2 > 95% on room air

Correct answer: Train-of-four ratio ≥ 0.9

A train-of-four (TOF) ratio of 0.9 or greater indicates adequate recovery of neuromuscular function and is the gold standard before extubation.

Question 19: Which of the following actions by a non-scrubbed (circulating) team member represents a break in sterile technique?

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

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 20: 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:

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

Correct answer: Pseudocholinesterase deficiency

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

Question 21: What gives the patient the right to decide not to receive treatment for a medical emergency that was brought on by routine anesthesia during surgery?

Patient Bill of Rights
Self Determination Act (Correct answer)
Advance Directives
HIPAA

Correct answer: Self Determination Act

Explanation: Compliance with the Patient Self-Determination Act (PSDA), a federal statute, is required. The aim of this law is to ensure that patients' rights to informed consent and protection in healthcare decisions are upheld.

Question 22: A surgical technologist has a needlestick injury during a case. What is the first action to take?

Squeeze the wound to remove blood and then apply a sterile dressing
Finish the case and report to employee health afterward
Immediately remove glove, wash the wound with soap and water, and report to supervisor (Correct answer)
Apply an alcohol swab to the puncture site and continue

Correct answer: Immediately remove glove, wash the wound with soap and water, and report to supervisor

Immediate wound washing with soap and water followed by prompt reporting initiates the exposure response protocol.

Question 23: An incorrect needle count is discovered after wound closure in a laparoscopic case. What is the most appropriate next step?

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

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 24: What is the recommended OR temperature range to reduce surgical site infections and prevent patient hypothermia?

85–90°F (29–32°C)
78–82°F (25–28°C)
68–75°F (20–24°C) (Correct answer)
60–65°F (15–18°C)

Correct answer: 68–75°F (20–24°C)

AORN guidelines recommend OR temperatures of 68–75°F (20–24°C) to balance infection control and normothermia maintenance for most adult procedures.

Question 25: A scrub person's sterile gown is torn above the elbow during a case. What is the correct action?

Inform the surgeon and continue if the tear is small
Apply a sterile glove over the sleeve to maintain sterility
Immediately leave the sterile field, change the gown, and re-glove before returning (Correct answer)
Cover the tear with sterile drape material and continue

Correct answer: Immediately leave the sterile field, change the gown, and re-glove before returning

A torn or wet gown is no longer considered sterile and requires immediate replacement before the team member can continue in the sterile field.

Question 26: Which preoperative finding in a diabetic patient scheduled for morning surgery requires the most immediate follow-up?

Blood glucose of 110 mg/dL
Blood glucose of 145 mg/dL
HbA1c of 7.2%
Blood glucose of 320 mg/dL (Correct answer)

Correct answer: Blood glucose of 320 mg/dL

A blood glucose of 320 mg/dL indicates poor glycemic control and increases risks for infection, poor wound healing, and hyperosmolar crisis.

Question 27: Which body position is commonly used for posterior spinal, rectal, and some gluteal surgeries?

Trendelenburg
Jackknife (Kraske) (Correct answer)
Supine
Reverse Trendelenburg

Correct answer: Jackknife (Kraske)

The jackknife (Kraske) position flexes the patient at the hips with the buttocks elevated, providing excellent exposure for rectal, coccygeal, and perianal procedures.

Question 28: When a sterile package's chemical indicator shows no color change after sterilization, this means:

The package is safe to use because no change indicates stability
The indicator failed and a new one should be applied before use
The sterilization parameters may not have been met and the package should not be used (Correct answer)
The item requires a second sterilization cycle to activate the indicator

Correct answer: The sterilization parameters may not have been met and the package should not be used

A chemical indicator that fails to change color suggests sterilization parameters were not achieved, and the item should be rejected.

Question 29: A trauma patient in the operating room is experiencing massive hemorrhage. The surgeon calls for the activation of the Massive Transfusion Protocol (MTP). The perioperative nurse's role in activating the MTP includes which critical communication step?

Clearly stating "Activate the Massive Transfusion Protocol" to the blood bank and specifying the OR location. (Correct answer)
Ordering 10 units of O-negative packed red blood cells STAT.
Requesting a hematology consult to guide component therapy.
Performing a point-of-care hemoglobin test before calling the blood bank.

Correct answer: Clearly stating "Activate the Massive Transfusion Protocol" to the blood bank and specifying the OR location.

Activating a Massive Transfusion Protocol (MTP) requires clear, direct, and unambiguous communication. The nurse's critical role is to contact the blood bank and explicitly state the need to "Activate the Massive Transfusion Protocol" for a specific patient in a specific location (e.g., OR 5). This specific phrase triggers a pre-defined emergency response from the blood bank to send coolers of blood products in a fixed ratio (e.g., 1:1:1 of PRBCs, plasma, and platelets) without needing individual orders for each component. Ordering a specific number of units or waiting for lab results would delay this life-saving intervention.

Question 30: 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?

Preoperative verification
Time-out (Correct answer)
Surgical site marking
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 31: A surgeon requests a frozen section during a thyroidectomy. The perioperative nurse's role includes:

Discarding the specimen if the surgeon does not specify the analysis needed
Properly labeling and transporting the specimen to pathology per institutional protocol (Correct answer)
Analyzing the tissue and reporting results to the surgeon
Fixing the specimen in formalin before sending it for frozen section

Correct answer: Properly labeling and transporting the specimen to pathology per institutional protocol

The perioperative nurse is responsible for correct specimen identification, labeling, and timely transport; frozen sections must NOT be placed in formalin.

Question 32: A 68-year-old patient reports occasional confusion and memory lapses. Which preoperative assessment tool is most appropriate to screen for cognitive baseline?

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

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

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

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 34: The American Society of PeriAnesthesia Nurses (ASPAN) and AORN recommend that intraoperative temperature be maintained at or above which threshold to prevent adverse outcomes?

36.0°C (96.8°F) (Correct answer)
37.5°C (99.5°F)
35.5°C (95.9°F)
34.5°C (94.1°F)

Correct answer: 36.0°C (96.8°F)

Maintaining core temperature at or above 36°C (96.8°F) is recommended to prevent complications of perioperative hypothermia including SSI, coagulopathy, and prolonged recovery.

Question 35: In the context of CNOR infection prevention, what does the term 'standard precautions' require?

Wearing gloves only when drawing blood or starting IV lines
Applying isolation precautions based on the patient's diagnosis
Treating blood, body fluids, non-intact skin, and mucous membranes of all patients as potentially infectious (Correct answer)
Using full PPE only for patients with known infectious diseases

Correct answer: Treating blood, body fluids, non-intact skin, and mucous membranes of all patients as potentially infectious

Standard precautions apply to all patients regardless of diagnosis and treat all blood and body substances as potentially infectious.

Question 36: Which pulse oximetry limitation is most clinically significant when monitoring a patient who has received large amounts of intravenous dye (methylene blue)?

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

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

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

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 38: 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.
Handling the specimen with bare hands to maintain tactile sense.
Confirming the specimen name and source aloud with the surgeon. (Correct answer)
Sending the specimen to pathology with a verbal report only.

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 39: A patient under general anesthesia with succinylcholine and a volatile anesthetic develops sudden tachycardia, masseter muscle rigidity, and a sharp increase in end-tidal CO2. What is the perioperative nurse's priority action?

Apply cooling blankets and prepare chilled IV fluids.
Notify the anesthesia professional and prepare to stop the triggering agents. (Correct answer)
Draw blood for an arterial blood gas (ABG) and electrolyte panel.
Prepare for immediate administration of intravenous dantrolene.

Correct answer: Notify the anesthesia professional and prepare to stop the triggering agents.

The immediate priority in managing a suspected malignant hyperthermia (MH) crisis is to alert the anesthesia professional to stop the administration of all triggering agents (e.g., volatile anesthetics, succinylcholine). This action is the first and most crucial step to halt the underlying hypermetabolic process. Subsequent actions, while also critical, include administering dantrolene, initiating cooling measures, and obtaining lab work.

Question 40: 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 41: Which of the following are crucial elements in creating a program of education for a patient and their family?

The patient’s reading abilities (Correct answer)
The patient’s relationship with their spouse (Correct answer)
The nurse’s schedule to allow enough time for teaching

Correct answer: The patient’s reading abilities

Explanation: The patient's reading skills and their relationship with their spouse should be taken into account while creating an educational program for them and their family. The patient's capacity for information acquisition must be evaluated by the nurse; if the patient is illiterate or has low reading ability, providing clinically complicated information may be perplexing. The primary support network for the patient after discharge should also be evaluated by the nurse.

Question 42: When assessing a patient's social history preoperatively, which information is most relevant to postoperative planning and discharge safety?

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

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

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

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 44: 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 45: Which power tool requires nitrogen or compressed air as its energy source?

Pneumatic drill or saw (Correct answer)
Ultrasonic cleaner
Harmonic scalpel
Bipolar electrosurgical forceps

Correct answer: Pneumatic drill or saw

Pneumatic-powered surgical tools such as drills and saws use compressed nitrogen or air to drive their cutting mechanisms.

Question 46: The perioperative nurse's role during a 'code blue' in the OR includes all of the following EXCEPT:

Obtaining the crash cart and defibrillator
Assuming the role of team leader for the resuscitation (Correct answer)
Assisting with chest compressions as assigned
Documenting interventions and timing

Correct answer: Assuming the role of team leader for the resuscitation

The anesthesia provider or most senior clinician typically leads OR resuscitation; the circulating nurse's role is to support the team with supplies, documentation, and compressions as assigned.

Question 47: Which position is MOST associated with the risk of venous air embolism during neurosurgical procedures?

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

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 48: Which factor most significantly increases a patient's risk of surgical site infection (SSI)?

Operating room temperature above 68°F
The use of self-retaining retractors
Using a reusable gown instead of disposable
Uncontrolled diabetes mellitus with elevated blood glucose (Correct answer)

Correct answer: Uncontrolled diabetes mellitus with elevated blood glucose

Hyperglycemia impairs neutrophil function and tissue perfusion, significantly increasing susceptibility to SSI.

Question 49: Which type of suture material is MOST appropriate for closing a contaminated wound where absorption over several weeks is needed?

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

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

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

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

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

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 52: A patient who is a Jehovah's Witness is scheduled for a procedure with anticipated blood loss. The preoperative nurse's priority is to:

Refuse to participate in the procedure
Administer iron supplements without consent
Document the patient's wishes regarding blood transfusion and notify the surgical team (Correct answer)
Arrange for blood products to be available without informing the patient

Correct answer: Document the patient's wishes regarding blood transfusion and notify the surgical team

Respecting patient autonomy requires documenting refusal of blood products and communicating this to all team members to plan accordingly.

Question 53: A patient scheduled for outpatient surgery under general anesthesia has a BMI of 42. Which preoperative assessment is most critical?

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

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 54: 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?

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

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 55: During a laparoscopic procedure, the anesthesia provider announces a sudden, unexplained drop in end-tidal CO2, accompanied by hypotension and tachycardia. A venous air embolism is suspected. What is the perioperative nurse's IMMEDIATE priority action?

Administer 100% oxygen as directed.
Assist in placing the patient in the left lateral Trendelenburg position. (Correct answer)
Notify the blood bank of a potential emergency.
Prepare a central line kit for aspiration of air.

Correct answer: Assist in placing the patient in the left lateral Trendelenburg position.

The immediate priority is to reposition the patient into the left lateral Trendelenburg (Durant's maneuver). This position helps to trap the air in the apex of the right ventricle, preventing it from entering the pulmonary artery and causing a life-threatening right ventricular outflow obstruction or 'air lock'. While administering 100% oxygen and preparing for central line placement are also important interventions, repositioning is the most critical first step to mitigate the immediate danger.

Question 56: 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?

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

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

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

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

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)
Using depilatory cream 12 hours before the scheduled incision
Performing no hair removal at any time regardless of hair density

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

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

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 60: 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
A supraglottic airway device that sits above the larynx (Correct answer)
An oral airway adjunct to maintain tongue position
A device inserted through the cricothyroid membrane

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

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

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 62: Which statement about event-related sterility is accurate?

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

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 63: Which zone of a sterile-draped table is considered the sterile field boundary?

Only the center of the table where instruments are placed
The entire top surface down to and including the table edge
Two inches from the table edge on all sides
The top surface only; the sides and drape edges hanging below are unsterile (Correct answer)

Correct answer: The top surface only; the sides and drape edges hanging below are unsterile

The sterile field includes only the top surface of the draped table; hanging edges and sides below the table level are considered contaminated.

Question 64: What is the primary purpose of the surgical hand scrub performed before donning sterile gloves?

To remove transient flora and reduce resident flora to as low a level as possible (Correct answer)
To remove all resident flora permanently
To completely sterilize the hands
To substitute for wearing sterile gloves during minor procedures

Correct answer: To remove transient flora and reduce resident flora to as low a level as possible

The surgical hand scrub reduces microbial counts on the hands but cannot achieve sterilization; it eliminates transients and suppresses residents.

Question 65: 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?

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

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 66: 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?

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

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 67: A patient receiving a prophylactic antibiotic at the start of a procedure suddenly develops hypotension, bronchospasm, and widespread urticaria. The perioperative team diagnoses anaphylaxis. Which medication should the nurse anticipate and prepare for immediate administration?

Intravenous hydrocortisone.
Intravenous diphenhydramine.
Intravenous epinephrine. (Correct answer)
Inhaled albuterol.

Correct answer: Intravenous epinephrine.

Epinephrine is the first-line and most critical treatment for anaphylaxis. It addresses the life-threatening manifestations of anaphylaxis by causing vasoconstriction (reversing hypotension), bronchodilation (relieving bronchospasm), and decreasing further mediator release from mast cells. Antihistamines (diphenhydramine) and corticosteroids (hydrocortisone) are considered second-line treatments that do not reverse the life-threatening symptoms as rapidly as epinephrine. Albuterol may be used as an adjunct for bronchospasm but does not treat the systemic effects.

Question 68: During a laparoscopic cholecystectomy, the surgeon reports difficulty visualizing the operative field. The circulating nurse notes the CO2 insufflation pressure is 25 mmHg. What is the standard maximum safe intraabdominal pressure?

20 mmHg
25 mmHg
15 mmHg (Correct answer)
10 mmHg

Correct answer: 15 mmHg

The standard safe intraabdominal insufflation pressure for laparoscopy is 15 mmHg; higher pressures increase the risk of cardiovascular and respiratory compromise.

Question 69: Which federal regulation governs the privacy of patient health information documented in the perioperative record?

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

Correct answer: HIPAA Privacy Rule

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

Question 70: Which of the following is true of the perioperative setting's clinical pathways?

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

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 71: During room turnover after a surgical case, what is the correct sequence for environmental cleaning and disinfection?

From the floor up to the ceiling to capture falling dust.
From top to bottom, and from cleanest to dirtiest areas. (Correct answer)
Simultaneously cleaning all surfaces to maximize efficiency.
From dirtiest to cleanest areas to contain contaminants.

Correct answer: From top to bottom, and from cleanest to dirtiest areas.

The correct procedure for cleaning the operating room is to start from top to bottom (e.g., lights before floors) and to move from the cleanest areas (e.g., periphery of the room) to the dirtiest areas (e.g., the area immediately around the operating table). This method prevents the contamination of already cleaned surfaces.

Question 72: When scrubbing for a surgical procedure, how long should the initial hand and forearm scrub last according to AORN standards?

10-15 minutes
3-5 minutes (Correct answer)
20 minutes
1-2 minutes

Correct answer: 3-5 minutes

AORN recommends a minimum of 3-5 minutes for the initial surgical hand scrub, though manufacturer instructions should also be followed.

Question 73: A Kocher clamp is primarily used for which purpose in the OR?

Irrigating the surgical field
Retracting soft tissue
Grasping heavy or tough tissue such as fascia (Correct answer)
Measuring wound depth

Correct answer: Grasping heavy or tough tissue such as fascia

Kocher clamps have interlocking teeth that allow them to grasp dense or tough tissue like fascia securely.

Question 74: A nurse notes a colleague is impaired during a surgical procedure. The PRIORITY action is to:

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

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

Document the event in the incident report
Call for break relief for the scrub person
Obtain additional suture and prepare for vascular repair (Correct answer)
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 76: Malignant hyperthermia (MH) is triggered by which class of agents?

Volatile halogenated anesthetic agents and succinylcholine (Correct answer)
Nitrous oxide and propofol
Opioid analgesics and benzodiazepines
Non-depolarizing neuromuscular blocking agents

Correct answer: Volatile halogenated anesthetic agents and succinylcholine

MH is a pharmacogenetic disorder triggered by volatile inhalation agents (e.g., sevoflurane) and the depolarizing agent succinylcholine.

Question 77: 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:

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

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

Epinephrine
Propofol
Dantrolene sodium (Correct answer)
Succinylcholine

Correct answer: Dantrolene sodium

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

Question 79: Which action is MOST important when a power outage occurs in the OR during an active surgical procedure?

Immediately evacuate all OR personnel
Cancel remaining cases for the day
Switch critical equipment to emergency battery backup and notify engineering (Correct answer)
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 80: Which action ensures proper sterile technique when a circulator opens a rigid sterilization container for the scrub person?

The scrub person reaches into the container to retrieve instruments
The circulator places the open container on the back table
The circulator hands the tray directly to the scrub person
The circulator holds the container while the scrub person retrieves items, or tips the tray onto the sterile field (Correct answer)

Correct answer: The circulator holds the container while the scrub person retrieves items, or tips the tray onto the sterile field

The scrub person retrieves items from the container held by the circulator, or the circulator tips sterile contents onto the sterile field, preventing the unsterile exterior from entering the sterile field.

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

5-10
35-40
15-20 (Correct answer)
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: After a sterile package falls on the floor, the scrub person should:

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

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

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

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

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

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 85: 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 86: The perioperative nurse notes that a patient's core temperature is 35.2°C intraoperatively. Which intervention is most appropriate?

Decrease IV fluid rate to reduce cold fluid infusion
Administer IV epinephrine to increase metabolic heat production
Notify the surgeon to expedite closure
Increase room temperature and apply a forced-air warming blanket (Correct answer)

Correct answer: Increase room temperature and apply a forced-air warming blanket

Increasing ambient temperature and applying active warming devices are the first-line interventions for intraoperative hypothermia.

Question 87: Which finding during preoperative skin assessment requires immediate communication to the surgeon before proceeding?

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

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 88: Which type of hemostasis involves using high-frequency electrical current to coagulate or cut tissue?

Mechanical hemostasis
Thermal (electrosurgical) hemostasis (Correct answer)
Chemical hemostasis
Biological hemostasis

Correct answer: Thermal (electrosurgical) hemostasis

Electrosurgery uses high-frequency electrical current to produce thermal energy that coagulates blood vessels or cuts tissue.

Question 89: A patient with decision-making capacity refuses a blood transfusion for religious reasons despite a life-threatening hemorrhage. The perioperative nurse should:

Consult the ethics committee before acknowledging the refusal
Respect the patient's decision and document it, notifying the care team (Correct answer)
Administer the transfusion under the surgeon's orders to save the patient's life
Request emergency guardianship to override the patient's wishes

Correct answer: Respect the patient's decision and document it, notifying the care team

A competent adult's informed refusal of treatment must be respected even if the decision may result in death; overriding it is a violation of autonomy.

Question 90: Negative pressure wound therapy (NPWT/VAC therapy) aids wound healing primarily by:

Removing exudate, reducing edema, promoting perfusion, and stimulating granulation tissue (Correct answer)
Replacing surgical closure for all complex wounds
Providing antibiotic delivery directly to the wound
Sterilizing the wound with negative pressure alone

Correct answer: Removing exudate, reducing edema, promoting perfusion, and stimulating granulation tissue

NPWT applies controlled sub-atmospheric pressure to the wound surface, removing excess fluid, decreasing bacterial colonization, and promoting granulation tissue formation.

Question 91: What do perioperative quality improvement programs aim to accomplish?

Quality improvement programs show nurses what types of mistakes they have made in documentation
Quality improvement programs assess equipment for damage and send items for repair
Quality improvement programs address nursing behaviors that need to be changed for better patient care
Quality improvement programs review policies to ensure nursing staff are meeting standards (Correct answer)

Correct answer: Quality improvement programs review policies to ensure nursing staff are meeting standards

Explanation: Programs for improving quality examine policies to make sure that nursing staff adheres to requirements. Hospitals are required to adhere to regulations based on established state and federal standards for care. The hospital also has its own rules for nursing duties and patient care. Through chart checks, performance evaluations of the nurses, and research into more effective practice strategies, quality improvement programs make sure that nurses are adhering to these requirements.

Question 92: 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:

Remind the patient of financial penalties for last-minute cancellations
Notify the surgeon and support the patient's right to withdraw consent (Correct answer)
Reassure the patient and proceed as planned
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 93: During a complex case, the circulating nurse notices that a surgeon's hands are trembling and smells what seems to be alcohol on their breath. The surgeon becomes irritable when questioned about an instrument count. What is the nurse's priority ethical and legal action?

Wait until the procedure is over to report the surgeon to the chief of surgery.
Follow the facility's chain of command to report the concern immediately and discreetly. (Correct answer)
Document the observations and say nothing to avoid disrupting the team.
Confront the surgeon in the operating room and demand they stop the procedure.

Correct answer: Follow the facility's chain of command to report the concern immediately and discreetly.

The nurse has an ethical and legal duty to protect the patient from harm. The priority is to report any suspected impairment of a team member that could jeopardize patient safety. This should be done immediately by following the established chain of command (e.g., notifying the charge nurse or OR manager), which allows for intervention while maintaining professionalism and minimizing disruption.

Question 94: When positioning a patient prone, the eyes must be checked frequently because prolonged prone positioning can cause:

Pupil dilation from parasympathetic stimulation
Subconjunctival hemorrhage from Valsalva
Corneal abrasions and pressure-related vision loss (Correct answer)
Increased intraocular pressure from drainage

Correct answer: Corneal abrasions and pressure-related vision loss

Corneal abrasions and ischemic optic neuropathy leading to vision loss are serious complications of prone positioning due to direct pressure and decreased ocular perfusion.

Question 95: Which of the following is an essential documented element required for a valid surgical informed consent?

The patient's insurance and billing information.
A discussion of the procedure's risks, benefits, and alternatives. (Correct answer)
The brand name of any anticipated prosthetic implants.
A list of all perioperative nursing staff present in the room.

Correct answer: A discussion of the procedure's risks, benefits, and alternatives.

According to The Joint Commission and AORN guidelines, a valid informed consent process must include and document a discussion with the patient about the nature of the procedure, its potential risks and benefits, and any reasonable alternatives to the proposed procedure. [5, 11, 15] This ensures the patient can make an autonomous and informed decision. The other options are not required components of the informed consent document itself.

Question 96: Under which circumstance is it ethically permissible for a perioperative nurse to share a patient's health information without consent?

When the surgeon instructs the nurse to inform next of kin
When the nurse believes it is in the patient's best interest
When required by mandatory reporting laws such as gunshot wounds or communicable diseases (Correct answer)
When the patient's family specifically requests it

Correct answer: When required by mandatory reporting laws such as gunshot wounds or communicable diseases

Mandatory reporting laws legally require disclosure of specific conditions (e.g., gunshot wounds, reportable diseases) without patient consent.

Question 97: When a cardiac arrest occurs in the OR, which team member is responsible for documenting the resuscitation timeline?

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

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

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

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 99: At the conclusion of a complex aortic valve replacement, the surgeon initiates a debriefing. What is a primary objective of this communication process?

To assign blame for any intraoperative complications that occurred.
To identify opportunities for improving teamwork and patient safety on future cases. (Correct answer)
To provide a detailed report to the patient's waiting family members.
To finalize the instrument count and sign out of the room.

Correct answer: To identify opportunities for improving teamwork and patient safety on future cases.

The surgical debriefing, part of the Sign Out phase of the surgical safety checklist, is a crucial communication tool. Its primary goal is to reflect on the procedure to identify what went well, what could be improved, and to address any patient safety concerns, thereby fostering continuous team learning and enhancing the quality of care for future patients. [7, 19, 27]

Question 100: 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
Prepare succinylcholine for immediate administration
Administer 100% oxygen via non-rebreather mask

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 101: When managing a malignant hyperthermia crisis, which cooling measure is appropriate?

Applying ice to the groin and axillae only
Passive air cooling with fan only
Iced saline lavage of open body cavities and IV cold saline (Correct answer)
Warm saline irrigation of body cavities

Correct answer: Iced saline lavage of open body cavities and IV cold saline

Active cooling in MH includes iced saline lavage of accessible body cavities, cold IV saline infusion, and surface cooling to rapidly lower core temperature.

Question 102: A patient's preoperative ECG shows new ST-segment changes that were not present 6 months ago. The perioperative nurse should:

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

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 103: Which retractor type is self-retaining and does not require a team member to hold it?

Richardson retractor
Army-Navy retractor
Deaver retractor
Balfour retractor (Correct answer)

Correct answer: Balfour retractor

The Balfour retractor is a self-retaining abdominal retractor that locks in place, freeing team members for other tasks.

Question 104: The responsibility for ensuring the patient's informed consent is documented before surgery rests primarily with:

The circulating nurse
The anesthesia provider
The operating surgeon (Correct answer)
The hospital administrator

Correct answer: The operating surgeon

Obtaining informed consent is the legal and ethical responsibility of the operating surgeon, who must explain the procedure, risks, benefits, and alternatives.

Question 105: When assessing a patient's airway preoperatively, the nurse notes a Mallampati class IV. This finding suggests:

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

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 106: A scrub technician notices a sponge count discrepancy before wound closure. What is the FIRST action the perioperative nurse should take?

Document 'count incorrect' and complete closure
Notify the surgeon immediately and repeat the count (Correct answer)
Call the charge nurse before telling the surgeon
Proceed with closure and document the discrepancy

Correct answer: Notify the surgeon immediately and repeat the count

The surgeon must be notified immediately so the wound can be explored before closure when a count discrepancy occurs.

Question 107: Which position places the patient flat on their back with arms extended on armboards?

Lithotomy
Supine (Correct answer)
Lateral
Prone

Correct answer: Supine

The supine (dorsal recumbent) position places the patient flat on their back, the most common surgical position used for abdominal, thoracic, and many other procedures.

Question 108: Which abbreviation has been identified by The Joint Commission as 'Do Not Use' in medical documentation?

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

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 109: Which hemostatic agent works by providing a physical matrix that promotes platelet aggregation and fibrin deposition?

Tranexamic acid
Gelatin foam (Gelfoam) (Correct answer)
Thrombin
Epinephrine

Correct answer: Gelatin foam (Gelfoam)

Gelatin foam acts as a physical scaffold that absorbs blood and supports the natural clotting cascade through platelet aggregation.

Question 110: The scrub person drops a sterile instrument onto the floor. The correct action is to:

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

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

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

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

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

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 113: Which action BEST demonstrates professional accountability in the perioperative setting?

Deferring all ethical decisions to the attending physician
Relying solely on hospital policy for all clinical decisions
Completing all tasks before the end of the shift regardless of accuracy
Performing self-evaluation and seeking peer feedback to improve practice (Correct answer)

Correct answer: Performing self-evaluation and seeking peer feedback to improve practice

Professional accountability includes ongoing self-assessment and seeking feedback to continually improve the quality and safety of care.

Question 114: Which ASA physical status classification applies to a patient with well-controlled Type 2 diabetes and hypertension on medications?

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

Correct answer: ASA II

ASA II indicates a patient with mild systemic disease that is well-controlled and not functionally limiting.

Question 115: What is the purpose of the preoperative checklist in perioperative documentation?

To bill insurance for preoperative services
To verify completion of required safety checks before transferring the patient to the OR (Correct answer)
To document the surgeon's postoperative orders
To record the patient's diet history

Correct answer: To verify completion of required safety checks before transferring the patient to the OR

The preoperative checklist ensures all required safety verifications—consent, labs, allergies, NPO status—are completed before the patient enters the OR.

Question 116: Which neuromuscular blocking agent is considered a depolarizing agent?

Vecuronium
Cisatracurium
Succinylcholine (Correct answer)
Rocuronium

Correct answer: Succinylcholine

Succinylcholine is the only commonly used depolarizing neuromuscular blocking agent, causing persistent depolarization of the motor end plate.

Question 117: Which position places the patient at highest risk for air embolism?

Prone jackknife position
Lithotomy position
Sitting (beach chair) craniotomy position (Correct answer)
Supine Trendelenburg

Correct answer: Sitting (beach chair) craniotomy position

In the sitting position, the operative site is above the level of the heart, creating negative venous pressure that allows air entrainment into open venous sinuses.

Question 118: Which suture gauge among the following is the smallest?

#0
#11-0 (Correct answer)
#2
#5-0

Correct answer: #11-0

Explanation: Like sewing thread, sutures are sized according to gauge. #11-0 is the smallest gauge, while #5 is the largest. #1–4-0 are the sizes that are most frequently used.

Question 119: During a laparoscopic cholecystectomy, the laparoscope is inadvertently dropped on the floor. Which action is most appropriate?

The circulator retrieves it and passes it back after wiping with a sterile towel
The surgeon continues without the laparoscope to avoid delay
The scrub tech rinses it with sterile saline and returns it to the field
A replacement sterile laparoscope is obtained or the dropped scope is sent for IUSS if urgently needed (Correct answer)

Correct answer: A replacement sterile laparoscope is obtained or the dropped scope is sent for IUSS if urgently needed

Any instrument that falls to the floor is considered contaminated and must be replaced with a sterile item or processed via IUSS if no replacement exists.

Question 120: 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
Increase the rate of intravenous fluids
Notify the anesthesia provider and surgeon immediately and prepare for potential cardiac intervention (Correct answer)
Administer aspirin 325mg per standing order

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 121: The term 'asepsis' in the perioperative setting refers to:

Elimination of all microorganisms from a surface
Use of antibiotics prophylactically before surgery
Sterilization of all surgical instruments
Absence of pathogenic microorganisms to prevent infection (Correct answer)

Correct answer: Absence of pathogenic microorganisms to prevent infection

Asepsis refers to the absence of pathogenic microorganisms and the practices used to prevent infection during surgical procedures.

Question 122: 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?

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

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 123: Which statement about sterile field maintenance is correct regarding a team member who steps away from the sterile field?

The team member may return if they were gone fewer than five minutes
The team member may return after reapplying sterile gloves only
The team member must be considered unsterile and cannot return to the sterile field without re-gowning and re-gloving (Correct answer)
The team member may return if their back was facing away from the field

Correct answer: The team member must be considered unsterile and cannot return to the sterile field without re-gowning and re-gloving

Once a scrubbed team member steps away from the sterile field, their sterility cannot be guaranteed and full re-gowning and re-gloving is required.

Question 124: When positioning a patient in the lateral decubitus position, the MOST important nursing consideration to prevent injury is:

Securing the patient with only one safety strap across the hips
Padding all bony prominences and ensuring the axillary roll is placed correctly (Correct answer)
Applying a warming blanket before positioning begins
Elevating the head of the bed 30 degrees to improve venous drainage

Correct answer: Padding all bony prominences and ensuring the axillary roll is placed correctly

Lateral positioning risks brachial plexus injury and pressure injuries; correct axillary roll placement and padding all bony prominences are critical safeguards.

Question 125: Which action best demonstrates closed-loop communication during a surgical procedure?

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

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 126: When performing surgical site skin preparation, which technique is correct for applying an antiseptic solution?

Scrub back and forth across the entire site in a horizontal pattern
Apply from the periphery inward toward the incision site
Apply in a single pass without overlapping strokes
Use a circular motion from the incision site outward to the periphery (Correct answer)

Correct answer: Use a circular motion from the incision site outward to the periphery

Prep solution is applied from the clean incision center outward in concentric circles to prevent dragging contamination toward the incision.

Question 127: Malignant hyperthermia (MH) is triggered by which class of agents?

Volatile inhalation anesthetics and succinylcholine (Correct answer)
Opioid analgesics and benzodiazepines
Non-depolarizing neuromuscular blockers
Local anesthetics and vasopressors

Correct answer: Volatile inhalation anesthetics and succinylcholine

Malignant hyperthermia is triggered by volatile halogenated inhalation anesthetics (e.g., sevoflurane, desflurane) and the depolarizing muscle relaxant succinylcholine.

Question 128: 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?

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

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

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

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 130: A patient receives a peripherally inserted central catheter (PICC) the morning of surgery for IV access. Before induction, the perioperative nurse should verify:

The PICC is used only for blood draws during the case
That the PICC was placed by a surgeon, not a nurse
Catheter tip position confirmed by chest X-ray and patency of all lumens (Correct answer)
That the PICC replaces the need for a peripheral IV

Correct answer: Catheter tip position confirmed by chest X-ray and patency of all lumens

Central line tip position must be radiographically confirmed before use to prevent complications such as cardiac arrhythmia or perforation from malposition.

Question 131: The anesthesia provider announces the patient has a difficult airway. Which piece of equipment should the perioperative nurse ensure is immediately available?

Defibrillator and crash cart
Chest tube insertion tray
Biopsy forceps
Video laryngoscope and surgical airway kit (Correct answer)

Correct answer: Video laryngoscope and surgical airway kit

A video laryngoscope improves visualization of a difficult airway, and a surgical airway kit allows emergency cricothyrotomy if intubation fails.

Question 132: When applying a tourniquet to the upper extremity, what is the maximum recommended inflation time before deflation and reperfusion?

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

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

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

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 134: A scrub technician notices the surgeon is about to use an instrument that was not properly sterilized. What is the perioperative nurse's FIRST action?

Immediately inform the surgeon and remove the instrument from the field (Correct answer)
Wait to see if any infection develops before acting
Document the incident after the procedure
Allow the procedure to continue and report to the charge nurse afterward

Correct answer: Immediately inform the surgeon and remove the instrument from the field

Patient safety requires immediate intervention to remove non-sterile items from the surgical field before use.

Question 135: The ethical principle of JUSTICE in perioperative nursing MOST directly relates to:

Avoiding actions that could harm the patient
Ensuring all patients receive equal, fair access to care and resources (Correct answer)
Providing the greatest benefit to each individual patient
Respecting patients' rights to make their own decisions

Correct answer: Ensuring all patients receive equal, fair access to care and resources

Justice requires fair distribution of care and resources without discrimination based on personal characteristics.

Question 136: A sterile field has been set up and left unattended for 30 minutes. The appropriate action is to:

Inspect it visually and proceed if no contaminants are visible
Cover it with a sterile drape and continue using it
Use it if the room was unoccupied during the 30 minutes
Consider it contaminated and re-establish the sterile field (Correct answer)

Correct answer: Consider it contaminated and re-establish the sterile field

An unattended sterile field cannot be guaranteed sterile; it must be considered contaminated and re-established.

Question 137: The first-line pharmacologic treatment for malignant hyperthermia crisis is:

Dantrolene sodium (Correct answer)
Sodium bicarbonate
Propofol
Epinephrine

Correct answer: Dantrolene sodium

Dantrolene sodium is the specific antidote for malignant hyperthermia, acting by inhibiting calcium release from the sarcoplasmic reticulum in muscle cells.

Question 138: When documenting irrigation fluid used during a procedure, the perioperative nurse should record which of the following?

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

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 139: Which preoperative assessment finding requires the nurse to question the antibiotic prophylaxis order?

The patient has a history of MRSA decolonization
The patient's weight is 95 kg
The patient's surgery is scheduled to start in 2 hours
The patient reports a severe allergy to penicillin with anaphylaxis (Correct answer)

Correct answer: The patient reports a severe allergy to penicillin with anaphylaxis

A severe penicillin allergy with anaphylaxis requires verification and likely substitution of cephalosporins or other beta-lactam antibiotics in the prophylaxis order.

Question 140: A perioperative nurse documents 'patient tolerated procedure well' without supporting objective data. This type of entry is considered:

Subjective and insufficient without objective assessment findings to support it (Correct answer)
Standard nursing language acceptable in all facilities
Ideal because it avoids overly detailed notes
Legally sufficient because it is brief and professional

Correct answer: Subjective and insufficient without objective assessment findings to support it

Documentation must include objective data such as vital signs, estimated blood loss, and patient responses rather than vague subjective statements.

Question 141: What is the purpose of documenting tourniquet application time and pressure in the intraoperative record?

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

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

Immediately report the breach to the surgeon and document the event, corrective action taken, and patient notification (Correct answer)
Address the breach silently to avoid disrupting the team
Document it only if a patient complication occurs
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 143: Flash sterilization (immediate-use steam sterilization) is appropriately used for:

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

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 144: Which gas is used to insufflate the abdominal cavity during laparoscopic surgery and why?

Nitrogen, because it is inert and safe
Oxygen, because it supports combustion for laser use
Helium, because it does not cause pain
Carbon dioxide, because it is non-flammable, highly soluble, and rapidly absorbed (Correct answer)

Correct answer: Carbon dioxide, because it is non-flammable, highly soluble, and rapidly absorbed

CO2 is used because it is non-combustible, rapidly absorbed by the body, and inexpensive, minimizing embolic risk compared to other gases.

Question 145: Which sterilization method is most appropriate for heat-sensitive flexible endoscopes used in the OR?

Dry heat sterilization at 320°F (160°C)
Steam autoclave at 270°F (132°C)
Flash sterilization at prevacuum settings
Low-temperature hydrogen peroxide gas plasma (Sterrad) or ethylene oxide (EtO) (Correct answer)

Correct answer: Low-temperature hydrogen peroxide gas plasma (Sterrad) or ethylene oxide (EtO)

Heat-sensitive devices like flexible endoscopes require low-temperature sterilization methods such as hydrogen peroxide plasma or EtO.

Question 146: A dispersive electrode (grounding pad) used during monopolar electrosurgery should be placed:

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

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

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

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 148: The principle of 'strike-through' contamination refers to:

Moisture passing through a sterile barrier, rendering it contaminated (Correct answer)
A scrub person's gown touching a non-sterile surface
An instrument puncturing through a sterile drape
A needle strike penetrating a glove during suturing

Correct answer: Moisture passing through a sterile barrier, rendering it contaminated

Strike-through occurs when moisture migrates through a sterile barrier (drape or packaging), creating a pathway for microorganisms and contaminating the field.

Question 149: 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 I
ASA III
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 150: Which type of wound closure is used for contaminated or dirty wounds to reduce infection risk?

Primary intention (primary closure)
Secondary intention (healing by granulation)
Subcuticular absorbable suture closure
Delayed primary closure (tertiary intention) (Correct answer)

Correct answer: Delayed primary closure (tertiary intention)

Delayed primary closure (tertiary intention) is used for contaminated wounds, leaving them open initially and closing after 3-5 days once infection risk decreases.

Question 151: 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?

Ginkgo biloba (Correct answer)
Echinacea
Probiotics
Melatonin

Correct answer: Ginkgo biloba

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

Question 152: The 'time to first antibiotic dose' standard for surgical prophylaxis is:

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

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 153: Steam sterilization using the gravity displacement cycle is most appropriate for which items?

Implantable orthopedic devices
Items that absorb steam and cannot be dried
Delicate optical instruments and cameras
Items that can withstand high heat and moisture (Correct answer)

Correct answer: Items that can withstand high heat and moisture

Gravity displacement steam sterilization is suitable for heat- and moisture-tolerant items such as metal instruments and textiles.

Question 154: When opening a sterile package, which action correctly maintains sterility?

Open all flaps simultaneously to minimize exposure time
Open the flap closest to you first
Open the far flap first, then the sides, then the near flap (Correct answer)
Hold the package at waist level while opening all flaps

Correct answer: Open the far flap first, then the sides, then the near flap

Opening the far flap first prevents reaching over the sterile field, then sides, and finally the near flap toward the body.

Question 155: The circulating nurse notes that the patient's arm is abducted greater than 90 degrees on the arm board. The primary concern is injury to which structure?

Ulnar nerve at the elbow
Brachial plexus from stretch or compression (Correct answer)
Radial nerve at the spiral groove
Median nerve at the wrist

Correct answer: Brachial plexus from stretch or compression

Arm abduction greater than 90 degrees stretches the brachial plexus and can cause traction injury; AORN guidelines recommend keeping abduction at 90 degrees or less.

Question 156: 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 entire front of the gown from the neckline to the bottom hem.
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 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 157: What is the minimum number of identifiers required to correctly identify a patient before a surgical procedure?

One
Three
Four
Two (Correct answer)

Correct answer: Two

The Joint Commission and AORN require at least two patient identifiers (such as name and date of birth) before any procedure.

Question 158: The following situations have the lowest postoperative infection rates:

Shaved
Removed using a depilatory cream
Removed using clippers
Not removed (Correct answer)

Correct answer: Not removed

Explanation: When the hair is left in its current location, infection rates are the lowest. Even neurosurgical procedures can be performed while leaving the hair on if the hair is stretched away from the incisional site using a non-flammable gel.

Question 159: Which of the following best describes the purpose of a surgical safety checklist as recommended by the WHO?

To replace the need for a surgical timeout
To document anesthesia technique only
To standardize communication and reduce preventable surgical complications across the three perioperative phases (Correct answer)
To serve as a billing and coding tool

Correct answer: To standardize communication and reduce preventable surgical complications across the three perioperative phases

The WHO Surgical Safety Checklist is designed to improve teamwork and communication across the Sign In, Time Out, and Sign Out phases to reduce preventable harm.

Question 160: Which microorganism is most commonly associated with surgical site infections (SSIs) in the perioperative setting?

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

Correct answer: Staphylococcus aureus

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

Question 161: During a procedure, the scrub person's sterile glove is perforated by a needle. The correct response is to:

Immediately step away from the sterile field and change gloves with the circulator's assistance (Correct answer)
Apply a sterile glove over the perforated one and continue
Inform the surgeon and change gloves only after the critical portion of the case is complete
Continue the procedure and change gloves at the next natural break

Correct answer: Immediately step away from the sterile field and change gloves with the circulator's assistance

A perforated glove immediately compromises the sterile barrier; the scrub must step back and change gloves with circulator assistance right away.

Question 162: What is the recommended approach when the perioperative nurse disagrees with a surgeon's order that may harm the patient?

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

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 163: 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
Compartment syndrome of the legs
Pressure injury to the occiput

Correct answer: Intraocular pressure increase

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

Question 164: When caring for a pediatric patient requiring emergency surgery without a guardian present, the perioperative nurse should:

Have the charge nurse sign consent on behalf of the child
Delay surgery until consent can be obtained from a legal guardian
Proceed with surgery under the doctrine of implied emergency consent and document thoroughly (Correct answer)
Transfer the patient to another facility where a guardian can be reached

Correct answer: Proceed with surgery under the doctrine of implied emergency consent and document thoroughly

In a life-threatening emergency involving a minor without a guardian, implied consent allows immediate treatment to prevent death or serious harm.

Question 165: 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 166: When preparing the OR for a patient with a known latex allergy, the perioperative nurse should:

Administer prophylactic epinephrine before arrival
Use powdered latex gloves to reduce direct contact
Ensure the room is stocked with latex-free supplies and schedule the case first (Correct answer)
Schedule the case as the last case of the day

Correct answer: Ensure the room is stocked with latex-free supplies and schedule the case first

A latex-free environment must be established using all latex-free supplies, and scheduling the case first reduces aerosolized latex particle exposure in the room.

Question 167: During a spine procedure in prone position, the patient develops a sudden drop in oxygen saturation and absent breath sounds on the left. The nurse anticipates:

Pneumothorax requiring chest tube insertion (Correct answer)
Endobronchial intubation requiring tube repositioning
Allergic reaction requiring epinephrine
Pulmonary embolism requiring anticoagulation

Correct answer: Pneumothorax requiring chest tube insertion

Sudden unilateral absent breath sounds with desaturation in a prone patient suggests tension pneumothorax, which requires immediate decompression.

Question 168: During preoperative assessment, a patient rates their pain as 8/10 at rest. The nurse's best action is to:

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

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 169: Which organization publishes the 'Guidelines for Perioperative Practice' that serves as a primary evidence-based resource for CNOR candidates?

Occupational Safety and Health Administration (OSHA)
Association of periOperative Registered Nurses (AORN) (Correct answer)
Centers for Disease Control and Prevention (CDC)
The Joint Commission (TJC)

Correct answer: Association of periOperative Registered Nurses (AORN)

AORN publishes the 'Guidelines for Perioperative Practice,' the comprehensive evidence-based resource that perioperative nurses, including CNOR candidates, use as their practice standard.

Question 170: A patient in the lithotomy position begins to complain of lower extremity pain after repositioning. What is the priority concern?

Nerve compression injury
Deep vein thrombosis
Compartment syndrome (Correct answer)
Pressure ulcer formation

Correct answer: Compartment syndrome

Compartment syndrome can result from prolonged lithotomy positioning with legs elevated, causing muscle ischemia due to increased compartment pressure.

Question 171: During a robotic-assisted procedure, the robotic system experiences a critical malfunction and cannot be safely disengaged. The FIRST nursing priority is:

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

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 172: 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.
Pour the entire contents of the solution into the basin at once to prevent contamination of the bottle's edge. (Correct answer)
Place the bottle cap on the sterile field with the inside facing up.
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 173: A patient develops intraoperative anaphylaxis to latex. After administering epinephrine, which intervention addresses the UNDERLYING trigger?

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

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 174: 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 175: The harmonic scalpel differs from conventional electrosurgery because it:

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

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

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

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

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

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 178: 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?

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

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 179: Which organization is responsible for the CNOR certification examination?

National Council of State Boards of Nursing (NCSBN)
American Nurses Association (ANA)
Association of periOperative Registered Nurses (AORN)
Competency & Credentialing Institute (CCI) (Correct answer)

Correct answer: Competency & Credentialing Institute (CCI)

The Competency & Credentialing Institute (CCI) administers and oversees the CNOR certification examination for perioperative nurses.

Question 180: A patient is positioned in lithotomy. Both legs should be raised and lowered simultaneously to prevent which complication?

Hemodynamic instability from sudden blood volume shifts (Correct answer)
Deep vein thrombosis
Sciatic nerve stretch injury
Lumbar spinal injury

Correct answer: Hemodynamic instability from sudden blood volume shifts

Raising or lowering both legs simultaneously prevents sudden shifts in blood volume that can cause hemodynamic instability.

Question 181: Which Spaulding classification applies to a rigid sigmoidoscope that contacts intact mucous membranes but does not penetrate sterile tissue?

Non-critical — requires intermediate-level disinfection
Semi-critical — requires high-level disinfection (Correct answer)
Critical — requires sterilization
Non-critical — requires low-level disinfection

Correct answer: Semi-critical — requires high-level disinfection

Semi-critical items contact intact mucous membranes and require high-level disinfection as a minimum standard of reprocessing.

Question 182: Which preoperative skin antiseptic agent is CONTRAINDICATED near the eyes and ears?

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

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 183: Which principle of surgical asepsis states that sterile items placed below the patient's waist level are considered contaminated?

Sterile persons and items contact only sterile areas
Items of questionable sterility are considered contaminated
Sterile tables are sterile only at table level (Correct answer)
The sterile field must remain in constant view

Correct answer: Sterile tables are sterile only at table level

A fundamental aseptic principle is that the sterile drape is only considered sterile at table level; anything that falls or is lowered below this level is contaminated.

Question 184: A sterile team member must move around the sterile field. The safest method is to:

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

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 185: A patient arrives in the emergency department unconscious following a severe motor vehicle accident and requires immediate emergency surgery to control internal bleeding. The patient is unidentified, and no family is present. Regarding informed consent for the surgery, what is the appropriate course of action?

The surgery must be delayed until a family member can be located to provide consent.
The surgeon can proceed with the surgery under the principle of implied consent in an emergency. (Correct answer)
Two nurses can sign the consent form on behalf of the patient.
A court order must be obtained before the surgery can be performed.

Correct answer: The surgeon can proceed with the surgery under the principle of implied consent in an emergency.

In a life-threatening emergency where the patient is unable to consent and no surrogate decision-maker is available, the law typically allows healthcare providers to proceed with necessary treatment under the principle of implied consent. It is assumed that a reasonable person would consent to life-saving treatment. Delaying surgery to find family or obtain a court order could result in the patient's death.

Question 186: A patient is NPO but has been taking oral medications as prescribed. Which medication should be held before surgery?

Proton pump inhibitor for GERD
Oral hypoglycemic agent for Type 2 diabetes (Correct answer)
Beta-blocker for hypertension
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 187: What does the Spaulding classification system categorize as 'critical' items requiring sterilization?

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

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 188: Which factor is most directly linked to an increased risk of developing a surgical site infection postoperatively?

Male sex
Prolonged operative time greater than the 75th percentile for the procedure (Correct answer)
Use of general anesthesia rather than regional anesthesia
Patient age under 40 years

Correct answer: Prolonged operative time greater than the 75th percentile for the procedure

Prolonged operative time increases SSI risk by extending exposure of the wound to environmental contaminants and reducing host defenses.

Question 189: Which personal protective equipment (PPE) combination is required when handling a patient with active pulmonary tuberculosis in the OR?

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

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 190: During a total knee arthroplasty, a tourniquet is applied. What is the maximum recommended continuous inflation time to minimize complications?

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

Correct answer: 120 minutes

Tourniquet inflation should generally not exceed 120 minutes; beyond this, the risk of nerve damage, compartment syndrome, and reperfusion injury increases significantly.

Question 191: When preparing a patient for a total hip arthroplasty in the lateral position, which padding is ESSENTIAL to prevent a common positioning injury?

Axillary roll placed below the axilla (Correct answer)
Heel pads for the dependent leg
Padded knee immobilizer for the upper leg
Foam headrest for cervical alignment

Correct answer: Axillary roll placed below the axilla

An axillary roll placed just below (not in) the axilla protects the brachial plexus and neurovascular structures of the dependent arm.

Question 192: 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 patient requires a urine drug screen before consent
It has no anesthetic implications
The surgery must be cancelled

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 193: Sugammadex (Bridion) is used intraoperatively to reverse which class of neuromuscular blocking agents?

Depolarizing agents such as succinylcholine
All benzodiazepines used for sedation
Aminosteroid non-depolarizing agents such as rocuronium and vecuronium (Correct answer)
Benzylisoquinolinium agents such as cisatracurium

Correct answer: Aminosteroid non-depolarizing agents such as rocuronium and vecuronium

Sugammadex is a modified cyclodextrin that selectively encapsulates aminosteroid non-depolarizing agents, rapidly reversing their neuromuscular blockade.

Question 194: A patient is scheduled for surgery under regional anesthesia. Which preoperative assessment finding would most likely change the anesthetic plan?

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

Correct answer: Anticoagulant therapy with recent therapeutic INR of 2.8

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

Question 195: In a 'can't intubate, can't oxygenate' (CICO) airway emergency, the DEFINITIVE rescue intervention is:

Repeated laryngoscopy attempts with a different blade
Nasopharyngeal airway insertion
Cricothyrotomy (Correct answer)
Bag-valve-mask ventilation with two providers

Correct answer: Cricothyrotomy

Cricothyrotomy is the definitive surgical airway rescue procedure when all other airway management attempts have failed in a CICO emergency.

Question 196: Which class of SSI involves infection only of the skin and subcutaneous tissue of the incision?

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

Correct answer: Superficial incisional SSI

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

Question 197: 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 198: Which type of anesthesia blocks sensation to a specific body region by injecting anesthetic near a nerve trunk?

Local infiltration
Regional (nerve block) anesthesia (Correct answer)
Monitored anesthesia care (MAC)
General anesthesia

Correct answer: Regional (nerve block) anesthesia

Regional anesthesia (nerve block) interrupts nerve transmission to a specific body region by depositing local anesthetic near a major nerve or nerve plexus.

Question 199: Which instrument classification describes tools used to cut or incise tissue?

Clamping instruments
Grasping instruments
Cutting instruments (Correct answer)
Retracting instruments

Correct answer: Cutting instruments

Cutting instruments such as scalpels, scissors, and osteotomes are specifically designed to incise or excise tissue.

Question 200: A patient in the OR develops pulseless ventricular tachycardia. The FIRST action by the perioperative nurse should be:

Perform a precordial thump
Begin CPR and call for the defibrillator (Correct answer)
Administer amiodarone IV push
Increase IV fluid rate

Correct answer: Begin CPR and call for the defibrillator

Pulseless VT is a shockable cardiac arrest rhythm; initiating CPR and obtaining the defibrillator are the immediate priorities per ACLS guidelines.

Question 201: A perioperative nurse is asked to co-sign a documentation entry made by a nursing student. What does co-signing legally imply?

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

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.

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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