CNOR Certification MCQ 4 — Questions and Answers
Question 1: Flash sterilization (immediate-use steam sterilization, IUSS) should be used:
- Routinely to increase instrument throughput between cases
- Only when there is no time to perform standard sterilization and documented need exists (Correct answer)
- For all implantable devices to save cost
- As the preferred method for heat-sensitive items
Correct answer: Only when there is no time to perform standard sterilization and documented need exists
AORN and AAMI recommend IUSS only as a last resort for a specific need, not as a routine practice or convenience measure.
Question 2: A patient with a known penicillin allergy is to receive surgical antibiotic prophylaxis. The perioperative nurse should anticipate which alternative?
- No antibiotic prophylaxis is needed for penicillin-allergic patients
- Clindamycin or vancomycin as alternatives based on the procedure and allergy severity (Correct answer)
- A higher dose of the same penicillin to overcome the allergic threshold
- Topical antibiotic irrigation in lieu of systemic prophylaxis
Correct answer: Clindamycin or vancomycin as alternatives based on the procedure and allergy severity
Clindamycin or vancomycin are commonly used alternatives for patients with penicillin allergy undergoing procedures requiring beta-lactam prophylaxis.
Question 3: 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 4: During the postoperative count, the sponge count is incorrect. The IMMEDIATE action is to:
- Close the wound, document the discrepancy, and order a postoperative X-ray
- Notify the surgeon immediately, search the field and room, and obtain an intraoperative X-ray if the sponge is not found (Correct answer)
- Repeat the count three times and proceed if two of three counts agree
- Ask the scrub tech to recount independently without informing the surgeon
Correct answer: Notify the surgeon immediately, search the field and room, and obtain an intraoperative X-ray if the sponge is not found
An incorrect count mandates immediate surgeon notification, systematic search, and intraoperative radiograph before wound closure to prevent RSI.
Question 5: Which position places the patient at highest risk for air embolism?
- Supine Trendelenburg
- Sitting (beach chair) craniotomy position (Correct answer)
- Prone jackknife position
- Lithotomy position
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 6: The 'time to first antibiotic dose' standard for surgical prophylaxis is:
- Administered 24 hours before surgery to achieve tissue levels
- Within 60 minutes before incision (120 minutes for vancomycin and fluoroquinolones) (Correct answer)
- 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 7: Which AORN recommended practice guides the management of documentation in the perioperative setting?
- Documentation is the responsibility of the anesthesia provider alone
- Perioperative nursing documentation should reflect the nursing process and be accurate, timely, and complete (Correct answer)
- Only adverse events require formal documentation in the intraoperative record
- Documentation templates are optional as long as verbal handoffs occur
Correct answer: Perioperative nursing documentation should reflect the nursing process and be accurate, timely, and complete
AORN standards require perioperative documentation to reflect assessment, planning, implementation, and evaluation — ensuring accountability and continuity of care.
CNOR Certification MCQ 4
Flash sterilization (immediate-use steam sterilization, IUSS) should be used: