CNOR Intraoperative Care and Safety 2 — Questions and Answers
Question 1: Which electrosurgical unit (ESU) setting requires the dispersive electrode to be placed as close as possible to the operative site?
- Bipolar mode
- Monopolar mode (Correct answer)
- Ultrasonic mode
- Argon beam mode
Correct answer: Monopolar mode
In monopolar mode, current travels from the active electrode through the patient to the dispersive electrode, so placement near the operative site minimizes current path length and tissue damage.
Question 2: During a laparoscopic procedure, the patient develops sudden onset of hypotension, tachycardia, and decreased oxygen saturation. The surgeon notices a frothy appearance in the suction tubing. What complication is most likely?
- Pneumothorax
- Venous gas embolism (Correct answer)
- Cardiac tamponade
- Tension pneumoperitoneum
Correct answer: Venous gas embolism
Frothy blood in suction tubing combined with hemodynamic instability during insufflation is classic for venous gas embolism, where CO2 enters a venous vessel.
Question 3: The scrub person notes that a sponge count is incorrect before closing a body cavity. What is the immediate first action?
- Notify the charge nurse
- Document the discrepancy and proceed
- Inform the surgeon immediately and search the wound (Correct answer)
- Perform an X-ray before informing the surgeon
Correct answer: Inform the surgeon immediately and search the wound
An incorrect count must be immediately communicated to the surgeon so the wound can be explored before closure to locate any retained item.
Question 4: Which action best prevents surgical site infections related to instrument handling during a procedure?
- Rinsing instruments with sterile water between uses
- Confining instruments to the sterile field until needed (Correct answer)
- 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 5: A patient with a pacemaker is about to undergo monopolar electrosurgery. What precaution is most important?
- Disable the pacemaker before the procedure
- Place the dispersive electrode as far as possible from the pacemaker (Correct answer)
- Use only bipolar electrosurgery
- 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 6: When positioning a patient in the lateral decubitus position, which structure is most at risk for a pressure injury if not properly protected?
- Occiput
- Sacrum
- Fibular head and peroneal nerve (Correct answer)
- Heel
Correct answer: Fibular head and peroneal nerve
The fibular head is a bony prominence in lateral positioning that can compress the common peroneal nerve, leading to foot drop if not padded.
Question 7: Which parameter should the perioperative nurse monitor to detect malignant hyperthermia early?
- Urine output
- End-tidal CO2 (Correct answer)
- Central venous pressure
- Blood glucose
Correct answer: End-tidal CO2
A rapid rise in end-tidal CO2 is one of the earliest and most sensitive indicators of malignant hyperthermia due to hypermetabolism.
CNOR Intraoperative Care and Safety 2
Which electrosurgical unit (ESU) setting requires the dispersive electrode to be placed as close as possible to the operative site?