CNOR Intraoperative Care and Safety 3 — Questions and Answers
Question 1: Which type of fire triangle element is most commonly represented by surgical drapes in the OR?
- Ignition source
- Oxidizer
- Fuel (Correct answer)
- Accelerant
Correct answer: Fuel
Surgical drapes are a common fuel source in OR fires; they can ignite when combined with an ignition source (ESU) and an oxidizer (oxygen-enriched environment).
Question 2: During closure, the instrument count is correct but the needle count is off by one. What should the perioperative nurse do?
- Proceed with closure and document the discrepancy
- Notify the surgeon, search the field and patient, and obtain an intraoperative X-ray if not found (Correct answer)
- Ask the circulator to recount the needles only
- Document and file an incident report after the case
Correct answer: Notify the surgeon, search the field and patient, and obtain an intraoperative X-ray if not found
A missing needle requires notifying the surgeon, thorough search of the sterile field and wound, and intraoperative imaging if unresolved before closure.
Question 3: What is the primary purpose of a time-out before surgical incision?
- To allow anesthesia providers to complete documentation
- To verify correct patient, site, side, procedure, and position (Correct answer)
- To ensure all supplies are opened and counted
- To confirm instrument sterilization indicators
Correct answer: To verify correct patient, site, side, procedure, and position
The surgical time-out is a standardized safety pause to confirm patient identity, procedure, and site/side before the first incision to prevent wrong-site surgery.
Question 4: A patient is in the Trendelenburg position for 3 hours. Which postoperative complication related to positioning is the nurse most concerned about?
- Peripheral neuropathy of the femoral nerve
- Intraocular pressure increase leading to vision changes (Correct answer)
- Sacral pressure ulcer
- Brachial plexus injury
Correct answer: Intraocular pressure increase leading to vision changes
Prolonged Trendelenburg increases intraocular pressure, which can cause postoperative vision loss especially in patients with pre-existing glaucoma.
Question 5: Which action by the scrub technician demonstrates correct technique when passing a scalpel?
- Placing it handle-first in the surgeon's palm
- Placing it blade-up in a neutral zone for the surgeon to retrieve (Correct answer)
- Handing it blade-up directly into the surgeon's hand
- Wrapping the blade in gauze before handing it off
Correct answer: Placing it blade-up in a neutral zone for the surgeon to retrieve
Using a neutral zone (hands-free technique) to pass sharps is the safest method, reducing sharps injury risk to both scrub person and surgeon.
Question 6: An obese patient is placed in the lithotomy position. Which complication is specifically increased in this population?
- Radial nerve palsy
- Compartment syndrome of the lower extremities (Correct answer)
- Brachial plexus stretch injury
- Pressure injury to the occiput
Correct answer: Compartment syndrome of the lower extremities
Obese patients in lithotomy are at increased risk for lower extremity compartment syndrome due to elevated pressures from leg weight and restricted perfusion.
Question 7: Which medication is the first-line treatment for malignant hyperthermia?
- Succinylcholine
- Dantrolene sodium (Correct answer)
- Propofol
- Neostigmine
Correct answer: Dantrolene sodium
Dantrolene sodium is the specific antidote for MH; it inhibits calcium release from the sarcoplasmic reticulum, stopping the hypermetabolic cascade.
CNOR Intraoperative Care and Safety 3
Which type of fire triangle element is most commonly represented by surgical drapes in the OR?