CNOR Intraoperative Care and Safety 5 — Questions and Answers
Question 1: When a flash (immediate-use) sterilization cycle is used for a dropped instrument, what documentation is required?
- Only physical cycle parameters need to be recorded
- The patient's name, implant status, reason for flash sterilization, and cycle parameters must be documented (Correct answer)
- No documentation is required for emergency flash cycles
- Only the sterilizer ID and time need to be logged
Correct answer: The patient's name, implant status, reason for flash sterilization, and cycle parameters must be documented
AORN and AAMI guidelines require complete documentation including patient identification, reason, implant/non-implant status, and cycle parameters for every flash sterilization cycle.
Question 2: A patient's blood pressure drops suddenly during a procedure using spinal anesthesia. Which positioning intervention can help reverse this hypotension?
- Place the patient in Trendelenburg position (Correct answer)
- Raise both legs using lithotomy stirrups
- Place the patient in reverse Trendelenburg position
- Turn the patient to the lateral position
Correct answer: Place the patient in Trendelenburg position
Trendelenburg (head-down) positioning increases venous return to the heart, which can temporarily raise blood pressure in spinal-anesthesia-induced hypotension.
Question 3: 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 4: Which grounding pad placement site is contraindicated for a monopolar ESU dispersive electrode?
- The outer thigh
- Over a bony prominence or scar tissue (Correct answer)
- The lower abdomen
- The upper arm ipsilateral to the surgical site
Correct answer: Over a bony prominence or scar tissue
Bony prominences and scar tissue have poor vascularity and uneven contact, increasing current density and the risk of burns at the dispersive electrode site.
Question 5: A scrub person drops a sponge off the sterile field. What is the correct action?
- Pick it up with a ring forceps and return it to the sterile field
- Kick it under the table and exclude it from the count
- Isolate it from the sterile field and inform the circulator to account for it in the count (Correct answer)
- Discard it in the kick bucket and subtract from the count silently
Correct answer: Isolate it from the sterile field and inform the circulator to account for it in the count
The dropped sponge must be isolated from the sterile field and the circulator must immediately account for it to maintain an accurate running count.
Question 6: What does a biological indicator (BI) confirm during sterilization monitoring?
- That the correct temperature was reached inside the sterilizer chamber
- That sterilization conditions were adequate to kill highly resistant bacterial spores (Correct answer)
- That all chemical indicators inside the package changed color
- That the sterilizer passed its mechanical printout review
Correct answer: That sterilization conditions were adequate to kill highly resistant bacterial spores
Biological indicators contain highly resistant bacterial spores (e.g., Geobacillus stearothermophilus) and are the gold standard to confirm the sterilization process achieved lethality.
Question 7: During a procedure, the circulating nurse observes that the sterile drape has become wet from a spill underneath. What should be done?
- Cover the wet area with additional sterile towels and continue
- Consider the area contaminated and change the drape (Correct answer)
- Blot the wet area dry with sterile gauze and continue
- Notify the surgeon and wait for the drape to dry before proceeding
Correct answer: Consider the area contaminated and change the drape
Strike-through contamination occurs when moisture creates a pathway for microorganisms through the drape; a wet drape must be considered contaminated and replaced.
CNOR Intraoperative Care and Safety 5
When a flash (immediate-use) sterilization cycle is used for a dropped instrument, what documentation is required?