CNOR Managing Emergency Situations 3 — Questions and Answers
Question 1: Which scenario BEST represents a 'never event' requiring immediate reporting per CMS guidelines in the perioperative setting?
- A patient requires a blood transfusion intraoperatively
- A retained surgical sponge is discovered on post-op imaging (Correct answer)
- The patient's procedure takes longer than planned
- A sterile field is broken and re-established
Correct answer: A retained surgical sponge is discovered on post-op imaging
Retained surgical items (RSIs) are classified as never events by CMS and require immediate reporting, root cause analysis, and corrective action.
Question 2: A fire ignites in the surgical field. Per the RACE mnemonic, the FIRST step is:
- Activate the alarm
- Confine the fire by closing doors
- Extinguish the fire
- Rescue patients in immediate danger (Correct answer)
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 3: An OR fire involving dry surgical drapes is BEST extinguished using which type of fire extinguisher?
- Class K (wet chemical)
- Class C (carbon dioxide)
- Class A (water-based) (Correct answer)
- Class D (dry powder)
Correct answer: Class A (water-based)
Class A fires involve ordinary combustibles like drapes and paper; a Class A water-based extinguisher or CO2 can be used, but Class A designation covers ordinary combustible materials in the OR.
Question 4: During a procedure under local anesthesia, a patient reports sudden chest tightness and difficulty breathing. The nurse's FIRST action should be:
- Administer supplemental oxygen and notify the surgeon (Correct answer)
- Perform a 12-lead ECG immediately
- Transfer the patient to the ICU
- Administer an anxiolytic
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 5: 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 6: The MH Hotline number that perioperative staff should have posted in the OR is:
- 1-800-MH-HYPER
- 1-800-644-9737 (Correct answer)
- 1-888-MALIGNANT
- 1-800-555-0199
Correct answer: 1-800-644-9737
The MHAUS (Malignant Hyperthermia Association of the United States) 24-hour hotline is 1-800-644-9737 (1-800-MH-HYPER).
Question 7: 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.
CNOR Managing Emergency Situations 3
Which scenario BEST represents a 'never event' requiring immediate reporting per CMS guidelines in the perioperative setting?