CNOR Managing Emergency Situations 5 — Questions and Answers
Question 1: The circulating nurse notices the surgical smoke evacuator has stopped functioning. The PRIORITY concern is:
- Procedure delay cost
- Exposure of personnel and patient to carcinogenic surgical plume (Correct answer)
- Increased operative field visibility
- Noise reduction in the OR
Correct answer: Exposure of personnel and patient to carcinogenic surgical plume
Surgical smoke contains carcinogens, mutagens, and infectious particles; loss of smoke evacuation creates a direct health hazard for the patient and entire OR team.
Question 2: A patient with an implanted pacemaker is scheduled for electrosurgery. Which ESU setting BEST minimizes the risk of pacemaker interference?
- Use bipolar electrosurgery whenever possible (Correct answer)
- Use monopolar ESU at the highest available setting for speed
- Place the dispersive electrode on the patient's chest near the pacemaker
- Disable the pacemaker before the procedure
Correct answer: Use bipolar electrosurgery whenever possible
Bipolar electrosurgery limits current to the immediate tissue between the forceps tips, minimizing electromagnetic interference with implanted cardiac devices.
Question 3: During a robotic-assisted procedure, the robotic system experiences a critical malfunction and cannot be safely disengaged. The FIRST nursing priority is:
- Contact the robotic system manufacturer's technical support
- Follow the facility's robotic emergency protocol and alert the surgeon (Correct answer)
- Attempt to manually override the robotic arms
- Document the malfunction in the electronic health record
Correct answer: Follow the facility's robotic emergency protocol and alert the surgeon
Patient safety requires immediate activation of the facility's emergency robotic protocol and alerting the surgeon to take control and prevent patient injury.
Question 4: Which sign differentiates tension pneumothorax from simple pneumothorax in the intraoperative setting?
- Absent breath sounds on the affected side only
- Tracheal deviation toward the affected side
- Hypotension with distended neck veins and tracheal deviation away from the affected side (Correct answer)
- Pleuritic chest pain reported by the awake patient
Correct answer: Hypotension with distended neck veins and tracheal deviation away from the affected side
Tension pneumothorax causes mediastinal shift away from the affected side, leading to tracheal deviation away, hypotension, and elevated venous pressure — a surgical emergency.
Question 5: A patient on the OR table develops ST-elevation on the cardiac monitor during a non-cardiac procedure. The nurse should:
- Continue the procedure and recheck in 5 minutes
- Notify the anesthesia provider and surgeon immediately and prepare for potential cardiac intervention (Correct answer)
- Administer aspirin 325mg per standing order
- Increase the rate of intravenous fluids
Correct answer: Notify the anesthesia provider and surgeon immediately and prepare for potential cardiac intervention
ST elevation suggests myocardial infarction; immediate notification of the anesthesia and surgical team is essential to decide whether to continue, abort, or modify the procedure.
Question 6: When a sharps injury occurs to a scrub person during an active procedure, the FIRST action is:
- Stop the procedure to complete an incident report immediately
- Pass the sharp off the field, allow the scrub to wash the wound, and have a replacement scrub relieve them (Correct answer)
- Continue the procedure and report the injury after the case
- Remove the contaminated glove and apply a sterile glove over the injured hand
Correct answer: Pass the sharp off the field, allow the scrub to wash the wound, and have a replacement scrub relieve them
Immediate wound care is the priority; passing the sharp off the field and replacing the scrub person allows proper wound management while maintaining sterile field integrity.
Question 7: The perioperative nurse's role during a 'code blue' in the OR includes all of the following EXCEPT:
- Obtaining the crash cart and defibrillator
- Assuming the role of team leader for the resuscitation (Correct answer)
- Documenting interventions and timing
- Assisting with chest compressions as assigned
Correct answer: Assuming the role of team leader for the resuscitation
The anesthesia provider or most senior clinician typically leads OR resuscitation; the circulating nurse's role is to support the team with supplies, documentation, and compressions as assigned.
CNOR Managing Emergency Situations 5
The circulating nurse notices the surgical smoke evacuator has stopped functioning.
The PRIORITY concern is: