CNOR Nursing MCQ 5 — Questions and Answers
Question 1: Malignant hyperthermia (MH) is triggered by which anesthetic agents? Select the combination the perioperative nurse should recognize.
- Propofol and midazolam
- Succinylcholine and volatile inhalational agents (Correct answer)
- Ketamine and fentanyl
- Vecuronium and isoflurane
Correct answer: Succinylcholine and volatile inhalational agents
Malignant hyperthermia is triggered by succinylcholine (a depolarizing neuromuscular blocker) and volatile inhalational anesthetic agents such as halothane, sevoflurane, and desflurane.
Question 2: When a patient develops suspected MH intraoperatively, what is the PRIORITY nursing action?
- Administer 100% oxygen and notify the attending anesthesiologist (Correct answer)
- Immediately administer dantrolene sodium
- Apply cooling blankets and ice packs to reduce temperature
- Obtain arterial blood gas and serum CK levels
Correct answer: Administer 100% oxygen and notify the attending anesthesiologist
The priority action is to notify anesthesia and provide 100% oxygen; dantrolene is then administered immediately, but it requires a physician order.
Question 3: Which preoperative skin antiseptic agent is CONTRAINDICATED near the eyes and ears?
- Povidone-iodine solution
- Chlorhexidine gluconate (CHG) (Correct answer)
- Isopropyl alcohol 70%
- Iodophor-based paint solutions
Correct answer: Chlorhexidine gluconate (CHG)
Chlorhexidine gluconate is ototoxic and can cause corneal damage, making it contraindicated for skin preparation near the eyes and ears.
Question 4: During a thyroidectomy, the surgeon requests a nerve integrity monitor (NIM) endotracheal tube. The perioperative nurse understands this device is used to monitor which structure?
- Phrenic nerve
- Recurrent laryngeal nerve (Correct answer)
- Hypoglossal nerve
- Vagus nerve at the carotid level
Correct answer: Recurrent laryngeal nerve
The NIM tube detects electromyographic signals from the vocalis muscle to monitor recurrent laryngeal nerve integrity during thyroid and parathyroid surgery.
Question 5: A patient receiving spinal anesthesia suddenly develops hypotension, bradycardia, and nausea. The perioperative nurse should recognize these as signs of:
- Anaphylaxis to the local anesthetic
- High spinal block affecting sympathetic fibers (Correct answer)
- Vasovagal syncope from surgical stimulation
- Pulmonary embolism
Correct answer: High spinal block affecting sympathetic fibers
A high or total spinal block causes widespread sympathetic blockade resulting in hypotension, bradycardia, and nausea due to loss of vascular tone.
Question 6: Which measure BEST prevents surgical site infection (SSI) related to operating room air quality?
- Using laminar airflow systems in orthopedic and implant rooms (Correct answer)
- Increasing OR temperature to above 72°F
- Limiting door traffic to fewer than 10 entries per case
- Wearing double gloves for all procedures
Correct answer: Using laminar airflow systems in orthopedic and implant rooms
Laminar airflow (HEPA-filtered unidirectional airflow) significantly reduces airborne particles and microbial contamination in high-risk implant and orthopedic procedures.
Question 7: The perioperative nurse documents that a specimen is sent to pathology as a 'frozen section.' What is the PRIMARY purpose of this intraoperative technique?
- To preserve tissue for permanent histological analysis
- To provide rapid diagnosis to guide intraoperative surgical decisions (Correct answer)
- To identify antibiotic sensitivities for postoperative treatment
- To determine tumor grade for chemotherapy planning
Correct answer: To provide rapid diagnosis to guide intraoperative surgical decisions
Frozen section allows rapid histopathological analysis within minutes so the surgeon can make real-time decisions about margins, lymph nodes, or tissue identity during the procedure.
CNOR Nursing MCQ 5
Malignant hyperthermia (MH) is triggered by which anesthetic agents? Select the combination the perioperative nurse should recognize.