CNOR Certification Exam — Questions and Answers

Question 1: Which is the correct criterion for removing a surgical case from an IUSS (immediate-use steam sterilization) cycle and using the item?

The item is cooled, double-wrapped, and stored for up to 24 hours
The biological and chemical indicators confirm a successful cycle and the item is used immediately without storage (Correct answer)
Only a chemical indicator is needed; biological monitoring is optional for IUSS
The operator visually confirms steam penetration before releasing the item

Correct answer: The biological and chemical indicators confirm a successful cycle and the item is used immediately without storage

IUSS items must pass all cycle parameters and be delivered immediately to the sterile field without storage, wrapping, or delay.

Question 2: Which layer of padding is recommended FIRST when protecting bony prominences from pressure injury during surgery?

Foam padding directly applied to skin
A layer of egg-crate foam over a gel pad
Adhesive hydrocolloid dressing applied before foam
Soft absorbent material (e.g., cotton batting or foam) directly against the skin (Correct answer)

Correct answer: Soft absorbent material (e.g., cotton batting or foam) directly against the skin

Soft, non-adhesive padding material should be applied directly against the skin first to absorb moisture and cushion the bony prominence before additional supportive layers.

Question 3: During a surgical timeout, which team member has the authority to call a stop if a safety concern is raised?

Only the circulating nurse
Only the surgeon
Any member of the surgical team (Correct answer)
Only the anesthesiologist

Correct answer: Any member of the surgical team

Any member of the surgical team has both the authority and the responsibility to call a stop when a safety concern arises during the timeout.

Question 4: What is the primary purpose of the surgical hand scrub performed before donning sterile gloves?

To remove all resident flora permanently
To remove transient flora and reduce resident flora to as low a level as possible (Correct answer)
To substitute for wearing sterile gloves during minor procedures
To completely sterilize the hands

Correct answer: To remove transient flora and reduce resident flora to as low a level as possible

The surgical hand scrub reduces microbial counts on the hands but cannot achieve sterilization; it eliminates transients and suppresses residents.

Question 5: Which position places the patient flat on their back with arms extended on armboards?

Prone
Supine (Correct answer)
Lithotomy
Lateral

Correct answer: Supine

The supine (dorsal recumbent) position places the patient flat on their back, the most common surgical position used for abdominal, thoracic, and many other procedures.

Question 6: A patient scheduled for a laparoscopic cholecystectomy tells the perioperative nurse they have changed their mind and want to cancel the surgery. The nurse should:

Administer pre-medication to calm the patient before reconsidering
Reassure the patient and proceed as planned
Remind the patient of financial penalties for last-minute cancellations
Notify the surgeon and support the patient's right to withdraw consent (Correct answer)

Correct answer: Notify the surgeon and support the patient's right to withdraw consent

A competent patient retains the right to withdraw informed consent at any time, and the care team must be notified immediately.

Question 7: A 68-year-old male is scheduled for a total knee arthroplasty. His medical history includes well-controlled hypertension and type 2 diabetes managed with oral medication. He quit smoking 10 years ago and has no other systemic diseases. According to the American Society of Anesthesiologists (ASA) Physical Status Classification System, which classification would be most appropriate for this patient?

ASA II (Correct answer)
ASA IV
ASA III
ASA I

Correct answer: ASA II

The ASA Physical Status Classification System categorizes patients based on their overall health and the presence of systemic disease. An ASA II classification is for a patient with mild systemic disease. This patient's well-controlled hypertension and type 2 diabetes fall into this category. ASA I is a normal healthy patient. ASA III is a patient with severe systemic disease. ASA IV is a patient with severe systemic disease that is a constant threat to life.

Question 8: What is the minimum number of identifiers required to correctly identify a patient before a surgical procedure?

One
Three
Two (Correct answer)
Four

Correct answer: Two

The Joint Commission and AORN require at least two patient identifiers (such as name and date of birth) before any procedure.

Question 9: During a surgical emergency, the surgeon gives the circulating nurse a verbal order for a critical medication. To ensure patient safety and proper documentation, what is the nurse's MOST important immediate action after receiving the order?

Wait for the surgeon to enter the order into the electronic health record before acting.
Write down the order and then read it back to the surgeon for verification. (Correct answer)
Ask the scrub person to confirm they also heard the order.
Administer the medication as quickly as possible.

Correct answer: Write down the order and then read it back to the surgeon for verification.

The single most critical step to prevent errors from verbal orders is the 'read-back' process. The nurse should first write down the order (to avoid memory errors) and then verbally read the complete order back to the prescriber. [8, 17, 30] This allows the prescriber to confirm that the order was heard and transcribed correctly before the medication is administered. Waiting for electronic entry is not practical in an emergency, and while a witness is helpful, the direct read-back to the prescriber is the primary safety check.

Question 10: A patient on the OR table develops ST-elevation on the cardiac monitor during a non-cardiac procedure. The nurse should:

Administer aspirin 325mg per standing order
Notify the anesthesia provider and surgeon immediately and prepare for potential cardiac intervention (Correct answer)
Increase the rate of intravenous fluids
Continue the procedure and recheck in 5 minutes

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 11: Which scenario BEST represents a 'never event' requiring immediate reporting per CMS guidelines in the perioperative setting?

The patient's procedure takes longer than planned
A sterile field is broken and re-established
A patient requires a blood transfusion intraoperatively
A retained surgical sponge is discovered on post-op imaging (Correct answer)

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 12: When documenting informed consent during the preoperative phase, the perioperative nurse's role is to:

Determine if the patient has decision-making capacity
Obtain the patient's signature on the consent form
Explain the surgical procedure, risks, and alternatives to the patient
Witness the patient's signature after confirming the surgeon explained the procedure (Correct answer)

Correct answer: Witness the patient's signature after confirming the surgeon explained the procedure

The nurse's role in informed consent is to witness the signature after verifying that the surgeon has provided the explanation; obtaining consent is the surgeon's responsibility.

Question 13: Polyglactin 910 (Vicryl) is an example of which type of suture?

Synthetic absorbable braided suture (Correct answer)
Stainless steel wire
Natural nonabsorbable suture
Nonabsorbable monofilament

Correct answer: Synthetic absorbable braided suture

Vicryl (polyglactin 910) is a synthetic braided absorbable suture that loses most of its tensile strength by 3–4 weeks.

Question 14: A patient expresses significant fear and anxiety about the upcoming surgery. The perioperative nurse's most therapeutic response is to:

Acknowledge the patient's feelings and provide specific information about what to expect (Correct answer)
Refer all emotional concerns to the surgeon
Administer the prescribed anxiolytic immediately
Tell the patient everything will be fine and not to worry

Correct answer: Acknowledge the patient's feelings and provide specific information about what to expect

Acknowledging anxiety and providing accurate procedural information is evidence-based and helps reduce preoperative fear.

Question 15: During a procedure, a sterile instrument accidentally contacts the anesthesia screen. The instrument should be:

Considered contaminated and removed from the sterile field (Correct answer)
Rinsed with sterile saline before reuse
Returned to the back table if no visible contamination is present
Wiped with a sterile towel and returned to use

Correct answer: Considered contaminated and removed from the sterile field

The anesthesia screen is in the unsterile anesthesia zone; any item contacting it is immediately considered contaminated.

Question 16: Which retractor type is self-retaining and does not require a team member to hold it?

Deaver retractor
Balfour retractor (Correct answer)
Army-Navy retractor
Richardson retractor

Correct answer: Balfour retractor

The Balfour retractor is a self-retaining abdominal retractor that locks in place, freeing team members for other tasks.

Question 17: A patient scheduled for outpatient surgery under general anesthesia has a BMI of 42. Which preoperative assessment is most critical?

Liver function tests
Serum lipid levels
Airway assessment and respiratory function (Correct answer)
Nutritional status and serum albumin

Correct answer: Airway assessment and respiratory function

Morbid obesity significantly increases the risk of difficult intubation and respiratory complications requiring thorough airway and pulmonary assessment.

Question 18: Which medication is the first-line treatment for malignant hyperthermia?

Propofol
Succinylcholine
Dantrolene sodium (Correct answer)
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.

Question 19: A surgical tray wrapped for terminal sterilization has been processed in a steam autoclave. The external chemical indicator on the wrapper has changed color, but the internal chemical indicator has not. What is the MOST appropriate action?

Use the instruments, as the external indicator confirms exposure to the sterilant.
Send the tray for immediate-use steam sterilization (IUSS) to ensure sterility.
Open the tray but separate the instruments in the middle from those on the outside.
Consider the entire tray unsterile and remove it from service for reprocessing. (Correct answer)

Correct answer: Consider the entire tray unsterile and remove it from service for reprocessing.

The external indicator only shows that the pack has been exposed to the sterilization process. The internal indicator demonstrates that the sterilant (e.g., steam) has penetrated the package and reached the instruments inside. A failed internal indicator means the sterilization parameters were not met within the tray, rendering the contents unsterile and unsafe for use. The entire tray must be reprocessed.

Question 20: What does the acronym 'STSR' stand for in the perioperative setting?

Sterilization Tracking and Safety Report
Surgical Technologist in Scrub Role (Correct answer)
Sterile Technique and Safety Record
Standardized Tray Setup Reference

Correct answer: Surgical Technologist in Scrub Role

STSR stands for Surgical Technologist in Scrub Role, referring to the allied health professional who serves as the primary scrub person during surgery.

Question 21: Which instrument is used to approximate wound edges during fascial closure?

Needle holder only without tissue graspers
Kocher or Allis clamp used to grasp fascia while placing sutures (Correct answer)
Metzenbaum scissors
Towel clip

Correct answer: Kocher or Allis clamp used to grasp fascia while placing sutures

Kocher or Allis clamps are used to grasp and approximate fascial edges while the surgeon places closure sutures.

Question 22: Which of the following patient statements during a preoperative assessment would indicate the highest risk for a potential latex allergy?

"My lips swell whenever I eat bananas or avocados." (Correct answer)
"I am allergic to penicillin."
"I have a family history of seasonal allergies."
"I get a rash from the adhesive on bandages."

Correct answer: "My lips swell whenever I eat bananas or avocados."

There is a known cross-reactivity between latex and certain foods, including bananas, avocados, kiwis, and chestnuts. A patient reporting an allergic reaction to these foods is at a significantly higher risk for a latex allergy. While an allergy to tape adhesive can indicate sensitivity, the food cross-reactivity is a stronger predictor. Seasonal allergies and penicillin allergies are not directly related to latex allergies.

Question 23: Which question is most important when assessing fall risk during the preoperative period?

Do you use any assistive devices for ambulation? (Correct answer)
Have you ever had a broken bone?
Do you follow a regular exercise program?
How many hours of sleep do you get per night?

Correct answer: Do you use any assistive devices for ambulation?

Use of assistive devices indicates impaired mobility and balance, which are key indicators of fall risk in the perioperative setting.

Question 24: The perioperative nurse is reviewing the preoperative laboratory results for a 55-year-old female scheduled for a total abdominal hysterectomy. The nurse notes a serum potassium level of 2.8 mEq/L. What is the nurse's primary concern?

Increased risk of postoperative infection.
Potential for intraoperative hypoglycemia.
Impaired wound healing.
Risk of cardiac dysrhythmias under anesthesia. (Correct answer)

Correct answer: Risk of cardiac dysrhythmias under anesthesia.

The normal range for serum potassium is typically 3.5 to 5.0 mEq/L. A level of 2.8 mEq/L indicates hypokalemia, which can increase the risk of cardiac irritability and lead to life-threatening dysrhythmias, especially during anesthesia and surgery. This finding must be reported to the anesthesia and surgical teams immediately for correction before the procedure.

Question 25: What is the minimum required concentration of isopropyl alcohol for a waterless alcohol-based surgical hand rub to be considered effective?

60–95% alcohol (Correct answer)
30–50% alcohol
Greater than 95% alcohol
10–30% alcohol

Correct answer: 60–95% alcohol

The CDC recommends alcohol-based hand hygiene products containing 60–95% alcohol for effective antimicrobial activity.

Question 26: The term 'asepsis' in the perioperative setting refers to:

Absence of pathogenic microorganisms to prevent infection (Correct answer)
Sterilization of all surgical instruments
Elimination of all microorganisms from a surface
Use of antibiotics prophylactically before surgery

Correct answer: Absence of pathogenic microorganisms to prevent infection

Asepsis refers to the absence of pathogenic microorganisms and the practices used to prevent infection during surgical procedures.

Question 27: A patient reports a previous anesthetic complication where they experienced a very high fever and muscle rigidity during surgery. The nurse should prioritize communicating this history because it suggests:

Chronic pain disorder
Malignant hyperthermia susceptibility (Correct answer)
An allergy to latex
An adverse reaction to antibiotics

Correct answer: Malignant hyperthermia susceptibility

Malignant hyperthermia is a life-threatening pharmacogenetic disorder triggered by certain anesthetic agents, requiring specific preparation and alternative agents.

Question 28: Which principle of surgical asepsis states that sterile items placed below the patient's waist level are considered contaminated?

The sterile field must remain in constant view
Items of questionable sterility are considered contaminated
Sterile persons and items contact only sterile areas
Sterile tables are sterile only at table level (Correct answer)

Correct answer: Sterile tables are sterile only at table level

A fundamental aseptic principle is that the sterile drape is only considered sterile at table level; anything that falls or is lowered below this level is contaminated.

Question 29: A patient who is a Jehovah's Witness is scheduled for a procedure with anticipated blood loss. The preoperative nurse's priority is to:

Document the patient's wishes regarding blood transfusion and notify the surgical team (Correct answer)
Refuse to participate in the procedure
Arrange for blood products to be available without informing the patient
Administer iron supplements without consent

Correct answer: Document the patient's wishes regarding blood transfusion and notify the surgical team

Respecting patient autonomy requires documenting refusal of blood products and communicating this to all team members to plan accordingly.

Question 30: When applying a tourniquet to the upper extremity, what is the maximum recommended inflation time before deflation and reperfusion?

90 minutes (Correct answer)
30 minutes
120 minutes
60 minutes

Correct answer: 90 minutes

Most guidelines recommend deflating pneumatic tourniquets after no more than 90 minutes on the upper extremity to prevent ischemic nerve and muscle injury.

Question 31: Which class of SSI involves infection only of the skin and subcutaneous tissue of the incision?

Remote infection
Deep incisional SSI
Superficial incisional SSI (Correct answer)
Organ/space SSI

Correct answer: Superficial incisional SSI

A superficial incisional SSI is limited to the skin and subcutaneous tissue without involvement of deeper fascial layers.

Question 32: A patient undergoing general anesthesia develops masseter muscle rigidity after succinylcholine administration. The perioperative nurse should FIRST:

Position the patient in Trendelenburg
Increase the anesthetic gas concentration
Administer a second dose of succinylcholine
Alert the team to potential malignant hyperthermia (Correct answer)

Correct answer: Alert the team to potential malignant hyperthermia

Masseter muscle rigidity after succinylcholine is a classic early warning sign of malignant hyperthermia and the entire team must be alerted immediately.

Question 33: During a malignant hyperthermia (MH) crisis, which medication is the FIRST-LINE treatment?

Succinylcholine
Propofol
Epinephrine
Dantrolene sodium (Correct answer)

Correct answer: Dantrolene sodium

Dantrolene sodium is the specific antidote for malignant hyperthermia and must be administered immediately upon recognition of MH crisis.

Question 34: The nurse is reviewing a preoperative checklist and notes the surgical site has not been marked. What is the correct action?

Notify the surgeon to mark the site before the patient enters the OR (Correct answer)
Mark the site using the operative report as a guide
Ask the anesthesia provider to mark the site
Proceed since the OR team will identify the site during the time-out

Correct answer: Notify the surgeon to mark the site before the patient enters the OR

Per AORN guidelines and Universal Protocol, the surgeon (or licensed independent practitioner performing the procedure) is responsible for marking the surgical site.

Question 35: During a procedure under local anesthesia, a patient reports sudden chest tightness and difficulty breathing. The nurse's FIRST action should be:

Administer an anxiolytic
Perform a 12-lead ECG immediately
Transfer the patient to the ICU
Administer supplemental oxygen and notify the surgeon (Correct answer)

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 36: Which sign differentiates tension pneumothorax from simple pneumothorax in the intraoperative setting?

Hypotension with distended neck veins and tracheal deviation away from the affected side (Correct answer)
Tracheal deviation toward the affected side
Absent breath sounds on the affected side only
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 37: What does the term 'chain of custody' mean in the context of intraoperative specimen handling?

The process of sterilizing instruments before and after a case
The sequence of nurses assigned to a patient's care
The order in which surgeons perform a procedure
The documented transfer of a specimen from collection to the laboratory, maintaining accountability at each step (Correct answer)

Correct answer: The documented transfer of a specimen from collection to the laboratory, maintaining accountability at each step

Chain of custody documents every person who handles a specimen, ensuring its integrity and traceability from collection through laboratory analysis.

Question 38: The circulating nurse notices the surgical smoke evacuator has stopped functioning. The PRIORITY concern is:

Noise reduction in the OR
Exposure of personnel and patient to carcinogenic surgical plume (Correct answer)
Increased operative field visibility
Procedure delay cost

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 39: Which principle guides the documentation of a critical event such as unexpected hemorrhage during surgery?

Have the surgeon document the event to avoid liability
Record events in real time or as close to real time as possible with accurate timestamps (Correct answer)
Delay documentation until after the patient is stable
Document only the final outcome of the event

Correct answer: Record events in real time or as close to real time as possible with accurate timestamps

Real-time or near-real-time documentation with accurate timestamps provides the most legally defensible and clinically accurate account of critical intraoperative events.

Question 40: Which organization sets the primary scope and standards of perioperative nursing practice in the United States?

The Joint Commission (TJC)
The American Nurses Association (ANA)
AORN (Association of periOperative Registered Nurses) (Correct answer)
The National Council of State Boards of Nursing (NCSBN)

Correct answer: AORN (Association of periOperative Registered Nurses)

AORN establishes the guidelines, standards, and recommended practices specific to perioperative nursing practice.

Question 41: A preoperative patient with known renal insufficiency is scheduled for a procedure requiring IV contrast. The perioperative nurse's priority action is to:

Check creatinine level and hold the procedure if elevated
Increase oral fluid intake the morning of surgery
Administer the contrast without concern since it is IV
Notify the radiologist and surgeon of the renal insufficiency before contrast administration (Correct answer)

Correct answer: Notify the radiologist and surgeon of the renal insufficiency before contrast administration

Renal insufficiency is a major risk factor for contrast-induced nephropathy and must be communicated to allow for preventive strategies or alternative imaging.

Question 42: A pediatric patient is brought to the preoperative area accompanied by both parents and a stepparent. Which individual(s) can legally provide informed consent?

The stepparent if married to the custodial parent
The biological or legal guardian with legal custody (Correct answer)
Only the biological mother
Any of the three adults present

Correct answer: The biological or legal guardian with legal custody

Informed consent for a minor must be obtained from the individual with legal custody or legal guardianship.

Question 43: According to The Joint Commission's Universal Protocol, what is the final step performed in the operating room, just before the initial incision, to confirm the correct patient, procedure, and site?

Time-out (Correct answer)
Patient identification
Surgical site marking
Preoperative verification

Correct answer: Time-out

The "time-out" is a critical safety check and the final step of the Universal Protocol. It is conducted immediately before the start of the invasive procedure or incision. The entire surgical team actively communicates and confirms the correct patient, correct procedure, and correct surgical site. Preoperative verification and site marking are earlier, essential components of the protocol.

Question 44: A surgeon asks the perioperative nurse to sign off on a surgical count that the nurse did not personally perform. The nurse should:

Sign the form because the surgeon was present during the count
Ask another nurse to sign in their place
Sign only if the count results appear correct upon visual inspection
Refuse to sign and explain that falsifying records is an ethical and legal violation (Correct answer)

Correct answer: Refuse to sign and explain that falsifying records is an ethical and legal violation

Signing documentation you did not perform is falsification of records, which is both an ethical breach and a legal violation.

Question 45: A 68-year-old patient reports occasional confusion and memory lapses. Which preoperative assessment tool is most appropriate to screen for cognitive baseline?

Braden Scale
Glasgow Coma Scale
Mini-Mental State Examination (MMSE) (Correct answer)
AUDIT-C questionnaire

Correct answer: Mini-Mental State Examination (MMSE)

The MMSE is a validated tool for assessing cognitive function and establishing a baseline to monitor for postoperative delirium.

Question 46: Which action is required when a sterile package is found with a small hole or tear before opening?

The item can be used if the hole is smaller than 2 mm
The hole can be covered with sterile tape and the item used immediately
The package must be considered contaminated and returned to SPD for reprocessing (Correct answer)
The circulator inspects the contents; if uncontaminated, use is acceptable

Correct answer: The package must be considered contaminated and returned to SPD for reprocessing

Any compromised packaging — holes, tears, moisture, or missing seals — renders the item non-sterile and it must be reprocessed.

Question 47: The purpose of applying cricoid pressure (Sellick's maneuver) during rapid sequence induction (RSI) is to:

Prevent laryngospasm
Increase oxygen delivery to the alveoli
Facilitate laryngoscopy visualization
Occlude the esophagus to prevent passive regurgitation (Correct answer)

Correct answer: Occlude the esophagus to prevent passive regurgitation

Cricoid pressure compresses the esophagus against the vertebral body, reducing the risk of passive regurgitation and aspiration during RSI.

Question 48: A sterile team member contaminates their glove by touching the back table below table level. What is the correct response?

Apply a sterile glove over the contaminated one
Continue the procedure if the contamination was minor
Re-glove using open gloving technique
Re-gown and re-glove using closed gloving technique (Correct answer)

Correct answer: Re-gown and re-glove using closed gloving technique

Any break in sterility requires re-gowning and re-gloving; closed gloving technique maintains sterility of the new gloves.

Question 49: When opening a sterile package, which action correctly maintains sterility?

Open all flaps simultaneously to minimize exposure time
Hold the package at waist level while opening all flaps
Open the flap closest to you first
Open the far flap first, then the sides, then the near flap (Correct answer)

Correct answer: Open the far flap first, then the sides, then the near flap

Opening the far flap first prevents reaching over the sterile field, then sides, and finally the near flap toward the body.

Question 50: In a 'can't intubate, can't oxygenate' (CICO) airway emergency, the DEFINITIVE rescue intervention is:

Repeated laryngoscopy attempts with a different blade
Nasopharyngeal airway insertion
Cricothyrotomy (Correct answer)
Bag-valve-mask ventilation with two providers

Correct answer: Cricothyrotomy

Cricothyrotomy is the definitive surgical airway rescue procedure when all other airway management attempts have failed in a CICO emergency.

Question 51: Which volatile anesthetic agent is associated with the highest risk of malignant hyperthermia triggering?

Desflurane (Correct answer)
Sevoflurane
Nitrous oxide
Propofol

Correct answer: Desflurane

All halogenated volatile agents including desflurane can trigger malignant hyperthermia, but desflurane is particularly potent; propofol and nitrous oxide are considered safe.

Question 52: Which preoperative assessment finding requires the nurse to question the antibiotic prophylaxis order?

The patient reports a severe allergy to penicillin with anaphylaxis (Correct answer)
The patient's surgery is scheduled to start in 2 hours
The patient has a history of MRSA decolonization
The patient's weight is 95 kg

Correct answer: The patient reports a severe allergy to penicillin with anaphylaxis

A severe penicillin allergy with anaphylaxis requires verification and likely substitution of cephalosporins or other beta-lactam antibiotics in the prophylaxis order.

Question 53: When a sterile field is broken, what is the primary documentation and communication action required?

Immediately report the breach to the surgeon and document the event, corrective action taken, and patient notification (Correct answer)
Document it only if a patient complication occurs
Address the breach silently to avoid disrupting the team
File an incident report only after the case is complete

Correct answer: Immediately report the breach to the surgeon and document the event, corrective action taken, and patient notification

A break in sterile technique must be immediately communicated to the surgeon and documented along with the corrective action taken to maintain patient safety.

Question 54: A sterile field has been set up and left unattended for 30 minutes. The appropriate action is to:

Inspect it visually and proceed if no contaminants are visible
Cover it with a sterile drape and continue using it
Consider it contaminated and re-establish the sterile field (Correct answer)
Use it if the room was unoccupied during the 30 minutes

Correct answer: Consider it contaminated and re-establish the sterile field

An unattended sterile field cannot be guaranteed sterile; it must be considered contaminated and re-established.

Question 55: A surgical technologist has a needlestick injury during a case. What is the first action to take?

Apply an alcohol swab to the puncture site and continue
Immediately remove glove, wash the wound with soap and water, and report to supervisor (Correct answer)
Finish the case and report to employee health afterward
Squeeze the wound to remove blood and then apply a sterile dressing

Correct answer: Immediately remove glove, wash the wound with soap and water, and report to supervisor

Immediate wound washing with soap and water followed by prompt reporting initiates the exposure response protocol.

Question 56: A patient is scheduled for surgery under regional anesthesia. Which preoperative assessment finding would most likely change the anesthetic plan?

Mild hypertension controlled with medication
BMI of 27
A history of general anesthesia with no complications
Anticoagulant therapy with recent therapeutic INR of 2.8 (Correct answer)

Correct answer: Anticoagulant therapy with recent therapeutic INR of 2.8

Therapeutic anticoagulation significantly increases the risk of spinal hematoma with neuraxial anesthesia.

Question 57: During sterile gloving using the closed-glove technique, which statement is correct?

The gloves may be donned before the gown to protect the hands
The hands remain inside the gown sleeves while the gloves are donned (Correct answer)
The gown cuff is pulled back to expose the hand before donning the glove
The circulator assists by holding the glove open for the scrub person

Correct answer: The hands remain inside the gown sleeves while the gloves are donned

In closed-glove technique, the hands remain inside the gown sleeves throughout glove donning, preventing ungloved skin from touching the exterior of the sterile glove.

Question 58: A Penrose drain differs from a Jackson-Pratt drain because it is:

A passive open drain relying on gravity and capillary action (Correct answer)
An active closed suction system
An electronic pressure-controlled device
Used only in thoracic surgery

Correct answer: A passive open drain relying on gravity and capillary action

A Penrose drain is a soft rubber tube that passively allows fluid to drain by gravity and capillary action without suction.

Question 59: An incorrect needle count is discovered after wound closure in a laparoscopic case. What is the most appropriate next step?

Document the discrepancy and notify risk management after the case
Notify the surgeon so an X-ray can be obtained before the patient leaves the OR (Correct answer)
File an incident report and notify the charge nurse only
Recount needles and if still incorrect, proceed with patient transfer

Correct answer: Notify the surgeon so an X-ray can be obtained before the patient leaves the OR

An incorrect needle count after closure requires immediate surgeon notification and an intraoperative X-ray to locate the missing needle.

Question 60: During a total hip arthroplasty, the OR experiences a complete power failure. The emergency generator fails to activate, resulting in a total loss of light and power to all equipment. Which of the following actions is the perioperative nurse's HIGHEST priority?

Begin manually ventilating the patient with an Ambu bag.
Locate the manual crank for the operating room bed.
Illuminate the surgical field and immediate patient area with emergency flashlights. (Correct answer)
Notify the hospital's engineering department of the failure.

Correct answer: Illuminate the surgical field and immediate patient area with emergency flashlights.

In a complete power failure, the immediate priority for the entire team is patient safety, which begins with providing adequate lighting. The circulating nurse should immediately use battery-powered flashlights or headlamps to illuminate the surgical field so the surgeon can control any bleeding and the anesthesia provider can assess the patient and equipment. While other actions like notifying engineering are important, they are secondary to ensuring the team can see to provide immediate, life-sustaining care. Manual ventilation is the responsibility of the anesthesia provider.

Question 61: Which parameter should the perioperative nurse monitor to detect malignant hyperthermia early?

End-tidal CO2 (Correct answer)
Blood glucose
Urine output
Central venous pressure

Correct answer: End-tidal CO2

A rapid rise in end-tidal CO2 is one of the earliest and most sensitive indicators of malignant hyperthermia due to hypermetabolism.

Question 62: When dantrolene is administered for malignant hyperthermia, what is the initial recommended dose?

5 mg/kg IV
10 mg/kg IV
0.5 mg/kg IV
2.5 mg/kg IV (Correct answer)

Correct answer: 2.5 mg/kg IV

The initial dose of dantrolene for malignant hyperthermia is 2.5 mg/kg IV, repeated every 5 minutes as needed up to 10 mg/kg.

Question 63: A patient is scheduled for a procedure under Monitored Anesthesia Care (MAC). What is a key characteristic that distinguishes MAC from moderate (conscious) sedation?

Capnography monitoring is considered optional and not a standard of care.
An anesthesia professional must be present and prepared to convert to general anesthesia if needed. (Correct answer)
The patient is expected to lose consciousness and all airway reflexes.
Only a specially trained registered nurse is required to administer the sedative medications.

Correct answer: An anesthesia professional must be present and prepared to convert to general anesthesia if needed.

The defining characteristic of Monitored Anesthesia Care (MAC) is the continuous presence of a qualified anesthesia professional (anesthesiologist or CRNA). This provider is skilled in managing the patient's airway and is prepared to deepen the level of sedation or convert to a general anesthetic if the patient's condition or surgical needs change, a requirement not present for nurse-administered moderate sedation.

Question 64: A scrub technician reports the electrosurgical unit (ESU) is not functioning during a procedure. The IMMEDIATE priority of the circulating nurse is to:

Reset the circuit breaker in the OR
Alert the surgeon and prepare for manual hemostasis alternatives (Correct answer)
Obtain a replacement ESU without stopping the procedure
Continue the procedure without electrosurgery

Correct answer: Alert the surgeon and prepare for manual hemostasis alternatives

Patient safety requires alerting the surgeon immediately so hemostasis can be maintained via alternative methods while the equipment issue is resolved.

Question 65: The 'time to first antibiotic dose' standard for surgical prophylaxis is:

Within 60 minutes before incision (120 minutes for vancomycin and fluoroquinolones) (Correct answer)
Administered at the discretion of the surgeon with no defined window
Administered 24 hours before surgery to achieve tissue levels
Given immediately after skin closure to prevent postoperative infection

Correct answer: Within 60 minutes before incision (120 minutes for vancomycin and fluoroquinolones)

Evidence-based guidelines require prophylactic antibiotics within 60 minutes of incision (extended to 120 minutes for vancomycin/fluoroquinolones) to achieve effective tissue concentrations.

Question 66: The American Society of PeriAnesthesia Nurses (ASPAN) and AORN recommend that intraoperative temperature be maintained at or above which threshold to prevent adverse outcomes?

37.5°C (99.5°F)
36.0°C (96.8°F) (Correct answer)
35.5°C (95.9°F)
34.5°C (94.1°F)

Correct answer: 36.0°C (96.8°F)

Maintaining core temperature at or above 36°C (96.8°F) is recommended to prevent complications of perioperative hypothermia including SSI, coagulopathy, and prolonged recovery.

Question 67: Malignant hyperthermia (MH) is triggered by which class of agents?

Opioid analgesics and benzodiazepines
Volatile inhalation anesthetics and succinylcholine (Correct answer)
Non-depolarizing neuromuscular blockers
Local anesthetics and vasopressors

Correct answer: Volatile inhalation anesthetics and succinylcholine

Malignant hyperthermia is triggered by volatile halogenated inhalation anesthetics (e.g., sevoflurane, desflurane) and the depolarizing muscle relaxant succinylcholine.

Question 68: Which zone of the operating room suite requires the highest level of air cleanliness and restricted access?

Restricted zone (Correct answer)
Transition zone
Unrestricted zone
Semi-restricted zone

Correct answer: Restricted zone

The restricted zone includes the operating rooms and requires masks, surgical attire, and the highest level of access control.

Question 69: A patient in the supine position develops hypotension shortly after positioning. The anesthesia provider suspects aortocaval compression. This is MOST likely in which patient population?

Pediatric patients under 10 kg
Elderly patients with pre-existing hypertension
Obese male patients undergoing abdominal surgery
Pregnant patients beyond 20 weeks gestation (Correct answer)

Correct answer: Pregnant patients beyond 20 weeks gestation

In pregnant patients beyond 20 weeks, the gravid uterus can compress the inferior vena cava and aorta in the supine position, causing significant hypotension.

Question 70: A patient develops intraoperative anaphylaxis to latex. After administering epinephrine, which intervention addresses the UNDERLYING trigger?

Administering a second dose of epinephrine prophylactically
Increasing anesthetic depth to suppress the response
Switching to non-latex gloves and removing all latex from the field (Correct answer)
Applying a tourniquet to slow allergen absorption

Correct answer: Switching to non-latex gloves and removing all latex from the field

Removing all latex products from the surgical field eliminates ongoing allergen exposure, which is essential to prevent continued or escalating anaphylaxis.

Question 71: How long must a perioperative RN practice before being eligible to sit for the CNOR exam?

2 years with 2,400 hours in perioperative nursing (Correct answer)
1 year with 1,200 hours in perioperative nursing
6 months with 300 hours in perioperative nursing
3 years with any clinical nursing experience

Correct answer: 2 years with 2,400 hours in perioperative nursing

CNOR eligibility requires an RN with 2 years (24 months) of perioperative nursing practice and a minimum of 2,400 hours in the specialty.

Question 72: Which of the following is an example of an 'error of omission' in perioperative documentation?

Using an unapproved abbreviation
Recording the wrong drug name
Failing to document a known allergy discovered during preoperative assessment (Correct answer)
Signing another nurse's entry

Correct answer: Failing to document a known allergy discovered during preoperative assessment

An error of omission occurs when relevant information—such as a newly identified allergy—is discovered but not recorded, leaving a dangerous gap in the medical record.

Question 73: Which component of SBAR communication represents the nurse's assessment of the patient's condition?

Background — relevant clinical history
Assessment — the nurse's clinical judgment (Correct answer)
Situation — what is happening now
Recommendation — proposed action needed

Correct answer: Assessment — the nurse's clinical judgment

The 'A' in SBAR stands for Assessment, where the nurse communicates her clinical interpretation of the situation.

Question 74: The perioperative nurse should recognize that nitrous oxide is CONTRAINDICATED in patients with:

Mild asthma
Type 1 diabetes
Pneumothorax or bowel obstruction (Correct answer)
Controlled hypertension

Correct answer: Pneumothorax or bowel obstruction

Nitrous oxide diffuses into closed gas-filled spaces faster than nitrogen exits, expanding volume and increasing pressure in pneumothorax or bowel obstruction.

Question 75: A patient undergoing preoperative assessment has a history of sleep apnea but does not use their CPAP device. The nurse's priority is to:

Document the history and inform the anesthesia team (Correct answer)
Proceed with surgery since CPAP is optional
Cancel the procedure immediately
Instruct the patient to bring their CPAP to the hospital

Correct answer: Document the history and inform the anesthesia team

Sleep apnea significantly affects anesthetic management and respiratory monitoring; the anesthesia provider must be informed.

Question 76: Which patient position is CONTRAINDICATED in a patient with suspected air embolism detected intraoperatively?

Left lateral decubitus (Durant's maneuver)
Right lateral decubitus
Head of bed elevated 30 degrees (Correct answer)
Trendelenburg

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 77: Which type of surgical fire requires a Class C fire extinguisher?

Drape fire from alcohol-based prep
Electrical equipment fire (Correct answer)
Oxygen-enriched airway fire
Laparoscopic gas ignition

Correct answer: Electrical equipment fire

Class C extinguishers are designed for energized electrical equipment fires, using non-conductive agents like CO2 or dry chemical.

Question 78: When assessing a patient's airway preoperatively, the nurse notes a Mallampati class IV. This finding suggests:

General anesthesia is contraindicated
Easy intubation is anticipated
Regional anesthesia will not be effective
Potentially difficult intubation requiring advance planning (Correct answer)

Correct answer: Potentially difficult intubation requiring advance planning

Mallampati class IV indicates minimal pharyngeal structures are visible, suggesting a potentially difficult airway for intubation.

Question 79: Which of the following is the primary strategy for preventing an operating room fire when an electrosurgical unit (ESU) is in use?

Keeping the ESU power setting below 30 watts.
Allowing all alcohol-based prep solutions to fully dry. (Correct answer)
Using only non-flammable anesthetic gases.
Ensuring the surgical site is completely dry before activation.

Correct answer: Allowing all alcohol-based prep solutions to fully dry.

The fire triangle consists of an ignition source (ESU), a fuel source (e.g., alcohol-based prep), and an oxidizer (e.g., oxygen). Allowing flammable agents like alcohol-based skin prep to fully dry and for vapors to dissipate is a critical step to eliminate the fuel source and prevent a surgical fire. While other options are components of fire safety, pooled or vaporized alcohol prep is a common and preventable fuel source.

Question 80: The concept of 'moral distress' in perioperative nursing occurs when a nurse:

Knows the right action but is prevented from taking it by institutional constraints (Correct answer)
Disagrees with a colleague's clinical technique
Feels physically exhausted after a long surgical case
Lacks sufficient training to complete a complex procedure

Correct answer: Knows the right action but is prevented from taking it by institutional constraints

Moral distress arises when ethical constraints prevent the nurse from acting on their moral judgment, leading to psychological distress.

Question 81: A perioperative nurse is asked to co-sign a documentation entry made by a nursing student. What does co-signing legally imply?

The nurse is acknowledging the entry exists but has no responsibility for it
The nurse is taking financial responsibility for the student's actions
The nurse is confirming the student's identity only
The nurse reviewed the entry and was present or supervised the care described (Correct answer)

Correct answer: The nurse reviewed the entry and was present or supervised the care described

Co-signing a student's entry signifies that the supervising nurse reviewed the documentation and either performed or directly supervised the care described.

Question 82: During a laparoscopic cholecystectomy, the laparoscope is inadvertently dropped on the floor. Which action is most appropriate?

The circulator retrieves it and passes it back after wiping with a sterile towel
A replacement sterile laparoscope is obtained or the dropped scope is sent for IUSS if urgently needed (Correct answer)
The surgeon continues without the laparoscope to avoid delay
The scrub tech rinses it with sterile saline and returns it to the field

Correct answer: A replacement sterile laparoscope is obtained or the dropped scope is sent for IUSS if urgently needed

Any instrument that falls to the floor is considered contaminated and must be replaced with a sterile item or processed via IUSS if no replacement exists.

Question 83: A patient in the lithotomy position begins to complain of lower extremity pain after repositioning. What is the priority concern?

Deep vein thrombosis
Nerve compression injury
Compartment syndrome (Correct answer)
Pressure ulcer formation

Correct answer: Compartment syndrome

Compartment syndrome can result from prolonged lithotomy positioning with legs elevated, causing muscle ischemia due to increased compartment pressure.

Question 84: Regarding hospital policies and practices, which of the following assertions is accurate?

Hospital policies describe a succession of activities required for patient care
Procedures serve as guides for nursing responsibilities in certain situations
Policies and procedures are based on standards set at local and national levels for care (Correct answer)

Correct answer: Policies and procedures are based on standards set at local and national levels for care

Explanation: <br> Policies and procedures are based on standards set at local and national levels for care. Hospital policies are designed to be used as guides for nursing responsibilities in certain situations, based on local, state and national standards. Procedures describe the step-by-step activities of the nursing staff necessary for patient care.

Question 85: Which preoperative skin antiseptic agent is CONTRAINDICATED near the eyes and ears?

Isopropyl alcohol 70%
Povidone-iodine solution
Iodophor-based paint solutions
Chlorhexidine gluconate (CHG) (Correct answer)

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 86: Which factor most significantly increases a patient's risk of surgical site infection (SSI)?

Uncontrolled diabetes mellitus with elevated blood glucose (Correct answer)
Operating room temperature above 68°F
The use of self-retaining retractors
Using a reusable gown instead of disposable

Correct answer: Uncontrolled diabetes mellitus with elevated blood glucose

Hyperglycemia impairs neutrophil function and tissue perfusion, significantly increasing susceptibility to SSI.

Question 87: Which behavior BEST demonstrates that a perioperative nurse is fulfilling lifelong learning obligations?

Relying on experienced colleagues to update them on new guidelines
Actively pursuing continuing education, reading current literature, and applying new evidence to practice (Correct answer)
Completing only the CE hours required for CNOR recertification
Attending mandatory annual competency reviews

Correct answer: Actively pursuing continuing education, reading current literature, and applying new evidence to practice

Professional accountability includes proactively seeking knowledge beyond minimum requirements to deliver the highest standard of care.

Question 88: During a procedure with sedation, the perioperative nurse observes a sudden drop in the end-tidal CO2 (EtCO2) waveform on the capnography monitor, which quickly becomes a flat line. This finding is the earliest and most reliable indicator of what condition?

Anaphylactic reaction
Malignant hyperthermia
Apnea or total airway obstruction (Correct answer)
Hypertensive crisis

Correct answer: Apnea or total airway obstruction

Capnography provides a real-time, breath-by-breath measurement of ventilation. A sudden loss of the EtCO2 waveform indicates that the patient is no longer exhaling carbon dioxide, which is the most immediate sign of apnea or a complete airway obstruction. This change is detected much earlier by capnography than by pulse oximetry, which can lag for several minutes.

Question 89: What does the term 'surgical conscience' mean in perioperative nursing?

Documenting all intraoperative events accurately
Personal commitment to maintain sterile technique and report breaks immediately (Correct answer)
Advocating for the patient's surgical preferences
Following hospital policy even when inconvenient

Correct answer: Personal commitment to maintain sterile technique and report breaks immediately

Surgical conscience is the internalized ethic of maintaining sterile technique and self-reporting any contamination without waiting to be observed.

Question 90: A Bovie scratch pad on the sterile field is used to:

Absorb electrosurgical smoke plume
Ground the patient during monopolar use
Clean dried eschar from the active electrosurgical electrode tip (Correct answer)
Calibrate the ESU generator

Correct answer: Clean dried eschar from the active electrosurgical electrode tip

The scratch pad removes carbonized tissue (eschar) from the ESU tip to maintain efficient electrical conduction during surgery.

Question 91: Which action best prevents the transmission of Clostridioides difficile (C. diff) in the perioperative environment?

Handwashing with soap and water rather than alcohol-based hand rub (Correct answer)
Applying chlorhexidine gluconate solution to all surfaces
Wearing double gloves during all cases
Using alcohol-based hand rub consistently before and after patient contact

Correct answer: Handwashing with soap and water rather than alcohol-based hand rub

C. diff spores are resistant to alcohol; soap and water physically remove spores from hands and are required for C. diff precautions.

Question 92: What is the purpose of documenting tourniquet application time and pressure in the intraoperative record?

To document the scrub technician's technique
To record the brand of tourniquet used for equipment tracking
To fulfill billing requirements for tourniquet use
To monitor for potential ischemic injury by tracking duration and inflation pressure (Correct answer)

Correct answer: To monitor for potential ischemic injury by tracking duration and inflation pressure

Tourniquet time and pressure must be documented to monitor for limb ischemia risk; prolonged inflation or excessive pressure can cause nerve or tissue damage.

Question 93: When caring for a pediatric patient requiring emergency surgery without a guardian present, the perioperative nurse should:

Delay surgery until consent can be obtained from a legal guardian
Proceed with surgery under the doctrine of implied emergency consent and document thoroughly (Correct answer)
Have the charge nurse sign consent on behalf of the child
Transfer the patient to another facility where a guardian can be reached

Correct answer: Proceed with surgery under the doctrine of implied emergency consent and document thoroughly

In a life-threatening emergency involving a minor without a guardian, implied consent allows immediate treatment to prevent death or serious harm.

Question 94: When performing surgical site skin preparation, which technique is correct for applying an antiseptic solution?

Apply in a single pass without overlapping strokes
Apply from the periphery inward toward the incision site
Use a circular motion from the incision site outward to the periphery (Correct answer)
Scrub back and forth across the entire site in a horizontal pattern

Correct answer: Use a circular motion from the incision site outward to the periphery

Prep solution is applied from the clean incision center outward in concentric circles to prevent dragging contamination toward the incision.

Question 95: After completing a surgical hand scrub, the scrub person is gowning. Which part of the sterile gown is considered sterile once it is donned?

The entire front of the gown from the neckline to the bottom hem.
The back of the gown from the waist to the neckline.
The cuffs of the gown, once covered by sterile gloves.
The front of the gown from the chest to the level of the sterile field, and the sleeves from 2 inches above the elbow to the cuff. (Correct answer)

Correct answer: The front of the gown from the chest to the level of the sterile field, and the sleeves from 2 inches above the elbow to the cuff.

AORN guidelines specify that the sterile area of a surgical gown includes the front from the chest line down to the level of the sterile field (or waist level). The sleeves are also considered sterile from 2 inches above the elbow down to the cuff, circumferentially. The neckline, shoulders, underarms, back, and sleeve cuffs are not considered sterile.

Question 96: When scrubbing for a surgical procedure, how long should the initial hand and forearm scrub last according to AORN standards?

10-15 minutes
1-2 minutes
3-5 minutes (Correct answer)
20 minutes

Correct answer: 3-5 minutes

AORN recommends a minimum of 3-5 minutes for the initial surgical hand scrub, though manufacturer instructions should also be followed.

Question 97: Which suture type is MOST appropriate for approximating the bowel anastomosis in a colorectal resection?

Polyglycolic acid (absorbable, braided) (Correct answer)
Nylon monofilament (non-absorbable)
Polypropylene monofilament (non-absorbable)
Silk (non-absorbable, braided)

Correct answer: Polyglycolic acid (absorbable, braided)

Polyglycolic acid (e.g., Vicryl) is an absorbable braided suture ideal for GI anastomoses, providing adequate tensile strength during healing and then absorbing.

Question 98: Which zone of a sterile-draped table is considered the sterile field boundary?

Two inches from the table edge on all sides
Only the center of the table where instruments are placed
The entire top surface down to and including the table edge
The top surface only; the sides and drape edges hanging below are unsterile (Correct answer)

Correct answer: The top surface only; the sides and drape edges hanging below are unsterile

The sterile field includes only the top surface of the draped table; hanging edges and sides below the table level are considered contaminated.

Question 99: A patient is NPO but has been taking oral medications as prescribed. Which medication should be held before surgery?

Beta-blocker for hypertension
Oral hypoglycemic agent for Type 2 diabetes (Correct answer)
Thyroid hormone replacement
Proton pump inhibitor for GERD

Correct answer: Oral hypoglycemic agent for Type 2 diabetes

Oral hypoglycemics should typically be held preoperatively to prevent hypoglycemia during the fasting and surgical period.

Question 100: 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 charge nurse outside the room
The surgeon

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.

Question 101: When using a fracture table for a hip procedure, the well-leg stirrup must be positioned to avoid pressure on which structure?

Popliteal artery
Obturator nerve
Saphenous nerve at the medial knee (Correct answer)
Femoral vein

Correct answer: Saphenous nerve at the medial knee

The saphenous nerve runs medially near the knee and is susceptible to compression injury from the well-leg stirrup post used with fracture tables.

Question 102: During preoperative assessment, a patient rates their pain as 8/10 at rest. The nurse's best action is to:

Notify the surgeon and anesthesia provider, as uncontrolled pain may indicate a new or worsening condition (Correct answer)
Reassure the patient that postoperative pain will be controlled
Document the rating and proceed with surgical preparations
Administer the prescribed PRN analgesic and reassess

Correct answer: Notify the surgeon and anesthesia provider, as uncontrolled pain may indicate a new or worsening condition

Severe uncontrolled preoperative pain at rest may signal a change in condition or complication that could affect the surgical plan.

Question 103: Which preoperative finding in a diabetic patient scheduled for morning surgery requires the most immediate follow-up?

Blood glucose of 110 mg/dL
Blood glucose of 320 mg/dL (Correct answer)
Blood glucose of 145 mg/dL
HbA1c of 7.2%

Correct answer: Blood glucose of 320 mg/dL

A blood glucose of 320 mg/dL indicates poor glycemic control and increases risks for infection, poor wound healing, and hyperosmolar crisis.

Question 104: Which of the following is a role of the surgery clinical nurse specialist?

Writing the surgical schedule for patients, nurses and surgeons
Researching current nursing standards and educating staff about best practices (Correct answer)
Acting as a resource for nurses who are filing grievance procedures
Obtaining insurance information for patients admitted to the surgical unit

Correct answer: Researching current nursing standards and educating staff about best practices

The clinical nurse specialist (CNS) is an advanced practice role focused on improving care quality by researching current nursing standards and educating staff on evidence-based best practices. The other options are administrative or clerical duties (collecting insurance info, handling grievances, building schedules) that fall outside the CNS's expert-practice and education mandate.

Question 105: The harmonic scalpel differs from conventional electrosurgery because it:

Uses ultrasonic vibration to cut and coagulate simultaneously with minimal thermal spread (Correct answer)
Requires a grounding pad on the patient
Uses electrical current at higher voltage
Is only used for laparoscopic cholecystectomy

Correct answer: Uses ultrasonic vibration to cut and coagulate simultaneously with minimal thermal spread

The harmonic scalpel converts electrical energy into ultrasonic mechanical vibration, producing less lateral thermal damage than monopolar ESU.

Question 106: Which statement about sterile field maintenance is correct regarding a team member who steps away from the sterile field?

The team member must be considered unsterile and cannot return to the sterile field without re-gowning and re-gloving (Correct answer)
The team member may return if they were gone fewer than five minutes
The team member may return if their back was facing away from the field
The team member may return after reapplying sterile gloves only

Correct answer: The team member must be considered unsterile and cannot return to the sterile field without re-gowning and re-gloving

Once a scrubbed team member steps away from the sterile field, their sterility cannot be guaranteed and full re-gowning and re-gloving is required.

Question 107: A perioperative nurse notes that a patient's temperature has risen to 39.8°C and ETCO2 is 78 mmHg during an otherwise routine procedure. These findings together suggest:

Malignant hyperthermia (Correct answer)
Mild hyperventilation
Fever from surgical site infection
Hypothyroid crisis

Correct answer: Malignant hyperthermia

The combination of rising temperature and elevated ETCO2 (reflecting increased CO2 production from hypermetabolism) are classic early signs of malignant hyperthermia.

Question 108: A circulating nurse needs to pour a sterile irrigation solution into a basin on the back table. To adhere to the principles of aseptic technique, which action is correct?

Maintain a distance of at least 12 inches above the basin while pouring.
Pour the entire contents of the solution into the basin at once to prevent contamination of the bottle's edge. (Correct answer)
Place the bottle cap on the sterile field with the inside facing up.
Hold the bottle so that the label is facing away from the sterile basin.

Correct answer: Pour the entire contents of the solution into the basin at once to prevent contamination of the bottle's edge.

According to AORN recommended practices, once a sterile solution container is opened, its edge is considered contaminated. Therefore, the entire contents should be poured at once, and the container should be discarded. Placing the cap on the field is incorrect as its outside is non-sterile. Holding the bottle with the label toward the palm can prevent dripping onto and obscuring the label, but the primary principle is to pour the entire contents. A distance of 12 inches is excessive and increases the risk of splashing.

Question 109: A patient receiving monitored anesthesia care (MAC) becomes unresponsive to verbal stimulation and requires airway intervention. This represents a transition to:

Moderate sedation
Minimal sedation
Deep sedation
General anesthesia (Correct answer)

Correct answer: General anesthesia

When a patient requires airway intervention under MAC, the level has progressed to general anesthesia regardless of the original intent.

Question 110: During a procedure, a scrubbed team member who is double-gloved contaminates the outer glove by touching a non-sterile surface. What is the MOST appropriate immediate action?

The individual removes the outer contaminated glove and dons a new sterile glove over the inner glove. (Correct answer)
The individual must leave the field to perform a full re-scrub, re-gown, and re-glove.
The contaminated outer glove is removed by the circulator, and the team member continues with the single inner glove.
Wipe the contaminated glove with a sterile alcohol wipe.

Correct answer: The individual removes the outer contaminated glove and dons a new sterile glove over the inner glove.

The standard and most efficient practice when a single glove is contaminated is for the individual to remove the outer glove without contaminating the inner glove. A new sterile glove is then donned, a process often assisted by another sterile team member or performed using an open-gloving technique. This restores the sterile barrier without major disruption. Continuing with a single glove is not ideal, wiping is not sterilization, and a full re-scrub is unnecessary if only the glove was contaminated.

Question 111: A patient with an implanted pacemaker is scheduled for electrosurgery. Which ESU setting BEST minimizes the risk of pacemaker interference?

Use monopolar ESU at the highest available setting for speed
Disable the pacemaker before the procedure
Place the dispersive electrode on the patient's chest near the pacemaker
Use bipolar electrosurgery whenever possible (Correct answer)

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 112: Which principle guides the correct use of loupe magnification or surgical microscopes in the OR?

Magnification eliminates the need for adequate surgical lighting
They replace the need for careful instrument handling
They must be properly focused and positioned before the sterile field is established (Correct answer)
Any team member may adjust the microscope without restriction during the case

Correct answer: They must be properly focused and positioned before the sterile field is established

Microscopes and loupes must be set up and focused before the sterile field is created to avoid contamination during repositioning.

Question 113: The term 'flash sterilization' (now called immediate-use steam sterilization, IUSS) should be used:

For all implants before every case
Routinely to save time on instrument processing
As the primary sterilization method for all instruments
Only in urgent situations when there is no time to wrap and fully sterilize an item (Correct answer)

Correct answer: Only in urgent situations when there is no time to wrap and fully sterilize an item

IUSS is intended only for urgent, unplanned situations and should not replace standard packaged sterilization cycles.

Question 114: Which indicator is considered the gold standard for confirming sterilization efficacy?

Biological indicator using resistant bacterial spores (Correct answer)
Mechanical printout showing correct time, temperature, and pressure
Class 5 chemical integrating indicator
Type 1 process indicator (autoclave tape)

Correct answer: Biological indicator using resistant bacterial spores

Biological indicators using resistant spores are the gold standard because they directly test whether the sterilization process killed microorganisms.

Question 115: Which principle guides the CNOR's role in maintaining the sterile field during a surgical procedure?

Sterile items may touch non-sterile items if contact is brief
A sterile field can be re-established after brief contamination
The surgeon determines sterility status of items in the field
Any item of doubtful sterility is considered contaminated (Correct answer)

Correct answer: Any item of doubtful sterility is considered contaminated

A fundamental principle of aseptic technique is that any item whose sterility is uncertain must be treated as contaminated.

Question 116: Which organization publishes the 'Guidelines for Perioperative Practice' that serves as a primary evidence-based resource for CNOR candidates?

Association of periOperative Registered Nurses (AORN) (Correct answer)
The Joint Commission (TJC)
Occupational Safety and Health Administration (OSHA)
Centers for Disease Control and Prevention (CDC)

Correct answer: Association of periOperative Registered Nurses (AORN)

AORN publishes the 'Guidelines for Perioperative Practice,' the comprehensive evidence-based resource that perioperative nurses, including CNOR candidates, use as their practice standard.

Question 117: A nurse is asked to circulate a procedure they have not been trained to perform. The nurse's ethical obligation is to:

Attempt the procedure and seek help if difficulties arise
Proceed if a senior surgeon is present to guide them
Decline and inform the charge nurse, stating the lack of training (Correct answer)
Accept the assignment to avoid delaying the surgical schedule

Correct answer: Decline and inform the charge nurse, stating the lack of training

Nurses are professionally and legally accountable for practicing within their competence level and must decline assignments beyond their training.

Question 118: The term 'retained surgical item' (RSI) refers to:

Only sponges and needles accidentally left inside the patient
Items documented as missing from the count sheet
Instruments left at the sterile field after the case ends
Any foreign object unintentionally left in a patient after surgery (Correct answer)

Correct answer: Any foreign object unintentionally left in a patient after surgery

An RSI is any foreign object — including sponges, instruments, needles, or devices — unintentionally left inside a patient after surgery.

Question 119: What is the recommended minimum number of air exchanges per hour in an operating room?

35-40
5-10
15-20 (Correct answer)
25-30

Correct answer: 15-20

AORN guidelines recommend a minimum of 15 air changes per hour in the OR, with at least 3 of those being fresh outside air.

Question 120: A surgeon requests a frozen section during a thyroidectomy. The perioperative nurse's role includes:

Properly labeling and transporting the specimen to pathology per institutional protocol (Correct answer)
Analyzing the tissue and reporting results to the surgeon
Discarding the specimen if the surgeon does not specify the analysis needed
Fixing the specimen in formalin before sending it for frozen section

Correct answer: Properly labeling and transporting the specimen to pathology per institutional protocol

The perioperative nurse is responsible for correct specimen identification, labeling, and timely transport; frozen sections must NOT be placed in formalin.

Question 121: Which action by the scrub technician demonstrates correct technique when passing a scalpel?

Placing it blade-up in a neutral zone for the surgeon to retrieve (Correct answer)
Placing it handle-first in the surgeon's palm
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 122: Which action ensures proper sterile technique when a circulator opens a rigid sterilization container for the scrub person?

The circulator hands the tray directly to the scrub person
The scrub person reaches into the container to retrieve instruments
The circulator places the open container on the back table
The circulator holds the container while the scrub person retrieves items, or tips the tray onto the sterile field (Correct answer)

Correct answer: The circulator holds the container while the scrub person retrieves items, or tips the tray onto the sterile field

The scrub person retrieves items from the container held by the circulator, or the circulator tips sterile contents onto the sterile field, preventing the unsterile exterior from entering the sterile field.

Question 123: Which of the following best defines an additional aspect of proper drapery that the scrub and circulating Registered Nurse should be aware of?

The surgeon should perform the procedure quickly to minimize potential infections.
The scrubbed team members should hold the drapes below waist level.
They should ensure that the prep solutions have dried before applying surgical drapes. (Correct answer)
The scrubbed team members never cuff the drapes over gloved hands.

Correct answer: They should ensure that the prep solutions have dried before applying surgical drapes.

It is important to make sure that the prep solutions have dried before using surgical drapes to guarantee proper draping. Pooled preparation fluids may harm your skin. These substances can catch fire while they're still in liquid form, especially ones that contain alcohol.

Question 124: A Class II wound classification (Clean-Contaminated) applies when:

The respiratory, alimentary, or genitourinary tract is entered under controlled conditions (Correct answer)
An acute non-purulent inflammation is encountered
No sterile technique is used
A perforated viscus is present

Correct answer: The respiratory, alimentary, or genitourinary tract is entered under controlled conditions

Class II includes procedures where a hollow organ is entered in a controlled manner without unusual contamination, such as an elective bowel resection.

Question 125: Which position is MOST associated with the risk of venous air embolism during neurosurgical procedures?

Sitting (beach chair) (Correct answer)
Lateral decubitus
Prone
Supine

Correct answer: Sitting (beach chair)

The sitting position elevates the surgical site above the heart, creating negative venous pressure that can draw air into open venous sinuses.

Question 126: Which type of fire triangle element is most commonly represented by surgical drapes in the OR?

Accelerant
Ignition source
Fuel (Correct answer)
Oxidizer

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 127: Which action by a circulator is correct when adding sterile solution to a sterile field?

Pour rapidly to minimize air exposure time
Pour from a height of 6 inches or less to avoid splashing (Correct answer)
Place the open bottle on the sterile back table
Hand the bottle directly to the scrub person

Correct answer: Pour from a height of 6 inches or less to avoid splashing

Pouring from a height of 6 inches or less prevents splashing that could contaminate the sterile field.

Question 128: When assessing a patient's social history preoperatively, which information is most relevant to postoperative planning and discharge safety?

The patient's education level
Whether the patient owns a car
The patient's occupation and work schedule
Whether the patient has a responsible adult to accompany them home (Correct answer)

Correct answer: Whether the patient has a responsible adult to accompany them home

Outpatient surgical patients must have a responsible adult to drive them home and monitor them, as anesthesia impairs judgment and reflexes.

Question 129: Flash sterilization (IUSS) should be used in which circumstance?

When the sterile processing department is backlogged
As a routine sterilization method for high-use instruments
When a dropped instrument is urgently needed and no alternative exists (Correct answer)
For all implants to save time

Correct answer: When a dropped instrument is urgently needed and no alternative exists

IUSS is reserved for urgent situations when a dropped or contaminated item is needed immediately and no sterile alternative is available.

Question 130: Which instrument count discrepancy action is required if counts do not reconcile before wound closure?

Recount once and proceed if the second count also differs
Proceed with closure and document the discrepancy
Notify the surgeon immediately and search the field, drapes, floor, and trash before closing (Correct answer)
Wait until the patient is in PACU to investigate

Correct answer: Notify the surgeon immediately and search the field, drapes, floor, and trash before closing

An unresolved count discrepancy requires immediate notification of the surgeon and a thorough search of all potential locations before wound closure.

Question 131: During preoperative assessment, the nurse notes the patient has a latex allergy. Which action is most appropriate?

Document the allergy and proceed normally
Reschedule the surgery for a later date
Alert the entire surgical team and prepare a latex-free environment (Correct answer)
Apply a latex allergy wristband only

Correct answer: Alert the entire surgical team and prepare a latex-free environment

A latex allergy requires preparation of a latex-free OR environment and notification of all team members to prevent anaphylaxis.

Question 132: Which action BEST reduces the risk of surgical site infection (SSI) related to hair removal?

Clipping hair at the operative site immediately before the procedure if removal is necessary (Correct answer)
Performing no hair removal at any time regardless of hair density
Shaving the operative site the night before surgery with a safety razor
Using depilatory cream 12 hours before the scheduled incision

Correct answer: Clipping hair at the operative site immediately before the procedure if removal is necessary

Clipping immediately before surgery is preferred over shaving because razors create micro-abrasions that harbor bacteria and increase SSI risk.

Question 133: The bispectral index (BIS) monitor is used intraoperatively to:

Assess depth of anesthesia and reduce awareness risk (Correct answer)
Measure neuromuscular blockade recovery
Detect malignant hyperthermia early
Monitor cardiac output continuously

Correct answer: Assess depth of anesthesia and reduce awareness risk

BIS monitoring analyzes EEG data to provide a numerical score reflecting depth of anesthesia, helping to prevent awareness under anesthesia.

Question 134: A sterile team member must move around the sterile field. The safest method is to:

Face the sterile field at all times while moving (Correct answer)
Step back and pass between two sterile fields if space is limited
Move quickly to reduce time near non-sterile areas
Pass unsterile persons back-to-back

Correct answer: Face the sterile field at all times while moving

Sterile team members must always face the sterile field to maintain visualization and prevent accidental contamination.

Question 135: A patient undergoing a prolonged procedure in the lithotomy position develops rhabdomyolysis postoperatively. Which intraoperative finding would have been the earliest indicator of this developing complication?

A rise in end-tidal CO2
Increasing peak airway pressures
A drop in SpO2 to 94%
Decreasing urine output with dark, tea-colored urine (Correct answer)

Correct answer: Decreasing urine output with dark, tea-colored urine

Dark, myoglobin-containing urine and decreased output are the hallmarks of rhabdomyolysis, which can occur from compartment syndrome or ischemia-reperfusion injury in the compressed limbs.

Question 136: During the final count for a laparotomy, the scrub person and circulating nurse identify a missing surgical sponge. After a thorough search of the sterile field, trash, and linen hampers is unsuccessful, what is the MOST appropriate next action?

Disassemble and search all sterile instrument trays again.
Close the surgical incision and obtain a postoperative radiograph.
Document the count as incorrect and send the patient to recovery.
Inform the surgical team and obtain an intraoperative radiograph. (Correct answer)

Correct answer: Inform the surgical team and obtain an intraoperative radiograph.

According to AORN guidelines, when a count discrepancy occurs and the item is not found, the surgeon must be notified immediately. The next step is typically to perform an intraoperative X-ray to rule out a retained surgical item before the final closure of the wound. This is a critical patient safety measure to prevent harm.

Question 137: Which electrosurgical unit (ESU) setting requires the dispersive electrode to be placed as close as possible to the operative site?

Bipolar mode
Monopolar mode (Correct answer)
Argon beam mode
Ultrasonic mode

Correct answer: Monopolar mode

In monopolar mode, current travels from the active electrode through the patient to the dispersive electrode, so placement near the operative site minimizes current path length and tissue damage.

Question 138: Ketamine is unique among anesthetic induction agents because it:

Is the only agent without analgesic properties
Causes significant respiratory depression
Produces a dissociative anesthetic state with maintained airway reflexes (Correct answer)
Reliably decreases blood pressure

Correct answer: Produces a dissociative anesthetic state with maintained airway reflexes

Ketamine produces dissociative anesthesia while typically preserving airway reflexes and hemodynamic stability, making it useful in trauma settings.

Question 139: The CNOR candidate should know that flash (IUSS) sterilization is indicated ONLY when?

A sterile item is dropped and no replacement is available (Correct answer)
Convenience for routine instrument turnover
Sterilizing implantable devices in an emergency
Processing items too large for standard sterilizers

Correct answer: A sterile item is dropped and no replacement is available

Immediate use steam sterilization (IUSS) is appropriate only when a needed item is contaminated and no replacement is available, not for implants or routine use.

Question 140: Which instrument classification describes tools used to cut or incise tissue?

Grasping instruments
Clamping instruments
Retracting instruments
Cutting instruments (Correct answer)

Correct answer: Cutting instruments

Cutting instruments such as scalpels, scissors, and osteotomes are specifically designed to incise or excise tissue.

Question 141: A patient receiving spinal anesthesia suddenly develops hypotension, bradycardia, and nausea. The perioperative nurse should recognize these as signs of:

Vasovagal syncope from surgical stimulation
Pulmonary embolism
High spinal block affecting sympathetic fibers (Correct answer)
Anaphylaxis to the local anesthetic

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 142: Which type of wound closure is used for contaminated or dirty wounds to reduce infection risk?

Primary intention (primary closure)
Subcuticular absorbable suture closure
Delayed primary closure (tertiary intention) (Correct answer)
Secondary intention (healing by granulation)

Correct answer: Delayed primary closure (tertiary intention)

Delayed primary closure (tertiary intention) is used for contaminated wounds, leaving them open initially and closing after 3-5 days once infection risk decreases.

Question 143: Which documentation practice best supports accurate accounting of implantable devices used during surgery?

Photographing the device before implantation
Affixing the manufacturer's label/sticker to the operative record (Correct answer)
Verbally reporting the device to the PACU nurse
Recording the device brand in the nurse's notes

Correct answer: Affixing the manufacturer's label/sticker to the operative record

Affixing the manufacturer's label with lot number and device identification to the operative record provides a permanent, traceable implant record.

Question 144: Which type of anesthesia is most appropriate for a patient undergoing a cesarean section who desires to remain awake?

Monitored anesthesia care (MAC)
Intravenous sedation with propofol
General anesthesia with endotracheal intubation
Spinal or epidural anesthesia (Correct answer)

Correct answer: Spinal or epidural anesthesia

Spinal or epidural (regional) anesthesia allows the patient to remain conscious and is the standard of care for cesarean sections.

Question 145: What is the primary purpose of a sterile drape placed over the surgical field?

To create a sterile barrier between the surgical site and surrounding environment (Correct answer)
To absorb blood and surgical fluids
To monitor skin temperature during surgery
To provide cushioning and patient comfort

Correct answer: To create a sterile barrier between the surgical site and surrounding environment

Drapes establish and maintain a sterile field by creating a microbial barrier around the operative site.

Question 146: Malignant hyperthermia (MH) is triggered by which class of agents?

Non-depolarizing neuromuscular blocking agents
Volatile halogenated anesthetic agents and succinylcholine (Correct answer)
Opioid analgesics and benzodiazepines
Nitrous oxide and propofol

Correct answer: Volatile halogenated anesthetic agents and succinylcholine

MH is a pharmacogenetic disorder triggered by volatile inhalation agents (e.g., sevoflurane) and the depolarizing agent succinylcholine.

Question 147: Flash sterilization (immediate-use steam sterilization) is appropriately used for:

Items that were dropped and are immediately needed, with no biofilm present (Correct answer)
All instruments when time between cases is less than 30 minutes
Implantable devices as a routine sterilization method
Heat-sensitive items requiring rapid turnaround

Correct answer: Items that were dropped and are immediately needed, with no biofilm present

Flash sterilization is reserved for dropped or contaminated instruments urgently needed when no other sterile item is available and the item is free of biofilm.

Question 148: Which antiseptic agent is contraindicated for skin preparation around the eyes?

Chlorhexidine gluconate
Povidone-iodine
Chlorhexidine gluconate and isopropyl alcohol (Correct answer)
Isopropyl alcohol 70%

Correct answer: Chlorhexidine gluconate and isopropyl alcohol

Both chlorhexidine and alcohol are ototoxic and can cause serious eye injury; only dilute povidone-iodine is approved for periocular skin prep.

Question 149: During preoperative assessment, a patient discloses recreational marijuana use. What is the most important implication for anesthesia?

The surgery must be cancelled
It may alter anesthetic requirements and interact with sedatives (Correct answer)
The patient requires a urine drug screen before consent
It has no anesthetic implications

Correct answer: It may alter anesthetic requirements and interact with sedatives

Marijuana use can affect anesthetic depth requirements, cause drug interactions, and increase airway reactivity.

Question 150: Compartment syndrome can occur as a complication of which surgical position when procedures are prolonged?

Reverse Trendelenburg with shoulder braces
Lithotomy with legs elevated in stirrups (Correct answer)
Prone with chest rolls
Supine with arms tucked

Correct answer: Lithotomy with legs elevated in stirrups

Lithotomy position with elevated legs can impair venous drainage and arterial perfusion in the lower extremities, leading to well-leg compartment syndrome in prolonged cases.

Question 151: Which element of the intraoperative nursing record documents the patient's position during surgery?

Surgeon's operative technique
Anesthesia type administered
Medication allergies
Positioning devices and body alignment used (Correct answer)

Correct answer: Positioning devices and body alignment used

The intraoperative record must document positioning devices, supports, and body alignment to track potential pressure injury risks.

Question 152: Under which circumstance is it ethically permissible for a perioperative nurse to share a patient's health information without consent?

When the nurse believes it is in the patient's best interest
When required by mandatory reporting laws such as gunshot wounds or communicable diseases (Correct answer)
When the patient's family specifically requests it
When the surgeon instructs the nurse to inform next of kin

Correct answer: When required by mandatory reporting laws such as gunshot wounds or communicable diseases

Mandatory reporting laws legally require disclosure of specific conditions (e.g., gunshot wounds, reportable diseases) without patient consent.

Question 153: Which situation requires the perioperative nurse to complete an incident report (occurrence report) in addition to the medical record?

A correctly labeled specimen sent to pathology
A surgeon who arrives on time for the case
A routine instrument count that is correct
A patient fall during transfer from the OR table to the stretcher (Correct answer)

Correct answer: A patient fall during transfer from the OR table to the stretcher

A patient fall is an adverse event requiring both an incident/occurrence report for risk management purposes and accurate documentation in the medical record.

Question 154: Which of the following BEST describes the responsibility of the registered nurse first assistant (RNFA) in the OR?

Administering anesthesia when the CRNA is on break
Performing independently without surgeon supervision in any state
Replacing the scrub technician when a second scrub is not available
Assisting the surgeon intraoperatively by handling tissue, providing hemostasis, and suturing under surgeon direction (Correct answer)

Correct answer: Assisting the surgeon intraoperatively by handling tissue, providing hemostasis, and suturing under surgeon direction

The RNFA works under surgeon direction to assist with tissue handling, hemostasis, exposure, and closure as an adjunct to — not a replacement of — the surgical team.

Question 155: A perioperative nurse documents 'patient tolerated procedure well' without supporting objective data. This type of entry is considered:

Standard nursing language acceptable in all facilities
Ideal because it avoids overly detailed notes
Subjective and insufficient without objective assessment findings to support it (Correct answer)
Legally sufficient because it is brief and professional

Correct answer: Subjective and insufficient without objective assessment findings to support it

Documentation must include objective data such as vital signs, estimated blood loss, and patient responses rather than vague subjective statements.

Question 156: An obese patient is placed in the lithotomy position. Which complication is specifically increased in this population?

Pressure injury to the occiput
Radial nerve palsy
Brachial plexus stretch injury
Compartment syndrome of the lower extremities (Correct answer)

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 157: The MH Hotline number that perioperative staff should have posted in the OR is:

1-800-644-9737 (Correct answer)
1-888-MALIGNANT
1-800-MH-HYPER
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 158: Which preoperative laboratory value would most concern the perioperative nurse in a patient scheduled for a major abdominal procedure?

Serum sodium of 138 mEq/L
Hemoglobin of 13 g/dL
White blood cell count of 8,000/mm³
Platelet count of 45,000/mm³ (Correct answer)

Correct answer: Platelet count of 45,000/mm³

A platelet count of 45,000/mm³ is critically low and significantly increases the risk of intraoperative hemorrhage.

Question 159: What is the purpose of the 'time-out' procedure performed immediately before a surgical incision?

To verify patient identity, surgical site, procedure, and consent (Correct answer)
To ensure the instrument count has been completed
To allow the surgeon to review the operative report
To confirm anesthesia medications have been given

Correct answer: To verify patient identity, surgical site, procedure, and consent

The time-out is a final safety check to prevent wrong-site, wrong-patient, and wrong-procedure errors.

Question 160: During preoperative assessment, the nurse identifies that the patient has an implanted cardiac pacemaker. The most critical action is to:

Schedule a cardiology consult to reprogram the device to a fixed rate postoperatively
Notify the surgeon and determine if electrosurgery requires pacemaker management (Correct answer)
Remove the pacemaker before surgery
Document the finding and proceed without further action

Correct answer: Notify the surgeon and determine if electrosurgery requires pacemaker management

Electrosurgical units can interfere with pacemaker function, requiring pre-planned management strategies before surgery begins.

Question 161: Which monitoring parameter is MOST important to assess continuously during a procedure performed in the sitting (beach chair) position?

Pulse oximetry waveform
Core body temperature
End-tidal CO2
Cerebral perfusion pressure via mean arterial pressure at head level (Correct answer)

Correct answer: Cerebral perfusion pressure via mean arterial pressure at head level

In the sitting position, the head is elevated above the heart, so mean arterial pressure must be measured and interpreted at the level of the head to ensure adequate cerebral perfusion.

Question 162: Which suture gauge among the following is the smallest?

#0
#11-0 (Correct answer)
#5-0
#2

Correct answer: #11-0

Explanation: <br> Like sewing thread, sutures are sized according to gauge. #11-0 is the smallest gauge, while #5 is the largest. #1–4-0 are the sizes that are most frequently used.

Question 163: At the conclusion of a complex aortic valve replacement, the surgeon initiates a debriefing. What is a primary objective of this communication process?

To identify opportunities for improving teamwork and patient safety on future cases. (Correct answer)
To provide a detailed report to the patient's waiting family members.
To finalize the instrument count and sign out of the room.
To assign blame for any intraoperative complications that occurred.

Correct answer: To identify opportunities for improving teamwork and patient safety on future cases.

The surgical debriefing, part of the Sign Out phase of the surgical safety checklist, is a crucial communication tool. Its primary goal is to reflect on the procedure to identify what went well, what could be improved, and to address any patient safety concerns, thereby fostering continuous team learning and enhancing the quality of care for future patients. [7, 19, 27]

Question 164: Which sterilization method is most appropriate for heat-sensitive flexible endoscopes used in the OR?

Low-temperature hydrogen peroxide gas plasma (Sterrad) or ethylene oxide (EtO) (Correct answer)
Flash sterilization at prevacuum settings
Steam autoclave at 270°F (132°C)
Dry heat sterilization at 320°F (160°C)

Correct answer: Low-temperature hydrogen peroxide gas plasma (Sterrad) or ethylene oxide (EtO)

Heat-sensitive devices like flexible endoscopes require low-temperature sterilization methods such as hydrogen peroxide plasma or EtO.

Question 165: Which abbreviation has been identified by The Joint Commission as 'Do Not Use' in medical documentation?

PRN
U (for units) (Correct answer)
BID
NPO

Correct answer: U (for units)

'U' for units is on The Joint Commission's Do Not Use list because it can be mistaken for the number zero or four.

Question 166: During the postoperative Sign Out phase of the surgical checklist, which of the following is confirmed?

Surgeon's operative technique preferences
Patient identity only
Instrument, sponge, and needle counts; specimen labeling; equipment concerns; and key recovery concerns (Correct answer)
Anesthesia type to be used

Correct answer: Instrument, sponge, and needle counts; specimen labeling; equipment concerns; and key recovery concerns

The Sign Out phase of the WHO checklist confirms count correctness, specimen labeling, equipment problems to report, and key concerns for recovery.

Question 167: A nurse practitioner colleague asks a perioperative RN to co-sign an order the RN did not assess or verify. The appropriate response is to:

Decline, as co-signing implies personal verification of the assessment and order (Correct answer)
Co-sign if the colleague is licensed and trusted
Agree only if the patient is stable
Ask the charge nurse to co-sign instead

Correct answer: Decline, as co-signing implies personal verification of the assessment and order

Co-signing documentation implies you have personally reviewed and verified the information; signing what you have not assessed is professional misconduct.

Question 168: After a surgical sponge count discrepancy is identified at wound closure, what is the FIRST action the perioperative nurse should take?

Document the discrepancy and proceed with closure
Inform the charge nurse
Immediately perform an X-ray of the patient
Recount all sponges thoroughly with the scrub person (Correct answer)

Correct answer: Recount all sponges thoroughly with the scrub person

Recounting all sponges is the first step when a discrepancy is identified, followed by a search of the surgical field, and then imaging if still unresolved.

Question 169: A perioperative nurse posts a picture on their private social media account showing an operating room setup for a rare and complex surgery. The post does not contain any patient names, faces, or medical record numbers, but the city's local news had recently reported on a prominent person undergoing that specific procedure. This action is a potential violation of which patient right?

Beneficence
Confidentiality and privacy (Correct answer)
Fidelity
Veracity

Correct answer: Confidentiality and privacy

Even without direct identifiers, sharing details about a case that could allow others to deduce the patient's identity is a breach of confidentiality and a violation of HIPAA. The combination of a rare procedure and recent news reports creates a situation where the patient could be identified, violating their right to privacy.

Question 170: When reviewing a patient's medication list preoperatively, which herbal supplement is most important to report to the anesthesia team due to risk of prolonged bleeding?

Ginkgo biloba (Correct answer)
Melatonin
Echinacea
Probiotics

Correct answer: Ginkgo biloba

Ginkgo biloba inhibits platelet-activating factor and can significantly increase bleeding risk perioperatively.

Question 171: Which document serves as the legal operative record and must be signed by the operating surgeon?

Perioperative nursing care plan
Operative report / dictated operative note (Correct answer)
Pre-admission testing results
Anesthesia induction record

Correct answer: Operative report / dictated operative note

The operative report, dictated or written by the surgeon, is the legal document describing the procedure performed and must be completed promptly.

Question 172: What is the function of the electrosurgical dispersive electrode (grounding pad)?

To provide a large surface area for the return of current to the ESU unit, preventing burns (Correct answer)
To generate electrical current for cutting tissue
To protect the surgeon from electrical shock
To monitor the patient's cardiac rhythm during surgery

Correct answer: To provide a large surface area for the return of current to the ESU unit, preventing burns

The dispersive electrode spreads the returning current over a large body surface area, reducing current density and preventing burns at the return site.

Question 173: The perioperative nurse notes that a patient's core temperature is 35.2°C intraoperatively. Which intervention is most appropriate?

Notify the surgeon to expedite closure
Increase room temperature and apply a forced-air warming blanket (Correct answer)
Decrease IV fluid rate to reduce cold fluid infusion
Administer IV epinephrine to increase metabolic heat production

Correct answer: Increase room temperature and apply a forced-air warming blanket

Increasing ambient temperature and applying active warming devices are the first-line interventions for intraoperative hypothermia.

Question 174: Which type of surgical count is performed to confirm the sterile field at the start of a procedure?

Final count before skin closure
Opening count before the procedure begins (Correct answer)
Relief count when a team member is replaced
Wound closure count

Correct answer: Opening count before the procedure begins

The opening count establishes a baseline inventory of all items in the sterile field before the procedure begins.

Question 175: During a laparotomy, the surgeon inadvertently enters the aorta. Which nursing action is HIGHEST priority?

Document the event in the incident report
Obtain additional suture and prepare for vascular repair (Correct answer)
Prepare the specimen for pathology
Call for break relief for the scrub person

Correct answer: Obtain additional suture and prepare for vascular repair

Life-threatening hemorrhage requires immediate preparation of vascular repair supplies to support the surgeon in controlling bleeding.

Question 176: A patient states they last ate solid food 4 hours ago. The surgery is scheduled to begin in 30 minutes. What should the perioperative nurse do?

Proceed since 4 hours is sufficient fasting time
Give the patient a small sip of water to take medications
Document and continue preoperative preparations
Notify the anesthesia provider immediately (Correct answer)

Correct answer: Notify the anesthesia provider immediately

NPO guidelines typically require 6-8 hours for solids; the anesthesia provider must be notified to determine if surgery should be delayed.

Question 177: The 'clean to dirty' principle in the sterile field means:

Sterile drapes are applied from the outer edge inward toward the operative site
Procedures always progress from the least contaminated area to the most contaminated area (Correct answer)
Instruments used on bone are cleaner than those used on soft tissue
Only the first instrument used in a procedure is considered clean

Correct answer: Procedures always progress from the least contaminated area to the most contaminated area

Moving from clean to dirty areas prevents cross-contamination — for example, a bowel anastomosis proceeds from mucosa to serosa to avoid spreading luminal contents.

Question 178: A patient under general anesthesia for a major abdominal surgery begins to exhibit muscle rigidity, a rapid rise in end-tidal CO2, and sinus tachycardia. The surgical team suspects malignant hyperthermia (MH). Which of the following is the first and most critical intervention?

Discontinue all volatile anesthetic agents and succinylcholine. (Correct answer)
Draw an arterial blood gas to assess for metabolic acidosis.
Begin active cooling with ice packs and chilled saline.
Administer intravenous dantrolene sodium.

Correct answer: Discontinue all volatile anesthetic agents and succinylcholine.

The absolute first step in managing a malignant hyperthermia crisis is to immediately stop all triggering agents, which include all volatile inhalation anesthetics (e.g., sevoflurane, desflurane) and the depolarizing muscle relaxant succinylcholine. This action removes the cause of the hypermetabolic state. While administering dantrolene, cooling the patient, and assessing blood gases are all crucial subsequent steps, they are performed only after the triggering agents have been discontinued.

Question 179: The scrub person should handle tissue on the sterile field by:

Squeezing tissue firmly with toothed forceps to prevent slipping
Using the least traumatic technique, handling tissue as gently as possible (Correct answer)
Avoiding moistening tissue with saline to keep the field dry
Applying maximum tension to expose the operative site

Correct answer: Using the least traumatic technique, handling tissue as gently as possible

Gentle tissue handling minimizes trauma, preserves viability, and reduces the risk of postoperative complications including infection and dehiscence.

Question 180: What is the primary purpose of a time-out before surgical incision?

To ensure all supplies are opened and counted
To verify correct patient, site, side, procedure, and position (Correct answer)
To allow anesthesia providers to complete documentation
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 181: Which physiological complication is most associated with prolonged Trendelenburg positioning?

Hypotension and decreased venous return
Increased intracranial pressure and airway edema (Correct answer)
Hypothermia due to vasodilation
Peripheral neuropathy of the lower extremities

Correct answer: Increased intracranial pressure and airway edema

Prolonged Trendelenburg position causes cephalad fluid shift, increasing intracranial pressure and causing facial and airway edema.

Question 182: During closure, the instrument count is correct but the needle count is off by one. What should the perioperative nurse do?

Document and file an incident report after the case
Proceed with closure and document the discrepancy
Ask the circulator to recount the needles only
Notify the surgeon, search the field and patient, and obtain an intraoperative X-ray if not found (Correct answer)

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 183: A scrub person notices a small hole in a sterile gown during donning. What is the appropriate action?

Cover the hole with sterile drape material and continue
Discard the gown and obtain an intact sterile gown (Correct answer)
Proceed if the hole is below the waist level
Reinforce the hole with sterile tape from the back table

Correct answer: Discard the gown and obtain an intact sterile gown

Any breach in gown integrity compromises the sterile barrier; the gown must be discarded and replaced.

Question 184: Capnography (end-tidal CO2) monitoring provides which of the following critical safety functions in the OR?

Monitors cardiac output continuously
Confirms correct endotracheal tube placement and detects disconnection (Correct answer)
Quantifies depth of neuromuscular blockade
Measures arterial oxygen saturation

Correct answer: Confirms correct endotracheal tube placement and detects disconnection

Capnography provides real-time confirmation of endotracheal tube placement and immediately detects ventilator disconnection, esophageal intubation, or airway obstruction.

Question 185: A patient's preoperative ECG shows new ST-segment changes that were not present 6 months ago. The perioperative nurse should:

Notify the anesthesia provider and surgeon before proceeding (Correct answer)
Administer aspirin and continue preparations
Proceed with surgery as the changes are minor
Repeat the ECG in one hour before notifying anyone

Correct answer: Notify the anesthesia provider and surgeon before proceeding

New ECG changes may indicate acute cardiac pathology and must be reported immediately to determine surgical safety.

Question 186: When should prophylactic antibiotics be administered to achieve the highest benefit in preventing SSIs?

Within 60 minutes before surgical incision (Correct answer)
30 minutes after the patient enters the OR
Immediately postoperatively in the PACU
At the time of incision

Correct answer: Within 60 minutes before surgical incision

Prophylactic antibiotics should be administered within 60 minutes before incision to ensure adequate tissue levels at the time of the cut.

Question 187: Which layer of the surgical gown is considered sterile and must be protected from contamination?

The entire gown including the back
The front from the neck to the knees
Only the front from the waist down
The front from the chest to the sterile field level and sleeves to 2 inches above the elbow (Correct answer)

Correct answer: The front from the chest to the sterile field level and sleeves to 2 inches above the elbow

The sterile area of the gown is considered to be the front from chest to the level of the sterile field, and the sleeves from above the elbow to the cuff.

Question 188: What does the Spaulding classification system categorize as 'critical' items requiring sterilization?

Items used exclusively in the substerile corridor
Items that contact intact mucous membranes only
Items that enter sterile tissue or the vascular system (Correct answer)
Items that contact only intact skin

Correct answer: Items that enter sterile tissue or the vascular system

Critical items contact sterile body tissue or the bloodstream and carry the highest infection risk, requiring sterilization before use.

Question 189: A closed suction drain (e.g., Jackson-Pratt or Blake drain) functions by:

Gravity drainage alone with an open system
Preventing wound closure tension
Delivering irrigation fluid into the wound continuously
Creating negative pressure to actively remove fluid from a surgical site (Correct answer)

Correct answer: Creating negative pressure to actively remove fluid from a surgical site

Closed suction drains use negative pressure from a collapsible bulb or reservoir to actively evacuate serous fluid, blood, or lymph from the surgical site.

Question 190: Which ASA physical status classification applies to a patient with well-controlled Type 2 diabetes and hypertension on medications?

ASA I
ASA III
ASA II (Correct answer)
ASA IV

Correct answer: ASA II

ASA II indicates a patient with mild systemic disease that is well-controlled and not functionally limiting.

Question 191: A patient is positioned in the lateral decubitus position for a thoracic procedure. Which anatomical structure is most at risk for compression injury?

Femoral nerve
Brachial plexus (Correct answer)
Sciatic nerve
Radial nerve

Correct answer: Brachial plexus

The brachial plexus is most vulnerable in lateral decubitus positioning due to pressure on the dependent shoulder and arm stretching.

Question 192: Which pathogen is responsible for surgical site infections most frequently caused by a break in sterile technique?

Pseudomonas aeruginosa
Clostridium difficile
Escherichia coli
Staphylococcus aureus (Correct answer)

Correct answer: Staphylococcus aureus

Staphylococcus aureus, particularly MRSA, is the most common cause of surgical site infections related to breaks in aseptic technique.

Question 193: During the preoperative nursing assessment, a patient reports a previous adverse reaction to anesthesia involving prolonged paralysis after receiving succinylcholine. This history most likely indicates:

Pseudocholinesterase deficiency (Correct answer)
Latex allergy
Neuroleptic malignant syndrome
Malignant hyperthermia susceptibility

Correct answer: Pseudocholinesterase deficiency

Pseudocholinesterase deficiency impairs the metabolism of succinylcholine, leading to prolonged neuromuscular blockade.

Question 194: During a spine procedure in prone position, the patient develops a sudden drop in oxygen saturation and absent breath sounds on the left. The nurse anticipates:

Pneumothorax requiring chest tube insertion (Correct answer)
Pulmonary embolism requiring anticoagulation
Allergic reaction requiring epinephrine
Endobronchial intubation requiring tube repositioning

Correct answer: Pneumothorax requiring chest tube insertion

Sudden unilateral absent breath sounds with desaturation in a prone patient suggests tension pneumothorax, which requires immediate decompression.

Question 195: What is the recommended approach when the perioperative nurse disagrees with a surgeon's order that may harm the patient?

Ask another nurse to carry out the order
Follow the order to avoid conflict
Use assertive communication, escalate through the chain of command, and document the interaction (Correct answer)
Refuse the order without explanation

Correct answer: Use assertive communication, escalate through the chain of command, and document the interaction

Perioperative nurses are obligated to advocate for patient safety using assertive communication, escalation protocols, and thorough documentation when orders appear harmful.

Question 196: Which type of hemostasis involves using high-frequency electrical current to coagulate or cut tissue?

Thermal (electrosurgical) hemostasis (Correct answer)
Chemical hemostasis
Biological hemostasis
Mechanical hemostasis

Correct answer: Thermal (electrosurgical) hemostasis

Electrosurgery uses high-frequency electrical current to produce thermal energy that coagulates blood vessels or cuts tissue.

Question 197: Which type of wound is considered a Class III (contaminated) surgical wound?

Infected wound with devitalized tissue present
Elective clean procedure with no break in aseptic technique
Open traumatic wound with gross spillage from the GI tract (Correct answer)
Clean elective procedure on an uninfected hollow viscus

Correct answer: Open traumatic wound with gross spillage from the GI tract

Class III wounds include open traumatic wounds, operations with major breaks in sterile technique, or gross GI spillage.

Question 198: According to the most recent CDC and AORN guidelines, which of the following is the recommended practice for preoperative patient bathing to prevent surgical site infections?

The surgical site should be shaved with a razor and cleansed with an antiseptic agent the evening before surgery.
Preoperative bathing is no longer recommended as it does not significantly reduce SSI rates.
The patient must shower with chlorhexidine gluconate (CHG) soap the morning of surgery.
A full-body shower or bath with either antimicrobial or non-antimicrobial soap is advised at least the night before surgery. (Correct answer)

Correct answer: A full-body shower or bath with either antimicrobial or non-antimicrobial soap is advised at least the night before surgery.

Current CDC guidelines recommend that patients shower or bathe their full body with either an antimicrobial or a non-antimicrobial soap at least the night before the operative day. Shaving with a razor is discouraged due to the risk of micro-abrasions; if hair removal is necessary, clippers should be used.

Question 199: A patient receiving a blood transfusion intraoperatively develops hypotension, hemoglobinuria, and back pain. The nurse should FIRST:

Stop the transfusion and maintain IV access with normal saline (Correct answer)
Document the reaction and notify the blood bank after the case
Slow the transfusion rate and continue monitoring
Administer diphenhydramine and continue the transfusion

Correct answer: Stop the transfusion and maintain IV access with normal saline

These signs indicate an acute hemolytic transfusion reaction; stopping the transfusion immediately while maintaining IV access is the critical first step.

Question 200: A medication on the sterile field is drawn into a syringe but not immediately labeled. The error is caught before administration, and the medication is discarded. According to patient safety principles, why is it important for the perioperative nurse to complete an incident report for this 'near miss'?

To collect data that can identify system vulnerabilities and prevent future errors. (Correct answer)
To allow the hospital to bill the patient for the wasted medication.
To ensure the involved staff member receives punitive action.
To document the event for potential future litigation against the hospital.

Correct answer: To collect data that can identify system vulnerabilities and prevent future errors.

Reporting near misses, also known as close calls or good catches, is a cornerstone of a robust safety culture. The purpose is not to punish individuals but to gather data that can reveal weaknesses in systems and processes. [9, 10] Analyzing these events helps the organization learn and implement changes to prevent a similar event from actually reaching and harming a patient in the future.

Question 201: Which statement BEST describes the perioperative nurse's responsibility regarding cultural competence?

Cultural practices should be accommodated only if they do not inconvenience the OR team
Cultural competence is the responsibility of the patient educator, not the OR nurse
Standardized care protocols eliminate the need for cultural accommodation in the OR
The nurse should recognize and respect cultural, religious, and individual differences that may affect perioperative care (Correct answer)

Correct answer: The nurse should recognize and respect cultural, religious, and individual differences that may affect perioperative care

Cultural competence requires acknowledging and integrating patients' cultural backgrounds into individualized perioperative care planning.

CNOR Certification Exam

The CNOR (Certified Perioperative Nurse) exam, administered by the Competency & Credentialing Institute (CCI), validates the specialized knowledge and skills of perioperative nurses working in surgical and procedural settings.

200

Questions

225 min

Time Limit

78%

To Pass

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