CNOR EXAM 2024/ACTUAL 300 EXAM QUESTIONS WITH CORRECT DETAILED AND VERIFIED ANSWERS WITH R, Exams of Nursing

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CNOR EXAM 2024/ACTUAL 300 EXAM QUESTIONS

WITH CORRECT DETAILED AND VERIFIED ANSWERS

WITH RATIONALES/CNOR EXAM 2024- 2025

A pt scheduled for an emergency hip arthroplasty has a preoperative prothrombin result of 12 seconds. The best action of the RN circulator is to ANSWER: inform the surgical team and transport the patient to the OR suite A pt with a fractured anterior fossa of the skull may have an alteration in which sense? ANSWER: smell Rational: fractures of the anterior fossa of the skull may affect the olfactory nerve, which is responsible for the sense of smell The preferred incisional type for an exploratory laparotomy is ANSWER : midline vertical Rational: a midline vertical incision is preferred for an exploratory laparotomy because it enables fast entry into the abdomen and excellent exposure to the abdominal contents and because it can be closed securely and rapidly A is a major cause of death during & immediately following a surgical procedure

that can result from blood pooling in low pressure areas ANSWER: pulmonary embolism Rational: PE can be caused by blood clots or other debris like fat. Debris blocks the pulmonary artery or one of the branches. A PE is most often caused by stasis of blood in deep veins during extended proceedures. In the absence of a sterile transfer device when dispensing medication to the sterile field, the best option is to ANSWER: have the RN circulator draw up the medication in syringe & transfer Rational: The best option is to use a sterile transfer device. If one is not available, the next best option is for the RN circulator to draw up the medication in a syringe and remove the needle prior to dispensing on the field most medication errors in pediatric care occur because this pt population varies dramatically in ANSWER : weight Rational: pediatric medication administration is based on the pt weight. An accurate wt measurement upon admission in both pounds and kg is an essential part of preventing medication errors. Determining whether re-anastomosis is possible after a low anterior resection of the sigmoid colon depends on

ANSWER : cancer free margin of the distal rectum Rational: the ability to reestablish continuity of the proximal sigmoid colon and the rectum is contingent on whether the distal rectal margin is cancer free and if there is sufficient length of the bowel to vreate a tension- free anastomosis What is the American Society of Anesthesiologists (ASA) classification of a pt with severe hypertention? ANSWER: ASA Class 3 Rational: Class 3 defined as pt having severe systemic disease that limits activity but does not completely incapacitate the pt. The chemical indicator inside a wrapped instrument tray has not changed to the appropriate color. The perioperative nurse should first ANSWER: review the sterilizer print out Rational: the sterilizer print out should be checked 1st to determine whether cycle parameters have been met. Physical monitors can provide a rapid means of identification of sterilizer failure. Subsequent actions are based on whether the reason for the failure is due to operator or sterilizer causes Using after high level disinfection of flexible endoscopes may help dry the lumen to prevent microorganisms from multiplying ANSWER: 70 - 90% ethyl alcohol

Rational: flushing w/70-90% ethyl or isopropyl alcohol should be determined by the interdisciplinary team at the organization. Flushing with alcohol may not be necessary if the flexible endoscope is dried properly Pt. is scheduled for burr holes to remove fluid accumulated secondary to blunt head trauma. The best option for a drain that removes cerebral spinal fluid while monitoring intracranial pressure is a ANSWER : ventriculostomy Rational: A ventriculostomy provides the most accurate method of monitoring intracranial pressure while providing the ability to drain cerebrospinal fluid mcburney's incision is used by surgeons when performin an open ANSWER: appendectomy Rational: this method involved pressing on the R lower quadrant below the umbilicus and medial to the anterior superior iliac spine. This is known as the McBurney's point The primary goal for moderate sedation/analgesia is for the pt to exhibit a depression level of consciousness while ANSWER: being aroused with tactile stimulation Rational: goals of moderate sedation include independent maintenance of airway

and appropriate response to physical and verbal stimulation. Although the pain threshold is elevated, all painfull sensation may NOT be eliminated shoes worn by perioperative team members within the surgical suite should have closed toes & backs, low heels, and non skid soles & must meet requirements ANSWER: OSHA pulse oximetry measures ANSWER: saturated hemoglobin in arterial blood local anesthesia injected during an epidural is diffused by the ANSWER: rate of injection Rational: the concentration, volume, and rate of injection determine the spread and diffusion of medication during an epidural injection which of the following is an effective way to prevent hypothermia in the perioperative pt? ANSWER: warm pt before induction of anesthesia which perioperative team member (s) is/are responsible for prevention of retained surgical items? ANSWER: all perioperative team memberst Rational: The entire surgical team should be reasonable for ensuring pt safety and prevention of retained surgical items. A system that includes a multidisciplinary

approach based on team skill and intervention is the best way to prevent pt injury passive drains like a Penrose provide ANSWER: during the stage of healing, granulation tissue can be felt as a firm ridge under the edges of the incision ANSWER: proliferative Rational: granulation tissue forms during the proliferative stage and resolves during the remodeling phase blood salvage for autotransfusion should not be done intraoperatively if there is presence of amniotic fluid, enteric organisms or ANSWER: Avitene Rational: Avitene may not be removed when the cells are washed and could lead to disseminated intravascular coagulation (DIC) and acute respiratory distress syndrome (ARDS). Avitene is a collagen used for hemostasis the recommended maximum cuff pressure limit for a pneumatic tourniquets applied to the lower leg is ANSWER: 250 - 300 Rational: Tourniquet pressure should not exceed the recommended maximum cuff pressure limits of 250 - 300mmHg for the lower leg. in the event of an in count during closing procedures, what is the 1st thing the nurse should do? ANSWER: immediately inform the surgeon Rational: the surgeon should be informed immediately to allow him to search the

wound area while temporarily suspending the closure. In some cases, the surgeon may continue to close based on the pt health status. which of the following is a sign of a blood transfusion reaction in the anesthetizing pt? ANSWER: temperature change Rational: pt under anesthesia may demonstrate profound hypotension, change in temperature, the presence of blood in the urine or a skin rash during intraoperative use of a monopolar electrosurgery unit, the ANSWER: return electrode should be placed as close to the surgical site as possible Rational: the electrical current pathway goes from the generator through the pt to the return electrode & back to the generator. The shortest path decreases the risk of aberrant pathways that could cause the pt burns contaminated items should be transported to the decontamination area ANSWER: in a closed container Rational: this minimizes the risk of staff exposure to blood-borne pathogens & other potentially infectious materials. Contaminated instruments should be separated from clean & sterile supplies before transport to the processing area Explanted medical devices that have caused serious injury to the pt must be reported to which of the following ANSWER: Device manufacturer Rational:

implants that have caused serious injury must be reported to the mfr. If the implant caused death, it must be reported to BOTH FDA & MFR during preoperative verification the nrse notes the pt has an implantable cardioverter-defibrillator (ICD). The nurse ensures the device is turned off prior to the planned procedure because the can deprogram the device and cause it to trigger during the procedure. ANSWER: wavelength Rational: unintended firing of an ICD can cause injury to the pt through an alternate current or potential injury to the caregiver during the procedure A/An forcep is angled to prevent the users hand from occluding vision in a small space ANSWER: bayonet Rational: bayonet forceps may be toothed or smooth and are angled like bayonet. This instrument is commonly used by ENT surgeons and in neurosurgery for a pt undergoing a L total knee replacement, appropriate marking of the surgical site includes which of the following? ANSWER: initialing the surgical site on the L knee by the surgeon with pt input Rational: site should be marked by person performing the operative procedure with pt input if possible. communicating sudden changes in a pt status, such as decerebrate posturing is

important because this may be a sign ANSWER: of worsening and damage Rational: increased intracranial pressure (ICP) may present with decerebrate posturing, which may signal serious damage or disruption of motor fibers in the midbrain & brainstem when performing an abdominal-vaginal skin preparation for a laparoscopic- assisted vaginal hysterectomy, the perioperative nurse proceeds in what order? ANSWER: Perineum, vagina, anus, & finally the abdomen Rational: when there is a combined procedure, the perineum & vaginal areas are prepped 1st, the anus is then prepped using a separate sterile preparation tray. The abdomen is prepped last to prevent splashing of contaminated contents onto the freshly prepped abdomen what is the shelf life of red blood cells when refrigerated? ANSWER: 42 days the perioperative nurse caring for a pt presenting with a traumatic wound for which the edges of the incision cannot be approximated can expect the wound to close by intention ANSWER: secondary Rational: traumatic wounds that cannot be closed are often allowed to heal by secondary intention, which allows the wound to granulate and heal from the inside out

a involves removal of the entire breast along with axillary lymph nodes, the pectoral muscles, and all adjacent tissues ANSWER: radical mastectomy Rational: tissues that have been identified as having malignancy should be removed in their entirety to prevent further spread of the cancer cells. A radical mastectomy will remove the breast and all surrounding tissues an anesthesia care provider uses stories to describe the purpose of each monitoring device to a pt aged 3 years as he prepares the child for induction. This is part of an age specific individualized plan of care addressing the child's ability to ANSWER: magically think Rational: the use of stories addresses a preschoolers magical thinking and beginning use of imagination to make meaning of his surroundings heel bone is referred to as the ANSWER: calcaneus perioperative registered nurse can expect the surgeon to explore the scrotum during which type of hernia repair? ANSWER: indirecta Rational: hallmark of indirect hernias is that the leave the abdominal cavity at the internal inguinal ring and pass with the cord structures down the inguinal canal. The indirect hernia sac may therefore be found in the scrotum.

which position puts the pt at greatest risk for development of a deep vein thrombosis ( DVT) ANSWER: reverse Trendelenburg Rational: any position that places the pt legs in a dependent position increases the risk for DVT formation when delayed primary closure is required, the skin edges are closed how many days after debridement? ANSWER: 4 to 6 days Rational: several factors should be considered when choosing delayed primary closure. Ideally, closure should be completed 4 to 6 days after the initial procedure. The would should be cleaned and debrided prior to closure during a postoperative follwoup phone call, a pt recovering from a R lumpectomy states that she is experiencing numbness to the ring & little fingers of her R hand. The perioperative nurse suspects possible damage to the ANSWER: ulnar nerve Rational: ulnar nerve innervates the middle, ring and little fingers. Numbness over the distal palmar surface of the little finger indicates ulnar nerve injury when stocking medications in the perioperative suite, it is important to stock single dose vials instead of multidose vials whenever possible because ANSWER: there is less risk of using a contaminated medication Rational: single does vials do not have preservative to prevent bacterial growth. When using a multidose vial, there may be viral contamination

the surgical count procedure is a method of accounting for items during the surgical procedure. When is a final count performed? ANSWER: during skin closure Rational: this count verifies that all the items counted match the tally of items used is an ideal complementary therapy to decrease pt anxiety during the intraoperative period, as there is no contact between the practitioner's hand and the pt ANSWER: therapeutic touch in infants older than 3 months, shivering from extremes of cooling generates body heat, which increases metabolic needs and causes a increase in oxygen consumption ANSWER: 200 - 500% Rational: temperature regulation is controlled by anterior hypothalamus when safely placing an adult pt in the prone position for surgery, a minimum of people are required ANSWER: 4 Rational: a minimum of 4 and up to 6 people are needed when placing a pt in the prone position to maintain body alignment a pt who receives a score of 3 using the Glasgow coma scale for eye opening is able to open his/her eyes ANSWER: in response to verbal stimuli Rational: a score of 3 on the eye opening portion of the scale signifies a response to

speech which of the following procedures is considered a class 3 wound? ANSWER: exploratory laparotomy with repair of ruptured diverticulum Rational: clean contaminated classification applies to procedures that enter the alimentary, genitourinary & respiratory tracts under controlled circumstances. A ruptured diverticulum is uncontrolled, contains spilled fecal material & would be classified as contaminated ( class 3) when a laser is in use during a procedure, the area around the surgical site that poses potential injury is known as ANSWER: Nominal hazard zone Rational: nominal hazard zone is a specifically identified area, usually within the surgical suite, that requires the implementation of certain safety measures, lasers do have the potential to penetrate through clear windows. The nominal zone once identified should have safety control measures instituted the lithotomy position is most often associated with compartment syndrome ANSWER: high Rational: flexing the thighs toward the abdomen & suspending the calves vertically compromise circulation, which leads to swelling and pressure on the blood vessels & nerves in the lower leg

During the preoperative assessment, the pt states that "donor-directed" RBCs are available and should be sued if a blood transfusion is necessary. Which of the following is accurate about donor directed RBCs? ANSWER: donated blood is tested and processed by the blood bank What is the physiological change associated w/ the normal aging process in geriatric pt? ANSWER: increased vascular resistance during the preoperative assessment, the perioperative nurse notes on the history & physical that the pt has an entrapped median nerve on the volar surface of the wrist secondary to her work as an IT specialist. The nurse will set up for which of the following procedures? ANSWER: carpal tunnel repair which of the following pt is at increased risk of inadvertent hypothermia? ANSWER: 82 year old undergoing colectomy pt is admitted from a long term facility with a fractured hip. The pt has a " do not resuscitate" (DNR) order in his medical record. The perioperative nurse's next action is to ANSWER: ensure that the pt, anesthesia care provider & surgeon have an opportunity to discuss options and answer questions

It is the responsibility of the to obtain informed consent for a proposed surgical procedure ANSWER: practitioner performing the procedure a form of standardized language in the perioperative setting is reinforced by the use of which documentation format? ANSWER: PNDS Pneumatic tourniquet inflation pressures are determined by ANSWER: systolic BP, age of pt, & circumference of extremity placing sequential compression devices ( SCDs) on a pt legs preoperatively addresses which of the following risk factors for the development of deep vain thrombosis (DVT)? ANSWER: venous stasis a pt is scheduled for a laparoscopic cholecystectomy at 1000. In response to a question related to NPO status, the pt states she had a sip of water with her usual dose of metoprolol/hydrochlorothiazide at 0700. The perioperative nurse's next response is to: ANSWER: proceed with the case as scheduled bone wax should be immediately available for craniotomies conducted in the Fowler position because of this position's increased risk for: ANSWER: air embolus

for a pt with a history of serum cholinesterase deficiency, which of the following anesthetic agents should be avoided? ANSWER: succinylcholin the perioperative registered nurse is caring for a developmentally delayed male pt aged 46 years whose cognitive level is comparable to a child aged 9 years.Which of the following is the most appropriate pain assessment tool? ANSWER: using a FACES pain rating scale Pt with a possible injury within the cranium should not be placed in a position unless absolutely necessary ANSWER: Trendelenburg Which of the following is an example of education using the pt centered care approach? ANSWER: call the dr if the blood on your dressing is bigger than a fifty cent piece greatest risk for transmitting the HIV virus is through exposure ANSWER: to infected blood or body fluids via a large bore hollow needle

which of the following complementary therapies may provide relief for postoperative nausea & vomiting? ANSWER: peppermint aromatherapy the major benefit of using the Perioperative Nursing Data set (PNDS) is its ANSWER: ability to document pt care that is unique to perioperative nursing pt preoperative health assessment form indicates that he uses a continuous positive airway pressuse (CPCP) machine at night for sleep apnea. The perioperative nurse knows to transfer this information to the postanesthesia care unit (PACU) nurse so that the pt can be monitored more closely for signs & symptoms of : ANSWER: hypoxia administration of the preoperative prophylactic antibiotic is the responsibility of ANSWER: a designated perioperative health care provider compared to adults, infants are at increased risk for hypothermia due to ANSWER: increased body surface area to weight ratio accountability for surgical counts is a professional responsibility that rests primarily on the ANSWER: scrub person & RN circulator PNDS uses domains to address the perioperative nursing process ANSWER: 4

the nurse should place a specimen in a container with when sending to pathology for a frozen section ANSWER: Nothing specimens should be transferred from the sterile field to the appropriate container using precautions ANSWER: standard 34 year old female pt with a diagnosis of breast cancer is scheduled for a R breast mastectomy. When performing the surgical skin prep, the nurse ANSWER: uses a no touch technique during prepping If the alimentary, respiratory & genitourinary tracts or oropharyngeal cavity are entered under controlled conditions without significant spillage or unusual contamination, the surgical wound is classified as which of the following? ANSWER: clean contaminated wound Rational: wound classification should be completed after conclusion of the surgical procedures. Determination of any alteration related to spillage of contaminated contents must be considered when applying the wound classification. Any GI or GU tracts are considered clean contaminated unless alterations occur.

During a subtotal thyroidectomy, both the R & L recurrent laryngeal nerves are ligated. The perioperative nurse can anticipate the need for which of the following interventions? ANSWER: obtaining an emergency tracheotomy tray While completing the preoperative assessment, a nurse notices the pt R knee has been marked by the surgeon but the pt is scheduled for the L Knee arthroplasty. What is the best action for the nurse? ANSWER : verify with the surgeon A pt age 7 is scheduled for a tonsillectomy and adenoidectomy at the ambulatory surgery center. During the preoperative telephone interview, the mother asks the preoperative nurse if her daughter will be able to take her favorite stuffed animal into the OR. Which of the following is the best response based on the child's developmental level ANSWER: we will make sure the toy stays with your daughter until the anesthetic takes effect The periperative registered nurse notes that the pt is taking garlic as a prophylactic cold remedy. This information is reported to which of the following health care providers? ANSWER: Anesthesia care provider, because garlic can prolong bleeding A pt who has just received a local anesthetic block is beginning to demonstrate decreased breathing rate & depth, tremors, and muscle twitching, the nurse should

suspect a/an ANSWER: toxic reaction to the local anesthesia the perioperative nurse can expect the would /ostomy/continence nurse to mark the site for the stoma for a colostomy at ANSWER: rectus muscle During a local procedure, the nurse notices that the pt is exhibiting a sense of uneasiness, agitation, coughing & wheezing. The nrse should suspect a/an ANSWER: allergic reaction to the local anesthesia the 3 tops risk factors associated w/ pt falls are medications, gait, and ANSWER: previous fall normal hematocrit for pt age 10 years ranges from ANSWER: 34 - 40% universal protocol is a process to keep pt safe in surgery. Verbal confirmation is performed at 3 points during the perioperative period. Which of the following is identified as 1 of the 3 critical points? ANSWER: sign in before induction of anesthesia a 12 year old boy is scheduled for srgery to repair a fracture to the knee involving the epiphyseal plate. The perioperative nurse recognizes the primary complication resulting from the injury is ANSWER: impaired growth to the affected leg

a pt suffers a cardiac arrest following the injection of bupivacaine 0.5% w/ epi 1:200,000 25 mLas a peripheral nerve block for L knee arthroscopy. The perioperative nurse can anticipate obtaining which of the following drugs for the anesthesia care provider? ANSWER: 20% lipid emulsion Which of the following is an assessment parameter monitored through the use of perioperative nurse process? ANSWER: documentation of potential needs preoperative pt assessment of the use of herbs is an important function of the perioperative nurse so that ANSWER: the appropriate healthcare provider can be notified of potential risks to the surgical procedure which electrolyte is important to check preoperatively after bowel prep the day before? ANSWER: Potassium AORN peripoperative nursing data set (PNDS) is the structured nursing vocabulary designed to describe nursing care in the perioperative setting. At the core of the PNDS conceptual model is the ANSWER: patient What Is Defined As The Standardized Process To Keep Patients Safe In Surgery? ANSWER: Universal protocol

The purpose of witnessing a surgical consent is to attest to which of the following? ANSWER: the signature was voluntary and not coerced Which one of the following antibiotics can potentiate neuromuscular blocking agents? ANSWER: piperacillin Universal protocol is ANSWER: a standardized means for ensuring pt safety during surgery during the discharge medication reconciliation process, the postanesthesia care unit nurse educates the pt and family members to ANSWER: use 1 pharmacy for filling all prescriptions and OTC medications which of the following situations would be categorized as a reportable sentinel event? ANSWER: a pt with a gunshot wound that results in preoperative death Rational:events resulting in unanticipated pt death or permanent loss of function caused by an assault are reportable while a nurse is charting in an electronic pt chart, a colleague who is NOT assigned to the pt walks up and begins to read some of the chart. What should the nurse do? ANSWER: tell the colleague that the pt chart is private & move from view

Rational: every pt has a right to privacy related to health care information. Information should not be misused or shared with those outside the immediate care providers it is important for the perioperative nurse to communicate a pt new onset atrial fibrillation because of an increased risk of ANSWER: stroke caused by embolus Rational: a fib causes small emboli to form in the atria, which may be dislodged and travel to the brain, causing new stroke a nurse assists the anesthesiologist with placement of a spinal anesthetic. The nurse notices the physicians sterile gloves brush againstteh OR table. Which of the following actions demonstrates professional conduct by the nurse? ANSWER: inform the md of the break in sterile technique & provide new sterile gloves Rational: pt safety should be maintained through effective communication of a break in sterile technique. It's the nurse's responsibility to speak up and protect the pt the RN circulator documents on the pt record what was counted, , and by whom, and if the counts were or in ANSWER: how many counts were performed Rarional: an RN is responsible for completing the counts and documenting them. Facility policy should be followed and recommended to include how many counts were performed. Those individuals counting are responsible for the accuracy of the counts

it is important for nurses to use when documenting nursing practice for the perioperative pt ANSWER: nursing terminology R/the use of nursing terminologies ofr documentation provides an efficient, consistent way to communicate nursing knowledge. Nurses will be better able to track, report, and improve the outcomes of nursing care National standards for securityand privacy of health data are set in the ANSWER: HIPPA when talking with the pt during teaching, using an open, relaxed sitting position is a form of communication. ANSWER: nonverbal the rationale for using a local anesthetic with adding epinephrine is to ANSWER: slow the rate of absorption of the local anesthetic by promoting vasoconstriction R/ epi causes vasoconstriction which lets the local anesthetic work longer because of decreased blood flow during a cataract extraction, which of the following medications is used as a prophylactic to reduce inflammation? ANSWER: dexamethasone

while a nurse is walking in the hallway to the preop area, he notices his neighbor on one of the surgical stretchers waiting for an anesthesia interview. What is the nurse's most appropriate action? ANSWER: not stopping or acknowledging the neighbor R/ privacy & confidentiality of all pt information must be protected. HIPAA prevents the health care provider from sharing any pt information with any one not directly associated with pt care Techniques used to enhance effective communication with pt who have impaired communication due to stroke include decreasing environmental stimuli, presenting one idea at a time, treating the pt as an adult and ANSWER: asking simple questions R/ asking simple questions allows pt who have experienced a stroke to answer with simple responses like yes and no. open ended questions may be frustrating and difficult including the pt family/caregivers in the perioperative plan of care has been found to ANSWER: reduce pt & family anxiety key component of quality end of life care is communication with the pt and caregiver that demonstrates empathy ANSWER: and active listening R/ pt who are in the palliative phase of care are silent, which allows time for