CNOR EXAM AND PRACTICE QUESTIONS 2024/2025 ACTUAL EXAM 400 QUESTIONS AND 100% CORRECT VERI, Exams of Nutrition

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CNOR EXAM AND PRACTICE QUESTIONS 2024/ 2025

ACTUAL EXAM 400 QUESTIONS AND 100% CORRECT

VERIFIED ANSWERS GRADED A+

During a procedure under local anesthesia, the patient complains of circumoral numbness, blurred vision, and dizziness. What should be the immediate action of the perioperative nurse monitoring this patient? a. Recheck the dose of local anesthesia given b. Ensure an airway c. Set the IV line to full flow d. Call for 20% lipid emulsion to be brought to the room b The circulating nurse reports that the needle count is incorrect. The surgeon continues to close the wound, stating, "I know it is not in the wound and I am not going to stop to look for it." The best plan of action is to: a. Accept the surgeon's response without comment and fill out an incident report b. Inform the surgeon of hospital policy and document subsequent actions c. Order X-rays regardless of the surgeon's wishes d. Notify the OR supervisor and ask for advice b A new employee unknowingly dispensed an unsterile solution to the sterile field. The following day, the supervisor learns of the incident. The supervisor's first action would be to: a. Initiate an incident report b. Instruct the employee on the technique of reading labels c. Counsel the employee verbally d. Notify the surgeon of the break in technique

d Due to an emergency, the perioperative nurse is unable to conduct the sponge, sharps, and instrument counts. At the conclusion of the surgery, the nurse should: a. Ask the surgeon to sign the count b. Immediately notify the OR supervisor c. Document the absence of counts d. Refuse to sign the sponge count record c The optimum patient position provides: a. Access and exposure, maintains circulatory and respiratory functions, and does not compromise neuromuscular structures. b. Optimum access and exposure to surgical site, with no permanent compromise to neuromuscular structures. c. Access for the surgeon, does not compromise the neuromuscular structures, and maintains an adequate airway for the anesthetist. d. Sustained circulatory and respiratory functions, does not compromise neuromuscular structures, and maintains body alignment. a A patient who is 8 months pregnant is to undergo an emergency laparotomy. In planning nursing care for this patient, the perioperative nurse should have available a wedge cushion or pillow to place under the patient's: a. Knees b. Left side c. Right side d. Shoulders c

You're loading the sterilizer with trays and wrapped towels. The correct configuration would be: a. The towels are on the bottom shelf and the trays on the top shelf b. The towels are on the top shelf and the trays are on the bottom shelf c. The trays and towels go on the top shelf and leave the bottom shelf empty d. There is no specific configuration when there is a mixed load of trays and wrapped textiles b During the induction of anesthesia, the perioperative nurse may notice fasciculation as a response to which of the following depolarizing muscle relaxants? a. Tubocurarine chloride (curare) b. Succinylcholine chloride (Anectine) c. Atracurium besylate (Tracrium) d. Pancuronium bromide (Pavulon) b The ER notifies you that it has an 18-yr-old patient who was in a sledding accident and who is accompanied by his parents. The patient is alert, oriented, in pain, has a blood pressure of 80/60, pulse of 120, and RR of 24. The abdomen is distended and tender. After being transferred to the OR bed, the patient is very apprehensive and complains of being cold. The nurse should confirm the patient's name, allergies, and operative procedure by: a. Speaking with the patient and reading the patient's chart b. Telephone conversation with the ER nurse c. Use of the ER record provided d. Telephone conversation with a parent of the patient a A critically injured patient requires immediate surgery, but all unassigned personnel have limited OR experience. In this situation, the charge nurse should: a. Assist the available personnel in caring for the patient b. Reassign experienced personnel to the emergency procedure

c. Personally assume care for the critically injured patient d. Call in additional personnel to handle the emergency b The nurse's initial response to a patient who develops signs of cyanosis during the preoperative assessment is to: a. Administer O2 and start an IV line b. Begin CPR c. Read the history and physical to determine health status d. Assess for breath sounds and airway obstruction d SPAULDING CLASSIFICATION SYSTEM Critical, semi-critical, or non-critical?

• Must be sterile
• Will enter sterile tissue or the vascular system critical SPAULDING CLASSIFICATION SYSTEM Critical, semi-critical, or non-critical?
• Instruments
• Cutting endoscopic accessories and endoscopes (ex. BIOPSY FORCEPS)
• Cardiac and urinary catheters (still fall into this category even though it does not meet the TRUE definition) critical SPAULDING CLASSIFICATION SYSTEM Critical, semi-critical, or non-critical?
• SHOULD be sterile, but high-level disinfection (kills everything EXCEPT SPORES) acceptable if

manufacturers' instructions require (going to be sterilized unless manufacturer specifically says not to)

• Contacts broken skin or mucous membrane semi-critical SPAULDING CLASSIFICATION SYSTEM Critical, semi-critical, or non-critical?
• Respiratory therapy
• Anesthesia equipment
• Bronchoscopes
• GI endoscopes semi-critical SPAULDING CLASSIFICATION SYSTEM Critical, semi-critical, or non-critical?
• Intermediate or low-level disinfection or cleaning
• Will come in contact with skin
• Ex. washing with soap and water/wiping equipment down/laundry non-critical SPAULDING CLASSIFICATION SYSTEM Critical, semi-critical, or non-critical?
• OR bed
• Linens
• EKG leads
• BP cuffs
• Tourniquets non-critical TRUE OR FALSE

There needs to be a physical separation (or a wall) between a decontamination area and processing area where instruments are processed true Sterile Processing Decontamination area or processing area?

• Has a high bioburden
• NEGATIVE airflow
• LOWER temperature decontamination Sterile Processing Decontamination area or processing area?
• POSITIVE airflow
• HIGHER temperature processing True or false You can skip the decontamination process in sterile processing false Can you walk through a decontamination area with sterile supplies in your hand? no Can you walk through a place with autoclaves with soiled instruments in your hand? no __________ is the most CRITICAL step to prevent infection

decontamination (cleaning) Is an enzymatic agent a disinfectant? no A(n) __________ agent is used to pre-treat instruments. It is non-drying and is NOT a disinfectant. It is something that BREAKS DOWN organic material. It digests that organic material and makes it something that is easy to clean and disinfect. It DISSOLVES the organic stuff and INCLUDES PROTEASES. enzymatic The size and length of brush lumens to clean instruments is determined by the manufacturer. true __________ is very difficult to get off instruments once it's on there. This adds texture on instruments where spores can hide. biofilm What is considered more effective: Automated cleaning (ultrasonic & washers) or manual cleaning? automated What type of sterilizers do pre-vacuum autoclave (dynamic air-removal) and gravity displacement autoclaves fall under? steam Both pre-vacuum autoclaves (dynamic air-removal) and gravity displacement autoclaves end in a chamber full of __________ steam Steam Sterilization Pre-vacuum autoclave (dynamic air-removal) OR gravity displacement autoclave?

• Sucks air out of the chamber
• Clean drains are essential
• 270 degrees F-276 degrees F
• Porous/lumen items in 4 minutes
• Nonporous in 3 minutes
• Most commonly used today
• Very good at pulling the steam through blue filters
• Good for packaged items pre-vacuum autoclave Steam Sterilization Pre-vacuum autoclave (dynamic air-removal) OR gravity displacement autoclave?
• Steam forces air from chamber
• Thermometer closes drain
• 270 degrees F-276 degrees F
• Clean drains are essential
• Porous/lumen items in 10 min
• Nonporous in 3 minutes
• Older form of sterilization
• Takes LONGER to penetrate filters
• Hardly anywhere uses this method anymore gravity displacement autoclave __________ sterilization is the preferred method of sterilization because of its efficacy steam Steam Sterilization In a pre-vacuum autoclave (dynamic air-removal), how long does it take for porous/lumen items? 4 minutes

Steam Sterilization In a pre-vacuum autoclave (dynamic air-removal), how long does it take for nonporous items? 3 minutes Steam Sterilization In a gravity displacement autoclave, how long does it take for porous/lumen items? 10 minutes Steam Sterilization In a gravity displacement autoclave, how long does it take for nonporous items? 3 minutes Which steam sterilization is better for packaged items: a pre-vacuum autoclave (dynamic air-removal) or a gravity displacement autoclave? pre-vacuum autoclave True or false? Clean drains are essential in both pre-vacuum autoclaves (dynamic air-removal) and gravity displacement autoclaves. true Steam Sterilization Pre-vacuum autoclave (dynamic air-removal) OR gravity displacement autoclave? Sucks air out of the chamber pre-vacuum autoclave

Steam Sterilization Pre-vacuum autoclave (dynamic air-removal) OR gravity displacement autoclave? Steam forces air from chamber gravity displacement autoclave If condensation occurs after steam sterilization and the items are moist, they are considered __________ and the sterilization process must be restarted. contaminated True or false? In steam sterilization, loads must be removed IMMEDIATELY because leaving the door ajar to cool increases likelihood of condensation. true True or false? After steam sterilization, hot items should be placed on cool solid surfaces or racks. false The requirement for handling items after steam sterilization includes that it must be cooled on a lined surface until it is easily handled with __________. bare hands After items are sterilized using steam sterilization, they should be placed on a __________ surface and allowed to cool until it can easily be carried with bare hands. lined Which of the following describes the process for gravity displacement sterilization? a. Steam enters the chamber at the bottom and slowly pushes the air down and out through a

discharge outlet b. Steam enters the chamber at the bottom and slowly pushes the air up and out through a discharge outlet c. Steam enters the chamber at the top and slowly pushes the air down and out through a discharge outlet d. Steam enters the chamber at the side and slowly pushes the air out the other side through a discharge outlet c __________ indicators include: Class 1: Heat Class 2: Pressure - Bowie Dick Class 3: Single parameter Class 4: Multi parameter Class 5: Integrated Class 6: Emulating indicator chemical Which 2 class indicators must every tray that we use have? class 1, class 5 Which class indicator is on the outside of the tray and is only there for verification that the tray went through heat? class 1 Which class indicator is on the inside of the tray (should be in the top of the tray and in the corner because this is the most difficult place for steam to penetrate) class 5 Which 2 classes of chemical indicators are ALL INCLUSIVE? (Meaning there are 4 parameters of sterilization)

1. TIME

2. TEMPERATURE

3. PRESSURE

4. QUALITY OF STEAM

(ALL FOUR MUST be present for indicator to change colors) class 5, class 6 Which class of chemical indicator says that a vacuum cycled properly? (used only in a pre-vacuum autoclave) class 2 Class 2 chemical indicators are only used with a __________ autoclave. (The only type of sterilization that has a vacuum cycle is this type of autoclave) pre-vacuum Which class of chemical indicator only checks ONE things and nothing else (ex. quality of steam) class 3 Which class of chemical indicator checks 2 or more parameters (usually TIME and TEMPERATURE)? (So if something gets to the right temperature for the right amount of time, this indicator will change) class 4 Which class of chemical indicator is made by the manufactorer of the autoclave and it is used to test a specific cycle on THEIR machine? (It is integrated and all four parameters of sterilization must be present) class 6 Types of Sterilization __________:

• No packaging, wrapped items, or textiles
• NO TOWELS
• A rigid sterilization container with a lid must be used
• Same decontamination process must be followed (ex. if surgeon drops forceps, it must still properly go through decontamination under water and scrubbed before being sterilized)
• Must use a class 5 chemical indicator
• NEVER an implant unless emergent - biological 1st must be used (with a spore)
• This method should only account for 10% or less of total sterilization immediate use steam sterilization Types of Sterilization __________:
• "Cold sterilization"
• Point of care use only
• Takes 10 hours of immersion (rapid takes 5 hours)
• Bad for instruments
• Suboptimal form of sterilization (environmental problems, poor ease of use because has to be used IMMEDIATELY - cannot be packaged and stored on a shelf for use later)
• Cannot be placed on patient skin, must be rinsed glutaraldehyde Types of Sterilization __________:
• Cold & dry
• For heat and moisture sensitive items
• 99 - 145 degrees F and 45-75% humidity
• 2 - 5 hours exposure (total of ~17 hours for one run)
• Aeration time 8-12 hours
• HUMAN CARCINOGEN (known to cause cancer, will MELT LUNGS)
• Exposure time limited to 1 ppm in an 8-hour period (workers must leave area immediately if exposure

exceeds)

• Wonderful for instruments
• Lumens must be COMPLETELY DRY
• Environmentally hazardous
• The only way to sterilize long, narrow lumens inside of a package (ex. foley catheters) - going to be BANNED in 2030, so we need to come up with a different way to sterilize
• Banned in Europe, so Europe buys from us ethylene oxide Types of Sterilization __________:
• Cold & dry
• Sterrad or V-PRO
• Used for heat and moisture sensitive items
• Electrical current changes hydrogen peroxide into a plasma
• Cycle time is 75 minutes (even if the cycle aborts due to wet items, it is still 75 minutes)
• Environmentally sound
• Items MUST BE DRY, plasma cannot reach instrument if there's a bead of water
• Waste product is oxygen and water
• Does NOT sterilize long narrow lumens inside of a package; must be forced through the lumens, so these instruments CANNOT be in a package low temperature hydrogen peroxide plasma sterilization Types of Sterilization __________:
• Very acidic like stomach acid
• Used a lot in GI labs
• Automated Endoscope Reprocessor (AER)
• For items that can be immersed
• Corrosive to instruments and people

• Temp 120-130 degrees F
• 20 - 30 minutes
• Micron filtered tap water rinses - FOUR OF THEM (turns it into vinegar, which is then OK for it to go down the drain and into regular sewage), very acidic so cannot go on someones skin until rinsed four times
• For point of care use only (must be dried and stored appropriately OR used immediately; won't wrap them in a package somewhere
• Documentation (for patient safety) peracetic acid Types of Sterilization __________:
• Low temperature sterilization
• Only one manufacturer in the USA
• FDA has cleared this for sterilization of METAL and PLASTIC
• Exhaust is passed through a CATALYTIC CONVERTER
• Environmentally sound (biproduct is oxygen and water)
• No aeration cycle is necessary ozone Types of Sterilization __________:
• High temperature
• Best for heat stable powders and oils
• "Expensive toaster oven"
• Common in doctors offices, dental offices, tattoo/piercing places
• Dental instruments, burrs, reusable needles, glassware
• DON'T USE TAPE
• 300 - 400 degrees F for 40-50 min (like an oven)

- DO NOT PUT BLUE WRAP IN - IT WILL BURN

• Must only use materials approved for use dry heat Types of Sterilization Immediate Use Steam Sterilization If one test fails, there must be __ consecutive tests that must pass 3 Types of Sterilization Immediate Use Steam Sterilization A __________ indicator must be used when using this type of sterilization because it makes the machine "prove" that the spores were killed (a live spore is actually placed inside and must be killed at end of sterilization process) ***MUST BE USED IF GOING TO PUT IMPLANT IN THIS STERILIZER biological Types of Sterilization Glutaraldehyde Is this type of sterilization good for instruments? no Types of Sterilization Glutaraldehyde Can you package these instruments and store them on the shelf for use later? no

Types of Sterilization Glutaraldehyde Is this type of sterilization good for the environment? no Types of Sterilization Ethylene oxide Is this type of sterilization good for instruments? yes Types of Sterilization Ethylene oxide This type of sterilization is known as a human __________. It is known to cause cancer. carcinogen Types of Sterilization Ethylene oxide Lumens must be completely __________ after this sterilization. dry Types of Sterilization Ethylene oxide Is this type of sterilization good for the environment? no __________ sterilization is the ONLY way we have to sterilize long, narrow lumens inside of a package (ex. foley catheters). This method is set to be banned in 2030. ethylene oxide

Types of Sterilization Low Temp Hydrogen Peroxide Plasma Sterilization Is this type of sterilization good for the environment? yes Types of Sterilization Low Temp Hydrogen Peroxide Plasma Sterilization No aeration cycle is needed in this type of sterilization because it is a __________ sterilization. This type of sterilization is good for HEAT and MOISTURE sensitive items. dry Types of Sterilization Low Temp Hydrogen Peroxide Plasma Sterilization The cycle time is 75 minutes for this type of sterilization, even if the cycle __________ due to wet items. aborts Types of Sterilization Low Temp Hydrogen Peroxide Plasma Sterilization Can this type of sterilization sterilize long narrow lumens inside of a package? no Types of Sterilization Peracetic Acid Is this type of sterilization good for instruments? no (highly corrosive)

Types of Sterilization Peracetic Acid After using this type of sterilization, there must be __ micron filtered tap water rinses in order to turn it into VINEGAR because it is so acidic, it cannot be placed on someones raw flesh until it is rinsed this amount of times. Since the rinsing turns it into vinegar, it is OK to go down the drain into regular sewage. 4 Peracetic acid is turned into __________ after being rinsed 4 times. vinegar Types of Sterilization Peracetic Acid Can you wrap and store instruments using this type of sterilization? no (must be used immediately) Types of Sterilization Ozone This type of sterilization only has one manufacturer in the USA and is cleared by the FDA to be used to sterilize metal and plastic. The exhaust is passed through a __________ and the biproduct is oxygen and water. No aeration cycle is necessary. catalytic converter Types of Sterilization Ozone Is this type of sterilization good for the environment? yes

Types of Sterilization Dry Heat This type of sterilization is best for heat stable __________ and __________. powders, oils Types of Sterilization __________: This type of sterilization is known as an "expensive toaster oven" but cheap form of sterilization. It acts almost as an oven (360-400 degrees F). Blue wraps and tape should not be placed in here because they will burn. Materials must only be placed inside that are approved for use. dry heat A prosthesis is contaminated during an orthopedic case and a suitable replacement is not immediately available. How should this prosthesis be sterilized? a. Immediate use sterilization @ 270° F for 3 minutes with a chemical indicator b. Send the implant to sterile processing to be returned after the biological indicator has been read c. Double-wrap and autoclave @ 270° F for 30 minutes with a chemical indicator d. Immediate use sterilization @ 270° F for 10 minutes with both chemical and biological indicators b The bowie-dick test is used to determine a. Proper functioning of the vacuum system b. The concentration of ethylene oxide gas c. Achievement of sterilization d. Adequate temperature requirements a A chemical indicator included with surgical instruments processed in a gravity displacement steam sterilizer indicates that the instruments were:

a. Exposed to the sterilizing conditions b. Free of all surface bioburden c. Exposed to the necessary vacuum pressure d. Sterilization has been achieved a What type of processing does an item classified by the Spaulding System as critical require? a. Sterilization b. High level disinfection c. Environmental Cleaning d. Low level disinfection a When items are heat or moisture sensitive which of the following sterilization techniques may be used? a. Dry Heat b. Low Temperature hydrogen peroxide gas plasma c. Glutaraldehyde d. Saturated Steam under pressure b Tape located on the outside of a sterilized package is considered a class ____ chemical indicator a. IV b. II c. I d. V c

Which of the following items is not considered critical according to the Spaulding Classification System? a. Foley Catheter b. Pneumatic tourniquet cuff c. Acupuncture needles d. IV catheter b When testing sterilizer efficacy, which sterilizers below must include a biological indicator with bacillus atrophaeus spore? a. Steam b. Dry Heat c. Hydrogen Peroxide Gas Plasma d. Ozone b The leak testing of an endoscope should be performed: a. after mechanical processing and before storage b. on the surgical field, immediately after use c. after handing off the field, prior to processing d. before every use c Cleaning and decontamination of the endoscope begins a. On the field throughout the procedure b. After the patient leaves the OR c. With an alcohol based solution d. Immediately after use

a Endoscopes must be stored... a. In a drying cabinet b. In a cabinet in the procedure room for easy accessibility c. Vertically for no more than 5 days d. In the hallway outside of the procedure room a Four laparoscopic tubal ligations have been scheduled for the same day. One of the four available laparoscopes is contaminated during the preparation for the second tubal ligation. The laparoscopes will not withstand steam sterilization. In this situation, what would be the most appropriate course of action? a. Soak the contaminated laparoscope in a high-level disinfectant for 20 min prior to use on the fourth patient b. Inform the surgeon of the potential compromise in the fourth patient's care and explore alternate solutions c. Inform the fourth patient that her tubal ligation can't be done due to the lack of sterile equipment d. Sterilize the contaminated laparoscope using ethylene oxide, omit the aeration cycle, and rinse with sterile water b Which type of sterilizer must be tested with a Bowie-Dick chemical indicator daily? a. Gravity displacement b. Dry heat c. Dynamic Air Removal d. Ozone c

Which item according to the Spaulding Classification System is considered critical and therefore must be sterile? a. Laparoscope b. Cystoscope c. Bronchoscope d. Colonoscope a The total weight of an instrument containment device, including contents, should not exceed a. Weight is irrelevant as long as the integrator has changed b. 25 pounds c. 35 pounds d. 40 pounds b What is another name for a pre-vacuum autoclave? dynamic air removal sterilizer Ideally, spore testing on autoclaves should be done __________, but ideally is done daily with gravity displacement and pre-vacuum autoclaves. weekly With __________, a biological spore indicator test should be in every load (1 load can take up to 17 hours long). ethylene oxide Sterilizer testing There are only __ types of spores used in testing:

• Geobacillus Stearothermophilus (steam, plasma, ozone, and peracetic acid)
• Bacillus atropheus (ethylene oxide and dry heat)

Sterilizer Testing Which 2 types of sterilizers use bacillus atropheus spores? (All others use Geobacillus Stearothermophilus spores) ethylene oxide, dry heat True or false? Steam (gravity displacement and prevacuum) sterilizers use Geobacillus Stearothermophilus spore testing true The weight of packaged instruments should not exceed __ pounds (this includes the tray, basket, and instruments all together). **If manufacturer instructions say a different limit, you go by the manufacturers IFU (overrides AORN standards) 25 Can you add in textiles, peel pouches, and rubber mats inside of a tray that don't come with it post market? no Can count sheets be on the inside of trays? yes Can you open a sterile envelope with a count sheet on the sterile field? no (must be passed off to circulator to be opened) Do you write on the plastic or paper side of peel pouches? plastic