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CNOR Practice Exam- Zander 199
Questions with Answers latest 2025
The patient's desirable and measurable physiological and psychological responses to nursing interventions are called: Process Standards Outcome Standards Clinical Efficiency Quality Improvement
- Outcome Standards he common goal of standards is quality patient care. Patient outcomes are an essential indicator of the quality patient care. Alexander's Care of the Patient in Surgery 16th ed. Ch 1 What the wound classification for vaginal hysterectomy? Class 1 Class 2 Class 3 Class 4
- Class 2 There is controlled entry into the genitourinary tract. Alexander's Care of the Patient in Surgery 16th ed. Ch 9 The 19-year-old patient arrives to the OR within 2 hours of a traumatic open Tib/Fib fracture for ORIF. What wound class is it? Class Class 2 Class 3 Class 4
- Class 3 A fresh open trauma is classified as Contaminated (Class 3), A fresh trauma is one that is less than 4-6 hours old at the start of surgery. Alexander's Care of the Patient in Surgery 16th ed. Ch 9 Patients with one or more of Virchow's triad are at increased risk for Deep vein thrombosis Hemorrhage
Surgical site infection Respiratory distress
- DVT Virchow's triad describes the three broad categories of factors that are thought to contribute to thrombosis. Hypercoagulability. Hemodynamic changes (stasis, turbulence) Endothelial injury/dysfunction. DVT is at an increased risk Alexander's Care of the Patient in Surgery 16th ed. Ch. 24 The Spaulding classification system is used to determine: Appropriate methods to attain desired level of processing required for safety in patient care items. Safety standards for safely administering and monitoring anesthesia care Post-operative discharge criteria Ideal pressurization for rubberized spherical items
- Appropriate methods to attain desired level of processing required for safety in patient care items. Earle Spaulding, a microbiologist, developed a classification system in 1968 to determine the appropriate method to attain the desired level of processing required for safety in patient care items. This system was adopted and later modified by the CDC. Berry and Kohn's Operating Room Technique 13th ed Ch 17 When passing the knife to the surgeon the best practice would be... To place the knife into a designated tray and so the surgeon can pick it up To firmly place the blade handle into the surgeon's palm Let the surgeon take what he wants from the mayo stand With the use of a safety scalpel passing device
- To place the knife into a designated tray and so the surgeon can pick it up The neutral zone is a sterile basin or tray or magnetic pad from which the surgeon or assistant can retrieve them. When finished the surgeon returns the item to the tray where the scrub person retrieves them. Hand to hand passing of sharps increases the chance of accidental sharps injury. Nobody but me gets to touch my mayo stand and I made up the safety scalpel passing device. Alexander's Care of the Patient in Surgery 16th ed. Ch. 7 The ultimate responsibility for the nurse's competency is: Nurse Educator Manager Director
- Nurse
want to do it'. The patient is scheduled for an AV fistula so she can begin renal dialysis. The CRNA asks "you don't want to have surgery?" The patient responds that she does not. What should be the response of the surgical team? The patient has versed on board and will not remember and likely doesn't know what she's saying. The team should proceed with induction The patient should be taken back to the holding area and the surgeon notified of the patient's decision The patient signed the consent for surgery and needs the procedure for dialysis. The team is obligated to proceed The surgeon should be called to come in the room and explain to the patient why she must have the procedure
- The patient should be taken back to the holding area and the surgeon notified of the patient's decision The informed consent remains in effect for as long as the person still agrees to the surgery or procedure. If at any time the patient no longer agrees the consent is withdrawn. There is no exception to this. Medications given or forms signed does not remove the individual's right to choose. Alexander's Care of the Patient in Surgery 16th ed. Ch. 24 Counting sponges is a nursing action. The nurse is accountable. The belief that the surgeon is responsible for all actions taken by staff in surgery, known as 'The Captain of the Ship' is outdated and no longer legally valid. The nurse is legally responsible for the surgical count. What type of law deals with injury to a person such as a retained object? Civil Law Criminal Law Civic Law Tort Law
- Tort Law A tort action law suit is filed when there is injury to a person caused by another person. A retained object is tort claim. Berry and Kohn's Operating Room Technique 13th ed Ch 3 What is the Perioperative Nursing Data Set (PNDS), and its function? The PNDS is a standardized vocabulary and care pathway in electronic documentation that can be aggregated and analyzed. It's used to evaluate the effectiveness of nursing care on patient outcomes The PNDS are standardized components of the perioperative nursing care used for reporting patient errors to hospital administration. The PNDS is a set of possible outcomes for surgical patients used for quality reporting and sentinel events.
The PNDS is the foundation on which all surgical nursing research is based allowing definable and measurable results.
- The PNDS is a standardized vocabulary and care pathway in electronic documentation that can be aggregated and analyzed. It's used to evaluate the effectiveness of nursing care on patient outcomes PNDS is a standardized language used to document patient care to enhance retrievability of data for evaluation of patient care. Alexander's Care of the Patient in Surgery 16th ed. Ch 1 Mr S has tuberculosis and has just started a rifampin therapy this week. He was admitted through the ED with active TB and acute Cholecystitis. The patient is stable and being made comfortable on the med/surg floor. At 1pm the general surgeon tells the charge nurse that surgery needs to be done within the next 24 hours. The surgeon and charge nurse collaborate to work the cholecystectomy patient into the schedule. It would be best if this patient's case is: done as soon as possible. Other cases on todays schedule will be bumped forward to allow the case to proceed immediately. scheduled as the first case of the following day. fit into the middle of the schedule the following day during a three-hour period when the surgeon's usual room will be empty. scheduled at the end of the day today
- scheduled at the end of the day today Treatment of TB is long term, usually 6-12 months. This patient's case cannot be delayed until the sputum shows a smear negative for TB and must be done while the patient is active. The case should be done at the end of the day when minimal personnel and patients are present and there will be minimal traffic in the area. Berry and Kohn's Operating Room Technique 13th ed Ch. 14 The surgeon is preparing to place plaster cast on the patient after the ORIF. According to rule of confine and contain what should happen next? How should the perioperative nurse respond? Ask the surgeon to remove his gown and gloves Remove the case cart from the room Tell the scrubbed person to cover the table Ask the surgeon to place the cast in the recovery area.
- Ask the surgeon to remove his gown and gloves To prevent blood from getting on the cast and irritation to the hands from the lime content the surgeon should done non sterile disposable gloves. Berry and Kohn's Operating Room Technique 13th ed Ch 36
Fractures corrected with closed reduction heal more quickly Closed reduction reduces the likelihood of infection Open reduction with internal fixation is more expensive. CMS requires we attempt closed reduction as the first treatment option
- Closed reduction reduces the likelihood of infection Opening the skin interrupts the first line of defense against infection. A closed reduction is a safer option for the patient. Open reduction actually tends to heal bone more quickly than closed reduction. CMS does not override the physician's decision. ORIF is more expensive but this is not as important as patient safety and outcome. Berry and Kohn's Operating Room Technique 13th ed Ch 36 Which of the following patients is at the least risk for a surgical fire? An intubated patient with bipolar cauterization during a peripheral vascular procedure A patient with oxygen by mask and monopolar electrocautery A bowel resection with monopolar electrocautery A laser microlaryngoscopy on an intubated patient on low concentration oxygen
- An intubated patient with bipolar cauterization during a peripheral vascular procedure The least risk is the patient with an isolated airway and an ignition source away from the airway. Open oxygen such as a mask has an increased rist. Laser work in an airway with supplemental oxygen brings the ignition and oxygen together. Methane from the bowel is a flammable gas. Bringing the fuel, ignition source and oxygen in proximity increases risk. Our goal is to keep these three as separated as possible Berry and Kohn's Operating Room Technique 13th ed Ch 13 The perioperative nurse is preparing the surgical site for a colostomy reversal and re- anastomosis of the bowel. How should the prepare the stoma? Prep from incision to periphery on the abdomen incorporating the stoma Isolate the stoma with a sterile barrier, prep from incision to periphery, prep the stoma last and cover with a sponge Prep the stoma then concentric circles out to the periphery Clip the hair from the site, scrub then paint the abdomen with betadine solution
- Isolate the stoma with a sterile barrier, prep from incision to periphery, prep the stoma last and cover with a sponge Intestinal stomas are contaminated. The stoma should be isolated with a sterile clear plastic adhesive dressing and prepped last. It's covered with a dressing to prevent fecal material from entering the wound. Berry and Kohn's Operating Room Technique 13th ed Ch 26 A biological indicator used to confirm that the Steam Gravity Displacement Sterilizer is functioning properly uses which kind of spore?
Geobacillus Stearothermophilus Bacillus atropheus Clostridium difficile
- Geobacillus Stearothermophilus Steam Sterilizers use the Geobacillus Stearothermophilus. The only two spores used to test sterilization efficacy are Geobacillus Stearothermophilus and Bacillus atropheus. The most common is the Geobacillus which is used for all types of sterilization other than Ethylene Oxide and Dry Heat. Alexander's Care of the Patient in Surgery 16th ed. Ch. 4 The emancipated minor is a 16-year-old female accompanied by her infant daughter and her boyfriend. The 16-year-old is having a hernia repair. The surgical consent is signed by whom? Because the minor is a parent, she can sign her own consent form Because she is a minor the legal guardian of the 16-year-old must sign consent The minor is emancipated so she can sign consent If the minor is living on her own and making a living, she can sign her own consent form
- The minor is emancipated so she can sign consent The key word here is emancipated. Emancipation of minors is a legal mechanism by which a minor is freed from control by their parents or guardians, and the parents or guardians are freed from any and all responsibility toward the child. It varies from state to state what is required for emancipation but that doesn't matter for the exam. Just know an emancipated minor is legally independent and can sign consent. The perioperative nurse explains how the surgical site will be prepared for surgery after induction. This is an example of what part of the nursing process Assessment Planning Implementation Outcome Identification
- Implementation Implementation is easy to identify because it is an action. It's a nursing action. In this example the nurse is 'explaining'. This is a nursing action for any nursing diagnosis of Knowledge Deficit. To make it measurable you could have the patient teach back to you how we will prepare the surgical site. Alexander's Care of the Patient in Surgery 16th ed. Chapter 1 What is the Nursing Code of Ethics?
At the end of the case
- Before closure of the uterus The first closing count is done before closure of a hollow organ. Berry and Kohn's Operating Room Technique 13th ed Ch 25 The perioperative nurse is preparing the room for the upcoming procedure. The RN understands that a surgical microscope is used with which of the following procedures? Vasovasotomy Cholecystectomy Orchiectomy Hydrocelectomy
- Vasovasotomy Vasovasotomy is microsurgery performed under the magnification of the operating microscope. Berry and Kohn's Operating Room Technique 13th ed Ch 35 OR attire can be worn in the following setting outside of the OR when covered with a lab coat? When going to the cafeteria To the surgeon's office To a meeting in a different building on campus To the designated smoking area on campus
- When going to the cafeteria OR attire should not be worn outside the OR suite or outdoors. On occasions outside the OR suite but remaining indoors, such as for lunch breaks, a single use cover coat or jacket completely buttoned closed may be worn over he OR attire. Smoking, going to the office or outdoors requires a change into street clothes. Berry and Kohn's Operating Room Technique 13th ed Ch 17 The surgeon has repeatedly asked to increase power setting on the electrosurgical unit (ESU) during the procedure. The perioperative nurse should first... Check that the grounding pad is secure and has full uniform body contact. Change the grounding pad if necessary Give the surgeon a new active electrode Swap the current ESU with a different one Turn the power up as often as required by the surgeon not to exceed cut 40 and coag of 60
- Check that the grounding pad is secure and has full uniform body contact. Change the grounding pad if necessary
The perioperative nurse should first assess. (always think nursing process when ready exam questions) The first thing to investigate when there is impedance in power is the grounding pad. Second check the pen. Lastly swap the machine. Power settings depend on many variables. There is not a 'max setting' that is reasonable for all tissue. Berry and Kohn's Operating Room Technique 13th ed Ch 20 The post-operative nurse is admitting the patient after an abdominal surgery. The patient's heart rate and BP are elevated, and he is very awake, grimacing and complaining of pain. The post-operative nurse understands that the most effective way to control the patient's pain is what? The patient is the authority about his or her pain and a patient-controlled analgesia pump is most effective The patient's pain is out of control, so the highest dose is given to most effectively control pain For patient safety the lowest dose is given, and then subsequent doses can be given until pain is controlled The patient's behavior is outside of the normal reaction. Suspecting narcotic seeking behavior, the nurse should first gather information about possible opioid addiction before treating the patient
- The patient is the authority about his or her pain and a patient-controlled analgesia pump is most effective The patient's self-report is the most reliable indicator of the existence and intensity of pain. There is no set dose of opioid that is effective for all patients. Patient controlled analgesia is most effective means of pain control. Alexander's Care of the Patient in Surgery 16th ed. Ch. 10 The 15-year-old patient has mumps and is coming to surgery for an open reduction internal fixation of is tibia and fibula bones. What, if any, isolation precautions should be taken during the care of this patient? Standard precautions are adequate for mumps isolation Droplet precautions should be taken for mumps isolation Contact isolation is required Strict isolation is implemented for mumps isolation
- Droplet precautions should be taken for mumps isolation Mumps virus is transmitted via inhalation of infectious respiratory droplets, direct contact with infected droplets or saliva. Droplet precautions are required Berry and Kohn's Operating Room Technique 13th ed Ch 15 The patient reports being told by his allergist that if he ever when to surgery he should let them know he is allergic to soybeans because there's some medication he can't have in surgery with a soybean allergy. He can't remember the name of the medication he can't have. What medication should be avoided in this patient?
The products and medical devices used in the perioperative setting are selected By a multidisciplinary product evaluation and selection committee By service specific nurses and surgical technicians With a goal to control institutional costs By the surgeon who requests the item
- By a multidisciplinary product evaluation and selection committee According to the AORN Guidelines a multidisciplinary committee to include members from all departments where the product will be used and personnel with expertise beyond the clinical end users should be involved in the selection process. 2019 AORN Guidelines p 184- The habit of truthfulness is expected from perioperative nurses. This habitual honesty the perioperative nurse gives patients is known as. Fidelity Veracity Excellence Quality of Practice
- Veracity Veracity is a character trait of habitual truthfulness. Alexander's Care of the Patient in Surgery 16th ed. Ch 1 The surgical consent is valid only... When there are two witnesses When the form is signed by the physician When the patient understands the procedure as well as risks and alternatives to surgery After the physician writes an order for surgery in the patient's medical record.
- When the patient understands the procedure as well as risks and alternatives to surgery Informed consent is an understanding between the physician and the patient. The patient must be knowledgeable about the procedure and understand the risks and alternatives. Alexander's Care of the Patient in Surgery 16th ed. Ch. 2 How should you treat a patient with a PH 7.13, CO2 80 and HCO3 30? The patient needs to be ventilated or possibly receive reversal agents for sedatives if the patient is overly sedated. The patient should receive Sodium Bicarbonate to correct the acidosis
The nurse should work to stop any uncontrolled vomiting or diarrhea that might be causing the HCO3 depletion. The nurse should continue to monitor for now and let anesthesia know if there are changes.
- The patient needs to be ventilated or possibly receive reversal agents for sedatives if the patient is overly sedated. This patient is experiencing a Respiratory Acidosis. They need to breath faster to reduce the excess CO2. Berry and Kohn's Operating Room Technique 13th ed Ch 27 The patient has a PVC on every other heartbeat. What is this arrhythmia? Complete heart block V-tach Supraventricular Tachycardia Bigeminy
- Bigeminy A PVC on every other beat is Bigeminy. Every third beat is Trigeminy American Heart Association A 42 year old fire fighter is brought to the OR for debridement of dead tissue. He has 2nd and 3rd degree burns over his torso, left arm, neck and left face and ear. The perioperative nurse prepares the OR by Increasing the room temperature Asking the manager how the room should be set up Attaining room temperature irrigation solution for debridement Bringing in the pneumatic tourniquet to decrease blood loss
- Increasing the room temperature The temperature in the OR is constantly monitored to prevent hypothermia. Room temperature irrigation is too cool. The pneumatic tourniquet is sometimes used when a distal extremity is burned to decrease blood loss during debridement but is not appropriate for the location of burns on this patient. Alexander's Care of the Patient in Surgery 16th ed. Ch. 22 When placing a patient in the Jackknife position a pillow is placed under the lower legs for what purpose? To elevate the feet and promote venous return to reduce swelling To maintain proper body alignment To prevent pressure on the toes To relieve lumbosacral strain
- To prevent pressure on the toes
Doppler test results
- Angiogram films and report You'll need the angiogram. The surgeon will need to see where the narrowing of the artery is and where the most patent part is so he or she can determine where to place the graft. If there is doubt about the patency of the popliteal artery or distal arterial tree, additional arteriograms might be performed after the exploration of the popliteal artery during the procedure. Alexander's Care of the Patient in Surgery 16th ed. Ch. 24 During the laser microlaryngoscopy there is an airway explosion and fire. The first thing to do is... Turn off the oxygen Pour saline or water into the airway Remove the endotracheal tube in its entirety Perform an emergency tracheotomy
- Remove the endotracheal tube in its entirety Airway explosion cased by the laser beam ignition of the endotracheal tube can cause a potentially lethal accident for the patient. The immediate action is to remove the ETT, ensuring the entire tub is removed, turn off the gasses and oxygen, pour water or saline into the airway reintubate and examine the airway. Next steps are decided upon examination. Alexander's Care of the Patient in Surgery 16th ed. Ch. 1 During the procedure the scrubbed nurse has contaminated his glove. How should the scrubbed nurse proceed after the circulator removes the glove? The scrubbed person regloves using the closed gloving method The scrubbed person regloves using the open gloving method The scrubbed person uses assisted gloving to reglove The scrubbed person will continue with only the inner glove
- The scrubbed person uses assisted gloving to reglove Another scrubbed team member may then facilitate regloving using the assisted gloving technique. Closed gloving is not acceptable for regloving because the stockinette cuff is considered contaminated. Open gloving is not recommended because of the risk of contamination. Double gloving is required. Alexander's Care of the Patient in Surgery 16th ed. Ch. 4 The trade name for Sublimaze is... Valium Fentanyl Dilaudid
Versed
- Fentanyl Valium is the trade name for Diazapam, Dilaudid is the trade name for Hydromorphone, and Versed is the trade name for Midazolam. Sublimaze is the generic name for Fentanyl Alexander's Care of the Patient in Surgery 16th ed. Ch. 5 The hospital administration is considering in house reprocessing of medical devices. What agency writes guidelines they should refer to? The Environmental Protection Agency The Joint Commission The Centers for Disease Control and Prevention The Food and Drug Administration
- The Food and Drug Administration Reprocessing of Single Use Medical Devices is strictly regulated by the FDA. The reprocessing regulations are the same as processing and are very difficult to accomplish in a hospital facility. AORN Guidelines: RP Sterilization and Disinfection II A process that uses both Evidence Based Practice and Research Utilization to improve quality measures and patient outcomes Research Utilization Culture of Accountability Change Implementation Quality Improvement
- Quality Improvement Quality Improvement uses EBP and RU to improve quality measures and patient outcomes. Alexander's Care of the Patient in Surgery 16th ed. Ch. 1 The perioperative nurse is circulating during a cystoscopy. The scrubbed person hands the stones off the field. The circulator places them into... A dry container. A moist sponge. An isotonic solution.. The refrigerator immediately.
- A dry container. Stones are placed in a dry container so they will not dissolve.
The patient arrives to the pre-operative area reporting that they have had uncontrolled vomiting and diarrhea for two days. The GI upset stopped early hours this morning but the patient reports feeling weak. They patient's initial VS show hypotension and the EKG shows an inverted T wave in lead II. The preoperative nurse calls the physician because? She suspects the patient has a low potassium level and needs labs drawn and fluids with potassium started The patient has the flu and needs to be isolated The patient's case will need to be moved up so he can be seen quickly He will want to know the patient has arrived
- She suspects the patient has a low potassium level and needs labs drawn and fluids with potassium started Hypokalemia can occur as a result of losing large amounts of bodily fluid, especially from the GI tract. Symptoms of hypokalemia include hypotension, loss of bowel sounds, weakness and conduction abnormalities (inverted T wave in lead II) Alexander's Care of the Patient in Surgery 16th ed. Ch. 5 Before closing the surgeon injects 1% Lidocaine with Epinephrine around the tissue within surgical site. What is the reason for the combination of medication? Together these medications will increase blood flow to the site to aid in healing and temporarily decrease incisional pain These medications are to relieve pain and prevent bradycardia and hypotension that may result These medications support blood pressure and prevent arrhythmias. The combination prolongs pain control postoperatively
- The combination prolongs pain control postoperatively Epinephrine is a vasoconstrictor so reduces blood flow to the area and so causes the absorption of the Lidocaine to be slowed and prolonged. The combination allows the effects of the lidocaine to last longer. It's for post op pain control. Alexander's Care of the Patient in Surgery 16th ed. Ch. 5 Mrs Garcia speaks very little English. What is most appropriate for her care during her experience in the perioperative area? Provide a hospital certified interpreter throughout the procedure Teach the staff a few phrases needed to explain basic care Allow a family member to escort her in the pre and post operative areas Have an interpreter explain what will happen during her care ahead of time
- Allow a family member to escort her in the pre and post operative areas A certified medical interpreter is required for surgical consent but a family member to escort and translate for her is reasonable. (Some facilities now use translation software
on electronic devices. This is not mentioned in the resources used for the CNOR exam, however.) Berry and Kohn's Operating Room Technique 13th ed Ch 21 The patient is scheduled for scleral buckling procedure. The perioperative nurse is speaking with the patient preoperatively when the patient says, 'I'm afraid I may lose sght after surgery' What nursing diagnosis is appropriate for this patient? knowledge deficit anxiety impaired body image inability to adapt
- anxiety Without the surgery or the surgery is ineffective the detached retina can worsen and certainly cause vision loss. This is a scary prospect and vision loss is heavy on the mind of the patient. Anytime a patient says 'I'm afraid' clearly anxiety is an appropriate Nursing Diagnosis. Alexander's Care of the Patient in Surgery 16th ed. Ch. 1 Post-operative patient teaching begins in what phase of the surgical process? Preadmission visit Pre-operative area Phase 1 Recovery Phase 2 Recovery
- Preadmission visit Ideally patient, family and caregiver education and discharge planning begin before the patient admission for surgery. Alexander's Care of the Patient in Surgery 16th ed. Ch. 10 An example of a class 1 chemical indicator is which of the following? Integrator inside of a tray Biological spore testing Indicator tape on a wrapped tray Indicator tab used with peracetic acid
- Indicator tape on a wrapped tray Class 1 indicators are process indicators that demonstrate that the package has ben exposed to the sterilization process to distinguish between processed and unprocessed packages. Indicator tape is an example. 2019 AORN Guidelines: Packaging Systems Which incision would likely be used for a cesarean section?
