CNOR® Q & A

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Sample Questions

Preoperative Patient Assessment and Diagnosis Questions

1. A 75-year-old female patient is scheduled for a total-hip arthroplasty. During your preoperative assessment, you notice hemoglobin of 8 g/dL. What should your next intervention be for this patient?
a. Take her back to the operating room.
b. Ask the surgeon if he or she would like a type and screen or type and cross-match.
c. The lab results are normal, so proceed with surgery.
d. Communicate this information to the preoperative nurse.


Answer: B

Rationale: The lab results are clearly not normal for this patient and should be addressed. The patient is anemic prior to surgery with the chance of losing a fair amount of blood during the procedure. In order to ensure this patient remains safe, the best response is to ask the surgeon if he or she would like a type and screen or type and cross-match. This will allow the patient's blood to be tested and the blood to be available before the patient requires it. The normal range for a female hemoglobin level is 12-15 g/dL. The patient should not be taken back to the operating room until there is a plan in place to address her anemia. This information should be communicated not only to the preoperative nurse, but to all staff involved in the care of this patient in order to ensure the patient's anemia is addressed prior to surgery. However the best answer remains to ask the surgeon about type and screen or type and cross-match.



Intraoperative Activities Questions

1. If Fowler's position is used and an air embolism is diagnosed, which of the following steps will not occur?
a. start of chest compressions
b. Anesthesia provider may aspirate from right atrium.
c. Exposed area is packed with saline-soaked sponges.
d. Site is irrigated with normal saline to prevent further venous aspiration of air.


Answer: A

Rationale: When an air embolism is diagnosed, the antesthesia provider may aspirate air from the right atrium through the central venous catheter. Pack the exposed area with saline-soaked sponges, then cover affected bone with bone wax or irriigate site with saline to prevent further venous aspiration of air.


2. A patient is in the lithotomy position undergoing a laparoscopic-assisted vaginal hysterectomy. The surgeon asked for the patient to be placed in the Trendelenburg position. What force does this position put the patient at risk to develop?
a. friction
b. pressure
c. shearing
d. negativity

Answer: C

Rationale: Shearing occurs when the underlying tissue folds as the skin remains stationary but the skeletal structure moves. This is attributed to a parallel force. This occurs in the Trendelenburg and reverse Trendelenburg positions, which can cause vascular occlusion and create tissue ischemia. Friction occurs when two surfaces rub against each other. For example, if the patient is not lifted off of the bed to reposition, but instead is slid across the bed, the sheets will cause friction and create skin breakdown. Pressure is the force on underlying tissues. For example, the instrument stand is accidentally placed over the patient and is resting on the patient's legs during surgery. This caused pressure and could cause skin breakdown. Negativity relates to layers of materials placed over the operating-room mattress, which reduces the pressure-reduction properties of the mattress.



Emergency Situations Questions

1. A patient is undergoing a craniotomy in the sitting position. The bone flap is lifted, and anesthesia suspects an air embolism. The circulator should assist anesthesia. The surgical tech should do which of the following?
a. Irrigate the wound.
b. Wait for anesthesia.
c. Place bone wax on exposed bone.
d. Put bone flap back on.


Answer: C

Rationale: When a patient is in the Fowler's position, this puts the patient at an increased risk for air embolism. In this scenario, the bone flap was just lifted, which was the cause of the air embolism. The surgical tech and surgeon should place bone wax over the exposed bone. The anesthesia provider will be trying to remove the air embolism from the right atrium via a central venous catheter.



Neurological Questions

1. A lumbar puncture reveals that a patient has viral meningitis. Which of the following interventions should the emergency nurse anticipate?
a. immediate initiation of strict isolation procedures
b. initiation of prophylactic anticonvulsant medication
c. serial neurological assessments to rule out the onset of increased intracranial pressure or the onset of encephalitis
d. prompt initiation of intravenous antibiotics for the patient and initiation of antibiotics for anyone who had been in close personal contact with the patient


Answer: C

Rationale: Viral meningitis is usually mild and requires nothing more than supportive therapy. Some patients with viral meningitis may even be discharged home. Because this infection affects the meninges surrounding the brain, serial neurological assessments should be performed to rule out negative sequelae such as increased intracranial pressure or encephalitis. Strict isolation procedures are not indicated for viral meningitis, as it is only mildly contagious. Patients should be instructed to wash their hands after defecating and to cover their mouth and nose when they cough or sneeze, but they do not require isolation. Prophylactic anticonvulsant medication is not indicated in cases of viral meningitis. Antibiotics will not be effective for viral meningitis.



Medical Emergency Questions

1. A nurse receives a needle stick after administering an IM injection of ceftriaxone (Rocephin) to a patient with a known history of hepatitis B. Which of the following would provide quick, passive immunity for this nurse?
a. immune globulin
b. hepatitis vaccine
c. ribarivin (Rebetol)
d. zidovudine (Retrovir)


Answer: A

Rationale: Immune globulin provides passive immunity to patients for post exposure prophylaxis. The vaccine is an active immunity that will create antibodies. Interferon and zidovudine are medications used to treat hepatitis B and HIV (human immunodeficiency virus).

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