AORN CNOR - Final Assessment Review (Qns & Ans) - 2025, Exams of Nursing

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AORN CNOR

Final Assessment Review

(Questions & Solutions)

1. Multiple Choice A 65-year-old patient scheduled for a total knee replacement has a known allergy to latex and a history of deep vein thrombosis (DVT). What is the most critical consideration in developing the individualized plan of care prior to surgery? A) Increase preoperative antibiotics dose B) Implement latex-free environment and DVT prophylaxis C) Use standard positioning aids without modification D) Reduce anesthesia dosage due to allergy risk ANS: B) Implement latex-free environment and DVT prophylaxis Rationale: Patients with latex allergy require strict avoidance to prevent allergic reactions. A history of DVT necessitates prophylactic measures to reduce thromboembolism risk during and after surgery.
2. Fill-in-the-Blank When conducting a preoperative assessment, the nurse must prioritize the identification of ____________ conditions that may impact anesthesia and surgical outcomes. ANS: comorbid Rationale: Comorbid conditions such as cardiovascular or pulmonary diseases can significantly influence perioperative management decisions.
3. True/False Individualized care plans should be adjusted intraoperatively based solely on anesthesiologist recommendations, without input from perioperative nursing staff. ANS: False Rationale: Care plans should be multidisciplinary and dynamic, incorporating input from all members of the perioperative team including nursing staff, to ensure patient safety and optimal outcomes.

Rationale: A minimum of 2 minutes contact time is considered effective to achieve surgical hand antisepsis.

7. True/False Transmission-based precautions are only necessary in postoperative care and not required during intraoperative management of patients with known infectious diseases. ANS: False Rationale: Transmission-based precautions must be maintained throughout the perioperative continuum to prevent pathogen spread.
8. Multiple Response Select all perioperative practices that reduce surgical site infection risk: A) Maintaining normothermia intra-op B) Administering prophylactic antibiotics after incision C) Using disposable sterile supplies D) Minimizing OR traffic E) Allowing sterile drape contamination to ensure access ANS: A) Maintaining normothermia intra-op, C) Using disposable sterile supplies, D) Minimizing OR traffic Rationale: Proper timing of antibiotics is before incision; all other options promote infection prevention. Instrumentation, Supplies & Environment
9. Multiple Choice A scrub nurse notices that an instrument with lumens was improperly cleaned before sterilization. Which sterilization method will be compromised if the instrument is not cleaned properly? A) Steam sterilization B) Dry heat sterilization C) Ethylene oxide sterilization D) All sterilization methods

ANS: D) All sterilization methods Rationale: Organic material must be removed before sterilization to ensure effectiveness, regardless of the method.

10. Fill-in-the-Blank The primary environmental control to reduce airborne microbial contamination in the operating room is the use of ___________ airflow systems. ANS: laminar Rationale: Laminar airflow provides unidirectional filtered airflow to reduce microbial contamination.
11. True/False All sterilized supplies must be stored on the floor as long as they are covered with sterile drapes. ANS: False Rationale: Sterile supplies must be stored at least 8-10 inches above the floor to avoid contamination.
12. Multiple Response Which of the following are indicators of effective sterilization? (Select all that apply.) A) Chemical indicator color change B) Temperature documentation C) Use of surgical smoke evacuators D) Biological indicator testing E) Visual inspection of package ANS: A) Chemical indicator color change, B) Temperature documentation, D) Biological indicator testing Rationale: Chemical and biological indicators along with proper documentation validate sterilization; smoke evacuators are for smoke removal, not sterilization.

B) Use of gel pads or foam overlays C) Maintaining adequate hydration D) Applying dry sterile dressings on pressure points E) Avoiding excess padding to reduce bulk ANS: A) Repositioning every 2 hours, B) Use of gel pads or foam overlays, C) Maintaining adequate hydration Rationale: Proper repositioning, cushioning, and hydration prevent pressure injuries; dry dressings alone do not protect pressure points. Emergency Situations & Advocacy

17. Multiple Choice A patient develops malignant hyperthermia in the OR. The first nursing action should be to: A) Administer dantrolene immediately B) Call for help and discontinue triggering agents C) Increase the patient’s temperature monitoring interval D) Document the event and notify anesthesia post case ANS: B) Call for help and discontinue triggering agents Rationale: Immediate cessation of triggering agents and summoning assistance is critical to survival in malignant hyperthermia.
18. Fill-in-the-Blank The legal principle of ____________ requires that perioperative nurses advocate for patient safety and intervene when unsafe practices are observed. ANS: accountability Rationale: Accountability obligates nurses to ensure patient safety through advocacy.
19. True/False In all emergency situations, the perioperative nurse’s primary responsibility is to maintain the sterile field regardless of patient stability.

ANS: False Rationale: Patient safety and stability supersede sterile field maintenance; non-sterile interventions may be necessary during emergencies.

20. Multiple Response Which of the following actions are appropriate when a staff member witnesses a colleague violating sterile technique? (Select all that apply.) A) Immediately intervene to stop the violation B) Report the incident to the charge nurse or supervisor C) Ignore if no contamination occurs D) Document the event in incident reporting system E) Discuss privately with the colleague after the procedure ANS: A) Immediately intervene to stop the violation, B) Report the incident to the charge nurse or supervisor, D) Document the event in incident reporting system Rationale: Immediate intervention prevents patient harm; proper reporting and documentation ensures accountability. Professional Accountability & Quality Improvement
21. Multiple Choice Which quality improvement tool is best for identifying the root cause of a recurring intraoperative issue? A) Fishbone (Ishikawa) diagram B) Gantt chart C) SWOT analysis D) Pareto chart ANS: A) Fishbone (Ishikawa) diagram Rationale: Fishbone diagrams systematically explore root causes of problems.
22. Fill-in-the-Blank

A) Restrict fluids aggressively B) Use low tidal volume ventilation with appropriate PEEP C) Avoid use of neuromuscular blockers D) Administer high-dose corticosteroids preoperatively ANS: B) Use low tidal volume ventilation with appropriate PEEP Rationale: Protective lung ventilation strategies reduce barotrauma and improve oxygenation in COPD patients.

26. Fill-in-the-Blank To minimize risk of surgical site infection, the perioperative nurse confirms that prophylactic antibiotics are administered within _____ minutes prior to surgical incision. ANS: 60 Rationale: Administration within 60 minutes before incision optimizes tissue antibiotic levels.
27. True/False Reusable surgical instruments require sterilization after every use regardless of visible soil or contamination. ANS: True Rationale: Sterilization after every use prevents cross-contamination.
28. Multiple Response During emergency craniotomy, which interventions enhance patient safety? (Select all that apply.) A) Securing airway with endotracheal tube B) Strict monitoring of intracranial pressure C) Ensuring radiology images are available intra-op D) Constant verbal updates to family during procedure E) Continuous neurovascular assessment ANS: A) Securing airway with endotracheal tube, B) Strict monitoring of

intracranial pressure, C) Ensuring radiology images are available intra-op, E) Continuous neurovascular assessment Rationale: Airway protection, ICP monitoring, imaging support, and neuro-assessment are critical; verbal family updates occur post-op.

29. Multiple Choice Which action best represents professional ethical behavior by a perioperative nurse? A) Reporting personal mistakes only if asked B) Maintaining patient confidentiality at all times C) Delegating all medication administration to anesthesia staff D) Following surgeon’s orders without question ANS: B) Maintaining patient confidentiality at all times Rationale: Confidentiality is a core ethical responsibility.
30. Fill-in-the-Blank The designated person responsible for maintaining sterile technique throughout the procedure is the ____________. ANS: scrub nurse Rationale: The scrub nurse manages sterile field and instruments.
31. True/False The use of surgical checklists has been shown to reduce perioperative morbidity and mortality. ANS: True Rationale: Checklists improve communication and safety compliance.
32. Multiple Response Which factors contribute to environmental contamination in the OR? (Select all that apply.) A) Increased OR staff movement B) Use of positive pressure ventilation

transmission between cases.

36. Multiple Response Which documentation components are essential for effective perioperative nursing care? (Select all that apply.) A) Patient allergies and risk factors B) Time and type of prophylactic antibiotic administration C) Sterile field breaches and corrective actions D) Staff breaks and lunch schedules E) Positioning devices used and patient tolerance ANS: A) Patient allergies and risk factors, B) Time and type of prophylactic antibiotic administration, C) Sterile field breaches and corrective actions, E) Positioning devices used and patient tolerance Rationale: Accurate clinical documentation supports safety and continuity; staff breaks are irrelevant.
37. Multiple Choice Which intraoperative monitoring parameter is most indicative of early hypovolemia? A) Elevated blood pressure B) Decreased urine output C) Hyperthermia D) Normal respiratory rate ANS: B) Decreased urine output Rationale: Reduced urine output signals decreased perfusion from hypovolemia.
38. Fill-in-the-Blank The perioperative nurse must activate the __________ protocol when a fire ignites in the OR. ANS: Emergency Rationale: Emergency protocols facilitate rapid and coordinated

responses to OR fires.

39. True/False Leading an interprofessional debrief after a sentinel event contributes to overall quality improvement. ANS: True Rationale: Debriefing fosters learning and system improvements.
40. Multiple Response Which actions demonstrate professional accountability? (Select all that apply.) A) Maintaining certification and competency B) Reporting unsafe practices promptly C) Ignoring minor breaches to maintain team harmony D) Participating in quality improvement initiatives E) Adhering to evidence-based protocols ANS: A) Maintaining certification and competency, B) Reporting unsafe practices promptly, D) Participating in quality improvement initiatives, E) Adhering to evidence-based protocols Rationale: Accountability encompasses ongoing education, safety reporting, QI participation, and protocol adherence. A surgical patient with a history of rheumatoid arthritis is scheduled for a total knee arthroplasty. Which of the following pre-operative assessments is MOST critical for the perioperative nurse to prioritize? a) Review of the patient's dietary habits. b) Assessment of the patient's social support system. c) Evaluation of the patient's range of motion and joint function. d) Inquiry about the patient's current medication list. Correct ANS: c)

Correct ANSs: b, c, d Rationale: Proper hand hygiene is a critical component of infection prevention. The surgical scrub brush is no longer recommended. Instrumentation, Supplies & Environment Multiple Choice: Which of the following sterilization methods is MOST appropriate for heat-sensitive instruments? a) Steam sterilization b) Ethylene oxide sterilization c) Dry heat sterilization d) Plasma sterilization Correct ANS: d) Rationale: Plasma sterilization is a low-temperature sterilization method suitable for heat-sensitive items. Fill-in-the-Blank: The surgical environment should be maintained at a temperature range of _ degrees Fahrenheit. Correct ANS: 68- 75 Rationale: This temperature range provides a comfortable environment for the surgical team while minimizing the risk of bacterial growth. Intra-op Patient Safety & Positioning True/False: When positioning a patient for a lateral decubitus procedure, the

dependent arm should be extended on an arm board at less than a 90- degree angle to prevent nerve damage. Correct ANS: True Rationale: Maintaining proper arm positioning prevents compression of the brachial plexus. Multiple Response: Which of the following are important considerations for patient safety during the administration of a nerve block? (Select all that apply.) a) Confirming patient identity and surgical site. b) Monitoring the patient's vital signs. c) Ensuring the availability of resuscitation equipment. d) Providing the patient with detailed information about the procedure. Correct ANSs: a, b, c, d Rationale: Patient safety is paramount during nerve blocks, and all of these elements are essential. Emergency Situations & Advocacy Multiple Choice: During a surgical procedure, a patient experiences a sudden drop in blood pressure and an increase in heart rate. The perioperative nurse's FIRST priority should be to: a) Notify the surgeon. b) Administer oxygen. c) Assess the patient's airway, breathing, and circulation. d) Check the anesthesia record. Correct ANS: c) Rationale: Assessing the patient's ABCs is the initial step in managing

Advanced Concepts Multiple Choice: A patient undergoing a laparoscopic cholecystectomy develops a pneumoperitoneum. The nurse should be prepared for which potential complication? a) Hypotension b) Hyperthermia c) Respiratory compromise d) Urinary retention Correct ANS: c) Rationale: Pneumoperitoneum can cause increased intra-abdominal pressure, potentially leading to respiratory difficulties. Fill-in-the-Blank: The use of _ is critical for preventing retained surgical items. Correct ANS: Surgical counts. Rationale: Accurate and consistent surgical counts are the primary method for ensuring that all items are accounted for. True/False: The circulating nurse is responsible for verifying the surgeon's preference card before the start of the surgical procedure. Correct ANS: True Rationale: This verification ensures that the correct instruments and supplies are available. Multiple Response:

Which of the following are responsibilities of the scrub person? (Select all that apply.) a) Maintaining the sterile field. b) Passing instruments to the surgeon. c) Performing the surgical hand scrub. d) Documenting the surgical procedure. Correct ANSs: a, b, c Rationale: The scrub person's role is centered on maintaining sterility and assisting the surgeon. Documentation is primarily the responsibility of the circulating nurse. Multiple Choice: During a surgical procedure, the patient's oxygen saturation drops to 88%. The FIRST action the perioperative nurse should take is to: a) Notify the anesthesia provider. b) Increase the patient's oxygen flow rate. c) Assess the patient's airway and breathing. d) Check the oxygen equipment for proper function. Correct ANS: c) Rationale: Assessing the patient's ABCs is the initial step in managing any emergency situation. Fill-in-the-Blank: The principles of _ are used to maintain the sterile field. Correct ANS: Asepsis Rationale: Aseptic technique is essential to prevent surgical site infections. True/False: