AORN Periop 101 - Final Assessment Review (Qns & Ans) - 2025, Exams of Nursing

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AORN Periop 101

Final Assessment Review

(Questions & Solutions)

1. Multiple-Choice A 53-year-old who does not speak English arrives for an endoscopic sinus procedure. You cannot locate the certified interpreter and the surgeon is eager to proceed. What is the safest and most compliant nursing action? A. Ask a bilingual scrub tech to translate quickly. B. Use a smartphone-based translation app at the bedside. C. Delay the start until a certified medical interpreter is present. D. Have the patient sign the consent while nodding yes. ANS: C Rationale: AORN and CMS regulations mandate language-concordant informed consent using a qualified interpreter; proceeding without one violates patient rights and places the facility at legal risk.

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2. Fill-in-the-Blank According to the ASA Physical Status Classification, a patient with severe systemic disease that is a constant threat to life is designated ASA _____ . ANS: IV Rationale: Classification IV signals the need for enhanced intra-operative monitoring, possible invasive lines, and contingency planning.

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3. True/False Risk stratification for venous thromboembolism must be completed before the patient is transferred into the OR. ANS: True Rationale: Pharmacologic or mechanical prophylaxis decisions (e.g., SCD

6. Multiple-Choice An elderly patient with kyphosis is scheduled for prolonged prone spine instrumentation. Which pre-operative imaging review is most critical to safe positioning? A. Recent lumbar spine MRI B. Post-void residual ultrasound C. Chest CT showing pulmonary blebs D. Carotid Doppler ultrasound ANS: A Rationale: Surgeons and nurses must understand spinal alignment limits; MRI clarifies fused segments and osteoporosis, guiding frame pad placement and reducing neurologic injury.

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7. Fill-in-the-Blank When using the Braden Scale, a cumulative score ≤ ______ indicates high pressure-injury risk and mandates pressure-redistribution padding in the OR. ANS: 18 Rationale: Preventive surfaces and turning schedules are instituted intra-operatively once the risk threshold is reached.

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8. True/False If a patient is unexpectedly found to be allergic to chlorhexidine, povidone-iodine skin prep can be used immediately without any drying time. ANS: False Rationale: Povidone-iodine must remain undisturbed and dry for at least three minutes (or per manufacturer) to achieve full microbicidal

effect.

Infection Prevention & Control (Questions 9-15)

9. Multiple-Choice A total joint tray wrapped in SMS fabric has a 1 cm tear discovered on the back table. The correct action is to: A. Place a sterile adhesive over the tear and continue. B. Flash-sterilize the tray for the manufacturer’s stated cycle. C. Remove the tray, obtain a new sterile set, and start a count again. D. Use individual instruments after immediate-use sterilization (IUSS). ANS: C Rationale: A wrap breach invalidates sterility; the entire set must be rejected, and counts repeated with the replacement to maintain count integrity.

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10. Multiple-Response Which factors compromise steam-sterilization efficacy? □ Residual air pockets □ Inadequate exposure time □ Excessive instrument spacing on racks □ Incorrect water quality ANSs: Residual air pockets, Inadequate exposure time, Incorrect water quality Rationale: Air inhibits steam penetration; exposure time is one leg of the steam “triangle”; high mineral content can form insulating scale. Proper spacing improves not compromises sterilization.

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14. Fill-in-the-Blank IUSS with immediate-use steam sterilization should only be performed for an urgent need, never for _______ or convenience purposes. ANS: workflow (or case turn-over) Rationale: AORN calls this “process short-cuts”; routine scheduling demands proper terminal sterilization, not IUSS.

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15. Multiple-Choice During an outbreak investigation, environmental cultures grow Aspergillus fumigatus in an OR HVAC supply register. The first containment step is: A. Chemically sterilize the air ducts. B. Immediately close the room to traffic and schedule emergency HVAC remediation. C. Continue cases with N95 respirators. D. Raise room ACH (air changes per hour) to maximum. ANS: B Rationale: Fungus in supply air indicates failure of filtration; patient exposure ceases until HVAC corrective actions are complete.

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Instrumentation, Supplies & Environment (Questions 16-22)

16. Multiple-Choice A powered microdebrider’s manufacturer IFU specifies lubrication after each autoclave cycle. Staff skip this, and the handpiece seizes mid-case. Which key AORN principle has been violated? A. The “point-of-use” cleaning standard. B. Adherence to manufacturer’s instructions for use (IFU).

C. Double-check of Preventive Maintenance (PM) logs. D. Environmental Prudent Practice (EPP). ANS: B Rationale: IFU compliance is non-negotiable; deviation relinquishes product liability and patient safety.

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17. True/False Blue light–enhanced headlights can impair polymerization of light-cured bone cement. ANS: False Rationale: UV wavelengths, not visible blue surgical headlights, affect cement curing.

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18. Fill-in-the-Blank ANSI requires ________ lux (≈ 1 000 foot-candles) of illumination directly over an open surgical site for high-precision work. ANS: 40 000 Rationale: Task lighting must meet this threshold to distinguish fine structures and color variations.

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19. Multiple-Choice Which insufflation gas alarm must be audible to the circulating RN during a laparoscopic colectomy? A. CO₂ cylinder temperature low B. Flow rate exceeds 20 L/min C. Intra-abdominal pressure > 15 mm Hg

code compliance. ANS: 18 Rationale: NFPA stipulates 18 in (46 cm) clearance for unobstructed water dispersion.

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Intra-Op Patient Safety & Positioning (Questions 23-29)

23. Multiple-Choice A super-obese patient (BMI = 62 kg/m²) requires robotic prostatectomy in steep Trendelenburg. Which positioning adjunct is most effective to prevent cephalad migration? A. Vacuum bean-bag with shoulder braces B. Cross-chest safety strap C. Sticky foam egg-crate under torso D. Wide gel sled with built-in chest wall bolsters ANS: D Rationale: Gel sleds cradle the torso without axillary nerve compression, outperforming shoulder braces that risk brachial plexus injury.

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24. Fill-in-the-Blank Forearm pronation in the prone position can compress the ulnar nerve at the __________ groove. ANS: cubital (ulnar) Rationale: Neutral or supinated forearm alignment protects the cubital tunnel.

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25. True/False When utilizing a lower-body forced-air warming blanket, active warming should begin after the patient is prepped and draped to limit contamination risk. ANS: True Rationale: Starting after draping reduces disruption of prep solution evaporation and minimizes airborne particles over the sterile field.

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26. Multiple-Choice Mid-case, the endotracheal tube cuff fails and the anesthesiologist requests immediate access to the head in a lithotomy-robotic case. The nurse should first: A. Undock the robot following the emergent undocking algorithm. B. Reverse Trendelenburg fully. C. Lower both legs simultaneously to neutral. D. Release the shoulder braces. ANS: A Rationale: Robotic systems obstruct head access; emergent undocking is scripted and rehearsed for airway-compromise events.

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27. Multiple-Response Which physiologic changes result from 25° Trendelenburg and pneumoperitoneum during lengthy gynecologic surgery? □ Increased intraocular pressure □ Decreased intracranial pressure □ Reduced pulmonary compliance □ Elevated venous return ANSs: Increased intraocular pressure, Reduced pulmonary compliance,

rigidity after succinylcholine. The immediate nursing priority is to: A. Call the blood bank for six units of PRBCs. B. Draw a rapid point-of-care potassium level. C. Obtain the malignant hyperthermia (MH) cart and notify the surgeon/anesthesia. D. Ask the perfusionist to set up cardiopulmonary bypass. ANS: C Rationale: Early dantrolene preparation is time-critical; masseter rigidity may herald MH.

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31. True/False During an electrical fire in the ESU pencil, shutting off oxygen flow should precede powering down the electrosurgical unit. ANS: False Rationale: The fire triad’s ignition source should be removed first; stopping ESU current halts sparking while anesthesia concurrently stops oxygen.

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32. Fill-in-the-Blank The mnemonic “RAMP” (Remove, Activate, Monitor, Provide) outlines the RN circulator’s steps in a __________ event such as rapid transfusion reaction. ANS: hemolytic (acute hemolytic transfusion reaction) Rationale: RAMP specifies removing the blood, activating emergency response, monitoring vitals/urine, providing supportive therapy.

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33. Multiple-Response Key components of the AORN Sharps Safety guideline include: □ Double-gloving for all invasive procedures □ Magnetic drape attachment of sharps holders □ Hands-free neutral zone technique □ Mandatory blunt suture needles for skin closure ANSs: Double-gloving, Hands-free neutral zone Rationale: Magnetic attachments are not standardized; blunt needles are recommended for fascia/muscle, not necessarily skin.

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34. Multiple-Choice A pacemaker-dependent patient requires monopolar electrosurgery above the umbilicus. Which action minimizes EMI risk? A. Place the dispersive electrode on the contralateral thigh. B. Position the ESU return pad so current flows at a right angle to the pacemaker leads. C. Use cutting mode with the highest possible wattage. D. Keep the active electrode in contact > 10 seconds at a time. ANS: B Rationale: Current path orthogonal to leads reduces induced voltage. Low-voltage cut bursts with brief activation are also recommended.

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Professional Accountability & Quality Improvement (Questions 35-40)

35. Multiple-Choice Which metric best reflects structure (not process or outcome) in Donabedian’s model for evaluating peri-operative quality? A. Percentage of completed surgical time-outs B. Number of airborne particle counts < 10 CFU/m³ in class A ORs

C. Quietly X-ray the patient in PACU. D. Initiate a root-cause-analysis form post-case. ANS: B Rationale: Advocacy for patient safety includes escalating concerns in real time, even if it delays turnover. Documentation alone is insufficient.

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39. Multiple-Response Which of the following are National Quality Forum (NQF) serious reportable events relevant to peri-op practice? □ Wrong surgical site □ Retained foreign object □ Intra-operative burn □ Post-op myocardial infarction ANSs: Wrong surgical site, Retained foreign object, Intra-operative burn Rationale: These qualify as “Never Events”; MI, while adverse, is not on the NQF list.

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40. Multiple-Choice A randomized audit shows that glove failure during orthopedic cases averages 37 minutes for primary gloves. Which evidence-based adjustment best improves barrier integrity? A. Switch to thicker latex gloves only. B. Double-glove and plan timed outer-glove changes at 20 minutes. C. Add alcohol hand rub over gloves every 15 minutes. D. Use glove liners instead of double-gloving. ANS: B Rationale: Literature supports double-gloving with scheduled outer- glove changes before micro-perforations typically occur, markedly

lowering blood exposure. Multiple Choice: A patient with a known latex allergy is scheduled for a laparoscopic cholecystectomy. Which of the following actions is most important for the perioperative nurse to take? a) Ensure all surgical instruments are sterilized using a steam sterilization method. b) Confirm the availability of a latex-free cart and supplies. c) Administer a prophylactic dose of diphenhydramine before the incision. d) Place a latex allergy alert band on the patient's wrist. ANS: b) Confirm the availability of a latex-free cart and supplies. Rationale: Ensuring a latex-free environment is paramount for patients with latex allergies. This includes all equipment and supplies that will come into contact with the patient. Fill-in-the-Blank: The surgical team's adherence to the principles of __ is critical to preventing surgical site infections. ANS: asepsis Rationale: Asepsis is the cornerstone of infection prevention in the surgical setting. True/False: The circulating nurse is responsible for verifying the surgeon's preference card and ensuring all instruments and supplies are available before the patient enters the operating room. ANS: True Rationale: This proactive approach ensures a smooth and efficient surgical procedure, minimizing delays and potential errors. Multiple Response: Which of the following are essential components of a comprehensive preoperative assessment? (Select all that apply.)

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) Monitoring the patient's vital signs. d) Counting instruments, sponges, and sharps. e) Documenting the procedure. ANS: a, b, d Rationale: The scrub person's primary responsibilities revolve around maintaining the sterile field and assisting the surgeon with instrumentation. Multiple Choice: A patient is undergoing a laparoscopic procedure. Which of the following is a priority nursing consideration related to patient positioning? a) Ensuring the patient's arms are tucked securely at their sides. b) Preventing nerve injuries. c) Maintaining the patient's airway. d) Providing adequate padding to pressure points. ANS: b) Preventing nerve injuries. Rationale: Prolonged positioning can lead to nerve compression. Fill-in-the-Blank: The surgical timeout is a critical safety measure that involves a verification process to prevent __. ANS: wrong-site, wrong-procedure, and wrong-patient surgery Rationale: The surgical timeout is a universal protocol designed to eliminate these preventable errors. True/False: The perioperative nurse is responsible for advocating for the patient's needs throughout the surgical experience. ANS: True

Rationale: Patient advocacy is a core principle of perioperative nursing practice. Multiple Response: Which of the following are key elements of effective communication within the surgical team? (Select all that apply.) a) Using clear and concise language. b) Actively listening to other team members. c) Providing constructive feedback. d) Avoiding interruptions. e) Maintaining a hierarchical structure. ANS: a, b, c, d Rationale: Effective communication is essential for teamwork and patient safety. Multiple Choice: A retained surgical item (RSI) is discovered after a procedure. Which of the following actions should be taken immediately? a) Notify the surgeon and document the incident. b) Conduct a thorough count of all instruments and supplies. c) Initiate an incident report. d) All of the above. ANS: d) All of the above. Rationale: All of these actions are crucial for managing an RSI and preventing future occurrences. Fill-in-the-Blank: AORN stands for __. ANS: Association of periOperative Registered Nurses Rationale: AORN is the professional organization for perioperative nurses. True/False: The perioperative nurse has a responsibility to participate in quality improvement initiatives.