CNOR Perioperative nursing certification
validating expertise in surgical patient care,
aseptic techniques, safety standards, and
operative procedures.
Question 1
A patient undergoing a laparoscopic cholecystectomy is positioned in the supine
position with both arms tucked at the sides. Which pressure point is at HIGHEST
risk for injury in this position?
A. Heels
B. Occiput
C. Ulnar nerves
D. Sacrum
Answer: C. Ulnar nerves
Rationale: When the arms are tucked at the sides, the ulnar nerves are at risk for
compression injury at the elbow (cubital tunnel) or wrist. Proper padding and
positioning of the arms in a neutral position with palms facing the body are
essential to prevent ulnar nerve palsy. The heels, occiput, and sacrum are also
pressure points but are typically addressed with standard padding and positioning
devices.
Question 2
The perioperative nurse is preparing the surgical site for a procedure. Which of the
following is the CORRECT sequence for preoperative skin antisepsis?
A. Clean the site, apply antiseptic, allow to dry, then drape
B. Apply antiseptic, clean the site, allow to dry, then drape
C. Clean the site, apply antiseptic, drape immediately
D. Apply antiseptic, allow to dry, clean the site, then drape
Answer: A. Clean the site, apply antiseptic, allow to dry, then drape
,Rationale: The correct sequence for preoperative skin antisepsis is to first clean
the site of gross contaminants, then apply the antiseptic agent, allow it to dry
completely (for the antiseptic to achieve its full effect), and then apply sterile
drapes. Applying drapes before the antiseptic has dried can reduce its efficacy and
increase the risk of surgical site infection.
Question 3
During a surgical procedure, the scrub nurse notices a tear in the sterile glove. The
appropriate action is to:
A. Cover the tear with an adhesive bandage
B. Change the glove immediately using the open-gloving technique
C. Change the glove immediately using the closed-gloving technique
D. Continue the procedure but avoid touching sterile items with that hand
Answer: C. Change the glove immediately using the closed-gloving technique
Rationale: A tear in a sterile glove compromises the sterile field. The glove must
be changed immediately. The closed-gloving technique is the preferred method for
changing gloves during a sterile procedure because it maintains sterility of the
outside of the glove. The open-gloving technique is used for initial gloving.
Covering the tear or continuing the procedure is unsafe.
Question 4
Which of the following is a PRIMARY responsibility of the circulating nurse
during a surgical procedure?
A. Setting up the sterile field
B. Counting sponges, needles, and instruments
C. Performing surgical hand antisepsis
D. Passing instruments to the surgeon
Answer: B. Counting sponges, needles, and instruments
Rationale: The circulating nurse is responsible for the initial, intraoperative, and
closing counts of sponges, needles, and instruments to prevent retained foreign
bodies. Setting up the sterile field and passing instruments are responsibilities of
,the scrub person. Surgical hand antisepsis is performed by both the scrub person
and the surgeon.
Question 5
A patient is scheduled for surgery and has a history of malignant hyperthermia.
Which of the following anesthetic agents should be AVOIDED?
A. Propofol
B. Ketamine
C. Succinylcholine
D. Midazolam
Answer: C. Succinylcholine
Rationale: Succinylcholine and volatile anesthetics (halothane, sevoflurane,
desflurane, isoflurane) are known triggers for malignant hyperthermia in
susceptible patients. Propofol, ketamine, and midazolam are considered safe for
patients with a history of malignant hyperthermia. The perioperative team should
have dantrolene readily available.
Question 6
A surgical patient is at risk for venous thromboembolism (VTE). Which of the
following interventions is MOST effective for VTE prophylaxis?
A. Early ambulation postoperatively
B. Sequential compression devices (SCDs)
C. Pharmacological prophylaxis (e.g., heparin, enoxaparin)
D. Elevation of the lower extremities
Answer: C. Pharmacological prophylaxis (e.g., heparin, enoxaparin)
Rationale: Pharmacological prophylaxis with anticoagulants such as heparin or
enoxaparin is the most effective intervention for preventing VTE in surgical
patients. Mechanical prophylaxis (SCDs, early ambulation) and elevation are
important adjuncts but are not as effective as pharmacological prophylaxis for
patients at moderate to high risk.
, Question 7
A patient is being transferred from the OR table to the stretcher. Which of the
following is the CORRECT technique to maintain safety?
A. Transfer the patient alone to minimize noise
B. Use a transfer board with at least two team members
C. Transfer the patient with all monitoring devices disconnected
D. Transfer the patient in the Trendelenburg position
Answer: B. Use a transfer board with at least two team members
Rationale: Safe patient handling during transfer requires a minimum of two team
members and the use of a transfer board or slide sheet to reduce the risk of injury
to both the patient and staff. Monitoring devices should remain in place during
transfer. Transferring alone or disconnecting monitoring devices is unsafe.
Question 8
The surgical count is incorrect at the end of a procedure. The PRIORITY action is
to:
A. Document the incorrect count and close the incision
B. Notify the surgeon and perform a repeat count
C. Continue closing the incision without further action
D. Request an X-ray only if the count cannot be reconciled
Answer: B. Notify the surgeon and perform a repeat count
Rationale: An incorrect count is a critical event that requires immediate
notification of the surgeon and a repeat count. The incision should not be closed
until the count is reconciled. X-ray may be necessary if the count remains
incorrect, but the priority is to notify the surgeon and perform a repeat count.
Question 9
Which of the following is the CORRECT position for a patient undergoing a
thyroidectomy?
A. Supine with a shoulder roll and head extended
B. Trendelenburg position
validating expertise in surgical patient care,
aseptic techniques, safety standards, and
operative procedures.
Question 1
A patient undergoing a laparoscopic cholecystectomy is positioned in the supine
position with both arms tucked at the sides. Which pressure point is at HIGHEST
risk for injury in this position?
A. Heels
B. Occiput
C. Ulnar nerves
D. Sacrum
Answer: C. Ulnar nerves
Rationale: When the arms are tucked at the sides, the ulnar nerves are at risk for
compression injury at the elbow (cubital tunnel) or wrist. Proper padding and
positioning of the arms in a neutral position with palms facing the body are
essential to prevent ulnar nerve palsy. The heels, occiput, and sacrum are also
pressure points but are typically addressed with standard padding and positioning
devices.
Question 2
The perioperative nurse is preparing the surgical site for a procedure. Which of the
following is the CORRECT sequence for preoperative skin antisepsis?
A. Clean the site, apply antiseptic, allow to dry, then drape
B. Apply antiseptic, clean the site, allow to dry, then drape
C. Clean the site, apply antiseptic, drape immediately
D. Apply antiseptic, allow to dry, clean the site, then drape
Answer: A. Clean the site, apply antiseptic, allow to dry, then drape
,Rationale: The correct sequence for preoperative skin antisepsis is to first clean
the site of gross contaminants, then apply the antiseptic agent, allow it to dry
completely (for the antiseptic to achieve its full effect), and then apply sterile
drapes. Applying drapes before the antiseptic has dried can reduce its efficacy and
increase the risk of surgical site infection.
Question 3
During a surgical procedure, the scrub nurse notices a tear in the sterile glove. The
appropriate action is to:
A. Cover the tear with an adhesive bandage
B. Change the glove immediately using the open-gloving technique
C. Change the glove immediately using the closed-gloving technique
D. Continue the procedure but avoid touching sterile items with that hand
Answer: C. Change the glove immediately using the closed-gloving technique
Rationale: A tear in a sterile glove compromises the sterile field. The glove must
be changed immediately. The closed-gloving technique is the preferred method for
changing gloves during a sterile procedure because it maintains sterility of the
outside of the glove. The open-gloving technique is used for initial gloving.
Covering the tear or continuing the procedure is unsafe.
Question 4
Which of the following is a PRIMARY responsibility of the circulating nurse
during a surgical procedure?
A. Setting up the sterile field
B. Counting sponges, needles, and instruments
C. Performing surgical hand antisepsis
D. Passing instruments to the surgeon
Answer: B. Counting sponges, needles, and instruments
Rationale: The circulating nurse is responsible for the initial, intraoperative, and
closing counts of sponges, needles, and instruments to prevent retained foreign
bodies. Setting up the sterile field and passing instruments are responsibilities of
,the scrub person. Surgical hand antisepsis is performed by both the scrub person
and the surgeon.
Question 5
A patient is scheduled for surgery and has a history of malignant hyperthermia.
Which of the following anesthetic agents should be AVOIDED?
A. Propofol
B. Ketamine
C. Succinylcholine
D. Midazolam
Answer: C. Succinylcholine
Rationale: Succinylcholine and volatile anesthetics (halothane, sevoflurane,
desflurane, isoflurane) are known triggers for malignant hyperthermia in
susceptible patients. Propofol, ketamine, and midazolam are considered safe for
patients with a history of malignant hyperthermia. The perioperative team should
have dantrolene readily available.
Question 6
A surgical patient is at risk for venous thromboembolism (VTE). Which of the
following interventions is MOST effective for VTE prophylaxis?
A. Early ambulation postoperatively
B. Sequential compression devices (SCDs)
C. Pharmacological prophylaxis (e.g., heparin, enoxaparin)
D. Elevation of the lower extremities
Answer: C. Pharmacological prophylaxis (e.g., heparin, enoxaparin)
Rationale: Pharmacological prophylaxis with anticoagulants such as heparin or
enoxaparin is the most effective intervention for preventing VTE in surgical
patients. Mechanical prophylaxis (SCDs, early ambulation) and elevation are
important adjuncts but are not as effective as pharmacological prophylaxis for
patients at moderate to high risk.
, Question 7
A patient is being transferred from the OR table to the stretcher. Which of the
following is the CORRECT technique to maintain safety?
A. Transfer the patient alone to minimize noise
B. Use a transfer board with at least two team members
C. Transfer the patient with all monitoring devices disconnected
D. Transfer the patient in the Trendelenburg position
Answer: B. Use a transfer board with at least two team members
Rationale: Safe patient handling during transfer requires a minimum of two team
members and the use of a transfer board or slide sheet to reduce the risk of injury
to both the patient and staff. Monitoring devices should remain in place during
transfer. Transferring alone or disconnecting monitoring devices is unsafe.
Question 8
The surgical count is incorrect at the end of a procedure. The PRIORITY action is
to:
A. Document the incorrect count and close the incision
B. Notify the surgeon and perform a repeat count
C. Continue closing the incision without further action
D. Request an X-ray only if the count cannot be reconciled
Answer: B. Notify the surgeon and perform a repeat count
Rationale: An incorrect count is a critical event that requires immediate
notification of the surgeon and a repeat count. The incision should not be closed
until the count is reconciled. X-ray may be necessary if the count remains
incorrect, but the priority is to notify the surgeon and perform a repeat count.
Question 9
Which of the following is the CORRECT position for a patient undergoing a
thyroidectomy?
A. Supine with a shoulder roll and head extended
B. Trendelenburg position
