The Competency and Credentialing Institute (CCI) offers the Certified Nurse Operating Room (CNOR) Examination for certification purposes. CNOR certification is intended to distinguish a skilled RN, reinforce conscious applications of theory when caring for patients and augment a nurse’s knowledge with ongoing education. With certification, candidates can demonstrate responsibility and ability to provide the best care. Certification helps demonstrate expertise in surgical nursing, and it gives potential employers a better understanding of a candidate’s skills. The CNOR certification is valid for five years. A BSN is not needed to take the exam, but candidates must have two years and 2400 hours of experience as an operating room nurse. The test is computer-based and includes 200 multiple-choice items. Out of these questions, 15 will not be scored. Candidates will not know which questions are scored and which are not. Since variations of the test have different levels of difficulty, the final score is formed in a process known as equating. In order to pass, candidates need a minimum scaled score of 620. The actual number of questions answered correctly (raw score) on a passing exam will vary for the different tests given.
In this assessment, candidates must be able to assess the patient’s health, form differential diagnoses, identify likely results, create a plan for medical attention, put a prevention plan into place, put a plan for the best physiological protection into practice, educate the patient and family, be reliable with patient rights and responsibilities, document perioperative events, assess how the patient is doing with the plan of care, manage people, manage tools and support services, communicate patient information, determine the plan for discharge, choose and utilize methods for cleaning, packaging, sterilizing and disinfecting, handle emergencies and be professionally accountable.
CNOR Practice Questions
1. The Mini-Cog test to assess for dementia includes:
A. Counting backward from 100 by 7s
B. Copying a picture of interlocking shapes
C. Following simple 3-part directions
D. Drawing the face of a clock with hands indicating a specified time
2. During a transurethral prostatectomy performed with regional anesthesia, the patient’s abdomen becomes rigid and swollen, the patient complains of nausea and abdominal pain and becomes hypotensive, and the nurse notes a decrease in bladder irrigating solution. The most likely cause is:
A. Transurethral prostatectomy syndrome
B. Bladder perforation
C. Bowel perforation
D. Internal hemorrhage
3. Desflurane is contraindicated for induction for infants and children because of:
A. Increased risk of anesthesia-related hepatitis
B. Decreased cerebral metabolism
C. Decreased cardiac output
D. Upper airway complications
4. If a metal plate is composed of stainless steel, the screws should be:
A. Stainless steel or cobalt-chromium
B. Stainless steel or titanium-vanadium aluminum
C. Stainless steel, cobalt-chromium, or titanium-vanadium aluminum
D. Stainless steel only
5. The purpose of diluting ethylene oxide with inert gases (such as CO2) and hydrochlorofluorocarbon (HCFC) is to:
A. Reduce flammability
B. Destroy spores
C. Increase bactericidal activity
D. Decrease carcinogenicity
6. When administering or handling open containers of chemotherapeutic agents, the nurse should:
A. Wear double gloves and then remove the outer gloves upon completion.
B. Wear single gloves and then change to new gloves upon completion.
C. Wear single gloves and then use alcohol hand wash before changing to new gloves.
D. Wear single gloves with no added precautions necessary.
7. Open shelves used for storage of sterile packages require all of the following except:
A. Lowest shelf 8 to 10 inches from floor.
B. Highest shelf 8 to 10 inches from ceiling.
C. Good ventilation with temperature and humidity control.
D. Shelves 2 inches away from outside walls.
8. The following medication is contraindicated for treatment of malignant hyperthermia:
A. Dantrolene sodium.
B. Regular insulin in 50% glucose solution.
C. Calcium chloride.
D. Calcium channel blocker.
9. The agent least likely to be responsible for anaphylaxis during surgery is:
A. Isosulfan blue 1%.
B. Anesthetic agents (eg, halothane, isoflurane)
D. Antibiotics (penicillin, cephalosporins, sulfonamides).
10. When developing quality improvement projects, the diagram that is used to help identify cause and effect and root causes is:
A. Ishikawa diagram.
B. Affinity diagram.
C. Prioritization matrix.
D. Gantt chart.
1. D: The Mini-Cog test to assess for dementia has 2 components:
Drawing the face of a clock with all 12 numbers and the hands indicating the time specified by the examiner.
Remembering and later repeating the names of 3 common objects.
2. B: Bladder perforation can occur during a transurethral prostatectomy because of overinflation of the bladder with irrigant or surgical instrumentation. An early indication is a decrease in return flow of bladder irrigant, so the nurse should monitor the irrigation fluids carefully. As fluid flows into the abdomen through the perforation, the abdomen becomes rigid and swollen, and the patient may complain of abdominal pain and experience nausea and vomiting. The patient may become hypotensive and later hypertensive.
3. D: Desflurane is used for induction and maintenance of anesthesia in adults but is contraindicated for induction in infants and children because of upper airway complications (coughing, apnea, laryngospasm), although it can be used for maintenance. Halothane is associated with many adverse effects, so other anesthetic agents are often used. Halothane effects include increased risk of anesthesia-related hepatitis in those with liver dysfunction and 50% reduction in BP and cardiac output. Cerebral blood flow and ICP are moderately increased, but cerebral metabolism is decreased and autoregulation is impaired.
4. D: All implants should have the same metal composition, so only stainless steel screws should be used with a stainless steel metal plate; otherwise, galvanic corrosion may occur and damage the device. Implants are devices intended to replace a biological body part (such as the hip), support injured parts (such as plates and screws), or enhance a body part (such as breast implants). Implants can include plates, screws, intramedullary nails, rods, hip prosthesis, external fixators, and pins.
5. A: Ethylene oxide (EO) is highly flammable and may lead to explosions, so it is diluted with inert gases (such as CO2) and hydrochlorofluorocarbon (HCFC) to reduce flammability. EO can be used for items that are heat labile and moisture sensitive, such as some microinstruments, electrical instruments, and large pieces of equipment. EO sterilization typically takes 105 to 300 minutes at temperatures of 37° to 63°C, humidity 45% to 75%, and gas concentration of 450 to 1,200 mg/L. Duration is inversely proportional to concentration of the gas.
6. A: When administering or handling open containers of chemotherapeutic agents, the nurse should wear double gloves and then remove the outer gloves upon completion. These agents should be transported in warning-labeled, leak-proof, break-resistant containers, and staff should wear PPE as indicated by the type of possible exposure. A gown impervious to chemotherapeutic agents should be worn if the agent may come in contact with arms or torso, and face shields should be used if a danger of splashing or splattering is present. Manufacturer’s guidelines should be followed regarding handling and discarding hazardous chemotherapeutic agents.
7. B: When open shelving is used to store sterile packages, the highest shelf should be 18 inches from the ceiling to ensure adequate air circulation. The lowest shelf must be 8 to 10 inches from floor to prevent contamination from the floor. The shelving unit should be at least 2 inches away from outside walls to promote circulation of air as well. All surgical storage equipment, including cabinets and shelving, should have good ventilation with temperature and humidity control.
8. D: Calcium channel blockers are contraindicated as treatment for malignant hyperthermia as they may result in severe hyperkalemia and myocardial depression. The primary treatment is 8 to 10 mg/kg of dantrolene sodium with repeat doses of 2.5 mg/kg up to 4 times. Other treatments include insulin in 50% glucose solution (0.15 units/kg of regular insulin in 1 mL/kg of glucose or 10 mg of regular insulin in 50 mL of glucose) and/or calcium chloride for treatment of hyperkalemia. Lidocaine or amiodarone may be indicated for cardiac arrhythmias.
9. B: Anesthetic agents, such as halothane and isoflurane, rarely cause anaphylactic reactions. Most anaphylaxis relates to antibiotics (penicillin, cephalosporins, sulfonamides) or latex. Isosulfan blue 1% (a blue dye) results in severe allergic reactions or anaphylaxis in up to 3% of those receiving the dye, commonly used for sentinel node biopsies. Typically, with IgE-mediated response (anaphylactic shock), an antigen triggers release of substances, such as histamine and prostaglandins, which affect the skin, cardiopulmonary, and GI systems. Each time the person has contact with the antigen, more antibodies form in response, so allergic reactions worsen with each contact.
10. A: The Ishikawa “fishbone” diagram, resembling the head and bones of a fish, is an analysis tool to determine causes and effects. In performance improvement, it is used to help identify root causes. An affinity diagram is used to brainstorm and organize large numbers of ideas, items, or issues (> 15) into major categories. A prioritization matrix is used to prioritize items or select one from a number of alternatives based on preselected criteria, such as benefit and cost. A Gantt chart is used to manage schedules and estimate time needed to complete tasks.