Free CNOR Practice Questions PDF

An interscalene block almost always causes temporary ipsilateral phrenic nerve palsy, which can lead to respiratory distress in a patient with contralateral diaphragm paralysis and low FVC. Ultrasound assessment of diaphragmatic movement (B) offers a dynamic, immediately relevant safety check before proceeding. Incentive spirometry (A) is a postoperative tool and does not predict acute diaphragmatic function. Smoking history (C) provides general pulmonary risk but not specific to the block. Horner syndrome (D) is a common, expected side effect and not a safety concern. Therefore, evaluating diaphragmatic function is the priority to avoid precipitating severe hypoventilation.

The efficacy of alcohol-based surgical hand rubs depends on applying the correct volume to ensure the hands remain wet for the manufacturer-recommended duration. Using a substantially smaller volume causes the product to dry too quickly, meaning the hands will lack sufficient antimicrobial contact time to achieve the necessary log reduction in resident and transient flora. Excessive skin irritation (Option A) is more commonly associated with applying too much product or failing to let it dry completely, rather than using too little. A rebound in microbial count (Option B) occurs over several hours during the procedure, but the immediate failure here is the initial reduction. Glove adherence (Option C) happens when hands are still wet, whereas this scenario explicitly states the product dried completely within ten seconds.

CRM emphasizes shared situational awareness and directed communication. Option A is best because directly alerting the anesthesia provider ensures the critical equipment failure is addressed without distracting the surgeon from hemostasis. Option B is dangerous because it fails to communicate a loss of resources to the team, undermining the shared mental model. Option C inappropriately shifts the circulator's immediate task to an outside provider while the patient is actively bleeding. Option D delays vital patient care during a crisis by prioritizing administrative tasks over clinical intervention.

Once the system recovers, the perioperative nurse who provided the care must transcribe the downtime documentation into the electronic health record to ensure continuity of care and accurate billing. Option A is incorrect because simply scanning the document without entering discrete data into the electronic flowsheets often prevents the system from generating automated safety alerts or accurate medication reconciliation. Option C is entirely inappropriate because the original downtime paper record is a legal document that must be retained according to facility policy, often placed in the physical chart alongside the electronic entry. Option D shifts the responsibility inappropriately; the PACU nurse did not witness the intraoperative events and cannot legally or accurately document them. The circulator must complete the data entry.

Delegation requires carefully assessing patient stability before assigning tasks. A hemodynamically stable patient awaiting a routine screening colonoscopy is highly appropriate for an orderly to transport because they do not require continuous clinical assessment. Conversely, the nurse must personally transport patients who recently received sedation, as they require ongoing airway assessment. Requiring an anesthesia provider or a registered nurse for a stable, unmedicated patient is an inefficient use of resources and misunderstands delegation principles. Unlicensed assistive personnel are perfectly capable of moving stable patients. The RN always retains accountability for patient safety and must ensure both the right circumstance and the right person are met when delegating any transport tasks.

During laparoscopic procedures, rapid abdominal insufflation can stretch the peritoneum and trigger a profound vagal response, leading to sudden bradycardia and hypotension. The most direct and effective initial intervention is to ask the surgeon to release the pneumoperitoneum, which removes the mechanical stimulus causing the reflex. Administering atropine is an anesthesia responsibility and is typically reserved for cases where releasing the gas does not resolve the bradycardia. Placing the patient in deep Trendelenburg would actually worsen diaphragmatic pressure and respiratory compliance. Chest compressions are entirely premature unless the patient progresses to true cardiac arrest.