AORN Perioperative 101 Advanced Prep:
Master Operating Room Nursing Practice
Questions & Detailed Explanations
Subject: Perioperative Nursing – Sterile Technique, Asepsis, and Surgical
Environment
Question 1: During a surgical procedure, a member of the sterile team accidentally touches a
non-sterile object with their sterile gown. According to the AORN Guidelines for Sterile
Technique, what is the most appropriate course of action?
A) Immediately wipe the area with a sterile towel soaked in alcohol and continue the procedure.
B) Consider the gown contaminated, perform a sterile change of the gown and gloves, and re-
establish the sterile field boundaries.
C) Spray the gown with a fast-acting antimicrobial agent and cover the area with a sterile drape.
D) Continue the procedure as the contamination is minor and unlikely to cause a surgical site
infection.
Correct Answer: B) Consider the gown contaminated, perform a sterile change of the gown
and gloves, and re-establish the sterile field boundaries.
Explanation: Sterile technique is binary; an item is either sterile or contaminated. Once a sterile
barrier—such as a gown—is compromised through contact with a non-sterile object, it must be
considered contaminated immediately. Aseptic protocol demands immediate mitigation to
prevent potential microbial transfer to the surgical site. Wiping or spraying does not restore
sterility.
Question 2: Which principle of sterile technique is most directly violated when a scrubbed
person reaches over a non-sterile area to retrieve a required instrument?
A) The principle that sterile field boundaries are defined by the level of the table.
B) The principle that the sterile field should be maintained and monitored constantly.
C) The principle that movement within the sterile field must not compromise the integrity of
sterile barriers.
D) The principle that only sterile items are allowed within the sterile field.
,Correct Answer: C) The principle that movement within the sterile field must not
compromise the integrity of sterile barriers.
Explanation: Reaching over non-sterile areas creates a significant risk of shed skin cells, lint, or
perspiration falling from the sterile person’s gown onto the non-sterile surface, or conversely,
non-sterile air currents contaminating the gown. Proper movement entails navigating around
non-sterile zones to maintain the integrity of the sterile gown and the field.
Question 3: When performing a surgical hand scrub, the nurse notices their skin has a small,
open abrasion. What is the AORN-compliant nursing action?
A) Apply a waterproof, sterile dressing over the abrasion, then perform the scrub.
B) Apply a double layer of sterile gloves over the affected hand.
C) Inform the supervisor and be excused from scrubbing into the procedure, as open lesions are a
significant source of microbial shedding.
D) Proceed with the scrub, as the antimicrobial scrub agent will sterilize the lesion.
Correct Answer: C) Inform the supervisor and be excused from scrubbing into the
procedure, as open lesions are a significant source of microbial shedding.
Explanation: Open skin lesions are high-risk sites for shedding bacteria, particularly
Staphylococcus aureus. Even with a bandage, moisture under a glove can cause the dressing to
fail, posing an unacceptable risk of patient contamination. Professional standards dictate that
personnel with skin breaks should not scrub.
Question 4: Regarding the preparation of the sterile field, which of the following practices is
considered evidence-based for the prevention of surgical site infections (SSIs)?
A) Preparing the sterile field as close to the time of incision as possible.
B) Setting up the sterile field at least 60 minutes before the patient enters the room to ensure
readiness.
C) Leaving the sterile field unattended for short intervals to allow the circulating nurse to assist
with induction.
D) Using fans to accelerate the drying of the skin prep solution on the patient.
Correct Answer: A) Preparing the sterile field as close to the time of incision as possible.
Explanation: Airborne contaminants, such as dust and skin squames, settle on sterile surfaces
over time. Preparing the field immediately before use minimizes the duration of exposure to
ambient air, significantly reducing the probability of contamination.
,Question 5: What is the recommended practice for handling a sterile package that is found to
have an intact wrapper but a perforated indicator tape?
A) Use the item, provided the internal chemical indicator changes color during sterilization.
B) Treat the item as contaminated and remove it from the sterile field immediately.
C) Re-autoclave the item in the same wrapper before use.
D) Wipe the exterior of the wrapper with a 70% isopropyl alcohol pad before opening.
Correct Answer: B) Treat the item as contaminated and remove it from the sterile field
immediately.
Explanation: The integrity of the sterile barrier is paramount. If the indicator tape—or any part
of the packaging—is compromised, the barrier is considered breached. There is no way to verify
if the contents were exposed to contaminants after the sterilization process, necessitating
removal.
Question 6: When positioning a patient for surgery, which factor is most crucial for preventing
peripheral nerve injury?
A) Ensuring the patient is as comfortable as possible before anesthesia.
B) Avoiding hyperextension, hyperflexion, or prolonged pressure on specific nerve distributions
(e.g., the ulnar or peroneal nerves).
C) Speeding up the transition to the surgical position to reduce anesthesia time.
D) Utilizing the thinnest possible padding to maintain the sterile field footprint.
Correct Answer: B) Avoiding hyperextension, hyperflexion, or prolonged pressure on
specific nerve distributions (e.g., the ulnar or peroneal nerves).
Explanation: Peripheral nerve injuries in the OR are frequently the result of ischemia from
prolonged compression or mechanical stretch. Proper padding and neutral anatomical
positioning are essential to mitigate the risk of patient injury during the intraoperative period.
Question 7: A circulator observes a sterile team member drop a sterile instrument on the floor.
The team member picks it up and places it on the edge of the sterile back table. What is the
circulator’s immediate responsibility?
A) Record the event in the intraoperative notes but allow the procedure to continue.
B) Instruct the team member to remove the instrument, consider the area where it was placed
contaminated, and facilitate a sterile change of the table drape or covers if necessary.
, C) Wipe the instrument with a disinfectant wipe and return it to the field.
D) Advise the surgeon that the instrument was dropped but is still functional.
Correct Answer: B) Instruct the team member to remove the instrument, consider the area
where it was placed contaminated, and facilitate a sterile change of the table drape or
covers if necessary.
Explanation: The floor is a non-sterile zone. Placing a dropped instrument onto the sterile field
immediately contaminates the entire surface of the table where it was laid. Standard practice
mandates that the contaminated area be isolated or the drape changed to maintain the integrity
of the field.
Question 8: According to current AORN recommendations, what is the standard temperature
range for the operating room?
A) 62°F to 68°F (16.7°C to 20°C)
B) 68°F to 75°F (20°C to 24°C)
C) 75°F to 80°F (24°C to 26.7°C)
D) 80°F to 85°F (26.7°C to 29.4°C)
Correct Answer: B) 68°F to 75°F (20°C to 24°C)
Explanation: The environmental temperature is critical for both patient thermoregulation and
the growth inhibition of microorganisms. Temperatures within this range are recommended to
maintain patient normothermia while minimizing the risk of bacterial proliferation.
Question 9: When using an electrosurgical unit (ESU), where should the dispersive electrode
(grounding pad) be placed?
A) Over an area with high hair density to improve conductivity.
B) Directly over a bony prominence to maximize current flow.
C) Over a large, well-vascularized muscle mass, as close to the surgical site as possible, avoiding
bony prominences or scar tissue.
D) As far away from the surgical site as possible to prevent electrical interference.
Correct Answer: C) Over a large, well-vascularized muscle mass, as close to the surgical site
as possible, avoiding bony prominences or scar tissue.
Master Operating Room Nursing Practice
Questions & Detailed Explanations
Subject: Perioperative Nursing – Sterile Technique, Asepsis, and Surgical
Environment
Question 1: During a surgical procedure, a member of the sterile team accidentally touches a
non-sterile object with their sterile gown. According to the AORN Guidelines for Sterile
Technique, what is the most appropriate course of action?
A) Immediately wipe the area with a sterile towel soaked in alcohol and continue the procedure.
B) Consider the gown contaminated, perform a sterile change of the gown and gloves, and re-
establish the sterile field boundaries.
C) Spray the gown with a fast-acting antimicrobial agent and cover the area with a sterile drape.
D) Continue the procedure as the contamination is minor and unlikely to cause a surgical site
infection.
Correct Answer: B) Consider the gown contaminated, perform a sterile change of the gown
and gloves, and re-establish the sterile field boundaries.
Explanation: Sterile technique is binary; an item is either sterile or contaminated. Once a sterile
barrier—such as a gown—is compromised through contact with a non-sterile object, it must be
considered contaminated immediately. Aseptic protocol demands immediate mitigation to
prevent potential microbial transfer to the surgical site. Wiping or spraying does not restore
sterility.
Question 2: Which principle of sterile technique is most directly violated when a scrubbed
person reaches over a non-sterile area to retrieve a required instrument?
A) The principle that sterile field boundaries are defined by the level of the table.
B) The principle that the sterile field should be maintained and monitored constantly.
C) The principle that movement within the sterile field must not compromise the integrity of
sterile barriers.
D) The principle that only sterile items are allowed within the sterile field.
,Correct Answer: C) The principle that movement within the sterile field must not
compromise the integrity of sterile barriers.
Explanation: Reaching over non-sterile areas creates a significant risk of shed skin cells, lint, or
perspiration falling from the sterile person’s gown onto the non-sterile surface, or conversely,
non-sterile air currents contaminating the gown. Proper movement entails navigating around
non-sterile zones to maintain the integrity of the sterile gown and the field.
Question 3: When performing a surgical hand scrub, the nurse notices their skin has a small,
open abrasion. What is the AORN-compliant nursing action?
A) Apply a waterproof, sterile dressing over the abrasion, then perform the scrub.
B) Apply a double layer of sterile gloves over the affected hand.
C) Inform the supervisor and be excused from scrubbing into the procedure, as open lesions are a
significant source of microbial shedding.
D) Proceed with the scrub, as the antimicrobial scrub agent will sterilize the lesion.
Correct Answer: C) Inform the supervisor and be excused from scrubbing into the
procedure, as open lesions are a significant source of microbial shedding.
Explanation: Open skin lesions are high-risk sites for shedding bacteria, particularly
Staphylococcus aureus. Even with a bandage, moisture under a glove can cause the dressing to
fail, posing an unacceptable risk of patient contamination. Professional standards dictate that
personnel with skin breaks should not scrub.
Question 4: Regarding the preparation of the sterile field, which of the following practices is
considered evidence-based for the prevention of surgical site infections (SSIs)?
A) Preparing the sterile field as close to the time of incision as possible.
B) Setting up the sterile field at least 60 minutes before the patient enters the room to ensure
readiness.
C) Leaving the sterile field unattended for short intervals to allow the circulating nurse to assist
with induction.
D) Using fans to accelerate the drying of the skin prep solution on the patient.
Correct Answer: A) Preparing the sterile field as close to the time of incision as possible.
Explanation: Airborne contaminants, such as dust and skin squames, settle on sterile surfaces
over time. Preparing the field immediately before use minimizes the duration of exposure to
ambient air, significantly reducing the probability of contamination.
,Question 5: What is the recommended practice for handling a sterile package that is found to
have an intact wrapper but a perforated indicator tape?
A) Use the item, provided the internal chemical indicator changes color during sterilization.
B) Treat the item as contaminated and remove it from the sterile field immediately.
C) Re-autoclave the item in the same wrapper before use.
D) Wipe the exterior of the wrapper with a 70% isopropyl alcohol pad before opening.
Correct Answer: B) Treat the item as contaminated and remove it from the sterile field
immediately.
Explanation: The integrity of the sterile barrier is paramount. If the indicator tape—or any part
of the packaging—is compromised, the barrier is considered breached. There is no way to verify
if the contents were exposed to contaminants after the sterilization process, necessitating
removal.
Question 6: When positioning a patient for surgery, which factor is most crucial for preventing
peripheral nerve injury?
A) Ensuring the patient is as comfortable as possible before anesthesia.
B) Avoiding hyperextension, hyperflexion, or prolonged pressure on specific nerve distributions
(e.g., the ulnar or peroneal nerves).
C) Speeding up the transition to the surgical position to reduce anesthesia time.
D) Utilizing the thinnest possible padding to maintain the sterile field footprint.
Correct Answer: B) Avoiding hyperextension, hyperflexion, or prolonged pressure on
specific nerve distributions (e.g., the ulnar or peroneal nerves).
Explanation: Peripheral nerve injuries in the OR are frequently the result of ischemia from
prolonged compression or mechanical stretch. Proper padding and neutral anatomical
positioning are essential to mitigate the risk of patient injury during the intraoperative period.
Question 7: A circulator observes a sterile team member drop a sterile instrument on the floor.
The team member picks it up and places it on the edge of the sterile back table. What is the
circulator’s immediate responsibility?
A) Record the event in the intraoperative notes but allow the procedure to continue.
B) Instruct the team member to remove the instrument, consider the area where it was placed
contaminated, and facilitate a sterile change of the table drape or covers if necessary.
, C) Wipe the instrument with a disinfectant wipe and return it to the field.
D) Advise the surgeon that the instrument was dropped but is still functional.
Correct Answer: B) Instruct the team member to remove the instrument, consider the area
where it was placed contaminated, and facilitate a sterile change of the table drape or
covers if necessary.
Explanation: The floor is a non-sterile zone. Placing a dropped instrument onto the sterile field
immediately contaminates the entire surface of the table where it was laid. Standard practice
mandates that the contaminated area be isolated or the drape changed to maintain the integrity
of the field.
Question 8: According to current AORN recommendations, what is the standard temperature
range for the operating room?
A) 62°F to 68°F (16.7°C to 20°C)
B) 68°F to 75°F (20°C to 24°C)
C) 75°F to 80°F (24°C to 26.7°C)
D) 80°F to 85°F (26.7°C to 29.4°C)
Correct Answer: B) 68°F to 75°F (20°C to 24°C)
Explanation: The environmental temperature is critical for both patient thermoregulation and
the growth inhibition of microorganisms. Temperatures within this range are recommended to
maintain patient normothermia while minimizing the risk of bacterial proliferation.
Question 9: When using an electrosurgical unit (ESU), where should the dispersive electrode
(grounding pad) be placed?
A) Over an area with high hair density to improve conductivity.
B) Directly over a bony prominence to maximize current flow.
C) Over a large, well-vascularized muscle mass, as close to the surgical site as possible, avoiding
bony prominences or scar tissue.
D) As far away from the surgical site as possible to prevent electrical interference.
Correct Answer: C) Over a large, well-vascularized muscle mass, as close to the surgical site
as possible, avoiding bony prominences or scar tissue.
