AORN PERIOP 101 FINAL EXAM TEST BANK
() EXPECTED AND REVISED
CORRECT ANSWERS. WITH 100% GUARANTEE
PASS.
1. During a major abdominal surgery, the surgical team notes that the patient's SpO ‚ has dropped
to 88% and end-tidal CO ‚ is rising. The anesthesia provider suspects malignant hyperthermia
(MH). Which sequence of interventions aligns with current AORN and Malignant Hyperthermia
Association of the United States (MHAUS) guidelines?
A. Discontinue volatile anesthetic, hyperventilate with 100% oxygen at high flow, administer dantrolene 2.5
mg/kg IV, and cool the patient with ice packs to axillae and groin.
B. Switch to propofol infusion, maintain sevoflurane at 0.5 MAC, administer dantrolene 1 mg/kg IV, and place
patient on a cooling blanket.
C. Discontinue all anesthetic agents, administer dantrolene 10 mg/kg IV push rapidly, and initiate active
warming to prevent hypothermia.
D. Administer dantrolene 1 mg/kg IV, increase fresh gas flow to 5 L/min, and apply forced-air warming to treat
suspected hypothermia.
Answer: A
Rationale: AORN/MHAUS guidelines for MH crisis: immediately discontinue trigger agents (volatile
anesthetics, succinylcholine), hyperventilate with 100% O ‚ at high flows ("e10 L/min), administer
dantrolene 2.5 mg/kg IV (titrated to response), and initiate active cooling (ice packs, cold IV fluids).
Option B is wrong because sevoflurane is a trigger; C uses excessive dantrolene dose (10 mg/kg) and
active warming is contraindicated; D gives inadequate dantrolene dose and warming is harmful.
2. A perioperative nurse is preparing the sterile field for a total knee arthroplasty. According to
AORN guidelines for maintaining sterility, which practice is correct regarding the sterile field and
its boundaries?
A. The sterile field is considered contaminated if any non-sterile item crosses the plane of the sterile field, even
if not touching it.
B. The sterile field is maintained as long as the sterile drape is dry and intact; moisture from non-sterile items
does not compromise sterility.
C. The inner 1-inch margin of the sterile drape around the field is considered contaminated and should not be
used.
D. The sterile field may be set up up to 4 hours before surgery if covered with a sterile drape.
Answer: A
Rationale: AORN states that the sterile field is considered contaminated if a non-sterile item crosses the
plane of the field (the invisible boundary extending 12 inches above the field). Option B is false because
moisture wicks bacteria, compromising sterility. Option C is false: the 1-inch margin is considered
contaminated only on the periphery of the drape (the edge), not the inner margin. Option D: sterile fields
Page 1
,should be set up as close to the time of surgery as possible; 4 hours exceeds recommended timeframes.
3. A surgical team is performing a laparoscopic cholecystectomy. The electrosurgical unit (ESU) is
set to monopolar mode. Which factor most significantly increases the risk of an alternate site
burn?
A. Use of a dispersive electrode with a large contact area.
B. The patient has a cardiac implantable electronic device (CIED).
C. Capacitive coupling due to insulated trocars and high voltage.
D. Placement of the dispersive electrode on a bony prominence.
Answer: C
Rationale: Alternate site burns in laparoscopy often result from capacitive coupling, where current from
the active electrode is induced onto an insulated trocar, potentially burning bowel or other tissues not in
the direct circuit. Option A: large dispersive electrode reduces risk. Option B: CIED increases risk of
EMI but not alternate site burns per se. Option D: placement on bony prominence is contraindicated but
may cause pad site burns, not alternate site burns.
4. A patient is scheduled for a right hemicolectomy under general anesthesia. The patient has a
history of obstructive sleep apnea (OSA) and is morbidly obese (BMI 42). According to AORN's
safe patient positioning guidelines, which positioning strategy is most appropriate to reduce the
risk of positioning-related injury and respiratory compromise?
A. Supine position with a 15-degree reverse Trendelenburg, use of a bariatric positioning device, and padding
under the heels.
B. Lithotomy position with stirrups adjusted to equal height, arms tucked at sides, and a roll under the lumbar
spine.
C. Prone position on a Jackson table with chest rolls, arms abducted less than 90 degrees, and head turned to one
side.
D. Supine position with arms abducted on arm boards at 90 degrees, no padding under heels, and a wedge under
the right hip.
Answer: A
Rationale: For a morbidly obese patient with OSA, supine with reverse Trendelenburg improves
ventilation by reducing abdominal pressure on the diaphragm. Bariatric positioning devices distribute
pressure. Heel padding prevents pressure injury. Option B: lithotomy may worsen respiratory mechanics
and increase risk of compartment syndrome. Option C: prone is not indicated for this procedure and
poses higher risk in obese patients. Option D: arms abducted 90 degrees risks brachial plexus injury; no
heel padding risks pressure ulcers.
5. A perioperative nurse is preparing a sterile field for a procedure requiring multiple medications.
Which of the following practices is correct regarding medication labeling and handling on the
sterile field?
A. All medications on the sterile field must be labeled immediately upon being drawn up, using a permanent
marker on the syringe, and the label must include the medication name, strength, and expiration time.
B. Medications may be passed to the sterile field in unlabeled syringes as long as the circulating nurse verbally
identifies them and the scrub person immediately labels them.
Page 2
,C. Medications in individual single-dose vials may be placed directly on the sterile field without labeling if only
one type of medication is used.
D. Pre-filled syringes from the manufacturer may be used without additional labeling because they are already labeled.
Answer: A
Rationale: AORN's medication safety guidelines require all medications on the sterile field to be labeled
immediately upon preparation, with name, strength, and expiration (or time prepared). Option B is
unsafe because unlabeled syringes increase risk of error; verbal confirmation alone is insufficient.
Option C: even single-dose vials must be labeled once transferred to the field. Option D: pre-filled
syringes should be labeled if removed from original packaging or if the label is obscured.
6. During a surgical procedure, the scrub person notices a small tear in the sterile gown on the
forearm. The tear is about 2 cm in length and occurred after contact with an unsterile surface.
What is the appropriate action according to AORN guidelines?
A. Cover the tear with a sterile adhesive drape and continue the procedure, as long as the underlying skin is not
exposed.
B. Replace the gown immediately by removing the old gown and donning a new sterile gown using the
closed-glove technique.
C. Place a sterile towel over the tear and secure it with a towel clip; proceed with the surgery.
D. The scrub person may continue the procedure if the tear is less than 2.5 cm and does not involve the cuff
area.
Answer: B
Rationale: AORN states that any breach in the sterile barrier (e.g., tear, puncture, or wetness) requires
immediate replacement of the gown. The scrub person must remove the gown without contaminating the
sterile field and don a new sterile gown using the closed-glove method. Option A: covering a tear does
not restore sterility. Option C: same issue. Option D: any size tear compromises sterility; the 2.5 cm rule
is not in AORN guidelines.
7. A surgical team is preparing for a procedure on a patient with a known history of latex allergy.
Which of the following sets of supplies is most appropriate for the sterile field, according to AORN
latex allergy guidelines?
A. Synthetic powder-free gloves (e.g., nitrile), latex-free tourniquet, silicone catheter, and polyurethane drapes.
B. Powdered latex gloves for the surgical team, latex-free Foley catheter, and natural rubber latex drains.
C. Vinyl gloves for the team, latex-free blood pressure cuff, and latex-containing anesthesia circuit.
D. Neoprene gloves, latex-free syringe, and latex Foley catheter with a silicone coating.
Answer: A
Rationale: For a patient with latex allergy, all items on the sterile field must be latex-free. Synthetic
gloves (nitrile, neoprene) are acceptable; powder-free reduces aerosolized allergen. Latex-free
tourniquets, silicone catheters, and polyurethane drapes are appropriate. Option B includes powdered
latex gloves (contraindicated) and latex drains. Option C: vinyl gloves offer poor barrier protection and
are not recommended for surgery; latex-containing circuit is unsafe. Option D: latex Foley catheter is
unsafe even if coated.
Page 3
, 8. A perioperative nurse is performing a surgical hand scrub before the first procedure of the day.
Which of the following describes the correct duration and technique according to AORN
guidelines?
A. Scrub for 2 minutes using a brushless waterless agent, covering all surfaces of hands and forearms, allowing
to air dry completely before donning gloves.
B. Scrub for 5 minutes using a chlorhexidine brush, focusing on nails and interdigital spaces, then rinse from
fingertips to elbows.
C. Scrub for 3 minutes using an alcohol-based rub, ensuring hands are dry before donning gloves; no brush is
needed.
D. Scrub for 10 minutes with povidone-iodine brush, then rinse from elbows to fingertips.
Answer: A
Rationale: AORN's current guidelines allow a surgical hand scrub of 2-3 minutes with a brushless
waterless agent (e.g., alcohol-based hand rub with persistent activity) for the first scrub of the day,
provided the agent is used according to manufacturer's instructions. Option B: 5-minute scrub is longer
than necessary; chlorhexidine brush can be used but not required. Option C: alcohol-based rubs are
acceptable but must be used on clean hands and for the recommended time (usually 2-3 minutes). Option
D: 10-minute scrub is outdated; rinse direction should be from fingertips to elbows.
9. A patient is undergoing a laparoscopic appendectomy. During the procedure, the surgeon
requests that the table be placed in Trendelenburg position. The perioperative nurse is responsible
for verifying that the patient is properly secured. Which of the following actions is most important
to prevent patient injury during positioning changes?
A. Ensure that the patient's arms are padded and tucked at the sides, with palms facing inward, and that the
safety strap is placed 2 inches above the knees.
B. Position the patient's arms on arm boards abducted less than 90 degrees, and secure the patient with a safety
strap across the thighs.
C. Place the patient in lithotomy stirrups before the procedure, and ensure that the stirrups are at equal height
and the legs are padded.
D. Apply sequential compression devices (SCDs) to the lower extremities before positioning, and ensure the
safety strap is across the chest.
Answer: A
Rationale: For Trendelenburg (head-down) position, the patient's arms should be tucked at the sides with
palms inward to avoid brachial plexus injury from the table edge. The safety strap should be placed 2
inches above the knees to prevent sliding. Option B: arms on arm boards in Trendelenburg increase risk
of shoulder/brachial plexus injury. Option C: lithotomy is not appropriate for appendectomy. Option D:
SCDs are for DVT prophylaxis, not positioning safety; chest strap may restrict breathing.
10. A surgical team is preparing to count sponges, sharps, and instruments at the end of a
procedure. According to AORN's recommended practices for prevention of retained surgical items
(RSI), which of the following statements is correct?
A. Counts should be performed only at the initial closing of the wound and at skin closure; no additional counts
are needed if the first count is correct.
B. If a count discrepancy occurs, the surgeon must order an intraoperative radiograph, and the team must search
the field and the room for the missing item.
Page 4
() EXPECTED AND REVISED
CORRECT ANSWERS. WITH 100% GUARANTEE
PASS.
1. During a major abdominal surgery, the surgical team notes that the patient's SpO ‚ has dropped
to 88% and end-tidal CO ‚ is rising. The anesthesia provider suspects malignant hyperthermia
(MH). Which sequence of interventions aligns with current AORN and Malignant Hyperthermia
Association of the United States (MHAUS) guidelines?
A. Discontinue volatile anesthetic, hyperventilate with 100% oxygen at high flow, administer dantrolene 2.5
mg/kg IV, and cool the patient with ice packs to axillae and groin.
B. Switch to propofol infusion, maintain sevoflurane at 0.5 MAC, administer dantrolene 1 mg/kg IV, and place
patient on a cooling blanket.
C. Discontinue all anesthetic agents, administer dantrolene 10 mg/kg IV push rapidly, and initiate active
warming to prevent hypothermia.
D. Administer dantrolene 1 mg/kg IV, increase fresh gas flow to 5 L/min, and apply forced-air warming to treat
suspected hypothermia.
Answer: A
Rationale: AORN/MHAUS guidelines for MH crisis: immediately discontinue trigger agents (volatile
anesthetics, succinylcholine), hyperventilate with 100% O ‚ at high flows ("e10 L/min), administer
dantrolene 2.5 mg/kg IV (titrated to response), and initiate active cooling (ice packs, cold IV fluids).
Option B is wrong because sevoflurane is a trigger; C uses excessive dantrolene dose (10 mg/kg) and
active warming is contraindicated; D gives inadequate dantrolene dose and warming is harmful.
2. A perioperative nurse is preparing the sterile field for a total knee arthroplasty. According to
AORN guidelines for maintaining sterility, which practice is correct regarding the sterile field and
its boundaries?
A. The sterile field is considered contaminated if any non-sterile item crosses the plane of the sterile field, even
if not touching it.
B. The sterile field is maintained as long as the sterile drape is dry and intact; moisture from non-sterile items
does not compromise sterility.
C. The inner 1-inch margin of the sterile drape around the field is considered contaminated and should not be
used.
D. The sterile field may be set up up to 4 hours before surgery if covered with a sterile drape.
Answer: A
Rationale: AORN states that the sterile field is considered contaminated if a non-sterile item crosses the
plane of the field (the invisible boundary extending 12 inches above the field). Option B is false because
moisture wicks bacteria, compromising sterility. Option C is false: the 1-inch margin is considered
contaminated only on the periphery of the drape (the edge), not the inner margin. Option D: sterile fields
Page 1
,should be set up as close to the time of surgery as possible; 4 hours exceeds recommended timeframes.
3. A surgical team is performing a laparoscopic cholecystectomy. The electrosurgical unit (ESU) is
set to monopolar mode. Which factor most significantly increases the risk of an alternate site
burn?
A. Use of a dispersive electrode with a large contact area.
B. The patient has a cardiac implantable electronic device (CIED).
C. Capacitive coupling due to insulated trocars and high voltage.
D. Placement of the dispersive electrode on a bony prominence.
Answer: C
Rationale: Alternate site burns in laparoscopy often result from capacitive coupling, where current from
the active electrode is induced onto an insulated trocar, potentially burning bowel or other tissues not in
the direct circuit. Option A: large dispersive electrode reduces risk. Option B: CIED increases risk of
EMI but not alternate site burns per se. Option D: placement on bony prominence is contraindicated but
may cause pad site burns, not alternate site burns.
4. A patient is scheduled for a right hemicolectomy under general anesthesia. The patient has a
history of obstructive sleep apnea (OSA) and is morbidly obese (BMI 42). According to AORN's
safe patient positioning guidelines, which positioning strategy is most appropriate to reduce the
risk of positioning-related injury and respiratory compromise?
A. Supine position with a 15-degree reverse Trendelenburg, use of a bariatric positioning device, and padding
under the heels.
B. Lithotomy position with stirrups adjusted to equal height, arms tucked at sides, and a roll under the lumbar
spine.
C. Prone position on a Jackson table with chest rolls, arms abducted less than 90 degrees, and head turned to one
side.
D. Supine position with arms abducted on arm boards at 90 degrees, no padding under heels, and a wedge under
the right hip.
Answer: A
Rationale: For a morbidly obese patient with OSA, supine with reverse Trendelenburg improves
ventilation by reducing abdominal pressure on the diaphragm. Bariatric positioning devices distribute
pressure. Heel padding prevents pressure injury. Option B: lithotomy may worsen respiratory mechanics
and increase risk of compartment syndrome. Option C: prone is not indicated for this procedure and
poses higher risk in obese patients. Option D: arms abducted 90 degrees risks brachial plexus injury; no
heel padding risks pressure ulcers.
5. A perioperative nurse is preparing a sterile field for a procedure requiring multiple medications.
Which of the following practices is correct regarding medication labeling and handling on the
sterile field?
A. All medications on the sterile field must be labeled immediately upon being drawn up, using a permanent
marker on the syringe, and the label must include the medication name, strength, and expiration time.
B. Medications may be passed to the sterile field in unlabeled syringes as long as the circulating nurse verbally
identifies them and the scrub person immediately labels them.
Page 2
,C. Medications in individual single-dose vials may be placed directly on the sterile field without labeling if only
one type of medication is used.
D. Pre-filled syringes from the manufacturer may be used without additional labeling because they are already labeled.
Answer: A
Rationale: AORN's medication safety guidelines require all medications on the sterile field to be labeled
immediately upon preparation, with name, strength, and expiration (or time prepared). Option B is
unsafe because unlabeled syringes increase risk of error; verbal confirmation alone is insufficient.
Option C: even single-dose vials must be labeled once transferred to the field. Option D: pre-filled
syringes should be labeled if removed from original packaging or if the label is obscured.
6. During a surgical procedure, the scrub person notices a small tear in the sterile gown on the
forearm. The tear is about 2 cm in length and occurred after contact with an unsterile surface.
What is the appropriate action according to AORN guidelines?
A. Cover the tear with a sterile adhesive drape and continue the procedure, as long as the underlying skin is not
exposed.
B. Replace the gown immediately by removing the old gown and donning a new sterile gown using the
closed-glove technique.
C. Place a sterile towel over the tear and secure it with a towel clip; proceed with the surgery.
D. The scrub person may continue the procedure if the tear is less than 2.5 cm and does not involve the cuff
area.
Answer: B
Rationale: AORN states that any breach in the sterile barrier (e.g., tear, puncture, or wetness) requires
immediate replacement of the gown. The scrub person must remove the gown without contaminating the
sterile field and don a new sterile gown using the closed-glove method. Option A: covering a tear does
not restore sterility. Option C: same issue. Option D: any size tear compromises sterility; the 2.5 cm rule
is not in AORN guidelines.
7. A surgical team is preparing for a procedure on a patient with a known history of latex allergy.
Which of the following sets of supplies is most appropriate for the sterile field, according to AORN
latex allergy guidelines?
A. Synthetic powder-free gloves (e.g., nitrile), latex-free tourniquet, silicone catheter, and polyurethane drapes.
B. Powdered latex gloves for the surgical team, latex-free Foley catheter, and natural rubber latex drains.
C. Vinyl gloves for the team, latex-free blood pressure cuff, and latex-containing anesthesia circuit.
D. Neoprene gloves, latex-free syringe, and latex Foley catheter with a silicone coating.
Answer: A
Rationale: For a patient with latex allergy, all items on the sterile field must be latex-free. Synthetic
gloves (nitrile, neoprene) are acceptable; powder-free reduces aerosolized allergen. Latex-free
tourniquets, silicone catheters, and polyurethane drapes are appropriate. Option B includes powdered
latex gloves (contraindicated) and latex drains. Option C: vinyl gloves offer poor barrier protection and
are not recommended for surgery; latex-containing circuit is unsafe. Option D: latex Foley catheter is
unsafe even if coated.
Page 3
, 8. A perioperative nurse is performing a surgical hand scrub before the first procedure of the day.
Which of the following describes the correct duration and technique according to AORN
guidelines?
A. Scrub for 2 minutes using a brushless waterless agent, covering all surfaces of hands and forearms, allowing
to air dry completely before donning gloves.
B. Scrub for 5 minutes using a chlorhexidine brush, focusing on nails and interdigital spaces, then rinse from
fingertips to elbows.
C. Scrub for 3 minutes using an alcohol-based rub, ensuring hands are dry before donning gloves; no brush is
needed.
D. Scrub for 10 minutes with povidone-iodine brush, then rinse from elbows to fingertips.
Answer: A
Rationale: AORN's current guidelines allow a surgical hand scrub of 2-3 minutes with a brushless
waterless agent (e.g., alcohol-based hand rub with persistent activity) for the first scrub of the day,
provided the agent is used according to manufacturer's instructions. Option B: 5-minute scrub is longer
than necessary; chlorhexidine brush can be used but not required. Option C: alcohol-based rubs are
acceptable but must be used on clean hands and for the recommended time (usually 2-3 minutes). Option
D: 10-minute scrub is outdated; rinse direction should be from fingertips to elbows.
9. A patient is undergoing a laparoscopic appendectomy. During the procedure, the surgeon
requests that the table be placed in Trendelenburg position. The perioperative nurse is responsible
for verifying that the patient is properly secured. Which of the following actions is most important
to prevent patient injury during positioning changes?
A. Ensure that the patient's arms are padded and tucked at the sides, with palms facing inward, and that the
safety strap is placed 2 inches above the knees.
B. Position the patient's arms on arm boards abducted less than 90 degrees, and secure the patient with a safety
strap across the thighs.
C. Place the patient in lithotomy stirrups before the procedure, and ensure that the stirrups are at equal height
and the legs are padded.
D. Apply sequential compression devices (SCDs) to the lower extremities before positioning, and ensure the
safety strap is across the chest.
Answer: A
Rationale: For Trendelenburg (head-down) position, the patient's arms should be tucked at the sides with
palms inward to avoid brachial plexus injury from the table edge. The safety strap should be placed 2
inches above the knees to prevent sliding. Option B: arms on arm boards in Trendelenburg increase risk
of shoulder/brachial plexus injury. Option C: lithotomy is not appropriate for appendectomy. Option D:
SCDs are for DVT prophylaxis, not positioning safety; chest strap may restrict breathing.
10. A surgical team is preparing to count sponges, sharps, and instruments at the end of a
procedure. According to AORN's recommended practices for prevention of retained surgical items
(RSI), which of the following statements is correct?
A. Counts should be performed only at the initial closing of the wound and at skin closure; no additional counts
are needed if the first count is correct.
B. If a count discrepancy occurs, the surgeon must order an intraoperative radiograph, and the team must search
the field and the room for the missing item.
Page 4
