CNOR Certification Examination: 150 Advanced Practice
Questions for Perioperative Nurse Specialists A
Comprehensive Test Bank Aligned with the 2025 CCI
Detailed Content Outline, AORN Guidelines for
Perioperative Practice, and Evidence-Based
Perioperative Standards
Table of Contents
1. Preoperative Patient Assessment and Diagnosis (Questions 1–25)
2. Individualized Plan of Care Development and Expected Outcome Identification (Questions 26–
40)
3. Intraoperative Patient Care and Safety: Positioning, Counts, Specimens, and Medications
(Questions 41–75)
4. Infection Prevention and Control of the Environment, Instrumentation, and Supplies (Questions
76–100)
5. Communication and Documentation (Questions 101–115)
6. Emergency Situations (Questions 116–135)
7. Management of Personnel, Services, and Materials (Questions 136–145)
8. Professional Accountability (Questions 146–150)
Section 1: Preoperative Patient Assessment and Diagnosis
🟢 1. A 72-year-old patient scheduled for total knee arthroplasty presents with a serum potassium level
of 2.9 mEq/L. Which action should the perioperative nurse take first?
A. Proceed with surgery as scheduled
🔴🔴 B. Notify the surgeon and anesthesia professional of the abnormal value
C. Document the result and continue with preoperative preparation
D. Administer oral potassium supplementation per standing orders
Rationale: Hypokalemia (serum potassium <3.5 mEq/L) places the patient at risk for cardiac
dysrhythmias, especially during anesthesia induction and surgical stress. The perioperative nurse must
notify the surgical and anesthesia teams before proceeding. Normal potassium range is 3.5–5.0 mEq/L.
Reference: AORN Guidelines for Perioperative Practice (2025), Preoperative Patient Assessment;
Ignatavicius & Workman, Medical-Surgical Nursing (2021).
,🟢 2. During preoperative assessment, a patient reports taking ginkgo biloba daily. The perioperative
nurse recognizes this herbal supplement increases the risk for which complication?
A. Malignant hyperthermia
🔴🔴 B. Increased bleeding
C. Severe hypertension
D. Delayed anesthesia emergence
Rationale: Ginkgo biloba has antiplatelet and anticoagulant properties and can increase the risk of
intraoperative and postoperative bleeding. AORN recommends discontinuing herbal supplements at
least 2 weeks before surgery when possible.
Reference: AORN Guideline for Medication Safety (2025); American Society of Anesthesiologists (ASA)
Preoperative Herbal Supplement Guidelines.
🟢 3. A patient with a documented history of malignant hyperthermia is scheduled for an emergency
laparoscopic appendectomy. Which anesthetic agent is safest for induction?
A. Sevoflurane
B. Succinylcholine
🔴🔴 C. Propofol
D. Isoflurane
Rationale: Propofol is a non-triggering intravenous agent safe for malignant hyperthermia-susceptible
patients. Sevoflurane, isoflurane, and succinylcholine are potent triggers of malignant hyperthermia.
Reference: AORN Malignant Hyperthermia Guideline (2025); Malignant Hyperthermia Association of the
United States (MHAUS) Guidelines.
🟢 4. The perioperative nurse is reviewing a patient's preoperative laboratory results. Which finding is
most concerning and requires immediate notification of the anesthesia professional?
A. Hemoglobin 11.5 g/dL
B. Blood glucose 145 mg/dL
🔴🔴 C. International Normalized Ratio (INR) 3.5
D. White blood cell count 12,000/mm³
Rationale: An INR of 3.5 indicates significantly prolonged clotting time and places the patient at high risk
for hemorrhage during surgery. The anesthesia professional must be notified before proceeding.
Reference: AORN Guideline for Preoperative Patient Assessment (2025); ACS/NSQIP Preoperative Risk
Assessment.
,🟢 5. A 25-year-old male is scheduled for venous access port placement for chemotherapy. His arterial
blood gas results are pH 7.2, PaCO₂ 50 mmHg, and HCO₃ 26 mEq/L. What is the perioperative nurse's
priority action?
A. Administer additional pain medication
B. Call the code arrest team
🔴🔴 C. Notify the physician of abnormal findings and encourage deep breathing
D. Document and proceed with surgery
Rationale: These ABG values indicate respiratory acidosis (elevated PaCO₂ with low pH). The nurse
should notify the physician, encourage deep breathing to improve ventilation, and request supplemental
oxygen orders if needed.
Reference: AORN Preoperative Assessment Guidelines (2025); Pagana & Pagana, Mosby's Diagnostic
and Laboratory Test Reference.
🟢 6. Which preoperative assessment finding in an older adult patient most strongly suggests potential
abuse?
A. Verbalizes an adequate food supply
B. Wears clean clothes
C. Verbalizes control of their finances
🔴🔴 D. Shows signs of poor hygiene including body odor
Rationale: Poor hygiene, unexplained injuries, dehydration, and malnutrition are red flags for elder
abuse. Perioperative nurses are mandated reporters and must follow facility policy and state/federal
regulations when abuse is suspected.
Reference: AORN Guideline for Patient Assessment (2025); The Joint Commission Sentinel Event Alert
on Abuse.
🟢 7. A patient scheduled for surgery reports a history of sleep apnea and uses a CPAP machine at home.
Which preoperative intervention is most important for the perioperative nurse to implement?
A. Instruct the patient to discontinue CPAP use on the morning of surgery
🔴🔴 B. Ensure the anesthesia professional is aware of the diagnosis and CPAP settings
C. Place the patient in the supine position immediately upon arrival to the OR
D. Administer a sedative to reduce preoperative anxiety
Rationale: Patients with obstructive sleep apnea (OSA) are at increased risk for airway obstruction,
desaturation, and respiratory depression during sedation and anesthesia. The anesthesia professional
must be informed to plan appropriate airway management.
Reference: ASA Practice Guidelines for the Perioperative Management of Patients with OSA (2020);
AORN Guideline for Preoperative Assessment.
, 🟢 8. The perioperative nurse is performing a preoperative assessment on a patient with a known allergy
to latex. Which item in the OR should be prioritized for removal or replacement?
A. Stainless steel instruments
🔴🔴 B. Surgical gloves and tourniquets containing natural rubber latex
C. Polypropylene sutures
D. Titanium implants
Rationale: Latex allergy can trigger anaphylaxis. All latex-containing items, including gloves, tourniquets,
catheters, and IV tubing, must be removed. The OR should be prepared as a latex-safe environment.
Reference: AORN Guideline for Latex Allergy (2025); CDC/NIOSH Latex Allergy Prevention Guidelines.
🟢 9. A patient with a body mass index (BMI) of 43 is scheduled for a laparoscopic abdominal procedure
in the Trendelenburg position. The perioperative nurse voices concern. What should the nurse
anticipate doing?
🔴🔴 A. Prepare for careful monitoring and discuss positioning alternatives with the surgical team
B. Reposition the patient frequently between Trendelenburg and supine
C. Send arterial blood gases to the lab as routine monitoring
D. Cancel the procedure until the patient loses weight
Rationale: Patients with a high BMI are at increased risk for respiratory compromise, increased intra-
abdominal pressure, and cardiovascular stress in Trendelenburg position. The nurse should advocate for
the safest positioning and ensure appropriate padding and monitoring. If the surgeon insists on
Trendelenburg, the team must monitor closely and consider periodic repositioning.
Reference: AORN Guideline for Patient Positioning (2025); Safe Patient Handling and Movement
Guidelines.
🟢 10. During preoperative assessment, the nurse notes the patient has an implantable cardioverter-
defibrillator (ICD). Which action is most important?
A. Proceed with monopolar electrocautery at the lowest setting
🔴🔴 B. Notify the anesthesia professional and ensure the device is reprogrammed or magnet applied if
indicated
C. Remove the device before surgery
D. Place the dispersive electrode directly over the device
Rationale: Electromagnetic interference from electrocautery can inhibit or trigger the ICD. The device
should be reprogrammed or a magnet applied by a qualified professional before surgery. Monopolar
cautery should be used with caution, and the dispersive pad should never be placed over the device.
Questions for Perioperative Nurse Specialists A
Comprehensive Test Bank Aligned with the 2025 CCI
Detailed Content Outline, AORN Guidelines for
Perioperative Practice, and Evidence-Based
Perioperative Standards
Table of Contents
1. Preoperative Patient Assessment and Diagnosis (Questions 1–25)
2. Individualized Plan of Care Development and Expected Outcome Identification (Questions 26–
40)
3. Intraoperative Patient Care and Safety: Positioning, Counts, Specimens, and Medications
(Questions 41–75)
4. Infection Prevention and Control of the Environment, Instrumentation, and Supplies (Questions
76–100)
5. Communication and Documentation (Questions 101–115)
6. Emergency Situations (Questions 116–135)
7. Management of Personnel, Services, and Materials (Questions 136–145)
8. Professional Accountability (Questions 146–150)
Section 1: Preoperative Patient Assessment and Diagnosis
🟢 1. A 72-year-old patient scheduled for total knee arthroplasty presents with a serum potassium level
of 2.9 mEq/L. Which action should the perioperative nurse take first?
A. Proceed with surgery as scheduled
🔴🔴 B. Notify the surgeon and anesthesia professional of the abnormal value
C. Document the result and continue with preoperative preparation
D. Administer oral potassium supplementation per standing orders
Rationale: Hypokalemia (serum potassium <3.5 mEq/L) places the patient at risk for cardiac
dysrhythmias, especially during anesthesia induction and surgical stress. The perioperative nurse must
notify the surgical and anesthesia teams before proceeding. Normal potassium range is 3.5–5.0 mEq/L.
Reference: AORN Guidelines for Perioperative Practice (2025), Preoperative Patient Assessment;
Ignatavicius & Workman, Medical-Surgical Nursing (2021).
,🟢 2. During preoperative assessment, a patient reports taking ginkgo biloba daily. The perioperative
nurse recognizes this herbal supplement increases the risk for which complication?
A. Malignant hyperthermia
🔴🔴 B. Increased bleeding
C. Severe hypertension
D. Delayed anesthesia emergence
Rationale: Ginkgo biloba has antiplatelet and anticoagulant properties and can increase the risk of
intraoperative and postoperative bleeding. AORN recommends discontinuing herbal supplements at
least 2 weeks before surgery when possible.
Reference: AORN Guideline for Medication Safety (2025); American Society of Anesthesiologists (ASA)
Preoperative Herbal Supplement Guidelines.
🟢 3. A patient with a documented history of malignant hyperthermia is scheduled for an emergency
laparoscopic appendectomy. Which anesthetic agent is safest for induction?
A. Sevoflurane
B. Succinylcholine
🔴🔴 C. Propofol
D. Isoflurane
Rationale: Propofol is a non-triggering intravenous agent safe for malignant hyperthermia-susceptible
patients. Sevoflurane, isoflurane, and succinylcholine are potent triggers of malignant hyperthermia.
Reference: AORN Malignant Hyperthermia Guideline (2025); Malignant Hyperthermia Association of the
United States (MHAUS) Guidelines.
🟢 4. The perioperative nurse is reviewing a patient's preoperative laboratory results. Which finding is
most concerning and requires immediate notification of the anesthesia professional?
A. Hemoglobin 11.5 g/dL
B. Blood glucose 145 mg/dL
🔴🔴 C. International Normalized Ratio (INR) 3.5
D. White blood cell count 12,000/mm³
Rationale: An INR of 3.5 indicates significantly prolonged clotting time and places the patient at high risk
for hemorrhage during surgery. The anesthesia professional must be notified before proceeding.
Reference: AORN Guideline for Preoperative Patient Assessment (2025); ACS/NSQIP Preoperative Risk
Assessment.
,🟢 5. A 25-year-old male is scheduled for venous access port placement for chemotherapy. His arterial
blood gas results are pH 7.2, PaCO₂ 50 mmHg, and HCO₃ 26 mEq/L. What is the perioperative nurse's
priority action?
A. Administer additional pain medication
B. Call the code arrest team
🔴🔴 C. Notify the physician of abnormal findings and encourage deep breathing
D. Document and proceed with surgery
Rationale: These ABG values indicate respiratory acidosis (elevated PaCO₂ with low pH). The nurse
should notify the physician, encourage deep breathing to improve ventilation, and request supplemental
oxygen orders if needed.
Reference: AORN Preoperative Assessment Guidelines (2025); Pagana & Pagana, Mosby's Diagnostic
and Laboratory Test Reference.
🟢 6. Which preoperative assessment finding in an older adult patient most strongly suggests potential
abuse?
A. Verbalizes an adequate food supply
B. Wears clean clothes
C. Verbalizes control of their finances
🔴🔴 D. Shows signs of poor hygiene including body odor
Rationale: Poor hygiene, unexplained injuries, dehydration, and malnutrition are red flags for elder
abuse. Perioperative nurses are mandated reporters and must follow facility policy and state/federal
regulations when abuse is suspected.
Reference: AORN Guideline for Patient Assessment (2025); The Joint Commission Sentinel Event Alert
on Abuse.
🟢 7. A patient scheduled for surgery reports a history of sleep apnea and uses a CPAP machine at home.
Which preoperative intervention is most important for the perioperative nurse to implement?
A. Instruct the patient to discontinue CPAP use on the morning of surgery
🔴🔴 B. Ensure the anesthesia professional is aware of the diagnosis and CPAP settings
C. Place the patient in the supine position immediately upon arrival to the OR
D. Administer a sedative to reduce preoperative anxiety
Rationale: Patients with obstructive sleep apnea (OSA) are at increased risk for airway obstruction,
desaturation, and respiratory depression during sedation and anesthesia. The anesthesia professional
must be informed to plan appropriate airway management.
Reference: ASA Practice Guidelines for the Perioperative Management of Patients with OSA (2020);
AORN Guideline for Preoperative Assessment.
, 🟢 8. The perioperative nurse is performing a preoperative assessment on a patient with a known allergy
to latex. Which item in the OR should be prioritized for removal or replacement?
A. Stainless steel instruments
🔴🔴 B. Surgical gloves and tourniquets containing natural rubber latex
C. Polypropylene sutures
D. Titanium implants
Rationale: Latex allergy can trigger anaphylaxis. All latex-containing items, including gloves, tourniquets,
catheters, and IV tubing, must be removed. The OR should be prepared as a latex-safe environment.
Reference: AORN Guideline for Latex Allergy (2025); CDC/NIOSH Latex Allergy Prevention Guidelines.
🟢 9. A patient with a body mass index (BMI) of 43 is scheduled for a laparoscopic abdominal procedure
in the Trendelenburg position. The perioperative nurse voices concern. What should the nurse
anticipate doing?
🔴🔴 A. Prepare for careful monitoring and discuss positioning alternatives with the surgical team
B. Reposition the patient frequently between Trendelenburg and supine
C. Send arterial blood gases to the lab as routine monitoring
D. Cancel the procedure until the patient loses weight
Rationale: Patients with a high BMI are at increased risk for respiratory compromise, increased intra-
abdominal pressure, and cardiovascular stress in Trendelenburg position. The nurse should advocate for
the safest positioning and ensure appropriate padding and monitoring. If the surgeon insists on
Trendelenburg, the team must monitor closely and consider periodic repositioning.
Reference: AORN Guideline for Patient Positioning (2025); Safe Patient Handling and Movement
Guidelines.
🟢 10. During preoperative assessment, the nurse notes the patient has an implantable cardioverter-
defibrillator (ICD). Which action is most important?
A. Proceed with monopolar electrocautery at the lowest setting
🔴🔴 B. Notify the anesthesia professional and ensure the device is reprogrammed or magnet applied if
indicated
C. Remove the device before surgery
D. Place the dispersive electrode directly over the device
Rationale: Electromagnetic interference from electrocautery can inhibit or trigger the ICD. The device
should be reprogrammed or a magnet applied by a qualified professional before surgery. Monopolar
cautery should be used with caution, and the dispersive pad should never be placed over the device.
