CNOR 2110: Alexander's Care of the Patient in Surgery
(17th Edition) – Ultimate Perioperative & OR Nursing
Course Code: CNOR 2110
Course Name: Alexander's Care of the Patient in Surgery
Topic: Ultimate Perioperative & OR Nursing Study Guide
Academic Year: 2026/2027
Unit 1: Foundations of Perioperative Nursing Practice
Question 1
During a preoperative assessment, the nurse notes that an elderly patient scheduled
for a total hip arthroplasty has a serum albumin level of 2.8 g/dL. Which
complication is this patient at the highest risk for developing postoperatively?
A. Impaired wound healing and surgical site infection (SSI)
B. Acute intraoperative hypothermia
C. Malignant hyperthermia
D. Severe postoperative urinary retention
CORRECT ANSWER: A
RATIONALE: Serum albumin levels below 3.5 g/dL signify severe nutritional
deficit and protein depletion. Protein is foundational for collagen synthesis, tissue
repair, and immune system competence. A level of 2.8 g/dL directly impairs
cellular proliferation and wound remodeling, exponentially increasing the risk of
impaired wound healing and surgical site infection (SSI). Hypothermia (B) is
,caused by environmental exposure and anesthesia; malignant hyperthermia (C) is a
genetic pharmacogenetic crisis; and urinary retention (D) is tied to anesthetic
agents or benign prostatic hyperplasia, not protein status.
Question 2
The perioperative nurse is preparing to perform the Universal Protocol before an
exploratory laparotomy. Which action represents a required element of the "Time-
Out" phase as established by The Joint Commission?
A. Verification of the patient's identity in the holding area before transfer
B. Agreement by all active surgical team members on correct patient, site, and
procedure
C. Marking the surgical site using a permanent marker by the circulating nurse
D. Obtaining signed informed consent from the patient's legal representative
CORRECT ANSWER: B
RATIONALE: The Universal Protocol consists of pre-procedure verification,
site marking, and the Time-Out. The Time-Out must be performed immediately
before starting the procedure. It requires the active verbal participation and
agreement by all active surgical team members on correct patient, site, and
procedure to prevent wrong-site or wrong-patient sentinel events. Holding area
verification (A) is the pre-procedure phase. Site marking (C) must be done by the
person performing the procedure, not the circulator. Informed consent (D) must be
secured before the patient enters the operating room suite.
Question 3
An operating room nurse is reviewing the Perioperative Patient Focused Model.
Which of the following domains serves as the foundational core for measuring
patient outcomes related to structural safety during the intraoperative phase?
A. Behavioral responses
B. Safety and physiological responses
C. Financial optimization
D. Postoperative vocational rehab
CORRECT ANSWER: B
RATIONALE: The Perioperative Patient Focused Model developed by
AORN incorporates structural, process, and outcome metrics centered around the
patient. The core outcome domains evaluated during the acute surgical phase are
,Safety and physiological responses (e.g., freedom from injury, prevention of
infection, maintenance of skin integrity). Behavioral responses (A) relate to
knowledge and anxiety. Financial optimization (C) and vocational rehab (D) are
institutional or long-term goals, not the focal physiological domains of
intraoperative nursing care models.
Question 4
A patient undergoing an open cholecystectomy is administered succinylcholine
during induction. Within minutes, the patient exhibits masseter muscle rigidity, an
abrupt spike in end-tidal carbon dioxide (EtCO2), and a temperature of 39.2°C.
What is the immediate pharmacological intervention?
A. Intravenous administration of regular insulin and 50% dextrose
B. Intravenous administration of dantrolene sodium
C. Rapid infusion of iced normal saline mixed with sodium nitroprusside
D. Intramuscular injection of epinephrine
CORRECT ANSWER: B
RATIONALE: The patient is displaying classic signs of malignant
hyperthermia (MH), a life-threatening hypermetabolic crisis triggered by volatile
anesthetics or depolarizing neuromuscular blockers like succinylcholine. The
pathognomonic sign is an unexplained, sharp increase in EtCO2 followed by
hyperthermia and muscle rigidity. The gold-standard treatment is the intravenous
administration of dantrolene sodium, a skeletal muscle relaxant that binds to
ryanodine receptors to halt the uncontrolled release of calcium from the
sarcoplasmic reticulum. Insulin/dextrose (A) treats hyperkalemia adjunctively but
does not arrest the MH cascade. Iced saline (C) treats hyperthermia, but
nitroprusside is incorrect. Epinephrine (D) will worsen the hypermetabolic
tachycardia.
Question 5
When applying the principles of surgical asepsis, which area of a properly attired,
sterilely gowned team member is considered technically sterile?
A. From the neckline to the waist anteriorly, including the axillary regions
B. From the chest to the level of the sterile field anteriorly, and the sleeves
from two inches above the elbow to the cuffs
C. The entire front and back of the gown since it was sterilized as a complete unit
D. From the crown of the head to the bottom edge of the gown hem anteriorly
, CORRECT ANSWER: B
RATIONALE: According to AORN standards for surgical asepsis, only
specific zones of a gowned team member are designated sterile. These include the
front of the gown from the chest to the level of the sterile field anteriorly, and
the sleeves from two inches above the elbow to the cuffs. The neckline,
shoulders, back (C), and axillary regions (A) are subject to friction and moisture
contamination, making them non-sterile. Moisture or rubbing in the axillae
breaches the protective barrier.
Question 6
A patient is placed in the trendelenburg position for a robotic-assisted
laparoscopic hysterectomy. The perioperative nurse must monitor closely for
which physiological alteration associated with this position?
A. Significant reduction in intracranial pressure (ICP)
B. Increased lung compliance and vital capacity
C. Decreased diaphragmatic excursion and reduced functional residual
capacity
D. Marked hypotension due to lower extremity venous pooling
CORRECT ANSWER: C
RATIONALE: The trendelenburg position involves tilting the head down and
elevating the pelvis. The weight of the abdominal viscera shifts cephalad against
the diaphragm. This cause a decreased diaphragmatic excursion and reduced
functional residual capacity, increasing the work of breathing and risks of
atelectasis. ICP is increased, not decreased (A). Lung compliance drops due to
mechanical restriction (B). Blood pressure increases initially due to increased
venous return from the lower extremities, rather than causing hypotension (D).
Question 7
During an ultra-clean orthopedic total joint procedure, the scrub nurse notes a
microscopic tear in their outer sterile glove. Which action must be executed to
maintain infection prevention standards?
A. Spray the glove tip with an antimicrobial alcohol solution immediately
B. Place a second sterile glove directly over the torn glove to create a fresh barrier
C. Have the circulating nurse assist in changing the glove using the open-glove
or assisted technique immediately
D. Ignore the tear if no blood exposure or visible fluid penetration is observed
(17th Edition) – Ultimate Perioperative & OR Nursing
Course Code: CNOR 2110
Course Name: Alexander's Care of the Patient in Surgery
Topic: Ultimate Perioperative & OR Nursing Study Guide
Academic Year: 2026/2027
Unit 1: Foundations of Perioperative Nursing Practice
Question 1
During a preoperative assessment, the nurse notes that an elderly patient scheduled
for a total hip arthroplasty has a serum albumin level of 2.8 g/dL. Which
complication is this patient at the highest risk for developing postoperatively?
A. Impaired wound healing and surgical site infection (SSI)
B. Acute intraoperative hypothermia
C. Malignant hyperthermia
D. Severe postoperative urinary retention
CORRECT ANSWER: A
RATIONALE: Serum albumin levels below 3.5 g/dL signify severe nutritional
deficit and protein depletion. Protein is foundational for collagen synthesis, tissue
repair, and immune system competence. A level of 2.8 g/dL directly impairs
cellular proliferation and wound remodeling, exponentially increasing the risk of
impaired wound healing and surgical site infection (SSI). Hypothermia (B) is
,caused by environmental exposure and anesthesia; malignant hyperthermia (C) is a
genetic pharmacogenetic crisis; and urinary retention (D) is tied to anesthetic
agents or benign prostatic hyperplasia, not protein status.
Question 2
The perioperative nurse is preparing to perform the Universal Protocol before an
exploratory laparotomy. Which action represents a required element of the "Time-
Out" phase as established by The Joint Commission?
A. Verification of the patient's identity in the holding area before transfer
B. Agreement by all active surgical team members on correct patient, site, and
procedure
C. Marking the surgical site using a permanent marker by the circulating nurse
D. Obtaining signed informed consent from the patient's legal representative
CORRECT ANSWER: B
RATIONALE: The Universal Protocol consists of pre-procedure verification,
site marking, and the Time-Out. The Time-Out must be performed immediately
before starting the procedure. It requires the active verbal participation and
agreement by all active surgical team members on correct patient, site, and
procedure to prevent wrong-site or wrong-patient sentinel events. Holding area
verification (A) is the pre-procedure phase. Site marking (C) must be done by the
person performing the procedure, not the circulator. Informed consent (D) must be
secured before the patient enters the operating room suite.
Question 3
An operating room nurse is reviewing the Perioperative Patient Focused Model.
Which of the following domains serves as the foundational core for measuring
patient outcomes related to structural safety during the intraoperative phase?
A. Behavioral responses
B. Safety and physiological responses
C. Financial optimization
D. Postoperative vocational rehab
CORRECT ANSWER: B
RATIONALE: The Perioperative Patient Focused Model developed by
AORN incorporates structural, process, and outcome metrics centered around the
patient. The core outcome domains evaluated during the acute surgical phase are
,Safety and physiological responses (e.g., freedom from injury, prevention of
infection, maintenance of skin integrity). Behavioral responses (A) relate to
knowledge and anxiety. Financial optimization (C) and vocational rehab (D) are
institutional or long-term goals, not the focal physiological domains of
intraoperative nursing care models.
Question 4
A patient undergoing an open cholecystectomy is administered succinylcholine
during induction. Within minutes, the patient exhibits masseter muscle rigidity, an
abrupt spike in end-tidal carbon dioxide (EtCO2), and a temperature of 39.2°C.
What is the immediate pharmacological intervention?
A. Intravenous administration of regular insulin and 50% dextrose
B. Intravenous administration of dantrolene sodium
C. Rapid infusion of iced normal saline mixed with sodium nitroprusside
D. Intramuscular injection of epinephrine
CORRECT ANSWER: B
RATIONALE: The patient is displaying classic signs of malignant
hyperthermia (MH), a life-threatening hypermetabolic crisis triggered by volatile
anesthetics or depolarizing neuromuscular blockers like succinylcholine. The
pathognomonic sign is an unexplained, sharp increase in EtCO2 followed by
hyperthermia and muscle rigidity. The gold-standard treatment is the intravenous
administration of dantrolene sodium, a skeletal muscle relaxant that binds to
ryanodine receptors to halt the uncontrolled release of calcium from the
sarcoplasmic reticulum. Insulin/dextrose (A) treats hyperkalemia adjunctively but
does not arrest the MH cascade. Iced saline (C) treats hyperthermia, but
nitroprusside is incorrect. Epinephrine (D) will worsen the hypermetabolic
tachycardia.
Question 5
When applying the principles of surgical asepsis, which area of a properly attired,
sterilely gowned team member is considered technically sterile?
A. From the neckline to the waist anteriorly, including the axillary regions
B. From the chest to the level of the sterile field anteriorly, and the sleeves
from two inches above the elbow to the cuffs
C. The entire front and back of the gown since it was sterilized as a complete unit
D. From the crown of the head to the bottom edge of the gown hem anteriorly
, CORRECT ANSWER: B
RATIONALE: According to AORN standards for surgical asepsis, only
specific zones of a gowned team member are designated sterile. These include the
front of the gown from the chest to the level of the sterile field anteriorly, and
the sleeves from two inches above the elbow to the cuffs. The neckline,
shoulders, back (C), and axillary regions (A) are subject to friction and moisture
contamination, making them non-sterile. Moisture or rubbing in the axillae
breaches the protective barrier.
Question 6
A patient is placed in the trendelenburg position for a robotic-assisted
laparoscopic hysterectomy. The perioperative nurse must monitor closely for
which physiological alteration associated with this position?
A. Significant reduction in intracranial pressure (ICP)
B. Increased lung compliance and vital capacity
C. Decreased diaphragmatic excursion and reduced functional residual
capacity
D. Marked hypotension due to lower extremity venous pooling
CORRECT ANSWER: C
RATIONALE: The trendelenburg position involves tilting the head down and
elevating the pelvis. The weight of the abdominal viscera shifts cephalad against
the diaphragm. This cause a decreased diaphragmatic excursion and reduced
functional residual capacity, increasing the work of breathing and risks of
atelectasis. ICP is increased, not decreased (A). Lung compliance drops due to
mechanical restriction (B). Blood pressure increases initially due to increased
venous return from the lower extremities, rather than causing hypotension (D).
Question 7
During an ultra-clean orthopedic total joint procedure, the scrub nurse notes a
microscopic tear in their outer sterile glove. Which action must be executed to
maintain infection prevention standards?
A. Spray the glove tip with an antimicrobial alcohol solution immediately
B. Place a second sterile glove directly over the torn glove to create a fresh barrier
C. Have the circulating nurse assist in changing the glove using the open-glove
or assisted technique immediately
D. Ignore the tear if no blood exposure or visible fluid penetration is observed
