AORN Periop 101 Final Exam Prep Questions
And Well Graded Solutions With Rationales
Updated 2026 2027
Master your AORN Periop 101 Final Exam with this comprehensive 300-question mock test
bank. Features highly structured multiple-choice questions matching real exam formats.
Includes italicized correct answers and deep-dive rationales mapping directly to the
official Guidelines for Perioperative Practice. Covers crucial topics: sterile technique,
patient positioning, surgical wound classifications, skin prep, and emergency protocols
(MH/LAST). Perfect for scoring above the mandatory 80% threshold.
1. When opening a wrapped sterile package, in which direction should the perioperative
nurse open the first flap?
A) Toward the body
B) To the right side
C) To the left side
D) Away from the body
D) Away from the body
Rationale: Opening the first flap away from the body ensures that the nurse does not
have to reach over the sterile contents when opening the remaining flaps,
maintaining strict asepsis.
2. During preoperative skin preparation, what is the primary reason for avoiding the use
of traditional razors?
A) Razors cause microabrasions that increase the risk of surgical site infections
(SSIs).
B) Razors are too time-consuming to use in the preoperative area.
C) Chemical depilatories are always required by AORN guidelines.
D) Hair removal causes immediate hair regrowth during long surgeries.
A) Razors cause microabrasions that increase the risk of surgical site
infections (SSIs).
Rationale: Traditional razors create microscopic cuts in the skin that serve as
breeding grounds for bacteria. If hair must be removed, electric clippers should be
used.
3. Which of the following physiological changes occurs when a patient is placed in the
Trendelenburg position?
A) Decreased intracranial pressure
B) Increased cardiac output and central venous pressure
C) Increased vital capacity of the lungs
1|Page
, D) Decreased intrathoracic pressure
B) Increased cardiac output and central venous pressure
Rationale: Gravity shifts blood from the lower extremities to the central circulation,
which increases venous return and cardiac output, while putting pressure on the
diaphragm.
4. When performing environmental damp dusting in the operating room, when and how
should the task be completed?
A) At the end of the day, working from the lowest surfaces to the highest
B) Before the first scheduled procedure of the day, working from the highest surfaces
to the lowest
C) Between every case, focusing only on the surgical lights
D) Once a week, using a dry microfiber cloth
B) Before the first scheduled procedure of the day, working from the highest
surfaces to the lowest
Rationale: Damp dusting removes settled overnight dust before cases begin.
Cleaning high-to-low prevents dust from falling back onto already-cleaned surfaces.
5. What is the standard margin of safety considered unsterile at the edge of a sterile
drape or wrapper?
A) 0.5 inches
B) 1 inch
C) 2 inches
D) 3 inches
B) 1 inch
Rationale: According to AORN guidelines, a 1-inch border around the edge of any
sterile wrapper or drape is considered unsterile and should not be placed over the
sterile field.
6. What is the correct initial intervention when a patient experiences Local Anesthetic
Systemic Toxicity (LAST)?
A) Administer a large dose of epinephrine
B) Administer 20% lipid emulsion therapy
C) Place the patient in a prone position
D) Apply a cooling blanket to lower body temperature
B) Administer 20% lipid emulsion therapy
Rationale: 20% lipid emulsion therapy is the antidote for LAST, acting as a "lipid
sink" to draw local anesthetic out of cardiac and neurological tissues.
7. A surgical wound that enters the respiratory, gastrointestinal, or genitourinary tract
under controlled conditions without unusual contamination is classified as what
wound class?
A) Class I: Clean
B) Class II: Clean-Contaminated
C) Class III: Contaminated
D) Class IV: Dirty-Infected
B) Class II: Clean-Contaminated
Rationale: Class II wounds involve entering a tract that naturally contains flora, but
doing so under controlled, elective conditions without significant spillage.
8. Which of the following is an example of an intrinsic patient risk factor for developing
a pressure injury during surgery?
A) Total length of the surgical procedure
B) Type of operating table mattress used
C) Pre-existing peripheral vascular disease
2|Page
, D) Ambient temperature of the operating room
C) Pre-existing peripheral vascular disease
Rationale: Intrinsic factors are patient-specific health characteristics, such as poor
circulation, advanced age, or malnutrition, which lower tissue tolerance to pressure.
9. When should a count of surgical items (sponges, sharps, and instruments) be
performed?
A) Only at the end of the procedure when the skin is being closed
B) At the start of the case, before closure of a cavity, and during skin closure
C) Whenever the scrub nurse takes a lunch break only
D) Only when requested by the attending surgeon
B) At the start of the case, before closure of a cavity, and during skin closure
Rationale: Counts must be done at baseline, before closing any deep cavity or
organ, at the start of skin closure, and whenever there is a permanent change in
scrub or circulating personnel.
10. What type of airflow is required in an operating room to prevent contaminated air
from entering the sterile field?
A) Negative pressure airflow
B) Positive pressure airflow
C) Equalized atmospheric pressure
D) Recirculated ambient air without filtration
B) Positive pressure airflow
Rationale: Positive pressure forces air out of the operating room when doors are
opened, preventing contaminated air from corridors from rushing into the room.
11. According to AORN guidelines, who is responsible for initiating the surgical "Time
Out" before the procedure begins?
A) Only the surgeon
B) Only the anesthesia provider
C) Only the circulating nurse
D) Any member of the perioperative team
D) Any member of the perioperative team
Rationale: While the circulating nurse often facilitates it, any member of the team can
and should initiate the Time Out to ensure patient safety before skin incision.
12. When transferring an anesthetized patient from the OR bed to the gurney, what is
the minimum number of personnel required to ensure safety?
A) Two
B) Three
C) Four
D) Five
C) Four
Rationale: A minimum of four people is recommended to safely transfer an
uncooperative or anesthetized patient to prevent injury to the patient and staff.
13. What is the optimal target range for relative humidity in the operating room to
minimize microbial growth and electrostatic sparks?
A) 10% to 30%
B) 20% to 60%
C) 50% to 80%
D) 70% to 90%
B) 20% to 60%
Rationale: AORN guidelines recommend maintaining humidity between 20% and
60% to ensure safety, comfort, and the preservation of sterile supplies.
3|Page
, 14. How should a sterile team member pass another sterile team member within the
sterile field?
A) Front-to-back
B) Back-to-back or front-to-front
C) Passing on the left side only
D) Walking completely out of the sterile field and returning
B) Back-to-back or front-to-front
Rationale: Sterile personnel must pass each other back-to-back or front-to-front to
avoid touching an unsterile area (the back) with a sterile area (the front).
15. What is the primary purpose of using a surgical skin prep solution containing
alcohol?
A) It provides a long-term cumulative antimicrobial effect for days.
B) It has a rapid, immediate kill rate of skin microorganisms.
C) It softens the skin layers for easier incisions.
D) It turns bright colors so the surgeon can see the prepped area.
B) It has a rapid, immediate kill rate of skin microorganisms.
Rationale: Alcohol has the fastest, most effective immediate reduction of microbial
counts on skin, though it lacks long-term residual activity on its own.
16. Which surgical wound classification applies to an open, fresh, accidental wound with
major breaks in sterile technique?
A) Class I
B) Class II
C) Class III
D) Class IV
C) Class III
Rationale: Class III (Contaminated) wounds include fresh, open traumatic wounds or
surgeries with gross spillage from the GI tract or major breaks in technique.
17. To prevent brachial plexus injury when a patient is in the supine position, the
patient's arm boards should not be abducted past how many degrees?
A) 45 degrees
B) 60 degrees
C) 90 degrees
D) 120 degrees
C) 90 degrees
Rationale: Abducting the arms greater than 90 degrees stretches the brachial plexus
nerves against the humeral head, increasing the risk of nerve damage.
18. What should the perioperative nurse do first if a needle count is incorrect at the end
of a procedure?
A) Call for a portable X-ray immediately
B) Notify the surgeon and repeat the count
C) Check the garbage cans outside the room
D) Document that the needle was likely thrown away
B) Notify the surgeon and repeat the count
Rationale: The immediate step is to notify the surgeon so they can stop closing,
check the wound, and have the circulating nurse re-count to rule out an error.
19. When using a bipolar electrosurgical unit (ESU), where should the patient dispersive
grounding pad be placed?
A) On the patient's closest large muscle mass
B) On the patient's lower back
C) On the patient's upper thigh
4|Page
And Well Graded Solutions With Rationales
Updated 2026 2027
Master your AORN Periop 101 Final Exam with this comprehensive 300-question mock test
bank. Features highly structured multiple-choice questions matching real exam formats.
Includes italicized correct answers and deep-dive rationales mapping directly to the
official Guidelines for Perioperative Practice. Covers crucial topics: sterile technique,
patient positioning, surgical wound classifications, skin prep, and emergency protocols
(MH/LAST). Perfect for scoring above the mandatory 80% threshold.
1. When opening a wrapped sterile package, in which direction should the perioperative
nurse open the first flap?
A) Toward the body
B) To the right side
C) To the left side
D) Away from the body
D) Away from the body
Rationale: Opening the first flap away from the body ensures that the nurse does not
have to reach over the sterile contents when opening the remaining flaps,
maintaining strict asepsis.
2. During preoperative skin preparation, what is the primary reason for avoiding the use
of traditional razors?
A) Razors cause microabrasions that increase the risk of surgical site infections
(SSIs).
B) Razors are too time-consuming to use in the preoperative area.
C) Chemical depilatories are always required by AORN guidelines.
D) Hair removal causes immediate hair regrowth during long surgeries.
A) Razors cause microabrasions that increase the risk of surgical site
infections (SSIs).
Rationale: Traditional razors create microscopic cuts in the skin that serve as
breeding grounds for bacteria. If hair must be removed, electric clippers should be
used.
3. Which of the following physiological changes occurs when a patient is placed in the
Trendelenburg position?
A) Decreased intracranial pressure
B) Increased cardiac output and central venous pressure
C) Increased vital capacity of the lungs
1|Page
, D) Decreased intrathoracic pressure
B) Increased cardiac output and central venous pressure
Rationale: Gravity shifts blood from the lower extremities to the central circulation,
which increases venous return and cardiac output, while putting pressure on the
diaphragm.
4. When performing environmental damp dusting in the operating room, when and how
should the task be completed?
A) At the end of the day, working from the lowest surfaces to the highest
B) Before the first scheduled procedure of the day, working from the highest surfaces
to the lowest
C) Between every case, focusing only on the surgical lights
D) Once a week, using a dry microfiber cloth
B) Before the first scheduled procedure of the day, working from the highest
surfaces to the lowest
Rationale: Damp dusting removes settled overnight dust before cases begin.
Cleaning high-to-low prevents dust from falling back onto already-cleaned surfaces.
5. What is the standard margin of safety considered unsterile at the edge of a sterile
drape or wrapper?
A) 0.5 inches
B) 1 inch
C) 2 inches
D) 3 inches
B) 1 inch
Rationale: According to AORN guidelines, a 1-inch border around the edge of any
sterile wrapper or drape is considered unsterile and should not be placed over the
sterile field.
6. What is the correct initial intervention when a patient experiences Local Anesthetic
Systemic Toxicity (LAST)?
A) Administer a large dose of epinephrine
B) Administer 20% lipid emulsion therapy
C) Place the patient in a prone position
D) Apply a cooling blanket to lower body temperature
B) Administer 20% lipid emulsion therapy
Rationale: 20% lipid emulsion therapy is the antidote for LAST, acting as a "lipid
sink" to draw local anesthetic out of cardiac and neurological tissues.
7. A surgical wound that enters the respiratory, gastrointestinal, or genitourinary tract
under controlled conditions without unusual contamination is classified as what
wound class?
A) Class I: Clean
B) Class II: Clean-Contaminated
C) Class III: Contaminated
D) Class IV: Dirty-Infected
B) Class II: Clean-Contaminated
Rationale: Class II wounds involve entering a tract that naturally contains flora, but
doing so under controlled, elective conditions without significant spillage.
8. Which of the following is an example of an intrinsic patient risk factor for developing
a pressure injury during surgery?
A) Total length of the surgical procedure
B) Type of operating table mattress used
C) Pre-existing peripheral vascular disease
2|Page
, D) Ambient temperature of the operating room
C) Pre-existing peripheral vascular disease
Rationale: Intrinsic factors are patient-specific health characteristics, such as poor
circulation, advanced age, or malnutrition, which lower tissue tolerance to pressure.
9. When should a count of surgical items (sponges, sharps, and instruments) be
performed?
A) Only at the end of the procedure when the skin is being closed
B) At the start of the case, before closure of a cavity, and during skin closure
C) Whenever the scrub nurse takes a lunch break only
D) Only when requested by the attending surgeon
B) At the start of the case, before closure of a cavity, and during skin closure
Rationale: Counts must be done at baseline, before closing any deep cavity or
organ, at the start of skin closure, and whenever there is a permanent change in
scrub or circulating personnel.
10. What type of airflow is required in an operating room to prevent contaminated air
from entering the sterile field?
A) Negative pressure airflow
B) Positive pressure airflow
C) Equalized atmospheric pressure
D) Recirculated ambient air without filtration
B) Positive pressure airflow
Rationale: Positive pressure forces air out of the operating room when doors are
opened, preventing contaminated air from corridors from rushing into the room.
11. According to AORN guidelines, who is responsible for initiating the surgical "Time
Out" before the procedure begins?
A) Only the surgeon
B) Only the anesthesia provider
C) Only the circulating nurse
D) Any member of the perioperative team
D) Any member of the perioperative team
Rationale: While the circulating nurse often facilitates it, any member of the team can
and should initiate the Time Out to ensure patient safety before skin incision.
12. When transferring an anesthetized patient from the OR bed to the gurney, what is
the minimum number of personnel required to ensure safety?
A) Two
B) Three
C) Four
D) Five
C) Four
Rationale: A minimum of four people is recommended to safely transfer an
uncooperative or anesthetized patient to prevent injury to the patient and staff.
13. What is the optimal target range for relative humidity in the operating room to
minimize microbial growth and electrostatic sparks?
A) 10% to 30%
B) 20% to 60%
C) 50% to 80%
D) 70% to 90%
B) 20% to 60%
Rationale: AORN guidelines recommend maintaining humidity between 20% and
60% to ensure safety, comfort, and the preservation of sterile supplies.
3|Page
, 14. How should a sterile team member pass another sterile team member within the
sterile field?
A) Front-to-back
B) Back-to-back or front-to-front
C) Passing on the left side only
D) Walking completely out of the sterile field and returning
B) Back-to-back or front-to-front
Rationale: Sterile personnel must pass each other back-to-back or front-to-front to
avoid touching an unsterile area (the back) with a sterile area (the front).
15. What is the primary purpose of using a surgical skin prep solution containing
alcohol?
A) It provides a long-term cumulative antimicrobial effect for days.
B) It has a rapid, immediate kill rate of skin microorganisms.
C) It softens the skin layers for easier incisions.
D) It turns bright colors so the surgeon can see the prepped area.
B) It has a rapid, immediate kill rate of skin microorganisms.
Rationale: Alcohol has the fastest, most effective immediate reduction of microbial
counts on skin, though it lacks long-term residual activity on its own.
16. Which surgical wound classification applies to an open, fresh, accidental wound with
major breaks in sterile technique?
A) Class I
B) Class II
C) Class III
D) Class IV
C) Class III
Rationale: Class III (Contaminated) wounds include fresh, open traumatic wounds or
surgeries with gross spillage from the GI tract or major breaks in technique.
17. To prevent brachial plexus injury when a patient is in the supine position, the
patient's arm boards should not be abducted past how many degrees?
A) 45 degrees
B) 60 degrees
C) 90 degrees
D) 120 degrees
C) 90 degrees
Rationale: Abducting the arms greater than 90 degrees stretches the brachial plexus
nerves against the humeral head, increasing the risk of nerve damage.
18. What should the perioperative nurse do first if a needle count is incorrect at the end
of a procedure?
A) Call for a portable X-ray immediately
B) Notify the surgeon and repeat the count
C) Check the garbage cans outside the room
D) Document that the needle was likely thrown away
B) Notify the surgeon and repeat the count
Rationale: The immediate step is to notify the surgeon so they can stop closing,
check the wound, and have the circulating nurse re-count to rule out an error.
19. When using a bipolar electrosurgical unit (ESU), where should the patient dispersive
grounding pad be placed?
A) On the patient's closest large muscle mass
B) On the patient's lower back
C) On the patient's upper thigh
4|Page
