Test your CNOR knowledge. Find the gaps beyond your daily cases.

Which finding is often one of the earliest and most concerning indicators of malignant hyperthermia during anesthesia?

During prep for a shoulder procedure, the circulating nurse sees alcohol-based antiseptic solution wick into the axillary hair and remain visibly wet. Draping is about to begin. What is the BEST action?

During a relief scrub handoff, the outgoing scrub reports that an additional pack of 10 sponges was opened but not added to the count board. The case is mid-procedure. What is the best action?

A patient is positioned in lithotomy for a prolonged pelvic procedure. The circulating nurse notes that one hip is more flexed and externally rotated than the other after the final table adjustment. Which action is BEST before incision?

A patient is in reverse Trendelenburg for laparoscopic upper GI surgery. After tilt, the safety strap remains secure but now rests directly across the patient’s IV tubing and urinary drainage tubing at the upper thighs. What is the BEST action?

In preop assessment, the patient states they ate a full breakfast 3 hours ago, but the chart lists the patient as NPO. The surgeon is asking to proceed. What is the perioperative RN’s BEST next action?

A patient with limited English proficiency is awake under minimal sedation immediately before incision. When asked to state the planned procedure, the patient describes a different procedure than what is scheduled and on the consent. The preop consent was obtained with a family member translating. What is the priority next action?

A patient is being discharged after cataract surgery. Which instruction is MOST important to prevent complications?

A perioperative RN is planning care for a patient with a history of severe opioid-induced respiratory depression. Which intervention best supports the outcome of safe analgesia?

During perioperative care, the RN identifies that a planned intervention is not achieving the desired outcome. What is the best next action to evaluate and update the plan of care?

During setup for a left wrist ORIF, the nurse discovers the charted laterality field says 'right' even though the consent, mark, and team verification are correct for the left side. The field is corrected before incision. Which documentation approach is best?

A patient is transferred after a case in which an intraoperative equipment malfunction was corrected using backup equipment. Which handoff omission is most concerning?

During a trauma laparotomy, the surgeon requests an additional sponge pack urgently. The circulator opens the pack correctly, but one sponge slides off the edge of the back table and hangs suspended partly below table level while still attached to the rest of the pack. What is the best action?

Which scenario best represents appropriate point-of-use management of contaminated instruments?

Which principle best guides PPE selection in the OR?

A staff member says transmission-based precautions do not matter in surgery because everyone is already masked and gloved. What is the best response?

When malignant hyperthermia is suspected, which nursing action is most important regarding emergency resources?

During a complex case, a surgeon asks the perioperative nurse to perform a task that is outside the nurse's authorized role in that setting because 'there's no time to wait.' What is the best response?

A perioperative nurse notices that a required verification step was missed, but the team corrected it before the patient was harmed. A coworker says there is no reason to report it now. What is the best response?

A team proposes a new turnover workflow because another hospital reported better room efficiency with it. Which question best reflects evidence-based judgment before adopting it?