The CNOR exam is a comprehensive and challenging assessment required by many jurisdictions during the certification process for operating room nurses. In order to sit for this exam, candidates must have at least two years and 2,400 logged hours as an operating room nurse. Once issued, certification lasts five years.
The content of the CNOR exam is divided into nine domains: patient assessment and diagnosis (12 percent of the exam); identification of expected outcomes and development of a plan of care (10 percent); intraoperative activities (37 percent); communication (7 percent); discharge planning (2 percent); cleaning, disinfecting, packaging, and sterilizing (15 percent); emergency situations (6 percent); management of personnel services and material (5 percent); and professional accountability (6 percent).
The CNOR exam is composed of 200 multiple-choice questions, 15 of which are pretest questions used to develop future versions of the exam. These questions do not contribute to the final score.
The CNOR exam takes three hours and 45 minutes to complete and is administered by computer. Scores are based on the number of questions answered correctly, which means that candidates should always guess even when they are uncertain of the answer.
Candidates who pass the exam will be notified of their passage but will receive no other indication of their performance. Candidates who fail will receive a scaled score indicating how far they were from passing. The exam scores for the CNOR exam are usually delivered four to six weeks after the exam date.
1. In the Pain Assessment in Advanced Dementia (PAINAD) scale, all of the following are common indicators of pain except:
a. Compliant behavior
d. Combative behavior
2. Long-term substance abuse is commonly suggested by all of the following physical assessment findings except:
a. Nasal irritation and sniffing repeatedly
b. Needle tracks on arms
c. Burns on fingers and lips
d. Unequal pupils
3. With the traditional surgical wound classification system, a surgical wound that enters into a colonized area of the body, such as the respiratory or urinary tract, is classified as:
a. Class I
b. Class II
c. Class III
d. Class IV
4. The most appropriate nursing diagnosis for a surgical patient with neutropenia and absolute neutrophil count (ANC) of 900 is:
a. Risk of injury
b. Risk of aspiration
c. Risk of infection
d. Ineffective coping
5. Medication reconciliation should be completed:
a. Prior to admission
b. During the admission assessment
c. On discharge
d. During all phases of care
1. A: Patients with dementia and pain do not usually react with compliance. PAINAD indicators include:
• Respirations: Rapid and labored breathing as pain increases with short periods of hyperventilation or Cheyne-Stokes respirations.
• Vocalization: Negative or quiet and reluctant. As pain increases, patients may call out, moan or groan loudly, or cry.
• Facial expression: Sad or frightened, frowning or grimacing, especially on activities that increase pain.
• Body language: Tense, fidgeting, pacing. As pain increases, patients may become increasingly combative, rigid, fists clenched, or lie in fetal position.
• Consolability: Less distractible or consolable with increased pain.
2. D: While pupils may be abnormally dilated or constricted and watery because of drug use, they are usually equal in size.
Physical signs Other signs
|Physical signs||Other signs|
3. B: Class II: Clean-contaminated wounds (risk < 10%) enter into colonized parts of the body, such as the respiratory or urinary tract. Class I: Clean wounds (risk < 2%) do not enter an area of the body that is usually colonized by normal flora. Class III: Contaminated wounds (risk 20%) have obvious inflammation but no purulent discharge. They may involve spillage of the gastrointestinal tract, penetrating wounds (< 4 hours), and/or substantial break in aseptic technique. Class IV: Dirty-infected wounds (risk 40%) show obvious inflammation and purulent discharge. There may be perforation of viscera prior to surgery and/or penetrating wounds (> 4 hours).
4. C: Surgical patients with neutropenia are at risk for both exogenous and endogenous infection. Total ANC should be 1,800 to 2,000/mm3 or higher. Risk of infection is significant if the level falls to 1,000 and severe at 500. ANC is calculated indirectly from the total white blood cell count (WBC) and the percentages of neutrophils and bands:
ANC = Total WBC x (% neutrophils + % bands/100)
If, for example, the WBC is 5,300 with 12% neutrophils and 2% bands, neutropenia is evident despite the normal WBC:
ANC = 5,300 X 13/100 = 689
5. D: Medication reconciliation should be an ongoing process during all phases of care. Medication reconciliation includes making a list of all current medications (dose and frequency), including herbs and nonprescription drugs and vitamins, as well as drug allergies or intolerances. This list should be posted prominently in the patient’s chart so physicians can check the list whenever ordering medications. The patient must receive a new/revised list on discharge with thorough explanation of any changes and access to drug information and the advice of a pharmacist.